Mortality in methadone poisoning: a decade-long analysis of clinical predictors in an Iranian cohort

This study aimed to evaluate the relationships between demographic characteristics, clinical features, treatment modalities, and outcomes in patients with acute methadone intoxication in Yazd.

This retrospective, hospital-based cohort study analyzed the clinical data of 1,400 patients diagnosed with methadone intoxication. Demographic data, clinical symptoms, laboratory tests, treatment methods, and outcomes were obtained from patients' medical records and the hospital information system.

The majority of patients (68.4%) were male, and most intoxication incidents occurred in the 15-30-year age group (37.4%). The most common clinical manifestations were decreased level of consciousness (97.5%), respiratory depression (84.9%), and miosis (82.0%). The most frequent complications were elevated creatine phosphokinase (CPK) (19.6%), aspiration pneumonia (10.4%), seizures (6.0%), and acute respiratory distress syndrome (ARDS) (0.9%). Endotracheal intubation was required in 12.9% of cases. The overall mortality rate was 1.4%. Logistic regression analysis identified elevated CPK (OR = 2.06, 95% CI: 1.16-3.66, P = 0.014), ARDS (OR = 27.86, 95% CI: 4.55-170.74, P < 0.001), and the need for endotracheal intubation (OR = 31.64, 95% CI: 8.37-119.60, P < 0.001) as independent predictors of mortality.

Acute methadone intoxication in this region predominantly affects young males and presents with significant central nervous system and respiratory depression. Although the mortality rate is relatively low, the development of ARDS, rhabdomyolysis (indicated by elevated CPK), and the requirement for endotracheal intubation are important risk factors associated with a significantly higher likelihood of death.