Many deaths in custody that are blamed on the police using excessive force in restraining "difficult" prisoners may in fact be the result of the prisoners' cocaine abuse. This provocative suggestion, from a leading forensic toxicologist, is sure to inflame controversy over one of the most contentious issues in policing.
Steven Karch, assistant medical examiner of the City and County of San Francisco, is convinced that many people who die in custody are suffering from excited delirium (ED). This condition can be caused by the long-term use of stimulants such as cocaine. Sufferers experience a dangerous rise in body temperature, act strangely, appear terrified, yet can show surprising strength. Unless treated quickly, usually by packing them in ice to reduce their body temperature, patients often die from cardiac arrest.
Many deaths from ED in custody are recognised as such. Last year, Canadian researchers found that 18 out of 21 people recorded as dying from ED in Ontario between 1988 and 1995 were under arrest. But at a meeting of the Royal Society of Medicine in London this week, Karch claimed that the documented cases are just the tip of the iceberg. He has devised a neurochemical test for ED that he argues should be done during autopsies whenever people die under restraint after arrest.
Together with Deborah Mash, a neurologist and pharmacologist at the University of Miami School of Medicine, and Charles Wetli, medical examiner of Suffolk County, New York, Karch has compared brain tissue taken at autopsy from cocaine abusers who died of ED with tissue from people killed by cocaine overdoses. They found that the ED patients had a defect in the brain protein that mops up the neurotransmitter dopamine, which surges each time a dose of cocaine is taken.
In the overdose victims, this protein had altered to become more
efficient at mopping up dopamine-presumably an adaptive response to persistent
use of the drug. But
Contact: Claire Bowles