Evidence Mounts: Methadone Risky in Chronic Pain

By Kristina Fiore, Staff Writer, MedPage Today

Published: July 03, 2012

 

The opioid-treatment drug methadone is culprit in almost one in three prescription painkiller overdose deaths, even though it only accounts for a fraction of scripts for pain, CDC researchers said.

About 5,000 patients died from methadone overdose in 2009, about six times more than 10 years earlier, Thomas Frieden, MD, PhD, director of the CDC, and colleagues said in a Vital Signs report.

"Methadone is riskier than other prescription painkillers ... and we don't think it has a role in the treatment of acute pain," Frieden said during a call with reporters.

He emphasized that most of these accidental deaths are tied to the drug's use in chronic pain -- a condition for which there is little evidence of its benefit, he noted -- and are not associated with its indication for the treatment of substance abuse.

In 2009, methadone accounted for only 2% of all painkiller prescriptions in the U.S., though it makes up a greater proportion of painkiller scripts in some states than others, particularly the Pacific coastal states as well as Maine, Vermont, and New Hampshire.

Frieden said that proportion has risen over the years, as insurers have increasingly made it a top-tier drug for chronic pain given its low cost per pill.

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

He added that using methadone in this situation "is penny wise and pound foolish ... with higher societal costs in terms of death and other problems that can be avoided," he said, adding that there are other, safer opiates that can be used for pain.

Methadone can cause more respiratory depression and disruption of heart rhythm than these other opiates, he said.

And he cautioned that there's limited evidence for the effectiveness of opiates as a class in chronic pain that's not related to cancer, and the drugs have been related to a rising number of overdoses and deaths in recent years.

In 2009, for instance, there were 15,500 prescription painkiller overdose deaths in the U.S., and these drugs now account for more deaths than heroin and cocaine combined, Frieden said.
Government agencies have put forward many efforts to curb that tide, he said, noting that his agency has been working with states to create more effective prescription drug management programs (PDMPs), which are in place in 49 states.

They're of varying levels of quality, however, and agents have been working to make them more real-time and easier for doctors to access, Frieden said.

He added that recent campaigns by the FDA and the DEA appear to be having an impact on methadone overdose and deaths, as preliminary figures for 2009 have shown a slight decrease in methadone scripts.

"I think this shows that it's possible to make further decreases in the number of people who overdose or die from methadone," Frieden said.