Depressed individuals contemplating suicide have cognitive rigidity, which does not appear to be a global brain dysfunction. Suicidal mental states may result from dysfunctional executive decision-making that is associated with the frontal lobe.

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Context.-Hot weather taxes cardiovascular function and is associated with increased deaths from heart disease. Cocaine can cause hypertension, tachycardia, coronary vasospasm, arrhythmias, and increased core temperature. Objective.-To determine the association between mortality from cocaine overdose and hot weather. Setting.-New York, NY. Design.-Retrospective review of medical examiner cases from 1990 through 1995. Subjects.-All fatal unintentional cocaine overdoses from 1990 through 1992 (n = 1382) and all hyperthermia deaths of cocaine users (n = 10) were used to identify a maximum daily temperature threshold above which mortality from cocaine intoxication increased. The study population consisted of all fatal unintentional cocaine overdoses from 1993 through 1995 (n = 2008) and 4 contemporaneous comparison groups that included fatal unintentional opiate overdoses (n = 793), all other fatal unintentional overdoses (n = 85), and a subset of homicides (n = 4638) and fatalities from motor vehicle crashes (n = 815). Main Outcome Measures.-The number of overdose deaths and the proportion of homicides and traffic fatalities with a positive cocaine toxicology test result on days with a maximum temperature above or below the temperature threshold. Results.-A threshold temperature of 31.1°C (88°F) was identified, above which the mean daily number of fatal cocaine overdoses increased steadily. On days with a maximum daily temperature of 31.1°C (88°F) or higher ("hot days"), the mean daily number of cocaine overdose deaths was 2.34 (SD = 1.68), which was 33% higher than the mean on days with a maximum temperature of less than 31.1°C (88°F) (mean = 1.76 [SD=1.37] (PϽ.001). In contrast, the mean number of opiate overdose deaths per day was 0.81 (SD = 0.94) on hot days and 0.71 (SD = 0.86) on other days (P = .28). For other drug overdose deaths, the mean number of deaths per day was 0.08 (SD = 0.28) on hot days and 0.08 (SD = 0.28) on other days (P = .69). Among homicides, the proportion with a positive cocaine toxicology test result was 18.9% on hot days and 19.5% on other days (P = .69), and among traffic fatalities, the proportions with positive cocaine toxicology test results were 9.5% on hot days and 10.3% on other days (P = .91). Conclusions.-High ambient temperature is associated with a significant increase in mortality from cocaine overdose. Based on our comparison groups, the increase is not explained by changes in cocaine use among the general population. Although cocaine use is dangerous on all days, it appears to be even more dangerous on hot days.

This ecological study examines the association of the poverty status of urban communities in New York City with their mortality rates of accidental drug overdoses. Mean annual age-adjusted rates of drug overdoses involving cocaine, opiates, or both (n = 1,684) were calculated for each of 59 residential community districts in New York City for 1990-1992. A linear regression analysis was performed to test the association of the mortality rate with the poverty status of the district as measured by the proportion of the district living below the 1989 U.S. poverty line. Poverty status accounted for 69% of the variance in the drug overdose mortality rates of communities (p < .001). This study suggests that mortality rates of overdoses involving cocaine and optiates are significantly associated with the poverty status of communities in New York City.

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