Abstract
All drug-related deaths registered at the Institute of Forensic Medicine, University of Aachen, Germany, during the period of February 1994 to February 1998 were reviewed retrospectively. One-fifth (19/102) of the cases were considered to be methadone related. Although the number of patients involved in methadone maintenance programs in the Aachen area increased by tenfold, the number of metha-done-associated deaths occurring each year remained steady. Polydrug toxicity was the leading cause of death. Two-thirds of the deaths of patients receiving licit methadone maintenance therapy occurred during the first three days of treatment. Police investigation revealed all these patients received an induction dose of methadone that exceeded the recommended amount. Additionally, some subjects were intolerant to opiates. The presented cases highlight the need for improved training and adequate supervision of methadone treatment.