Methadone for Pain Relief Leading Cause of Fatal Overdoses: CDC

By Steven Reinberg
HealthDay Reporter

TUESDAY, July 3 (HealthDay News) -- Although methadone accounts for only 2 percent of the painkiller prescriptions in the United States, it is tied to more than 30 percent of painkiller overdose deaths, according to a government report released Tuesday.

"There have been about 4 million prescriptions for methadone each year, and about 5,000 Americans die from methadone overdoses each year," said Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention.

Methadone is riskier than other opioid painkillers because it builds up in the body and may alter breathing or heart rhythm, the report explained.

Since the 1960s, methadone has been used safely as a heroin substitute in treating drug addiction. Its use as a painkiller has grown since the 1990s, the report indicated. Now, methadone is overused for pain, Frieden said.

Abuse of methadone for nonmedical purposes has also led to fatal overdoses, the report noted.

National data from 1999 to 2010 plus 2009 information from 13 states revealed that four of every 10 overdose deaths resulting from a single painkiller involved methadone -- twice as many as other prescription painkillers, such as Vicodin (hydrocodone) or OxyContin (oxycodone), the CDC reports.

In 2009, six times more people died of methadone overdoses than in 1999, the researchers found.

"Currently, deaths from prescription opiates kill more people than heroin and cocaine combined and cause more emergency department visits as well," Frieden said during a late morning press conference Tuesday.

Frieden was talking specifically about methadone for treating chronic pain, not its use in drug-addiction treatment programs.

"All of the evidence suggests that the increase in methadone deaths is related to the increased use of methadone to treat pain," he said.

In the United States, more people now receive prescriptions for methadone to relieve pain than to treat drug addiction, Frieden said.

The reason is cost. It's cheaper than other prescription painkillers, so many insurance companies list it as a preferred drug for relieving chronic pain, he explained.

Methadone should not be used for mild, acute or occasional pain, he added. "There is little evidence that methadone works for chronic non-cancer pain," Frieden pointed out, mentioning backache or headache.

Safer alternatives to methadone exist for pain relief, he noted. "There are non-opiate alternatives that can be very effective in reducing non-cancer chronic pain and there are also safer opiates," Frieden said.

Although the government has warned doctors that methadone can be dangerous and should not be their first choice for pain relief, methadone prescriptions have not declined by much, the CDC researchers found.

Most of these prescriptions are written by doctors not trained in pain management, the report added.

To help reduce painkiller overdoses, the CDC recommended that only doctors experienced with methadone prescribe it. They also suggested doctors should:

  • Screen and monitor patients for substance abuse and other mental health problems.
  • Prescribe only as much as needed based on the expected length of pain.
  • Use patient-doctor agreements plus urine tests for people taking methadone over a long-term period.
  • Use drug-monitoring programs to identify patients misusing or abusing methadone or other prescription painkillers.
  • Educate patients on use, storage and disposal of prescription painkillers, and prevention and recognition of overdoses.

For the analysis, Vital Signs: Risk for Overdose From Methadone Used for Pain Relief--United States, 1999-2010, published in the CDC's July 3 early edition of the Morbidity and Mortality Weekly Report, the researchers used data from the Drug Abuse Warning Network of the U.S. Substance Abuse and Mental Health Services Administration.

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SOURCES: July 3, 2012, press conference with: Thomas R. Frieden, M.D., M.P.H., director, and Leonard J. Paulozzi, M.D., M.P.H., Medical Epidemiologist, Division of Unintentional Injury Prevention, both U.S. Centers for Disease Control and Prevention; July 3, 2012, CDC report, Vital Signs: Risk for Overdose From Methadone Used for Pain Relief--United States, 1999-2010