The following are some suggestions that I have to prevent methadone deaths:

Required training for all medical personal with testing on material learned and that will be verified ( Samhsa can keep records) STRESS all the deaths that have occurred with methadone.

Required training of patient with a video that stresses all the DEATHS that have occurred with methadone, The risk of use of ANY medication with Methadone and the high chance of death during the induction phase. Inform patient of risk of sudden cardiac death and advise patient they may want to have a full cardiac workup before beginning drug. Give patient examples and statistics of DEATHS.
Require patient to have family monitor patient for signs and symptoms of overdose during the first two weeks of induction. STRESS the fact patient may go to sleep and not wake up!

Send patient home with emergency narcan.

Strict guidelines for determining opiate tolerance of patients. Make it mandatory that Cows score and dosage guidelines are used.

Set a safe guideline for doctors concerning induction. Advise doctors of a correct safe low dose to start medication instead of just listing a maximum dose of 30 mg which is not safe for opiate naïve persons and some opiate tolerant persons.

Do not allow doctors to increase dose for at least 5 days.

Before increasing dose, patient should be observed at peak ( 4 to 5 hours after drug is given)

A central registry system that a doctor can use to retrieve information on all medications that a patient is currently prescribed.

Require doctors NOT to start methadone until physical is complete.

Never allow a patient to start on methadone if they have benzodiazepines or other medication that is contraindicated in their system.

Mandatory reporting of all deaths when patient is receiving methadone