Mortality associated with New South Wales methadone programs in 1994: lives lost and saved

Abstract

Objectives To estimate the effects of methadone programs in New South Wales on mortality. Design and cases Retrospective, cross‐sectional study of all 1994 New South Wales coronial cases in which methadone was detected in postmortem specimens taken from the deceased. Cases were people we identified as patients in NSW methadone maintenance programs or those whose deaths involved methadone syrup diverted from maintenance programs. Outcome measures Relative risks of fatal, accidental drug toxicity in the first two weeks of treatment and later; the number of lives lost as a result of maintenance treatment; preadmission risks and the number of lives saved by maintenance programs, calculated from data from a previous study. Results There was very close agreement between this study's classifications and official pathology reports of accidental drug toxicity. The relative risk (RR) of fatal accidental drug toxicity for patients in the first two weeks of methadone maintenance was 6.7 times that of heroin addicts not in treatment (95% Cl RR, 3.3‐13.9) and 97.8 times that of patients who had been in maintenance more than two weeks (95% Cl RR, 36.7‐260.5). Despite 10 people dying from iatrogenic methadone toxicity and diverted methadone syrup being involved in 26 fatalities. In 1994, NSW maintenance programs are estimated to have saved 68 lives (adjusted 95% Cl, 29‐128). Conclusions In 1994, untoward events associated with NSW methadone programs cost 36 lives in NSW. To reduce this mortality, doctors should carefully assess and closely monitor patients being admitted to methadone maintenance and limit the use of takeaway doses of methadone.

Postmortem toxicology of drugs of abuse

“…Furthermore, with long half-life drugs such as methadone significant risks are associated with drug accumulation from one dose to the next. This has led to a substantial increase in mortality both on the street and in methadone maintenance programs [164][165][166][167].…”

Predictors of Opioid-Related Death During Methadone Therapy

“…Drug-related deaths are common among patients on methadone therapy, as are other medical causes and trauma (Clausen, Waal, Thoresen, & Gossop, 2009;Zador & Sunjic, 2000). Individuals on methadone therapy have a higher risk of death during periods of induction and discontinuation (Caplehorn & Drummer, 1999;Clausen et al, 2009;Degenhardt et al, 2009;Srivastava & Kahan, 2006;Zador & Sunjic, 2000;Zanis & Woody, 1998). Additionally, some evidence suggests an association between drug-related death and psychiatric disorders, during or after cessation of methadone treatment (Cousins et al, 2011;Zanis & Woody, 1998).…”

Sleep-Disordered Breathing and Psychiatric Disorders

“…The deaths are mostly due to respiratory arrest and very often occur during sleep when breathing is primarily regulated by automatic neurochemical control [81,82]. This has prompted clinical research on the effects of narcotic drugs on breathing during sleep [83].…”

“…In contrast, acute narcotic use is often fatal. Australian data showed that the relative risk of fatal accidental drug toxicity for patients in the first 2 weeks of methadone maintenance was 6.7 times that of heroin addicts not in the treatment programme and 97.8 times that of patients who had been on maintenance for more than 2 weeks [81]. The immediate cause of death is often pulmonary oedema secondary to prolonged hypoventilation [81,82].…”

“…Australian data showed that the relative risk of fatal accidental drug toxicity for patients in the first 2 weeks of methadone maintenance was 6.7 times that of heroin addicts not in the treatment programme and 97.8 times that of patients who had been on maintenance for more than 2 weeks [81]. The immediate cause of death is often pulmonary oedema secondary to prolonged hypoventilation [81,82]. Also worth noticing is that infants born to substance-abusing mothers have higher prevalence of periodic breathing during sleep and a 5-10 times increased risk of sudden infant death syndrome (SIDS) [90,91].…”