Pubdate: Sun, 01 Sep 2002
Source: Portland Press Herald (ME)
Copyright: 2002 Blethen Maine Newspapers Inc.
Author: David Hench


Methadone poisoning killed six of the eight Portland overdose victims for 
whom blood tests are complete, providing the strongest evidence yet that 
the medication has contributed to this year's surge in overdose deaths in 

All six had histories of substance abuse. None was a client of the two 
local clinics that distribute methadone to help quell addicts' craving for 
heroin, according to data provided by police agencies at the request of the 
Portland Press Herald/Maine Sunday Telegram. All six obtained the 
methadone, at least indirectly, from someone for whom it was prescribed and 
presumably without the warnings that medical staff dispense.

The findings come as Maine is trying to address a major increase in the use 
of heroin and other illegal opiates, which is causing a wave of accidental 
overdoses and drug arrests statewide. It also comes as one of the two 
clinics that operates in Greater Portland, Discovery House, is trying to 
open an office in Bangor. It would be that city's second treatment center 
and Maine's fifth.

Methadone clinics are designed to address addiction problems by blunting 
the craving that users feel. But the clinics also create the potential that 
people who are not supposed to have the medication will misuse it.

"While this drug is effective for people under a physician's care, it's a 
very potent and dangerous drug to use recreationally," said Kim Johnson, 
director of the state Office of Substance Abuse.

On Friday, Johnson met with officials from the Maine Drug Enforcement 
Agency to analyze the 23 Portland deaths believed to have been caused by 
accidental drug overdoses so far this year. They are looking for clues 
about what has caused the sharp rise in accidental overdoses from the 16 
Portland experienced during all of 2001.

"Really, of the people that died, the only common factor is they were known 
drug users," Johnson said. Authorities suspect methadone is the culprit in 
10 cases, but the number cannot be confirmed until toxicology reports are 
complete. Those reports can take several weeks to finish.

In the meantime, the Maine Office of Substance Abuse, Portland Police 
Department and Portland's Department of Health are trying to understand the 
surge in overdose deaths, particularly those related to methadone. 
Methadone has not historically been a recreational drug because it does not 
produce the high of many other drugs.

The state medical examiner's office is analyzing overdose deaths for the 
past five years, looking for trends and trying to determine when the 
problem started to spike upward. Yale University researchers are studying 
Mainers' illegal drug habits to determine why certain drugs become popular.

Police are investigating the deaths for possible criminal charges and are 
working to stem the illegal diversion of methadone, a synthetic narcotic.

"When people accidentally overdose, you have a public health issue where 
the availability of these drugs on the street is a concern," said Portland 
Deputy Police Chief William Ridge. "When that person's dying, that's of 
particular concern to us."

Ridge said the overdose data "speaks to the potency of methadone, and I 
think it speaks to the dangers of these very strong medications being 
handed out the way they are and then changing hands."

State and city health workers are trying to reduce illicit demand by 
developing a public education campaign in conjunction with the clinics and 
federal health officials. The goal would be to counteract whatever 
misperceptions have made methadone a trendy street drug in the Portland 
area. Medical experts from the federal Center for Substance Abuse Treatment 
will visit Portland's clinics to explore why efforts to curb illegal 
methadone use have failed.

A Yale University study currently under way in Maine could provide some 
insight. Researchers are examining how certain drugs come to be popular and 
have recently added methadone to the list of drugs being studied, Johnson said.

"Basically, this is a new experience. When I talk with experts across the 
country they are kind of astounded with what's happening in Portland," 
Johnson said. "On the list of opiates, methadone is not a good high. It 
doesn't have a very strong euphoric effect. It has a pretty strong sedative 
effect," Johnson said. "That's the story for why people don't generally 
abuse it. It doesn't make you feel very good like the other drugs do."

Methadone is a legal medication designed as a heroin substitute for 
addicts, but it also is a powerful narcotic that depresses the respiratory 
system in ways similar to heroin. Its sedative effects are magnified 
greatly by alcohol and other prescription and illegal drugs.

The high number of confirmed methadone poisonings so far this year comes at 
a time when methadone use, both legitimate and illegal, is growing. Greater 
Portland's two clinics, Discovery House in South Portland and CAP Quality 
Care in Westbrook, serve 925 clients compared to 475 served by one clinic 
just over a year ago.

Growth in the legitimate use of methadone has resulted from an increase in 
the addict population, officials say. Many of those users may have started 
their drug habits with prescription painkillers like oxycodone, Percocet or 
Dilaudid - a drug problem that has had a presence in Maine. Growing abuse 
of such prescription opiates could help explain the rising demand for 
methadone and an increasing incidence of its theft or diversion.

"If we hadn't had growth in opiate abuse in general, we wouldn't have had 
growth in methadone treatment," Johnson said. "Because opiates in general 
is a popular class of drugs right now and because methadone is in that 
category, that's part of why it's getting used more."

Health officials say Portland's fatal overdoses represent about one- third 
of the total for the state.

Rhode Island-based Discovery House, which also runs a clinic in Winslow, 
wants to open a new clinic for up to 250 patients in Bangor, which would be 
that city's second methadone clinic. Acadia Hospital, the city's first 
methadone provider, is looking to expand its year-old drug treatment 
program from 150 patients to 300.

Abuse of drugs like oxycodone has been a serious problem in Bangor and 
surrounding communities, as well as in the state's eastern counties.

Steve Cotreau, program director at CAP Quality Care in Westbrook, said he 
believes the growing problem with misuse of methadone by long-term 
substance abusers indicates that the region has a serious problem with 
addiction, but that those people could not or would not access treatment.

"As much as it is a problem of what they got ahold of, it's 'why are they 
seeking it in the first place?' It's just not something that somebody who 
isn't addicted or has a substance abuse problem would think of," Cotreau said.

"When we can reach people, we can educate them on the danger of mixing any 
opiates with, especially, alcohol and benzodiazepines (a class of 
sedatives)," Cotreau said. "The challenge is, for the person who is not in 
treatment, how do we get that message out there. If we can educate friends 
and family and acquaintances, so they might see something going on if they 
know what the dangers are, that might help," he said.

Cotreau supports efforts at educating some people who do not use the 
clinics about the dangers of inappropriate methadone use. However, he said 
curtailing the ability of clients to take their medicine home would be too 
drastic and could aggravate the overdose problem. Despite its dangers, 
methadone has helped hundreds of people stay off illegal drugs in Greater 
Portland and health officials and providers of the medication say 
eliminating clients' ability to take the medication home could lead many to 
turn back to street drugs.

"There's no simple fix to this," Cotreau said. "You can say the options are 
either close clinics or have people come in daily. Either of those options 
is going to put an inordinate number of people back on street drugs and 
that's going to lead to more overdose deaths.

"People build lives around those take-home doses. They get jobs. They have 
commitments that will no longer allow them to come to the clinic daily. If 
we said, 'You have to come back to the clinic daily,' that would in fact be 
turning them back onto the street."

Most of the thousand people in treatment at the two Portland-area clinics 
are at a point in their treatment where they're starting to live normal 
lives and reside in other parts of southern Maine, said Johnson, the state 
substance abuse prevention director. "You would be asking people who are 
basically like you or me to travel every single day to get a medication."

Federal take-home regulations were relaxed last year to allow long- term 
addicts to take home up to 31 days' worth of methadone at a time. State 
regulations are being tightened to limit that to two weeks.

An inspection found that Portland-area clinics are following federal 
regulation, in terms of screening and monitoring clients, as well as how 
they dispense methadone. Still, some drug investigators question whether 
the rules regarding take-home doses are sufficient.

"Just because the regulations are being followed doesn't mean the 
regulations are correct," said Sgt. Scott Pelletier, Portland-area 
supervisor for the Maine Drug Enforcement Agency. "And just because it's a 
legal drug doesn't mean it's not creating a problem when it's used illegally."

Public health officials say the methadone problem in Portland centers 
around how the clinics are deciding which clients are ready for take- home 

"Take-home doses do make sense for stable people who have their addiction 
under control," said Nate Nickerson, Portland director of public health. 
"They don't make sense for people whose lives are rocky, who are not 
housed, and who are not ready for that kind of responsibility.

"The clinics have to be vigilant and continue to monitor the issues around 
the diversion of methadone to people who don't understand how it works and 
are taking doses intended for people with much higher tolerance," he said.

People who are prescribed methadone receive extensive guidance about using 
the drug and its interaction with other drugs. They must sign a document 
that says they agree to keep take-home doses locked and hidden, 
particularly from acquaintances with substance abuse problems.

The documents states: "Taking a single dose can easily cause overdose and 
death in anyone not physically dependent on methadone, heroin or 'pain 
pills.' " Heavily addicted clients might take 180 milligrams of methadone a 
day to stave off withdrawal, but just 50 milligrams can kill a person who 
does not have a tolerance for the drug.

The clinics have made it more difficult for clients to earn the privilege 
of having take-home doses. They now open seven days a week to serve those 
people who can't be trusted to manage take-home doses.

Cotreau said an analysis of the overdose deaths could help shed light on 
which clients are unable to manage their doses and for what reason.

In some cases, the medicine is diverted to a friend or loved one who is 
experiencing withdrawal from his own addiction but has not sought 
treatment. In other instances, the medicine is stolen by or sold to other 

Some city law enforcement and health officials are critical of the 
Portland-area clinics because they are for-profit companies that offer no 
programs to help clients get off drugs. They are considered methadone 
maintenance programs, which means an addict can expect to be on methadone 
for the rest of his or her life, they say.

"I don't think health care should be for profit because I think there's an 
inherent conflict of interest," said Gerald Cayer, Portland's director of 
health and human services. "And I think methadone treatment is health care."

Cotreau bristles at the suggestion that the for-profit clinics try to 
promote business.

"I don't want any more patients," said Cotreau, a social worker who said he 
made more money managing a restaurant. "It would be like saying there's a 
cancer doctor that wants people to get cancer. I would love to close the 
doors because there's no need."

Staff Writer Kelley Bouchard contributed to this report.


Rules, Warnings For Methadone Use

Before methadone clinic clients receive doses of the medicine to take home, 
they must agree to abide by certain rules and be aware of the dangers. At 
CAP Quality Care in Westbrook, the rules and warnings include the following:

Methadone should be secured in a locked box at all times; the box should be 
hidden even in the home and nobody else should know where it is kept.

Selling or giving away your methadone will result in termination from 
treatment, and you will face legal charges.

Methadone in the wrong hands can result in death.

Methadone, mixed with alcohol, or any other drugs, is a dangerous 
combination and could lead to death.

Never assume that a verbal warning is enough to discourage someone from 
taking your methadone.
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MAP posted-by: Larry Stevens