Dangerous Double Dipping Seen in Methadone Patients


A study released from the Centre for Addiction and Mental Health in Canada exposed one problem with methadone maintenance treatment for opioid addiction: patients who receive other prescription pain pills outside of the program. These patients were, in a sense, double dipping by getting drugs from doctors and pharmacies who didn’t know they were on methadone.

Methadone is a powerful narcotic given to heroin (or other strong opioid) addicts as a form of harm reduction. It is better for them, both medically, socially and economically to use oral methadone rather than inject a narcotic. Essential to this treatment, however, is limiting a patient’s use of other drugs. For this reason, patients are often tested to make sure they aren’t taking heroin – but other opioids may slip through.

Without having a single data base for prescriptions, addicts were getting pain meds without approval from the methadone treatment program. In the Canadian study, 18% were doubling up. The concern isn’t just about addiction issues, adding another narcotic to methadone treatment is very dangerous – it can lead to an overdose. Furthermore, if patients get other narcotics, they can be used to balance a dose reduction in methadone. To the addiction treatment staff, it would look like a patient is being weaned off of narcotics (one goal of the program) when they were just substituting one for another.

Because Canada has a type of universal healthcare system in place, it is easier to track multiple prescriptions for the same patient. The problem is probably worse in the U.S., where methadone treatment would be separate (and private) from other treatments a patient gets. Also, payment may be split between different insurances or cash, making it even harder to track.

While Canada addressed this problem with a combined database, currently there is no single database that has all the prescription information for a patient in the States. There are some systems in place at the state level, but no national system. The best we have are databases by insurance, so that using the same carrier to pay for multiple, duplicate prescriptions will show up. Who is informed of the conflicts is a matter of policy for each insurance company.


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