The long-term visual sequelae were clearly underestimated on discharge, suggesting a significantly higher amount of patients with long-term sequelae than earlier reported. Thorough examinations before discharge and during follow-up will likely uncover a higher morbidity also after methanol poisonings in general.

Genetic polymorphisms influence the metabolism of ethanol and methanol, but the potential effects of genetic predisposition on the clinical course, outcome and short-term health sequelae of acute methanol poisoning are unknown. To evaluate the role of the MEOS system in methanol poisoning, we analysed the effect of three polymorphisms (RsaI -rs2031920; PstIrs3813867; insertion/deletion I/D) within the CYP2E1 enzyme (MEOS system) in 50 adult survivors of methanol poisoning and compared their genotype frequencies with 460 controls. The minor allele frequencies of all three polymorphisms were below 5% in both groups. We did not detect significant differences in the genotype frequencies between survivors of methanol poisoning and controls (p = 0.34 for the RsaI variant; p = 0.59 for the PstI variant and p = 0.21 for the I/D polymorphism). The carriers of at least one minor allele in the CYP2E1 gene had less severe clinical symptoms and better short-term outcome after acute poisoning. Variants within the CYP2E1 gene are likely not significant genetic determinants of acute methanol poisoning (if survivors are analysed), but they may influence the severity of methanol poisoning and its visual/central nervous system (CNS) outcome.Methanol poisoning is a rare condition, occurring mainly as a result of consuming adulterated liquor/spirit.From September 2012 to December 2013, approximately 150 cases of acute methanol poisoning with 48 deaths were registered in the Czech Republic. The cause of these poisonings was the consumption of illegal spirits adulterated with methanol. However, the registered number of intoxicated individuals does not reflect the estimated number of bottles that have toxic contents (according to law enforcement, several thousand bottles may be poisoned), and the poisoning severity in many cases did not correspond to the dose of ingested toxic spirits [1]. Therefore, we suggest that there may be specific genetic backgrounds that are more sensitive (or more resistant) to the toxic effects of methanol and its metabolite formic acid and that may potentially influence the clinical course and outcome of acute methanol poisoning. To date, no study examining the potential role of such genetic (pre)dispositions has been published.Approximately 30% of consumed methanol is excreted unchanged through the respiratory tract, and low amounts of methanol are excreted through sweat or urine [2]. In human beings, methanol is metabolized by the same pathways as ethanol due to its structural similarity to ethanol. The majority of methanol is oxidized by alcohol dehydrogenase [3]; however, this enzyme is monomorphic in poisoned Czech patients (Hubacek, unpublished results).The second largest amount of consumed methanol (approximately 10%) is metabolized by the inducible hepatic MEOS (microsomal ethanol oxidizing system) [4]. The activity of this system is strongly increased in individuals who consume ethanol regularly (long-term ethanol abuse) and with higher ethanol blood concentrations (over 0.5&).The most imp...

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Opioid agonist therapy (OAT) has been available in a standard regime in the Czech Republic since 2000. Buprenorphine is the leading medication, while methadone is available only in a few specialised centres. There is an important leakage of buprenorphine onto the illicit market, and the majority of Czech opioid users are characterised by the misuse (and injecting) of diverted buprenorphine medications. Most prescribed buprenorphine for OAT is not covered by current national health insurance schemes, and patients have to pay considerable prices to afford their treatment. This affordability barrier together with limited accessibility is likely the leading factor of limited coverage of OAT and of recent stagnation in the number of patients in the official treatment programmes in the Czech Republic. It also encourages doctor shopping and the re-selling of parts of their medication at a higher price, which represents the main factor that drives the Czech illicit market for buprenorphine, but at the same time co-finances the medication of clients in official OAT programmes. Improving access to OAT by making it financially affordable is essential to further increase OAT coverage and is one of the factors that can reduce the illicit market with OAT medications.