The consensus report, "Methadone-Associated Mortality, Report of a National Assessment," concludes that "although the data remain incomplete, National Assessment meeting participants concurred that methadone tablets and/or diskettes distributed through channels other than opioid treatment programs most likely are the central factor in methadone-associated mortality."
The methadone report was released at the Sixth International Conference on Pain and Chemical Dependency in New York City. SAMHSA convened the panel to determine whether its methadone regulations were allowing diversion of methadone from clinics or whether the rise of methadone mentions in hospital emergency rooms and reports of deaths were due to methadone coming from other sources.
Hospital emergency department visits involving methadone rose 176 percent from 1995 to 2002. The rise from 2000 to 2002 was 50 percent, according to SAMHSA's Drug Abuse Warning Network. The panel of state and federal experts, researchers, epidemiologists, pathologists, toxicologists, medical examiners, coroners, pain management specialists, addiction medicine specialists and others was convened in May 2003.
"The participants in the meeting reviewed data on methadone formulation, distribution, patterns of prescribing and dispensing, as well as relevant data on drug toxicology and drug-associated morbidity and mortality, before concluding that the cases of overdosing individuals were not generally linked to methadone derived from opioid treatment programs," SAMHSA Administrator Charles Curie said. "SAMHSA will continue to monitor the situation to insure that SAMHSA's supervision of opioid treatment programs is always in the public interest."
"The Office of National Drug Control Policy (ONDCP) is pleased that the consensus report findings demonstrate that the controls on methadone are working," Dr. Andrea Barthwell, Deputy Director for Demand Reduction at the White House Office of National Drug Control Policy, said. "We applaud the diligence that the providers of methadone have shown in keeping this a safe modality for the patients they serve and the communities in which they reside."
The panel based it conclusion that methadone is coming from other sources on data showing that the greatest growth in methadone distribution in recent years is associated with its use as a prescription analgesic prescribed for pain, primarily in solid tablet or diskette form, and not in the liquid formulations that are the mainstay of opioid treatment programs that treat patients with methadone for abuse of heroin or prescription pain killers.
"Methadone continues to be a safe, effective treatment for addiction to heroin or prescription painkillers," Dr. Clark said. "While deaths involving methadone increased, experiences in several states show that addiction treatment programs are not the culprits."
Pain Prescriptions Increasing
The expert panel learned that in North Carolina only four percent of the decedents were participating in addiction treatment at or near the time of death, and in Washington State use of multiple drugs was reported in 92 percent of deaths involving methadone. In Texas, cases of overdose involving persons being treated in opioid treatment programs declined between 1999 and 2002.The experts noted that the increasing numbers of prescriptions for methadone are paralleling the increase in prescriptions for oxycodone, hydrocodone, and morphine, as physicians prescribe to ameliorate chronic pain.
The panel recommended creation of case definitions that would make a distinction between deaths caused by methadone and deaths in which methadone is a contributing factor or merely present. They want health care curricula to train health care professionals in both "the diagnosis and treatment of addiction and appropriate pharmacotherapies for pain."
The experts surmise that current reports of methadone deaths involve one of three scenarios: illicitly obtained methadone used in excessive or repetitive doses in an attempt to achieve euphoric effects; methadone, either licitly or illicitly obtained, used in combination with other prescription medications, such as benzodiazepines (anti-anxiety medications), alcohol or other opioids; or an accumulation of methadone to harmful serum levels in the first few days of treatment for addiction or pain, before tolerance is developed.
