Abusers Are Not Who You Think
Linda Martz
News-Journal (Mansfield, OH) Tue, 07 Dec 2004
MANSFIELD — Those tracking drug trends “expected” to see a spike in deaths from Methadone within Ohio over the past year, the top official at Ohio’s State Board of Pharmacy says.
But the good the drug does as an inexpensive painkiller outweighed that risk, Executive Director William T. Winsley said.
Most middle-aged or older Americans know Methadone as a drug used in the past to treating opiate addictions — especially to heroin.
But starting more than a year ago, Ohio “loosened up” its policy to allow Methadone’s use outside of drug addiction clinics, allowing regular physicians to prescribe it as a painkiller, Winsley said.
Helps cancer patients
It was meant to be used to relieve pain for terminal cancer patients, Winsley said.
“It’s very inexpensive — particularly when compared with other opiates of choice — OxyContin, Percocet and Vicodin.”
There is no reason why Methadone would be more lethal than other opiates — but there are reasons why it might suddenly begin causing deaths, Winsley said.
Methadone clinics designed to treat addictions are state licensed and limited in numbers — found mostly in larger cities, with doctors specially trained in how to use Methadone with patients already identified as susceptible to addiction, Winsley said.
Addicts obtaining Methadone from clinics traditionally got measured doses in liquid form while a nurse made sure they got the correct dosage, under traditional treatment protocol, Winsley said.
“You needed to show up to the clinic, and it was administered by the nurse, who watched you take it, and then checked under your tongue to make sure you took it.”
But Methadone given to kill pain may be dispensed by regular physicians or clinics, and obtained by regular prescription through local pharmacies, in pill form, Winsley said.
Easily accessible
Pills are “easy to traffic,” the State Board of Pharmacy director noted.
“We knew there was going to be a problem. But it’s effective (as a painkiller), and it’s cheap,” he said.
Where methadone turns up as a cause of death in overdoses, is likely to show up among a mix of drugs, Winsley said.
Dr. Harvey Siegal, spokesman for the Ohio Substance Abuse Monitoring Network, said methadone originally was developed by German officials when its morphine Supply got cut off during wartime, and medics needed a synthetic substitute.
Ohio’s addiction treatment facilities that use methadone are so tightly regulated that the biggest complaints lodged there are that heroin-addicted patients get “inadequate doses.” “Some clinics wanted to do everything they could to wean people off methadone,” he said.
But proprietary clinics in neighboring states, including Indiana, are somewhat more loosely regulated, sometimes allowing take-home doses in pill form, he said.
Siegal said methadone’s newer use, dispensed by regular doctors as a painkiller in pill form, has resulted in addicts obtaining it and diverting it from its medical use, to substance abuse. “It has only been in the last couple of years that we have gotten consistent reports about methadone tablets or wafers being available on the street,” he said.
“You have well-intentioned doctors who are scammed by patients,” Siegal said. “There are even some docs who may be abusing the system — the so-called ‘prescription mills.’ ”
When fatal overdoses involving prescription drugs occur, methadone may be found in a person’s body, but may not always appear by itself, officials said. Nationwide and statewide, more “poly-drug” deaths are occurring, Winsley said.
“There’s almost never just one drug — it’s almost always three or four or five, where they’ve been mixing drugs,” he said. “If you’re taking three or four illegally obtained opiates, it’s harder to calculate how many you can handle.”
Crossroads Center for Change Director Lynne Spencer believes methadone can work for treatment of heroin addiction — but only used in combination with behavior modification. “methadone really should be used under doctor’s care, in an in-patient setting.”
“There are better drugs out there to use, certainly, for heroin (addiction). It’s just too easy to abuse that drug,” Spencer said. “The treatment community always looked at it as exchanging one addiction for another.”
Response
January 3, 2005
Dear Linda,
I am the coordinator of the West Virginia Methadone Advocacy Project, a chapter of the National Alliance of Methadone Advocates. I read your recent article after it was posted by a member to our email list. Sort of stunned by what I was Reading as fact, I felt from the start, having had some interaction with Methadone Treatment Officials and The Board of Pharmacy in Ohio, that you had fallen victim of a shortage of credible sources on methadone and Methadone Maintenance Treatment. Therefore the purpose of my letter is to point out how the “facts” provided to you in your research for this story are flawed, but not to blame you for it. I wanted to let you know that only by working in the State of Ohio could you have found so many sources for this story with so little factual information to give about Methadone. Let me share some facts with you, I will gladly offer independent verification of these facts on your request.
1. The State of Ohio did not have to loosen up it’s policy to allow the prescription of methadone as an analgesic drug. It has been used as such in the United States since first introduced here by the Eli Lilly Company in 1947 under the trade name of Dolophine. It has been under Schedule II (drugs of medical use)of the Uniform Controlled Substances Act since passage of the act and was similarly available for prescription use in all states before the UCSA was enacted. Under FDA regulations enacted in the 1970s methadone was basically very tightly controlled insofar as treatment of opiate dependence was concerned but was no more tightly regulated than any other similar opiate analgesics when prescribed for the relief of pain by physicians. Even in Ohio, despite what your sources say, methadone was there on the shelf in many pharmacies awaiting use; in fact it would have been much more commonly stocked in prudent pharmacies than some drugs better known for their abuse potential such as Dilaudid or OxyContin.
2. Methadone was developed in Germany in 1937 by chemists searching for anti-spasmodic drugs, less as a narcotic and mainly for quieting the bowel; but was never used pharmacuetically there by civilian or military physicians during or right after World War II. Part of the great technological “spoils of war” along with advanced rocketry and Volkswagens taken by the allies; methadone’s first commercial use was it’s US patent by the Lilly Corporation, It remained a little understood and lightly used medication until it’s accidental discovery as the drug of choice for the maintenance and detox of opiate addicts by Doctors Dole and Nyswander at the Lexington, Kentucky home of the U.S. Public Health Prison Hospital. Since that time methadone has become one of the mostly widely tested and studied medications in use in the modern world. Despite that fact, misconception and misinformation, much like your sources gave you; have served to displace factual information available about this drug. Another example: Lilly’s trade name of Dolophine is often reported to be a tribute on the name of Adolph Hitler when it fact it was adopted from the Latin words for sleep and pain by the folks at Lilly, Dolophine was not a German name for methadone.
3. Methadone Clinics in 49 states are regulated in virtually the same way under Federal Regulations developed over the years and adopted in 2001. The State of Ohio has lagged far behind the nation, often due to the prejudices of just a couple of state officials, and since 2002 or 2003, when it’s repressive State Methadone Authority retired, it has struggled to catch up with Methadone Maintenance Treatment (MMT) Programs in other states. Far from apart from the so called “Treatment Community” referred to by your source, MMT is considered to be the “Gold Standard” of Opiate Addiction Treatment in the USA and the Free World. Both the Clinton and Bush Administrations have been committed to MMT as the prudent treatment of choice for Opiate Dependant Persons. At the November 2004 Conference of the American Association for the Treatment of Opiate Dependence (AATOD), officials from virtually every state and treatment program were gathering all they could of the exponentially increasing information and technology of MMT.
4. With the increase of “proprietary” MMT Programs a record number of Opiate Dependent people have entered treatment at their own expense and returned to productive lives with their often medically inspired addictions back in the hands of physicians and counselors. Far from “exchanging one addiction for another” those in MMT are happily no longer lined up in “prescription mills” seeking the services of corrupt physicians and in drug courts for crimes committed in the pursuit of drugs. MMT patients have finally began to benefit from Drs. Dole and Nyswander’s “discovery”. Perhaps the real story about methadone and it’s new widespread use is in the lives of those returned to sanity by MMT. Should you like, we would be happy to assist you in profiling some of their experiences by arranging some interviews for you with patients.
Again Linda, thanks for your interest in methadone, and forgive me for teasing you about your sources. Believe me, had you lived in any other state………..Oh well,
Thanks
Dann White
Director
West Virginia Methadone Advocacy Project