Methadone mortality

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). 

Prescribers often worried about the risk of increasing methadone dose in combined usage, but overall high-dose methadone reduces both such use and mortality... 

Evaluating the impact of methadone maintenance programmes on mortality due to overdose and AIDS in a cohort of heroin users in Spain. Addiction, 100, 981-9... 

Dolan KA, Shearer J, White B, Zhou J, Kaldor J Wodak AD (2005). Four-year follow-up of imprisoned male heroin users and methadone treatment mortality, re-incarceration and hepatitis C infection. Addiction, 100, 820-8... 

An analysis of the balance of benefit to harm during methadone maintenance treatment for diamorphine dependence has shown lower mortality and morbidity with improvement in quality of life (7). The risks of methadone treatment include an increased risk of opiate overdosage during induction into treatment, and adverse effects of methadone in some patients. However, with careful management the benefits of prescribing methadone outweigh the risks. 

From a literature search and subsequent analysis of data on the relation between methadone prescribing and mortality, it was concluded that (46) ... 

Narcotic-induced pulmonary edema. Pulmonary edema is a common sequel to narcotic overdose (morphine, heroin, methadone, and propoxyphene) and is associated with a significant mortality rate. The exact mechanism has not been delineated, but two reasonable hypotheses have been suggested. First, narcotic-induced pulmonary edema may be a form of neurogenic pulmonary edema because both syndromes have complications of cerebral edema and hypothalamic dysfunction (Jaffe, 1970). Second, narcotics are known to release histamine, which may alter alveolar capillary membrane permeability (Brashear et al, 1974). Early treatment with narcotic antagonists produces immediate reversal of respiratory depression and miosis, while the pulmonary edema resolves more slowly. 

Comprehensive methadone treatment that includes prenatal care reduces the risk of obstetrical and fetal complications, in utero growth retardation, and neonatal morbidity and mortality. 

Mortality related to the use and abuse of opioids is of public health concern. In an epidemiological study, mortality over 20 years among 42 676 clients in contact with opioid pharmacotherapy programs was reduced by 29% [24 "]. Mortality was higher when out of treatment, particularly in the first few weeks and during induction on to methadone, but not buprenorphine. The main causes of mortality were drug overdose and trauma. 

DNA polymorphisms. The authors suggested that despite the risk of mortality associated with methadone-induced QT prolongation, the high mortality in untreated drug users tips the balance in favor of methadone. 

Death Mortality from a naltrexone implant (w = 376) and methadone ( = 658) have been compared in opioid-dependent individuals [91 ]. Methadone was associated with increased mortality during the induction period. 

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