Methadone deaths: a toxicological analysis

Abstract

Aims-To perform a toxicological analysis of deaths involving methadone and to determine the fatal concentration of methadone in such deaths. Methods-Deaths in which methadone was mentioned in the cause of death were identified. Deaths were divided into those associated with methadone only and deaths in which the cause of death was a combination of methadone and other drugs. Toxicological findings in these deaths were analysed and compared with previously published data. Results-One hundred and eleven cases were analysed. In 55 cases, methadone poisoning was given as the sole cause of death. Fifty victims were adults, age range 17-51 years (median, 23), with five victims under 14 years of age. The mean methadone concentration in the adult deaths was 584 µg/litre (median, 435; range, 84-2700). In 56 cases, age range 15-49 years, (median, 28), death was ascribed to a combination of methadone and other drugs. The mean methadone concentration in these deaths was 576 µg/litre (median, 294; range, 49-2440). In 26 cases, multiple site sampling was performed. This revealed that there could be a 100% discrepancy between methadone concentrations, and other drugs, in samples collected in diVerent sites in the same body. Conclusions-There is an overlap between quoted therapeutic methadone concentrations and methadone concentrations seen in fatalities. However, those dying from methadone poisoning might not be the same as those in a methadone programme. A degree of caution must be exercised in determining a fatal concentration because of the phenomenon of postmortem redistribution. Pathologists and toxicologists need to examine all the available postmortem findings in identifying the cause of death. (J Clin Pathol 2000;53:277-281)

Trends in methadone-related deaths in Zurich

“…The existence of such high MBL implies a methadone-induced tolerance and enough survival-time for resorption in case of oral application or an intravenous application of a large dosage of methadone [14]. With regard to the increasing age of the deceased in our study an induction of tolerance is quite comprehensible and would also lead to an intake of a higher daily methadone-dosage.…”

“…This explains the high mean MBL of 1,324 µg/L and the "usual" median MBL of 700 µg/L. However, many previous investigators have also commented on the difficulty in performing post-mortem toxicologic analyses, interpreting the results and establishing a lethal MBL [3,7,12,14,17,18,22].…”

Diversion of Methadone and Buprenorphine from Opioid Substitution Treatment: A Staff Perspective

“…Methadone is a strong respiratory depressant, potentially fatal for individuals without sufficient tolerance. 4,5 Buprenorphine is less potent, but if mixed with alcohol or sedatives there is a risk of polydrug intoxication. 6 Both medications have high abuse potential and are sought after on the illicit drug market.…”

Resting-state Abnormalities in Heroin-dependent Individuals

“…More specifically, according to Wolff et al (2000) the median elimination half-life of methadone has been found to be diminished more than 60% when the addict has reached a steadystate methadone level. Thus, patients suffering from addiction who are methadone-naïve are in a high risk of overdosing specifically during the initial phase of methadone maintenance treatment programs (Drummer et al, 1992;Caplehorn and Drummer, 1999;Milroy, 2000;Wolff et al, 2000;Corkery et al, 2004).…”