Source: LA Times
Date: 26 February 2007

Methadone emerges as new killer

Patients and addicts are mixing the opiate
with other drugs, as did Anna Nicole Smith's son.

By Charles Proctor,
Times Staff Writer

methadone bottle

Methadone, a potent opiate once used almost exclusively to treat heroin addicts, is increasingly being prescribed by doctors as a pain medication and abused by drug users searching for a cheap, easy way to get high, physicians and federal drug officials say.

The drug, which comes in pill or liquid form, recently has come under scrutiny in the death of former Playboy model Anna Nicole Smith. A doctor in Studio City prescribed methadone to Smith for pain treatment before she was found dead Feb. 8 in her Hollywood, Fla., hotel suite.

A coroner has yet to determine her cause of death, and the doctor said his treatment was "medically sound and appropriate."

Months earlier, Smith's 20-year-old son died in the Bahamas after taking a lethal mixture of methadone and two antidepressants, Zoloft and Lexapro.

Well before these deaths, however, drug counselors and clinicians were concerned about increased abuse of the drug on the streets, in group homes and even in middle schools.

It is an ironic turn in the history of methadone, which for years has been used to treat heroin addiction.

A synthetic opiate, methadone is similar to heroin in chemistry, curbing a user's craving for the illegal opiate by blocking the sensors that heroin stimulates without producing a heroin high.

In recent years, methadone has proved lethal to a growing number of patients or addicts who use it in conjunction with prescription drugs including Valium, Xanax or, in the case of addicts, illegal narcotics such as cocaine.

Sometimes users swallow methadone before or after they "puff," when they seek to get high by slowly inhaling the chemicals from an aerosol can.

"Every year, we see hundreds of these deaths, and the numbers continue to increase," said Bruce Goldberger, director of toxicology at the University of Florida, who has been at the forefront of tracking methadone-related deaths. "It is absolutely the fastest-growing drug problem."

A federal government study found that nationwide methadone-related deaths climbed to more than 3,800 in 2004 from about 780 in 1999. Among all narcotic-related deaths in 2004, only cocaine killed more people in the United States than methadone.

Physicians and others point out that methadone's potential for abuse isn't as high as that of opiates like heroin because it does not induce a strong euphoria on its own.

But repeated use can still cause a physical dependence, doctors say, and when users stop taking it, withdrawal-like symptoms can occur.

Given its low cost compared with heroin and other drugs, its recent proliferation and its potentially lethal potency when mixed with other drugs, officials worry that methadone is largely evading the scrutiny applied to other abused prescription medications, such as OxyContin and Vicodin.

The drug can be lethal even when mixed with antidepressants, or grapefruit juice, experts and federal drug authorities say.

Methadone can linger in body tissue for an unusually long time — 24 to 59 hours in some cases. Sometimes users assume it has worn off, then take other drugs or more methadone, leading to respiratory depression, coma and eventual death.

Methadone is available at clinics that prescribe it to treat heroin addiction, from doctors who can prescribe it for pain or to treat addictions and, increasingly, as a street drug.

The clinics face stringent federal and state regulations as to how much methadone they can administer to patients, but physicians don't go beyond a general rule that says they can't prescribe more than a 30-day supply, said Mark Parrino, president of the American Assn. for the Treatment of Opioid Dependence.

In Southern California, parts of downtown, East and South Los Angeles have emerged as places to buy and sell methadone, said Kalante Holmes, a counselor at a methadone clinic in West Los Angeles. "It's one of those easy-to-get things right now," he said.

It's the "easy-to-get" nature of the drug that has led to the recent spike in methadone deaths, experts and government officials say.

As the study of pain has grown over the last five to 10 years, more physicians are prescribing methadone to patients to treat pain, especially chronic and nerve pain.

The Food and Drug Administration issued a warning in November to all physicians saying that misuse of the drug could lead to breathing problems and possible death.

Patients might prefer methadone to other painkillers because not only is it powerful, but it's also less expensive.

For example, a pharmacy can buy a month's supply of methadone for one patient for as little as $8, whereas it would have to pay more than $170 for a similar amount of OxyContin, according to wholesale pharmaceutical price books.

As the availability of the drug increases, so does abuse and misuse of it, experts and drug officials say. Problems usually don't arise from physicians who specialize in pain treatment and know how to safely prescribe and monitor methadone use, but from general and family practice physicians who may prescribe the drug more often than they should.

"My hunch is that some of what we're seeing with the current problems are the administration of [methadone] by physicians who don't understand how powerful it is to a patient population who might not necessarily need it," said Richard Rawson, an associate director of Integrated Substance Abuse Programs at UCLA.

Data compiled by the federal government show a steady increase in the number of people nationwide admitted to clinics and programs for methadone treatment, from about 1,000 in 1995 to more than 3,700 in 2005.

"This is an emerging problem," said Bertha Madras of the White House Office of National Drug Control Policy.

It's been a persistent problem for people like Sean, 20, a resident of West Los Angeles and a former heroin addict.

Sean, who asked that only his first name be used because of the stigma associated with drug abuse, carved a steady path to heroin use at a young age. He tried marijuana when he was 11, cocaine at 14 and heroin at 17.

When he was 19, living in a downtown L.A. apartment and experiencing heroin withdrawals, he tried methadone. Mostly, he said, he used it to satiate his desire for heroin. At least once he took it with Klonopin, a muscle relaxant.

"I don't want to say the feeling was similar to alcohol," said Sean, who is in drug treatment and was interviewed in the presence of his counselor. "But that's sort of what it was like. Your body feels relaxed."

Though he said he had not used methadone lately because he'd heard it had been responsible for a rash of deaths, Sean said he could easily get it on the street.

Recently, on a bus in Santa Monica, he was approached by a methadone pusher who offered him a deal: one pill for $45 or two for $60, he said.

Sean said he declined. But he knows it won't be so easy for others.

"The fact of the matter is, if you're a drug addict and you don't want treatment, you're going to go try to get high off something," he said. "You're broke, you can't afford heroin, so you go get methadone."

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