Methadone Prescribing and Overdose Deaths

Methadone was involved in more than 30% of opioid-related deaths in the United States in 2009, second only to the painkiller oxycodone, according to new data from the Centers for Disease Control and Prevention. The high rate of overdose deaths from methadone occurred even though the drug accounted for less than 2% of opioid prescriptions in 2009. Part of problem is that methadone is more likely than other opioids to cause an overdose, according to the CDC. The findings, which were published on July 3 in Morbidity and Mortality Weekly Report, show that as the use of methadone for pain relief has risen, so has the number of overdose deaths associated with the drug (MMWR 2012;61:1-5). Health officials urged physicians not to prescribe the drug unless they had experience with it, and to limit its use to areas where the benefits outweigh the risks, such as in the treatment of cancer pain or for palliative care. In the MMWR article, the CDC researchers said that the current uses of the drug in pain treatment might be inappropriate. They pointed to a study from the FDA showing that musculoskeletal problems such as back pain and arthritis were the most common diagnoses associated with methadone use for pain in 2009. The researchers specifically urged physicians not to prescribe methadone for low back pain because studies have not shown benefits to using opioids for this condition. Methadone also should not be prescribed for acute pain or to opioid-naive patients, and should be avoided in patients taking benzodiazepines because of the risk for severe respiratory depression, according to the researchers. In a separate CDC web article the following recommendations were published: Health care providers can: Follow guidelines for prescribing methadone and other prescription painkillers correctly, including Screening and monitoring for substance abuse and mental health problems. Prescribing only the quantity needed based on the expected length of pain. Using prescription drug monitoring programs to identify patients who are misusing or abusing methadone or other prescription painkillers. Monitoring patients on high doses of methadone for heart rhythm problems. Educating patients on how to safely use, store, and dispose of methadone and how to prevent and recognize overdoses. Health insurers can: Evaluate methadone’s place on preferred drug lists. Consider strategies to ensure that pain treatment with any dose higher than 30 mg of methadone a day (the recommended daily starting dose) is appropriate. I hope that we can all be part of the solutions because lately I see a proliferation of methadone prescribing among my colleagues, many of whom I do NOT recognize as experts in pain management or pharmacology. Appreciate your comments and suggestions. Yours Bernd