The effect of the postmortem interval on the redistribution of drugs: a comparison of mortuary admission and autopsy blood specimens.

Filed under: Methadone Clinics

Forensic Sci Med Pathol. 2012 May 22;
Gerostamoulos D, Beyer J, Staikos V, Tayler P, Woodford N, Drummer OH

Postmortem redistribution (PMR) is an accepted toxicological phenomenon that may affect the interpretation of postmortem blood concentrations. The extent of PMR is not well understood for some drugs. This report describes the PMR of selected substances resulting from the analysis of 149 cases comparing blood specimens taken at admission of the deceased to the mortuary and then at autopsy. Blood was collected in preserved tubes containing 1 % sodium fluoride/potassium oxalate. All cases were subject to a full autopsy and blood extracts were analyzed using a targeted screen by LC-MS/MS. 30 drug or drug metabolites that were detected with an incidence of 6 or more were included in this study. The pre-autopsy interval ranged from 0.5 to 164 h (6.4 days) with an average of 64 h for the cases analyzed. The increase in drug concentration from mortuary admission to autopsy ranged from 30 % for drugs such as citalopram, mirtazapine, and sertraline to 300 % for doxylamine. Only 7 drugs of the 30 studied showed increases of greater than 20 % when comparing autopsy to mortuary admission blood irrespective of the length of the postmortem interval. Drugs including methadone, EDDP, fluoxetine, mirtazapine, and sertraline all showed statistically significant increases during the pre-autopsy interval (p < 0.05) while 6-acetylmorphine, 9-hydroxy-risperidone, and caffeine showed significant decreases (p < 0.05) from mortuary admission to autopsy. While femoral blood is thought to reduce PMR, this data shows that for some drugs significant redistribution can occur even when taking peripheral specimens irrespective of the delay in the postmortem interval. Source

Perioperative role of methadone in adolescent patients.

Filed under: Methadone Clinics

Anesthesiology. 2012 Jun; 116(6): 1400-1
Gurnaney H, Kraemer FW, Ganesh A

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Erectile Dysfunction Among Male Heroin Addicts Receiving Methadone Maintenance Treatment in Guangdong, China.

Filed under: Methadone Clinics

J Addict Med. 2012 May 18;
Chen W, Li X, Li X, Ling L, Xia Y, Chen J, He Q

OBJECTIVES:: Erectile dysfunction (ED) is common among methadone-maintained patients and reduces their quality of life. This study reports the prevalence of ED among male heroin addicts receiving methadone maintenance treatment (MMT) in China and describes factors that may contribute to ED. METHODS:: Seventy-four male heroin addicts enrolled in 4 MMT clinics for the first time were interviewed about general baseline characteristics. Scales for assessing erectile function and psychological disorders were completed monthly. Blood was drawn for serum hormone-level measurement at the baseline and at a 3-month follow-up. Daily methadone dosages were recorded by physicians. RESULTS:: Erectile dysfunction was reported in 75.7%, 88.7%, 80.8%, and 80.9% of the patients at the baseline, 1-, 2-, and 3-month follow-ups, respectively. No significant differences in the prevalence of ED were found during the course of treatment. About two-thirds of the patients who had ED at the 3-month follow-up had had the condition while on heroin. The delayed erectile function was significantly associated with duration of treatment (odd ratio, OR1-month vs baseline = 1.86, P = 0.021; OR2-month vs baseline = 1.67, P = 0.066) and methadone dosage (OR = 1.02, P = 0.038). Ongoing substance, serum hormone levels, and psychological disorders were not associated with ED. CONCLUSIONS:: The prevalence of ED among male methadone-maintained patients in China is very high and individuals with altered erectile function while on heroin represent a high-risk group for the development of ED upon initiation of MMT. In the setting of delayed erectile function after receiving methadone, a trial of dosage reduction and symptomatic treatments may be a reasonable initial approach.
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Preconcentration of trace amounts of methadone in human urine, plasma, saliva and sweat samples using dispersive liquid-liquid microextraction followed by high performance liquid chromatography.

Filed under: Methadone Clinics

Talanta. 2012 May 30; 94: 116-22
Ranjbari E, Golbabanezhad-Azizi AA, Hadjmohammadi MR

A simple, rapid and efficient method for the preconcentration of methadone was developed using dispersive liquid-liquid microextraction (DLLME) followed by high performance liquid chromatography with ultra violet detection (HPLC-UV). The extraction method is based on the fast injection of a mixture of extracting and disperser solvents into the aqueous solution to form a cloudy ternary component solvent (aqueous solution:extracting solvent:disperser solvent) system. The extraction parameters such as nature and volume of extracting and disperser solvents, pH of sample, and extraction time were studied for optimization. Under the optimal conditions (extracting solvent: chloroform, 250?L; disperser solvent: methanol, 2.5mL and pH of sample: 10.0) a linear calibration curve was obtained in the range of 0.5-5000ngmL(-1) with r(2)=0.9995. To demonstrate analytical performance, figures of merits of the proposed method in four different biological matrices (urine, plasma, saliva and sweat) spiked with methadone were investigated. The limits of detection and quantification in these matrices were ranged from 4.90 to 24.85ngmL(-1) and 16.32 to 82.75ngmL(-1), respectively. The extraction recoveries were above 97% and the preconcentration factors of methadone in distilled water, urine, plasma, saliva, and sweat samples were 196.52, 10.03, 9.93, 1.97 and 1.99, respectively. While the precision for inter-day was ?6.43 (n=5), it was ?2.26 (n=5) for intra-day assay. Finally, the method was successfully applied in the determination of methadone in the human urine, plasma, saliva and sweat samples.
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Dispatches part 6: Inside Lynn's methadone clinic

Filed under: Methadone Clinics

One of them, a 29-year-old Saugus High School graduate and daughter of a police officer, credits the methadone treatment she receives each day with not only helping her stay off heroin, but also with saving her life. “I have to say that without this …
Read more on Daily Item

Pols fear drug clinic 'menace'

Filed under: Methadone Clinics

By Dave Wedge A proposed methadone clinic that would be the third in an industrial city block is closer to reality, despite vigilant opposition from lawmakers who fear it will “oversaturate” the neighborhood with dopesick junkies.
Read more on Boston Herald

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