Drugs and Drowning: The Toxicology of Adult Drownings in Baths and Hot Tubs in Australia, 2015-2024.

Introduction: Drowning is the third leading cause of unintentional injury death. We aimed to determine the toxicology and circumstances of all adult drowning deaths that occurred in bath/hot tubs in Australia over the period 2015-2024.

Methods: Retrospective study of all adult (≥ 15 years) drowning deaths in baths or hot tubs in Australia (1 January 2015-1 November 2024) retrieved from the National Coronial Information System (n = 195). In all cases the formal finding was based upon police, toxicology and forensic pathology reports.

Results: There were 195 adult drownings in baths or hot tubs. The mean age was 54.9 years (range 15-98) and 127 (65.1%) were female. Most fatal (171, 87.7%) incidents occurred in a bath. In 113 (57.9%) cases proximal substance use was noted in the coronial conclusions as contributory. The majority (108, 55.4%) were unintentional, with 73 (37.4%) deemed intentional. A psychotropic drug was detected in the blood of 152/179 (84.9%), most commonly hypnosedatives (77/179, 43.0%) and alcohol (75/179, 41.9%). Amongst alcohol positive cases the mean blood alcohol concentration was 0.176 g/100 mL (range 0.010-0.537). In 33 (16.9%) there appeared to have been a medical episode, such as a seizure or a cardiovascular event, that preceded drowning, and a slip or fall in 17 (8.7%).

Discussion and conclusions: Substances were present in the majority of cases. The risk of drowning in such settings in the presence of drugs needs to be widely appreciated. Public campaigns that focus on the potential dangers of substance use in these settings would appear prudent.