Dextropropoxyphene deaths: coroner's report

Dextropropoxyphene has been increasingly prescribed as an analgesic in the UK, chiefly in the form of Distalgesic (dextropropoxyphene hydrochloride 32.5 mg and paracetamol 325 mg per tablet). After reports of sudden deaths from the misuse of this combination, prescribing is declining. Distalgesic remains the most common cause of fatal drug overdose in the West Midlands, UK. The 1983 Birmingham inquests are compared with those from the year 1976 to 1979. In comparison with other drug fatalities, death characteristically occurs rapidly, as little as 1 h after ingestion and usually before hospital treatment can be initiated. Toxicity is increased by alcohol which is also extensively abused. The fatal dose may be as small as 15 tablets or possibly less. Many victims are young and some never intended to take their life. Convulsions and respiratory failure precede death. The elderly and respiratory cripples may be more vulnerable to accidental death. Evidence suggests a liability to dependence or even addiction with dextropropoxyphene.