3. Rättskemiska data är viktigare än vad som tidigare framkommit

Del 20.

The prevalence of dextropropoxyphene in autopsy blood samples. Forensic Sci Int. 1998 Sep 28;96(2-3):181-7. Jonasson U, Jonasson B, Holmgren P, Saldeen T. Department of Forensic Medicine, University of Uppsala, Sweden.

The prevalence of dextroproxyphene (DXP) in the total medico-legal autopsy material in Sweden during 1992 to 1996 was examined. Simultaneous findings of paracetamol and alcohol in the blood were considered in the analyses. DXP in peripheral blood was found in 1782 (7.5%) of the 23,691 cases analyzed during 1992-1996. The autopsy prevalence of DXP increased by 25% from 1992 to 1996. The mean blood DXP concentration was 1.62 micrograms/g (the blood level of DXP after a therapeutic dose is 0.05-0.75 microgram/g).

The blood DXP level was < 0.75 microgram/g in 947 cases and > or = 0.75 microgram/g in 835 cases. The cases < 50 years of age had a significantly higher mean concentration (2.36 micro-grams/g) than those > or = 50 years (1.04 micrograms/g).

Paracetamol in the blood was found in 53% of the DXP cases (mean 75.0 micrograms/g; therapeutic level 2.5-25 micrograms/g) and alcohol in 43% (mean level 0.14%). According to the death certificates 54% (956) died from fatal poisoning. Among these, 74% (707) showed a blood DXP concentration > or = 0.75 micrograms/g. Other Scandinavian countries, Denmark and Norway have reduced the rate of fatal DXP poisonings through government regulations for prescription.

As the defined daily dose/1000 inhabitants during a 12-month period (DDD) of DXP preparations in Sweden (14.4 in 1996) is six times as high as in Denmark and nine times as high as in Denmark and nine times as high as in Norway, introduction of similar regulations in Sweden should be considered.

Kommentar: Förekomsten av DXP ökade med 25% från 1992 till 1996. I det undersökta materialet – 1782 personer – var DXP koncentrationen i blodet 1.62 mikrogram/gram, den terapeutiska dosen ligger mellan 0.05 – 0.75 mikrogram/gram. Nivå av DXP i blodet var under 0.75 mikrogram/gram in 947 av fallet och över 0.75 mikrogram/gram i 835 av fallen. (Helén hade som bekant 2,0 mikrogram/gram DXP i blodet vid sitt dödsfall, vilket som synes är en mycket hög siffra, mycket överstigande den övre gränsen i den terapeutiska nivå, dvs när man tar en tablett p g a av normal värk)