Anatomic and toxicologic findings in 413 deaths where methamphetamine was detected were compared with findings in a control group of 114 drug-free trauma victims. Blood concentrations of methamphetamine and amphetamine were indistinguishable in cases where methamphetamine was related to the cause of death (MR) and cases where it was not. Coronary artery disease, ranging from minimal to severe multivessel, was identified in 79 of the 413 drug users but in only 6 of the 114 drug-free controls, and MR decedents had enlarged hearts compared with controls. There were also 10 cases of subarachnoid and intracranial hemorrhage in the MR group. Abnormalities of the liver and lungs were frequent. In 65 percent of these cases, death was due to accidental methamphetamine toxicity. In the remaining cases, methamphetamine was an incidental finding. Decedents were almost all Caucasian males and many were approaching middle age. Figures, tables, references