Table 2.

Case details of Group A1 and Group A2 deaths

Case number	Circumstance	Cause of death Autopsy findings	Toxicology	Comment
Group A1
Case 1	Male in his thirties consumed a "hit" and experienced difficulty breathing. He was later found unconscious and unresponsive. Paramedics attended and pronounced him deceased	Toxic effects of MA BMI 25 IVDU stigmata Fibrotic capsule around the left testis	PM femoral blood t1 3.8 h t2 4.7 h MA 2.1 mg/L Amphetamine 0.37 mg/L	Heavy 'ice' user (5 years) and known to smoke/inject MA
Group A2
Case 2	Male in his forties found deceased at home	MA toxicity BMI 34 IVDU stigmata Patchy myocardial fibrosis Hepatosplenomegaly with evidence of chronic hepatitis C Fatty liver Atrophic left testis	PM femoral blood t1 23 h MA 0.93 mg/L Amphetamine 0.11 mg/L Paliperidone 54 ng/mL	Prescribed paliperidone (monthly 150 mg depot injections) and temazepam (not detected) Hx of hepatitis C, necrotising fasciitis, obesity, peripheral neuropathy, schizophrenia, IVDU Illicit drug abuse since the 1980s and MA use continued until the date of his death
Case 3	Male in his thirties returned home and used "ice". He later complained of stomach pains and vomited. He was incoherent with features of cyanosis prior to collapsing the next morning. Paramedics attended and found him in asystole, unresponsive (GCS 3), not breathing, without pulse, and dilated pupils. His body temperature was 34.5 °C. CPR administered by paramedics resulted in ROSC. He developed sinus tachycardia and atrial fibrillation involving weak cardiac output, prior to asystole and was declared dead	MA toxicity BMI 29 IVDU stigmata Non-caseating granulomatous inflammation within the lung and the liver Renal impairment Acute hepatitis and hepatitis C Focal cardiac fibrosis	PM femoral blood t1 4.5 h t2 21 h MA 0.46 mg/L Amphetamine 0.076 mg/L Quetiapine 0.045 mg/L	Hx of depression, anxiety, and hepatitis C, IVDU (heroin and MA) Prescribed fluoxetine and quetiapine “heavy” MA user
Case 4	Male in his thirties felt unwell and started hyperventilating due to shortness of breath. He collapsed and became unresponsive. CPR was administered and paramedics attended. He developed asystolic cardiac arrest involving prolonged downtime. CPR administered by paramedics resulted in ROSC. He was intubated and required adrenaline to treat hypotension. In hospital, possible myoclonus was treated with levetiracetam, and he was subsequently sedated with morphine and midazolam. The deceased had no brain activity and developed renal failure. He was pronounced deceased without cardiovascular function five days later	Hypoxic ischemic encephalopathy secondary to an out of hospital cardiac arrest in the setting of MA use BMI 26 IVDU stigmata Global cerebral ischemic injury Bronchopneumonia Tracheal ulceration Bilateral pleural effusions Gastric ulceration Right atrial lesion with the characteristics of a papillary fibroelastoma	AM blood t2 16 h MA 1.9 mg/L Amphetamine 0.20 mg/L Hospital drug screen positive for opioids, benzodiazepines, and amphetamines	Hx of IVDU (amphetamines)
Case 5	Male in his fifties smoked MA and was found the next day in the water with heavy equipment including a bag with 30 kg of contents	MA toxicity in an immersed scuba diver BMI 29 Mild coronary artery atherosclerosis	PM femoral blood t1 86 h t2 108 h MA 1.9 mg/L Amphetamine 0.38 mg/L
Case 6	Male in his thirties consuming “ice” and had not slept for three days. He appeared drug affected, displaying features of paranoia and aggression. His behaviour was increasingly erratic and involved strenuous physical activity. The deceased was restrained (without force applied to the back, head, or neck) and became unresponsive without a pulse. CPR was administered and paramedics arrived to provide additional CPR. He was transported to hospital, intubated, and ventilated, however CT brain scan showed widespread hypoxic injuries including oedema, cerebral herniation, and progressive brain swelling, consistent with recent cardiac arrest. Brain death was subsequently pronounced	Toxicity to MA BMI 27 Widespread cutaneous abrasions Hypoxic ischemic brain injury Positive myoglobin staining in renal tubules	AM blood MA 0.38 mg/L Amphetamine 0.032 mg/L Hospital drug screen was positive for amphetamines
Case 7	Male in his twenties reportedly stumbling. He was found in an altered conscious state by paramedics. The man went into cardiac arrest in the ambulance. CPR was commenced. He was hyperthermic (45 °C) with an unrecordable blood pressure. CPR was unsuccessful and he died after continuous cardiac arrests in the emergency department	Hyperthermia in a man consuming MA and amphetamine BMI 32 Focal perivascular myocardial fibrosis Mild myocardial vessel dysplasia Mild coronary artery atherosclerosis	PM femoral blood t1 18 h MA 2.2 mg/L Amphetamine 0.16 mg/L Ethanol 0.02 g/100 mL Olanzapine 0.1 mg/L Paliperidone 2 ng/mL Nordiazepam 0.03 mg/L Haloperidol 0.04 mg/L Benztropine 0.1 mg/L	Prescribed clozapine (not detected) Hx of asthma, schizophrenia, and drug abuse (alcohol, cannabis, and MA)
Case 8	Male in his fifties found inside a public toilet between two walls	Positional asphyxia in the setting of MA use BMI 27 Multiple abrasions possibly sustained whilst struggling to maneuver between the two walls IVDU stigmata Moderate coronary atherosclerosis Prominent lymphocytic inflammatory infiltrate surrounding the portal tracts Mild hepatic fibrosis	PM femoral blood t1 91 h MA 1.6 mg/L Amphetamine 0.061 mg/L	Hx of amphetamines use since 2011, and MA dependence
Case 9	Male in his thirties was agitated and reportedly experiencing persecutory delusions. He begun destroying property and was confronted by a bystander. There was a physical altercation and the deceased attempted to get into a number of passing vehicles. A second physical altercation occurred which involved an arm around the deceased neck. The man fell to the ground and was retrained (the deceased arms were held behind his back in a prone position, and no force was applied to his back). The deceased was punched multiple times in the head by a second bystander. The deceased reportedly had difficulty breathing, his shirt was damp, skin very hot, and his pulse was “too fast to count”. He became unresponsive and CPR was initiated. He was in cardiac arrest when paramedics arrived with no palpable pulse and fixed dilated pupils. His body temperature was 38.5 °C. CPR was unsuccessful and treatment was ceased	Cardiorespiratory arrest during prone restraint including pressure on the neck of an obese male using MA BMI 31 Blunt force trauma to the anterior and posterior neck (intramuscular and soft tissue bruising involving a fracture of the superior horn of the right thyroid cartilage) Mild brain swelling Remote lacunar infarct left caudate head Congested upper chest and head Heavy congested lungs Abrasions over the forehead, nose, left shoulder, and multiple subcutaneous bruises Multiple small and superficial incised injuries to the soles of the feet Linear mucosal laceration on the lower lip Minor left kidney hilar haematoma Mild left ventricular hypertrophy Sigmoid adenomatous polyp Blanching PM lividity over the posterior aspect of the body	PM femoral blood t1 16 h MA 1.5 mg/L Amphetamine 0.18 mg/L	Hx of depression, post-traumatic stress disorder, and drug abuse (MA)

AM ante-mortem, BMI body mass index, CPR cardiopulmonary resuscitation, CT computed tomography, GCS Glasgow Coma Scale, Hx history, IVDU intravenous drug user, MA methylamphetamine, PM post-mortem, ROSC return of spontaneous circulation, t1 time (h) between death and PM blood time of collection (TOC), t2 survival time (h) between last known MA dose and specimen TOC