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I am worried that currently there is a great deal of publicity about the dangers of methadone, in the ACT and in the USA. I'm afraid that publicity like this will blind the public to the real value of this drug, and possibly lead to tightening of the law that will disadvantage many - including me.
Methadone is a synthetic opiate that is taken mainly 1. by heroin addicts who want to kick their habit by substituting methadone for heroin; and 2. by chronic pain patients like myself. (Pethidine, given to many after surgery for pain control, is another synthetic opiate.)
The reason methadone is given to heroin addicts is that, unlike most opiates, it does not give the user a "buzz"; however it substitutes for the heroin the user's brain is accustomed to getting, and so reduces cravings.
On a methadone program, the addict is able to rebuild their life, with an assured supply of opiate to keep withdrawals at bay. They don't have to steal and deal to get black market drugs, and they don't have to mix with other users. This helps tham to avoid getting sucked back into the drug culture.
Methadone is a powerful drug. It is an opiate like heroin or morphine, and abuse can lead to death. I take this drug for pain relief and, in my experience, it is safe and effective if used properly.
The USA government's Substance Abuse and Mental Health Services Administration (SAMHSA) released a report in February 2004, concluding that most methadone-related deaths in the USA seemed to be from methadone in pain-tablet form, rather than the syrup dispensed to heroin addicts trying to beat their habit.
ABC's Stateline
ABC's 7.30 report 13 July 2004
Scientic American article
My response (as written and as printed)
Setting the record straight
Scientific American
10:32 07 March 04
Doctors prescribing methadone for pain relief may inadvertently be the cause of an alarming rise in deaths related to the drug in the US. Forensic science experts fear that a huge increase in methadone prescriptions is feeding the black market and encouraging abuse.
In 2001, the Food and Drug Administration's MedWatch programme recorded 61 methadone-related deaths in the US. That is more than occurred in the whole of the 1990s, and by 2002 the number had doubled to 123.
The figures confirm reports from Maine, Florida, Oklahoma, North Carolina, West Virginia and Maryland that methadone-related deaths are rising. Methadone is often used to wean addicts off heroin, and the recent spate of deaths has led to calls for heroin-treatment programmes to be curtailed.
But the drug is also used to treat chronic pain - in cancer patients, for example. It works well because it stays in the body for a long time, taking between 15 and 55 hours to be broken down to half its initial levels, compared with a matter of minutes for heroin. The downside is that this means accidental overdoses are common, even when the drug is prescribed.
Black market
According to a report in February by the Substance Abuse and Mental Health Services Administration in Rockville, Maryland - the federal agency that oversees methadone distribution for addiction treatment - the amount of the drug dispensed by pharmacies has more than trebled since 1998, while its use in addiction treatment has hardly changed.
This suggests that the rising death toll is mainly due
to misuse of methadone prescribed for pain relief. While 40 tablets cost as
little as $5 on Medicaid, each tablet can be worth $10 to $20 if sold on the
black market.
Reports from Oklahoma back this up. Ronald Distefano, from the state's Office
of the Chief Medical Examiner, told the American Academy of Forensic Sciences
annual conference in Dallas, Texas, in February that in 2001 and 2002 around
two-thirds of the people whose deaths were associated with methadone did not
have a prescription for the drug.
What's more, the SAMHSA report shows that while seizures of illegal methadone pills more than doubled from 2001 to 2002, seizures of liquid methadone only increased by 11 per cent.
The liquid form is the type most often prescribed for addicts. At post-mortem, methadone is often found along with other drugs, which makes it difficult to pin down the exact cause of death.
But Bruce Goldberger, a toxicologist and vice-president of the AAFS, thinks that the figures mark a new trend in drug abuse. "I have never seen this number of deaths before," he says. "It is a new generation of people using drugs."
James Randerson, Dallas
http://www.newscientist.com/news/news.jsp?id=ns99994736
(They did print my letter, but it was edited. This is the original version)
In the Decade of Pain Control and Research, I am very disappointed to read this article in Scientific American:-
"Painkiller linked to rise in overdose deaths: Doctors prescribing methadone for pain relief may inadvertently be the cause of an alarming rise in US deaths related to the drug."
The "alarming rise" in deaths due to methadone overdose that you report is from 61 in 2001 to 123 in 2002 - in the whole of the USA. Your article also suggests that "around two-thirds of the people whose deaths were associated with methadone did not have a prescription for the drug". In other words, you are telling us that around forty people who were prescribed methadone in the USA in 2002 died from it. This surely has to make it one of the safest drugs in the world. And around 85 people who managed to obtain the drug illegally died from it. This surely has to make it one of the least dangerous abused drugs.
The drugwarfacts website reports that 430,000 died from tobacco and 110,00 from alcohol - both of which are legal. Le Magazine reports this month that
"the number of people having in-hospital, adverse reactions to prescribed drugs [is estimated] to be 2.2 million per year ... The most stunning statistic, however, is that the total number of deaths caused by conventional medicine is an astounding 783,936 per year."
Compared to those figures, the 40-odd deaths from prescribed methadone, while unfortunate and sad, do not seem to herald a public health crisis.
There is an important reason for keeping a sense of proportion in these matters. Not long ago there was a similar scare about OxyContin (the sustained release form of oxycodone), which is also used to treat chronic pain. The danger of illegal use was similarly exaggerated. The resulting media frenzy led to many genuine pain patients being refused further prescriptions by doctors who either believed the stories, or were afraid (with good reason) of the result a crack-down on oxycontin prescribing could have on their practice and livelihood.
"Cancer patients and sufferers of debilitating diseases report that they are getting ineffective dosages of OxyContin, running out of places to fill legal prescriptions for it, or finding themselves without doctors, many of whom choose to avoid OxyContin headaches by sending patients to overwhelmed pain specialists struggling with the same regulations. Our simmering fear of painkiller abuse, brought to a boil by the OxyContin scare, has created a world of hurt for legitimate victims of illness" reported Damien Cave in Salon Magazine.1
It seems that now the bogey of addiction in chronic pain patients has proved baseless 2, media attention has turned to the potential for abuse and "diversion". The actual numbers are small, because few people who have been fortunate enough to find a doctor to prescribe these drugs for their terrible pain would be willing to sell them for any amount of money. But the result of such publicity can leave thousands in unrelieved agony.
I am asking you, as a responsible journal, please don't participate in this dreadful misrepresentation with methadone.
You should know that suicide is a common cause of death among chronic pain patients (I don't have the figures, but considering that there are estimated to be up to 50 million Americans who suffer chronic pain - it disables more Americans than heart disease or cancer - I am sure that the figure is commensurately large).
I speak as a chronic pain patient who has taken methadone safely and effectively for over seven years. The day it was prescribed for me, I told my doctor "I don't see how I can carry on dealing with this amount of pain."
Moira Smith
6 March 2004
www.mecfscanberra.org.au
1. See also OxyContin Problem— Not That Complicated: This Law Enforcement Issue Should NOT Drive Medical Policy Toward Those In Pain
2. See, for example:
Risk Of Addiction To Pain Relief Is Small, Expert Says
... "You will not make any patient an addict if you give
them drugs to treat their pain," says Henry Farkas, MD, MPH, Medical Director
of the Northern Chesapeake Hospice and a staff physician at Union Hospital,
in Elkton, MD. He pointed to the results of a very large study done in the 1980s,
which found that only four patients became addicted out of 12,000 treated with
opiates for pain.
Scientific American then published an explanation of the figures in their story:
Last week we published a letter from Moira Smith criticising media overreaction to deaths caused by pain killers (27 March, p 30). The letter was a response to our article about methadone deaths in the US (6 March, p 14). We did not make it clear enough in our article that the figures we reported (61 deaths in 2001 and 123 in 2002) are not comprehensive for the whole country - such figures do not exist. The US Federal Drug Administration's MedWatch database logs reports of adverse reactions to drugs and medical devices sent in voluntarily by medical professionals. It is therefore not a systematic reporting system, but is used to flag up emerging problems. As we reported, the increase is reflected in more systematic data from individual states. For example, in Florida there were 357 methadone-related deaths in 2001 and 556 in 2002. http://www.newscientist.com/opinion/opletters.jsp?id=ns244119
Letter to New Scientist (with editorial changes)
In the Decade of Pain Control and Research, I am very disappointed to read this article in Scientific American:- "Painkiller linked to rise in overdose deaths: Doctors prescribing methadone for pain relief may inadvertently be the cause of an alarming rise in US deaths related to the drug" (6 March p 14)
The "alarming rise" in deaths due to methadone overdose that you report is from 61 in 2001 to 123 in 2002 - in the whole of the USA. Your article also suggests that "around two-thirds of the people whose deaths were associated with methadone did not have a prescription for the drug". In other words, you are telling us that around forty people who were prescribed methadone in the USA in 2002 died from it. This surely has to make it one of the safest drugs in the world. And around 85 people who managed to obtain the drug illegally died from it. This surely has to make it one of the least dangerous abused drugs.
Compared with the hundreds of thousands who die because of alcohol and tobacco, which are legal, and the equally huge number of deaths caused by conventional medicines, the 40-odd deaths from prescribed methadone, while unfortunate and sad, do not seem to herald a public health crisis.
There is an important reason for keeping a sense of proportion in these matters. Not long ago there was a similar scare about OxyContin (the sustained release form of oxycodone), which is also used to treat chronic pain. The danger of illegal use was similarly exaggerated. The resulting media frenzy led to many genuine pain patients being refused further prescriptions by doctors who either believed the stories, or were afraid (with good reason) of the result a crack-down on oxycontin prescribing could have on their practice and livelihood.
It seems that now the bogey of addiction in chronic pain patients has proved baseless, media attention has turned to the potential for abuse and "diversion". The actual numbers are small, because few people who have been fortunate enough to find a doctor to prescribe these drugs for their terrible pain would be willing to sell them for any amount of money. But the result of such publicity can leave thousands in unrelieved agony.
I speak as a chronic pain patient who has taken methadone safely and effectively for over seven years.
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last revised 14 July 2004