The prescribing of methadone for pain patients has taken a significant jump over the last few years. Not surprisingly, it appears that there has been a considerable increase in the diversion of this class 2 drug. Several states have reported significant increases in overdose deaths attributed to methadone abuse or misuse.
The increased prescribing of methadone appears to be directly linked to the practitioner?s paranoia over prescribing OxyContin (oxycodone)?a paranoia that has been fueled by inaccurate reporting by the media. (For example, a recent newspaper article covered the story of a physician arrested for illegally distributing hydroco-done products. The article stated that hydrocodone was the same ingredient as in OxyContin. Of course, it was not true, because oxycodone is in OxyContin.) Methadone also is very inexpensive?another reason why it has found favor with some health insurers wanting to keep costs down.
Of course, methadone has been used in clinics for decades as narcotic maintenance for addicts. Because most of the clinic patients consume their methadone in liquid form, the diversion of liquid methadone is usually the result of a week?s or a weekend?s doses being allowed to go home with the patient.
Recently, in my county this type of behavior came to light when a married couple was selling their take-home methadone to several addicts out of their residence. A young customer, who had just purchased several doses? worth of methadone, overdosed and died 1 night on a secluded creek bank after drinking the substance.
A few days later, an undercover officer of mine began purchasing methadone from the couple. The couple joked about the death of their former customer and had no qualms about continuing the illegal operation. After a few weeks, and several undercover buys, the couple was arrested and charged with trafficking drugs?felonies in Ohio. The sad part is that both received very short sentences in local jails for their crimes.
A credible theory explaining the unusual number of overdose deaths from methadone in pill form is that abusers may not realize how it works in the body. Because it has a slow onset and a long half-life, experts think that abusers increase their dose for several days and then end up in trouble.
I have had pain experts tell me that prescribing methadone can be very tricky. If the physician is unfamiliar with prescribing this drug, it can lead to tragedy. Pharmacists have even more of a burden placed on them to scrutinize these prescriptions and to make sure that patients are not prescribed more than they can handle. Prudent pharmacists should take a few extra minutes to consult with patients who are being prescribed methadone for the first time.
Practitioners need to remember that the reason why drugs are categorized as Schedule II is that this class of prescription drug has the highest propensity for abuse and/or addiction. Methadone is no exception, and unfortunately this is being brought to the forefront as the prescribing increases along with the number of overdose deaths.
John Burke, director of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 32-year veteran of law enforcement.
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