Methadone maintenance programs - A two-edged sword?

Retrospective review was undertaken of all autopsies in which methadone was detected at the Forensic Science Centre, South Australia, during a 3-year period from July 1996 to June 1999. Thirty-five cases were found in which m ethadone had either caused or contributed to death (age range = 14-54 years ; average = 31 years; M:F = 3.4:1). Ten victims were participating in a met hadone maintenance program, of whom four died within a week of enrollment. Eight victims (23%) not enrolled in a methadone maintenance program were fo und who had died after the use of "diverted" methadone (i.e., prescribed fo r someone else) (age range = 14-34 years; average = 25 years; M:F = 6.2). D eaths were directly attributable to methadone toxicity in seven of the eigh t cases, with additional drugs or alcohol being found in seven cases. Preve ntion of ongoing deaths caused by methadone diversion could be achieved by allowing only daily releases of methadone, with the addict having to consum e the drug under close supervision.