Methadone-related deaths in Norway

Bernard, Jean‐Paul; Havnes, Ingrid Amalia; Slørdal, Lars; Waal, Helge; Mørland, Jörg; Khiabani, Hassan Z.

doi:10.1016/j.forsciint.2012.11.010

Cited by 60 publications

(61 citation statements)

References 19 publications

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“…It is possible that PWID are purchasing and using street methadone as a strategy to reduce heroin consumption and self treat opioid withdrawal symptoms. While this may be viewed as a harm reduction strategy, the risks of street methadone use on fatal overdoses have been well described previously [9,11,18]. Similarly, as we have shown in the present study, this practice is associated with several other high-risk behaviors.…”

Section: Discussionsupporting

confidence: 84%

“…However, the risk of sedation and respiratory depression with improper methadone dosing remains. Specifically, despite precautions for methadone prescription such as the dispensing of methadone under daily witnessed supervision in unstable patients and regular urine drug screen testing to verify compliance, fatalities associated with methadone have increased markedly across numerous jurisdictions in recent years [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with illicit methadone injecting in a Canadian setting

Tucker

Milloy

Hayashi

et al. 2015

Drug and Alcohol Dependence

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Factors associated with illicit methadone injecting in a Canadian setting

Tucker

Milloy

Hayashi

et al. 2015

Drug and Alcohol Dependence

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“…The use of opioid maintenance therapy, including methadone and buprenorphine, has been successful in many aspects; however, these drugs are addictive and can contribute to overdose deaths (Simonsen et al, 2011;Hakkinen et al, 2012;Bernard et al, 2013). Concern may also be raised toward the reported negative effects of methadone on cognitive functions (Verdejo et al, 2005;Prosser et al, 2006Prosser et al, , 2009Andersen et al, 2011Andersen et al, , 2012).…”

Section: Introductionmentioning

confidence: 99%

A Monoclonal Antibody Specific for 6-Monoacetylmorphine Reduces Acute Heroin Effects in Mice

Bogen¹,

Boix²,

Nerem³

et al. 2014

J Pharmacol Exp Ther

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Immunotherapy against drugs of abuse is being studied as an alternative treatment option in addiction medicine and is based on antibodies sequestering the drug in the bloodstream and blocking its entry into the brain. Producing an efficient vaccine against heroin has been considered particularly challenging because of the rapid metabolism of heroin to multiple psychoactive molecules. We have previously reported that heroin's first metabolite, 6-monoacetylmorphine (6-MAM), is the predominant mediator for heroin's acute behavioral effects and that heroin is metabolized to 6-MAM primarily prior to brain entry. On this basis, we hypothesized that antibody sequestration of 6-MAM is sufficient to impair heroin-induced effects and therefore examined the effects of a monoclonal antibody (mAb) specific for 6-MAM. In vitro experiments in human and rat blood revealed that the antibody was able to bind 6-MAM and block the metabolism to morphine almost completely, whereas the conversion of heroin to 6-MAM remained unaffected. Mice pretreated with the mAb toward 6-MAM displayed a reduction in heroin-induced locomotor activity that corresponded closely to the reduction in brain 6-MAM levels. Intraperitoneal and intravenous administration of the anti-6-MAM mAb gave equivalent protection against heroin effects, and the mAb was estimated to have a functional half-life of 8 to 9 days in mice. Our study implies that an antibody against 6-MAM is effective in counteracting heroin effects.

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“…Such findings are interesting and quite puzzling, especially as there has been an increase in methadone-related deaths in Norway during the same time period as our investigation (Bernard et al, 2013). The positive association of illicit buprenorphine use and overdose risk may be explained by the patterns of use and/or the methods of drug intake.…”

Section: Discussionmentioning

confidence: 62%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Bretteville-Jensen¹,

Lillehagen²,

Gjersing³

et al. 2015

Drug and Alcohol Dependence

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Background and aims: Diversion of opioid substitution drugs (OSD) is of public concern. This study examined the prevalence, frequency, and predictors of illicit OSD use in a group of injecting drug users (IDUs) and assessed if such use was associated with non-fatal overdoses.Methods: Semi-annual cross-sectional interviews conducted in Oslo, Norway, (2006Norway, ( -2013, from 1,355 street-recruited IDUs. Hurdle, logistic, and multinomial regression models were employed.Results: Overall, 27% reported illicit OSD use in the past four weeks; 16.8% methadone, 12.5% buprenorphine, and 2.9% both drugs. Almost 1/10 reported at least one non-fatal overdose in the past four weeks, and roughly 1/3 reported such experience in the past year. Use of additional drugs tended to be equally, or more prevalent among illicit OSD users than other IDUs. In terms of illicit OSD use being a risk factor for non-lethal overdoses, our results showed significant associations only for infrequent buprenorphine use (using once or less than once per week). Other factors associated with non-fatal overdoses included age, education, homelessness, as well as the benzodiazepines, stimulants, and heroin use. Conclusions:Users of diverted OSD may represent a high-risk population, as they used more additional drugs and used them more frequently than other IDUs. However, illicit OSD use may be less harmful than previously assumed. After accounting for an extensive set of covariates, only infrequent illicit buprenorphine use, but not methadone use, was associated with non-fatal overdoses.

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Methadone-related deaths in Norway

Cited by 60 publications

References 19 publications

Factors associated with illicit methadone injecting in a Canadian setting

Factors associated with illicit methadone injecting in a Canadian setting

A Monoclonal Antibody Specific for 6-Monoacetylmorphine Reduces Acute Heroin Effects in Mice

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

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