Tuesday, July 17, 2012

Methadone is Now the Biggest Killer

Peter R. Coleman, M.D. 
The number of people killed by Methadone is startling. Consider this - Methadone accounts for only 2% of all painkiller prescriptions, but it causes over 30% of all deaths!  And lately, there have been a lot of deaths from painkillers.  In 2009, there were over 15,500 Americans killed from opiate painkillers.  In fact, there are now more Americans killed by prescription painkillers than all other drugs combined.

Two questions arise.  Why is there such an increase in deaths from Methadone, and what can be done about it?  The answer to the first question is fairly easy.  The answer to the second question is more complicated.

Methadone has been available as a treatment for opiate addiction for a number of decades. It has unique properties that make it a useful treatment, both to help patients detoxify off Heroin and other short acting opiates.  Its properties also make it useful as a maintenance drug for patients who are not ready, or able, to become completely drug free.  Methadone is active orally, so it does not need to be injected or snorted to have its effect.  Methadone has a very long half-life - it varies from patient to patient, but Methadone’s half-life can be up to 6 days - which is to say that it acts in the body for a very, very long time.  When a drug has a long half-life, it easily accumulates in the body every time you take another dose - increasing the risk for an overdose.  The long half-life of Methadone is both a good and a bad thing.

The good news about Methadone’s long half-life is that it only needs to be taken once a day, making it ideal for use in clinics where the patient is given their medicine under observation.  Second, drugs with long half-lives also do not give as much of a pleasurable high when they are taken, because quick highs seem to be more addicting.  In general terms, addicts like the feeling of rapidly going up, which is one of the reasons that cocaine is so addictive. So, Methadone is able to be given in a clinic once-a-day and the clients don’t get too much of a buzz from it.

But the long half-life is also the biggest problem with Methadone – it accumulates.  There have always been quite few deaths at Methadone clinics – almost always in the first few days of starting patients on it.  If a dose is given that is too high for the patient, and the patient keeps getting that same dose every day, then the blood level will keep rising for over a week.  It is not uncommon that if patients start on a dose of 60mg daily and get that dose daily, they die of an overdose within the first week.  Good Methadone clinics start patients at very low doses and see the patients daily until they are out of this danger zone, even if it means not fully abolishing their withdrawal symptoms in the first few days.

The long half-life also means that Methadone is not a very effective painkiller.  When patients are in pain, they want relief quickly.  A drug that has its peak effect 24-hours later is not going to be very effective to relieve pain.  If patients don’t feel much pain relief, it is very tempting for them to take another dose – a situation that can cause severe problems with accumulation.  Patients can easily overdose and die if they keep taking Methadone to try to relieve all of their pain.

The other reason that there are more Methadone deaths is that there is a lot more of it available on the streets.  It has become quite fashionable for pain clinics and other doctors to prescribe Methadone for chronic pain patients. The drug is cheap and physicians like the fact that patients are not getting much of a buzz from their pain meds.  So there is a lot of Methadone being prescribed, often by very conscientious physicians, and this means there is a lot more out there.  This means that there is going to be more sold.  I think the latest price for Methadone is about $10 per pill.

Street abuse of Methadone is rampant.  Addicts like it.  There is a lot available and it is relatively inexpensive.  Whereas it may cost addicts $100 daily to get high with Heroin or Oxycodone, addicts can frequently relieve their withdrawal symptoms for only about $30 a day.  This is probably the most common form of abuse of Methadone.  Most addicts know that they are not going to get much of a buzz from Methadone, but it is usually available when other drugs are not available and it is lot cheaper.  Addicts frequently use Methadone to keep their costs down and then use Heroin or OxyContin when they want to catch a good buzz.

When a long-acting opiate is used frequently, it is going to cause a lot of deaths.  The deaths come predominantly in three ways.  If enough Methadone is taken, it stops the person’s breathing.  Even more of a problem is when Methadone is taken with other sedatives, including alcohol.  This combination of Methadone plus sedatives is particularly lethal because both drugs can suppress breathing and the combination suppresses breathing very powerfully.  The third way Methadone is fatal is that it can cause a blockage in the rhythm of the heart – a prolonged QT interval.  Sometimes this happens at high doses (good clinics should periodically check an EKG on their patients), but sometimes it can happen unexpectedly even at lower doses.

Unfortunately, trying to do something about the number of fatalities caused by Methadone is not easy.  Obviously, authorities should crack down on physicians who are fraudulently prescribing it, but most patients are getting their prescriptions quite legally.  For patients who have chronic pain that requires opiate medication, there are no perfect solutions.  What we have found at The Coleman Institute is that many chronic pain patients don’t require opiates at all.  They actually feel better and have less pain after we detox them and put them on Naltrexone therapy.  That is one solution that doesn’t have any side effects!

At The Coleman Institute, we love to help people get clean and stay clean.  If you or someone you love is in need of detox from opiatesalcoholbenzosMethadone, or Suboxone, please do not hesitant to call Jennifer Pius at 1-877-77-DETOX (33869).  We are here to help you and yours get clean and stay clean! 

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