OVERDOSE DEATHS SPUR METHADONE WARNING

Many doctors prescribe methadone to avoid the high caused by other
painkillers, but the drug has its own risks. The U.S. Food and Drug
Administration issued a strong advisory this week for methadone, a
commonly prescribed pain medicine, warning patients and doctors that
the drug can kill.

The alert was provoked by reports of overdose deaths among patients
who took the medicine to combat chronic pain, the FDA release said.

In some patients, particularly new users or those switching from
another narcotic pain medicine, methadone can slow breathing to a
stop. The FDA warned that it also can cause dangerous changes in heartbeat.

Methadone, invented in Germany in the 1930s, was used mostly over the
past 50 years as a safe, effective way to wean addicts off heroin. In
the 1990s, many doctors turned to this standby painkiller after
recognizing the dangerous high that its narcotic cousin OxyContin was
causing. Doctors say it was a superior alternative: cheap and not
likely to cause a high as other narcotic painkillers do.

But the FDA warns that methadone is tricky. Patients suffering from
acute pain might be inclined to pop another pill while the medication
is still in their system, creating a toxic buildup, researchers say.

"This really gives physicians the opportunity to recognize how
important their role is," said Kay Sanford, an epidemiologist with
the state Division of Public Health who has studied the sharp spike
in methadone overdoses in North Carolina. "I don't think there's been
recognition among physicians of their role in the increase of
methadone-related deaths."

Problem surfaces

Public health officials discovered the problem with methadone in 2002
when they noticed a spike in accidental overdoses. From 2000 through
2004, methadone caused or contributed to the deaths of 817 North Carolinians.

A News & Observer analysis in March found that methadone was
particularly deadly among teens. It accounted for three-quarters of
all accidental overdoses in teens from 2002 through 2004.

In most of these deadly cases, methadone got into the hands of
someone who hadn't been screened by a doctor. Methadone, like many
pain pills, is swapped or sold on the black market or handed out by
legitimate users to someone in pain.

The FDA also drafted a patient information sheet to accompany
methadone prescriptions. It, too, warns patients of the deadly side
effects and urges them to guard their pill bottles.

Other drugs risky too

Some doctors who treat chronic pain fear that methadone is being
singled out unfairly, which could have a chilling effect on doctors
willing to help these patients. They also worry that the added
scrutiny of methadone will cause doctors to switch to other narcotics
with a host of other potential harms.

"Methadone shouldn't be demonized in isolation," said Paul
Chelminski, a UNC-Chapel Hill internist who treats patients for
chronic pain and teaches other doctors how to carefully monitor
narcotic pain medicines. "It's just the most conspicuous canary in
the coal mine right now."