Methadone Related Deaths in New York City

Baden, Michael M.

doi:10.3109/10826087009057014

Cited by 39 publications

(14 citation statements)

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“…In their discussion, these authors do not address treatment drop-outs and their known excessive mortality. 5 It is also unfortunate that with their speculation on sleep disorders that they have not collaborated with experts in this complex field. Their evidence for a sleep-apnoea like syndrome is tantalising if not very substantial.…”

Section: Commentary Dr Andrew Byrnementioning

confidence: 99%

“…2,3 However, as the weeks passed and patients developed a tolerance to the respiratory depressant effects of methadone, their risk of fatal drug toxicity fell dramatically (RR first two weeks vs. later maintenance 97.8, 95% CI 36.7-260.5). 3 The first warnings 5,6 and clinical reports 7,8 of severe methadone toxicity soon followed the rapid expansion of New York City methadone maintenance programs in the early 1970s. 9 Methadone toxicity was found to cause a profound hypoxia (lack of oxygen in the blood) and a severe pulmonary oedema.…”

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confidence: 99%

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Fatal methadone toxicity: signs and circumstances, and the role of benzodiazepines

Caplehorn

Drummer

2002

Australian and New Zealand Journal of Public Health

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Objective: To describe the signs and symptoms and circumstances of fatal methadone toxicity and investigate the role of benzodiazepines in these deaths. Methods: Data were extracted from 1994 New South Wales (NSW) coronial files and cause of death established independently. Cases were grouped according to the likely source of methadone. Data describing the clinical history and circumstances of death were extracted from witnesses' and police statements. Results: Methadone contributed to the deaths of 57 of the 87 adult coronial cases in which it was detected in NSW in 1994. The most commonly reported early signs of severe methadone toxicity were ataxia, slurred speech and evident euphoria. The late signs were unconsciousness, loud snoring and brown pulmonary oedema fluid coming from the mouth or nose. Death occurred an average 5.1 and 6.0 hours after oral ingestion and intravenous injection of methadone, respectively. Benzodiazepines were significantly more likely to have contributed to deaths from methadone toxicity among maintenance patients and people taking methadone tablets for pain relief than deaths involving diverted methadone syrup and deaths to which methadone did not contribute (OR 4.8, 95% 1.7 to 14.4). Conclusions and implications: Benzodiazepines may contribute to deaths from methadone toxicity by increasing upper airways obstruction. Victims would have had a greater chance of survival if they had either been placed in the coma position or given mouth‐to‐mouth ventilation and an ambulance had been called. Benzodiazepines are more likely to contribute to fatal methadone toxicity in newly admitted maintenance patients and those taking methadone tablets for pain relief.

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Section: Commentary Dr Andrew Byrnementioning

confidence: 99%

mentioning

confidence: 99%

Fatal methadone toxicity: signs and circumstances, and the role of benzodiazepines

Caplehorn

Drummer

2002

Australian and New Zealand Journal of Public Health

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“…Although non-fatal poisoning of children by methadone is well recognised only a small number of deaths in infants and older children attributed to methadone toxicity have been reported in the literature [2][3][4][5][6][7][8][9][10]. Cases of methadone related poisoning and/or fatalities have been reviewed previously [11,12].…”

Section: Introductionmentioning

confidence: 99%

Methadone toxicity in infants: a report of two fatalities

Mistry

Jeffery

Madira

et al. 2010

Forensic Sci Med Pathol

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Fatalities in infants resulting from methadone toxicity are rare within the United Kingdom. We report two cases of fatality attributed to methadone toxicity in infants aged 3(1/2) and 15 months of age, respectively. One of the two cases was also associated with diazepam ingestion. We discuss the difficulties with the interpretation of paediatric forensic toxicology and review the current literature related to methadone and diazepam toxicity in infants and older children.

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“…In parallel with early expansion of methadone treatment, case reports of methadone fatalities have been documented for over 35 years (Baden 1970;Gardner 1970). As community-based methadone programs continue to expand for both addiction and chronic pain, further reports of deaths due to metha done have now surfaced from the US (Bryant et al 2004) , Austral ia (Zador & Sunjic 2000;Capelhorn & Drummer 1999), Sweden (Fugelstad et al 1995), Germany (Schmoldt et al 1999), Switzerland (La Harpe & Frye 1995), Scotland (Seymour et al 2003;Cooper et al 1999;Bentley & Bu suttil 1996) as well as England and Wales (Griffith, Brock & Mickleburgh 2002;Neeleman & Ferrell 1997;Cairnes, Roberts & Benbow I996).…”

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confidence: 98%

Methadone Death, Dosage and Torsade de Pointes: Risk-Benefit Policy Implications

Latowsky

2006

Journal of Psychoactive Drugs

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Methadone maintenance treatment (MMT) for opioid dependency has consistently shown important heath, social and legal benefits. What started as a small experimental program in Lexington, Kentucky has grown and expanded substantially over 35 years. Its practice is now well established both in specialized centers and in the broader community. In society, methadone deaths represent an important issue of public safety: methadone diversion to and ingestion by nontolerant individuals outside of treatment. Within treatment, methadone deaths occur most commonly in the early stabilization period (due to issue of tolerance), in periods of transition, or among certain individuals who abuse other substances (opioids, benzodiazepines, or alcohol). Research suggests moderately high methadone dosages help improve patient retention. Results from pharmacodynamic, kinetic and stereospecific studies continue to support the importance of individualizing dose. For some patients, much larger doses may be necessary to fully achieve all pharmacotherapy goals of treatment. Practitioners must be cautious however as certain patients on higher dosages are predisposed to torsade de pointes and increased mortality. Policymakers have a responsibility in their decision-making to balance the quality of life benefits for patients within MMT with the risks of increased mortality both for individuals within treatment and the general public.

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Methadone Related Deaths in New York City

Cited by 39 publications

References 0 publications

Fatal methadone toxicity: signs and circumstances, and the role of benzodiazepines

Fatal methadone toxicity: signs and circumstances, and the role of benzodiazepines

Methadone toxicity in infants: a report of two fatalities

Methadone Death, Dosage and Torsade de Pointes: Risk-Benefit Policy Implications

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