Demographic, Clinical, and Forensics Findings in Deceased Cases of Acute Methadone Poisoning

Document Type : Original Article (s)

Authors

1 General Practitioner, Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Forensic Medicine Specialist, Isfahan Province Forensic Medicine Office, Isfahan, Iran

3 Professor, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

4 Professor, Department of Clinical Toxicology, School of Medicine AND Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Methadone is a common medication used for pain relief and addiction treatment. We evaluated clinical, demographic, and forensics findings in deceased cases of acute methadone poisoning.Methods: An 11-year chart review study was done on deceased cases diagnosed with methadone poisoning admitted to a referral emergency ward affiliated to Isfahan University of Medical Sciences, Iran. Data were obtained through patients' records from 2005 to 2016 and analyzed using SPSS statistical software.Findings: Of 81 deceased cases, 86.5% were men. The mean age of cases was 42.70 ± 19.22 years. The majority of men were 20-45 years old compared to less than 20 years old in women (P = 0.005). Methadone abuse (55.6%) and suicide (35.8%) were the main causes of methadone poisoning in the deceased cases. Eighty two percent of cases had low consciousness on admission. Causes of poisoning, history of suicide, self-mutilation, smoking, and underlying diseases were significantly different in the various age groups. Respiratory failure as a mortality cause was recorded for the majority of cases (37.0%). Pathologic findings of liver and brain were recorded in 43.9% and 31.7% of cases, respectively. Multiorgan damages were noted in 42.6% of cases without any significant differences in the various age groups.Conclusion: Given the prevalence of deceased cases due to methadone abuse at a young age, it is necessary to manage administration of methadone in different age groups to reduce mortality.

Keywords


  1. Eizadi-Mood N, Yaraghi A, Sharifian Z, Feizi A, Hedaiaty M, Sabzghabaee AM. Clinical presentation and the outcome of therapy in a cohort of patients with methadone toxicity in Iran. Mater Sociomed 2015; 27(4): 276-9.
  2. Taheri F, Yaraghi A, Sabzghabaee AM, Moudi M, Eizadi-Mood N, Gheshlaghi F, et al. Methadone toxicity in a poisoning referral center. J Res Pharm Pract 2013; 2(3): 130-4.
  3. Chen YZ, Huang WL, Shan JC, Lin YH, Chang HC, Chang LR. Self-reported psychopathology and health-related quality of life in heroin users treated with methadone. Neuropsychiatr Dis Treat 2013; 9: 41-8.
  4. Zamani N, Sanaei-Zadeh H, Mostafazadeh B. Hallmarks of opium poisoning in infants and toddlers. Trop Doct 2010; 40(4): 220-2.
  5. Gibson JC, Vulliamy A. Accidental methadone poisoning in children: A call for Canadian research action. Child Abuse Negl 2010; 34(8): 553-4.
  6. LoVecchio F, Pizon A, Riley B, Sami A, D'Incognito C. Onset of symptoms after methadone overdose. Am J Emerg Med 2007; 25(1): 57-9.
  7. Torrents R, Picot C, Glaizal M, Courne MA, Schmitt C, Richard N, et al. Child poisonings with methadone in France: A 6-year prospective national survey since the availability of capsules in 2008. Clin Toxicol (Phila) 2015; 53(8): 819-22.
  8. Eizadi-Mood N, Naeini SA, Hedaiaty M, Sabzghabaee AM, Moudi M. Prevalence of pulmonary edema among the deceased cases with acute Methadone poisoning: A report from Iran. J Res Pharm Pract 2016; 5(4): 290-3.
  9. Hassanian-Moghaddam H, Zamani N, Rahimi M, Shadnia S, Pajoumand A, Sarjami S. Acute adult and adolescent poisoning in Tehran, Iran; the epidemiologic trend between 2006 and 2011. Arch Iran Med 2014; 17(8): 534-8.
  10. Shokrzadeh M, Yazdani Charati J, Pourhossein M, Amadeh Juybary N. Epidemiological study of mortality rate from opioid abuse in referential bodies to Mazandaran Department of Forensic Medicine. J Mazandaran Univ Med Sci 2014; 24(115): 122-7. [In Persian].
  11. Behnoush B, Taghadosinejad F, Salahshour B, Yousefinejad ‎V‎. Methadone overdose and its complications in patients admitted to ‎the toxicology emergency ward of Baharloo hospital of Tehran in 2011-2012. Iran J Toxicol 2014; 7(23): 932-9.
  12. Hejazi A, Zare G, Zeid Abadinejad MB, Shakeri MT. Epidemiologic study of deaths related to opiate abuse in Khorasan Legal Medicine Center from March 20, 2004 to March 20, 2006. Med J Mashad Univ Med Sci 2009; 52(2): 101-6. [In Persian].
  13. Izadi-Mood N, Tavahen N, Masoumi GR, Gheshlaghi F, Siadat ZD, Setareh M, et al. Demographic factors, duration of hospitalization, costs of hospitalization, and cause of death in patients intoxicated with amphetamines and opioids. J Isfahan Med Sch 2011; 29(146): 890-900. [In Persian].
  14. Moradi Sad E, Khademi A. Evaluation of suicides resulting in death in Iran, comparing with the world rates. Sci J Forensic Med 2002; 8(27): 16-21. [In Persian].
  15. Aghabiklooei A, Edalatparvar M, Zamani N, Mostafazadeh B. Prognostic factors in acute methadone toxicity: A 5-year study. J Toxicol 2014; 2014: 341826.
  16. Fonseca F, Marti-Almor J, Pastor A, Cladellas M, Farre M, de la Torre R, et al. Prevalence of long QTc interval in methadone maintenance patients. Drug Alcohol Depend 2009; 99(1-3): 327-32.
  17. Stringer J, Welsh C, Tommasello A. Methadone-associated Q-T interval prolongation and torsades de pointes. Am J Health Syst Pharm 2009; 66(9): 825-33.
  18. Hanon S, Seewald RM, Yang F, Schweitzer P, Rosman J. Ventricular arrhythmias in patients treated with methadone for opioid dependence. J Interv Card Electrophysiol 2010; 28(1): 19-22.
  19. Darke S, Duflou J, Torok M. The comparative toxicology and major organ pathology of fatal methadone and heroin toxicity cases. Drug Alcohol Depend 2010; 106(1): 1-6.
  20. Ernst E, Bartu A, Popescu A, Ileutt KF, Hansson R, Plumley N. Methadone-related deaths in Western Australia 1993-99. Aust N Z J Public Health 2002; 26(4): 364-70.
  21. Dinis-Oliveira RJ. Metabolomics of methadone: clinical and forensic toxicological implications and variability of dose response. Drug Metab Rev 2016; 48(4): 568-76.
  22. Corkery JM, Schifano F, Ghodse AH, Oyefeso A. The effects of methadone and its role in fatalities. Hum Psychopharmacol 2004; 19(8): 565-76.
  23. Sabzghabaee AM, Soleimani M, Farajzadegan Z, Hosseinpoor S, Mirhosseini SM, Eizadi-Mood N. Social risk factors and outcome analysis of poisoning in an Iranian referral medical center: A toxico-epidemiological approach. J Res Pharm Pract 2013; 2(4): 151-5.