JAMA News reports that methadone deaths are increasing far faster than deaths from other types of poisoning, a trend observed between 1999 and 2004.
Now that timeline, showing methadone deaths to rise 7 times faster than all poison deaths, is an interesting one. It speaks volumes. A Substance Abuse and Mental Health Services Administration report concluded that it reflects increased use of methadone as a prescription analgesic rather than a treatment for opiate addiction.
1999 was about the time pain management became politicized and activists were beating up on doctors for under treating pain. They pummeled us with arguments based 90% on dogma and 10% on science. They told us that the patient’s numeric rating of pain was “the fifth vital sign.” They redefined the concept of addiction to suit their agenda and told us that most instances of drug seeking behavior were in fact “pseudo addiction”, supposedly an indication to give more narcotics. A stable patient verbalizing “eight out of ten” pain was a medical emergency and a mandate for narcotics. Respiratory hazards were downplayed.
Around the time Joint Commission launched their pain initiative they held a panel discussion with Q&A. A pulmonologist asked “Aren’t you concerned about an increased incidence of respiratory depression?” The panel’s answer was, in effect, “It’s your problem. Your hospital needs to draft policies and procedures for respiratory assessment.”
Methadone seemed appealing for chronic pain management because it was cheap and its pharmacokinetic profile was thought to limit its abuse potential. Now we’re seeing the consequences of our zeal. True, not many years ago we under treated pain, but the pendulum has swung too far.
Many of us anticipated respiratory deaths from methadone, but the problem of cardiotoxicity was below the radar screen until the drug began enjoying heavy use as an analgesic.
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Methadone’s new FDA warning.
Methadone and the death of Anna Nicole Smith’s son.