Methadone-Associated Mortality:
Report of a National Assessment

Part 3. Deliberations

As part of the National Assessment, SAMHSA commissioned a Background Briefing Report containing research data and other information to help establish a common understanding of the problem. This briefing report was distributed to participants in advance of the May meeting and is available on SAMHSA's web site (http://www.samhsa.gov).

Opening the meeting, CSAT Director H. Westley Clark, MD, JD, MPH, CAS, FASAM, reaffirmed SAMHSA's concerns about methadone-associated mortality and the importance of a response to the problem. He noted that, if OTPs or their clinical practices were responsible for any part of the increase in methadone-associated mortality, SAMHSA, as the Federal agency that regulates such programs, would work actively to rectify the problem. If, on the other hand, OTPs were not a significant source of methadone in overdose cases, that finding should be documented and communicated widely.

Next, SAMHSA's Alan Trachtenberg, MD, MPH, described the policy context surrounding reports of opioid-associated deaths, particularly fatalities involving methadone. Dr. Trachtenberg defined the meeting's objectives as:

Determining whether OTPs' use of methadone in the treatment of opioid addiction and the revised Federal regulations governing the manner in which OTPs administer methadone could be contributing to methadone-associated mortality;

Assessing the need for improved nationwide surveillance of opioid-associated deaths, particularly methadone-associated mortality;

Assessing the adequacy of case definitions used by coroners and medical examiners (MEs) in the attribution of opioids' specific role in drug-associated deaths; and

Recommending preventive measures for implementation by health care professionals and educators, regulators, and law enforcement agencies at all levels of government.

Dr. Trachtenberg's remarks were followed by participants' presentations of the epidemiologic data; problems involved in surveillance; definitions and patterns of opioid misuse, abuse and addiction; and case definitions of methadone-related fatalities. (Summaries of the presentations and slide handouts are found online at http://www.samhsa.gov.)

Each day's presentations were followed by action planning sessions that focused on specific questions. Based on their review of background information, speaker presentations, and the action planning sessions, meeting participants reached consensus on a set of findings and recommendations.