Eleven years after the Food and Drug Administration put a black-box warning on methadone as a pain medicine, three states still list it as a Medicaid "preferred" drug for pain. That's according to a new study by the Pew Charitable Trusts, which checked states' Medicaid policies as of December of 2016, in addition to a more recent search conducted by Pacific Standard. Such a listing contradicts medical recommendations and leaves Medicaid patients disproportionately likely to be prescribed a pain medicine that's especially risky, even compared to other opioids. In 2014, more than one in five fatal opioid painkiller overdoses involved methadone, even though methadone constituted just 1 percent of opioid painkiller prescriptions, according to the Centers for Disease Control and Prevention.
Colorado, Rhode Island, and Georgia haven't taken methadone off their Medicaid preferred drug lists. States use these lists to steer doctors toward cheaper and more effective medicines for Medicaid patients. In this case, however, pain experts want to see doctors discouraged from relying on methadone as a first choice for treating aches. (Methadone is also used to help people who are trying to overcome a heroin or prescription painkiller addiction, but that isn't as controversial among experts.)
In addition, the new Pew study found that Medicaid patients, especially those in managed-care systems, are still prescribed methadone for pain at higher rates than Americans with private insurance or Medicare. That means some of America's poorest people, many of whom depend on Medicaid, are more likely to get this riskier painkiller.
The study's author, Pew analyst Cynthia Reilly, wasn't able to discern in her data why Medicaid patients are prescribed methadone more often than other Americans. It might be that these folks tend to have complicated pain that didn't respond to safer alternatives, such as long-acting morphine or oxycodone. Prescriber guidelines suggest methadone might be a good choice in those situations.
An older Pew report, published in 2015, found that the majority of states had methadone on their Medicaid preferred drug lists, mostly because it's so much cheaper than other prescription painkillers. In 2011, a Seattle Times investigation found that Washington state officials ignored warnings of methadone's dangers.
That's not to say there hasn't been any progress. Between 2013 and 2016, there's been an estimated 26 percent drop in methadone prescriptions for pain in America, Reilly found in her more recent work. At the same time, prescriptions for comparable painkillers fell 18 percent. And since 2015, more than a dozen states have dropped methadone from their preferred drug lists; some states were perhaps motivated by a memo issued by the Centers for Medicare and Medicaid Services, sent out in January of 2016, urging states to do so.
Reilly is optimistic about her findings. "It's great news in terms of patient safety," she says.