How is it determined when a fatal drug overdose is considered “accidental.”
How is it determined when any untoward death is considered accidental? You look at the circumstances surrounding and leading up to the death and try to divine the intent of the relevant people as best you can, and them make a judgment.
Having a large meteorite crush you is likely accidental.
With adulterated street drugs, the answer is quite a bit harder.
Find the adulterant, check its LD50, and compare that to the drug dose taken.
An accident is when a small amount of pot kills you via heart attack because your jerk of a dealer sold you something heavily contaminated with strychnine. Small amounts of strychnine produce a more intense high when used tor cruddy Marijuana.
Drug dealers are not known for their skill in compounding safe and effective medicines.
It’s a lot of work finding the adulterants in drugs, so the easy way out is to all it accident
They’re still selling funny stuff as, banned JWH-18 and “bath salts”.
A lot of it also depends on whether the person left a note.
Accidental vs homicide or vs suicide?
In an unclear situation they may well like to nail a dealer for homicide even if it clearly the user’s mistake.
In another unclear situation when no dealer can be found and there is a possibility of suicide authorities may well decide it is an accident to avoid stigma for the family. [that elderly, terminally ill person–obviously that overdose of pills was because he/she was confused.]
This is why we would have an inquest in the UK. Usually months after the death, and after all the relevant authorities have completed their investigations, the Coroner (and the relatives) will examine the evidence and come to a conclusion. In most cases, it is not going to be cut and dried and the Coroner would likely avoid a suicide verdict unless there was a strong indication of it. in the case of “that elderly, terminally ill person” they would also consider whether someone might have helped them along the way.
Or it really was an accident in that the intent might have been to escape pain rather than seek death - when my spouse was dying of cancer at a certain point he handed the pain killers to me to dole out, and I kept careful record of when and how much was given out and there were a few instances where I think he could have gotten into trouble when the pain was really bad - the time interval before the oral medication kicked in could get ugly. Which is why he eventually wound up in the hospital on IV painkiller round the clock. And yeah, the elderly and/or terminally ill DO get genuinely confused.
Another truly accidental drug OD can happen with acetaminophen/paracetamol - people are ill, take this OTC drug, and that OTC drug, and don’t realize they all have some of the medication. Next thing you know they OD, enter liver failure, and… well, it happens. To the tune of about 50,000 ER visits and around 500 deaths a year from it in the US.
There are probably other circumstances where genuine accidents can happen.
As mentioned previously, the determination is made by examining not only the deceased but also the circumstances around the death. There are probably many ambiguous cases as well. Life (and death) is not always neat and tidy.
This is pretty much it. Stepping away from street drugs and concentrating on legit medicines, I attended 3 inquests professionally (2 on the stand, one in the audience, as it were) and it does just come down to the coroner’s opinion based on (usually) unclear and incomplete evidence. And yes they do lean towards an open verdict where there is any doubt; the verdict can have financial consequences too. The one inquest that I attended where death was ruled as suicide resulted in the surviving spouse losing out on insurances etc. My guess is that this is at least in the back of the coroner’s mind - nobody is looking to make a bad situation worse.
In my experience the issue of confusion was addressed in detail. For example you have the scenario where the coroner asks, could a standard dose actually cause the patient to become confused? Might they then have taken an additional dose, because they were unaware that they had already taken a dose? And then a third dose? And so on.
j
Presumably, people who die from intentional overdoses tend to vastly overdo it on the dose. Like they’ll down tens of times more than they’re used to. If you wanted to kill yourself with benzos, wouldn’t you down the whole bottle and add alcohol?
People who die from accidental overdoses were likely taking a dose close to what they’re used to while they were physically weaker or their tolerance had gone down or the potency was higher than usual.
Presumably, there are numerous cases where there may not have been a conscious desire to die but there was willful recklessness or some subconscious death wish.
That was exactly what had happened in the one OD inquest where I saw a suicide verdict returned. There really wasn’t any way to avoid a suicide verdict in that case.
j
This is a major problem with fentanyl, since the LD50 is so small. Street dealers may cut it with inert ingredients to facilitate portioning, but if they don’t get the fentanyl completely mixed, one person could get a dose of the final blend that contains way more fentanyl than expected.