Pubdate: Sun, 13 Aug 2006
Source: Charleston Gazette (WV)
Copyright: 2006 Charleston Gazette
Note: Does not print out of town letters.
Author: Scott Finn and Tara Tuckwiller
Bookmark: (Chronic Pain)
Bookmark: (Methadone)


West Virginia's death rate from the prescription drug methadone is 
the nation's highest. Next month, doctors from across the state will 
attend an education session to learn more about the drug, and how to 
prescribe it more safely.

An investigation published by the Sunday Gazette-Mail in June "led us 
to include a methadone expert at our conference this year," said 
Nikki Williams, coordinator of the 10th annual Mountain Retreat 
Continuing Education Conference.

The investigation found that methadone is involved in the deaths of 
more people nationwide than any other prescription narcotic. Some of 
those victims took their methadone exactly as their doctors 
prescribed it for pain, and it killed them anyway.  - advertisement -

Methadone behaves differently from other painkillers, said Chris 
Terpening, assistant professor in West Virginia University's 
Department of Clinical Pharmacy, who will speak at the conference. 
The same unique properties that make it a good painkiller also can 
make it deadly.

But the doctors prescribing it don't always know that. Terpening and 
Michael Johnson, an assistant professor of family medicine, recently 
co-authored a journal article on that topic after Johnson saw 
methadone being prescribed frequently to nursing home and hospice patients.

The Sunday Gazette-Mail investigation found "fairly obvious errors in 
how [methadone] was being used," Terpening said.

Also, it found that the package insert that comes with methadone 
contains potentially deadly language about the "usual adult dosage," 
according to several physicians and pain researchers contacted by the 
Gazette-Mail. The drug manufacturer writes the language and the U.S. 
Food and Drug Administration approves it.

"The usual adult dosage is 2.5 mg to 10 mg every three or four hours 
as necessary," the package insert states.

But 10 milligrams is a dangerous dose for patients who aren't 
accustomed to opioid painkillers, Terpening said.

In his article to be published in the West Virginia Medical Journal, 
"I'm fairly clear," Terpening said. "If, on those odd occasions 
you're going to use it [on an opioid-naive patient], you'll probably 
want to start at 2.5 milligrams initially -- and that's pretty much it."

However, 10 milligrams might seem like a perfectly reasonable 
starting dose to a doctor unfamiliar with methadone. "Everybody is 
used to writing [prescriptions for] 5 to 10 milligrams of morphine," 
a much weaker opiate painkiller than methadone. "If they're not 
really sure of the dose, they might say, 'Oh, I see it can go up to 
10 [milligrams].' They're doing it out of habit, more than awareness."

When morphine doesn't kill a patient's pain, doctors might try 
methadone -- sometimes under pressure from insurance companies, 
several doctors told the Sunday Gazette-Mail, because methadone is very cheap.

It is cheap to make and sell, Terpening said, because it has "an 
ungodly long half-life" compared with other painkillers. Drug 
companies have to spend a lot of money making other painkillers 
time-release, but not methadone.

However, it stays in the body so long that it can easily build up to 
toxic levels. "It's a lot cheaper," Terpening said. "But it comes at a price."

Terpening first became interested in methadone when he started seeing 
prescriptions being written for more and more patients. "When I was 
in pharmacy school in the late '90s, we got very little training on 
it," he said. "That was before it took off as a common-use analgesic.

"I took it upon myself to learn a little bit more about it ... The 
more I learned, I found out that methadone is kind of a double-edged 
sword. It has these very good properties, but those same properties 
make it dangerous."

Now, Terpening always teaches his students about methadone. "But I 
think they could still have even more [training] ... There definitely 
is a need for a lot of education how to appropriately use methadone, 
so we can avoid some of these adverse events."

The Mountain Retreat conference usually includes up to 175 
participants -- physicians, physician assistants, nurses, 
pharmacists, social workers, psychologists, counselors and 
occupational therapists, Williams said. It will be at Snowshoe 
Mountain Resort Sept. 8-10 and will cover topics ranging from obesity 
to Alzheimer's. For information or to register, visit or call (304) 346-0300.
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MAP posted-by: Beth Wehrman