OVERDOSE FINDINGS POINT TO DRUG'S RISK

Methadone poisoning killed six of the eight Portland overdose victims for
whom blood tests are complete, providing the strongest evidence yet that
the medication has contributed to this year's surge in overdose deaths in
Portland.

All six had histories of substance abuse. None was a client of the two
local clinics that distribute methadone to help quell addicts' craving for
heroin, according to data provided by police agencies at the request of the
Portland Press Herald/Maine Sunday Telegram. All six obtained the
methadone, at least indirectly, from someone for whom it was prescribed and
presumably without the warnings that medical staff dispense.

The findings come as Maine is trying to address a major increase in the use
of heroin and other illegal opiates, which is causing a wave of accidental
overdoses and drug arrests statewide. It also comes as one of the two
clinics that operates in Greater Portland, Discovery House, is trying to
open an office in Bangor. It would be that city's second treatment center
and Maine's fifth.

Methadone clinics are designed to address addiction problems by blunting
the craving that users feel. But the clinics also create the potential that
people who are not supposed to have the medication will misuse it.

"While this drug is effective for people under a physician's care, it's a
very potent and dangerous drug to use recreationally," said Kim Johnson,
director of the state Office of Substance Abuse.

On Friday, Johnson met with officials from the Maine Drug Enforcement
Agency to analyze the 23 Portland deaths believed to have been caused by
accidental drug overdoses so far this year. They are looking for clues
about what has caused the sharp rise in accidental overdoses from the 16
Portland experienced during all of 2001.

"Really, of the people that died, the only common factor is they were known
drug users," Johnson said. Authorities suspect methadone is the culprit in
10 cases, but the number cannot be confirmed until toxicology reports are
complete. Those reports can take several weeks to finish.

In the meantime, the Maine Office of Substance Abuse, Portland Police
Department and Portland's Department of Health are trying to understand the
surge in overdose deaths, particularly those related to methadone.
Methadone has not historically been a recreational drug because it does not
produce the high of many other drugs.

The state medical examiner's office is analyzing overdose deaths for the
past five years, looking for trends and trying to determine when the
problem started to spike upward. Yale University researchers are studying
Mainers' illegal drug habits to determine why certain drugs become popular.

Police are investigating the deaths for possible criminal charges and are
working to stem the illegal diversion of methadone, a synthetic narcotic.

"When people accidentally overdose, you have a public health issue where
the availability of these drugs on the street is a concern," said Portland
Deputy Police Chief William Ridge. "When that person's dying, that's of
particular concern to us."

Ridge said the overdose data "speaks to the potency of methadone, and I
think it speaks to the dangers of these very strong medications being
handed out the way they are and then changing hands."

State and city health workers are trying to reduce illicit demand by
developing a public education campaign in conjunction with the clinics and
federal health officials. The goal would be to counteract whatever
misperceptions have made methadone a trendy street drug in the Portland
area. Medical experts from the federal Center for Substance Abuse Treatment
will visit Portland's clinics to explore why efforts to curb illegal
methadone use have failed.

A Yale University study currently under way in Maine could provide some
insight. Researchers are examining how certain drugs come to be popular and
have recently added methadone to the list of drugs being studied, Johnson said.

"Basically, this is a new experience. When I talk with experts across the
country they are kind of astounded with what's happening in Portland,"
Johnson said. "On the list of opiates, methadone is not a good high. It
doesn't have a very strong euphoric effect. It has a pretty strong sedative
effect," Johnson said. "That's the story for why people don't generally
abuse it. It doesn't make you feel very good like the other drugs do."

Methadone is a legal medication designed as a heroin substitute for
addicts, but it also is a powerful narcotic that depresses the respiratory
system in ways similar to heroin. Its sedative effects are magnified
greatly by alcohol and other prescription and illegal drugs.

The high number of confirmed methadone poisonings so far this year comes at
a time when methadone use, both legitimate and illegal, is growing. Greater
Portland's two clinics, Discovery House in South Portland and CAP Quality
Care in Westbrook, serve 925 clients compared to 475 served by one clinic
just over a year ago.

Growth in the legitimate use of methadone has resulted from an increase in
the addict population, officials say. Many of those users may have started
their drug habits with prescription painkillers like oxycodone, Percocet or
Dilaudid - a drug problem that has had a presence in Maine. Growing abuse
of such prescription opiates could help explain the rising demand for
methadone and an increasing incidence of its theft or diversion.

"If we hadn't had growth in opiate abuse in general, we wouldn't have had
growth in methadone treatment," Johnson said. "Because opiates in general
is a popular class of drugs right now and because methadone is in that
category, that's part of why it's getting used more."

Health officials say Portland's fatal overdoses represent about one- third
of the total for the state.

Rhode Island-based Discovery House, which also runs a clinic in Winslow,
wants to open a new clinic for up to 250 patients in Bangor, which would be
that city's second methadone clinic. Acadia Hospital, the city's first
methadone provider, is looking to expand its year-old drug treatment
program from 150 patients to 300.

Abuse of drugs like oxycodone has been a serious problem in Bangor and
surrounding communities, as well as in the state's eastern counties.

Steve Cotreau, program director at CAP Quality Care in Westbrook, said he
believes the growing problem with misuse of methadone by long-term
substance abusers indicates that the region has a serious problem with
addiction, but that those people could not or would not access treatment.

"As much as it is a problem of what they got ahold of, it's 'why are they
seeking it in the first place?' It's just not something that somebody who
isn't addicted or has a substance abuse problem would think of," Cotreau said.

"When we can reach people, we can educate them on the danger of mixing any
opiates with, especially, alcohol and benzodiazepines (a class of
sedatives)," Cotreau said. "The challenge is, for the person who is not in
treatment, how do we get that message out there. If we can educate friends
and family and acquaintances, so they might see something going on if they
know what the dangers are, that might help," he said.

Cotreau supports efforts at educating some people who do not use the
clinics about the dangers of inappropriate methadone use. However, he said
curtailing the ability of clients to take their medicine home would be too
drastic and could aggravate the overdose problem. Despite its dangers,
methadone has helped hundreds of people stay off illegal drugs in Greater
Portland and health officials and providers of the medication say
eliminating clients' ability to take the medication home could lead many to
turn back to street drugs.

"There's no simple fix to this," Cotreau said. "You can say the options are
either close clinics or have people come in daily. Either of those options
is going to put an inordinate number of people back on street drugs and
that's going to lead to more overdose deaths.

"People build lives around those take-home doses. They get jobs. They have
commitments that will no longer allow them to come to the clinic daily. If
we said, 'You have to come back to the clinic daily,' that would in fact be
turning them back onto the street."

Most of the thousand people in treatment at the two Portland-area clinics
are at a point in their treatment where they're starting to live normal
lives and reside in other parts of southern Maine, said Johnson, the state
substance abuse prevention director. "You would be asking people who are
basically like you or me to travel every single day to get a medication."

Federal take-home regulations were relaxed last year to allow long- term
addicts to take home up to 31 days' worth of methadone at a time. State
regulations are being tightened to limit that to two weeks.

An inspection found that Portland-area clinics are following federal
regulation, in terms of screening and monitoring clients, as well as how
they dispense methadone. Still, some drug investigators question whether
the rules regarding take-home doses are sufficient.

"Just because the regulations are being followed doesn't mean the
regulations are correct," said Sgt. Scott Pelletier, Portland-area
supervisor for the Maine Drug Enforcement Agency. "And just because it's a
legal drug doesn't mean it's not creating a problem when it's used illegally."

Public health officials say the methadone problem in Portland centers
around how the clinics are deciding which clients are ready for take- home
doses.

"Take-home doses do make sense for stable people who have their addiction
under control," said Nate Nickerson, Portland director of public health.
"They don't make sense for people whose lives are rocky, who are not
housed, and who are not ready for that kind of responsibility.

"The clinics have to be vigilant and continue to monitor the issues around
the diversion of methadone to people who don't understand how it works and
are taking doses intended for people with much higher tolerance," he said.

People who are prescribed methadone receive extensive guidance about using
the drug and its interaction with other drugs. They must sign a document
that says they agree to keep take-home doses locked and hidden,
particularly from acquaintances with substance abuse problems.

The documents states: "Taking a single dose can easily cause overdose and
death in anyone not physically dependent on methadone, heroin or 'pain
pills.' " Heavily addicted clients might take 180 milligrams of methadone a
day to stave off withdrawal, but just 50 milligrams can kill a person who
does not have a tolerance for the drug.

The clinics have made it more difficult for clients to earn the privilege
of having take-home doses. They now open seven days a week to serve those
people who can't be trusted to manage take-home doses.

Cotreau said an analysis of the overdose deaths could help shed light on
which clients are unable to manage their doses and for what reason.

In some cases, the medicine is diverted to a friend or loved one who is
experiencing withdrawal from his own addiction but has not sought
treatment. In other instances, the medicine is stolen by or sold to other
addicts.

Some city law enforcement and health officials are critical of the
Portland-area clinics because they are for-profit companies that offer no
programs to help clients get off drugs. They are considered methadone
maintenance programs, which means an addict can expect to be on methadone
for the rest of his or her life, they say.

"I don't think health care should be for profit because I think there's an
inherent conflict of interest," said Gerald Cayer, Portland's director of
health and human services. "And I think methadone treatment is health care."

Cotreau bristles at the suggestion that the for-profit clinics try to
promote business.

"I don't want any more patients," said Cotreau, a social worker who said he
made more money managing a restaurant. "It would be like saying there's a
cancer doctor that wants people to get cancer. I would love to close the
doors because there's no need."

Staff Writer Kelley Bouchard contributed to this report.

(SIDEBAR)

Rules, Warnings For Methadone Use

Before methadone clinic clients receive doses of the medicine to take home,
they must agree to abide by certain rules and be aware of the dangers. At
CAP Quality Care in Westbrook, the rules and warnings include the following:

Methadone should be secured in a locked box at all times; the box should be
hidden even in the home and nobody else should know where it is kept.

Selling or giving away your methadone will result in termination from
treatment, and you will face legal charges.

Methadone in the wrong hands can result in death.

Methadone, mixed with alcohol, or any other drugs, is a dangerous
combination and could lead to death.

Never assume that a verbal warning is enough to discourage someone from
taking your methadone.