Pathology Findings for San Luis Obispo

County Coroner Investigated Deaths:

April 2015- March 2018
Introduction
This report is a summary of the toxicology findings from coroner-investigated deaths for the period April
1, 2015 through March 31st, 2018 (three years). The Coroner is required to review or investigate every
death in which a decedent has not been seen by a physician within the past 20 days, in unattended or
violent deaths, deaths involving drugs, and other circumstances as required by law. A pathology report is
sometimes ordered to help determine the cause of death. Although prescription drugs, homeopathic
medicines or illegal drugs may be present, their presence alone is only one factor used to determine a
cause of death. The type of drug, quantities present, or combination of drugs found may also be
important factors in determining a final cause of death.

For the purposes of this report, the following definitions are used:

 Positive Pathology Report: post mortem testing done by the San Luis Obispo Coroner's Office to
determine the presence of specified drug(s) that show the presence of drugs in a decedents
system.
 Drug Related Deaths: deaths in San Luis Obispo County with positive pathology reports for
opioids, stimulants and/or sedatives.
 Toxic level: pathology reports determined the presence of a lethal level of the drug in the
deceased's system. It is important to note that while a dose may be toxic to a casual user, some
users build up tolerance to drugs, and that level may not be toxic to them.

Between April 1, 2015 and March 31, 2018, there were 6,699 deaths in San Luis Obispo County. Of the
6,699 deaths in San Luis Obispo County, the San Luis Obispo County Coroner’s office requested
toxicological analysis in 732 of the cases to help determine cause of death. Of the 732 deaths in which a
pathology report was ordered to help determine cause of death, 679 deaths had positive toxicology
reports for opioids, stimulants, sedatives, or any combination of the three.

 In this report, drugs were broken down into three categories: opioids, stimulants and sedatives.
o Opioids are drugs containing any opiate, natural or synthetic.
o Stimulants include drugs such as cocaine, methamphetamine, and ephedrine.
o Sedatives include benzodiazepines, antihistamines, and sleeping aids.
 Of the 679 deaths with positive toxicology screens, the following was found:
o 183 tested positive for opioids alone or in combination with stimulants and/or sedatives
o 141 tested positive for stimulants alone or in combination with opioids and/or sedatives
 o 658 tested positive for sedatives alone or in combination with stimulants and/or opioids
 Sedatives were the most commonly found drug type in toxicology samples, with 57% of samples
positive for a sedative only, and an additional 28% in combination with an opiate.
 Of the 658 decedents testing positive for sedatives, 26% of those had toxic levels of drug in their
blood.
 Of the 141 decedents testing positive for stimulants, 63% had toxic levels of drug in their blood.

Drug Related Deaths for San Luis Obispo County

(April 2015-March 2018)
700 658

600
500
400
300
183
200 141
100
0
Opioids Sedatives Stimulant

Drug Combinations for San Luis Obispo County

(April 2015- March 2018)
450
386
400
350
300
250
200
141
150 104
100
50 11 26
6 5
0

 Often positive toxicology reports can be misleading due to the fact that multiple drugs may be
present in the deceased's system at the time of their death
o Drug related deaths where only sedatives were involved were most common, making up
57% of drug related deaths from 2015-2018
 oDrug related deaths where only stimulants and opioids were involved made up 1% of
deaths
 Both stimulants and opiates were commonly found with sedatives
 Opioids and stimulants were least commonly found together

Proportion of Male vs Female for Drug Abuse

Combinations (April 2015- March 2018)
100%
90% 17% 26%
80% 32%
41% 42%
70% 55%
60% 80%
50%
40% 83% 74%
30% 68%
43% 58%
20% 45%
10% 20%
0%

% Male % Female

Drug Related Deaths in SLO County by Gender

(April 2015 - March 2018)
300
250
200
150
100
50
0
Stimulant +
Only Opioid+Stimu Opioid+Sedat Stimulant +
Only sedative Only Opioid Sedative +
stimulant lant ive Sedative
Opioid
Male 5 264 5 1 72 77 15
Female 1 122 6 4 69 27 11

Male Female

 Males were significantly more likely to have stimulants and sedatives in their system; however,
females were more likely to have stimulants and opioids in their system.
 Females were proportionally more likely to abuse opioids, either alone or in combination with
other drugs.
 Of the 679 drug related deaths, 440 were male and 239 were female.
o 76% of deaths that tested positive for sedatives were men while woman made up 24%
o Opioids were abused almost equally by men (53%) and women (47%)

Age Breakdown of Positive Pathology Reports

for Opioids (April 2015 - March 2018)
60 53
50
40 33
30 25 26
17
20 13
7 7
10
1
0
0-17 18-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age Breakdown of Positive Pathology Reports

for Sedatives (April 2015 - March 2018)
200
168

150

99 107
100 84
65
49
50 38
18 25

0
0-17 18-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
 Age Breakdown of Positive Pathology Reports for Stimulants
(April 2015 - March 2018)
35 33

30
25
25 23
19
20
15
15
9
10
6 5 5
5

0
0-17 18-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

 Opioids, Sedatives and Stimulants were most likely found in decedents aged 55-64

Alcohol Presense in Drug Related Deaths for SLO

County (2015-2018)
100%

80%

60% 75% 72% 73%

40%

20%
25% 28% 27%
0%
Opioids Sedatives Stimulants

Alcohol Present No Alcohol Present

 Alcohol presence at time of death is determined in the coroner's toxicology report

 Many drug related deaths involved alcohol
o Independent of drug type, about 25-30% of drug related deaths involved alcohol
 Percentage Toxic Level of Drug Detected in
Drug Related Deaths (2015-2018)
100%
90%
80%
70%
60%
63%
50%
40%
30%
20% 27% 26%
10%
0%
% Toxic Levels of % Toxic Levels of % Toxic Levels of
Opioids Detected Stimulents Detected Sedatives Detected

 Often drug related deaths can be overlooked due to the fact that toxic levels of the drug are not
detected
o For deaths that had opioid and sedatives present, only about a quarter detected toxic
levels of the drug
o 63% of deaths with positive pathology reports for stimulants had toxic levels in their
systems
o A toxic level of any one drug is not required to cause death, sometimes multiple drugs
can combine to create a toxic level present in an individual’s system

Conclusion

Drugs, whether legal or illegal can be a significant contributor to an individual’s death. In San Luis Obispo
County, this report represents the first analysis of the types of drugs present in decedent’s systems at
the time of death, and can serve as a baseline for further analysis. Opioids are of great concern in our
community, but it is clear that stimulants and sedatives are also being abused and contributing to
mortality amongst our citizens.