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Feds act on methadone deaths

A federal agency is developing a plan to deal with an increase in deaths tied to the prescription drug methadone, one month after a Sunday Gazette-Mail series revealed a spike in overdoses nationwide.

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) is coming up with a strategy to deal with the spike in deaths, said spokeswoman Leah Young. The agency plans to work with the White House Drug Czar and the Drug Enforcement Administration to reduce the number of overdose deaths, she said.

The agency is developing a standard to determine just what should qualify as an overdose death caused by methadone ? something that was called for three years ago during a federal conference on methadone deaths convened by SAMHSA.

Also, SAMHSA plans to provide training on the proper use of methadone for health-care providers before the end of the year, according to Mark Parrino, president of the American Association for the Treatment of Opioid Dependence.

Methadone contributes to more deaths nationwide than any other prescription narcotic, and West Virginia?s methadone death rate is the nation?s highest, a Gazette-Mail investigation found.

Methadone was a factor in the deaths of 2,992 people in 2003, up from 790 in 1999, according to an analysis of death certificates conducted by the National Center for Health Statistics for the Gazette-Mail.

The drug was blamed for more deaths than heroin and about 1,500 fewer deaths than all other narcotic painkillers combined, including oxycodone, fentanyl, morphine and hydrocodone.

Criminals and addicts are not the only people dying. Some overdose victims took the drug as prescribed and died anyway. A Utah study found that 42 percent of methadone overdose victims had a valid prescription for the drug.

Once, methadone was given mostly to heroin addicts to stop their cravings for the illegal drug. Recently, more doctors are prescribing it to treat pain. Insurance companies favor it because it is cheap and effective.

Most overdose deaths are caused by pill-form methadone, the kind that is prescribed for pain, not the liquid methadone usually given out at methadone treatment centers.

The bad publicity regarding methadone-related overdoses could scare drug users away from methadone treatment centers, said Parrino, who represents the nation?s methadone clinics.

Most of the overdose deaths are coming from doctors who improperly prescribe the drug, patients who don?t take it as prescribed and people getting the drug illegally, Parrino said.

The federal government should send a letter to all doctors who prescribe methadone for pain that warns them of the danger of overdose, he said.

Parrino said he recently spent three days in Washington, D.C., meeting with federal officials about overdose deaths tied to methadone. He encouraged federal agencies to join together to fight the problem.

?I think they realize this is an issue,? he said. ?They understand the serious nature of this.?

?That devil drug?

Last month, one of the nation?s largest newsletters dealing with addiction devoted its lead article to the Sunday Gazette-Mail series.

?Methadone Painkiller Overdoses Causing PR Problem for Treatment Field,? read the headline in ?Alcoholism & Drug Abuse Weekly.?

??Killer Cure? Series in West Virginia Paper not Helpful,? read the second headline.

?The problem for the treatment field is that each time the overdoses make headlines, many people in the public, including lawmakers, don?t understand the difference between methadone the addiction medication, and methadone the painkiller,? the article says.

Actually, there is no difference in the chemical composition of the two forms of methadone. But methadone clinics in most states are highly regulated and must closely monitor patients, whereas doctors with little training in pain management can prescribe methadone.

In the article, Parrino said too many doctors and pharmacists are ignorant about methadone?s unique properties.

?Unlike with other prescription opioids, the doctors aren?t sufficiently educating the patients. The pharmacists aren?t doing anything. There?s no education,? he said.

Also, the package insert that comes with methadone contains dangerous and potentially deadly language about the ?usual adult dosage? of methadone, according to several physicians and pain researchers contacted by the Gazette-Mail. The drug manufacturer writes the language and the U.S. Food and Drug Administration approves it.

?The usual adult dosage is 2.5 mg to 10 mg every three or four hours as necessary,? reads the drug?s package insert under ?For Relief of Pain.?

Someone reading that label could believe it is safe for an adult to consume up to 80 milligrams of methadone a day.

But 50 milligrams of methadone or less can kill a patient not used to strong painkillers, studies say.

?Most people would die if they took 80 milligrams a day,? said Lynn Webster, a pain doctor and researcher from Utah. ?That?s an extremely dangerous, liberal guideline.?

Last month, Sen. Jay Rockefeller, D-W.Va., and Sen. Chuck Grassley, R-Iowa, called on the FDA to strengthen the warnings to consumers about methadone.

An FDA spokeswoman said the agency was working with the makers of methadone to make appropriate changes to the labeling for methadone painkillers. But one of the largest manufacturers of methadone said the FDA hasn?t talked to them, and the other major manufacturer referred a reporter to the FDA.

The FDA has not responded to a Freedom of Information Act request from the Gazette-Mail asking for information about its effort to change the methadone labeling.

Parrino said the label might need to be changed, but he opposes adding a ?black-box warning? or other strong language about overdose risks because it might scare away people who need methadone treatment.

?If this goes unchecked, somewhere along the line some elected official will want a black-box warning,? he said. ?But is more harm done than good? It further stigmatizes a medication, a treatment and a disease.

?[The deaths] further stigmatize the treatment system,? Parrino said. He added that during a recent trip to Charleston, someone told him, ?We don?t want that devil drug here.?

For the rest of ?The Killer Cure? series, go to www.wvgazette.com/section/Series/The Killer Cure

To contact staff writers Scott Finn and Tara Tuckwiller, use e-mail or call 357-4323.


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