METHADONE A FACTOR IN DRUGS-LINKED DEATHS

A pioneering study of the mortality risks of methadone has raised concern
about the number of deaths in Dublin city in which the drug is implicated.

The study also discloses that benzodiazepines (tranquillisers) were
implicated in the largest category of the drug-related deaths investigated
by the Dublin City Coroner last year.

Of the 108 deaths related to drugs or alcohol investigated by the coroner,
Dr Brian Farrell, in 1998, benzodiazepines were implicated in 48 cases (69
per cent), while cases in which methadone was implicated were the
second-largest category with 37 deaths (53 per cent).

Heroin was implicated in 36 deaths (51 per cent), and 28 deaths were
primarily alcohol-related.

The coroner's office data were analysed by Mr Ray Byrne, a former
residential youth worker with Father Peter McVerry's Arrupe Society for
homeless young people, in pursuit of a primary degree in social care.

He found that the characteristics of drug-related deaths in Dublin
correspond to those shown in international studies. The vast majority of
cases (77) were young men, and polydrug misuse accounted for most deaths,
of which alcohol and benzodiazepines were the most commonly misused, with
heroin and/or methadone.

Last weekend the national GP co-ordinator, Dr Ide Delargy, urged the
Department of Health and the Medical Council to declare war on the
irresponsible prescribing of tranquillisers by general practitioners to
patients recovering from drug addiction.

Such drugs had to be used with extreme caution where drug addicts were
concerned, she said, because of the "enormous potential" for abuse and
because they could destabilise patients on methadone. Mr Byrne said
yesterday that two distinct findings emerge from his analysis of the 1998
coroner's office data.

First, benzodiazepines were implicated in the largest category of deaths
and, second, people who took methadone in Dublin in 1998 were apparently at
least twice as likely to have methadone implicated in their deaths as those
who took heroin would have heroin implicated in their deaths.

After reviewing current international research on methadone and
drug-related deaths, he had concluded that, while methadone was apparently
the most effective and most evaluated form of treatment for heroin
addiction, concern remained about eventual detoxification.

Admission criteria, dosage, dispensing policy, clinical orientation and the
provision of therapeutic support services were all factors which
contributed to the overall quality of care provided, he stressed.

He agreed with the view expressed in some international research reports
that badly delivered methadone treatment might be substantially worse than
badly delivered treatment alternatives. He said the risk of death from
misusing many different drugs must be made clear to those undergoing drug
treatment. Detection, through urinanalysis, of benzodiazepines and/or
alcohol, should be acted on immediately.

"The danger to society of prescribing beyond therapeutic levels demands
strict monitoring," he said.

While the value of methadone as a treatment for heroin addiction was
established, its dangers were obvious. The success of initiatives to
curtail the availability of methadone on the streets had to be evaluated
and, if necessary, further measures taken.

Mr Byrne plans to carry out further research into drug-related deaths.

He will also study the extent of the benzodiazepines problem in the
capital, including the extent of their prescription and the amount of
street-diverted benzodiazepines being consumed.