The use of methadone to treat pain instead of treating opioid use disorder (eg, addiction), has been established as a contributor to the country’s opioid overdose epidemic. 

In 2009, methadone made up only 2% of opioid prescriptions but it was involved in almost one-third of overdose deaths. 

The Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services and Centers for Disease Control and Prevention (CDC) reviewed methadone distribution, reports of diversion, and overdose deaths during 2002–2014 using the National Vital Statistics System multiple cause of death mortality data. Methadone-related deaths were defined as those with an underlying cause of death classified by ICD-10 external cause of injury codes ( X40–X44, X60–X64, X85, Y10–Y14) and ICD-10 code for methadone poisoning.  Data from the Drug Enforcement Administration (DEA) Automation of Reports and Consolidated Orders System was used to assess methadone distribution (in grams); methadone distributed to opioid treatment programs was not included. 

The analysis showed the rate of methadone distribution increased an average of 25.1% per year during 2002–2006 and then declined 6.5% per year during 2006–2014. Also during 2002–2006, rates of methadone diversion increased 24.3% per year, then at a slower rate during 2006–2009, then at a 12.8% per year decline from 2009–2014. Researchers noted a strong positive correlation between the rate of methadone distribution and the rates of overdose death (P<0.05) and methadone diversion (P<0.05). 

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Deaths from methadone overdose peaked during 2005–2007 for most age groups, racial/ethnic groups, U.S. census regions, and genders; a decline was seen in the years following. The rates of methadone diversion and overdose death within the census regions followed a similar trend as distribution. Specifically, males exhibited consistently higher overdose death rates vs. females during 2002–2014. 

During the study period, people aged 25–54 years experienced the highest overdose death rates. Among people aged 55–64 years, the rate of methadone overdose deaths continued to rise through 2015; for those aged ≥65 years, there was no change. 

The declining rates found in the analysis coincide with various actions issued by the FDA and the DEA to reduce methadone use to treat pain. More clinical and public health policy changes are required to reduce the dangers associated with methadone used for pain, especially among those aged ≥55 years. Insurer strategies and clinical practice guidelines that place parameters on methadone use for pain seem hopeful and warrant further studies.

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