Methadone: Too Risky to Treat Pain

Methadone: Too Risky to Treat Pain

Nearly a third of the deaths caused by prescription painkillers in the U.S. involve methadone and doctors are prescribing the drug too often to treat pain, according to a new report from the Centers for Disease Control.

About 5,000 people died from methadone overdoses in 2009, far more than oxycodone, hydrocodone and other more widely prescribed prescription painkillers. Only 2 percent of prescription painkillers are for methadone.

“Methadone is riskier than other prescription painkillers,” said Thomas Frieden, MD, PhD, director of the CDC. “And we don’t think it has a role in the treatment of acute pain.”

Frieden didn’t stop there. The CDC report warns that there is little evidence that methadone or any opioid should be used to treat pain.

“Methadone and other, extended-release opioids should not be used for mild pain, acute pain, “breakthrough” pain, or on an as-needed basis. For chronic noncancer pain, methadone should not be considered a drug of first choice. This is especially true for conditions for which the benefits of opioids have not been demonstrated, such as headache and low back pain,” Frieden said.

“Only a small fraction of patients with intractable chronic headache treated with opioids experience long-term pain reduction or functional improvement. Evidence that any opioids are effective in chronic low back pain is limited,” Frieden added.

The CDC report said most methadone prescriptions were written by primary-care providers, rather than pain specialists, and called some of the prescriptions “inappropriate.”

According to the FDA, the most common diagnoses associated with methadone were back pain, arthritis and headache. Over four million methadone prescriptions were written for pain in 2009. Nearly a third were for patients who had not taken an opioid in the previous month.

Although methadone overdoses peaked in 2007, Frieden says its use as a painkiller was growing, primarily because it is cheaper than other opioids. Because of its lower cost, methadone  is often listed as a preferred drug by insurance companies. He called that “penny wise and pound foolish.”

“All of the evidence suggests that the increase in methadone-related deaths is related to the increased use of methadone to treat pain,” said Frieden, who cautioned that health-care providers who prescribe methadone should have substantial experience with its use and should follow guidelines for appropriate opioid prescribing.

Methadone can cause respiratory depression and disrupt the heart’s rhythm. Taking the drug more than three times a day can cause it to build up in a person’s body. The CDC report also warns that the difference between an appropriate dose of methadone and a dangerous one is small.

Authored by: Pat Anson, Editor

There are 9 comments for this article
  1. pain patient at 10:03 am

    I do not nod off, I am not impaired and I do not get my medication from a “pain clinic.” I assure you that my spinal cord being stuck and ripping in two is pretty darn painful and I too hope no one ever has to walk in my shoes. I am not arguing I am stating my opinion. If someone says something they should be able to back it up with facts. I use methadone and other medications. I have for years now and most days I am happy to be alive. Not everyone reacts the same to any medication. For me methadone works, does not leave me zoned out like others and makes me feel like I can make it another year, month, day. Without it I don’t know how I would survive with my pain. I tried everything out there before finally getting on the combination I am on now. I do not believe it is a bad drug. I believe if taken correctly it helps quite a few people.

    I am sorry for people who have overdosed, but studies ar4e skewed depending on what they want the studies for.

  2. Bren ONeal at 5:06 am

    I am a True chronic pain patient that understands all too well I will live in pain the rest of my life. I can no longer drive and basically homebound. It is extremely physically painful sitting here typing in response to your comment. But, I choose not to live nodding out or in a state of impaired consciousness.Do not take my word for it like I said earlier do Your own research pertaining to Pain Management Clinics. Google it or call/visit Methadone Clinics and you will find out they do take chronic pain patients. More importantly I pray you will Never walk in my shoes that has buried a child. Living in grief physically, mentally and spiritually by far out weighs any long term severe chronic pain one can ever endure.I am not trying to argue with You only help bring awareness and educate the public. You or anyone suffering from chronic pain or grief are in my prayers.

  3. Pain Patient at 8:19 pm

    IF you are a TRUE pain patient that has chronic pain, that means you will live with pain for the rest of your life. Addiction really isn’t an issue when you are a true chronic pain patient. One with severe pain. My choices of pain medication are methadone, fentanyl or double the amount of oxy or morphine that someone with acute pain would take (actually in my opinion no one with pain that isn’t severe and lasting a lifetime should EVER be put on oxy, methadone, fentanyl or any other type of sch II narcotic). I have heard of no pain management clinics treating someone for pain with methadone and then turning them over to a methadone clinic. That is absolutely not true. If it is tell me where this happened and to whom. Not the “I’ve heard” crap. I am tired of people who do not have chronic severe pain trying to dictate and tell people who truly hurt and hurt severely and will for the rest of their lives that something is dangerous or addictive. People like that have no idea what chronic severe pain feels like. Death is the better option if that gives you any idea.

  4. Bren ONeal at 6:14 am

    I am a chronic pain patient however I believe in taking part in my own Health Care. Do not put all of your trust into one doctor and research medications that are being offered to you. Many pain killers on the market today often lead to serious addictions or death. Oxycontin was thought to be a miracle drug by Pain Management Clinics unfortunately it led to serious addictions in their patients. Then Pain Management Clinics started treating the pain patients with Methadone or turning them away to Methadone Clinics. Methadone interactions with prescription meds and OTC that can be fatal. Please visit http://www.stopmethadonedeaths.com as we help bring awareness and educate the public the truth behind Methadone.

  5. pain patient at 12:24 pm

    I also have adhesive arach and tethered cord syndrome and a host of other truly painful conditions. If it were not for methadone I truly don’t think I would be alive today. Before they finally got my pain somewhat controlled I wanted to die. I mean that in a very literal sense od the term!!

  6. PWP at 10:33 am

    In 1996, after years of being unsuccessfully treated with short acting opiods for failed back syndrome and arachnoiditis, my doctor suggested I try methadone or morphine. I was horrified. Numerous invasive steroidal procedures only exacerbated my neuropathic pain so I’d sworn those off and I was quite forlorn that these were the choices now offered me for pain control. (I was already taking neurontin, an anti-depressant, and exercising, but was getting little to no relief.) After 2 weeks of bemoaning my limited options I tried the morphine. (At that time, methadone was primarily used to treat heroin addiction and that frightened me somewhat.) While the morphine did control my pain more effectively, I felt very drugged and itchy, so I gave in and tried the methadone. It was a miracle and it changed my life. For the first time in years my pain level was manageable. I could get out of the house and I didn’t feel drugged and under the influence. Methadone successfully controlled my chronic pain for 16 years, until neuroscience finally provided the pain solution I’d been praying for. I was able to “unlearn” my chronic, neuropathic pain using cognitive methods based on neuroplasticity and I’m just a few weeks from being off methadone completely. I certainly agree with Dr. Frieden about not prescribing methadone for acute pain and frankly I’m shocked to hear that doctors have done so when there are numerous other and better choices. However, methadone happens to be a GREAT drug for chronic pain (as many pain docs also believe), but like any medication it MUST be used as directed. I’d love to see the breakdown of how these deaths occurred. Who was being treated for what and how they were taking the drug? Unfortunately, and all too often lately, news regarding opiate addiction and deaths are being reported with very broad strokes. (check out the related posts.) While any death from medication is a tragedy, as a chronic pain patient and advocate for others who live with pain, I’m aware of people who are suffering terribly because this type of reporting has influenced doctors, pharmacies and now legislation. Suits who know very little about chronic pain are mandating prescribing practices and as a result, patients who suffer from miserable diseases that cause chronic pain can’t get the medicine that controls it. It doesn’t surprise me that primary care docs are prescribing methadone for acute pain because pain control is not part of the curriculum in the majority of our country’s medical schools – even though pain is the #1 reason someone goes to the doctor and over 100 million Americans currently suffer from pain. It’s time for a national discussion on all aspects of CHRONIC PAIN and not just the drugs used to treat it.

  7. Bren ONeal at 5:57 am

    How come the CDC are not reporting Methadone deaths that occur in Methadone Clinics ? There are too many deaths within the first and second week of induction that are not being acounted for.Pain Management and Methadone deaths from diversion are being under reported, also. We lost our 33 y/o daughter on April 5, 2006 due to a negligent doctor an Internist in private practice who prescribed her Methadone as pain medication. We were shocked to find out Methadone is now being used as a pain killer.It is outrageous the number of doctors over prescribing Methadone that lack training and education about this dangerous deadly drug. Innocent victims continue to die all across the USA at an epidemic rate. Please visit http://www.stopmethadonedeaths.com

  8. pain advocate at 3:20 am

    I speak to tons of pain patients. I feel that methadone has a place in pain management. It just needs to be used correctly and only for patients that been taking long acting opioids. I bet that Dr. doesn’t need pain medicine. So how does he know how it feels or if it’s effective. I feel these doctors saying that pain medicines are not effective long term just want them gone because everyone I have spoke with say they have a much improved life on these medications. So any doctors in 2012 claiming these facts, are not listening to patients. They just what they want and are getting paid to make these claims. It’s all BS. Legitimate pain patients have great success at the majority level. Sure nerve damage or nerve pain is hard to control and not much does help that. So, tell these opiophobic doctors to knock it off and stop lying!

  9. pain patient at 1:14 pm

    duh don’t take out more than 3 times a day. let’s ban this and all other opioid. that east chronic pain patients will kill themselves and save insurance companies money. at least the.druggies.will be alive.