Mortality associated with New South Wales methadone programs in 1994: lives lost and saved

Objectives: To estimate the effects of methadone programs in New South Wale s on mortality. Design and cases: Retrospective, cross-sectional study of all 1994 New Sout h Wales coronial cases in which methadone was detected in postmortem specim ens taken from the deceased. Cases were people we identified as patients in NSW methadone maintenance programs or those whose deaths involved methadon e syrup diverted from maintenance programs. Outcome measures: Relative risks of fatal, accidental drug toxicity in the first two weeks of treatment and later; the number of lives lost as a resul t of maintenance treatment; preadmission risks and the number of lives save d by maintenance programs, calculated from data from a previous study. Results: There was very close agreement between this study's classification s and official pathology reports of accidental drug toxicity. The relative risk (RR) of fatal accidental drug toxicity for patients in the first two w eeks of methadone maintenance was 6.7 times that of heroin addicts not in t reatment (95% CI RR, 3.3-13.9) and 97.8 times that of patients who had been in maintenance more than two weeks (95% CI RR, 36.7-260.5). Despite 10 peo ple dying from iatrogenic methadone toxicity and diverted methadone syrup b eing involved in 26 fatalities. In 1994, NSW maintenance programs are estim ated to have saved 68 lives (adjusted 95% CI, 29-128). Conclusions: In 1994, untoward events associated with NSW methadone program s cost 36 lives in NSW. To reduce this mortality, doctors should carefully assess and closely monitor patients being admitted to methadone maintenance and limit the use of takeaway doses of methadone.