Methadone and drug addicts
Dead drug addicts from Copenhagen City and County in 1981 and 1989 respectively were analysed for methadone. Ninety-four cases from 1981 and 70 cases from 1989 were analysed; from 1981, 16% were found positive for methadone, while in 1989, 37% were positive. Methadone alone was found to be the cause of death in 50% more cases in 1989 than in 1981. Only half of the methadone positive dead drug addicts had been in methadone treatment. Morphine and benzodiazepines were the most frequently occurring other substances in both 1981 and 1989. Alcohol was found present in only about 30% of the methadone-positive cases. Medians for methadone whole blood conc. were 0.9 mumol/kg with no alcohol present and 0.5 mumol/kg with alcohol present in addicts dying from methadone. In living persons using methadone, the median was 0.4 mumol methadone/kg whole blood with no alcohol present and 0.3 mumol/kg with alcohol present.
Available from: Sys Stybe Johansen
- "In Denmark, methadone is the preferred option in the treatment of opioid dependence, and deaths related to methadone among drug addicts have increased through the years (Simonsen et al., 2007). As with other opioids, the methadone blood concentration is highly variable in fatal cases, and there is an appreciable overlap between methadone blood concentrations found in drug addicts, who died of a methadone poisoning (0.06–3.10 mg/L, median = 0.28 mg/L, N = 59), and the concentration found in living subjects receiving methadone treatment (0.03–0.56 mg/L, median = 0.11 mg/L, N = 62) (Worm et al., 1993). Even though, different studies have been performed to investigate the risk factors Please cite this article in press as: Nielsen, M.K.K., et al., Evaluation of metabolite/drug ratios in blood and urine as a tool for confirmation of a reduced tolerance in methadone-related deaths in Denmark. "
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ABSTRACT: Methadone blood concentrations in fatal cases are highly variable and there is an appreciable overlap between therapeutic methadone concentrations and the concentrations detected in fatalities. As with other opioids, the background of these methadone-related deaths is unclear. The aim of this study was to investigate if short-time abstinence was contributing to the cause of death in methadone-related deaths by evaluation of the EDDP/methadone ratio in blood and urine.
Samples of blood and urine were collected from 103 autopsy cases and analysed for the concentrations of methadone and its main metabolite EDDP. The cases were divided into three groups according to the cause of death: cases where methadone was the cause of death (N=67), cases where poly-drug poisoning including methadone was the cause of death (N=24) and cases where death were caused by other factors (N=12). Urine samples from 11 living persons receiving methadone were also included.
In general, a substantial overlap of the methadone concentrations in blood and urine was seen between the groups. There was a tendency of lower median EDDP/methadone urinary ratios in the methadone poisoning group (median: 1.0), poly-drug poisoning group (median: 0.94) and in the fatalities not related to methadone (median: 1.1) compared to the living subjects in methadone treatment (median: 1.6), although the differences were not significant.
It was not possible to reveal a possible abstinence period prior to death by using the EDDP/methadone ratio in blood and urine in methadone-related deaths.
Drug and alcohol dependence 07/2013; 133(2). DOI:10.1016/j.drugalcdep.2013.07.001 · 3.42 Impact Factor
Available from: John Corkery
- "A fatal dose for a novice/naı¨ve or non-tolerant person may be the same or lower than an individual undergoing MMT. Worm et al. (1993) found that the blood methadone level for fatalities who were not in a maintenance programme was almost half that of those in treatment (median 0.22 mg/l vs 0.43 mg/l; mean 0.27 mg/l vs 0.47 mg/l). They also found that when alcohol was present (blood alcohol levels above 50 mg/100 ml), the level of methadone needed to cause death was significantly lower than when only methadone was present post-mortem (median 0.15 mg/l vs 0.28 mg/l; mean 0.25 mg/l vs 0.43 mg/l). "
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ABSTRACT: Methadone is a synthetic opioid, used both as an analgesic in severe pain relief and now mainly in the treatment of opiate dependence. Such use of the drug has increased as its advantages have become widely recognized. There are undesirable outcomes from its greater use, including a substantial market in diverted methadone and a high number of deaths where the drug has been implicated. It is important to understand how and why methadone causes death so that such fatalities can be minimized, and to disseminate such information. This paper presents an overview of the chief effects of methadone on the human body, considering its metabolism, drug interactions and tolerance. The principal mechanisms by which methadone causes death are discussed: respiratory depression, aspiration of vomit, pulmonary oedema, bronchopneumonia, cardiac problems and renal failure. Many such deaths are preventable, if drug interactions and polydrug use are avoided, its longer period of metabolism and individuals' tolerance levels are considered. It is hoped that this paper will (a) help guide health professionals in their management and treatment of patients participating in methadone treatment programmes, and (b) provide some basic information for those dealing with individuals who have consumed methadone.
Human Psychopharmacology Clinical and Experimental 12/2004; 19(8):565-76. DOI:10.1002/hup.630 · 2.19 Impact Factor
Available from: Robert S Gable
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ABSTRACT: A procedure is outlined for comparing dependence potential and acute toxicity across a broad range of abused psychoactive substances. Tentative results, based on an extensive literature review of 20 substances, suggested that the margin of safety ("therapeutic index") varied dramatically between substances. Intravenous heroin appeared to have the greatest risk of dependence and acute lethality; oral psilocybin appeared to have the least. Hazards due to behavioral deficits, perceptual distortion, or chronic illness were not factored into the assessments.
The American Journal of Drug and Alcohol Abuse 02/1993; 19(3):263-81. DOI:10.3109/00952999309001618 · 1.78 Impact Factor
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