Methadone Related Deaths: Identifying the Vulnerable Patients.

Methadone has been used in opioid dependence treatment since the 1960s and is now prescribed also as a chronic pain treatment. Even though its effectiveness has been worldwide assessed, literature reports several cases of death associated with the administration of this drug. Risk factors are still uncertain and the frequent combination with other substances of abuse makes it even more difficult to determine the exact role of methadone in the pathogenesis of fatalities. In this paper the authors present the autopsy findings in a subset of deaths characterized by blood being positive for the methadone only at a therapeutic dose in order to point out those pre-existent pathologic conditions that seem to increase the risk of death in methadone treatment. A routine screening test for a broad spectrum of drugs in urine samples (including methadone, benzodiazepines, cocaine, amphetamines/ methamphetamines, opioids, barbiturates, tetrahydrocannabinol, tricyclic antidepressants) using the ASCENDTM Multi-immunoassay kit (TriageTM8 - Merk®) was performed in all cases of suspected drug-related death, which occurred in the East side of Rome during 2011 (a total of 104 subjects; 73 % male; 27 %female; mean age 32 years old). Among all the subjects examined, 51 were positive for methadone but only 8 belonging to this subset were negative for any other tested drug. A complete autopsy and histological examination was performed in cases where methadone was detected alone and the results were analysed. The histological findings and our observations demonstrated pre-existing conditions affecting the heart and lungs and/or the liver suggesting the importance of an accurate screening/follow up focused on these organs prior to and during treatment in order to promptly identify the presence/onset of clinical conditions increasing the patient’s vulnerability to methadone treatment.