- The Washington Times - Wednesday, August 7, 2002

ROANOKE (AP) Four years after OxyContin abuse became widespread in Southwest Virginia, authorities are seeing an increase in fatal overdoses from another prescription painkiller methadone.
Forty-four persons died from methadone overdoses last year in the western half of Virginia, said Dr. William Massello, assistant chief medical examiner in Roanoke. There were 40 fatal overdoses from oxycodone, the active ingredient in OxyContin, during the same period.
The numbers are the latest evidence of a prescription-drug-abuse problem that is most prevalent in the southwest region of the state.
Authorities are not sure what to make of the methadone deaths, which have been climbing for several years while OxyContin abuse has been the topic of widespread attention from law enforcement, politicians and the news media.
"We're theorizing that perhaps because of the bad publicity that OxyContin has received, there are physicians who are switching to methadone" to treat pain, Dr. Massello said. The pharmaceutical black market is driven primarily by "doctor shoppers" who fake ailments to obtain drugs from physicians and then sell the drugs on the street.
Another theory is that prescription-drug abusers are being forced to turn to other drugs, such as methadone, because law-enforcement efforts have made it harder for them to find OxyContin on the street.
"I still think OxyContin is the drug of choice," said Tazewell County Commonwealth's Attorney Dennis Lee, who serves on a state task force studying prescription-drug abuse. "But in a pinch, people will buy methadone and use it also."
Methadone is a synthetic narcotic that is perhaps best known as a treatment for people addicted to opium-based drugs, such as heroin, morphine and OxyContin. Operating under tight security, methadone clinics provide a liquid form of the drug that blocks withdrawal symptoms, making it easier for addicts to get clean.
But methadone also is prescribed in tablets to treat pain. It is that form of the drug that seems most susceptible to abuse.
Roanoke pain specialist Dr. Cecil Knox is facing charges of illegally prescribing OxyContin and methadone. A wrongful-death lawsuit also claims that Dr. Knox overprescribed methadone to a patient who suffered a fatal overdose.
Dr. Massello said he was aware of only one or two cases in which a methadone overdose victim had been receiving treatment at a clinic.
He said fewer than half of the methadone overdose victims examined by his office had valid prescriptions for the drug, suggesting that many of them got their methadone from what he called a "thriving black market."
There have been 21 fatal methadone overdoses so far this year in western Virginia. There have been 10 oxycodone deaths. Because it takes up to two months for autopsy toxicology tests to be completed, the latest figures cover only the first quarter of the year.
Like OxyContin, methadone is abused by addicts who crush the tablets and then snort or inject the powder.

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