METHADONE DEATHS SURGE ACROSS STATE

Popular Painkiller Florida's Second Most-Lethal Drug

MANATEE - Methadone, a drug long employed to treat drug addiction and
increasingly prescribed to treat chronic pain, is now one of the most
lethal narcotics in Florida.

The Florida Medical Examiners Commission recently reported methadone
is second only to cocaine in drug-related deaths in the state.

"There is a certain undercurrent belief that because methadone is
used to treat heroin addiction, you can take it with less concern and
don't have to worry too much about it," said Dr. Russell Vega, the
chief medical examiner for District 12 that covers Manatee, Sarasota
and DeSoto counties.

The number of methadone-related deaths has risen in recent years, but
not because of methadone's role as a drug addiction treatment.
Instead, experts said, the deaths are linked to the fact that
methadone has become a popular prescription for chronic pain and is
sometimes abused or misused.

Doctors who prescribe methadone call it an effective medication, but
doctors also say that methadone may be spiraling down the infamous
route of other prescription painkillers such as OxyContin.

"In general, people are abusing pain medications rather than taking
appropriate dosage," Vega said.

Recently released statistics by the Florida Medical Examiners
Commission chart a morbid trend: Methadone caused the most
drug-related deaths in the state after cocaine in 2005.

The presence of methadone in the bodies autopsied in Florida last
year increased by 10 percent from 2004, and deaths caused by
methadone rose by 11.5 percent from 2004 to 2005, according to the report.

In District 12 there were 49 methadone-related deaths in 2005 - the
number has grown steadily since 2001, when there were 11
methadone-related deaths.

The trend seems to mirror a nationwide problem.

"The deaths are occurring not because clients are getting it through
substitute opiates . . . (that's) largely controlled," said Bill
Janes, director of the Governor's Office of Drug Control. "It's the
abuse of prescription painkillers. The steady increase in those
years, and the substantial increase in 2003 and 2004, was certainly alarming."

Bad reps

The notoriety of the abuse of painkillers such as Oxycodone in recent
years can make patients wary of their prescribed treatment, doctors
said. So methadone-related deaths create a quandary for health
officials - how to curtail abuse without stigmatizing or discouraging use.

"The problem is, it's either a drug with a bad reputation or a drug
with a less-bad reputation," said Dr. Michael Sheehan, the medical
director of Operation PAR, which runs substance-abuse treatment
centers in four Florida counties, including a methadone clinic on
26th Street West in Bradenton.

There are several reasons why methadone is prescribed for chronic
pain, said Dave Craig, the director of Pain and Palliative Care
Specialty Residency at the H. Lee Moffitt Cancer Center and Research
Institute in the Tampa Bay area.

Methadone is a cheaper medication, compared with other prescription
painkillers - 100 tablets of methadone might cost $43.99 compared
with 100 tablets of Oxycodone, priced at $430.69.

Twenty milligrams of Oxycodone is equivalent to about 10 milligrams
of methadone, Sheehan said.

"Most insurance companies will reimburse, including Medicaid," Craig said.

Methadone, which is a sedative, comes in multiple forms, including
tablets and solutions, Craig added.

The drug's effects last more than 24 hours - significantly longer
than some other pain medications.

Also, methadone can be highly effective for people living with cancer
and moving from one pain medication to another, Craig said.

"It's not the best medication for everybody, but most of our patients
have been on methadone," Craig said. "I don't think that patients on
methadone are at risk of having adverse outcomes from methadone."

Sheehan noted that when correctly used in an addiction maintenance
program, certain dosages of methadone can be therapeutic for former addicts.

For people on a methadone maintenance program - there are about 2,000
patients in Operation PAR's multi-county program - 100 mg of
methadone may be the normal dosage to keep them functional, Sheehan said.

But for an average person who has never taken an opiate such as
heroin, less than half of that amount can kill, Sheehan warned.

"If you take an overdose, your brain slows down, you become sedated
and calm, your breathing slows down and can stop," Sheehan said.

Pain, not pleasure

Nationally, the Substance Abuse and Mental Health Services
Administration, an agency under the U.S. Department of Health and
Services, reported a 200 percent increase in the distribution of
methadone between 1999 and 2002.

With more doctors prescribing methadone, the likelihood of abuse has
also increased, though Manatee law enforcement officials said they
don't often deal with methadone being traded as an illicit substance.

Some of the methadone-related deaths reported by the state's medical
examiners stemmed from overdoses or use in a lethal combination with
tranquilizers or alcohol, Janes said.

The medical examiners' findings confirmed that most methadone-related
deaths were not from methadone alone. Out of more than 900
methadone-related deaths last year, 819 of those were associated with
other drugs, according to the Florida Medical Examiner's Commission report.

In some of those deaths, someone prescribed the drug might have taken
"too many (doses) too early and didn't build up tolerance," Janes said.

Though the figures from the commission's report are alarming, the
findings do not surprise Sheehan.

"Trying to treat someone with severe and intractable pain, many
physicians will use opiate drugs," Sheehan said. "The more commonly a
drug is used, the more likely the drug ends up on a list that will
cause fatality."