Abstract
The aim of this study was to determine the number, and to describe the circumstances, of accidental methadone syrup-related deaths (MSRDs) in New South Wales (NSW), Australia from 1990 to 1995. Coronial files of all cases positive for methadone at autopsy between July 1990 and December 1995 in NSW were reviewed to determine methadone syrup-related cases. One hundred and thirty-four cases of MSRD were identified, of which 72 (54%) were registered in methadone maintenance treatment (MMT) at time of death. Diverted sources were implicated in the remaining 62 cases (46%) not registered in MMT. The majority of all cases were single (60%), unemployed (80%) males (75%), with a mean age of 31 years. Intravenous injection of methadone prior to death was evident in 35% of cases not in MMT, and in 10% in MMT. Polydrug use was detected in 89% of cases, most commonly benzodiazepines (52%), followed by morphine (37%) and alcohol (28%). However, forensic authorities did not implicate other drugs detected at autopsy in the cause of death in 34% of cases. The large proportion of deaths involving diverted sources of methadone may be indicative of high-risk behaviour among some injecting drug users, who abuse methadone in combination with other drugs to enhance the effects of intoxication. Alternatively, heroin users who use illicit methadone may be doing so to medicate opioid withdrawal symptoms, which could suggest a high unmet demand for MMT. Failure to implicate other drugs detected at autopsy in the cause of death may result in over-reporting of methadone-detected cases as methadone-caused deaths. The findings from this study support an urgent review of the current classification and reporting mechanisms for methadone-related deaths.