Increase in methadone deaths tracked

Medical experts are keeping a close eye on methadone-related deaths after an increase in the number of accidental overdoses involving the synthetic opiate last year.

Data obtained from the Chief Medical Examiner's office shows 19 Manitobans died following an accidental methadone overdose last year -- up from the 13 deaths reported in 2008 and 2007.

Chief medical examiner Dr. Thambirajah Balachandra said the increase could be a blip, but officials should know for certain by the end of the year. He said the number of methadone overdoses so far this year is not "alarming."

Addictions workers have seen unprecedented demand for methadone treatment from a new generation of drug addicts hooked on opiates such as OxyContin. The synthetic opiate curbs symptoms of withdrawal and the number of methadone patients has recently tripled, including at one Main Street clinic where 200 methadone patients started treatment in the last 18 months.

Balachandra couldn't say whether any of the 19 people who died were enrolled in a methadone-treatment program for opiate addiction. He said some methadone patients divert doses to sell illegally, and that a small amount can be lethal to someone who has never taken it before.

Balachandra said many of the deaths involved a mixture of methadone and other drugs, making it difficult to tell how big a role it played.

"There's a black market for methadone. Sometimes they trick the doctor, take the methadone and sell it," Balachandra said. "People go partying, they take the drug knowing very well they are not supposed to take these things, and if they experiment or become macho they take it and they die."

Opiate addicts start off on a very low dose of methadone that is closely monitored and increased slowly over several months until their cravings subside. Patients must drink their daily dose of methadone in front of a clinician until they prove reliable enough to take "carry" doses home with them.

Dr. Lindy Lee, director of Health Sciences Centre's addiction unit, reviewed deaths involving methadone in Manitoba between 2000 and 2006 and said there are usually 12 to 14 each year.

She said other provinces such as Ontario and B.C. use Suboxone instead of methadone to treat opiate addiction in younger patients, since there is a lower risk of overdose and accidental death if doses get diverted.

"Even in our program we have concerns about (methadone patients) we have to watch more closely," Lee said.

Balachandra said methadone treatment can be a delicate balance for physicians and patients. He said some patients beg doctors to increase their dose of methadone to curb their cravings, but physicians must be careful not to give them too much. He said if methadone programs are too strict patients don't adhere to the rules, but if they are too lax, patients die.

"On the one hand, the patient is crying and complaining, begging, and on the other side if you give (it) then they die, so where do you draw the line?"

jen.skerritt@freepress.mb.ca

What is methadone?

Methadone is a synthetic opiate that curbs symptoms of withdrawal from opiates such as OxyContin. It used to be considered a last resort for hard-core opiate addicts, but the recent increase in opiate abuse has prompted addiction-treatment workers to relax rules about who is accepted into a methadone program.

How does methadone treatment work?

Opiate addicts start off on a very low dose of methadone that is closely monitored, and increased slowly over several months until their drug cravings subside. Addiction Foundation of Manitoba's methadone-intervention program has nurses who act as case managers, and try to reel in any patient who fails to show up to the clinic for their daily drink of methadone or starts to exhibit signs of abusing other drugs, putting them at higher risk of overdose. A patient isn't considered stable until three consecutive clean drug urine screens and the demonstration of positive lifestyle changes.

How many methadone-related ODs are typically reported?

Experts say there are between 12 and 14 annually. Many overdoses involve other drugs, and it's tough to tell how much methadone contributed to the deaths, since it may only take a small amount to kill someone who has never taken methadone before. Other longtime methadone patients can tolerate higher levels of the drug.

Republished from the Winnipeg Free Press print edition September 7, 2010 A4