METHADONE ABUSE HITS STATE HARD

345 Deaths In 17 Months Tied To Drug

Methadone Has Become Kentucky's Deadly Drug Of Choice, Investigators And
Many Coroners Say.

More than 340 Kentuckians have died from overdoses related to the synthetic
narcotic since January 2003, according to a survey by The Courier-Journal.

A top Eastern Kentucky drug investigator said methadone is replacing
OxyContin as the region's most abused prescription drug.

Methadone, invented in Germany during World War II as a substitute for
morphine and used now as a painkiller and to treat heroin addiction, has
found new popularity because of tighter controls on OxyContin, authorities
said.

"Most of your big pain treatment centers and doctors quit prescribing as
much OxyContin and started prescribing methadone," said Dan Smoot, a former
state police detective who is head of law enforcement for the federally
funded anti-drug task force Operation UNITE in Hazard.

No county in Eastern Kentucky has been hit harder than Breathitt,
population 16,000. Since January 2003, 40 people have died from a
combination of methadone and either alcohol, another painkiller or a
tranquilizer, according to Bobby Thorpe, the county coroner.

In Jefferson County, 34 people have died from methadone-related overdoses
in the past 16 months, by far the most of any drug, Chief Deputy Coroner
Mark Handy said.

On average, Kentucky has about 400 overdose deaths annually from all drugs,
said Tracy Corey, the state's medical examiner.

No agency keeps a statewide total of methadone-related deaths, but The
Courier-Journal called coroners or deputy coroners in all 120 counties. As
of Friday, 80 from all parts of the state had responded, reporting a total
of 345 deaths linked to the drug since January 2003. Those counties
represent about 75 percent of Kentucky's population.

Some coroners who responded to the survey, which began the last week in
April, said their methadone figures were estimates rather than precise counts.

Asked about the results of the survey, Lt. Gov. Steve Pence, who also is
the state's justice secretary, said, "It disturbs me."

In an interview Friday, Pence discussed the possibility of creating a
"central depository on drug overdose deaths" to track whether certain areas
are having abuse epidemics.

A team of 50 state, local and federal officials is compiling a report on
Kentucky's substance-abuse issues, and Pence said the report will go to
Gov. Ernie Fletcher on June 20.

Overdose victims

The survey of coroners showed that many victims have died from combining
methadone with sedatives.

Bonnie Honaker, who lives in the Lost Creek community of Perry County, lost
her sister to a lethal mixture of methadone and what her family described
as nerve pills.

On the day after Christmas last year, 41-year old Jackie Melson, a mother
of six, died in her Breathitt County home in Flintville, one of 10 county
residents who died that month from a methadone-related overdose, according
to Thorpe, the coroner.

Honaker said she knew that her sister occasionally abused drugs but that
she was on the verge of getting her life back in order. She said Melson
recently had moved from Columbia, Ky., to be closer to her parents and had
told her family that the move marked a new start.

"She always called me and said, `I'm tryin' to straighten my life up,'"
said Melson's 23-year-old daughter, Jennifer York, who lives in
Cartersville, Ga. "I think she was real close to doing that when she died."

Dean Craft, a Kentucky State Police detective in Hazard, said an
investigation into Melson's death is still open.

In 2001, Kentucky physicians wrote more than 150,000 prescriptions for
OxyContin, but that dropped to 130,000 in 2003, according to the Cabinet
for Health Services. Meanwhile, the number of methadone prescriptions
increased by about 340,000, to nearly 2.7million, during that time.

Authorities seized more methadone than any other drug during a series of
investigations earlier this year that led to warrants for the arrest of
more than 200 street-level drug traffickers in the region, Smoot said.

Abusers, who span a wide range of ages, often crush and snort methadone
with other drugs, or dissolve them in liquid and inject them. The
combination can produce a lethal high by leading to respiratory failure or
a heart attack, coroners said.

With a prescription, 90 tablets of methadone are available for about $40 at
a pharmacy, Smoot said, and one methadone tablet on the street sells for
around $12. Methadone wafers - large sheets of the drug used at, and
sometimes stolen from, methadone clinics - sell for $50 on the street.

`Deadly cocktail'

Karen Engle, executive director of Operation UNITE, referred to methadone
and certain sedatives as a "deadly cocktail."

Thorpe, the Breathitt County coroner who has a locker full of methadone
pills taken from overdose scenes, said most of the deaths there were
attributed to methadone tablets prescribed by doctors and either given to
the victims or trafficked on the street.

The increase in methadone prescriptions and deaths related to the drug come
at a time when OxyContin has become less available, partly because of
publicity about the abuse epidemic that included the conviction of at least
seven Eastern Kentucky doctors for overprescribing the powerful painkiller.

But the methadone-related deaths have received little of the fanfare
associated with Oxyfest, a 2001 operation that led to the arrest of 207
drug dealers. In announcing Oxyfest in February 2001, authorities said
OxyContin had killed 59 Kentuckians in the previous year.

Some coroners pointed out that OxyContin abuse is still a problem. Lawrence
County Coroner Mike Wilson said six people in his county have died of
OxyContin-related overdoses in the past 16 months, but the county has had
only one methadone-related death in that time.

Last month, officials announced the largest drug crackdown in the state.
Smoot said about half of more than 200 arrests involving eight Eastern
Kentucky counties were for possession or trafficking of methadone.

Medical fallout

Elsewhere, a Louisville doctor had his medical license suspended last year
after 10 patients in his care died from methadone overdoses, said Handy,
the chief deputy coroner.

The doctor, David Thurman, has since had his license restored by the
Kentucky Board of Medical Licensure, but he is prohibited from prescribing
controlled substances pending a full hearing scheduled for later this month.

Thurman also is under state investigation stemming from the patient deaths,
said Alex Dathorne, an assistant commonwealth's attorney in Jefferson County.

Thurman declined to comment, but his attorney, J. Fox DeMoisey, said the
case is a good example of how doctors are made scapegoats when patients in
their care overdose.

"The simple fact is that methadone in prescribed dosages should not have
this effect," DeMoisey said. "When a physician gives medicine and says you
should take it in a certain way and a patient doesn't listen, how does a
doctor bear responsibility?"

Grady Stumbo, a Hindman physician and former chairman of the Professional
Activities Committee at ARH Hazard Regional Medical Center, said doctors
need to recognize when patients seek prescriptions for illegitimate purposes.

"We're part of the problem because we're making too many of these drugs
available," Stumbo said. "But we're part of the solution, too, if we take a
greater stand and speak out and keep that from happening."

Some prosecutors hope that methadone cases lead to criminal charges against
doctors and other people who knowingly give someone a fatal combination.

"If we start bringing charges for murder, it'll scare the hell out of
people," said Perry Commonwealth's Attorney John Hansen.

Some pharmacies, meanwhile, are watching how many methadone prescriptions
they fill, and in what doses.

Brenda Turner, a Breathitt County pharmacist, said her pharmacy plans to
stop stocking 10-milligram methadone tablets starting in June in response
to the high number of deaths.

Rural areas hit hard

Other Appalachian states also have seen an increase in methadone-related
deaths.

Dr. William Massello III, Virginia's assistant chief medical examiner in
Roanoke, said 85 methadone-related overdose deaths were reported last year
in southwestern Virginia, an area with around 1.5 million people.

"Methadone is a very deadly drug," Massello said. "And this seems to be
happening in many rural areas in America."

A report released in March by the federal Substance Abuse and Mental Health
Services Administration said that nationwide, most methadone-related deaths
are a result of diverted pharmaceuticals and not from methadone taken at or
from treatment centers.

Mac Bell, the state narcotic authority commissioner at the Cabinet for
Health Services, said strict regulation and monitoring of Kentucky's
methadone clinics indicates that drug abusers are getting methadone elsewhere.

"From the reports I'm getting from the field, the methadone is not coming
from our clinics," Bell said. "It's coming from pain management clinics."

Methadone clinics dispense the drug in liquid form on site, and clients are
permitted to take home doses only after showing an ability to remain clean.

Of Kentucky's 12 methadone facilities, 10 are private clinics and two are
publicly funded, Bell said.

But the number of Kentuckians receiving methadone treatment for opiate
addiction has increased from 200 in 1995 to more than 1,500 this year, Bell
said.

In Breathitt County, only one of the 40 people who died from a
methadone-related overdose in the past 16 months was a client at a
methadone clinic, Thorpe said.