Drug overdose with methadone is an increasing problem in the United States. Previous research has found that most cases of methadone overdose are unrelated to opioid addiction treatment. In fact, most patients with overdose had not even been prescribed methadone themselves. The current study from the US Centers for Disease Control and Prevention (CDC) examines the problem of fatal methadone overdose and provides recommendations to stem the tide of this rising public health issue.
CDC researchers looked at data from 1999-2010 and, using 2009 data from 13 statesthose covered by a surveillance system for drug-related deaths, the Drug Abuse Warning Network of the Substance Abuse and Mental Health Services Administrationcame up with some startling statistics.
Published in the July 3 issue of the CDC’s Vital Signs, an early release of the Morbidity and Mortality Weekly Report, the research showed that
– Methadone contributed to almost 1 in 3 prescription painkiller deaths in 2009
– 6 times as many people died of methadone overdose in 2009 than a decade earlier
– About 5000 people die every year of overdose related to methadone, and a great majority of these cases are unintentional
– This represents more than 30% of prescription painkiller deaths, even though only 2% of painkiller prescriptions are for this drug
“The data are consistent over time and across different states, and they are consistent year to year,” CDC director Thomas R. Frieden, MD, MPH, told reporters in a conference call. “We have seen a steady increase in prescription drug overdoses, and it matches very closely the steady increase in prescriptions for opiates.”
According to Leonard J. Paulozzi, MD, MPH, medical epidemiologist from the Division of Unintentional Injury Prevention, at CDC’s National Center for Injury Prevention and Control, regardless of where the information comes fromemergency departments or mortality dataall indications point to a “dramatic” increase in deaths overall for opioids, particularly for methadone.
Methadone, which has been prescribed safely and effectively for decades in the treatment of addiction, has recently been used increasingly as a pain reliever. Some prescriptions are obtained illegally or are used for nonmedical purposesa practice known as diversion.
Unlike other drugs, methadone may build up in the body and disrupt respiration or cardiac rhythm. According to the CDC report, 4 of every 10 overdose deaths from a single prescription painkiller involved methadonetwice as many as any other prescription painkiller.
“Methadone is riskier than other prescription painkillers and it should only be used for pain when other drugs haven’t been effective,” said Dr. Frieden. “There are plenty of safer alternatives to methadone,” he added, including other opiates, nonopioid drugs, and physical therapy.
“Since it’s available as a generic drug, methadone may be less costly than other drugs, but using it comes with a huge human cost,” said Dr. Frieden.
“Using methadone for pain is pennywise and pound foolish because although it may cost a couple of dollars less per pill, the result is many more emergency department visits and a much higher societal cost in deaths and addiction and other problems that can be avoided.”
No Special Training
Federal efforts to warn healthcare providers that methadone should not be the first choice for pain relief have not significantly lowered the number of methadone prescriptions.
“The amount of methadone declined in recent years, but the number of prescriptions has not declined through 2009, so there’s no indication that doctors are prescribing it less often; it’s just that they’re probably prescribing it at somewhat lower dosages,” said Dr. Paulozzi. A majority of these prescriptions are written by practitioners who typically do not have special training in pain management.
According to Dr. Frieden, almost all states have some sort of prescription drug monitoring program.
“We are encouraged by some of the innovation and commitment we’re seeing around the country,” said Dr. Frieden. He used Oklahoma as an example of a state that has developed a “real-time” prescription drug monitoring program that posts information on its system almost immediately after a prescription has been written.
“Other states are doing more and more to reach out to doctors who may have problematic prescribing patterns to either educate them if it’s an information gap or to take regulatory action if they are essentially selling prescriptions and, similarly, to identify patients who may be in need of treatment and encourage them to get treatment, or those who are using medication refills as a way of selling prescriptions, and to take appropriate action.”
According to the CDC, healthcare providers can help prevent prescription painkiller overdoses by adhering to the following guidelines:
– Screening and monitoring for substance abuse and other mental health problems
– Prescribing only the quantity needed based on the expected length of pain
– Using patient-provider agreements combined with urine drug tests for people taking methadone long term
– Using prescription drug monitoring programs to identify patients who are misusing or abusing methadone or other prescription painkillers, and
– Educating patients on how to safely use, store, and dispose of prescription painkillers and how to prevent and recognize overdoses