Rais­ing aware­ness of methadone’s dan­ger

Los Angeles Times - - Medicine - Kate San­tich ksan­tich@or­lan­dosen­tinel.com Amina Khan of the Los An­ge­les Times con­trib­uted to this re­port.

Jonathan Lu­cas Levine should be cel­e­brat­ing his 21st birth­day this month. Prob­a­bly he would be in col­lege by now, study­ing to be a math pro­fes­sor or per­haps a psy­chol­o­gist. Surely he would have plenty of friends. The way other kids used to fol­low him around, his mom dubbed him the Pied Piper.

In­stead, Donna Levine sits in her Or­lando, Fla., apart­ment sur­rounded by pho­tos of her only child and tries not to cry again. Three years ago this month, at 18, Jonathan died of a drug over­dose.

Among the mix of chem­i­cals in his sys­tem was methadone — a drug that is read­ily avail­able, rel­a­tively cheap and le­gal. The med­i­cal ex­am­iner ruled that methadone was the key in­gre­di­ent that made the over­dose lethal.

“Peo­ple just don’t know about the dangers,” Donna Levine said. “Kids take these pills from their par­ents’ medicine cabi­net, and they have no idea what they’re get­ting into.”

Levine is on a mis­sion to ed­u­cate par­ents and their chil­dren about those dangers. She calls her fledg­ling non­profit or­ga­ni­za­tion Mad Over Methadone — or MOM for short — and has sold her car to cover start-up le­gal ex­penses. “I have to do this,” the 52year-old said. “This is my pur­pose.”

While most peo­ple know methadone as a treat­ment for ad­dic­tion to heroin, in re­cent years the drug has be­come an in­creas­ingly pop­u­lar — if con­tro­ver­sial — choice to treat se­vere pain.

“I hear sto­ries all the time of the drug be­ing mis­used,” said Monte Dren­ner, an Or­lando mental-health ther­a­pist and cer­ti­fied ad­dic­tion pro­fes­sional who sup­ports Levine’s ef­forts. “Most peo­ple are naive. They have the idea that if some­thing is pre­scribed, it’s safe.”

But that’s a false im­pres­sion.

Poi­son­ing spike

Ac­cord­ing to a re­port last year from the Na­tional Cen­ter for Health Statis­tics, “the num­ber of poi­son­ing deaths in­volv­ing methadone in­creased nearly sev­en­fold from al­most 790 in 1999 to al­most 5,420 in 2006.”

A 2009 re­port from the Govern­ment Ac­count­abil­ity Of­fice said the spike was partly due to the drug’s in­creased use in pain man­age­ment. The re­port points to data from the Drug En­force­ment Agency show­ing that methadone dis­tri­bu­tion to phar­ma­cies and prac­ti­tion­ers nearly tripled from 2002 to 2007.

Dr. Lynn Webster, a Salt Lake City-based anes­the­si­ol­o­gist who co­founded the non­profit Life­Source to ad­dress is­sues such as un­in­ten­tional over­dose, blamed the in­dus­try-wide push for cheaper pain-man­age­ment drugs as an al­ter­na­tive to ex­pen­sive op­tions like OxyCon­tin.

“Methadone rep­re­sents just 5% of treat­ment of chronic pain but is as­so­ci­ated with about a third of all the deaths,” Webster said. That’s partly be­cause many physi­cians don’t know how to safely start pa­tients on the drug, or how to care­fully raise the dose. And even in cases where the doc­tor does ev­ery­thing right, “pa­tients try to man­age their own pain in spite of doc­tors’ or­ders,” he added.

The Food and Drug Ad­min­is­tra­tion is­sued a pub­lichealth

ad­vi­sory in late 2006, warn­ing that “methadone use for pain con­trol may re­sult in death and life-threat­en­ing changes in breath­ing and heart­beat.” The FDA fur­ther noted that pre­scrib­ing methadone for pain is a “com­plex” is­sue be­cause of po­ten­tially fa­tal in­ter­ac­tions with other drugs and be­cause methadone has a long halflife, stay­ing in the body for at least sev­eral days.

Bad mix

Dr. Stacy Seikel, med­i­cal di­rec­tor at the Cen­ter for Drug-Free Liv­ing in Cen­tral Florida, said the drug has a le­git­i­mate — and suc­cess­ful — use in treat­ing ad­dic­tion to heroin and OxyCon­tin. But Seikel said she never pre­scribes it to any­one tak­ing ben­zo­di­azepines, a class of drugs used for anx­i­ety, in­som­nia, seizures and mus­cle spasms.

“It’s very pow­er­ful, par­tic­u­larly in peo­ple who haven’t built up any tol­er­ance,” she said. “And when you com­bine it with some­thing like Xanax or Ati­van, you ba­si­cally just stop breath­ing.”

The pri­mary source of the prob­lem, Seikel said, is methadone that is pre­scribed by “pill mill” doc­tor of­fices fre­quented by drug-seek­ing pa­tients. Those pre­scrip­tions too of­ten end up be­ing sold by the pa­tient for a profit.

That’s what hap­pened in Jonathan’s case.

On Sept. 20, 2007, while vis­it­ing a friend in Al­ta­monte Springs, he com­plained of ex­cru­ci­at­ing pain in his face and si­nuses — the re­sult of a surgery that had left him with an im­planted metal plate and a pair of ti­ta­nium screws.

The friend’s mother, Donna Levine said, sold Jonathan a pair of methadone pills. He took only one, but he al­ready had taken a trio of other drugs pre­scribed by his doc­tors for pain and mood sta­bi­liza­tion.

Later, he would call his mom to say he was too tired to come home and was spend­ing the night with a friend. By morn­ing, he was dead.

It took two years of griev­ing be­fore she knew what she wanted to do. With help from some young peo­ple who knew her son, she plans to take the mes­sage to schools, youth groups and camps. She is also try­ing to spread the word to par­ents — and of­fer so­lace to moth­ers and fa­thers who learn of the dan­ger too late.

“I am not one of these peo­ple who say it will all be worth it if it saves one life,” she said. “I want to save a lot of lives.”

Los An­ge­les Times

USE WITH CARE: Methadone, used to treat heroin ad­dic­tion, is gain­ing pop­u­lar­ity for pain man­age­ment.

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