Methadone‐related deaths among youth and young adults in Sweden 2006–15

Fugelstad, Anna; Bremberg, Sven; Hjelmström, Peter; Thiblin, Ingemar

doi:10.1111/add.15152

Cited by 11 publications

(17 citation statements)

References 32 publications

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“…The literature so far produced has suggested that victims of methadone-related death are mostly represented by males over 30 years of age [19,20,36,44,68,72,73,83,87,88,91,92,94,95,[97][98][99]101]. The epidemiology of victims of the in-house casuistry was consistent with that of literature cases.…”

Section: Discussionsupporting

confidence: 72%

“…Our literature review has showed that deaths due to methadone occurred mostly in the first week after the beginning of MMT or in subjects who are not participating to MMT [24,36,48,49,77,91,112,116,117]. In a study by Bernard et al, a significant difference in methadone levels was encountered in the comparison between MMT and non-MMT victims and this difference was seen across all type of fatalities, from those involving methadone as the sole cause to those involving additional drugs at non-lethal and lethal levels [113].…”

Section: Tolerance To Methadonementioning

confidence: 99%

See 1 more Smart Citation

The Role of Risk or Contributory Death Factors in Methadone-Related Fatalities: A Review and Pooled Analysis

et al. 2021

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Methadone-related deaths are characterized by a wide range of post-mortem blood concentrations, due to the high pharmacokinetic/dynamic inter-individual variability, the potential subjective tolerance state and to other risk factors or comorbidities, which might enhance methadone acute toxicity. In the present study, the association among pre-existing and external conditions and diseases and the resultant methadone death capacity have been investigated. Beside a systematic literature review, a retrospective case-control study was done, dividing cases in which methadone was the only cause of death (controls), and those with associated clinical-circumstantial (naive/non-tolerant state), pathological (pulmonary or cardiovascular diseases) or toxicological (other drugs detected) conditions. Methadone concentrations were compared between the two groups and the association with conditions/diseases was assessed by multiple linear and binomial logistic regressions. Literature cases were 139, in house 35, consisting of 22 controls and 152 cases with associated conditions/diseases. Mean methadone concentrations were 2122 ng/mL and 715 ng/mL in controls and cases respectively, with a statistically significant difference (p < 0.05). Lower methadone concentrations (by 24, 19 and 33% respectively) were detected in association with naive/non-tolerant state, pulmonary diseases and presence of other drugs, and low levels of methadone (<600 ng/mL) might lead to death in the presence of the above conditions/diseases.

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Section: Discussionsupporting

confidence: 72%

Section: Tolerance To Methadonementioning

confidence: 99%

The Role of Risk or Contributory Death Factors in Methadone-Related Fatalities: A Review and Pooled Analysis

et al. 2021

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“…In a recent study, Fugelstad et al found that prescription opioid-and methadone-related deaths increased in the 15-29-year age group in Sweden between 2006 and 2015 (Fugelstad et al, 2020). Among the 269 methadone-related deaths, thirty-eight (14 %) were attributed to methadone only.…”

Section: Discussionmentioning

confidence: 99%

Concomitant drugs with buprenorphine user deaths

Mariottini

Kriikku

Ojanperä

2021

Drug and Alcohol Dependence

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Background: Buprenorphine is abused in several countries notwithstanding its benefits as an analgesic and as an opioid agonist treatment medication. Benzodiazepines and alcohol have previously been associated with buprenorphine toxicity. This study elucidates the role of emerging concomitant drugs in different groups of buprenorphine user deaths. Methods: All cases in the Finnish national post-mortem toxicology database from 2016-2019 in which buprenorphine or norbuprenorphine was a laboratory finding in any post-mortem specimen and age at death of 15-64 years were investigated for cause and manner of death, concurrent drug and alcohol findings, age, and gender. Results: There were 792 deaths with a buprenorphine finding, of which buprenorphine was implicated in poisoning without other opioids in 271 cases (34 %). In this group of buprenorphine poisoning deaths, concomitant benzodiazepines were found in 94 % (clonazepam 53 %), illicit drugs in 63 %, gabapentinoids in 50 % (pregabalin 41 %), alcohol in 41 %, antidepressants in 32 %, and antipsychotics in 28 % of cases; only three deaths showed no benzodiazepines, alcohol, or gabapentinoids. Polydrug use was common regardless of the cause of death. In the age group 15 to 24 years, concomitant use of benzodiazepines and illicit drugs, and buprenorphine poisoning were more prevalent than in the age group 25-64 years. Conclusions: The unprecedentedly high concomitant use of benzodiazepines in buprenorphine user deaths obscures other possible pharmacological risk factors for buprenorphine poisoning that could be relevant for prevention. Higher mortality in the younger age group suggests particularly unsafe drug use patterns that should be addressed.

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“…There has been a change in which opioids cause the most deaths in many western countries since the turn of the millennium, from heroin to prescription opioids, including methadone and buprenorphine [53][54][55][56]. This trend has also been noted in Sweden [8,40,57]. In a recently published study Fugelstad and colleagues showed that methadone-related deaths have increased among Swedish 15-29-year olds between 2006 and 2015.…”

Section: Discussionmentioning

confidence: 99%

“…In a recently published study Fugelstad and colleagues showed that methadone-related deaths have increased among Swedish 15-29-year olds between 2006 and 2015. Only a few individuals had been prescribed methadone the year before the death, which indicates that the increasing trend was mainly a result of an increased exposure to non-prescribed methadone among younger opioid users [57]. Another recent study by Mariottini and colleagues [58] investigated buprenorphine-related deaths in Finland 2016-2019.…”

Section: Discussionmentioning

confidence: 99%

Changes in opioid-related deaths following increased access to opioid substitution treatment

Andersson

Håkansson

Berge

et al. 2021

Subst Abuse Treat Prev Policy

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Background Opioid-related mortality is high and increasing in the Western world, and interventions aimed at reducing opioid-related deaths represent an important area of study. In Skåne County, Sweden, a patient choice reform resulted in increased access to opioid substitution treatment (OST). In addition, a gradual shift towards less restrictive terms for exclusion from OST has been implemented. The aim of this study was to assess the impact of these policy changes on opioid-related deaths. Methods Detailed data on opioid-related deaths in Skåne during the 2 years prior to and following the policy change were obtained from forensic records and from health care services. Data on overdose deaths for Skåne and the rest of Sweden were obtained using publicly available national register data. Time periods were used as the predictor for opioid-related deaths in the forensic data. The national level data were used in a natural experiment design in which rates of overdose deaths were compared between Skåne and the rest of Sweden before and after the intervention. Results There was no significant difference in the number of deaths in Skåne between the data collection periods (RR: 1.18 95% CI:0.89–1.57, p= 0.251). The proportion of deaths among patients enrolled in OST increased between the two periods (2.61, 1.12–6.10, p= 0.026). There was no change in deaths related to methadone or buprenorphine in relation to deaths due to the other opioids included in the study (0.92, 0.51–1.63, p= 0.764). An analysis of national mortality data showed an annual relative decrease in unintentional drug deaths in Skåne compared to the rest of Sweden following the onset of the reform (0.90, 0.84–0,97, p= 0.004). Conclusions Opioid-related deaths, as assessed using forensic data, has not changed significantly in Skåne following a change to lower-threshold OST. By contrast, national level data indicate that the policy change has been associated with decreased overdose deaths. The discrepancy between these results highlights the need for more research to elucidate this issue. The result that more patients die during ongoing OST following an increase in access to treatment underlines the need for further preventive interventions within the OST treatment setting.

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Methadone‐related deaths among youth and young adults in Sweden 2006–15

Cited by 11 publications

References 32 publications

The Role of Risk or Contributory Death Factors in Methadone-Related Fatalities: A Review and Pooled Analysis

The Role of Risk or Contributory Death Factors in Methadone-Related Fatalities: A Review and Pooled Analysis

Concomitant drugs with buprenorphine user deaths

Changes in opioid-related deaths following increased access to opioid substitution treatment

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