Pubdate: Sun, 25 Mar 2007
Source: Salisbury Post (NC)
Copyright: 2007 Post Publishing Co.
Contact:  http://www.salisburypost.com/
Details: http://www.mapinc.org/media/380
Author: Scott Jenkins
Bookmark: http://www.mapinc.org/find?136 (Methadone)

METHADONE, A QUIET KILLER: DEATHS FROM UNINTENTIONAL OVERDOSES RISING

Jamie Pethel had a drug problem.

But the last time his mother, Mary Haynes talked with him in 
September, Pethel was "trying to get it back together," she said. 
Less than 24 hours later, he was dead. A recently completed 
toxicology report revealed the cause of 23-year-old Pethel's death: 
acute methadone toxicity.

He overdosed. Pethel was one of more than 300 North Carolinians who 
lost their lives to an unintentional methadone overdose last year, 
according the latest statistics from the N.C. Office of the Chief 
Medical Examiner. That's up from 34 people who fatally overdosed on 
the drug in 1999. Over that period, methadone has become responsible 
for about a third of accidental overdose deaths in the state, as many 
as cocaine and more than all other prescription drugs. In Rowan 
County, medical examiners found methadone in the blood of nearly half 
the people who died of unintentional overdoses from 2003 to 2005, the 
most recent year for which county numbers are available. Experts 
blame ignorance, in large part.

Long used to ease addicts' craving for heroin, methadone has grown 
increasingly used as a painkiller over the past decade -- and 
increasingly available to people who don't know its potentially 
lethal effects. Prescribed and taken correctly, methadone can provide 
long-term relief for chronic pain sufferers, experts say. And it 
does, over time, give recovering addicts a mood-altering benefit that 
helps them function. But methadone can build up to toxic levels fast 
if a person takes too much, especially someone who hasn't taken it before.

Patients accustomed to faster-acting medications might take extra 
methadone pills when the first one doesn't quickly provide relief. 
Drug abusers might do the same thing, expecting a quick high that 
never comes. "It's simply not anything that's going to get them 
there," Dr. Robert Wilson, a local pain specialist who prescribes 
methadone to treat some of his patients, said of the drug abusers' 
quest for a buzz. "It's just going to get them the potential to kill 
themselves." Pethel once bragged to his mother about his "tolerance" for drugs.

When he died, a toxicologist found between 60 and 80 milligrams of 
methadone in his body. The medical examiner's office told his mother 
that with that amount, he couldn't have been taking it long. "It 
looked like a one-time thing," Haynes said. No warning It only takes 
one time, experts say.

Methadone stays in the body a long time, up to 59 hours.

But when taken to treat chronic pain, its effects only last four to 
eight hours.

And it doesn't produce the euphoric rush that drug abusers seek. 
"Patients or people using the drug often can't tell they've taken too 
much," said Kay Sanford, a state epidemiologist who has tracked 
methadone deaths. "They don't get any warning signs." So in either 
case, looking for pain relief or a high, a person might take the 
drug, then take more soon after, or take too much to start with. 
After that, it doesn't take long to die. The Rev. Brit Baldwin, a 
47-year-old chaplain at the Hefner VA Medical Center, died from an 
overdose of methadone in 2002. Baldwin suffered from migraine 
headaches, but hadn't been prescribed methadone. A friend of 
Baldwin's had a prescription for methadone, and the chaplain had 
gotten the drug from the friend's home at least one other time before 
his death, authorities said. The day he died, friends told 
investigators Baldwin had a "terrible headache." He took "several 
tablets" from the friend's house, a medical examiner said. Baldwin's 
sister later discovered his body at home, in bed. Some people take 
one pill for pain, think it's not working, then take a second and 
even a third, Sanford said. But methadone acts as a respiratory 
depressant. Taking too much stops the lungs from working. "The lungs 
simply shut down, and the person simply shuts down," Sanford said. 
"The person goes to sleep and doesn't wake up." Available and deadly 
Availability is driving the rising death tolls, experts say.

Toxicologists can tell the difference between the liquid form of the 
drug given to addicts at methadone clinics and the pill form given 
patients suffering from chronic pain. And they say in very few cases 
have they seen overdose victims with the liquid form in their 
systems. Throughout the 1980s and until around 1997, the state saw 
between one and five fatal methadone overdoses a year, said Dr. Ruth 
Winecker, the state's chief toxicologist. "And those were exclusively 
from heroin maintenance programs," she said. "Doctors didn't 
prescribe methadone for chronic pain through that time period." Part 
of the reason doctors prescribe methadone more now is its relatively 
low cost, Winecker said. At pennies per pill, compared with a 
painkiller like OxyContin at $2 a pill, it's an affordable 
alternative for chronic pain sufferers with no health insurance. And 
doctors believed it was less likely to wind up on the street, said 
Sanford, the state epidemiologist. Methadone "has been assumed to be 
less likely to be used for recreation or abuse because it doesn't 
give the user a high," Sanford said. However, she said, it is "very 
addictive." There are no firm statistics on the number of people 
dying who had valid methadone prescriptions. Sanford said in a study 
several years ago it was as much as 37 percent, but she can't apply 
that statistic to newer data, she said, because witnesses often lie 
to authorities investigating overdose deaths and she doesn't have the 
money or staff to go through medical examiners' records again. "But 
the majority of people who are dying are either first getting it off 
the street or getting a prescription and then using that prescription 
inappropriately," Winecker said. Prescription deaths Some, though, 
are using the drug just as prescribed and still dying.

Thirty-four-year-old Jeffrey Sepski went to a pain specialist in 
Jackson County on March 23, 2006. He had been in a lot of pain from a 
hip replacement surgery two years before and other medications 
weren't helping, his father, John Sepski said. The doctor prescribed 
methadone -- 30 milligrams three times a day -- as well as morphine, 
an anti-depressant and a generic form of Ritalin "to fight fatigue," 
his mother, Pat Sepski, said. Sepski started his medications that 
day. The next day, his aunt, with whom he was staying at the time, 
told his parents he got very nauseous and started throwing up. Then 
he couldn't hear because of "a constant rushing in his ears, like 
traffic," Pat Sepski said. That night, around midnight, his aunt 
heard Sepski in the kitchen before he returned to a building outside 
the house where he was staying.

She didn't see him the next morning.

Around 1:30 p.m., she looked in the window where he was staying. 
Sepski was on the floor, dead. His parents believe Sepski had taken 
four doses of methadone.

His autopsy noted the other drugs, but listed the cause of death as 
"acute methadone toxicity." The Sepskis said a medical examiner told 
them the levels of methadone in their son's system were lower than he 
normally saw, and that he didn't believe he exceeded the prescribed 
amount. "There's no way Jeff took more than he should have," John 
Sepski said. Taking only what was prescribed, Sepski would have 
ingested 90 milligrams of methadone in one day. In November, the Food 
and Drug Administration issued a warning that taking what had 
previously been recommended as an initial adult dosage for pain 
treatment, up to 80 milligrams a day, could be fatal. Dr. Robert 
Wilson, the local pain specialist who operates Piedmont 
Interventional Pain Care, said he learned all about methadone, its 
benefits and its potential pitfalls in his fellowship in 
anesthesiology and pain medicine, and has honed that knowledge in 
years of practice. He contends a small fraction of people with valid 
prescriptions are overdosing "if their physician has some idea how to 
write for the medicine." Unfortunately, many without specialized 
training do not, he said. "Doctors with good intentions may be 
overprescribing it," he said. Even after the FDA warning, there's no 
hard line to follow. "The challenge with methadone is that a safe 
amount for one person is not necessarily a safe amount for another 
person," Sanford, the state epidemiologist, said. "This is a drug 
where there are very different responses in different people." Killer 
combinations Winecker, the state toxicologist, said that she rarely 
sees methadone alone in an overdose victim.

And Sanford said many of the deaths she's seen involved methadone and 
an antidepressant. "I'm not going to demonize one or the other, or 
say they should never be taken together," Sanford said. "But there's 
a safe way to do it and an unsafe way to do it, and obviously the 
people we're looking at didn't take the safe dose." In September, 
Daniel Smith, the son of celebrity model Anna Nicole Smith, died of 
an apparent accidental overdose in a hospital room in the Bahamas 
after reportedly taking a deadly combination of methadone, Zoloft and 
Lexapro. Then his mother died in February under mysterious 
circumstances. She reportedly had been prescribed methadone and other 
drugs under an assumed name. The cause of her death has not been 
released. When Jamie Pethel died, he had Xanax in his system as well 
as methadone.

But his mother said there wasn't much Xanax and the medical examiner 
listed only methadone as the cause of death. Pethel came from a 
family with a history of addiction.

His mother, Mary Haynes, had her own drug problem, but is now a 
substance abuse counselor in a treatment program. Pethel started 
smoking pot when he was around 12 years old, Haynes said. At 17, he 
started taking pills and was in and out of substance abuse programs 
for the next six years. But Haynes said Pethel was always "dead set 
against" methadone.

He attended the funerals of three friends who overdosed and died on 
the drug. And he resisted when staff at a drug treatment facility in 
Winston-Salem tried to get him to use methadone to curb his own 
addictions. Haynes said she doesn't know for sure, but she believes 
Pethel did try methadone there. She knows he took it the night of 
Sept. 3. He was found dead the next morning in his truck, outside his 
father's house in Cabarrus County, near the Rowan County line. Haynes 
doesn't know where her son got the methadone, and neither do 
authorities. "I don't think I'll ever know," she said. "But I know 
that's what killed him."
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