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Methadone: Public Enemy No. 1

The opioid class painkiller, methadone, is the cause of one in 3 prescription painkiller overdose deaths, despite accounting for only 2 percent of painkiller prescriptions written, reports Kristina Fiore for MedPage Today.

Methadone took center stage in a recent CDC report.  Approximately 5,000 patients died from methadone overdose in 2009, about six times more than 10 years ago.

“Methadone is riskier than other prescription painkillers … and we don’t think it has a role in the treatment of acute pain,” said Thomas Frieden, director of the CDC.

Frieden explained that the proportion of methadone to other painkiller prescriptions is on the rise because insurers have increasingly made it a top-tier drug for chronic pain since it has such a low cost.  Evidence suggests that the increase in methadone overdoses is directly related to the increased use of methadone to treat chronic pain.

It’s  “penny wise and pound foolish …with higher societal costs in terms of death and other problems that can be avoided” Frieden said adding that there are other, safer opiates that should be used for pain.

Frieden cautioned that there’s limited evidence for the efficacy of opiates on chronic pain that is not related to cancer.

I suppose this is simply another example of insurance companies using a cost/benefit analysis on human life.


Congress hesitates to impose austere regulations on painkillers

800px-Pills_MC_inverseThe New York Times did a piece today on a bill that would have handed down stricter controls on drugs such as hydrocodone and oxycodone.  Efforts by Congress to pass the bipartisan bill were apparently impeded by a massive wave of lobbying from pharmacists and drugstore chains.  The bill ultimately fell flat yesterday.

Everyone knows about the rampant abuse of pain killers, but what struck me were some of the facts that Congress was looking at.  Apparently abuse has spiked over the past ten years.  A recent report by the federal Centers for Disease Control and Preventions said that lethal overdoses involving prescription painkillers are at “epidemic levels” and currently kill more Americans than heroin and cocaine combined.  “The death toll from overdose of prescription painkillers has more than tripled in the past decade.”  Wow!  Please everyone, be very careful with your medications!

I guess what the pharmacists and drugstores objected to was the high cost that it would take to comply with tightened security, e.g. storage would require more substantial safes, etc.  They also claimed that it would be harder for us, the patients, to get out meds, but there seems to be some contention on that point.

I personally understand the need to address the out-of-control abuse of these drugs, but I’m not sure these measures would be the best angle to attack it from.  I feel like it’s already a pain to get narcotic medications, and placing more hoops in front of people isn’t going to solve the problem.  Perhaps pain management doctors are  prescribing recklessly.  I know there aren’t really any viable alternatives, but passing the buck onto the drugstores is rather unfair.  It’s a very difficult and concerning issue to take on, and I can’t imagine many easy answers. 

I guess the moral of the story is to be careful with your meds.  Does anyone have any thoughtful comments on the issue?