Pubdate: Sat, 17 Jan 2009 Source: Regina Leader-Post (CN SN) Copyright: 2009 The Leader-Post Ltd. Contact: http://www.canada.com/reginaleaderpost/letters.html Website: http://www.canada.com/regina/leaderpost/ Details: http://www.mapinc.org/media/361 Author: Memory McLeod Bookmark: http://www.mapinc.org/find?136 (Methadone) METHADONE: A DEADLY PARTY DRUG All the experts agree that methadone, a proven, safe and unparalleled treatment of opioid addiction when administered by a licensed doctor, is dangerous when abused by naive users. Dr. Lowell Lowen with the College of Physicians and Surgeons of Saskatchewan, which administers the program and is currently reviewing all deaths where methadone was involved said it's the irresponsible partier who gets into trouble with methadone. "From what I see, there is not a problem with those who are prescribed and on the program. Already, the problem I do see is with those who are not on the program, naive users who party, and when they run out of one drug they start up with another. Studies show that you will lose one per cent of your methadone patients due to poly (multiple) drug use. The problem there is that with poly drug use while on methadone, sometimes people's minds are altered and they are not aware of how much they are taking," Lowen said. Methadone is used in the treatment of opioid addiction. It prevents withdrawal, decreases cravings and blocks euphoria produced by other short-acting opioids. Lowen pointed out that naive users of methadone put themselves in danger because they don't know how the drug works. "It accumulates in the body over time. The body accommodates the drug to the point where they can handle prescribed doses. For those who don't know that, and they take 60 or 90 milligrams they will just fall asleep. They can be revived, but if they are partying they go to sleep and their friends go home, they will not be revived. It's the irresponsible party person who can get into trouble with this," Lowen explained. He estimated that the majority of patients use less than 100 mg per day but due to the nature of the drug it is dependent on the user. "Some patients can be very large and require only a small dose and then other people can be very small and thin and require a larger amount. A doctor would use a number of factors to decide the amount prescribed," he added. Each bottle of methadone in a carry dose lists the amount of methadone in the solution, but one cannot gauge the dose simply by measuring the amount of a bottle one drinks. "Every bottle is full but has a different dosage. They each contain the same amount of liquid but not concentration," noted program co-ordinator Bernadette Amyotte. She estimates that 30 to 35 mg could harm someone who is not an opioid addict. "Drugs that are prescribed are on prescription for a reason, because they can be dangerous. Illegal drugs are illegal for a reason, because they are dangerous," she said. Even a small amount of methadone can cause respiratory depression and arrest in those who have not built up a steady tolerance to the drug. Because of it's gradual and cumulative effect -- blood levels increase with each successive dose until it reaches a steady state at about four or five days -- the progression of respiratory depression can go unnoticed by the patient's companions. Province-wide, 24 deaths have occurred where methadone was either a primary or contributing factor between January 2007 and June 2008. Of those, 12 were on the methadone program and 12 were not. Of the 12 that were, seven died from combined drug overdoses, including prescribed and illicit drugs. Three died of methadone alone, and two died of other causes of chronic drug use such as pneumonia or liver disease. Of those who were not on the program, one died of a methadone overdose and 11 died as a result of a combination of methadone and alcohol and/or prescription and illicit drugs. "Looking at the statistics it's certainly a concern that there is this number of deaths that are related to methadone in this province," said Chief Coroner Kent Stewart. "This raises a couple of issues, the use of illicit drugs while on the provincial methadone program. If you look at these statistics you will see that there is certainly a significant number of deaths of those that are on the program. Two, the deaths of individuals who are not on the program, which raises the issue of diversion, meaning where are these individuals getting it from? There are two possibilities there, it may be going astray and being sold and it also may be brought in. The question is where is this coming from and that is really a concern," Stewart said. Illegal use, trade, sale or sharing is not something the Regina Police Service's drug unit hears much about, according to spokeswoman Lara Guzik Rostad. "When looking at crime trends in the city, illegal methadone use is not something that is seen or heard about too often by our officers," said Guzik Rostad. "If a person was found with someone else's prescription that would be investigated but it's not something that is encountered very often." Insp. Jerome Engele of the Saskatoon Police Service agrees that while there are those who use the drug illegally it is not a popular choice among street users. "Some prescribed users will sell some of their carries in order to supplement their incomes. How they do this is say they get a week's supply. They go in and take their Monday supply at the pharmacy, that will carry (them) until (they) have to come back in and take another witnessed drink on Wednesday so that frees up the Tuesday supply," he explained. Because the treatment is used as a means to live a more stable and productive life, most on the program will not take risks such as sharing or selling their carries, he explained. Still, Engele points out there is a big risk involved for those who choose to abuse the drug. "Those who choose to abuse it are really taking a big chance because it is a very dangerous drug, especially in a recreational setting. It doesn't take very much of it to make a lethal dose. For those who use it in conjunction with other drugs, they too are taking a big risk." Amyotte said the risk of overdose for patients is managed in several ways including the requirement of a lock box to house all take-home (carry) doses and the requirement of all bottles being returned before any more carries are given. While alcohol and drug use, particularly cocaine, mixed with methadone increase the risk of overdose, patients who are known users of these drugs are not prohibited from the program. "As long as they are able to provide proof of opioid addiction, that is the main thing. This program is considered as a last resort. The patients need to show that they have been to detox or treatment, that they are trying to deal with the addiction," Amyotte explained. "Also, we go over a list of drugs not to mix with methadone, we explain what can happen. The signs of overdose are slowed-down breathing and heart rate, then what we call 'going on the nod', or falling asleep, and then dying," she explained. Since officiating at a funeral for a victim of methadone overdose in 2004 where mourners left early to attend another funeral for an 18-year-old who had overdosed on the drug, local minister Nathan Pelletier has been concerned. Pelletier believes that the carry or take-home medication program administered by the Harm Reduction Methadone Program is posing a risk to those who take the drug illegally. "People take their carry dose and they get way too much. I think the only time people should get their carry dose is when they are on a very limited amount," he said. Pelletier said the risk comes when people sell or trade a prescribed carry dosage on the street -- where according to one estimate the drug sells for $1 per millilitre. Carry privileges are given to patients who are considered to be functionally stable in cases where there is a rationale for granting carries such as full-time employment or school and is not recommended during the first three months of treatment. Amyotte estimated there are about 25 patients on the one-in-six carry program where they take one dose in front of the dispenser and then take six doses home. She would not speculate to the maximum amount currently given to patients but pointed to a guideline given by the College of Physicians and Surgeons, which she cited as recommending no more than 400 mgs that should be taken home. She also pointed out that each patient's dose is decided by the doctor overseeing the patient's care. Lowen said the guidelines Amyotte referred to are federal and have not been applied for some years. "People do take home more than (400 mg). That is a federal guideline which was instated in the early '90s and has not been reviewed. It is not used any longer, even by the feds," he said. The risk of relapse increases sharply if methadone maintenance is discontinued, which is why for some patients, the treatment is considered to be a life-long necessity. There are currently about 190 patients in Regina who are prescribed the drug through the Harm Reduction Methadone Clinic, and about 1,800 province-wide. The program is aimed to reduce injection drug use, drug-related crime rates and hepatitis C and HIV infection rates in Regina and area. The hope is that once stabilized on methadone the addicted person can live a normal productive life. Amyotte recommends that anyone struggling with an opioid addiction should contact the program rather than risk taking someone else's methadone to keep away drug sickness. "If evidence was brought in to the clinic of sharing or selling the drug, such as a misplaced bottle, the matter would be looked into," she said. - --- MAP posted-by: Jay Bergstrom