SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

P20
A COMPARISON OF METHADONE, HYDROCODONE, AND OXYCODONE ASSOCIATED
MORTALITY IN CUYAHOGA COUNTY, OHIO: 1998 - 2003
Daniel D. Baker IV*, and Amanda J. Jenkins, The Office ofthe Cuyahoga County Coroner
11001 Cedar Ave., Cleveland, OH 44106, U.S.A.
Significant increases in methadone related deaths have been recently documented across the United States.
Historically, the substantial rise in oxycodone associated mortality is well documented as opposed to
hydrocodone, where a paucity of literature remains. In response to these reports, the authors investigated
cases over a six-year period in which postmortem toxicological analyses revealed the presence of
methadone, hydrocodone, and oxycodone in any matrix type. The study was designed to detennine
whether methadone associated mortality in Cuyahoga County reflected national trends and more
specifically, to distinguish methadone trends from other commonly used opioid analgesics.
All records of decedents that were found to be positive for methadone, hydrocodone, and oxycodone from
1998-2003 were reviewed. Demographic information including age, sex, race, and location of residence
was collected. The cause and manner of death was compiled and the cases were divided into drug
overdoses and those cases where a positive result was detennined to be an incidental finding. Overdoses as
a result of only methadone, hydrocodone, and oxycodone were separated from poly drug overdoses. The
data was calculated for each type of drug based on quantitative heart blood drug concentrations for
comparison.
Review of21,460 deaths in Cuyahoga County, from 1998-2003, revealed that a total of 55 decedents were
positive for methadone and of these, 29% were ruled overdoses. 202 cases were found to be positive for
hydrocodone in which, 28% were due to a lethal dose. Oxycodone was discovered in 190 decedents of
which, 29% were caused by an overdose. Mortality caused by methadone, hydrocodone, and oxycodone
increased 400%,183%, and 366% respectively from 1998 to 2003.
Demographic data revealed 286 males and 161 females were positive for the studied opioids. 351 opioid
positive decedents were white, as opposed to 96 black. Decedent ages ranged from 2 to 101 years.
Caucasian males between the ages of 34 and 51 (mean 42.5 ±2SD) were the demographic group
predominantly positive for each of the three opioids. Decedents in which methadone was detected were
shown to live within Cleveland city limits vs. the suburbs 3:1, as opposed to hydrocodone and oxycodone
positive decedents who principally resided in the suburbs.
Heart blood methadone overdose concentrations ranged from 0.11-1.31 mg/L (mean=0.67 mgIL, n=19)
Similarly, heart blood methadone incidental finding concentrations ranged from 0.08-4.26 mgIL
(mean=0.76 mgIL, n=35). Lethal. hydrocodone heart blood concentrations ranged from 0.01-1.66 mgIL
(mean=0.29 mg/L, n=54). Incidental hydrocodone findings ranged from 0.01-2.56 mgIL (mean=0.11 mgIL,
n=112). Oxycodone overdose concentrations ranged from 0.01-36.54 mg/L (mean=1.80 mg/L, n=48).
Oxycodone positive concentrations that were detennined to be incidental findings ranged from
0.01-1.78 mg/L (mean=0.31 mg/L, n=81).
During the study period, an increase was observed in the number of positive cases for all three opioid
analgesics. In conflict with recent national data however, although the number of methadone positive cases
increased from 4 cases in 1998 to 18 cases in 2003, this did not result in a substantial increase in methadone
overdoses, 1 death in 1998 to 4 deaths in 2003. No methadone level of lethal toxicity was discemable by
comparing decedents whose death was caused by methadone intoxication as opposed to, an incidental
finding. In contrast, the mean lethal hydrocodone and oxycodone blood concentrations were definable, at
two and five times greater than non-overdose mean blood concentrations, respectively. Methadone,
hydrocodone, and oxycodone overdoses equally comprised 28-29% of cases in which these drugs were
detected.
Keywords: Methadone, Oxycodone, Hydrocodone
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