|January 19, 2012|
Since 2004, the majority of methadone-related ED visits involved nonmedical use. Specifically in 2009, there were 91,360 ED visits involving methadone; of these, 69 percent were nonmedical use visits. The number of methadone-related ED visits involving nonmedical use rose 71 percent between 2004 and 2009 (from 36,806 to 63,031 visits) overall, but has leveled off in recent years (Figure 1).
|* Because gender is unknown in a small number of visits, estimates for males and females do not add to the total.
** The change from 2004 to 2009 is statistically significant at the .05 level.
Source: 2004 to 2009 SAMHSA Drug Abuse Warning Network (DAWN).
Among females, methadone-related ED visits involving nonmedical use doubled from 14,376 visits in 2004 to 29,402 visits in 2009 (Figure 1). During the same time period, visits among males increased 50 percent from 22,424 to 33,612 visits. In 2009, 53 percent of visits were made by males.
Visits made by patients aged 25 to 54 accounted for most (70 percent) of the methadone-related ED visits involving nonmedical use. More specifically, 28 percent were made by patients aged 25 to 34; 23 percent were made by patients aged 35 to 44; and 19 percent were made by patients aged 45 to 54 (Figure 2).
|Aged 12 to 17||1%|
|Aged 18 to 24||12%|
|Aged 25 to 34||28%|
|Aged 35 to 44||23%|
|Aged 45 to 54||19%|
|Aged 55 to 64||12%|
|* Due to rounding, the total adds to less than 100 percent.
Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN).
Nearly two thirds (65 percent) of methadone-related ED visits involving nonmedical use also involved another drug. Although there was an average of two drugs per visit, a substantial portion of visits (19 percent) involved methadone combined with three or more other drugs (Table 1).
|Drug Combination||Number of
of ED Visits
|Total ED Visits||63,031||100%|
|Methadone with One Other Drug||17,336||28%|
|Methadone with Two Other Drugs||11,818||19%|
|Methadone with Three or More Other Drugs||11,945||19%|
|Methadone with Other Drugs||41,099||65%|
|Other Pharmaceutical Drugs||33,397||53%|
|Drugs That Treat Anxiety or Insomnia||18,244||29%|
|Narcotic Pain Relievers Other Than Methadone||17,686||28%|
|* Because multiple drugs may be involved in each visit, estimates of visits by drug may add to more than the total, and percentages may add to more than 100 percent.
Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN).
In 2009, pharmaceuticals were present in about half (53 percent) of methadone-related ED visits involving nonmedical use; in one third (33 percent) of visits, pharmaceuticals were the only other type of drug involved (Figure 3). The pharmaceuticals most commonly combined with methadone were drugs that treat anxiety and insomnia (e.g., sedatives and sleeping pills) (involved in 29 percent of visits) and other narcotic pain relievers (involved in 28 percent of visits) (Table 1).
Illicit drugs were involved in one in four (25 percent) nonmedical use visits involving methadone (15,990 visits) (Table 1). Many of these visits also involved other pharmaceuticals and/or alcohol (Figure 3). Of the methadone and illicit drug combinations, marijuana (6,718 visits), heroin (5,741 visits), and cocaine (5,271 visits) were the most common (Table 1). Alcohol was involved in 10 percent of visits, often along with other pharmaceuticals and/or illicit drugs (Figure 3).
|Types of Combinations||Percent|
|Methadone Combined with Pharmaceuticals Only||33%|
|Methadone Combined with Illicit Drugs and Pharmaceuticals Only||14%|
|Methadone Combined with Illicit Drugs Only||8%|
|Methadone Combined with Alcohol and Pharmaceuticals Only||4%|
|Methadone Combined with Alcohol Only||3%|
|Methadone Combined with Alcohol, Illicit Drugs, and Pharmaceuticals||2%|
|Methadone Combined with Alcohol and Illicit Drugs Only||1%|
|Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN).|
Methadone is a safe drug when used appropriately and monitored by medical staff. Although it has been historically used to treat opiate addiction, methadone has become a commonly used pain reliever in recent years. As its popularity has increased among prescribing physicians, its availability—and therefore, its potential for diversion and misuse—has also increased. Consequently, this has made methadone more accessible, even for those who do not have a prescription.
In this report, approximately half of the methadone-related ED visits involving nonmedical use involved another pharmaceutical. However, combining methadone with other drugs can be risky, especially if those drugs mimic the sedative effects of methadone. The most common pharmaceutical combinations involved drugs that are known to be dangerous when combined with methadone (e.g., other narcotic pain relievers and drugs that treat anxiety or sleep disorders). Such drug combinations can result in depression of the respiratory and/or central nervous systems, which may result in a range of symptoms from shallow breathing, excessive drowsiness, or abnormal heart beat to loss of consciousness and death.
Patients who are prescribed methadone should be educated about its appropriate use and the risks of misuse. These discussions should cover methadone's long-lasting effects and the dangers of combining it with other drugs. Education may prevent patients from taking more frequent or larger doses of methadone when they think the methadone has worn off and/or from consuming other drugs, including alcohol, in combination with methadone. Patients should also be instructed to store their methadone securely and not share it with others.6 Family members and friends of methadone patients can be educated to recognize signs of an overdose (e.g., shallow breathing, weak heartbeat, confusion) and be urged to contact emergency services if they suspect an overdose.
In addition to educating themselves about appropriate methadone dosing and possible drug interactions, physicians who intend to prescribe methadone for pain management should also take steps to prevent nonmedical use of methadone by their patients. This includes first screening patients for substance abuse and mental health problems, monitoring patients' use, and prescribing only enough for the length of time that the pain is expected to last.6 Resource materials are readily available online to help guide medical personnel when methadone is under consideration (e.g., http://pain-topics.org/pdf/Methadone-Drug_Intx_2006.pdf).2,7
In this report, nearly one third of the nonmedical use ED visits involved methadone only, underscoring the need for broader public awareness of the dangers of methadone misuse. Public health campaigns targeting methadone safety have been developed by the Substance Abuse and Mental Health Services Administration, including brochures, posters, fact sheets, and media materials.8 These materials may be accessed via http://www.dpt.samhsa.gov/methadonesafety/index.aspx.
The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related morbidity and mortality. DAWN uses a probability sample of hospitals to produce estimates of drug-related emergency department (ED) visits for the United States and selected metropolitan areas annually. DAWN also produces annual profiles of drug-related deaths reviewed by medical examiners or coroners in selected metropolitan areas and States.
Any ED visit related to recent drug use is included in DAWN. All types of drugs—licit and illicit—are covered. Alcohol involvement is documented for patients of all ages if it occurs with another drug. Alcohol is considered an illicit drug for minors and is documented even if no other drug is involved. The classification of drugs used in DAWN is derived from the Multum Lexicon, copyright 2010 Lexi-Comp, Inc. and/or Cerner Multum, Inc. The Multum Licensing Agreement governing use of the Lexicon can be found at http://www.samhsa.gov/data/DAWN.aspx.
DAWN is one of three major surveys conducted by the Substance Abuse and Mental Health Services Administration's Center for Behavioral Health Statistics and Quality (SAMHSA/CBHSQ). For more information on other CBHSQ surveys, go to http://www.samhsa.gov/data/. SAMHSA has contracts with Westat (Rockville, MD) and RTI International (Research Triangle Park, NC) to operate the DAWN system and produce publications.
For publications and additional information about DAWN, go to http://www.samhsa.gov/data/DAWN.aspx.
|The DAWN Report is published periodically by the Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Center for Behavioral Health Statistics and Quality are available online: http://www.samhsa.gov/data/. Citation of the source is appreciated. For questions about this report, please e-mail: firstname.lastname@example.org.
This page was last updated on October 11, 2010.