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
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
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.
Back to Top