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Monday, August 25 Drugs of Abuse and Testing

Drummer O.H.
Victorian Institute of Forensic Medicine and Department of Forensic Medicine, Monash University,57-83 Kavanagh Street, Southbank, Melbourne, Victoria, 3006, Australia

Methadone is an orally active opioid used in the treatment of opioid dependent persons such as chronic heroin users. The literature associated with the interpretation of deaths attributed to the use of methadone is confusing. This presentation details the Victorian experience over the last three years and provides guidelines for the toxicological interpretation of methadone-associated deaths.

Methods. All 89 deaths in which methadone was detected over 1994 to 1996 have been reviewed. All cases involved a full toxicological screen for common drugs and drugs suspected of being used by the deceased including quantitations of all detected drugs, a review of the circumstances of the death, dose and availability of methadone, and the pathological findings.

Results. There were 60 drug-related deaths in this period and 29 whose deaths were not attributed to methadone (control group). The control group comprised natural (n=5), non drug-related suicides (n=11), car accidents (n=7), homicides (n=3) and others (n=3). Of the methadone-related deaths 17 occurred within 10 days of starting a Methadone Maintenance Program (MMP) and 17 were not registered on a MMP. Methadone concentrations in femoral blood in drug-related cases (mean 0.54 mg/L, range 0.1-2.8) were not significantly different to this control group (mean 0.43 mg/L, range 0.1-1.6, P>0.05). Those on a MMP for some time were significantly higher than those using the drug casually or who had just started a MMP (P<0.05). No dose relationship was observed, nor was any significant effect observed by other drugs on blood concentrations of methadone.

Conclusions. These data show that toxic methadone concentrations overlap completely with non-toxic concentrations. Those starting a MMP or who use the drug casually are most at risk of death.

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