METHADONE EMERGES AS NEW KILLER

Patients, Addicts Mix Opiate With Other Drugs, With Potentially Lethal Results

Methadone, a potent opiate once used almost exclusively to treat
heroin addicts, is increasingly being prescribed by doctors as a pain
medication and abused by drug users searching for a cheap, easy way
to get high, physicians and federal drug officials say.

The drug, which comes in pill or liquid form, recently has come under
scrutiny in the death of former Playboy model Anna Nicole Smith. A
doctor in Studio City prescribed methadone to Smith for pain
treatment before she was found dead Feb. 8 in her Hollywood, Fla., hotel suite.

A coroner has yet to determine her cause of death, and the doctor
said his treatment was "medically sound and appropriate."

Months earlier, Smith's 20-year-old son died in the Bahamas after
taking a lethal mixture of methadone and two antidepressants, Zoloft
and Lexapro.

Well before these deaths, however, drug counselors and clinicians
were concerned about increased abuse of the drug on the streets, in
group homes and even in middle schools.

It is an ironic turn in the history of methadone, which for years has
been used to treat heroin addiction.

A synthetic opiate, methadone is similar to heroin in chemistry,
curbing a user's craving for the illegal opiate by blocking the
sensors that heroin stimulates without producing a heroin high.

In recent years, methadone has proved lethal to a growing number of
patients or addicts who use it in conjunction with prescription drugs
including Valium, Xanax or, in the case of addicts, illegal narcotics
such as cocaine.

Sometimes users swallow methadone before or after they "puff," when
they seek to get high by slowly inhaling the chemicals from an aerosol can.

"Every year, we see hundreds of these deaths, and the numbers
continue to increase," said Bruce Goldberger, director of toxicology
at the University of Florida, who has been at the forefront of
tracking methadone-related deaths. "It is absolutely the
fastest-growing drug problem."

A federal government study found that nationwide methadone-related
deaths climbed to more than 3,800 in 2004 from about 780 in 1999.
Among all narcotic-related deaths in 2004, only cocaine killed more
people in the United States than methadone.

Physicians and others point out that methadone's potential for abuse
isn't as high as that of opiates like heroin because it does not
induce a strong euphoria on its own.

But repeated use can still cause a physical dependence, doctors say,
and when users stop taking it, withdrawal-like symptoms can occur.

Given its low cost compared with heroin and other drugs, its recent
proliferation and its potentially lethal potency when mixed with
other drugs, officials worry that methadone is largely evading the
scrutiny applied to other abused prescription medications, such as
OxyContin and Vicodin.

The drug can be lethal even when mixed with antidepressants, or
grapefruit juice, experts and federal drug authorities say.

Methadone can linger in body tissue for an unusually long time -- 24
to 59 hours in some cases. Sometimes users assume it has worn off,
then take other drugs or more methadone, leading to respiratory
depression, coma and eventual death.

Methadone is available at clinics that prescribe it to treat heroin
addiction, from doctors who can prescribe it for pain or to treat
addictions and, increasingly, as a street drug.

The clinics face stringent federal and state regulations as to how
much methadone they can administer to patients, but physicians don't
go beyond a general rule that says they can't prescribe more than a
30-day supply, said Mark Parrino, president of the American Assn. for
the Treatment of Opioid Dependence.

In Southern California, parts of downtown, East and South Los Angeles
have emerged as places to buy and sell methadone, said Kalante
Holmes, a counselor at a methadone clinic in West Los Angeles. "It's
one of those easy-to-get things right now," he said.

It's the "easy-to-get" nature of the drug that has led to the recent
spike in methadone deaths, experts and government officials say.

As the study of pain has grown over the last five to 10 years, more
physicians are prescribing methadone to patients to treat pain,
especially chronic and nerve pain.

The Food and Drug Administration issued a warning in November to all
physicians saying that misuse of the drug could lead to breathing
problems and possible death.

Patients might prefer methadone to other painkillers because not only
is it powerful, but it's also less expensive.

For example, a pharmacy can buy a month's supply of methadone for one
patient for as little as $8, whereas it would have to pay more than
$170 for a similar amount of OxyContin, according to wholesale
pharmaceutical price books.

As the availability of the drug increases, so does abuse and misuse
of it, experts and drug officials say. Problems usually don't arise
from physicians who specialize in pain treatment and know how to
safely prescribe and monitor methadone use, but from general and
family practice physicians who may prescribe the drug more often than
they should.

"My hunch is that some of what we're seeing with the current problems
are the administration of [methadone] by physicians who don't
understand how powerful it is to a patient population who might not
necessarily need it," said Richard Rawson, an associate director of
Integrated Substance Abuse Programs at UCLA.

Data compiled by the federal government show a steady increase in the
number of people nationwide admitted to clinics and programs for
methadone treatment, from about 1,000 in 1995 to more than 3,700 in 2005.

"This is an emerging problem," said Bertha Madras of the White House
Office of National Drug Control Policy.

It's been a persistent problem for people like Sean, 20, a resident
of West Los Angeles and a former heroin addict.

Sean, who asked that only his first name be used because of the
stigma associated with drug abuse, carved a steady path to heroin use
at a young age. He tried marijuana when he was 11, cocaine at 14 and
heroin at 17.

When he was 19, living in a downtown L.A. apartment and experiencing
heroin withdrawals, he tried methadone.

Mostly, he said, he used it to satiate his desire for heroin. At
least once he took it with Klonopin, a muscle relaxant.

"I don't want to say the feeling was similar to alcohol," said Sean,
who is in drug treatment and was interviewed in the presence of his
counselor. "But that's sort of what it was like. Your body feels relaxed."

Though he said he had not used methadone lately because he'd heard it
had been responsible for a rash of deaths, Sean said he could easily
get it on the street.

Recently, on a bus in Santa Monica, he was approached by a methadone
pusher who offered him a deal: one pill for $45 or two for $60, he said.

Sean said he declined. But he knows it won't be so easy for others.

"The fact of the matter is, if you're a drug addict and you don't
want treatment, you're going to go try to get high off something," he
said. "You're broke, you can't afford heroin, so you go get methadone."