Postmortem Redistribution of Oxycodone.

Abstract

The abuse of oxycodone (OC) as a "recreational" drug has increased in the last two decades the risk of fatalities. We report two drug-related deaths in which OC intoxication was considered the cause of death. Two brothers, a 19-year-old male (Subject 1) and a 27-year-old male (Subject 2), were found dead in their bedroom, lying on their beds. They were testified as alive in the morning, both deeply sleeping and loudly snoring in their beds; they were found dead later in the afternoon. On death scene investigation, two packs of 40 mg OxyContin extended release and one alprazolam blister were found. The external examination was performed 72 h after death with the collection of blood from femoral vein, vitreous humor, and urine samples. There were no trace of injection and no external signs of injury. A complete autopsy was performed 10 days after death with the collection of peripheral blood from the femoral vein; central blood from the right ventricle; urine; gastric contents; and bile, adipose tissue, kidney, liver, brain, skeletal, and cardiac muscle tissue samples. The toxicological ascertainment evidenced the presence of OC, alprazolam, and bromazepam in fluids and tissues. For Subject 1, the concentration of OC in peripheral blood collected 72 h after death (0.33 mg/L) was similar to the concentration in vitreous humor (0.41 mg/L); vitreous humor to peripheral blood ratio was 1.24. Ten days after death, OC levels were more than 10 times higher in peripheral blood (5.14 mg/L) and about six times higher compared to central blood specimen (1.78 mg/L), while OC levels in urine were, as expected, analogous. For Subject 2, OC concentration in peripheral blood collected 72 h after death (0.50 mg/L) was similar to vitreous humor (0.87 mg/L). At Day 10 after death, OC levels were four times higher in peripheral blood (2.10 mg/L) while levels in central blood were lower (0.40 mg/L). OC concentration in urine was substantially similar at the two times of collection. OC levels in gastric contents were quite high (more than 50 mg/L). The analyses of specimens collected at two different times clearly demonstrate variation of blood OC concentrations with time. Postmortem redistribution from organs was also evidenced by high concentrations of OC in tissues such as the liver and kidney.