Painkiller linked to rise in overdose deaths

March 03, 2004

DOCTORS prescribing methadone for pain relief may inadvertently be the cause of an alarming rise in deaths related to the drug in the US.

Forensic science experts fear that a huge increase in methadone prescriptions is feeding the black market and encouraging abuse.

In 2001, the Food and Drug Administration's MedWatch programme recorded 61 methadone-related deaths in the US.

That is more than occurred in the whole of the 1990s, and by 2002 the number had doubled to 123.

The figures confirm reports from Maine, Florida, Oklahoma, North Carolina, West Virginia and Maryland that methadone-related deaths are rising.

Methadone is often used to wean addicts off heroin, and the recent spate of deaths has led to calls for heroin-treatment programmes to be curtailed.

But the drug is also used to treat chronic pain - in cancer patients, for example.

It works well because it stays in the body for a long time, taking between 15 and 55 hours to be broken down to half its initial levels, compared with a matter of minutes for heroin.

The downside is that this means accidental overdoses are common, even when the drug is prescribed.

According to a report last month by the Substance Abuse and Mental Health Services Administration in Rockville, Maryland- the federal agency that oversees methadone distribution for addiction treatment- the amount of the drug dispensed by pharmacies has more than trebled since 1998, while its use in addiction treatment has hardly changed.

This suggests that the rising death toll is mainly due to misuse of methadone prescribed for pain relief. While 40 tablets cost as little as $5 on Medicaid, each tablet can be worth $10 to $20 if sold on the black market.

Reports from Oklahoma back this up. Ronald Distefano, from the state's Office of the Chief Medical Examiner, told the American Academy of Forensic Sciences annual conference in Dallas, Texas, last month that in 2001 and 2002 around two-thirds of the people whose deaths were associated with methadone did not have a prescription for the drug.

What's more, the SAMHSA report shows that while seizures of illegal methadone pills more than doubled from 2001 to 2002, seizures of liquid methadone only increased by 11 per cent.

The liquid form is the type most often prescribed for addicts. At post-mortem, methadone is often found along with other drugs, which makes it difficult to pin down the exact cause of death. But Bruce Goldberger, a toxicologist and vice-president of the AAFS, thinks that the figures mark a new trend in drug abuse. "I have never seen this number of deaths before," he says. "It is a new generation of people using drugs."
-end-
James Randerson, Dallas
New Scientist issue: 6 March 2004

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