Do the Risks Outweigh the Benefits?
Even though methadone accounts for only 2% of all prescribed opioids, it has attributed to 30% of all opioid related deaths.
Methadone is an opioid used to treat pain and to treat addiction to heroin and other opioids. In 2009 there were 5000 methadone related deaths nationwide.
Who Oversees Methadone Maintenance?
- (SAMHSA) Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (CSAT)
- Drug Enforcement Agency (DEA)
- State Methadone Authorities
- State Regulatory Agencies
- Accreditation Agencies (CARF and Joint Commission)
What is the Purpose of Methadone Maintenance?
- Harm Reduction-(Approaches aimed to lessen the negative Consequences of Risky Behavior)
- To Prevent withdrawals and cravings to opiates
- To reduce crime
- To reduce risky behavior
- To slow the spread of HIV and Hepatitis
- It is not a cure
- Many clinics encourage treatment for LIFE.
How Most Methadone Clinic Operates
- Hours of Operation- Mon-Fri 6:00 am to 11:00 am
- Number of Patients- 250- 2000
- Number of Hours a Doctor is on Duty- Approximately 2 Hours per week
- Staff at a Methadone Clinic- (1) Nurse, Counselors, Security Guard, Pharmacist
- Cost of Treatment- $12.00- $15.00 per day per patient
Beginning Methadone Maintenance
- The patient arrives at the clinic at 6:00 am on the one day per week that the doctor works.
- The patient completes the medical/legal paperwork
- The patient takes a drug screen and a cursory physical is done.
- The patient is then given their first dose of methadone, which is typically 30mg (even though SAMHSA has stated 30mg is not a safe staring dose for all patients-see the 2007 Dear Colleague Letter from SAMHSA) http://www.dpt.samhsa.gov/pdf/dearColleague/09-04-07%20DearColleagueLetter%20on%20Dosing.pdf
- The next day the patient arrives and is assessed through a dosing window while receiving their dose and their dose is increased per protocol. This assessment does not involve any vital signs or pupil checks.
- Most patients are in and out in less than 3 minutes. It’s “dose and go”.
- The patient does not see a doctor again until their annual physical.
- Most patients are encouraged to continue on methadone for life.
Points about Methadone
- Respiratory depression, including fatal cases, have been reported during initiation and conversion of patients to methadone, and even when the drug has been used as recommended and not misused or abused
- Methadone is a drug of abuse and highly addictive
- Methadone is an opioid that is used to treat an opioid addiction.
- Federal and State tax dollars fund treatment in many states and in some cases even pays for daily transportation to and from the clinic.
- Most doctors prescribing methadone are not educated on safe induction and most believe that 30mg is a safe starting dose for all patients.
- Most deaths occur within the first two weeks of treatment and yet these patients are NOT being monitored and assessed for signs of intoxication during this time.
- A high degree of “opioid tolerance” does not eliminate the possibility of a methadone overdose.
- Methadone’s plasma elimination half-life is substantially longer than that of morphine (typically 8 to 59 hours vs. 1 to 5 hours) can be up to 100 hrs.
- There is no safe starting dose for all patients and that there are no safe conversion tables when converting a patient from another opioid to methadone.
- The risk of death during the first two weeks is 6.7 time higher than that of a heroin addict.
- Methadone can cause fatal heart problems( QT Interval prolongation with can lead to (Torsades de Pointes)
- Withdrawals from methadone are harder and last longer than that of other opioids.
- What is therapeutic for one may be lethal for another.
- Basically treating a patient with methadone is like playing Russian roulette.
- Darvon was second to Methadone in number of deaths. (2000 vs. 5500) Darvon was pulled from the market in 2010, methadone remains. Why?
- The general public believes that these clinics are highly regulated by SAMHSA , DEA, the state methadone authority/regulatory agencies, and the accreditation agencies but this is NOT the true!
- In many cases one agency thinks the other agency oversees certain things when in fact no one is addressing the issues at it at all. I have spoken to all these agencies and they have all told me they would never question a doctor because they do not have a medical background.
- Many clinics are operating like “pill mills” Many of the doctors in these clinics do not specialize in addiction and are actually retired OB/GYNS, pediatricians, ect.
- Physicians are only required to have 16 hours training but this is not being monitored and the education is not effective.
- Many of these clinics are only open a few hours a week (approximately 27 hrs./wk.) and provide very little counseling if any at all, even though studies have proven methadone is not effective without counseling.
- Anyone can walk off the street, test positive for opiates/opioids, and be admitted and dosed the first day.( even though federal regulations require at least one year history of opiate addiction)
- The majority of patients entering methadone treatment today are for prescription pill addictions, not heroin even though most studies using methadone were for IV Heroin users.
- They will also be given their first “take home” dose that same week. (This increases the risk of diversion)
- Patients will eventually be allowed to take home a months supply of medication.
- Methadone for addiction is supposed to be a last resort.
- Methadone costs less than $1.00 per dose but sells on the street for $1.00 per mg.
- The average daily dose is 80-120mg.
- These patients typically only see a doctor once per year, if at all.
- After the first day, the patient is assessed only by a nurse.
- This assessment is done through a dosing window while the patient receives their daily dose. (No vital signs are taken even knowing the high death rate during the first two weeks)
- Most patients are in and out in less than three minutes even on days they receive their “take home” doses and daily dose.
- Many of these clinics have standing orders for titrating a patient up even though SAMHSA has stressed that doses must be individualized.
- With pain patients, it’s recommends that you do not increase the dose for 5-7 days to allow methadone time to stabilize in the body, with addiction in most cases the dose is increased the very next day.
- Many doctors are basing the starting dose on what a patient tells them alone (subjective findings) In addition, they are asking the patient what dose they would like to receive.
- You have to base the dose on subjective and objective findings.
- The motto for methadone dosing is “START LOW, GO SLOW” This is not the way patients are being dosed. treatment is NOT “Highly” regulated and “Monitored”
- Too much wrong (deadly) information concerning treatment with methadone
- SAMHSA has been trying to educate providers for years concerning safe treatment with methadone but the deaths continue.
- Treating high risk patients with a high risk drug
- Putting high risk medication into the hands of high risk patients
- Causes of Deaths- overdoses due to uneducated providers and patients, diversion, auto accidents and child deaths
Methadone Treatment is NOT highly “Regulated” and “Monitored”. The current regulations are not being enforced well and people are dying due to this. Methadone Treatment is completely out of control since the authority changed from the FDA to SAMHSA in 2001. At what point do the risks outweigh the benefits?
Methadone treatment is a very lucrative business. This is no longer a treatment for addiction. It is now a huge money making venture.
Who is actually benefiting from treatment? The owners or the patients?
This report from March 2009: GAO Report to Congressional Requestors
METHADONE-ASSOCIATED OVERDOSE DEATHS –Factors Contributing to Increased Deaths and Efforts to Prevent Them. http://www.gao.gov/new.items/d09341.pdf highlights some of the issues but most of the studies involved only five states. There were only three states used to determine that most of the deaths were from methadone prescribed to treat pain. I do not feel this reflects the true number of deaths associated with methadone used for addiction throughout the US. Even still, the CDC reports 25% of methadone deaths are from methadone used to treat addiction. In addition some of the people involved in this report are actually part of the problem and are currently under senate investigation.
Visit our website and view the educational video and also read the stories on the petition from families who have lost loved ones to this deadly drug.
How many people have to die?
Tags: acute methadone toxicity, Methadone, methadone abuse, methadone and crime, methadone clinics, Methadone Deaths, methadone diversion, methadone overdose, methadone toxicity, methadone treatment, MMT