Accidental fatal methadone poisoning of an infant

The substance methadone is used for substitution therapy since the 1960s in the U.S.. Mainly because of the endemic spread of HIV-1 infections among i ntravenous drug abusers methadone was made legally available through medica l prescription in Austria in 1987. Legal authorities today also allow the p atient to take home the necessary daily consumption for weekends or public holidays. The drug is distributed as a watery solution in tiny bottles, whi ch are fitted with an ordinary screw cap, This kind of distribution may, ho wever, have fatal consequences. This is demonstrated in the following case of accidental poisoning of an infant: A two-year-old girl whose parents wer e both participating in the substitution scheme was found dead in her bed i n Vienna in 1997. Forensic autopsy revealed a methadone concentration in th e liver tissue of 640 ng/g. The criminal investigation determined that the girl had opened a bottle of methadone solution and subsequently had taken t he drug. Considering the circumstances of this accident, from the medical p oint of view safety devices for the screw caps of the methadone bottles sho uld be required by law, in order to avoid future accidental poisoning.