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For months, high school sophomore Sara Corbett of New Hartford, Conn., had begged her mother for permission to get her tongue pierced. On Aug. 7, 2004, Sara's mother, Robin DeBaise, relented and the two went to nearby mall.
The next day, Sara, 16, was in severe pain. At her aunt's house, she found a couple of methadone pills — amounting to twice the recommended dosage — and took them. She passed out and was rushed to a hospital, where she died.
"I know she had absolutely no clue of the strength of what she had taken. No clue," says DeBaise, 41, who says she did not know Sara had taken the pills until she had to be taken to the hospital. DeBaise says she is familiar with methadone's potency because she is being treated for an addiction to it.
Sara was among 3,849 people across the nation to die from an overdose of methadone in 2004, a record for methadone deaths and a jump of more than 3,000 such deaths from five years earlier, according to a study by the National Center for Health Statistics (NCHS).
The dramatic rise in fatal overdoses — which appears to have continued since 2004 — reflects how methadone, once known mainly for its usefulness in treating heroin addicts, has become increasingly prevalent in the illicit drug market as more and more doctors have prescribed it to treat chronic and severe pain.
Highly addictive, and lingers As methadone has become more widespread — the number of pharmacy prescriptions for the drug increased fivefold from 1998-2002, according to the Substance Abuse and Mental Health Services Administration (SAMHSA) — its drawbacks have become more apparent.
Among them: It's highly addictive. And because it takes longer to work than most opiate painkillers, it can remain in the body for more than four days after its effects are no longer noticeable, increasing the chances of an overdose.
Patients, and some doctors who have prescribed the narcotic, often have difficulty determining proper dosages, says Nicholas Reuter, a senior public health analyst at SAMHSA.
Dozens of overdoses have been linked to such miscalculations, he says.
Methadone is "being prescribed more frequently not only by pain specialists who know how to use it, but by general practice physicians, who may not," says Denise Curry of the Drug Enforcement Administration.
However, Curry and other drug specialists say, most methadone-related deaths in recent years have involved people like Sara: users who overdosed after taking the drug without a prescription, or methadone addicts who took too much of it while chasing the warm, euphoric feeling that users experience over four to six hours after taking the drug.
"With more prescriptions, there's more methadone in the supply pipeline," Curry says, and therefore more chance the drug will wind up for sale on the street.
The 390% rise in methadone-related deaths from 1999 to 2004 far outpaced the rate for fatal drug overdoses involving all types of drugs, the NCHS says. The overall number of fatal overdoses rose from 9,955 in 1999 to 16,735 five years later, an increase of 68%.
Those figures, and reports from coroners and drug specialists nationwide who say the trend is continuing, reflect how methadone has joined OxyContin and Vicodin as addictive drugs of the moment at a time when there is increasing concern about the abuse of prescription drugs, particularly by teenagers.
The NCHS study identified 12 states as having especially significant increases in methadone-related fatalities from 1999-2004: Florida, Kentucky, Louisiana, Maine, Massachusetts, New Hampshire, Ohio, Oregon, Pennsylvania, Tennessee, West Virginia and Wisconsin.
Several other states also are reporting big increases in methadone deaths.
In Oklahoma, for example, the number of overdose deaths involving methadone rose from 45 in 2001 to 118 in 2005, according to a report from the state's chief medical examiner.
Doctors have used methadone to treat pain for more than 50 years, but the drug has gotten a boost in the past four or five years, in part because of the attention Vicodin and OxyContin have received as frequently abused prescription drugs, Reuter says.
He adds that because law enforcement and medical boards have been stepping up their scrutiny of opiates such as OxyContin, some doctors may believe that prescribing methadone leaves them less vulnerable to such scrutiny.
Cheaper choice for doctors Methadone's pharmacy price — pennies a dose — also encourages doctors to use it rather than far more expensive narcotics such as OxyContin, Reuter says.
"Physicians find it more convenient for the patient (and) easier to get approval from Medicaid," he says of doctors' trend toward prescribing methadone over other prescription pain relievers.
Meanwhile, the Food and Drug Administration is warning doctors, patients and others that methadone can be deadly if improperly prescribed or used.
Methadone also can be deadly when used with benzodiazepines such as the anti-anxiety drug Xanax, the FDA said in a warning about methadone on Nov. 26.
"Methadone is a drug of abuse," Reuter says. "It's abuse potential is not quite as dramatic as heroin. It has a much slower onset and doesn't produce the euphoric highs associated with heroin, but people do seek it out expecting euphoric properties."
DeBaise, who keeps her daughter's ashes in a stuffed animal she calls "Sara Bear," says she remembers how seductive methadone can be.
"You can get high on methadone. It's the same exact high like a heroin high," she says. "It's very mellowing. You get a warmth through your body. It would make me feel good. It would make me talkative."
"Doctors have used methadone to treat pain for more than 50 years, but the drug has gotten a boost in the past four or five years, in part because of the attention Vicodin and OxyContin have received as frequently abused prescription drugs, Reuter says.
Meanwhile, the Food and Drug Administration is warning doctors, patients and others that methadone can be deadly if improperly prescribed or used."