METHADONE SUDDENLY GROWING AS KILLER DRUG

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
to 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, fatalities caused by methadone increased eightfold, from
seven in 1997 to 58 in 2001 - an "absolutely amazing" jump, according to
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.
In the first six months of last year, methadone killed 18 people in Maine,
up from four in all of 1997.

Dr. John H. 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."

The surge in methadone abuse 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 J. Pelletier, who works for the Maine Drug Enforcement Agency
handling drug cases in Portland and Cumberland County, where methadone
caused at least 30 deaths in 2002, according to the state medical examiner's
office.

In most states with increased methadone deaths, the methadone being abused
appears to be tablets prescribed for pain. These are sold or sometimes given
to addicts by people who have stolen them from patients or, in some cases,
by the patients themselves. 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 say 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 C. 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. We do see a lot of
methadone getting diverted out here on the street from the clinic, and we
have to watch our clients very carefully because it's a secondary source of
income for a lot of them."

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 number of such visits in 1999.

Experts say 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 might mix it in with a beer or with some other drug. 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 say.

"By the time they've actually overdosed, no one is with them to see what's
happening," said Kimberly Johnson, director of the Maine Office of Substance
Abuse.

Grappling with methadone used in addiction treatment may be even more
difficult.

For three decades, 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 say.

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 as many as 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.