The detection of dihydrocodeine and its main metabolites in cases of fataloverdose

The levels of dihydrocodeine found in impaired individuals and in fatalitie s show a wide overlap in the ranges. Among other factors, the genetically c ontrolled metabolism of dihydrocodeine should play an important role in dih ydrocodeine toxicity. For the first time, the most important metabolites of dihydrocodeine were i nvestigated in femoral blood from three fatal cases by simultaneous determi nation using HPLC and native fluorescence for detection. The amount of pare nt drug always exceeded dihydrocodeine-glucuronide formation and dihydromor phine concentrations ranged from 0.16-0.21 mg/L. The similar binding affini ties of dihydromorphine and morphine to mu-opioid receptors suggest similar pharmacological effects and adverse reactions. The determination of the ph armacologically active metabolites should help to clarify the cause of deat h in fatal cases especially if a relatively low concentration of the parent drug is found.