Methadone deaths increase as its use as painkiller grows
Drug used to treat addiction relieves pain in high doses
Published: Sun, Jul. 13, 2008 12:30AM
Modified Thu, Jul. 17, 2008 08:15AM
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CORRECTION
A front-page story Sunday about methadone drug overdoses misspelled the last name of victim Jason Huffman's mother. Her name is Pam Osborne.
CLINICS' ROLE IN OVERDOSES DEBATED
In North Carolina, less than 5 percent of those who died from accidental methadone overdoses from 1997 through 2001 were identified as current or former patients at clinics that use methadone to treat drug addiction.
But some families of victims perceive the clinics as a larger threat.
Last year, the state linked fatalities to a Statesville clinic, one of eight operated by McLeod Addictive Disease Center, a nonprofit organization based in Charlotte. McLeod was fined $27,000, and the state said McLeod did not properly report the deaths of several clients.
The state report also indicated that one client who died was improperly dosed. For a few days, the client's methadone was increased daily instead of every other day.
McLeod's president, Eugene Hall, declined to comment. The company is appealing the findings.
In a November story in the Charlotte Observer, Hall criticized the state's investigation. He said he had been told to send death reports to the N.C. Division of Mental Health, and that an official there had noted the thoroughness of McLeod's reporting.
One man who died after seeking help at a clinic was Jason Huffman, 23. A pain pill addict, he told his mother, Pam Osborn of Conover, that he wanted to break his addiction and improve his life.
He told his mother: "Mama, I'm so sick of how I've been living," Osborn recalled. "It was like he was growing up finally."
Huffman overdosed on cocaine and methadone after starting treatment at a McLeod clinic in April 2007, Osborn said.
"They did not monitor him," she said.
While on the methadone, "He kept telling me, 'Mama, I'm so tired,' " Osborn said in an interview.
Two days after starting treatment, he was sluggish and dropping cigarettes, his mother said. Two days after that, he died.
He was staying with friends.
"The last time they saw him, he was baking biscuits" at 3 a.m., Osborn said. Huffman was found dead about seven hours later.
A year after his death, his mother's living room was alive with plants -- plants from his funeral.
OVERDOSE MORE COMMON IN WESTERN N.C.
The highest rates of methadone overdoses are clustered in a few areas, especially the Appalachians.
Methadone death rates in North Carolina generally climb from east to west. The state's three worst counties for fatal accidental overdoses in general -- Yancey, Mitchell and Cherokee -- are all on the Tennessee state line, according to a report by former state epidemiologist Catherine "Kay" Sanford.
Fatal accidental overdoses in general have a higher rate in rural North Carolina counties and have been growing faster in rural states.
Authorities aren't sure of the causes for the geographic variations.
ON THE WEB
Helping America Reduce Methadone Deaths -- an organization of victims' loved ones: www.harmd.org
Zero Unintentional Deaths -- an educational campaign to prevent accidental overdoses of prescription medication: www.zerodeaths.org
National Center for Health Statistics -- Increases in Poisoning and Methadone-Related Deaths: United States, 1999-2005: http://tinyurl.com/5wc533
Project Lazarus -- Plan to test antidote kits in Wilkes County: http://tinyurl.com/59c25r
OVERDOSE SYMPTOMS
Symptoms of methadone overdose can include extreme drowsiness, pinpoint pupils, confusion, cold and clammy skin, weak pulse, fainting, shallow breathing or breathing that stops.
(DRUGS.COM)
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Methadone, long prescribed as an alternative to heroin, is proving to be a hazard of its own.
As a treatment for addiction, methadone is considered an effective tool. But as its use as a low-cost pain reliever becomes more widespread, a growing number of people are dying from methadone overdoses.
Methadone contributed to 299 fatal overdoses in the state in 2005, the latest year with national data available. The number of such deaths has more than quintupled from 47 in 1999.
A state report indicates that from 1997 to 2001, at least a third of North Carolina victims had been prescribed methadone for pain relief.
Now, North Carolina is tied with Oregon in having the seventh-highest rate of fatal methadone-related overdoses, according to figures from the National Center for Health Statistics. In 2005, North Carolina had about twice the national rate of such overdoses.
"The problem is so huge, you don't know where to begin," said Mary Haynes, a substance abuse counselor in Western North Carolina.
Commonly used as a treatment for addiction, especially to heroin, methadone is increasingly prescribed in pill form as a pain medication, leading to an uptick in accidental overdoses. One danger is that methadone remains in the body long after its painkilling effects wear off. As a result, even legal prescriptions can turn fatal when doses accumulate over time into overdoses.
That phenomenon may have contributed to the death of a Winston-Salem woman.
Jewel Imperial, 25, a student and musician, overdosed in September 2007. Her father, Bobby Imperial, said she died five days after being prescribed up to 80 milligrams per day for back pain. He declined to identify her doctor because the family is pursuing legal action.
Imperial's dosage was more than double the recommended maximum for patients new to opioids, the family of drugs that includes methadone.
Her parents didn't know she had been prescribed methadone then. But a few days after she started the prescription, her mother, Nancy Imperial, took her back to the same doctor. Her symptoms were disorientation, aches, sweats, cough and, sometimes, a spacey feeling, her father wrote.
She died the next day.
Little room for error
Methadone is a tricky medicine. In addition to its tendency to linger and accumulate in the body, it offers pain relief in a dosage that is very close to the amount that can be toxic.
Patients sometimes increase their dosage to kill their pain. A toxic buildup of the drug can lead to heartbeat and breathing problems.
Still, many pain specialists value methadone for severe, chronic pain patients.
One of its selling points is its low price, compared with similar pain relievers. A month's supply can cost about a tenth as much as generic morphine.
Methadone's use as a painkiller has shot up as the country has become more medicated and as physicians have become more attentive to patients' pain. From 1997 to 2006, annual retail methadone distribution in North Carolina grew from 25 kilograms to 264 kilograms.
But many professionals administering methadone for pain "remain largely unaware of the need for extraordinary safety measures," wrote Dr. Lynn Webster of Lifetree Pain Clinic in Salt Lake City on the Web site Pain Treatment Topics. For example, prescribers might give too high a dose or increase the amount too quickly, he wrote. Webster, co-founder of a campaign against overdoses, treats chronic pain as well as opioid addiction.
maurreen.skowran@newsobserver.com or (919) 829-4857
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