Methadone Treatment Facilities

$27,000 FINE FOLLOWS PROBE IN CLINIC DEATHS

Charlotte Company Calls Accusations Untrue, Raps Inquiry

N.C. regulators probing the deaths of at least 13 patients in a
Charlotte company's methadone clinics have fined the firm $27,000 for
violations of safety-and-treatment rules.

A state report detailing the allegations specifically mentions the
deaths of two people who received methadone at a Statesville clinic
run by McLeod Addictive Disease Center, a nonprofit based in
Charlotte. The report says McLeod didn't follow precautions that
might have prevented the deaths, and then failed to report the
fatalities to a state agency as required. The fines were among the
heaviest of more than 200 imposed this year by the N.C. Division of
Health Service, which oversees facilities ranging from methadone
clinics to group homes for mentally ill children. Methadone clinics
administer the drug to those recovering from addictions to heroin,
and increasingly, to powerful painkillers.

McLeod President Eugene Hall on Wednesday called the accusations
untrue, and accused investigators of being ill-informed about how his
clinics work. He said none of McLeod's seven other clinics were fined
even though they operate under the same rules and management as the
Statesville office. He said he will appeal. "This is just terribly
frustrating and angering to me." The fines stem from the state
agency's investigation of at least 16 McLeod patient deaths in just
over a year. Officials list two probable causes: methadone toxicity,
and a lethal combination of methadone and other drugs. State
officials declined to comment Wednesday, saying they are wrapping up
their inquiry and wouldn't speak about their findings until complete.
They have said they began the investigation because of recent federal
advisories about the dangers of methadone.

They also have said they are checking for deaths in the 27 other
methadone programs around the state, but it's unclear whether any of
those face the intensive reviews given McLeod.

Regulators probed the Statesville clinic in October. Their report
zeroes in on the October 2006 death of a 28-year-old man. He died of
acute methadone and oxycodone toxicity, plus an abnormal build-up of
fluid in the lungs caused by heart failure.

Oxycodone, sometimes marketed under the better-known name of
OxyContin, is a powerful painkiller; methadone is sometimes used to
wean people off oxycodone addictions.

An autopsy report also showed that the man had ingested
benzodiazepines -- sedatives doctors warn methadone patients against
taking. The mixture can send patients into a sleep so deep that they
stop breathing and die. Still, patients combine the drugs for the
euphoric high they can't get from methadone. According to the state
report, the 28-year-old tested positive at least three times for the
sedatives after he began treatment.

'I Wanna Go Up'

The state report also accuses McLeod of improperly increasing the
man's methadone dosage more quickly than a doctor recommended. The
report quotes the man's sister as telling the state: "They give you
such high doses, it just puts them to sleep."The dead man's father,
who was also being treated at the clinic, told the state if a patient
wanted a higher dosage, "all you had to do was stand at the window
and say, 'I wanna go up.' They never asked you nothing."

The clinic's medical director told investigators the man's death
prompted policy changes at McLeod in April. The clinic began using a
more immediate test for benzodiazepines. It allowed doctors to keep
prospective patients out of the program until they gave up the
sedatives. Other changes included new limits on dosage increases and
upgraded patient-education sheets warning about the dangers of mixing
drugs. But the state report said the changes weren't enacted in time
to save a 53-year-old woman who died in April, nine days after
starting treatment. The state report says her counselor's notes did
not contain required documentation about the risks of methadone.

She had a history of depression, and was taking Prozac and fentanyl,
a painkiller.

State rules required McLeod to report the deaths to the Division of
Health Service Regulation within 72 hours.

Investigation criticized Hall said regulators at the N.C. Division of
Mental Health told him to send the reports to them. An official with
that agency even praised the thoroughness of McLeod's reporting, he added.

When officials at mental health failed to send the reports on to
their sister agency, they stacked up on one official's desk, he said.
Some were even misplaced, he said, requiring McLeod to re-send
copies. He accused regulators of using criteria not normally applied
to methadone clinics. "If these standards were to apply," he said,
"there's no (methadone) program in North Carolina that can operate."