Hydromorphone-related fatalities in ontario

The interpretation of drug intoxication in death investigations is based on the available published literature. In the case of hydromorphone, the literature is limited. This report serves to facilitate the evaluation of cases where hydromorphone may be implicated in a fatality through the examination of 251 hydromorphone-positive cases in the province of Ontario from 1985 to 2003. Thirty-three of these cases were selected for review in greater detail. In four cases in which hydromorphone was the sole drug detected and death was attributed to hydromorphone toxicity, concentrations ranged from 77 to 2684 ng/mL. Hydromorphone concentrations ranged from 21 to 441 ng/mL in 28 cases in which at least one other drug was detected. In five deaths attributed to natural causes, blood hydromorphone concentrations ranged from 75 to 423 ng/mL. The results of this study emphasize the importance of case specific information. Fatalities due to hydromorphone occurred at 51 ng/mL and greater; however, tolerant users of this drug, as seen in the deaths attributed to natural causes, may achieve incidental concentrations that would otherwise be considered fatal. Hydromorphone was detected and quantitated using gas chromatography-mass spectrometry.