Accidental methadone poisoning in children: a call for Canadian research action

Predictive Factors of Treatment Outcomes for Hospital Care in Children with Acute Methadone Poisoning

OBJECTIVE

The trend of methadone toxicity in children and adolescents seems to be increasing in Iran since it is used as a legal measure of the treatment for opioids addiction in methadone maintenance therapy clinics. In the present study, we describe the clinical and demographical characteristics of acute methadone toxicity in a cohort of pediatric poisoned patients in Isfahan, Iran and discussed the predictive factors for their treatment outcomes.

METHODS

In this 4-year cross-sectional study which was performed from 2013 to 2016 in a referral university hospital (Isfahan, Iran), medical records of the demographic and admission time clinical characteristics of all in-patients aged <18 years with acute methadone poisoning were abstracted and analyzed. According to the outcomes of hospital care and treatment, patients were divided as survived without medical complication and patients survived with at least one medical complication or death.

FINDINGS

A total number of 157 (79 male) children and adolescents with a mean age of 105.4 ± 6.1 months were hospitalized and included in the study. A total of 145 (92.4%) patients survived and discharged from the hospital without any medical complication. Pupil size, respiratory rate, and level of consciousness were predictive factors for the outcome of death or medical complications.

CONCLUSION

It seems that methadone poisoning in children and adolescents is more commonly accidental in school-aged boys (6-12 years old) and it occurs mostly with the syrup dosage form, especially when one of the parents or people who live with the child has an addiction history and if the patients' house located in lower socioeconomic class area of Isfahan city (Iran).

Clinical Signs and Symptoms and Laboratory Findings of Methadone Poisoning in Children

BACKGROUND

Poisoning accounts for about 7% of all accidents in children under 5 years and is implicated in over 5% of all childhood deaths in developing countries.

OBJECTIVES

Due to the potential risks of methadone poisoning in children and increased cases of methadone poisoning among Iranian children, this study was conducted to investigate the clinical signs and symptoms and laboratory findings of methadone toxicity in children.

PATIENTS AND METHODS

The present retrospective, descriptive, cross-sectional study describes the clinical symptoms and signs and laboratory findings of methadone poisoning in children under 12 years old in Shahid Beheshti Hospital, Kashan, during the years 2009 to 2013.

RESULTS

Of 58 patients, 33 (56.9%) were male and 25 (43.1%) female (P = 0.294). The mean age of patients was 5.2 ± 1.0 years. All the cases of poisoning happened with methadone syrup, due to unsafe keeping of methadone in mineral water bottles and containers of other drugs. Signs and symptoms included drowsiness (91.4 %), miosis (75.9%), vomiting (69.0%), ineffective breathing (any kind of breathing problem except apnea) (62.1%), apnea (53.4%), cyanosis (43.1%), seizure (8.6%), ataxia (6.9%) and delirium (3.4%).

CONCLUSIONS

Keeping methadone in appropriate containers and warning methadone consumers about the dangerous side effects of its consumption and the symptoms of methadone poisoning in children may minimize the occurrence of this form of poisoning and its complications in children.