title: Methadone-related deaths. A ten year overview.
abstract: Over the last 10 years we have registered in our district (about 500,000 inhabitants) 36 cases of fatal methadone poisoning, involving both patients on treatment and naive subjects: this is a significant increase of deaths due to methadone use, misuse or abuse compared with previous years. Twenty-four patients (66.7%) were on methadone maintenance programs for heroin detoxification, while 12 (33.3%) were taking the drug without a medical prescription. The average blood concentration of methadone in patients undergoing a maintenance program was 1.06 mg/L (0.21-3.37 mg/L), against 0.79 mg/L (0.2-3.15 mg/L) in those taking the non-prescribed drug. Since 111 heroin-related deaths were recorded in our district in the same period, the fact that there appear to be many methadone deaths (about a third of heroin-related deaths) cannot be overlooked. The aim of this work is to understand the possible reasons for such a large number of methadone-related deaths. On this subject, we have noticed that risks associated with methadone intake are often underestimated by clinicians prescribing the drug: sometimes methadone is prescribed without taking into account patient's tolerance to opiates, and a large number of subjects enrolled in methadone maintenance programs in Italy, have also been given take-home doses, thus increasing the risk of abuse and diversion.
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini, 12, 27100 Pavia, Italy. Electronic address: claudia.vignali@unipv.it.
authors.forename: Claudia
authors.initials: C
authors.lastname: Vignali
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini, 12, 27100 Pavia, Italy.
authors.forename: Cristiana
authors.initials: C
authors.lastname: Stramesi
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini, 12, 27100 Pavia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Morini
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini, 12, 27100 Pavia, Italy.
authors.forename: Fulvia
authors.initials: F
authors.lastname: Pozzi
authors.affiliation: Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Via Forlanini, 12, 27100 Pavia, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Groppi
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002853:Chromatography, Liquid; D062787:Drug Overdose / Q000401:mortality; D005260:Female; D053593:Forensic Toxicology; D008401:Gas Chromatography-Mass Spectrometry; D006197:Hair / Q000737:chemistry; D006708:Homicide / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008691:Methadone / Q000032:analysis / Q000506:poisoning*; D008875:Middle Aged; D009294:Narcotics / Q000032:analysis / Q000506:poisoning*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000401:mortality* / Q000534:rehabilitation; D015813:Substance Abuse Detection; D053719:Tandem Mass Spectrometry; D055815:Young Adult
chemical_list: D009294:Narcotics; D008691:Methadone
keywords: Blood levels; Death; Maintenance; Methadone