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Background: Methadone is a common medication used for pain relief and addiction treatment. We evaluated clinical, demographic, and forensics findings in deceased cases of acute methadone poisoning. Methods: An 11-year chart review study was done on deceased cases diagnosed with methadone poisoning admitted to a referral emergency ward affiliated to Isfahan University of Medical Sciences, Iran. Data were obtained through patients' records from 2005 to 2016 and analyzed using SPSS statistical software. Findings: Of 81 deceased cases, 86.5% were men. The mean age of cases was 42.70 ± 19.22 years. The majority of men were 20-45 years old compared to less than 20 years old in women (P = 0.005). Methadone abuse (55.6%) and suicide (35.8%) were the main causes of methadone poisoning in the deceased cases. Eighty two percent of cases had low consciousness on admission. Causes of poisoning, history of suicide, self-mutilation, smoking, and underlying diseases were significantly different in the various age groups. Respiratory failure as a mortality cause was recorded for the majority of cases (37.0%). Pathologic findings of liver and brain were recorded in 43.9% and 31.7% of cases, respectively. Multiorgan damages were noted in 42.6% of cases without any significant differences in the various age groups. Conclusion: Given the prevalence of deceased cases due to methadone abuse at a young age, it is necessary to manage administration of methadone in different age groups to reduce mortality.