Oxycontin(R): The Concept of a "Ghost Pill" and the Postmortem Tissue Distribution of Oxycodone in 36 Cases

Abstract

Oxycodone is a semi-synthetic opioid that is structurally similar to codeine and equipotent to morphine in producing analgesic effects. Oxycodone has been prescribed in many immediate-release formulations including Percodan, Percocet, Tylox, Roxicodone, and Toxicet. In 1995, the Food and Drug Administration approved Oxycontin, a controlled-release form of oxycodone. Although the immediate-release forms of oxycodone can be prescribed in doses of 10-30 mg every 4 h, it is recommended that Oxycontin be prescribed in doses of 10-160 mg every 12 h. In a six-year period, the Los Angeles County Department of Coroner's Toxicology Laboratory detected oxycodone in 67 cases, 36 of which were determined to be the controlled-release form. The objectives of this paper are to provide general information about Oxycontin, including postmortem tissue distributions of oxycodone in cases in which the controlled-release form was identified, and to introduce the concept of ghost pills. A ghost pill is a seemingly intact but drug-free tablet that resembles an undigested pill. The isolation and identification of oxycodone from postmortem specimens was achieved using a basic, liquid-liquid extraction with screening and quantitation by gas chromatography-nitrogen-phosphorus detection and gas chromatography-mass spectrometry, respectively. Oxycodone-d3 was used as an internal standard for quantitation. The assays were linear from 0.10 to 5.0 mg/L. The tissue distribution ranges of oxycodone in the 36 case examples were heart blood 0.12-46 mg/L (36), femoral blood + < 0.10-13 mg/L (35), liver 0.11-6.1 mg/kg (16), urine 2.5-122 mg/L (22), bile 0.19-49 mg/L (15), vitreous 0.24-0.82 mg/L (6), and gastric 0.06-119 mg total (21).

A Transit Compartment Model Unmasks OxyContin's Reflective Pharmacokinetics From Urine Measurements in Humans

“…This finding is consistent with the concept of a "ghost pill," a seemingly intact but drug-free OXC tablet that resembles an undigested pill, found in patient's feces. 54 Our finding that MRT GI was about 4 hours is consistent with the time it takes for an ingested OXC tablet to transit through the stom-ach and small intestines, which on average is about 4 hours. 55, 56 Pöyhia and coworkers 14 reported that 8% to 14% of an administered dose of OC is removed in urine; 86% to 96% is metabolized mainly in the liver.…”

Fatal bupropion overdose with post mortem blood concentrations

“…There has been a previous report of ''ghost pills'' in fatalities with a sustained-release formulation of oxycodone and elevated post mortem blood concentrations [13]. Additionally, the manufacturer's prescribing information for Wellbutrin XL (the sustained-release formulation of bupropion available in the US) states that ''The insoluble shell of the extendedrelease tablet may remain intact during gastrointestinal transit and is eliminated in the feces'' [14].…”

Simultaneous analysis of Thebaine, 6-MAM and six abused opiates in postmortem fluids and tissues using Zymark® automated solid-phase extraction and gas chromatography–mass spectrometry

“…1. While published methods exist for the identification and quantitation of various opiate compounds, including thebaine [2,[9][10][11][12][13][14][15], none offer the sensitivity of this method, combined with the simultaneous extraction and analysis of the eight opiate compounds in postmortem fluids and tissues.…”