Background Dextropropoxyphene (DXP) is one of the most frequently prescribed analgesiccompounds in Sweden and the principal aim of the present study was to document some adverseeffects of its use.

Methods Chronic pain patients treated at a rehabilitation clinic in 1992 were assessedregarding substance use disorders, and the attitudes of staff and patients to this assessment routinewere examined. All fatal DXP poisoning cases in Sweden during 1992-1996 and all fatalpoisonings in one forensic medicine district from 1992-1997 were examined through deathcertificates, toxicological analyses, police reports and autopsy protocols.

Results The addiction liability of DXP was convincingly documented. It was foundpossible, and even positive, for both staff and patients to systematically assess patients forsubstance use disorders at departments treating chronic pain. Accidental DXP fatalities wereunder-estimated and the classification of the manner of death differed between the Swedishforensic medicine districts and between individual physicians. The basis for classification of themanner of death was often limited, with deficient information from relatives, friends andsignificant others about the intent of the deceased to commit suicide. Fatal DXP poisoning wasover-represented among younger people, when the death rate from DXP was related to the DXPprescription rate, compared with deaths due to sedatives and antidepressants.

Conclusions Strict regulations regarding DXP prescription should be considered, andreclassification of medical preparations containing DXP to schedule III or IV. Uniform criteriafor determination of suicide should be implemented to guarantee valid death statistics.