TO POLICE, METHADONE IS A PROBLEM

Editor's note: This is the conclusion of Methadone in the Mountain State, a
series on the powerful opiate painkiller often used to treat withdrawal
from other narcotics. Available both through physician prescriptions and
clinic treatment programs, methadone is a source of relief for patients in
pain or the throes of withdrawal, but for local police, it's also a source
of frustration.

PRINCETON - It's a powerful prescription painkiller and a recommended
treatment for opiate addiction. For people suffering from either chronic
pain or the agonizing symptoms of withdrawal, it represents a dose of hope
in the form of a pill or a vial of red liquid. It's been called a lifesaver.

But, for law enforcement officials, sometimes methadone is just a "major
problem."

An extremely powerful synthetic opioid created as a painkiller during World
War II, methadone is growing in popularity in southern West Virginia and
across the nation.

Affordable and available either through a doctor's prescription or
methadone maintenance treatment (MMT) clinics, the drug is also becoming
more abundant on the streets, according to West Virginia State Police Sgt.
M.R. Crowder, of the Princeton detachment.

"It's almost on a daily basis one of my officers deals with some type of
methadone case," he said. "We're just having a time with them."

As a painkiller, methadone works like other opiates, such as OxyContin,
Percocet and LorTab. It has proven useful to treat addiction to those drugs
and heroin because it dulls the symptoms of withdrawal without the high, or
feeling of euphoria, associated with the other narcotics.

However, methadone itself is extremely addictive, and its long-acting
nature makes it potentially fatal when ingested in large quantities or
mixed with other drugs, especially other opiates.

Along with illicit sales, overdose deaths are mounting. In just the first
seven months of 2004, there were 63 methadone-related deaths reported in
West Virginia.

Since the drug remains in the body much longer than most substances, it
often takes hours for the person to feel the drug's effects and days to
reach full potency, psychiatrist and addiction specialist Dr. Michael
McNeer said.

Methadone's potency can be hazardous. According to McNeer, 30 milligrams of
methadone could kill an "opioid-naive" person, and 50 milligrams would be
much more likely to be fatal. The typical daily dose of an MMT patient is
80-120 milligrams.

Most of the people who die of methadone overdoses simply go to sleep and
stop breathing, he said, especially when the drug is taken in conjunction
with other substances that depress the respiratory system. The part of the
brain that tells the body to breathe simply stops working, McNeer said.

The fatalities usually include a mixture of the wrong chemicals, Crowder
said. "In most cases, we also find evidence of some other drugs, some other
kinds of narcotics. Methadone is very volatile when mixed with other
drugs." Part of the controversy surrounding methadone and maintenance
treatment arises from the practice of take-home doses, which clinic
officials say are necessary to provide treatment and a consistent
lifestyle. Opponents argue the doses only put addictive substances into the
hands of people who already have a problem.

All clinics are required under federal law to implement diversion control
policies to ensure the methadone that leaves their structures is
administered as intended. Casey Aust, administrator of the Beckley
Treatment Center, said the clinic requires patients to exhibit a stable
lifestyle, submit to regular drug screenings and prove they have a way to
lock their methadone up before they get more than one take-home dose weekly.

Methadone maintenance treatment continues years, or even for a lifetime,
because the patients are still addicted to the opiates during the therapy.
The methadone keeps their bodies from going into withdrawal and allows them
to focus on mental health, education, employment and family issues without
the added stress and sickness of stopping the drugs "cold turkey," Aust said.

If patients choose, they can detox slowly from the methadone and escape
most of the withdrawal symptoms, but she said some patients will choose to
remain on the MMT forever.

That's a decision some of the officers can't understand.

"I'm not saying that the clinics haven't helped somebody, but from what I
see, it's very rare that doses actually go down," Crowder said.

But, clinic officials say the blame for methadone's illicit market
shouldn't fall on their facilities. They, and even a Department of Health
and Human Resources study, conclude that most of the methadone illegally on
the streets is diverted from physician prescriptions in pill form, rather
than the liquid doses administered to MMT patients.

Bailey concurred. As chief deputy, he said he isn't on the streets as much
as some officers, but he's also in charge of the evidence room. "What I'm
seeing is pills," he said.

Crowder said State Police officers are "definitely" encountering both forms
of the drug, and at least one local investigator reported purchasing the
liquid in a controlled-buy situation.

Whatever form it takes, its methadone's presence outside of medical
supervision that weighs on Bailey's mind.

"It's another drug in our opinion, instead of a medication," he said.