DEATHS IN THE FIRST 2 WEEKS OF MAINTENANCE TREATMENT IN NSW IN 1994 -IDENTIFYING CASES OF IATROGENIC METHADONE TOXICITY

A study was undertaken to estimate the frequency of iatrogenic methado ne toxicity in the first 2 weeks of maintenance treatment in NSW. Case s were identified from a list of all 1994 methadone-associated deaths using data on methadone patients herd by the NSW and Queensland Health Departments. The likely causes of death were determined from data col lected from coronial files. A forensic toxicologist experienced in the area gave an independent opinion. Of the 14 deaths in the first 2 wee ks of maintenance, at least 10 were primarily caused by the toxic effe cts of methadone prescribed by NSW doctors. The rate of fatal iatrogen ic methadone toxicity was 2.2 per thousand admissions to maintenance. Victims of fatal iatrogenic toxicity often displayed signs of methadon e intoxication in the days before their death. They invariably died se veral hours after taking the fatal dose, usually after seeming to go t o sleep. Often friends or family were concerned about their welfare, w ere unable to rouse them from their ''sleep'' and frequently reported the deceased was ''snoring'' loudly for some time before their demise. The author recommends that patients entering methadone maintenance sh ould be informed of the risks and should be required to give written c onsent to treatment. To prevent fatal methadone toxicity, patients sho uld receive daily medical assessment during the flat 1-2 weeks of main tenance.