METHADONE DEATHS INCREASE AS ITS USE AS PAINKILLER GROWS

Drug Used to Treat Addiction Relieves Pain in High Doses

Methadone, long prescribed as an alternative to heroin, is proving to
be a hazard of its own.

As a treatment for addiction, methadone is considered an effective
tool. But as its use as a low-cost pain reliever becomes more
widespread, a growing number of people are dying from methadone
overdoses. Methadone contributed to 299 fatal overdoses in the state
in 2005, the latest year with national data available. The number of
such deaths has more than quintupled from 47 in 1999.

A state report indicates that from 1997 to 2001, at least a third of
North Carolina victims had been prescribed methadone for pain relief.
Now, North Carolina is tied with Oregon in having the seventh-highest
rate of fatal methadone-related overdoses, according to figures from
the National Center for Health Statistics. In 2005, North Carolina had
about twice the national rate of such overdoses.

"The problem is so huge, you don't know where to begin," said Mary
Haynes, a substance abuse counselor in Western North Carolina.
Commonly used as a treatment for addiction, especially to heroin,
methadone is increasingly prescribed in pill form as a pain
medication, leading to an uptick in accidental overdoses. One danger
is that methadone remains in the body long after its painkilling
effects wear off. As a result, even legal prescriptions can turn fatal
when doses accumulate over time into overdoses. That phenomenon may
have contributed to the death of a Winston-Salem woman. Jewel
Imperial, 25, a student and musician, overdosed in September 2007. Her
father, Bobby Imperial, said she died five days after being prescribed
up to 80 milligrams per day for back pain. He declined to identify her
doctor because the family is pursuing legal action.

Imperial's dosage was more than double the recommended maximum for
patients new to opioids, the family of drugs that includes methadone.
Her parents didn't know she had been prescribed methadone then. But a
few days after she started the prescription, her mother, Nancy
Imperial, took her back to the same doctor. Her symptoms were
disorientation, aches, sweats, cough and, sometimes, a spacey feeling,
her father wrote. She died the next day.

Little room for error Methadone is a tricky medicine. In addition to
its tendency to linger and accumulate in the body, it offers pain
relief in a dosage that is very close to the amount that can be toxic.

Patients sometimes increase their dosage to kill their pain. A toxic
buildup of the drug can lead to heartbeat and breathing problems.
Still, many pain specialists value methadone for severe, chronic pain
patients. One of its selling points is its low price, compared with
similar pain relievers. A month's supply can cost about a tenth as
much as generic morphine. Methadone's use as a painkiller has shot up
as the country has become more medicated and as physicians have become
more attentive to patients' pain. From 1997 to 2006, annual retail
methadone distribution in North Carolina grew from 25 kilograms to 264
kilograms.

But many professionals administering methadone for pain "remain
largely unaware of the need for extraordinary safety measures," wrote
Dr. Lynn Webster of Lifetree Pain Clinic in Salt Lake City on the Web
site Pain Treatment Topics. For example, prescribers might give too
high a dose or increase the amount too quickly, he wrote. Webster,
co-founder of a campaign against overdoses, treats chronic pain as
well as opioid addiction. New methadone patients often need a small
dose, supplemented by another pain killer, Webster said in a phone
interview. The combination of medications allows effective pain
treatment while getting the patient accustomed to methadone. Legal and
illegal use Victims of prescription drug deaths tend to be older and
white. In the period from 2001 to 2005, more than half of methadone
victims in the state were 35 through 54.

Some die after getting legitimate prescriptions to control their pain,
while others get the drug on the streets. Haynes, the drug counselor,
said she became a methadone activist after her son, Jamie Pethel,
overdosed in September 2006 on illicit methadone, with the
anti-anxiety drug alprazolam contributing.

She said the chief toxicologist explained to her that her son "forgot
to breathe." Pethel, 23, had planned to go camping, "where he was
going to try to get his life together and to be closer to his job as a
landscaper," his mother wrote on a memorial Web page.

But Pethel got sidetracked by a problem with his truck. He went to his
father's home and overdosed.

"They think he had been out of it for many hours" before anyone
realized he was dead, his mother wrote.

Overdoses of methadone and other prescription drugs are gradually
drawing more attention and more action.

The Drug Enforcement Agency and manufacturers early this year
restricted distribution of 40-milligram tablets to hospitals and
facilities authorized to treat addictions.

And in July 2007, North Carolina started a controlled substances
reporting system to help doctors and pharmacists prevent patients from
doctor-shopping, or getting multiple prescriptions from different
doctors. Pharmacies enter information about prescriptions filled for
certain controlled substances into a confidential database that can be
accessed by other druggists and doctors. Then, for example, physicians
can check on patients to see whether they are getting prescriptions
that they hadn't told the doctor about. If so, the doctor can counsel
the patient or change the prescription.

"It is very easy to divert medications in North Carolina," said Sgt.
Steve Fredrickson, a drug diversion agent with the Buncombe County
Anti-Crime Task Force. Officials and family members say more should be
done. To prevent overdoses from legitimate uses, "The onus is on the
physician," said Catherine "Kay" Sanford, a former North Carolina
state epidemiologist who retired in 2007.

Doctors need to ensure that they are prescribing properly and that
patients know how to use methadone, she said.

In addition to educating doctors and patients, Sanford and others also
advocate prescribing an antidote along with methadone. An antidote
program called "Project Lazarus" is being planned for testing in
Wilkes County, which has one of the state's higher rates of accidental
opioid deaths. Qualified opioid users would receive training and a kit
with a nasal version of the antidote, naloxone, which restores
breathing. Similar programs already operate in Chicago, Baltimore and
several other areas nationwide. But Sanford says Project Lazarus will
break new ground a few ways. For example, it will be the first to
focus on prescription opioids. For Jewel Imperial's father, Bobby
Imperial, the move is too late. He will never know whether the
antidote would have saved his daughter: "She was taking her last
breath when I got to her."

[Sidebar]

In North Carolina, less than 5 percent of those who died
from accidental methadone overdoses from 1997 through 2001 were
identified as current or former patients at clinics that use methadone
to treat drug addiction. But some families of victims perceive the
clinics as a larger threat. Last year, the state linked fatalities to
a Statesville clinic, one of eight operated by McLeod Addictive
Disease Center, a nonprofit organization based in Charlotte. McLeod
was fined $27,000, and the state said McLeod did not properly report
the deaths of several clients.

The state report also indicated that one client who died was
improperly dosed. For a few days, the client's methadone was increased
daily instead of every other day.

McLeod's president, Eugene Hall, declined to comment. The company is
appealing the findings.

In a November story in the Charlotte Observer, Hall criticized the
state's investigation. He said he had been told to send death reports
to the N.C. Division of Mental Health, and that an official there had
noted the thoroughness of McLeod's reporting.

One man who died after seeking help at a clinic was Jason Huffman, 23.
A pain pill addict, he told his mother, Pam Osborn of Conover, that he
wanted to break his addiction and improve his life.

He told his mother: "Mama, I'm so sick of how I've been living,"
Osborn recalled. "It was like he was growing up finally."

Huffman overdosed on cocaine and methadone after starting treatment at
a McLeod clinic in April 2007, Osborn said.

"They did not monitor him," she said. While on the methadone, "He kept
telling me, 'Mama, I'm so tired,' " Osborn said in an interview.

Two days after starting treatment, he was sluggish and dropping
cigarettes, his mother said. Two days after that, he died.

He was staying with friends. "The last time they saw him, he was
baking biscuits" at 3 a.m., Osborn said. Huffman was found dead about
seven hours later.

A year after his death, his mother's living room was alive with plants
- -- plants from his funeral.

Overdose More Common in Western N.C.

The highest rates of methadone
overdoses are clustered in a few areas, especially the
Appalachians.

Methadone death rates in North Carolina generally climb from east to
west. The state's three worst counties for fatal accidental overdoses
in general -- Yancey, Mitchell and Cherokee -- are all on the
Tennessee state line, according to a report by former state
epidemiologist Catherine "Kay" Sanford. Fatal accidental overdoses in
general have a higher rate in rural North Carolina counties and have
been growing faster in rural states. Authorities aren't sure of the
causes for the geographic variations.