Background: Some recent studies have suggested a lower risk of fatal intoxications in drug-dependent patients under buprenorphine compared to methadone treatment. Methods: Epidemiological reference data for the Munich region suggest that in 2003 approximately 10 % of all substitution patients were treated with buprenorphine, and 87 % with methadone. We studied the proportion of patients under methadone and buprenorphine substitution among drug-related deaths. Data from forensic post-mortem and toxicological analysis were analyzed. Results: Data indicate that in 96 (35 %) of all 272 so-called drug deaths, methadone was involved compared to a single case of buprenorphine, possibly indicating a relatively better risk profile of buprenorphine. Discussion: More prospective studies are necessary to assess the risk of fatal intoxications under different substitution regimens.
References
-
1
Amass L, Kamien J B, Mikulich S K.
Efficacy of daily and alternate-day dosing regimens with the combination of buprenorphine-naloxone tablet.
Drug Alcohol Depend.
2000;
58
143-152
-
2
Auriacombe M, Fatseas M, Dubernet J, Daulouede J P, Tignol J.
French field experience with buprenorphine.
Am J Addict.
2001;
13 (Suppl. 1)
S17-28
-
3
Barnett P G, Rodgers J H, Bloch D A.
A meta-analysis comparing buprenorphine to methadone for treatment of opiate dependence.
Addiction.
2001;
96
683-690
-
4
Bickel W K, Amass L, Crean J P, Badger G J.
Buprenorphine dosing every 1,2, or 3 days in opioid-dependent patients.
Psychopharmacology.
1999;
146
111-118
-
5
Brugal M T, Domingo-Salvany A, Puig R, Barrio G, Garcia de Olalla P, de la Fuente L.
Evaluating the impact of methadone maintenance programmes on mortality due to overdose and aids in a cohort of heroin users in Spain.
Addiction.
2005;
100
981-989
-
6
Bryant W K, Galea S, Tracy M. et al .
Overdose deaths attributed to methadone and heroin in New York City, 1990-1998.
Addiction.
2004;
99
846-854
-
7
Bühringer G, Kröger C, Küfner H, Lieb R, Schütz C, Soyka M, Wittchen H -U.
Substance abuse research network ASAT: allocating substance abuse to patient heterogeneity (in German).
Suchtmed.
2004;
6
7-13
-
8
Davids E, Gastpar M.
Buprenorphine in the treatment of opiod dependence.
Eur Neuropsychopharmacology.
2004;
14
209-216
-
9
Heinemann A, Andresen H, Raschke P.
Methadone-associated mortality among opiate users in Hamburg/Germany 1990-2001 (in German).
Suchtmed.
2005;
7
27-32
-
10
Kagerer S, Backmund M, Walcher S, Soyka M.
Substitution with Buprenorphine and Driving Ability - Results from an experimental study (in German).
Suchtmed.
2002;
4
17-24
-
11
Kintz P.
A new series of 13 buprenorphine-related deaths.
Clin Biochem.
2002;
35
513-516
-
12
Penning R, von Meyer L, Sachs H, Zinka B.
Methadone-associated drug deaths in 2002 and 2003 - data of the Institute of Legal Medicine Munich (in German).
Suchtmed.
2005;
7
19-25
-
13
Pirnay S, Borron S W, Giudicelli C P, Torneau J, Baud F J, Ricordel I.
A critical review of the causes of death among post-mortem toxicological investigations: analysis of 34 buprenorphine-associated and 35 methadone-associated deaths.
Addiction.
2004;
99
978-988
-
14
Robinson G M.
Dukes PD, Robinson BJ, Cooke RR, Mahoney GN. The misuse of buprenorphine and a buprenorphine-naloxone combination in Wellington, New Zealand.
Drug Alcohol Depend.
1993;
33
81-86
-
15
Schifano F, Corkery J, Gilvarry E, Deluca P, Oyefeso A, Ghodse A H.
Buprenorphine mortality, Seizures and prescription in the UK, 1980-2002.
Hum Psychopharmacol Clin Exp.
2005;
20
343-348
-
16
Shah N, Lathrop S L, Landen M G.
Unintentional methadone-related overdose death in New Mexico (USA) and implications for surveillance, 1998-2002.
Addiction.
2005;
100
176-188
-
17
Soyka M, Horak M, Dittert S, Kagerer S.
Less driving impairment on buprenorphine than methadone in drug dependent patients.
J Neuropsychiatry Clin Neurosci.
2001;
13
527-528
-
18
Soyka M, Hock B, Kagerer S, Lehnert R, Limmer C, Kuefner H.
Less Impairment on one portion of adriving-relevant psychomotor battery in buprenorphine-maintained than in methadone-maintained patients: results of a randomized clinical trial.
J Clin Psychopharmacol.
2005;
25
490-493
-
19 Stempel J. Illegal drugs - numbers and facts (in German.) Deutsche Hauptstelle gegen die Suchtgefahren (Ed): Jahrbuch Sucht 2005. Geesthacht; Neuland Verlag 69-82
-
20
Strain E C, Preston K L, Liebson I A, Bigelow G E.
Buprenorphine effects in methadone-maintained volunteers: effects at two hours after methadone.
J Pharmacol Exp Ther.
1995;
261
985-993
-
21
Strain E C, Preston K I, Liebson I A, Bigelow G E.
Buprenorphine effects in methadone-maintained volunteers: effects at two hours after methadone.
J Pharmacol Exp Ther.
1995;
272
628-638
-
22
Vormfelde S V, Poser Z.
Death attributed to Methadone.
Pharmacopsychiatry.
2001;
34
217-222
-
23
Wittchen H -U, Apelt S M, Christl B, Hagenau K A, Groß A, Klotsche J, Soyka M.
The practice of supply in the substitution therapy for opiate addicts (COBRA) (in German).
Suchtmed.
2004;
6
80-87
-
24
Wittchen H -U, Apelt S, Soyka M, Bühringer G, Gastpar M, Backmund M, Gölz J, Kraus M R, Tretter F, Klotsche J, Siegert J, Pittrow D, Soyka M.
Buprenorphine and methadone in the treatment of opioid dependence: methods and design of the COBRA study.
Int J Meth Psychiatric Res.
2005;
14
14-28
Michael Soyka, M.D.
Psychiatric Hospital
University of Munich
Nussbaumstr. 7
80336 Munich
Phone: +89 5160 5324
Fax: +89 5160 5617
Email: Michael.soyka@med.uni-muenchen.de
