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Methadone maintenance programs--a two-edged sword?

H Green1, R A James, J D Gilbert

  • 1Forensic Science Centre, Adelaide, South Australia.

The American Journal of Forensic Medicine and Pathology
|January 11, 2000
PubMed
Summary
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Methadone toxicity caused or contributed to 35 deaths in South Australia. Diversion of methadone, particularly among younger individuals, led to fatal overdoses, highlighting the need for supervised consumption.

Area of Science:

  • Forensic Toxicology
  • Clinical Toxicology
  • Public Health

Background:

  • Methadone is a widely used opioid agonist therapy for opioid use disorder.
  • Methadone overdose and diversion are significant public health concerns.
  • Understanding patterns of methadone-related deaths is crucial for prevention strategies.

Purpose of the Study:

  • To review cases of death where methadone was detected in South Australia.
  • To identify the role of methadone in contributing to or causing mortality.
  • To analyze characteristics of individuals who died from methadone toxicity, including those involving diverted methadone.

Main Methods:

  • Retrospective review of autopsy cases at the Forensic Science Centre, South Australia.
  • Data collection period: July 1996 to June 1999.

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  • Inclusion criteria: Autopsies where methadone was detected and potentially involved in death.

    • Main Results:

    • Thirty-five cases identified where methadone caused or contributed to death (age 14-54, average 31).
    • Ten individuals were in methadone maintenance programs; four died within a week of enrollment.
    • Eight individuals (23%) died from "diverted" methadone (age 14-34, average 25), with toxicity directly causing death in seven cases. Seven of these also involved other drugs or alcohol.

    Conclusions:

    • Methadone diversion is a significant cause of fatal overdose, particularly in younger populations.
    • Supervised consumption and daily dispensing of methadone could prevent deaths related to diversion.
    • Further interventions are needed to address methadone toxicity and misuse within maintenance programs and illicit use.