Oxycodone Rarely the Sole Cause of Drug Abuse Deaths

New Study Finds Oxycodone Rarely the Sole Cause of Drug Abuse Deaths
Landmark Analysis Sets Standard for Interpretation of Deaths Involving Drug Abuse

February 26, 2003 12:08 PM
PRNewswire/ --

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. The March issue of the Journal of Analytical Toxicology will be available on their web site, http://www.jatox.com/jan-june03.htm on February 27, 2003.

Further, in this study of deaths involving oxycodone, the specific pain medicine OxyContin® (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."

Study Methodology 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.

The study was funded by Purdue Pharma L.P. The principal investigators, who are not employed by Purdue Pharma, served as consultants and received compensation for their participation in this work.

The Journal of Analytical Toxicology (JAT) is the international source for practical, clinical/forensic applications for isolating, identifying, and quantitating potentially toxic substances.

Since its inception in 1977, JAT has striven to present state-of-the-art techniques to address current issues in toxicology.

SOURCE The Journal of Analytical Toxicology

Drug mix proves deadly

March 3, 2003
Overdoses linked to OxyContin may have to do with combinations.
By Linda Marsa, Times Staff Writer

The prescription painkiller OxyContin may not be the sole culprit behind the hundreds of drug overdoses for which it's been blamed.

Researchers have found that most of the drug-abuse deaths associated with Oxycodone -- a morphine-like painkiller that is the active ingredient in OxyContin, Percocet and other medications -- are the result of mixing several drugs.

The overdoses have prompted increased regulatory scrutiny of prescriptions nationwide, making some doctors reluctant to prescribe the drug, even for patients in severe pain.

"We found that the oxycodone deaths were primarily related to mixing many different kinds of drugs with these opiates," says Edward J. Cone, lead author of the study and a forensic toxicologist. "These drugs often have a synergistic effect on each other, and in combination can be a deadly brew."

Researchers solicited the records of 1,243 oxycodone-related cases from medical examiners in 23 states from August 1999 through January 2002. OxyContin caused only 12 of these deaths, and another 18 were linked to Oxycodone. In the vast majority of cases (96.7%), victims had at least three other drugs in their system, such as benzodiazepines (Valium-like drugs), alcohol, cocaine, marijuana, antidepressants or other narcotics.

This finding is in stark contrast to the figures compiled last year by the U.S. Drug Enforcement Administration, which lists OxyContin as the cause of 146 deaths, and the "likely" cause of an additional 318 fatalities.

Purdue Pharma, the Stanford, Conn., maker of OxyContin, funded the study, which was in the March issue of the Journal of Analytical Toxicology.

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