Forensic Toxicology Perspectives of Methadone‐associated Deaths in Tehran, Iran, a 7‐year Overview

Abstract

Methadone has a long history of pain relief and successful substitute for maintenance treatment in heroin and narcotic addiction. The aim of the study was to assess the trends of methadone-associated deaths in Tehran, Iran, in 2009-2015, from a forensic toxicology point of view. All methadone-associated deaths during this 7-year study period were evaluated according to demographic parameters and forensic toxicology analysis results. Results showed that 1274 cases of methadone-associated deaths were investigated during the study period. The incidence rate of methadone-associated deaths had risen 7.7 times in 2015 in comparison with 2009 (p < 0.05). The majority of cases were men (90.35%), aged from 20 to 40 years. About 80% of cases had shown positive results for other drugs and poisons in combination with methadone. Methamphetamine and tramadol were the most drugs detected in post-mortem samples. Death rates among methadone users in Tehran, Iran, increased year by year during 2009-2015. These findings raise the attention to the concomitant use of drugs with the need for changes in regulation and regulatory policy to restrict access and use of controlled drugs.

Tramadol use and public health consequences in Iran: a systematic review and meta‐analysis

“…From all victims of vehicle accidents, tramadol was reported to be the third most prevalent substance detected after alcohol and morphine (2.6%). In another study evaluating methadone‐related deaths ( n = 1274), tramadol was the second most common drug detected in the postmortem evaluations (18.5% of cases) after methamphetamine [46].…”

Drug-facilitated crime caused by drinks or foods

“…Residues were analyzed using TLC method as screening and high-performance liquid chromatography (HPLC) and gas chromatography/mass spectrometry (GC/MS) instrumentation as confirmatory methods. Pre-coated TLC aluminum sheets (20 × 20), with 0.25 mm silica gel layer thickness and ultraviolet fluorescent indicator ALUGRAM® Xtra SIL G SIL UV254, Macherey-Nagel Gmbh, Duren, Germany, were used as screening method (Bazmi et al 2016;Akhgari et al 2018). It should be noted that all samples were searched for pregabalin and baclofen.…”

Validation and Optimization of Ultrasound-Assisted Dispersive LiquidLiquid Microextraction as a Preparation Method for Detection of Methadone in Saliva with Gas Chromatography-Mass Spectrometry Technique

“…1 For efficient extraction of intended substances, biological samples need to be prepared before chemical analysis. 1,2 Dispersive Liquid-liquid microextraction (DLLME) is a fast, easy, cost-effective and environmentally friendly preparation method that can be followed by Gas chromatography-mass spectrometry (GC-MS) analysis. 1,3 Studies show that use of ultrasound waves during DLLME rises its efficiency and speed and reduces the required volume of toxic solvents.…”

“…5 In our forensic laboratories, DLLME/GC-MS is the routine method for methadone detection which is typically conducted on urine samples. 2 Oral fluid (saliva) can be a good substitute for urine sample because of its easy collection, low probability of adultration and high accuracy for methadon detection. 5 Limited resources in our forensic laboratories and increasing demand for methadone testing in Iran made us to seek for a more efficient, rapid and cost-effective technique of methadone analysis in biological samples as an alternative to current methods.…”