Drug overdose is a leading cause of injury death in the United States; 47,055 
fatal drug overdoses were reported in 2014, a 6.5% increase from the previous 
year (1), driven by opioid use disorder (2,3). Methadone is an opioid prescribed 
for pain management and is also provided through opioid treatment programs to 
treat opioid use disorders. Because methadone might remain in a person's system 
long after the pain-relieving benefits have been exhausted, it can cause slow or 
shallow breathing and dangerous changes in heartbeat that might not be perceived 
by the patient (4,5). In December 2006, the Food and Drug Administration issued 
a Public Health Advisory that alerted health care professionals to reports of 
death and life-threatening adverse events, such as respiratory depression and 
cardiac arrhythmias, in patients receiving methadone (4); in January 2008, a 
voluntary manufacturer restriction limited distribution of the 40 mg formulation 
of methadone.* CDC analyzed state mortality and health care data and preferred 
drug list (PDL) policies to 1) compare the percentage of deaths involving 
methadone with the rate of prescribing methadone for pain, 2) characterize 
variation in methadone prescribing among payers and states, and 3) assess 
whether an association existed between state Medicaid reimbursement PDL policies 
and methadone overdose rates. The analyses found that, from 2007 to 2014, large 
declines in methadone-related overdose deaths occurred. Prescriptions for 
methadone accounted for 0.85% of all opioid prescriptions for pain in the 
commercially insured population and 1.1% in the Medicaid population. In 
addition, an association was observed between Medicaid PDLs requiring prior 
authorization for methadone and lower rates of methadone overdose among Medicaid 
enrollees. PDL policies requiring prior authorization might help to reduce the 
number of methadone overdoses.