Can someone Please help me????

student4ever · May 27, 2005

Unfortunately, I'm still pre-nursing, so I don't know the answer to your question, but I really hope someone who does will answer you back. I did want to let you know that I'm so sorry for your loss, and I can't even imagine the pain and frustration you must be going through following the death of a loved one, especially with being so distanced emotionally from her life. I sincerely wish you the best throughout your grieving process and in your search to find the truth about this event. I hope with all my heart that you find the answers you are looking for, and that those answers offer some sense of closure and satisfaction as you deal with such turbulent circumstances. My thoughts (and prayers, hopefully this is not offensive to you - if so, I appologize) are with you and the rest of your loved ones through this rough time. (((hugs))) to someone who sounds like you need some!

CritterLover, BSN, RN · May 27, 2005

shicky2001,

i am so sorry for the loss of your sister. i can empathize with wanting to find answers. unfortunately, i'm really not sure how much we can help you. there are just so many variables involved. it would be tough to figure it all out even if you did know details, which you don't. are you a nurse or have a health care background? it would help to try and make sense of all the info that is out there. i am going to try to give you the facts that i found, because i am really not qualified to draw any conclusions

.

i found the info on valium (diazepam) pretty easily in one of my lab manuals: the therapeutic level for valium is 100-1000 ng/ml. toxic is >5000 ng/ml. the coroner's report said that your sister's blood level was 0.11 mcg/ml, which is 110 ng/ml. that would seem to be therapeutic. however, body chemistry changes after death, and i don't know how much that would affect these results.

the info on methadone is more difficult to find. on source i read stated that the best results in methadone treatment are found at levels above 200 ng/ml. your sister's level was 600 ng/ml. however, i am not familiar at all with methadone. i do know that people become tolerant to narcotics the longer they take them, and it takes a bigger dose to have an effect (like alcohol. i've seen drunks in the er walking and talking with blood alcohol levels that would kill me). i don't know if the same is true for methadone or not.

much of the literature i read states that one is most likely to overdose on methadone at the beginning of treatment. there was also some evidence that benzodiazpine (valium falls in this class of drugs) use can make one more likely to overdose on methadone. however, in my mind i can certainly come up with very good reasons to take valium and methadone together, and i would predict that they are often taken together. one would just need to be careful in the dosing. i would guess that many of these deaths are due to carelessness more than anything else. but please take these last few sentances as something to think about, not as facts. as i said earlier, i am not an expert in this area.

try doing a google search for "methadone toxic levels" or "methadone therapeutic levels" and see what kind of information you find.

i ddin't look to see your background before i replied, so if any of this terminology isn't clear, let me know and i will try to elaborate more.

i hope you find some of the answers you are looking for.

Dixielee, BSN, RN · May 27, 2005

I am sorry for your loss, I know you must be suffering even though you were not close to your sister at the time of her death. Have you tried to speak to someone at the medical examiners office? They may be more helpful than we can here. I don't know how to translate those results into how much she may have taken.

You may also speak with a trusted physician if you know one, but I suspect they may not really know how to translate these numbers either. Have you thought about a grief support group to help you work thru issues related to her death? It sounds like they may be of benefit to you. My sister was killed 2 years ago and I know how painful it can be. Talk to someone who can help you come to terms with this. God bless you, and good luck.

Anonymous2013 · May 27, 2005

I just want to say thank you. This is the first place I have gone, where someone cared enough to reply. Thanks for the info, Now I have a little better idea, and a direction to go in. I'll drop back in now and then to see if there are any more replies. Thank you so much all of you.

Anonymous2013 · May 28, 2005

just thought I'd bump this up for the saturday crowd.

Trauma Columnist · May 28, 2005

So very sorry for the loss of your sister. I would imagine there was an inquest? If so, you may be able to obtain a copy of that. Also, you can contact the coroner's officer that did the autopsy to obtain more information as to their scale of what constitutes ingestion versus level of drug. Good luck.

nurse_wannabe · May 28, 2005

First of all, I'm so sorry for your loss. :crying2:

I did find some levels of methadone, but I'm not sure how helpful this will be in determining if your sister's death was accidental or intentional:

The Methadone blood level should be maintained in the therapeutic range of 100 - 400 ng/ml or less.

The Methadone serum blood level should not exceed the toxic range of greater than 400 ng/ml.

Like someone else said, your sister's methadone level was 600 ng/ml, so she was definitely toxic. This doesn't mean she killed herself - it could have easily been an accident. I found one statistic somewhere that 9 people just in the state of WV die every single month from methadone OD. That seems like a very high number to me.

I'm still just a student, but from what I've gathered it will be nearly impossible to figure out how much she might have taken, because the half-life of methadone ranges from 12-190 hours depending on several factors. Half-life is the time it takes for the blood level of a drug to fall by 50 percent. With such a huge range of hours for the half-life, it would be very difficult to determine.

The only thing I can think of is to contact some of those who were closest to her. A boyfriend or husband maybe? Best friend? They can probably give you some insight as to her emotional status, and you just might find you are able to grieve together and have some closure. Best of luck to you.

MistyDawnRN06, BSN, RN · May 28, 2005

"The toxicology report lists

methadone (0.60 ug/ml) and

diazepam (0.11 ug/ml)

in her blood. "

I ran a drug interaction check. I can give you this information:

Severity: Moderate

Concomitant administration of diazepam with CNS-depressant drugs [5443], including opiate agonists, buprenorphine, butorphanol, nalbuphine, pentazocine, phenothiazines, pregabalin [7523], barbiturates [5443], dronabinol, THC, ethanol [5443], sedating H1-blockers, entacapone, general anesthetics, tolcapone, tramadol, tricyclic antidepressants, or other anxiolytics, sedatives, and hypnotics [5443] can potentiate the CNS effects (e.g., increased sedation or respiratory depression) of either agent. The dose of any opiate agonist administered with parenteral diazepam should be reduced by at least one-third.

Due to the severity of the interaction of meperidine (a related opioid) with monoamine oxidase inhibitors (MAOIs), a sensitivity test for methadone should be performed in patients taking MAOI therapy by administering repeated small incremental doses of methadone over several hours while carefully monitoring the patient's condition and vital signs.[5109] Concomitant use of methadone with a MAOI or other CNS depressant can lead to additive respiratory depression. These agents include: amitriptyline, amoxapine, anxiolytics, sedatives, and hypnotics, clomipramine, clozapine, doxepin, dronabinol, THC, droperidol, entacapone, ethanol, general anesthetics, sedating H1-blockers, haloperidol, imipramine, maprotiline, mirtazapine, molindone, nefazodone, nortriptyline, olanzapine, other opiate agonists, phenothiazines, pimozide, pramipexole, quetiapine, risperidone, ropinirole, skeletal muscle relaxants, tolcapone, tramadol [5043], and trazodone. Methadone should be used with caution and in reduced dosages if used concurrently with a CNS depressant. Respiratory depression, hypotension, and profound sedation or coma may result.[5109] In addition, some of the listed drugs (e.g., amoxapine, clozapine, droperidol, general anesthetics, haloperidol, phenothiazines, pimozide, risperidone, tricyclic antidepressants) may theoretically increase the risk of methadone-induced QT prolongation, which is a concern for patients receiving higher doses of methadone [4951] [5048] [5049] [5050] [5051].

Anonymous2013 · May 28, 2005

Very interesting MistyDawn, thank you.

Reading the coroners report further says, "victim allegedly injested drugs." I think my feeling that she did this to herself might be right. The more info I get the more I feel that way. My sister died at home, so, I am assuming that by the time the fire department got there she was already dead. And there was an exact time of death listed, she lived with her fiance, so it very well could have been intentional. hhhhmmmmm.