Methadone from Clinics Is Not the Culprit

Methadone-associated deaths are not being caused primarily by methadone diverted from methadone treatment programs, according to a panel of experts convened by SAMHSA.

"While deaths involving methadone increased, experiences in several states show that addiction treatment programs are not the culprits," said SAMHSA Center for Substance Abuse Treatment (CSAT) Director H. Westley Clark, M.D., J.D., M.P.H. He cited the expert panel consensus report at the Sixth International Conference on Pain and Chemical Dependency in New York City in early February.

Methadone-Associated Mortality, Report of a National Assessment concludes that "although the data remain incomplete, National Assessment meeting participants concurred that methadone tablets and/or diskettes distributed through channels other than opioid treatment programs most likely are the central factor in methadone-associated mortality."

Hospital emergency department visits involving methadone rose 176 percent from 1995 to 2002. The rise from 2000 to 2002 was 50 percent, according to SAMHSA's Drug Abuse Warning Network.

SAMHSA convened the panel in May 2003 to determine whether its methadone regulations were allowing diversion of methadone from clinics or whether the rise of methadone mentions in hospital emergency rooms and reports of deaths were due to methadone coming from other sources.

The panel—state and Federal experts, researchers, epidemiologists, pathologists, toxicologists, medical examiners, coroners, pain management specialists, addiction medicine specialists, and others—concluded that the methadone from reported deaths came from sources other than opioid treatment programs.

"The participants in the meeting reviewed data on methadone formulation, distribution, patterns of prescribing and dispensing, as well as relevant data on drug toxicology and drug-associated morbidity and mortality, before concluding that the cases of overdosing individuals were not generally linked to methadone derived from opioid treatment programs," said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W.

The panel based its conclusion that methadone is coming from other sources on data showing that the greatest growth in methadone distribution in recent years is associated with its use as a prescription analgesic prescribed for pain, primarily in solid tablet or diskette form, and not in the liquid formulations that are the mainstay of opioid treatment programs that treat patients with methadone for abuse of heroin or prescription painkillers.

The experts surmise that current reports of methadone deaths involve one of three scenarios: illicitly obtained methadone used in excessive or repetitive doses in an attempt to achieve euphoric effects; methadone, either licitly or illicitly obtained, used in combination with other prescription medications such as benzodiazepines (anti-anxiety medications), alcohol, or other opioids; or an accumulation of methadone to harmful serum levels in the first few days of treatment for addiction or pain, before tolerance is developed.

"SAMHSA will continue to monitor the situation to ensure that SAMHSA's supervision of opioid treatment programs is always in the public interest," Mr. Curie emphasized.

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