Toxicological detection of pholcodine in blood, urine and hair in three cases of fatal intoxication

Pholcodine is an opioid antitussive reputed for its low toxicity and absence of addictive effect. We report three cases of pholcodine intoxication with fatal outcome. Large concentrations of pholcodine were quantified by gas chromatography coupled to mass spectrometry (GC/MS) in peripheral postmortem blood (respectively 2890 ng/mL, 979 ng/mL and 12,280 ng/mL). Segmental hair analyses by GC/MS and detected pholcodine in three 1.5-2 cm segments (38-161 ng/mg, 8.54-41.6 ng/mg, and 0.26-2.66 ng/mg, respectively). These findings underline that pholcodine can be involved in fatal poisoning and raise the question of misuse or abuse and of taking account of this drug in opioid overdose prevention policies. (c) 2021 Published by Elsevier B.V.

Automated summary

Three cases of fatal pholcodine intoxication were reported, with high concentrations of pholcodine detected in postmortem blood and hair samples. These findings highlight the concern of drug misuse and the necessity of considering pholcodine in opioid overdose prevention policies.