DANGEROUS MEDICINE

Methadone

ACROSS West Virginia and the nation, patients consume a powerful
painkiller called methadone, and an alarming number of them die.

The drug -- once used mostly as a heroin substitute to help addicts
wean themselves from their habit -- is increasingly prescribed for
pain, sometimes because of its effectiveness, sometimes because it's cheap.

Nationally, death certificates show that 2,992 Americans were killed
by the drug in 2003. But that's a conservative count. Not every
family asks for an autopsy and not every cause of death is
discovered. The number of deaths has climbed, nearly quadrupling from
790 in 1999. Eighty-two percent of those fatalities were declared accidental.

Reporters Scott Finn and Tara Tuckwiller found that West Virginia's
rate of accidental methadone overdose deaths in 2003 was four times
the national rate. Across the country, there were 0.8 deaths per
100,000 people, while in West Virginia, there were 3.7, according to
the National Center for Health Statistics.

Relatives tell painful stories of young parents and spouses who took
the medicine as their doctors instructed and died of it. Most West
Virginia overdose victims between 2001 and 2005 had other drugs in
their systems -- either prescription medications, illicit drugs or
alcohol. Still, medical examiners found that 19 percent who died had
only methadone in their bodies.

Usual adult doses listed on the packaging and approved by the U.S.
Food and Drug Administration are much too high to be safe, doctors say.

Because methadone remains in the body longer than other painkillers,
it is effective against debilitating, ongoing pain. But because it
lingers longer, it can build up to toxic levels. A dose that provides
relief for one person may be deadly to another.

The FDA has been tragically slow in responding to these deaths. The
agency increased warnings on the intravenous form administered in
hospitals, but has not required a label change for pills -- the form
people take home and administer themselves. An FDA spokeswoman said
the agency feared that stronger warnings would scare off drug
treatment patients. However, addicts or not, people should be well
advised of their risks.

FDA's attitude on this issue does not inspire confidence. After the
record 2003 deaths, the federal government convened a conference on
the danger, but has acted on few recommendations. The government
hired an industry-funded writer to draft the report from that effort.

Methadone is an old drug, developed by Germans during World War II as
a substitute for morphine. Its unintentional deadliness is well
documented. Doctors and researchers around the country have recorded
the mounting deaths and called for caution. North Carolina launched a
public health effort to educate patients and doctors. England went
through a similar problem about a decade ago.

The FDA, the pharmaceutical industry and medical community must act
quickly to better dispense this valuable but dangerous drug. Until
they do so, patients must be wary and ask a lot of questions before
consuming even one tiny, harmless-looking pill.