Death attributed to methadone

Besides its other effects, MMT (methadone maintenance treatment) reduces th e high mortality of intravenous heroin addicts to about 30% of controls. On the other hand, deaths of patients and non-patients have been attributed t o methadone. Here, we will report on the major reasons for deaths attribute d to methadone and discuss suggestions for their prevention. 69% of deaths attributed to methadone occurred in subjects not on MMT at the time of thei r death. 51% of deaths attributed to methadone in subjects in MMT occurred during the dose-finding period of MMT. Further apparent risk situations are methadone intake in addition to that received for MMT, discharge from pris on and intravenous injection of methadone. Intake of methadone in nonpatien ts is almost entirely due to abuse of diverted take-home methadone. Not giv ing methadone as take-home should reduce methadone deaths most effectively. Replacing take-home methadone by substances acting longer than one day, su ch as LAAM (levacetylmethadol) or buprenorphine, should also be effective. Restriction of take-home prescriptions to substances with a slow onset of a ction, such as LAAM, or to partial agonists with an extended safety margin such as buprenorphine should be partly effective. Meticulous evaluation of substance history, slow dose increases and strict supervision of the patien t by experienced personal should prevent methadone overdose during the dose -finding period. Discharge from prison closely corresponds to this situatio n; informing addicts shortly before discharge and psychosocial help during the first months out of prison may reduce this risk. Naloxone as an adjunct to oral agonist preparations should effectively prevent high-risk intraven ous injection, for example of methadone syrup. This has been the case with tilidine plus naloxone in Germany. Reducing deaths attributable to methadon e increases the net benefit of MMT. Also, reducing deaths attributable to m ethadone avoids decreases in the public acceptance of MMT.