NEAR-FATAL INTOXICATION WITH CONTROLLED-RELEASE MORPHINE TABLETS IN ADEPRESSED WOMAN

Background: A 46-year-old woman suffering from a reactive depression w as admitted to the emergency room in coma and with severe respiratory failure. She later developed cardiovascular instability and general co nvulsions. Two days following admission the patient had no respiratory effort but was able to communicate in writing that she had ingested a large amount of controlled-release morphine tablets. Following treatm ent with naloxone she was successfully weaned from the respirator the next day. Methods: Sampling for determination of plasma and urine conc entrations of morphine and its metabolites morphine-3-glucuronide (M3G ) and morphine-6-glucuronide (M6G) was started 60 h after the presumed time of intake and continued up to 8 days after admission. Results: T he initial plasma concentrations of morphine, M3G and M6G were 2160, 1 3100 and 2330 nM, respectively, compatible with a lethal dose in an op ioid-naive patient. The urinary recovery of morphine, M3G and M6G corr esponded to 6.8 mmol, equivalent to an oral intake of at least 2500 mg . Conclusion: The plasma concentrations of morphine and morphine metab olites documented in this case, indicative of considerable absorption of drug, demonstrate that prolonged observation is necessary following intoxications with controlled-release morphine tablets. This case als o highlights the importance of continuous follow-up of oral morphine t herapy, so that unused drug is not left unaccounted for in the patient 's home.