Maximizing Safety with Methadone & Other Opioids

Opioids provide life-saving analgesia for the millions of Americans who suffer with chronic pain, yet overdose deaths are rising at an alarming rate, with methadone implicated to a disproportionate degree [Paulozzi et al. 2006; Webster 2005; Warner et al. 2009]. Methadone deaths increased almost seven-fold from 790 in 1999 to 5,420 in 2006, rising faster than deaths from heroin or other opioids, such as oxycodone, hydrocodone, and fentanyl [Warner et al. 2009].

At least some of the deaths appear to be associated with methadone prescribed for pain. The increase in deaths involving methadone (213%) is comparable to the increase in its use for pain management (175%) but not to the increase for opioid-addiction treatment programs (43%) [Paulozzi et al. 2006]. The US Substance Abuse and Mental Health Services Administration (SAMHSA) agrees that the increase in overdose deaths does not correspond to the methadone used in addiction treatment; however, the agency stops short of tracing the increase exclusively to pain treatment [CSAT 2007]. Law-enforcement seizures of methadone increased 262 percent from 2001 to 2007, indicating that diversion for illegal use could drive many deaths [GAO 2009]. Insufficient knowledge among healthcare providers and patients on the safe prescribing and consuming of methadone for pain is another contributing factor to methadone mortality, according to the Government Accountability Office, which analyzed methadone deaths in 2009 [GAO 2009].