Première série de décès en France liés à l'oxycodone

Oxycodone is a semi-synthetic opiate, derived from thebaine. It is a narcotic analgesic proposed for relief of pain (moderate to severe, or chronic pain). Although first developed in 1916, oxycodone is available on the French market only since 2000, in immediate release (OxyNorm® and OxyNormOro®, as capsule or injectable form and oral liquid, respectively) and controlled release (OxyContin®, as tablet). The delivery of oxycodone follows the rules of drugs of abuse (special medical prescription, prescription for no more than 28 days). Numerous fatal overdoses have been described in the US, but are very seldom in France as recreational use remains rare. We describe here 3 fatalities (2 women and 1 man) involving oxycodone, including analytical procedures and interpretation that occurred in 3 different cities of France. A general screening, involving immunochemistry and gas-liquid chromatography identified in each case oxycodone and some other pharmaceuticals. Neither ethanol nor drugs of abuse were detected. Oxycodone was tested by LC-MS/MS in the 3 cases. The following results were obtained in peripheral blood: case 1, oxycodone (2344 ng/mL) + alprazolam (112 ng/mL) + sertraline (1323 ng/mL); case 2, oxycodone (600 ng/mL) + zopiclone (1000 ng/mL) + mianserine (580 ng/mL) + citalopram (150 ng/mL); case 3, oxycodone (1400 ng/mL) + zopiclone (1850 ng/mL) + nordiazepam (395 ng/mL) + oxazepam (45 ng/mL). Due to the toxicological findings, all 3 deaths were listed as acute oxycodone intoxication in a polydrug abuse situation. The discussion will be focused on the comparison of our results with the existing literature, the absence of drug abuse and the original circumstances of death.