Harmful patterns of painkiller prescriptions seen among methadone patients

November 28, 2011

A new study has shown harmful prescription patterns of powerful painkillers among a substantial number of Ontario patients who received methadone therapy to treat their opioid addiction.

Methadone, which is a type of long-acting opioid, has proven to be an for opioid dependence.

According to a new study by the Centre for Addiction and Mental Health (CAMH) and Institute for Clinical Evaluative Sciences (ICES), 18% of maintenance therapy also received for more than a week's supply of other opioids.

"It is concerning when large quantities of these types of opioids are combined with methadone therapy, as it can lead to overdose or fatal consequences," says Dr. Paul Kurdyak, head of CAMH's Emergency Crisis Services and Research.

The study is published online in the journal Addiction. (It should be noted that these data were collected before the Government of Ontario announced its narcotics strategy. The strategy includes improved monitoring of narcotics prescribing which took effect November 1, 2011.)

On average, this group of methadone patients had 12 non-methadone opioid prescriptions a year during a seven-year period from 2003-2010. In addition, nearly half (46%) of the non-methadone opioid prescriptions were from physicians and pharmacies that were not involved in prescribing and monitoring methadone use.

"If someone on methadone maintenance therapy needs pain management, they should be prescribed short-acting opioids for short periods of time, and these prescriptions should be written by the methadone prescriber so that the patients can be monitored," says Dr. Kurdyak, adjunct scientist at ICES and assistant professor of medicine at the University of Toronto.

Opioid prescriptions and related overdoses and deaths have increased dramatically in recent years in North America. Recent research has suggested that the cause of many methadone-related deaths could be the use of non-methadone opioids.

The researchers used the Ontario Drug Benefit (ODB) database to identify prescription records for methadone and other opioids, and examined opioid prescription patterns among 18,759 people who received methadone .

"People taking methadone should not be taking other opioids for extended periods. The fact that we're seeing this happen in nearly one in five cases, coupled with the observation that multiple doctors and pharmacies are often involved suggests that, in some instances at least, patients in methadone treatment programs are deceiving doctors to obtain other opioids," says Dr. David Juurlink, co-author of the study and ICES scientist.

Because patients on methadone therapy undergo random urine tests – and could face consequences if additional opioids are found in their system – it is also possible that these prescriptions are being sold illicitly.

"One remedy to this problem is a prescription monitoring system that allows pharmacies to communicate in real time, similar to what British Columbia implemented in the mid-1990s," says Juurlink. "Had such a system been in place in Ontario, I imagine that our findings might have been very different."

Since the study was carried out, Ontario has enacted the Narcotics Safety and Awareness Act to balance the need to access and prescribe monitored drugs appropriately for pain management, while reducing the abuse, misuse and diversion to the illicit market.

In 2010, the Canadian Guideline for Safe and Effective Use of for Chronic Non-Cancer Pain was developed as a guide for Canadian physicians and pharmacists for the same purpose.

Explore further: Deaths from strong prescription painkillers are on the increase

Related Stories

Deaths from strong prescription painkillers are on the increase

August 24, 2011
Action is needed to tackle the increasing number of deaths in the United States and Canada from prescription painkillers known as opioids, say experts in the British Medical Journal today.

Recommended for you

Data revealed under FOI shows benefits of multiple sclerosis drug currently blocked by regulators

August 17, 2017
A drug that is blocked by the EU regulatory system has now been found to improve the quality of life of people with multiple sclerosis (MS), according to a study by Queen Mary University of London (QMUL).

Opioids overused in migraine treatment, regardless of race, study finds

August 17, 2017
African-Americans are more likely to experience debilitating migraine headaches than whites, but a new study probing the issue found no evidence of racial disparities in treatment practices.

Finding better ways to reduce serious drug side effects

August 14, 2017
Many of the medicines we depend on to treat disease—and even to save our lives—pose potentially serious risks along with their benefits. Data from the U.S. Centers for Disease Control and Prevention indicate that about ...

Ultrasound-triggered liposomes for on-demand, local anesthesia

August 10, 2017
Researchers at Boston Children's Hospital have found a new way to non-invasively relieve pain at local sites in the body; such systems could one day improve pain management by replacing addictive opioids and short-lasting ...

Independent pharmacies and online coupons help patients save money on drugs

August 8, 2017
Uninsured patients or those with limited prescription drug coverage can save significant money by buying their drugs at independent pharmacies instead of big box, grocery or chain drug stores and by using discount coupons, ...

New study generates more accurate estimates of state opioid and heroin fatalities

August 7, 2017
Although opioid and heroin deaths have been rising dramatically in the U.S., the magnitude of the epidemic varies from state to state, as does the relative proportion of opioid vs heroin poisonings. Further complicating the ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.