Methadone Maintenance Programs-A Two-Edged Sword?

Abstract

Retrospective review was undertaken of all autopsies in which methadone was detected at the Forensic Science Centre, South Australia, during a 3-year period from July 1996 to June 1999. Thirty-five cases were found in which methadone had either caused or contributed to death (age range = 14-54 years; average = 31 years; M:F = 3.4:1). Ten victims were participating in a methadone maintenance program, of whom four died within a week of enrollment. Eight victims (23%) not enrolled in a methadone maintenance program were found who had died after the use of "diverted" methadone (i.e., prescribed for someone else) (age range = 14-34 years; average = 25 years; M:F = 6:2). Deaths were directly attributable to methadone toxicity in seven of the eight cases, with additional drugs or alcohol being found in seven cases. Prevention of ongoing deaths caused by methadone diversion could be achieved by allowing only daily releases of methadone, with the addict having to consume the drug under close supervision.

Methadone dose and post‐mortem blood concentration

“…While there are no similar risk estimates available for comparison, similar clusters of death from fatal methadone toxicity in the first 2 weeks of maintenance have been identified: in 1989-90 in Victoria [1]; in 1987-92 in Harris County, Texas [7]; in 1996-99 in South Australia [8]; in 1991-96 in the Strathclyde region of Scotland [9]; in 1991-94 in Sheffield, England [10]; and in 1994-98 in Aachen, Germany [11]. While some deaths were caused by clearly inappropriate use of methadone, most were due to the difficulty in determining a starting methadone dose that is both safe and adequate to prevent withdrawals.…”

Treatment retention, drug use and social functioning outcomes in those receiving 3 months versus 1 month of supervised opioid maintenance treatment. Results from the Super C randomized controlled trial

“…Supervision ensures that patients take their medication as prescribed and prevents illicit drug diversion . Diversion poses a risk to others and may leave patients under‐treated, continuing heroin use . Equally, regular patient contact provided by supervision may promote stability and retention.…”

Issues in the interpretation of postmortem toxicology

“…There may also be habituation to the effects of a drug so that high levels can be tolerated. Good examples are some of the ring-derivative amphetamines and opiates [11,12]. Users may also have ingested a number of drugs that may have synergistic effects.…”