The causes of hospital mortality in methadone associated poisonings: analysis of the data from the Kyiv toxicological center for 2005–2019

Abstract

Scientific interest in poisoning by synthetic opioids, in particular Methadone, is due to a significant increase in their number in Kyiv over the past 15 years and fatal consequences. The Aim of the Research. Is to identify the causes of fatal poisoning associated with methadone and to determine measures to prevent them. Materials and Methods. A retrospective analysis of medical data of 1340 patients with Methadone poisoning who were treated at the Toxicology Center in Kyiv in the period 2005–2019; including 38 fatalities cases. Results. The share of drug poisonings registered at the Kyiv Toxicology Center has increased from 15% to 42% over the past 30 years. The top five drugs and psychotropic substances in 2019 were Benzodiazepines, Methadone, Barbiturates, Amphetamines, and Marijuana. The number of Methadone poisonings in 2005–2014 increased 150 times. The main cause of poisoning is the use of illegal Methadone. There is a direct relationship between the growth of hospital mortality and the appearance of combined poisonings: Methadone-Ethanol (r = 0,79); Methadone-Ethanol-Amphetamines (r = 0,69); Methadone-Ethanol-Benzodiazepines (r = 0,61); Methadone-Ethanol-Cocaine (r = 0,43). According to the results of forensic medical studies of 38 patients who died as a result of Methadone poisoning, the following were identified: toxic hepato-nephropathy – 12 cases (31,57%); long-term soft tissue compression syndrome – 10 (26,31%); acute kidney damage – 4 (10,52%); aspiration of gastric contents – 7 (18,42%); apallic syndrome – 4 (10,52%). The direct effect of polymorbidity on mortality has been confirmed, which justifies the need for a personalized approach to intensive care. Conclusions. Today in Ukraine, combined illegal methadone poisoning is the most common type of drug poisoning, which has a severe course, high mortality, and requires long and complex treatment. Key Words: acute poisoning, methadone, combined poisoning, mortality.