Methadone-Related Deaths in Palm Beach County

Abstract

The authors reviewed cases investigated by the Palm Beach Medical Examiner's Office in which postmortem toxicologic studies indicated the presence of methadone over the period from 1998 to 2002, to examine the role of the drug in these deaths. There were 139 methadonepositive cases, including 75 in which the death was attributed to combined drug toxicity and 23 to methadone toxicity alone. Methadone was most frequently used in conjunction with other prescription or illicit drugs, most commonly benzodiazepines and/or cocaine. There was considerable overlap in the postmortem blood methadone concentrations among the groups. Concentrations ranged from 0.

Determinants of Increased Opioid-Related Mortality in the United States and Canada, 1990–2013: A Systematic Review

“…Determining exact cause of death is often difficult, 11,62,69 particularly in cases involving methadone. 69 Prescription data are proprietary, and data on adverse events are held privately.…”

“…Determining exact cause of death is often difficult, 11,62,69 particularly in cases involving methadone. 69 Prescription data are proprietary, and data on adverse events are held privately. 57 There is some inconsistency in International Classification of Diseases codes for drug poisoning, as well as a lack of standardization in drug categorization and terminology 57 and coroners' reports.…”

Methadone and methadone metabolites in postmortem specimens

“…Previous investigators have commented that fatal and nonfatal levels of methadone overlap and that determination of the metabolite, EDDP, did not assist interpretation [1][2][3][4]. We have measured a second methadone metabolite, EMDP, in postmortem cases to gain a better understanding of the accumulation/distribution of this metabolite and also of the overall process of METH demethylation.…”

“…For example, after a retrospective review of medical examiner cases involving methadone, Karch and Stephens [1] wrote that ''postmortem measurements of methadone or its metabolite, or both, cannot be used in isolation to identify which deaths are associated with methadone toxicity.'' Similarly, Milroy and Forrest [2], Gagajewski and Apple [3], and Wolf et al [4] reported overlapping methadone concentrations in postmortem tissues in cases where methadone toxicity either was or was not, the cause of death. Greater knowledge of the metabolism and tissue distribution of methadone and its demethylated metabolites may assist in the interpretation of methadone-related deaths.…”

“…It is also used in management of chronic pain. These applications are longterm, involve escalating dosages, and persons in treatment often become tolerant to the desired and/or toxic effects of methadone [1][2][3][4].…”