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Published:
Journal of Analytical Toxicology,
ISSN 0146-4760,
Volume 26, Number 7, October 2002,
pp. 448-459
Oxycontin®: The Concept of a “Ghost Pill”
and the Postmortem Tissue Distribution of Oxycodone in 36 Cases
Daniel T. Anderson, Kristina L. Fritz, and Joseph
J. Muto
Los Angeles County Department of Coroner, 1104 N. Mission Road, Los Angeles,
California 90033
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). Reproduction
of editorial content of this journal is prohibited without publisher’s
permission.
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