[Methadone and drug addicts].

Københavns Universitet, Retskemisk Institut.
Ugeskrift for laeger 08/1993; 155(29):2245-7.
Source: PubMed

ABSTRACT 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.

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    ABSTRACT: In Denmark, fatal poisoning among drug addicts is often related to methadone. The primary mechanism contributing to fatal methadone overdose is respiratory depression. Concurrent use of other central nervous system (CNS) depressants is suggested to heighten the potential for fatal methadone toxicity. Reduced tolerance due to a short-time abstinence period is also proposed to determine a risk for fatal overdose. The primary aims of this study were to investigate if concurrent use of CNS depressants or reduced tolerance were significant risk factors in methadone-related fatalities using segmental hair analysis. The study included 99 methadone-related fatalities collected in Denmark from 2008 to 2011, where both blood and hair were available. The cases were divided into three subgroups based on the cause of death; methadone poisoning (N = 64), poly-drug poisoning (N = 28) or methadone poisoning combined with fatal diseases (N = 7). No significant differences between methadone concentrations in the subgroups were obtained in both blood and hair. The methadone blood concentrations were highly variable (0.015–5.3, median: 0.52 mg/kg) and mainly within the concentration range detected in living methadone users. In hair, methadone was detected in 97 fatalities with concentrations ranging from 0.061 to 211 ng/mg (median: 11 ng/mg). In the remaining two cases, methadone was detected in blood but absent in hair specimens, suggesting that these two subjects were methadone-naive users. Extensive poly-drug use was observed in all three subgroups, both recently and within the last months prior to death. Especially, concurrent use of multiple benzodiazepines was prevalent among the deceased followed by the abuse of morphine, codeine, amphetamine, cannabis, cocaine and ethanol. By including quantitative segmental hair analysis, additional information on poly-drug use was obtained. Especially, 6-acetylmorphine was detected more frequently in hair specimens, indicating that regular abuse of heroin was common among the deceased. In conclusion, continuous exposure of methadone provide by segmental hair analysis suggested that reduced tolerance of methadone was not a critical factor among methadone-related fatalities. In contrast, a high abundance of co-ingested CNS depressants suggested that adverse effects from drug-drug interactions were more important risk factors for fatal outcome in these deaths.
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    Journal of Forensic Sciences 02/2014; 59(5). DOI:10.1111/1556-4029.12425 · 1.31 Impact Factor