Please Post Any Ideas You May have to Stop Methadone Deaths in Comment Section. (Note: These are not listed in order of Priority)
- The methadone clinics that are being run like “pill mills” need to be shut down. The doctors and clinic owners need to be prosecuted for these deaths. They are “legal” drug dealers. The agencies that could do somthing about this are not acting fast enough, if at all. (FDA, SAMHSA, DEA , STATE AGENCIES that are responsible for enforcing state and federal regulations and State Methadone Authorities) We need to contact them on a regular basis and force them to do their job. We pay their salary!
- Contact your Representative and ask them to co-sponsor HR672 or to suggest any ideas you may have. Click HERE to contact. This is the National Drug Control Strategy for 2012 from the White House-National Drug Control Strategy 2012 Policy Focus: Preventing Prescription Drug Abuse begins on Page 47.
- Pharmaceutical Companies need to pay for all cost for inpatient drug treatment (Abstinence Based) due to prescription drug addiction
- Require physcians to have training on prescribing opiates before they are assigned a DEA number.
- METHADONE NEEDS A LABEL REVISION TO INCLUDE ADDICTION TREATMENT This not the solution but should have been included in the 2006 label revision. The excerpt below is from the relabeling revision on methadone that was released by the FDA 11/17/2006. Please note that this addresses treatment for pain patients only and does not include treatment for addiction. It states deaths have been reported during initiation and conversion from chronic high dose opioid agonists. Most methadone deaths from treatment of addiction occur during the first two weeks of “treatment”.The label needs to be revised to include treatment for opiate addiction. Opiate addicts are being converted for high dose opioid agonists to methadone also.
Methadone Hydrochloride Tablets 5mg, 10mg
“Deaths, Cardiac and Respiratory have been reported during initiation and conversion of pain patients to methadone treatment from other treatment with opioid agonists.”
“Respiratory Depression, Incomplete Cross-tolerance, and Iatrogenic Overdose Respiratory depression is the chief hazard associated with methadone hydrochloride administration. Methadone’s peak respiratory depressant effects typically occur later, and persist longer than its peak analgesic effects, particularly during the initial dosing period. These characteristics can contribute to cases of iatrogenic overdose, particularly during treatment initiation or dose titration. Patients tolerant to other opioids may be incompletely tolerant to methadone. Incomplete cross-tolerance is of particular concern for patients tolerant to other mu-opioid agonists who are being converted to treatment with methadone, thus making determination of dosing during opioid treatment conversion complex. Deaths have been reported during conversion from chronic, high-dose treatment with other opioid agonists. Therefore, it is critical to understand the pharmacokinetics of methadone when converting patients from other opioids (There are no safe conversion tables when converting a patient from another Opioid to Methadone). A high degree of “opioid tolerance” does not eliminate the possibility of methadone overdose, iatrogenic or otherwise.”
The following are some suggestions that I have to help reduce Methadone Deaths In MMT:
- Required training for all medical personal with testing on material learned and that will be verified (maybe SAMHSA can keep records) STRESS all the deaths that have occurred with methadone.
- Required training of patient with a video that stresses all the DEATHS that have occurred with methadone, The risk of use of ANY medication with Methadone and the high chance of death during the induction phase. Inform patient of risk of sudden cardiac death and advise patient they may want to have a full cardiac workup before beginning drug. Give patient examples and statistics of DEATHS.
- Since inpatient induction would not be cost effective but would be safer, require patient to have family monitor patient for signs and symptoms of overdose during the first two weeks of induction. STRESS the fact patient may go to sleep and not wake up!
- Send patient home with emergency narcan and train family members how to administer
- Strict guidelines for determining opiate tolerance of patients.
- Set a safe guideline for doctors concerning induction. Advise doctors of a correct safe low dose to start medication instead of just listing a maximum dose of 30 mg which is not safe for opiate naive persons or some opiate tolerant persons.
- Do not allow doctors to increase dose for at least 5 to 7 days.
- Before increasing dose, patient should be observed at peak ( 4 to 5 hours after drug is given)
- A PMP which is central registry system that a doctor can use to retrieve information on all medications that a patient is currently prescribed. (This needs to be made mandatory that doctors use before prescribing) Many states have these but it is not mandatory to use. These are also NOT connected state to state.
- Require doctors NOT to start methadone until physical is complete. (The federal regulations allow 14 days to complete the physical) States can require physical to be complete BEFORE the first dose.
- Never allow a patient to start on methadone if they have benzodiazepines in their system.
- Mandatory reporting of all deaths when patient is receiving methadone.
- People that divert methadone that causes death need to be prosecuted. There are already laws in place in most states but most are not being enforced.
This is a video on Naloxone, a lifesaving drug that can reverse opiate overdoses.
Blue For Prescriber Continuing Education Program (This will not be a mandatory program. Can you believe that? )