Northland men’s deaths in car crash inspire legislative action on methadoneFollowing the deaths of two Northland men, State Rep. Tom Huntley and State Sen. Roger Reinert say they want to hold hearings this fall to determine if more restrictions are needed on how methadone treatment is administered in Minnesota.
David and Kathy Lingren fight back tears when they speak about what their son, Mitch, meant to them.
“It is devastating, in terms of the impact on us,” David said.
“The most important thing to know is that he loved his family, and he was loved by his family,” said Kathy.
To Jim and Wendy Gamache, the loss of their son, Zachary, is still too painful to talk about.
Mitch Lingren, 29, of Duluth and Zachary Gamache, 25, of Esko were working for the Carlton County Highway Department when they were killed the morning of Oct. 1 in what law enforcement said was a methadone-related crash.
Vanessa Rae Brigan, 26, faces two counts of criminal vehicular homicide after authorities accused her of driving while impaired by methadone when she ran into the truck carrying Lingren and Gamache and causing them to hit a trailer.
Following the two men’s deaths, State Rep. Tom Huntley, DFL-Duluth, said he wants to hold hearings in St. Paul this fall to determine if more restrictions are needed on how methadone treatment for addiction to opioid drugs is administered in Minnesota.
“Two people are dead, and we need to find out if there’s something we can do,” said Huntley, the ranking member of the House Health and Human Service Finance committee who also sits on the House Health and Human Service Reform committee. “This obviously needs to be looked into, and we need to know if the law requires changing.”
Brigan was a patient of a Brainerd methadone clinic, had methadone in her system and had a large dose of methadone in her car, according to the criminal complaint filed against her by Carlton County authorities. A needle and syringe were found in her car as well as near the scene of the crash, and needle marks were found on her arm when she was booked into jail, the complaint said.
Her passenger was also a patient of the clinic and was wanted on outstanding warrants, according to the complaint. Brigan was driving without a valid license, according to Carlton County Attorney Thom Pertler.
In Minnesota, the News Tribune has found, methadone clinics aren’t required to:
State Sen. Roger Reinert, DFL-Duluth, said he agrees that legislative hearings should be held to discuss methadone treatment.
“The recent crash only highlights some of the troubling trends (the News Tribune) has found in terms of lack of oversight,” Reinert said.
A News Tribune series that ran in September found widespread problems stemming from methadone treatment in Minnesota, including abuse of prescribed methadone with resulting deaths, dealers selling it on the streets, unmonitored spending by the state and a 5 percent completion rate from treatment over the past five years.
“The lack of oversight is very troubling,” Reinert said. “In a time of very scarce resources, taxpayers need to know that the kind of money that’s being spent is having an impact.”
‘Does not go that far’
The car Brigan drove was weaving from the fog line on the side of the road to the center line of Highway 210 as she returned to Cloquet from Pinnacle Recovery Services, a methadone clinic in Brainerd, according to the criminal complaint. At about the Tamarack River, between Wright and Cromwell, she again crossed the center line, hitting Lingren’s and Gamache’s Carlton County Highway Department pickup in its left rear tire, the complaint said.
The impact from Brigan’s car caused the axle on the pickup truck to break, forcing the vehicle to veer into oncoming traffic, sideswipe a 2006 Ford 350 pickup and then hit the gooseneck trailer it was pulling. Gamache and Lingren weren’t wearing seat belts and were ejected onto the road, probably dying instantly.
Brigan already had more than 30 traffic-related convictions on her record, and as recently as March was convicted of driving after having her license revoked, records show. Despite this, she told investigators that she and her passenger, Jesse David McMillen, 25, routinely drove from the Cloquet area to the Brainerd methadone clinic and got take-home doses of the drug.
Methadone clinics are not required to check whether a patient has a valid license before giving them an unsupervised dose of the drug, also known as take-home doses, said Nick Reuter, a public health analyst for the Substance Abuse and Mental Health Services Administration.
Under federal law, if patients prove their trustworthiness at methadone clinics, they can get up to a month’s worth of take-home doses of the drug. It’s intended to be a reward for patients, who start their treatment by having to go to a clinic each day, six to seven days a week, to take their dose. Getting take-home doses is standard practice at methadone clinics around the country and is fully legal.
Reuter said that most clinics ask for an ID to verify the patient’s identity, but they aren’t required to do that.
“Take-homes have been part of our regulatory scheme since 1976, and there’s never even been a discussion about requiring ID for any purpose in the rules,” he said.
The News Tribune has found widespread abuse of take-home methadone in the Duluth area, and since 2001 at least 38 overdose deaths have occurred in the Northland from the drug.
Under federal law, before clinics give patients a take-home dose of methadone they must “consider” whether a patient has refrained from recent drug abuse. This is typically done through tests that search for other drugs in a patient’s system; if someone is abusing methadone, it doesn’t show up in a test.
But clinics don’t have to physically inspect a patient to meet that requirement.
“They’re not required to check for track marks,” Reuter said. “Injecting methadone is unusual.”
Clinics are also required to consider patients’ known criminal activity before giving them take-home doses.
Troopers said McMillen told them he fled the scene of the crash because he was wanted on active arrest warrants, according to the criminal complaint against Brigan. One of those warrants included failing to appear at a September hearing for a conviction that same month of possessing drug paraphernalia, court records show.
Reuter said even if a patient is found to be abusing other drugs or methadone, or has recent criminal activity, that person can still be given take-home methadone.
“The regulation is not quite that direct,” Reuter said. “Does it clearly say if a patient comes in with track marks, including recent track marks, should they be denied take-homes? It does not say that. It does not go that far.”
Reuter said it’s up to a clinic’s medical director to determine if take-home doses are warranted for a client.
“It’s a physician’s clinical judgment,” he said. “We’ve put in writing things they’re required to consider as part of that judgment. … We think that placing that responsibility as part of the physician’s medical judgment is adequate at this time.”
Pinnacle Recovery Services began treating patients in April, according to the Department of Human Services. No one from the clinic returned the News Tribune’s request for comment for this article.
A ‘relatively high dose’
Clinics also are not required to check whether their clients are OK to drive after taking methadone.
According to the criminal complaint, a witness to the crash and a state trooper said Brigan appeared to be impaired by drugs after the accident.
“Both were fully aware from medical advice that they were not to be driving a motor vehicle while consuming the methadone,” the complaint said.
But it’s only illegal to drive in Minnesota with methadone in your system if it impairs your driving ability, said Department of Public Safety spokesman Nathan Bowie.
It’s possible the dose found with Brigan could have impaired her driving, said Ted Jackson, a journalist who has reported on methadone for the publication he founded, Treatment Magazine.
The dose found in Brigan’s vehicle, 300 milligrams, was “uncommonly high,” Jackson said.
“A very high dosage like that can be tolerated if it’s being given over a very long period of time,” he said. “But if someone is quickly put on that, it will get them high.”
Reuter called 300 milligrams a “relatively high dose.”
“It’s something that would get your attention,” he said. A single take-home dose from a methadone clinic is meant to be taken orally at one time. If taken correctly, and not abused, experts say methadone should not get a patient high but allow them to live a normal life.
Methadone-related motor vehicle deaths appear to be rare, according to statistics from the Minnesota Department of Public Safety. From 2006 to 2011, there were 11 traffic fatalities in which the driver had been using drugs, compared to 215 in which the driver was drinking. (The DPS’s statistics on drug fatalities do not break numbers down into the type of drug).
Jackson, who supports methadone treatment, said he worries that too much will be made of the fatal crash, stigmatizing the treatment.
“How is (the Oct. 1 fatality) any different than a drunk driving accident?” asked Jackson, “Methadone saves lives.”
But Jackson also said the crash showed there may be a need to prevent people from abusing methadone while in treatment. One way he said that could be achieved is by monitoring the amount of methadone provided at clinics to ensure that patients aren’t receiving too high a dose.
Neither the Federal Substance Abuse and Mental Health Services Administration nor the Minnesota Department of Human Services, both of which license and inspect methadone clinics, monitor dosing levels at clinics.
A rule that limited dosing to 100 milligrams a day was changed in 2001 to allow more discretion for physicians to decide what was appropriate for patients. Since then, according to the DHS, there has been an increase in dose levels at methadone clinics.
“This would correlate with an increase in the purity of heroin and use of stronger opioid medications by addicts,” said Dave Hartford, the assistant DHS commissioner for chemical and mental health services.
Reuter said anecdotal evidence suggests the average dose at a clinic is about 80 to 120 milligrams a day.
The Lingrens declined to talk about methadone being a part of the crash that killed their son, saying they wanted to wait for more information to be released.
What they want to focus on, they said, is the life their son, Mitch, led, and the impact he had on others.
“The Duluth and Carlton communities have all been touched by this, and we do feel and appreciate their support,” said Mitch’s mother, Kathy.
They also want to focus on what he left behind: a wife, an 8-year-old son and a 3-year-old daughter.
“It’s so wrong what happened to two wonderful men who had so much potential and so much to give and needed so much,” Kathy Lingren said.
“It’s going to be so difficult for his wife and two children to go on without him,” she said. “Our life has changed because of this.”