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Conversations with Iranian patients after their recovery from methadone overdoses

Opioid-dependent patients recovering from methadone overdose

Location: Loghman Hakim Hospital Tehran, Iran

Date: September 2021

Patient characteristics:

Demographic variables n = 18 patients
Age, median [IQR] 35 [30 to 42] years
 Not declared5%
Daily methadone use (mg) 25 [15 to 75]
Methadone overdose (mg) 100 [55 to124]
Pure methadone toxicity 78%

1. Number of previous overdoses:

56% of patients reported a previous opioid overdose. Overdose number was 1, 2, 3, and >5 times in 6%, 11%, 11%, and 6% of patients. Three patients did not respond; one could not recall.

2. Reported symptoms after receiving naloxone:

One-third of the patients felt fine and did not report any complications. The other patient reported feeling unwell during the naloxone infusion, including: muscle cramps (33%), sweating (33%), tremor (33%), confusion (28%), yawning (28%), nausea and vomiting (22%), fast breathing rate (22%), fast heart rate (22%),  rhinorrhoea (17%), tearing (17%), restlessness (17%), diarrhoea (11%), breathlessness (11%) and allergic reactions (6%).

3. Cause of overdose

This question was asked to better understand how the dependent patients became overdosed. A few patients had more than a reason. Euphoria was the most common reason of overdose (44%). 28% reported family or work conflicts, 11% cases due to self-harm, 11% in miscalculating the dose, 11% to reduce anxiety and improve mood, and 6% to increase sexual desire. One patient declined to answer.

4. Suggested improvements while receiving hospital care

28% of cases requested a better drug service during hospitalization to avoid withdrawal. 6% requested their methadone dose be reduced, 6% wanted to quit methadone, 6% requested family counselling and 6% a rapid discharge from hospital.

5. Regular methadone use, with supervision

50% of patients received methadone under the supervision of an MMT clinic, while 39% purchased methadone on the black market. One patient regularly used other opioids (not methadone), while one did not reply to this question.

6. Knowledge and interest in buprenorphine therapy

The majority (72%) of patients had not heard about buprenorphine treatment.  Three of 4 patients who had heard about buprenorphine treatment were interested in trying maintenance treatment with this medicine. None had heard about the use of buprenorphine for reversing methadone overdoses

7. Witnessed overdoses amongst others

44% of patients had witnessed at least one overdose, the majority of whom were friends (75%). Half of the witnessed overdoses had led to the person’s death.

8. Recommendations about preventing methadone overdoses

Almost two-third had no recommendation. Others suggested training on problem solving for prisoners (two were prisoners; 29%). Individuals suggested reducing the methadone dose, substitution with other drugs, psychotherapy, awareness raising including drug interactions and a combination of above.

9. Final comments

This was linked with questions 4 about their care while in hospital. Two patients recommended giving warning messages to the community and public education.