METHADONE, A QUIET KILLER: DEATHS FROM UNINTENTIONAL OVERDOSES RISING

Jamie Pethel had a drug problem.

But the last time his mother, Mary Haynes talked with him in
September, Pethel was "trying to get it back together," she said.
Less than 24 hours later, he was dead. A recently completed
toxicology report revealed the cause of 23-year-old Pethel's death:
acute methadone toxicity.

He overdosed. Pethel was one of more than 300 North Carolinians who
lost their lives to an unintentional methadone overdose last year,
according the latest statistics from the N.C. Office of the Chief
Medical Examiner. That's up from 34 people who fatally overdosed on
the drug in 1999. Over that period, methadone has become responsible
for about a third of accidental overdose deaths in the state, as many
as cocaine and more than all other prescription drugs. In Rowan
County, medical examiners found methadone in the blood of nearly half
the people who died of unintentional overdoses from 2003 to 2005, the
most recent year for which county numbers are available. Experts
blame ignorance, in large part.

Long used to ease addicts' craving for heroin, methadone has grown
increasingly used as a painkiller over the past decade -- and
increasingly available to people who don't know its potentially
lethal effects. Prescribed and taken correctly, methadone can provide
long-term relief for chronic pain sufferers, experts say. And it
does, over time, give recovering addicts a mood-altering benefit that
helps them function. But methadone can build up to toxic levels fast
if a person takes too much, especially someone who hasn't taken it before.

Patients accustomed to faster-acting medications might take extra
methadone pills when the first one doesn't quickly provide relief.
Drug abusers might do the same thing, expecting a quick high that
never comes. "It's simply not anything that's going to get them
there," Dr. Robert Wilson, a local pain specialist who prescribes
methadone to treat some of his patients, said of the drug abusers'
quest for a buzz. "It's just going to get them the potential to kill
themselves." Pethel once bragged to his mother about his "tolerance" for drugs.

When he died, a toxicologist found between 60 and 80 milligrams of
methadone in his body. The medical examiner's office told his mother
that with that amount, he couldn't have been taking it long. "It
looked like a one-time thing," Haynes said. No warning It only takes
one time, experts say.

Methadone stays in the body a long time, up to 59 hours.

But when taken to treat chronic pain, its effects only last four to
eight hours.

And it doesn't produce the euphoric rush that drug abusers seek.
"Patients or people using the drug often can't tell they've taken too
much," said Kay Sanford, a state epidemiologist who has tracked
methadone deaths. "They don't get any warning signs." So in either
case, looking for pain relief or a high, a person might take the
drug, then take more soon after, or take too much to start with.
After that, it doesn't take long to die. The Rev. Brit Baldwin, a
47-year-old chaplain at the Hefner VA Medical Center, died from an
overdose of methadone in 2002. Baldwin suffered from migraine
headaches, but hadn't been prescribed methadone. A friend of
Baldwin's had a prescription for methadone, and the chaplain had
gotten the drug from the friend's home at least one other time before
his death, authorities said. The day he died, friends told
investigators Baldwin had a "terrible headache." He took "several
tablets" from the friend's house, a medical examiner said. Baldwin's
sister later discovered his body at home, in bed. Some people take
one pill for pain, think it's not working, then take a second and
even a third, Sanford said. But methadone acts as a respiratory
depressant. Taking too much stops the lungs from working. "The lungs
simply shut down, and the person simply shuts down," Sanford said.
"The person goes to sleep and doesn't wake up." Available and deadly
Availability is driving the rising death tolls, experts say.

Toxicologists can tell the difference between the liquid form of the
drug given to addicts at methadone clinics and the pill form given
patients suffering from chronic pain. And they say in very few cases
have they seen overdose victims with the liquid form in their
systems. Throughout the 1980s and until around 1997, the state saw
between one and five fatal methadone overdoses a year, said Dr. Ruth
Winecker, the state's chief toxicologist. "And those were exclusively
from heroin maintenance programs," she said. "Doctors didn't
prescribe methadone for chronic pain through that time period." Part
of the reason doctors prescribe methadone more now is its relatively
low cost, Winecker said. At pennies per pill, compared with a
painkiller like OxyContin at $2 a pill, it's an affordable
alternative for chronic pain sufferers with no health insurance. And
doctors believed it was less likely to wind up on the street, said
Sanford, the state epidemiologist. Methadone "has been assumed to be
less likely to be used for recreation or abuse because it doesn't
give the user a high," Sanford said. However, she said, it is "very
addictive." There are no firm statistics on the number of people
dying who had valid methadone prescriptions. Sanford said in a study
several years ago it was as much as 37 percent, but she can't apply
that statistic to newer data, she said, because witnesses often lie
to authorities investigating overdose deaths and she doesn't have the
money or staff to go through medical examiners' records again. "But
the majority of people who are dying are either first getting it off
the street or getting a prescription and then using that prescription
inappropriately," Winecker said. Prescription deaths Some, though,
are using the drug just as prescribed and still dying.

Thirty-four-year-old Jeffrey Sepski went to a pain specialist in
Jackson County on March 23, 2006. He had been in a lot of pain from a
hip replacement surgery two years before and other medications
weren't helping, his father, John Sepski said. The doctor prescribed
methadone -- 30 milligrams three times a day -- as well as morphine,
an anti-depressant and a generic form of Ritalin "to fight fatigue,"
his mother, Pat Sepski, said. Sepski started his medications that
day. The next day, his aunt, with whom he was staying at the time,
told his parents he got very nauseous and started throwing up. Then
he couldn't hear because of "a constant rushing in his ears, like
traffic," Pat Sepski said. That night, around midnight, his aunt
heard Sepski in the kitchen before he returned to a building outside
the house where he was staying.

She didn't see him the next morning.

Around 1:30 p.m., she looked in the window where he was staying.
Sepski was on the floor, dead. His parents believe Sepski had taken
four doses of methadone.

His autopsy noted the other drugs, but listed the cause of death as
"acute methadone toxicity." The Sepskis said a medical examiner told
them the levels of methadone in their son's system were lower than he
normally saw, and that he didn't believe he exceeded the prescribed
amount. "There's no way Jeff took more than he should have," John
Sepski said. Taking only what was prescribed, Sepski would have
ingested 90 milligrams of methadone in one day. In November, the Food
and Drug Administration issued a warning that taking what had
previously been recommended as an initial adult dosage for pain
treatment, up to 80 milligrams a day, could be fatal. Dr. Robert
Wilson, the local pain specialist who operates Piedmont
Interventional Pain Care, said he learned all about methadone, its
benefits and its potential pitfalls in his fellowship in
anesthesiology and pain medicine, and has honed that knowledge in
years of practice. He contends a small fraction of people with valid
prescriptions are overdosing "if their physician has some idea how to
write for the medicine." Unfortunately, many without specialized
training do not, he said. "Doctors with good intentions may be
overprescribing it," he said. Even after the FDA warning, there's no
hard line to follow. "The challenge with methadone is that a safe
amount for one person is not necessarily a safe amount for another
person," Sanford, the state epidemiologist, said. "This is a drug
where there are very different responses in different people." Killer
combinations Winecker, the state toxicologist, said that she rarely
sees methadone alone in an overdose victim.

And Sanford said many of the deaths she's seen involved methadone and
an antidepressant. "I'm not going to demonize one or the other, or
say they should never be taken together," Sanford said. "But there's
a safe way to do it and an unsafe way to do it, and obviously the
people we're looking at didn't take the safe dose." In September,
Daniel Smith, the son of celebrity model Anna Nicole Smith, died of
an apparent accidental overdose in a hospital room in the Bahamas
after reportedly taking a deadly combination of methadone, Zoloft and
Lexapro. Then his mother died in February under mysterious
circumstances. She reportedly had been prescribed methadone and other
drugs under an assumed name. The cause of her death has not been
released. When Jamie Pethel died, he had Xanax in his system as well
as methadone.

But his mother said there wasn't much Xanax and the medical examiner
listed only methadone as the cause of death. Pethel came from a
family with a history of addiction.

His mother, Mary Haynes, had her own drug problem, but is now a
substance abuse counselor in a treatment program. Pethel started
smoking pot when he was around 12 years old, Haynes said. At 17, he
started taking pills and was in and out of substance abuse programs
for the next six years. But Haynes said Pethel was always "dead set
against" methadone.

He attended the funerals of three friends who overdosed and died on
the drug. And he resisted when staff at a drug treatment facility in
Winston-Salem tried to get him to use methadone to curb his own
addictions. Haynes said she doesn't know for sure, but she believes
Pethel did try methadone there. She knows he took it the night of
Sept. 3. He was found dead the next morning in his truck, outside his
father's house in Cabarrus County, near the Rowan County line. Haynes
doesn't know where her son got the methadone, and neither do
authorities. "I don't think I'll ever know," she said. "But I know
that's what killed him."