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Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens
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Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens

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This handout includes Michael J. Berens' Pulitzer-winning methadone series with The Seattle Times. …

This handout includes Michael J. Berens' Pulitzer-winning methadone series with The Seattle Times.

Berens presented "Finding Your Best Investigative Business Story," a free business journalism webinar hosted by the Donald W. Reynolds National Center for Business Journalism.

For more information about free training for journalists, please visit businessjournalism.org.

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  • 1. METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT December 11-13, 2011 seattletimes.com/methadone
  • 2. EXHIBIT 1 December 11, 2011 METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT State pushes drug thatsaves money, costs lives MIKE SIEGEL / THE SEATTLE TIMES Sara Taylor, mother of former King County 911 dispatcher Angeline Burrell, describes her daughter’s battle with excruciating chronic pain. In early 2008, Burrell’s metha- done dose was doubled. She died two days later. At left is Taylor’s husband, Dale.First of three parts 2003, there are 2,173 of these dots. That alone is striking, a graphicBY MICHAEL J. BERENS illustration of an ongoing epidemic.AND KEN ARMSTRONGSeattle Times staff reporters But it’s the clusters that pop out — the concentration of dots inM ap the deaths and you see places with lower incomes. the story. Everett, whose residents earn Assign a dot to each per- less than the state average, has 99son who has died in Washington by dots. Bellevue, with more peopleaccidentally overdosing on metha- and more money, has eight. Work-done, a commonly prescribed drug ing-class Port Angeles has 40 dots.used to treat chronic pain. Since Mercer Island, upscale and more seattletimes.com/methadone
  • 3. METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT EXHIBIT 1populous, has none. For the past eight years Washing-ton has steered people with state-subsidized health care — Medicaidpatients, injured workers and stateemployees — to methadone, a nar-cotic with two notable characteris-tics. The drug is cheap. The drug isunpredictable. The state highlights the formerand downplays the latter, cuttingits costs while refusing to own upto the consequences, according toa Seattle Times investigation thatincludes computerized analysis ofdeath certificates, hospitalizationrecords and poverty data. Methadone belongs to a class ofnarcotic painkillers, called opioids,that includes OxyContin, fentanyland morphine. Within that group,methadone accounts for less than10 percent of the drugs prescribed— but more than half of the deaths,The Times found. Methadone works wonders forsome patients, relieving chronicpain from throbbing backs toinflamed joints. But the drug’sunique properties make it unforgiv-ing and sometimes lethal. Most painkillers, such as OxyCon-tin, dissipate from the body withinhours. Methadone can linger fordays, pooling to a toxic reservoirthat depresses the respiratory sys-tem. With little warning, patientsfall asleep and don’t wake up. Doc-tors call it the silent death. needed pain relief. One, with pri- In Washington, the poor have vate insurance, received OxyCon-been hit the hardest. While Medic- tin, an expensive drug. The other,aid recipients make up about 8 per- on Medicaid, received methadonecent of Washington’s adult popula- — and within a week, overdosedtion, they account for 48 percent of and died.the methadone deaths. “I kept telling her not to go on A case from 2009 epitomizes this methadone,” said the survivingdivide. Two sisters, injured in a sister, who asked that the family’scar accident in South King County, name not be used, for privacy. seattletimes.com/methadone
  • 4. METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT EXHIBIT 1 Washington’s methadone death cials more inclined to rationalizerate ranks among the country’s than reckon.highest. California, with more thanfive times the people, has fewer Losing it alldeaths. Doctors expected Angeline But year after year, Washington Burrell’s surgery to be routine. Buthealth officials have proclaimed when Burrell, a 911 dispatcher formethadone to be just as safe as King County, had her gall bladderany other painkiller. They have removed in 2004, she was left withdisregarded repeated warnings, excruciating pain, mystifying physi-obscured evidence of harm, and cians.failed to adopt simple lifesaving Doctors prescribed painkillers,measures embraced by other states, but the pain wouldn’t go away. Thethe Times investigation shows. more Burrell sought help, the more Jeff Rochon, head of the Wash- doctors suspected she was a pillington State Pharmacy Association, seeker, a prescription addict scam-says pharmacists have long recog- ming for drugs.nized that methadone is different “She tried to find a doctor tofrom other painkillers. “The data believe her,” says her mother, Sarashows that methadone is a more Taylor. “She became depressed,risky medication,” he says. “I think and it just kept getting worse.”we should be using extreme cau- Co-workers pitched in, donatingtion to protect our patients.” sick days to Burrell. Washington’s methadone deaths Two years passed before doctorstell a story of the politics of health diagnosed surgical-related nervecare in a slumping economy. Tight damage. By then, Burrell had lostbudgets force tough cuts. Often, her job, her house in Spanawaythose hurt the most can afford it and her private insurance. Sheleast. And often, the suffering is moved into her mother’s home inmet with silence, with public offi- Renton, destitute and on Medicaid. seattletimes.com/methadone
  • 5. METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT EXHIBIT 1 JOHN LOK / THE SEATTLE TIMESThe safety of methadone will be on the agenda — again — when the Washington Pharmacyand Therapeutics Committee meets later this month. Above, the committee, which has hugeinfluence over patient care, meets in SeaTac in October. Her pain made walking unbear- has a respiratory disorder. Burrellable. She gained weight. Her did. State guidelines warn againsteyesight dimmed. She spent long giving methadone to someone alsohours in bed, reading Patricia Corn- receiving other long-acting painkill-well crime novels, anguishing over ers. Burrell was.her lost prospects of ever becoming In early 2008 Dr. Anna Samsona sheriff’s deputy. doubled Burrell’s methadone dose The Roosevelt Clinic at the Uni- to 10 milligrams every six hours,versity of Washington Medical according to her medical notes.Center prescribed drugs for her Samson’s notes also said she wouldpain, insomnia, nausea, depression be tapering Burrell off oxycodone,and anxiety, according to medical a more expensive painkiller thatrecords Burrell’s family provided to she began taking while on privateThe Times. insurance. But in the meantime “I was so scared about what all Burrell remained on both.the pills were doing to her,” Taylor Samson’s notes made no men-says. tion of Burrell’s sleep apnea One of those drugs was metha- — involuntary pauses in breathing.done. Methadone can compound apnea’s Federal regulators say it can be effects; federal regulators have tieddangerous to give methadone to combining the two to hundreds ofsomeone on anti-anxiety medica- preventable deaths.tions. Burrell was. They say metha- But Samson’s notes did mentiondone can disrupt breathing and the dangers of Burrell’s pharma-heart beat, especially if a patient cological mix: “I advised her that seattletimes.com/methadone
  • 6. METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT EXHIBIT 1combinations of these medicationscan depress her respiratory rateand cause her to stop breathing.” Samson’s notes were dated Feb.13, 2008. Two days later, Burrell was foundin a nightshirt, slumped on her bed,arms dangling with open hands.She had stopped breathing, herrespiratory muscles paralyzed withstunning speed. The King County Medical Exam-iner’s Office found methadone andthree other prescription drugs inher body, consumed at normaldoses. The medications had com-bined into a toxic cocktail. The casewas ruled an unintended death. University hospital officialsreviewed Burrell’s case and con-cluded her care was “appropriate,”according to a written statement toThe Times. At age 32, Angeline Burrellbecame another dot on the map.The origins of Washington Rx most important decisions get made not by legislators on the House or Starting a decade ago, states Senate floor, but by easy-to-missdiscovered a new way to save committees meeting in mundanemoney on prescription-drug costs, places. That’s the case with Wash-which were increasing about 17 ington’s Pharmacy and Therapeu-percent a year. All but four created tics Committee — or P&T com-a Preferred Drug List, a register of mittee, for short — a group withmedications the state will pay for enormous influence over patientin cases where it covers a patient’s care.care. Under Washington Rx, a P&T The goal is to steer patients committee comprising doctors,toward less expensive drugs with- pharmacists and other medicalout sacrificing safety; plus, by experts evaluates drugs in variousconsolidating purchases, states can classes, weeding out any found tooften negotiate better deals with be less safe or effective. After thatdrug companies. initial cut the state draws up its list, Washington’s list took effect in taking into account cost.2004, the year after Gov. Gary No state officials sit on the com-Locke signed the state’s new pre- mittee, an arrangement designed toscription-drug program, Washing- protect the panel’s independence.ton Rx, into law. But the committee’s members Often, in state government, the are hand-picked by the three state seattletimes.com/methadone
  • 7. METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT EXHIBIT 1 Dr. Jeff Thompson, chief medical officer of the state Medic- aid program, hasdefended methadone during meetings of the state committeethat evaluates drugs. MIKE SIEGEL / THE SEATTLE TIMES agencies or programs with a finan- Committee meets: 2004-05 cial stake in the panel’s winnow- To Dr. Stuart Rosenblum, a pain ing process: Medicaid; Labor & specialist in Portland, what he Industries, which handles workers’ had to say was worth the six-hour compensation; and the Health Care round trip. Authority, which administers medi- In June 2004, Rosenblum drove cal benefits for state employees. to the Holiday Inn SeaTac and told Though not committee members, Washington’s P&T committee that officials from these three entities Oregon had seen a 400 percent attend committee meetings and increase in deaths associated with often dominate discussions. With methadone. He advised the commit- methadone, two doctors in particu- tee to exclude the painkiller from lar — Jeff Thompson, chief medical Washington’s preferred drug list. officer of the Washington Medicaid “Virtually no response,” he says of program, and Gary Franklin, medi- the reaction. “It was like, ‘Thanks cal director for L&I — have repeat- for testifying.’ ” edly deflected concerns about the The committee ruled that metha- drug, a review of meeting tran- done was as “safe and effective” as scripts shows. any other painkiller, allowing the In May 2004, when Washington’s state to keep it as a preferred drug. preferred drug list for long-acting In June 2005, at the Radisson painkillers took effect, only two Hotel near SeaTac, Oregon’s meth- drugs were included: morphine adone deaths came up again. One and methadone. member of the P&T committee, Dr. Across the country, 31 states have Carol Cordy, asked the right ques- methadone on their preferred list. tion: “And does Washington have But most offer a broad inventory of numbers like Oregon?” other pain medications, expanding But Jeff Thompson, of Washing- the options available to physicians, ton Medicaid, sidestepped it. He according to a Times survey of talked about measures the state these formularies. was taking to address overdoses for painkillers in general — “We’re seattletimes.com/methadone
  • 8. METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT EXHIBIT 1doing a lot. ... In my mind, I think poisonings linked to methadone.it’s working” — but provided no They included a 30-year-old nurs-numbers for methadone-related ing assistant from Spokane, adeaths. 43-year-old waitress from Puyal- One committee member seemed lup and a 44-year-old welder fromto think Washington had nothing to Vancouver.worry about, saying: “I know with The day after the committee met,methadone we don’t really encour- a 38-year-old database special-age it as a preferred drug.” Citing ist from Shelton who was on both“issues” with doctors not knowing methadone and antidepressantshow to use methadone, she claimed overdosed and died.physicians were directed to mor-phine instead. A methadone primer: Another member wondered if any cheap but complexeffort was being made to look at For decades, methadone — aWashington’s methadone overdose synthetic opioid developed in therate. But then he dismissed the 1930s by a German company —thought: “Sounds like in our state, was associated not with pain reliefmethadone’s just not used much. ... but with weaning addicts off heroinSo it may be just a moot point.” and other drugs. The word sum- In fact, the point was anything moned an image of clinics, often inbut moot. Washington’s problems seedy parts of town.with methadone weren’t minor But when the medical communi-compared to Oregon’s. Washing- ty’s philosophy on pain shifted, soton’s were much worse. did its take on methadone. In 2004, the amount of metha- As recently as the mid-1990s,done used in Washington had Washington discouraged doctorssoared to about 224,000 grams. from prescribing narcotic painkill-Oregon, meanwhile, used about ers to noncancer patients. Pain157,000 grams. was considered a symptom, not While Oregon’s methadone-asso- an ailment. But in the late ’90s, asciated deaths leveled off in 2002, patients protested, the health-careWashington’s became a dramatic system switched course, viewingfever chart, shooting up. Deaths untreated pain as unnecessarylinked to methadone went from suffering. By 2001, the nation’s140 in 2002, to 166 in 2003, to top hospital-accreditation agency256 in 2004, according to a Times mandated treatment of pain.analysis of death certificates. Ore- In this new environment, metha-gon, by comparison, had 99 deaths done emerged as an attractivein 2004. option. Less than a dollar a dose, Washington’s deaths were among the drug was three to four timesthe highest in the country — sur- cheaper than its closest competitorpassed, in 2004, by only North and 12 times cheaper than brand-Carolina and Florida, both more name OxyContin.populous states. From 1999 to 2005, the use of In May 2005, the month before methadone in the United Statesthe meeting at the Radisson, 28 went from 965,000 grams to 5.4people in Washington died from million grams, according to the seattletimes.com/methadone
  • 9. METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT EXHIBIT 1U.S. Drug Enforcement Administra-tion. But then there are the drug’s com- Methadone: What patientsplicating factors. need to know While the pain relief from metha-done might last four to eight hours, Methadone can be more difficult tothe drug’s half-life can extend for manage than other drugs. Experts saydays. Various studies have placed it’s important to tell your health-carethe high end at 59 hours, or 91 provider and pharmacist about allhours, or even 128 hours. That drugs you are taking, including vita-means the drug’s dangers — main- mins.ly, its effect on the respiratorysystem — last long after its benefits • Methadone can slow your breathinghave worn off. A patient in pain even long after the drug’s pain-reliefmight be tempted to take another effect wears off. Never take morepill without being aware of the methadone than your doctor has pre-toxic buildup. scribed. Death can occur if breathing Most prescription drugs harbor becomes too weak.risks when mixed with alcohol orother medications. Methadone can • Drinking alcohol while taking meth-be particularly hazardous when adone can cause serious side effects,combined with drugs called ben- even death.zodiazepines, used to treat anxietydisorders. • Without your doctor’s approval, Patients struggling with pain don’t take methadone with other nar-often become depressed or anxious, cotic painkillers, sedatives, tranquiliz-doctors say, making this risk factor ers, or any medicines that slow breath-a critical one. For 2009, The Times ing or make you sleepy.documented 274 methadone-relat-ed deaths in Washington. Death • Methadone may not be the rightcertificates show that 119 patients, drug for you if you have certain medi-or 43 percent, also consumed pre- cal conditions. Let your doctor knowscription medications for anxiety or first if you have asthma; sleep apnea;other mental-health disorders. other breathing disorders; diseases In its regulation of addiction of the liver, kidneys or gallbladder;clinics, the federal government has underactive thyroid; a history of headlong recognized methadone’s dan- injury or brain tumor; seizure disor-gers. Under the mantra “start low, ders; low blood pressure; adrenal-go slow,” federal law requires tight gland disorders; enlarged prostate; orcontrols. Addicts, for example, must mental illness.visit the clinic daily at the begin-ning of treatment. That’s because If you have questions, contact the statethe drug’s effects on individuals can Department of Health’s Customer Ser-vary dramatically. vice Call Center at 360-236-4700 But with pain patients, many doc- or painmanagement@doh.wa.gov.tors prescribe a month’s worth ofmethadone, with little or no follow-up. seattletimes.com/methadone
  • 10. METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT EXHIBIT 1 As the use of methadone hasclimbed, so have the overdoses.From 1999 to 2005, methadone-associated deaths in the UnitedStates climbed from 786 to 4,462,according to the Centers for Dis-ease Control and Prevention. Of course, not all those deathscan be attributed to prescribingpractices. Some overdose victimsobtain methadone without a pre-scription or combine it with illegaldrugs such as cocaine. The Timesfound that up to 20 percent ofmethadone-related deaths in Wash-ington involved a combinationwith illicit substances, suggestingthe overdoses were a byproduct ofabuse. In November 2006, the U.S. Foodand Drug Administration soundedan alarm about methadone, fol-lowing an investigative report ina West Virginia newspaper, TheCharleston Gazette. The FDAlowered its dosage guideline formethadone and issued a public-health advisory with this headline:“Methadone Use for Pain ControlMay Result in Death and Life-Threatening Changes in Breathingand Heart Beat.”Committee meets: 2006 Once again, committee memberCarol Cordy asked the right ques-tion. Gary Franklin, L&I’s medical When the P&T committee met director, cited a study of workers’in December 2006 at the Seattle compensation recipients that foundAirport Marriott, it had been three 32 overdose deaths between 1995weeks since the FDA issued its and 2002. “They were half metha-methadone alert. Cordy, a family done and half oxycodone,” Franklinphysician in Seattle, brought up said.methadone and morphine — the But those numbers didn’t answerstate’s choices as preferred painkill- Cordy’s question. The L&I studyers — and asked: “Has there been applied only to a small popula-any increase in accidental over- tion. More important, its time spandoses?” preceded the start of Washington’s preferred drug list. “No,” Cordy seattletimes.com/methadone
  • 11. METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT EXHIBIT 1said. She wanted to know about ferred drug list with the long-actingany increase after 2003. opioids, OxyContin represented 70 “Yeah, I guess we haven’t looked percent of our utilization. Today ...at that,” Franklin said. He kicked we’re down to less than 3 percent.”the question to L&I’s pharmacy Washington’s death toll frommanager, who talked up the chal- methadone was soaring. But thelenges of doing such analysis, state was realizing its goal of mov-saying death certificates often list ing people off more expensivemore than one drug: “So it’s kind painkillers.of hard to divvy out, you know, theparticular.” ‘Very little data’ Cordy’s question was not an In evaluating drugs for safety andimpossible one to answer. The state effectiveness, the P&T committee isDepartment of Health analyzes required to rely on the best avail-death certificates and reaches con- able science. To find it, the stateclusions even when multiple drugs hired Oregon Health & Scienceare listed. The Times did the same University, a teaching hospital andand found these numbers: In 2003, research center based in Portland.the year before the preferred drug The OHSU researchers collect andlist took effect, the state recorded analyze medical studies, looking166 deaths linked to methadone; for the best clinical trials, ones thatby 2006, that number had more compare drugs head-to-head andthan doubled, to 342. are randomized, controlled and of Just as telling, those 342 deaths long duration.were three times the number In the case of long-acting opioids,attributed to any other long-acting however, researchers have had onlypainkiller. a few studies of poor or fair quality Cordy wasn’t the first to question to consider.methadone in 2006. A doctor from At a P&T committee meeting inthe Seattle Cancer Care Alliance, 2005, Dr. Roger Chou of OHSUDermot Fitzgibbon, appeared at a told members there is “a continuedP&T committee meeting that sum- lack of good study on methadone.”mer and urged the state to offer In 2006 he said, “There’s no evi-more choices than methadone and dence that one long-acting opioidmorphine, calling methadone “par- is superior to others,” to which theticularly problematic.” But Wash- committee’s vice chair said, “Thankington refused to change course. you, Roger, that was excellent.” In At the end of the December 2006 2008 Chou said, “We really havemeeting, Siri Childs, pharmacy very little data on methadone’sadministrator for Washington Med- use.”icaid, told the committee what she In the absence of top-notchcalled a “good story.” clinical trials, Washington officials “Do you all want me to tell you adopted the position that metha-how many OxyContin users we done is just as safe and effective ashave in Washington nowadays?” other drugs in its class. “Sure,” came the answer. Franklin, the L&I medical direc- “You’re going to be just amazed, tor, told The Times that “if it wasn’tbecause when we started the pre- methadone killing people” in seattletimes.com/methadone
  • 12. METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT EXHIBIT 1Washington, it would be another despite its low cost. North Carolina,long-acting painkiller — oxycodone like Washington, has consistentlyor fentanyl or something else. He ranked among the top five statessaid prescribers and patients have in methadone-associated deaths.become too quick to turn to long- When North Carolina adopted itsacting painkillers in general, a first preferred drug list last year,shift fueled by “weak science” and the state rejected methadone.support from the pharmaceutical North Carolina had analyzedindustry. the drug’s toll and did not want to “The overall problem — the pub- “encourage its use,” said Dr. Lisalic-health emergency in this coun- Weeks, chairwoman of the state’stry — is a dosing problem,” Frank- Preferred Drug List Review Panel.lin said. “It is not a methadoneproblem.” Committee meets: 2009 Thompson, the Medicaid chief “Quite frankly, I’m at a loss ofmedical officer, said: “If you’re what to do,” Thompson told thelooking for a single villain, you committee at its February 2009could make methadone that villain. meeting.But I think it’s more complex than His consternation traced to athat.” recent Department of Health study Methadone, he said, “is a safe that produced some alarming num-drug if used correctly. ... If it’s an bers about Medicaid.unsafe drug, why have we been Analyzing all prescription-opioidusing it for 40 years?” fatalities in Washington from 2004 For Washington, the preferred to 2007, department researchersdrug list has yielded financial discovered that a stunning 64 per-rewards. In fiscal year 2008, the cent involved methadone.Medicaid program’s estimated sav- And of the people whose deathsings came to $45.5 million, accord- were linked to methadone, 48 per-ing to an audit by the state’s Joint cent were on Medicaid.Legislative Audit & Review Com- The findings highlighted meth-mittee. Looking only at long-acting adone’s “prominence” in opioidopioids — the class with methadone overdoses, the Health Department— that year’s savings amounted to study said, and indicated “the Med-$3 million. icaid population is at high risk.” Some other states, meanwhile, “I think this is a distinction thathave treated methadone’s mortality we don’t want, and it just keepsfigures and complex properties as growing,” Thompson said of thesufficient grounds to urge caution. Medicaid population’s dispropor- New York issued a health advi- tionate share of the state’s prescrip-sory in January 2009 about tion-drug deaths.methadone’s dangers. Five months In medical circles, the depart-later, Oregon alerted doctors that ment’s findings about methadonemethadone’s “safety is of increasing and Medicaid broke new ground. Inconcern,” and the drug “should not the fall of 2009, the Centers for Dis-be considered a first-line agent.” ease Control and Prevention — the Fifteen states have left metha- federal agency assigned to protectdone off their preferred drug lists, public health — published the seattletimes.com/methadone
  • 13. METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT EXHIBIT 1study in its Morbidity and Mortality potent painkillers.Weekly Report. One of the state’s broadest ini- But in Washington, state officials tiatives to save lives, Thompsonhave done little to spread the word. said, is a “lock-out” program that When the P&T committee met in requires about 3,800 MedicaidDecember 2009, Bill Struyk, a phar- patients to use only one practitio-maceutical representative, brought ner for prescriptions in order toup “Generic News,” a newsletter avoid “doctor shopping.”produced by state Medicaid officialsfor health-care professionals. He ‘Elephant in the room’said the newsletter told only half In December 2010, Dr. Michaelthe story of methadone: Officials Schiesser, a pain specialist in Bel-publicized how cheap it was, with- levue, wrote a letter to the P&Tout saying how many deaths it was committee, retracing the state’slinked to. history with methadone and crying “Without disclosure of that fact, foul.are we making informed deci- When it comes tosions?” Struyk asked. methadone, Schiesser Thompson jumped to metha- is the closest thingdone’s defense, pointing to other the state has to adrugs — for example, ones used whistle-blower. Threein mental-health treatment — also years ago he joined alinked to fatal overdoses. The state Dr. Michael Health Departmentshould be “very careful” about Schiesser, a work group on acci-“picking on a drug,” he said. Bellevue pain dental poisonings. “If you look at the dangers, it’s specialist After that he becamenot just methadone,” Thompson involved in legislativesaid. deliberations about pain manage- How about a note, Struyk sug- ment.gested, advising methadone pre- He reviewed transcripts of P&Tscribers to be cautious? committee meetings and swept “It’s not only due just to metha- up reports about methadone. Thedone,” Thompson said. more research he did, the more “No,” Struyk said. “But 64 percent troubled he became.are.” Schiesser uses the word “creep” Thompson said he would include to describe methadone’s grip onmethadone’s toll in a future news- Washington. As more years passedletter. “Because it is important,” he with the P&T committee saying thesaid. But he never did. drug was as safe as any other, the Alarmed by the Health Depart- harder it became for the state toment study, state officials launched reverse course or hedge by issu-an internal monitoring program to ing special alerts to physicians oftrack practitioners who prescribe potential complications with meth-high volumes of narcotics to Med- adone.icaid patients, Thompson told The “So you start to ignore the ele-Times. In addition, the state now phant in the room, which is theeducates hundreds of Medicaid mounting evidence,” Schiesserpatients on the risks and use of says. seattletimes.com/methadone
  • 14. METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT EXHIBIT 1 His letter challenged a 2008 ity has allowed the state to keepreport that Oregon Health & Sci- saying there’s no evidence of meth-ence University provided to the adone being especially risky — andcommittee, saying it “contains to the state, no news is good news.errors, deficient logic, and relevant He describes the result as: “Becauseomissions.” we don’t know, therefore it ain’t The report said one study “found so.”no differences” between metha- In Washington, medications candone and other drugs for overdose go on and off the Preferred Drugrisk, when, in fact, the opposite List as more evidence develops.was true, Schiesser wrote. The The P&T committee meets laterreport mentioned a “black-box this month, when its members willwarning” from the FDA about evaluate — once again — the safetyOxyContin but not one from the of methadone.same agency about methadone, hewrote. Database reporter Justin Mayo and news In a written reply, an OHSU doc- researchers David Turim and Gene Balktor downplayed Schiesser’s points, contributed to this report.saying, for example, that FDA Michael J. Berens: 206-464-2288black-box warnings are “not evi- or mberens@seattletimes.com;dence.” Ken Armstrong: 206-464-3730 To Schiesser, such hyper-selectiv- or karmstrong@seattletimes.com. seattletimes.com/methadone

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