Mortality associated with New South Wales methadone programs in 1994: lives lost and saved

OBJECTIVES: To estimate the effects of methadone programs in New South Wales on mortality. DESIGN AND CASES: Retrospective, cross-sectional study of all 1994 New South Wales coronial cases in which methadone was detected in postmortem specimens taken from the deceased. Cases were people we identified as patients in NSW methadone maintenance programs or those whose deaths involved methadone syrup diverted from maintenance programs. OUTCOME MEASURES: Relative risks of fatal, accidental drug toxicity in the first two weeks of treatment and later; the number of lives lost as a result of maintenance treatment; preadmission risks and the number of lives saved by maintenance programs, calculated from data from a previous study. RESULTS: There was very close agreement between this study's classifications and official pathology reports of accidental drug toxicity. The relative risk (RR) of fatal accidental drug toxicity for patients in the first two weeks of methadone maintenance was 6.7 times that of heroin addicts not in treatment (95% CI RR, 3.3-13.9) and 97.8 times that of patients who had been in maintenance more than two weeks (95% CI RR, 36.7-260.5). Despite 10 people dying from iatrogenic methadone toxicity and diverted methadone syrup being involved in 26 fatalities. In 1994, NSW maintenance programs are estimated to have saved 68 lives (adjusted 95% CI, 29-128). CONCLUSIONS: In 1994, untoward events associated with NSW methadone programs cost 36 lives in NSW. To reduce this mortality, doctors should carefully assess and closely monitor patients being admitted to methadone maintenance and limit the use of takeaway doses of methadone.     

Tuberculosis in New South Wales

Surveillance of tuberculosis in New South Wales depends on notification of cases by medical practitioners and careful follow-up by public health nurses dedicated to the control of tuberculosis. Evaluation of tuberculosis surveillance data enables identification of patterns of infection, highlighting areas requiring specific interventions. In 1986, 290 cases of tuberculosis were notified to the Department of Health, New South Wales. The majority of patients (72.8%) were diagnosed as having pulmonary disease. The highest rates of infection were in people from Southeast Asian countries. Whereas 5.2% of cases were identified when the patients entered Australia, a substantial proportion of diagnoses (23.1%) were made in people who had been resident in Australia for 10 or more years. This article highlights the need to continue efforts to improve tuberculosis surveillance and control programmes in New South Wales.     

A case of desquamating rash associated with methadone use

A man who had been taking prescribed methadone for many years presented with a desquamating rash (predominantly affecting the hands and feet) complicated by cellulitis of the right leg. There have now been multiple reports of a similar rash among methadone users in Sydney. The cause remains unknown.     

A review of refugee medical screening in New South Wales

Public health concern in relation to refugees arriving in New South Wales is due to the high prevalence of tuberculosis, syphilis and hepatitis B infection in some refugee groups. Other infectious diseases (with the exception of malaria in the Northern Territory and Queensland) do not pose a significant threat to public health owing to their low prevalence (which may result from overseas screening and treatment) and/or low infectivity in Australian conditions. Because of overseas screening by the Commonwealth Government before the departure of the refugees, it was uncommon in 1984 for previously undetected tuberculosis to be detected when refugees were screened on arrival in Sydney (found in only one in 800 refugees who underwent screening). However, of the refugees in Sydney who had positive results of serological tests for syphilis, a substantial proportion (at times in excess of 50%) had had a negative result at the overseas screening; subsequent follow-up of those with positive serological results indicated inactive disease in almost all cases. There is a need to monitor the infectious disease prevalence and the effectiveness of overseas screening of refugees by on-arrival screening; decisions about screening procedures and the selection of particular incoming refugee groups for screening should be based on sound epidemiological and clinical analysis.     

The cost of asthma in New South Wales

OBJECTIVE: To determine the economic cost of asthma to the New South Wales community. DESIGN: Direct costs (both health-care and non-health-care) plus indirect costs (loss of productivity) were estimated from various sources to assess retrospectively the dollar costs of asthma. Intangible costs (such as quality of life) were not included. SETTING: Estimates of costs were made at all levels of medical care of asthma patients, including inpatient and outpatient hospitalisations, emergency department visits, and visits to general practitioners and specialist physicians, plus costs of pharmaceuticals, nebulisers and home peak-flow monitoring devices. The cost of time lost by the patient attending for medical visits and loss of productivity due to absence from employment as a result of asthma were also included. RESULTS: The total cost of asthma in New South Wales was $209 million in 1989. This was made up of $142 million in direct health-care costs, $19 million in direct non-health-care costs and $48 million in indirect costs. CONCLUSION: Although we believe that our estimate is an underestimate of the true dollar cost of this disease to the community, it represents $769 per asthmatic person per year, assuming a current prevalence rate for asthma in New South Wales of 6%. The cost effectiveness of any new treatment of asthma should be estimated to ensure that the economic cost to the community does not rise unnecessarily.