Government Undertakes Effort to Cut Methadone-Related Deaths

Evidence suggests that the illicit use of methadone in the United States is a growing public health problem, resulting in a dramatically increasing number of deaths in recent years, according to federal health officials who are working with medical experts and pharmacists to curb the problem.

While the Centers for Disease Control and Prevention does not have comprehensive figures on methadone-related deaths for all states, the data it does have indicate that the number increased from 786 in 1999 to 3,849 in 2004, a 390 percent jump. The number among people aged 15 to 24 increased 11-fold in that same time.

Definitive data on methadone-related deaths are not available because of the lack of consistent systems to collect information from all available sources in each state, such as medical examiners and police, according to background information released at a conference last month on methadone mortality sponsored by the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA). The purpose of the conference was to bring together experts from various fields to assess current knowledge on methadone-associated deaths and review progress in addressing the situation.

The conference was a follow-up to an initiative launched by SAMHSA in 2003 to reduce the illicit use of the drug. That effort involved epidemiologists, clinicians, educators, patient advocates, and policymakers to identify the sources of the methadone that is abused and develop a national response to the problem. Among the sources they identified were thefts from pharmacies and private homes, “doctor shopping” by addicts, and trading drugs on the street, according to H. Westley Clark, M.D., director of CSAT, who spoke at a press briefing during the July conference.

Although it is believed that the single greatest source of illicitly used methadone is still unknown, Clark said that a national response should address all known sources.

“You don't want to create a unitary response only to have the problem worsen in other areas,” Clark said.

As part of that response, CSAT is considering the development of physician-prescribing guidelines for methadone. The drug has become increasingly popular in recent years as a low-cost and effective pain-management tool by general practitioners. The volume of methadone distributed through pharmacies increased fivefold from 1998 through 2002, according to CSAT's 2003 National Assessment of Methadone-Associated Mortality. The number of prescriptions written for methadone increased by 300 percent in that same time, according to the Drug Enforcement Agency.

Also as part of the response to the methadone-mortality problem, the American Pain Society is completing a physician guide on the use of opioids for pain management. SAMHSA's outreach to physicians on the problem has included the 2006 release of a Treatment Improvement Protocol (TIP) on detoxification and substance abuse treatment (Psychiatric News, August 18, 2006).

Seddon Savage, M.D., director of the Dartmouth Center on Addiction Recovery and Education and a contributor to the ongoing CSAT assessment of the methadone-fatalities trend, said during the conference that she expects new recommendations from CSAT to build on those from 2003, which included calls for more useful data—there is no national database of drug deaths—and public education. The 2003 recommendations also urged better training for “health care professionals” to address pain and addiction.

Savage traced much of the increase in deaths to methadone's status as“ a drug of the moment” and noted that there are an increasing number of deaths from all opioid analgesics.

Clark said SAMHSA efforts will include increased data collection and a patient education campaign on proper use of prescriptions and the importance of prompt disposal of unused medications. Final recommendations from the conference were expected in late August.

SAMHSA's 2004 report “Methadone-Associated Mortality: Report of a National Assessment” is posted at<www.atforum.com/SiteRoot/pages/addiction_resources/CSAT-MAM_Final_rept.pdf>.▪