Deaths Related to Propoxyphene or Codeine or Both

Abstract

Ninety-nine deaths involving propoxyphene or codeine or both were investigated through interviews with surviving relatives and associates. The criterion for admission to this study was the presence of propoxyphene or codeine in the body fluids or tissues, determined analytically. The codeine-related group included more ethnic minority persons, more histories of primary drug addiction, more users of street drugs, and more accidental deaths. In the propoxyphenerelated group there were fewer histories of drug addiction and more persons with mental illness and more suicides. Most victims had considerable past experience with one or both of the drugs and other drugs as well. Propoxyphene was usually obtained by physician prescription. Codeine was often obtained illegally.

Codeine concentrations in human samples in a case of fatal ingestion

“…In other fatal cases in which codeine was implicated, the post mortem blood concentrations for codeine ranged from 0.02 to 0.85mg/1 (association with glutethimide, [4], 15 and 48 mg/1 (association with acetaminophen or propoxyphene, [5]), 0.05 and 1.2mg/1 (association with various barbiturates, [11]). …”

Abuse of Weak Opioid Analgesics

“…Education of primary-care doctors is essential: how many are fully aware that they are giving their patient an opioid drug when they prescribe Distalgesic? And, as in the USA (Litman et al, 1983), the manufacturers and clinical pharmacologists could help by mounting responsible educational campaigns. I hope this symposium is the harbinger of such an important, co-operative, educational initiative.…”

Suicide Prevention in a Treatment Setting

“…I believe it will be helpful to bring their attention to the suicide problem repeatedly and dramatically. When I did research on suicide and accidental deaths due to poisoning with prescription narcotics, such as codeine and propoxyphene (Litman, Diller, & Nelson, 1983), the primary care doctors who were prescribing these drugs had little or no information concerning the mental state of their patients. Therefore the doctors were shocked and surprised to learn about the deaths from overdoses of the very medicines they had prescribed.…”