Methadone Accounted for 23% of Opioid OD Deaths in 2014

Methadone Accounted for 23% of Opioid OD Deaths in 2014

http://www.medpagetoday.com/painmanagement/painmanagement/64247

CDC report: Higher use of the prescription drug found among Medicaid population

  • by Molly Walker
    Staff Writer, MedPage Today
 Methadone-related overdoses accounted for nearly one in four deaths related to prescription opioids in 2014, despite a recent decline in drug overdose deaths involving methadone, said researchers from the Centers for Disease Control and Prevention.

Overall, the rate of methadone-overdose deaths increased 600% from 1999 to 2006 (from 0.3 persons per 100,000 to 1.8 per 100,000) before declining to 1.1 per 100,000 in 2014, reported Mark Faul, PhD, and colleagues.

While the drug accounted for only 1% of all opioid prescriptions, methadone-related deaths were responsible for 22.9% of opioid-related deaths in 2014, the authors wrote in the Morbidity and Mortality Weekly Report,

In an attempt to explain this decline in methadone-related mortality, the researchers noted that the FDA issued a Public Health Advisory in December 2006 that linked methadone to reports of respiratory depression and cardiac arrhythmias, among other serious side effects. Moreover, in January 2008, there was a voluntary manufacturer restriction that limited the distribution of the 40 mg formulation of methadone.

Faul and colleagues also examined methadone prescription by insurance type and found that prescriptions for methadone accounted for a higher portion of all opioid prescriptions in the Medicaid population compared with the commercially insured population — 0.85% weighted versus 1.1%, respectively.

Further, the team investigated the role that Medicaid preferred-drug-list (PDL) policies played in these potential deaths, examining the rates of fatal and nonfatal methadone overdose among Medicaid enrollees in two states where methadone was listed as a preferred drug on its PDL (Florida and North Carolina) versus one state where methadone was not listed on the PDL (South Carolina). Not surprisingly, overdose rates were significantly lower in South Carolina than in both North Carolina and Florida:

  • Florida: 1.75 per 100,000 persons, 95% CI 1.57-1.94
  • North Carolina: 1.67 per 100,000 persons, 95% CI 1.35-1.98
  • South Carolina: 0.81, 95% CI 0.65-0.96

“Given that methadone prescribing rates are higher among persons enrolled in Medicaid, strategies to reduce methadone prescribing among persons in this population might further reduce injuries and deaths from methadone,” the authors wrote. “If confirmed by additional studies, other states could consider Medicaid drug utilization management strategies such as PDL placement among other evidence-based strategies.”

The researchers examined three sources for these data: Drug overdose deaths and mortality rates were calculated through National Vital Statistics System Multiple Cause of Death mortality files and bridged U.S. Census data for 1999-2014. Truven Health’s MarketScan database for commercial claims and encounters was examined and compared with information from Medicaid multistate databases for 2014. Finally, Health Care Utilization Project data were examined from three states to determine whether a state’s policy was associated with higher methadone morbidity and mortality rates.

Methadone can be a excellent pain management medication but it should not be prescribed by prescribers that are not “up to speed” on the idiosyncrasies of this medication and does not do the necessary follow up testing on pts taking Methadone.

IMO.. this is another good example of bureaucrats interfering with the practice of medicine by mandating Methadone as the drug of choice for Medicaid pts because Methadone is a VERY INEXPENSIVE medication.

Of course, no bureaucrat/politician will be held responsible for helping to contribute to all these preventable deaths.

3 Responses

  1. Your post is right,,,that is exactly the truth,,,,,I know,,i am on it,,exactly as u state,,I have keep it a certain level or it does NOT WORK,,..It never works as good as 1 oxy,,or 1 dalota,,,never,,,but in this day and age of opiatephobia,,,me and my Doctor have no other choice,,,,mary

  2. Here is how people die on methadone. Even though it has to be dosed 3-4 times per day for pain control, it has a long half-life. That means it continues to be in the body for a long time, and the effect is cumulative. So taking one pill does not give immediate effect like taking oxycodone or hydrocodone. A person has to take methadone for 5-7 days to achieve a pain control. So when a person that doesn’t understand methadone takes a pill and gets no effect, they take another. And then a little later they take another, and so on. But in 3 days, all those pills add up. Then when the person lays down to go to sleep, they stop breathing. Doctors who prescribe methadone need to know its idiosyncrasies. Patients have to be built up slowly to avoid the respiratory depression, with a week’s lapse between a change in dose, starting at 2 1/2 mg TID.

    Now what is happening is that methadone is being sold on the street because of the lack of pain medication. And people are therefore dosing themselves, and running into the problem described above. Also, if people run out of their medication, and then restart at the same dose they were on, it can be an overdose.

  3. The problem w/methadone,,,i take it,,,is u have to take 4 x as much verses just taking 1 oxycodone,or dalota,,,u have to take more of the methadone to get the relief,,u would get w/1 dolpta,or oxycodne,,,mary

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