A Retrospective Cross-Sectional Study on Methadone Poisoning: A Decade of Insights from Kerman, Iran

Document Type : Original Article

Authors

1 Pistachio Safety Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

2 Pharmaceutics Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran

3 Medicine and Religious Research Center, Kerman University of Medical Sciences, Kerman, Iran

4 Gastroenterology and Hepatology Research Center, Kerman University of Medical Sciences, Kerman, Iran

5 Department of Toxicology and Pharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran

6 Iraqi syndicate of pharmacists, Baghdad, Iraq

7 Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

10.34172/ahj.1678

Abstract

Introduction: Methadone poisoning, involving both syrup and tablet formulations, represents a significant public health concern, particularly in regions where methadone is widely utilized for opioid substitution therapy. Methadone accounted for approximately 16% of pediatric acute poisonings and was the leading cause of drug-related deaths in 2023. This study provides a decade-long retrospective analysis of methadone poisoning cases in Kerman, Iran, with a focus on demographic patterns, clinical outcomes, and risk factors to guide prevention and treatment strategies.
Methods: This retrospective cross-sectional study reviewed medical records of 5,826 methadone poisoning cases, primarily acute but including some chronic cases, admitted to Afzalipour Hospital between 2013 and 2023. Data on demographics, clinical presentations, comorbidities, and outcomes were analyzed using SPSS version 22, with statistical significance set at P < 0.05.
Results: The majority of patients were male (63.5%), with the highest prevalence among individuals aged 19–40 years (45.3%). Notably, 17.7% of cases involved children under six years old, primarily due to accidental ingestion linked to unsafe storage practices. Intentional poisoning accounted for 80.2% of cases, underscoring the role of mental health and socio-economic factors. Co-intoxication with benzodiazepines (9.8%) and alcohol (4.9%) exacerbated toxicity, while 8.8% of cases coincided with COVID-19 infection, compounding respiratory complications. The mortality rate was low at 1.9% (95% CI: 1.6–2.2%), with 63.8% of cases achieving full recovery; and notably, 17.7% of cases involved were children aged under six years old.
Conclusion: The findings, including high co-intoxication risks with benzodiazepines (9.8%) and alcohol (4.9%), highlight the urgent need for targeted interventions, including stricter regulation of methadone distribution, childproof packaging, and public education campaigns to reduce accidental pediatric poisonings. Integrated mental health services are critical to addressing intentional poisoning cases (80.2%), while healthcare providers should remain vigilant about polysubstance use. These strategies can significantly reduce methadone-related morbidity and mortality, especially among vulnerable populations such as children and young adults.

Highlights

Somayyeh Karami-Mohajeri(Google Scholar)(Pubmed) Zohreh Oghabian(Google Scholar)(Pubmed)

Keywords

References

  1. Abrar A, Zafar A, Ahmed N. Pharmacological comprehensive overview of methadone from structure to clinical applications and its abuse with toxicity. Forensic Insights and Health Sciences Bulletin 2024;2(2):40-6.
  2. Madani K, Soltani M, Bagheri F, Karami-Mohajeri S, Mehrpour O, Oghabian Z. An investigation of methadone-related mortalities: a report from southeast of Iran. J Opioid Manag 2025;21(2):181-7. doi:10.5055/jom.0897
  3. Eide D, Muller A, Bukten A, Clausen T. Treatments for Opioid Use Disorder: A Heroin-Assisted Treatment Trial. Available from: https://www.med.uio.no/klinmed/english/research/ projects/hab-evaluation-heroin-assisted-treatment/treatments-for-opioid-use-disorder.pdf.
  4. Ghoreishi SMS, Shahbazi F, Mirtorabi SD, Ghadirzadeh MR, Hashemi Nazari SS. Epidemiological study of mortality rate from alcohol and illicit drug abuse in Iran. J Res Health Sci 2017;17(4):e00395.
  5. Degenhardt L, Webb P, Colledge-Frisby S, Ireland J, Wheeler A, Ottaviano S, et al. Epidemiology of injecting drug use, prevalence of injecting-related harm, and exposure to behavioural and environmental risks among people who inject drugs: a systematic review. Lancet Glob Health 2023;11(5):e659-72. doi:10.1016/s2214-109x(23)00057-8
  6. Alinejad S, Zamani N, Abdollahi M, Mehrpour O. A narrative review of acute adult poisoning in Iran. Iran J Med Sci 2017;42(4):327-46.
  7. Oghabian Z, Barghi F, Ahmadianranjbar H, Mandegary A, Shojaeepour S, Khazaeli P, et al. Investigating the relationship between the severity of oxidative stress with the severity of toxicity and clinical response in methadone-poisoned subjects. J Opioid Manag 2025;21(2):171-80. doi:10.5055/ jom.0912
  8. Strang J, Volkow ND, Degenhardt L, Hickman M, Johnson K, Koob GF, et al. Opioid use disorder. Nat Rev Dis Primers 2020;6(1):3. doi:10.1038/s41572-019-0137-5
  9. Zamani S, Farnia M, Tavakoli S, Gholizadeh M, Nazari M, Seddighi AA, et al. A qualitative inquiry into methadone maintenance treatment for opioid-dependent prisoners in Tehran, Iran. Int J Drug Policy 2010;21(3):167-72. doi:10.1016/j.drugpo.2009.03.001
  10. Noori R, Narenjiha H, Aghabakhshi H, Habibi G, Khoshkrood Mansoori B. Methadone maintenance therapy outcomes in Iran. Subst Use Misuse 2012;47(7):767-73. doi:10.3109/108 26084.2010.517726
  11. Moradi G, Farnia M, Shokoohi M, Shahbazi M, Moazen B, Rahmani K. Methadone maintenance treatment program in prisons from the perspective of medical and non-medical prison staff: a qualitative study in Iran. Int J Health Policy Manag 2015;4(9):583-9. doi:10.15171/ijhpm.2015.60
  12. Jabbehdari S, Farnaghi F, Shariatmadari SF, Jafari N, Mehregan FF, Karimzadeh P. Accidental children poisoning with methadone: an Iranian pediatric sectional study. Iran J Child Neurol 2013;7(4):32-4.
  13. Bazmamoun H, Fayyazi A, Khajeh A, Sabzehei MK, Khezrian F. A study of methadone-poisoned children referred to Hamadan’s Besat hospital/Iran. Iran J Child Neurol 2014;8(2):34-7.
  14. Jain H, Jain J, Odat RM, Goyal A, Yadav R. FDA announces recall of over 300 000 arrow radial artery catheterization kits: a call for action - an editorial. Ann Med Surg (Lond) 2024;86(9):4952-3. doi:10.1097/ms9.0000000000002364
  15. Kaufman DE, Kennalley AL, McCall KL, Piper BJ. Examination of methadone involved overdoses during the COVID-19 pandemic. Forensic Sci Int 2023;344:111579. doi:10.1016/j. forsciint.2023.111579
  16. Taheri F, Yaraghi A, Sabzghabaee AM, Moudi M, Eizadi- Mood N, Gheshlaghi F, et al. Methadone toxicity in a poisoning referral center. J Res Pharm Pract 2013;2(3):130-4. doi:10.4103/2279-042x.122387
  17. Caplehorn JR, Drummer OH. Fatal methadone toxicity: signs and circumstances, and the role of benzodiazepines. Aust N Z J Public Health 2002;26(4):358-62. doi:10.1111/j.1467- 842x.2002.tb00185.x
  18. Alinejad S, Kazemi T, Zamani N, Hoffman RS, Mehrpour O. A systematic review of the cardiotoxicity of methadone. EXCLI J 2015;14:577-600. doi:10.17179/excli2015-553
  19. Durand L, O’Driscoll D, Boland F, Keenan E, Ryan BK, Barry J, et al. Do interruptions to the continuity of methadone maintenance treatment in specialist addiction settings increase the risk of drug-related poisoning deaths? A retrospective cohort study. Addiction 2020;115(10):1867-77. doi:10.1111/ add.15004
  20. Karch SB, Stephens BG. Toxicology and pathology of deaths related to methadone: retrospective review. West J Med 2000;172(1):11-4. doi:10.1136/ewjm.172.1.11
  21. Hosseininejad SM, Sharifpour A, Akbarnezhad F, Veisi H, Zakariaei Z. The clinico-epidemiological, diagnostic, and therapeutic aspects of methadone poisoning: a registry-based clinical study. Ann Med Surg (Lond) 2024;86(12):7037-41. doi:10.1097/ms9.0000000000002709
  22. Torrents R, Glaizal M, Sinno-Tellier S, Richard N, Nisse P, Vodovar D, et al. Methadone poisonings: a seven-year retrospective study of the French poison center network focusing on suicide attempts vs. misuses. Fundam Clin Pharmacol 2020;34(2):290-5. doi:10.1111/fcp.12506
  23. Moradzadeh M, Karamouzian M, Najafizadeh S, Yazdi- Feyzabadi V, Haghdoost AA. International Journal of Health Policy and Management (IJHPM): a decade of advancing knowledge and influencing global health policy (2013-2023). Int J Health Policy Manag 2023;12:8124. doi:10.34172/ ijhpm.2023.8124
  24. Mehrpour O, Sharifi M, Zamani N. Tramadol poisoning. In: Andreazza AC, Scola G, eds. Toxicology Studies - Cells, Drugs and Environment. IntechOpen; 2015. p. 101-26. doi:10.5772/60439
  25. Fishman M, Wenzel K, Scodes J, Pavlicova M, Lee JD, Rotrosen J, et al. Young adults have worse outcomes than older adults: secondary analysis of a medication trial for opioid use disorder. J Adolesc Health 2020;67(6):778-85. doi:10.1016/j. jadohealth.2020.07.038
  26. Hoopsick RA, Homish GG, Leonard KE. Differences in opioid overdose mortality rates among middle-aged adults by race/ethnicity and sex, 1999-2018. Public Health Rep 2021;136(2):192-200. doi:10.1177/0033354920968806
  27. Viera A, Bromberg DJ, Whittaker S, Refsland BM, Stanojlović M, Nyhan K, et al. Adherence to and retention in medications for opioid use disorder among adolescents and young adults. Epidemiol Rev 2020;42(1):41-56. doi:10.1093/epirev/mxaa001
  28. Fariabi R, Raesi R, Sardu EG, Movahed E, Salarpour A, Daneshi S. Symptoms, consequences, and action across of methadone poisoning in children referred to a hospital in the south of Iran. Open Public Health J 2024;17(1):e18749445271239. doi:10. 2174/0118749445271239231121052019
  29. Farnaghi F, Gholami N, Hassanian-Moghaddam H, McDonald R, Zamanzadeh R, Zamani N. Unintentional buprenorphine and methadone poisoning in children: a matched observational study. Clin Toxicol (Phila) 2021;59(8):727-33. doi:10.1080/1 5563650.2020.1869755
  30. Narzikulov RA, Lodyagin AN, Sinenchenko AG, Batotsyrenov CB, Rustamov BR, Lisitsa IA, et al. A clinical case of acute methadone poisoning in an infant child. Toxicol Rev 2023;31(4):237-42. doi:10.47470/0869-7922-2023-31-4- 237-242
  31. Rashidan M, Zolfaghari P, Ghasemian Aghmashadi M, Yahyaei E, Sohrabi MB. Case report: unusual infant methadone poisoning. J Clin Images Med Case Rep 2022;3(1):1613. doi: https://doi.org/10.52768/2766-7820/1613
  32. Lee C, Wanson A, Frangou S, Chong D, Halpape K. Opioid toxicity due to CNS depressant polypharmacy: a case report. Ment Health Clin 2021;11(2):70-4. doi:10.9740/ mhc.2021.03.070
  33. White JM, Irvine RJ. Mechanisms of fatal opioid overdose. Addiction 1999;94(7):961-72. doi:10.1046/j.1360- 0443.1999.9479612.x
  34. Zhong BL, Xu YM, Xie WX, Lu J, Yu WB, Yan J. Alcohol drinking in Chinese methadone-maintained clients: a self-medication for depression and anxiety? J Addict Med 2019;13(4):314-21. doi:10.1097/adm.0000000000000500
  35. Shah R, Kuo YF, Baillargeon J, Raji MA. The impact of long-term opioid use on the risk and severity of COVID-19. J Opioid Manag 2020;16(6):401-4. doi:10.5055/jom.2020.0597
  36. Schimmel J, Manini AF. Opioid use disorder and COVID-19: biological plausibility for worsened outcomes. Subst Use Misuse 2020;55(11):1900-1. doi:10.1080/10826084.2020.1 791184
  37. Volkow ND. Collision of the COVID-19 and addiction epidemics. Ann Intern Med 2020;173(1):61-2. doi:10.7326/ m20-1212
  38. Hickman M, Steer C, Tilling K, Lim AG, Marsden J, Millar T, et al. The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom. Addiction 2018;113(8):1461-76. doi:10.1111/add.14188
  39. Calcaterra SL, Bach P, Chadi A, Chadi N, Kimmel SD, Morford KL, et al. Methadone matters: what the United States can learn from the global effort to treat opioid addiction. J Gen Intern Med 2019;34(6):1039-42. doi:10.1007/s11606-018-4801-3
  40. Ghaemi NP, Nobari M, Salehzadeh Mohamadpouri M, M, Ghanipourbadelbuu S. Evaluation of methadone poisoning, clinical manifestations, and laboratory findings in hospitalized children at shahid motahari hospital, urmia, during 2019– 2024. Studies in Medical Sciences 2025;36(2)143-151.
  41. Budnitz DS, Lovegrove MC, Crosby AE. Emergency department visits for overdoses of acetaminophen-containing products. Am J Prev Med 2011;40(6):585-92. doi:10.1016/j. amepre.2011.02.026
Addiction & Health
Volume 18
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