A Review of Methadone Deaths in Jefferson County, Alabama

Abstract

Interpretation of the concentration of a drug is more difficult when a combination of drugs is present in a decedent's blood. An increase in deaths resulting from co-intoxication with methadone and a benzodiazepine led the authors to perform a retrospective study of cases examined at the Jefferson County Coroner/Medical Examiner Office. They found 101 deaths wherein methadone was detected in the blood. Based on the drugs detected in the blood, these 101 cases were grouped into four categories: (1) pure methadone intoxication, (2) intoxication with methadone and benzodiazepine, (3) intoxication with methadone and other drugs excluding benzodiazepine, and (4) intoxication with methadone, benzodiazepines, and other drugs. Methadone was the sole intoxicant in 15 cases, with a mean concentration of 0.27 mg/L. Benzodiazepines were the most frequently detected co-intoxicant (60 of 101 cases). Benzodiazepine was the only co-intoxicant in 30 cases, and the mean methadone concentration in those 30 cases was 0.599 mg/L. Higher levels of methadone may occur in acute intoxication with methadone and benzodiazepine because benzodiazepines compete with methadone for methadone receptors. Higher levels of methadone may occur with chronic abuse of methadone and benzodiazepines because over time, benzodiazepines inhibit the hepatic enzymes that metabolize methadone.

Methadone: A new old drug with promises and pitfalls

“…Combining methadone with sedative drugs such as benzodiazepines, barbiturates, and alcohol may cause fatal respiratory depression. Studies of opioid or methadone overdose-related deaths have documented that the majority involve additional substances, most commonly benzodiazepines, alcohol, cocaine, and antidepressants [33][34][35][36][37][38][39]. Although many of these overdoses involve illicitly obtained substances, some combinations result from unsafe prescribing or medication misuse.…”

Perceived stress and substance use in methadone-maintained smokers

“…These substances might be used together to manage affect (Ross et al, 2005), or more deleteriously, this combination may produce a subjective “high” not induced by methadone alone (Lintzeris and Nielsen, 2010). The link between benzodiazepine use and stress is particularly concerning because methadone-related deaths are often linked to the concurrent use of benzodiazepines (Lintzeris and Nielsen, 2010; Mikolaenko et al, 2002; Oliver et al, 2002). …”

Clinical Characteristics of Central European and North American Samples of Pregnant Women Screened for Opioid Agonist Treatment

“…Second, there were worrying rates of concurrent benzodiazepine use disorders observed in the entire screening sample across all regions and both continents. This issue is of grave concern not only because of poor psychosocial functioning and treatment response [37][38][39][40][41] , but also because of pharmacodynamic interactions with methadone and buprenorphine, leading to significant central nervous system depression [42][43][44] and death [45][46][47][48] . Phy-sicians need to be more aware of this problem before prescribing benzodiazepines and to have a heightened awareness of psychiatric comorbidities, which often foster concomitant benzodiazepine abuse [49] .…”