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The powerful drug methadone accounts for one-third of all painkiller deaths in 13 states, including Utah, according to a new report.
The Centers for Disease Control and Prevention on Tuesday called for doctors to rein in how they prescribe the drug.
In Utah, the number of methadone-related deaths has dropped as efforts to educate physicians and the public have increased.
"The problem's not solved but we made progress," said Robert Rolfs, deputy director of the Utah Department of Health. He noted the number of such deaths dropped from up to 120 a year between 2004 and 2008 down to 60 to 70. But "It's still a lot of people dying."
In a report Tuesday, the CDC showed methadone accounted for 10 percent of the prescribed painkillers in 13 states in 2009, but was involved in 31 percent of painkiller-related deaths.
Nationally, the death rate due to methadone overdoses appears to have peaked in 2007.
In Utah, all painkiller-related overdose deaths also peaked that year, at 326 deaths. In 2010, the count was 236.
Originally used to treat heroin addiction, methadone has increasingly been used to treat chronic noncancer pain since the mid-1990s. It is long acting, costs less and is available in liquid form.
But it can build up in the body, leading to dangerously slowed breathing. And it can disrupt the heart's rhythm.
The CDC suggests doctors may be too quick to prescribe methadone. One-third of prescriptions are given to patients who have not used painkillers in the previous month. And it's being prescribed for headaches and low back pain even though there's little evidence it works for those conditions.
The CDC said providers who continue to prescribe it should have "substantial experience" with its use right now, most prescriptions are not written by pain specialists.
By limiting prescriptions to patients with cancer or on palliative care, it will reduce the amount of the drug available for misuse, the CDC says. Most people who overdosed were using it without a prescription.
The CDC researchers analyzed a decade of national prescription data, as well as drug-related death data from 13 states. The number of methadone-related deaths rose from fewer than 800 in 1999 to more than 5,500 in 2007, before slipping the next two years to 4,900 and 4,700.
The drop may be due to a couple of actions: In 2006, the Food and Drug Administration warned doctors to be more careful in prescribing it. The FDA also lowered the recommended dosage, and in 2008 manufacturers voluntarily limited distribution of the largest formulation to authorized opioid addiction treatment programs and hospitals only.
Individual states also started to crack down.
In 2009, the Utah Department of Health issued guidelines telling doctors to rarely if ever prescribe methadone for acute pain and that it should be prescribed by providers who know the risks and will carefully monitor patients.
In a Utah study, methadone was the most common drug identified by the Utah medical examiner as causing or contributing to accidental deaths. In 2006, methadone was implicated in 30 percent of painkiller-related deaths. Half of those who died had a valid prescription.
Today, methadone is second to oxycodone for contributing to accidental painkiller deaths, Rolfs said.
While state funding has run out for the health department's program to reduce painkiller-related deaths, some efforts continue. The state requires physicians take extra classes on prescribing opioids before renewing their license.
The Associated Press contributed to this story.
Read the report
O Find the prescription-drug analysis by the Centers for Disease Control and Prevention online. > cdc.gov/mmwr