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Character cannot be developed in ease and quiet, only through experience of trial and suffering can the soul be strengthened, ambition inspired........... and success achieved.  Helen Keller


Low doses of drug used to treat opioid addiction worked without toxic effects, study finds.

August 1, 2008

FRIDAY, Aug. 1 (HealthDay News) -- Methadone, a drug used to break addiction to heroin and other opioid drugs, appears to be a potent killer of leukemia cells, a new study finds.

"Methadone kills sensitive leukemia cells and also breaks treatment resistance, but without any toxic effects on non-leukemic blood cells," study senior author Claudia Friesen, of the Institute of Legal Medicine at the University Ulm in Germany, said in a news release issued by the American Association for Cancer Research. "We find this very exciting, because once conventional treatments have failed a patient, which occurs in old and also in young patients, they have no other options."Related NewsVideo: Health News & Features Join a Discussion More from Health

The findings were published in the Aug. 1 issue of Cancer Research.

Methadone blocks opioid receptors that exist on the surface of some cancer cells. In tests on leukemia cells in laboratory culture, methadone proved as effective as standard chemotherapies and radiation treatments against non-resistant leukemia cells. Methadone also effectively killed leukemia that was resistant to multiple chemotherapies and to radiation.

Unlike some treatments, though, non-leukemic peripheral blood lymphocytes still survived after methadone treatment.

Researchers found methadone activates the mitochondrial pathway within leukemia cells, which switches on enzymes called caspases. These prompt a cell into apoptosis, or programmed cell death. Chemotherapy drugs use the same approach, but methadone activated caspases in sensitive leukemia cells, and also reversed deficient activation of caspases in resistant leukemia cells.

While the doses of methadone used to kill leukemia cells in this study were greater than those used to treat opioid addiction, the researchers have since found a lower daily dose of methadone to achieve the same effect.

While methadone can become addictive, the habit is much easier to break than being hooked on true opioids, Friesen said.

"Addiction shouldn't be an unsolvable problem if methadone is ever used as an anti-cancer therapy," she said.

Studies using methadone in animal models of human leukemia are beginning, Friesen said, and others will look into whether the agent is also effective against other cancers. Another research group has already found methadone induces cell death in human lung cancer cell lines.

More information

The American Cancer Society has more about leukemia.Tags: cancer | chemotherapy | drugs | leukemia | radiation | drug abuse | therapy Print  | Subscribe  | + Share this Story | Yahoo! Buzz| Sphere: Related Content advertisement


Drug War Chronicle    March 21, 2008

Oxycontin, Lorcet and other pain control drugs are the leading cause of the tens of thousands of annual drugs overdoses---why the silence? 

According to a little noticed January report from the Centers for Disease Control (CDC), drug overdoses killed more than 33,000 people in 2005, the last year for which firm data are available. That makes drug overdose the second leading cause of accidental death, behind only motor vehicle accidents (43,667) and ahead of firearms deaths (30,694).

What's more disturbing is that the 2005 figures are only the latest in such a seemingly inexorable increase in overdose deaths that the eras of the 1970s heroin epidemic and the 1980s crack wave pale in comparison. According to the CDC, some 10,000 died of overdoses in 1990; by 1999, that number had hit 20,000; and in the six years between then and 2005, it increased by more than 60%.

"The death toll is equivalent to a hundred 757s crashing and killing everybody on board every year, but this doesn't make the news," said Dan Bigg of the Chicago Recovery Alliance, a harm reduction organization providing needle exchange and other services to drug users. "So many people have died, and we just don't care."

Fortunately, some people care. Harm reductionists like Bigg, some public health officials, and a handful of epidemiologists, including those at the CDC, have been watching the up-trend with increasing concern, and some drug policy reform organizations are devoting some energy to measures that could bring those numbers down.

But as youth sociologist and long-time critic of the drug policy establishment's overweening fascination with teen drug use Mike Males noted back in February, the official and press response to the CDC report has been "utter silence." That's because the wrong people are dying, Males argued: "Erupting drug abuse centered in middle-aged America is killing tens of thousands and hospitalizing hundreds of thousands every year, destroying families and communities, subjecting hundreds of thousands of children to abuse and neglect and packing foster care systems to unmanageable peaks, fostering gun violence among inner-city drug dealers, inciting an epidemic of middle-aged crime and imprisonment costing Americans tens of billions of dollars annually, and now creating a spin-off drug abuse epidemic among teens and young adults.

Yet, because today's drug epidemic is mainly white middle-aged adults -- a powerful population that is "not supposed to abuse drugs" -- the media and officials can't talk about it. The rigid media and official rule: Drugs can ONLY be discussed as crises of youth and minorities."

The numbers are there to back up Males' point. Not only are Americans dying of drug overdoses in numbers never seen before, it is the middle-aged -- not the young -- who are doing most of the dying. And they are not, for the most part, overdosing on heroin or cocaine, but on Oxycontin, Lorcet, and other opioids created for for pain control but often diverted into the lucrative black market created by prohibition.

Back in October, CDC epidemiologist Leonard Paulozzi gave Congress a foretaste of what the January report held. Drug death "rates are currently more than twice what they were during the peak years of crack cocaine mortality in the early 1990s, and four to five times higher than the rates during the year of heroin mortality peak in 1975," he said in testimony before the House Oversight and Investigations Committee.

"Mortality statistics suggest that these deaths are largely due to the misuse and abuse of prescription drugs," Paulozzi continued. "Such statistics are backed up by studies of the records of state medical examiners. Such studies consistently report that a high percentage of people who die of prescription drug overdoses have a history of substance abuse.

But there is more to it than a mere correlation between increases in the prescribing and abuse of opioid pain relievers and a rising death rate, said Dr. Alex Krall, director of the Urban Health Program for RTI International, a large nonprofit health organization. Krall, who has been doing epidemiological research on opioid overdoses for 15 years, said there are a variety of factors at work.

There hasn't been a big increase in heroin use," he said.   "What's changed has been prescription opiate drug use. Oxycontin is probably a big part of the answer.  The pharmaceutical companies have come up with good and highly useful versions of opioids, but they have also been diverted and used in illicit ways in epidemic fashion for the past 15 years."

But Krall also pointed the finger at the resort to mass imprisonment and forced treatment of drug offenders as a contributing factor. "What happens is that people who are opiate users go into prison or jail and they get off the drug, but when they come out and start using again, they use at the same levels as before, and they don't have the same kind of tolerance.  We know that recent release from jail or prison is a big risk factor for over dose," he said.

"The last piece of the puzzle is drug treatment," Krall said. "Besides the tolerance problems for people who have been abstaining in treatment, there has been an increase in the use of methadone and buprenorphine, which is a good thing, but people are managing to overdose on those as well."  There are means of reducing the death toll, said a variety of harm reductionists, and the opioid antagonist naloxone (Narcan) are mentioned by all of them.

Naloxone is a big part of the answer, said the Chicago Recovery Alliance's Bigg. "It's been around for 40 years, it's a pure antidote, and it has no side effects. It consistently reverses overdoses via intramuscular injection; it's very simple to administer. If people have naloxone, it becomes much, much easier to avoid overdose deaths."

"Naloxone should be made available over the counter without a prescription," said Bigg. "In the meantime, every time a physician prescribes opioids, he should also prescribe naloxone."

"For a couple of years now, we've been talking about trying to get naloxone reclassified so it's available over the counter or maybe prescribed by a pharmacist," said Hilary McQuie, Western director for the Harm Reduction Coalition. "The problem is that you don't just need congressional activity, you also need to deal with the FDA process, and it's hard to find anyone in the activist community who understands that process."

Harm reductionists also have to grapple with the changing face of drug overdoses. "We're used to dealing with injection drug users," McQuie admitted, "and nobody really has a good initiative for dealing with prescription drug users. In our lobbying meetings about the federal needle exchange funding ban, we've started to talk about this, specifically about getting naloxone out there."

But while the overdose epidemic weighs heavily on the movement, no one wants to spend money to bring the numbers down. "This is a very big issue, it's very present for harm reduction workers," said McQuie.

"But we haven't done a lot of press on it because there is no funding for over-dose prevention.  We have a very good program in San Francisco to train residential hotel managers and drug users at needle exchanges. It's very cheap; it only cost $70,000, including naloxone. But we can't get funders interested in this. We write grants to do this sort of work around the state, and we never get any money."

Perversely, the Office of National Drug Control Policy also opposes making naloxone widely available -- on the grounds that it is a moral hazard. "First of all, I don't agree with giving an opioid antidote to non-medical professionals. That's No. 1," ONDCP's Deputy Director of Demand Reduction said in January. "I just don't think that's good public health policy."

But even worse, Madras argued that availability of naloxone could encourage drug users to keep using because they would be less afraid of overdoses. And besides, Madras, continued, overdosing may be just what the doctor ordered for drug users. "Sometimes having an overdose, being in an emergency room, having that contact with a health care professional is enough to make a person snap into the reality of the situation and snap into having someone give them services," Madras said.

"The drug czar's office argues that if you take away the potential consequences, in this case, a fatal overdose, you facilitate the use, but betting someone's life on that is just cruel and bizarre," snorted Bigg.

RTI's Kraal noted that there are now 44 naloxone programs run by community groups across the country. "It would be wonderful if there were more of them, because they are staving off a lot of deaths, but they are controversial. The ONDCP says they condone drug use, but you can't rehabilitate a dead drug user."

While battles over naloxone access continue, said Bigg, there are other things that can be done. "We need to engage people, and that means overcoming shame," said Bigg. "Every couple of months, I get a call from a family that has lost a member to drugs and I ask them if they're willing to come forward and talk to reporters to stop it from happening again, and they say 'let me think about it,' and I never hear from them again.

Another means of reducing the death toll would be to start local organizations of people whose friends or family members have died or are still using and at risk. "We could call them 'First Things First,' as in first, let's keep our folks alive," he suggested.

"When people found out naloxone is out there, that it's this medicine that has no ill effects -- it has no effect at all unless you're using opioids -- and that it can't be abused, and that their family member could have had it and still be alive, that's a hard thing to realize," said Bigg. "Everyone who has lost a loved one wants him back, and to think he could still be alive today if there were naloxone is a bitter, bitter pill to swallow."

Despite the apparent low profile of drug policy reform groups, they, too, have been fighting on the overdose front. "We worked to pass groundbreaking overdose prevention bills in California and New Mexico," said Bill Piper, national affairs director for the Drug Policy Alliance. "We're working to advance overdose prevention bills in Maryland and New Jersey. We had a bill in 2006 in Congress that would have created a federal grant program for overdose prevention," he said, pointedly adding that not a single federal dollar goes to overdose prevention. "We've tried to introduce that in the new Congress but can't find someone to take a lead. To be frank, few politicians care about this issue. Their staff care even less."

A massive public education campaign is needed, said Piper, adding that DPA is working on a report on this very topic that should appear in a few weeks.

In the meantime, while politicians and drug war bureaucrats avert their gaze and deep-pocketed potential donors keep their purses tightly closed, while the nation worries about baseball players on steroids and teenagers smoking pot, the bodies pile up like cordwood. 

Reference: Drug War Chronicle   March 21, 2008


State's only public treatment system says 93% of patients aren't using other opiates.

By Diane Knich (Contact)
The Post and Courier            Monday, July 14, 2008

When he tried to quit using OxyContin, heroin and other opiates cold turkey, Ken S. said the pain was so great he felt it in the marrow of his bones.

Ken, 40, who chose not to give his last name so he could remain anonymous, said that about a year ago he landed on the doorstep of the Charleston Center of Charleston County, a drug and alcohol treatment program that runs the state's only public methadone program.

He had been abusing opiates since he chugged a bottle of codeine cough syrup at 10 years old. And he was at the end of a two-year spree of heavy abuse of prescription opiates and heroin that left him in fear of losing his job and his family.

He was so out of control, Ken said, that he physically and verbally abused his wife as his child watched. "My 9-year-old son was scared of me," he said.

Ken was so ashamed of what he'd done that he tried to stop using the drugs, but the withdrawal symptoms were unbearable. He found himself doubled over and vomiting in the shower as nearly scalding water washed over him.

"It was disgusting," he said. He knew then that he desperately needed help.

He remembered hearing that a former girlfriend, who also was an opiate addict, had participated in a methadone program and was successful getting off the drugs.

So, Ken showed up at the Charleston Center. It was his last hope, he said, "the last house on the block."

Ken said he hasn't abused drugs in about a year. And he takes the methadone only as prescribed.

He's rebuilding his life with the help of the methadone program, which includes counseling and regular drug screening. He also is part of a 12-step recovery program. For the first time in many years, Ken said, he can think about doing things to help others instead of simply thinking about himself and planning to get more drugs.

He's aware of the stigma surrounding methadone programs, how they conjure images of homeless junkies injecting themselves with heroin.

Ken is employed, middle class, married and has never used a needle. He thinks the negative stereotype keeps other addicts from seeking the help they need.

Methadone, a long-acting synthetic opiate, has been used to treat heroin and other opiate addicts since the 1960s. Some addicts treated with methadone gradually decrease their dosage until they are drug-free while others stay on it for decades. They don't get high from methadone, and are able to function normally, including holding jobs.

According to the White House Office of National Drug Control Policy, methadone is a rigorously well-tested medication that is safe and efficacious for the treatment of narcotic withdrawal and dependence.

Still, it remains controversial with the public and among some alcohol and drug treatment professionals who believe that only abstinence-based programs are effective.

Dr. Jack Emmel, medical director of the Charleston Center, winces when people ask him whether treating heroin and other opiate addicts with methadone is simply trading one drug for another.

When it comes to opiate addiction, he said, "you'll find no program that has the success rate of a good methadone program."

Addiction to shorter-acting opiates, which include heroin, OxyContin, Lortab and Vicodin, severely alters a person's brain chemistry, he said, while methadone stabilizes it.

Methadone, however, doesn't work quickly. It takes many months, even a year in some cases, for an addict's brain chemistry to return to normal, Emmel said.

Addicts who attempt to stop using opiates too quickly experience severe withdrawal symptoms and are likely to return to abusing the drugs, he said. Ninety percent of such addicts who stop cold turkey, even those whose withdrawal is medically supervised, relapse, he said.

Ed Johnson, program administrator for the center's opiate treatment program, said patients who use methadone fare better.

The center's random drug tests have found that 93 percent of patients who are using methadone aren't using any other opiates. And 65 percent aren't using any other drugs. Those rates indicate that the methadone program is more successful than most drug treatment programs, not just programs for opiate addiction, he said.

Johnson said the stigma surrounding methadone programs has worsened after some recent highly publicized drug overdose deaths involving methadone and other drugs.

Methadone also is used as a painkiller, he said, so it ends up on the street. But most addicts use it only when no other opiates are available. It doesn't give them a good high, but it holds off painful withdrawal symptoms, he said.

Johnson and Emmel said the center's staff thinks gradually decreasing the dosage of methadone and becoming drug-free or staying on the drug long-term are both viable options.

"A person whose methadone dose is adjusted properly is 100 percent functional," Emmel said. And some people can't get off it, just as some people with diabetes can't eliminate the need for insulin by changing their diets and exercising.

The center serves about 250 patients in the methadone program, Johnson said. They are all different ages and come from all walks of life. Fewer than half use needles. Most abuse prescription drugs.

The state has 10 private methadone programs, including one in Charleston.

The Center's program is self-supporting, and patients pay about $13 per day, Johnson said. That includes methadone and counseling. Without counseling, most patients would likely relapse, he said.

Ken says that's true for him. In the year he's been on methadone, he's been "working full-throttle on recovery," he said. He's been decreasing his dosage of methadone over the past several months, and expects to be off of it and completely drug-free by mid-August.

Reach Diane Knich at 937-5491 or dknich@postandcourier.com.

Editor:  Deborah Shrira                                              Dated:   August 2008

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