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Unwelcome comeback: Once a treatment, methadone abuse now on the rise

By JARED DuBACH - Staff Writer
Wednesday, November 19, 2008 12:50 PM PST

Photo illustration by Ross Andr/son/Elko Daily Free Press

Whether it goes by brand names of Dolophine or Methadose or by its street names “fizzies” and “juice,” methadone has one constant - this drug once associated with heroin withdrawal treatment has made a big comeback as an abused prescription drug.

According to Doug Fisher, deputy sheriff and dog handler with the Elko County Sheriff's Office, one of the reasons methadone has made a comeback as a mainstream painkiller is because a more efficient drug has been manufactured for heroin withdrawal, leaving methadone to sit on the shelves.

The U.S. Department of Justice's National Drug Intelligence Center stated the rise in methadone prescriptions may come as a result of negative publicity associated with oxycodone (OxyContin) and hydrocodone (Vicodin and Lortab) from prescription drug abuse reports.

Larry Pinson, executive secretary of the Nevada State Board of Pharmacy, said many patients have been driven to methadone due to insurance companies wanting to pay out for the cheapest drug available.

Pinson said methadone costs pennies on the dollar compared to hydrocodone or oxycodone.

It's no coincidence overdose deaths related to methadone abuse rose 390 percent from 1999 to 2004 nationally, according to numbers from the Drug Enforcement Administration. Dispersal through pharmacies, hospitals and practitioners rose 487 percent for the same time period.

In addition to overdoses from abusers taking too much of the drug, the DEA suspects some physicians may be prescribing a 40-milligram diskette that's generally used for opiate addiction treatment inappropriately for pain relief. Methadone is also available in a liquid form.

Regular use of methadone results in tolerance and later dependence. The more the drug is used, the more the dosage has to increase over time to achieve the same euphoric effect. Chance of overdose increases when people unfamiliar with the drug compare it to other opiates.

But unlike other opiates, methadone's half-life lasts longer than its pain relieving effects, and bringing alcohol or other drugs into the equation intensifies the effects.

Even those with prescriptions for the drug have overdosed due to lack of information provided from their physicians.

Pinson said methadone isn't like hydrocodone or oxycodone, which produce highs or euphoric rushes for the user. Methadone is efficient at pain relief, but people often will take more under the assumption a little more will produce a high.

In 2006, the Food and Drug Administration issued an advisory which stated: “Prescribing methadone is complex. Methadone should only be prescribed for patients with moderate to severe pain when their pain is not improved with other non-narcotic pain relievers. Pain relief from a dose of methadone lasts four to eight hours.

However, methadone stays in the body much longer, from eight to 59 hours after it is taken. As a result, patients may feel the need for more pain relief before methadone is gone from the body. Methadone may build up in the body to a toxic level is it is taken too often, if the amount taken is too high or if it is taken with certain other medications or supplements.”

According to the National Center for Health Statistics, methadone deaths are higher for people age 35-44 and 45-54 than those younger or older. But every age group's use has grown exponentially since 1999.

The methadone death rate in Nevada in 1999 was 18 people. By 2005 it jumped to 93.

Methadone makes its way onto the black market through numerous ways. Teens raid family members' medicine cabinets or buy the drugs from friends who have done the raiding. Adults purchase much of their drugs illegally online without a prescription from overseas sellers and engage in prescription fraud. Outright theft is another major form of distribution. Aside from thefts of personal property, shipments are being diverted from manufacturers to distributors such as clinics and pharmacies.

Pinson said Nevada was one of the first Prescription Monitoring Program states, and has had the system for about 12 years. The system is used by pharmacists and physicians to monitor how often a person has filled prescriptions and for what type of drug. The system has proven effective at stemming drugs obtained through doctor shopping.

“We're very proud of our PMP system,” Pinson said. “Ours is one of the first and the best. We've gone further than any other state.”

Pinson said other states have asked Nevada for help in establishing their own PMP programs. The Legislature recently passed a bill making it mandatory for all physicians to use the system. The system gets between 6,000 and 10,000 hits per month from doctors. Pinson said there's “no question” the rate of abuse would be higher due to more easily accessible prescriptions.

As a result, adults turn toward theft and purchasing drugs illegally from overseas online. According to the National Drug Intelligence Center, the number of methadone shipment thefts increased from 28 in 2004 to 39 in 2005 and 68 in 2006. In 2006, 108,615 individual pills were reported stolen in transit to distributors.

Dorothy North, chief executive officer for Vitality Unlimited, said the rehabilitation center has started testing specifically for methadone because methadone doesn't show up on a standard opiate test. North said the number averages about two people per month testing positive for methadone. North said many people entering the facility don't mention methadone as a drug they've been abusing, but it shows up in the 10-panel test.

And if methadone is a major source of abuse for a person, North said the facility will often have to turn them down for treatment. It simply takes too long to get them off of methadone through detox, a process that can take from five days to a week for those with a more standard addiction to a drug such as heroin.

“They came up with heroin to get people off of morphine and they came up with methadone to get people off of heroin,” North said. “It doesn't work.”

Vitality Unlimited's treatment facility, Vitality Center, has the practice of stopping the cycle of substance abuse, rather than continuing to substitute one for another. Instead, methadone addicts end up resorting to outpatient treatment for a period of time to combat addiction.

A report from the National Drug Intelligence Center places responsibility on parents to educate themselves on the dangers of methadone to better protect their children from abusing it. Law enforcement will continue to identify the illegal trafficking of methadone and stem the rate of thefts.

However, if methadone abuse is not curbed successfully, the report states opiate abuse will likely increase and move into more illicit drugs.

“As the dangers of becoming addicted to or overdosing on methadone become more widely known, those who have become dependent on methadone either during pain management or through recreational use may turn to other prescription opioids, such as hydrocodone or oxycodone, and may eventually switch to heroin.

“Opioid abusers generally seek out the highest purity, most inexpensive form of the drug and in many instances heroin will be the drug to which prescription opioid abusers turn.”

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