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Sunday, November 23, 2014
Pharmacy and Medications
If a person had an oxycodone blood level of 0.40 found during an autopsy, how much of the drug would have had to be ingested?
I know that you learned in grade school that your answer was wrong unless you provided the units. A level of 0.4 is meaningless. Drug levels drawn at autopsy are difficult to interpret for all kinds of reasons. Opioid levels have the added issue that patients who take them regularly develop tolerance to opioid effects. This can lead to difficulty interpreting postmortem levels because a tolerant individual could take higher doses safely and have higher plasma levels than a naive individual who died from an opioid overdose.
Basselt reports the following information in Disposition of Toxic Drugs and Chemicals in Man (5th edition page 644-645)
In normal volunteers given 10mg of immediate release oxycodone orally, plasma concentrations averaged 0.030 mg/L at between 0.8 and 2.5 hours after the dose.
Three deaths have been reported involving acute ingestion of oxycodone overdoses by adults who exhibited post-mortem blood concentrations of 0.4-0.7mg/L, but each case involved at least one other [CNS] depressant drug.
In his book "Karch's Pathology of Drug Abuse (3rd edition, 2002 p 372 - 373) Karch lists oxycodone therapeutic level as less than 0.1mg/L
If you need further help interpreting post mortem levels of drugs, you might want to consider speaking with a forensic toxicologist.
Robert James Goetz, PharmD, DABAT
Assistant Professor of Pharmacy Practice
College of Medicine
University of Cincinnati