Spike in Methadone Prescriptions, Deaths

Spike in Methadone Prescriptions, Deaths
August 18, 2008

News Summary

Methadone now ranks as the fastest-growing source of narcotic deaths in the country, and many experts believe lack of federal oversight and dangerous prescribing practices by physicians are largely to blame, the New York Times reported Aug. 17.

The number of methadone prescriptions increased by 700 percent from 1998 to 2006 -- a period during which the Food and Drug Administration (FDA) unwittingly labeled package inserts with a dangerously high dosage recommendation of up to 80 mg per day for a starting dose.

The FDA cut the recommended starting dose to 30 mg in late 2006, but some experts believe the FDA should also require physicians to take special classes on prescribing narcotics, a move the agency is considering.

"This is a wonderful medicine used appropriately, but an unforgiving medicine used inappropriately," said Howard A. Heit, M.D., a Georgetown University pain specialist. "Many legitimate patients, following the direction of the doctor, have run into trouble with methadone, including death."

Nationally, the number of deaths in which methadone was listed as a contributing factor increased fivefold to 4,462 from 1999-2005, but experts say that figure understates the problem because of incomplete reporting in some states. Florida saw its deaths caused at least in part by methadone increase from 367 in 2003 to 785 in 2007.

Many health experts believe doctors who are increasingly prescribing the medication for pain management do not have enough knowledge of how slowly methadone is metabolized, or how various patients can experience different effects from the medication. They say some physicians prescribe too much of the drug too fast, while others do not inform patients of the risks of using alcohol or sedatives with the medication.

As a result of these problems, some physicians have instituted innovative practices in conjunction with prescribing methadone for pain management, including contracts with patients that list mutual obligations or occasional phone calls from the physician to a patient's loved ones to check on the patient's progress.

COMMENTS ON THIS ARTICLE:

Posted by Donalisa McNichols on 09 Oct 08 01:00 PM EDT

It is sad that many blame a medication for someone's choice to abuse it. I have worked as a counselor for a methadone clinic for 8 years. MANY patients have been successful in learning to live life without the use of illicit substances. For those who believe that this is a toxic substance and blame the medication for overdoses...consider how many people are lost each year to the 'toxic medication' insulin. Are you willing to attack this medication? Ignorance fuels unhealthy behaviors, including discrimination.

Posted by lilydisc55 on 05 Oct 08 12:36 AM EDT

Please say NO to this poisonous drug. Nancy Garvin Mothers Against Medical Abuse. GET a grip poisonous drugs include asprin,tylenol,antibiotics,sugar to a diabetic etc etc. Please stop placing the blame on methadone and deal with the closure that some people in the boohoowho.orgs desaperately need.

Posted by Terrance Lee Newton on 29 Aug 08 11:15 AM EDT

We are just now starting to understand some brain chemistry changes associated with addictions. Medical and behavioral treatments in combination tend to be the most effective in treating many diseases that have a behavioral component. Methadone has proved to be one of the most researched and respected medications utilized to help stabilize people's lives. Buprenorphine, another promising medication utilized but, contrary to some beliefs, it can be abused as well. Rigid thinking and more government control is not the answer here. Education of physicians for safer prescribing practices and, educating the public at large, of the dangers of prescription drug abuse, is a better solution. Diversion of methadone is more common from pain clinics than methadone clinics. I dread thinking of the consequences of removing a medication that has helped many for addiction and/or pain control. To not address people's pain or addictions is not a viable alternative either. I am sorry for people's losses here. The medical community, and government, need to continue working together, to make prescribing practices safer.

Posted by in recovery on 25 Aug 08 09:25 PM EDT

Methadone is the most viable form of treatment today. It is also only one part of what should be a well rounded program of individual counseling and group therapy. We can't just give the drug and say this will make you all better. people need to learn how to live without the use of drugs. I think a good place to learn this is where others are living successfully without the use of drugs and that is meetings. Self-help AA NA are good places to find people who vcan teach clients the life side not the clinical side of this disease. But to be successful you need ALL SIDES!!! I do feel pharmacudical companies should be held accountable they are creating new drugs and not addmitting the consequences of its use. be accountable for your part nothing more nothing less and stop blaming others>

Posted by gr8ful2hp on 25 Aug 08 06:49 PM EDT

I managed a Methadone clinic in Brooklyn, and serviced people who were on the program for decades who only shot dope for a year or two before treatment! I also saw people come into treatment addicted to pain meds such as Methadone, Oxycontin, Morphine, Vicodin, etc. The rush to prescribe these narcotics should not be treated with minimal concern, especially when long range implications/complications aren't even known or considered by the prescribers. Dentists prescribing Vicodin, PCPs handing out Methadone and Oxycontin for pain that historically was treated with aspirin or Tylenol is a small indication of where pharmacological solutions are headed. If we look at the increase in deaths by prescription pain medications overall, a snapshot is presented to us depicting the gross ineptitude of the prescribing doctors; the regulating agencies; and the pharmaceutical companies that are developing new medications to “assist” in pain management. Extreme measures (possibly legal consequences) need to be put in place that will hold accountable those that are neglectful re: the diagnosis, prescribing and monitoring of anyone that is put on narcotics as a pain management treatment plan.

Posted by lilydisc on 25 Aug 08 06:00 PM EDT

Sorry, I ment Joda,wrote a meaningfull piece. All hatred.orgs take notice of her open honest post.

Posted by lilydisc on 25 Aug 08 05:51 PM EDT

YODA wrote:I am sorry for anyone’s loss but I can tell you as one who also lost a loved one to a drug overdose, the sooner I finished playing victim and attempting catharsis through external means, the sooner I got back to living responsibly. Most misinterpret events as "this was not supposed to happen" or this happened as a "sacrifice for the greater good that I am now doing". The truth is everything, I mean evrything, happens exactly as it is supposed to happen. Our quest for external power through control and self-justification leads us on a endless journey to satisfy our ego’s need to assert itself over our soul’s true need to love and be loved. The spiritual alternative is to accept responsibility for EVERYTHING that happens in our lives. This also means extending forgiveness in the place of blame. THis is the best advice I have heard yet.You have my utmost respect Now for the 'Constant Grievers' I suggest you read this and get on with your lives.CLOSURE not guilt

Posted by lilydisc55 on 25 Aug 08 05:43 PM EDT

The truth is everything, I mean evrything, happens exactly as it is supposed to happen. Our quest for external power through control and self-justification leads us on a endless journey to satisfy our ego’s need to assert itself over our soul’s true need to love and be loved. The spiritual alternative is to accept responsibility for EVERYTHING that happens in our lives. This also means extending forgiveness in the place of blame. Every doctor and every person who’s overdosed each have their own karmic debts to pay in regard all shared and unshared circumstances. It is between them and God; not you, not me. I know that all this is hard to accept; it took me much pain and personal soul searching to finally come to terms with God’s awe-filled grace YODA, THAT is THE BEST ADVICE I HAVE HEARD YET. I AM IMPRESSED! Now- for these Radical GRIEVERS YOU should heed her beautifully written advice

Posted by Seen It on 25 Aug 08 04:59 PM EDT

Let's be frank, Frank. As one who cannot accept fundamentalism, religously or otherwise, and that no where in my narrow point of view did I mention holding hands or saying prayers, I think I sense a little guilt in you're self proclaimed inability to list those defects. Had a bad day at a 12 step meeting, eh? Neverltheless, I am glad to hear you're an ex-junkie (with emphasis on the ex)and wish you the best.

Posted by Frank Gathers M.S. on 25 Aug 08 02:48 PM EDT

Let's see what we have learned boys and girls. "Seen It" epitomizes the "one-size-fits-all" approach to recovery, choosing to focus on those who are not successful utilizating a modality instead of those who are helped by it. This approach says "lets serve the idea of recovery over recovery; because the "idea is the goal". Anyway you serve it up: tastes like Fundementalism to me. As a ex-junkie who just could'nt get it through making laundry lists of my defects, holding hands or saying prayers, I say thank God for methadone.

Posted by Seen It on 25 Aug 08 01:30 PM EDT

Didn't know they used it for chronic pain but do know it's mostly used by heroin addicts as an excuse not to get clean and stay clean. After talking with hundreds over the years, the addicts who are now clean (off methadone and other mind altering substances) invariaby state that they were addicted to methadone and that life was never really fulfilling but could not see that until free from methadone. It's tantamount to government and socially sanctioned addiction primarily to keep sick addicts out of prison but still keeping them from reaching their full potential. As we can see by the comments, there are many "reasons" to use this addictive substance, but, from what I have witnessed, anyone can stop using methadone. Its time to do away with it- it's outdated and does much more harm than good.

Posted by Bee on 25 Aug 08 11:43 AM EDT

Are you all kidding me or what? Why not go after the Thousands of deaths each year from new drugs that are ADVERTIZED on T.V.Forced vaccinations. Methadone has been around for generations. Stay out other peoples lives. Run your own

Posted by Frank Gathers M.S. on 25 Aug 08 11:04 AM EDT

Fisherman expresses the sentiments of many like myself. As a medical tool, methadone has helped many x-junkies reconstruct their lives free of addiction. With unmatched rates of client retention, we can also treat secondary addictions with counseling that otherwise go untreated. Heroin addicts just don't stick around when all we are offering is what they call "watershots". I have scene more people die each year from NOT getting adequate medication-assisted treatment like methadone, than from mishandling the drug. 200,000 Americans die every year from medicating errors involving 150 other medicines. Does this mean we should abandon the millions of people helped by these same 150 medications by eliminating their use? “Our learning becomes impeded when we are no longer led by experience but by ideas; by what should be rather than what is.”

Posted by Brent on 25 Aug 08 10:32 AM EDT

The irony is that a majority of methadone related deaths occur not from methadone prescribed from methadone clinics or among opioid addicted people in treatment at those clinics, but from pill-form methadone prescribed by community physicians for treatment of pain. To change this alarming trend, more than education on safe prescribing practices is needed. A shift in medical treatment philosophies that incorporates the use of holisitc treatments, cognitive and behavioral therapies (in place of or in addition to Rx narcotics) and in general, less emphaisis on the "magice bullet" of narcotics to "cure" pain is required. It also would not be a bad idea to require physicians who precribe opioids for treatment of pain to also have the certification to precribe Burpenorphine if necessary.

Posted by mr.cholito@yahoo.com on 25 Aug 08 10:05 AM EDT

Any medication not taken as prescribed could be fatal even aspirin.So my point is that when Methadone is taken in the correct dose for the person it is prescribed for it is a safe and effective way to treat a person who has a disease of opioid addiction,severe pain,ect. If a person is not properly educated on the use/misuse of this and ALL medication,we cannot blame the medication but the fault lies in the hands of the provider.Remember this,If this medication was to be taken out of the hands of the people who depend on it to treat their disease the only people who would gain by this would be the Illegal Drug dealers,cartels and the countries who import opiates.And we all know who they are!You would not take away a diabetics insulin,Why would you try to take away anything that could help anyone feel better and live a normal productive life?

Posted by fisherman on 25 Aug 08 09:42 AM EDT

I'm the father of a son who was addicted to heroin and has been clean for the past 3 years. For these three years, he has been on a daily dose of methadone and is currently lowering the dose every week. I see the problem of methadone deaths not with the drug, but with the doctors that prescribe it and the patients that use it for the wrong purpose. It has been a miracle drug for my son and family.

Posted by Bonnie Benis...Angel Bubba's Mom on 25 Aug 08 09:30 AM EDT

I lost my 19 year old Son to Methadone in 2005,I can't even count on my fingers how many more deaths just here in Crystal River, Florida there has been since then.The ones whom get it from their Dr then take it out on the streets to give out.This has to STOP.I support MAMA.org and HARMD.org along with others to get the word out so another Family never has to walk in our shoes.

Posted by Bren O'Neal on 22 Aug 08 08:49 AM EDT

I agree 110 % with Addict In Recovery. People you just heard it as the saying goes " straight from the horses mouth." Pure common sense and facts from other addicts and recovering pain patients and those of us who live with chronic severe pain daily. Anonoymous there is widespread addiction and deaths from Methadone being prescribed as a pain pill.And same goes for those that are becoming long term addicts and those who die while seeking help at Methadone Clinics. You know Suboxone is not the only choice you have you are the only one who can save your life with the right help. Surely I'm not the only one seeing on the news channels or reading in newspapers where Methadone patients go right outside to sell their Methadone doses, in pill, wafer or liguild form. This is nothing new people honestly this has been going on for decades.

Posted by Anonymous on 20 Aug 08 09:17 PM EDT

There are some pain patients whose pain has been relieved ONLY by methadone. IN addition, there is no "other alternative" to methadone as a medication for opiate addiction except buprenorphine, and studies show that it is often not effective for those with heavy, long term addictions. In fact, a DEA agent at AATOD told me that they do not consider Suboxone a substitute for methadone because it has not been around long enough and because it is not effective for many addicts due to it's ceiling effect. No one is denying that methadone is a tricly medication--however, the primary problems have developed in the past few years as it became more widely used for pain, not from addiction treatment.

Posted by Addict in Recovery on 20 Aug 08 07:14 PM EDT

I too lost a child to acute methadone toxicity. It is sickening to read about the continued deaths of not only addicts, but babies who had methadone rubbed on their gums or given a small dose to stop their withdrawals, legit pain patients who were following their doctor's orders and children who are given or who accidentially take their parent's take home doses. This must stop and these government officials like SAMHSA/CSAT who are suppose to be keeping an eye on the clinics are turning a blind eye to these deaths that have now been occuring since methadone was taken out of the hands of the DEA in 2001. They have known the deaths have been increasing and they have done absolutely nothing until some groups were formed to start restricting the use of this deadly/dangerous drug. Now, they MUST do some things to at least look like they care, if they don't they know these groups are ready and willing to call for the banning of this drug and they sure do not want that. This next two years should be very interesting. I for one want to see it banned, for there are other ways for a addict to get and stay clean and much better/safer meds for the pain patients.

Posted by Bren O'Neal on 20 Aug 08 06:55 AM EDT

Our 33 year old daughter that died from a negligent doctor that prescribed her 240 10 mg. Methadone pills and Xanax knew he was negligent. Please Zenith if you're ever going to tell the truth I think it's high time you did instead of misleading people of the facts you jump on every site so you can to defend your right and others to be prescribed Methadone. I recall vividly when Methadone Clinics started opening widespread across the United States in the late 1960's and 1970's to treat heroin addicts.The FDA,SAMHSA,DEA and the Dept. of Health and Human Services haven't rushed into helping to stop Meathadone or any other popular prescription drug related deaths.I suffer myself from chronic pain and have seen excellent specialist over many years and not one has ever offered to prescribe me Methadone, Oxycontin or any of the drugs that families are devastated by.For joda I'm not a victim our daughter was.I support MAMA, Mothers Against Medical Abuse, HARMD that wants to Help Reduce Methadone Deaths, MAME, Mothers Against Medical Errors. We have wonderful brilliant Doctors and some of the finest Hospitals in the world and I support their rights, also.

Posted by joda on 19 Aug 08 10:12 PM EDT

I am sorry for anyone’s loss but I can tell you as one who also lost a loved one to a drug overdose, the sooner I finished playing victim and attempting catharsis through external means, the sooner I got back to living responsibly. Most misinterpret events as "this was not supposed to happen" or this happened as a "sacrifice for the greater good that I am now doing". The truth is everything, I mean evrything, happens exactly as it is supposed to happen. Our quest for external power through control and self-justification leads us on a endless journey to satisfy our ego’s need to assert itself over our soul’s true need to love and be loved. The spiritual alternative is to accept responsibility for EVERYTHING that happens in our lives. This also means extending forgiveness in the place of blame. Every doctor and every person who’s overdosed each have their own karmic debts to pay in regard all shared and unshared circumstances. It is between them and God; not you, not me. I know that all this is hard to accept; it took me much pain and personal soul searching to finally come to terms with God’s awe-filled grace.

Posted by Angelo on 19 Aug 08 09:12 PM EDT

MAMAorg you need to stop blaming methadone. Your acting off your emotions. Re-read the other comments again and I hope you'll get it right.

Posted by Bren O'Neal on 19 Aug 08 06:20 PM EDT

I lost my daughter to a negligent doctor that prescribed her Methadone for pain medication. Without any test or review of her medical records that he held in his hands my daughter was dead within eight hours of leaving his office.I've spent over two years reasearching the uses of Methadone there are other safer options that are available for both pain and addiction patients.Methadone was put on the market as pain medication because it is so inexspensive.My family has learned the hard way where the blame belongs and that is on Pharmecutical Company's, as well as greedy doctor's that open Methadone Clinics and Pain Management Clinics. Now I spend countless hours comforting families that have lost their loved ones to Methadone and most have nothing to do with abuse.People are dying at an epidemic rate as Nancy Garvin stated.The FDA are finally releasing reports on these deaths almost daily.Please help stop this outrageous behavior.

Posted by Joe Motterotz on 19 Aug 08 04:20 PM EDT

All forms of chemotherapy can be deadly if it is not delivered by qualified and informed professionals. Methadone is no different. Instead trying to legislate the problem away, maybe each individual needs to take responsibility for their role in relationship to the problem, if one exists, within their sphere of influence. If no problem exists, then you have NO role to play other than hands off! Speaking from my experience as a recovering heroin addict, methadone has been nothing short of miraculous and the resultant benefit to my daily life equally magnificent in its regularity. Used in conjunction with an individualized treatment plan methadone is an essential component of many former heroin addicts sustained recovery. Regardless of what position one takes, recovery is never one-size-fits-all except if one has a private agenda to push or wish to exhort fundamentalism in any of its many forms. Many people have as their overriding goal, the need-to-be-right and it often comes at the expense of doing what’s right; which in this case is do nothing unless you have a compelling interest with methadone and a desire to do what is good in regards to everyone else who does too.

Posted by Zenith on 19 Aug 08 01:13 PM EDT

The goal of maintenance treatment is not to wean the patient off methadone--it is to stabilize their lives, stablize damaged brain chemistry, and return them to a functional, law abiding existence. The article was a very good one overall, but the FDA should have acted MUCH sooner on the insert information recommending as much as an 80mg starting dose for pain management patients--there were MANY organizations that had informed them that this was ludicrous and WAY too high.

Posted by Zenith on 19 Aug 08 01:12 PM EDT

Mr diamant asked about people being weaned from methadone (presumably for addiction treatment). Some are weaned off at their request and a small percentage (about 10%) do well. However, the vast majority that end up in a methadone clinic have long term, heavy addictions that have been found to be unresponsive to traditional abstinence based treatment and who are chrnic relapsers. Current science shows that many long term opiate addicts experience permanent changes in the brain chemistry as a result of abusing these drugs, or even had deficient endorphin production from an early age which may have contributed to their drug use in the first place. Methadone stabilizes the brain chemistry without causing a high or euphoria in stable patients, enabling them to feel normal and to focus on other things and return to a normal, law abiding life. However, as many times these brain changes are permanent in nature, the relapse rate for those leaving methadone treatment is very very high (90%), while the success rate for those remaining IN treatment is higher than with any other treatment for opioid addiction--around 65% to 90% depending on the clinic.

Posted by Zenith on 19 Aug 08 01:09 PM EDT

This "poisonous drug" has restored many thousands of people, both pain and addiction patients, to a useful life when no other medication could do so. As the article stated and as Dr Heit stated, used APPROPRIATELY, it is a wonderful medicine. Why would a prescriber like Dr Heit, who obviously is fully aware of the dangers of misusing this drug, continue to use it if other meds worked just as well for everyone? I know many who have gotten pain relief ONLY from this medication, and as a former RN in an orthopedic ward, we used it frequently for postop back surgery patients as many doctors felt it was uniquely valuable for that type of pain.

Posted by Neil on 19 Aug 08 12:10 PM EDT

I'm amazed that the starting doasage is now 80mg. As a substance abuse counselor, to my knowledge in previous years the 80 mg was considered a blocking dosage--but this was for outpatient maintainence purposes. As I've stated in another posted comment, education has to be the starting point to make one aware of both the benefits and the risks of taking this medication--or any meds!!

Posted by Steve Kudlak on 19 Aug 08 10:47 AM EDT

Please be careful about calling upon the powers of the feds who seem to have a bad habit of rushing in and pouring rules, often misguided over things. Fed on by well meaning people people whp just want to see some "evil" stamped out; Thery could make lives of chronic pain patients literal hell. Higher does of short lived breaktrhough pain drugs might help if people can see beyond the buzz factor. PLease be careful invokinv authorities.

Posted by John Keppler MD on 19 Aug 08 09:36 AM EDT

The problem is not only mixing it with other meds. Methadone has a very long half life in some folks up to 48 hrs, however its pain relieving qualties only last 6-8 hrs. Thus the misinformed MD or the patient increases the frequency of the dosage or the dosage itself leading to a build up of methadone in the bloodstream to the level that stops respiration. ODs occur but are much less common in Opiate Maintenance Programs

Posted by Charlie on 19 Aug 08 09:22 AM EDT

Nancy, I am truly sorry for your loss. But, methadone has been a God-send for many people. Closely reading the NYT article, I see that most of the blame is laid at the feet of doctors and abusers, not at the medication itself. Often times people seek out a devil instead of acknowleging personal responsibility. It's not the methadone killing people.

Posted by Joe Diament on 19 Aug 08 09:05 AM EDT

It would be helpful to know how many overdoses are due to poor prescribing practices for legitimate purposes Vs. diversion from legitimate channels of distribution. The biggest problem I continue to have with Methadone is not its efficacy in managing pain and/or heroine addiction, but rather the fact that, to my knowledge, few if any former heroine addicts are ever weaned from Methadone.

Posted by Karen Ventimiglia on 19 Aug 08 08:35 AM EDT

Great article.. So many people want to blame the methadone when its been used for a very long time to treat chronic severe pain and addiction. Im all for doctors having to take classes to learn more about pain management. Methadone should NOT be used unless all other medications are found to be ineffective. Why is it we constantly look at the drug instead of the prescribers? People are not only dying from negligent doctors who are prescribing methadone but more people die in this country every single year from prescription drugs then all the illicet drugs put together. Lets wake up people and put the blame where is lies and stop this Stuff.

Posted by Donalisa McNichols on 19 Aug 08 08:15 AM EDT

We need to find a way to test for the medication phenergan. We have had several overdoses at our program with this mixture. It is very deadly

Posted by MAMAorg on 18 Aug 08 11:58 PM EDT

Methadone is the most deadly drug on the market and nothing is being done to stop this epidemic. I was featured in that NY Times article along with the story of my son Robby Garvin which this article failed to include. I am now an advocate to stop the senseless deaths that our sweeping our nation as our government turns there heads in support of corrupt drug companies. Please say NO to this poisonous drug. Nancy Garvin Mothers Against Medical Abuse. Org Help Stop Rx, Methadone Deaths

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