Susan Patterson, a 27-year-old Aboriginal woman with a history of alcohol and polysubstance use, died from mixed methadone and alcohol intoxication. She consumed an unknown substance from a brown bottle offered by a neighbour on 8 November 2009, then fell asleep and was found unresponsive the following morning. Post-mortem toxicology revealed moderate blood alcohol (0.10) and substantial methadone (0.5 mg/L). As methadone and alcohol are both CNS depressants with synergistic effects, particularly in non-tolerant individuals, the combination proved fatal. Key clinical lessons include recognising the lethal potential of methadone-alcohol combinations, assessing substance use history thoroughly, and understanding that individuals not enrolled in methadone programs may still access the drug. The coroner could not definitively establish how methadone was obtained, highlighting gaps in substance use monitoring for vulnerable populations subject to community orders.
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