Clinical Presentation and the Outcome of Therapy in a Cohort of Patients with Methadone Toxicity in Iran

Abstract

Background:Agonist maintenance therapy with methadone is amongst the preferred remedies for treating opioid dependence and is increasingly supported by the regional governments in this part of the world. In this study we have investigated the clinical manifestations and factors affecting the outcome of therapy in patients with methadone poisoning in a Middle-Eastern (Iranian) referral tertiary care University hospital.Methods:In this prospective and descriptive-analytic study which was done in a tertiary care and referral University hospital in Iran (2012-2013) all of the admitted patients with a clear and reliable history of methadone poisoning (n=433) were included and demographic data, Clinical status on admission including Glasgow Coma Scale (GCS) score, time elapsed from ingestion to hospital admission, average dose of naloxone used, any history of psychiatric disorder, type of toxic exposure, co ingestion of other medication, hospitalization time and the outcome were recorded and statistically analyzed.Results:The average length of hospital stay was 33 ± 26 hours. 80.1% of patients had ingested methadone alone, and 90.3% survived. Complications were pulmonary edema (7%), aspiration pneumonia (1.4%), generalized tonic colonic seizure (0.9%), and renal failure (0.5%). GCS, systolic blood pressure and respiratory rate were lower in fatal cases and GCS had prognostic value for the outcome of therapy in methadone intoxicated patients. Patients with higher GCS on admission had better outcome [OR =0.47 (95% CI: 0.38-0.580); P value< 0.0001].Conclusion:Admission time GCS score maybe considered as an important predictor for the outcome of therapy in methadone poisoning.

Histopathological study of liver tissue due to methadone consumption and its effect on liver enzymes and inflammatory indices in rat

“… 78 – 81 There are numerous studies conducted on MET overdose. 82 – 84 In a pathological examination of the livers of individuals who had died of MET overdose, positive hepatic pathological findings were observed in 43.9% of them, including hepatocyte degeneration in 2.4%, hepatic steatosis in 9.8%, hepatocyte necrosis in 24.4%, and more than one pathological finding in 7.3%. 84 The study by Darke et al on the individuals who had died of MET overdose indicated a hepatic pathology prevalence rate equal to 80.7%.…”

Nephrotoxicity of methadone: a systematic review

“…Methadone toxicity outcomes can depend on us factors like age, gender, history of suicide attempts and psychological disorders, and the time interval between consumption of the drug and obtaining medical care (Eizadi-Mood et al 2015). All of the aforementioned cases, except Tóth and Varga (2009) involved young males; also, as described in the original articles, men more frequently present with acute methadone toxicity.…”

“…In two later studies, opiate toxicity was found to be the most common cause of rhabdomyolysis (Talaie et al 2007, 2008). In addition, rhabdomyolysis can be induced by methadone abuse (Criner et al 2002; Iranmanesh 2015; Gramenz et al 2010; Nanji and Douglas Filipenko 1983; Aghabiklooei et al 2014; Eizadi-Mood et al 2015). …”

Prevalence of pulmonary edema among the deceased cases with acute Methadone poisoning: A report from Iran

“…Despite its efficacy, there are no comprehensive care facilities for the people who are still under treatment. [123456]…”

“…[2] Furthermore, the epidemiology of deaths from opioid toxicity in a poisoning referral center showed that the majority of deaths have been observed most in patients with methadone poisoning. [3] Pulmonary edema is a mortal complication for acute methadone overdose which causes mortality in many patients. Considering the fact that methadone toxicity is common in our society, we evaluated the prevalence of pulmonary edema in the deceased cases with methadone poisoning and considered its possible relationship with different variables.…”