Roy Exum: The Methadone Threat

Sunday, January 6, 2019 - by Roy Exum
Roy Exum
Roy Exum

Methadone, an opioid pain reliever that has for over 50 years been best known as the best friend to heroin addicts, is reportedly on the verge of destroying all Tennessee has done in the state’s noble effort to contain the opioid epidemic. Our state has made tremendous strides but if we eliminate oversight and control of methadone, we are courting ruin and an end result of so many overdoses we won’t have enough ambulances.

I am told there is a distinct possibility that if nearly 100 Office-Based Opioid Treatment (OBOT) centers across the state are successful in using existing Federal patient privacy laws to avoid the state’s now-sweeping gains in our country’s narcotics nightmare, such a grievous mistake could create havoc. Face it, we are in a must-win battle against opioids and other drugs that have resulted in record numbers of overdoses and deaths across the United States. Methadone is a Schedule II narcotic – treat it like an angry rattlesnake.

I’m thinking the methadone industry has skillfully hoodwinked some set of legislative bozos into approving a scheme that will allow methadone outpatient centers to prescribe and distribute the opioid drug methadone to their patients rather than go through the now well-regulated system that is working. The legislature needs to amend this in a hurry.

How convenient these patients will receive medicine on site – hello! -- but remember Rule 62 in the Life Manual of Reality: “Every hen in the chicken house ain’t a good layer.” The idea, in theory, is that at these centers, a psychiatrist will prescribe the doses and amounts necessary to treat opioid addiction and everybody leaves with a sack of capsules. But the raw fact is they just caught a nurse in Nashville who prescribed one patient 52 pills a day. This is a crowd where rules mean nothing.

The way to cheat? Here’s the hook -- because of federal HIPAA laws (the Health Insurance Portability and Accountability Act of 1996) the same clinics must follow “confidentiality, integrity, and availability of electronic-protected information.” All patient names, records, prescription dosages, etc., are absolutely locked and confidential. I’ll guarantee you in the first week at least 250 of our addicts will have at least five accounts in welcoming clinics in as many small Tennessee towns.

Don’t you see? With confidentiality protected by heavy fines, addicts are the craftiest souls among us. Think! You mix narcotics, cash, “low-hanging fruit” (anonymous doctor-shopping) and a slick doctor who gets paid by the number of patients he can see in a day … heck, we can all go to Disney Land. Seriously, this will take us back to where we’ve already been, albeit very painfully and costly (think: millions.)

A new state law that went into effect Jan 1, 2019, decrees a ridiculous limit of only a three-day supply of opioid pain prescriptions for new patients, with exceptions for major surgeries, cancer, hospice, sickle cell and treatment in certain licensed facilities. Any legislator who voted this in has never experienced pain … but the promise is “yet.” That’s when you learn that just three days is ding-dong dumb.

Opioids such as hydrocodone really work but our medical community has done a poor job of explaining that if you don’t taper off a dose, you get “drug sick.” The symptoms are so bad, trust me, that I honestly believe it is a big reason people stay on opioids and get addicted.  Pilgrim, tell me how you taper off a three-day supply or how something so unrealistic becomes a law?

Doctors across the state feel this is too strict and not only does a three-day supply fall short of any emergency room doctor’s common sense, it is commonly agreed among physicians that opioid drugs do not reach their maximum efficiency until after about four-five days of supervised use. (Everybody’s metabolism differs.)

Tennessee’s three-day limit is guaranteed to slight the patient, who is instead is the person who we want to help. Most unfortunately, we have allowed a strange collection of pharmacists, insurance companies and the government know-nothing to disrupt a main objective. That’s nuts and is quite candidly the latest in a number of errors we have made due to America’s over-reaction to the opioid crisis.

It has been estimated that between five million to seven million Americans who suffer from chronic pain cannot obtain their opioid medicines all across the United States – get this -- at this very minute! Some stores, such as Walmart, have issued a company policy that the store pharmacist can refuse to fill a valid opioid prescription on a whim. I’ve got victims who will gladly testify about being openly mistreated at the Walmart in Tiftonia.

Now we have just the opposite horror: To allow methadone to go completely unregulated will cause a stampede to these deregulated because they are confidential clinics and all but negate the state data base, the DEA’s ability to monitor drug usage, the TBI’s genius approach, and law-enforcement’s efforts to lessen the flow of opioids. Imagine how catastrophic it might be.

Whereas the ever-tightening grip on legal opioids has now driven those addicted to the black markets, the availability of methadone at a licensed clinic is on face a good idea. It allows health -insurance payments and – just as big – methadone does not show on most drug tests. (Methadone requires a special test to be detected.) But without careful controls and privacy rules, this is every bit as equally dangerous.

With the sharp crackdown on opioids, Tennessee has reduced the number of so-called “pill mills” from over 300 to 120 in just the last three years, and opioid prescriptions have reduced dramatically. At the same time, overdoses have increased with a record high for each new year. The opioid crackdown has forced those addicted to abandon prescription drugs for “street drugs” – both illegal and far deadlier due to non-existent quality control. Heroin use has also increased and fentanyl – about 50 times stronger than morphine and 10 times stronger than heroin -- has become America’s No. 1 heroin derivative.

What happens is a high school dropout in Kansas City is delivered a healthy bag of heroin. This ain’t pure ‘horse,’ it’s been cut between 8 and 20 times. So, our fledgling chemist gets his hand on an envelope of fentanyl – something to give the tired ‘horse’ a renewed life. What difference does it make – 20 grams or 200 grams? Throw it in, cut the lines with a long knife like you’re somebody, and weigh each serving so everybody will achieve the same blessing.

Our chemical salesman jacks the powder up, empties some BC Powders so refill the Glassine papers with his trick, you know … disguise his sale, and when his stash is grabbed on the street, our man is already in Lincoln, Neb., when the radio tells him there were 62 overdoses that same afternoon in Kansas City. That only means our guy can’t do KC for the next 18 months, but he’s headed to South Padre Island to set up for spring vacation. Bring it, son!

In 2016, more Americans died from overdoses (63,639) than were killed in the entire Viet Nam war (58,220). Also, in 2016 there was a 21 percent increase in drug-induced death over 2015 and the epidemiologists all said, “This is not slowing down at all.” The 2017 total of 72,000 was a 10 percent increase and computes 198 fatalities each day. Of the 2017 record number, 68 percent were due to opioids. Hey, remember methadone is an opioid. We cool?

In October, 14 people overdosed on heroin laced with fentanyl in 3 ½ hours, according to Camden, NJ police. Just this Wednesday New Haven CT police reported 100 overdoses in a 36-hour period with black market synthetic opioids so readily available you can order synthetic delivered by UPS.

“A bag of chemicals from Thailand doesn’t even need a customs stamp. Stir in the fentanyl, the heroin, and a small serving of cannabis oil, and call me a gourmet.

In other words, opioid use has been affected but overall drug abuse has not. With “privacy” mandated by the Federal government, and no way to regulate or limit methadone use, Tennessee could return to its wide-open “wild west” approach to drug control where tour buses from out-of-state would flock to towns like Manchester, which at one time had over 30 pain control clinics for less than 11,000 citizens.

Make no mistake. I could care less what some legislator might say: Methadone is a powerful Schedule II opiate. Sold under the brand name Dolophine among others, it is an opioid used for opioid maintenance therapy in opioid dependence, and for pain. Detoxification using methadone can either be done relatively rapidly in less than a month or gradually over as long as six months.

Doctors know a single dose has a rapid effect, maximum effect can take five days of use. (Remember, please, today there is the new three-day prescription limit for legal drugs – and that makes about as much sense as using HIPPA’s privacy laws to allow Methadone to go free.)
Methadone relieves the dreaded symptoms of “drug sickness” (withdrawal). The pain-relieving effects last about six hours after a single dose, similar to morphine's. After long term use, in people with normal liver function, effects last 8 to 36 hours. Methadone is usually taken by mouth and rarely by injection into a muscle or vein, which gives the drug easy portability between office visits.

So, do we beg our legislature, our new governor, his new cabinet or his pretty wife to intercede on our behalf or do we wait for the morning radio to say our crowd is now 15 less than what we hoped … who would have suspected a “bad batch” would end up here, in the very shadow of our Missionary Ridge?

There ain’t much choice but to fight. It’s who we are. And, while sad, we must fight as never before.

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