Fw: Methadone and buprenorphine related deaths rare in Paris study.

Preston Peet ptpeet at nyc.rr.com
Tue Aug 31 20:49:04 EDT 2004


----- Original Message ----- 
From: "Andrew Byrne" <ajbyrne at ozemail.com.au>
To: "Andrew Byrne" <ajbyrne at ozemail.com.au>
Sent: Tuesday, August 31, 2004 7:15 PM
Subject: Methadone and buprenorphine related deaths rare in Paris study.


> A critical review of the causes of death among post-mortem toxicological
> investigations: analysis of 34 buprenorphine-associated and 35
> methadone-associated deaths. Pirnay S, Borron SW, Giudicelli CP,
> Tourneau J, Baud FJ, Ricordel I. Addiction (2004) 99: 978–988
>
> Dear Colleagues,
>
> This adds to the modest amount of published research on the major French
> ‘experiment’ with buprenorphine, starting in 1996. To add another
> variable, two years after the release of unrestricted buprenorphine
> prescription, methadone treatment also became available, albeit in a
> more structured manner.
>
> This is a detailed report of 60 consecutive overdose deaths in Paris
> over a 5 year period from 1997 in which buprenorphine (34), methadone
> (35) or both (9) were found in the post-mortem toxicology. An exhaustive
> investigation of each case classified the relative contribution (if any)
> of the two drugs towards the death. Unfortunately as a retrospective
> study, the authors were not able to determine the subjects’ treatment
> status.
>
> Despite buprenorphine being prescribed at a rate about 8 times that of
> methadone in France, the numbers of deaths most likely attributable to
> each drug were about the same (12 versus 14). In these deaths, as in
> other reports, an average of about 4 other drugs (excluding nicotine)
> was found, and in one case there were 13 additional drugs! Alcohol,
> benzodiazepines and other opioids were the most common, sometimes in
> very high concentrations. Heroin (morphine) was also found in toxic
> levels in 5 buprenorphine cases and 6 methadone subjects. Other cases
> either had clear alternative causes of death (eg. homicide, suicide,
> burns, carbon monoxide, etc) or else the cause of death could not be
> determined (12 cases).
>
> In 1995 there were ~500 opioid overdose deaths in France. This annual
> rate had reportedly dropped to 100 by 1999. During this period,
> Australian overdose deaths increased relentlessly. Due to its restricted
> status, methadone in France is generally reserved for the more difficult
> cases. The authors state: “From the beginning, methadone appears to have
> had the image in France of ‘a drug of last resort’ for the most
> desperate cases”. Hence the higher per-patient death rates are probably
> a combination of the drug’s higher toxicity as well as it being used in
> higher risk circumstances clinically in France.
>
> When compared, the figure of 60 deaths in a five year period is
> reassuringly low. This is in stark contrast to 900 methadone overdose
> deaths reported in New York City over a 9 year period (Bryant and
> colleagues in last month’s Addiction). The difference is so great that
> it would appear France is doing something right while America is doing
> something wrong. Treatment access is doubtless a factor, and one can
> only speculate about the contribution of so-called US zero tolerance or
> ‘harm maximization’ policies as being related to the marked differences
> in outcomes in what is essentially the same social phenomenon in two
> very large, sometimes very tough cities on opposite sides of the
> Atlantic. New York’s Rockefeller laws, with long mandatory jail terms
> for relatively minor drug offences, seem not to have had the desired
> effect, yet it seems they are politically very hard to reverse. It is
> good to know that the US has finally introduced buprenorphine treatment
> but sad to learn that, like methadone, most of the people who need it
> either cannot afford it or it is simply find that it is not available in
> their neighbourhood.
>
> Comments by Andrew Byrne ..
>
> Pirnay S, Borron SW, Giudicelli CP, Tourneau J, Baud FJ, Ricordel I. A
> critical review of the causes of death among post-mortem toxicological
> investigations: analysis of 34 buprenorphine-associated and 35
> methadone-associated deaths. Addiction (2004) 99: 978–988
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
> Dr Andrew Byrne MB BS (SYD) FAChAM (RACP)
> Dependency Medicine,
> 75 Redfern Street, Redfern,
> New South Wales, 2016, Australia
> Email - ajbyrneATozemail.com.au
> Tel (61 - 2) 9319 5524 Fax 9318 0631
> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
> My grandfather Harry Gracie's letters from 1924 trip to Mayo Clinic:
> http://bpresent.com/harry/code/mayo.htm
> For 'opera reviews' or 'dependency briefings' send email request.
> Author of: "Addict in the Family" and
> "Methadone in the Treatment of Narcotic Addiction"
> http://www.csdp.org/addict/
> http://www.drugpolicy.org/library/byrne_contents_methadone2.cfm
> Photo (ugly):
> http://www.opiateaddictionrx.info/aboutus/aboutus06.html#
>
>
>
>




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