ALMOST 4000 "METHADONE-RELATED" DEATHS IN 2004 - OVERWHELMINGLY ASSOCIATED WITH PRESCRIPTIONS FOR PAIN MANAGEMENT
The death toll was reported in the Charleston (W.Va.) Gazette on 31 Dec 06; West Virginia is said to lead the nation in this regard, with 99 fatalities. SAMHSA and CDC determined several years ago that methadone-related deaths are overwhelmingly associated with pain management and occurred largely in individuals for whom the medication was prescribed. Two months ago FDA changed the "recommended usual dose" for analgesic use from a range of up to 80 mg daily (correctly described in the Gazette article to be "potentially fatal") to 30 mg - but this radical (and long-overdue) change was not mentioned in the "advisory" or "alert" or "patient information notice" that was publicized. So how are physicians and patients to know?
posted by RGNewman, MD @ 9:57 AM
12 comments
12 Comments:
I am writing on behalf of the victims and those yet to be victims of methadone. I have come together with many other families throughout the United States who have lost loved ones to methadone.
We are asking government agencies to enact stricter guidelines in prescribing methadone for any reason. It must be mandatory that all doctors be certified and trained in the pharmacology of methadone; inpatient stays must be required during induction to methadone; all staff be extensively trained in monitoring methadone patients for symptoms of toxicity. Clinic patients should be tested for legal and illegal drugs that are taken with methadone to get “ hi gh” of experience “euphoria” such as benzodiazepines, alcohol, cocaine, heroin ect… and face severe consequences / mandatory detoxification from methadone program when presenting inebriated at clinic, clinic should also document such activity as well as prevent client from driving. Take home doses for all patients receiving methadone should be eliminated thus preventing the risk of diversion or precautions such as pill safe should be implemented. http://www.thepillsafe.com/
Current statistics show that nearly 4000 people a year die from methadone. These deaths are mostly happening to pain management and detoxification patients wit hi n the first 10 days of taking initial dose. Most of these deaths are related to methadone prescribed with other medications that react as additives with methadone. Diversion of methadone is a serious problem because it lands t hi s most deadly drug on streets. Statistics also state that methadone is contributing to more deaths nationwide then heroine and cocaine.
The government did take notice after the 2003 record number of deaths associated with methadone and the Bush administration responded by gathering the top experts on drug overdoses, doctors, researchers, and medical examiners, as well as representatives from the federal Drug Enforcement Administration, Food and Drug Administration, and Substance Abuse and Mental Health Association. Finn and Tuckwiller (2006) report that “the man hired to research and write the report based on the conference, as well as background paper for conference participants, was Stewart B. Leavitt, and addiction specialist whose work is funded by the makers of methadone”. Stewart B. Leavitt PhD served as researcher/writer for A National Assessment of Methadone-Associated Mortality: Background Briefing Report from the U.S. Department of Health and Human Services. Stewart B Leavitt also writes Addiction Treatment Forum Methadone Dosing & Safety in the Treatment of Opioid Addiction which is funded by Mallinckrodt, Inc. a manufacturer of methadone. My question is why hasn't a team of independent researchers not funded by pharmaceutical companies; a person or group of people that stand to gain no financial benefit on the outcome of the studies been hired to conduct the research? Finn and Tuckwiller (2006) report that “the man hired to research and write the report based on the conference, as well as background paper for conference participants, was Stewart B. Leavitt, and addiction specialist whose work is funded by the makers of methadone”. Stewart B. Leavitt PhD served as researcher/writer for A National Assessment of Methadone-Associated Mortality: Background Briefing Report from the U.S. Department of Health and Human Services. Stewart B Leavitt also writes Addiction Treatment Forum Methadone Dosing & Safety in the Treatment of Opioid Addiction which is funded by Mallinckrodt, Inc. a manufacturer of methadone. On the forum associated with his website several of the clinic participants speak of diverting, misusing, stockpiling, selling, and potentiating methadone and other prescription drugs.
This methadone epidemic and deaths associated with it are not going away. It's only getting worse; I get contacted by families on a daily basis who have lost someone to this drug. At what point do we value human life over the convenience of others? Methadone patients, whether they are pain or clinic pose a risk to themselves and society as a whole if they are not monitored, dosed, and assessed correctly. Clinic patients getting into cars after being dosed who are using benzodiazepines, alcohol, or other opiates are killing innocent people on the road. This type of harm reduction is not saving lives it’s taking them. The government cannot continue to be a legal drug dealer in order for its citizens to “behave”. Many MMT patients claim that they have been able to maintain sobriety for long periods of time (several years) but are unhappy and depressed therefore seek out MMT and describe the "high" they get from this that makes they happy. Endorphin Deficiency is another "off-label" use of methadone. I have yet to be able to find this "diagnosis" listed in the DSM IV but I'm am sure they a large percentage of the population suffer from this as endorphin deficiency precipitated not only by opiate abuse but also eating disorders, ADHD, low levels of neurotransmitter GABA, PMS, stress, MS, depression etc....
I know the rules are in place for the clinics but they are NOT being followed. Patients sell take homes outside the clinics. In one news article a man died in the parking lot of a clinic after taking his brothers take home. This drug is too dangerous to be allowed in medicine cabinets! There is A LOT of money to be made from methadone but what expense is that money being made at? When do the risks outweigh the benefits of this drug? How many more people must die before changes are made that actually save lives?
http://www.thepetitionsite.com/takeaction/472711451
http://www.actionstudio.org/public/page_view_all.cfm?option=begin&pageid=7555&tmode
On June 24th 2006 I lost my fiancé (Ron) to t hi s deadly drug prescribed by a physician with a combination of other medications that acted as additives to the Methadone. He had knee surgery and became addicted to the percocet he was prescribed. He checked hi mself into Greenleaf in Valdosta , GA for detoxification. Upon entering the facility he was drug tested and did not come up positive for opiates (he had stopped taking the percocet 4 days before entering the facility). On the fourth day in detox he died sometime between 2am and 1pm in the afternoon (he was never checked on in all of those hours). The night before he died he was complaining of migraines and vomiting, apparently the staff thought he was still experiencing withdrawals and was not concerned about these symptoms. The symptoms of methadone toxicity mimic withdrawal symptoms physicians and staff must be very cognizant of the complex properties and metabolization of methadone. There were many errors made in my fiancé’s death including the fact that he was given numerous amounts of additive medications such as benzodiazepines. He had only been taking percocet for about 4 months and according to the DSM IV he wouldn’t be an appropriate candidate methadone maintenance treatment.
It doesn't matter specific reasons for taking methadone but what does matter is that t hi s medication is deadly and physicians need to more prudent in prescribing it as well as monitoring their patients w hi le beginning treatment of any kind using Methadone. I'm not sure if Ron was given methadone for the sole purpose for detoxification from opiates or if it was a combination of pain relief associated with numerous surgeries and opiate addiction. Methadone is difficult to properly dose no matter what reason it's being used for and primarily relies on the patient’s indications of how they feel (assumedly they are being monitored). There are ways to make the administration of methadone safer, it's just a matter of putting the focus on t hi s drug and the deadly consequences when administered incorrectly or not monitored.
Many people are dying unnecessarily at the hands of the physicians they turn to for help. Methadone deaths are rising throughout the country. Ron was 32 years old and has 2 c hi ldren from a previous marriage that now do not have a father.
I'm also providing you a link to a website I created in hi s memory to give a more human touch to t hi s email. http://renato-capozzo.memory-of.com/
Regarding 4000 methadone deaths nationwide and blog responder Melis11577: First, sincere condolences on her loss! Surely nothing can lessen the terrible tragedy when someone loses a loved one, but especially when the death appears to have been avoidable. Before advocating regulatory and other changes to address a problem, however, one must understand just what causes it.
Methadone programs for the treatment of addiction, and their patients and staff and policies, are not the problem. This has been unequivocally found in an exhaustive, year-long study of the panel of experts convened by the Federal Government – to which Melis has referred. The panel was large and diversified and well respected. In sum, the panel reported – in their words – when it comes to deaths attributed to methadone “maintenance programs are not the culprit.”
What was determined to be “the culprit” was overwhelmingly methadone prescribed for pain. In fact, a study by the authoritative Centers for Disease Control (CDC) reported in one of the most prestigious medical journals in America (JAMA, vol 290, 2003) that fully 75% of those whose deaths were attributed to methadone prescribed for pain were the patients for whom the prescriptions were written.
And yet, methadone is recognized as a superb and safe pain medication for many patients. So what might account for these pain-prescription methadone overdoses? Very possibly it is the recommended “usual dosage” of methadone that has been referred to for decades by the Food and Drug Administration and manufacturers, and was included in the “package insert” of every prescribed package of the medication dispensed. That “usual dosage” range was up to 80 mg per day – a dose that for those not accustomed to taking opiates can be lethal. And it has not been a secret that such a “usual dosage” can be dead wrong for a new patient; Federal regulations have for years put an upper limit of 30 mg as a starting dose for heroin addicts beginning methadone maintenance treatment. This limit of 30 mg was referred to by an extensive report of the Institute of Medicine in 1995, which urged that it be retained in the interests of the safety of new maintenance patients.
Finally, in November of 2006, the FDA changed the recommendation for “usual dosage” from a top-of-the-range 80 mg down to 30 mg! The bad news: it seems that no public notice mentioned this dramatic decrease, so that one must be concerned that some physicians, pharmacists and patients continue to follow the long-standing previous recommendations that put patients at grave risk.
My condolences also to the woman who lost her fiancee. However, I must agree with Dr.Newman. The problem is NOT with the methadone maintenance clinics - and to do away with take home medication, require lengthy inpatient stays for new methadone patients, etc., is not the solution. Methadone as prescribed and dispensed for Opiate Replacement Therapy is one of the most highly regulated and monitored drugs in the nation. Punishing the majority of patients and placing additional barriers to access to this life-saving treatment is not the answer. Diversion of medication is about the worst offense a patient can commit at a clinic, and is already dealt with severely. It is not the drug that is the problem, it is a lack of knowledge and understanding of the drug. A few years ago the "Evil Drug" was Oxycontin - even though the active ingredient, oxycodone, had been used safely and effectively for decades. Thousands of people die every year from overdose with aspirin and other over-the-counter pain relievers. Should we ban Bayer and Tylenol? I do agree with the suggestion that doctors be given more training in the pharmacology of ALL drugs, and more education about the disease of addiction. It is information, not prohibition, that is the solution
INFORMATION IS KEY. Unfortunately the ratio of those knowledgeable in methadone pharmacology to those who prescribe it is HUGE. If I a mere mortal were to give a client of mine wrong information due to my lack of knowledge I would be fired. But a doctor can give a 2 minute exam and prescribe methadone for numerous reasons.Even with the knowledge their patients are taking benzodiazepenes. please. there should be a rule for dr.'s to take a test whatever u all do to make sure your knowledge of methadone pharmacology is correct. People r dying and the fact that a few know the dangers and pharmacology is not helping the families of those who r now dead.There should be an overall checklist a doctor has to go thru with a patient . I am just so in a bind as to what to do about it and this seems to be a great way of making sure all the mds out there are on the same page at the very least. steff
wkI lost two brothers in 2006.Cause of death was methadone. They died within four months apart. This was very hard on my family. My little brother was not even perscribed methadone but got it from another family member. However, the dose he took was lethal and it killed him. My older brother had been a drug addict for years and took the drug methadone to get off other drugs and for pain. He became addicted and it took his life over. I remember seeing him severals times nodding off and shallow breathing. The doctor that prescribed it to him knew that he was taken other drugs but continued to perscribe the drug. His fate was methadone and xanex overdose. I don't care what one say's methadone is addictive and you do get high off of it. They should ban the drug and do away with the clinics. They (the clinics) are such a joke. Wake up. Methadone is a very powerful, addictive, and lethal drug. Methadone is killing people everyday.The only way to be free is to stop. Never get started. I wish they never would have invented this drug.A drug is a drug.
Please see these videos and what actually goes on at clinics http://www.nbc10.com/news/13843471/detail.html and http://video.nbc10.com/player/?id=142152
www.HARMD.org
Melis this is ONE clinic out of thousands. Please come see my clinic and I promise you will not be able to tell it's not a doctors office.
If your goal is to end methadone overdoses than your goal should be to get more people into treatment because clinic patients aren't dying-addicts on the street die.
I am sorry for your loss. However, what will you tell my mother and my daughter when I DIE because I could no longer take my dose of methadone because of the restrictions your trying to place on clinic patients.
Why aren't you heading a crusade to educate Doctors about prescribing instead of a crusade to end the use of ONE drug that even if you did get banned would put 250thousand patients back on the street and dying at alarming numbers.
If the problem is with Doctor prescribing and that has been proven why do you continue to aim your energy at clinics?
I am a Doctor who works in a clinic that gives Methadone to heroin addicts. As long as you tell a patient what they cannot use, when taking methadone, it is safe, and patients need a dose that fits their habit. Makes no sense giving 30 mg to someone who uses 2 grams a day, like it makes no sense giving 80 mg/day to someone who uses a daily dose that comes out to be a gram a week.
Plus, there are many better drugs for pain control like Gabapentine, Carbamazepine, Lyrica ( as a trade name).
Doctors just have to be well informed abut the medications that do not mix well with Methadone, and all it takes is reading the information and applying it to every patient, having patients write out all the medications they take, and don´t use Methadone for pain management.
I am currently prescribed methadone as a treatment for my long-term heroin addiction. As such I have first hand knowledge and experience of methadone and it’s effects.
Aside from the obvious health implications of methadone (my personal opinion being that it is entirely safe if prescribed and used properly), there is also the overwhelming fact that when a drug addict is prescribed methadone, they no longer need to commit crime to maintain their habit on street drugs, thus eliminating them as a menace to society. I feel this fact hugely outweighs the issue of potential overdose, which is always a minor risk when taking ANY drug or mixture of drugs.
My life was very hectic while I was using heroin in addition to other drugs. Although I personally never needed to commit crime to maintain my habit, my life still became unmanageable and I feel I became out of touch with reality to a certain extent, as I separated myself from society as much as possible, probably due to shame. Being on a methadone program now has improved my life and moods exponentially. I’ve never been so well adjusted and I feel I have a regulated normal life and are a legitimate member of society again. I’m no longer ashamed; as I know what I’m doing is legal and is prescribed to me.
I also very much agree with Michael, that Methadone should not be used for a pain medication in non-opiate dependant patients. I knew that subutex (buprenorphine) was sometimes prescribed for pain, but it was in fact news to me that methadone had been as well. I happen to know that subutex is comparatively a very expensive drug, whereas methadone is extremely cheap. Subutex is also far less dangerous in terms of overdose. And there are many other effective pain medications on the market. If a doctor feels he has to prescribe a substitute opiate drug for pain, why not prescribe subutex? I can’t help thinking that methadone has only been prescribed in these instances because it is such a cheap drug. We as opiate dependants are strongly advised of the possibility of overdose with methadone, so I can’t imagine prescribing it to a non-opiate dependant person. I think Methadone should be exclusively used to treat opiate addiction.
I lost the love of my life to Methadone in 2004. I has been just about 7 years now but its so painful to deal with still. We had a child together who is now 8 and my hearts totally breaks for him not having his dad in his life! I am the one that found him dead, he had foamed at the mouth and was completely purple by the time I found him in out home together. If the Clinic would have checked his vidal signs that morning he would still be alive today. This has made my life an emotional hell. Please regulate this drug better!
Very sorry foir all who hace lost someone due to a methadone overdose, the thing is, unless a person has used opiate drugs, methadone can kill. The use of opiates, create more receptors, so heroin users, or addicts to Vocodin, can take Methadone, but you need to give the correct dose, for heroin, if the habit was a gram a day, you give a dose of 100 mg of methadone. What is more, when a person's methadone is not enough, and they take opiates with it, that can also cause lung failure. You just have to be careful, methadone is not for many people.
I'm trying to stop this drug in three days i will be pruposing to stop this drug called methadone if you would like to follow me in the fight to stop it comment plz and thank you god bless you all.
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