Concentration of Oxymorphone in Postmortem Fluids and Tissue

Abstract

Oxymorphone, a semi-synthetic opioid analgesic, has been available as Numorphan since the 1950s in the form of injectable solutions and a suppository. Recently, in 2006, oxymorphone was approved by the Federal Drug Administration for use in the form of immediate and extended release tablets under the trade name Opana. Since the advent of Opana, the number of deaths involving oxymorphone has risen considerably in the State of North Carolina. To date, there are very few reported values for postmortem concentrations of oxymorphone in the literature to aid in the interpretation of these cases. We report 33 medical examiner cases involving oxymorphone and provide the distribution of oxymorphone in postmortem blood, liver, and urine samples. Oxymorphone was detected in blood by enzyme immunoassay and confirmed by gas chromatography- mass spectrometry utilizing a solid-phase extraction procedure. Calibration curves from 0.025 to 0.50 mg/L were established with a limit of quantitiation of 0.025 mg/L. The mean concentration for oxymorphone in postmortem central (n = 28) and peripheral (n = 23) blood samples was 0.15 mg/L. The median values for the central and peripheral samples were 0.10 mg/L (range: 0.011-0.59) and 0.075 mg/L (range: 0.017-0.82), respectively. Liver concentrations ranged from "none detected" to > 2.0 mg/kg, with mean and median values of 0.36 and 0.30 mg/kg, respectively. The majority of urine samples were > 0.50 mg/L.