@article{ref1,
title="Intravenous methadone application as a serious risk factor for an overdose death: methadone-related fatalities in Hamburg from 2007 to 2012",
journal="International journal of legal medicine",
year="2014",
author="Iwersen-Bergmann, Stefanie and Jungen, Hilke and Andresen-Streichert, Hilke and Müller, Alexander and Elakkary, Sally and Püschel, Klaus and Heinemann, Axel",
volume="128",
number="5",
pages="751-764",
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 methadone 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 disaccharides. 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.<p /> <p>Language: en</p>",
language="en",
issn="0937-9827",
doi="10.1007/s00414-014-1017-x",
url="http://dx.doi.org/10.1007/s00414-014-1017-x"
}