Are “Fatal” Opioid Concentrations Really Fatal?

When medical examiners conclude that the cause of death is opioid overdose, they rely primarily on the opioid blood concentration level in comparison to a pre-determined “fatal” cutoff. This approach is potentially inaccurate; the fatal ranges used are wide, and they overlap significantly with the ranges for living opioid users.Numerous fatal ranges have been quoted for methadone:220-3040 μg/L (mean, 1371),320-2980 μg/L (mean, 772), and600-3000 μg/L. Baselt’sDisposition of Toxic Drugs and Chemicals in Man found fatal levels of 400-1800 μg/L (mean, 1000) and 60-3100μg/L (mean, 280). These ranges are much too broad for determining cause of death because they include ranges experienced by many living users.Worm et al. (1992) compared the methadone blood concentration levels of individuals who reportedly died from methadone toxicity while in treatment, out of treatment, or living: 30 –1240μg/L (mean, 470), 30–990μg/L (mean, 270), and 30–560 μg/L (mean, 140). While the mean was lower for living methadone users, the ranges overlapped substantially.Loimer and Schmid (1992) found a blood concentration range of 20 –1308 μg/L (mean, 451.4) after a moderate oral methadone dose in 104 living addicts.Gagajewski and Apple (2003) found blood concentration ranges in deaths where methadone was an incidental finding of 180-3000 μg/L (mean, 1100 μg/L). In contrast,by Milroy and Forrest (2000) found the mean methadone range for those who reportedly died from methadone t...
Source: Cato-at-liberty - Category: American Health Authors: Source Type: blogs