Investigating the role of commonly misused drugs in suspected unnatural and/or unexplained deaths in Cape Town in 2022

Munarini, Murendwa Success

Investigating the role of commonly misused drugs in suspected unnatural and/or unexplained deaths in Cape Town in 2022

Thesis / Dissertation

2025

Publisher

Universiy of Cape Town

Department

Department of Pathology

Faculty

Faculty of Health Sciences

Abstract

Background: Unnatural deaths, which include homicides, suicides, and accidental deaths, often require toxicological analysis to assist with determining the cause of death. In 2022, the Forensic Toxicology Unit within the Western Cape Forensic Pathology Service piloted a targeted drugs analysis at Salt River Mortuary in Cape Town. This permitted an assessment of commonly misused drugs in suspected unnatural and/or unexplained deaths, which was previously not feasible, given the backlogs of National toxicological analyses. Aim: To assess toxicological findings of a targeted LC-MS/MS drugs of misuse panel in suspected unnatural death cases in the west metropole of Cape Town, Western Cape. Methods: A retrospective, descriptive study was conducted on all cases for which specimens were submitted to the Forensic Toxicology Unit between 1 January 2022 and 31 December 2022 for a targeted drugs analysis of 31 analytes using LC-MS/MS. Blood alcohol and toxicology results from the National Forensic Chemistry Laboratory were also compared within the cohort. Results: The Forensic Toxicology Unit analysis was requested in 735 cases, with qualitative (n=723, 98.4%) and quantitative (n=108, 14.7%) analyses performed. Drugs were detected in 382 (52.8%) of the 723 cases analysed. The most frequently detected drugs were acetaminophen (24.8%), methamphetamine (17.6%), amphetamine (14.4%), methaqualone (13.8%) and THC-COOH (12.9%). Blood alcohol analysis was requested from the National Forensic Chemistry Laboratory in 541 cases (73.6%), and ethanol was detected (≥0.01 g/100mL) in 138 (25.6%) of these cases, with a mean positive BAC of 0.14 ± 0.02 g/100 mL (range: 0.01-0.54 g/100 mL). Conclusion: This study revealed that commonly misused drugs were frequently present in suspected unnatural and/or unexplained deaths admitted to Salt River Mortuary in Cape Town. However, given that only a portion of cases were submitted for analysis, and that the panel was limited in scope, it does not represent the full landscape of drug exposure in unnatural deaths. Nonetheless, this study represents the first comprehensive data on drugs (other than alcohol) in post-mortem toxicology casework in South Africa, using validated methodology.