struct
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ckittyid 6521
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file_separator /
group_filepath /www/sites/mfapp/templates/groups/
group_info
struct
IHG Integration API 2.0 NO
PIURL [empty string]
SITEMESSAGE
component net.medfusion.cfcs.sitebroadcast
DATASOURCE Providers
METHODS
GETMESSAGE
function getMessage
Arguments:
Name Required Type Default
groupid Required numeric  
clearcache Optional boolean false
ReturnType: string
Roles:  
Access: public
Output: No
DisplayName:  
Hint:  
Description:  
activate NO
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group_name TO CREATE (Options in Health Care and Education)
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house NO
ifx NO
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inteng NO
kiosk NO
lab NO
lite NO
loc_url www.2create.yourmd.com
logo 0
mfpay NO
mfpid 10
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mfplus NO
mfpname Medem
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mobile NO
mu NO
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muu 7935
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rx NO
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temp_id 1376
tplan NO
tvd NO
vcs NO
vov NO
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loc_info
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loc_id 12783
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4 82785
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6 Frequently Asked Questions
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array
1 18
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4 82786
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3
array
1 6287
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3 7281
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4
array
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3 7281
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5
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47
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self index.cfm
site_filepath /www/sites/mfapp/templates/main/
 
TO CREATE (Options in Health Care and Education)  
     
     
MAD in Europe
(http://tinyurl.com/f810)

Methadone Mortality: A Reassessment - Friday, July 20, 2007 in Washington, DC (http://www.dcprovidersonline.com/catalog.php?event_id=SAMHSA1 ; key= sdfh8h)

FDA ALERT [11/2006]: Death, Narcotic Overdose, and Serious Cardiac Arrhythmias Associated with Methadone: (http://www.fda.gov/cder/drug/infopage/methadone/default.htm)

Increases in Methadone-Related Deaths: 1999-2004
by Lois A. Fingerhut, NCHS Office of Analysis and Epidemiology



OFFICIAL SAMHSA REPORT -
Methadone-Associated Mortality: Report of a National Assessment, and Background Briefing Paper by A. Trachtenberg & S. Leavitt:
(http://www.dpt.samhsa.gov./reports/index.htm)
LOCAL COPY (Methadone-Associated Mortality: Report of a National Assesment (February, 2004)

Confusion between methylphenidate and methadone: (http://www.fda.gov/cder/drug/MedErrors/methylphenidate.pdf)
(LOCAL COPY)

CSAT Press Release (February 6, 2004):(http://dpt.samhsa.gov/press_methdeaths.htm)

Latest from the New Scientist
(http://www.newscientist.com/news/news.jsp?id=ns99994736):

Painkiller linked to rise in overdose deaths
19:00 03 March 04
Exclusive from New Scientist Print Edition.

Doctors prescribing methadone for pain relief may inadvertently be the cause of an alarming rise in deaths related to the drug in the US. Forensic science experts fear that a huge increase in methadone prescriptions is feeding the black market and encouraging abuse.

In 2001, the Food and Drug Administration's MedWatch programme recorded 61 methadone-related deaths in the US. That is more than occurred in the whole of the 1990s, and by 2002 the number had doubled to 123.

The figures confirm reports from Maine, Florida, Oklahoma, North Carolina, West Virginia and Maryland that methadone-related deaths are rising. Methadone is often used to wean addicts off heroin, and the recent spate of deaths has led to calls for heroin-treatment programmes to be curtailed.

But the drug is also used to treat chronic pain - in cancer patients, for example. It works well because it stays in the body for a long time, taking between 15 and 55 hours to be broken down to half its initial levels, compared with a matter of minutes for heroin. The downside is that this means accidental overdoses are common, even when the drug is prescribed.

Black market

According to a report in February by the Substance Abuse and Mental Health Services Administration in Rockville, Maryland - the federal agency that oversees methadone distribution for addiction treatment - the amount of the drug dispensed by pharmacies has more than trebled since 1998, while its use in addiction treatment has hardly changed.

This suggests that the rising death toll is mainly due to misuse of methadone prescribed for pain relief. While 40 tablets cost as little as $5 on Medicaid, each tablet can be worth $10 to $20 if sold on the black market.

Reports from Oklahoma back this up. Ronald Distefano, from the state's Office of the Chief Medical Examiner, told the American Academy of Forensic Sciences annual conference in Dallas, Texas, in February that in 2001 and 2002 around two-thirds of the people whose deaths were associated with methadone did not have a prescription for the drug.

What's more, the SAMHSA report shows that while seizures of illegal methadone pills more than doubled from 2001 to 2002, seizures of liquid methadone only increased by 11 per cent.

The liquid form is the type most often prescribed for addicts. At post-mortem, methadone is often found along with other drugs, which makes it difficult to pin down the exact cause of death.

But Bruce Goldberger, a toxicologist and vice-president of the AAFS, thinks that the figures mark a new trend in drug abuse. "I have never seen this number of deaths before," he says. "It is a new generation of people using drugs."

James Randerson, Dallas



2002 Definition: These are deaths, most often coroners' cases, where methadone has been found on post-mortem toxicology, often in combination w/other drugs, in which the methadone MAY or MAY NOT have been contributory or causitive. I am currently investigating the toxicology and epidemiology of these deaths, within the larger context of the increasing numbers of deaths associated w/a broad range of prescription opioids and also of heroin. Persons who want to help, by providing me with toxicology and/or autopsy reports from such deaths, or case series, death certificate reviews, suspicious electrocardiograms from patients on methadone or LAAM, and etc., are invited to call me at 301-443-1281, or to email me reports at atrachte@samhsa.gov. Persons performing death scene investigation should be advised to look for indications of methadone source, including prescription vials of 5 or 10 mg tablets (generally prescribed for pain) vs. liquid or 40 mg scored diskettes (which are more likely to have come from opioid treatment programs (OTP's), where methadone is used in the treatment of opiate addiction. An unknown number of MAD's in which methadone was contributory or causitive may be the result of QT prolongation and Torsades de Pointes, a malignant ventricular arrhythmia. (PubMed search on Methadone AND Torsades de Pointes) . I am very interested in finding prior EKG's on methadone or LAAM, from decedents with MAD, to help assess the potential contribution of this mechanism, in contrast with the usual opioid overdose mechanism of central respiratory depression. A relevant case series can be found under Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, Robertson AD, Mehler PS; Torsade de pointes associated with very-high-dose methadone. Ann Intern Med 2002 Sep 17;137(6):501-4. (LOCAL FULLTEXT COPY). A SUMMARY FOR PATIENTS on Very High Doses of Methadone May Cause Abnormal Heart Rhythm can be found at: (http://www.annals.org/issues/v137n6/nts/200209170-00004.html) From Annals of Internal Medicine
. Two letters to the Annals in response to this article revealed several more cases of interest, especially in patients with HIV on multiple co-medications and truly high dose methadone: Letters; Page 307 19 August 2003 Annals of Internal Medicine Volume 139; Number 4: Torsade de Pointes Due to Methadone PDF File

My current working assumption is that this mechanism is responsible for only a very small (but unknown) proportion of methadone associated deaths (MAD's). Pathologists with heart tissue from such cases are urged to contact me to discuss the possibility of looking for genetic markers for the predisposition to this mechanism, which is being studied in collaboration with Dr. Ray Woosley of the University of Arizona (among others). My current review of many autopsy reports and clinical records indicates that many of the historical deaths attributed to "Methadone overdose," especially among the many deaths so attributed despite the presence of low therapeutic or even subtherapeutic methadone levels, could have been due to this mechanism and we would have no way of knowing. If there are OTP's that have had a standard practice of doing electrocardiograms (ECG's, also known as EKG's) on their patients on a regular basis who would be willing to submit a collection of them for review, along with a standard set of anonymous patient data to go with them, please contact me. While this is probably a small part of the current mortality problem, the risk for cardiac arhythmia can be screened for in both pain and addiction patients being treated with methadone (or LAAM) and probably should be to a greater extent than is the current practice. Having said this, the more important issues in safely prescribing methadone probably have much more to do with ensuring that both patient and practitioner are fully aware of methadone's uniquely slow and variable pharmacokinetics in contrast to most other opioids, as well as the important potential for both pharmacokinetic (mostly CYP 450 3A4 metabolism and extensive protein binding) and pharmacodynamic (NMDA antagonism, incomplete cross-tolerance, synergism w/CNS depressants, especially benzodiazepines and etc.) interactions. Methadone associated deaths can only be understood within the larger context of all opioid associated deaths, among which the MAD's comprise only a small proportion. To address the entire issue prospectively in an efficient way, One might consider a national death registry for all opioid (+) coroners' cases, that would collect autopsy reports, associated toxicology studies, and death scene investigations (when available). Data could be abstracted from these centrally, to minimize the burden for the local and state officials (ME's Coroners, toxicologists, forensic investigators, etc.) and standardized data sets and reports could be provided back to the originators on an ongoing basis. At the central repository, case definitions and decision algorythms could be drafted, tested and refined with greater statistical power than they could at any local level. Direction and oversight for this process could be situated in a consortium of the relevant proffesional groups. These groups would have to determine when adequate consensus had been reached to justify the standardization and dissemination of case definitions in the area of opioid associated coroners cases.

An important parallel effort, currently funded by National Institute of Justice (http://www.ojp.usdoj.gov/nij/) is starting at the Institute of Medicine (IOM):
IOM Medicolegal Death Investigation Workshop Website: http://www.iom.edu/iom/iomhome.nsf/pages/Workshop+On+The+Medicolegal+Death+Investigation+System?OpenDocument Local Copy of PreConference Information:
the IOM EXPLORATORY WORKSHOP ON THE MEDICOLEGAL DEATH INVESTIGATION SYSTEM,
This took place March 24-25, 2003, and may represent a historic first step in a long-needed overhaul of the entire national system of death investigation, which will have major legal and medical as well as public health implications.

Medscape Report of IOM Meeting http://www.medscape.com/viewarticle/451226?mpid=11718&WebLogicSession=Por1gskdjjqXNaME6uNabyn0hgWrjt1kPn7ciZ3cnVIa2hFtzDiY|-2905108248437858207/184161395/6/7001/7001/7002/7002/7001/-1

Medicolegal Death Investigation System: IOM Post-Workshop Summary;-Published 8/22/03 (http://www.iom.edu/report.asp?id=14792)

Table of Contents (IOM SUmmary):(http://books.nap.edu/books/0309089867/html/index.html
MAD IN EUROPE
(http://www.emcdda.eu.int/situation/themes/death_mortality.shtml#coh)


In the meantime, Adverse Publicity for Methadone continues from such papers as the NY Times, for instance on 2/9/2003: (http://www.nytimes.com/2003/02/09/health/09METH.html?ei=5062&en=3e0001616ac2a78f&ex=1045458000&partner=GOOGLE&pagewanted=all&position=top)
Local Copy: (LOCAL COPY)


Overdoses and Deaths From Abuse of Drug Methadone Are Up - NY Times 2/2/2003: (http://www.nytimes.com/2003/02/02/national/02METH.html?ex=1044766800&en=c6b9ad344a4bec3b&ei=5062&partner=GOOGLE#)
Local Copy: (LOCAL COPY)



DRUG OVERDOSE DEATHS are coded on the Death Certificate as poisonings. National mortality data, based on death certificates, are available from NCHS:
Poisoning mortality, 1985-1995; A report from NCHS: Fingerhut LA, Cox CS. Poisoning mortality, 1985-1995. Public Health Reports, Vol 113, Issue 3 218-233, © 1998 by US Public Health Service (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9633866&dopt=Abstract)
POISONING MORTALITY, 1985-1995; A report from NCHS: Fingerhut LA, Cox CS. Poisoning mortality, 1985-1995. Public Health Reports, Vol 113, Issue 3 218-233, © 1998 by US Public Health Service (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9633866&dopt=Abstract)
Poisoning was reported as the underlying cause of death for 18,549 people in the United States in 1995 and was ranked as the third leading cause of injury mortality, following deaths from motor vehicle traffic injuries and firearm injuries. Poisoning was the leading cause of injury death for people ages 35 to 44 years. Poisoning death rates were higher in 1995 than in any previous year since at least 1979. From 1990 to 1995, the age-adjusted rate of death from poisoning increased 25%; all of the increase was associated with drugs. About three-fourths of poisoning deaths (77%) in 1995 were caused by drugs. The age-adjusted rate of drug-related poisoning deaths for males (7.2 per 100,000) in 1995 was more than twice that for females (3.0 per 100,000). From 1985 to 1995, poisoning death rates for males ages 35-54 years nearly doubled to 20.4 per 100,000, and the drug-related poisoning death rate for males ages 35-54 years nearly tripled, reaching 16.1 per 100,000. From 1990 to 1995, death rates associated with opiates and cocaine more than doubled among males ages 35-54 years. The numbers of opiate and cocaine poisoning deaths for 1995 more than doubled when all multiple cause of death codes were examined instead of only the underlying cause of death codes. FULL TEXT PART 1
FULL TEXT PART 2





INDIVIDUAL STATE REPORTS FROM PUBLIC HEALTH AUTHORITIES:
Maine Medical Examiner Report: Maine Drug-Related Mortality Patterns:1997-2002 by Marcella H. Sorg, RN, PhD, D-ABFA, Margaret Chase Smith Center for Public Policy, University of Maine; Margaret Greenwald, MD, Maine Chief Medical Examiner; In cooperation with the Maine Office of the Attorney General and Maine Office of Substance Abuse (December 27, 2002).

FLORIDA TOXICOLOGY REPORTS:
New 2002 FINAL Report: (http://www.fdle.state.fl.us/publications/examiner_drug_report.pdf)
(LOCAL COPY, Final 2002 Report)
Previous (Interim) Reports: 2002 Interim Report of Drugs Identified in Deceased Persons by Florida Medical Examiners," Florida Dept. of Law Enforcement, in pdf (http://www.fdle.state.fl.us/publications/examiner_drug_report_2002.pdf)
OR (http://www.fdle.state.fl.us/publications/#Annual) and scroll down to the report title. OR, click on: (LOCAL COPY)

For questions about Methadone toxicology in Florida, call:
Bruce A. Goldberger, Ph.D., DABFT
Director of Toxicology and Clinical Associate Professor
Department of Pathology, Immunology & Laboratory Medicine
University of Florida College of Medicine
4800 S.W. 35th Drive
Gainesville, FL 32608
Phone: (352) 265-0680 ext. 72001 Fax: (352) 265-9904
E-mail: bruce-goldberger@ufl.edu
Web: (http://www.pathology.ufl.edu/~goldberg/)



North Carolina Death Certificate Report: (http://www.communityhealth.dhhs.state.nc.us/hlthprom/Unintentional%20Poisonings%20report-9-02-final.pdf)
This report was released with the following announcement:

"Unintentional drug overdose deaths increasing in North Carolina

RALEIGH - The number of deaths from unintentional drug overdoses in North Carolina increased over 110 percent from 1997 to 2001, according to a study released today by the N.C. Department of Health and Human Services. Overdoses of either legal or illicit drugs accounted for more than half of all poisoning-related deaths in the state during that 5-year period. The rate and number of drug overdose deaths in North Carolina is rising faster than the increase nationally, the study found.

Eighty percent of those dying from drug overdoses were white. The average age of the decedents was 39. Two-thirds of the deaths from unintentional drug overdoses occurred in men; however, the number of deaths among women increased by over 200 percent in the same time period. The highest number of drug-related deaths occurred in the most populous counties, but the state?s smaller rural counties had the highest drug-related mortality rates (deaths per 100,000 population).

The number of deaths from heroin and cocaine was fairly consistent from 1997 to 2001. The sharp increase in the total number of deaths over that period was driven by prescription narcotics such as morphine, oxycodone, fentanyl and methadone. While the source of the drugs was not always reported, there is strong evidence that a growing proportion of these drugs was originally obtained with physician-written prescriptions. Methadone clinics do not appear to be the source of methadone-related fatalities in North Carolina.

The increase in deaths among North Carolinians from abuse of prescription narcotics is alarming, said Carmen Hooker Odom, secretary of the N.C. Department of Health and Human Services. We must act quickly to reverse this trend.

I am appointing a Task Force to Prevent Deaths from Unintentional Drug Overdoses, Hooker Odom said. That group of experts professionals from public health, substance abuse and law enforcement, and medical examiners, physicians and pharmacists will begin working immediately to develop recommendations for new policies and procedures for reducing these kinds of deaths, before the problem reaches a crisis level, she said.

The study was conducted by epidemiologists from the N.C. Division of Public Health's Injury and Violence Prevention unit, aided by Epidemic Intelligence Service and Public Health Service officers from the Centers for Disease Control and Prevention (CDC). Data sources inluded the N.C. Center for Health Statistics, the N.C. Vital Records Section, and the N.C. Office of the Chief Medical Examiner. Information from over 1,300 death records was analyzed. The report is available on the Internet; use the Topics index on the N.C. DHHS homepage (www.dhhs.state.nc.us) to select Deaths from Unintentional Drug Overdoses.
2003 PUBLICATION IN THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION-
JAMA Research Letter 7/2/2003: Increase in Deaths Due to Methadone in North Carolina by Balesteros & Budnitz, (CDC Epidemic Intelligence Service) et al (JAMA, July 2, 2003?Vol 290, No I page 40).


This is not a new issue, but perhaps has increased in incidence over previous outbreaks of the 90's (eg. Texas & New Mexico):

Texas Outbreak in the Early 90's: (Barrett, D. H., Luk, A. J., Panish, R. G., and Jones,T.S., - An Investigation of Medical Examiner Cases In Which Methadone Was Detected, Harris County, Texas, 1987-1992, Journal of Forensic Sciences, JFSCA, Vol. 41, No. 3, May 1996, pp. 442-448.)
In 1991, media reports of an increase in the number of deaths attributed to methadone toxicity in Harris County, Texas, raised public concern about the safety of methadone. This concern was heightened by publicity surrounding the closure of three Harris County methadone maintenance treatment programs due to their poor compliance with federal methadone regulations. In response to this concern, the Texas Department of Public Health requested that the Centers for Disease Control and Prevention (CDC) assist in an epidemiologic study to determine the extent of methadone-related mortality in Harris County during 1991 and to determine the role of methadone maintenance treatment in these deaths. We reviewed cases investigated by the Harris County Medical Examiner's Office from 1987 through 1992 in which methadone was detected by postmortem drug testing. The autopsy reports for cases occurring in 1991 were also reviewed by three independent forensic pathologists who were asked to determine the role of methadone in the death. In addition, we attempted to document Harris County methadone maintenance treatment program enrollment for each decedent. We identified 91 decedents in whom methadone was detected at the time of death, with the largest number of cases occurring in 1991 (n = 27). Other substances, including alcohol, were detected in 85% of the cases. The Harris County Medical Examiner attributed 11 of the deaths to methadone toxicity. No more than three cases per year from 1987 through 1992 were attributed to methadone toxicity. In contrast, 34 deaths were attributed to polydrug toxicity, the largest number occurring in 1991 (n = 11). There was good agreement between the results of the independent review and the opinions of the Harris County Medical Examiner. Only 20% of the decedents were found to have been enrolled in a Harris County methadone maintenance treatment program at the time of death. Four people died of drug toxicity shortly after enrolling in a methadone maintenance treatment program. We found an increase in the number deaths occurring in Harris County, Texas, in 1991 in which methadone was detected. We also found that methadone blood levels were higher among decedents identified for 1991 and 1992 than among those identified in the previous years studied. However, we did not find evidence that the cause of these deaths could be attributed solely to methadone toxicity. Instead, for all years studied, the use of multiple drugs was the leading cause of death among people in whom methadone was detected. This finding points out the difficulties involved in determining the role of methadone as a cause of death. (Pubmed Citation from Journal of Forensic Sciences on Texas)



Death Certificate AND Medical Examiner Study in New Mexico from Outbreak in the later 90's, which continues currently and was probably the sentinel outbreak to the current epidemic of opioid (+) coroners' cases:
Methodological issues in the surveillance of poisoning, illicit drug overdose, and heroin overdose deaths in new Mexico. by Landen MG, Castle S, Nolte KB, Gonzales M, Escobedo LG, Chatterjee BF, Johnson K, Sewell CM. Am J Epidemiol 2003 Feb 1;157(3):273-8: (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12543628&dopt=Abstract)
Office of Epidemiology, New Mexico Department of Health, Santa Fe, NM 87502-6110 , USA. Contact=Michaell@doh.state.nm.us.
ABST: New Mexico leads the nation in poisoning mortality, which has increased during the 1990s in New Mexico and the United States. Most of this increase has been due to unintentional deaths from illicit drug overdoses. Medical examiner and/or vital statistics data have been used to track poisoning deaths. In this study, the authors linked medical examiner and vital statistics records on underlying cause of death, coded using the International Classification of Diseases, Ninth Revision, to assess the extent to which these data sources agreed with respect to poisoning deaths. The authors used multiple-cause files, which are files with several causes listed for each death, to further assess poisoning deaths involving more than one drug. Using vital statistics or medical examiner records, 94.7% of poisoning deaths were captured by each source alone. For unintentional illicit drug and heroin overdose deaths, each data source alone captured smaller percentages of deaths. Deaths coded as E858.(unintentional poisoning due to other drugs) require linkage with medical examiner or multiple-cause records, because this code identifies a significant percentage of illicit drug overdose deaths but obscures the specific drug(s) involved. Surveillance of poisoning death should include the use of medical examiner records and underlying- and multiple-cause vital statistics records. (LOCAL FULLTEXT COPY)

MARYLAND: 1997-2001-
An Examination of Data from the
Office of the Chief Medical Examiner OF
Alcohol and Drug-Related
Overdose Deaths by
Dana M. Lehder, Amelia Arria,
E. Erin Artigiani, and Eric D. Wish
Center for Substance Abuse Research: (http://www.dewsonline.org/dews/pubs/me11-02.pdf)
Maryland's Drug Early Warning System (DEWS): (http://www.dewsonline.org/dews/pubs/me11-02.asp)
DEWS REPORT (LOCAL FULL-TEXT (.pdf) COPY)




Medical Press Coverage:
href="http://www.ama-assn.org/sci-pubs/amnews/pick_02/prsd1216.htm"> Prescription drug abuse deadlier than use of illegal drugs: American Medical News (AMA) 12/16/2002
A surge in methadone abuse in Florida matches a national trend that also finds emergency visits for narcotic analgesics outnumbering visits for heroin overdoses.


Forensic Resource Websites:
href="http://www.soft.org">(http://www.soft.org)


(http://www.thename.org/)


(http://www.aafs.org.htm)



Prescription drug abuse deadlier than use of illegal drugs: American Medical News (AMA) 12/16/2002
A surge in methadone abuse in Florida matches a national trend that also finds emergency visits for narcotic analgesics outnumbering visits for heroin overdoses.

The pharmacology in the following article is a bit rough, but the use of Medical Examiner (MD) data is exemplary:
Mikolaenko I, Robinson CA Jr, Davis GG. A review of methadone deaths in Jefferson County, Alabama. Am J Forensic Med Pathol. 2002 Sep;23(3):299-304: (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12198363&dopt=Abstract)

(Local Full text copy)


The following paper using ME data on Oxycodone Associated Deaths may demonstrate useful methodology for us to apply in MAD's:
href="http://www.jatox.com/JAT-Oxycodone.pdf">(http://www.jatox.com/JAT-Oxycodone.pdf)


href="http://www.jatox.com/JAT-Oxycodone.pdf">(http://www.jatox.com/JAT-Oxycodone.pdf)

Journall of Analytic Toxicology:
(http://www.jatox.com/current.htm#)






KEEPING SOME PERSPECTIVE ON OD DEATHS:
Risk factors for overdose mortality: a case-control study within a cohort of intravenous drug users.
Davoli M, Perucci CA, Forastiere F, Doyle P, Rapiti E, Zaccarelli M, Abeni DD.
Epidemiology Unit, Latium Regional Health Authority, Rome, Italy.
Overdose mortality is the major adverse health effect of drug injection. The potential determinants of overdose death are poorly understood; the aim of this study was to investigate risk factors for overdose mortality among intravenous drug users (IVDU). A cohort of 4200 IVDU attending methadone treatment centres in Rome during the period 1980-1988, was enrolled. Data were collected from clinical records. Vital status and cause of death were ascertained as of 31 December 1988. A matched case-control analysis within the cohort was performed to identify risk factors of death from overdose. All overdose deaths were included as cases and four controls, matched on year of birth and sex, were selected for each case from among the cohort members still alive at the time of death of the corresponding case. In all, 81 deaths from overdose were identified as cases and compared with 324 controls. A high risk of overdose death occurred among subjects who left treatment compared with those still in treatment (odds ratio [OR] = 3.55, 95% confidence interval [CI]: 1.82-6.90). The OR was particularly elevated in the first 12 months after drop-out compared with those retained in treatment (OR = 7.98, 95% CI: 3.40-18.73). The risk of overdose death was higher for unmarried compared with married people (OR = 2.48, 95% CI: 1.31-4.68); a higher risk of overdose death was also associated with lower educational status and younger age at first drug use, but such association was not statistically significant. ABSTRACT TRUNCATED AT 250 WORDS(PUBMED LINK)

Unintentional Opiate Overdose Deaths --- King County, Washington, 1990--1999: (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4928a2.htm)



(Barrett, D. H., Luk, A. J., Panish, R. G., and Jones,T.S., ?An Investigation of Medical Examiner Cases In Which
Methadone Was Detected, Harris County, Texas, 1987-1992,?
Journal of Forensic Sciences, JFSCA, Vol. 41, No. 3, May 1996,
pp. 442?448.)
Local Copy

For release: Immediate Date: Sept. 26, 2002
Contact: Carol Schriber (919) 733-9190 or Kay Sanford (919) 733-3732

Unintentional drug overdose deaths increasing in North Carolina

RALEIGH - The number of deaths from unintentional drug overdoses in North Carolina increased over 110 percent from 1997 to 2001, according to a study released today by the N.C. Department of Health and Human Services. Overdoses of either legal or illicit drugs accounted for more than half of all poisoning-related deaths in the state during that 5-year period. The rate and number of drug overdose deaths in North Carolina is rising faster than the increase nationally, the study found.

Eighty percent of those dying from drug overdoses were white. The average age of the decedents was 39. Two-thirds of the deaths from unintentional drug overdoses occurred in men; however, the number of deaths among women increased by over 200 percent in the same time period. The highest number of drug-related deaths occurred in the most populous counties, but the state?s smaller rural counties had the highest drug-related mortality rates (deaths per 100,000 population).

The number of deaths from heroin and cocaine was fairly consistent from 1997 to 2001. The sharp increase in the total number of deaths over that period was driven by prescription narcotics such as morphine, oxycodone, fentanyl and methadone. While the source of the drugs was not always reported, there is strong evidence that a growing proportion of these drugs was originally obtained with physician-written prescriptions. Methadone clinics do not appear to be the source of methadone-related fatalities in North Carolina.

?The increase in deaths among North Carolinians from abuse of prescription narcotics is alarming,? said Carmen Hooker Odom, secretary of the N.C. Department of Health and Human Services. ?We must act quickly to reverse this trend.

?I am appointing a Task Force to Prevent Deaths from Unintentional Drug Overdoses,? Hooker Odom said. ?That group of experts?professionals from public health, substance abuse and law enforcement, and medical examiners, physicians and pharmacists?will begin working immediately to develop recommendations for new policies and procedures for reducing these kinds of deaths, before the problem reaches a crisis level,? she said.

The study was conducted by epidemiologists from the N.C. Division of Public Health?s Injury and Violence Prevention unit, aided by Epidemic Intelligence Service and Public Health Service officers from the Centers for Disease Control and Prevention (CDC). Data sources inluded the N.C. Center for Health Statistics, the N.C. Vital Records Section, and the N.C. Office of the Chief Medical Examiner. Information from over 1,300 death records was analyzed. The report is available on the Internet; use the Topics index on the N.C. DHHS homepage (www.dhhs.state.nc.us) to select ?Deaths from Unintentional Drug Overdoses.?

###
unintentional drug deaths.doc

Prescription drug abuse deadlier than use of illegal drugs

American Medical News (AMA): A surge in methadone abuse in Florida matches a national trend that also finds emergency visits for narcotic analgesics outnumbering visits for heroin overdoses.

RELEVANT NATIONAL ORGANIZATIONS:
National Association of Medical Examiners
1402 South Grand Blvd.
St. Louis, MO 63104
Phone: (314) 577-8298 x2
Fax: (314) 268-5971
National Association of Medical Examiners Web Site: (http://www.thename.org/library_index_nowork.htm)

American Academy of Forensic Sciences (AAFS) (http://www.aafs.org/)

The Society of Forensic Toxicologists, Inc. (SOFT) is an organization composed of practicing forensic toxicologists and those interested in the discipline for the purpose of promoting and developing forensic toxicology:
href="http://www.soft-tox.org/">(http://www.soft-tox.org/)
The CONTACT INFORMATION for the SOFT Administrative Office is:
P.O. Box 5543
Mesa, AZ 85211-5543
Phone/Fax: (480) 839-9106
href="http://www.soft-tox.org/">(http://www.soft-tox.org">(http://www.soft-tox.org/">(http://www.soft-tox.org)


Poisoning mortality, 1985-1995; A report from NCHS: Fingerhut LA, Cox CS. Poisoning mortality, 1985-1995. Public Health Reports, Vol 113, Issue 3 218-233, © 1998 by US Public Health Service (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9633866&dopt=Abstract)



DAWN Mortality Data, 2001: (http://www.samhsa.gov/oas/DAWN/mortality2k1.pdf)



To search the NCHS Ambulatory care
databases for mentions of specific drugs: (http://www2.cdc.gov/drugs)


IOM Medicolegal Death Investigation Workshop Website: (http://www.iom.edu/iom/iomhome.nsf/pages/Workshop+On+The+Medicolegal+Death+Investigation+System?OpenDocument)


MAD IN EUROPE


Methadone-Related Deaths
Associated with Faulty Induction Procedures
by
Désirée Wagner-Servais, Dr. med
Manfred Erkens, Dr. rer. nat (Journal of Maintenance in the Addictions, Vol. 2(3) 2003):(http://www.haworthpress.com/store/E-Text/View_EText.asp?sid=25N47KQ8KQ5J8L7M4MCEE6X68J6GC735&a=3&s=J126&v=2&i=3&fn=J126v02n03%5F06)
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. Onefifth (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 methadone-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.

Confusion between methylphenidate and methadone: (http://www.fda.gov/cder/drug/MedErrors/methylphenidate.pdf)
(LOCAL COPY)

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Overdoses and Deaths From Abuse of Drug Methadone Are Up - NY Times 2/2/2003: (http://www.nytimes.com/2003/02/02/national/02METH.html?ei=5062&en=c6b9ad344a4bec3b&ex=1044766800&partner=GOOGLE&pagewanted=print&position=top)

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PubMed citation for Torsade de pointes associated with very-high-dose methadone; by Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, Robertson AD, Mehler PS. Ann Intern Med 2002 Sep 17;137(6):501-4 (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12230351&dopt=Abstract)

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(http://dpt.samhsa.gov/press_methdeaths.htm)
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IOM Report: Informing America's Policy on Illegal Drugs: What We Don't Know Keeps Hurting Us (2001)
(http://www.nap.edu/books/0309072735/html/)



(http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12543628&dopt=Abstract)



Unintentional Opiate Overdose Deaths --- King County, Washington, 1990--1999: (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4928a2.htm)



Unintentional Opiate Overdose Deaths --- King County, Washington, 1990--1999: (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4928a2.htm)


PDF file:
href="http://www.cdc.gov/mmwr/PDF/wk/mm4928.pdf">(http://www.cdc.gov/mmwr/PDF/wk/mm4928.pdf)



BUT LET'S NOT FORGET HEROIN:
==================================================================

Heroin Overdose Deaths --- Multnomah County, Oregon, 1993--1999
href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4928a1.htm">(http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4928a1.htm)




US PA: Heroin Reigns As Most Lethal In Allegheny, 4
URL: http://www.mapinc.org/drugnews/v03/n228/a06.html
Newshawk: http://www.mapinc.org/resource/
Pubdate: Sun, 09 Feb 2003
Source: Tribune Review (Pittsburgh, PA)
Copyright: 2003 Tribune-Review Publishing Co.
Contact: opinion@tribweb.com
Website: http://triblive.com/
Details: http://www.mapinc.org/media/460
Author: Carl Prine


HEROIN REIGNS AS MOST LETHAL IN ALLEGHENY, 4 NEIGHBORING COUNTIES

She was the hardest worker they knew.

Melissa Lockovitch toiled the 2-10 p.m. shift as a nurse's aide at UPMC South Side. Then, with the energy only a 20-year-old could muster, she darted into a restroom and changed uniforms for her overnight security guard duty at the University of Pittsburgh.

For the former straight-A Keystone Oaks student, the long hours, the scrimping and saving, had paid off. She'd just been accepted into nursing school. She ordered new scrubs. It was time to celebrate.

Her mother, Janet Kapsis, saw her last on Oct. 20, when the daughter she adored dropped off her dirty laundry.

"She looked so pretty. Curly hair. Pink top. So pretty," Kapsis said. "She told me, 'Just think, Mummy, in three weeks I'll be 21.' "

But Melissa never got the chance to blow out the candles. The night before Halloween, she died alone in her Whitehall apartment, a crumpled packet of heroin at her side, her lungs drowning in their own blood.

"Every time I look out the window, I see her car and think she's come back," said Kapsis.

"I cry a lot."

Heroin now reigns as the most lethal drug in Allegheny, Beaver, Butler, Washington and Westmoreland counties, based on autopsy reports at area coroners' offices. Last year, heroin killed Lockovitch and 190 other people across the region. That's more than double the 2000 death count and it doesn't include several dozen Allegheny County cases pending lab results.

But it's not the unprecedented body count that's causing parents in picture-perfect communities to take notice. It's who's dying. Never before have area victims of drug abuse been so young or so white.

According to death records on file at the coroners' offices:

Heroin's victims are getting younger. Across the region in 1999, heroin killed four people under the age of 24. Last year, 27 died.

Four out of five heroin deaths are male, but more women are dying from the drug than ever before. Last year, 37 perished, double the 2000 count. The youngest was 19, and five were under 30.

Heroin is an equal-opportunity killer. Heroin claims 10 times as many whites as blacks, but it also remains the deadliest drugs for black abusers.

It's more than a city problem. Seven out of every 10 heroin deaths occur outside Pittsburgh, in predominately white rural and suburban enclaves spread across five counties.

"The perception is that it's an inner-city problem. That's why they moved to the suburbs in the first place, to escape stuff like drugs," said Bethel Park Police Chief John Mackey. "They don't understand that kids have the opportunity to travel, to spend money, like never before.

"I tell parents, 'People don't drive to Bethel Park to buy drugs. They drive to the North Side or Duquesne, and bring the drugs back. But that doesn't mean our kids aren't doing drugs, because they are."

If smack had its own calendar for 2001, May would feature a 25-year- old electrician found face-down in his South Park lawn; September, a Fox Chapel High School senior who died in his friend's garage; and for April, a 22-year-old Pitt man, set graduate that weekend.

"One would think that after awhile, the message would get out to people," said Allegheny County Coroner Cyril Wecht. "Heroin use is a very dangerous endeavor to engage in. Anyone can die from heroin."

Wecht's prescription: A large-scale effort to educate people about the dangers of illegal opiate use, plus more coordination with police, health providers and schools to reach the youngest potential users and, especially, their parents. Wecht said the region's 438 heroin deaths since 2000 comprise a public health issue, one that's hidden behind the myth of race.

"The problem is that the great majority of people believe this problem affects largely African-American young adults," said Wecht. "I really believe that racial bias is a big factor explaining the lack of a public outrage, of people asking, 'What's going on here?'"

In 1985, when Melissa Lockovitch was three years old, black men had the highest drug death rate in Pennsylvania, six times higher than whites, according to the state Department of Health. Then, drugs killed about 29 out of every 100,000 black men; for whites, 1.4 in 100,000.

The typical victim was an aging black junkie in the slums of Philadelphia or Pittsburgh using heroin or crack cocaine, according to the state Department of Health.

Fast forward to 2000 and the trend is reversing. Black male drug death rates have plummeted 75 percent to 6 in 100,000. For white men, the rate is soaring Nearly six out of every 100,000 will die this year.

Bethel Park, an upper-middle class South Hills suburb, is 97 percent white. Officials there suspect that, based on calls to treatment centers and the number of arrests, up to