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Methadone-Related Overdose Deaths in Rural Virginia: 1997 to 2003

Wunsch, Martha J. MD; Nuzzo, Paul A. MA; Behonick, George PhD; Massello, William MD; Walsh, Sharon L. PhD

doi: 10.1097/ADM.0b013e31828c4d33
Original Research

Aim: Nonmedical use of prescription drugs and poisoning overdose deaths related to prescription drugs are increasing. This article presents an in-depth description of decedents from rural southwestern Virginia, where methadone was identified on toxicology.

Methods: Cases for this study were derived from a population-based review of 893 drug-related deaths occurring from 1997 to 2003 in the Office of the Medical Examiner, Western District of Virginia.

Results: Deaths in which methadone was identified on toxicology in rural southwestern Virginia increased rapidly over the 7-year study period. In the majority of cases, the cause of death was polydrug toxicity, and the manner of death was classified as accident. A majority of decedents did not have prescriptions for drugs identified on toxicology. The mean concentration of methadone for all cases was 495 mg/L, and there was no significant difference between concentrations where methadone was found alone or in combination with other drugs. There was a significant difference in methadone concentrations for those with prescriptions (645 mg/L vs 449 mg/L) when compared with those without.

Conclusions: Cases where methadone was identified on toxicology increased significantly over the time studied. Efforts to prevent these deaths include the use of State Prescription Monitoring Programs, Universal Precautions, and Guidelines from the Federation of State Medical Boards.

From the Kaiser Permanente (MJW), Union City, CA; Department of Behavioral Sciences (PAN, SLW), Center on Drug and Alcohol Research, University of Kentucky, Lexington; AIT Laboratories (GB), Indianapolis, IN; and North Dakota State Forensic Examiner (WM), Bismarck.

Send correspondence and reprint requests to Martha J. Wunsch, MD, Medical Director CDRP, 3555 Whipple Road, Building C, Union City, CA 94587. e-mail:

This study was sponsored by National Institute on Drug Abuse DA019047 (M.J.W.).

The authors declare no conflicts of interest.

Received September 16, 2009

Accepted February 07, 2013

© 2013 American Society of Addiction Medicine