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Propoxyphene in postmortem toxicology 1976-1978

B S Finkle, Y H Caplan, J C Garriott

    Journal of Forensic Sciences
    |October 1, 1981
    PubMed
    Summary

    Propoxyphene involvement in fatalities is often secondary to polypharmacy and self-medication. While not linked to street-drug deaths, excessive use, especially with depressants, remains dangerous.

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    Area of Science:

    • Forensic Toxicology
    • Clinical Pharmacology
    • Public Health

    Background:

    • Propoxyphene, a widely prescribed analgesic, has been detected in postmortem toxicological analyses.
    • Cases involving propoxyphene often present with pre-existing conditions like hypochondria, chronic illness, and psychiatric disorders.

    Purpose of the Study:

    • To evaluate the role of propoxyphene in a large cohort of deceased individuals.
    • To investigate the circumstances surrounding propoxyphene-related fatalities, including co-ingestions and manner of death.

    Main Methods:

    • Toxicological analysis of blood and tissues from 1859 deceased individuals across the US and Canada.
    • Review of medical examiner and coroner case files from late 1975 to December 1978.

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    Main Results:

    • Propoxyphene and its metabolite were identified in 1859 cases.
    • High rates of suicide (44.1%) and multiple-drug toxicity (88.6%) were observed.
    • Propoxyphene's presence in postmortem toxicology declined after 1977, with no evidence linking it to "street-drug" fatalities.

    Conclusions:

    • The significance of propoxyphene in fatalities may be overstated, with polypharmacy and unsupervised self-medication being greater concerns.
    • Propoxyphene is dangerous when misused, particularly in combination with alcohol and other central nervous system depressants.