Imputabilité d’un décès à la méthadone : comparaison de deux méthodes appliquées aux décès associés à une exposition à la méthadone au cours de cinq années d’analyses au CHU de Rennes

Abstract : Purpose of the study Comparing two approaches for discussing the imputability of methadone-related death. Methods A retrospective study was conducted over the period from January 2003 to October 2011, on the forensic toxicology laboratory in Rennes. The records of dead individuals, where the presence of methadone in blood or urine has been established, were selected. The imputability of methadone-related deaths has been established by two approaches: the first one, called “traditional” method and was only based on post-mortem blood concentration of methadone. The second, called “global”, was based on a critical study of all the data collected during forensic investigations. Results Twenty-five cases were included. The average age was 31.4 years. The percentage of cases without conclusion was 56% for the traditional method against 24% for the global one. Four deaths have been attributed to methadone for the latter, against just one for the former. Xenobiotic cytochrome P450 substrate or inhibitor was present in 20% of cases. The concomitant presence of respiratory depressant xenobiotics was common (72% of cases). The most frequently found cardiac risk factors concerned the presence of xenobiotics that prolonged the QT interval (36% of cases). Conclusion The method based on single blood concentration of methadone did not conclude in more than 75% of the cases studied. A method based on a forensic approach of risk factors proved to be more efficient
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C. Hugbart, R. Bouvet, A. Baert, I. Morel, M Le Gueut. Imputabilité d’un décès à la méthadone : comparaison de deux méthodes appliquées aux décès associés à une exposition à la méthadone au cours de cinq années d’analyses au CHU de Rennes. La Revue de Médecine Légale, Elsevier Masson, 2013, 4 (3), pp.112--120. ⟨10.1016/j.medleg.2013.07.001⟩. ⟨hal-01259444⟩

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