No Training Can Mean Methadone Overdoses

Methadone improperly prescribed leading to spike in fatal overdoses

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) New guidelines by the U.S. Centers for Disease Control and Prevention (CDC) outline needed changes in policy for methadone, saying that the medication needs to be used only for heroin addiction, palliative care, and cancer-related pain.

The CDC released a report showing that fatal overdoses involving methadone jumped from around 800 deaths in 1999 to close to 5,000 deaths in 2009.

The CDC report concludes that the current cost to society of using methadone for other uses is excessive.

"Ask your doctor about appropriate pain medications."

Leonard J. Paulozzi, MD, from the Division of Unintentional Injury Prevention in the CDC's National Center for Injury Prevention and Control, was the lead author of the report. It describes how a narcotic representing only two percent of prescribed pain medication is involved in nearly a third of fatal overdoses in that category.

The CDC found that methadone was the cause of 40 percent of fatal overdoses involving a single drug, which strongly hints that the drug is improperly prescribed in those patients.

The report references a 2009 study by the U.S. Food and Drug Administration which found that the majority of methadone was prescribed for back pain, arthritis, and headaches by nurse practitioners or family doctors without any background in narcotic treatments.

As described by the authors of the FDA report, the most worrying issue was that a third of those questionable prescriptions for methadone were given to patients who had never used narcotic painkillers.

Initial studies supported the safe use of methadone for use by patients with an addiction to opiates, and methadone remains the recommended treatment for cases of heroin addiction.

In some cases, methadone is the default treatment chosen by insurance companies or health care organizations with limited finances in cases of severe pain, because of the drug's low cost and the long-lasting effects.

But the advantages of the drug are also part of the risks. he slow effects and long duration of methadone can become a major problem when toxic levels are reached. Consistent monitoring needs to be used to make sure the drug is used properly and at the correct dose, which is why the CDC recommended that only experienced pain physicians should prescribe methadone.

Although one major risk of methadone treatment is the possibility of fatal interactions with other prescriptions, methadone was responsible for 40 percent of fatal overdoses when no other prescriptions were involved.

The CDC said that the risks are related to the unpredictable side effects, which include the possibility of the heart losing its natural rhythm.

The ability to give methadone as a liquid instead of an injection, the very long effects of the drug and the low cost were all strong arguments in favor of using methadone rather than other opiate drugs.

Like all narcotics, the dose can have different effects depending on the person's ability to metabolize the drug but is generally far longer than other opiates, with effects of up to three days.

Unfortunately, a large drawback of methadone is that the withdrawal symptoms are worse than morphine or heroin and can last for weeks rather than days. Safely quitting a course of methadone treatment can take up to two years.

The report was released by the Centers for Disease Control on July 6, 2012.

Reviewed by: 
Review Date: 
July 5, 2012
Last Updated:
July 7, 2012