UF researchers link increasing prescription methadone use for chronic pain to rise in abuse-related deaths

Published: October 3 2002

Category:Health, Research

GAINESVILLE, Fla. — Doctors’ efforts to stop widespread abuse of oxycodone by prescribing an alternate painkiller may have backfired, University of Florida medical experts warn.

Methadone, an opiate used to help recovering heroin addicts avoid withdrawal symptoms, is now commonly prescribed for chronic pain instead of oxycodone, a narcotic popular in the illegal drug trade since the late 1990s. But Florida Department of Law Enforcement statistics show an alarming rise in methadone-related deaths in 2001, and UF researchers say the trend appears to mirror a nationwide problem.

Some methadone deaths result from accidental or deliberate overdoses by patients with legitimate prescriptions, said Bruce Goldberger, a UF forensic toxicologist whose laboratory performs drug analyses for medical examiners in 35 Florida counties. But others occur when the drug is used recreationally for its euphoric, long-lasting high, often by patients who go “doctor shopping” to obtain multiple prescriptions. Deaths also can occur when individuals borrow pills from others for pain medication and accidentally overdose.

“In Florida, we had a 71 percent increase in methadone-related deaths from 2000 to 2001 – now methadone is associated with more deaths than heroin,” said Goldberger, a clinical associate professor of pathology, immunology and laboratory medicine at UF’s College of Medicine. “Colleagues in other states have told me they’ve seen an upswing in methadone deaths.”

Methadone was detected during 357 autopsies statewide in 2001, compared with 328 autopsies involving heroin, according to an FDLE report on drug-related deaths issued in June. Nationwide, methadone-related emergency room visits nearly doubled between 1999 and 2001, from 5,426 to 10,725, according to the Drug Abuse Warning Network, a federal data collection system.

The statistics underscore the dangers of using prescriptions intended for someone else, said Dr. Mark Gold, a distinguished professor at UF’s McKnight Brain Institute and chief of addiction medicine in the psychiatry department. Gold presented data on methadone-related deaths last month at the annual meeting of the American Academy of Clinical Pharmacology in San Francisco.

“If you’ve never used opiates before, it’s very difficult to predict how you’ll respond to the typical methadone pill – that’s why doctors use such care in determining the correct initial dosage,” he said. “More than half the methadone-related deaths in Florida in 2001 were people ages 35 to 50. I suspect many of them were not trying to get high; they simply needed pain relief, got a pill from someone else and didn’t realize the danger they were getting into.”

Goldberger said he’s seen deaths in nearly every age group, from an 18-year-old man who ingested small doses of methadone and alcohol recreationally, to middle-aged and elderly patients who were prescribed methadone legitimately but died as a result of combined drug intoxication.

Methadone, a synthetic opiate developed by German doctors during World War II, was introduced into the United States in 1947 as a pain reliever, according to the federal Drug Enforcement Administration. In recent decades it has been used primarily for treating heroin addiction.

In the past two years, Gold said, physicians nationwide have increasingly prescribed methadone for chronic pain sufferers, in response to widespread abuse of oxycodone, hydrocodone and similar opiate painkillers.

A central nervous system depressant, methadone lowers blood pressure and heart rate and slows respiration, Goldberger said. Respiratory failure is the most common cause of methadone-related deaths. Recreational users sometimes combine methadone with other depressants such as alcohol, Valium and Xanax, which can cause a powerful drug interaction.

“I never would’ve guessed we’d see widespread methadone abuse,” Gold said. “In heroin treatment programs where patients may receive methadone under strict supervision and receive support, drug testing and counseling, it’s a safe medication. Under those circumstances, abuse and methadone-related deaths are rare.”

Methadone abuse in Florida is increasing because it’s too easy to obtain the drug fraudulently, said James McDonough, director of the Florida Office of Drug Control in Tallahassee. Florida is one of 32 states with no system to alert doctors and pharmacists when patients obtain and fill multiple prescriptions for narcotic painkillers.

“This year we’re working to pass legislation that would establish a monitoring system for scheduled drugs that would act as a safety check for patients, prescribers and pharmacies,” McDonough said. “We believe it would cause an immediate reduction in methadone deaths.”

Because it can be habit-forming, methadone is classified as a Schedule II controlled substance, so its domestic use and production are regulated by federal law.

Prosecutor Mark Moseley in Starke said tighter controls on narcotic painkillers can’t come soon enough. As division chief of the Bradford County State Attorney’s Office, Moseley has seen cases involving prescription drugs skyrocket.

“Many of these defendants probably don’t consider themselves drug dealers just because they split a prescription with somebody, but they end up in that legal posture,” he said. In Florida, illegal sale of a single methadone pill is a second-degree felony, punishable by up to 15 years in prison.

Moseley said defendants with multiple prescriptions often claim they were following doctor’s orders, making prosecutions more difficult. But if a case goes to trial, physicians may testify that the patient said they had no other source of narcotic pain medication.

“When patients lie to their doctors to obtain medication, they are committing another crime – obtaining a prescription by fraud,” he said. “I believe many of these defendants are themselves drug abusers and what they really need is treatment.”

Credits

Writer
Tom Nordlie, tnordlie@ifas.ufl.edu, (352) 392-0400, ext. 276

Category:Health, Research