Methadone replacement therapy has been utilized as a treatment for opiate addiction for more than thirty (30) years. In recent years, however, the use of methadone as a treatment for chronic pain has been increasing, as has the number of practitioners prescribing the medication. Against this backdrop, both Federal and State agencies, including the Center for Disease Control (CDC) and the National Center for Heath Statistics (NCHS), have documented striking increases in the number of methadone-related deaths. For example, according to data from the NCHS, the number of poisoning deaths involving methadone increased 390 percent between 1999-2004; that’s 336 percent higher than the increase in the number of poisoning deaths involving all sources. Coincidence? The data would suggest otherwise. Of all narcotics mentioned in these poisoning deaths, not one demonstrated a larger relative increase than methadone.
The data suggest multiple causes for this alarming trend. For instance, for many methadone patients, the fatal and therapeutic dosages are almost the same. Further, responses to the medication and the rate at which it is eliminated from the body’s tissues varies tremendously from person to person. Methadone has also been shown to interact negatively with an alarming number of medications and substances which, if used in conjunction with methadone, can produce a lethal cocktail resulting in arrhythmia, respiratory depression and/or death. As such, it is not surprising that methadone patients are 7 times more likely to die from a methadone overdose during the first two weeks of treatment, while their individual response to methadone is still being determined.
At least 2 alternatives to methadone, “Subutex" and “Suboxone”, exist and are currently approved by the FDA to treat opiate dependence in the United States. Others, such as “Pure R” methadone, have been used with success overseas. Given that the data suggest that these alternatives carry a lower risk of the fatal cardiac disturbances and respiratory depression than are associated with the “R/S” methadone utilized in the United States, one can only wonder why methadone remains so widely prescribed and whether the health care community in the U.S. is sufficiently attuned to the serious risks its use presents. The data discussed above demonstrates that placing any patient on methadone can truly represent a “life and death” decision. As such, one would hope that doctors and clinics are not motivated by profit to prescribe methadone over the alternatives. But methadone is big business. And, for the pharmaceutical companies which manufacture it and certain of the clinics which dispense it, a source of big profits. Coincidence? You be the judge.
