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Decline in methadone overdose deaths follow reduction in use for pain

The significant declines in methadone overdose death and diversion reports since 2006, strongly correlate with reduced amounts of methadone used in the treatment of pain, according to data published in Morbidity and Mortality Weekly Report.

“Use of the prescription opioid methadone for treatment of pain, as opposed to treatment of opioid use disorder (eg, addiction), has been identified as a contributor to the U.S. opioid overdose epidemic,” Christopher M. Jones, PharmD, of the HHS Office of the Assistant Secretary for Planning and Evaluation, and colleagues wrote. “Although methadone accounted for only 2% of opioid prescriptions in 2009, it was involved in approximately 30% of overdose deaths. Beginning with 2006 warnings from the [FDA], efforts to reduce methadone use for pain have accelerated.”

To analyze trends in methadone distribution for pain treatment from 2002 to 2014, and their effects on diversion and overdose deaths, Jones and CDC researchers obtained mortality data from the National Vital Statistics System. In the system, methadone could be listed alone or in combination with other drugs. In addition, researchers examined the DEA’s automation reports and the consolidated orders system for methadone distribution in grams for 2002 to 2013.

Data on methadone diversion from 2002 to 2014 were obtained through forensic laboratory testing of substances associated with drug cases associated with federal, state and local law enforcement operations, received through the DEA’s National Forensic Laboratory Information System. The researchers used joinpoint regression to examine changes in trends in the rates over time.

According to the researchers, the average rate of grams of methadone distributed increased 25.1% each year from 2002 to 2006, but declined 3.2% per year from 2006 to 2013. Overdose deaths involving methadone increased 22.1% per year from 2002 to 2006, and then declined 6.5% per year from 2006 to 2014. Rates of methadone diversion into illicit markets increased 24.3% during 2002 to 2006, and then increased at a slower rate from 2006 to 2009. From 2009 through 2014, diversion rates decreased an average of 12.8% per year.

Methadone overdose death rates peaked during 2005 to 2007 across sex, most age groups, racial/ethnic populations and U.S. Census regions, before declining in subsequent years. However, there was no change among people aged 65 years and older, and among those aged 55 to 64 years, the methadone overdose rate continued to increase through 2014.

“During 2002 to 2014, there was a strong positive association between rates of methadone distribution for use in pain treatment and methadone diversion and overdose deaths,” Jones and colleagues wrote. “The 3,400 reported methadone overdose deaths in 2014 is the lowest number since 2003…. Importantly, these declines occurred in the context of more than 100,000 additional persons receiving methadone for the treatment of opioid use disorder during 2002 to 2013, suggesting that policies targeting methadone use for pain are not affecting access to methadone for treatment of opioid use disorder.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.