Remarks at Pain and Chemical Dependency Conference
February 6, 2004
Mark W. Parrino

	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.
	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.
	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.
	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".
	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."
	"Taken together, the data (DEA/FDA) confirm a correlation between increased methadone distribution through pharmacy channels and the rise in methadone associated mortality".
	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".
	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".
	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.
	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.
	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.
	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.