[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

Hi Mike,

This is another reason why I am no longer taking Opioids. I have been on the Duragesic patch, and Dilaudid which is pretty much street heroin. Here is a article about it.

http://www.heroinaddiction2.com/dilaudid.htm

This is why Methadone probably doesn't work for reg. heroin addicts, it's still a opioid. Roz

[tayla4me]

Originally Posted by 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

I think what is important not to lose sight of, is the fact that these people are not taking Methadone for pain!! Anna Nicole had no pain, she was an addict!!
People with severe chronic opain do not experience euphoria and if you do then you do not need such a strong analgesic.
I think it is unfair that there maybe some people who are missing out on a possible cure for pain because of those who take the drug illicitly.

[fmichael]

Originally Posted by tayla4me

I think what is important not to lose sight of, is the fact that these people are not taking Methadone for pain!! Anna Nicole had no pain, she was an addict!!
People with severe chronic opain do not experience euphoria and if you do then you do not need such a strong analgesic.
I think it is unfair that there maybe some people who are missing out on a possible cure for pain because of those who take the drug illicitly.

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 . . . ."

[tayla4me]

Originally Posted by fmichael

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 . . . ."

I am certainly not inferring that there are not many complications that can evolve from taking any medications for the pain of CRPS. I am a pain sufferer and a reg. nurse so have seen the impact they can have, I have also seen the devastating impact on patients who have been too afraid to avail themselves to medications which may have just given them the ability to have some semblence of normality. These people have succumbed in a different way.
It is unfortunately a situation of being caught between a rock and a hard place. I think if only we could all have access to a Pain Management Team or Doctor who allow informed decisions to be made after being made fully aware of the medications and their possible effects and interactions. There also needs to be a high level of scrutiny and control of their patients drug intake too.
In this ideal situation I am sure there would be far less indescriminate drug use.

[fmichael]

For what it's worth, I'm currently dealing with a single unexplained incident of syncope - momentary loss of consciousness - that happened a few weeks ago when I was well rested and had a decent breakfast, a good cup of coffee and minimal medications in me at the time. I apparently complained of a migrane and keeled over backwards on a ceramic tile floor, acquiring 7 surgical staples in the back of my head in short order. That, and apparently some retrograde amnesia, so I don't remember the comment about the migrane, even though my 14 year old son wrote it down, with punctuation no less!

Subsequent workups have included a CT brain scan, blood work, a 24 hour halter monitor, an EEG, a brain MRI (w/ and w/o contrast), and an MRA. I go back for some follow up blood work on Friday. Thus far, the only potentially related symptoms of note include peripheral neuropathy and some transient loss of strength in my right arm that antidated the fall by about 10 days. I had an angiogram about a month before this happened and everything looked good in that department, with ejection fractions >65%.

Maybe the follow up blood work will show something. Right now my neurologist is just stumped and is looking for drug interactions, almost by default. So go figure.

Mike

[tayla4me]

What a mystery Mike
I do hope you can find the cause, it is always easier to deal with something if the aetiology is known.
I have developed generalised myoclonic seizures in the last 12 months, sometimes with momentary Loss of consciousness.
EEG only abnormal at the time of a seizure, however I have some "white degeneration " of brain tissue on MRI.
I wonder if there is a similarity?
Good luck with finding th answer.

Oh Lord, how worrying for the both of you, I do hope you can get to the bottom of whatever is causing the problems, that's disturbing news....

all the best.

[tayla4me]

Originally Posted by artist

Oh Lord, how worrying for the both of you, I do hope you can get to the bottom of whatever is causing the problems, that's disturbing news....

all the best.

Oh thanks "artist" .There is always someone worse off though and I am sure we will get to the bottom of it. I have a great team!

[dreambeliever128]

I have been on Methadone for over 3 years now and I think you always have to keep a thought or fear in the back of your mind that if you take too much it can kill you or do a good job on you anyway. I never let go of the fact that I should take more then what the Dr. and I talk about me taking and if I go up on it, I talk to him first.

One thing though I wanted to say. I know of 4 people around here that are hooked on Oxycontin so bad that the Drs. have had to either quit giving them the meds or they have switched Drs. to get it. The ironic part is that they tried Methadone and didn't like it. It didn't do for them what they wanted it to. They have since went back to the Oxcycontin and Diludid. You can tell by talking to them or watching their actions that they are way over medicated. They have became addicted to drugs while dealing with their health problems and now what they get from a Dr. is not enough for them. As I said they go Dr. shopping.

With any drug you have these problems.

I honestly believe that if you keep it in the back of your mind that if you take too much then you will be in a mess as I call it. A person should fear the narcotics but not to the extent of not taking them at all to keep your pain from getting so high that you get suicidal. I was that way. I never grew up around drugs and was afraid to take them and wouldn't for the longest time. I finally relented and let my Dr. prescribe meds to get my pain level down.

I grew up in a little town in Ky. I didn't know what drugs were until I moved to Co. in the early 70's. Boy was I nieve? Now I have seen through people I know what they are and can do to a person.

Ada