Pubdate: Sun, 15 Sep 2002
Source: Portland Press Herald (ME)
Copyright: 2002 Blethen Maine Newspapers Inc.
Author: David Hench
Note: Staff researchers Julia McCue and Beth Murphy contributed to this story


Several areas of the country have experienced a surge in methadone 
overdoses much like Portland has seen this year, part of what drug policy 
officials say is an increasing problem with the illegal use of prescription 

Portland has experienced a record 23 suspected overdose deaths this year, 
nine of which are believed to have been caused by methadone. In all of 
2001, there were 16.

Officials in Virginia and Florida say they witnessed a similar increase in 
2001, and the problem seems to be growing this year.

Nationally, emergency room treatment tied to methadone abuse grew 37 
percent from 2000 to 2001, according to the Drug Abuse Warning Network of 
the U.S. Department of Health and Human Services.

Drug policy officials have been unable to pinpoint the cause for the 
dramatic increase in methadone abuse, although increased availability of 
powerful prescription drugs, misinformation about their properties and 
faddish trends in use seem to be factors.

"There's always been prescription drug abuse as long as there have been 
prescription drugs," said Kim Johnson, director of the Maine Office of 
Substance Abuse. "The thing that seems different now is they're young 
people, and I just think the quantity of it is bigger than it has been in 
the past."

The prescription drugs frequently being abused today - opiates like 
methadone and oxycodone - are extremely powerful and deadly when misused.

"It's spread the same way as any other kind of fad. It's just word of 
mouth. Unfortunately, a lot of (the information) they share with each other 
is really wrong, and it seems clear in this case there's a lot of mythology 
about prescription drugs in general and methadone in particular," Johnson said.

And prescription drugs are more available to those people who would abuse them.

Synthetic opiates like oxycodone had become common on the street through 
forged prescriptions; drugs improperly obtained through feigned symptoms 
and patients using multiple doctors; and theft.

The increased use of methadone to curb the craving for drugs like heroin 
and OxyContin also has created new avenues for drug users to obtain methadone.

None of the people who died as a result of methadone poisoning in Portland 
were clients of the area's two methadone clinics. This fact suggests they 
obtained the drug illicitly and has led to calls by some police officials 
for new curbs on its distribution. These officials have called for an end 
to the practice of allowing methadone clinics to dispense doses of the drug 
for future use, which they say dramatically increases the opportunity for 

"Methadone has become a major law enforcement problem across the country," 
said Portland Police Chief Michael Chitwood.

For example, methadone overdose deaths in Florida surged 80 percent last 
year to 179. By comparison, cocaine killed 390 people and heroin 271.

The methadone problem appears most severe in Florida's rural panhandle, 
where oxycodone abuse has also been a major problem. The problem of 
misusing prescription drugs seems to have spiked in the past 24 months, 
said James McDonough, director of the state's Office of Drug Control.

Florida has had some success curbing oxycodone and hydrocodone abuse 
through education of potential users and health professionals and through 
law enforcement, and McDonough hopes similar strategies will pay off in 
dealing with methadone abuse.

"You have to almost prove drug by drug that you're playing with your life," 
said McDonough. "Maybe the addicts had to understand that oxycodone and 
hydrocodone were super dangerous and then their buddy told them methadone 
was less dangerous. There's been a major movement toward abuse of 
prescription drugs and methadone is seen as a painkiller just like 
oxycodone is seen as a painkiller."

Police describe a new group of hard-drug users - those who were initially 
attracted by the perceived safety of prescription OxyContin, which when 
stripped of its time-release properties produces a powerful high. Some of 
those who became addicted to the painkillers moved on to heroin, police say.

In many methadone clinics across the country, clients seeking help with 
addiction to oxycodone - the active chemical in the brand-name drug 
OxyContin - exceed those addicted to heroin, according to a survey by the 
Drug Enforcement Administration.

Addicts, whether on heroin or OxyContin, find themselves experiencing the 
craving that methadone helps alleviate.

But a methadone dose that may be appropriate for one person can kill 
someone else. Also, the depressant effects on the body are exaggerated by 
the use of other drugs or alcohol, which is often the case when methadone 
is used without physician supervision.

That problem seems to be at the root of some methadone overdose deaths in 
Maine, where people have taken large doses of methadone in search of a 
high, or mixed it with other drugs with the same intention.

Western Virginia has struggled with OxyContin abuse, and the number of 
methadone deaths doubled to 44 from 2000 to 2001. There were 22 in the 
first three months of this year, said assistant chief medical examiner 
William Massello.

In the rural area of the state, drug users have only sporadic access to 
drugs like heroin and cocaine, and so prescription drug diversion has 
become a major source of narcotics, as it has in rural parts of eastern Maine.

"We saw a sudden increase in OxyContin in 1998, '99 and 2000. That's when 
we got this tremendous surge. Then right behind it, methadone started 
picking up," Massello said. "Right now we're anticipating we'll see more 
methadone than OxyContin, significantly more."

But there are differences in Virginia's and Maine's experiences. While 
police here believe most of the methadone involved in overdoses has come 
from methadone clinics, Massello said virtually every methadone overdose he 
is aware of in his state has been related to pills prescribed for pain by 

In Maine, some officials are linking the problem to the dispensing policies 
of methadone clinics.

"What has happened is it's becoming more available because there are more 
and more clinics that allow take-home, which is going to lead to diversion 
on the street in some cases," Chitwood said.

Methadone also is being prescribed more often as a pain medication by 
doctors trying to avoid prescribing OxyContin because of its potential for 
abuse, he said.

But not all police officials in Maine are focused on dispensing practices 
as the root cause of methadone-related overdose deaths.

Westbrook Police Chief Steven Roberts, whose city hosts one of the Portland 
area's two methadone clinics, says methadone maintenance has a strong track 
record for keeping people off illegal drugs. And that, he said, helps to 
reduce the burglaries, thefts and robberies that coincide with illegal drug 

Investigators suspect methadone played a part in several of the seven 
overdose deaths Westbrook has experienced so far this year, but police are 
focusing their investigation on those individuals who provided the 
methadone, not on the clinics.

"Some people choose to ignore the warnings. A small percentage of them are 
going to die from it. That doesn't mean you have to throw the baby out with 
the bathwater," said Roberts, who supports the use of methadone.

"The reality is there are some people who can only be treated by take- home 
doses by nature of their work, where they live and distance to the clinics. 
Let's not demonize the people attempting to treat these folks; let's look 
at the people who are diverting it and hold them responsible."

Clinic directors say the abuse of methadone by those for whom it is not 
prescribed reflects a problem in the community with untreated addiction. 
They say they are working to make sure only those people who handle their 
take-home doses responsibly maintain those privileges.

Diversion of methadone is a relatively new problem, at least to the current 
degree. The medication has been used effectively to replace addiction to 
opiates for more than 30 years. Drug policy officials say people receiving 
methadone treatment are 68 percent more likely to hold a job and 47 percent 
less likely to commit crime.

"What else do we do in this society that would reduce criminal behavior by 
that percentage?" asked Johnson, of the Maine Office of Substance Abuse.

Johnson said police who favor scaling back take-home doses see only the 
worst in methadone usage, drug users who are not in recovery and the bodies 
of those who have gambled with powerful drugs and lost.

"They only see the people who are in trouble. They're never going to know 
all the rest of the patients who come to work every day, who live stable 
lives and have families. That's the majority of patients," she said.

There are 925 patients enrolled at the Portland area's two methadone 
clinics, Discovery House in South Portland and CAP Quality Care in 
Westbrook. There are also clinics in Winslow and Bangor.

Historically, methadone has not been viewed as a recreational drug, because 
it does not produce the high that other drugs do. It is designed to stop 
the cravings for heroin and other opiates, without creating a sense of 

But for some reason, the drug culture in Portland and possibly other parts 
of the country has identified methadone as a recreational drug.

Johnson traveled to Washington recently to discuss the problem with 
officials at the National Center for Substance Abuse Treatment. She 
returned with a $50,000 grant to study users' beliefs about methadone and 
other prescription drugs and to devise an educational campaign to 
counteract dangerous misinforma-tion.

Drug habits do change over time, and sometimes identifying the reasons 
behind the popularity of a particular drug can be difficult.

During the late 1970s and early 1980s, PCP was a popular recreational drug 
until it was linked to several deaths. In the 1960s, powerful amphetamines 
were all the rage on Munjoy Hill, recalls Roberts, a Portland police 
officer at the time, "till you had several kids die and then it dropped off."
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