Pubdate: Fri, 04 Mar 2005
Source: Princeton Times, The (WV)
Copyright: 2005 The Princeton Times
Contact:  http://www.bdtonline.com/ptonline/
Details: http://www.mapinc.org/media/3692
Author: Tammie Toler
Bookmark: http://www.mapinc.org/find?136 (Methadone)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)
Referenced: Part 1 Of Ongoing Series: 
http://www.mapinc.org/drugnews/v05/n283/a08.html
Referenced: Part 2 Of Ongoing Series: 
http://www.mapinc.org/drugnews/v05/n319/a05.html

OFFICIALS: WITHDRAWAL DOESN'T KILL PEOPLE, BUT THEY WISH THEY WERE DEAD

Editor's note: This story is the third installment in a series on 
methadone, a controversial painkiller often used to treat opiate addictions.

PRINCETON - Imagine preparing for a job interview or trying to fix a broken 
relationship without any sleep, amid a state of confusion. The room is 
spinning, your hands are shaking and your stomach is cramping. That's life 
for someone in the throes of opiate withdrawal.

"Withdrawal doesn't kill people, but they wish they were dead," Dr. Michael 
McNeer, a psychiatrist and addiction specialist, said recently explaining 
the often-vicious cycle of opiate addiction and withdrawal.

Opiates, natural or synthetic drugs that behave like opium once ingested, 
are highly addictive. Heroin, morphine, codeine, Dilaudid and oxycodone are 
all opioids, and all have the potential to create physiological dependency 
in users.

Once a person's body becomes dependent upon the opioids, receptors in the 
brain need the drug's presence in order to function, and stay out of 
withdrawal. "The opioid receptors are crying out for the drug," McNeer 
said, creating intense cravings and physical manifestations of the addiction.

Because withdrawal can be physically excruciating and psychologically 
overwhelming, methadone maintenance treatment (MMT) has become an 
increasingly popular way of treating addiction.

An entirely manmade opioid originally created in Germany during World War 
II as a painkiller, methadone first became available in the United States 
in 1947.

In the medical community, methadone has grown in popularity as a painkiller 
because it is less expensive than similar drugs, such as oxycodone and 
hydrocodone, and because patients tend to be afraid of the addictive 
qualities of brand-name pain pills such as OxyContin, McNeer said.

Since 1965, the powerful medication has been used to treat addiction to 
opiates such as heroin, morphine and Dilaudid, but locally, officials said 
people addicted to OxyContin dominate those seeking help at treatment centers.

Methadone occupies the opioid receptors in the brains of people addicted to 
opiates, without producing the euphoria, or high, associated with the drugs 
they first became hooked on. It keeps their bodies from going into 
withdrawal, and since it occupies the opioid receptors other drugs would 
typically act on, it also dulls or eliminates the high they would 
experience from their first drugs of choice.

But, methadone itself is highly addictive also, and it does not eliminate 
the addiction. Patients undergoing MMT are no less addicted than when they 
began the treatment. They are simply dependent on a different drug.

Because opiate addiction and withdrawal take such a physical toll, 
treatment requires a lifestyle change, according to Casey Aust, director of 
Beckley Treatment Center, an MMT clinic.

Methadone treatment facilities operate as risk-reduction centers, she said, 
rather than as drug-abstinence programs. For $12.50 a day, patients get the 
methadone to keep their bodies out of withdrawal, but she said the 
treatment also keeps them from committing crimes to get other drugs and 
decreases hazardous behavior such as sharing needles.

If patients wish to detox after methadone stabilizes their cravings, they 
may do so slowly under a doctor's supervision, but Aust said some of her 
patients will never be able to discontinue MMT.

Just as insulin is essential to a diabetic's well-being, she said methadone 
may be a permanent, crucial part of life for a person addicted to opioid drugs.

She said the goal of the treatment is to stabilize patients physically so 
they may address personal or mental health issues such as family life, 
employment and education.

"If they are in withdrawal and are not physically feeling well, they cannot 
focus on fixing what's wrong in their lives," Aust said.

If MMT keeps her patients "functioning and keeps them being productive 
members of society, then it's worth it," she said.

Controversy has put MMT in the spotlight due to the growing presence of 
methadone for sale on the streets, the increasing numbers of 
methadone-related deaths and the indefinite detoxification process.

In the first seven months of last year, 63 West Virginians died after 
reportedly taking methadone, whether in the form of prescribed pain pills 
or liquid doses from methadone clinics.

Two Mercer County deaths involving methadone resulted in murder charges in 
2003, and Prosecuting Attorney Bill Sadler said this week that methadone 
was involved in "most of our overdose cases."

Treatment center supporters have often argued that the methadone for sale 
on the street comes predominantly from diverted prescriptions, but local 
law enforcement officers reported that both forms are available.

There is a place for MMT in society, McNeer said, but he also pointed out 
that it is important that people taking methadone understand how 
potentially dangerous it can be.

"The real danger of methadone is that it is very potent. It builds up in 
the system, and it is a complex drug with variable metabolism," McNeer said.

Slowly absorbed, methadone is a long-acting drug with a half-life of 24-36 
hours, meaning that 24 hours after a person ingests methadone, at least 
half of the drug's concentration is still in the body. Taken daily, the 
drug will continue to build potency for several days before reaching full 
concentration.

And, it is so slow-acting that McNeer said, "It's not unusual to not feel 
anything for some time after it's taken."

He cautioned that deaths involving methadone usually take place hours after 
the drug is ingested, and it's especially dangerous when taken with other 
substances that depress, or slow down, the central nervous system and 
breathing, McNeer said.

Alcohol, Xanax, Vallium and muscle relaxers, often dangerous on their own, 
can be fatal in combination with methadone.

Most people who die of methadone overdose simply stop breathing in their 
sleep because the part of the brain that tells the body to breathe stops 
working, McNeer said.

And, for individuals with no opioid tolerance or dependency, even a small 
dose of methadone could be fatal.

"To someone who is opioid naive, 30 milligrams can be fatal, and 50 
milligrams is much more likely to be fatal," McNeer said.

The daily MMT dose administered to people already addicted to opiates 
typcially ranges from 80 to 120 milligrams.

For safe treatment, McNeer said methadone "ought to be taken under the most 
competent, strictest supervision" possible.

Despite the potential hazards, Aust said methadone maintenance treatment 
helps people from all walks of life cope with addictions.

"Opiate addiction is not choosy," she said.

Many of her patients first became addicted after an injury required 
painkillers. "Before they knew it, their body was addicted," she said. 
"They come to us after they've crossed the road ... when they've hit rock 
bottom."

Aust said she routinely participates in community outreach and education 
projects. She encouraged anyone with questions concerning MMT to contact 
her at (304) 254-9262. 
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MAP posted-by: Beth