Methadone: A Major Driver of Prescription Painkiller Overdose Deaths

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Methadone accounts for nearly 1 in 3 prescription painkiller overdose deaths in the U.S., even though only 2% of prescriptions for opioid painkillers are for this drug, according to a new report by the Centers for Disease Control and Prevention (CDC). The report also found that six times as many people died of methadone-related overdoses in 2009, compared with a decade earlier.

The research showed further that about 4 million methadone prescriptions for pain are written annually and the drug causes about 5,000 overdose deaths each year. While most overdoses involve mixtures of drugs, methadone accounted for 40% of deaths involving a single drug in 2009, twice as many as for any other prescription opioid.

“Deaths from opioid overdose have increased fourfold in the past decade, and methadone now accounts for nearly a third of opioid-associated deaths,” said CDC director Dr. Thomas R. Frieden in a statement.

For the report, the CDC analyzed national data on prescription sales and overdose death rates from 1999 to 2010, as well as 2009 data on deaths from methadone and other opioids, such as Oxycontin, Vicodin and heroin, from 13 states covered by the Drug Abuse Warning Network.

(MORE: Government Considers Overdose Antidote, Naloxone, to Fight Prescription Drug Misuse)

Methadone is best known for its use in addiction treatment, but the deaths included in the CDC report are not associated with these programs. “We’re not talking about methadone maintenance treatment in this data,” said Frieden in a press teleconference on Tuesday. “All of the evidence suggests that the increase in methadone related deaths is related to increased use of methadone to treat pain.”

The drug has been used safely to treat addiction since the 1960s, but in recent years prescriptions for pain relief have increased. In Nov. 2006, federal health officials warned against using methadone as a first-choice pain reliever, because it’s so tricky to prescribe safely, but prescriptions haven’t declined much. So, in tandem, rates of nonmedical use of methadone and fatal overdoses have risen; the drugs involved in these cases are typically diverted from pain treatment, not from addiction treatment programs.

So why is methadone so much more deadly when used to treat chronic pain? Because it’s long-lasting and it builds up in the body. Methadone kills pain for about six hours on average, but with accumulating doses, it can slow a person’s breathing and disrupt heart rhythm — effects that can last for days. (These problems can become deadly on their own, but are even riskier when users take drugs like alcohol or Valium with methadone.) This means that taking methadone three times a day — exactly as prescribed — can lead to a potentially fatal overdose if the person is not fully tolerant to the drug. Worse, the effects vary widely from person to person.

The methadone prescription problem goes back to the late 1990s and early 2000s, when drug addicts discovered that a new painkiller called Oxycontin could be snorted or injected to produce an intense high — and get around the pill’s time-release mechanism. Oxycontin’s manufacturer, Purdue, was eventually fined $634 million for selling the medication as less addictive than other opioids. With law enforcement scrutiny intensifying on Oxycontin prescribing, doctors began looking for a drug that had similarly long-lasting effects on pain.

Methadone fit the bill perfectly. Not only is it one of the longest acting opioid drugs, it’s also generic and about 12 times cheaper than brand-name Oxycontin. Its long history of safe use in addiction treatment may also have made it look less risky than it is, leading many insurers and some state health programs to put it on their formularies as a preferred drug, meaning that it would be covered when other similar medications like Oxycontin would not be.

But there’s a big difference between addiction patients and pain patients: people using methadone for maintenance treatment have a long history of opioid use — that’s why they’re in treatment — and therefore, a high tolerance to the entire class of drugs. That means that as a population, they are already self-selected to be able to manage large doses of opioids successfully. But that’s not true for many pain patients, which is why the CDC report states bluntly that, “[M]ethadone should not be prescribed to opioid-naive patients.” Yet as the report shows, about one-third of all pain patients who were prescribed methadone had no prescriptions for another opioid in the month before they received the drug.

Also, the doses of methadone used in maintenance treatment for addiction are very carefully controlled. Initial doses are small — the difference between appropriate and dangerous doses of methadone is slight — and patients aren’t allowed to take the drug home until they have proved through months of daily program attendance and drug-free urine tests that they are tolerant to it and can use it safely. In contrast, most methadone prescribing for pain is done by general practitioners and other nonspecialists who don’t have training in pain management.

(MORE: Addiction Treatment in America: Not Based in Science, Not Truly ‘Medical’)

Even the Food and Drug Administration‘s own labeling information regarding appropriate doses of methadone for pain was inaccurate, until 2006 when an expose by the Charleston Gazette revealed that following the package insert could cause overdose, especially in patients who did not have prior exposure to opioids. Unlike in methadone maintenance treatment, pain patients are not monitored when they take the drug initially.

“There are plenty of safer alternatives to methadone,” said Frieden, noting that for most pain patients, there are other opioids, other types of drugs and nonpharmacological approaches like physical therapy that can help. He added, however, that the CDC wants to make sure the drug is available for cancer patients, people in addiction treatment programs and others for whom it is found to be the best option.

As for using the generic drug to cut costs, Frieden says methadone is a bad bargain. “Using methadone [to reduce spending in pain care] is pennywise and poundfoolish,” he said. “It results in many more emergency rooms visits and higher societal costs in deaths.”

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.

12 comments
FUSEDBACKHIP
FUSEDBACKHIP

MY DOCTOR WANTS TO TAKE ME OF OXYCONTIN AND PUT ME ON METHADONE .WHEN I HAVE BEEN ON THIS MEDICATION SINCE 1996 THAT GAVE ME BACK MY LIVELYHOOD/LIFE...ANDIT WORKS FOR ME I HAVE NOT ASKED TO BE RAISED OR SWITCHED TO ANYTHING STRONGER??????
WHY WOULD THEY WANNA PUT ME ON A MEDICATION THAT CLEARLY KILLS MORE PPL THAN WHAT I CURRENTLY TAKE

JannetVereVinenLane
JannetVereVinenLane

That's easy for you to say that their is better opiods. But you or who ever is saying this has made it now that doctors don't want to help the real cronic pain suffers any more. I hope you people realize what you have caused. People only care about looking after their selves now. So try and get the pain meds you say are available. I never abused my pain meds and now my doctor doesn't want to prescribe them any more and thinks I can handle having pain with out them. I don't believe it's because he really thinks it's better for me, he just would rather not have to deal with the damm presure you people write about. Thinking your making things better. All your doing is hurting the ones who are suffering. Addicts will always find somthing else. Oxycontin was a good pain medication and when used properly was and still would be safe. That new crap with the gell plastic in it made me so sick and over a period of 8 months I lost 20pounds . Before anyone would believe it was that. Now I have a doctor who won't help me. Only reason I can think is there all scared. Saw my specialist yesterday that put me on it 12 years ago to see if he could help. Well for some reason out right lied to me and said he doesn't and never has prescribe opiods for pain. Lucky for me I have the letter he wrote to my doctor telling him to give me oxycontin. Now you tell me why would a specialist lie.

drron
drron

I had no idea there was such a high death rate with Methadone!  Although, I suppose any of these medications would have the potential for serious side effects but you don't really hear a lot about the death rate.  It's a little scary.  But I think it's also important to mention that even over-the-counter pain medications have negative side effects that many don't know about.  Even something as basic is Ibuprofen.  I think natural alternatives are probably something to look into.

margaretwilde
margaretwilde

Seriously lowering intake of salt and salty food is a safe

drug-free way to reduce many pains. It has no adverse effects and it

benefits health in many other ways too.

bellaluna30
bellaluna30

And yet MMJ is still demonised. And, far as I know, it's not killed anybody.

tonya1968
tonya1968

I am glad the spotlight is being put on all the methadone related deaths. Unfortunately they are downplaying all the deaths that occur from the methadone clinics due to inadequate physician training and diversion. Most of these deaths are greatly under reported due to the fact that most patients taking methadone are also taking other prescribed medication and therefore the cause of death is listed as polypharmacy when actually methadone is the real culprit! Why would you treat induction of methadone different for pain management and opiate addiction when converting a patient to methadone, since the first two weeks of induction are when most deaths occur? Incomplete cross-tolerance is of particular concern for patients tolerant to other mu-opioid agonists who are being converted to treatment with methadone, thus making determination of dosing during opioid treatment conversion complex.Please visit www.stopmethadonedeaths.com

JaylikeBird
JaylikeBird

Real pain, honey bear. You don't understand real chronic pain.

tonya1968
tonya1968

Think again.... It has caused many many deaths!

margaretwilde
margaretwilde

 I do understand it. I do suffer from it. - But why not try this safe, simple measure yourself? There is nothing to lose by trying it. Many people have found it helpful. - Go on! - Try it! - You will feel so much better.

All the best to you.