The prevalence of dextropropoxyphene in autopsy blood samples

The prevalence of dextropropoxyphene (DXP) in the total medico-legal autops y material in Sweden during 1992 to 1996 was examined. Simultaneous finding s of paracetamol and alcohol in the blood were considered in the analyses. DXP in peripheral blood was found in 1782 (7.5%) of the 23 691 cases analys ed during 1992-1996. The autopsy prevalence of DXP increased by 25% from 19 92 to 1996. The mean blood DXP concentration was 1.62 mu g/g (the blood lev el of DXP after a therapeutic dose is 0.05-0.75 mu g/g). The blood DXP leve l was <0.75 mu g/g in 947 cases and greater than or equal to 0.75 mu g/g in 835 cases. The cases <50 years of age had a significantly higher mean conc entration (2.36 mu g/g) than those greater than or equal to 50 years (1.04 mu g/g). Paracetamol in the blood was found in 53% of the DXP cases (mean 7 5.0 mu g/g; therapeutic level 2.5-25 mu g/g) and alcohol in 43% (mean level 0.14%). According to the death certificates 54% (956) died from fatal pois oning. Among these, 74% (707) showed a blood DXP concentration greater than or equal to 0.75 mu g/g. Other Scandinavian countries, Denmark and Norway have reduced the rate of fatal DXP poisonings through government regulation s for prescription. As the defined daily dose/1000 inhabitants during a 12- month period (DDD) of DXP preparations in Sweden (14.4 in 1996) is six time s as high as in Denmark and nine times as high as in Norway, introduction o f similar regulations in Sweden should be considered. (C) 1998 Elsevier Sci ence Ireland Ltd. All rights reserved.