Pubdate: Sun, 17 Aug 2003
Source: Kentucky Post (KY)
Copyright: 2003 Kentucky Post
Author: Shelly Whitehead, Post staff reporter 
Bookmark: (Methadone)
Bookmark: (Oxycontin/Oxycodone)
Bookmark: (Heroin)
Bookmark: (Treatment)


Northern Kentucky Is Sedating Itself To Death.

Heroin, methadone, morphine, OxyContin -- all strong opiates -- have
been found in varying degrees and combinations in the blood of the 44
people dead so far this year from accidental drug overdoses in Boone,
Campbell and Kenton County.

That overdose death count for the three counties so far in 2003 is
nearly equal to the number in all of 2002. County coroners see it as
an alarming upsurge in a deadly abuse trend in opiates overall.

Increasingly, though, the cure is part of the disease. The three
coroners say toxicology reports point to another growing problem with
a particular opiate -- methadone.

The narcotic, known for its use in addiction treatment, has been
involved in 16 overdose deaths already this year in Northern Kentucky,
double the number in all of last year.

Yet amid these reports that suggest a growing problem with methadone
abuse comes news of a new effort to open Northern Kentucky's first
methadone maintenance clinic. State officials will say little about
the effort except to confirm that "there's an interest to open one in
Northern Kentucky" involving a group of local business people anxious
to fill what many say is a gap in treatment.

For the growing number of Northern Kentucky residents addicted to
heroin, OxyContin and other opiates, there's one local option for
methadone maintenance treatment: the East Indiana Treatment Center, 30
miles away in Lawrenceburg.

"From Northern Kentucky, we have about 600-plus addicts who drive to
Lawrenceburg every day to get their dosages. Most are coming from the
Florence area," said Mac Bell, support services coordinator  for the
Kentucky Division of Substance Abuse, who keeps close tabs on the
state's addict population and Kentucky's nine narcotic treatment programs.

"There's just a large opiate addiction problem in Northern Kentucky,
and heroin is the drug of choice, mostly because Oxy-Contin has gotten
extremely expensive. -- So there's an interest to open one (a
methadone clinic) in Northern Kentucky.

"This will be the third group that's tried to open up here. The others
got chased out by the community. It all boils down to the old
'not-in-my-backyard' thing."

That "not-in-my-backyard" sentiment was instrumental most recently in
a four-year court fight between Covington and MX Group, a Pittsburgh
concern which planned to open a for-profit clinic in Covington.
Residents and business owners feared the clinic would bring addicts,
crime and plummeting property values. City officials tried to amend
zoning to keep the clinic out.

Last winter, an appeals court ruled in the clinic's favor. After
Covington paid a $140,000 settlement to MX Group last February,
though, the company dropped its plans for a clinic here.

Still, Bell and others say the opiate-addict population continues to
grow in Northern Kentucky. And though the attitude toward treatment
clinics is "not-in-my-backyard," experts say the simple truth is the
addicts already are in everyone's backyards.

All three coroners say the problem is larger than a simple "heroin
problem" or "OxyContin abuse trend." They say most of the dead mixed
three or more medications and street drugs, apparently in search of
that "more perfect high." Too often this year the results have instead
been tragic.

"I go to these death scenes and a lot of people are on numerous
medications and you'll come out with shopping bags filled with
medications," said Boone County Coroner Doug Stith. "They've either
been prescribed a lot, or they're getting a lot of them illegally and
they just start mixing meds, and they don't know the interaction of
the drugs."

The addicts are not those many might suspect. Most are young adults or
middle-aged. Despite the lethal pharmaceutical cocktails they mixed,
the coroners say most only meant to get high rather than die.

Too often the death scenes reveal little about what drugs they took
and where they got them. Only the toxicologist's microscopic analysis
reveals the nature of their fatal addiction.

"I don't think any of these people were determined to be suicides,"
said Campbell County Coroner Mark Schweitzer, who reported 15 overdose
deaths in his jurisdiction in the first half of this year. "They're
usually people who have troubles, and the issue is they're not in
control of what they're taking. They get in over their heads. -- "

Kenton County Coroner Dr. David Suetholz was so concerned about his
medical patients' ability to get monitored medical treatment, he
continued writing methadone prescriptions for addiction. That's
something currently forbidden to family doctors in Kentucky, and
Suetholz lost his license to prescribe drugs for nearly a year.

Though the presence of an amber bottle filled with prescribed
methadone tablets would seem to finger methadone maintenance clinics
as the source of the problem, Bell says otherwise. Methadone clinics
in Kentucky, he says, do not prescribe the drug, only dispense it in
carefully approved portions in a form that is nearly impossible to
abuse for the purpose of a drug high.

Bells asserts that much of the methadone abuse problem in Kentucky
comes out of pain-management clinics where the drug is prescribed like
morphine, OxyContin and other opiates to treat severe pain.

"The methadone we're finding on the streets is the 10 mg. form, and
they don't come from our clinics. We use longer-acting liquid or
sulferated tablets where you have to add water to it so it's not
injectable," Bell said.

"I'm sure some of the methadone (abused) comes out of (maintenance)
clinics. But in the state of Kentucky the (methadone) diversion we see
on the streets is coming from pain management clinics where they may
get 300 tabs of methadone to last for a month and they end up selling
half." On the street, a 10 mg. methadone tablet sells for about $20 in
Kentucky, and, unlike the clinic doses, the pain tablets can be easily
crushed and snorted or injected for the sought-after high. Best of
all, from the opiate-addict's perspective, it's affordable.

These days, though, Bell said heroin is cheaper than methadone on the
street. Methadone is still a "cleaner" and supposedly more reliable
street buy that is much cheaper than other highs like OxyContin (about
$50 per 10 mg. on the street). Apparently, as indicated by its growing
presence in coroners' reports and emergency room visits, it's far more
available than many opiates.

"Obviously there's an access problem here," said Suetholz, a Taylor
Mill family practitioner.

"The ones (methadone addicts) I've seen and been associated with have
had much greater access to it. They take it home from the clinics. --
They go to the methadone clinic -- the patients I talk to -- and the
average dose is over 100 mg. --

"One girl I had that died was given wafers in bottles -- pills this
big -- 100 mg. methadone wafers," he said, making a half-dollar sized
circle with his thumb and index fingers.

"She was taking 150 mg. a day. She had recently taken her weekly
take-home of seven bottles with 150 mg. in each bottle."

Depending on addiction level and other health issues, some addicts can
be maintained on 40 mg of methadone a day.

Many local law enforcement personnel also say that they see methadone
obtained at nearby clinics being abused.

Much of the methadone available in Northern Kentucky comes out of the
Lawrenceburg treatment center. The for-profit business has drawn
criticism for both the ease with which it dispenses methadone and the
take-home quantities provided to patients.

Center officials contend that the clinic has helped thousands who have
come there struggling with opiate addictions.

And, according to the Indiana Division of Mental Health and
Addiction's 2001 report on the 6,809 addicts treated at the state's 12
methadone clinics, patient data refutes the assertion that
clinic-dispensed methadone is being sold in substantial amounts on the
street. The report says the state's experience, based on information
provided by the treatment programs, agrees with national data that
indicates that only one one-thousandth of the methadone dispensed is
diverted to the illegal drug trade.

Besides, as Bell said, the East Indiana Treatment Center undeniably
fills that aforementioned "treatment gap" for the growing number of
Northern Kentucky residents who choose methadone maintenance to kick
the opiate monkey off their backs.

Though Kentucky is renowned for the stringent operating guidelines
imposed on the state's two public and seven private methadone clinics,
those nine facilities combined can treat only about 1,600 opiate addicts.

The closest one to Northern Kentucky is in Lexington -- a long trip
for a daily dose, especially for people whose lives have been so
ravaged by addiction that they may not have a car.

At the Lawrenceburg clinic, 1,800 patients are treated annually -- a
third of them from Northern Kentucky.

To those who argue the programs simply replace one drug of addiction
for another, Bell argues that well-executed and monitored programs
turn lost lives into thriving ones. He says the patient data from
Kentucky's methadone programs shows the difference methadone treatment
can make.

The proposed Florence clinic would have to adhere to Kentucky's
stringent regulations.

"Seventy to 90 percent of our clients eliminate all criminal activity.
Eighty percent or better hold down jobs and have stopped all other
illicit drug use," Bell said. "That's the main thing: to get them off
the streets and stop the criminal activity."

In Kentucky's narcotic treatment programs, continual drug screens
detect the type and quantity of drugs clients are using, including
methadone. Bell said the tests finger clients who are abusing other
drugs or selling clinic-supplied methadone.

He says few do that, particularly at the two state-run lower-cost
clinics where waiting lists are up to 13 months long. The desperation
of some addicts to kick their habits is evident in the lengths some
indigent women have gone to for free treatment.

"In Kentucky, our public clinics are based on ability to pay because
we don't have a third-party payer in the state at all. We don't have
Medicaid reimbursements for substance abuse," Bell said.

"The only way (to get treatment paid for in Kentucky) is for pregnant
opiate addicts. We have a lot of women who intentionally go get
pregnant to get the services for nine months. -- It sounds off the
wall, but we're talking about a disease here."

That desperation and level of addiction exists in hundreds of people
in Northern Kentucky now, Bell says.

He and others in law enforcement, health care and the legal system
believe the problem of opiate abuse here is fast becoming an issue
that demands immediate attention before the addicts in our backyards
become the addicts in our graveyards.
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MAP posted-by: Larry Seguin