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Painkiller often abused, and legitimate users mistakenly mix it with sedatives
By Erik Eckholm
and Olga Pierce
New York Times
Published on Sunday, Aug 17, 2008
Methadone, once used mainly in addiction treatment centers to replace heroin, is today being given out by family doctors, osteopaths and nurse practitioners for throbbing backs, joint injuries and a host of other severe pains.
A synthetic form of opium, it is cheap and long-lasting, a powerful pain reliever that has helped millions. But because it is also abused by thrill-seekers and badly prescribed by doctors unfamiliar with its risks, methadone is now the fastest-growing cause of narcotic deaths. It is implicated in more than twice as many deaths as heroin, and is rivaling or surpassing the tolls of painkillers like OxyContin and Vicodin.
''This is a wonderful medicine used appropriately, but an unforgiving medicine used inappropriately,'' said Dr. Howard A. Heit, a pain specialist at Georgetown University. ''Many legitimate patients, following the direction of the doctor, have run into trouble with methadone, including death.''
Between 1999 and 2005, deaths that had methadone listed as a contributor increased nearly fivefold, to 4,462, a number that federal statisticians say is understated because states do not always specify the drugs in overdoses.
Florida alone, which keeps detailed data, listed methadone as a cause in 785 deaths in 2007, up from 367 in 2003. In most cases it was mixed with sedatives and other drugs that increased the risks.
The rise of methadone is in part because of a major change in medical attitudes in the 1990s, as doctors accepted that debilitating pain was often undertreated. From 1998 to 2006, the number of methadone prescriptions increased by 700 percent, according to DEA figures, flooding parts of the country where it had rarely been seen.
But too few doctors, experts say, understand how slowly methadone is metabolized and how greatly patients differ in their responses. Some prescribe too much too fast, allowing methadone to build to dangerous levels; some fail to warn patients of the potential dangers of mixing methadone with alcohol or sedatives. And some patients do not follow the doctor's orders.
In what critics call a stunning oversight, the FDA-approved package insert for methadone for decades recommended starting doses for pain at up to 80 mg per day. ''This could unequivocally cause death in patients who have not recently been using narcotics,'' said Dr. Robert G. Newman, former president of Beth Israel Medical Center in New York and an expert in addiction.
Methadone, which is made by Roxane Laboratories Inc. of Columbus, Ohio, and Covidien-Mallinckrodt Pharmaceuticals of Hazelwood, Mo., creates dependency and is sometimes sought by abusers who say they experience a special buzz when mixing it with Xanax.
While the greatest numbers of methadone-related deaths have occurred among the middle-aged, the fastest growth — an elevenfold jump between 1999 and 2005, to 615 — occurred among those 14 to 24, which experts say may be mainly a result of pill abuse.
Methadone, once used mainly in addiction treatment centers to replace heroin, is today being given out by family doctors, osteopaths and nurse practitioners for throbbing backs, joint injuries and a host of other severe pains.
Get the full article here.
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