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The Painkiller That Saves Money But Costs Lives
Hugh Pickens writes "Over 2,000 patients have died since 2003 in Washington State alone by accidentally overdosing on a commonly prescribed narcotic painkiller that costs less than a dollar a dose and the deaths are clustered predominately in places with lower incomes because Washington state has steered people with state-subsidized health care — Medicaid patients, injured workers and state employees — to methadone because the drug is cheap. Methadone belongs to a class of narcotic painkillers, called opioids, that includes OxyContin, fentanyl and morphine. Within that group, methadone accounts for less than 10 percent of the drugs prescribed — but more than half of the deaths and although Methadone works wonders for some patients, relieving chronic pain from throbbing backs to inflamed joints, the drug's unique properties make it unforgiving and sometimes lethal. 'Most painkillers, such as OxyContin, dissipate from the body within hours. Methadone can linger for days, pooling to a toxic reservoir that depresses the respiratory system,' write Michael J. Berens and Ken Armstrong. 'With little warning, patients fall asleep and don't wake up. Doctors call it the silent death.'"
Wait: You use it as a painkiller? Why do you do that? It's almost the worst opioid you could possibly use for that!
There is no way that methadone should be used for anything other than treating opioid addiction.
Doctors don't generally like to prescribe pain killers. They worry about addiction, they worry about the DEA auditing their prescribing habits and yanking their license, without which it's kind of hard to be a doctor.
When they prescribe methadone, is it really out of cost, or have they grown so fearful of prescribing Oxycontin that somehow methadone seems like a reasonable alternative? And how many of those fears are medical/pharmacological, and how many are "if I prescribe Oxycontin I'll get in trouble" or "gee, there's a lot of press about Oxycontin, I shouldn't prescribe it"?
18 years ago I messed up my back, 8 years ago I did it again. The second time around didnt have the results of the first. I live with constant pain while awake unless laying down.
Pain is depressing, it ruins your attitude and life. I have learned to live with it, with pain pills to manage the pain. When sent to pain management every so often to get the pain medication adjusted methadone is always pushed, I am also low income. I have done a lot of study of pain drugs and will always tell the doctor that is one medication I want to avoid. At present I am on Percoset (oxycodone/acetaminophen). While it isnt as cheap as the methadone on my crappy insurance, my life is way more important than the $10 a month extra it costs me.
But the problem may not be the drug itself but the idea that some people in pain have that they can avoid pain completely. This isnt always the case when you are on these types of medication. You can control pain, you can moderate pain. But if you think that if I take a pill or two extra it will get rid of it altogether you are on a slippery slope. My brother tried that, he ended up taking more and more pills because over time your body starts resisting them. Thats where the danger lies. You take so many that you end up killing yourself by overdose, like my brother did at 36.
I trust Microsoft as far as I could comfortably spit a dead rat
Ritalin used to be the same size and color as methadone until one pharmacist accidentally put Methadone in some kids prescription of Ritalin. No one could figure out what was wrong with the kid, even as far as making the kid take more of it. The kid died. That's how you accidentally overdose.
I've got 101 mod points and you can't have them!
And, what's more, there are pieces of shit who advocate even canceling what little we give to the unfortunate.
figures why the world is STILL deep in shit in godfrigging 21st century.
Read radical news here
We use it like that here in the US, but thanks to our Puritanical roots, we frequently see it used only "unofficially" in that capacity.
We have tons of rules regarding where methadone clinics can go, how many people they can serve, under what conditions people can use it, how long, etc. So you end up seeing a lot of methadone prescribed for "chronic pain", despite the fact that it really kinda sucks for the whole "pain management" thing that opiates normally excel at.
Really, it does one and only thing well - It keeps people from going into withdrawal.
So basically, when you see a cluster of poor minorities with loq education OD'ing on this stuff, it doesn't mean their doctors have failed, it means a not-quite-ex-addict tried to get high on it and learned the hard way that it doesn't work very well for that, either.
I disagree entirely. You have to select patients very carefully, but it works wonders on some. I'm a pharmacy resident at a mid-sized hospital, and I did a pain consult on a patient who was sedated and intubated in the ICU. Poor nurse was out of her mind giving him Dilaudid shots every 30 minutes so he wouldn't spike his BP and breathe against the ventilator (both signs of inadequate pain control). Wanted to give him a longer acting opioid for basal pain control. Can't use OxyContin or MSContin here cause you can't crush it to put it in a feeding tube. Guy was also morbidly obese so it would take several days for a Duragesic patch to saturate all the subcutaneous binding sites. Methadone turned out to be the perfect answer.
Obviously you have to be extremely careful, but I don't have a problem with using methadone so long as the patient has good renal function, good hepatic function, good respiratory function (or a protected airway) and isn't taking any drugs that lengthen the QTc interval. This tends to rule out your older, sicker patients, and I suspect that most of the deaths from methadone toxicity happens in them.
In the case specifically addressed in TFA, the fact that the patient was on both methadone and Oxy simultaneously is mind-boggling. Especially in the setting of sleep apnea. More blame rests on the prescriber than on the drug.
I have to post anonymously about this, as well as leave out some details due to a settlement I got because of the mess you describe.
I have a problem with chronic kidney stones. My PCP eventually sent me to a pain clinic, where a doctor evaluated my current meds, my current needs, etc. I got a prescription for Oxycontin. Upon trying to fill this prescription, there were only two pharmacies that could fill it (several manufacturers were shut down due to illegal selling/distribution). One was at the pain clinic where I got the script, and the other was at CVS where I always filled all of my other prescriptions. The pharmacist was way way way beyond rude and pretty much called me a junky. I was absolutely furious. This man has made an extreme judgement of who I was because of my need for a powerful painkiller.
I come to find out this particular person owns http://banoxycontin.com/. It was obvious this person had an agenda and I was just one of his targets to push it. I can't get anymore into the resolution of the situation, but rest assured I won.
The "war on drugs" causes shit like this. It ends up just being a witch hunt and there are too many innocents that end up burning