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We
are extremely pleased that the CSAT/SAMHSA report on methadone-associated
mortality has been released today. I am particularly grateful
for Dr. Westley Clark's leadership on this project and for his
staff's perseverance. They achieved the impressive goal of coordinating
the work of many federal agencies, state authorities and national
organizations in producing the report in record time. |
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AATOD
has always been extremely sensitive to methadone associated
mortality reports throughout our existence over the past twenty
years. Some in this audience may recall the Houston Chronicle
series in Texas, which published inflammatory reports about
methadone-associated deaths during 1991, which led to the 60
Minutes story on the topic. At that time, federal agency representatives
were involved in evaluating the veracity of such reports and
were on the road to developing a standardized case definition
for medical examiners. |
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We
are particularly pleased that Dr. Goldberger and his associates
have been supportive of developing such standardized reporting
criteria at this time. We concur with the recommendation of
the report to move in this direction with all due haste. |
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It
is also instructive to note as the report has found that "the
greatest incremental growth in methadone distribution in recent
years is associated with use of the drug as analgesic and its
distribution through pharmacies rather than OTP's". |
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The
report indicates that "from 1998 through 2002, the volume
of methadone distributed through pharmacies increased five fold,
whereas the volume distributed through OTP's increased only
1.5 fold. In 2002 alone, pharmacies accounted for 88% of all
purchases of methadone tablets." |
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"Taken
together, the data (DEA/FDA) confirm a correlation between increased
methadone distribution through pharmacy channels and the rise
in methadone associated mortality". |
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We
also know that the number of OTP's has increased over the past
ten years in addition to the number of patients being treated.
The report indicates that "the growth in the number of
OTP's administering methadone and in the number of persons receiving
methadone treatment has been modest and does not parallel the
rate of increase in methadone-associated deaths". |
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It
is also instructive to note that the report indicated that CSAT's
2001 regulatory changes did "not have a significant effect
on rates of methadone associated mortality". "The
upward trend in fatalities involving methadone appeared prior
to 2001 and thus preceded the regulatory changes". |
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The
report results will be extremely important, especially in states
where there has been a significant increase in methadone-associated
mortalities. It is our hope that this report will be widely
distributed through the federal government among other federal
and state agencies in addition to national organizations. |
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We
also believe that methadone treatment has an appropriate place
in pain management and I will defer to Dr. Savage to discuss
this portion of the report and its implications in educating
practitioners in the use of methadone as an analgesic. |
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We
agree with the report recommendations that "the diagnosis
and treatment of addiction and appropriate pharmacotherapies
for pain be part of the core educational curriculum for all
health care professionals. |
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I
want to thank Drs. Goldberger and Savage for their leadership
in developing this report and in co-chairing the pivotal meetings
of May 8-9, 2003. |
