title: Methadone induction doses: are our current practices safe?
abstract: OBJECTIVE
  To review the literature on methadone deaths and propose evidence-based dosing guidelines.
  
  
  METHODS
  A literature search was conducted on overdose deaths during the induction phase. Data on methadone deaths from the Ontario coroner's office, as well as prescribing guidelines from different countries and jurisdictions, were reviewed. The information was collectively considered and, using the best available evidence, translated into safe dosing guidelines for methadone induction.
  
  
  RESULTS
  A literature review found high death rates during the methadone induction period. Data from the Ontario coroner's office revealed that of deaths that were felt to be attributable to methadone overdose, the majority occurred in those who had consumed diverted methadone: of those deaths within a registered program, the majority occurred during the initial dosing phase. Despite high death rates during induction onto methadone treatment, many jurisdictions do not have prescribing guidelines that take this evidence into account.
  
  
  CONCLUSIONS
  Safer prescribing guidelines are needed to reduce deaths during induction onto methadone treatment. Recommendations are made for safe methadone induction doses.
authors.affiliation: Centre for Addiction and Mental Health, Department of Family and Community Medicine, University of Toronto, ON, M5S 2S1, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Srivastava
authors.forename: Meldon
authors.initials: M
authors.lastname: Kahan
mesh_terms: D000367:Age Factors; D004334:Drug Administration Schedule; D004347:Drug Interactions; D016903:Drug Monitoring; D064420:Drug-Related Side Effects and Adverse Reactions; D017408:Guidelines as Topic / Q000592:standards*; D006556:Heroin Dependence / Q000401:mortality / Q000534:rehabilitation*; D006801:Humans; D008691:Methadone / Q000008:administration & dosage* / Q000627:therapeutic use; D009294:Narcotics / Q000008:administration & dosage* / Q000627:therapeutic use; D010353:Patient Education as Topic; D012307:Risk Factors
chemical_list: D009294:Narcotics; D008691:Methadone