Saturday, November 22, 2008

Methadone-Turning into a Killer?


I looked this up again to make sure I was reading the article from Bedford, IN Times-Mail correctly.

Methadone Maintenance Therapy
A type of treatment for individuals who are addicted to heroin or other opiate drugs (such as Percodan or OxyContin). Methadone is a safe and effective medication that acts as a stabilizer so people can return to daily life. Methadone does not make people high and does not replace one drug addiction with another - methadone's effects are very different from opiates. Most people receive methadone daily from a clinic, where counseling and group meetings are also available. (Join Together)

Okay, so this isn't suppose to get people high and it is safe. Well not according to a recent article from this city outside of Indianapolis. The coroner in this town has said that 10 of the 58 deaths he has investigated were related to overdose. Plus 10 more were related to drugs. These deaths were the result of prescription drugs with "methadone leading the way."

Methadone tablets, mostly what’s being abused on the area, is prescribed for chronic pain. Other prescription drugs being abused include hydrocodone and Xanax.


Isn't what the coroner saying the opposite of what the treatment is suppose to do?

Here is another fact I found in the article:
Nationally, according to the Centers for Disease Control and Prevention, the number of methadone-related deaths increased by 390 percent from 1999 to 2004: 786 deaths in 1999 compared to 3,849 deaths in 2004 (the most recent year for which statistics are available).

Now, if the individuals are getting methadone to assist them with their already existing habit, why are not these people being closely monitored? I know that prescription drugs are easily taken,but how are they getting the multiple doses?
Doctor shopping, robbery...those are current answers. Kids are selling their drugs for gas money is another comment. But 16 - 20 pills is what overdoses consist of. Sometimes even more. It boggles my mind.

3 comments:

Anonymous said...

Hi

I saw your comment and wanted to respond to some of your questions.

Methadone has been used for over 45 years for a treatment for opioid addiction, and is, in fact, by far the most successful treatment available for this disease. Opioid addiction causes disorders of the brain chemistry--specifically with endorphin production. Endorphins are the body's natural opiates. Sometimes this disruption in endorphin production is permanent, meaning that no matter how long the patient is abstinent they never again manufacture endorphins, leaving them severely depressed, anhedonic, exhausted, irritable, and desperately miserable. Methadone stabilizes the brain chemistry without causing a high--in stable, tolerant patients. That is the key here. People who take street methadone, bought from a friend for a "kick" or whatever, may indeed feel something--usually more akin to sedation than euphoria, but some people like that feeling.

However, methadone crosses the blood-brain barrier very slowly--there is no "rush" of pleasure like you get with short acting opiates, and it takes hours to feel the effects that a non-tolerant patient may feel. This leads to people often taking more and more, seeking the high they expected, and finally ending up going to sleep and dying without ever getting that high they were chasing.

The reason for the recent increase in methadone related deaths (and be aware that any death involving methadone is considered "methadone related" even if it also involved 5 other drugs, even if it was an intentional suicide, etc) is due to the recent increase in it's being prescribed for pain in the wake of the oxycontin scandals. Methadone is a very good painkiller--and unlike most others, it is inexpensive--however, it must be used very judiciously in those without a tolerance and must be titrated upwards very slowly by a trained doctor who is familiar with the drug. Methadone builds up in the tissues and can still be active up to 72 hours after dosing. Opioid treatment patients take it once a day--but those taking it for pain must take it 2-3 times daily because the analgesic effects only last that long. So, if the patient is not closely observed and the medication properly titrated upwards, tragedy can occur, even with relatively small doses. Prior to this decade, methadone was not often used as a prescribed pain medication--usually only immediately postoperative patients took it. That has been one cause of the deaths.

As a fallout of the increase in methadone being prescribed for pain, it has been more readily available in medicine cabinets, pharmacy shelves, etc. With the recent uptick in prescription drug abuse among teens, many have taken it from medicine cabinets, purses, etc. Also, pain patients sometimes sell their medication for money they need for other things. Studies done by SAMHSA in 2003 and 2007 show that the vast majority of diverted methadone comes NOT from the methadone clinics, but from pain management and the people who steal from pain patients. However, most people, when they hear "methadone", think "methadone clinic" and don't bother to investigate further.

Methadone is the most restricted and regulated drug available today. Clinic patients must earn takehome doses by meeting an 8 point criteria, and must attend the clinic daily for 90 days without any problems or positive drug screens to earn even a single weekly takehome dose. Clinics already operate under so much stigma, prejudice and restrictions that only about 10% of those who could benefit from this treatment can access it. Clinic patients must store their medication in a locking container that they bring to the clinic with them, and are subject to medication callbacks so that their doses can be counted and checked. They are regularly drug tested, and any problems result in rescinding takehome privileges.

Also, it is quite true that methadone patients who are stable on their dose (i.e., accustomed to it) and who do not use other drugs with their medication do not get high off methadone--that is the reason it is used. Methadone is the most studied and tested medication around, and the results clearly show that patients are able to function normally, can drive, work, care for their families and obligations without impairment. When you read stories of car accidents involving methadone there is almost always either other drugs involved, or the person was not tolerant of methadone.

The government is now taking action to provide better training and education for doctors prescribing this drug for pain, as well as for patients, and law enforcement takes diversion seriously. Does some diversion occur from clinics? Certainly it does--but it has always been at a low and stable rate, and usually involves patients selling doses to street addicts who do not want to get on the clinic themselves or cannot afford to do so, or who cannot get their drug of choice that day and do not want to get sick. They usually have a tolerance to opiates, and so death was not often a result. Lately, however, young and inexperienced drug users have been trying the drug, with tragic results. And it does not take 16-20 pills to cause a methadone overdose--not at all. Methadone comes in 5 and 10mg pills (for pain) and in 40mg dissolvable wafers and 10mg per ml. liquid, for addiction treatment. Overdose for a non tolerant adult can occur with as little as 30mgs and in some cases even less.

methadone has saved many thousands of lives, and eliminated severe pain for many people, but it must not be abused or mixed with other drugs without close supervision, and education for both patients and providers must be given. But please, don;t place all the blame on the clinics without getting the facts.

Anonymous said...

With methadone, it doesn't take 16 - 20 pills to overdose. Currently, the reccomended starting dose for someone who has a history of heroin or other opiate addiction is aroung 30mg/day. The pills come in 5, 10, and 40mg. The person receiving 30mg for addiction already has a tolerance for opiates, and the 30mg dosage reccomendation has been brought about because of what has happened in the past, so a person with no tolerance can overdose on less. This drug is extremely dangerous when prescribed for pain in instances when the person has not been on other pain meds. for a substantial period of time.

Anonymous said...

Methadone treatment for DRUG ADDICTION has had a safe record for over 40 years....however, RECENTLY methadone prescribed from a pharmacy by regular doctors for CHRONIC PAIN has increased directly in proportion with the increase in overdose deaths (about 300% over the past 8 years).

Methadone for addiction is given to addicts by a nurse once daily at a clinic for up to a year before the addict can take the medication home. Addicts that use methadone treatment REDUCE their chances of overdosing DRAMATICALLY. It's the people NOT being monitored closely by their doctors and or using illcit methadone who are dying.

Recent deaths are a direct result of numerous things,but clinics treating addiction aren't one of those reasons. Opiate addiction is now a huge problem that we have never seen in the past...with more addicts comes more deaths. ALSO because methadone DOESN'T give the high drug users seek they take more and more (or mix with alcohol or other drugs) hoping to obtain the high they are looking for--only it never comes and they die in their sleep.

Please, don't be like the person that wrote this story and jump to conclusions about methadone treatment without all the facts. People hear the word "methadone" and immediately think of junkies sleeping on the street and run down buildings handing out needles and methadone. Nothing could be further from the truth for the majority of clinics-which are well run, heavily regulated and secure.\

The Center for Substance Abuse Treatment (CSAT) has already thoroughly researched this problem and concluded TWICE that it is not a problem because of clinics treating opiate addiction. The increase of deaths is due to the sudden flooding of the market with methadone that isn't even handed out at clinics (tablets).

FORTY YEARS of treatment without these problems--without these kinds of death rates. It's only rational to look at what is different instead of assuming that it has to be the clinic's solely because they help addicts.