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Methadone and Other Opioids Not Always Equivalent, Conversion Can Be Lethal
Date:2/4/2010

deaths, and then bring the pain community together to find a solution."

Webster reviewed published data and case reports and found trends in the information that led him to develop theories about the cause of this increase in opioid deaths. The first was the high-proportion of methadone-related deaths in comparison to other opioids. Although it represented about five percent of the opioid prescriptions in this time period, it was mentioned in one-third of the deaths. The research also showed that one-third of the deaths occurred within five days after a dosage change -- also suggesting that unfamiliarity with the medicine could lead to accidental deaths.

Webster then brought this information to a consensus conference sponsored by the LifeSource Foundation where an esteemed panel of colleagues representing the best in research, practice, epidemiology, and public health helped him determine root causes of the problem. After reviewing and discussing the data, the panel identified the following as probable causes underlying the spike: physician error due to knowledge deficits, patient non-adherence to medication regimen, unanticipated medical and psychiatric co-morbidities (including substance abuse), and payer policies that mandate methadone as a first-line coverage.

"Not all pain medicines -- even within a class -- and not all patients -- are created equally," said Dr. Webster. "Methadone is a safe and effective opioid with pharmacokinetics and pharmacodynamics unlike other opioids, so knowledge about it and how it may affect a specific patient is paramount to a positive clinical outcome. Education about pain medicine is the best safeguard against the unintended deaths and side effects we've seen with methadone in the last decade."

According to Webster, simple conversion from one opioid twice a day to another twice a day is not safe. Patient pharmacogenetics (a patient's unique response to medicine based on
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SOURCE American Academy of Pain Medicine
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