Often, a medical examiner will rely on toxicology or toxicological findings to determine cause of death. Toxicology, or the study of poisons, refers to the labwork performed on the body post-mortem. Occasionally, the cause of death will be listed as “fentanyl intoxication.” I have received calls from potential clients who wondered why the medical examiner listed “intoxication” as the cause of death, as they had not noticed the family member to be “intoxicated” as that word is generally used when referring to alcohol intoxication. Intoxication means that the drug has reached “toxic” or poisonous levels. The medical examiner could have also listed fentanyl overdose as cause of death, or fentanyl poisoning. It would have meant the same thing as fentanyl intoxication.

Fentanyl (Duragesic®) is a narcotic (opioid) pain medication that comes, not in a pill form, but in a patch applied to the skin. The fentanyl patch works by slowly releasing the narcotic pain reliever directly into the skin over several days.

If fentanyl or high doses of opiates are used in patients who are not “opioid tolerant”—sometimes called opioid-naïve, the patient can suffer an overdose and die.

Overdoses of alprazolam can be fatal. Most alprazolam deaths are associated with the concomitant use of other cns depressants, such as opiates, including methadone and OxyContin. Alprazolam is significantly more toxic in overdose than other benzodiazepines with higher rates of fatalities. A study in New Zealand found that alprazolam is almost 8 times more likely to result in death in overdose than other sedative hypnotics as a group, with higher rates of ICU admissions and mechanical ventilation. Combined use with tricyclic antidepressants, alcohol, or opiates increases the likelihood for severe toxicity and possible fatality.18-19

Morphine acts on the central nervous system, and overdose can cause respiratory depression, asphyxia and death. A person is especially at risk of death if morphine is administered with other opiates or CNS depressants, or with benzodiazepines, like alprazolam.

In June 2008, manufacturing errors may have led for this morphine to be distributed for consumption. Subsequent recalls were issued for additional lots of morphine and at least 30 other generic drugs manufactured by Ethex which may have contained up to twice the necessary amount of the active pharmaceutical ingredient.

In the last few years, there have been several reported cases of Darvocet® or propoxyphene toxicity deaths, as a result of giving a patient too much Darvocet® or administering Darvocet® with other drugs that cause toxicity. Often, when patients die from a Darvocet® overdose, they die within a few hours of taking the drug.

Heparin overdoses occur when patients are administered excessive amounts of the injectable anti-coagulant drug heparin.

Oxycodone, and particularly OxyContin has a high abuse potential, and in the past few years it has been linked to a number of overdose deaths.

Oxycodone is a semi-synthetic opiate. It is the active ingredient in a number of commonly prescribed pain relief medications such as Percocet, Percodan, and Tylox. Each of these contains oxycodone in small doses combined with other active ingredients like acetaminophen.1 OxyContin is an extended release formulation of oxycodone, for long-term relief (up to 12 hours) of moderate to severe pain associated with conditions such as cancer and arthritis.2 Oxycodone is a schedule II controlled substance. Oxycodone, and particularly OxyContin has a high abuse potential, and in the past few years it has been linked to a number of overdose deaths.3 In 1996 data oxycodone was linked to 49 deaths; in 1999 that number rose to 262.4