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Methadone-related overdose deaths in South Australia, 1984-1994. How safe is methadone prescribing?
P A Williamson1, K J Foreman, J M White
1Drug and Alcohol Services Council of South Australia, Adelaide.
Objective:
To assess the safety of prescribing of methadone tablets and syrup in South Australia by investigating overdose deaths of patients using prescribed methadone and non-patients using illegally obtained methadone.
Design:
Surveillance study of deaths related to methadone overdose, 1984-1994.
Data Sources:
Coroner's Office and the Therapeutic Goods Section of the South Australian Health Commission.
Results:
Per capita prescription of methadone tablets for chronic pain in South Australia was the highest in Australia in 1994. A large increase in deaths, due mainly to methadone tablets prescribed for chronic pain, occurred in 1993-1994. Illegal diversion of methadone to non-patients was responsible for half of the deaths during these two years. Deaths from overdoses of methadone syrup prescribed in maintenance therapy for drug dependence declined from 1984 to 1994. The relative risk for patient deaths due to methadone tablets versus methadone syrup was estimated to be 7.29 (95% confidence limits, 2.15-31.48). Psychotropic drug combinations were present in 86% of deaths.
Conclusion:
The methadone syrup program for drug dependence remains relatively safe. Our data raise concerns about prescribing methadone tablets for chronic pain. Better prescriber education and accountability, patient assessment and supervision and advice to patients about concurrent use of alcohol and benzodiazepines are needed.
Insights
Methadone syrup for drug dependence is relatively safe, but methadone tablets prescribed for chronic pain show increased overdose deaths. Safer prescribing practices are needed for pain management to reduce fatalities.
Area of Science:
- Pharmacovigilance
- Public Health
- Pain Management
Background:
- Methadone is used for drug dependence treatment and chronic pain management.
- Prescribing patterns and overdose deaths require ongoing safety assessment.
Purpose of the Study:
- To evaluate the safety of methadone tablet and syrup prescribing in South Australia.
- To investigate methadone overdose deaths among patients and non-patients.
Main Methods:
- A surveillance study of methadone overdose deaths from 1984 to 1994.
- Data sourced from the Coroner's Office and the South Australian Health Commission.
Main Results:
- Methadone tablet prescriptions for chronic pain were highest in Australia in 1994, coinciding with increased overdose deaths.
- Illegal diversion of methadone accounted for half of the deaths in 1993-1994.
- Deaths from methadone syrup overdoses declined, while methadone tablets posed a significantly higher risk (RR 7.29).
- 86% of deaths involved psychotropic drug combinations.
Conclusions:
- The methadone syrup program for drug dependence remains safe.
- Prescribing methadone tablets for chronic pain raises safety concerns.
- Improved prescriber education, patient supervision, and warnings about concurrent substance use are recommended.