New Concerns for an "Old" Drug? Dihydrocodeine: Two Fatalities in Northeast Ohio.

Introduction: Dihydrocodeine (6-alpha-hydrocodol, DHC) is an opioid agonist, prescribed for moderate to severe pain. In European countries DHC has been used to treat opioid addiction in place of methadone or buprenorphine. In the US, DHC is formulated with caffeine and acetaminophen (APAP) or aspirin (i.e. Synalgos®, Panlor®), but is not available as an isolated drug. Until recently, detection of DHC at The Cuyahoga County Medical Examiner’s Office (CCMEO) has only been attributed to hydrocodone (HC) metabolism. This study describes two cases of DHC toxicity which are not consistent with HC exposure.