Methadone “tablets” Used in Methadone Clinics- Is Methadone Prescribed for Pain Really the Cause of All These Deaths?

Posted on: June 4th, 2013 by
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Methadone

Methadone “tablets” Used in Methadone Clinics

 I felt like this was an important subject to write on because most methadone deaths are blamed on methadone prescribed for pain. Many in the general public believe that methadone that comes from a clinic to treat addiction is always liquid and this is not true. Methadone Clinics and hospitals are the ONLY ones allowed to prescribe 40 mg Methadone tablets (AKA wafers) (see below). Also the information used to determine that most deaths occured from methadone prescribed to treat pain, the  2009 “GAO Methadone Associated Deaths’ report(see link below) was based on information from FIVE STATES ONLY with limited information. This report even shows that most deaths that occurred in New Mexico were from Methadone Clinics.

Common sense tells you  patients being treating for addiction are at a higher risk of diverting their methadone than a patient being treated for pain. Although we know this occurs too!

What is it going to take for the federal government to  begin to address all the  methadone deaths we have that are directly related to methadone clinics used to treat addiction? Why do they continue to cover up and protect methadone used for addiction?

If we stopped all use of tablets for addiction and only used liquid it would be eaiser to determine where the methadone is coming from.

Methadone Hydrochloride Tablets USP 40 mg (Dispersible)

As of January 1, 2008, manufacturers of methadone hydrochloride tablets 40 mg (dispersible) have voluntarily agreed to restrict distribution of this formulation to only those facilities authorized for detoxification and maintenance treatment of opioid addiction, and hospitals. Manufacturers will instruct their wholesale distributors to discontinue supplying this formulation to any facility not meeting the above criteria.

Methadone is a long-lasting opioid medication used in the treatment of pain and narcotic addiction. The 5mg and 10 mg formulations indicated for the treatment of pain will continue to be available to all authorized registrants, including retail pharmacies. The 40 mg methadone formulation is indicated for the detoxification and maintenance treatment of opioid addiction. The 40 mg strength is not FDA approved for use in the management of pain. Thus, the distribution and availability of the 40 mg formulation will be limited to registrants in only those settings using the 40 mg formulation for the appropriate indication.

The DEA and pharmaceutical industry agree that the reported increase in methadone-related adverse events merits action and further agree to a united effort to assure that methadone is properly distributed, consistent with its approved uses. Industry and the federal entities involved commit to monitor the progress of this initiative.

Below is pg. 27& 28 from the 2009 Governement Accountablility Office “Methadone Associated Overdose Deaths”  This is the report that was used to decide that most methadone related deaths were from methadone prescribed for pain using information from only FIVE STATES.

State Data and Research Support That Lack of Knowledge and Abuse of Diverted Methadone Contribute to Deaths, but Death Circumstances Are Variable

Data and research regarding methadone-associated overdose deaths in the five states we reviewed support the idea that lack of knowledge and abuse of diverted methadone contributed to deaths, but also suggest that the circumstances under which people are dying are variable. Specifically, state data and research show that death circumstances, such as the source of the drug and the most commonly detected other drugs, may vary by state. Furthermore, participants at SAMHSA’s 2007 Methadone-Associated Mortality Reassessment concurred that the circumstances of methadone-associated overdose deaths vary by state. While research suggests that the source of methadone for those who die from overdose deaths is often unknown, available information indicates that there are three distinct populations who are dying: individuals with a prescription for methadone; individuals undergoing methadone maintenance treatment in OTPs; and individuals who obtained methadone from some other source, such as diversion. However, generally more of those who died had a prescription for methadone or obtained it through diversion rather than receiving methadone for addiction treatment in an OTP.

 47 For example, a Kentucky study of deaths from 2000 to 2004 found that of the 95 deaths for which coroners documented methadone use, 48 percent of those who died had a physician’s prescription for methadone, 20 percent obtained methadone through illicit means, 22 percent obtained methadone through unknown means, and 10 percent had received treatment in OTPs. Coroners’ investigations also documented that one-third of the victims had been undergoing pain management. A New Mexico study of unintentional methadone-associated overdose deaths from 1998 to 2002 found that although a much larger percentage of deaths were related to methadone maintenance treatment than in the other states we reviewed, more deaths overall were linked with prescriptions for methadone. Specifically, of the 79 methadone-associated overdose deaths for which a source of methadone was available, 39 percent had methadone because they were undergoing methadone maintenance treatment, while 47 percent had a prescription for methadone. See appendix III for a summary of the findings of research studies in the five states we reviewed.

 

47Data available from Florida do not include information on the source of methadone for those who died, and research from Maine did not contain information regarding the source of methadone for most deaths.  

 

State Years studied

Number of methadone-associated overdose deaths

Decedent characteristics Drugs detected Sources of methadone
Florida 2007

1,095

Ages of decedents: <18: 2%

18-25: 21%

26-34: 23%

35-50: 38%

>50: 17%

n=785b

Methadone only: 11%

Drugs in combination with methadone:

89%

n=1,095

No data available
Kentucky 2000-2004

176d

Caucasian: 100%Male: 60%

Mean age: 38 years

Methadone only: 6%

Drugs in combination with methadone:e

Antidepressants: 40%

Benzodiazepines: 32%

Additional opioids: 28%

Private physician: 48%Illicit means: 20%

OTP: 10%

Unknown: 22%

n=95f

Maine 1997-2002

88h

All drug-related deaths: Caucasian: 96%

Male: 62%

Mean age: 40 years

Other known health conditions:

Mental illness: 55%

Drug abuse: 50%

Methadone deaths:Methadone primary or secondary causal factor: 88%

Methadone a significant contributing factor: 12%

n=66i

Limited data available
New Mexico 1998-2002

143k

White non-Hispanic: 55%Male: 75%

Median age: 40 years

Other known health conditions:

Mental illness: 24%

Drug abuse: 25%

Methadone only: 22%

Drugs in combination with methadone:e

Prescription drugs (no illicit drugs): 24%

Illicit drugs: 50%

Methadone maintenance treatment: 39%Prescription for chronic pain: 34%

Prescription for unknown reason: 13%

Diversion: 14%

n=79f

 

West Virginial        2006

112m

All drug-related deaths:n Male: 67%

Mean age: 39 years

Substance abuse indicators, all drug-related deaths:n

History of substance abuse: 78%

Used diverted pharmaceuticals: 63%

Doctor shopped (Five or more prescribing clinicians in the year before death): 21%

Methadone only: 26%

Drugs in combination with methadone:e

Other prescription drugs: 63%

Illicit drugs: 13%

Alcohol: 10%

Diversion: 68%Prescription: 21%

OTP: 11%

 


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