Landmark analysis sets standard for interpretation of deaths involving drug abuse
NILES, IL, Feb. 26, 2003 – The vast majority of drug abuse deaths involving oxycodone (96.7%) are related to the ingestion of multiple drugs, not solely oxycodone (3.3%), according to an analysis of over 1000 deaths published in the March issue of Journal of Analytical Toxicology. Further, in this study of deaths involving oxycodone, the specific pain medicine OxyContinÒ (oxycodone hydrochloride controlled-release) Tablets was the only drug found in 12 (1.3%) of the cases. Oxycodone is a morphine-like pain medication found in dozens of analgesics sold throughout the United States.
The investigators evaluated oxycodone related deaths solicited from Medical Examiner and Coroner offices in 23 states. The results showed that the vast majority of the 1014 cases (919 or 90.6%) involved drug abuse, with the remainder of deaths due to other causes, such as cancer. Of the drug abuse cases, 30 deaths involved oxycodone only; the remaining cases (889 or 96.7%) had multiple drugs present at autopsy.
"While abuse of any medication is dangerous, abuse of multiple drugs may be a cause for even greater concern, as there is little recognition of the added risks of abusing opioids with other drugs, such as alcohol and depressants", said Dr. Bruce Goldberger, Director of Toxicology and Associate Professor, University of Florida College of Medicine and Editor-in-Chief, Journal of Analytical Toxicology.
The new system used to analyze drug abuse deaths built upon the federal Drug Abuse Warning Network (DAWN) system for reporting drug abuse mortality data in the United States, by instituting a more rigorous method of classifying and reviewing deaths thought to involve drugs. This system enabled objective grouping of cases into single drug and multiple drug categories, drug-induced and drug-related categories, as well as categories not involving drug abuse.
In an accompanying commentary, also published in the Journal, James L. Frost, M.D., Deputy Chief Medical Examiner, State of West Virginia and past-president of the National Association of Medical Examiners, states, "The current study provides an excellent means of classifying deaths thought to be drug-related. Deaths involving oxycodone were examined in a very thorough manner." Frost further writes, "The DAWN terminology employed by the authors is very useful and is to be recommended."
"This analysis sheds light on the nature and complexity of determining whether a specific product plays a role in a drug death," said Dr. Bruce Goldberger. "This new, enhanced method of classification, based on the DAWN system, should be implemented as a standard for analyzing deaths involving drugs."
An Oxycodone Postmortem Database containing 1243 cases was assembled that consisted of solicited submissions from Medical Examiner and Coroner offices in 23 states in the United States over the period from August 27, 1999, through January 17, 2002. A system of categorization developed for this study was based on the federal DAWN system for reporting drug abuse mortality data in the United States. Only cases of death involving oxycodone were requested. Each case was evaluated to determine the role of oxycodone and the specific drug product OxyContin in the death. Oxycodone presence was based on toxicology testing; OxyContin identification was based on evidence found at the scene, credible witness reports, or identification of tablets or remnants in gastrointestinal contents. A board-certified forensic pathologist and a board-certified forensic toxicologist reviewed each case file independently. In addition, following their assessments, two more reviewers performed independent assessments of each case based on a set of predetermined questions.
Source: Journal of Analytical Toxicology. February 2003.