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.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 www.mountainretreatwv.com
or call (304) 346-0300.To contact staff writers Scott Finn or Tara Tuckwiller, use e-mail or call 357-4323 or 348-5189.