Deaths from methadone and heroin

Marks, John

doi:10.1016/s0140-6736(94)90100-7

Cited by 28 publications

(14 citation statements)

References 4 publications

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“…In Britain, Neeleman and Farrell (24) reported that between 1974 and 1992 at population level, though rates of overdose had risen, methadone was no more likely than heroin to be involved in fatal overdosing. Nevertheless high methadone-related mortality through overdose has been reported (19,25). The 1994 Drug Abuse Warning Network (DAWN) survey reported 367 methadone-related deaths, amounting for 4.1% of all reported narcotic deaths for that year (26).…”

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confidence: 99%

Characterization of Methadone Overdose: Clinical Considerations and the Scientific Evidence

Wolff¹

2002

Therapeutic Drug Monitoring

106

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Overdosing with methadone is a growing phenomenon in Britain and other countries due to the increase in prescription and the availability of this compound. Little is known of the circumstances surrounding methadone death due to some extent to the difficulty of defining drug-related death and also the difficulty of collecting clinical and biographical data in a predominantly illegal and marginal milieu. However, the evidence points to highest risk at night (to this end manifestations of its toxicity often go unrecognized) in those whose usual tolerance has been reduced and occurring some considerable time after ingestion. Further investigations are needed to elucidate fully the mechanism and spectrum of methadone overdose. Death from methadone is eminently preventable more so because of the long-term nature of the clinical sequelae. Indeed the key issue with methadone that sets it apart from other opioids is its potential for delayed toxicity. Consequently steps should be taken to disseminate the salient facts to all those who come into contact with the drug.

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confidence: 99%

Characterization of Methadone Overdose: Clinical Considerations and the Scientific Evidence

Wolff¹

2002

Therapeutic Drug Monitoring

106

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“…Nevertheless, these authors suggest that "the current vogue for methadone in the management of addiction should be reviewed". 6 If the risk of death through overdose were indeed higher among addicts taking methadone compared with those taking heroin, and given the relatively rapid increase of methadone use in the addict population,' the proportion of overdose deaths involving methadone would rise at a faster pace than that involving heroin. We examine the contribution of methadone and heroin overdoses to total mortality from accidental and intentional self poisoning in England and Wales between 1974 and 1992.…”

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Fatal methadone and heroin overdoses: time trends in England and Wales.

Neeleman

Farrell

1997

Journal of Epidemiology & Community Health

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Study objective-Although the total number ofselfpoisonings in England and Wales has dropped by 32%, the number involving methadone and/or heroin rose by 900% in 1974-92. Because ofconcern about the role of methadone in this increase, the part played by methadone and heroin in poisoning deaths in England and Wales in 1974-92 was investigated. Design-A proportional mortality design was used to study whether the ratio between deaths involving methadone or heroin and other substances had increased. Opiate addiction is a strong suicide risk factor,' and opiate addicts are also at increased risk of accidental death, principally through overdose.2 Substitution with methadone has become one of the mainstays of the treatment of opiate addiction and the proportion of opiate addicts using methadone has risen sharply over the past decades. ' Clinical research suggests that methadone maintenance reduces mortality (including overdose mortality) among clients.4 However, like heroin, methadone is dangerous in overdose.5 Marks6 and Newcombe7 have suggested, on the basis of analyses of cause of death returns and estimated numbers of addicts taking methadone and heroin respectively, that in the UK as a whole methadone in overdose kills proportionately more people than heroin. A limitation ofthis finding is that it depends crucially on unproven assumptions concerning the number of methadone and heroin users at risk in the population. Nevertheless, these authors suggest that "the current vogue for methadone in the management of addiction should be reviewed".6If the risk of death through overdose were indeed higher among addicts taking methadone compared with those taking heroin, and given the relatively rapid increase of methadone use in the addict population,' the proportion of overdose deaths involving methadone would rise at a faster pace than that involving heroin. We examine the contribution of methadone and heroin overdoses to total mortality from accidental and intentional self poisoning in England and Wales between 1974 and 1992. The proportional mortality design used eliminates the need to make unsafe assumptions concerning the numbers of addicts in the population taking methadone or heroin. (1982 not available).8 Hand-searching rather than relying on aggregate figures published by the OPCS8 or the Home Office9 was necessary in order to identify deaths which had involved heroin without methadone and deaths which had involved both substances simultaneously. Deaths were divided into three categories according to the substances involved as follows: * Methadone with or without heroin regardless of other substances, * Heroin without methadone regardless of other substances, * Deaths not involving methadone or heroin.The time period was divided into six successive three year spans. In the main tabulation (table 1) the three classes of death (accident, suicide, and undetermined) were combined and ratios were calculated, firstly, of deaths involving methadone with or without heroin versus all other deaths, and, secondly...

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“…Corkery et al (2) stated that ARDS, respiratory depression, and aspiration pneumonia are the main causes of morbidity and mortality in MTD-overdosed patients. Several studies have shown that MTD-related deaths occur rather frequently in subjects undergoing rehabilitation (23,24). Among a total of 1120 deaths due to opioid overdose, 12.8 % were MTD-related and ARDS could have well had an important role (25).…”

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confidence: 99%

Acute Respiratory Distress Syndrome Caused by Methadone Syrup

Aghabiklooei

Shadnia

Hassanian‐Moghaddam

et al. 2013

Archives of Industrial Hygiene and Toxicology

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Acute respiratory distress syndrome (ARDS) due to methadone (MTD) toxicity is a known but rather uncommon phenomenon. In most of the previously reported cases of MTD-related ARDS, MTD was ingested orally in the form of tablets in high or unknown amounts. Despite the findings from the available literature, this case report is aimed at demonstrating that even small amounts of MTD syrup can cause ARDS earlier than it is usually expected. We present a non-addicted MTD-overdosed patient who developed ARDS after ingesting a very small amount of MTD syrup. We suggest close monitoring of MTD-overdosed patients from at least 48 h to 72 h for possible respiratory complications such as pulmonary oedema.

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Deaths from methadone and heroin

Cited by 28 publications

References 4 publications

Characterization of Methadone Overdose: Clinical Considerations and the Scientific Evidence

Characterization of Methadone Overdose: Clinical Considerations and the Scientific Evidence

Fatal methadone and heroin overdoses: time trends in England and Wales.

Acute Respiratory Distress Syndrome Caused by Methadone Syrup

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