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.

******

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.

Next page >