Abstract: Methadone continues to be a widely used maintenance therapy for opiate dependence. However, methadone-related deaths have been reported frequently for over 4 decades now. Anoxic brain injury with pulmonary edema secondary to respiratory depression is the recognized mechanism of methadone death, although pathological intracranial findings are rarely described in methadone deaths. A selective area of brain injury has never been reported with methadone use. We present a case of a 23-year-old man who had acute necrosis of the bilateral globi pallidi in the brain and systemic rhabdomyolysis after ingesting methadone and nasally insufflating alprazolam. We also present a review of the literature on deaths following opioid use and associated brain injury.
From the *Department of Pathology and Laboratory Medicine and †Waisman Center, University of Wisconsin, Madison, WI.
Manuscript received May 11, 2011; accepted September 2, 2011.
R.F.C. and R.M. contributed equally to this study.
The authors report no conflicts of interest.
Reprints: Robert F. Corliss, MD, Department of Pathology and Laboratory Medicine, 600 Highland Ave, University of Wisconsin, Madison, WI 53792. E-mail: RCorliss@uwhealth.org.