Fatal poisonings where ethylmorphine from antitussive medications contributed to death

The hypothesis that antitussives containing ethylmorphine are abused by alc oholics and drug addicts and that this may lead to fatal poisonings where e thylmorphine causes or contributes to death was investigated. For this purp ose 14 cases were analysed where a blood ethylmorphine concentration above the therapeutic level of greater than or equal to 0.3 mu g/g was found in a utopsy blood samples. Alcohol was found in 8 of the 14 cases and alcoholism or drug addiction was noted on 8 of the 14 death certificates. Other drugs , mostly benzodiazepines, were found in all 14 cases. The cause of death wa s fatal poisoning in 8 of the 14 cases and although there were no mono-into xications, the cause of death was specified as fatal ethylmorphine poisonin g in 2 cases. Among the unspecified medicinal drug poisonings there were fi ve cases with very high blood levels of ethylmorphine, indicating that this drug played an important contribution to the cause of death. The results i ndicate that deaths due to ethylmorphine in antitussive medicines may occur among drug addicts and alcoholics taking it in overdose. Physicians should therefore be restrictive in prescribing cough mixtures containing ethylmor phine to these categories of patients. Prescription of large amounts of the drug should be avoided.