Advisory Warns Pharmacists of Methadone, Other Opioid Dangers

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A stunning statistic is the basis for a new warning issued by the Washington State Board of Pharmacy. The Pharmacy and Therapeutics Committee issued an advisory ( download document here) that says, “ Washington is among those states with the highest rate of opioid-related deaths in the U.S. This now exceeds both motor-vehicle accidents and firearms as the leading cause of injury-related death.

They then go on to give important overview information on a list of opioid medications, including Fentanyl, morphine, Oxycontin, and methadone. The advice to pharmacists is to:

  • * Monitor prescriptions for any irregularities or very large doses. This includes early refills or quantities above normal amounts.
  • * Counsel patients on proper use and make sure caregivers know the signs of overdose.
  • * “Stop and take a deep breath” by seeking assistance with patients on doses of 120 mg/day or higher and when pain and function are not improving.
  • * Pay particular attention to other drugs given along with methadone, including benzodiazepines and hypnotics.
  • * Make sure patients (and caregivers) know to consult the prescribing physician before starting or stopping any other medications – including over the counter and herbal types.
  • * Emphasizing that methadone should be taken exactly as prescribed and upping or lowering the dose can have unexpected consequences. This is essential because there isn’t necessarily a linear relationship between dose and pain relief for methadone. Adjustments must be made cautiously and with medical advice.

They also offer links to continuing professional education on methadone and narcotic dosing and use.

The numbers cited about fatalities (more than automobile accidents) really illustrate how extreme the problem is in Washington State. The advisory doesn’t give separate figures for illegal verses legal use, but nationwide, the abuse of prescription narcotics is on the rise. Abuse of powerful opioids like methadone add another dimension – without medical supervision, the risk of overdose and death increases. Further, those who take opioids illegally are less likely to get help when they need it. They may fear prosecution if they go to an ER. That kind of delay can be deadly.

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