OFFICIALS: WITHDRAWAL DOESN'T KILL PEOPLE, BUT THEY WISH THEY WERE DEAD

Editor's note: This story is the third installment in a series on
methadone, a controversial painkiller often used to treat opiate addictions.

PRINCETON - Imagine preparing for a job interview or trying to fix a broken
relationship without any sleep, amid a state of confusion. The room is
spinning, your hands are shaking and your stomach is cramping. That's life
for someone in the throes of opiate withdrawal.

"Withdrawal doesn't kill people, but they wish they were dead," Dr. Michael
McNeer, a psychiatrist and addiction specialist, said recently explaining
the often-vicious cycle of opiate addiction and withdrawal.

Opiates, natural or synthetic drugs that behave like opium once ingested,
are highly addictive. Heroin, morphine, codeine, Dilaudid and oxycodone are
all opioids, and all have the potential to create physiological dependency
in users.

Once a person's body becomes dependent upon the opioids, receptors in the
brain need the drug's presence in order to function, and stay out of
withdrawal. "The opioid receptors are crying out for the drug," McNeer
said, creating intense cravings and physical manifestations of the addiction.

Because withdrawal can be physically excruciating and psychologically
overwhelming, methadone maintenance treatment (MMT) has become an
increasingly popular way of treating addiction.

An entirely manmade opioid originally created in Germany during World War
II as a painkiller, methadone first became available in the United States
in 1947.

In the medical community, methadone has grown in popularity as a painkiller
because it is less expensive than similar drugs, such as oxycodone and
hydrocodone, and because patients tend to be afraid of the addictive
qualities of brand-name pain pills such as OxyContin, McNeer said.

Since 1965, the powerful medication has been used to treat addiction to
opiates such as heroin, morphine and Dilaudid, but locally, officials said
people addicted to OxyContin dominate those seeking help at treatment centers.

Methadone occupies the opioid receptors in the brains of people addicted to
opiates, without producing the euphoria, or high, associated with the drugs
they first became hooked on. It keeps their bodies from going into
withdrawal, and since it occupies the opioid receptors other drugs would
typically act on, it also dulls or eliminates the high they would
experience from their first drugs of choice.

But, methadone itself is highly addictive also, and it does not eliminate
the addiction. Patients undergoing MMT are no less addicted than when they
began the treatment. They are simply dependent on a different drug.

Because opiate addiction and withdrawal take such a physical toll,
treatment requires a lifestyle change, according to Casey Aust, director of
Beckley Treatment Center, an MMT clinic.

Methadone treatment facilities operate as risk-reduction centers, she said,
rather than as drug-abstinence programs. For $12.50 a day, patients get the
methadone to keep their bodies out of withdrawal, but she said the
treatment also keeps them from committing crimes to get other drugs and
decreases hazardous behavior such as sharing needles.

If patients wish to detox after methadone stabilizes their cravings, they
may do so slowly under a doctor's supervision, but Aust said some of her
patients will never be able to discontinue MMT.

Just as insulin is essential to a diabetic's well-being, she said methadone
may be a permanent, crucial part of life for a person addicted to opioid drugs.

She said the goal of the treatment is to stabilize patients physically so
they may address personal or mental health issues such as family life,
employment and education.

"If they are in withdrawal and are not physically feeling well, they cannot
focus on fixing what's wrong in their lives," Aust said.

If MMT keeps her patients "functioning and keeps them being productive
members of society, then it's worth it," she said.

Controversy has put MMT in the spotlight due to the growing presence of
methadone for sale on the streets, the increasing numbers of
methadone-related deaths and the indefinite detoxification process.

In the first seven months of last year, 63 West Virginians died after
reportedly taking methadone, whether in the form of prescribed pain pills
or liquid doses from methadone clinics.

Two Mercer County deaths involving methadone resulted in murder charges in
2003, and Prosecuting Attorney Bill Sadler said this week that methadone
was involved in "most of our overdose cases."

Treatment center supporters have often argued that the methadone for sale
on the street comes predominantly from diverted prescriptions, but local
law enforcement officers reported that both forms are available.

There is a place for MMT in society, McNeer said, but he also pointed out
that it is important that people taking methadone understand how
potentially dangerous it can be.

"The real danger of methadone is that it is very potent. It builds up in
the system, and it is a complex drug with variable metabolism," McNeer said.

Slowly absorbed, methadone is a long-acting drug with a half-life of 24-36
hours, meaning that 24 hours after a person ingests methadone, at least
half of the drug's concentration is still in the body. Taken daily, the
drug will continue to build potency for several days before reaching full
concentration.

And, it is so slow-acting that McNeer said, "It's not unusual to not feel
anything for some time after it's taken."

He cautioned that deaths involving methadone usually take place hours after
the drug is ingested, and it's especially dangerous when taken with other
substances that depress, or slow down, the central nervous system and
breathing, McNeer said.

Alcohol, Xanax, Vallium and muscle relaxers, often dangerous on their own,
can be fatal in combination with methadone.

Most people who die of methadone overdose simply stop breathing in their
sleep because the part of the brain that tells the body to breathe stops
working, McNeer said.

And, for individuals with no opioid tolerance or dependency, even a small
dose of methadone could be fatal.

"To someone who is opioid naive, 30 milligrams can be fatal, and 50
milligrams is much more likely to be fatal," McNeer said.

The daily MMT dose administered to people already addicted to opiates
typcially ranges from 80 to 120 milligrams.

For safe treatment, McNeer said methadone "ought to be taken under the most
competent, strictest supervision" possible.

Despite the potential hazards, Aust said methadone maintenance treatment
helps people from all walks of life cope with addictions.

"Opiate addiction is not choosy," she said.

Many of her patients first became addicted after an injury required
painkillers. "Before they knew it, their body was addicted," she said.
"They come to us after they've crossed the road ... when they've hit rock
bottom."

Aust said she routinely participates in community outreach and education
projects. She encouraged anyone with questions concerning MMT to contact
her at (304) 254-9262.