Pubdate: Sun, 09 May 2004 Source: Courier-Journal, The (KY) Copyright: 2004 The Courier-Journal Contact: http://www.courier-journal.com/ Details: http://www.mapinc.org/media/97 Author: Alan Maimon, The Courier-Journal METHADONE ABUSE HITS STATE HARD 345 Deaths In 17 Months Tied To Drug Methadone Has Become Kentucky's Deadly Drug Of Choice, Investigators And Many Coroners Say. More than 340 Kentuckians have died from overdoses related to the synthetic narcotic since January 2003, according to a survey by The Courier-Journal. A top Eastern Kentucky drug investigator said methadone is replacing OxyContin as the region's most abused prescription drug. Methadone, invented in Germany during World War II as a substitute for morphine and used now as a painkiller and to treat heroin addiction, has found new popularity because of tighter controls on OxyContin, authorities said. "Most of your big pain treatment centers and doctors quit prescribing as much OxyContin and started prescribing methadone," said Dan Smoot, a former state police detective who is head of law enforcement for the federally funded anti-drug task force Operation UNITE in Hazard. No county in Eastern Kentucky has been hit harder than Breathitt, population 16,000. Since January 2003, 40 people have died from a combination of methadone and either alcohol, another painkiller or a tranquilizer, according to Bobby Thorpe, the county coroner. In Jefferson County, 34 people have died from methadone-related overdoses in the past 16 months, by far the most of any drug, Chief Deputy Coroner Mark Handy said. On average, Kentucky has about 400 overdose deaths annually from all drugs, said Tracy Corey, the state's medical examiner. No agency keeps a statewide total of methadone-related deaths, but The Courier-Journal called coroners or deputy coroners in all 120 counties. As of Friday, 80 from all parts of the state had responded, reporting a total of 345 deaths linked to the drug since January 2003. Those counties represent about 75 percent of Kentucky's population. Some coroners who responded to the survey, which began the last week in April, said their methadone figures were estimates rather than precise counts. Asked about the results of the survey, Lt. Gov. Steve Pence, who also is the state's justice secretary, said, "It disturbs me." In an interview Friday, Pence discussed the possibility of creating a "central depository on drug overdose deaths" to track whether certain areas are having abuse epidemics. A team of 50 state, local and federal officials is compiling a report on Kentucky's substance-abuse issues, and Pence said the report will go to Gov. Ernie Fletcher on June 20. Overdose victims The survey of coroners showed that many victims have died from combining methadone with sedatives. Bonnie Honaker, who lives in the Lost Creek community of Perry County, lost her sister to a lethal mixture of methadone and what her family described as nerve pills. On the day after Christmas last year, 41-year old Jackie Melson, a mother of six, died in her Breathitt County home in Flintville, one of 10 county residents who died that month from a methadone-related overdose, according to Thorpe, the coroner. Honaker said she knew that her sister occasionally abused drugs but that she was on the verge of getting her life back in order. She said Melson recently had moved from Columbia, Ky., to be closer to her parents and had told her family that the move marked a new start. "She always called me and said, `I'm tryin' to straighten my life up,'" said Melson's 23-year-old daughter, Jennifer York, who lives in Cartersville, Ga. "I think she was real close to doing that when she died." Dean Craft, a Kentucky State Police detective in Hazard, said an investigation into Melson's death is still open. In 2001, Kentucky physicians wrote more than 150,000 prescriptions for OxyContin, but that dropped to 130,000 in 2003, according to the Cabinet for Health Services. Meanwhile, the number of methadone prescriptions increased by about 340,000, to nearly 2.7million, during that time. Authorities seized more methadone than any other drug during a series of investigations earlier this year that led to warrants for the arrest of more than 200 street-level drug traffickers in the region, Smoot said. Abusers, who span a wide range of ages, often crush and snort methadone with other drugs, or dissolve them in liquid and inject them. The combination can produce a lethal high by leading to respiratory failure or a heart attack, coroners said. With a prescription, 90 tablets of methadone are available for about $40 at a pharmacy, Smoot said, and one methadone tablet on the street sells for around $12. Methadone wafers - large sheets of the drug used at, and sometimes stolen from, methadone clinics - sell for $50 on the street. `Deadly cocktail' Karen Engle, executive director of Operation UNITE, referred to methadone and certain sedatives as a "deadly cocktail." Thorpe, the Breathitt County coroner who has a locker full of methadone pills taken from overdose scenes, said most of the deaths there were attributed to methadone tablets prescribed by doctors and either given to the victims or trafficked on the street. The increase in methadone prescriptions and deaths related to the drug come at a time when OxyContin has become less available, partly because of publicity about the abuse epidemic that included the conviction of at least seven Eastern Kentucky doctors for overprescribing the powerful painkiller. But the methadone-related deaths have received little of the fanfare associated with Oxyfest, a 2001 operation that led to the arrest of 207 drug dealers. In announcing Oxyfest in February 2001, authorities said OxyContin had killed 59 Kentuckians in the previous year. Some coroners pointed out that OxyContin abuse is still a problem. Lawrence County Coroner Mike Wilson said six people in his county have died of OxyContin-related overdoses in the past 16 months, but the county has had only one methadone-related death in that time. Last month, officials announced the largest drug crackdown in the state. Smoot said about half of more than 200 arrests involving eight Eastern Kentucky counties were for possession or trafficking of methadone. Medical fallout Elsewhere, a Louisville doctor had his medical license suspended last year after 10 patients in his care died from methadone overdoses, said Handy, the chief deputy coroner. The doctor, David Thurman, has since had his license restored by the Kentucky Board of Medical Licensure, but he is prohibited from prescribing controlled substances pending a full hearing scheduled for later this month. Thurman also is under state investigation stemming from the patient deaths, said Alex Dathorne, an assistant commonwealth's attorney in Jefferson County. Thurman declined to comment, but his attorney, J. Fox DeMoisey, said the case is a good example of how doctors are made scapegoats when patients in their care overdose. "The simple fact is that methadone in prescribed dosages should not have this effect," DeMoisey said. "When a physician gives medicine and says you should take it in a certain way and a patient doesn't listen, how does a doctor bear responsibility?" Grady Stumbo, a Hindman physician and former chairman of the Professional Activities Committee at ARH Hazard Regional Medical Center, said doctors need to recognize when patients seek prescriptions for illegitimate purposes. "We're part of the problem because we're making too many of these drugs available," Stumbo said. "But we're part of the solution, too, if we take a greater stand and speak out and keep that from happening." Some prosecutors hope that methadone cases lead to criminal charges against doctors and other people who knowingly give someone a fatal combination. "If we start bringing charges for murder, it'll scare the hell out of people," said Perry Commonwealth's Attorney John Hansen. Some pharmacies, meanwhile, are watching how many methadone prescriptions they fill, and in what doses. Brenda Turner, a Breathitt County pharmacist, said her pharmacy plans to stop stocking 10-milligram methadone tablets starting in June in response to the high number of deaths. Rural areas hit hard Other Appalachian states also have seen an increase in methadone-related deaths. Dr. William Massello III, Virginia's assistant chief medical examiner in Roanoke, said 85 methadone-related overdose deaths were reported last year in southwestern Virginia, an area with around 1.5 million people. "Methadone is a very deadly drug," Massello said. "And this seems to be happening in many rural areas in America." A report released in March by the federal Substance Abuse and Mental Health Services Administration said that nationwide, most methadone-related deaths are a result of diverted pharmaceuticals and not from methadone taken at or from treatment centers. Mac Bell, the state narcotic authority commissioner at the Cabinet for Health Services, said strict regulation and monitoring of Kentucky's methadone clinics indicates that drug abusers are getting methadone elsewhere. "From the reports I'm getting from the field, the methadone is not coming from our clinics," Bell said. "It's coming from pain management clinics." Methadone clinics dispense the drug in liquid form on site, and clients are permitted to take home doses only after showing an ability to remain clean. Of Kentucky's 12 methadone facilities, 10 are private clinics and two are publicly funded, Bell said. But the number of Kentuckians receiving methadone treatment for opiate addiction has increased from 200 in 1995 to more than 1,500 this year, Bell said. In Breathitt County, only one of the 40 people who died from a methadone-related overdose in the past 16 months was a client at a methadone clinic, Thorpe said. - --- MAP posted-by: Jo-D