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Atypical postmortem redistribution in chronic methadone consumers.

Béatrice Garneau1, Cynthia Roy1, Julie Motard1

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This summary is machine-generated.

Methadone redistribution causes variable postmortem blood concentrations. Analyzing multiple blood sources, not just femoral, is crucial for accurate interpretation in chronic users.

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Area of Science:

  • Forensic Toxicology
  • Pharmacology

Background:

  • Methadone exhibits moderate postmortem redistribution with high variability in central to peripheral blood ratios (C/P).
  • Previous literature indicates a C/P ratio typically above 1, but atypical cases exist.

Purpose of the Study:

  • To describe a case series of chronic methadone users with atypical C/P ratios < 1.
  • To investigate the cause of atypical C/P ratios and their implications for toxicological interpretation.

Main Methods:

  • Analysis of methadone and its metabolite EDDP in femoral, cardiac, and ante-mortem blood samples from 10 chronic users.
  • Review of case histories, pathological findings, and other toxicological data.

Main Results:

  • Ten cases with C/P ratios ranging from 0.26 to 0.82 were identified.
  • EDDP concentrations were similar centrally and peripherally, suggesting postmortem redistribution of methadone.
  • Case 4 demonstrated femoral blood methadone concentrations significantly higher than cardiac and ante-mortem blood, highlighting cardiac blood's representativeness.

Conclusions:

  • Atypical C/P < 1 ratios in chronic methadone users are likely due to postmortem redistribution from tissues into femoral blood.
  • Relying solely on femoral blood can lead to misleading toxicological interpretations.
  • Analysis of multiple blood sources is essential for accurate postmortem methadone interpretation in chronic users.