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http://www.charlotte.com/112/story/710969.html

Methadone gets a hard look after overdoses

Used to treat pain and help heroin addicts, the drug is now blamed on a growing number of deaths.

By S. Maurreen Skowran

(Raleigh) News & Observer

Methadone, long prescribed as an alternative to heroin, is proving to be a hazard of its own.

As a treatment for addiction, methadone remains an effective tool. But as its use has rapidly increased as a low-cost pain reliever for the general population, a growing number of people are dying from methadone overdoses.

Methadone contributed to 299 fatal overdoses in the state in 2005, the latest year with national data available. The number of such deaths has more than quintupled from 47 in 1999. Many victims die after prescriptions to control their pain.

A state report indicates that in 1997-2001, at least a third of North Carolina victims had been prescribed methadone to relieve their pain.

The increasing deaths have tied North Carolina as the nation’s seventh worst for fatal methadone-related poisonings, according to figures from the National Center for Health Statistics. In 2005, North Carolina had about twice the national rate of such overdoses.

“The problem is so huge, you don’t know where to begin,” said Mary Haynes, a substance abuse counselor in Western North Carolina.

Commonly viewed as a treatment for addiction, especially to heroin, methadone is increasingly prescribed in pill form as a pain medication, leading to an uptick in accidental overdoses. One danger is that methadone remains in the body long after its painkilling effects wear off. As a result, even legal prescriptions can turn fatal when doses accumulate over time into overdoses.

That may have been what contributed to the death of a Winston-Salem woman.

Jewel Imperial, 25, a student and musician, overdosed last September. Her father, Bobby Imperial, said she died five days after being prescribed up to 80 milligrams per day for back pain. He declined to identify her doctor because the family is pursuing legal action.

Methadone is a tricky medicine. In addition to its tendency to linger and accumulate in the body, it offers effective pain relief in a dosage that is very close to the amount that can be toxic.

Patients sometimes increase their dosage to kill their pain. A toxic buildup of the drug can lead to heartbeat and breathing problems. The respiratory system can slow down to the point that breathing stops.

Still, many pain specialists value methadone for severe, chronic pain patients.

One of its selling points is its low price, compared with similar pain relievers. A month’s supply can cost about a tenth as much as generic morphine.

Victims of prescription drug deaths tend to be older and white. In the period 2001-05, more than half of methadone victims in the state were 35 through 54.

Some die after getting legitimate prescriptions to control their pain, while others get the drug on the streets. Overdoses of methadone and other prescription drugs are gradually drawing more attention and more action.

On a national level, the Drug Enforcement Agency and manufacturers early this year restricted distribution of 40-milligram tablets to facilities authorized to treat addictions and hospitals. And in July 2007, North Carolina started a controlled substances reporting system to help doctors and pharmacists prevent patients from doctor shopping, or getting multiple prescriptions from different doctors.

Officials and family members say more should be done.

To prevent overdoses from legitimate uses, “The onus is on the physician,” said Catherine “Kay” Sanford, a former North Carolina state epidemiologist who retired in 2007.

Doctors need to ensure that they are prescribing properly and that patients know how to use methadone, she said.

In addition to educating doctors and patients, Sanford and others also advocate prescribing an antidote along with methadone.



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