Methadone causes respiratory depression and coma in overdose. There can be a narrow margin between a safe and a fatal dose especially in the presence of other CNS depressants (prescribed or illicit) or if there is no opioid tolerance established.
This is one of the major underlying reasons behind the emphasis on safety and the limitations on takeaway doses in OST patients.
*See Section 4.1 Overdose; 4.1.1 Consumption of takeaway doses by a child, page 30 of " New Zealand Practice Guidelines for Opioid Substitution Treatment 2014"
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