A teaspoon of methadone would have been enough to kill a toddler who died with a "significant amount" of the drug in her bloodstream, the province's deputy chief toxicologist testified Monday.
But a dose of an opiate antidote available at city hospitals could have saved the girl's life, Dr. Peter Singer told the court on the sixth day of proceedings in the trial of the little girl's parents.
Jonathan Hope and Lisa Guerin (also known as Lisa Hope) are charged with manslaughter, criminal negligence causing death and failure to provide the necessities of life for their daughter, 16-month-old Summer Hope.
When Summer died in April 2006, it was initially believed to be due to sudden infant death syndrome.
Singer ran tests on the little girl's blood, liver, bile and other fluids to try to determine a cause of death.
Results from the toxicology tests showed Summer had a lethal amount of methadone in her system.
Testing showed she had 0.42 milligrams per litre in her blood, Singer said, calling it a "significant amount."
"This would be typical of a non-tolerant adult death."
Methadone is a synthetic opiate used to treat those with addiction issues. People prescribed to take it acquire a tolerance, but even small amounts can be toxic to those who have never taken it or other opiates.
The amount that Summer had in her bloodstream would be lethal to an adult or a child, Singer told the court. However, there is an antidote for opiate overdoses, including methadone, that is available in hospitals' emergency departments, he said.
"It's used all the time for overdoses. It's been used for children who have overdosed," he said, noting it works within minutes.
Narcan can be administered successfully while the person is still awake. After the person has fallen into a coma there may be some brain damage, which would be irreversible, he said.
While Singer was unable to determine exactly how much methadone Summer ingested that led to those levels of the drug in her bloodstream, he said the minimum lethal dose would have been around five millilitres -- a teaspoon of liquid. (Methadone is typically mixed with fake orange juice, similar to Tang, to offset the bitter taste. One milligram of the drug is usually found in one millilitre of liquid.) An overdose of methadone causes symptoms such as sleepiness, muscle flaccidity and shallow breaths, followed by the person falling into a coma and dying.
Even after falling into a coma, the person may continue breathing and could appear to just be sleeping, Singer told the court.
In the morning proceedings, a doctor with the clinic that Hope used to attend testified that even residual traces of methadone can be enough to put a person into a coma within 30 minutes.
Dr. Ian Postnikoff, a doctor with the methadone program formerly known as First Street Clinic, said at the time of Summer's death, Jonathan Hope was receiving daily doses of 280 milligrams of methadone.
"That's a relatively high dose," he said.
Postnikoff also told the court that Hope had at one point qualified to take part in the "take-home carry" program, which allowed him to take a week's worth of methadone to consume at home instead of attending the pharmacy daily. He was given two weeks' worth of the drug for the Christmas holidays.
In January of 2006, Hope was moved back to a program that had him taking his dose at the clinic's pharmacy in front of a witness.
He was on the daily witness ingestion program in April 2006 when Summer died.
Residual traces of methadone can be enough to put a person into a coma within 30 minutes, court heard this morning in the case against two parents accused in the overdose death of their toddler daughter.
Testifying on the sixth day of the two-week trial, Dr. Ian Postnikoff said the danger with methadone is it is a long-lasting drug and if a dose is raised too quickly it can create toxic levels.
Methadone kills people by stopping their breathing, he said.
"The lethal dose for a child, to my knowledge, has not been determined," he said.
Postnikoff is a doctor with the methadone program formerly known as First Street Clinic. Jonathan Hope was participating in that clinic's methadone treatment program in April 2006 when his 16-month-old daughter, Summer Hope, died of an overdose of that drug.
He and his former wife Lisa Guerin (also known as Lisa Hope) are charged with manslaughter, criminal negligence causing death and failure to provide the necessities of life in the death of their daughter.
At the time of Summer's death, Hope was receiving daily doses of 280 milligrams of methadone.
"That's a relatively high dose," Postnikoff said. "We don't have too many patients at that dose."
It would have taken only a small dose of methadone to cause the death of Calgary toddler Summer Hope, her parents’ manslaughter trial heard Monday.
Dr. Peter Singer, an expert in toxicology, testified it would have taken about a teaspoonful of the drug to take the life of the 16-month-old victim.
But Singer said because there were too many variables, such as absorption rate and an unknown time of death, it was impossible to say how much methadone Summer consumed.
Her father, Jonathan Hope, and mother Lisa Guerin, are on trial for the little girl’s April 29, 2006, death.
Both are accused of manslaughter as well as charges of criminal negligence and failing their parental duties.
Singer told Crown prosecutor Ken McCaffrey that based on literature in the area, he estimated the victim had consumed 5 ml to 10 ml of methadone.
But under cross-examination by defence lawyer Adriano Iovinelli, he acknowledged he estimated in an earlier report the amount was “up to 5 ml.”
He also said a child wouldn’t immediately be effected by consuming methadone and Summer could have ingested the liquid at 4:30 p.m. and still been active at 10 p.m.
Even at midnight, when Hope reported seeing her breathing, the girl could have been unconscious, but still taking breaths.
Earlier, Dr. Ian Postnikoff, who worked at a methadone treatment clinic, said Hope had been taking daily doses at the facility to combat an opiate addiction.
He said Hope became addicted to pain medicine after being involved in a serious car accident and was on the program to combat his drug problem.
