METHADONE: A DEADLY PARTY DRUG

All the experts agree that methadone, a proven, safe and unparalleled
treatment of opioid addiction when administered by a licensed doctor,
is dangerous when abused by naive users.

Dr. Lowell Lowen with the College of Physicians and Surgeons of
Saskatchewan, which administers the program and is currently
reviewing all deaths where methadone was involved said it's the
irresponsible partier who gets into trouble with methadone.

"From what I see, there is not a problem with those who are
prescribed and on the program. Already, the problem I do see is with
those who are not on the program, naive users who party, and when
they run out of one drug they start up with another. Studies show
that you will lose one per cent of your methadone patients due to
poly (multiple) drug use. The problem there is that with poly drug
use while on methadone, sometimes people's minds are altered and they
are not aware of how much they are taking," Lowen said.

Methadone is used in the treatment of opioid addiction. It prevents
withdrawal, decreases cravings and blocks euphoria produced by other
short-acting opioids.

Lowen pointed out that naive users of methadone put themselves in
danger because they don't know how the drug works.

"It accumulates in the body over time. The body accommodates the drug
to the point where they can handle prescribed doses. For those who
don't know that, and they take 60 or 90 milligrams they will just
fall asleep. They can be revived, but if they are partying they go to
sleep and their friends go home, they will not be revived. It's the
irresponsible party person who can get into trouble with this," Lowen
explained.

He estimated that the majority of patients use less than 100 mg per
day but due to the nature of the drug it is dependent on the user.

"Some patients can be very large and require only a small dose and
then other people can be very small and thin and require a larger
amount. A doctor would use a number of factors to decide the amount
prescribed," he added.

Each bottle of methadone in a carry dose lists the amount of
methadone in the solution, but one cannot gauge the dose simply by
measuring the amount of a bottle one drinks.

"Every bottle is full but has a different dosage. They each contain
the same amount of liquid but not concentration," noted program
co-ordinator Bernadette Amyotte.

She estimates that 30 to 35 mg could harm someone who is not an opioid addict.

"Drugs that are prescribed are on prescription for a reason, because
they can be dangerous. Illegal drugs are illegal for a reason,
because they are dangerous," she said.

Even a small amount of methadone can cause respiratory depression and
arrest in those who have not built up a steady tolerance to the drug.
Because of it's gradual and cumulative effect -- blood levels
increase with each successive dose until it reaches a steady state at
about four or five days -- the progression of respiratory depression
can go unnoticed by the patient's companions.

Province-wide, 24 deaths have occurred where methadone was either a
primary or contributing factor between January 2007 and June 2008. Of
those, 12 were on the methadone program and 12 were not.

Of the 12 that were, seven died from combined drug overdoses,
including prescribed and illicit drugs. Three died of methadone
alone, and two died of other causes of chronic drug use such as
pneumonia or liver disease.

Of those who were not on the program, one died of a methadone
overdose and 11 died as a result of a combination of methadone and
alcohol and/or prescription and illicit drugs.

"Looking at the statistics it's certainly a concern that there is
this number of deaths that are related to methadone in this
province," said Chief Coroner Kent Stewart.

"This raises a couple of issues, the use of illicit drugs while on
the provincial methadone program. If you look at these statistics you
will see that there is certainly a significant number of deaths of
those that are on the program. Two, the deaths of individuals who are
not on the program, which raises the issue of diversion, meaning
where are these individuals getting it from? There are two
possibilities there, it may be going astray and being sold and it
also may be brought in. The question is where is this coming from and
that is really a concern," Stewart said.

Illegal use, trade, sale or sharing is not something the Regina
Police Service's drug unit hears much about, according to spokeswoman
Lara Guzik Rostad.

"When looking at crime trends in the city, illegal methadone use is
not something that is seen or heard about too often by our officers,"
said Guzik Rostad.

"If a person was found with someone else's prescription that would be
investigated but it's not something that is encountered very often."

Insp. Jerome Engele of the Saskatoon Police Service agrees that while
there are those who use the drug illegally it is not a popular choice
among street users.

"Some prescribed users will sell some of their carries in order to
supplement their incomes. How they do this is say they get a week's
supply. They go in and take their Monday supply at the pharmacy, that
will carry (them) until (they) have to come back in and take another
witnessed drink on Wednesday so that frees up the Tuesday supply," he
explained.

Because the treatment is used as a means to live a more stable and
productive life, most on the program will not take risks such as
sharing or selling their carries, he explained.

Still, Engele points out there is a big risk involved for those who
choose to abuse the drug.

"Those who choose to abuse it are really taking a big chance because
it is a very dangerous drug, especially in a recreational setting. It
doesn't take very much of it to make a lethal dose. For those who use
it in conjunction with other drugs, they too are taking a big risk."

Amyotte said the risk of overdose for patients is managed in several
ways including the requirement of a lock box to house all take-home
(carry) doses and the requirement of all bottles being returned
before any more carries are given.

While alcohol and drug use, particularly cocaine, mixed with
methadone increase the risk of overdose, patients who are known users
of these drugs are not prohibited from the program.

"As long as they are able to provide proof of opioid addiction, that
is the main thing. This program is considered as a last resort. The
patients need to show that they have been to detox or treatment, that
they are trying to deal with the addiction," Amyotte explained.

"Also, we go over a list of drugs not to mix with methadone, we
explain what can happen. The signs of overdose are slowed-down
breathing and heart rate, then what we call 'going on the nod', or
falling asleep, and then dying," she explained.

Since officiating at a funeral for a victim of methadone overdose in
2004 where mourners left early to attend another funeral for an
18-year-old who had overdosed on the drug, local minister Nathan
Pelletier has been concerned.

Pelletier believes that the carry or take-home medication program
administered by the Harm Reduction Methadone Program is posing a risk
to those who take the drug illegally.

"People take their carry dose and they get way too much. I think the
only time people should get their carry dose is when they are on a
very limited amount," he said.

Pelletier said the risk comes when people sell or trade a prescribed
carry dosage on the street -- where according to one estimate the
drug sells for $1 per millilitre.

Carry privileges are given to patients who are considered to be
functionally stable in cases where there is a rationale for granting
carries such as full-time employment or school and is not recommended
during the first three months of treatment.

Amyotte estimated there are about 25 patients on the one-in-six carry
program where they take one dose in front of the dispenser and then
take six doses home.

She would not speculate to the maximum amount currently given to
patients but pointed to a guideline given by the College of
Physicians and Surgeons, which she cited as recommending no more than
400 mgs that should be taken home. She also pointed out that each
patient's dose is decided by the doctor overseeing the patient's care.

Lowen said the guidelines Amyotte referred to are federal and have
not been applied for some years.

"People do take home more than (400 mg). That is a federal guideline
which was instated in the early '90s and has not been reviewed. It is
not used any longer, even by the feds," he said.

The risk of relapse increases sharply if methadone maintenance is
discontinued, which is why for some patients, the treatment is
considered to be a life-long necessity.

There are currently about 190 patients in Regina who are prescribed
the drug through the Harm Reduction Methadone Clinic, and about 1,800
province-wide.

The program is aimed to reduce injection drug use, drug-related crime
rates and hepatitis C and HIV infection rates in Regina and area. The
hope is that once stabilized on methadone the addicted person can
live a normal productive life.

Amyotte recommends that anyone struggling with an opioid addiction
should contact the program rather than risk taking someone else's
methadone to keep away drug sickness.

"If evidence was brought in to the clinic of sharing or selling the
drug, such as a misplaced bottle, the matter would be looked into," she said.