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'One pill can kill'

On Memorial Day weekend in 2004, a traveling fair came to the small town of Oconto Falls, Wis. Sixteen-year-old Josh Engebregtsen and three of his friends decided to go.

His mother, Sue, remembers the night. Everything seemed so normal. Her son called before his 9 p.m. curfew, asked if he could stay at his friend?s house. The boys went home, sat up talking until 3 a.m.

Engebregtsen died in his sleep that night.

During the boys? night of fun at the fair, another local teen offered them some pills. It was methadone that his mother was prescribed for pain. Engebregtsen took two.

The number of people like Engebregtsen that methadone has helped to kill has multiplied ? from 790 in 1999 to 2,992 in 2003, according to an analysis of death certificates conducted by the Centers for Disease Control and Prevention?s National Center for Health Statistics for the Charleston Gazette.

Some government officials are responding. Thousands of miles apart, they have developed the same solutions ? keep track of who is being prescribed methadone and who is dying from it, and educate doctors, pharmacists and patients about the drug?s dangers.

Two 10-milligram pills

Catherine Sanford, a North Carolina epidemiologist, watched the number of deaths caused by methadone in her state rise from seven in 1997 to 248 in 2004.

?It was shocking,? she said in a telephone interview. ?We couldn?t believe what we were seeing.?

In 2002, Sanford went to her boss, Carmen Hooker Odom, secretary of the North Carolina Department of Health and Human Services. Odom called together a task force of state experts to develop a plan.

Something similar happened on the national level in 2003, when the federal government convened a conference about methadone overdose deaths. But few of the conference?s recommendations have been implemented, experts who were involved in the conference told the Gazette.

In North Carolina, officials set up a special ?working group? to make sure their plan was implemented. Every three months, representatives from law enforcement, public health, doctors and pharmacist groups met to figure out which goals were being met and which were not.

Since then, the state Legislature passed a law to create a statewide database to keep track of potentially addictive and easily abused prescription drugs such as methadone.

The database is designed to stop ?doctor shoppers? ? patients who go from doctor to doctor, piling up multiple prescriptions for the same drug.

Pharmacists and doctors are being asked to tell their patients to keep the drug in a lockbox or other safe place.

?We?re not trying to demonize methadone. But if we don?t make it safe to use these drugs, they might be taken away. We don?t want that to happen,? Sanford said.

Sanford closely tracks methadone overdose deaths in her state. Because of the state?s surveillance system, she noticed when more and more teenagers began dying from methadone.

In response, the state is developing an educational campaign on the dangers of prescription drugs, especially methadone.

Teenagers are being told in explicit language that taking methadone to get high, even in small doses, can be deadly.

??One pill can kill? is one of our slogans,? Sanford said.

Or two pills, in Josh Engebregtsen?s case ? two 10-milligram pills.

Sue Engebregtsen had never heard of methadone before her son?s death. She had to research it on the Internet.

?It?s just so scary, because it is a tiny little white pill,? she told the Gazette. ?Think about two aspirin ? that?s 500 milligrams. You look at that tiny little pill that says ?10? on the top and think, ?How dangerous can that be?? From a kid?s perspective ? or an adult.?

Even the local newspaper assumed he must have downed the pills with alcohol, she said.

?The papers here said he had been partying and drinking,? she said. ?But the toxicology reports showed nothing but the methadone.?

Not in our family

About 10 years ago, England was experiencing its own epidemic of overdose deaths involving methadone.

English health officials tackled the problem head-on and cut in half the number of methadone overdoses in seven years.

In 1997, methadone helped to kill 421 people in England and Wales, according to the British Office for National Statistics. By 2004, that number had fallen to 200.

In 2000, in a national report on ?Reducing Drug Related Deaths,? methadone was the only drug to merit a whole chapter. ?If allowed to continue unchecked, the number of methadone-related deaths will threaten to discredit an otherwise good treatment,? the Advisory Council on the Misuse of Drugs report said.

The British government developed a multi-pronged strategy to fight drug overdose deaths. Officials there:

  • Asked a group of experts for advice on how methadone can be safely prescribed, then distributed the guidelines to all general practitioners, emergency workers and drug treatment centers.
  • Set up a system to track drug overdose deaths as they happened.
  • Trained coroners and local law enforcement officers to spot overdose deaths.
  • Got more people into drug treatment. Although methadone was a leading cause of overdose deaths in the U.K., officials said proper methadone treatment had the potential to stop some of those deaths. Officials poured money into drug treatment programs, to make them more accessible and effective.
  • Taught the general public how to prevent drug overdoses. They produced videos, posters and wallet-sized cards, with instructions on how to avoid overdoses, how to detect them, and how to do first aid to stop them from being deadly.
  • People cannot fight a problem unless they confront it head on, British Health Minister Hazel Blears said in a 2001 press release.

    ?We are determined to make a real difference by focusing our initial work on overdoses from heroin and methadone,? she said.

    Sue Engrebregsten also is trying to educate parents and teenagers about the dangers of methadone.

    Three months ago, she created a Web site to tell the story of her son?s death. She posted photos of her son from the last few months of his life: sitting beside his dad at Christmas, posing with his older brother Eric and the family?s two dogs, hugging his grandma on the porch.

    ?It?s been devastating,? she said. ?People ask me how many kids I have, and when I have to tell them I lost my younger son ... right away they?re going to jump to conclusions ? he?s some drug addict. I?m constantly defending him to people who didn?t know him. I don?t have to do that to the people who did.

    ?We never ever thought in a million years that something like this would happen in our family.?

    Nineteen months after Josh Engebregtsen?s death, the boy who brought the methadone to the fair was sent to jail for supplying it to him, Sue Engebregtsen said.

    The boy?s mother is dead; she overdosed on methadone on what would have been Josh Engebregtsen?s 18th birthday.

    To contact staff writers Scott Finn or Tara Tuckwiller, use e-mail or call 357-4323 or 348-5189.

    What you can do

    Methadone is an effective painkiller and treatment for drug addiction. To avoid accidental overdose, experts advise caution:

    Never take methadone unless it is prescribed to you. Even people who are accustomed to other opioids (OxyContin, fentanyl, etc.) can die if they take methadone, which behaves differently in the body.

    If methadone is prescribed to you, make sure your physician is properly trained and experienced in methadone therapy. The doctor must be familiar with methadone?s unique properties and how it interacts with other drugs.

    ?Start low and go slow? is the rule for this long-acting drug. Do not take more doses than prescribed. Even after methadone?s effects seem to have worn off, it is still depressing the respiratory system.

    Watch out for other drugs. Several drugs can intensify methadone?s effects and cause overdose. Before you take methadone, ask a doctor experienced with the drug whether your other prescriptions are safe to take with it.

    Lock up your methadone. If consumed by children or other family members, or stolen and sold on the street, it can kill.


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