Fatal injuries after cocaine use as a leading cause of death among young adults in New York City

N Engl J Med. 1995 Jun 29;332(26):1753-7. doi: 10.1056/NEJM199506293322606.


Background: Cocaine intoxication can lead to fatal cardiovascular and cerebrovascular events. In addition, the neurobehavioral effects of cocaine may increase the likelihood that a user will receive violent fatal injuries. Since New York City is a center for the importation and distribution of cocaine, we sought to determine the extent of cocaine use among city residents with fatal injuries.

Methods: Among a total of 14,843 residents of New York City who received fatal injuries from 1990 through 1992, we determined the proportion who used cocaine shortly before their deaths. We also determined the population-based rates of fatal injuries that were known to follow cocaine use and the proportion of all deaths of New York City residents that was represented by these cases for each demographic stratum. For adults 15 to 44 years of age, fatal injury after cocaine use was ranked with other causes of death as though it was a separate cause.

Results: Cocaine use, as measured by the detection of the metabolite benzoylecgonine in urine or blood, was found in 26.7 percent of all New York City residents receiving fatal injuries; free cocaine was detected in 18.3 percent. Approximately one third of deaths after cocaine use were the result of drug intoxication, but two thirds involved traumatic injuries resulting from homicides, suicides, traffic accidents, and falls. If fatal injury after cocaine use was considered as a separate cause of death, it would rank among the five leading causes of death among those 15 to 44 years of age in New York City.

Conclusions: Fatal injuries among cocaine users account for a substantial proportion of all deaths among young adults in New York City.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Cause of Death*
  • Cocaine* / analogs & derivatives
  • Cocaine* / blood
  • Cocaine* / urine
  • Ethanol / blood
  • Female
  • Humans
  • Male
  • New York City / epidemiology
  • Substance-Related Disorders / complications*
  • Substance-Related Disorders / diagnosis
  • Wounds and Injuries / etiology
  • Wounds and Injuries / mortality*


  • Ethanol
  • benzoylecgonine
  • Cocaine