Death, related methadone

Even though methadone treatment reduces the high mortality of intravenous addicts to about 30% of controls, a number of patients and non-patients still overdose on methadone itself (Vormefelde and Poser, 2000), although the availability of methadone itself does not appear to be linked to increases in drug-related deaths (Oliver, 2002). 

Vormefelde SV and Poser W (2000). How to count methadone-related deaths. Drug and Alcohol Review, 19(4), 469-470. 

Propoxyphene (dextropropoxyphene Darvon) is structurally related to methadone but is much less potent as an analgesic. Compared with codeine, propoxyphene is approximately half as potent and is indicated for the treatment of mild pain. It is not antipyretic or antiinflammatory like aspirin and is less useful than aspirin in most cases of mild pain. Toxicity from propoxyphene, especially in combination with other sedatives, such as alcohol, has led to a decrease in its use. Death following ingestion of alcohol in combination with propoxyphene can occur rapidly (within 20 minutes to 1 hour). The drug is not indicated for those with histories of suicide or depressive illnesses. 

Further situations in which methadone can seem an unsatisfactory substitution agent are towards the other end of the treatment spectrum. In uncomplicated maintenance treatment or for detoxification, the criticisms which are levelled at methadone relate not so much to the subjective effects, but to the aspects of addictiveness, abuse potential and toxicity. The issue of whether methadone is too addictive to be really suitable for detoxification is considered in detail in Chapter 3, and the controversial subject of methadone risks and deaths in Chapter 1. It is in the relatively milder cases of heroin dependence that buprenorphine treatment as an alternative to methadone has risen to great prominence in several countries, although, importantly, the condition definitely does not have to be mild for this medication to be used. Undoubtedly the introduction of buprenorphine is one of... 

Bigwood CS Coehelho AJ (1990). Methadone and caries. British Dental Journal, 168, 231 Bird SM Hutchinson SJ (2003). Male drugs-related deaths in the fortnight after release from prison Scotland, 1996-99. Addiction, 98, 185-190... 

Shanahan W, Seivewright N Ford C (2003). Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. British Journal of Psychiatry, 183, 304-13 Webster LR (2005). Methadone-related deaths. 

Propoxyphene is chemically related to methadone but has low analgesic activity. Various studies have reported its potency at levels ranging from no better than placebo to half as potent as codeine that is, 120 mg propoxyphene = 60 mg codeine. Its true potency probably lies somewhere between these extremes, and its analgesic effect is additive to that of an optimal dose of aspirin or acetaminophen. However, its low efficacy makes it unsuitable, even in combination with aspirin, for severe pain. The increasing incidence of deaths associated with its use and misuse has caused it to be scheduled as a controlled substance. Moreover, banning its use in the United States is under consideration. 

A review of 139 methadone-related deaths between 1998 and 2002 in Palm Beach County supported those of previous investigations and suggested that it is not possible to establish a definitive lethal methadone blood concentration range. Methadone-related death is usually associated with the use of other drugs and toxicological analysis in such cases should be contextualized by the clinical circumstances surrounding the event and even a few months before the incident occurred (50). 

Wolf BC, Lavezzi WA, Sullivan LM, Flannagan LM. Methadone-related deaths in Palm Beach County. J Forensic Sci 2004 49 375-8. 

Seymour A, Black M, Jay J, Cooper G, Weir C, Oliver J. The role of methadone in drug-related deaths in the west of Scotland. Addiction 2003 98 995-1002. 

The potential role of methadone in drug deaths has been highlighted in some countries. Research shows that substitution treatment reduces the risks of drug-related death. However, since methadone substitution has increased substantially in Europe (see Chapter 4), toxicological examinations of overdoses, AIDS deaths or accidents increasingly indicate the presence of methadone, regard-... 

Torsades de pointes ventricular tachycardia and sudden cardiac-related death in the setting of a prolonged QT interval. QT prolongation is more likely to occur in patients taking high dose of methadone in the presence of contributing factors, such as cocaine abuse, other CYP450 enzyme inhibitors, and hypokalemia. 

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