Doctors Say Methadone Too Risky for Pain Management

Doctors Say Methadone Too Risky for Pain Management

Methadone is increasingly being used by physicians to manage chronic pain, but it is a risky drug to prescribe as a pain reliever, according to an article published in the Journal of the American Medical Association (JAMA).

The article cites a recent study by the Centers for Disease Control and Prevention (CDC), which found that methadone was involved in over 30 percent of overdose deaths linked to painkillers, even though the drug makes up only about 2% of painkiller prescriptions. Over 5,000 methadone overdose deaths occur annually — more than the combined overdose deaths caused by cocaine or heroin.

Part of methadone’s appeal is its low cost. Many states and insurance companies list methadone as the preferred opioid medication in their formularies. Methadone-related deaths surged in Washington after the state began encouraging patients in its health care system to use the drug, according to an investigation by the Seattle Times.

Other painkillers, such as OxyContin, have a short half-life and dissipate in a persons’ system in a few hours. Methadone, on the other hand, can linger in the bloodstream for days. Methadone has a half-life that’s both long and hard-to-predict. This can lead to toxic levels of methadone building up in a patients’ system and causing respiratory depression. With little or no warning, a patient can fall asleep – never to wake up again.

In addition, methadone may interact with anti-anxiety medications, which patients suffering from pain often take and frequently abuse.

“Many physicians, who are well meaning, don’t know how to use methadone,” said Lewis Nelson, an emergency physician and medical toxicologist at New York University School of Medicine.

Methadone has been used successfully for more than 40 years as a treatment for heroin addiction and it is increasingly being prescribed to manage pain. In 2009 alone, methadone prescriptions exceeded 4 million, reports the CDC. The increase in prescriptions coincided with the rise in its overdose deaths.

Both Nelson and CDC director Thomas Friedman advise physicians to avoid prescribing methadone to treat chronic non-cancer pain or acute pain. Rather, doctors should consider other treatment options, including safer opioid medications.“These drugs must be treated with a healthy respect,” Nelson told JAMA. “I don’t think methadone should be used for chronic [non-cancer] pain. It’s the least safe option.”

Authored by: Elizabeth Magill

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slobo

How did Gabapentin work out for your pain?

Shalom

I was prescribed oxy both time released and immediate release at the same time I wore a 100 mg fentenyl patch. Oxy was 80 mg time rel am and pm and 80 mg immediate release every 4 hrs. My pain still came crashing through. I was taken off that and began methadone 3 x 10 mg/day. 1 yr and 5 mos later my methadone is at 3 x 25 mg/day after being as high as 3 x 30/day. My pain is still beyond tolerable even with additional 60 mg Cymbalta. Have also tried Lyrica and Gabapentin with the oxy as well as amytriptaline and trazadone. When first prescribed methadone my GP prescribed Ativan for sleep. Apparently very dangerous with methadone. Was stopped immediately. I have added Mindful Meditation for chronic pain management and Reiki on my own. Any suggestions sincerely welcome.

dave

Doctors- given their pushing opioids without good evidence, can’t be relied on to serve the public when it comes to pain care. Doctors and medicine has proven too concerned with profits then the public good. Until their are much more energetic laws regulating the practice of medicine and scientific medicine, pain sufferers will suffer the vagaries and whims of a profession that has mislead them and selfishly served profit motives.

Mr. Twillman should know doctors dont want to obtain needed education in pain care- and they dont promote informed consumerism when it comes to pain care. In the near future increasingly decisions in pain care will be made to limit access to any pain care. This is the result of the carelessnes in medicine which has lead to runaway costs in medicine-as well as a failure of researchers to demonstrate cost savings due to pain management. Discussions regarding meications like methadone miss the mark as government is seeking to limit access to pain care-now that pain specialists have told about the great cost due to pain care.

slobo

I suffer from avascular-necrosis (AVN). I just weaned myself off of Methadone 2X10mgs. per day for ten years. It occured to me that it was no longer working. Withdrawl lasted four days and was more of an irritation than anything else. I was a little scared. But after withdrawl susbsided, guess what? No change in the pain!Currently, I am taking hydrocodone to manange my pain short term until I find a new pain specialist, and figure out what to do next. I am 66 years old. I have ejoyed AVN since 1993. The pain is exsquisite!

Bob Twillman, Ph.D.

I disagree with Dr. Nelson to some extent. His statement, “I don’t think methadone should be used for chronic [non-cancer] pain” is another example of an overly simplistic baby-with-the-bathwater reaction to very real problems with the way in which this medication has been used. I’ve personally seen a good number of patients who had marvelous results with methadone, when no other opioid did anything for them. As is true for ANY use of opioids to treat chronic pain (cancer-related or not), it’s not a case of whether we should or should not use them. The question is “for which patients should we use them, at what dose, for how long, and with what precautions?” Methadone can be used effectively and safely, but it takes a reliable patient who will follow instructions and a knowledgeable and experienced prescriber who monitors the patient and his/her treatment very closely.