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Methadone-Related Delirium

Prevalence, Causes, and Outcomes

Westermeyer, Joseph, MD, MPH, PhD*†; Thuras, Paul, PhD*†; Yoon, Gihyun, MD‡§; Kolla, Bhanu Prakash, MD, MRCPsych; Batres-y-Carr, Tegan, BS; Dimitropoulos, Erica, PharmD*

The Journal of Nervous and Mental Disease: May 2019 - Volume 207 - Issue 5 - p 371–377
doi: 10.1097/NMD.0000000000000978
Original Articles

Goals consist of determining 5-year prevalence and recurrence of methadone-related delirium (MRD), along with causes, treatments, and outcomes. Sample comprised 81 patients in methadone maintenance treatment. Criteria for MRD encompassed delirium with high methadone serum levels plus alleviation of delirium upon lowering methadone serum levels. MRD occurred in 14 cases who had 25 episodes. MRD precipitants included physician prescribing (i.e., excessive methadone or medications slowing methadone metabolism), drug misuse, and renal-fluid alterations. Social affiliation (housing with family, intimate partner) reduced MRD; employment increased MRD. Recovery occurred in 23/25 episodes of MRD; two episodes progressed to dementia. Obtaining serum methadone levels fostered prompt recognition.

*Minneapolis VA Medical Center;

Department of Psychiatry, Health Sciences Center, University of Minnesota, Minneapolis, Minnesota;

West Haven VA Medical Center, West Haven;

§Department of Psychiatry, Yale University, New Haven, Connecticut; and

Mayo Clinic School of Medicine, Rochester, Minnesota.

Send reprint requests to Joseph Westermeyer, MD, MPH, PhD, 1935 Summit Ave, Saint Paul, MN 55105. E-mail:

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