Pubdate: Sun, 28 Oct 2007
Source: Charlotte Observer (NC)
Copyright: 2007 The Charlotte Observer
Contact:  http://www.charlotte.com/observer/
Details: http://www.mapinc.org/media/78
Author: Eric Frazier
Bookmark: http://www.mapinc.org/find?136 (Methadone)

Company: N.C. Officials 'Welcomed'

CLINICS PROBED IN DEATHS LINKED TO METHADONE

At Least 16 Tied To Drug Used To Help Addicts; Fatalities Rise In N.C.
As Prescriptions Grow

N.C. health officials are investigating the deaths in the past year 
of at least 16 patients treated for drug addiction at clinics run by 
a Charlotte company. The probe comes as the state tries to combat a 
growing number of deaths involving methadone, a drug traditionally 
used to help heroin addicts but increasingly prescribed as a painkiller.

In 2004, North Carolina's 245 methadone-poisoning deaths trailed only 
Florida's, according to a new federal study.

The N.C. Department of Health and Human Services is investigating 13 
patient deaths this year and three from late last year involving 
McLeod Addictive Disease Center. Health officials list the probable 
cause of death as methadone toxicity or a lethal combination of 
methadone and other drugs. Little comparative data exist on methadone 
deaths involving clinics; state and federal authorities couldn't say 
for certain whether McLeod's 16 deaths are unusually high.

"I can only say that would be troubling to us here," said Robert 
Lubran, head of the federal agency that regulates methadone clinics. 
He said N.C. officials have asked for help in responding to the 
deaths at the company's clinics. McLeod President Eugene Hall said 
his company runs an exemplary program that follows all state and 
federal guidelines. McLeod operates eight clinics throughout the 
Charlotte region and in Marion and Boone. It bills itself as the 
Carolinas' largest methadone treatment program.

Hall said his clinics serve more than 6,000 people each year, an 
increase of about 2,000 in the past three years. By his company's 
count, 19 patients died this year in methadone-related cases -- the 
same number as in each of the two previous years. (McLeod defines 
methadone-related deaths more broadly than the state, thus the higher 
number.) "I've welcomed (state officials) down to look at our 
program," he said. "If we're not doing it right, then nobody's doing 
it right." State rules require clinics to report all deaths to 
county-based regulators, and state officials are supposed to track 
such statistics. But methadone clinics, like group homes and other 
state-regulated facilities, operate largely on an honor system when 
it comes to reporting deaths. When asked last week how many clinic 
patients have died statewide, N.C. officials said they did not have 
the data readily available. Prescribed more as painkiller Methadone 
traditionally has been used to wean heroin and other drug addicts of 
their habits. Increasingly, doctors have prescribed it for chronic 
pain, or for patients who've become addicted to powerful painkillers 
such as OxyContin.Methadone prescriptions nationwide jumped from 
about half a million in 1998 to more than 4 million last year, 
federal statistics show. Most of the new users are patients with 
prescriptions for pain medication. Experts say methadone is so 
powerful that improper dosages, or combining it with other drugs such 
as cocaine, Valium or Xanax can prove fatal. In North Carolina, 
methadone-related deaths of all types jumped from 121 in 2001 to 318 
in 2005, state figures show. South Carolina had 37 deaths in 2004, 
according to a federal study.

Government and academic researchers say clinics aren't to blame for 
much of the increase. Instead, they point to the growing use of the 
drug as a prescription painkiller. The amount of methadone sold to 
N.C. pharmacies and hospitals quadrupled between 1997 and 2001, one 
study showed. Patients who take the drug at home, rather than in the 
controlled doses offered at clinics, are more likely to misuse it, 
said Lubran, with the U.S. Department of Health and Human Services.

Federal officials in recent months have been warning all states to 
keep an eye out for increases in methadone deaths.

N.C. health officials say such federal advisories prompted them to 
investigate McLeod, a nonprofit company with nearly 300 employees. 
Lethal drug combinations McLeod treats addicts on a walk-in basis, 
charging them $10 per day for pre-measured doses of methadone after 
they've been examined by a doctor. Some come to McLeod because judges 
have ordered them to get treatment. Hall said his clinics saw a 
series of deaths from the fall of 2006 until this spring. In an Oct. 
17 letter to state officials, McLeod's medical director, Jana Burson, 
said the company investigated and found that most cases involved 
fatal combinations of methadone and other drugs. Patients nationwide 
have been known to use it with Xanax or Valium in search of the kind 
of euphoric high methadone alone can't provide. The McLeod clinics 
responded to the deaths by restricting admissions of patients 
suspected of such addictions and by more aggressively warning of the 
dangers of such lethal drug cocktails, Burson wrote.

Hall said investigators have visited five of the eight McLeod clinics 
in recent weeks. "The findings have been absolutely minimal in terms 
of finding anything wrong," he said.

State health official Spencer Clark declined to discuss what was 
found on those visits, saying the information is part of an ongoing 
investigation. But Hall provided a copy of a report filed after state 
auditors in September visited the McLeod facility in Marion. The 
report showed minimal problems. The Observer, using the N.C. open 
records law, also received copies of the state reports McLeod filed 
for each fatality. State officials blackened out the patients' names 
and personal information, and many of the reports shed little light 
about the deaths.

One case, though, involved a woman who traded her methadone to a drug 
dealer, then overdosed on what she received in return. Several others 
died after mixing methadone with alcohol and other drugs. Two other 
companies operate methadone clinics in Mecklenburg, but neither has 
reported any deaths since 2004, said Grayce Crockett, head of 
Mecklenburg Area Mental Health.

Crockett's agency is responsible for monitoring the sole McLeod 
clinic in Mecklenburg and submitting quarterly reports to the state. 
She said a visit this summer to the facility on Remount Road turned 
up no problems. "We found everything was appropriate and in place," 
she said. "Our medical director didn't have any recommendations for 
them as a result of the review." McLeod only clinic probed Clark, of 
the Division of Mental Health, said his agency also is checking to 
see if any deaths have been reported at the 27 other clinics around 
the state. But he stopped short of saying whether any of those 
facilities is being investigated.Lubran, the federal methadone 
regulator, said N.C. officials have expressed concern only about 
McLeod's numbers, but he wants a statewide look at clinic deaths.

Depending on the results of the state investigation, McLeod could 
lose federal certification and be forced to close. Lubran said three 
out of more than 1,100 clinics nationwide have been closed this year. 
Hall, the McLeod president, said the state would not know of his 
clinics' deaths had he not been scrupulous about reporting them. The 
state doesn't have accurate totals, he said, because many other 
clinics don't report. "We're being punished, essentially, because we 
were attempting to comply." Methadone Precautions Last year, the U.S. 
Food and Drug Administration issued a public health advisory about 
the use of methadone:   Patients should take methadone exactly as 
prescribed. Bigger doses can slow or stop breathing and can be fatal.

Patients taking methadone should not start or stop taking other 
medicines or dietary supplements without talking to their health care 
provider. Taking other medicines or dietary supplements may reduce 
pain relief. They may also cause a toxic buildup of methadone.

Trouble signs: Difficult or shallow breathing, extreme fatigue or 
sleepiness; blurred vision; inability to think, talk or walk 
normally; and feeling faint, dizzy or confused. If these signs occur, 
patients should get immediate medical help.

For more, visit www.fda.gov/CDER/Drug/advisory/methadone.htm History 
of Methadone Methadone is a synthetic narcotic similar to morphine. 
Synthesized in Germany, it came into clinical use after World War II. 
When methadone is given to a heroin addict who is later withdrawn 
from methadone, the addict will undergo methadone withdrawal instead 
of the more severe heroin withdrawal. In the 1960s, Drs. Marie 
Nyswander and Vincent Dole promoted methadone as a therapeutic tool 
to rehabilitate narcotics addicts. The drug is now in use in 
maintenance programs in the United States, Thailand, Sweden and Hong 
Kong. Methadone is mostly dispensed in oral form, as a liquid or a 
wafer, under supervision.

Source: Columbia Electronic Encyclopedia
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MAP posted-by: Jay Bergstrom