title: An overdose death involving the insufflation of extended-release oxymorphone tablets.
abstract: Two cases are reported involving the abuse of extended-release oxymorphone hydrochloride tablets (Opana® ER) in combination with alprazolam (Xanax®). Two juvenile females were discovered unresponsive and hypoxic by a male acquaintance. The trio had reportedly crushed and snorted Opana ER tablets and consumed Xanax for recreational purposes. Emergency personnel were able to stabilize one female. The second female was pronounced dead at the scene. Blood and urine samples from the surviving female were collected at the trauma center between 48 and 96 h post incident. Toxicology results showed the presence of oxymorphone, doxylamine, dextromethorphan, alprazolam, α-hydroxyalprazolam, oxazepam, and temazepam in her urine. No drugs were detected in her blood. Toxicology on the deceased female revealed the presence of 0.13 mg/L oxymorphone and 0.04 mg/L alprazolam in her blood. Gastric contents contained 0.25 and 0.93 mg/L of oxymorphone and alprazolam, respectively. Oxymorphone, alprazolam, and α-hydroxyalprazolam were present in her urine. Quantitative results were achieved by gas chromatography-mass spectrometry monitoring selected ions for the oxime-oxymorphone-trimethylsilyl derivative, alprazolam, and the α-hydroxyalprazolam tert-butyldimethylsilyl derivative. The established linearity ranges for the opiate and benzodiazepine methods were 0.050-3.000 and 0.025-1.000 mg/L, respectively. The cause of death was reported as multiple drug toxicity, and the manner of death was accidental.
authors.affiliation: Division of Forensic Toxicology, Armed Forces Medical Examiner System, Armed Forces Institute of Pathology, 1413 Research Blvd., Bldg. 102, Rockville, Maryland 20850, USA.
authors.forename: Shawn P
authors.initials: SP
authors.lastname: Vorce
authors.forename: Barry
authors.initials: B
authors.lastname: Levine
authors.forename: Pamela C
authors.initials: PC
authors.lastname: McDonough
authors.forename: Marilyn R
authors.initials: MR
authors.lastname: Past
mesh_terms: D000281:Administration, Intranasal; D000701:Analgesics, Opioid / Q000493:pharmacokinetics / Q000506:poisoning*; D062787:Drug Overdose; D017809:Fatal Outcome; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D009294:Narcotics / Q000493:pharmacokinetics / Q000506:poisoning*; D010111:Oxymorphone / Q000493:pharmacokinetics / Q000506:poisoning*; D019966:Substance-Related Disorders / Q000401:mortality; D013607:Tablets
chemical_list: D000701:Analgesics, Opioid; D009294:Narcotics; D013607:Tablets; D010111:Oxymorphone