Oxycontin®: The Concept of a “Ghost Pill” and the Postmortem Tissue Distribution of Oxycodone in 36 Cases

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®, Roxicodonei®, 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 0.11–6.01 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).