Saturday, February 9, 2008

Methadone Deaths Gain Attention Of Medical Examiners

Formerly a drug used only to treat heroin addiction, methadone is becoming more popular in recent years to treat pain.

As the use of the drug increases, so too do the deaths at an "alarming rate," according the National Drug Intelligence Center. Florida has become one of the leading states for methadone overdose deaths, according to the Center for Disease Control.

Now, authorities are wondering if methadone may be fatal even in therapeutic doses.
"I would never let anybody in my family take methadone unless they were a heroin addict to begin with," said Hillsborough County Medical Examiner Vernard Adams.

The chairman of the Florida Medical Examiners Commission on Friday distributed a study to other commissioners citing increased instances of sudden deaths among methadone users.

Researchers in Oregon reported in the study published last month that methadone has been implicated as a likely cause of sudden death at therapeutic doses. In the study published in the American Journal of Medicine, the researchers recommended clinical safeguards and further studies designed to enhance the safety of the drug.

Adams said he's also noticed some methadone-associated deaths that are different from other deaths attributed to drug overdoses.

In addition to the fact that deaths are occurring at therapeutic doses, Adams said some methadone deaths involve heart issues. Most drug overdoses involve respiratory failure, Adams said.

But Adams said he has no statistics and cannot cite specific cases related to this possible phenomenon. He said he just has a general sense that this is something that should be examined.

"The fact that these people are dying from methadone at therapeutic concentrations, this is anecdotal," Adams said. "We haven't studied it the way these people in Oregon have."

In Hillsborough County, methadone was listed as a contributing cause in 37 deaths in the first six months of last year. Methadone was listed as the only cause in five deaths. In 2006, methadone was listed as a cause in 49 deaths, according to medical examiner data. In ten deaths, methadone was listed as the sole cause. In 2005, methadone was listed as a cause in 30 deaths in the county and as the sole cause in 10 more.

The numbers reflect a trend in Florida, where methadone was listed as a cause in 392 deaths in the first six months of 2007 and in 716 cases in all of 2006, compared with 2005 when the drug was a cause in 620 deaths.

Stephen J. Nelson, the chairman of the state Medical Examiners Commission, distributed the Oregon study at the commission's regular meeting. Nelson said he wanted medical examiners to be aware of the potential problem and to be on the lookout. It's possible, he said, that the commission may attempt to track methadone levels in the deceased.

In November, the National Drug Intelligence Center published a study titled, "Methadone Diversion, Abuse and Misuse: Deaths increasing at Alarming Rate." According to the report, the quantity of methadone dispensed nationwide more than tripled between 2001 and 2006.

The report described methadone as "safe and effective when used as prescribed," but said the drug has increasingly been misused and abused.

Methadone has been used in addiction treatment for the past 50 years, according to the report, which noted that the drug's use in pain management has increased steadily since the late 1990s. Physicians turned to methadone as an alternative to oxycodone and hydrocodone, which were being increasingly abused. It also can be used less frequently and is less expensive than other drugs, the report states.


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