Published: January 31, 2009 10:34 pm         

Methadone is now the top cause of accidental overdoses in Wabash Valley

TERRE HAUTE — For different reasons, Chuck Fortner and Dylan McClain probably would not have read an article about the dangers of methadone.

Their mothers hope the families of people like them will.

“Use it,” Cindy Pierce said of her son Chuck’s story. “Anything that can help the reader. I want that very much.”

Fortner, 36, suffered from chronic back pain and died in an accidental overdose involving methadone last June 23.

“It’s just a very lethal drug,” Cindy McClain said.

McClain’s son, Dylan, 20, died May 5, 2007.

Dr. Roland Kohr, Vigo County coroner and pathologist at Terre Haute Regional Hospital, said methadone is now the top cause of accidental overdoses in the area, noting 21 of 290 autopsies he performed in 2008 involved the drug.

Kohr not only performs autopsies in Vigo, but also counties ranging from Edgar in Illinois to Sullivan and elsewhere throughout the Wabash Valley. That number represents 7 percent of the total autopsies he performed last year.

And with the shocking price difference between methadone and OxyContin, the former has quickly become a widely prescribed alternative to other forms of pain medication.

According to information provided by a Wabash Valley pharmacy Thursday, 100 10-milligram tablets of methadone retails for $21.13.

Meanwhile, 100 40-milligram tablets of OxyContin is $694.33.

As Fortner pointed out, methadone is “very cheap pain medication,” often going to the underinsured, the uninsured, those lacking education, those on disability and those with chronic pain.

And that demographic, as well as the kids to whom it trickles down to on the street, just aren’t likely to research what makes methadone so unforgivingly different from medication that was actually designed to alleviate pain instead of service heroin addicts.

“They don’t understand the difference,” she said.

And that’s what McClain and Pierce want to change.

Deceptive

and unforgiving

Methadone’s roots go back to World War II, as the German and American governments sought a cheap alternative to morphine.

During the late 1960s, methadone was introduced as a way to wean addicts off heroin.

A synthetic opioid, the drug was administered orally at designated clinics. Doses were monitored and scheduled to wean addicts off gradually so they wouldn’t die from the effects of heroin withdrawal. Identification was required and distribution was supervised to ensure the appropriate dosage was used at the correct intervals.

But according to Kohr, over the past 10 years physicians have come to realize that when prescribed correctly, methadone can be an effective pain medication.

And with other name-brand pain medications coming under fire for a variety of problems, methadone has moved to the front, prescribed in what Kohr agreed are large quantities.

And while patients who follow their physician’s directions are in all likelihood safe, misuse can be fatal.

“It’s a far more dangerous drug than I think people have a concept of,” Kohr said.

Ignorance of the “wallop” packed by methadone can be lethal, he said.

McClain, spokeswoman for Indiana’s HARMD, which stands for Helping America Reduce Methadone Deaths, said methadone’s “half-life” is the problem.

Designed to combat the withdrawal symptoms of heroin addiction, methadone stays in a person’s system longer than other drugs.

So even after an individual has “come down” from the high, the chemicals are still working inside the body.

People used to the manner in which other pain medication gradually wears off are susceptible to shrugging at the doctor’s warnings and simply taking more of the highly addictive narcotic.

This makes the next dose potentially lethal, as the first isn’t fully out of the body yet.

“You just can’t take methadone like that,” McClain said, explaining the tolerance one builds up to other medications can lead one to believe they’re strong enough for larger doses of methadone.

Pierce said physicians need to monitor their patients’ usage and test their blood to make sure other medications aren’t mixed.

“Doctors are giving out 30 days worth of this drug,” she said, noting that for people with addiction problems and/or chronic pain, the temptation can be too great. That’s why the methadone clinics for heroin addicts make patients go on-site for the drug. “Just because you’re not feeling it doesn’t mean it’s not in your system,” she said.

And as pill-poppers look for the next high once methadone wears off, the result can be an immediate overdose, she said.

The Result

Fortner was a construction worker who first injured his back at age 20, Pierce said.

While roofing houses over the next 16 years, he had four back surgeries and suffered chronic pain.

Fortner had been taking OxyContin on prescription for two years before he moved to methadone.

“He thought it was a safer choice,” she said, noting he was unemployed at the time and cost could have been a factor.

Fortner was on methadone less than two weeks before he was dead.

The tolerance to OxyContin and other meds he’d built up over the years probably boosted his confidence, leading him to reach for a second dose when the effects of the first wore off, she now guesses.

“That tells me Chuck was in pain and he was trying to alleviate the pain. He didn’t realize the dangers,” she said, acknowledging she didn’t know much about the drug, either, until after her son died.

Kohr said he hasn’t performed a single autopsy involving a person who followed the prescription as written by a physician, but those who self-diagnose or mix methadone with other medications are at risk.

But as Pierce noted, the very demographic most likely to get the drug are the least likely to maintain discipline when a ready supply of relief is right in their hand, especially if they don’t understand the consequences.

“They’ll just go to sleep and not wake up,” she said.

Kohr first encountered the drug’s effects about four years ago while performing an autopsy on a 20-year old, otherwise healthy male, who had died without apparent cause.

Toxicology results showed methadone present, but at levels within the “therapeutic range,” he said.

It wasn’t until he probed further that he realized the “therapeutic range” of methadone is very wide as the drug is designed for heroin addicts with years of narcotic tolerance.

This could make the “therapeutic range” of methadone lethal to individuals who have never taken heroin.

Since then, he’s seen a spike in methadone-related deaths, usually where the drug is taken in combination with others, for pain or recreation.

Awareness

McClain said HARMD is her emotional outlet.

“I never feel like I do enough,” she said, recalling the 750 people who attended her son’s funeral last year, and the number of other kids’ friends affected by other kids’ deaths.

Through the association, McClain has met scores of families touched by methadone and other prescription drugs, ranging from patients with chronic pain to pill-popping teens.

Pills lack the stigma associated with needles and are easier to conceal than pipes and other drug paraphernalia, she said.

High-school students and even middle-schoolers engage in “trail mix parties” where bowls full of random pills are grabbed by the handful.

Kohr said the age and demographics of the autopsies involving methadone vary greatly, but combination with other medications seems to be a common denominator.

Whether it’s legitimate patients that unwittingly take other medications at the wrong time, or kids seeking a higher high, the result is the same.

Kohr said people with methadone prescriptions should “guard it” and make sure it doesn’t fall into the wrong hands.

McClain referred to this as “diversion,” where someone takes a pill prescribed to someone else. She called it a major problem everywhere but particularly among kids.

The goal of HARMD is not the elimination or ban of methadone, McClain said, noting it, like all drugs, has a proper function.

But in all likelihood, everyone knows someone involved in pain medication, or knows kids who experiment with drugs.

Spreading awareness about methadone’s potential effects and lobbying for tougher penalties on those caught selling the drug to addicts are the main courses of action.

“And being there for other people who are going through the same thing,” McClain said of other families who have lost members to overdose.

Because the people most likely to misuse methadone are the least likely to read about its dangers, McClain and Pierce said they want the whole community to be aware.

Had they known then what they now know, their sons might still be alive.

“You always struggle with it. It never, never, ever goes away,” McClain said of her son’s death.

Brian Boyce can be reached at 812-231-4253 or brian.boyce@tribstar.com.