Methadone deaths

Several countries reported the presence of methadone in a substantial proportion of drug-related deaths in the 2004 Reitox national reports. The information is provided in accordance with national terminology and, in some cases, it is difficult to assess exactly what role methadone played in the death; some cases are genuine methadone intoxications, but in others the presence of the substance is merely noted. Denmark reported that methadone was present in 49 % of deaths from intoxication (97 out of 198 cases, of which 64 cases involved methadone alone). Germany reported that 23 % of cases were attributed to ‘substitution substances’, of which 3 % were such substances alone (55 cases) and 20 % in combination with alcohol and narcotic drugs (354 cases), while in 2002 these figures were 30 % overall (7 % alone and 23 % in combination). The United Kingdom reported 418 cases with ‘mention’ of methadone, although this does not mean a causal relationship. Other countries reported the presence of methadone in drug-related deaths less frequently: France (eight cases alone or in association), Austria (found in 10 % of fatalities), Portugal (detected in 3 % of cases) and Slovenia (four deaths due to methadone). In the 2003 Reitox national reports, Ireland and Norway also reported significant numbers of cases associated with the presence of methadone.

As is the case with all opiates, methadone is a potentially toxic substance, but research has shown that substitution treatment reduces the risk of overdose mortality among programme participants. Several studies have indicated that deaths in which methadone is implicated are more likely to be the result of illicit rather than prescribed use, and others have found a higher risk during the initial phases of methadone maintenance treatment. These findings suggest the need to ensure good quality standards in substitution programmes.