Pubdate: Tue, 27 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 ONLY THING THAT MAKES LIFE BEARABLE FOR ARTHRITIS SUFFERER

Robert Mulkey tried a lot of different treatments for the arthritis
that racks his body, but it wasn't until a doctor prescribed methadone
that he got any relief at all.

"It's been my lifesaver, honestly," Mulkey said recently. "My life is
pain 24 hours a day, but the methadone makes it bearable." Since the
1970s, Mulkey has suffered from osteoarthritis, psoriatic arthritis
and fibromyalgia. At 37, the debilitating afflictions forced him to
quit his job at Freightliner.

"I just got one day where I couldn't get out of bed," he said. Mulkey
went through "a whole chain of doctors" until he found himself at a
pain clinic at Wake Forest University Baptist Medical Center in
Winston-Salem.

After several other drugs and many treatments, doctors there tried
methadone. It worked. Mulkey still feels pain pretty much all the
time, but it's pain he can tolerate.

"If I didn't have it," Mulkey said of the methadone, "I don't know
what I'd do." Bad reputation Methadone is rapidly gaining a reputation
as a killer. And, based on the numbers alone, it seems deserved.
Methadone-related deaths rose nearly tenfold in North Carolina between
1999 and 2006, and medical examiners found the drug in nearly half of
Rowan County's unintentional overdoses from 2003 to 2005. But Mulkey
and the pain specialist he sees now, Dr. Robert Wilson of Piedmont
Interventional Pain Care in Salisbury, say those numbers don't tell
the whole story. Taken correctly, methadone can save lives, or at
least restore as close to a normal life as some people will ever have,
Wilson said. "I treat a lot of patients with it," he said. "It's very
useful for the right patient, right condition."

Wilson did his fellowship in pain medicine at Baptist Medical Center
and said doctors there prescribed methadone"quite a bit." He said
Mulkey was already taking the drug for pain when he came to the
Salisbury clinic, but he is the type of long-term chronic-pain
sufferer for whom Wilson would consider it.

"If it's taken as prescribed, and prescribed by the right people, it's
very safe," Wilson said.

Wilson has about eight years experience with methadone but allows that
doctors without the proper training may not know how to prescribe the
drug and that "doctors with good intentions ... may be overprescribing
it." Going by old guidelines in place before a Food and Drug
Administration warning last year, the recommended initial adult dosage
could have been up to 80 milligrams a day -- potentially toxic levels.

Wilson said that doctors and patients have to be aware that methadone
has an extremely long presence in the body -- up to 59 hours -- even
though its effects may wear off in less than eight hours. Taken
correctly, its pain-managing effects build up over time. Taken
incorrectly, it can kill. "You can't take four or five of them," he
said. "It's more a drug you take on a prescribed schedule. That's true
for methadone or any long-acting drug." And Wilson said he doesn't
even prescribe the highest dosage of methadone, which comes in 5, 10
and 40 milligram tablets for use in pain management. He starts a
patient out at 15-30 milligrams a day and doesn't go much higher.
Mulkey, over several years, has built up to a 10 milligrams tablet
every four hours or so, but no more than four a day.

A cautious watch Wilson said that doctors write more prescriptions for
methadone now than they have in the past, in part because it's an
affordable alternative for people without health insurance, like
Mulkey, who can bear $20 for a month's supply of methadone a lot
easier than $200 for the same amount of the pain reliever OxyContin.

But its increase in use is also because other effective painkillers,
including OxyContin, have gained so much popularity among abusers, and
doctors are being cautious, he said.

The state hopes a new reporting system scheduled to go online in July
will help prevent abusers from going doctor to doctor looking for
prescription drugs to sell or feed their own habits. For now, though,
Wilson said he has to do his own "detective work" to keep that from
happening.

When a new patient comes into his clinic, Wilson said, he often asks
them a question for which he already has the answer, such as what
their last doctor prescribed and how long ago he prescribed it.

He watches for other "red flags," too, such as a patient coming in
with no job or insurance asking for an expensive brand-name drug like
OxyContin. Wilson said he tells patients to lock up their medications
and lets them know that if they come back in before a prescription is
due to run out saying they lost the drugs or had them stolen, they
won't get more. Patients also know they are subject to random drug
tests at any time. Wilson said he discharges patients regularly if he
finds other drugs in their systems or doesn't find the drug he's prescribed.

"Patients in this clinic have to be held accountable for what they're
doing," he said.

And Wilson contends that accountability, not methadone, is the real
problem. "It's the kind of world we're living in," he said. "Nobody's
responsible for their actions."

Easing the pain Mulkey said he is "not a drug addict." But he is
thankful for methadone. Only 47, Mulkey moves like a much older man,
slowly and leaning on a cane. Methadone doesn't take the pain away,
just moderates it so that Mulkey can do things most people take for
granted but that he found too excruciating before, like putting on his
pants, or tying his shoes, or getting a gallon of milk out of the
refrigerator.

"I'm able to do a few things in the house and have a little bit of a
life," he said. "I don't go outside and throw the football or
anything. I don't go fishing. I used to love to fish."

One recent day, it took Mulkey a long time to make it to the end of
his driveway. He had to take a break along the way. Once there, near
his mailbox, Mulkey bent forward deliberately and grasped the plastic
wrapper around his newspaper. Then he made his way slowly back up the
driveway. He's thankful he can get the paper, get the mail. Without
methadone, he said, he couldn't do that.

"It's painful," he said. "But I can get it."
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