Sept. 14--A therapeutic dose of methadone for one person can be a deadly dose for another.
The number of deaths caused by a methadone poisoning continues to grow in this country, especially in North Carolina. It's why health officials urge people of all ages not to take medication that isn't prescribed for them.
"It's unfortunately all too common an accident," said Spencer Clark, assistant chief of community policy management with the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services.
Methadone toxicity is to blame for the death of Harry Cohen, the 17-year-old Williams High School quarterback. Cohen died Aug. 29 at UNC Hospitals in Chapel Hill of cardiopulmonary arrest after he took some methadone pills that were prescribed to his grandmother for fibromyalgia pain.
The directions on the bottle said take two pills every four hours, which was the dose prescribed for the grandmother. The exact number of pills that Cohen took isn't immediately known -- the state Medical Examiner's office still hasn't released toxicology results -- but health officials say it wouldn't take much of a dose to kill even a healthy 17-year-old for a variety of reasons.
"What would be a therapeutic dose for someone who has been taking it for a long time can be a fatal dose for someone who never took it before," Clark said. "Methadone is very unforgiving."
Cohen's size -- he weighed 150 pounds -- and lack of body fat also contributed to the problem, said Richard Kaffenberger, Cohen's stepfather, as was explained to him by his son's physician. There wasn't any fat to absorb the drug that Cohen's parents believe he took to treat pain caused by playing football.
Methadone, a synthetic narcotic, has been around since the 1960s and was used primarily in treating people addicted to heroin and other opioids in a clinical setting. Since the late 1990s, doctors started prescribing it for pain management, especially for people dealing with chronic pain. In more recent years, it's been prescribed more often than drugs such as oxycodone and hydrocodone.
"Methadone has been more popular among pain-management physicians in recent years," Clark said.
The number of unintentional poisoning deaths in North Carolina in 2009 was 1,103 and 235 of those were from methadone poisoning. Nine people died of methadone poisoning in Alamance County in 2009, according to a N.C. Division of Public Health report.
Methadone, oxycodone, hydrocodone and other opioid painkillers are the most common causes of unintentional poisoning deaths in both the United States and North Carolina, according to a 2010 N.C. Division of Public Health report.
"This is a public health epidemic in the nation," Clark said. "North Carolina happens to be in the mix, and it's very unfortunate."
Methadone remains in the body for a long time, often more than 50 hours, and a person who hasn't used the drug before might not feel the full impact until four hours after taking it. If the wrong dose is taken, it can cause respiratory depression, Clark said.
"Typically, with a person that dies, the family member will report that the person was making funny noises in their sleep, snoring loudly and when they woke up the next morning, the person was dead," Clark said. "It's sudden and there is not a lot of warning. A person will go to sleep one night and not wake up the next day."
Cohen's mother, Jennifer Kaffenberger, went to wake him for church on the morning of Aug. 28, and her son didn't respond. His parents called 911 and performed CPR. An ambulance took him to Alamance Regional Medical Center and then he was transferred to UNC Hospitals where he relied on a ventilator to breathe. After a test was done to determine brain activity on Aug. 29, his family opted to remove him from the ventilator. Cohen died that night.
One way health officials are trying to reduce the number of methadone-related deaths is by targeting the physicians who prescribe the medication. The goal is to get them to educate their patients about the dangers of the drug and also about the need to keep it locked up so it doesn't fall into the wrong hands.
"There is always potential for error or accidents," Clark said. "You would hope every patient prescribed the drug would be advised both in verbal and written fashion on how to safely use it and safely store it. It's really very critical."
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