INVOLVEMENT OF CODEINE IN DRUG-RELATED DEATHS

The incidence and role of codeine in drug-related deaths in Victoria w as investigated over a 5-year period. There were a total of 107 cases involving codeine, representing 8.8% of all drug-related deaths in thi s period in Victoria. There were only six fatalities in which codeine was considered the major poison. The mean (+/-SD) concentration of cod eine in femoral blood was 4.0+/-2.3 mg/L (range, 2.1-8.0 mg/L). The me an concentration of free codeine was 1.3+/-0.9 mg/L (range, 0.4-2.8 mg /L). The remaining 101 cases involved a combination of codeine and oth er drugs. The mean total codeine blood concentration was 1.8+/-3.3 mg/ L (range, 0.04-26 mg/L), which was significantly lower than in those c ases where codeine was the major poison (p <0.002). The mean concentra tion of free codeine was 0.82+/-4.9 mg/L (range, 0.02-9.0 mg/L), which was not significantly different (p >0.05) from the six codeine-only c ases. The most common drugs found in this group, other than codeine, w ere acetaminophen (62%), diazepam (46%), salicylate (20%), and ethanol (25%). The association of other psychoactive drugs in these deaths ma de the contribution of codeine difficult to assess. Free codeine conce ntrations >0.4 mg/L and total codeine concentrations >2.0 mg/L may be sufficient to cause death in the absence of any other contributing fac tors.