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To the Editor: A study by Dr Hall and colleagues¹ of overdose fatalities in West Virginia in 2006 found that, relative to the amount of medication distributed, methadone was implicated far more frequently than oxycodone or hydrocodone (47.2, 3.9, and 3.0 deaths per 1000 g, respectively). One possible explanation offered was that "methadone is for unknown reasons favored by drug diverters. . . . " This seems improbable given the very slow onset of action of methadone; drugs whose peak effectiveness occurs hours after ingestion are not popular among those seeking a high.

The authors also observed that methadone may be riskier to users than other opioids. One reason for this could be the package insert, which until November 2006 recommended a "usual adult dosage" of 2.5 to 10 mg every 3 to 4 hours for pain, stating that "occasionally, it may be necessary to exceed the usual dosage recommended. . . . "² However, Food and Drug . . . [Full Text of this Article]

Robert Newman, MD, MPH
rnewman@icaat.org
Baron Edmond de Rothschild Chemical Dependency Institute
Beth Israel Medical Center
New York, New York

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