[Iatrogenic methadone poisoning].

Two young drug addicts received in the course of their treatment a 10-fold overdose of methadone by error. One person died, the other was severely intoxicated but survived. The cause for the mistreatment was the unawareness of the medical personnel, that did not realize the change in concentration of the methadone stock solution from 0.1% to 1.0%, provided by the pharmacy. To prevent such mistakes in the future a change in labelling of the bottle giving directions for correct dosing is suggested.