POSTMORTEM DISTRIBUTION OF DIHYDROCODEINE AND METABOLITES IN A FATAL CASE OF DIHYDROCODEINE INTOXICATION

A report of a fatal dihydrocodeine ingestion under substitution therap y is given. Quantitation of dihydrocodeine, dihydromorphine, N-nordihy drocodeine, dihydrocodeine-6-, dihydromorphine-6- and dihydromorphine- 3-glucuronide was performed simultaneously after solid-phase extractio n prior to HPLC analysis, and the analytes were detected using their n ative fluorescence. Postmortem concentrations of blood samples from di fferent sampling sites as well as from liver, kidney and cerebrum are reported. A hair sample was investigated to prove long-term use of the substitute drug. Site-to-site differences of the analytes from blood samples were very small. The partition behavior of the opioid glucuron ides depended on the hematocrit value of the particular blood sample, Most important findings seemed that dihydromorphine and dihydromorphin e-6-glucuronide concentrations decisively contributed to the toxicity of dihydrocodeine. This case report outlines that in dihydrocodeine re lated deaths the concentrations of the pharmacologically active metabo lites should additionally be determined for reliable interpretation. ( C) 1998 Elsevier Science Ireland Ltd. All rights reserved.