Methadone - It's Not Just for Heroin Addicts Any More

Newspaper editors know that they will sell papers if they characterize Anna Nicole Smith in as trashy a manner as possible. Thus, coverage of the death of Daniel Smith, Anna Nicole's son, has included lines such as this:

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Anna Nicole Smith's 20-year-old son died from a lethal combination of a drug that treats heroin addiction -- methadone -- and two antidepressants, pathologist Cyril Wecht says.

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This was the opening paragraph in the news story, and for those of us who just read the opening paragraphs of stories, the implication is clear - Smith was a recovering heroin addict.

The text above is what displays when you perform a Yahoo search. But when you go to the article itself, the text now reads slightly differently:

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Anna Nicole Smith's 20-year-old son died from the "accidental" effect of methadone and two antidepressant drugs interacting in his system, according to a well-known American pathologist who conducted a private autopsy.

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And later in the story, the article backs away from the previous implications:

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Wecht said he did not know why Smith was taking methadone, a pain-reliever that is also used to ease heroin cravings for recovering addicts.

"It is used for people who have been on heroin or morphine," Wecht said from his home in the Pittsburgh area. "I have made those inquiries. I can only say to you no one has suggested anything having to do with drug addiction in this boy."

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But, as another story points out, methadone is not only used for recovering heroin addicts. It has other uses:

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One use for the drug is to relieve pain.

"It keeps the pain moderate. Basically I just don't feel pain," said a Kalamazoo man who uses the drug three times a day and who wished to remain anonymous.

"I've had several surgeries, I suffer from chronic pain. I've had two operations for cancer in the past," the man added.

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And in fact, when you look at the Daniel Smith story, there's a logical reason - other than kicking heroin - why he may have been taking methadone:

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Methadone is a drug most commonly associated with helping wean addicts off heroin. But in recent years, it has also been prescribed as a painkiller.

According to Smith's camp, the younger Smith was treated for back pain, as well as depression, in the weeks leading up to his death.

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So it's possible that Smith was taking methadone for his back pain, and the other two drugs for the depression - and someone didn't ask the right questions beforehand. Pharmacies often check prescriptions against each other to make sure that multiple drugs don't result in a toxic combination. For whatever reason, that didn't happen in this case.

Now I'll grant that there are people who are convinced that pain patients should not be taking methadone or oxycontin or whatever, and if they'd just buck up, they could get by with Tylenol or whatever. The underlying assumption is that over the counter medications are "safe" - not just safer, but safe. Don't be so sure about that:

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If you take acetaminophen as recommended, serious side effects are uncommon. Effects of overdose include:

bloody or black, tarry stools
decrease in amount of urine passed
difficulty breathing, wheezing
fever or sore throat
nausea, vomiting
skin rash
stomach cramps
unusual bleeding or bruising, pinpoint red spots on the skin
unusual tiredness or weakness
yellowing of the skin or eyes

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In some cases, it's better to take one methadone tablet rather than a handful of "safe" over the counter medications.

Just watch out what you mix.

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What other medicines can interact with acetaminophen?

alcohol
antacids
cimetidine
medicines for mental problems and psychotic disturbances
phenobarbital
warfarin

Tell your doctor or pharmacist: about all other medicines you are taking, including non-prescription medicines; if you are a frequent user of drinks with caffeine or alcohol; if you smoke; or if you use illegal drugs. These may affect the way your medicine works. Check before stopping or starting any of your medicines.

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From the Ontario Empoblog (Latest OVVA news here)