title: Oxycontin: the concept of a "ghost pill" and the postmortem tissue distribution of oxycodone in 36 cases.
abstract: Oxycodone is a semi-synthetic opioid that is structurally similar to codeine and equipotent to morphine in producing analgesic effects. Oxycodone has been prescribed in many immediate-release formulations including Percodan, Percocet, Tylox, Roxicodone, and Toxicet. In 1995, the Food and Drug Administration approved Oxycontin, a controlled-release form of oxycodone. Although the immediate-release forms of oxycodone can be prescribed in doses of 10-30 mg every 4 h, it is recommended that Oxycontin be prescribed in doses of 10-160 mg every 12 h. In a six-year period, the Los Angeles County Department of Coroner's Toxicology Laboratory detected oxycodone in 67 cases, 36 of which were determined to be the controlled-release form. The objectives of this paper are to provide general information about Oxycontin, including postmortem tissue distributions of oxycodone in cases in which the controlled-release form was identified, and to introduce the concept of ghost pills. A ghost pill is a seemingly intact but drug-free tablet that resembles an undigested pill. The isolation and identification of oxycodone from postmortem specimens was achieved using a basic, liquid-liquid extraction with screening and quantitation by gas chromatography-nitrogen-phosphorus detection and gas chromatography-mass spectrometry, respectively. Oxycodone-d3 was used as an internal standard for quantitation. The assays were linear from 0.10 to 5.0 mg/L. The tissue distribution ranges of oxycodone in the 36 case examples were heart blood 0.12-46 mg/L (36), femoral blood + < 0.10-13 mg/L (35), liver 0.11-6.1 mg/kg (16), urine 2.5-122 mg/L (22), bile 0.19-49 mg/L (15), vitreous 0.24-0.82 mg/L (6), and gastric 0.06-119 mg total (21).
authors.affiliation: Los Angeles County Department of Coroner, California 90033, USA.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Anderson
authors.forename: Kristina L
authors.initials: KL
authors.lastname: Fritz
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Muto
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000493:pharmacokinetics* / Q000506:poisoning; D003692:Delayed-Action Preparations / Q000493:pharmacokinetics / Q000506:poisoning; D005260:Female; D005554:Forensic Medicine / Q000379:methods*; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000493:pharmacokinetics* / Q000506:poisoning; D014018:Tissue Distribution
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D010098:Oxycodone