TBO.com - TBO is Tampa Bay Online

Methadone Is Too Often Prescription For Tragedy

ADVERTISEMENT

The New York Times

Published: August 17, 2008

Suffering from excruciating spinal deterioration, Robby Garvin, 24, of South Carolina tried many painkillers before his doctor prescribed methadone in June 2006, just before Garvin and his friend Joey Sutton set off for a weekend at an amusement park.

Saturday night, Garvin called his mother to say, "Mama, this is the first time I have been pain-free; this medicine just might really help me." The next day, though, he felt bad. As directed, he took two more tablets, then he lay down for a nap. It was after 2 p.m. that Joey said he heard a strange sound that must have been Robby's last breath.

Methadone, once used mainly in addiction treatment centers to replace heroin, is today being given out by family doctors, osteopaths and nurse practitioners for throbbing backs, joint injuries and a host of other severe pains.

A synthetic form of opium, it is cheap and long-lasting, a powerful pain reliever that has helped millions. But because it is also abused by thrill-seekers and badly prescribed by doctors unfamiliar with its risks, methadone is the fastest-growing cause of narcotic deaths. It is implicated in more than twice as many deaths as heroin, and is rivaling or surpassing the tolls of painkillers like OxyContin and Vicodin.

"This is a wonderful medicine used appropriately, but an unforgiving medicine used inappropriately," said Howard A. Heit, a pain specialist at Georgetown University. "Many legitimate patients, following the direction of the doctor, have run into trouble with methadone, including death."

Federal regulators acknowledge that they were slow to recognize the dangers of newly widespread methadone prescribing and to confront physician ignorance about the drug.

In fact, a dangerously high dosage recommendation remained in the Food and Drug Administration-approved package insert until late 2006. The agency has adjusted the label and is considering requiring doctors to take special classes on prescribing narcotics.

Between 1999 and 2005, deaths that had methadone listed as a contributor increased nearly fivefold, to 4,462, a number that federal statisticians say is understated because states do not always specify the drugs in overdoses. Florida alone, which keeps detailed data, listed methadone as a cause in 785 deaths in 2007, up from 367 in 2003. In most cases it was mixed with other drugs, like sedatives, that increased the risks.

The rise of methadone is, in part, because of a major change in medical attitudes in the 1990s, as doctors accepted that debilitating pain was often undertreated. Insurance plans embraced methadone as a generic, cheaper alternative to other long-lasting painkillers like OxyContin, and many doctors switched to prescribing it because it seemed less controversial and perhaps less prone to abuse than OxyContin.

But too few doctors, experts say, understand how slowly methadone is metabolized and how greatly patients differ in their responses.

This year the federal government started sponsoring voluntary classes that teach doctors the elaborate precautions they should take with methadone, like inching upward from low starting doses and screening patients for addictive behavior.

MANDATORY EDUCATION

Should doctors be required to undergo special education in order to prescribe powerful narcotics? The Food and Drug Administration soon may recommend that they do so, though such a move would most likely prove controversial.

"I think it is a good idea, and it is something we are considering," said Bob Rappaport, director of the division of Anesthesia, Analgesia and Rheumatology Products at the FDA. But the agency itself does not have the authority to take such a step, Rappaport said.

Pain experts say they support increased education for doctors, but some fear that mandatory training may harm pain patients by limiting the number of doctors prescribing such drugs.

The New York Times

Share this:

Loading Comments...

Email Print

ADVERTISEMENT