Vital Signs: Risk for Overdose from Methadone Used for Pain Relief — United States, 1999–2010

Leonard J. Paulozzi, MD; Karin A. Mack, PhD; Christopher M. Jones, PharmD


Morbidity and Mortality Weekly Report. 2012;61(26):493-497. 

In This Article


The rate of overdose deaths involving methadone in the United States in 2009 was 5.5 times the rate in 1999 (Figure 1). The mortality rate peaked at 1.8 deaths per 100,000 persons in 2007 and then declined in parallel with the amount of methadone being distributed nationally in 2008 and 2009. The annual rate of methadone prescriptions for pain rose to 1.5 per 100 persons by 2008 and did not increase further in 2009. Methadone accounted for 4.4 million (1.7%) of the 257 million opioid prescriptions in 2009. However, in 2010, methadone accounted for 9.0% of all the MME of all major opioids tracked by ARCOS other than buprenorphine. This proportion varied by state from 4.5% in New Jersey to 18.5% in Washington (Figure 2).

Figure 1.

Rates of methadone distribution for pain, methadone-related overdose deaths, and methadone prescriptions for pain — United States, 1999–2010.

Figure 2.

Percentage of opioid distribution accounted for by methadone prescribed for pain, by state — United States, 2010

Among the 13 DAWN Medical Examiner states, methadone accounted for 9.8% of the MME tracked by ARCOS. Methadone was involved in 31.4% of the 3,294 deaths involving these opioids, more than any opioid other than oxycodone in 2009 (Table). Among the 748 single-drug deaths, methadone was involved in 298 (39.8%), twice as many as any other opioid. The rate of methadone deaths per 100 kg sold in MME was significantly higher than that for any other opioid for both all deaths and single-drug deaths. The difference between methadone and other opioids was more pronounced in the analysis of single-drug deaths. Even if some of these deaths (e.g., 25%) had been attributable to methadone dispensed from opioid treatment programs, the differences between methadone and other opioids would remain significant. The methadone death rate was still significantly higher than the rate for any other opioid in both comparisons.


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