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Fatal Poisonings Involving Propoxyphene Before and After Voluntary Withdrawal From the United States Market: An Analysis From the State of Florida

NCJ Number
Forensic Science International Volume: 280 Dated: November 2017 Pages: 228-232
Chris Delcher; Guanming Chen; Yanning Wang; Svetia Slavova; Bruce A. Goldberger
Date Published
November 2017
5 pages
This study examined the characteristics and occurrences of propoxyphene-related deaths in Florida before and after its voluntary market removal.
The synthetic opioid propoxyphene was a schedule IV controlled substance with multiple reported health risks before the U.S. Food and Drug Administration issued a request for voluntary market withdrawal in November 2010. In the current study, decedent-level toxicology data from Florida's Medical Examiners Commission was used to compare the temporal, polysubstance use, sociodemographic, and geographic profiles associated with propoxyphene-involved deaths for a period before (November 2008-November 2010) and after its voluntary removal from the market (December 2010-December 2012). Sensitivity analyses using multiple data sources, including Florida's Prescription Drug Monitoring Program and other states' data, were conducted to examine potential reporting bias. Results showed that the number of propoxyphene-involved deaths declined by 84 percent, from 580 deaths to 92 deaths, after market withdrawal. The co-occurrence of other prevalent drugs, such as oxycodone (17.2 percent to 26.1 percent, p = 0.0422) increased significantly in the post-withdrawal study period. A larger proportion of the propoxyphene-related deaths were reported from South Florida after the withdrawal (28.4 percent to 56.5 percent, p < 0.0001). No significant changes in age and race/ethnicity were observed. Sensitivity analyses revealed that several deaths occurred in other states after market withdrawal, as recently as 2016. These findings are consistent with previous studies that found propoxyphene was still available after removal from the U.S. market. Due to on-going safety risks, this study recommends continued surveillance after highly abused opioids are withdrawn from the market due to on-going safety risks. (publisher abstract modified)