Toxicological insights into sharp force-related homicides: A retrospective study at Tygerberg mortuary, Cape Town, South Africa

16/08/2026

AI Summary

Alcohol present in 66.1% and at least one psychoactive drug in 56.5% of sharp-force fatalities, indicating frequent substance involvement.
Most common analytes: THC metabolite 29.0%, methaqualone 27.0%, methamphetamine 25.8%; 57.6% of drug-positive cases showed polydrug use.
Many drug-positive deaths had blood alcohol below 0.05 g/100 mL; findings support comprehensive post-mortem toxicology and integration into violence-prevention strategies.

AI Summary

Sharp-force fatalities represent a major proportion of homicidal deaths in South Africa, yet the contribution of alcohol and drugs of misuse and abuse to these incidents remains poorly characterised.

Demographic, injury, and toxicological data were extracted from forensic records, and post-mortem blood and urine specimens were analysed using validated headspace gas chromatography for alcohol and liquid chromatography-tandem mass spectrometry targeting 29 drugs.

Of the 140 drug-positive cases, 72 (51.4%) had blood alcohol concentrations below 0.05 g/100 mL, including those with no detectable alcohol, indicating that alcohol was unlikely to have been a major contributing factor in many of these fatalities.

Basic summary

Leg Med (Tokyo). 2026 Aug 13;85:102957. doi: 10.1016/j.legalmed.2026.102957. Online ahead of print.

ABSTRACT

Sharp-force fatalities represent a major proportion of homicidal deaths in South Africa, yet the contribution of alcohol and drugs of misuse and abuse to these incidents remains poorly characterised. This retrospective, cross-sectional study reviewed 248 sharp-force fatalities admitted to a large urban forensic service in Cape Town during 2024. Demographic, injury, and toxicological data were extracted from forensic records, and post-mortem blood and urine specimens were analysed using validated headspace gas chromatography for alcohol and liquid chromatography-tandem mass spectrometry targeting 29 drugs. Blood alcohol was detected (>0.01 g/100 mL) in 66.1% of tested cases, while 140 cases (56.5%) were positive for at least one drug. The most frequently identified analytes were 11-nor-9-carboxy-tetrahydrocannabinol (29.0%), methaqualone (27.0%), and methamphetamine (25.8%). Polydrug use occurred in 57.6% of drug-positive cases, most commonly involving methaqualone and methamphetamine, demonstrating a recurrent stimulant-sedative co-use pattern. Of the 140 drug-positive cases, 72 (51.4%) had blood alcohol concentrations below 0.05 g/100 mL, including those with no detectable alcohol, indicating that alcohol was unlikely to have been a major contributing factor in many of these fatalities. These findings demonstrate that psychoactive substances are frequently detected in individuals who die from sharp-force injuries and suggest that intoxication, particularly involving multiple substances, may contribute to impaired judgment, aggression, or increased vulnerability to violence. The results underscore the importance of comprehensive post-mortem toxicological investigations and the integration of toxicological patterns into violence-prevention initiatives and public health strategies.

PMID:42600216 | DOI:10.1016/j.legalmed.2026.102957

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