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

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Abstract

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.

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Acknowledgments

We thank the Association of Statutory Health Insurance Physicians, Hamburg for their support in procuring the data about substitution status, especially Christine Schwarzloh. Thanks also to Frauke Petersen for her excellent technical assistance.

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Authors and Affiliations

  1. Institute of Legal Medicine, Department of Toxicology, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany

    Stefanie Iwersen-Bergmann, Hilke Jungen, Hilke Andresen-Streichert, Alexander Müller, Sally Elakkary, Klaus Püschel & Axel Heinemann

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  1. Stefanie Iwersen-Bergmann
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  2. Hilke Jungen
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  3. Hilke Andresen-Streichert
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  7. Axel Heinemann
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Correspondence to Stefanie Iwersen-Bergmann.

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Iwersen-Bergmann, S., Jungen, H., Andresen-Streichert, H. et al. Intravenous methadone application as a serious risk factor for an overdose death: methadone-related fatalities in Hamburg from 2007 to 2012. Int J Legal Med 128, 751–764 (2014). https://doi.org/10.1007/s00414-014-1017-x

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  • DOI: https://doi.org/10.1007/s00414-014-1017-x

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