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Evidence from a number of paradigms suggests that methamphetamine use is associated with increased risk for the development of Parkinson's disease and parkinsonism, and that it may be associated with the premature development of Parkinson's disease. Prevalence of Parkinson's disease and parkinsonism is greater in both methamphetamine users and people who previously used methamphetamine, and evidence from animal studies provides a plausible mechanism for this observation. Despite this increased risk, Parkinson's disease is rarely diagnosed in methamphetamine users. Reasons for this may include under‐detection, premature mortality, and individual and substance use characteristics which moderate the risk, including higher rates of smoking. Clinicians should be vigilant to signs and symptoms of Parkinson's disease and parkinsonism in methamphetamine users. [ABSTRACT FROM AUTHOR]

Background and aims: Lysergic acid diethylamide (LSD) and psilocybin are used as recreational drugs, and there is renewed interest in their clinical use. The current study aimed to (1) determine the circumstances of death and case characteristics of LSD‐ and psilocybin‐related death in Australia, 2000–23; and (2) determine the toxicological profile and major autopsy findings of these cases. Methods: This was a retrospective exploratory study of all cases of LSD‐ and psilocybin‐related death in Australia, 2000–23, retrieved from the National Coronial Information System. Results: A total of 43 cases were identified: 33 LSD and 10 psilocybin. The median ages were 24 years [interquartile range (IQR) = 13, range = 16–53] (LSD) and 26 years (IQR = 18.5, range = 20–58) (psilocybin), and fewer than five cases were female. The most common circumstance of death among both groups was traumatic accident (LSD 36.4%, psilocybin 40.0%). There were 12 cases of self‐harm, all of which involved LSD, all by physical means. In a fifth, death was attributed to multiple drug toxicity (LSD 18.2%, psilocybin 20.0%). In one case, death was attributed solely to LSD toxicity, while in a further two cases death was attributed to a cardiovascular event following LSD consumption (one LSD only, one multiple drug toxicity). In four psilocybin cases, the cause of death was undetermined. The most common clinical presentation was severe agitation (LSD 27.3%, psilocybin 20.0%). Median blood concentrations were LSD 0.8 μg/l (IQR = 1.7, range = 0.1–3), psilocin 20 μg/l (IQR = 53.5, range = 6–83). LSD was the only drug present in 25.0% of LSD cases and psilocybin in 20.0% of psilocybin cases. Pre‐existing organ pathology was uncommon. Conclusions: Lysergic acid diethylamide (LSD)‐ and psilocybin‐related death in Australia from 2000 to 2023 was primarily due to traumatic injury, whether through accident or self‐harm. Cases of acute toxic reactions that were attributed solely to LSD were rare. [ABSTRACT FROM AUTHOR]

Introduction: Acute alcohol toxicity is a significant component of alcohol‐related mortality. The study aimed to: (i) determine the circumstances of death and characteristics of fatal alcohol toxicity cases, 2011–2022; (ii) determine their toxicological profile and major autopsy findings; and (iii) determine trends in population mortality rates. Methods: Retrospective study of acute alcohol toxicity deaths in Australia, 2011–2022, retrieved from the National Coronial Information System. Results: A total of 891 cases were identified, with a mean age of 49.2 years, 71.0% being male. Alcohol use problems were noted in 71.3%. In 57.5% death was attributed solely to acute alcohol toxicity, and combined acute alcohol toxicity/disease in 42.5%. There was evidence of sudden collapse in 24.9% of cases. The mean BAC was 0.331 g/100 mL (range 0.107–0.936), and spirits were the most commonly reported beverages (35.8%). Cases of combined toxicity/disease had significantly lower BACs than those attributed solely to alcohol toxicity (0.296 vs. 0.358 g/100 mL). Cardiomegaly was diagnosed in 32.5%, and severe coronary artery disease in 22.1%. Aspiration of vomitus was noted in 18.0%, and chronic obstructive pulmonary disease in 19.6%. Severe liver steatosis was present in 33.4% and 13.6% had cirrhosis. There was an average annual percentage increase in deaths of 7.90. Discussion and Conclusions: The 'typical' case was a long‐standing, heavy spirits drinker. BACs showed enormous variation and no arbitrary concentration may be deemed lethal. Clinically significant disease was associated with death at a lower BAC and people with such disease may be at increased risk of alcohol poisoning. [ABSTRACT FROM AUTHOR]

Background and aims: Mortality rates among people who use heroin are estimated to be 15 times that of the general population. The study aimed to determine (1) the case characteristics and circumstances of death of heroin‐related toxicity deaths in Australia, 2020–2022; (2) their toxicological profile and major autopsy findings; (3) the proportion of cases in which blood 6‐acetyl morphine (6AM) was detected, as a proxy measure of survival times; and (4) compare 6AM positive and negative cases on toxicology, circumstances of death and acute clinical presentation. Design: Retrospective study of heroin toxicity deaths in Australia, 2020–2022, retrieved from the National Coronial Information System. Setting: This study was conducted Australia‐wide. Cases There were 610 cases of fatal heroin‐related drug toxicity. Measurements Information was collected on characteristics, manner of death, toxicology and autopsy results. Findings The mean age was 42.6 years (range 18–73 years), 80.5% were male and 7.5% were enrolled in a drug treatment programme. The circumstances of death were as follows: unintentional drug toxicity (86.2%), combined unintentional drug toxicity/disease (11.3%) and intentional drug toxicity (2.5%). The median free morphine concentration was 0.17 mg/L (range 0.00–4.20 mg/L). Psychoactive drugs other than heroin were present in 95.2% (Confidence Interval 93.1%–96.8%), most commonly hypnosedatives (62.3%, 58.2%–66.4%) and psychostimulants (44.8%, 40.7%–49.1%). Major autopsy findings of clinical significance included acute bronchopneumonia (14.8%, 11.3%–18.8%), emphysema (16.9%, 13.2%–21.1%), cardiomegaly (30.1%, 12.7%–28.2%), coronary artery disease (27.4%, 23.0%–32.3%), coronary replacement fibrosis (13.4%, 10.1%–17.3%), hepatic cirrhosis (8.8%, 6.6%–12.2%) and renal fibrosis (10.3%, 7.3%–14.0%). In 47.0% (42.3%–51.2%), 6AM was present in blood. Conclusions: The 'typical' heroin overdose case in Australia from 2020 to 2022 was a male who injected heroin, aged in the 40s, not enrolled in a treatment programme and had used multiple drugs. In over half of cases, there had been a sufficient survival time for 6‐acetyl morphine to have been metabolised, which may indicate times in excess of 20–30 min. [ABSTRACT FROM AUTHOR]

The authors discuss the extent of the problem regarding chronic obstructive pulmonary disease (COPD) among heroin users, its implications for heroin overdose risk, and strategies to address this issue. Topics include how common is early onset COPD among heroin users, evidence that COPD progresses at an accelerated rate among heroin users, and clinical implications of such high rates of COPD.