METHADONE VAULTS INTO ROLE AS KILLER DRUG

PORTLAND, Maine - Methadone, a drug long valued for treating heroin
addiction and for soothing chronic pain, is increasingly being abused by
recreational drug users and is causing an alarming increase in overdoses
and deaths, federal and state officials say.

In Florida, methadone-related deaths jumped from 209 in 2000 to 357 in 2001
and 254 in just the first six months of 2002, the latest period for which
data are available.

"Out of no place came methadone," said James McDonough, director of the
Florida Office of Drug Control. "It now is the fastest rising killer drug."

In North Carolina, methadone deaths increased eightfold, to 58 in 2001 - an
"absolutely amazing" jump, said Catherine Sanford, a state epidemiologist.

In Maine, methadone was the drug found most frequently in people who died
of overdoses from 1997 to 2002. It was found in almost a quarter of the
deaths. Dr. John Burton, medical director for Maine Emergency Medical
Services, said hospital emergency rooms were seeing "a tidal wave" of
methadone-related cases.

The increase in methadone overdoses and deaths has floored many drug
experts because methadone, which does not provide a quick or potent high,
has long been considered an unlikely candidate for substance abuse. It can
be hours before a user feels any effect, and it works more like a sedative
than a stimulant.

And because methadone is considered such an important and affordable tool
for treating addiction and pain, health and law-enforcement officials are
facing a quandary: how to stop methadone abuse without curtailing its
valuable uses - and especially without driving addicts back to drugs like
heroin.

"We've got years of experience with methadone, and suddenly we've got this
problem," said Dr. H. Westley Clark, director of the federal Center for
Substance Abuse Treatment. "We realize that lives are being lost, and we're
trying to stop that. But we're trying not to do quick fixes that will cause
us more problems."

A spike in methadone-related deaths hasn't been seen in the Seattle area,
according to the Alcohol and Drug Abuse Institute at the University of
Washington. A report last month by the institute showed 14
methadone-related deaths in King County in the first half of 2002, a rate
that's been fairly stable for the past three years.

More available

The surge in methadone abuse in many places appears linked to several
factors, including the growing abuse of heroin and OxyContin, a powerfully
addictive prescription painkiller. Health and law- enforcement officials
are reporting that some of these addicts are turning to methadone when they
cannot get the other drugs.

At the same time, methadone has become more available. Physicians are
increasingly prescribing it for pain relief, in part because law-
enforcement officials have been cracking down on OxyContin, and more
methadone clinics have sprung up to treat the growing number of heroin addicts.

"The availability of methadone for treatment and pain has put people who
would not normally be in a position to divert drugs in that position," said
Sgt. Scott Pelletier, of the Maine Drug Enforcement Agency handling drug
cases in Portland and Cumberland County.

In most states with increased methadone deaths, the methadone being abused
appears to be tablets prescribed for pain. These are sold or given to
addicts by people who have stolen them from patients or, in some cases, by
the patients. Addicts either swallow the tablets or grind them into powder
that can be inhaled or turned into liquid and injected.

In Maine, however, and to a lesser degree in a few other states, the
authorities said much of the methadone has been the liquid form used in
drug clinics and spread, in some cases, by clinic patients. Many clinics
across the country, following federal guidelines designed to make methadone
treatment more accessible, have stopped requiring patients to take all
their daily doses at the clinic and instead are allowing them to take home
doses of methadone once a week or more.

In Chicago, "kids are now coming from suburbia and they're buying methadone
on the street," said Dr. Ernest Rose, a specialist in drug addiction who
works for several methadone clinics there.

"In the inner city, you can get 80 milligrams of methadone for $20 to $30,
which is a lot cheaper than a heroin habit would be."

There are no national figures for methadone deaths or overdoses. But the
federal Drug Abuse Warning Network reported that in 2001, 10,725 people
turned up in emergency rooms after having abused methadone. That is nearly
double the 1999 figure.

Addiction and naivete

Experts said those attracted to methadone fall mostly into two categories:
people already addicted to other opiates and naive, sporadic drug users who
have often never tried methadone before.

"Most people who are addicted for any period of time aren't out chasing the
buzz anymore," Rose said. "Most of them are trying to keep their sick off,
and methadone will do that."

Naive users might be "people who are just at a party and someone will give
them some methadone," said Burton, the emergency-medicine specialist in
Maine. "They take it thinking it's just like any other drug and will give
them a buzz, and they end up either dead or deeply unconscious."

Methadone's delayed narcotic effect and its lack of a potent high are
important reasons the drug can be so dangerous, experts said.

Joseph Haddock, an analyst for the Justice Department's National Drug
Intelligence Center, said some people, unaware of the drug's delayed
effects, "take methadone, don't get the effect that they want, take more
methadone, still don't get that reaction, and they take more methadone, so
they end up overdosing."

While methadone has been available as a pain medication since World War II,
many physicians have only recently begun to prescribe it, said Dr. Edward
Covington, director of the chronic-pain-rehabilitation program at the
Cleveland Clinic in Ohio and a past president of American Academy of Pain
Medicine.

The change, he said, is partly the result of a new consensus that chronic
pain should be treated and an awareness that methadone is a legal and
effective way to do so.

Doctors wary of prescribing OxyContin because of warnings from the police
about the potential for abuse also have turned increasingly to methadone,
Clark and others said.

But methadone is also complicated to prescribe. Doses are often difficult
to calibrate, Covington said, because of the way the drug accumulates in
fatty tissues and is slowly released in the body.

"Methadone is probably one of the very few drugs that I've seen doctors
almost kill patients with," he said.

Grappling with methadone used in addiction treatment may be even more
difficult. For 30 years, many health experts have praised methadone for
pulling addicts away from heroin. While those addicts usually remain on
methadone for long periods and may never be able to function without it,
many lead productive lives, experts said.

Clinics as source

To make methadone more accessible, the Substance Abuse and Mental Health
Services Administration in 2001 relaxed its policy on distributing it.

In the past, patients who reliably took their methadone each day could earn
the privilege of taking up to six days' worth of doses home. The new rules
lengthened that to 31 days, a boon for people who had to travel long
distances to clinics.

But while experts such as Dr. Andrea Barthwell, the White House drug czar's
deputy director for demand reduction, consider patients who earn 31-day
take-home privileges to be highly unlikely to sell their methadone, they
worry more about another policy that allows clinics to close Sundays and to
send patients home with a "Sunday bottle" of methadone. "Some of these
people exchange their Sunday bottle for other drugs or money," she said.

Seattle Times reporter Julia Sommerfeld contributed to this report.