An update on oxycodone: lessons for death investigators in Australia

Area of Science:

• Forensic Toxicology
• Public Health
• Pharmacovigilance

Background:

• Oxycodone is a frequently abused prescription opioid.
• Iatrogenic factors, including mis-prescribing, contribute to oxycodone-related fatalities.
• Early identification of prescribing issues is crucial for death prevention.

Purpose of the Study:

• To investigate oxycodone-related deaths in Australia between 2001 and 2011.
• To explore potentially inappropriate prescribing practices.
• To analyze the role and thoroughness of coroner investigations in these cases.

Main Methods:

• Utilized the National Coronial Information System to identify cases.
• Included cases where oxycodone was detected via toxicological analysis (2001-2011).
• Analyzed demographic data, causes of death, prescription appropriateness, and details of coroner reports.

Main Results:

• 806 oxycodone-related deaths occurred, with a significant sevenfold increase from 2001 to 2011.
• Most deaths involved combined drug toxicity (63.4%) or oxycodone toxicity alone (11.8%).
• While 39% had legitimate prescriptions (often for chronic pain), at least 43 inappropriate indications were identified; coroner reports were often lacking in detail (74.4% had minor/no drug description).

Conclusions:

• Medical practitioners must exercise caution when prescribing oxycodone.
• Coroners need to provide more consistent and detailed reporting on drug involvement in deaths.
• Improved prescribing practices and detailed investigations are essential for developing effective prevention strategies.