John Burke, commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 40-year veteran of law enforcement. Cmdr Burke also is the current president of the National Association of Drug Diversion Investigators. For information, he can be reached by e-mail at , via the Web site www.rxdiversion.com, or by phone at 513-336-0070.
As this piece is being written, concerns over methadone seem to have swelled, as reports of abuse have become more widespread. This has been building for a few years now, as the drug has seen a surge in prescribing due to its low cost and, I believe, the thought that it had relatively low abuse potential.
Manufacturers of the 40-mg methadone tablet, as of January 1, 2008, have decided to withdraw this strength from the retail market and make it available only in health facilities and clinics that address substance abuse. This was in response to a recommendation by the Drug Enforcement Administration and is not currently mandated by the agency. My office is in the process of concluding a criminal case with a physician who was illegally prescribing the 40-mg tablet, and a single pill was being sold at $40 to $45 on the street in southwest Ohio.
Methadone is a Schedule II drug, so when prescribing is increased significantly, it is clear why the abuse of the drug also would increase, due to the mere fact that more of the product exists for potential diversion. This is the case with most controlled substances, as you might guess. It is important to point out that the vast majority of increase in abuse of methadone occurs with the drugs that are being prescribed by physicians and dispensed in retail pharmacies. The liquid form of methadone, commonly used in clinics to address substance abuse, is mostly not the potential culprit. Some abuse will always exist in the clinics, mostly involving the practice of allowing some patients to take home a supply to prevent them from having to visit the clinic every day. Again, diversion from this source appears to be relatively low across the United States.
Instead, improper prescribing has been reported as a larger problem and a potential cause of many of the methadone overdose deaths. Methadone has a slow onset and long halflife, placing those who want to get high in potential peril. As they take their initial dose and do not attain the high they were looking for, they increase the dose over several days and run the risk of overdose and even death.
So with all of these problems, why do we not just get rid of methadone altogether—the world would be a better place, right? Some groups, like those supporting the Web site www.harmd.org, would very much like to do that—very similar to a few radical folks who still want to ban oxycodone (OxyContin) from the market.
The problem with banning methadone and other prescription drug painkillers is that, every day, they serve a vast number of patients who desperately need legitimate pain relief. Estimates suggest that less than 10% of the individuals who ingest controlled substances are abusing them. If my math is correct, this means that over 90% of those individuals who are prescribed controlled substances need them and take them as directed.
The other point that sometimes does not seem politically correct when dealing with parents whose children have died while taking these drugs is that many of them were either taking the drug that was not prescribed to them, abusing what was prescribed to them, or involved in some sort of criminal behavior that allowed them to obtain the prescription medications. I have tremendous sympathy for these parents, but it does not justify not telling the entire truth. We have all made decisions in our life that we wish we could rescind. I continue to be an avid legitimate pain-patient advocate, but it worries me whenever these types of situations arise.
The Oncology Care Pharmacist in Health-System Pharmacy
According to the National Cancer Institute, almost 40% of men and women will be given a diagnosis of some form of cancer in their lifetime.
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