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Article

The Role of Risk or Contributory Death Factors in Methadone-Related Fatalities: A Review and Pooled Analysis

1
DIMEC, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
2
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35121 Padova, Italy
3
Department of Excellence of Biomedical Sciences and Public Health, University “Politecnica delle Marche” of Ancona, via Conca 71, 60126 Ancona, Italy
*
Author to whom correspondence should be addressed.
These authors equally contributed to the study and should be considered as co-first authors.
Academic Editor: Cornelius Hess
Metabolites 2021, 11(3), 189; https://doi.org/10.3390/metabo11030189
Received: 22 February 2021 / Revised: 16 March 2021 / Accepted: 18 March 2021 / Published: 22 March 2021
(This article belongs to the Special Issue Metabolite Analysis in Forensic Toxicology)
Methadone-related deaths are characterized by a wide range of post-mortem blood concentrations, due to the high pharmacokinetic/dynamic inter-individual variability, the potential subjective tolerance state and to other risk factors or comorbidities, which might enhance methadone acute toxicity. In the present study, the association among pre-existing and external conditions and diseases and the resultant methadone death capacity have been investigated. Beside a systematic literature review, a retrospective case-control study was done, dividing cases in which methadone was the only cause of death (controls), and those with associated clinical-circumstantial (naive/non-tolerant state), pathological (pulmonary or cardiovascular diseases) or toxicological (other drugs detected) conditions. Methadone concentrations were compared between the two groups and the association with conditions/diseases was assessed by multiple linear and binomial logistic regressions. Literature cases were 139, in house 35, consisting of 22 controls and 152 cases with associated conditions/diseases. Mean methadone concentrations were 2122 ng/mL and 715 ng/mL in controls and cases respectively, with a statistically significant difference (p < 0.05). Lower methadone concentrations (by 24, 19 and 33% respectively) were detected in association with naive/non-tolerant state, pulmonary diseases and presence of other drugs, and low levels of methadone (<600 ng/mL) might lead to death in the presence of the above conditions/diseases. View Full-Text
Keywords: methadone; drug-related death; post-mortem examination; forensic toxicology methadone; drug-related death; post-mortem examination; forensic toxicology
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MDPI and ACS Style

Giorgetti, A.; Pascali, J.; Montisci, M.; Amico, I.; Bonvicini, B.; Fais, P.; Viero, A.; Giorgetti, R.; Cecchetto, G.; Viel, G. The Role of Risk or Contributory Death Factors in Methadone-Related Fatalities: A Review and Pooled Analysis. Metabolites 2021, 11, 189. https://doi.org/10.3390/metabo11030189

AMA Style

Giorgetti A, Pascali J, Montisci M, Amico I, Bonvicini B, Fais P, Viero A, Giorgetti R, Cecchetto G, Viel G. The Role of Risk or Contributory Death Factors in Methadone-Related Fatalities: A Review and Pooled Analysis. Metabolites. 2021; 11(3):189. https://doi.org/10.3390/metabo11030189

Chicago/Turabian Style

Giorgetti, Arianna, Jennifer Pascali, Massimo Montisci, Irene Amico, Barbara Bonvicini, Paolo Fais, Alessia Viero, Raffaele Giorgetti, Giovanni Cecchetto, and Guido Viel. 2021. "The Role of Risk or Contributory Death Factors in Methadone-Related Fatalities: A Review and Pooled Analysis" Metabolites 11, no. 3: 189. https://doi.org/10.3390/metabo11030189

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