Pubdate: Fri, 22 Feb 2008
Source: Herald-Dispatch, The (Huntington, WV)
Copyright: 2008 The Herald-Dispatch
Author: David Caraway
Bookmark: (Chronic Pain)
Bookmark: (Methadone)
Note: David Caraway is medical director of the Center For Pain Relief Tri


I read with interest the comments of Gen. Barry McCaffrey, a paid
adviser to CRC Health Group, which operates a methadone clinic in
Huntington, and of CRC CEO Barry Karlin published in The
Herald-Dispatch on Feb. 15 urging West Virginia lawmakers to embrace
methadone clinics.

The information supplied is not balanced or complete.

Methadone maintenance was described as being a safe and efficacious
method for treatment of opioid addiction. McCaffrey stated that
methadone programs "... can get many people addicted to maintain sobriety."

What has not been clearly communicated to the customers of these
clinics, to lawmakers and to the general public is that methadone
maintenance as provided by CRC and similar for-profit centers is
primarily a drug substitution and distribution program.

Methadone is a potent opioid meaning that it has a mechanism of action
very much like heroin, oxycodone, morphine and hydrocodone -- with
similar abuse and dependency characteristics. Methadone is used in
these clinics because it is cheap, long-acting and can be delivered
orally as a single daily dose.

However, there is emerging evidence, including recent FDA warnings,
that this drug may have unique risks associated with its use,
including sudden cardiac death and unpredictable accumulation in the
tissues of the body with resultant lethal interaction when used with
other medications. West Virginia has gained international notoriety
for opioid abuse and in recent years has led the nation in deaths due
to methadone abuse.

Methadone is sold legally by methadone clinics to individuals addicted
to methadone, heroin, oxycodone or other opioids. Ultimately, the
client usually remains physically dependent on the drug but the
behavioral aspects of addiction may be modified.

Good studies demonstrate that, especially when used to treat heroin
addiction, long-term stabilization of methadone dosing can be achieved
with improved societal economic impact. While this may well be a
desirable goal, methadone maintenance does not free an addict from
opioid dependency, has risks and is not uniformly effective.

Certainly, there is a financial incentive for methadone clinics to
continue to dispense methadone rather than work toward opioid
abstinence. This should be clearly understood by Legislature. Some
states limit the amount of time an addict may remain on methadone
maintenance. The goal is to gradually reduce the dose until the addict
is off of all opioids. There are many sound clinical reasons why this
should remain the goal. Unfortunately, multiple relapses are common.
The frequency of ongoing drug abuse while receiving methadone
treatment is also significant.

Methadone treatment centers play a role in helping opioid addicts
improve the quality of their lives and may reduce drug-related crime
and the economic burden of opioid drug abuse. Lawmakers must ensure
that these centers have appropriate guidelines to prevent diversion of
the dispensed methadone, monitor clients for ongoing illicit drug
abuse, employ well-trained staff, and maintain the ultimate goal of
abstinence from all drugs of abuse.

David Caraway is medical director of the Center For Pain Relief Tri
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