Methadone: ’60s treatment for drug addiction comes with deadly risks todayMethadone, a drug available since the 1960s and deemed by the National Institute of Health and the Centers for Disease Control as “the most effective treatment for opiate addiction,” is in essence a risk-versus-reward system.
Methadone, a drug available since the 1960s and deemed by the National Institute of Health and the Centers for Disease Control as “the most effective treatment for opiate addiction,” is in essence a risk-versus-reward system.
Proponents say it’s better to have addicts of drugs such as heroin and Oxycontin hooked and functioning on methadone — itself a strong, risky narcotic — than to be breaking laws to get a fix.
But in Minnesota, and the Northland in particular, that treatment comes at a steep cost, a News Tribune investigation has found.
Since 2001 in Minnesota, 392 people have died of methadone-involved overdoses. From 2006 to 2010, the number of deaths almost equals those who died from firearms.
In the Northland, at least 38 users have died from methadone overdoses since 2001.
At least 11 of the Northland’s reported methadone deaths since 2001 are of people with ties to the Fond Du Lac Band of Lake Superior Chippewa near Cloquet, which helps explain why Carlton County has the highest per-capita methadone death rate in Minnesota, more than three times as high as the state’s rate.
“If this were bird flu, we’d be on the cover of Time magazine. We’d be in front of the cameras on ‘60 Minutes,’ ” Phil Norgaard, director of human services for the band, said of the deaths on the reservation. “This is a threat to public health.”
As the number of deaths across the state has increased, so has the cost to taxpayers. Methadone treatment has become a thriving industry, with half of the patients in Minnesota on some sort of public assistance to pay for the care.
And yet some of the methadone paid for by public money and used to treat patients is sold on the streets, where dealers can get hundreds of dollars a dose.
“Huge quantities of illegal methadone are being used in the communities and being used without a prescription or without medical direction,” Norgaard said.
Data kept by the Minnesota Department of Human Services, the state agency that licenses and inspects the clinics, suggest that methadone’s track record doesn’t compare favorably to that of other drug treatment programs.
In the past four years, for example, patients discharged from Minnesota’s methadone clinics have higher rates for relapsing and being jailed after their discharge — both key measures the agency uses for the state’s treatment providers — than patients in the state’s other chemical dependency treatment programs.
And the rate at which patients successfully complete methadone treatment in Minnesota? Five percent.
Agency officials say comparing the effectiveness of methadone treatment to other forms of chemical dependency treatment is comparing “apples to oranges,” because addiction to opiates is distinct from other kinds of chemical dependency.
DHS officials said they have not done any studies to examine how well methadone treatment works in the state, and defend its use.
“What we rely on are national studies that have shown that methadone therapy is the best practice in health care,” said Maureen O’Connell, the DHS assistant commissioner for chemical and mental health services.
‘People do die from it’
Methadone works by occupying the same brain receptor sites affected by opiates, blocking the “highs” and “lows” and relieving the craving and withdrawal symptoms for those drugs, the Centers for Disease Control and Prevention explained in a 2002 fact sheet. Because it’s a synthetic opiate, it can only be used to treat opiate addiction.
When given in stable doses, it shouldn’t cause highs or lows of its own, so it allows the client to work and function normally in society, the CDC said.
But it can make people high if given in large doses. It also goes through the system relatively slowly, so it should be taken only once a day.
All of that requires that it be used under strict guidelines.
“It’s a Schedule II narcotic,” said Nick Reuter, public health analyst for the Substance Abuse and Mental Health Services Agency. “It is a dangerous drug. So people do die from it, even in treatment programs.”
Duluth native Terence Kall is one of those people.
In 2003, Kall hurt his back at work and was prescribed the opiate-based narcotic Oxycontin for the pain. But he became addicted to that painkiller and ultimately sought narcotics on the streets, said his father, Joe Kall, a retired chief engineer at the University of Minnesota Duluth heating plant.
“He would do anything to get them,” he said.
In September 2006, Kall enrolled as a patient at the Lake Superior Treatment Center in Duluth, and, with assistance through taxpayer-funded state health insurance, replaced his addiction to painkillers with an addiction to methadone.
Records provided by his father show four years of being prescribed daily high doses of the drug.
“I know he wanted to get off of the drug, but he was afraid to,” Joe Kall said. “The last two years he was walking around like a zombie. He spoke in bullet phrases. He acted like he was drunk.”
On April 18, 2010, he died in his home at age 42 from a methadone overdose, with medical records showing that methadone was the only drug in his system. Police recovered five bottles of methadone in his home, including one bottle that was three-quarters empty.
Kall left behind a 15-year-old son.
“His son doesn’t like to talk about it that much,” Joe Kall said. “He felt his dad had abandoned him, pretty much.”
The director of the Lake Superior Treatment Center did not return repeated phone calls for comment.
A representative for Colonial Management Group, which owns the Lake Superior Treatment Center along with more than 50 other clinics across the country, told the News Tribune from Florida that the company does not speak to the media.
However, Dr. Tom Payte, a corporate medical director for Colonial Management Group, said in general that overdose deaths can occur among patients. He said those should be rare so long as the treatment is being properly delivered.
“Methadone remains, I’d say still, the gold standard for treatment in terms of acceptance and effectiveness and overall safety,” Payte said. “There are risks involved in methadone treatment. Overdoses can and do occur, and they are preventable.”
Overdose explanations differ
Minnesota has had one of the highest increases of methadone-related deaths in the country: a 1,325 percent jump since 2000. The U.S. increase since 2000 was 623 percent.
Many supporters of methadone treatment say the deaths aren’t of people undergoing treatment for drug addiction but of people who have been prescribed methadone for pain.
In the mid-1990s, doctors began prescribing methadone for pain because it was a cheap alternative to narcotics such as Oxycontin. But it can be unpredictable and can stay in a user’s system for days. A methadone patient can take it, not feel a desired effect, take more and overdose.
It can be such a difficult drug to prescribe that in July 2012, the Centers for Disease Control found that methadone was responsible for a third of the country’s deaths from opioid pain relievers, despite being prescribed far less than other narcotic pain killers.
“The clear majority of methadone deaths are driven … by the extraordinary use of methadone in pain management,” said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, who cited several federal studies on the issue.
Officials with the state Department of Human Services say that of the 79 deaths from methadone the DHS found from 2008 to 2010, only 12 were enrolled in a methadone clinic.
But the Northland has seen a different trend entirely.
Of the area’s 38 methadone-related overdose deaths, the News Tribune could conclusively determine only one was tied to misuse of the drug for pain, according to death and medical records, police reports, and interviews with surviving friends and family members. Thirty-six deaths appear to be from people who were drug addicts using methadone as part of their treatment or to get high, according to the interviews and data reviewed, while the cause of one death could not be determined.
“I have not come across one person who was using the methadone for pain purposes,” said Dr. Richard Puumala, the head medical examiner for Carlton County, whose office has identified 15 methadone-related deaths since 2003.
Some people who use methadone to get high, said Puumala, “don’t realize that it sometimes takes hours for the stuff to kick in. So they take another dose, nothing happens, take another dose, and then I get to see them the next morning (in the medical examiner’s office). That’s the usual mode.”
In St. Louis County, Assistant County Coroner Dr. Donald Kundel said the deaths his office has seen are mostly from addicts who buy methadone off the streets.
“We’re seeing deaths of people who have no prescription for it,” Kundel said.
Liquid or pill form
The two types of methadone available — either from doctors who prescribe it in pill form for pain, or from methadone clinics, which provide it only in liquid form — have both been heavily abused in the Northland, local law officials say.
Often, abusers use both forms of methadone, said Darren Berg, a detective with the Cloquet Police Department who specializes in narcotics investigations.
“Almost every one of those guys has been kicked out of the (methadone) clinic; they’ll just go to their doctor and get it in pill form,” Berg said.
By law, the clinic is supposed to check patients to ensure that only methadone is in their systems. Berg and methadone addicts said that, despite the law, users will sell the liquid and take pills to keep levels of methadone in their system.
Often, they’re using other drugs in addition to methadone to increase their high. The majority of people in Minnesota who have died from a methadone-involved overdose have other drugs in their system, ranging from other opiates to sedatives to cocaine and alcohol, records show.
Duluth police Sgt. Rodney Wilson, who works with the Lake Superior Drug and Gang Task Force, said many addicts who go to the methadone clinic are using other drugs.
“What we’re seeing is that people who use methadone to treat opiate addiction are consistently using street drugs to supplement that addiction as well,” Wilson said.
Others are finding a connection between deaths and use of methadone from addiction clinics.
In 2003, medical examiner A. Quinn Strobl published one of the first studies looking at the cause of deaths from methadone in Minnesota.
Of 96 deaths she reviewed from 1992 to 2002, she found a third were of people in methadone treatment programs, while another 39 percent were of people who used it recreationally. Only 15 percent were given methadone for chronic pain.
Nearly 10 years later, Strobl is still seeing deaths from methadone-toxicity due to abuse of the drug. As the head of the Midwest Medical Examiner’s Office, which provides coroner and forensic examination services for numerous counties, including Anoka and Isanti in Minnesota and Douglas County in Wisconsin, she said her office has seen 28 deaths from methadone from 2008 to 2011, with 10 of those coming in 2011 alone.
Seventeen of the 28 deaths involved the decedent using someone else’s methadone, Strobl said.
For the others, she said, the decedents had a prescription for methadone, but died due to misuse of the drug and/or combining it with other narcotics, including heroin. Most of the cases involved apparent intentional misuse of their prescription, with the amount of pills out of count for the prescription date, Strobl said. Three deaths were suicides. She said she found only one person who was prescribed the methadone for pain, did not misuse it, but still died.
What it will take to stop the methadone-related deaths isn’t an easy answer, said Norgaard, director of human services for the Fond du Lac band. The rise in deaths isn’t just about abusing methadone but about a dramatic increase in abuse of all opiate drugs.
“We have wittingly — through drug companies — or unwittingly — through doctors and administration of the drugs — flooded the American society with synthetic opioids, and we have not understood the potential consequences of our behavior,” he said. “Highly damaging and addictive drugs require greater scrutiny, and we have not given them the level of scrutiny that they deserve.”
News Tribune staff writer John Lundy contributed to this report.