The cure for oxycodone addiction can be deadly


Meridian Healthcare Opioid Treatment Program counselor Sandra Reed speaks with a patient on Thursday. Meridian Behavioral Healthcare plans to open a second Opioid Treatment Program in Lake City.

Doug Finger/Staff photographer
Published: Friday, January 20, 2012 at 10:42 p.m.
Last Modified: Friday, January 20, 2012 at 10:42 p.m.

What 26-year-old Ashley Gunn of Gainesville has called a lifesaver over the past five years also has killed nearly than twice as many area residents as oxycodone, the drug at the center of Florida's prescription drug epidemic.

In the deadliest year out of the last five — 2008 — local statistics show that methadone killed area residents at a rate nearly on par with the national murder rate, according to statistics from the Centers for Disease Control and Prevention.

But Gunn, a waitress and the mother of three children, credits the daily dose of methadone she has been administered for the past year at Meridian Behavioral Healthcare Services with recovering her car, her job and her relationship with her husband.



These were all parts of her life that her addiction to the powerful painkiller oxycodone nearly stole from her.

"When I first heard about it, I thought, ‘Oh, my God, the methadone clinic?' — I thought of this horrible place," she said. "But when I went there, it totally changed my mind — it's a big help and blessing in a lot of ways."

Eight years since opening the opioid treatment program at its campus on Southwest 13th Street, Meridian Healthcare is about to open its second such program in Lake City – part of the biggest expansion of methadone distribution in Florida over the last 20 years.

Meridian says it keeps a tight rein on the methadone it dispenses to its patients to treat oxycodone addiction. And studies have shown that methadone deaths are rarely traced to treatment programs, said Sara Mihlfeld, director of Meridian's opioid treatment program.

"Pain doctors can write (prescriptions) for it as well, and they do," she said. "The source of it (methadone overdoses) we just don't know.

"We just know they are getting it from somewhere," she added.

Gainesville Police Department Lt. Matt Nechodom, a member of the combined city-county drug task force, agrees that the methadone leading to overdoses is not coming from programs such as Meridian's.

"It seems to go hand in hand with a lot of people who abuse prescription drugs," he said. "For the large majority of what we find, it comes from Tampa, Orlando or South Florida."

Meridian's is one of 11 new opioid treatment programs that the state has authorized in the past year to distribute methadone and other opioid replacement drugs, adding to the 36 opioid treatment programs now up and running in the state.

"For the past 20 years, this is the most extensive expansion we have had, due primarily to prescription drug abuse," said Erin Gillespie, press secretary for the Florida Department of Children and Families.

But state statistics show that the methadone cure for opioid addiction can be deadly — and in this area exacted a greater toll in recent years — than the drug it's supposed to safely replace.

In 2008, for example, methadone was the cause of 23 deaths in the Gainesville district, compared with 11 deaths from oxycodone, according to the Florida Medical Examiners Report of Drugs Identified in Deceased Persons.

Between 2006 and 2010, methadone was found at lethal levels in 99 bodies from the medical examiner's district that covers the counties of Alachua, Baker, Bradford, Gilchrist, Levy and Union.

By comparison, autopsies showed that 56 people had oxycodone in their system at lethal levels from those same counties over the same time frame.

No other drug identified in the medical examiners' reports between 2006 and 2009 killed as many area residents on an annual basis as did methadone.

Mihlfeld, Meridian's opioid treatment program director, said the deaths from patients at Meridian's clinic have been few and far between in the eight years the clinic has been operating — maybe one or two.

What it is, does

Methadone is classified as a Schedule II substance, which means it has a high potential for abuse resulting in severe psychological or physical dependence.

But it softens the after-effects of withdrawing from heroin and prescribed medications such as oxycodone and hydrocodone without producing the euphoria that comes with those medications, said Mihlfeld.

"I've heard it (withdrawing from opiates) described as the flu times 10," she said. "Runny nose, diarrhea, vomiting, cramps, high fever, chills," she said. "Methadone takes away the withdrawal and the craving."

Methadone is becoming increasingly available. The amount of methadone distributed or delivered by the manufacturers rose dramatically from 2000 to early 2007, with increases ranging from 9 to 22 percent annually, according to the U.S. Substance Abuse and Mental Health Services Administration.

Methadone can be dangerous because it reacts with other drugs. And its properties can cause slow or shallow breathing, depression of the central nervous system, abnormal heart rhythms and excessive sleepiness, according to the federal government.

Mihlfeld said that programs such as Meridian's — which include intensive monitoring — are designed to avert the dangers of using methadone as people become weaned off these opioid prescriptions.

The clinic is open every day of the year. Only those who have participated without any rules infractions get a methadone supply they can take home.

Self-pay patients pay $84 a week to be in the program; for Medicaid patients, it's a $2 co-pay.

Mihlfeld said she has patients who have been getting the drug at Meridian since the clinic opened eight years ago.

"We see the changes in them," she said. "They are feeling like getting up, going to work and taking care of their children.

"And it keeps them from doing all the bad behaviors they did before they came to the clinic," she said.

She said the travel time of patients at the Gainesville clinic led DCF to put out a request for proposals for another treatment program in Lake City.

"We're filled to the brim here," she said of the 374 patients currently enrolled at the Gainesville location. Some of those patients will be going to the Lake City operation when it opens.

Getting off methadone and all drugs is Meridian's goal for its patients, Mihlfeld said. But it's not mandatory that they get off methadone.

One mother's story

Gunn said that ultimately she doesn't want to take any drug every day to get through life's challenges.

The mother of 6-year-old twins and a 2-year-old said her addiction nightmare has consumed five years. It started, she said, with a prescription she received as she recovered from a Cesarean section and a painful case of endometriosis, a female disorder, after the birth of her twins.

"My doctor put me on Percocet … and they moved me up to something stronger," she said — with her eventually being prescribed oxycodone.

"Once you start taking them, you have to have them," she said. "If you don't have them, you are sick.

"It's like having the worst flu you could imagine," she added.

A relative told her about Meridian as her life unraveled.

But now, she said she's glad to be at a methadone dose half as strong as when she first started at the treatment program. Her dose, once 100 milligrams daily, has been tapered down to 55 milligrams.

Sometimes, before she gets her daily dose, she has to pass a urine test to make sure she's not using any other drugs, depending on whether a random computer check requests it.

The urine test has a temperature sensor to make sure it's not urine she brought with her. Right now, since she hasn't kept up with her counseling sessions as she gets back to work, she's been coming to the clinic every day to get her methadone dose.

Gunn will get take-home methadone only as she earns it by participating in counseling sessions. When she gets it, Meridian has reserved the right to audit her take-home supply to make sure it's not being diverted or abused.

Gunn said the one-on-one help she got at Meridian made the difference.

"It's that step to help you say, ‘I don't want an addict's life anymore,' " she said.

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