Intravenous methadone application as a serious risk factor for an overdose death: methadone-related fatalities in Hamburg from 2007 to 2012

• Published in: International journal of legal medicine 2014-09, Vol.128 (5), p.751-764
• Main Authors: Iwersen-Bergmann, Stefanie, Jungen, Hilke, Andresen-Streichert, Hilke, Müller, Alexander, Elakkary, Sally, Püschel, Klaus, Heinemann, Axel
• Format: Article
• Language: English
• Subjects: Adult; Buprenorphine - administration & dosage; Buprenorphine - analysis; Buprenorphine - poisoning; Drug abuse; Drug dosages; Drug overdose; Drug Overdose - mortality; Fatalities; Female; Forensic Medicine; Forensic Toxicology; Germany - epidemiology; Heroin; Humans; Intoxication; Lactose; Lactose - urine; Legal medicine; Male; Medical Law; Medicine; Medicine & Public Health; Methadone; Methadone - administration & dosage; Methadone - analysis; Methadone - poisoning; Methods; Middle Aged; Narcotics; Narcotics - administration & dosage; Narcotics - analysis; Narcotics - poisoning; Opiate Substitution Treatment - statistics & numerical data; Original Article; Risk Factors; Substance abuse treatment; Substance Abuse, Intravenous - mortality; Sucrose; Sucrose - blood; Sucrose - urine; Urine
• ISSN: 0937-9827; 1437-1596
• DOI: 10.1007/s00414-014-1017-x

Methadone plays an increasing role in drug-related deaths in Hamburg. To find out whether intravenous application of methadone plays a relevant role in methadone-related deaths, body fluids of all methadone-positive cases ( n  = 130) and three buprenorphine-positive cases where a urine sample was available ( n  = 58 + 3) were investigated for disaccharides (sucrose and lactose as markers for intravenous methadone abuse). Sixty-four percent of the urine samples of the methadone cases showed positive results for disaccharides (22 times sucrose alone, range 2 to >1,000 mg/L; 6 times lactose and sucrose; and 9 times lactose alone, range 22 to 382 mg/L). The three buprenorphine cases showed positive results for lactose in urine. In blood, it was not possible to detect any disaccharides. Of the 116 fatal methadone intoxications, 49 % were under opiate maintenance treatment (OMT) at the point of death (A-OMT), 30 % were never in OMT (N-OMT) and 21 % were formerly in an OMT, but not at the point of death (F-OMT). Of the deceased in the OMT group, 12 % ( n  = 7) died within the first 2 weeks of treatment, six of them within the first week. Overall, intravenous abuse of methadone plays a relevant role in methadone-related fatal cases of substituted patients and of drug consumers not in therapy. Thus, it is necessary that therapists keep to the statutory regulations and give take-home doses only after at least 6 months of successful therapy and when there is no suspicion of intravenous abuse.