As Medical Use Expands, The Need For Methadone Detox Increases

Methadone, an addictive narcotic painkiller most commonly known for its controversial use as a “replacement addiction” for heroin addicts, has become the subject of even more controversy because of an unprecedented rise in prescriptions for common aches and pains, making it the fastest-growing cause of narcotic deaths and soaring rates of dependence and addiction requiring methadone detox to get off the drug.

Many, if not most addictions and overdose deaths, trace back to a growing practice not just among specialists but also family doctors and even nurse practitioners, to dispense methadone for almost any kind of pain that until recently would never have been treated with powerfully addictive narcotics.

The recent increase in methadone prescribing followed a shift in attitude in the 1990s that chronic and debilitating pain was “undertreated”. Methadone, a generic narcotic that is much cheaper than all other opioid painkillers, such as OxyContin, Vicodin and the other hydrocodone and oxycodone preparations, became the drug of choice for thousands of doctors whose patients' insurance or income could not support the more expensive brand names.

Some studies found that doctors considered methadone to be less controversial, and less prone to abuse, because it was less likely to cause the euphoria or “high” of OxyContin and other narcotic painkillers. Unfortunately the reverse has proven true. Methadone detox and rehab facilities across the country can attest that methadone is now much abused, especially among teens and young adults.

The result of the shift in prescribing habits, according to the Drug Enforcement Administration, has been a 700-percent rise in methadone prescriptions since 1998. In recent years, methadone has become a problem drug in areas of the country it has never before been seen.

And according to the Food and Drug Administration, the problem is being made worse because too few doctors understand how methadone works, and how differently each patient responds to it.

First and most importantly, methadone is metabolized (is used and excreted) more slowly than other narcotic painkillers. Significant amounts of methadone can remain in the body after pain relief has worn off. And when the pain returns, patients take more than was prescribed, often leading to a dangerous overdose, which can cause injury or even death. They almost all become dependent and addicted even if they take the prescribed doses, requiring methadone detox to regain a drug-free life.

The FDA has also noted that too many doctors prescribe too much methadone at the outset, causing dangerously high levels of the narcotic in the body. Doctors have also failed to warn patients about all of the potentially lethal danger of mixing methadone with other drugs or with alcohol. And although it’s well known that many patients don’t follow doctors’ orders to the letter, many doctors still don’t insist that methadone patients stay in close contact with the doctor at least for the first week of treatment.

Federal regulators admit they failed to spot the serious problems at first, and to address physician ignorance about methadone. And a dangerously high dosage recommendation remained in the FDA-approved package insert until late 2006. The label has been amended, and there has been discussion -- but no action yet -- about requiring additional training for doctors on the use of narcotic painkillers. Such training is still seen by many experts as a vital necessity.

Meanwhile, since 1999, deaths listing methadone as a contributing factor have increased more than fivefold, and statisticians say that it is likely higher because some states don’t specify drugs in overdoses. But in Florida, where detailed drug overdose information is maintained, methadone was the cause of 785 deaths in 2007, up from 367 in 2003.

And across the country, young adults and middle-aged Americans continue to fall victim to methadone dependence and methadone addiction, while deaths among teens, particularly tragic and worrisome, continue to rise.