A new study is highlighting the dangers of prescribing methadone for pain patients outside of a supervised medical setting. The study, conducted by Vanderbilt University Medical Center, reveals disturbingly high mortality rates among patients who self-administer methadone. Compared with other equally effective painkillers, it seems as though methadone prescriptions put patients at an unnecessarily high risk of accidental death.
Increased Death Rate Tied to Suppressed Respiration
The findings were published in JAMA Internal Medicine and compared one group of Tennessee Medicaid patients who were prescribed methadone against another group of patients who were prescribed Morphine SR (sustained release). The conclusions showed that the methadone group was at a 46 percent higher risk of death than the morphine group. Dr. Wayne Ray, one of study’s authors, calls the numbers quite high by medical standards and questions the continued prescription of methadone given that it offers no benefits over alternative painkillers. One of the most alarming statistics gleaned from the study was that three-fourths of the prescriptions were for back pain rather than for serious illnesses like cancer.
The increased risk of death is due to the unusual way in which methadone reacts with body functions. Like other opiate-based medications, methadone works as an analgesic to eliminate pain. Additionally, both methadone and morphine suppress the patient’s respiratory system. However, the analgesic effects of methadone wear off faster than morphine, so patients feel that they need to take more. The danger is that the suppressed respiratory effects don’t wear off as fast. Thus, subsequent doses suppress breathing even further, leading to an unintentional overdose and possibly death. This could also inadvertently lead to a methadone addiction.
The study’s findings are important because they contradict the only other previous study on the death rate of methadone. That study found that patients taking methadone had a 44 percent decrease in mortality. However, the previous study focused on severely ill cancer patients, not all patients as the most recent study did. This new study eliminated patients older than 75, those with severe illness and those currently in a hospital in an attempt to weed out those who were already at an increased risk of death.
FDA Recommended Actions
While methadone is a relatively low cost pain medication, it offers no other advantages for patients. For this reason, the risks associated with premature death are far too high to continue prescribing it to patients who are not under direct medical supervision. While prescription drug costs continue to be an issue for both physicians and patients, prescribing lower cost drugs that increase a patient’s risk of death is not an acceptable treatment plan. The FDA and CDC have both recommended that methadone not be used as the first method of pain treatment for patients due to the risk involved with its use. The study’s authors affirm those recommendations.
Physicians who previously thought that lower doses of methadone were safer for patients must reconsider their prescribing methods. Because of the way that methadone builds up in a patient’s body, lower doses are not safer because, as this study shows, patients simply take more of it. Patients who are exhibiting signs of misuse of methadone should enter a methadone detox program immediately to mediate the risk of premature death.
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