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Methadone related deaths compared to all prescription related deaths.
Forensic Sci Int. 2015 Dec; 257:347-352.FS

Abstract

BACKGROUND

Methadone is increasingly implicated in unintentional overdose deaths. Despite major interventions, rates continue to remain high. One primary intervention, Prescription Drug Monitoring Programs (PDMP) are limited in their ability to impact this epidemic due to federal law restricting Opioid Treatment Programs (OTPs) from sharing data to PDMPs, despite being a major source of Methadone dispensing.

METHODS

This retrospective, observational study analyzed all prescription-related deaths occurring in San Diego County during the year 2013 with a specific focus on methadone-related deaths. All patients designated by medical examiner to have died by unintentional prescription were then referenced in the California PDMP, the Controlled Substance Utilization Review and Evaluation System (CURES).

RESULTS

As a whole, patients who died had a high number of average prescriptions, 21, and averaged 4.5 different providers, and three different pharmacies. Methadone-related deaths (MRD) accounted for 46 out of the 254 total patient deaths (18.1%). Methadone prescriptions were found in 14 patients with PDMP reports, 10 of who had methadone on toxicology report. Notably, 100% of methadone prescribed by primary care specialists. MRD patients were less likely to have toxicology reports matching PDMP data compared to other related drug deaths (20.6 vs. 61.2%, p<0.0001). Of the 46 methadone deaths, only 10 (29.4%) had prescriptions for methadone recorded in the database. Out of the 51 patients with only one drug recorded at death, methadone was most common (n=12; 23.5%). While all deaths had a notably high rate of chronic prescriptions at death (68.8% compared to 2% for all patients in CURES), there was no significant difference between MRD and other drug-related deaths (73.5 vs. 67.8%, p=0.68, respectively). MRD patients were less likely than other drug patients to have matching PDMP data without any illicit substance or alcohol (14.7 vs. 41.4%, p=0.003, respectively).

CONCLUSION

Methadone is a long-acting opioid that carries a higher risk profile than other opioids. In San Diego, the great majority of MRD had no data on methadone in the statewide PDMP database, bringing to question the restriction of OTP clinics from uploading information into the database. A risk-benefit analysis should be made to consider changing laws that would allow for OTP to input data into PDMP. OTP should make it standard of care to check PDMP data on their patients. Methadone prescribed for pain management should be limited to the most compliant patients.

Authors+Show Affiliations

Department of Emergency Medicine, Scripps Mercy Hospital, San Diego, CA, USA. Electronic address: roneet@cox.net.University of Southern California Medical Center, Los Angeles, CA, USA.Department of Emergency Medicine, Scripps Mercy Hospital, San Diego, CA, USA; University of Southern California Medical Center, Los Angeles, CA, USA; San Diego County Medical Examiner's Office, San Diego, CA, USA; Department of Emergency Medicine, University of California, San Diego School of Medicine, La Jolla, CA, USA.Department of Emergency Medicine, Scripps Mercy Hospital, San Diego, CA, USA; University of Southern California Medical Center, Los Angeles, CA, USA; San Diego County Medical Examiner's Office, San Diego, CA, USA; Department of Emergency Medicine, University of California, San Diego School of Medicine, La Jolla, CA, USA.San Diego County Medical Examiner's Office, San Diego, CA, USA.Department of Emergency Medicine, University of California, San Diego School of Medicine, La Jolla, CA, USA.Department of Emergency Medicine, University of California, San Diego School of Medicine, La Jolla, CA, USA.Department of Emergency Medicine, University of California, San Diego School of Medicine, La Jolla, CA, USA.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

26513639

Citation

Lev, Roneet, et al. "Methadone Related Deaths Compared to All Prescription Related Deaths." Forensic Science International, vol. 257, 2015, pp. 347-352.
Lev R, Petro S, Lee A, et al. Methadone related deaths compared to all prescription related deaths. Forensic Sci Int. 2015;257:347-352.
Lev, R., Petro, S., Lee, A., Lee, O., Lucas, J., Castillo, E. M., Egnatios, J., & Vilke, G. M. (2015). Methadone related deaths compared to all prescription related deaths. Forensic Science International, 257, 347-352. https://doi.org/10.1016/j.forsciint.2015.09.021
Lev R, et al. Methadone Related Deaths Compared to All Prescription Related Deaths. Forensic Sci Int. 2015;257:347-352. PubMed PMID: 26513639.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Methadone related deaths compared to all prescription related deaths. AU - Lev,Roneet, AU - Petro,Sean, AU - Lee,Ariella, AU - Lee,Oren, AU - Lucas,Jonathan, AU - Castillo,Edward M, AU - Egnatios,Jeremy, AU - Vilke,Gary M, Y1 - 2015/10/22/ PY - 2015/04/29/received PY - 2015/09/22/revised PY - 2015/09/30/accepted PY - 2015/10/30/entrez PY - 2015/10/30/pubmed PY - 2016/9/23/medline KW - CURES KW - Methadone KW - Opioid treatment KW - Overdose KW - PDMP KW - Prescription deaths SP - 347 EP - 352 JF - Forensic science international JO - Forensic Sci Int VL - 257 N2 - BACKGROUND: Methadone is increasingly implicated in unintentional overdose deaths. Despite major interventions, rates continue to remain high. One primary intervention, Prescription Drug Monitoring Programs (PDMP) are limited in their ability to impact this epidemic due to federal law restricting Opioid Treatment Programs (OTPs) from sharing data to PDMPs, despite being a major source of Methadone dispensing. METHODS: This retrospective, observational study analyzed all prescription-related deaths occurring in San Diego County during the year 2013 with a specific focus on methadone-related deaths. All patients designated by medical examiner to have died by unintentional prescription were then referenced in the California PDMP, the Controlled Substance Utilization Review and Evaluation System (CURES). RESULTS: As a whole, patients who died had a high number of average prescriptions, 21, and averaged 4.5 different providers, and three different pharmacies. Methadone-related deaths (MRD) accounted for 46 out of the 254 total patient deaths (18.1%). Methadone prescriptions were found in 14 patients with PDMP reports, 10 of who had methadone on toxicology report. Notably, 100% of methadone prescribed by primary care specialists. MRD patients were less likely to have toxicology reports matching PDMP data compared to other related drug deaths (20.6 vs. 61.2%, p<0.0001). Of the 46 methadone deaths, only 10 (29.4%) had prescriptions for methadone recorded in the database. Out of the 51 patients with only one drug recorded at death, methadone was most common (n=12; 23.5%). While all deaths had a notably high rate of chronic prescriptions at death (68.8% compared to 2% for all patients in CURES), there was no significant difference between MRD and other drug-related deaths (73.5 vs. 67.8%, p=0.68, respectively). MRD patients were less likely than other drug patients to have matching PDMP data without any illicit substance or alcohol (14.7 vs. 41.4%, p=0.003, respectively). CONCLUSION: Methadone is a long-acting opioid that carries a higher risk profile than other opioids. In San Diego, the great majority of MRD had no data on methadone in the statewide PDMP database, bringing to question the restriction of OTP clinics from uploading information into the database. A risk-benefit analysis should be made to consider changing laws that would allow for OTP to input data into PDMP. OTP should make it standard of care to check PDMP data on their patients. Methadone prescribed for pain management should be limited to the most compliant patients. SN - 1872-6283 UR - https://www.unboundmedicine.com/medline/citation/26513639/Methadone_related_deaths_compared_to_all_prescription_related_deaths_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0379-0738(15)00413-2 DB - PRIME DP - Unbound Medicine ER -