METHADONE DEATHS RISE IN WESTERN VA.

Some Authorities Said Increased Attention On OxyContin Abuse Might Be a Factor

Four years after OxyContin abuse hit Southwest Virginia, authorities are
seeing a dramatic increase in fatal overdoses from another prescription
painkiller - methadone.

Forty-four people died from methadone overdoses last year in the western
half of Virginia, according to Dr. William Massello, assistant chief
medical examiner in Roanoke. There were 40 fatal overdoses from oxycodone,
the active ingredient in OxyContin, during the same period.

The numbers are the latest evidence of a prescription drug abuse problem
that is most prevalent in the far southwest region of the state.
Authorities are not sure what to make of the methadone deaths, which have
been climbing sharply for several years while OxyContin abuse has been the
topic of widespread attention from law enforcement, politicians and the
news media.

There are several theories:

"We're theorizing that perhaps because of the bad publicity that OxyContin
has received, there are physicians who are switching to methadone" to treat
pain, Massello said. The pharmaceutical black market is driven primarily by
"doctor shoppers" who fake ailments to obtain drugs from multiple
physicians and then sell them on the street.

Another theory is that prescription drug abusers are being forced to turn
to other drugs such as methadone because increased law enforcement efforts
have made it harder for them to find OxyContin on the street.

"I still think OxyContin is the drug of choice," said Tazewell County
Commonwealth's Attorney Dennis Lee, who serves on a state task force
studying prescription drug abuse. "But in a pinch, people will buy
methadone and use it also."

Methadone is a synthetic narcotic that is perhaps best known as a treatment
for people addicted to opioids, or opium-based drugs such as heroin,
morphine and OxyContin. Operating under tight security, methadone clinics
provide a liquid form of the drug that blocks withdrawal symptoms, making
it easier for addicts to get clean.

But methadone is also prescribed in tablets to treat pain. It is that form
of the drug that seems most susceptible to abuse.

Roanoke pain specialist Cecil Knox is facing charges of illegally
prescribing both OxyContin and methadone. A wrongful death lawsuit also
claims that Knox overprescribed methadone to a patient who suffered a fatal
overdose.

In Montgomery County, a woman whose infant son died from a methadone
overdose earlier this year has been charged with second-degree murder,
felony child abuse and four drug offenses.

Massello said he was aware of only one or two cases in which a methadone
overdose victim had been receiving treatment at a clinic.

The Life Center of Galax, a drug treatment program that administers
methadone to opioid addicts from locations in Galax and Tazewell County, is
considering opening a third clinic in the Roanoke Valley.

Officials with the center could not be reached for comment Friday.

Massello said fewer than half of the methadone overdose victims examined by
his office had a valid prescription for the drug, suggesting that many of
them got their methadone from what he called a "thriving black market."

Based on the latest numbers, "things are not getting any better," he said.

There have been 21 fatal methadone overdoses so far this year in Western
Virginia. Oxycodone deaths number 10. Because it takes up to two months for
autopsy toxicology tests to be completed, the latest figures cover only the
first quarter of the year.

Even if illegal use of methadone is less common than OxyContin abuse, as
some in law enforcement believe, its chemical makeup could be one reason
for the high number of overdoses.

Methadone has a longer half-life than OxyContin, meaning it remains in the
user's body longer. As a result, it would be easier for someone to overdose
on an amount of methadone that might not have been lethal by itself.

Like OxyContin, methadone is abused by addicts who crush the tablets and
then snort or inject the powder.

But the drug has a different effect than that of OxyContin, which packs a
potent dose of oxycodone that is supposed to be released gradually into a
patient's blood stream over 12 hours - a process that abusers compromise by
crushing the tablets to produce an immediate sense of euphoria.

Methadone does not produce the same rush, according to Holly Catania of the
Baron Edmond deRothschild Chemical Dependency Institute of the Beth Israel
Medical Center in New York.

"Methadone is typically not a recreational drug," Catania said. People who
abuse the drug are most likely to be heroin or OxyContin users who "are
trying to get a break" by taking an opioid that will ease their cravings
without making them high, she said.

Formal methadone treatment is not available to many addicts because of the
stigma associated with methadone clinics, Catania said.

Residents and police typically oppose the opening of new clinics, fearing
increased crime from the presence of drug addicts in the area. But there is
little evidence to support that view, Catania said. She also questioned the
many fatal overdoses attributed to methadone, saying they could have been
the result of a combination of drugs.

Most methadone clinics administer the drug in liquid form under tight
restrictions. Addicts are required to visit the clinics regularly, and must
take the drug in the presence of a counselor. Only those who have been in
the program for some time are allowed to take a single dose home with them.

A study by the National Institute on Drug Abuse found that methadone
treatment for heroin addicts reduced their drug use by 70 percent. Criminal
activity among the recovering addicts was down by 57 percent, the study found.

Yet many people wrongly consider methadone more of a problem than a
solution, Catania said.

"That has got to change if we really want people to stop dying and
committing crimes," she said.