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Int J Legal Med (2014) 128:751764 DOI 10.1007/s00414-014-1017-x
ORIGINAL ARTICLE
Intravenous methadone application as a serious risk factorfor an overdose death: methadone-related fatalities in Hamburg from 2007 to 2012
Stefanie Iwersen-Bergmann & Hilke Jungen &
Hilke Andresen-Streichert & Alexander Mller &
Sally Elakkary & Klaus Pschel & Axel Heinemann
Received: 10 March 2014 /Accepted: 30 April 2014 /Published online: 25 May 2014 # Springer-Verlag Berlin Heidelberg 2014
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 metha-done 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 disaccha-rides. 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.
Keywords Methadone . Buprenorphine . Intravenous misuse . Disaccharides . Lactose . Sucrose . Marker . Opiate Maintenance Programme (OMT) . Drug related death
Introduction
In Germany, the number of drug-related deaths declined considerably from 2,140 to 944 within a span of 12 years (2000 2012) [1]. Despite of this noticeable trend, there is still an unacceptably high number of deaths every year as a result...