# Presentation: 110154

## RADARS® SystemMethadone Study

- Richard C. Dart, MD, PhD
- Director, RADARS® System, Denver Health
- Professor, University of Colorado School of Medicine

## Organization of RADARS® System

- Organization of RADARS® System

- The RADARS System has at least one system active in 854 of the 930 3 digit zip codes in the United States.
- 792 of 854 (93%) had evidence of drug abuse activity.

## Methadone Overview

- RADARS® System

## Abuse/Misuse/Diversion Rates per 1,000 URDD

- Drug Diversion

- Key Informant

- Opioid Treatment Program

- Poison Center

## Who Abuses Methadone?

- Rosenblum, et al. Drug Alc Depend 2007;90:64-71.

## Methadone:  Top 5 Hot Spots

- Per 1,000 Persons filling a Prescription

## Methadone Mortality Data

- RADARS® System

## RADARS System

- Poison center “associated medical outcome”
- Data collected from 2003 – 2006
- 11 of 60 US centers (18%) in 1st quarter 2003
- 43 of 60 US centers (72%) in 4th quarter 2006
- 132 deaths associated with methadone
- Deaths underestimated
- Center participatation is voluntary
- Poison centers not always contacted

## Death Rates per 1,000 URDDReported to RADARS Poison Centers

## Methadone Deaths by Age Group2003 – 2006

## Opioid Rx Pediatric ExposuresRADARS Poison Centers 2003 - 2006

|  | Buprenorphine
(n=176) | Hydrocodone
(n=6,003) | Methadone
(n=415) |
| --- | --- | --- | --- |
| Age Mean years (SD) | 2.1 (0.9) | 2.3 (1.2) | 2.0 (1.1) |
| Male N (%)* | 99 (56.3) | 3,232 (53.9) | 232 (56.7) |
| Site N (%) |  |  |  |
|  Own Home | 169 (96.0) | 5,581 (93.0) | 372 (89.6) |
|  Other Home | 3 (1.7) | 335 (5.6) | 27 (6.5) |

## Methadone Pediatric Deaths 

| Age
(mo) | M/F | Form | Other drugs available | Circumstances |
| --- | --- | --- | --- | --- |
| 9 | M | Tablet | None | Patient found “not breathing”. Mother treated with methadone.  |
| 20 | M | Liquid | Amitryptiline
Anticonvulsant
Benzodiazepine | Patient arrived with vital signs. EKG without TCA effect. Urine screen positive for opiates. Bilateral cerebellar infarcts and hemorrhages found.  |

## Reported Source of Methadone Methadone Deaths, 2003 – 2006

## Methadone FormulationsMethadone Deaths, 2003 – 2006

## Exposure ReasonMethadone Deaths, 2003 – 2006

## Involvement of Multiple DrugsMethadone Deaths, 2003 – 2006

## Summary

- All RADARS System indicate abuse of methadone occurs.
- Methadone has the highest rate of deaths by patients filling a prescription
- Deaths do not appear to be rising
- Most patients “found down”

## Summary

- Age groups 0-5 yrs and all adults involved
- Liquid and wafer preparations are involved, but are unusual
- Multiple drugs are usually involved
- There is evidence of abuse in many cases.
- Next steps
- Near miss approach

## Primary Source of Prescription Drug Diversion

## Primary Source ofPrescription Opioids

## Four Views on Prescription Drug Abuse

** ****Acute incident - calling for care advice **
** ****All ages and geographic regions**

** ****Dependent or addicted patients **
** ****Health care provider perspective **

** ****Drug Diversion**
** ****Criminal justice perspective**

-  **Dependent or addicted patients **
** ****Patient’s perspective**

## Methadone Death DetailsExample

- DR Calling 21 YO Male Partying ( etoh - methadone) - Got ride home 3 AM (Sunday)
- Girlfriend fell asleep 6 AM - girl woke up 1 PM - time frame between 1 PM - 4:30 PM-vague ? frothy & blue
- CPR - medic's arrived on scene (4:30 PM) blue no pulse- intubated gave atropine- Epi brought back rhythm - PH 6.76 CO2-85 O2-76
- UDS - ETOH negative 16 hrs later ( REC machinery may not have been set low enough to detect at time point- or may....

## RADARS System College Survey Abuse or Misuse by Endorsers of Abuse

**18%**