The prescription drug methadone accounted for two percent of painkiller prescriptions in the United States in 2009, but was involved in more than 30 percent of prescription painkiller overdose deaths, according to a report released by the Centers for Disease Control and Prevention (CDC).
Methadone carries more risks than other painkillers because it tends to build up in the body and can disrupt a person’s breathing or heart rhythm. According to the report, four of every 10 overdose deaths from a single prescription painkiller involved methadone, twice as many as any other prescription painkiller.
Methadone has been used safely and effectively for decades to treat drug addiction, but in recent years it has been increasingly used as a pain reliever. As methadone prescriptions for pain have increased, so have methadone-related nonmedical use and fatal overdoses. CDC researchers found that six times as many people died of methadone overdoses in 2009 compared with methadone-related deaths in 1999.
Researchers analyzed national data from 1999-2010, and 2009 data from 13 states (those covered by a surveillance system for drug-related deaths, the Drug Abuse Warning Network of the Substance Abuse and Mental Health Services Administration).
“Deaths from opioid overdose have increased four-fold in the past decade, and methadone now accounts for nearly a third of opioid-associated deaths,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “Methadone used for heroin substitution treatment does not appear to be a major part of this problem. However, the amount of methadone prescribed to people in pain has increased dramatically. There are many safer alternatives to methadone for chronic non-cancer pain.”
Lack of training
Despite recent federal efforts to warn health care providers that methadone prescribing is complex and that methadone should not be the first choice as a pain reliever, the number of methadone prescriptions has not declined significantly. The majority of these prescriptions are written by practitioners who typically do not have special training in pain management.
“Methadone continues to play an important role in substance abuse treatment and should not be limited in its use for that application,” said Linda C. Degutis, Dr.P.H., M.S.N., director of CDC′s National Center for Injury Prevention and Control. “Health care providers can take precautions to reduce the risks of methadone overdose when used for treating pain.”
Health care providers can take additional measures to help prevent prescription painkiller overdoses. A key step includes following guidelines for prescribing methadone and other prescription painkillers correctly, which include:
- 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,
- Educating patients on how to safely use, store, and dispose of prescription painkillers and how to prevent and recognize overdoses.