Methadone-related death in detention |
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| Institution: | 1. Precision Medicine, Networked Services, Bessemer Wing, King''s College Hospital NHS Foundation Trust, London, SE5 9RS, UK;2. PO Box 498, Northwich, Cheshire, CW9 9BE, UK;1. Department of General Physiology, Medical Institute of Russian University of People Friendship, Research Institute of Human Morphology, Moscow, Russia;2. Department of Forensic Medicine and Toxicology, Government Medical College and Hospital, Chandigarh, 160030, India;3. Department of General Pathology and Pathological Physiology, Medical Institute of Russian University of People Friendship, Moscow, Russia;4. Department of Forensic Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;5. Institute of General Resuscitation Named After V. A. Negovsky Federal State Budgetary Scientific Institution, Federal Scientific and Clinical Center of Reаnimatology and Rehabilitation, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;1. Department of Pediatrics, Harbor-UCLA Medical Center, USA;2. Department of Pediatrics and Emergency Medicine, Harbor-UCLA Medical Center, USA;3. Department of Emergency Medicine, Harbor-UCLA Medical Center, USA;1. LABANOF (Laboratorio di Antropologia e Odontologia Forense), Sezione di Medicina Legale, Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Via Luigi Mangiagalli, 37, 20133, Milano, Italy;2. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy;1. Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai, 200063, PR China;2. Department of Forensic Medicine, Nanjing Medical University, Nanjing, Jiangsu, 211166, PR China;3. Yangpu Branch of Shanghai Public Security Bureau, Shanghai, 200090, PR China;4. Institute of Criminal Science and Technology, Putuo Branch of Shanghai Public Security Bureau, Shanghai, 200333, PR China;5. Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, Nanjing, Jiangsu, 211166, PR China |
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| Abstract: | Oral methadone may be prescribed to detainees with the aim of minimising the risk of fatal opioid poisoning on release. To study the circumstances under which methadone-related deaths can occur in detention, we audited reports of 17 14 male, 3 female; median (range) age 34 (22–52) years] such deaths, July 2010–December 2011. The median (range) methadone dose was 40 (10–110) mg/d (N = 16). The median (range) post-mortem blood methadone concentration was 0.42 (0.16–1.40) mg/L. Those who died within 7 days of the commencement of methadone treatment were significantly younger (Mann-Whitney U 102.5, p < 0.05), were prescribed a significantly lower dose (U = 80.0, p < 0.05) and had significantly lower blood methadone concentrations at death (U = 106.5, p < 0.02) than in those given methadone long-term. In 8 reports the prisoner had been recorded as either ‘sleepy’ (N = 7), or ‘unwell’ in the hours before death. In 13 deaths, the prisoner was either found dead first thing in the morning, or in one instance could not be roused (‘snoring heavily’). Pneumonia, tracheobronchitis, end-stage cirrhosis, and ischaemic heart disease/coronary artery atherosclerosis were cited as associated factors in four patients, all of whom were on long term stable methadone treatment. Attention to warning signs of likely methadone toxicity (daytime or excessive drowsiness, snoring, nausea/vomiting) and associated risk factors (use of drugs such as benzodiazepines and gabapentinoids, the presence of respiratory infection, liver or renal disease) could help minimise the risk of unexpected death in patients given methadone. |
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