Methadone Is a Painkiller With Risks

The first thought I had upon reading this article about methadone use is that insurance companies probably love methadone because it doesn’t have an active patent, and thus is cheap to proscribe.

Methadone, once used mainly in addiction treatment centers to replace heroin, is today being given out by family doctors, osteopaths and nurse practitioners for throbbing backs, joint injuries and a host of other severe pains.

A synthetic form of opium, it is cheap and long lasting, a powerful pain reliever that has helped millions. But because it is also abused by thrill seekers and badly prescribed by doctors unfamiliar with its risks, methadone is now the fastest growing cause of narcotic deaths. It is implicated in more than twice as many deaths as heroin, and is rivaling or surpassing the tolls of painkillers like OxyContin and Vicodin.

“This is a wonderful medicine used appropriately, but an unforgiving medicine used inappropriately,” said Dr. Howard A. Heit, a pain specialist at Georgetown University. “Many legitimate patients, following the direction of the doctor, have run into trouble with methadone, including death.”

OxyContin is still widely prescribed, but a survey of Medicare plans in 2008, by the research firm Avalere Health LLC, found that many did not even include OxyContin on the list of reimbursable drugs. Critics like Dr. June Dahl, professor of pharmacology at the University of Wisconsin, fault the insurance companies for favoring methadone simply because of its monetary cost. “I don’t think a drug that requires such a level of sophistication to use is what I’d call cheap, because of the risks,” Dr. Dahl added.

Federal regulators acknowledge that they were slow to recognize the dangers of newly widespread methadone prescribing and to confront physician ignorance about the drug. They blame “imperfect” systems for monitoring such problems.

[From Methadone Rises as a Painkiller With Risks – NYTimes.com]

and apparently, I was right:

The rise of methadone is in part because of a major change in medical attitudes in the 1990s, as doctors accepted that debilitating pain was often undertreated. Insurance plans embraced methadone as a generic, cheaper alternative to other long-lasting painkillers like OxyContin, and many doctors switched to prescribing it because it seemed less controversial and perhaps less prone to abuse than OxyContin.

The subtext is that the FDA only was concerned with methadone for narcotic abuse1:

In what critics call a stunning oversight, the F.D.A-approved package insert for methadone for decades recommended starting doses for pain at up to 80 mg per day. “This could unequivocally cause death in patients who have not recently been using narcotics,” said Dr. Robert G. Newman, former president of Beth Israel Medical Center in New York and an expert in addiction.

The F.D.A. says that in the absence of reports of problems by doctors or surveillance systems, “we would have no reason to suspect that the dosing regimen” might need to be adjusted.

In November 2006, after reports of overdoses and deaths among pain patients multiplied and The Charleston Gazette reported on the dangerous package instructions, the F.D.A. cut the recommended starting limit to no more than 30 mg per day. “As soon as we became aware of deaths due to misprescribing for pain patients, we began the process of instituting label changes,” Dr. Rappaport said.

Footnotes:
  1. in other words, there was not expensive advertising campaign touting the benefits of methadone, thus the FDA didn’t really care what the materials describing proper use actually said. Junkies don’t care what the current advertising says, and the FDA officials can’t get future jobs []

2 thoughts on “Methadone Is a Painkiller With Risks

  1. I have been actively exposing Purdue Pharma (a $10 billion criminally convicted pharmaceutical company) and its 3 CEO’s Michael Friedman, Howard Udell and Paul Goldenheim for criminally marketing OxyContin. I have worked on this for 6 years. In July 2007, they were charged in Federal Court with marketing OxyContin to patients and physicians as less likely to be addictive or abused. They pled guilty and were sentenced. I testified against them in Federal Court and in front of the US Senate. Their actions have resulted in an epidemic of OxyContin addiction and death in every state in the country. My work now focuses on further action being taken against them and J. David Haddox, the gatekeeper of Purdue Pharma’s involvement in the criminal marketing of OxyContin. I am working with government agencies and the FDA to accomplish this next goal. Purdue Pharma has recently begun marketing OxyContin to pregnant women for pain. I have notified all Attorney Generals of this latest marketing ploy which will cause an epidemic of addiction and death to pregnant women and unborn babies. I have also filed a charge against Purdue Pharma with the FDA which they have advised me they are taking “very seriously.” We do not need further devastation of OxyContin by an out of control, greedy Purdue Pharma.

    Marianne Skolek
    Activist for Victims of OxyContin and
    Purdue Pharma – a criminally convicted pharmaceu
    tical company
    http://www.nytimes.com/2007/05/10/business/11drug-web.html?ex=1336536000&en=9cc24d9d766e92a6&ei=5124&partner=permalink&exprod=permalink
    I testified against Purdue Pharma before the U.S. Senate
    http://judiciary.senate.gov/testimony.cfm?id=2905&wit_id=6612
    908-285-1232
    mskolek@aol.com
    http://www.oxydeaths.com

  2. France says:

    Hi everyone,
    I thank you for these messages (please excuse my bad english…I am a french woman and not bilangual…yet…thank you)

    I am 46 years young and I’ve been sadly taking drugs since I’m 14, in 1999 I got on a medical program and I’m on permanent methadone with a dosage of: 180mg EACH DAY, my lungs have big problems because of this high dosage and noone in the methadone clinic had told me that we could have respiratory trouble with a high dosage, I fund it myself going through the net like i did to find this…

    I beg and beg my doctor to give me something else so I could finally get rid of methadone for good, but they don’t want to, ( but I know they have other means to get rid of this horrible addiction )

    I feel my health going away with each day, i tell that to my doctor but i have better luck that a dog, a cat and even a stranger would listen to me better…

    the government, the FDA, the doctors and all the medical health system should think health first and money last, i even heard some doctors talking in the doctors bathroom (i was in the toilette and they did not know i was there) and Oh dear God the horrible things they said shock me and i’m not one who shocks easily believe it,,,
    they said that their patients were annoying, disgusting, ugly, needy and they hated the poor ones and they were all a waist of their time & energies…and they did not give them money enough, after that, their only subject was :
    MONEY, MONEY, MONEY, MONEY let me tell you; I was disgusted and my faith in the doctors went to hell in a blink…

    Something is got to be change, human is a word that means exactly that; human, but many of us don’t deserve to wear that name many of us are not worthy…

    I just wish that people would love one another more than this sad display of greedy ill intended doctors
    that are suppose to care and cure their fellowman,
    not doctors treat their patients like farm animals.

    N.B. if someone has an answer for me about my doctor not wanting to help find another way to help me get rid of methadone problem, PLEASE, PLEASE go to my myspace page at:
    http://www.myspace.com/francebat
    THANK YOU EVERBODY…AND GOOD LUCK TO YOU MARIANNE SKOLEK, YOU’RE A BRAVE WOMAN, I ADMIRE THAT…
    “GOD FAVOR THE BRAVE”
    Goodbye all…
    ^France bat^
    xoxoxo

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