The Delhi Cocktail and the crisis of substance use: An autopsy-based pilot study

This pilot study was conducted to analyze and describe recurring patterns of fatal polydrug use in autopsy cases. We also propose a novel descriptive term, "Delhi Cocktail," based on the specific pattern of drug use observed, and highlight the public health and medicolegal implications of such trends.

This was an autopsy-based pilot study presenting six fatal instances of polydrug overdose in New Delhi. Each case involved the postmortem identification of distinct combinations of psychoactive substances, including illicit drugs and prescription medications. The "Delhi Cocktail" was defined by the postmortem presence of (1) three or more drugs, (2) at least one DEA Schedule I/II substance, and (3) a therapeutic drug used in addiction treatment or a psychotropic drug not prescribed to the individual.

The substances most frequently identified in these fatal cases included opioids (morphine, methadone, buprenorphine, and tramadol), benzodiazepines, tricyclic antidepressants (TCAs), tetrahydrocannabinol (THC), and Phencyclidine (PCP). The misuse of opioid agonist therapies (methadone and buprenorphine) alongside street opioids suggested non-compliance with treatment or unregulated drug availability. The concurrent presence of multiple CNS depressants magnified the risk of fatal respiratory depression, while additives like TCAs and PCP increased the risk of arrhythmia and neurotoxicity.

This pilot study, despite the lack of quantitative toxicological data, suggests the need for robust prescription monitoring systems, enhanced forensic infrastructure, and deaddiction protocols specifically tailored to address emerging trends in drug use.