Methadone: Not Just for Junkies Anymore 

As the drug moves beyond methadone clinics and into everyday use as a painkiller, overdoses related to its slow-onset effect are growing increasingly common. The very traits that help heroin addicts can kill other drug users.

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Back when Simon was still an undergrad, a frightening trend began surfacing in emergency rooms and morgues across the country. Accidental overdoses blamed on prescription drug use were soaring. It wasn't exactly news that painkillers were high on the list, but everyone was puzzled by the rise of one newcomer: methadone.

Ask anyone what methadone is, and you're likely to hear that it's used to get people off heroin. German scientists synthesized it as a morphine replacement during World War II, and after the war, an American doctor brought it back to the states. Eli Lilly began churning it out under the name Dolophine, and in the 1960s it found its niche treating heroin addicts. Opioid treatment programs, known colloquially as methadone clinics, sprung up across the country.

In 2005, more than 200,000 Americans, including 28,500 Californians, sought help at these highly regulated clinics. Residents of Alameda and Contra Costa counties have more than a hundred to choose from. The vast majority of programs dispense methadone as a liquid mixed with fruit juice. A single daily dose blocks the effects of heroin, eliminates withdrawal symptoms, and curbs cravings without imparting a buzz. Regular drug testing and counseling are mandatory. In 2001, stringent federal guidelines finally relaxed to allow model patients to walk off with take-home doses. Accidental overdoses not involving other drugs have historically been rare.

Critics contend that methadone clinics merely replace one addiction with another. And while they have a point — some former users claim the medication is even tougher to kick than heroin — studies have shown that a former heroin addict's brain on methadone looks and acts like the brain of a non-drug-user. Some experts compare it to diabetics who rely on insulin to stay healthy. But addictive or not, methadone lets thousands of otherwise ill-functioning people lead constructive lives.

Yet methadone has another use, approved in the mid-'70s but only common in the last decade: It works magic on pain. As any of the millions of Americans battling chronic pain might tell you, anything that can do that is worth its weight in gold. And methadone doesn't take all that much gold.

"It's cheap as dirt," said Dr. Michael Moscowitz, a partner with Bay Area Pain Medical Associates in Mill Valley and a former president of the American Pain Society. "If a patient without insurance needs treatment for pain, methadone is about one-fifteenth the cost of the next drug in line." The most popular med on the market, a sustained-release formulation of oxycodone marketed as OxyContin, costs pharmacies about $177 for a one-month supply. An equivalent supply of pill-based methadone, which has always been generic, is just $8.

But it hasn't gained popularity solely because it's a bargain. Doctors increasingly prescribe it because Vioxx was yanked from shelves in 2004 and OxyContin's dubious reputation as an easily abused pill has cost them countless headaches, and even jail time. With doctors under increasing scrutiny from the Drug Enforcement Administration, methadone is an alluring alternative.

Thus the drug that always seemed a poor candidate for abuse quietly stepped into the role of the cool new kid in class. And the new kid started raising hell.

In May of 2003, as the federal government convened its first conference on methadone-related deaths, Simon successfully completed his first year of grad school. He was known around school as a funny, high-spirited guy who always had a cold can of Red Bull in his hand, and time to shoot the shit around one of the picnic tables in the courtyard. I assumed that the energy drink explained his ever-constant pep. I never thought to check his peacoat pockets for pills. When we went drinking every so often with classmates, he'd get fairly ripped, but in journalism school it was the teetotalers who seemed suspicious. We had an easy friendship that consisted largely of him offering advice — most laughable, some helpful — as I bitched about my languishing love life.

Among professors, he was frequently viewed as talented but exasperating. Professor Paul Grabowicz appreciated Simon's directness: "There was nothing contrived about him. For better or worse, Simon seemed to say, 'This is me.'"

A classic example was the day he showed up late to a new class. "Do you plan to be late next time?" demanded Todd Carrel, the infamously tough instructor who had nearly reduced another student to tears just moments earlier. "I don't know," Simon replied with a sloppy shrug, triggering a collective intake of breath around the table. "I don't plan on it, but I could be." The professor quietly asked Simon to stay after class. They walked around campus for an hour, swapping stories from their marbled pasts and forming an unlikely bond. "He's a cool guy who's been through a hell of a lot in his life," Simon said later. "I think he gets me now."

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