The recent spate of news reports, together with FDA warnings implicating methadone in a number of deaths, has created an environment of fear regarding the use of methadone in treating pain patients. Notwithstanding its unusual metabolism and the extreme care required in its application, Dr. Forest Tennant maintains that methadone remains a valuable tool in the pain physicians armamentarium. This Viewpoint continues the dialog on the issues surrounding methadone prescribing.
An anti-methadone salvo has come forth from the US Food and Drug Administration. It has issued a black box warning to prescribing doctors that methadone is a potential death hazard if not properly prescribed. Their basis for this warning is soundly based on increasing methadone deaths. Between 1999 and 2004 methadone poisoning deaths rose from 786 to 3,849, a 390% increase. The rise in all-poisoning deaths rose only 54%. In 2003, methadone-related deaths rose 29% while all poisonings rose only 6%.
The crux of the problem can be found in a 2004 consensus report from the Substance Abuse and Mental Health Services Administration that concluded the increase in methadone-related deaths are caused by the growing use of the drug for pain treatment rather than as a treatment for opioid addiction.
Lets be abundantly clear. Methadone often provides pain control in severe chronic pain patients far superior to other long-acting opioids. The same is true for Oxycontin