Paul William Lowe, a 42-year-old man with treatment-resistant epilepsy, schizophrenia, and long-standing opioid dependence, died from acute methadone intoxication on 12-13 August 2018. Evidence strongly indicates he injected his Sunday takeaway methadone dose, which was the immediate cause of death. Track marks on his arm and drug paraphernalia found in his bedroom support this conclusion. While his GP Dr Frank Reynolds had non-complied with methadone guidelines by prescribing four rather than two takeaway doses weekly, the coroner found this earlier breach could not have contributed to death, as the dose was corrected to two weekly before Lowe's death. Clinicians should be aware that methadone diversion and injection represent serious risks in opioid pharmacotherapy programs; regular urine screening and strict adherence to takeaway dose limits are essential safeguards.
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addiction medicinepsychiatryneurologygeneral practicepharmacyforensic medicine
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