Chronic Painkiller Abuse, Methadone-Related Deaths Both Increasingly Common

JULY 09, 2012
Daniel Weiss, Senior Editor
Recent research from the CDC finds that chronic abuse of prescription painkillers has leaped in recent years and methadone is disproportionately associated with prescription painkiller deaths.

In the last decade, chronic prescription painkiller abuse rates have increased dramatically, and methadone has come to play a major role in causing prescription painkiller overdose deaths, according to 2 recent reports from researchers at the Centers for Disease Control and Prevention (CDC).
In 2009, 15,597 people in the United States died of overdoses involving the painkillers oxycodone, hydrocodone, and methadone, an increase of 109% since 2002. However, estimates of the overall rates of abuse of these drugs have not changed over this time span. To determine whether changes in the rate of chronic painkiller abuse could help explain the increase in overdose deaths, Christopher Jones, PharmD, MPH, of the CDC, looked at data from the National Survey on Drug Use and Health from 2002-2003 and 2009-2010.
His study’s results, published online on June 25, 2012, in Archives of Internal Medicine, found that the portion of people who abused prescription painkillers at least 200 days out of the year leaped from 2.2 per 1000 people in 2002-2003 to 3.8 per 1000 people in 2009-2010—an increase of 74.6%. During the same period, the overall portion of people who abused prescription painkillers at any frequency did not change significantly.
The increase in chronic prescription painkiller abuse was particularly steep among men (105.3%), among those between the ages of 26 and 34 (81.0%), and among those between the ages of 35 and 49 (134.6%). Dr. Jones notes that these rates of increase parallel the increases in overdose death rates for these groups. The study did find one bright spot: The rate of overall prescription painkiller abuse for adolescents between the ages of 12 and 17 fell 15.5% between 2002-2003 and 2009-2010.
Further clues to the increase in deaths associated with prescription painkiller abuse are found in the July 2012 issue of CDC Vital Signs. It notes that methadone accounted for just 2% of painkiller prescriptions in 2009 but was involved in more than 30% of prescription painkiller overdose deaths that year. These findings are based on national data from 1999 to 2010 and 2009 data from the 13 states covered by the Drug Abuse Warning Network of the Substance Abuse and Mental Health Services Administration, a surveillance system for drug-related deaths.
The report notes that methadone has been used for years to treat drug addiction, but is now increasingly prescribed as a painkiller as well. As methadone prescriptions to treat pain have increased—to 4 million in 2009—so have methadone abuse and fatal overdoses involving the drug, which increased 6-fold between 1999 and 2009. Methadone is particularly risky because it builds up in the body’s system and can disrupt a user’s breathing and heart rhythm. In addition, the difference between an appropriate dose and a dangerous dose of the drug is very small.
Despite recent efforts to warn health care providers of the potential dangers associated with methadone, the number of prescriptions for the drug to treat pain has not declined significantly. One reason for methadone’s popularity is that it is available as a low-cost generic drug and is on the list of preferred drugs for many insurance companies. Another challenge for those trying to raise awareness of the drug’s dangers is that the majority of methadone prescriptions for pain relief are written by providers who lack special training in pain management.
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