Pa. Williamson et al., METHADONE-RELATED OVERDOSE DEATHS IN SOUTH AUSTRALIA, 1984-1994 - HOWSAFE IS METHADONE PRESCRIBING, Medical journal of Australia, 166(6), 1997, pp. 302-305
Objective: To assess the safety of prescribing of methadone tablets an
d syrup in South Australia by investigating overdose deaths of patient
s using prescribed methadone and non-patients using illegally obtained
methadone. Design: Surveillance study of deaths related to methadone
overdose, 1984-1994.Data sources: Coroner's Office and the Therapeutic
Goods Section of the South Australian Health Commission. Results: Per
capita prescription of methadone tablets for chronic pain in South Au
stralia was the highest in Australia in 1994. A large increase in deat
hs, due mainly to methadone tablets prescribed for chronic pain, occur
red in 1993-1994. illegal diversion of methadone to non-patients was r
esponsible for half of the deaths during these two years. Deaths from
overdoses of methadone syrup prescribed in maintenance therapy for dru
g dependence declined from 1984 to 1994. The relative risk for patient
deaths due to methadone tablets versus methadone syrup was estimated
to be 7.29 (95% confidence limits, 2.15-31.48). Psychotropic drug comb
inations were present in 86% of deaths. Conclusion: The methadone syru
p program for drug dependence remains relatively safe. Our data raise
concerns about prescribing methadone tablets for chronic pain. Better
prescriber education and accountability, patient assessment and superv
ision and advice to patients about concurrent use of alcohol and benzo
diazepines are needed.