Killer or cure?

Spike in methadone-related deaths has some seeking drug regulation

A drug commended years ago for helping to loosen heroin’s deadly grip in Pennsylvania and beyond may now be the region’s No. 1 killer.

Coroners say 21 people in Blair, Cambria and Clearfield counties died of accidental methadone overdoses in 2007 – more than the statewide total in 2001.

It’s an eye-opening number, particularly in Cambria County, where 12 people died of methadone overdoses last year, even compared with the state’s rising toll of deaths – 114 in 2005, the most recent year for which totals are available.

And in this region, the sharply rising number of methadone deaths in recent years vaulted the drug among the top – if not the top – drug overdose killers last year.

It was No. 1 in Blair and Cambria in 2007 – representing about one-third of both counties overdose deaths, coroners’ statistics show.

While Blair tallied five deaths, 23 people have died from accidental methadone overdoses in the past two years in Cambria County, compared with six in 2005 and onein 2002, Cambria Coroner Dennis Kwiatkowski says.

Clearfield tallied four after having five in 2006 and none five years ago.

“A lot of the accidental overdoses we’ve seen, there’s been methadone involved,” Kwiatkowski said. “And it’s not just kids – you’re looking at a list where most of these people are in their 30s, 40s and 50s.”

“It’s killing people at therapeutic levels,” said Marti Hottenstein, vice president of Helping America Reduce Methadone Deaths, a grass-roots group battling to tighten regulations on the drug. “It’s killing more than illicit drugs – drugs it’s supposed to help people from.”

Like in other counties, several of those found dead in Cambria County had alcohol, and in some cases, other drugs in their systems when they died. In all 12 cases last year, methadone was the main factor, Kwiatkowski said.

Bedford and Centre counties reported no methadone-related deaths in 2007, although Centre Coroner Scott Sayers said overdoses with two or more drugs in the system were classified only as “multidrug” deaths – an increasingly common finding, he said.

Methadone is a synthetic opioid used to treat addiction to heroin and powerful painkillers such as OxyContin to ease withdrawal symptoms.

Once rarely found outside a methadone clinic’s walls, the drug now has become a common doctor’s prescription for moderate to severe pain.

And distribution has been on the rise – not just in clinics, but at pharmacies and in doctor’s offices, statistics show.

Clinics and attention

Methadone and the clinics that dispense it have become almost synonymous in this area – and for good reason, folks like Hottenstein believe. She believes many clinics are over- medicating users and should face tighter regulations.

Deserving or not, clinics have been a lightning rod for attention in this region, drawing opposition anytime an operator tries to open one.

Although supporters say there is no proof crime and problems follow the clinics, residents picked up signs and protested in Blair County, for example, when plans for a clinic near Foot of Ten Elementary School surfaced.

It has been the same in Clearfield County, where District Attorney William Shaw has been a vocal opponent of the clinics and sought legislation to regulate them further.

“The establishment of a methadone clinic in our community has created an unacceptable situation where these types of senseless deaths occur,” Shaw said after Bobbi Jo Morgan’s vehicular homicide arrest last year.

A jury found the Patton woman was high on the drug when she crashed her vehicle in Mahaffey, killing two people.

At the time, she was on her way home from a methadone clinic.

But while clinics often take the heat when methadone-related deaths or crimes are reported, they aren’t the only place the drug is distributed.

In fact, investigators and experts say, they are just one increasingly minor player.

Not just a clinic drug

Blair, Cambria and Clearfield all had at least one methadone clinic operating within their boundaries in 2007, but more people fear it’s the increased distribution of the drug that may be to blame.

Once used primarily to wean addicts off of powerful painkillers, methadone now is being used to treat pain, as well.

In part, experts say it was a reaction by doctors looking for an alternative to another powerful drug – OxyContin, which began wreaking havoc in the region earlier this decade.

Methadone has been around for years as a useful therapy for people who are opiate-dependent, but it wasn’t until the past five years that a surge of users started ending up in body bags, said Dr. Westley Clark, Substance Abuse Treatment Center director for the U.S. Department of Health’s SAMHSA agency, the Substance Abuse and Mental Health Services Administration.

From a doctor’s perspective, there are good reasons to prescribe the drug, he said.

“Methadone is a generic drug,” Clark said, adding that the price of methadone has made it a popular option. “Health plans encourage cheaper drugs, and it is an alternative.”

But it is putting the drug into the hands of more people – those who may not need a drug that strong – and to help with problems it wasn’t designed to treat, he said.

Kevin Price, Cambria County Drug Task Force field supervisor, didn’t see the drug on the streets four or five years ago.

“A lot of the times we find methadone, we’re finding quantities of it – not just one or two. We’ll find empty pill bottles that should be filled and aren’t,” Price said.

The detective has mixed feelings about methadone clinics.

“But from what I know about them, they have strict rules and regulations on how they dispense their methadone, and I think that’s the right idea to have,” he said, adding that a patient typically only receives a pill or two at a time.

“Do some of those pills still make the streets? Sure, but is that where they are all coming from? Absolutely not.”

SAMHSA wrote in a 2007 report on the drug that the greatest rise in methadone tablet distribution is coming from pharmacies – not clinics.

But Hottenstein points out something SAMHSA has seemed to agree with: that no one has proven that any single prescribing practice – whether it’s through clinics or local doctors – should shoulder the blame for the surge in accidental overdose deaths.

“You can’t rule out clinics because we don’t know where most of these deaths are coming from,” she said. “We still don’t know.”

Killer or cure?

Clark supports methadone for opiate addiction treatment, and he believes it is doing its job helping heroin addicts, curbing related overdose deaths and, in many areas, reducing trafficking.

“There was a time when use of drugs like heroin through injection was nearly 40 percent of new cases. That major heroin problem meant a major HIV problem,” he said, adding that use of methadone makes injecting the drug worthless by taking away the “high.”

With methadone in the mix, injection rates have dropped to 19 percent, Clark said.

There are signs methadone is making a positive difference here, too.

Cambria hasn’t had a heroin-related death in several years, and while it remains a significant problem in Blair, it is no longer dubbed an “epidemic” – or spawned double digit deaths since 2005.

But Clark, too, is worried about methadone.

“Methadone,” he said, “is a drug with its own unique properties.”

It is effective if used properly – but potent and long-acting, he said, adding that a dose of the drug can begin to work slowly in the body and last 12 hours to several days or more.

It gives uneducated users ample time to make deadly mistakes, Clark said.

“Methadone is a somewhat complicated and dangerous drug,” Philadelphia-area forensic toxicologist Matthew McMullin testified at Morgan’s Clearfield County vehicular homicide case in June. “Unlike other drugs, therapeutic and lethal concentrations overlap with methadone, particularly when someone is just starting to use the drug.”

With methadone more readily available than it used to be – and education about it not always following suit – it can lead to deadly consequences for those who mix alcohol or other drugs – even a day or two after the drug is taken, Clark said.

Hottenstein, of Bucks County, said her son didn’t know that when he bought a few methadone pills from a friend on the street in 2006.

At the time, the young man was struggling to kick painkiller addiction – the fallout from a car crash that left him in serious pain and medication-dependent.

“I lost my son to methadone,” said Hottenstein, who is now part of a Pennsylvania Senate-formed task force to study the drug. “He didn’t know what he was getting himself into.”

Her son wasn’t alone.

It’s likely many overdose victims in this region didn’t know much about methadone either when they started taking the drug – in many cases, illegally, coroners said.

In Blair County, for example, only one of five who died from methadone overdoses had been a clinic patient, Coroner Patty Ross said after tallying her county’s 2007 deaths.

“If used right,” Kwiatkowski said, “methadone is a good drug. If it is used the way it is intended, like a lot of drugs, it has helpful qualities.

“But if you abuse it, it can kill you.”

Clark: Education needed

Inside state-regulated clinics, education and counseling are part of methadone maintenance programs, Clark said.

Those added measures – combined with “lock boxes” for take-home doses – something SAMHSA recommends – all work to curb the likelihood of overdosing, as well as opportunity for thefts, he said.

But with practitioners, “there has to be a greater emphasis placed on educating them about the dangers of opiates like methadone,” said Clark, who believes that, in many cases, there may be better alternatives for pain treatment.

He says SAMHSA is working on drug policy and with the federal Drug Enforcement Administration on strategies to “encourage” practitioners to learn more about methadone.

Because things could get worse, Clark said.

“We need to reach out to patients, the public and the media because we need to be aware that we have a boomer population that will be running into more pain problems associated with getting older. There’s going to be that demand [for pain medication].”

His message to physicians: Know the drug.

“Know the drug and know your patient,” Clark said, because it might be the best option available for those who cannot afford high-priced anesthetics.

Price agreed. Of course, anyone who uses the drug would be wise to know what they are taking.

“People think, ‘Hey, pills like these come from doctors,'” so there’s that perception there that this is medicine that will help you,” Price said. “But when you start mixing any drugs, it can be a death sentence.”

Hottenstein believes anyone who distributes the drug should have a special Drug Enforcement Agency license to do so – as is required with some other drugs. Clinics, she said, should be open seven days a week – not five or six – to avoid giving users take-home doses and opportunities to misuse the drug.

And in Pennsylvania, where a 2007 Senate resolution was passed to commission a task force to study methadone, she’s hopeful the findings will yield stricter laws to regulate the drug.

To date, though, no state in the region has passed laws to regulate methadone further, she said.

Law enforcement, physicians, the community – everyone “needs to pay attention to what’s happening,” Price said, “because people are dying.”
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source: The Altoona Mirror, http://www.altoonamirror.com