[fmichael]

My neurologist brought this article from the front page of today's Los Angeles Times to my attention this morning:


Methadone emerges as new killer
------------------------------------------

Patients and addicts are mixing the opiate with other drugs, as did Anna Nicole Smith's son.

By Charles Proctor
Times Staff Writer

February 26, 2007

Methadone, a potent opiate once used almost exclusively to treat heroin addicts, is increasingly being prescribed by doctors as a pain medication and abused by drug users searching for a cheap, easy way to get high, physicians and federal drug officials say.

The drug, which comes in pill or liquid form, recently has come under scrutiny in the death of former Playboy model Anna Nicole Smith. A doctor in Studio City prescribed methadone to Smith for pain treatment before she was found dead Feb. 8 in her Hollywood, Fla., hotel suite.

A coroner has yet to determine her cause of death, and the doctor said his treatment was "medically sound and appropriate."

Months earlier, Smith's 20-year-old son died in the Bahamas after taking a lethal mixture of methadone and two antidepressants, Zoloft and Lexapro.

Well before these deaths, however, drug counselors and clinicians were concerned about increased abuse of the drug on the streets, in group homes and even in middle schools.

It is an ironic turn in the history of methadone, which for years has been used to treat heroin addiction.

A synthetic opiate, methadone is similar to heroin in chemistry, curbing a user's craving for the illegal opiate by blocking the sensors that heroin stimulates without producing a heroin high.

In recent years, methadone has proved lethal to a growing number of patients or addicts who use it in conjunction with prescription drugs including Valium, Xanax or, in the case of addicts, illegal narcotics such as cocaine.

Sometimes users swallow methadone before or after they "puff," when they seek to get high by slowly inhaling the chemicals from an aerosol can.

"Every year, we see hundreds of these deaths, and the numbers continue to increase," said Bruce Goldberger, director of toxicology at the University of Florida, who has been at the forefront of tracking methadone-related deaths. "It is absolutely the fastest-growing drug problem."

A federal government study found that nationwide methadone-related deaths climbed to more than 3,800 in 2004 from about 780 in 1999. Among all narcotic-related deaths in 2004, only cocaine killed more people in the United States than methadone.

Physicians and others point out that methadone's potential for abuse isn't as high as that of opiates like heroin because it does not induce a strong euphoria on its own.

But repeated use can still cause a physical dependence, doctors say, and when users stop taking it, withdrawal-like symptoms can occur.

Given its low cost compared with heroin and other drugs, its recent proliferation and its potentially lethal potency when mixed with other drugs, officials worry that methadone is largely evading the scrutiny applied to other abused prescription medications, such as OxyContin and Vicodin.

The drug can be lethal even when mixed with antidepressants, or grapefruit juice, experts and federal drug authorities say.

Methadone can linger in body tissue for an unusually long time — 24 to 59 hours in some cases. Sometimes users assume it has worn off, then take other drugs or more methadone, leading to respiratory depression, coma and eventual death.

Methadone is available at clinics that prescribe it to treat heroin addiction, from doctors who can prescribe it for pain or to treat addictions and, increasingly, as a street drug.

The clinics face stringent federal and state regulations as to how much methadone they can administer to patients, but physicians don't go beyond a general rule that says they can't prescribe more than a 30-day supply, said Mark Parrino, president of the American Assn. for the Treatment of Opioid Dependence.

In Southern California, parts of downtown, East and South Los Angeles have emerged as places to buy and sell methadone, said Kalante Holmes, a counselor at a methadone clinic in West Los Angeles. "It's one of those easy-to-get things right now," he said.

It's the "easy-to-get" nature of the drug that has led to the recent spike in methadone deaths, experts and government officials say.

As the study of pain has grown over the last five to 10 years, more physicians are prescribing methadone to patients to treat pain, especially chronic and nerve pain.

The Food and Drug Administration issued a warning in November to all physicians saying that misuse of the drug could lead to breathing problems and possible death.

Patients might prefer methadone to other painkillers because not only is it powerful, but it's also less expensive.

For example, a pharmacy can buy a month's supply of methadone for one patient for as little as $8, whereas it would have to pay more than $170 for a similar amount of OxyContin, according to wholesale pharmaceutical price books.

As the availability of the drug increases, so does abuse and misuse of it, experts and drug officials say. Problems usually don't arise from physicians who specialize in pain treatment and know how to safely prescribe and monitor methadone use, but from general and family practice physicians who may prescribe the drug more often than they should.

"My hunch is that some of what we're seeing with the current problems are the administration of [methadone] by physicians who don't understand how powerful it is to a patient population who might not necessarily need it," said Richard Rawson, an associate director of Integrated Substance Abuse Programs at UCLA.

Data compiled by the federal government show a steady increase in the number of people nationwide admitted to clinics and programs for methadone treatment, from about 1,000 in 1995 to more than 3,700 in 2005.

"This is an emerging problem," said Bertha Madras of the White House Office of National Drug Control Policy.

It's been a persistent problem for people like Sean, 20, a resident of West Los Angeles and a former heroin addict.

Sean, who asked that only his first name be used because of the stigma associated with drug abuse, carved a steady path to heroin use at a young age. He tried marijuana when he was 11, cocaine at 14 and heroin at 17. When he was 19, living in a downtown L.A. apartment and experiencing heroin withdrawals, he tried methadone.

Mostly, he said, he used it to satiate his desire for heroin. At least once he took it with Klonopin, a muscle relaxant.

"I don't want to say the feeling was similar to alcohol," said Sean, who is in drug treatment and was interviewed in the presence of his counselor. "But that's sort of what it was like. Your body feels relaxed."

Though he said he had not used methadone lately because he'd heard it had been responsible for a rash of deaths, Sean said he could easily get it on the street.

Recently, on a bus in Santa Monica, he was approached by a methadone pusher who offered him a deal: one pill for $45 or two for $60, he said.

Sean said he declined. But he knows it won't be so easy for others.

"The fact of the matter is, if you're a drug addict and you don't want treatment, you're going to go try to get high off something," he said. "You're broke, you can't afford heroin, so you go get methadone."


--------------------
charles.proctor@latimes.com

[finz]

I hate that they sat that Methadone is "so easy to get"

Yet so many of us CP'rs have trouble finding adequate pain relief. Do we need to see Anna Nicloe's doctor ?

[Idiopathic_Human]

This issue is very upsetting to me personally and in itself scares me very much.

I am struggling and have been since 2004, Chronic Pain that already is so difficult for others who are not experiencing chronic pain and in my experience often am or feel very sterotyped or the media prints such articles and adds to the existing stuggle for those who do take the narcotic medications as prescribed and as a last resort when unable to have any type of corrective surgery.

I am prescribed Methadone, Oxycodone HCL, MS Contin (time released brand of Morphine Sulfate), and take on a daily basis as my only option to be relieved of cronic pain, yet still be experiencing pain with the three, I have not achieved euphoria from any of these medications, and still I face the 'look' from some who giggle and snicker indicating I am surely high as a kite at all times, and battle to remain independant living and pray to god that truth will be with those who have as I a genuine need for these medications that they not be taken off market or denied or discontinued due to 'recreational users' and the media placing the unknown in such situations.

[fmichael]

Originally Posted by Idiopathic_Human

This issue is very upsetting to me personally and in itself scares me very much.

I am struggling and have been since 2004, Chronic Pain that already is so difficult for others who are not experiencing chronic pain and in my experience often am or feel very sterotyped or the media prints such articles and adds to the existing stuggle for those who do take the narcotic medications as prescribed and as a last resort when unable to have any type of corrective surgery.

I am prescribed Methadone, Oxycodone HCL, MS Contin (time released brand of Morphine Sulfate), and take on a daily basis as my only option to be relieved of cronic pain, yet still be experiencing pain with the three, I have not achieved euphoria from any of these medications, and still I face the 'look' from some who giggle and snicker indicating I am surely high as a kite at all times, and battle to remain independant living and pray to god that truth will be with those who have as I a genuine need for these medications that they not be taken off market or denied or discontinued due to 'recreational users' and the media placing the unknown in such situations.

What's important not to lose sight of is that any narcotic taken for any good purpose always has the potential of turning around and biting us in the butt.

Look at the warning on combining methadone with Xanax. How many of us are on benzodiazepines such as Xanax for shooting pain? I know I take 4 of the 0.5 mg. tablets a day. And sometimes with a lot of everything that's going through me (including Oxycontin) I can be lying down and suddenly feel startled as my body has to effortfully find its next breath.

I don't deny that this stuff is useful for the treatment of pain. I just don't know that simply because we're taking it for a non-recreational purpose, there's somehow an implied warranty that it couldn't have profound interactions with other medications we may be on. So be careful out there.

Mike

p.s. The literature is full of cases of pain patients succumbing to stuff that was taken with the best on intentions, see, e.g., fentanyl patches. It's like the man said when he titled his book, it wasn't "Whether Bad Things Happen to Good People," but "When . . . ."

[Idiopathic_Human]

[QUOTE=fmichael;75157]Look at the warning on combining methadone with Xanax. How many of us are on benzodiazepines such as Xanax for shooting pain? I know I take 4 of the 0.5 mg. tablets a day. And sometimes with a lot of everything that's going through me (including Oxycontin) I can be lying down and suddenly feel startled as my body has to effortfully find its next breath.

I don't deny that this stuff is useful for the treatment of pain. I just don't know that simply because we're taking it for a non-recreational purpose, there's somehow an implied warranty that it couldn't have profound interactions with other medications we may be on. So be careful out there.

Mike
"[QUOTE]


I totally agree that the risks are out there even when it comes to taking the medication as prescribed. I do as well take for muscle spasms generic form of Valium being 10mg four times day every day, as well as 1mg of generic Ativan two times a day, along with Morphine daily and Roxicodone for breakthrough pain and recently I fell down and now have two broken ribs from the fall, yet I waited 10 days to even seek treatment from the family doctor, who is seperate from the pain management prescriber who does so track me monthly for random urine drug screens to check for illegal drugs in my system, and also to make sure that between the 30 day visit that the prescribed medication is in my system and have not sold or otherwise used the meds all in one time period.

At one time the medication diladid was available in long acting form, and am told it did wonders for people who had legitmate pain need for the medications only the mixture of other drugs with it and mixture of alcohol I am told made for it to have to me removed from the market and I begin to wonder what is to come of people like us with chronic pain and if or when the abusers and recreational users end up causing chronic pain patients to no longer recieve the medications they respond to...

I do send out positive hope and care to those who need and use as prescribed and all.

[NJPain]

My prediction is....once drs really start to grasp methadone's power and potential, you will see pharm companies making much smaller doses like 5mg, 1mg, even .5mg. Those are safe starting doese for opiate naive patients.

Methadone, when taken properly, is a nearly perfect drug all the way around. When I take oxycontin, I'm counting the hours til my next dose. When I take methadone, sometimes I forget to take a dose. There is no cravings with methadone, works just as good if not better and is expotentially cheaper. Month worth of oxy costs $1300. Month of methadone costs $40. Now you know why the pharm companies never pushed for Methadone to be prescribed for chronic pain.

[Idiopathic_Human]

Originally Posted by NJPain

My prediction is....once drs really start to grasp methadone's power and potential, you will see pharm companies making much smaller doses like 5mg, 1mg, even .5mg. Those are safe starting doese for opiate naive patients.

Methadone, when taken properly, is a nearly perfect drug all the way around. When I take oxycontin, I'm counting the hours til my next dose. When I take methadone, sometimes I forget to take a dose. There is no cravings with methadone, works just as good if not better and is expotentially cheaper. Month worth of oxy costs $1300. Month of methadone costs $40. Now you know why the pharm companies never pushed for Methadone to be prescribed for chronic pain.

Hi, In regards to the power and potential in the Pain Mangagement Specialty, it has been known for quite some time and has been prescribed many times to those patients for the control of pain who lack health insurance and has been around along time. In the cases I have known, including myself no one is 'started' on a drug like methadone for pain control, it is used more as a last resort and a final addition to those patients who are already opiate tolerant.

The prescribing info says in the notes that drugs like Methadone are only intended to those patients already opiate tolerant to a certain level of equivilant comparable to such as Morphine. Oxycontin does cost alot, only now that the generic form has become available, I am sure the cost will begin to decrease in order to accomidate for the competition or the demand.

I believe in any sense no matter what the prescription drug is, when used in ways or ignoring the warnings of dosage, and drug interactions, toxicity will surely result and is stated so on the warning information that comes along with the medication. If people do not take the medication as prescribed or buy it illegal on the streets, regardless of which drug it is, then the potential for deadly results have no one to blame other than that of the person taking the drug.

I take 40mg four times a day in addition to other medications and understand the risks involved and as it states on the paper I do sign stating that "I understand the medical professional is prescribing the medication be a medical necessity, being more of a need than the risk factors of the medication."

"IH"

[NJPain]

Originally Posted by Idiopathic_Human

The prescribing info says in the notes that drugs like Methadone are only intended to those patients already opiate tolerant to a certain level of equivilant comparable to such as Morphine.

Like I tried to explain in my previous post, once methadone's true potential is realized, you will see companies producing much smaller quantities of methadone.

Of course you can't start opiate naive patients on methadone NOW, companies are making doseages that are too high a starting dose but like I said, they WILL start to make much smaller doses that opiate naive patients CAN tolerate.

Yes, we all know docs have been prescribing methadone for chronic pain, even though it was an off label use but those docs were in the very small minority. The majority of docs never touched methadone and left it to the addiction clinics to use/dispense.

You can safely start an opiate naive patient on .5mg a day and build them up from there but no one produces that small amount........but they will, they will.