To the Editor:
We reviewed the article “Methadone toxicity: comparing tablet and syrup formulations during a decade in an academic poison center of Iran”.Citation1
It is a valuable study because of its long duration of observation and large number of patients included.
However, some recommendations in the conclusion part of the article could not be applicable and may be unhelpful.
The authors recommended using child-resistant containers for dispensing methadone syrups.Citation1 It has been observed that in the case of using such kind of containers, parents usually leave them open and this behavior will expose their children at more poisoning risk. Better recommendation will be not to use methadone at home. In this regard, we suggest delivering methadone as a control drug via Smart Cards in local health centers and drug stores according to a daily basis even after the period of supervision. By these cards, the patient can be identified via an internet-based databank of patients who are under maintenance therapy and hence the dependent person can meet medical team on a standard schedule for recharging.
Another point that needs attention is the recommendation of adding a coloring agent and special flavor for reducing the rate of poisoning.Citation1 It is known that methadone is a bitter drug. On the other hand, several studies showed that adding flavor to medicines will increase children's compliance in treatment. The majority of children are interested to use syrups with flavor and many manufactures routinely add a flavor in the pediatric medicine to help parents giving the medicine to children easier. Adding color or flavor to methadone syrup can potentially increase the children's attention toward using it and will ensue in methadone poisoning.Citation2
We strongly recommend considering all possible aspects of authors’ suggestions before any change in formulation of methadone syrup or structure of its container. We recommend the deletion adding flavor and color to methadone syrup.
We also recommend patient education about the safe storage of the drugCitation3 as it has been shown to be effective in reducing threats of methadone maintenance treatment.
Declaration of interest
The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
References
- Shadnia S, Rahimi M, Hassanian-Moghaddam H, Soltaninejad K, Noroozi A. Methadone toxicity: comparing tablet and syrup formulations during a decade in an academic poison center of Iran. Clin Toxicol (Phila) 2013; 51:777–782.
- Mennella JA, Kennedy JM, Beauchamp GK. Vegetable acceptance by infants: effects of formula flavors. Early Hum Dev 2006; 82:463–468.
- Bloor RN, McAuley R, Smalldridge N. Safe storage of methadone in the home–an audit of the effectiveness of safety information giving. Harm Reduct J 2005; 2:9.