Propoxyphene Fatalities: Blood and Tissue Concentrations of Propoxyphene and Norpropoxyphene and a Study of 115 Medical Examiner Cases

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Abstract
Propoxyphene (P) and its major metabolite, norpropoxyphene (N), have been determined in an increasing number of acute and drug abuse related medical examiner cases in Maryland during 1974–1976. Acute fatalities were typified by a female in her 30's with a P/N ratio in blood of 4.1, while drug abuse related fatalities were exemplified by a male in his 20's with a P/N ratio in blood of 1.9. Propoxyphene related fatalities were generally accompanied by the simultaneous detection of ethanol or other drugs. Blood propoxyphene concentrations exceeding 0.1 mg/dl appear significant in elucidating the cause of death in the absence of other evidence, while concentrations exceeding 0.2 mg/dl may reasonably be considered an independent causative factor in a fatality. The P/N ratio in brain was consistently the highest value when compared to blood, liver and kidney. Propoxyphene and norpropoxyphene blood and tissue concentrations and P/N ratios are useful in the diagnosis of propoxyphene related deaths.

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