A National Assessment of Propoxyphene in Postmortem Medicolegal Investigation, 1972–1975

Abstract

Propoxyphene in its various proprietary forms is among the most commonly prescribed drugs in the United States. As an analgesic which physicians find useful to bridge the gap between aspirin and the narcotics, propoxyphene has reached general application unparalleled by any other “pain-killer.” It is inevitable for any drug with such widespread usage that if it has any toxicity at all, in whatever form or circumstance, it will eventually come to the attention of forensic pathologists and toxicologists. So it has been with propoxyphene in the 1970s through a series of papers in the scientific literature [1–8] suggesting that propoxyphene was increasingly implicated in medicolegal investigations of drug-related deaths. Many groups of cases have been reported by toxicologists in particular areas such as Dallas [3], North Carolina [5], Southern California [1], and the San Francisco Bay area [6], but generally in terms of the analytical toxicology findings alone, and usually as a “snapshot” of an incidence at one point in time.

Fatal dextropropoxyphene poisonings in Jutland (Denmark)

“…Yet, persons dying of dxp are most often drug and/or alcohol misusers. This corresponds with the results of other studies [9,10].…”

“…The concentrations of dxp and ndxp in this study are in accordance with other studies [4,[9][10][11][12][13][14][15]. Concentrations above 75 mg/kg have -although they are exceptions -also been described previously [11,12].…”

Pharmacokinetic interaction of propoxyphene with ethanol.

“…Such relative or absolute increases in propoxyphene could result in concentrations which could exceed the levels at which deaths have been reported (i.e. 1 ,ug/ml) (Finkle et al, 1976;Cimbura, 1979 Time (h) Figure 1 Mean serum concentration (ng/ml) of propoxyphene (0) and norpropoxyphene (A), with ( ) and without (---) ethanol, for six subjects. BAC = breath ethanol concentration.…”

“…The combination of propoxyphene with ethanol has often been associated with accidental and intentional fatalities (Finkle et al, 1976). Propoxyphene is completely absorbed when taken orally, but has a low systemic bioavailability (Gram et al, 1979).…”

Deaths from Paracetamol and Dextropropoxyphene (Distalgesic) Poisoning in England and Wales in 1979

“…Further reports have come from Scotland (Young & Lawson, 1980) and the West Midlands (Whittington & 136S Barclay, 1981). In addition to these reports, more extensive studies have been undertaken, particularly in the USA, to examine fatal poisonings due either to dextropropoxyphene alone or its combination with ethanol and/or other drugs (Bogartz & Miller, 1971;Young, 1972;Stumer & Garriott, 1973;Sundkvist & Petrovics, 1974;Baselt et al, 1975;Finkle et al, 1976;Gustafson & Gustafsson, 1976;Caplan et al, 1977;Hudson et al, 1977;Sengupta & Peat, 1977;Finkle et al, 1981;Litman et al, 1983).…”