A review of GP records relating to methadone-associated deaths in the Lothian region of Scotland 1997-9

Abstract

Aims To ascertain the characteristics of patients whose death was associated with methadone intoxication during the period 1997-9 in the Lothian region of Scotland. Design Patients were identified from death certificates. General practitioner records relating to methadone-associate d deaths were reviewed in association with autopsy, toxicology and police reports. Deprivation categories (DepCat) were derived from the postal code of residence and the Carstairs index. Findings There were 77 methadoneassociated deaths in the Lothian Health Board area. GP records were obtained for 60 patients registered with a general practitioner. The majority of methadoneassociated deaths (73%) occurred in persons who were not prescribed methadone at the time of their death. Thirty-eight persons were prescribed medication other than methadone or dihydrocodeine at the time of death. Thirty (79%) of those being prescribed for were receiving benzodiazepines . Fortyseven per cent had a history of excessive alcohol consumption. Fifty per cent had a reported psychiatric history. Sixty per cent had previously attended Accident and Emergency through deliberate self-harm or accidental overdose. Low socioeconomic status was found to be associated with the highest rate of methadone-related deaths. Conclusions Given the variety of characteristics outlined it is likely that reducing drug-related deaths is a longer term aim, not amenable to one particular solution.

The effects of methadone and its role in fatalities

“…At least three-fifths of deaths associated with methadone in England and Wales are accounted for by the use of methadone which may have been illicitly obtained (Ghodse et al, 2003). Rates as high as 75% have been reported in Scotland (Fiddler et al, 2001).…”

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

“…The literature review resulted in 207 articles, with a final inclusion of 84 papers ( Table S1, Supplementary Electronic Material ) [ 16 , 19 , 20 , 29 , 34 , 35 , 36 , 37 , 38 , 39 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 ,…”

“…In the majority of literature series and cases, BZDs were the most frequent co-consumed substance in addition to methadone [ 19 , 20 , 28 , 35 , 36 , 37 , 44 , 60 , 80 , 81 , 83 , 85 , 91 , 97 , 98 , 109 , 111 ]. BZDs were also the second most common drug detected in the merged database.…”

Differences between injectors and non-injectors, and a high prevalence of benzodiazepines among drug related deaths in Scotland 2003

“…However, most of them have been limited to either regional urban populations (Hammersley et al 1995;Jones et al 2002), particular types of drug death such as methadone related deaths (Fiddler et al 2001;Seymour et al 2003), or particular settings such as recent liberation from prison . One study examined DRDs across Scotland per 100 injecting drug users in 2000-2001 and found that older and male injecting drug users were at higher risk of dying of drug-related causes .…”