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Welcome to the New Drug Scare of 2007

Meth, we hardly knew you; say howdy to methadone – the new demon drug according to the media, who – oops – helped turn it into a hazard

Looks like there’s a new demon drug on the block – the opioid painkiller methadone, which is also commonly used as a substitute therapy to treat people addicted to heroin or prescription painkillers. But as usual with drugs coverage, the press doesn’t recognize its own responsibility in the devil’s creation.

Recently, media ranging from the Birmingham News to ABC’s 20/20 have noted increased numbers of methadone overdose deaths.

But what they haven’t done is put the story in context. While the coverage is careful to say that most methadone on the street is not being diverted from the clinics that use it to treat addicts, it usually claims that, as the Birmingham News put it by citing a police source, “the drug is being prescribed more often to help people treat pain than to control addiction. As the prescriptions have increased, so have instances of abuse.”

However, these stories fail to note the reason why methadone prescriptions for pain treatment have increased. In the early 00’s, the media went into a feeding frenzy over a new deadly painkiller, OxyContin, which was supposedly addicting countless young people and causing record numbers of overdose deaths in rural areas. The drug became known as “hillbilly heroin,” and once there was a clever name for it, the hype express took off.

Even though skeptics rapidly discovered that the death rates and new addiction rates had been exaggerated, and even though stories about people “accidentally addicted” by doctors turned out in the main to be stories of addicts scamming doctors to get drugs, OxyContin kept its bad name. And as the DEA started a new initiative to fight prescription drug abuse focused on ending the “Oxy” menace, physicians became much more cautious about prescribing it.

With the DEA looking closely at OxyContin prescriptions and with no decline in the number of pain patients, doctors began to look for alternatives. OxyContin had been a revolutionary drug because if it is used appropriately (not ground up and made into a short-acting drug as addicts do with it), it provides 12 hours of pain relief, compared to four to six hours for other drugs.

An older, cheaper drug also provides lasting relief, and yes, it’s called methadone. It has long been used as a “maintenance” treatment for addicts precisely because it is the opioid drug which has the greatest staying power (only a derivative, LAAM lasts longer).

Methadone’s effects persist for 24-48 hours. Contrary to popular belief, the longer a high lasts, the less addictive it is. This is part of why crack is more addictive than powder cocaine and why ground-up Oxycontin is more addictive than OxyContin taken as directed (and yes, it means, too, that crack is more addictive than methamphetamine, contrary to media claims that longer-acting drugs are more attractive to addicts).

Once a user is tolerant to opioids, they produce no high and - with longer acting drugs - none of the “ups and downs” associated with addiction, thereby allowing people to function normally. Such users are not cognitively, emotionally or physically impaired and can drive safely on doses that would incapacitate the non-tolerant. The same is true for people who take these drugs for pain.

But long-acting drugs are a double-edged sword: if there are going to be adverse effects, they may not appear immediately. Because neither OxyContin nor methadone is intended to be given to patients who are not already tolerant to other opioids, they are generally very safe when taken by such people as prescribed.

Methadone, however, is less safe than OxyContin because of the extreme length of its action. Pain patients or street users unfamiliar with this effect may believe the drug has worn off long before it has – and the result can be overdose. Doctors unfamiliar with prescribing the drug can inadvertently lead patients to overdose as well; an investigation by a Charleston paper noted that the prescribing information packaged with the drug may mislead doctors about safe doses for those who are not tolerant to opioids.

So, by hyping the dangers of OxyContin, the media has actually driven doctors to use a more dangerous drug. And by hyping the dangers of methadone without putting them in context, it is failing to acknowledge the larger story and failing to give readers and viewers the accurate information they need to understand the complexities of pain treatment and addiction.

Related articles
How the New York Times perpetuated the idea of widespread abuse and accidental addiction to OxyContin

Drug warriors put the fear of prosecution in physicians who dare to treat pain.

Is meth America;s number one drug problem?