Methadone Detox


At Florida Detox®, We Specialize in Methadone Detox

Methadone Detox | Methadone Withdrawal | Methadone Addiction

Scientific Addiction Treatment – Methadone Detox

With our scientific addiction treatment, you do not have to be “locked up” in a rehab facility. You will spend 2 hours a day in our clinic receiving our proprietary all natural intravenous amino acid and toxin removal therapy. We will optimize your Brain and Body to stop your craving for methadone.  You will no longer need methadone to calm your anxious brain. Furthermore, you will not go through painful methadone withdrawal symptoms.

Scientific Addiction Treatment – Stops Methadone Craving 

Methadone Detox is only the first step of our addiction treatment.  A Drug Detox is worthless if you relapse. Through treating 7000 addicted patients, we have learned that Detox and Counseling are not enough to prevent relapse – we must optimize your brain function. This requires quickly healing drug-induced brain damage while simultaneously correcting drug-induced deficiencies of brain neurotransmitters and hormones.

Dr. Sponaugle has designed a Brain and Body Wellness Program that uses all natural, intravenous amino acid and toxin removal therapy that can accomplish significant brain healing in weeks.  Our scientific addiction treatment will optimize your brain chemistry and stop your Methadone craving.  You will no longer need Methadone to calm your anxious brain.

Most Experienced

Dr. Rick Sponaugle is the most experienced methadone rapid detox physician in America.  The Florida Detox® team has performed methadone detox on thousands of patients.

Safest Methadone Detox

Dr. Sponaugle and the Florida Detox® team have a 14 year safety record of performing painless methadone detox.  Safety should be you primary concern when choosing a rapid detox center for methadone detox.

Sponaugle Protocol for Methadone Detox

You will undergo a light sedation with intravenous sedatives similar to what you would have in a dental office.  While you are sleeping, we will remove the Methadone from your opiate receptors.  You will undergo Methadone Detox in a safe, comfortable, and caring medical environment staffed by dedicated ICU specialty nurses.

Dr. Sponaugle’s Anti-aging Brain & Body Wellness Program

Our Methadone Detox patients receive 3 weeks of Dr. Sponaugle’s powerful anti-aging program which uses oral and intravenous modalities to quickly restore health stolen from Methadone Addiction.

Methadone Addiction

Methadone addiction greatly reduces blood flow to the brain as seen in the SPECT scan below. Compare the brain of the patient suffering 7 years of methadone addiction to the healthy brain.  The methadone brain suffers from less than half-normal blood flow which are represented visually as “holes” – the methadone brain is deprived of normal blood flow – oxygen and nutrients.

methadone detox program

 

 

 

 

 

 

Brain scientists suggest the number one reason patients develop early Alzheimer’s Disease is reduced blood flow to the brain. SPECT brain imaging as seen on the left measures blood flow in the brain – methadone addiction causes a drastic reduction in brain blood flow.

SPECT brain imaging has proven that methadone addiction is worse than most other drug addiction for causing compromised cerebral blood flow.

SPECT studies at the Amen Clinic and University Medical Centers have proven it takes one year of abstinence from methadone before the methadone addicted brain looks normal on SPECT imaging.

Dr. Rick Sponaugle has proven that his post detox Brain Wellness program can heal the methadone addicted brain, producing a normal SPECT scan in just four weeks versus one year!!

Our brain wellness protocol stops opiate craving!

Compare the two brain scans seen below. The brain on the right belongs to Deborah, a 52 year old business consultant from North Carolina who agreed to go public for an ABC news documentary (watch Debora’s ABC News clip on our media page) . Deborah had suffered 20 years of methadone addiction, not 7 years, as the brain on the left. She also suffered a severe Xanax addiction of 20 mg per day.

Deborah had her SPECT scan at Amen Clinic just six weeks after Dr. Sponaugle performed her methadone detox. During the six week post detox period, we used the Sponaugle Brain Wellness program for restoration and correction of multiple deficiencies and abnormalities caused by methadone addiction (brain chemical, hormonal, vitamin and amino acid).

The Sponaugle Brain Wellness protocol dramatically accelerated the healing process of Deborah’s brain. To learn more about the biochemical mechanisms by which opiate pain medication like Methadone and Oxycontin damage your brain and ultimately causes more physical pain, please visit our NFL/Chronic Pain page.

Methadone Side Effects

How does methadone affect me?

Methadone has many side effects of which unsuspecting patients are unaware:

Methadone can cause sudden death

Recent medical studies have revealed that methadone addiction can cause sudden cardiac arrest. Prior to 2001, federal law did not allow methadone clinics to prescribe methadone doses higher than 100mg/day. Successful lobbying from methadone doctors and businessmen who own methadone clinics changed the law allowing methadone clinics to use their judgment and push methadone doses much higher.

Today many patients with methadone addiction are receiving hundreds of milligrams of “methadone treatment” per day from methadone clinics nationally. Over one third of methadone addicted patients who are prescribed high dose methadone develop QT prolongation on their EKG. This methadone side effect frequently causes a cardiac arrhythmia called “Torsade de Pointes”.

Some methadone patients suffer sudden death which is then automatically assumed to be the patients fault; a drug overdose! “After all they are just another drug addict.” Wrong!! Prejudice against patients with drug addiction has resulted in second class medical care, especially for patients with known methadone addiction. The severe cardiac toxicity is caused by higher methadone doses from methadone maintenance clinics and the recent surge of methadone prescriptions by pain doctors who are fearful of prescribing OxyContin.

Methadone decreases brain blood flow and electricity

Methadone markedly decreases cerebral (brain) blood flow and electricity. These large holes on the SPECT (functional brain scan) demonstrate areas of the methadone addicted patient’s brain that are less than 45% of normal electrical activity. As the brain’s electricity is decreased by the methadone, so is the brain’s overall function.

Because the decrease in cognitive function is gradual and develops over time, patients with methadone addiction do not realize they have lost their competitive edge regarding analytic thinking and I.Q.

Pituitary Suppression

The pituitary gland is the brain’s primary endocrine gland. Its responsibility is to release hormones that “turn on” other vital organs such as the thyroid, adrenal glands, ovaries and testicles.

Methadone treatment, particularly at high doses (above 80mg/day) causes severe depression of the brain’s hypothalamus and pituitary. Katz at Harvard and other doctors have studied and proven that methadone induced pituitary suppression causes methadone addicted patients to suffer from all of the following side effects:

   – Hypothyroidism

More common in females with methadone addiction than in men. Causes depression, chronic fatigue, fibromyalgia, memory loss, weight gain, cold intolerance, dry skin, elevated cholesterol, elevated triglycerides, and metabolic syndrome – which causes increased risk for heart attack and stroke.

   – Estrogen Deficiency

Depression, insomnia, decreased pain tolerance, decreased memory, hot flashes, bladder pain, increased stroke/cardiac risk – which causes increased blood pressure, and increased clotting.

   – Progesterone Deficiency

Through three chemical reactions progesterone converts to a GABA-ergic chemical. GABA is the most relaxing chemical in the brain.

Decreased GABA levels cause the following:

Newfound anxiety disorder
Newfound insomnia disorder
Increased physical pain throughout body
Heavy menstrual bleeding
Painful menstrual bleeding
Increased migraine headache syndrome

   – Testosterone Deficiency

Decreases:

Bone density
Muscle mass (positive nitrogen balance)
Libido
T-cell (fighter cell) activity
Memory recall
Testosterone deficiency in men and women causes significant depression

An increase in testosterone from 300-600 (midrange) in men older than 50 decreases risk of heart attack and death by 40% (2007 Harvard University Study)

   – Adrenal Gland Suppression

Results in deficiency of all your “get up and go” chemicals:

Epinephrine
Norepinephrine
Dopamine
Cortisol How does methadone affect me?

Are Methadone Clinics Drug Dealers?

Methadone Clinics

Are Methadone Clinics Glorified Drug Dealers?

Methadone Maintainence Therapy (MMT) began in the 1960’s, in the United States and remains controversial today. Long half life Methadone is used as a replacement for heroin and other opiate and opioid medications, in MMT, offered at methadone clinics. Many argue methadone clinics reduce crimes caused by heroin addicts and reduce the personal and societal cost of heroin and other opiate addictions. Others argue methadone clinics merely replace one addiction with another. Methadone is the most difficult opioid to detoxify from, due to the extremely long half life.

Methadone tapers seldom work

Very few methadone patients succeed in withdrawing from methadone and remaining opiate free. In a 41 month study of methadone dependent veterans, none of the 30 veterans studied, succeeded in becoming methadone free, without using the opioid medication, buprenorphine. Four patients, 13.3 percent, succeeded in becoming methadone free, using buprenorphine. www.oatc.ca/research/Slow.tapering.from.methadone.maintenance.in.a.program.pdf

Illicit methadone reported easy to obtain

Unfortunately, methadone is abused, as an illegal street drug, by many addicts and has a high black market value. To reduce illegal diversion of deadly methadone to the drug black market, methadone clinics generally require methadone patients to report daily, to the methadone clinic, for witnessed methadone dosing.

The few clues that should have warned me against Methadone Maintenance escaped me then, as I ignorantly believed that hydrocodone addiction was the worst addiction one could have. I should have looked at the fact that people will wait outside the clinic doors in freezing cold weather just to be able to be the first in line at the Methadone clinic’s counter. I should have realized that if they are worried one may actually take the Methadone outside the clinic in their mouths, there must be someone willing to then buy the Methadone that had once been inside that patient’s mouth. It did not occur to me, however, that my measly little pill addiction was not something that would cause that behavior. I would never have bought a pill someone smuggled to me inside their mouth. No way. It did not occur to me that perhaps Methadone was a drug that could cause someone to be that desperate in obtaining more.

That first day, however, nothing anyone could have told me would have ever swayed my support of this ingenious little answer known as Methadone Maintenance. I was on cloud nine, if there ever were such a place. Methadone was it, buddy, and if you didn’t think so, you just had not tried it before. I was higher than I had ever been on any other opiate, and for that matter, on any other drug I had tried up until Methadone. It was the god of highs. It was my answer. And the very next morning, bright and early, I was up and standing in that line, ready to receive that second dose of 30mgs, which I actually did not need because I was still as high as a freaking kite. Upon standing once again at that counter and peering into the window at the seemingly imprisoned nurse, I went through the signing and paying routine, again only $11, and was then asked, “Is 30mgs holding you?” I answered that it was, and she told me that if it does not, I can go up 5 more milligrams. In fact, a Methadone Maintenance patient at that time could go up 5mgs a day until they reached 50mgs. At that point, they could increase another 10mgs a day until they reached 100mgs. And the $11 per day remained the same, no matter what milligram a Methadone Maintenance patient dosed at. These days, the milligram allowed is much higher per day. EMPHASIS ADDED

Jeanne Sparks-Carreker ,Methadone: The Cure for Opiate Addiction? April 11, 2007 Used with permission from the author

Methadone is promoted as an inexpensive opiate medication, which does not cause a buzz or high. If methadone is dosed correctly, despite variations of almost 100 fold, in individual rate of methadone clearance from the body and interactions with dozens of prescribed and unprescribed medications, methadone does not cause a high or buzz. During the first two weeks of methadone medication, patients are 7 times more likely to die, while physicians perform the extremely difficult task of determining the correct dose of methadone. Clinics often overdose methadone patients and many opiate addicts intentionally mislead physicians and clinic staff to obtain the high or buzz from excessive methadone doses.

Some methadone clinics allow “take home” methadone doses, to methadone patients, who have consistently provided “clean” urine samples, without amphetamines, cocaine, morphine, benzodiazepines or barbiturate metabolites or residues. Many methadone clinic patients report selling part of their take home dose, which is provided as a pink liquid.

Illegal diversion of dangerous clinic methadone is not new.
Illegal diversion of methadone prescribed by methadone clinics has been occurring, for over a decade. Unfortunately, regulatory agencies and methadone clinics often fail to respond adequately, to prevent illegal diversion, of potentially deadly methadone.

At a hearing on August 2, 1989, the Select Committee heard from DEA officials regarding a month-long DEA undercover investigation of methadone diversion in the vicinity of methadone treatment programs in the five boroughs of New York City in August 1988, during which agents were able to purchase 98 containers totaling 5.45 grams of methadone, with an average price of about $35 per 80 mg (U.S. Congress, 1989, pp. 150–152; A.L. Carter, DEA, personal communication, April 15, 1994). Agents observed as many as 20 to 25 people selling their methadone at a given location. As a result of this investigation, DEA, in cooperation with FDA and the New York State Bureau of Controlled Substances, inspected five programs near which illegal methadone sales had been observed. The violations found at two of these programs led to the initiation of proceedings to have their DEA registration revoked (the cited problems were later corrected). The results of this action appeared on a nationwide news broadcast and were reported at a hearing of the Select Committee in March 1990 (U.S. Congress, 1990). Thus, methadone diversion remained before members of Congress and the public. EMPHASIS ADDED http://www.nap.edu/openbook.php?record_id=4899&page=98

In March 1992, acting on the basis of an undercover purchase of illicit methadone, DEA ordered a privately owned, for-profit methadone clinic in Houston to show cause why its license to dispense methadone should not be suspended. The clinic was closed and this closure was soon followed by similar orders to close two more clinics—all three owned by the same person. DEA orders to close these three clinics were described in a series of articles by the Houston Chronicle (e.g., “Methadone Clinic Shut in Raid Here,” March 19, 1992, and “2d Methadone Facility Shuts Down,” April 10, 1992), which were distributed over the national wire services and publicized widely. The 1992 DEA investigations were discussed in a 1995 Institute of Medicine report.
A San Francisco methadone clinic was unable to account for 22,069 milligrams of methadone, when inspectors with the state Department of Alcohol and Drug Programs dropped by BAART’s Market Street facility in May 1999. A year and a half later, inspectors returned to find the clinic didn’t know what had happened to 18,088 milligrams of methadone. (Fatal methadone overdoses, have resulted from single methadone doses as low as 20 milligrams.) EMPHASIS ADDED http://www.sfbg.com/37/51/cover_kingpin.html

Creative Living magazine exposed illegal methadone dealing and inadequate regulation of Atlanta area methadone clinics, in a 4/04/01 article, which is available at http://atlanta.creativeloafing.com/gyrobase/Content?oid=oid%3A4156 Creative Living reported all of the following, in the 2001 article, by MARA SHALHOUP.

Clinics regularly give methadone to patients who haven’t proved an addiction, increase dosages without a physician’s approval and provide take-home doses even to patients who were caught selling previous take-home doses on the street.

Some of metro Atlanta’s 10 methadone clinics have gone up to four years without state inspections, and some have faced no penalties or follow-up visits despite reports of multiple violations of state and federal regulations. One was skewered in a 1995 inspection report citing “serious violations,” but the state didn’t get around to visiting again until last year.

“It’s an open-air drug market in those clinics,” says Bill Reeves, a former heroin addict who spent three years in a methadone treatment program. “They’re worse than dope dealers. The way it’s dispensed is wrong.”

At GPA Treatment Center in Doraville, a patient caught selling methadone was allowed eight take-home doses the next month. Counselors, not physicians, had been writing medication orders for four years, according to a 1995 inspection report. For three days, the pharmacy door was left open. “The program’s accountability for methadone was very poor,” the DHR noted.

At the end of that inspection, the DHR listed more than a dozen violations and eight recommendations for improvement. Hester wrote: “It should be noted that all of the above recommendations concern serious violations of applicable rules and regulations.” The letter urged the clinic to “take all steps necessary to come into compliance with all applicable state and federal rules and regulations.”

That letter was sent shortly after the 1995 inspection. The DHR did not check on the clinic again until November 2000.

“You walk in with $10 and a picture ID, and you’re high for two days,” Reeves says of opportunistic patients he knows at one Atlanta-area clinic. “You take a drug test, but it doesn’t come back for a week. It takes 30 minutes to get dosed. I didn’t even see a doctor.”

Patients interviewed by CL claim they can easily work the system to get more methadone. State rules say clinics can start a patient on a maximum dose of 30 milligrams and can increase the dosage until signs of withdrawal disappear.
EMPHASIS ADDED

Although authorities have been aware of patients illegally reselling methadone obtained from clinics, many methadone clinics fail to adequately supervise patients today. An August, 2007 undercover video, filmed at the Parkville methadone clinic, in West Philadelphia, revealed suspicious activity, indicating drug dealing was apparently occuring immediately outside the methadone clinic building. When the methadone clinic learned NBC 10 was filming outside the clinic, security was increased and the suspicious activity ceased. A former addict reported, going to Parkville was a disaster for her. “They sell drugs right out front of the place. It’s kind of hard when you’re first trying to get clean to walk out of the place and they’re selling drugs right there in your face, mostly pills. They sell their methadone bottles, you know, their take-home bottles,” the former addict said. EMPHASIS ADDEDhttp://www.nbc10.com/news/13868849/detail.html

Illegal diversion of clinic methadone also occurs in Australia, where almost a third of injection drug users reported using illicit methadone syrup, in the preceeding six months. Illicit methadone was reported easy or very easy to obtain, by injection drug users.

Many methadone clinics are closed on Sunday and allow all patients a “take home” dose, Saturday, to prevent methadone withdrawal, on Sunday. Reporting to the methadone clinic daily for a methadone dose, is costly, inconvenient and prevents some methadone patients from obtaining employment. In May, 2007, a Pensylvania methadone clinic patient was arrested for selling clinic methadone to undercover officers, three times. Fortunately the Discovery House, where he was treated, opened all of their methadone clinics, on Sundays and ceased providing take home doses, on Saturday, to reduce illegal sales of liquid clinic methadone. http://www.phillyburbs.com/pb-dyn/news/113-08282007-1398732.html http://www.phpbbplanet.com/methadonedeath/viewtopic.php?t=289&highlight=parkside+clinic+west+philadelphia&mforum=methadonedeath

Most methadone clinics are open from approximately 0500 AM, till about 1200 AM. Strangely, few methadone clinics are open in the evening, when daily methadone dosing might interfere less with employment, education and childcare. While liquid clinic methadone is a source of dangerous illegal methadone, methadone tablets or diskettes, prescribed to outpatient pain patients, by nonclinic physicians may be contributing even more heavily to the methadone overdose epidemic.

Methadone Clinics Can Be Profitable

Methadone Clinics can be Very Profitable

Initially, most methadone clinics were operated by nonprofit organizations, frequently hospitals and  local or state governments.  Increasingly, private, for-profit businesses earn high profits operating methadone clinics.  Reported methadone clinic profits range from 16 to 50 percent of revenues.  CRC Health, the nation’s largest provider of methadone maintainence therapy, treats over 20,000 methadone patients daily, and reported daily profits per Methadone patient of $10.91 to $11.07.

EITC, in Indiana, charges $11.50 per dose, cash only. When Townsend, a methadone authority in Kentucky, visited, the EITC center was collecting $16,100 a day for methadone, seven days a week. In Ohio, clinics pay $46 for 1,000 milligrams. “Do the math — that’s a big-time for-profit methadone program,” Townsend said.

A  Feb-21-2007 Mergerline listing of a New Mexico methadone clinic for sale advertises, At least half of the Revenues are Profit, with revenues of $1,200,000. The advertisement states, “ look at the profits – better than a bar!” Apparently Medicare and Medicaid patients are also profitable, since the advertisement states the clinic serves 480+ patients, with 280 patients on a cash basis, and 200 Federal or state funded. Three counselors  carry 95 % of the patient load, which means each counselor has a caseload of 152 methadone patients!  The advertisement explains, There are three owners, two are nurses and  involved with clinical services. The entire advertisement can be read at http://www.mergernetwork.com/businesses-for-sale/105585-Methadone-Rehabilitation-Medical-Clinic.htm

A January 04, 2004  article, by Laurence Hammack, in the Roanoke Times, reveals National Specialty Clinics projected a  Virginia methadone clinic, would earn profits of 16 percent, after taxes. Projected revenues were $492,580, for the first year, with first year profit estimated at $127,026 and after tax profits of $80,027. The entire article is at http://www.roanoke.com/roatimes/news/story160675.html

Merger Network listed two methadone clinics for sale in the Midwest, on August 8, 2007.  Profits reported were $400,000, on sales of $2,500,000, a profit of 16 percent.  The listing is viewable at, http://www.mergernetwork.com/businesses-for-sale/124800-Methadone-Clinics-for-Sale.htm

Many believe highly profitable for- profit methadone clinics create an unjustifiable conflict of interest, since they profit, from reducing counseling and medical treatment, while maintaining methadone dependency.  Numerous methadone patients complain methadone clinics do not provide adequate methadone detoxification, to methadone addicted patients wishing to decrease or eliminate their  methadone dependence.  Other methadone patients complain they were not provided adequate informed consent concerning methadone toxicity or side effects.  Some methadone clinic patients state methadone clinics failed to inform them that methadone is highly addictive and methadone withdrawal symptoms are severe.

A very frequent complaint, by methadone clinic patients, is the inadequacy of counseling and medical care, provided by methadone clinics.  Low pay, inadequate staffing levels, inadequately trained and experienced methadone counseling and medical staff, and high methadone clinic staff turnover impair patient care at many methadone clinics.  Inside the Methadone Clinic Industry: The Financial Exploitation of America’s Opiate Addicts, by Lisa Berry, , MCDC, CSAC describes her experiences working at four different methadone clinics.  One of the methadone clinics where she worked, suffered a 400 percent staff turnover, in one year!

Methadone Overdose Epidemic

Most Methadone Overdoses Accidental

Emergency department and mortality data provided by the Drug Abuse Warning Network (DAWN) and reporting from law enforcement agencies indicate that methadone abuse is increasing. In addition, state-level public health agency data reveal increasing methadone abuse.

According to DAWN, the number of emergency department mentions for methadone increased overall from 3,832 in 1997 to 10,725 in 2001. Moreover, DAWN reports that 65 percent of methadone-related emergency department episodes also involved other drugs or alcohol in 2001. In that year alcohol was the substance most frequently used in combination with methadone, followed by cocaine and heroin.
DAWN mortality data for 2001 show that in most methadone-related deaths the drug was used in combination with other substances; however, those substances were not identified. Nevertheless, the data show that methadone ranked among the top 10 drugs mentioned in drug-related deaths in 24 of 33 DAWN reporting cities including Baltimore, Chicago, Detroit, Newark, and Phoenix.

According to the National Drug Intelligence Center National Drug Threat Survey 2003–a statistically representative nationwide survey of state and local law enforcement agencies–nearly 33 percent of all state and local law enforcement agencies indicate that methadone was commonly diverted or illicitly abused in their areas. Survey data further show that a higher percentage of agencies (42.7%) in southeastern states reported methadone abuse.

According to the Florida Department of Law Enforcement and the Florida Office of Drug Control, increased methadone abuse in Florida has resulted in an increase in overdose deaths involving the drug. The 2002 Report of Drugs Identified in Deceased Persons by Florida Medical Examiners indicates that methadone was found in 556 of the 5,816 decedents whose deaths were drug-related. Of these, methadone was determined to have contributed to the cause of death of 308 decedents. Furthermore, the number of drug-related deaths involving methadone increased 56 percent from 357 in 2001 to 556 in 2002, more than any other drug included in the report.

In North Carolina the number of single-drug deaths involving methadone–where methadone was determined to cause the death but was not necessarily the only drug found in the decedent–increased overall from 7 in 1997 to 58 in 2001. For all methadone-related deaths from 1997 to 2001, the source of the methadone was identified in 46 percent (92 deaths) of the medical examiner’s reports. Of these deaths, 73 decedents were found to have a prescription for methadone that had been written for them by a physician; 11 had methadone from a prescription that had been written for another person; 3 were known to have obtained their methadone illegally, and 5 were reported as having a combination of prescription methadone and methadone obtained illegally.

Methadone abuse also is a problem in other parts of the United States. Medical examiner data from Maine indicate that methadone increasingly is involved in overdose deaths. According to the report Maine Drug-Related Mortality Patterns: 1997-2002, methadone was the prescription drug most commonly identified in toxicology reports. The report shows that the number of cases in which methadone was listed as the cause of death or as a contributing factor fluctuated but increased overall from 4 in 1997 to 14 in 2001. In the first 6 months of 2002, 18 deaths were reported in which methadone was a cause of death or contributing factor. The report further indicates that in 2001 fewer than half of decedents whose deaths were caused by methadone or in which methadone was a contributing factor had a documented prescription for the drug. Most of them had not been enrolled in a methadone maintenance program. In 2001 an analysis of 14 cases in which methadone was a cause of death or contributing factor statewide indicated that only three individuals had been receiving treatment from a methadone maintenance clinic.

METHADONE DEATHS INCREASING

Sunday, 04/01/07

Prescription-drug deaths soar in state
Medicine fatalities rival murder numbers

By MELVIN CLAXTON
and BRAD SCHRADE
Staff Writers

Prescription-drug misuse is a quickly growing, silent epidemic that claims the lives of hundreds of Tennesseans each year.

Prescription drugs now outstrip illegal narcotics — such as cocaine, methamphetamine and heroin — as a cause of death across the state, a Tennessean review of the state’s medical examiner’s records show.

Deaths from prescription drugs now roughly equal murders in the state. Officially, there were just 31 fewer prescription-drug deaths than murders in 2005, the most recent year for which statistics are available.

The troubling figures illustrate far-reaching problems in the pharmaceutical trade where mistakes, missteps or criminal behavior by doctors, pharmacists, patients, or regulatory agencies can result in death.

The victims range from a newborn baby, whose death was blamed on the mother’s methadone use, to an 82-year-old woman who overdosed on a combination of prescription and over-the-counter drugs. The collateral damage is often the children, spouses and other relatives left behind.

A prime example is Jerry Dillingham. He is still trying to come to grips with the death of his 16-year-old daughter, who accidentally overdosed on painkillers 17 months ago in Donelson.

“This stuff is killing people,” Dillingham said. “It’s killed my daughter.”

Nowhere is the problem more acute than in Davidson County , where prescription drugs were linked to the deaths of at least 67 people in 2005. Statewide, there were 401 such deaths.

The numbers are constantly climbing.

From 2002 to 2005, at least 1,240 Tennessee deaths were linked to prescription drugs. During those four years, the number of prescription-related deaths jumped 62 percent.

The numbers are probably really even higher. The medical examiner only tracks drug deaths when an autopsy is performed, which is not always the case in some counties across Tennessee .

“Prescription-drug abuse and accidental overdose is clearly a huge and escalating problem,” said State Medical Examiner Bruce Levy. “The cases are coming from all across the state.” The deaths, says Levy, “are only the tip of the iceberg.”

“Medical examiners only see cases where people are dying,” Levy said. “But most people who repeatedly abuse prescription drugs don’t die. Many live with the devastating consequences of their abuse.”

Tennessee’s experience is part of a larger national trend. A recently released report by the Substance and Mental Health Services Administration showed that the number of emergency room visits nationwide for prescription-drug overdose — 598,542 in 2005 — has almost caught up with those for illicit drugs.

Levy said his office has been sounding the alarm for years, but the issue has remained below the public’s radar. The rising death toll, coupled with Tennessee ’s identification as the state with the highest per capita prescription-drug use in the nation, adds a sense of urgency to the problem.

But there is little in the public records to indicate that federal, state and local agencies charged with monitoring the prescription-drug industry have had much success on this new front in the war on drugs.

Painkillers hit streets

While deaths from illegal narcotics such as cocaine and heroin have grabbed the headlines and are often dramatized in television shows and movies, it is powerful prescription painkillers such as methadone, oxycodone and hydrocodone that play a greater role in overdose deaths in Tennessee , autopsy records show.

Methadone, once primarily used to help heroin addicts kick the habit, has proved especially deadly. Now often prescribed for chronic pain, methadone has become a popular street drug linked to 231 deaths statewide from 2002 to 2005.

Dillingham’s 16-year-old daughter, Bridgette, died of a methadone overdose on Oct. 6, 2005. He keeps her ashes in a cream-colored urn on an end table in his West Nashville home.

Dillingham said Bridgette, who died in her sleep, had been partying the day before with friends and took a lethal dose of methadone.

The medical examiner “said she went into such a deep sleep she forgot to breathe,” Dillingham said.

Like Bridgette, many of the them had no legitimate prescriptions for the drugs that killed them. But they were likely to have had little trouble obtaining the drugs from friends and relatives or on the streets, say law-enforcement officials and others.

Doctors willing to write repeated prescriptions for powerful painkillers and other narcotics, and pharmacists and pharmacy technicians willing to skirt the law by selling drugs without the required prescriptions, have also helped ensure a steady supply of drugs for abusers.

“You get a different answer on how prescription drugs are diverted based on who you speak to,” said James Inciardi, director of the Center for Drug and Alcohol Studies at the University of Delaware in Coral Gables, Fla. “We have seen that people obtain these drugs from a range of sources.” The sources Inciardi and colleagues have identified include: “Physicians and pharmacists; parents and relatives; leftover supplies following an illness or injury; personal visits to Mexico, South America and the Caribbean; prescriptions intended for the treatment of mental illness; direct sales on the street and in nightclubs; pharmacy and hospital theft; through friends or acquaintances; under-the-door apartment fliers advertising telephone numbers to call; and ’stealing from grandma’s medicine cabinet.’ ”

It wasn’t supposed to be this way.

Under federal and state law, legal drugs deemed too potent, too addictive or too easily abused can only be obtained by prescription. Doctors sign the prescriptions and licensed pharmacists — whose records are subject to scrutiny by state and federal regulators — dispense the drugs.

But with black market prices significantly higher than standard retail prices, there is tremendous financial incentive for the illegal sale of prescription drugs. From January 2005 to Feb. 21 this year, police in Nashville investigated 408 drug cases — 114 involved prescription drugs.

Ten of the prescription-drug investigations involved a doctor, pharmacist or pharmacy technician, said Capt. Todd Henry, head of the Metro Police Department’s special investigations division. He said eight of the cases resulted in people being charged and the other two were dropped.

The most recent case involved Brooks Pharmacy in south Nashville , where tens of thousands of pills were missing. Five people were arrested in that case, including Williamson County Sheriff Ricky Headley.

The number of known cases may understate the extent of the problem.

The pharmacy board, charged with regulating pharmacies and their employees, has just five investigators for the state’s roughly 2,000 pharmacies, 8,000 pharmacists and 10,000 technicians. The board, by its own admission, rarely identifies pharmacists who break the law and is heavily dependent on the public and law enforcement to ferret out wrongdoing.

Most ODs accidental

More than half of Tennessee drug deaths resulted from a toxic combination of two or more prescription drugs — typically powerful painkillers, tranquilizers or stimulants. In addition, prescription drugs were increasingly mixed with illegal narcotics to create more deadly narcotic cocktails.

The majority of prescription deaths were from accidental overdoses; less than 11 percent were suicides. As deaths mount, so does the circle of people affected.

Not every death was from the intentional misuse of prescription drugs. Some resulted from toxic interactions between prescribed drugs that were legally taken for genuine illnesses. There are no statistics on how many deaths fall into this category.

Experts say the key to preventing such deaths is education.

“A number of people have different doctors for different conditions,” said medical examiner Levy, whose office is a depository for drug-death reports from other medical examiners across the state. “The key is to tell your doctors every prescribed or over-the-counter medication you are on. I can’t overstate the importance of this because there are some drugs that should never be taken together.”

For many, legitimate prescriptions have led to fatal addictions.

When nurse Victoria Olivier severely damaged two vertebrae in her back while helping a patient, a doctor prescribed mild painkillers, according to Olivier’s parents, Harry and Marian Sir of Brentwood . They say the drugs didn’t work.

The prescriptions were increased in number and dosage, but the pain never seemed to go away. At the same time, Olivier’s addiction to painkillers and muscle relaxants increased dramatically. It was a devil’s choice: Suffer in severe pain or take the addictive drugs that would eventually wreck her life.

The Sirs watched the drugs transform their daughter from a productive, independent adult into a dependent child, who moved back home and could not support herself or even cook a meal. Harry Sir said he couldn’t believe some of the drugs prescribed to his daughter.

“When I saw methadone, I said, ‘You might as well be giving her heroin,’ ” he said.

In May 2004, Olivier fatally overdosed on methadone, the antidepressant citalopram and two other potent prescription drugs. She was 42.

The Sirs blame a medical system that they say did little to prevent their daughter’s addiction or help her kick the problem once she became hooked.

And like so many survivors, they second-guess how they responded to their daughter’s addiction. Harry Sir wishes he had sought a court order to have his daughter forced into a treatment program — a dramatic step that might have saved her life.

“We should have taken more decisive action as soon as we saw a problem,” he said. “Like everyone else, we thought it would get better.”

Some distraught relatives have sought to fight back by trying to identify the source of the prescription drugs that killed their loved ones. They have not always succeeded.

Jerry Dillingham said that when he gave police the name and phone number of the person he believes sold his daughter Bridgette a fatal dose of methadone on the street, he got sympathy from the detective but little else.

“He said he was sorry for my loss,” Dillingham said. “He said, ‘You need to take a deep breath and when you leave this office you need to let it go.’ ”

Cases such as Olivier’s and Dillingham’s highlight the human cost of the escalating prescription-drug problem in Tennessee . It is a problem for which many — including doctors, pharmacists, patients and regulators — share the blame.

The federal Drug Enforcement Administration, charged with enforcing the nation’s drug laws, beefed up the staff of its unit that combats the illegal sale of prescription drugs in Tennessee . DEA officials, who won’t say how many investigators or agents are in the unit, say that the staff was increased by a third within the past year and a half.

But DEA officials and other law-enforcement agencies readily admit that combating prescription drugs poses unique challenges.

“One of the major problems with investigating prescription-drug cases is the commingling of legal and illegal activity,” said Assistant Special Agent Harry Sommers, head of the DEA’s Nashville district office. “The pharmacist who might be selling drugs without prescriptions is also selling drugs legally. This makes it harder to discern illegal activity.”

http://www.dicksonherald.com/apps/pbcs.dll/article?AID=/20070401/NEWS03/704010405/1297/MTCN02

Methadone Cardiotoxicity

Methadone Cardiotoxicity

Methadone Cardiac Deaths Exceeded Respiratory Deaths

Mechanisms of Opioid Associated Death and the Apparent Cardiotoxity of Methadone at Low Dosages — An Examination of a Series of 18 Cases

Frank B. Fisher, M.D.

ABSTRACT
A series of 18 opioid associated deaths around which pain treating physicians were accused of murder, manslaughter, and wrongful death was analyzed with the purpose of evaluating the diagnostic accuracy with which medical examiners determined causes of death. Diagnostic accuracy was poor because apparent cardiac mechanisms were regularly overlooked. Unexpectedly, the data suggested a causal relationship between therapeutic Methadone use and sudden cardiac death. This resulted in the recognition that multiple lines of evidence exist in the literature supporting a causal relationship between Methadone and sudden cardiac death, and the ongoing epidemic of Methadone associated deaths. EMPHASIS ADDED

HYPOTHESES
(1) Deaths occurring among patients suffering from chronic pain and attributed by medical examiners to opioid overdoses may in fact often result from other causes, particularly sudden cardiac death. (2) Methadone may be cardiotoxic, especially during the initial phase of treatment, and this may contribute substantially to the ongoing epidemic of Methadone related deaths among chronic pain sufferers treated with this medication.

OVERVIEW
Chronic pain has recently been identified as a disease in and of itself.  When it remains under treated, it produces or amplifies risk factors for cardiovascular disease. These include physical inactivity, and stress. Associated hormonal and inflammatory factors are recognized to play a role in the pathogenesis of cardiovascular disease caused by chronic pain.ii

The recent phenomenon of homicide accusations against pain treating physicians offers a unique opportunity to examine the subject of opioid associated death,iii and Methadone related deaths in particular. This opportunity exists because the government typically spends millions of dollars in the process of investigating and prosecuting individual pain treating physicians. As a result, a wealth of information surrounding each death becomes available for analysis.

Accused physicians are compelled to hire experts to examine this data to an extent unlikely to occur outside the context of adversarial proceedings. Such analysis was performed in all of the cases in this series of deaths.

MATERIALS & METHODS
Materials Examined
Data for analysis were extracted from the following sources.

1. Autopsy reports.
2. Toxicology reports.
3. Medical records.
4. Investigative reports containing statements by witnesses, as well as descriptions of death scenes by police, and by investigators associated with the offices of medical examiners.
5. Trial and deposition transcripts.

Selection Criteria
Cases meeting the following criteria were selected for analysis. A physician was accused of killing a patient through his prescription of opioid analgesics. Criminal accusations included murder and manslaughter charges. Malpractice accusations included wrongful death.

The one case in which a medical examiner attributed death entirely to cardiac causes met the selection criteria for inclusion in this series because it was an opioid associated death in which the physician was sued for wrongful death. The theory concocted by the plaintiff’s attorney was that treatment with opioids caused the patient to become addicted and consequently neglect his cardiac risk factors.

RESULTS
Respiratory vs. Cardiac Mechanisms of Death
Eight different medical examiners offered opinions concerning the deaths in this series of 18 cases. In 17 of the cases medical examiners attributed death to drug overdose.

In 2 deaths, a single medical examiner attributed death to cardiac mechanisms. In one of these, law enforcement prevailed upon him to attribute the patient’s cardiac death to an imagined toxic effect of his pain medications.

Opioid Levels Were Within Therapeutic Ranges

With only two exceptions, postmortem opioid levels fell within published therapeutic ranges for live patients suffering from chronic pain.iv v Analysis of circumstances surrounding these deaths excluded respiratory depression as a mechanism in each. EMPHASIS ADDED

One of the two exceptions was the death caused by massive trauma. The blood level of oxycodone of 21,900 ng/ml was drawn from the abdominal cavity after the heart had ruptured. The medical examiner testified that the patient would have died momentarily of a drug overdose, if a motor vehicle crash hadn’t intervened.vi

In the other exception with a postmortem Methadone level of 13,800 ng/ml the suddenness with which death occurred precluded opioid overdose. The patient had dropped off a prescription at his pharmacy minutes earlier and did not appear to be sedated. The elevated level of Methadone measured in his blood was most likely an error occurring in the laboratory, or in the transcription process.

Cardiac Deaths

11 of the 14 decedents were autopsied. Significant cardiac pathology was discovered in 10 of these 11. Autopsy findings included evidence of cardiac enlargement in the form of elevated cardiac weight and increased thickness of ventricular walls, acute inflammation of the epicardium, stenosis of the coronary arteries, perivascular fibrosis of the myocardium, and diffuse myocyte hypertrophy. EMPHASIS ADDED

In 7 of the 11 autopsied cases, cardiac enlargement based on a weight of greater than 350 grams was found. Analysis of evidence indicated that 14 of the 18 deaths in the series were cardiac in nature. EMPHASIS ADDED

Non Cardiac & Respiratory Mechanisms of Death
Four of the 18 deaths in this series can reasonably be attributed to other than cardiac mechanisms.

One of these 4 was the previously mentioned trauma death.

Another was a death resulting from alcohol poisoning and aspiration of vomitus. Evidence of the possibility of foul play was present in the form of ligature marks on all four extremities. The medical examiner ignored this finding.

Evidence supported respiratory depression as the mechanism of death in two of the four non-cardiac deaths. In both suicides were likely on the basis of psychological autopsy.

Substances Potentially Precipitating Arrhythmia

In 7 of 14 cases where sudden cardiac death was likely, substances known to precipitate cardiac arrhythmia were determined through toxicological analysis to be present. The most common of these substances was cocaine, which was present in 5 of the 14. An excessive level of Reglan was present in the blood of one of the decedents. An excessive level of paroxetine was present in another.

Diagnostic Criteria Employed by Medical Examiners

In the majority of the cases reviewed, the presence in postmortem blood of an opioid at a concentration known to have been associated with any other deaths attributed to opioids was sufficient to provoke medical examiners to attribute death to overdose.

Pulmonary edema, which is an expected finding in deaths resulting from respiratory depression, as well as other mechanisms including cardiac death, was routinely regarded by medical examiners as evidence confirming that death was caused by overdose and consequent respiratory depression.

The Issue of Postmortem Redistribution of Opioids

Opioid levels were routinely accepted by medical examiners at face value. The phenomenon of postmortem redistribution of opioids was seldom considered. Even when defense attorneys brought it up medical examiners typically discounted it as insignificant.

Failure to Autopsy

Autopsies were performed on a total of 15 of the 18 decedents. In the 3 cases where autopsies weren’t performed, 2 different medical examiners each based their determinations that death was caused by opioids on postmortem blood levels alone.

Determining Tolerance

While medical examiners were usually aware that the decedent had been a chronic pain sufferer, no attempts were made to determine what sort of tolerance to opioid analgesics the decedent might have carried. Medical examiners routinely failed to review medical records and other documents, which contained evidence supporting the existence of opioid tolerance.

Circumstances Determined Through Police Investigation

In many cases, accounts of events surrounding the death were available in the form of police reports. These contained information such as when the decedent was last seen alive, details about timing and dosage of medications, and histories of alcohol and illicit substance abuse. Medical examiners routinely disregarded, or failed even to make themselves aware of this information.

Cardiac Risk Factors

Many decedents carried an array of cardiac risk factors. Some, such as obesity, should have been apparent at autopsy. Others, such as smoking, hypertension, or a previous myocardial infarction would have been apparent upon review of medical records, but medical examiners routinely failed to do this.

Methadone Associated Deaths

Seven of the 14 probable cardiac deaths were associated with Methadone. Medical examiners attributed all of these to drug overdose and consequent respiratory depression.

In 5 of these 7 cases, the timing of events surrounding these deaths excluded respiratory depression as a possibility. In the other two, there was compelling evidence that the deaths were most likely due to cardiac mechanisms as well. These issues are discussed in detail in the final section of this paper addressing a causal link between therapeutic Methadone use and sudden cardiac death.

6 of the 7 deaths occurred within 10 days of starting Methadone. In 3 cases, death occurred within 48 hours. EMPHASIS ADDED

In 6 of the 7 Methadone associated cases, decedents carried multiple cardiac risk factors and autopsies revealed significant cardiac pathology.

Clusters, A Widespread Phenomenon
5 of the 6 accused physicians in the series were accused of causing between 2 and 5 patient deaths. The physicians who were accused of killing their pain patients practiced in 6 different states.

Tables
Data and observations about mechanism of death are summarized in the accompanying tables.

DISCUSSION OF MEDICAL EXAMINERS’ ERRORS, OMISSIONS, AND MISCONCEPTIONS

Problems with opinions and testimony offered by experts against physicians accused of misprescribing opioid analgesics are abundant.vii The conduct of medical examiners in the cases in this series fit this pattern.

Confusing Association with Causation, and Failure to Engage in the Process of Differential Diagnosis

The 8 medical examiners in this series routinely committed the classic error of confusing association with causation. They focused their attention on how opioids killed the decedent, rather than whether these medications were accountable.

The process of differential diagnosis is an essential element of medical thought. Its implementation is universally understood to be necessary in order to arrive at rational diagnostic conclusions. When opioids were found in the postmortem blood of patients whom a physician was suspected of killing, this process was abandoned.

Problems Associated with Thinking About the Role of Opioid Analgesics in Associated Deaths

Among the medical examiners contributing to this series, ignorance about opioid physiology and opioid pharmacology was abundant. As a result, their diagnostic framework for thinking about opioid associated deaths proved inadequate for the task in the majority of the cases reviewed.

Ignorance of the Phenomenon of Tolerance

Tolerance to opioid analgesics develops through ongoing exposure to these substances. It is also conferred by the presence of pain, which stimulates respiratory drive.viii This phenomenon accounts for the vast range of therapeutic levels of opioid analgesics known to exist for chronic pain patients.

By definition, the phenomenon of tolerance mitigates powerfully against the occurrence of respiratory depression in opioid tolerant individuals. Medical examiners were for the most part ignorant of the implications of this crucial aspect of opioid physiology.

Inappropriate Reliance on Postmortem Opioid Levels In order to achieve therapeutic goals in the treatment of opioid tolerant chronic pain sufferers, blood levels that would kill naïve individuals are often necessary. The phenomenon of tolerance allows these patients to consume dosages of opioids that would kill individuals not possessed of a tolerance.

For this reason the forensic pathology literature is replete with cautions that causality in opioid associated deaths cannot be determined through the measurement of postmortem levels alone.ix This however is exactly what most of the medical examiners in this series did.

Ignorance of Postmortem Redistribution

The phrase, postmortem redistribution, describes a process through which opioid levels in heart blood may change after death. This occurs when there was a difference between opioid levels in the blood and those in surrounding tissues of the myocardium and lungs. As a result of this process, opioid levels measured in postmortem heart blood may be as much as 4X as high as the as they were when the patient was alive. EMPHASIS ADDED

Medical examiners typically failed to reckon with this possibility. A consequence was that in a number of cases they based their theories about how death occurred on dramatically elevated blood levels of opioid analgesics that didn’t exist while the decedent was still alive.

Ignorance of the Physiology of Opioid Overdose

Testimony by the medical examiner in the above described trauma death, that the patient involved would have been dead within minutes anyway if the motor vehicle accident hadn’t interceded, reveals an astonishing ignorance of the manner in which death occurs in opioid overdose. Sedation is followed by somnolence, in a progressive manner, and finally gradual slowing of respirations occurs.viii

In contrast, the patient in question had been alert and shopping for furniture just minutes before the accident. These circumstances left no time for her to have passed through the expected stages. In other words, the mechanism of death proposed by the medical examiner was physiologically impossible.

Misinterpreting the Presence of Pulmonary Edema
When pressure relationships within the lungs are altered by cardiac or pulmonary events, fluid accumulates in the alveoli. When the dying process is protracted, more fluid accumulates. This produces higher post mortem lung weights.

Normal combined postmortem lung weights fall in the range from 700-800 grams. Weights of >1,700 grams occur when respiratory depression occurs gradually over a period of hours. Lung weights in deaths occurring through the mechanism of lethal ventricular arrhythmia fall into an intermediate range. Medical examiners routinely failed to consider lung weights as data useful in determining mechanism of death. Having concluded that a postmortem opioid level fell within the range that they believed was potentially lethal, they would simply point to the presence of pulmonary edema as if this confirmed their presumptive diagnosis of opioid overdose. Any elevation in lung weight would satisfy in this pursuit.

Only one combined lung weight in this series actually exceeded 1,700 grams. This death was likely the result of respiratory depression.

Deficient Autopsy Procedures, A Failure to Procure Important Evidence
Determining that a lethal ventricular arrhythmia may have caused an opioid associated death is impeded by the fact that ventricular arrhythmia doesn’t leave a distinct anatomical signature on which a medical examiner can rely. Only an EKG tracing documenting the event can do this. However, in 95% of deaths where the mechanism of death is cardiac, careful autopsy will disclose anatomical evidence to support this determination.x

In all decedents in this series, postmortem examinations of heart tissues were perfunctory. Thorough examinations of these hearts would have included intensive sectioning of the coronary arteries, detailed examination of the valves, and an examination of the conduction systems. The routine failure of medical examiners to seek this information in cases where their colleagues are accused of homicide is inexcusable.

Disregarding Important Evidence

When cardiovascular pathology such as atherosclerosis was revealed at autopsy, medical examiners invented ways to discount it. One referred to the finding of atherosclerosis as “normal” for age. Atherosclerosis is immutable evidence of cardiovascular disease. It is only normal in the sense that it is common.

Other positive findings were simply ignored. Notable among these were elevated heart weights indicative of significant ventricular hypertrophy, which is a risk factor for lethal arrhythmia,

Ignorance of Cardiac Medicine

When defense attorneys raised the concept of sudden cardiac death, medical examiners typically resisted this possibility. One testified that the decedent wasn’t known to suffer from cardiac disease. This contention reveals a startling ignorance of general medicine, as it is widely known among physicians that sudden death is the commonest presenting symptom of cardiovascular disease. xi

Ignorance of Benzodiazepine Tolerance

Chronic pain patients are often treated with benzodiazepines in combination with opioid analgesics. This is necessary because anxiety and insomnia are highly prevalent in this population as symptoms of the underlying disease. Additionally, benzodiazepines are neuromodulators. As such, they likely exert the beneficial effect of controlling neuropathic pain, which is ubiquitous in chronic pain syndromes.

Knowing that benzodiazepines can contribute to respiratory depression in opioid naïve individuals, medical examiners typically implicate them as contributing to presumed opioid induced respiratory depression and death. This approach ignores the (1) fact that with repeated exposure tolerance to benzodiazepines develops, just as it does with opioids.xii, and (2) respiration is not depressed in opioid tolerant patients to begin with.

Ignorance of the Pharmacology of Methadone

When a drug is administered repeatedly, it takes approximately 5 half lives for it to reach steady state blood levels. In the case of methadone, this process requires several days. During this time, Methadone levels rise to progressively higher peaks with each successive dose. This phenomenon, often referred to as “stacking up”, was repeatedly invoked by medical examiners in support of their presumption that patients died of overdoses.

However, medical examiners invoked this concept indiscriminately, failing to grasp that after Methadone levels peak, some 3-4 hours following administration, levels then fall until the time that the next dose is taken. While the level is falling, the patient will not experience respiratory depression if this didn’t occur at the time the level peaked. As a result of ignorance of this fact, medical examiners consistently committed the error of attributing death to overdoses occurring many hours after Methadone levels had already peaked.

The Apparent Role of Bias in Cases Involving Accusations Against Physicians
The diagnostic accuracy of the medical examiners examined in this series was abominable. Review of published series of opioid associated deaths, including those that will be cited later in this article, indicates that in cases where pain treating physicians aren’t accused, medical examiners attributed deaths to a variety of mechanisms.

By implication, the most likely explanation for why medical examiners in this series performed so badly is bias, introduced by the nature of the cases themselves. All of the medical examiners involved knew at the time they offered their opinions that the physician involved had been accused of wrongdoing.

DISCUSSION OF FACTORS THAT RULED OUT RESPIRATORY DEPRESSION AS A MECHANISM OF DEATH IN DECEDENTS IN THIS SERIES

Analysis of factors surrounding the Methadone associated deaths in this series excluded respiratory depression as the mechanism in 5 of the 7, and found it unlikely in the other 2. The following considerations operated during analysis:

- When death is known to have been sudden, this by definition excluded the mechanism of opioid induced respiratory depression, as these deaths are understood to occur gradually over a time span of hours.

- Combined postmortem lung weights found in this series in the range of 1,500 grams or less are inconsistent with gradual respiratory depression. These are intermediate lung weights that favor sudden cardiac death as a mechanism.

- Human physiology and opioid pharmacology don’t allow for the attribution of death to respiratory depression, under circumstances when death occurs long after opioid levels and corresponding physiologic effects have long since peaked.

- None of the Methadone using patients in this series were opioid naïve.

After a process of exclusion, ventricular arrhythmia remains as the most likely mechanism of death. This raises the specter of a previously unrecognized causal relationship between Methadone and lethal cardiac arrhythmia.

EVIDENCE SUPPORTING A CAUSAL RELATIONSHIP BETWEEN METHADONE AND LETHAL VENTRICULAR ARRHYTHMIA
A number of existing lines evidence converge to support a causal relationship between Methadone and lethal ventricular arrhythmia.

The Initiation of Methadone Treatment is Dangerous
The risk of sudden death is dramatically increased during the initiation of Methadone treatment. It may be as much as 7-fold higher than that of addicts remaining outside Methadone programs.viii

Dosages & Blood Levels in Methadone Associated Deaths
Patients have been noted to succumb to dosages of Methadone understood to be too low to provoke respiratory depression. Deaths have been noted at as little as 20 mg/day.xiii

Blood levels of Methadone lower than the expected lethal range are noted to occur in deaths attributed to Methadone. On this basis, a paper describing a series of Methadone associated deaths in Hennepin County, Minnesota, concluded that “no definable lethal level” for the medication could be established.xiv A similar series from Palm Beach County, Florida, concluded on the basis of deaths occurring at levels below the previously reported range that it may be impossible to define a lethal range for Methadone.xv  EMPHASIS ADDED

This data suggests that there may be no safe dosage of Methadone in patients initiating the use this substance.

Timing of Methadone Associated Deaths
A recent review of deaths occurring early in treatment with Methadone cited 5 studies in which deaths occurred many hours after the last dose of the medication had been ingested.xiii This occurred in a number of the deaths analyzed in present series as well.

A Potential Cardiac Mechanism
There exists electrocardiographic evidence associating Methadone with prolongation of QT intervals, even at low dosages.xvi It remains to be determined if this troubling observation has any bearing on the apparent phenomenon of sudden cardiac death associated with Methadone, occurring at low dosages and early in treatment.

DISCUSSION OF THE SCOPE AND NATURE OF THE EPIDEMIC OF METHADONE RELATED DEATHS
Methadone became widely prescribed in the treatment of chronic pain during the years between 1999 and 2004. This occurred as a result of law enforcement driven media hysteria over Oxycontin, making Methadone the pain medication of first choice for many pain treating physicians, who perceived this medication as posing less risk to themselves.

As a result, America now finds itself in the midst of an epidemic of Methadone associated deaths. Data from National Center for Health Statistics includes the following: xvii

- Nationwide, Methadone associated deaths increased 389.7% between 1999 and 2004. During this same time period, all poisoning deaths increased by only 54%.
EMPHASIS ADDED

Methadone associated deaths increased from 4% to 13% of the total of all poisoning deaths  EMPHASIS ADDED

- The statistics concerning Methadone associated deaths determined to be unintentional are even more dramatic. Between 1999 and 2004, more than 90% of Methadone related deaths were classified in this manner. There were 3,202 such deaths nationwide in 2004. This represents a 414% increase between 1999 and 2004.

- In some states, the increase in Methadone associated deaths observed between 1999-2004 was much larger than the nationwide average. The statistics include 2,500% in Virginia , 1,500% in Kentucky , 1,400% in Florida and Oregon , and 700% in North Carolina and Texas . This data is meaningful on the basis of sample size. In each state listed above, at least 50 of these deaths occurred during at least 3 of the six years that information was collected. What Population is at Risk?

It is widely believed that Methadone related deaths occur primarily among drug addicts. Evidence gathered in North Carolina refutes this supposition. xviii

- From 1997 to 2001 there were 198 deaths attributed by medical examiners primarily to Methadone. The number of such deaths increased from 12 in 1997 to 80 in 2001, a 666% increase.

- During this time period, there was a 400% increase in Methadone sold to pharmacies and hospitals. Retailing to addiction treatment programs increased by a factor of 2.6.

- In 75% of the 198 cases, medical examiners concluded that Methadone was the only drug that significantly contributed to death.

- Methadone associated deaths in pain patients outnumbered those of patients in addiction treatment by a factor of at least 9:1. This is apparent because a total of 8 (4%) decedents were enrolled in an addiction program at the time of their deaths, while at least 73 (37.5%) were determined to have been receiving Methadone through a prescription that could only have been intended for the treatment of pain.  EMPHASIS ADDED

The above data establishes that in North Carolina , Methadone is far more dangerous to patients treated for pain than it is to the population in which it is intended for the treatment of addiction. In fact, the disparity in risk between these two groups may be substantially larger than the data suggests, as many of the patients in addiction treatment programs are in reality chronic pain sufferers.

Often, pain patients, desperate to obtain relief unavailable from their intimidated physicians, pose as addicts and lie their way into addiction programs.xix In this manner pain sufferers, predisposed to sudden cardiac death through their underlying pain disease, are regularly forced to endure the additional risk of death that accompanies Methadone treatment.

The fact that 75% of the 198 Methadone associated deaths in North Carolina were attributed by medical examiners essentially to Methadone alone supports the hypothesis that Methadone is cardiotoxic. The following facts concerning pain treatment and opioid analgesics are worthy of consideration:

- When opioid associated death occurs through the mechanism of respiratory depression, it is commonplace for multiple drugs to be implicated as contributing to the overdose. With Methadone, one finds the opposite.

- Pain sufferers possess tolerance to opioid analgesics, which protects them against respiratory depression. This tolerance develops on the following bases:
(1) The presence of pain confers tolerance by stimulating breathing. (2) Ongoing use of opioid analgesics produces tolerance through continuing exposure of brain receptors, which become inured to the presence of these medications.

Consequently, if overdose causing respiratory depression were the underlying mechanism producing the current epidemic of Methadone associated deaths, pain sufferers should be the group most likely to survive. Instead, this group represent the lion’s share of the body count.

CONCLUSIONS

The Cardiotoxicity of Methadone
Compelling evidence indicates that Methadone provokes sudden cardiac death. This danger is so pronounced that it emerged in the form of clusters of deaths occurring within individual medical practices that contributed to this series of 18 opioid associated deaths. This apparent threat to public health demands that Methadone be immediately repositioned within the hierarchy of treatment choices both for chronic pain, and for addiction. An adjustment in the risk benefit analysis is required.   EMPHASIS ADDED

The recognized causal relationship between chronic pain and cardiac disease may render this group of patients particularly vulnerable to lethal ventricular arrhythmia triggered by Methadone. This circumstance is likely the basis of the almost 10:1 disparity in Methadone associated deaths observed between pain patients and addiction patients in North Carolina .

The Field of Forensic Pathology

The field of forensic pathology is in profound disarray around the subject of opioid associated death. Members of the discipline are ignorant of fundamental physiological and pharmacological principles at the interface between opioid analgesics and the management of chronic pain. As a result, they are bereft of the tools that would allow them to arrive at rational conclusions when determining causation in opioid associated deaths.

The apparent causal relationship between Methadone and sudden cardiac death urgently demands further investigation. This endeavor will likely be hampered by a dearth of accurate information concerning causes of death in opioid associated cases, as the results of this investigation raise troubling questions concerning the ability of the field of forensic pathology to produce meaningful data in this area.

Implications for Pain Treating Physicians

When a physician is accused of misprescribing opioid analgesics, the diagnostic performance of medical examiners further deteriorates. Medical examiners’ only apparent function within this context is to rubber stamp the accusations of prosecuting attorneys. As a consequence, if a patient dies and a prosecutor decides to file criminal charges, it is all too likely that the local county medical examiner will eagerly testify against his pain treating colleague. The risk that a pain patient will die during treatment is amplified by the selection of Methadone.

Implications for Patients

Assuming that Methadone is cardiotoxic, many of the thousands of associated deaths that occur each year among pain patients represent an ongoing and preventable public disaster. Preventable because there is no evidence to suggest that the increased prescribing of other opioid analgesics has resulted in anything resembling an epidemic of deaths among pain patients. Shameful because pain treating physicians have been bullied by zealous government drug warriors, and by their counterparts in the field of addictionology, into switching suffering patients from relatively safe analgesics such as oxycodone, to this deadly drug.

The Chilling Effect Exerted by Law Enforcement Drives the Epidemic

It is unlikely that chance accounts for the dramatic increases in Methadone associated deaths encountered in the particular states that registered 700% or greater increases in Methadone associated deaths between 1999 and 2004. In all of these states, brutal repression of pain treatment by law enforcement manifested itself in the form of high profile prosecutions of pain treating physicians.

- In Virginia , where an astonishing 2,500% increase in Methadone associated deaths occurred, law enforcement continues to conduct its highest profile persecution of a pain treating physician. This culminated in the 2004 witch trial and judicial lynching of Dr. William Hurwitz.

- In Kentucky , numerous pain treating physicians have been persecuted and imprisoned. At the same time, a prescription monitoring program, KASPER, was highly touted by law enforcement as serving public health interests.

- In Florida , Drs. Deonarine and Luyao were both accused of multiple murders, among other crimes. While the murder charges failed to stick, both physicians are serving very long prison terms. Also in Florida , Dr. James Graves is serving a prison term of 63 years because the government took exception to his treatment of chronic pain.

- In Oregon , the state medical board has relentlessly hounded Dr. Martin Klos.

- In North Carolina , Dr. Joe Talley was run out of practice by his state medical board. While never indicted Dr. Talley has been threatened with criminal prosecution for over 5 years.

- In Texas , following a media blowout around his arrest, Dr. Daniel Maynard continues to face criminal prosecution on multiple counts of manslaughter Physicians are well known to be averse to risk, and only a fool would suggest that these high profile politically motivated prosecutions don’t chill prescribing behavior, to the detriment of millions of patients.

Distorting Medical Decision Making Through Errors in Social Policy

The history of the 20th Century reminds us that when the executive branch of government has seized control of the physician/patient relationship, some of the worst things that happened during the 20th Century occurred. The ongoing epidemic of Methadone deaths among pain patients serves as an example of such a phenomenon. A social agenda, prohibition in the guise of the war on some drugs, has dangerously distorted medical decision making. The unforeseen and unintended consequences are horrific.

END NOTES:
iArgoff CE. Managing Neuropathic Pain: New Approaches for Today’s Clinical Practice. Medscape. Available at: http://www.medscape.com/viewarticle/453496_1

iiTennant F. Identification and Management of Cardiac-Adrenal-Pain Syndrome. Practical Pain Management. September 2006. P. 12-21.

iiiLibby R. Treating Doctors as Drug Dealers, The DEA’s War on Prescription painkillers. Policy Analysis, CATO Institute. 2005;545:1-26. Available at: http://www.cato.org/pubs/pas/pa545.pdf

ivJung BF, Reidenberg MM. Interpretation of opioid levels: comparison of levels during chronic pain therapy to levels from forensic autopsies. Clin Pharmacol Ther. 2005 Apr;77(4):324-34

vTennant F. Tennant Blood Study, Summary Report, Opioid Blood Levels in High Done, Chronic Pain Patients. Practical Pain Management. March 2006. 28-29

viState of California vs. Dr. Frank Fisher. Transcript of preliminary hearing. 1999. Available @ PRN Web site. http://www.painreliefnetwork.org/

viiFisher F. How Expert Testimony Distorts the Standard of Care. Practical Pain Management 2005; 5:33-41.

viiiBrookoff D. Chronic Pain: Part 2. The Case for Opioids. Hospital Practice. 2000

ixKarch SB, Stevens BG. Toxicology and pathology of deaths related to methadone: retrospective review. West J Med. 2000 Jan;172(1):15-6. xChugh SS et al. Sudden Cardiac Death With Apparently Normal Heart. Circulation. 2000;102:649. Available at: http://circ.ahajournals.org/cgi/content/abstract/102/6/649

xiZipes DP, Wellens HJJ. Sudden Cardiac Death. Circulation. 1998;98:2334-2351. Available at: http://circ.ahajournals.org/cgi/content/full/98/21/2334

xiiShader RI, Greenblatt DJ. Use of Benzodiazepines in Anxiety Disorders. NEJM. 1993;328:1398-1405.

xiiiProceedings of Expert Workshop on the Induction and Stabilisation of Patients Onto Methadone. January 28th and 29th 1999. Adelaide , South Australia . Available at: http://www.
health.gov.au/internet/wcms/publishing.nsf/Content/
87AFC56E26122571CA2570370007714F/$File/mono39.pdf

xivGagajewski A, Apple FS. Methadone-related deaths in Hennepin County , Minnesota : 1992-2002. J Forensic Sci. 2003 May;48(3):668-71.

xvWolf BC, Lavezzi WA , Sullivan LM, Flannagan LM. Methadone-related deaths in Palm Beach County . J Forensic Sci. 2004 Mar;49(2):375-8.

xviLeavitt SB, Krantz MD. Cardiac Considerations During MMT (Methadone Maintenance Treatment). Addiction Treatment Forum. October 2003. Available at: http://66.102.7.104/search?q=cache:gobcBLV77ZMJ:
www.atforum.com/SiteRoot/pages/addiction_resources/CardiacPaper.
pdf+Cardiac+Considerations+During+MMT&hl=en&gl=us&ct=clnk&cd=1

xviiFingerhut LA. Increases In Methadone-Related Deaths: 1999-2004. National Center For Health Statistics.

xviiiBallesteros MF et al. Increase in Deaths Due to Methadone in North Carolina . JAMA. Vol. 290 No. 1, July 2, 2003

xixJoranson DE. Is Methadone Maintenance the Last Resort for Some Chronic Pain Patients? American Pain Society Bulletin. 1997;7(5)1,4-5.

About the Author

Dr. Fisher is a Harvard-trained general practitioner who has dedicated his career to caring for medically underserved populations. His appropriate treatment of patients suffering from chronic pain resulted in his 1999 arrest and prosecution on charges of multiple murders, drug dealing, fraud, and conspiracy. Following his exoneration, he has served as an expert witness in numerous cases brought against other similarly accused physicians.

Other Publications

Pain Killer. Harvard Medical Alumni Bulletin. Winter 2006;32-37.

How Expert Testimony Distorts The Standard Of Care For Pain Management With Opioid Analgesics Practical Pain Management. September/October 2005.

Evaluating The Risks Of Unwarranted Prosecution Part I: The Criminalization Of Pain Management. The Journal of American Physicians and Surgeons. Fall 2004.

The Role Of Controlled-Release Opioids In The Treatment Of Chronic Pain, The Journal of American Physicians and Surgeons. Summer 2004.

Interpretation of “Aberrant” Drug-Related Behaviors. The Journal of American Physicians and Surgeons. Spring 2004

Contact Info:
Phone: 510-233-3490
E-mail: frankbfisher@sbcglobal.net

Medication Interactions

Avoiding Deadly Methadone-Medication Interactions

Methadone interactions with other prescription and non prescription medications, cigarettes and even grapefruit juice, can increase or decrease methadone clearance, from the body.  Many medications commonly prescribed to methadone patients, including benzodiazepines (Xanax, Klonopin, Valium, Ativan, Serax, Restoril), tricyclic and selective serotonin reuptake inhibitor antidepressants, neuroleptics, antibiotics, antifungals, retrovirals, ribavirin and some cardiac drugs can have adverse reactions with methadone, often increasing or decreasing clearance rate of methadone.  Medications decreasing methadone clearance rate can produce fatal methadone overdoses. Nicotine cigarettes also decrease methadone clearance.

Opiate addicts frequently abuse medications decreasing methadone clearance, to obtain a longer or more intense “high,” or “buzz.”   Drugs increasing methadone level are most likely to cause a methadone overdose death.  Drugs or medications interacting with methadone are listed at http://pain-topics.org/pdf/Methadone-Drug_Intx_2006.pdf.

Medications decreasing methadone level can cause methadone withdrawal which is seldom fatal, but nausea and seizures can occur during methadone withdrawal.  Many physicians prescribing methadone do not appear to adequately consider methadone interactions, with other medications. Tragically, fatal overdoses due to methadone interactions with medications continue to occur.

I used to know so little about Methadone. I had read some of the major websites on the internet, which try to portray Methadone as safe and effective. What I didn’t know was the extreme danger and lethal side effect of this dangerous medication.  With so little knowledge, my son and I decided for Matthew to enter a Methadone Maintenance Treatment program after relapsing on pain-killers for about a week; he had been drug-free for over six months.  Matt had started getting his life back together, enrolled back in college, started going to church, and had goals and dreams for his life.  He started the Methadone Clinic on the early morning of Monday, August 7th.  Matthew started exhibiting adverse reactions to the Methadone treatment within the first day, some of these were normal, some were far from normal. There were other legal prescriptions Matt was taking prior to MMT that the Dr said would be ok; they should NOT have been mixed with methadone (xanax, anti-depressant), plus other rx (promethazine) and OTC med (Benadryl) that the clinic said would be ok.  Matt experienced multiple adverse reactions (problems swallowing, trouble urinating, severe rash, hallucinations, hyper, could not sleep, + more and more) which increased each day. He called the clinic and was told, these reactions were normal.  On the 2nd day, Matthew became more miserable with his side effects and again called the clinic, and again told everything was normal.  On Wednesday, Day 3, when he complained Matt was told his body would “adjust”.   On Thursday, Day 4, Matthew was supposed to have a follow-up appointment with the doctor, but the appointment never took place.  When the nurses went to dose Matt at 45 mg, he begged them to reduce the dose; however, they could not do so without doctor’s orders.  On Friday, Day 5, Matt went and picked up his college books for the fall semester and went by the clinic for his 50 mg dose.  I never had much of a chance to ask him if he discussed his symptoms again (by this time he could not swallow his own saliva unless he was drinking something to force it down).  I spoke with my sweet baby son around 10am and he was very lethargic; I thought he was tired from not sleeping.  We laughed and I told him to take a nap and call me back at work when he woke up.   He never called…..
When I came home from work that Friday afternoon, I found my son sitting in the floor of our hallway, with his body slumped over.  I thought he had just collapsed, but I was not that fortunate.  When I laid his body down, purple splotches (livor mortis) contrasted against stark white covered his handsome face.  I called 911 and while waiting, started to do CPR, hoping I could breathe some of my life back into him.  Rigor mortis had set in and I could not manipulate his mouth or jaw to try to start CPR.  His skin was cold as ice.  It is estimated that he had been dead about 5-6 hours.   When Matt’s toxicology report came back he only had Methadone and his prescribed medications the doctor had approved in his system. The clinic has never accepted any responsibility or been held accountable in any way for my son’s death.
So, PLEASE alert anyone you know who is contemplating Methadone for treatment, for pain or for a high to stay away from this lethal drug.  It is unpredictable with a long half-life (up to as long as 72-96 hours) that most people don’t understand.  There is no safe way to dispense or control Methadone and its results are FATAL, with no warning signs before death occurs. There are no do-overs, no going back and choosing a different form of treatment.  My son is gone, forever.  My hope now is that the public becomes educated about this fatal drug
MY SON – MATTHEW
What a waste for my son Matthew’s life to end so needlessly at the young age of 20 because of an approved drug so dangerous and because of negligence on the part of the clinic and doctor.  Matthew blessed us when he was born on January 10, 1986 and continued blessing us for 20 years.  We watched him grow from a curly-haired, cute little boy into a handsome young man.  Matthew always had a smile on his face from the time he was little.  His smile and sense of humor were uplifting and contagious.  He had a compassionate heart and would give his last penny or the shirt off his back if someone asked.  He never knew a stranger anywhere he went; he would strike up conversation with anyone and as his personality shined through, he would have anyone talking, laughing or giggling within minutues.  Matthew was also very sensitive and emotional, and wore his emotions on his sleeve.  He was also very vulnerable and opened himself to hurt and pain, because he lived without shields or barriers to his heart.  Matthew was one of the most loving, compassionate people I have ever met; he was sweet and kind, loving and trusting.  Matt was also known by anyone that had ever met him for his loving hugs.  He hugged people when he met them, he hugged them when he left, and he held and hugged many friends through difficult times.  As I was getting ready to leave for work on the day Matt passed away, he cupped his hands around my face and told me I was beautiful, and how much he loved me and then gave me a huge hug (I wasn’t going on a trip, just to work for 8 hrs).  How many 20 yr old young men do that with their mothers?  It is the last memory I have of Matthew and I together and it is very, very special.  We did not part with regrets or anger, only mutual professions of love between mother and son.

http://www.matthew-fielder.memory-of.com/

Xanax, Klonopin, Ativan, Valium, Serax, Librium and other benzodiazepine tranquilizer medications can increase blood methadone levels, since the liver detoxifies benzodiazepine tranquilizers, using the same Cytochrome P450 3A4 pathway, which is involved in initial breakdown of methadone.

Benzodiazepines almost never produce death, due to respiratory depression, but when combined with methadone or other opiates, they impair metabolism or breakdown of opiates and increase risk of death, due to opiate overdose. Sadly methadone deaths are skyrocketing, with increased prescriptions for chronic pain, by physicians who do not fully understand how deadly methadone can be.

This abstract discusses three fatal methadone overdoses, caused when normally safe, nonfatal methadone doses were combined with Alprazolam (Xanax).

J Forensic Sci. 1997 Jan;42(1):155-6 Detection of alprazolam in three cases of methadone/benzodiazepine overdose.Rogers WO, Hall MA, Brissie RM, Robinson CA.
University of Alabama at Birmingham 35294, USA.

Benzodiazepine abuse is common among clients at methadone maintenance clinics. Diazepam and lorazepam are readily detected by immunological screening methods and confirmed by GC/MS. Alprazolam has been relatively difficult to confirm. We recently reported a modification of an existing serum HPLC procedure which allows us to analyze whole blood. We report here three cases of fatal drug overdose caused by co-ingestion of methadone and alprazolam. In all three cases, alprazolam was detected by HPLC and could not be identified by alkaline extraction GC/MS. Postmortem blood concentrations of methadone were at the lower range or below the concentrations previously identified in methadone overdose fatalities, suggesting an increased risk from co-ingestion of methadone and alprazolam.

Xanax levels are more difficult to measure, than Valium or Ativan. Methadone fatalities have increased alarmingly, in the last few years, when methadone prescriptions increased. Although medical literature has reported that benzodiazepine medications can increase methadone serum level, some physicians, methadone clinics and methadone patients apparently are unaware of the increased fatal overdose risk, when benzodiazepines medications are combined with methadone.

Requiring physicians to obtain an additional certification to prescribe methadone,might be necessary, since there are accounts of fatal methadone overdoses, where prescribing physicians did not appear to be aware of the methadone overdose risk.

Since Xanax combined with methadone, appears especially risky, compared to Valium and other longer half life benzodiazepines, it appears advisable to avoid prescribing Xanax, with methadone, if possible.

This abstract also explains that the commonly used urine and blood drug tests do not detect Xanax levels and additional specialized tests are required to accurately measure Xanax levels. Unlike Xanax, Valium (diazepam) levels are detectable by the routinely used drug screen tests. The following journal abstract indicates that alprazolam (Xanax), which is one of the most deadly benzodiazepines when overdosed, seldom causes death by itself, but increases deadliness of methadone, other opiates or cocaine. Benzodiazepines appear to cause more deaths, due to accidents resulting from over- sedation, than from toxicity or respiratory arrest. In this study, Alprazolam deaths caused by trauma were 22 times more common, than deaths caused by Alprazolam toxicity.

Am J Forensic Med Pathol. 2005 Mar;26(1):24-7.
Alprazolam-related deaths in Palm Beach County.
• Wolf BC,
• Lavezzi WA,
• Sullivan LM,
• Middleberg RA,
• Flannagan LM.
Office of the Medical Examiner, Palm Beach County, West Palm Beach, Florida, USA. bwolf@leegov.com

Alprazolam is a commonly prescribed benzodiazepine. The abuse of benzodiazepines is most frequently seen in conjunction with the abuse of other drugs. Only rare fatalities have been attributed to alprazolam alone. We undertook a retrospective review of cases investigated by the Palm Beach County Medical Examiner’s Office in which postmortem toxicologic studies indicated the presence of alprazolam, to further study the pattern of alprazolam abuse. Our review consisted of 178 cases, including 87 in which death was attributed to combined drug toxicity, 2 to alprazolam toxicity alone, 44 to trauma, 12 to natural causes, and 33 to another drug or drugs. Cocaine and methadone were the most common cointoxicants in the cases of combined drug toxicity, while heroin was less frequently detected. There was considerable overlap in the postmortem blood alprazolam concentrations among the groups. The overlapping ranges of concentrations of alprazolam detected indicate that it may be difficult to define a lethal alprazolam range, and that it may not be possible to determine the actual role of alprazolam as a causal factor in cases of combined drug toxicity. This study confirms that alprazolam alone is rarely a cause of death, and that alprazolam abuse usually occurs within a polydrug use pattern. The high incidence of cocaine as a cointoxicant has not been previously reported. EMPHASIS ADDED

Methadone Detox Testimonials

Bill, Destin FL March 2002 - methadone
Previously Addicted to: methadone

I have had five back surgeries over the last ten years and had learned how to mask the pain with all kinds of opiates. For the last seven months I had been on physician prescribed methadone. I had no idea what it was doing to me. My physician here in Destin, Florida told me that I needed two weeks in-house detox treatment since I did not want to take methadone anymore. Needless to say, I was devastated.

The Bible teaches me that if I will only seek, I will find. Having found much information on the Internet about Rapid Opiate Detox, I chose to pursue Florida Detox. One of the best decisions I have ever made. Dr. Sponaugle and his entire staff treated me with such respect and dignity. All went way beyond the necessary. It seemed as if I was in a ZERO DEFECT environment. As for the procedure, it was like a four day resting vacation.

I truly believe God sent me to Florida Detox to get my life back. It worked!!! I have such a motivation to keep it that way. As I see it, mind controlling drugs are a bondage used to prevent us from having a joy filled life. Jesus did not die on the cross for me or you to live our life in handcuffs The freedom I feel is awesome!!! I urge you, if you are being controlled by opiates, please give Florida Detox a call and they will help you make the first step to freedom.

Bill
Destin, FL March 2002

Tommy - methadone
Previously Addicted to: methadone

 Dear Dr. Sponaugle,

How do I begin to tell you how grateful I am to you? Tommy is doing so much better since his hospitalization. Of course, he still has a way to go, but you have put him on the right path to good health. He always felt like a loser while he was going to the Methadone Clinic. You have helped to give him back his self-esteem. For this I thank you with all my heart. Rick, you’ve given us both a new lease on life. I believe firmly that God led us to you. You are truly a blessing! By the way, the day we left to come home, you prayed that Angels would help us. They did in the form of a lovely young woman who helped us in our struggle to get home.

John, Tarpon Springs - Methadone
Previously Addicted to: Methadone

 Dear Mr. Kiefer:

With great conviction, I would like to take a few minutes of your time to share with you a life changing event in my life, that will impress upon you the invaluable presence of a physician and his company that you are privileged to be associated with and the many lives that are being changed and set free from a bondage that is not only physical, but mental as well.

In 1992 while driving with my son, I was broadsided by a drunk driver that had no insurance. My vehicle was totaled, but I was blessed by my son escaping serious injury. I wasn’t as fortunate as this accident initiated the beginning of my back problems. During this time, I had been running and participating in triathlons with my friend Dr. ****** and did not want to stop. With therapy and pain medication, I held up for 2 years. In 1994, I had my first back surgery at Helen Ellis performed by Dr. Sweeney. In 1995 after continual problems, I went to Shands in Gainesville to have more problems with my back discovered. Dr. McMillian put me thru a procedure and then intense rehabilitation. I continued to push my recovery so that I could run and keep up with my 60-70 hour workweeks, being the General Manger of an automobile dealership. I started going to a pain clinic in Spring Hill, FL near my place of business and the physician prescribed methadone to me. Initially I was alarmed, but he assured me it was a very effective medication. Well, it did work very well. No side effects and I was able to continue my hectic pace.

After close to 2 years on the medication, it started to bother me that I was still taking it. Thru much prayer and spiritually seeking God’s will, I immediately decided to discontinue the medication. I attempted traditional detoxification from the methadone, however, the withdrawal symptoms were too strong. Crushed both mentally and physically, I was at an impass.

Fate would have it that my mother was admitted to Helen Ellis for a heart condition. I ran into Dr. Sponaugle and inquired about the anesthesia technique for getting off of pain killers. God had answered my prayers. We scheduled the procedure and I must say that a great weight lifted from my shoulders. Your staff and Dr. Sponaugle were kind and professional. I was admitted on a Tuesday and discharged on Wednesday with normal withdrawal symptoms left over.

A few days after my discharge, I was readmitted to Helen Ellis as I had begun to experience severe burning in my upper stomach. Dr. Sponaugle and Dr. Durai felt I should see a gastroenterologist. They found a large tumor in my esophagus just above the stomach. Apparently the pain medicine (methadone) had been masking the pain. Since the particular cancer I had is difficult to detect and extremely malignant, I would have never known until it was too late. I believe with my entire being that God spared my life through Dr. Sponaugle. If it were not for your detox program, I would not be here today to tell you how grateful I am. As a local businessman who grew up in Tarpon Springs, I want to congratulate you on the great strides Helen Ellis has made over the last decade.

John
Tarpon Springs, FL

Anastasia, Gainesville, FL - Methadone
Previously Addicted to: Methadone

 I am writing this letter to offer you my warmest thanks for the services which you provided to a member of my family who had been addicted to Methadone for several years . As you know, he elected to have the rapid detoxification procedure which you administered to him about one month ago. The procedure which took a few hours and involved a few days of hospitalization was a Godsend.

The family member who went through the procedure was desperate because of the pain that he had caused himself and other family members and because of the large amount of money that was being used to support his addiction. He had searched in many places trying to find a treatment source that he could handle and manage within his current life style. As fate would have it, we got on the Internet one night and your page regarding the detoxification procedure appeared without any input on our part. We can only assume that God was looking over us and sent us to you.

There is no question as to your professional expertise as evidenced by documentation of your training, degrees, board certification, and numerous affiliations with notable medical associations. But, only the people who have met you can attest to your generosity, your empathy, your unconditional concern, and the amount of caring that you provided. You are unselfish with the time that you give your patients and their families. At a time, when most physicians can provide only a few minutes of consultation, your lengthy individual attention to our needs involving several hours at a time was magnanimous.

Technically, Rapid Detoxification appears to work; but, what is most important and what contributes heavily to its success is your presence with all your warmth, confidence, and motivation to do all for your patients. You really believe in them and it is very obvious that you do. Thank God that you are lighting one light in the utter despair and darkness of substance abuse treatment.

Very sincerely and with warm regards,
Anastasia
Gainesville, FL
September 21, 2000

Deborah, Lockport, LA - Methadone
Previously Addicted to: Methadone

 Dear Dr. Sponaugle and Rose,

I’m sorry it’s taken so long for me to write. Since we’ve last seen you we’ve had a lot to deal with at home. I am happy to say that John is now living in his own apartment and has been drug free for three months. John is a chef at a restaurant in Gonzales, LA and publishing some of his recipes for the owner of the business. We will be certain to send both of you some copies.

Dr. Sponaugle, please feel free to use me as a reference for the Neuraad program. I have spoken to a few mothers that I have met these last few months. As you know John was addicted to Methadone and other opioid drugs. At the time we sought your help, I was not aware of the intensity of John’s addiction, but with your help John was able to take that first step to recovery. I will gladly testify that your medical program is the best method and gift a parent can give their addicted child. There is no doubt that the medical procedure works. The strongest part of your program is your faith in our HIGHER POWER. Through you John was able to hang on to the wisdoms and strengths you passed on to him. Addicts tend to think God doesn’t love them and they turn away from their Savior. You and Rose continued to share your faith with John and I weeks after we had left. I will always feel very comfortable calling either one of you for guidance and a prayer when in need. To who ever reads this letter please know that you can trust your life or your child’s life in Dr. Sponaugle’s and Rose’s hands. They share their lives with you at the time of the procedure and continue to care about you forever. Seven months ago I listened to my heart and I put my son’s life in the hands of God sent individuals and I have never regretted my decision. My son needed extra help, but it was the Neuraad Group that gave him the chance to survive.

There are really not enough words or praises available to express my gratitude. To Dr. Sponaugle, Kim, and Rose, thank you and you will forever be in my prayers.

Sincerely Yours,
Deborah
Lockport, Louisiana, April 2000

Debi, Bradenton, FL - Methadone
Previously Addicted to: Methadone

 I find myself on unfamiliar ground. I want to make this the most prolific thing that I have ever written. Yet, all that I can do is tell my story and pray that it touches just one soul.

About five years ago, I was diagnosed with an eye disease. I received many different drugs to treat this affliction. One of them was morphine. I was on 180 mg a day. This drug was necessary for me to take for the eye pain for about a 2 _ year time period. Time and time again, I was assured, by the pain clinic doctor that I would be weaned slowly down from this powerful narcotic when the time was right.

Yet, when the disease I had been suffering from went into remission, I was told to go to a Methdone Clinic. All I knew of methadone was that it was some sort of drug used for heroin addicts. I was handed a prescription paper with the words “Go to local methadone clinic for morphine detoxification.” I had no choice if I simply stopped the morphine I knew the horrible withdrawal that I would have to go through.

Off to the Methadone Clinic I went. I had always thought myself a fairly streetwise woman. Well, let me tell you in the next 2  years that I was in the methadone clinic I learned things that I never ever knew even existed. I had not led a sheltered life, by any means, but some of the things I was witness to, changed me drastically forever. The injustice of a person who was only following a doctor’s advice was a daily occurrence for me.

The clinic was constantly firing and hiring different employees. From the “dosing nurses” to the office workers to the drug counselor themselves.

The clinic has ONE doctor who oversees around 250 patients. This is the one clinic out of the few that he runs single handedly. I was assured by the clinic doctor that I would be detoxed in about a 6 month period. There was ALWAYS another problem or reason that I couldn’t go down on my weekly milligram amount. To even see this doctor in person took at least 2-3 weeks for an appointment.

I was started at 80mg. Later, I found it would have been wiser to not have ever walked through their doors. I began to worry about a car malfunction; for fear that I couldn’t get my precious dose for the day. I saw people come to the door of the clinic at exactly 11:03 am and they were turned away with a sneer and a grin. Dosing hours run from 5:30 am until 11:00 am. I was in terror of a hurricane because you have to go and find the mobile unit, to receive your dose. That is, if someone from the clinic came to work to drive it. It was always a secret place. I could go on and on about the terror of a daily methadone nightmare. It’s been known to be called “liquid handcuffs!” But, chances are if you are reading this you’re already familiar with a methadone, opiate, or heroin nightmare of your own. I understand. I have been there too!!!!

So, here I was, with this heavy on my mind and heart and in this monstrous mood at midnight. I couldn’t sleep so I was playing around on our computer and I hit the word “methadone,” search and all sorts of sites came up. All I can say is, it was by the grace of God that I hit “Florida Detox!!!!!!” That literally saved my life!

Dr. Sponaugle is the Chief of Anesthesiology of a hospital called Helen Ellis Memorial. He runs a program there called Florida Detox. He puts you completely asleep and gives you certain drugs that push the opiates out of your body. You are asleep for approximately 4-6 hours and you never feel a thing. Then you are awakened slowly, they monitor you in ICU for a day or so. All you really feel is weak and tired!!! Not too bad compared to cold turkey or even a slow methadone detox.

The fact that I had completely given up on the medical community was solid to me, yet, something told me to look into this. I found about how kind and decent these people were. Rose is the receptionist who usually answers the phone. She gave me the most kind and reassuring answers. I found out that Dr. Sponaugle is a Christian. He was wonderful to me. I was constantly reassured and things were explained to me before they were done. They have Dr. Butts, who works with them. He is their psychologist.

From the doctors to the nurses to the rest of the people there, they were all so kind and compassionate to me. There was never once where I felt like a drug addict. I was treated with dignity and with respect.

So, if you are looking for an answer to a daily drug problem, I suggest you logon or call ASAP!!!!!!!!! http://www.detoxmd.com.top.htm or phone 1-888-775-2770. I have never felt closer to God or my life. My family says everyday how much better I am as a mother and a wife. That is music to my ears!!! Please don’t worry that you won’t be treated right or accepted, these people are the answer to the prayer that I know all addicts pray!!!

Thank you for reading my lengthy letter.

Sue, Mississippi - Methadone
Previously Addicted to: Methadone

 No love is greater than the love of a mother for their child. When they hurt, you hurt, when they are happy, you are happy, but when the evils of addiction take hold of your child, a mother is rendered helpless.

The drug becomes the most important thing and a caregiver, whether it be a mother, father, wife, sister or friend, cannot penetrate this hold. Thus we spent many anxious hours in worry, wondering what has happened to the person we love so much, and what can we do to help. As a mother, I can only speak of my experiences, but I feel there are many who are seeking help and trying everything like I did. First and foremost, there has to be a want to get off the drugs. He was taking Methadone 60mg/day. The withdrawals are so painful that he was not going to go the traditional method of hospitalization.

We began to seek an alternative and were led to Dr. Rick Sponaugle in Tarpon Springs, FL. We arrived on a Wednesday and met with Dr. Sponaugle for three hours. We returned to the hospital on Thursday at noon to begin the rapid detox. My son was asleep for 3-4 hours while his system was completely cleaned of all medication. He stayed in the hospital where he was constantly monitored for any change in vital signs.

The next morning upon my arrival, I found him to be weak, but no other problems. By noon he was sitting up and eating jello with no nausea, which is part of withdrawals. By 1:00 p.m., (24 hours later) he wanted to go outside in the sunshine so a nurse came with a wheelchair and rolled him out. By 3:00 p.m., he was standing on his own and still no stomach cramps, nausea or diarrhea. He was discharged a little over 24 hours after beginning the program. We returned to our motel to stay close by Dr. Sponaugle and his program. We stayed one more day and then returned home. All totaled, our time spent was from Wednesday to Saturday. He was off all medications and was not experiencing any of the problems that go along with withdrawals. He returned to work on Monday and is doing great.  EMPHASIS ADDED

The big concern of everyone was what is he going to do about the pain after he comes off all medication. To the glory of our Lord Jesus Christ, he has little or no pain. I cannot say enough about Dr. Sponaugle and his program. We were treated by everyone at the hospital, as well as Dr. Sponaugle and his staff, with respect and a want to make this person well again attitude.

So often a person who is addicted to a drug is characterized as a “bad” person who does not deserve compassion and love. These people deserve more attention than anyone else. Did not Jesus teach us to care for the sick? My son is laughing again for the first time in over a year, and I can only say that my prayers were answered. God sent me to a fellow Christian who treated my son with expert medical knowledge and a loving willingness to make him well. If additional information is needed, please write me at *****@aol.com.

Sue,
Mississippi

Angela S. - Methadone
Previously Addicted to: Methadone

My reasons for writing this email is to give you the pros and cons for Rapid-Detox; even more the reasons for doing so at Helen-Ellis Hospital.

Though I didn’t have the procedure done myself, my sister did. I could go though 100 horrific stories of the drug abuse and actions that go along with it, but you already know about those.

Both my sister and I at one time were on Methadone. The nastiest of all opiates. We both detoxed in the same facility – Charter. We both didn’t sleep for 1 week straight. We were given little to no drugs for the painful process. It was a nightmare.

I once again don’t have to tell you why we both got back on Methadone, it’s an easy answer – we were drug addicts with no direction in life, except “I can handle this again”.

If only we had known about Rapid-Detox and Naltrexone. I can’t go back and predict what would have happened. I can only say that it would have been a hell of a lot easier.

My sister awoke with only leg cramps, for which medications were given as often as needed. There wasn’t anything that my sister complained of that fell on deaf ears.

Dr. Sponguale and his staff are God sent.

Rose, the precious lady that goes over the procedure in such detail, you wonder if you are the only patient there.

Kathy and Gary, the Doc’s nurses – I can’t say enough about the people. These are the ones that listen to your complaints, your aches, your anxiety and fear of the unknown. The are constantly available.

Then there is John, a man who who’s been there (everywhere) and is probably in the happiest time of his recovery. I don’t know how long John has been clean, years I’m sure. He will talk to you about anything, your past, your present, and future life.

There is a psychiatrist that is attentive as well. Asking questions and as they do, analyzing them.

What absolutely slaps you in the face is there is not one of these people that I have mentioned that would not drop what they were doing and hold your hand to truly listen. The hope this staff shares is incredible.

The one attribute I simply held on to, was that they were all christians. Now you may not believe in God but, if there is one, wouldn’t you want people taking care of you that have a relationship with him?

Now I haven’t mentioned any “Cons”, my reason? There simply are none.

Sincerely,
Angela S.

Larry, Alabama - Methadone
Previously Addicted to: Methadone

February 16, 2004

I have been to at least two other centers. I was in Bradford, close to my home in Alabama, I almost died there, and went straight back to Methadone. I tried another inpatient program as well. I never got anything from any of the programs before you. I came down to Florida Detox and you did more for me than any of the other programs. I was taking over 100mg of Methadone.

After the detox I felt a little weak, but other than that I had no withdrawal symptoms. I could sleep, I was comfortabl, and was back at work about a week after detox. You have the best program around. You are nicer and more compassionate than any others.

Thank you all for everything

Larry
Alabama

Susan W. - Methadone
Previously Addicted to: Methadone

I spent 20 years on Methadone. I tried cutting my dose. I made it once all the way. I was off Meth for 1 week and I started getting high. I got right back on Meth. I was sick of paying $85 a week, sick of the shame, sick of having someone else in control of my life. I was looking for a place to detox. I stopped using everything but weed and Meth 10 years before.

I found the least painful way, Anesthesia Assisted Detox for Rapid Detox. I found Dr. Sponaugle at Neuraad in Tarpon Springs, FL. Since I had been paying $85 a week for Meth plus buying extra at times, you come out saving money.

Dr. Sponaugle is a Christian and is very dedicated to getting people drug free. I had the detox procedure in October. You meet with the doctor for a couple of hours and later a psychologist for an interview. On the day of detox, you are given Valium to relax you. I don’t remember anything after the Valium. You spend the night at Helen Ellis Memorial Hospital in the Cardiac Telemetry Unit. The whole time you are connected to heart monitors and all the other equipment used in ICU. I awoke in the evening the next night. Feeling very relaxed. NO SYMPTOMS OF WITHDRAWAL, NO CRAWLY SKIN. After 3 days, I felt a little weak.

Dr. Sponaugle would call everyday. He would try to prescribe something if you have any discomfort. He also is constantly trying to better his program. So he really listens to what you have to say.

If you really want to detox, I would recommend you give them a call. They really care. You are treated as a person instead of a junkie. The only regret I have is that I did not do this sooner.

Charles, Moss Point, MS - Methadone
Previously Addicted to: Methadone

Today, I am happy to say it is one month that I have been free. Free from a prison that has no bars. For the past year I was addicted to methadone. I started using methadone on the streets and progressed to daily one hour trips to a methadone clinic. I thought that going to the clinic was the answer to slowly stop using. What I found out is that the clinic is a highly profitable business. If you are like I was then you know that creating your own plan is almost impossible. Today, I thank the good Lord above for not having to make that drive.

I owe a great deal of credit to my wife. She did all of the research that eventually led me to Florida Detox. The cost of the treatment was at first a concern, but after I started adding up eleven dollars a day, plus fuel and time, I quickly realized the payback. As everyone, that has experienced the power of addiction knows I could list many more reasons that support.

I began the treatment early the next morning. I was sedated and slept through the day. When I awoke I felt weak but I did not feel any of the awful withdrawal symptoms I had felt before. I stayed in the hospital for another day to regain my strength to travel. The last time Dr. Sponaugle visited my room I thanked him for what he does for people like me. His response was that God has a plan for me and to let him guide me. I want to thank Rose, for she truly allows God to speak through her. The concern for her patients is truly genuine and together she and Dr. Sponaugle are a great team.

After arriving home, I thought a lot about my experience and I just could not deny the feeling of being led to Tarpon Springs, FL. Today I feel great and I trust in God to help me with my recovery and show me his plan for me. Wow, now that’s just hard to believe that these feelings are coming from me!

Charles
Moss Point, MS
December 11, 2000

David - Methadone
Previously Addicted to: Methadone

I am a 49-year-old man who has been on some type of opiates for the last 22years, for the last 12 it was methadone (160 mg. Per day). I had no intention of getting off methadone at this time.

Except for the fact that, the Methadone Clinic in Knoxville, TN was treating me like a sub-human/non-person. They even refused to grant me extra take homes so I could go home for my Mother’s funeral. I was angry and frustrated because of this. I looked up rapid detox on the Internet, but told my wife I had no desire of going through what I had seen on TV. There was a man going through a rapid detox procedure in California. He was flopping on the hospital table like a fish. It was not what I wanted to go through! We were going to be in Florida for a while, so I looked up rapid detox in Florida. I read the information provided on the site (floridadetox.com) also, read the testimonials, I believe this was no accident.

I believe that God led me to Dr. Sponaugle and his team of professionals at Helen Ellis Memorial Hospital. I was guided to this great professional team of compassionate, caring, and loving people, headed up by Dr. Sponaugle. I called and talked to Michele and Rose. They had another team member, John call me back. John told me his story about being on methadone and going through the rapid detox procedure. He said it was nothing like what I had seen on TV. That Dr. Sponaugle has developed a procedure that is totally different then what I had seen. I made the decision then to cut this umbilical cord, and prison sentence of methadone and clinics.

We went to Tarpon Springs and talked to the driven man who is on a mission to develop the rapid detox procedure to perfection and to whom I owe my life, Dr. Sponaugle. All the while, I went through his rapid detox procedure, Dr Sponaugle kept me very comfortable during my stay at Helen Ellis Memorial Hospital. He used all the knowledge and medicine at his disposal. After I was released from the hospital, I was awestruck by the after care provided by Dr. Sponaugle and his team.

I was on the phone everyday for the next 20+ days, with Dr. Sponaugle, who made himself available to me and guided me through the problems which I encountered for being on methadone at high doses for 12 years. I called him during his dinner at home, while on vacation, during his working hours, and Dr. Sponaugle always talked to me. I will say that Dr. Sponaugle is a person, guided by God to perfect the rapid detox procedure. I can not put into words, how Dr Sponaugle and his professional team gave me back my freedom to choose, self-esteem, my marriage, and my life.

I do pray that any person who would want these things for themselves go to Dr. Sponaugle and his rapid detox, which I will say, is the best in this country. If any one would want to contact me, you can reach me through Rose at Helen Ellis Memorial Hospital.

To sum it all up I am free to choose and do as I please, thanks to Dr. Sponaugle and his team I owe my life.

I love you all,
David

grateful parent - Methadone
Previously Addicted to: Methadone

September 19, 2001

Dear Dr. Sponaugle,

I am a very grateful parent, my adult child, Tricia had her 28th birthday last week. I will try to tell the story that took place the last four years. I pray this will help others decide if Florida Detox is part of the answer to the life controlling problem one is seeking freedom from.

During the last few years I was alarmed every time I talked to Tricia. How close to death she has come. Tricia has a painful shoulder injury. During the last four years doctors prescribed pain medication, the strength increased to the addictive opiates. Tricia came to me two years ago and said the pain medication was out of control. She went into a detox hospital for seven days. Ten days out she relapsed. Five months ago Tricia was out of money, her addiction was costing about $1,600 a month, decided to ask for help again. She found a pain management clinic and made an appointment for the next day, the next two months were expensive and the injection-able medication for the detox from Oxycontin would be for up to six months at about $1,300 per month. Tricia’s doctor made the decision to change Tricia to Methadone, much less expensive. Tricia decided to go to a long term detox treatment facility to put her life back together, but the Methadone was very hard to detox from. The doctor at the long term rehab facility suggested a rapid detox for Tricia.

I went on the internet and started to study the facilities. I had been told of experiences from family members who went to a facility in New York, a 24 hour in and out, the patient was basically on their own. I was praying and asking God for guidance. I found Florida Detox, gave the office a call, the concern and care they permeated helped me with the questions we had.

Tricia had the procedure two and half months ago. The staff thoroughly screened Tricia for the detox procedure. We felt confident with Dr. Sponaugle and his staff, you would think Tricia was the only patient with the time and care she received. Every step of the way we were given information, medical assistance and emotional support. The procedure went as explained, about 4 hours, then Tricia was taken to Telemetry floor, where she spent the next two days. The next morning Dr. Sponaugle released Tricia and we stayed at a nearby hotel and kept in tough with Dr. Sponaugle. The next morning was Sunday, Tricia and I went to the morning and evening service at a local church, the afternoon was spent resting. Monday morning we returned to the hospital for a conference with Dr. Sponaugle to go over after care for the next few weeks. Tricia went directly into the long term rehab program. She is half way through and I will never forget the phone call in which Tricia stated “I must have been so out of it Mom!” My daughter has returned from the hell of addiction.

The after care by Dr. Sponaugle is an ongoing treatment with his detox patients. He has Tricia on a pain medication for her shoulder that is not addictive. He walks his patients through the [following] months after care. Each patient is treated with their special needs. Dr. Sponaugle monitors the physical and mental needs. I can assure you that you are in the very best hand with Florida Detox. I must also add that Dr. Sponaugle is a born again believer and trusts in the Lord Jesus Christ and the Holy Spirit to discern and give care for his patients.

Sat Mar 04, 2006 7:11 pm    Post subject: My Experience With and Opinions of Florida Detox

This was my experience with as well as my personal opinion of Florida Detox:Once I knew I would be going for Detox and was given the date, I was excited but petrified at the same time. My need for Detox was pretty extreme. (my story leading up to the need for Florida Detox is posted in another area ) after 15 years of extremely high doses of opiates, at this point I had been on 180mg of Methadone for the last 3 of those years. I was no stranger to attempting every possible method of discontinuing opiod use. My biggest fear is probably the possibility of ever facing withdraws again. I swore for years if I could just get through the withdraw part; I would never put anything remotely close to an opiate in my body ever again. I think one of my worst experiences was when I was taking 1,000mg of oxicontin and I attempted to kick them. I went a full five months with out taking anything and even after five months I was still extremely sick. I could not tolerate it any longer. No one seemed to know what to do or how to help me so I knew I could not continue living that way.There is a long time line between then and my Detox. I mentioned the above because if anyone reading is skeptical, I understand skepticism just as much as anyone. I could not conceive how it was possible to do in a few hours with 180mg of methadone, that which I could not do over a five month period several years prior. After learning methadone is probably the hardest of detoxes, in addition to the amount I was taken and the length of time I had been dependant on all of it, plus my many attempts over the last few years to search for help, I had it drilled in my head by several different doctors that I needed to accept the fact that I would never live a day with out needing medication. I was told my body was too far gone and it would never begin to produce what it needed to on its own.I had given up all hope until I stumbled across Florida Detox online one day searching for some new research for opiate dependency. After my first phone call to them, it was very clear that I had finally found help. I laid everything out on the table and even specifically asked why they felt they could do in a few hours ect.. (as I said above) It was explained to me in detail what they do, why it works and why I was unable to accomplish all my attempts. I talked to this person the first time for what had to be over two hours. Never once was I made to feel like I was bothering her. This was after hours, I know she wanted to go home and I probably kept asking the same things over and over. She never faltered. When I hung up the phone, I felt like I had just talked to my best friend.Jumping ahead to the morning I arrived at the hospital;
After I had convinced my self this was it and I could not wait, the second I walked through the doors, I froze. I was so scared. All of the sudden I was not so sure. I was even contemplated turning around when I saw a familiar face from the meeting that you will all attend prior to your intake. She recognized me and greeted me with the biggest smile, stopped what she was doing and came to me and hugged me. She was so inviting and just assured me all was going to be fine. I would almost swear she was reading my mind. She walked me to the waiting room where I did some paper work and it was not long after that I went to have some blood drawn. Next I was being taken to my room. Once in my room I was given a gown to change into. After changing it was almost immediate that I had an I.V. put in my hand.I of course knew better but each nurse, staff member, and every one else I came in contact with made me feel like I was their only patient. I felt safe and as big of a chicken as I am, I was enjoying the company of everyone and actually smiling instead of the pure panic I felt when I first got there.

Okay, back to the I.V. I really can not tell you too much after that for the next day almost two. I do remember waking up a few times through what I assume was the actual procedure. I remember sitting straight up (which is normal for me I do it at home if I wake in the middle of the night) and looking around. I was not in the same room as when I went to sleep. I remember it being much bigger and I remember there being a line of beds. I again assume these were the people detoxing the same time as I was. When I sat up, I was in no pain..I really felt nothing bad. I was surprised. I think I remember saying to the anesthesiologist “oh, it is not over yet, is it? and I laughed. He was at my side immediately making sure I was okay. He laughed too (I think-its kind of foggy) and I was immediately put back to sleep. I also remember looking around me at the other beds and patients in them. Everyone was just sleeping. There was no movement or anything going one. It was very peaceful. I am pretty sure I woke up like I did due to my very high tolerance but I can not swear to that.

When I woke up and the procedure was over, I was back in my room and perfectly comfortable. I honestly did not expect to be so comfortable but I can not complain about anything. I do not remember the first day much. I pretty much slept.

The next day I awoke and things were clearer. Once again the care and treatment I received is not easy to describe. These people go above and beyond what is needed to even be considered a good staff. You know in your head that they have other patients and that they have had patients in and out of the same bed you are laying in, yet I personally felt so important and safe.

I stayed an extra day due to some diarrhea. They really make sure you are okay before you walk out of the hospital. I really do not remember any negative things to tell those of you reading this. I know I requested valium at different times because I wanted to be as relaxed as possible and rest as much as I could while I was there. Even after all the positive experiences since I was checked in, I think I still was afraid of feeling pain and that caused me some anxiety. I believe that it was due to my own personal fears. I do not think it was the Detox. The nurses were always there immediately if I needed anything and even if I did not they just made sure I was comfortable physically as well as in a good place mentally. And that I was. I was extremely happy.

When I did come home, I was sent home with meds to get me thru any further withdraws. This is all done on an individual basis. I had some limb aches and some lethargy but if you have ever experienced withdraws. Trust me, these were very welcome aches and I even laughed about it. I could not believe I was opiate free for the first time in 15 years and I was not praying for death. I was up walking around, happy, and for the most part  Pain free.

Before I go, I would like to just add a few things. I am not in the medical field so what I write is from my own personal experience and from things I have researched and learned along the way.

If you are here reading this because you are considering this procedure I would like to point out a few things. UROD has been related to many horror stories. Please do you research and learn all you can. If you are coming to Florida Detox, I can tell you with out a doubt you will be in the best of hands. Dr. Sponagule is, in my opinion, the most incredible doctor there is. You will see that for yourself after your first 5 minutes with him. I can not stress to you enough that this is more than his job. He truly cares about his patients. He strives continuously to learn and do research and find the best way to give you the best treatment possible. His knowledge alone stands him out from any doctor I have ever had contact with. That is no small accomplishment considering the doctors I have seen over the years. I could go on and on about him but you will see for yourself after you meet him or even if you talk with him on the phone. His staff is no less unique than he is. You will not receive better care anywhere else you go. You may find a place who will promise you all I am telling you about. I am sure if you do your research and find past patients to other places that take you in and toss you out a few hours later, you will not find happy, healthy, or sober people. I can personally tell you that your care here is second to none. I am sure there might be other places that are sure to be safe and even follow up with you but I have never heard of any place that can come close to what Dr. Sponagule gives his patients. He honestly goes above and beyond what I am pretty sure is required by him in order to do these detoxes. Scary as it is, there are doctors out there performing this procedure and sending you home the same day. These places censored people in so easily because their cost is so low. These are the places that cause the horror stories you hear about. These are the places that cause deaths and instead of the truth that the patient was not given proper care and it was the fault of the facility.  UROD takes the rap. Patients of Florida Detox could not receive better care. Dr. Sponaugle interviews you in detail prior to your procedure. He is knowledgeable on advanced issues dealing with brain chemistry and much more. After your procedure he makes sure you get the best after care. Tests are run and he does all in his power to find and treat any problems you may have outside of your dependency. These things are so crucial in really getting healthy and staying sober. For these reasons, whether you come to Florida Detox or go somewhere else please be safe and do not settle for less than the absolute best care. UROD got me through my withdrawls as I prayed for over and over for years but it was the knowledge and concern of Florida Detox/Dr. Sponaugle that I contribute the ability to get my life back.

Clean from Methadone, 14 months (posted on Dr Phil board)

tepolmUser Mood
HappyMessage Emote
October 10, 2005, 11:05 am PDT Message for Florida Detox PresentationMy 26 year old son has been clean for 14 months following his detox off of methadone at Florida Detox. Dr. Spinogle and his staff were awesome. He has been to one outpatient and two inpatient treatment centers including a halfway house. He has had very difficult struggle. However, Dr. Spinogle’s resident psychologist correctly diagnosed him with ADHD which had previously gone undiagnosed. He has since been to the Amen clinic in Reston Virginia shere the diagnosis was confirmed. At that time he started on Adderall which he is still taking regularly. His drug cravings are gone, and he is finishing up his college degree. Our experience with Florida was a very positive one, and I would glady refer anyone there for opiate detox. Thanks you for giving me the opportunity to share.
Methadone and Xanax (originally posted at heroindetox.com)

8string
New MemberUSA
1 Posts Posted – Aug 14 2007 : 2:45:30 PM
——————————————————————————–This is how things developed for me with Rapid Detox. It is lengthy, but worth the read. I hope it is helpful, particularly if you are considering stopping the use of methadone, or other opiates.I was on Methadone for 2 years, at 90 mgs per day, and 3 mg of xanax per day. The methadone was for pain management after 2 back surgeries, and the xanax due to stress. I was on percocet for two years prior to the methadone. My back finally started hurting less earlier this year. EMPHASIS ADDED

I had tried to wean off methadone and xanax, but it was a constant battle, with no success, and my dependency had left me in a very worried state, both for my health, mental clarity, and paranoia of not having methadone, and the possiblilty of suffering withdrawal symptoms. I also was having side effects from the drugs that were as bad as the symptoms that caused me to take the drugs years earlier. I was getting no where, yet my back was healed. I was left with a drug dependency, nice word for addiction, without debate of word definitions to “make it feel” ok.I researched the web, checked groups like this, called rapid detox centers (hospitals, clinics (mostly clinics)). The clinics scared me. I decided that I would not subject myself and my family to the risks of a clinic, and particularly the ones that send you to a hotel the next day. I decided it was going to have to be done in a fully accredited, operational hospital, and that they had to include enough post procedure days for me to feel comfortable.I narrowed it down to a Detox, in Florida. I checked in on July 9th. The first day I attended a seminar that the Dr conducted. The room was full, with well over 50 people from all over the area, to hear what he had to say about the effects of all types of drugs, and alcohol, on the brain. He did a great job of explaining this, better than anything I’d been told.

They had me relax in my hospital bed the rest of the day. My wife stayed with me every day from morning to night. I was set up with an IV, and stayed on my methadone and xanax right up to the procedure, so I didn’t have to feel any withdrawal. They put me under anesthesia that night. I woke up 36 hours later, and asked when they were going to start. I had no idea it was done already. They kept me pretty medicated till Thursday.

The staff was more than GREAT. Thank God for such talented, caring people. There were  about four other patients undergoing the same procedure in other hospital rooms. The Detox Center is on a floor of their own in the Hospital. I was released on Friday, and followed a tapering plan on several medications, including Subutex, so that I wouldn’t feel any symptoms as I adjusted to life without methadone and xanax. It is now August 14th, 5 weeks later, and this will be the last week of the medications for symptoms.

I have only had to call Florida Detox two times in the 5 weeks, due to minor withdrawal feelings. They were prompt, and told me what to do to feel better. I never once had nausea, or anything as close as some of the bad feelings I had while on the drugs.

I cannot express how happy and how good I feel now. My clarity is back, and I have optimism again. The chains have been broken, and I look forward to the rest of my life. My family keeps saying that “the old Guy is back. They now can finally talk about the concerns they have had over the last five years (I was on percocet for over two years before the methadone). There were times when I would doze off during conversations, due to the combination of methadone and xanax. I feel better than I have in years, and wouldn’t trade this for all the drugs in the world. I am free again.

Please feel free to email me if I can answer any questions about my experience. I hope this helps someone.

Guy

© Copyright (2012) Marvin Sponaugle, MD All Right Reserved

Share