Methadone is a factor in many Dublin deaths linked to drugs

A pioneering study of the mortality risks of methadone has raised concern about the number of deaths in Dublin city in which the drug is implicated.

The study also discloses that benzodiazepines (tranquillisers) were implicated in the largest category of the drug-related deaths investigated by the Dublin City Coroner last year.

Of the 108 deaths related to drugs or alcohol investigated by the coroner, Dr Brian Farrell, in 1998, benzodiazepines were implicated in 48 cases (69 per cent), while cases in which methadone was implicated were the second-largest category with 37 deaths (53 per cent).

Heroin was implicated in 36 deaths (51 per cent), and 28 deaths were primarily alcohol-related.

The coroner's office data were analysed by Mr Ray Byrne, a former residential youth worker with Father Peter McVerry's Arrupe Society for homeless young people, in pursuit of a primary degree in social care.

He found that the characteristics of drug-related deaths in Dublin correspond to those shown in international studies. The vast majority of cases (77) were young men, and polydrug misuse accounted for most deaths, of which alcohol and benzodiaze pines were the most commonly misused, with heroin and/or methadone.

Last weekend the national GP co-ordinator, Dr Ide Delargy, urged the Department of Health and the Medical Council to declare war on the irresponsible prescribing of tranquillisers by general practitioners to patients recovering from drug addiction.

Such drugs had to be used with extreme caution where drug addicts were concerned, she said, because of the "enormous potential" for abuse and because they could destabilise patients on methadone. Mr Byrne said yesterday that two distinct findings emerge from his analysis of the 1998 coroner's office data.

First, benzodiazepines were implicated in the largest category of deaths and, second, people who took methadone in Dublin in 1998 were apparently at least twice as likely to have methadone implicated in their deaths as those who took heroin would have heroin implicated in their deaths.

After reviewing current international research on methadone and drug-related deaths, he had concluded that, while methadone was apparently the most effective and most evaluated form of treatment for heroin addiction, concern remained about eventual detoxification.

Admission criteria, dosage, dispensing policy, clinical orientation and the provision of therapeutic support services were all factors which contributed to the overall quality of care provided, he stressed.

He agreed with the view expressed in some international research reports that badly delivered methadone treatment might be substantially worse than badly delivered treatment alternatives.

He said the risk of death from misusing many different drugs must be made clear to those undergoing drug treatment. Detection, through urinanalysis, of benzodiazepines and/or alcohol, should be acted on immediately.

"The danger to society of prescribing beyond therapeutic levels demands strict monitoring," he said.

While the value of methadone as a treatment for heroin addiction was established, its dangers were obvious. The success of initiatives to curtail the availability of methadone on the streets had to be evaluated and, if necessary, further measures taken.

Mr Byrne plans to carry out further research into drug-related deaths.

He will also study the extent of the benzodiazepines problem in the capital, including the extent of their prescription and the amount of street-diverted benzodiazepines being consumed.