Methadone is responsible for almost one in three prescription painkiller overdose (OD) deaths, even though it only accounts for a fraction of prescriptions for pain, according to a new report.

Researchers at the US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) found that prescription painkiller OD was responsible for more than 15,500 deaths in 2009. But while all prescription painkillers have contributed to an increase in OD deaths over the last decade, methadone has played a central role in the epidemic, since more than 30% of prescription painkiller deaths involving methadone, while only 2% of painkiller prescriptions are for this drug. In all, six times as many people died of methadone overdoses in 2009 than a decade before.

Methadone, like other painkillers, is commonly prescribed for chronic problems like back pain, even though it might not help these problems in the long run. Despite warnings about the risks associated with methadone, it is available as a low-cost generic drug, and is often listed as a preferred drug by insurance companies. Methadone's risks include a small distinction between appropriate prescribed doses and dangerous doses; interactions with tranquilizers or other prescription painkillers; potential arrhythmia; and that taking it more than three times a day can cause the drug to build up in a person’s body, leading to dangerously slowed breathing.

While Methadone has been used safely and effectively to treat drug addiction for decades, it has been prescribed increasingly as a painkiller because it is a generic drug that can provide long-lasting pain relief. But, as methadone’s use for pain has increased, so has nonmedical use of the drug and the number of overdoses incurred due to diversion, a phenomenon that describes the illegal selling of drugs. The report was published in the July 2012 issue of the CDC Vital Signs report.

“Methadone is riskier than other prescription painkillers. All of the evidence suggests that the increase in methadone-related deaths is related to the increased use of methadone to treat pain,” said Thomas Frieden, MD, PhD, director of the CDC. “Using methadone in this situation is penny wise and pound foolish [..]. with higher societal costs in terms of death and other problems that can be avoided.”

Methadone is a synthetic opioid, used as an analgesic and as an antiaddictive in patients with opioid dependency. Although chemically unlike morphine or heroin, methadone acts on the same opioid receptors as these drugs, thus stabilizing patients by mitigating opioid withdrawal syndrome. Higher doses of methadone can block the euphoric effects of heroin, morphine, and similar drugs; as a result, properly dosed methadone patients can reduce or stop altogether their use of these substances. Methadone is also used in managing severe chronic pain, owing to its long duration of action, extremely powerful effects, and very low cost.

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