Sunday, March 18, 2007

Methadone deaths increasing

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.

Background:
Methadone’s proarrhythmic effects reviewed.
Methadone’s new FDA warning.
Methadone and the death of Anna Nicole Smith’s son.

10 comments:

Melis11577 said...

I'm writing to you about the methadone epidemic taking place in the United States .
I am writing on behalf of HARMD (Helping America Reduce Methadone Deaths). We are the families of victims and those yet to be victims of methadone. www.HARMD.org I have come together with many other families throughout the United States who have lost loved ones to methadone.

On June 24th 2006 I lost my fiancé (Ron) to methadone prescribed by a physician with a combination of other medications that acted as additives to the Methadone. He was a professional Jai Alai player at Hamilton Downs Jai Alai in Jasper, FL and had knee surgery after an injury on the court. He became addicted to the percocet he was prescribed. He checked hi mself into Greenleaf in Valdosta , GA (part of South Georgia Medical Center ) for detoxification. Upon entering the facility he was drug tested and did not come up positive for opiates or any other drugs (he had stopped taking the percocet 4 days before entering the facility). He was prescribed by a Dr. excessive amounts of methadone (for a person without a known tolerence) with valium and Klonopin. On the fourth day in detox he died sometime between 2am and 1pm in the afternoon (he was never checked on in all of those hours). When hi s body was found at 1pm he was already in rigor mortis. He was extremely neglected bordering abusive considering he was supposed to be monitored every 1/2 hour according to hi s medical charts. The night before he died he was complaining of migraines and vomiting, apparently the staff thought he was still experiencing withdrawals (but again he had NO drugs in hi s system upon entering the facility) and was not concerned about these symptoms. The symptoms of methadone toxicity mimic withdrawal symptoms; physicians and staff must be very cognizant of the complex properties and metabolization of methadone. There were many errors made in my fiancé's death including the fact that he was given numerous amounts of additive medications such as benzodiazepines (valium and klonapin). He had only been taking percocet for about 4 months and according to the DSM IV he wouldn't be an appropriate candidate methadone maintenance treatment.

We are asking government agencies to enact stricter guidelines in prescribing methadone for any reason. It must be mandatory that all doctors be certified and trained in the pharmacology of methadone; inpatient stays must be required during induction to methadone; all staff be extensively trained in monitoring methadone patients for symptoms of toxicity. Clinic patients should be tested for legal and illegal drugs that are taken with methadone to get “high” or experience “euphoria” such as benzodiazepines, alcohol, cocaine, heroin, marijuana etc… and face severe consequences / mandatory detoxification from methadone program. When presenting inebriated at clinic, clinic should also document such activity as well as prevent client from driving. Take home doses for all patients receiving methadone should be eliminated thus preventing the risk of diversion or precautions such as pill safe should be implemented. http://www.thepillsafe.com/

Current statistics show that nearly 4000 people a year die from methadone. These deaths are mostly happening to pain management and detoxification patients within the first 10 days of taking initial dose. Most of these deaths are related to methadone prescribed with other medications that react as additives with the methadone. Diversion of methadone is a serious problem because it lands this most deadly drug on streets. Statistics also state that methadone is contributing to more deaths nationwide then heroine and only second to cocaine deaths.

The government did take notice after the 2003 record number of deaths associated with methadone and the Bush administration responded by gathering the top experts on drug overdoses, doctors, researchers, and medical examiners, as well as representatives from the federal Drug Enforcement Administration, Food and Drug Administration, and Substance Abuse and Mental Health Association. Finn and Tuckwiller (2006) report that “the man hired to research and write the report based on the conference, as well as background paper for conference participants, was Stewart B. Leavitt, and addiction specialist whose work is funded by the makers of methadone”. Stewart B. Leavitt PhD served as researcher/writer for A National Assessment of Methadone-Associated Mortality: Background Briefing Report from the U.S. Department of Health and Human Services. Stewart B Leavitt also writes Addiction Treatment Forum Methadone Dosing & Safety in the Treatment of Opioid Addiction which is funded by Mallinckrodt, Inc. a manufacturer of methadone. My question is why hasn't a team of independent researchers not funded by pharmaceutical companies; a person or group of people that stand to gain no financial benefit on the outcome of the studies been hired to conduct the research? Finn and Tuckwiller (2006) report that “the man hired to research and write the report based on the conference, as well as background paper for conference participants, was Stewart B. Leavitt, and addiction specialist whose work is funded by the makers of methadone”. Stewart B. Leavitt PhD served as researcher/writer for A National Assessment of Methadone-Associated Mortality: Background Briefing Report from the U.S. Department of Health and Human Services. Stewart B Leavitt also writes Addiction Treatment Forum Methadone Dosing & Safety in the Treatment of Opioid Addiction which is funded by Mallinckrodt, Inc. a manufacturer of methadone. On the forum associated with his website several of the clinic participants speak of diverting, misusing, stockpiling, selling, and potentiating methadone and other prescription drugs.

This methadone epidemic and deaths associated with it are not going away. It's only getting worse; I get contacted by families on a daily basis who have lost someone to this drug. At what point do we value human life over the convenience of others? Methadone patients, whether they are pain or clinic pose a risk to themselves and society as a whole if they are not monitored, dosed, and assessed correctly. Clinic patients getting into cars after being dosed who are using benzodiazepines, alcohol, marijuana or other opiates are killing innocent people on the road. This type of harm reduction is not saving lives it’s taking them. The government cannot continue to be a legal drug dealer in order for its citizens to “behave”.

I know the rules are in place for the clinics but they are NOT being followed. Patients sell take homes outside the clinics. In one news article a man died in the parking lot of a clinic after taking his brothers take home. This drug is too dangerous to be allowed in medicine cabinets! There is A LOT of money to be made from methadone but what expense is that money being made at? When do the risks outweigh the benefits of this drug? How many more people must die before changes are made that actually save lives?
I have called several methadone clinics and have found out that many do not test for marijuana and are not open 7 days a week. These two things are of special concern to my organization because all methadone patients will receive a take home bottle of methadone on Saturday for Sunday (the day they are closed) whether they are new to the program or have been abusing other drugs. Marijuana and methadone have an effect on the user very similar to heroin. Many clinics do not test for marijuana because it is not believed to be a drug of choice or a "hard drug", I beg to differ because of the effect when combining the two have the potential to be more dangerous then the user/staff is aware. This poses a serious public health risk to those on the road innocently driving to work or school.
The state of Delaware has just added Methadone to the list of medications covered under the Medicaid program that require prior authorization for pain treatment. The potential of abuse, diversion, and overdose to new patients being prescribed methadone is overwhelming. The unique properties of methadone, it's long half life, short analgesic properties, cardiac risks and it's negative interaction with numerous drugs make it an optimal choice as a last result treatment for chronic pain.

Thank you for taking the time to read this letter.

Sincerely

Melissa Zuppardi

Anonymous said...

I have taken methadone five years for severe pain and have never had a problem with it. I am under a doctor's care and follow their instructions to the letter.

If you take methadone as perscribed you won't have a problem. The problem is not methadone but it is unlawful use of methadone. Any medication can be abused. Methadone is a life saving medication. You are trying to make it out the devil. The problem is the abusers not methadone.

Anonymous said...

Anyone taking oral methadone long term,please contact me. I live with someone doing this and I have questions and strong concerns. I feel something is not right.

Anonymous said...

On April 4, 2006 our daugher saw a Dr. in a Family Practic Clinic, in Batesville Arkansas. The DR. she had normally seen for over 2 years was unavailable that day. Since day one of her 1st vist her chart was flagged for pain pill addiction. This so called DR. prescribed her 240 10mg, methadone pills. Within 8 hours she was dead. Unfortunately, SHE WAS NOT FOUND UNTIL THE NEXT MORNING ON HER LIVING ROOM FLOOR. HE still practices at the same clinic & we know he still prescribes methadone on several occassions AS A FACT. He tried to cover his tracts & didn't list the methadone on her patient sheet, the coroner requested. Would you believe in about 6 weeks due to lack of not wanting to sue him for medical mal practice & neglect is blamed on not worth our time economically viable ? He will be free to kill due to 2 year statue of limitation law in our fine state of Arkansas, on April 4, 2008.She was not a methadone patient. She did however suffer from manic-depression for 14 years. No one who suffers from a Mental Illness should ever be prescribed methadone. Just read on your computer like her parents.We whole heartedly support HARMD.org & MAMA.org. Please wake up people, this is about Pharmecutical Company's making billions of dollars, that paid the DEA'S last deadly decision. It's highly addictive, put on the market for Doctors to prescribe as a pain medication because it is so cheap. One pill can kill. Sincerely, Wendy's mother & daddy.

Anonymous said...

I lost my first born and only son Sept.4,2002 to a methadone overdose, that was given to him by a woman who got twice the dosage of methadone she had been using at the er or walk in clinic. we went to court the whole deal and she got off. He was 17, and she was 23, her 3 or 4 year old son was on the couch watching t.v. while he was dying. he died around 3am yet the emts were not called until after 7am.She also gave birth a short time later to a methadone addicted baby. The father was unaware of her past, and has also told me she told him she killed my son. Years later life is not the same. When will it stop. Why are the docs reponsible????????????????

Patrick Houston said...

HELP! I HAVE BEEN TAKING METHADONE FOR ABOUT 5 YEARS. I STARTED TAKING IF FOR PAIN, AND NOW I AM TAKING IT FOR OPIUM ADDITION TREATMENT. I HELPS IN THAT I DON' CRAVE OTHER DRUGS. BUT IT SEEMS THAT THE NEG EFFECTS OUTWEITH THE POS EFFICTS. I FEEL LIKE AM WALKING (BARLEY) DEAD. IT HAS COST ME MORE THAN THE MONEY I HAVE SPENT ON IT AT METHADONE CLINIC. MY FAMILY DISOWNS ME, MY BOYFRIEND IS READY TO 'THROW ME OUT'. I CAN BARELY WALK, I FALL ALL THE TIME, I BURN HOLES IN ALL MY CLOTHES AND FURNITURE AND FLOORS. I SPILL SHIT EVERYWHERE, IT IS PATHEDIC!!! I HAVE BEEN THRU DETOX SEVERAL TIMES BEEN TO NA. AND I KEEP RELLAPSING. I AM THINKING ABOUT TRYING SUBUTEC OR SUBLOXZONE. SHOULD I? I WANT TO GET CLEAN AND STAY CLEAN. ITS VERY HARD WITH LIVING IN PAIN, MOST OF ALL I DON'T WANT TO BE 'DOPE SICK' AND GO THROUGH WITHDRAWELS. I WOULD WELCOME ANY SUGGESTIONS, I REALLY NEED HELP BEFORE I REALLY AM DEAD!!!

Anonymous said...

My son, Matthew, passed away at the young age of 20 on 8/11/06 due to methadone toxicity. Matthew started Methadone treatment at a clinic in our city. From the first day, he showed adverse reactions, that were not the typical side effects. He reported the adverse reactions everyday to the clinic, but they totally ignored him, he was holding up the dosing line. By the 3rd day he was totally miserable with rash and itching so bad he carried a hair brush with him to scratch, he had hallucinations, trouble urinating, and problems swallowing. Still the clinic ignored him and continued to increase his dosage each day even after he reported these effects. On the 5th day of treatment, I talked to Matt from work around 10am and he sounded lethargic; I thought he was just sleepy. The clinic never warned us of the severe dangers of methadone. Although I knew my son's reactions were uncomfortable, I never, ever considered them to be fatal. When I arrived home from work at 5pm, the house was eerily silent. As I went through the house I found my son dead in the hallway. He was in a sitting position with his head slumped forward, which caused the blood to pool in his face after death and no blood circulation. When I moved my son from the sitting position to laying down, his face was like a scene from a horror movie, the point where you usually close your eyes because it is so gruesome. I called 911 and tried to start CPR, however, his mouth and jaw were complete locked and would not move due to rigor mortis. I was still sure the paramedics could revive him because this could not really be happening. However instead, it took them about 10 seconds to pronounce him dead. My life stopped that moment, and I haven't been able to live since then. My son was my heart and soul and our love was boundless, as most mother/child relationships. The reason my son died was that he was totally ignored when he was blatantly exhibiting signs of Methadone Toxicity. How can a treatment center that specializes in one medication ignore what they should know as toxic? This clinic was negligent, careless and ignorant. Matthew went into methadone treatment for help the safest way we knew; going to an accredited, licensed clinic with a doctor and nurses on staff. This shows how dangerous this drug is! It is unpredictable and lethal. A therapeutic dose for one person can prove to be fatal in the next, just like my loving son, Matthew, who is gone forever. All due to Methadone and a negligent clinic. Every morning I ask myself how can I face another day without him? If methadone is not safe in a clinic setting with a dr and nurse, how could it be safe in any setting? The reality is Methadone is dangerous, lethal, and fatal no matter how it is prescribed, acquired or ingested. The message is to stay away from Methadone, it it not safe in any scenario.

R. W. Donnell said...

Patrick Houston,
I can't give advice on this blog and, furthermore, am not qualified to comment about the treatments you are considering. I wish I knew a way to help. All I can say is keep trying to get help and don't give up. God bless you.

jbsjohn said...

The man hired to research and write the report based on the conference, as well as background paper for conference participants, was Stewart B. Leavitt, and addiction specialist whose work is funded by the makers of methadone.
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Jbsjohn

Delaware Alcohol Addiction Treatment

Anonymous said...

I have been on methadone for 5 years and it has given me my life back, if you are taking methadone as prescribed by your doctor and not more than your supposed to or taking anything that does not "mix" with methadone. I take methadone and only methadone I don't "mix"it with other drugs, that Dr. should have known you dont mix methadone with valium and klonopin .Every Doc I have talked to has told me that, many times. I know my body and when the dose was too much I got groggy and told my doctor and he reduced my dose and now I am on just the right amount to function and care for my pain and my dependence on narcotic pain meds. Methadone has saved many lives I am very sorry about the death of your fiance but methadone saves lives too.So I don't blame the methadone I blame the Doctor that gave him the other drugs with it when it is A FACT YOU CAN NOT MIX MEHTADONE WITH BENZOS. Its sad that many people do not see that methadone also saves MANY MANY lives.