title: Intravenous methadone application as a serious risk factor for an overdose death: methadone-related fatalities in Hamburg from 2007 to 2012.
abstract: Methadone plays an increasing role in drug-related deaths in Hamburg. To find out whether intravenous application of methadone plays a relevant role in methadone-related deaths, body fluids of all methadone-positive cases (n=130) and three buprenorphine-positive cases where a urine sample was available (n=58+3) were investigated for disaccharides (sucrose and lactose as markers for intravenous methadone abuse). Sixty-four percent of the urine samples of the methadone cases showed positive results for disaccharides (22 times sucrose alone, range 2 to >1,000 mg/L; 6 times lactose and sucrose; and 9 times lactose alone, range 22 to 382 mg/L). The three buprenorphine cases showed positive results for lactose in urine. In blood, it was not possible to detect any disaccharides. Of the 116 fatal methadone intoxications, 49 % were under opiate maintenance treatment (OMT) at the point of death (A-OMT), 30 % were never in OMT (N-OMT) and 21 % were formerly in an OMT, but not at the point of death (F-OMT). Of the deceased in the OMT group, 12 % (n=7) died within the first 2 weeks of treatment, six of them within the first week. Overall, intravenous abuse of methadone plays a relevant role in methadone-related fatal cases of substituted patients and of drug consumers not in therapy. Thus, it is necessary that therapists keep to the statutory regulations and give take-home doses only after at least 6 months of successful therapy and when there is no suspicion of intravenous abuse.
authors.affiliation: Institute of Legal Medicine, Department of Toxicology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany, s.iwersen-bergmann@uke.uni-hamburg.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Iwersen-Bergmann
authors.forename: Hilke
authors.initials: H
authors.lastname: Jungen
authors.forename: Hilke
authors.initials: H
authors.lastname: Andresen-Streichert
authors.forename: Alexander
authors.initials: A
authors.lastname: Müller
authors.forename: Sally
authors.initials: S
authors.lastname: Elakkary
authors.forename: Klaus
authors.initials: K
authors.lastname: Püschel
authors.forename: Axel
authors.initials: A
authors.lastname: Heinemann
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage / Q000032:analysis / Q000506:poisoning; D062787:Drug Overdose / Q000401:mortality*; D005260:Female; D053593:Forensic Toxicology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007785:Lactose / Q000652:urine; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000032:analysis / Q000506:poisoning*; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000032:analysis / Q000506:poisoning*; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000401:mortality*; D013395:Sucrose / Q000097:blood / Q000652:urine
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D013395:Sucrose; D007785:Lactose; D008691:Methadone