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Methadone Overdose a Growing Problem

Aug 18, 2008 | Parker Waichman LLP Once mainly used to treat heroin addiction, Methadone is being prescribed by family doctors, osteopaths, and nurse practitioners for some types of severe pain.  Methadone, a synthetic form of opium, is powerful, cheap, and long lasting.  Unfortunately, while it has helped millions, methadone is also widely abused and poorly prescribed by physicians.  Because of this, methadone is now the fastest growing cause of narcotic deaths, is implicated in more than twice as many deaths as heroin, and is equaling or exceeding OxyContin and Vicodin in negative responses.

Federal regulators admit to not understanding the dangers of newly widespread methadone prescribing and to confront physician ignorance about the drug, blaming “imperfect” systems for monitoring such problems; methadone, is made by Roxane Laboratories Inc. of Columbus, Ohio and Covidien-Mallinckrodt Pharmaceuticals of Hazelwood, Missouri.  “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.”  Worse, in what critics call a stunning oversight, the Food and Drug Administration (FDA)-approved package insert for methadone—for decade—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 on addictions.  This dangerously high dosage recommendation remained in the insert until late 2006.

Experts say doctors misunderstand how methadone is metabolized and how patients’ responses differ. Some prescribe too much too fast, allowing methadone to build to dangerous levels; some fail to warn patients of the dangers of mixing methadone with alcohol or sedatives, or do not maintain patient contact during the dangerous first week of treatment; some patients simply ignore doctors’ orders.  “Those problems were not soon recognized,” said Dr. Bob Rappaport, a division director at the FDA, who added, “Methadone is an extremely difficult drug to use, even for specialists. People were using it rather blithely for several years.”  Dr. James Finch, an addiction specialist in Durham, N.C., said, “In the clinical and regulatory communities, everyone is trying to run and catch up with and deal with the causes of methadone overdoses.”

Another source of danger has been the conversion tables doctors use when switching opioids in patients.  Until recently, these charts indicated dangerously high doses for methadone.  Newer ones suggest lower levels but many experts say these may be useless because methadone responses differ widely.  Abuser misuse was initially believed to be the problem, but now, according to Dr. H. Westley Clark, director of the Center for Substance Abuse Treatment of SAMHSA, “We know that a significant share of the methadone deaths involve doctors making well-intended prescriptions.”  Still, the death rate appears to be rising.  “Methadone can be important for patients when other drugs don’t work,” said Dr. Inturrisi, ”but unless the doctor has the training and resources to manage the patient properly, he’s going to get in trouble at a rate that’s unacceptable.”


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