LETHAL METHADONE, DRUG MIX

Christena Constible was so desperate for methadone the day before she died
that she threatened her doctor she would be dead by the next day if he
didn't give it to her.

In fact, she died in her sleep within 12 hours of that statement - not
because she didn't take methadone - but because she did.

The 20-year-old Abbotsford woman died from a mixed prescription drug
overdose and a lethal amount of methadone, a toxicologist testified this
week during the Fraser Valley Coroner's inquest into Christena's death. The
traumatized young woman received a dose of the methadone she craved in Dr.
James Swanney's office on May, 11, 2000.

Swanney appeared exhausted after spending the day Thursday and half of
yesterday answering a barrage of questions from several lawyers during the
inquest.

He testified that Christena was profoundly mentally disturbed, agitated and
bent on self-destruction when she and her mother came into his office on
the afternoon of May 11. Christena, a former heroin addict, had weaned
herself off methadone in mid-March without Swanney's approval, prompting
him to try to control her addiction cravings and mental agitation with
prescription anti-depressant drugs, he said. He knew her overwhelming
mental problems were driven by her powerful addiction to heroin, said
Swanney. Methadone is a synthetic opiate substitute that allows addicts to
live a relatively normal life.

Christena had done exceptionally well when she was taking methadone,
testified Swanney.

However, Christena's boyfriend and her parents were pressuring her to stop
taking it.

Her dad wouldn't let her drive the car while on methadone and she wanted to
drive again, said Swanney.

He noted that her father's concerns were unfounded since patients who are
stabilized on methadone are permitted to drive by law.

Meanwhile, Christena went against Swanney's professional medical advice and
weaned herself off methadone starting on March 10, 2000 - a decision that
threw Christena into a downward spiral, according to Swanney's testimony.

When she arrived at Swanney's office on May 11, the doctor said she was
very anxious, agitated and in a profound mental crisis when she asked
Swanney this powerful question: "How would you feel if you read in the
newspaper tomorrow that a young woman had died, because she didn't get her
medication?"

Swanney said he'll never forget the comment.

He left the room and went to the fridge where he kept an emergency supply
of methadone that had been returned to him by a former addict and patient.
He guessed the methadone was about a year or a year-and-a-half old and he
had used it previously without any problem, he testified.

Swanney mixed the drug in two vials, diluting it with water to a
concentration of about 40 milligrams per litre. Christena swallowed the
methadone from one vial. Swanney gave her the second vial to take at home
that night if she became more anxious.

Swanney testified that the methadone he gave to Christena was "pale yellow
to orange" in colour, which conflicted with evidence presented by
Christena's mother who said it had been an unusual green colour.

Coroner lawyer Chris Godwin asked Swanney if he realized that Christena's
last dose of methadone in mid-March had only been 20 milligrams per litre
and that she would no longer have any tolerance for the drug.

Swanney replied that he knew this.

However, Swanney explained that he had attended a conference on methadone
education by the College of Physicians and Surgeons where he had learned
that 40 milligrams per litre is an appropriate starting dosage.

Christena ingested the second vial of methadone that evening and went to
sleep on her parents' couch about 10:30 p.m. Her mother discovered she was
cold to the touch and had quit breathing about 1 a.m.

The coroner's jury learned of several occasions when Swanney had apparent
discrepancies or inaccurate notes in his charts and medical records.

For example, he wrote in his records that he "gave" Christena 20 milligrams
of methadone on Dec. 13, 1999. However, under cross-examination on
Thursday, he said he did not recall giving her any methadone in his office
that day. He thinks he gave her a prescription, yet no prescription records
exist to substantiate this.

Swanney also told the coroner's jury that most doctors in Abbotsford won't
accept heroin addicts as patients, because they are so time-consuming
compared to a diabetic or heart patient, for example.

"They (addicts) walk in to the office and you can't turn them away," said
Swanney, adding that it's not unusual for an addict in crisis to take a
half-hour to three-quarters of an hour of his time every visit.

As one of only two doctors in Abbotsford licenced to prescribe methadone,
Swanney was compassionately accepting these patients. In fact, Swanney said
he would take phone calls at home from patients in distress.

"The patient who is chemically addicted is the hardest patient we deal with
as a general practitioner," said Swanney. No family physician would want to
have more that two or three such patients in his practice.

Swanney earlier testified he had about a dozen.

Swanney said heroin addiction is very powerful and some addicts may have to
stay on a methadone maintenance program for the rest of their lives. Most
need to take it at least three to four years before they can stop.
Christena was only on methadone for about 14 months.

Contrary to Swanney's testimony that Christena deteriorated because she
stopped taking methadone - Christena's parents say the doctor prescribed
too many prescription anti-depressant drugs to her.

Christena was prescribed a number of prescription drugs during the two
months before she died including: Ativan, Paxil, Serax, Risperidal,
Welbutrin and others.

She tried to commit suicide during that time and was admitted to MSA
General's psychiatric ward for two periods during April.

The inquest is scheduled to resume Jan. 10-11.