title: Fatal poisonings where ethylmorphine from antitussive medications contributed to death.
abstract: The hypothesis that antitussives containing ethylmorphine are abused by alcoholics and drug addicts and that this may lead to fatal poisonings where ethylmorphine causes or contributes to death was investigated. For this purpose 14 cases were analysed where a blood ethylmorphine concentration above the therapeutic level of >/= 0.3 microg/g was found in autopsy 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 was fatal poisoning in 8 of the 14 cases and although there were no mono-intoxications, the cause of death was specified as fatal ethylmorphine poisoning in 2 cases. Among the unspecified medicinal drug poisonings there were five cases with very high blood levels of ethylmorphine, indicating that this drug played an important contribution to the cause of death. The results indicate 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 ethylmorphine to these categories of patients. Prescription of large amounts of the drug should be avoided.
authors.affiliation: Department of Forensic Medicine, Uppsala University, Dag Hammarskjölds väg 17, S-752 37 Uppsala, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Jonasson
authors.forename: U
authors.initials: U
authors.lastname: Jonasson
authors.forename: P
authors.initials: P
authors.lastname: Holmgren
authors.forename: T
authors.initials: T
authors.lastname: Saldeen
mesh_terms: D000328:Adult; D000435:Alcoholic Intoxication / Q000175:diagnosis / Q000473:pathology; D014151:Anti-Anxiety Agents / Q000032:analysis / Q000506:poisoning; D000996:Antitussive Agents / Q000032:analysis / Q000506:poisoning*; D001344:Autopsy / Q000331:legislation & jurisprudence; D001569:Benzodiazepines; D002423:Cause of Death; D004305:Dose-Response Relationship, Drug; D005036:Ethylmorphine / Q000032:analysis / Q000506:poisoning*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000209:etiology* / Q000473:pathology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000473:pathology; D013548:Sweden
chemical_list: D014151:Anti-Anxiety Agents; D000996:Antitussive Agents; D001569:Benzodiazepines; D005036:Ethylmorphine