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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"Things are going well, though I have to find a job soon if I'm ever to continue living," he wrote in an e-mail on June 4. His thesis was done, his degree won at last. "I really only started sending out résumés this past Friday, which is irresponsible, lazy, and totally me."

When I complimented him on a beautiful story he'd written for a school magazine about his relationship with Frances' son, he wrote, "That kid's cute, isn't he? Sad thing is, I don't know how much longer Frances and I can last." He addressed his lack of a job: "I met this chick who knows the editor for the Oakland Tribune. He drinks nightly at this bar by my apartment. I'll have to get him wasted and convince him to hire me."

That plan didn't quite pan out, but a few weeks later Simon started an internship at the Express, where his editors were struck by his skill and charm but altogether oblivious to his drug use. His relationship with Frances slid steadily downhill, and when their roommate moved out they decided to live apart for a while. He sublet a room in a friend's apartment in San Francisco, and passed lazy Sunday afternoons playing baseball in Oakland. He picked up his guitar again. He appeared to be holding things together, although he and Frances were still spending much of their free time at her place, getting high. One night he punched her, and she called the cops. Simon's mother bailed him out the next morning, and a week later the charges were dropped. But the two couldn't stay apart.

"He was the best apologizer in the world," Frances recalled. "He really meant it, too. I know he loved me. He could get violent, but he'd also sing songs to me in bed, that his mother used to sing to him. And I've never been with anyone who held me all night long like he did." But soon after he hit her, she started finding him in the bathroom at night, retching. "That's when I knew he was buying bad junk from the street," she said. "He'd hide it from me, but I knew."

I did not. After we caught up by phone a month later, I came away feeling only mildly concerned. He didn't mention his night in jail, though he did say he'd been mugged in downtown Oakland a few days earlier. A bunch of kids jumped him, cracked his jaw, and stole his iPod. He sounded embarrassed and angry, but brushed it off as no big deal.

On July 27, Simon sent me another e-mail. "Frances and I are no longer together. I do miss her, but it was a bad scene. I'm still putting the 'free' in 'freelance.' ... I have a master's degree from one of the best universities in the country and am a meal away from starving. I'm telling ya, this 'paying your dues' phase of my life had better end soon."

A few days later, he packed his things once more and moved in again with Jason Hasley, who was about to go to Mexico with his girlfriend. For the next two weeks, their apartment was all his.

One of the most significant conclusions drawn from the 2003 national meeting on the surge in methadone-related deaths was that methadone clinics are not to blame. The numbers bear this out: In 1997, about 110,000 grams of methadone, primarily in pill form, were distributed to pharmacies across the country. By 2004, this retail volume had ballooned to more than one million grams. During the same period of time, the volume of mostly liquid methadone distributed to treatment programs didn't even double. In many states, including California, more methadone is now dispensed to treat pain than to treat addiction. Nor is it clinic patients who are dying. Just one of the nineteen Alameda County residents who fatally overdosed in 2005 was enrolled in a program.

California's methadone clinics actually have declining admissions — curious, because the use of heroin here hasn't dipped. Research by Berkeley health economist David Rinaldo suggests this could be partly due to former clients who find it easier, and maybe even cheaper, to buy methadone on the street, or from a private physician.

It's certainly a snap to find online. During a thirty-minute search, I made contact with two people pawning it on Google and Yahoo message boards, as well as a handful of "pharmacies" ready to send it to me without a prescription. Results of an annual study by Columbia University researchers, released in June, found 185 Web sites hawking prescription drugs. Only 11 percent of the sites require a prescription. One site offered some heavy-duty painkillers, but not methadone, so I shot off an e-mail to the address given for customer service: "how come no methadone??" Twenty minutes later, an e-mail from "Pablo Ortega" landed in my inbox: "methadone 40mg 20tabs $220.00 Thanks."

"Jake" of Walnut Creek has been on methadone maintenance for nine years, yet said that he's occasionally "forced" to obtain pills on the street. "At my clinic, if anything happens to your take-home doses, they will not replace those doses," he wrote in an e-mail. "I can remember one time when I actually stepped on the take-home bottle by accident (early in the a.m., no coffee yet) and watched the medication squirt all over the carpet. My choice was to face withdrawal and incapacity or turn to the street for a replacement dose. I chose the latter. The street trade in methadone is alive and well in San Francisco."

So who else is taking all the pills? Software engineer Mike Yang is a typical pain patient. The forty-year-old was in a car accident as a teenager that left him with spinal cord damage. Two years ago, when his pain became harder to control, he sought out a specialist. When the doctor suggested methadone, Yang didn't think twice. "It was the first time my pain was quieted," said the San Francisco resident, who added that he's never gotten a high off the med. "I'd always felt a little bit of phantom something, but methadone really took it all away. I've read that it's very addictive, and very difficult to get off of. But for me, it's not a short-term thing. It's forever."

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