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"A slow onset is good in avoiding the very addictive, high-impact 'rush' to the brain," explained Dr. Judith Martin, chair of the California Society of Addiction Medicine's Opioid Dependence committee and the medical director of the 14th Street Clinic in Oakland. This is why it works so well in treating heroin addicts. "However, if a naive person is taking it on the street or at a party, they may feel it is weak because it hasn't 'kicked in,' and may take more and more. When it finally reaches peak action, two or three hours after ingestion, the person may fall asleep and not wake up."
In 2004, 32,000 people who'd illicitly taken methadone were admitted to American emergency rooms, triple the figure from three years prior, according to the federal Drug Abuse Warning Network. Some woke up; others did not, like UC Berkeley senior Patrick McCann. On the morning of October 14, the 22-year-old's friends dropped his lifeless body at the Alta Bates emergency room and split. Berkeley police subsequently sniffed around. Between the in-law unit McCann had shared with a roommate, and the adjacent house, where three other guys lived, the cops uncovered six marijuana plants, six pounds of dried pot, four guns and hundreds of rounds of ammunition, a pillowcase stuffed with $14,000, and assorted pills, including more than one hundred stamped "Methadose," a major manufacturer's name for methadone.
Patrick's mother told the coroner that her son had used marijuana the only one of those items found in his living space but methadone? Not as far as she knew. A couple weeks after his death, the toxicology results were in. Cause of death: acute methadone toxicity. Other than a small quantity of alcohol, it was the only drug he'd ingested.
California suffered 123 fatalities from methadone-related poisonings in 2003, the most recent year for which statistics are available. This represents an 89 percent increase from 1999, the year death certificates were first amended to allow mentions of methadone, and yet California still ranks last among the thirty states reporting data. At least, so say these figures from the National Center for Health Statistics the only statewide statistics available.
"In an ideal world, every drug would be written down and coded for on the death certificate," said Lois Fingerhut, an epidemiologist with the National Center for Health Statistics. But that's often not the case, she explained. Methadone mentioned solely in a toxicology report doesn't get counted anywhere other than that medical examiner's office.
Records from Alameda County show how profoundly the official death toll fails to describe the problem. Of nineteen recorded overdose cases citing methadone in 2005, the word "methadone" wound up on only three death certificates. No official tally will ever note that methadone actually played a role in more than six times that many fatalities. The others involved multiple substances, and thus the cause of death was listed as multiple drug intoxication.
"One thing we can say with certainty is that there is more than one drug involved," said Lubran of the Center for Substance Abuse Treatment. "It's a rare phenomenon to see a person who has died and methadone is the only drug in their system."
Thus the same slow-onset high that lulls people into mixing methadone with other drugs and makes its abuse so deadly also explains why this phenomenon has not attracted more attention.
As we headed into the home stretch of our final semester, Simon and I shared what I thought was a heart-to-heart talk over Indian food. I finally asked if he was using. "Oh, I was doing a lot of speed last semester," he replied without hesitation, pushing his fork around a big plate of chicken tikka. "I got into some stupid shit, but it's over. And I never came to class high." I was so relieved that I didn't press him further, though I knew the latter was a lie. He went on to blame his unkempt, unhealthy appearance on stress, then deftly changed the subject.
He was excited because Frances was moving in with him. It meant that her toddler would spend a few nights a week with them, which both awed and unnerved him. Not because of their drug use Frances was adamant that they never got high when her son was around but because Simon wasn't sure he'd be a good role model. "I mean, look at me," he said with a laugh. "What kind of a father figure am I going to be? I'm just a big kid myself!"
Before we hugged goodbye, he told me something that stuck with me. "You'd be surprised by how many people at the J-school use drugs, and I'm not talking about a little speed, or smoking up," he said. "It's crazy, Lauren. There are people in our class who are using heroin. Who are into serious shit." I agreed that it was nuts.
On May 16, the class of 2004 collected our diplomas. Simon, whose family had flown to San Francisco for the event, was not among us. A week earlier, his master's thesis had been rejected as both late and subpar. Though he was the first to admit he'd started it a few weeks before the deadline not months, like most of us it still came as a surprise that he wouldn't be allowed to attend graduation. So I didn't see him that day, or at any parties that weekend, and a few days later I moved to New York.