Death Attributed to Methadone

Abstract

Besides its other effects, MMT (methadone maintenance treatment) reduces the high mortality of intravenous heroin addicts to about 30% of controls. On the other hand, deaths of patients and non-patients have been attributed to methadone. Here, we will report on the major reasons for deaths attributed to methadone and discuss suggestions for their prevention. 69% of deaths attributed to methadone occurred in subjects not on MMT at the time of their death. 51% of deaths attributed to methadone in subjects in MMT occurred during the dose-finding period of MMT. Further apparent risk situations are methadone intake in addition to that received for MMT, discharge from prison and intravenous injection of methadone. Intake of methadone in non-patients is almost entirely due to abuse of diverted take-home methadone. Not giving methadone as take-home should reduce methadone deaths most effectively. Replacing take-home methadone by substances acting longer than one day, such as LAAM (levacetylmethadol) or buprenorphine, should also be effective. Restriction of take-home prescriptions to substances with a slow onset of action, such as LAAM, or to partial agonists with an extended safety margin such as buprenorphine should be partly effective. Meticulous evaluation of substance history, slow dose increases and strict supervision of the patient by experienced personal should prevent methadone overdose during the dose-finding period. Discharge from prison closely corresponds to this situation; informing addicts shortly before discharge and psychosocial help during the first months out of prison may reduce this risk. Naloxone as an adjunct to oral agonist preparations should effectively prevent high-risk intravenous injection, for example of methadone syrup. This has been the case with tilidine plus naloxone in Germany. Reducing deaths attributable to methadone increases the net benefit of MMT. Also, reducing deaths attributable to methadone avoids decreases in the public acceptance of MMT.

Use of Illegally Acquired Medical Opioids by Opiate-Dependent Patients in Detoxification Treatment

“…Along with these benefi ts is the risk that patients will not take the maintenance drug as prescribed, and especially the risk of selling it on the black market [6] . According to recent studies, 40-60% of drug deaths in German cities are from a combination of drugs including methadone [7,8] .…”

Methadone-associated long QT syndrome: improving pharmacotherapy for dependence on illegal opioids and lessons learned for pharmacology

“…Considering MMT and analgesic therapy by methadone together, it has been observed that an increase of the amount of methadone sold is associated with an increase in methadone-related death based on medical examiner records [72]. These observations might be entirely due to the way in which methadone is used [70] and might be due to illegal use of methadone, but it is not excluded that methadone can in certain contexts induce ADRs that have only been recently considered.…”

“…Fatal events, especially at the beginning of MMT have been repeatedly reported [70,71]. Considering MMT and analgesic therapy by methadone together, it has been observed that an increase of the amount of methadone sold is associated with an increase in methadone-related death based on medical examiner records [72].…”

Illicit use of opioid substitution drugs: Prevalence, user characteristics, and the association with non-fatal overdoses

“…For instance, injection of crushed buprenorphine tablets and methadone syrup appear riskier than oral intake, as is concomitant intake of other substances, particularly benzodiazepines (Kintz, 2001;Mégarbane et al, 2006;Nielsen et al, 2008;Renard et al, 2008). Even though buprenorphine is generally considered safer than methadone (Bernard et al, 2013;Ernst et al, 2002;Heinemann et al, 2000;Seymour et al, 2003;Vormfelde et al, 2001), there have been reported fatalities after buprenorphine snorting or injecting (Ferrant, 2011;Tracqui et al, 1998). Further, fatalities have also been reported after highdose buprenorphine consumption regardless of intake mode, especially when combined with benzodiazepines and alcohol (Häkkinen et al, 2012;Lai et al, 2006;Schifano et al, 2005;Seldén et al, 2012).…”