Prescription Drug Outranks Cocaine and Heroin as No. 1 Killer

At the time, I was in the middle of a methadone death case. We had filed suit on behalf of a 40-something year old executive with sciatica who was given 360 methadone pills by his pain doctor along with a prescription which read, "Take 1-4, 4 times a day." His eight year old found him dead in bed on the third day.

I had downloaded the epidemiological study from Kay Sanford at the North Carolina Department of Health and Human Services. This was a study of North Carolina unintentional poisoning deaths from 1997-2001. In the study, the numbers confounded me. Before my first methadone case a couple of years earlier, I had hardly heard of the drug methadone. It seems there was scant mention of methadone in law school in connection with some discrimination case I was assigned. The issue was whether an employer could refuse to hire candidates who failed a drug screen based on their attendance at a methadone clinic. Methadone clinics had something to do with heroin detox, I knew. But this seemed an obscure drug and obscure issue, and I did not think about methadone for the next ten years. But during this methadone death case, I read the Sanford study. In that study, Sanford reported that from the time period 1997 to 2000, methadone went from being responsible for 7 deaths in North Carolina to outranking cocaine and heroin as the number 1 killer drug. Methadone deaths increase 729% from 1997 to 2001. Cocaine was top killer drug in 1997, and 1999, while heroin edged out cocaine as the top killer in 1998. But beginning in 2000, methadone-- a prescription drug, has killed more people in this state than any other street drug.

North Carolina is not alone. The National Center for Health Statistics and others have also noticed that deaths from methadone across the country are skyrocketing. What does it mean when a prescription drug kills more people than illegal street drugs like cocaine and heroin? In my mind it means that our controls on prescription methadone are not good. While I do not know how many deaths are from physician prescriptions, how many deaths are occurring at methadone clinics and how many are occurring from buying on the street, also called "diversion," I do not believe that all or even most of the deaths are a result of prescriptions being diverted for street sales. I get calls every week from people who have lost a child, usually a son, as a result of a dose given to him at a methadone clinic, or as a result of an aggressive prescription from a pain physician. In Kay Sanford's study of methadone deaths, of the medical examiner reports that contained information about the source of the methadone, 29% of the deaths occurred to patients prescribed methadone by physicians. Only 19% of the deaths occurred as a result of use of methadone obtained on the street. One person was a patient of a methadone clinic. One was given methadone by a physician during a hospitalization.

I have been told by a pharmacist that our legal work has changed his practices. I have been told by a lawyer that a case I brought led to a physician's office changing its methadone prescribing habits. I have been told that a regulator has taken notice and is looking closely at clinics where patients are dying. This is slow work trying to change the landscape, but if you think this is important, drop me a line and let me know. I have some ideas. Phyllis Lile-King