Among fatal poisonings dextropropoxyphene predominates in younger people, antidepressants in the middle aged and sedatives in the elderly

To compare the characteristics of dextropropoxyphene (DXP) poisoning victim s with those of victims of poisonings by antidepressants and sedatives, we examined all fatal poisonings due to DXP, antidepressants or sedatives amon g autopsies performed at one department of forensic medicine in Sweden duri ng the six-year period from 1992 to 1997. In 202 cases, death was classified as fatal poisonings by DXP, antidepressa nts or sedatives. DXP caused death in 78 cases (39%), antidepressants in 49 (24%), and sedatives in 75 (37%). DXP as a single preparation was predomin ant in causing death. The second compound, flunitrazepam, caused death in 3 0 cases (15%). The victims of poisonings by DXP, antidepressants, or sedatives shared a si milar history of alcohol/drug abuse, depression and somatic illness. They w ere mostly living alone at the time of death (>60%), the majority died at h ome (81%), and suicide was the most frequent manner of death (73%). Age seemed to be an important characteristic regarding the choice of drug. Younger people predominantly died of DXP (mean age 43 years, 95% confidence interval, CI 39-47), and elderly people of sedatives (mean age 59 years, C I 55-63). Antidepressants were found mainly in middle-aged victims (mean ag e 51 years, CI 48-54). The predominance of sedatives among the elderly might be explained by a ver y high prescription rate of such drugs in older age groups, but prescriptio n rate could not explain the DXP predominance among younger people. We hypo thesize that younger people are more prone to abuse therapeutic drugs for e uphoric reasons than elderly people, and that because of its high toxicity, DXP leads to accidental deaths more often than sedatives.