Don't Blame Clinics for Methadone ODs, SAMHSA Says
Methadone has been involved in a growing number of drug overdoses, but diversion from methadone clinics is not the source of the problem, according to officials at the federal Substance Abuse and Mental Health Services Administration (SAMHSA).
Rather, most of the methadone associated with overdoses originated with physicians prescribing the drug as a painkiller. “While deaths involving methadone increased, experiences in several states show that addiction treatment programs are not the culprits,” said H. Westley Clark, M.D., J.D., M.P.H., director of SAMHSA's Center for Substance Abuse Treatment.
Clark's comments reflected the findings of an expert policy panel, convened in 2003, which recently stated in Methadone-Associated Mortality, Report of a National Assessment that “although the data remain incomplete … methadone tablets and/or diskettes distributed through channels other than opioid treatment programs most likely are the central factor in methadone-associated mortality.”
The panel noted that most methadone involved in overdoses was taken in tablet or diskette form, whereas most methadone clinics distribute the drug in liquid form. The experts suggested that most overdoses were the result of excessive use for purposes of intoxication, deadly combination with alcohol or other drugs, or accidentally building up toxic levels of the drug during the first few days of treatment, before tolerance is developed.
The Associated Press reported April 9 that the state of West Virginia, concerned over rising methadone overdoses, has put a moratorium on opening new methadone clinics. But a SAMHSA official said that a report from the Centers for Disease Control and Prevention on methadone overdoses in North Carolina found that 85 percent involved drugs from pharmacies, not methadone clinics.
Phil Herschman, president of the outpatient division of CRC Health Group, which runs seven methadone clinics in West Virginia, said his programs are being wrongly blamed for problems associated with the drug. “It's a battle we struggle with on a regular basis,” he said. “We're more public and a more obvious target.”
Some state lawmakers, however, said the moratorium is not just about overdoses but whether methadone clinics are doing enough to wean patients off the drug. Residents in Huntington, W. Va., also complain that a methadone program there has become a magnet for panhandling and prostitution, which clinic officials dispute.