Prescriptions for methadone have declined

Study finds doctors follow guidelines to have patients use other painkillers first

Doctors have made progress in recent years to reduce the prescription of methadone to fight pain amid efforts to reduce use of the drug after a spate of overdose deaths, a study by the Pew Charitable Trusts found.

Nationwide, the number of prescriptions written by doctors for methadone declined 26 percent between 2013 and 2016, according to the Pew study.

Public health officials have been concerned about methadone as a painkiller because it has been shown to be responsible for a disproportionate number of overdose deaths, particularly among the Medicaid population. The drug accounts for 1 percent of all opioid prescriptions, but was the cause of 23 percent of prescription opioid-related overdose deaths nationwide in 2014, according to the Pew report.

Known mostly for treating people with opioid use disorder, methadone is also sometimes used to treat pain.

Methadone can cause physiological changes to the lungs and heart long after the pain relief wears off. People may take a second dose of the drug too soon, putting further stress on their organs, which can lead to respiratory and other deadly issues.

Nationwide, the prescribing of methadone for pain relief under Medicaid fee-forservice plans has fallen 55 percent. In Maryland, it has dropped even more, 59 percent.

“The good thing is that there was an overall decrease of the use (of methadone) given what we know about potential harm,” said Cynthia Reilly, director of the Pew Charitable Trust’s substance use prevention and treatment initiative.

States and federal agencies in recent years have instituted prescribing rules to try to reduce the prescription of methadone for pain. The Food and Drug Administration first released a public health advisory cautioning about the risks of using methadone for pain relief in 2006. The agency has joined other groups and doctors in pushing instead for using other long-acting and extended release opioids.

“Methadone for pain is not recommended to be used first — only if a patient is not responsive to other forms of painkillers, they can’t tolerate them or they don’t work,” Reilly said.

In 2016, the Centers for Medicare & Medicaid Services called on Medicaid programs to remove methadone for the treatment of pain from their preferred drug lists, which encouraged doctors to prescribe other drugs for pain. Maryland removed methadone from preferred status that same year. Methadone is now only prescribed if a patient can’t take other drugs.

In Maryland, the number of methadone prescriptions for pain under Medicaid fee-for-service plans plunged from 1,158 in 2013 to 474 in 2016, according to the Pew report. Nationwide, they dropped from 179,402 in 2013 to 80,414 in 2016.

Methadone prescriptions, as a share of total prescriptions of long-acting prescriptions, fell much less in Medicaid-managed care plans, Medicare and commercial health insurance plans, the Pew study found.

Meanwhile, methadone-related overdose deaths fell 39 percent between 2007 and 2014, the Pew study found. Such deaths dropped another 9 percent between 2014 and 2015.

The Pew researchers said they can’t say how much of the prescription declines came because of the efforts to curb methadone use, but said they believe it played some role.

“We can’t say putting these programs in place is the absolute cause of the decrease, but certainly there is a correlation there,” Reilly said.