Propoxyphene-Associated Fatalities in Ontario: Incidence and Forensic Toxicologic al Aspects

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Abstract
The incidence of propoxyphene-associated fatalities in Ontario has been steadily increasing since 1974, with the increase being still evident at the end of 1977. In 1977, propoxyphene had become the third most frequently encountered drug on the drug-induced fatality scene in Ontario, and propoxyphene-associated fatalities comprised 16.3% of all ethanol and drug deaths in the Province. Propoxyphene was infrequently implicated alone; in a great majority of the fatalities propoxyphene was found together with ethanol and/or other drugs. The minimal lethal blood level of propoxyphene found was in the order of 0.1 mg/dl. This blood level is generally cohsistent with an acute ingestion of 8–14 capsules containing 65 mg propoxyphene hydrochloride or 100 mg of the napsylate. Combinations of propoxyphene with ethanol and/or other depressant drugs can cause dangerous drug inter-actions due to the mutual enhancement of effects; death can result accidentally at blood levels of drugs well below their respective fatal ranges.