Although methadone is often prescribed for use outside of a hospital setting, new research shows that this unsupervised usage puts patients at a 46 percent higher rate of death than with other forms of painkillers. The data points to accidental overdose as a major contributing factor to the deaths due to methadone’s effects of decreasing respiration and its shortened ability to relieve pain. The new research brings into question methadone’s role in pain relief and whether the drug should be more strongly regulated in light of the fact that many other effective substitutes exist.
New Data: Methadone Increases Risk of Death
The landmark data was released in the January issue of JAMA Internal Medicine by Vanderbilt University Medical Center. Their study compared patients on methadone with another group who were prescribed morphine SR (sustained release). The results were that those prescribed methadone were 46 percent more likely to die from an overdose or complication than the ones who were on morphine. The data was gleaned from Tennessee Medicaid records from 1997 through 2009 and tracked 6,014 patients who took methadone and 32,742 who took morphine SR. It’s important to note that ¾ of the prescriptions were for back pain. A previous study conducted on the safety of methadone arrived at an opposite conclusion of the new study, finding that there was a 44 percent decrease in mortality for methadone patients. The difference is that the first study followed critically ill cancer patients and the second followed otherwise healthy individuals.
Methadone Causes of Death
The increased risk of death appears to be from the abnormal way in which methadone functions as compared with other opiates. As an opiate-based painkiller, methadone causes a decrease in respiration among patients, as do all other opiate-based medications. However, the analgesic properties of methadone, or the ability to eliminate pain, wear off sooner than other drugs. The result is that patients feel pain sooner and take more methadone even though the decreased respiratory effects are still in effect from the first dose. Thus, accidental overdoses occur when a second dose decreases respiration to the point of death. Another cause of death results because methadone is a pro-arrhythmic drug that can cause ventricular arrhythmias. Because physicians know of these risks, they often prescribe only the lowest dose of methadone believing that it eliminates the overdose risk. However, they fail to consider the cumulative effects of the drug if the patient decreases the time between recommended doses.
Methadone’s Benefits Debated
This study is the first one to identify an increased risk of death with methadone. As both physicians and researchers agree that methadone offers no advantage over morphine with regards to pain relief, it calls into question whether methadone should continue to be prescribed for use without physician supervision. The answer from the study’s authors and established medical organizations is no. In fact, in 2006, the Centers for Disease Control (CDC) and the Food and Drug Administration (FDA) recommended that physicians not prescribe methadone as a first-line treatment for pain. The study’s authors go further stating that it should be used only for cancer patients. Physicians are urged to consider other painkillers, such as morphine SR, when treating patients outside of a hospital.
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