Sudden, unexpected death can occur following rapture of an artery weakened by aneurysmal dilatation or by medial dissection. In both of these diseases the arterial abnormality is exacerbated by hypertension. This arterial weakness could also be aggravated by the use of drags with a hypertensive effect. We report seven cases of sudden death in patients abusing methamphetamine-four cases of ruptured bony aneurysms and three cases of aortic dissection with cardiac tamponade. The autopsy findings are reviewed, and various mechanisms are considered by which methamphetamine may contribute to death in such cases.