Pubdate: Sat, 17 Jan 2009
Source: Regina Leader-Post (CN SN)
Copyright: 2009 The Leader-Post Ltd.
Contact: http://www.canada.com/reginaleaderpost/letters.html
Website: http://www.canada.com/regina/leaderpost/
Details: http://www.mapinc.org/media/361
Author: Memory McLeod
Bookmark: http://www.mapinc.org/find?136 (Methadone)

METHADONE: A DEADLY PARTY DRUG

All the experts agree that methadone, a proven, safe and unparalleled 
treatment of opioid addiction when administered by a licensed doctor, 
is dangerous when abused by naive users.

Dr. Lowell Lowen with the College of Physicians and Surgeons of 
Saskatchewan, which administers the program and is currently 
reviewing all deaths where methadone was involved said it's the 
irresponsible partier who gets into trouble with methadone.

"From what I see, there is not a problem with those who are 
prescribed and on the program. Already, the problem I do see is with 
those who are not on the program, naive users who party, and when 
they run out of one drug they start up with another. Studies show 
that you will lose one per cent of your methadone patients due to 
poly (multiple) drug use. The problem there is that with poly drug 
use while on methadone, sometimes people's minds are altered and they 
are not aware of how much they are taking," Lowen said.

Methadone is used in the treatment of opioid addiction. It prevents 
withdrawal, decreases cravings and blocks euphoria produced by other 
short-acting opioids.

Lowen pointed out that naive users of methadone put themselves in 
danger because they don't know how the drug works.

"It accumulates in the body over time. The body accommodates the drug 
to the point where they can handle prescribed doses. For those who 
don't know that, and they take 60 or 90 milligrams they will just 
fall asleep. They can be revived, but if they are partying they go to 
sleep and their friends go home, they will not be revived. It's the 
irresponsible party person who can get into trouble with this," Lowen 
explained.

He estimated that the majority of patients use less than 100 mg per 
day but due to the nature of the drug it is dependent on the user.

"Some patients can be very large and require only a small dose and 
then other people can be very small and thin and require a larger 
amount. A doctor would use a number of factors to decide the amount 
prescribed," he added.

Each bottle of methadone in a carry dose lists the amount of 
methadone in the solution, but one cannot gauge the dose simply by 
measuring the amount of a bottle one drinks.

"Every bottle is full but has a different dosage. They each contain 
the same amount of liquid but not concentration," noted program 
co-ordinator Bernadette Amyotte.

She estimates that 30 to 35 mg could harm someone who is not an opioid addict.

"Drugs that are prescribed are on prescription for a reason, because 
they can be dangerous. Illegal drugs are illegal for a reason, 
because they are dangerous," she said.

Even a small amount of methadone can cause respiratory depression and 
arrest in those who have not built up a steady tolerance to the drug. 
Because of it's gradual and cumulative effect -- blood levels 
increase with each successive dose until it reaches a steady state at 
about four or five days -- the progression of respiratory depression 
can go unnoticed by the patient's companions.

Province-wide, 24 deaths have occurred where methadone was either a 
primary or contributing factor between January 2007 and June 2008. Of 
those, 12 were on the methadone program and 12 were not.

Of the 12 that were, seven died from combined drug overdoses, 
including prescribed and illicit drugs. Three died of methadone 
alone, and two died of other causes of chronic drug use such as 
pneumonia or liver disease.

Of those who were not on the program, one died of a methadone 
overdose and 11 died as a result of a combination of methadone and 
alcohol and/or prescription and illicit drugs.

"Looking at the statistics it's certainly a concern that there is 
this number of deaths that are related to methadone in this 
province," said Chief Coroner Kent Stewart.

"This raises a couple of issues, the use of illicit drugs while on 
the provincial methadone program. If you look at these statistics you 
will see that there is certainly a significant number of deaths of 
those that are on the program. Two, the deaths of individuals who are 
not on the program, which raises the issue of diversion, meaning 
where are these individuals getting it from? There are two 
possibilities there, it may be going astray and being sold and it 
also may be brought in. The question is where is this coming from and 
that is really a concern," Stewart said.

Illegal use, trade, sale or sharing is not something the Regina 
Police Service's drug unit hears much about, according to spokeswoman 
Lara Guzik Rostad.

"When looking at crime trends in the city, illegal methadone use is 
not something that is seen or heard about too often by our officers," 
said Guzik Rostad.

"If a person was found with someone else's prescription that would be 
investigated but it's not something that is encountered very often."

Insp. Jerome Engele of the Saskatoon Police Service agrees that while 
there are those who use the drug illegally it is not a popular choice 
among street users.

"Some prescribed users will sell some of their carries in order to 
supplement their incomes. How they do this is say they get a week's 
supply. They go in and take their Monday supply at the pharmacy, that 
will carry (them) until (they) have to come back in and take another 
witnessed drink on Wednesday so that frees up the Tuesday supply," he 
explained.

Because the treatment is used as a means to live a more stable and 
productive life, most on the program will not take risks such as 
sharing or selling their carries, he explained.

Still, Engele points out there is a big risk involved for those who 
choose to abuse the drug.

"Those who choose to abuse it are really taking a big chance because 
it is a very dangerous drug, especially in a recreational setting. It 
doesn't take very much of it to make a lethal dose. For those who use 
it in conjunction with other drugs, they too are taking a big risk."

Amyotte said the risk of overdose for patients is managed in several 
ways including the requirement of a lock box to house all take-home 
(carry) doses and the requirement of all bottles being returned 
before any more carries are given.

While alcohol and drug use, particularly cocaine, mixed with 
methadone increase the risk of overdose, patients who are known users 
of these drugs are not prohibited from the program.

"As long as they are able to provide proof of opioid addiction, that 
is the main thing. This program is considered as a last resort. The 
patients need to show that they have been to detox or treatment, that 
they are trying to deal with the addiction," Amyotte explained.

"Also, we go over a list of drugs not to mix with methadone, we 
explain what can happen. The signs of overdose are slowed-down 
breathing and heart rate, then what we call 'going on the nod', or 
falling asleep, and then dying," she explained.

Since officiating at a funeral for a victim of methadone overdose in 
2004 where mourners left early to attend another funeral for an 
18-year-old who had overdosed on the drug, local minister Nathan 
Pelletier has been concerned.

Pelletier believes that the carry or take-home medication program 
administered by the Harm Reduction Methadone Program is posing a risk 
to those who take the drug illegally.

"People take their carry dose and they get way too much. I think the 
only time people should get their carry dose is when they are on a 
very limited amount," he said.

Pelletier said the risk comes when people sell or trade a prescribed 
carry dosage on the street -- where according to one estimate the 
drug sells for $1 per millilitre.

Carry privileges are given to patients who are considered to be 
functionally stable in cases where there is a rationale for granting 
carries such as full-time employment or school and is not recommended 
during the first three months of treatment.

Amyotte estimated there are about 25 patients on the one-in-six carry 
program where they take one dose in front of the dispenser and then 
take six doses home.

She would not speculate to the maximum amount currently given to 
patients but pointed to a guideline given by the College of 
Physicians and Surgeons, which she cited as recommending no more than 
400 mgs that should be taken home. She also pointed out that each 
patient's dose is decided by the doctor overseeing the patient's care.

Lowen said the guidelines Amyotte referred to are federal and have 
not been applied for some years.

"People do take home more than (400 mg). That is a federal guideline 
which was instated in the early '90s and has not been reviewed. It is 
not used any longer, even by the feds," he said.

The risk of relapse increases sharply if methadone maintenance is 
discontinued, which is why for some patients, the treatment is 
considered to be a life-long necessity.

There are currently about 190 patients in Regina who are prescribed 
the drug through the Harm Reduction Methadone Clinic, and about 1,800 
province-wide.

The program is aimed to reduce injection drug use, drug-related crime 
rates and hepatitis C and HIV infection rates in Regina and area. The 
hope is that once stabilized on methadone the addicted person can 
live a normal productive life.

Amyotte recommends that anyone struggling with an opioid addiction 
should contact the program rather than risk taking someone else's 
methadone to keep away drug sickness.

"If evidence was brought in to the clinic of sharing or selling the 
drug, such as a misplaced bottle, the matter would be looked into," she said.
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MAP posted-by: Jay Bergstrom