'Safe' drug a leading killer

Drug users take methadone thinking it is less dangerous than other drugs. But it causes more deaths in the state than any other drug.

By LISA GREENE
Published May 15, 2005

Deaths from methadone, considered by many a "safe" painkiller, are spiraling upward so fast it has become the leading drug killer in the state of Florida.

In the first six months of last year, methadone overdoses killed 264 Floridians, tied with cocaine as the leading cause of overdose deaths. That was a 50 percent increase over the previous six months for the drug that most people associate with clinics to help addicts kick heroin.

But methadone is a powerful narcotic, too - one that, these days, is killing far more people than heroin. It's also a bigger killer than more notorious prescription drugs, such as OxyContin and Vicodin.

"This can be a very deadly drug," said Jim McDonough, Florida's drug czar. "It can also be a very helpful drug, but if abused, it's very deadly."

Methadone's reputation for safety contributes to its danger.

Over the past few years, doctors worried about the publicized abuse of OxyContin and similar painkillers have prescribed methadone instead. U.S. methadone prescriptions more than tripled between 1998 and 2003, to 1.8-million. That has made it easier for abusers and drug dealers to obtain it.

People who would stay away from better-known dangers, such as heroin, mistakenly believe methadone is safe, addiction experts say.

"That's what we see over and over again," said Robert Lubran, an official with the federal Substance Abuse & Mental Health Services Administration. "People who take it without really understanding the danger, thinking they're going to get high - but it has this really deadly effect."

Methadone overdose deaths have been rising around the country, Lubran's agency found in a report released last year. The report found that the number of such deaths reported in one federal database doubled from 2001 to 2002. Emergency room visits for methadone overdoses in 21 major U.S. cities increased 230 percent from 1994 to 2001.

Drug abusers take methadone without knowing it's even riskier when combined with other drugs. Teens raid their parents' medicine cabinets and steal their methadone pills. Small children find stray pills and pop them in their mouths.

One pill alone can kill a toddler.

When Seminole resident Sandy Zalewski was told about her son's death, she thought he must have had a terrible accident.

She was proud when he started his tree-trimming business, sure he was putting his life back together. But she worried it was dangerous.

Then she heard: overdose. She thought cocaine, the drug he battled for years, had finally claimed him.

But it didn't. It was a new drug, one that Zalewski didn't know her son, 32-year-old Bobby Mullis, had ever taken before.

She called the medical examiner to make sure.

"Methadone?" she asked. "What is methadone? Isn't that something to get off heroin?"

It is. But it's also is a prescription painkiller leaking onto the streets.

For heroin addicts, methadone is useful because it lasts. It doesn't give the euphoric high of heroin, and it stays in the body for hours, even days, blunting painful withdrawal symptoms and heroin cravings.

But for methadone abusers, the lasting effect makes it more dangerous. In Pinellas County alone last year, methadone either killed or contributed to the deaths of 26 people. In Hillsborough, it was 52.

Methadone's pain relief wears off after about six to eight hours. But the body metabolizes methadone slowly. A person's body still contains half the dose 24 to 36 hours after taking it.

"A lot of people don't understand it is a very long-acting drug," said Lubran, who is director of the division of pharmacologic therapies at the federal substance abuse agency. "You don't get high in the first 15 to 30 minutes. People are taking more than they should be taking."

What's more, people break down methadone at different speeds, said forensic toxicologist Bruce Goldberger, director of forensic medicine at the University of Florida College of Medicine. Some people still have half the dose five days later.

Methadone was approved by the FDA as a painkiller in 1947. In the 1960s, doctors realized that daily methadone could help heroin addicts, leading to the clinics where addicts still receive the drug today. For the first few months of treatment, addicts must go to a clinic almost every day, where someone watches as they take their methadone doses.

While some clinic patients may sell their methadone, a federal report released last year, which Goldberger helped write, concluded that wasn't the reason why methadone deaths started to rise.

The more likely cause, addiction experts believe, is the shift in prescribing.

"The physicians who were regularly prescribing OxyContin were put under a magnifying glass," Goldberger said of the powerful time-released painkiller that came under FDA scrutiny about four years ago. "With the widespread abuse of OxyContin, a lot of physicians began to distrust their patients."

And so they turned to methadone.

Dr. Rafael Miguel, program director of pain medicine at the University of South Florida College of Medicine, is passionate about providing powerful drugs to those who live in constant pain. Such pain changes lives, he says. It drains souls.

But Miguel knows some of his patients are liars.

"We are all being fooled," he tells colleagues when he gives lectures about pain medicines. "We all have patients who are taking it just to get high."

Miguel, a former member of the Florida Board of Medicine, regularly prescribes methadone himself.

It's an effective pain reliever. And it's cheap. A 10 mg methadone pill costs 25 cents, while the same dose of OxyContin costs $5.28.

But even many doctors don't realize how powerful the drug is, Miguel said. Some medical textbooks say methadone is about as powerful as morphine. Newer research shows that methadone is about five to seven times more potent, Miguel said.

Methadone is dangerous because it depresses the central nervous system and slows breathing.

Young children are especially sensitive, said Vincent Speranza, managing director of the Florida Poison Information Center, based at Tampa General Hospital. Nationally, 11 percent of the medication deaths among young children are from taking methadone, he said.

It's especially powerful in combination with other drugs that also affect breathing - other opiates and such drugs as Valium and Xanax. Overdose victims often have taken more than one drug.

Because of methadone's duration, combining drugs is risky days later.

"You party with methadone Thursday," Miguel said. "You go to work on Friday, on Saturday you mow the lawn. Saturday night you crack an OxyContin on the dance floor, and you kill yourself."

Other drugs, from antibiotics to heartburn medicine, also can affect methadone levels because the body metabolizes them the same way. So once someone takes such a drug, the body breaks it down instead of methadone.

Doctors can cut down on abuse, Miguel said. He checks MRIs and other tests to make sure the pain is real. Former doctors are called. Some doctors make patients take drug tests. They check whether the patient is taking other drugs - and also whether he or she is taking the prescribed painkiller, not selling it.

Miguel prescribes other drugs, rather than letting patients rely solely on narcotics. He prescribes lower daily doses than some other doctors, even when he's had patients get a second opinion and return with a prescription for three times more.

Still, there are limits.

"Once the patient leaves your office," he said, "There goes your control."

These days, the endless ads for Viagra and Zoloft make Sarasota resident Stephany Murphy mad.

"As a society, we have let our young people down. There's a pill for everything now," she said. "I know a lot of these are helpful, but we're sending the wrong message: "If you take this pill, it'll help.' "

Last year, Murphy's daughter and her boyfriend were found dead in his apartment, a lethal cocktail of several drugs in their blood. Methadone was one of them. Stephany McClure was 17.

It is such deaths that lead drug czar McDonough to label the illegal diversion of prescription drugs as his top concern.

"What you really have is mass murder, a new type of mass murder," he said. "These are not light casualties . . . every day, five more die."

Such drugs include OxyContin, Percocet and Vicodin as well as methadone. McDonough, whose official title is director of the Florida Office of Drug Control, called methadone "one of the worst."

Florida has formed several state and federal "diversion response teams" to investigate pill dealers. Some doctors have been charged with fraud, trafficking and murder for pushing pills.

Still, such cases often are harder to investigate and prove than busting a cocaine or heroin ring. Just having the drugs isn't illegal. Police have to prove illegal sales. It also can be hard to link an overdose death to a specific pharmacy or doctor.

After McClure died, investigators pursued several theories about where the drugs came from that killed her and her boyfriend.

No arrests have been made.

One of the best ways to cut overdoses would be a centralized registry of narcotic prescriptions, say Miguel and McDonough. McDonough has been trying to get a bill for such a registry passed for three years now, but so far some lawmakers' worries about privacy have stalled the bill.

The registry would list narcotics prescriptions, allowing pharmacists to make sure people aren't getting multiple prescriptions from different doctors and filling them at different drug stores. Other states already have such registries, the pair said.

"Florida is a particularly bad offender in this regard," Miguel said. "We can't continue to wait, because people are dying."

Zalewski and Murphy want greater public awareness of how dangerous methadone is. If their children had known just how risky the drug is, both women said, they might still be alive.

Instead, they are struggling with dates they never wanted to see. Last month would have been Stephany McClure's 18th birthday. Next month will mark the first anniversary of Bobby Mullis' death.

Zalewski will have a memorial service and invite her son's friends. His dog Cheeko will be there too.

She thought that her son had finally beaten drugs, that there would be no more rehab programs, arrests or broken promises. No more late-night calls, confessing and begging for rescue.

"He's really going to make it," she told her sister.

Mullis had been clean for nearly four years. He had a long list of business clients. He sent his mother to Las Vegas for her birthday. He bought a boat.

But one night last June, an old friend asked him to buy some cocaine, just this once. He did. Zalewski still doesn't know when he took the methadone.

She just knows that the day he died, she took him to breakfast. He ate bacon and eggs and said he was sorry about the cocaine. He promised he was back on track. Then Mullis went home to take a nap, Cheeko at his side.

He never woke up.

"I don't think people realize," Zalewski said, "that when you take that drug and mix it with anything else, you're playing Russian roulette."

Methadone is a synthetic narcotic. Brand names include Dolophine and Methadose. It is an effective pain reliever and has been used for decades as a way to help addicts stop using heroin. But when misused, it can be deadly.

Methadone is dangerous because it slows breathing and depresses the nervous system. It stays in the body for days, and other drugs can magnify its effects.

Symptoms of overdose include: difficulty breathing, pinpoint pupils, drowsiness, confusion, nausea, vomiting and low blood pressure.

Speedy medical treatment can save someone from an overdose. Anyone with overdose symptoms should call 911.

Photo detail:

Sandy Zalewski reads a poem, entitled "You are Always With Me," she keeps at the grave of her son Bobby Mullis, who died of a methadone overdose in June.

St. Petersburg Times

TampaBay.com