Concentration of oxymorphone in postmortem fluids and tissue

Area of Science:

• Forensic Toxicology
• Pharmacology
• Medicinal Chemistry

Background:

• Oxymorphone, a semi-synthetic opioid analgesic, has been available since the 1950s.
• The 2006 FDA approval of immediate and extended-release oxymorphone tablets (Opana) has been linked to increased oxymorphone-related deaths in North Carolina.
• Limited postmortem concentration data exists for oxymorphone, hindering case interpretation.

Purpose of the Study:

• To report postmortem oxymorphone concentrations from 33 medical examiner cases.
• To establish reference ranges for oxymorphone in postmortem blood, liver, and urine.
• To aid in the interpretation of oxymorphone-associated fatalities.

Main Methods:

• Analysis of 33 medical examiner cases involving oxymorphone.
• Oxymorphone detection in blood using enzyme immunoassay.
• Confirmation by gas chromatography-mass spectrometry with solid-phase extraction.
• Quantification using calibration curves (0.025–0.50 mg/L) with a limit of quantitation of 0.025 mg/L.

Main Results:

• Mean oxymorphone concentration in postmortem central blood (n=28) was 0.15 mg/L; peripheral blood (n=23) was 0.15 mg/L.
• Median oxymorphone concentrations were 0.10 mg/L (central blood) and 0.075 mg/L (peripheral blood).
• Liver concentrations ranged from undetected to >2.0 mg/kg (mean: 0.36 mg/kg, median: 0.30 mg/kg).
• The majority of urine samples exceeded 0.50 mg/L.

Conclusions:

• This study provides the first extensive dataset of postmortem oxymorphone concentrations.
• The established ranges can assist forensic toxicologists in interpreting oxymorphone levels in postmortem investigations.
• The findings highlight the need for continued monitoring of oxymorphone's role in mortality.