Center for Addiction Medicine

11/06/2009 - Methadone-Associated Overdose Deaths

Methadone, a federally regulated narcotic drug used for pain management and opioid addiction, has caused or contributed to a fivefold increase in death from 1999 to 2005. Since the late 1990’s , methadone has been increasingly prescribed by physicians, physician assistants, nurse practitioners and dentists for the treatment of pain. It is inexpensive and has a long duration of action (generally 4 to 8 hours). It has been primarily used in opioid treatment programs as a replacement for heroin and prescription drugs (hydrocodone, oxycodone, fentanyl) to prevent withdrawal symptoms and for long term maintenance use.  Methadone cannot be prescribed for the purpose of addiction by physicians or other practitioners unless they are a federally approved opioid treatment program. Unfortunately this unapproved prescribing is happening frequently by practitioners who do not understand the federal regulations and whom are not knowledgeable in the potential dangers associated with methadone. The same scenario can also apply to methadone prescribing for the purpose of pain management.

Insufficient patient education has also been cited as contributing to methadone-associated overdose deaths. Patients may not understand how methadone works, including that it can stay in the body long after the pain returns. As a result, these patients might take methadone more frequently than prescribed to manage their recurring pain, risking overdose as the drug builds to toxic levels in their bodies. Patients might also take methadone with other drugs, including antianxiety drugs and other opioids, or alcohol, thus risking potentially lethal drug combinations.

While the pharmacology of methadone is important to the patient and practitioner, it is even more important for the patient to ask the prescriber a number of questions:

                    1)   Why am I being prescribed this medication? If for pain, what
                          is their training and experience in pain management?
                    2)   How many times has the practitioner prescribed this drug?
                    3)   What are the potential drug interactions, contraindications,
                          and side effects?
                    4)   What are the benefits versus the risks of taking methadone?
                    5)   How will the practitioner withdraw the patient from methadone
                          and what is their experience in withdrawal treatment?
  
Pay attention to the answers to these questions. Your life may depend on it.

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