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Methadone abuse hits state hard 345 deaths in 17 months tied to drug 5-9-04
By ALAN MAIMON  The Courier-Journal   PHOTOS BY TIM WEBB, SPECIAL TO THE C-J
Methadone has become Kentucky's deadly drug of choice, investigators and many coroners say.
More than 340 Kentuckians have died from overdoses related to the synthetic narcotic since January 2003, according to a survey by The Courier-Journal. A top Eastern Kentucky drug investigator said methadone is replacing OxyContin as the region's most abused prescription drug.  Methadone, invented in Germany during World War II as a substitute for morphine and used now as a painkiller and to treat heroin addiction, has found new popularity because of tighter controls on OxyContin, authorities said.  "Most of your big pain treatment centers and doctors quit prescribing as much OxyContin and started prescribing methadone," said Dan Smoot, a former state police detective who is head of law enforcement for the federally funded anti-drug task force Operation UNITE in Hazard. No county in Eastern Kentucky has been hit harder than Breathitt, population 16,000. Since January 2003, 40 people have died from a combination of methadone and either alcohol, another painkiller or a tranquilizer, according to Bobby Thorpe, the county coroner. In Jefferson County, 34 people have died from methadone-related overdoses in the past 16 months, by far the most of any drug, Chief Deputy Coroner Mark Handy said. On average, Kentucky has about 400 overdose deaths annually from all drugs, said Tracy Corey, the state's medical examiner. No agency keeps a statewide total of methadone-related deaths, but The Courier-Journal called coroners or deputy coroners in all 120 counties. As of Friday, 80 from all parts of the state had responded, reporting a total of 345 deaths linked to the drug since January 2003. Those counties represent about 75 percent of Kentucky's population. Some coroners who responded to the survey, which began the last week in April, said their methadone figures were estimates rather than precise counts.
Asked about the results of the survey, Lt. Gov. Steve Pence, who also is the state's justice secretary, said, "It disturbs me."
In an interview Friday, Pence discussed the possibility of creating a "central depository on drug overdose deaths" to track whether certain areas are having abuse epidemics. A team of 50 state, local and federal officials is compiling a report on Kentucky's substance-abuse issues, and Pence said the report will go to Gov. Ernie Fletcher on June 20.
Overdose victims
The survey of coroners showed that many victims have died from combining methadone with sedatives.
Bonnie Honaker, who lives in the Lost Creek community of Perry County, lost her sister to a lethal mixture of methadone and what her family described as nerve pills. On the day after Christmas last year, 41-year old Jackie Melson, a mother of six, died in her Breathitt County home in Flintville, one of 10 county residents who died that month from a methadone-related overdose, according to Thorpe, the coroner. Honaker said she knew that her sister occasionally abused drugs but that she was on the verge of getting her life back in order. She said Melson recently had moved from Columbia, Ky., to be closer to her parents and had told her family that the move marked a new start. "She always called me and said, `I'm tryin' to straighten my life up,'" said Melson's 23-year-old daughter, Jennifer York, who lives in Cartersville, Ga. "I think she was real close to doing that when she died."
Dean Craft, a Kentucky State Police detective in Hazard, said an investigation into Melson's death is still open.
In 2001, Kentucky physicians wrote more than 150,000 prescriptions for OxyContin, but that dropped to 130,000 in 2003, according to the Cabinet for Health Services. Meanwhile, the number of methadone prescriptions increased by about 340,000, to nearly 2.7million, during that time.
Authorities seized more methadone than any other drug during a series of investigations earlier this year that led to warrants for the arrest of more than 200 street-level drug traffickers in the region, Smoot said.
Abusers, who span a wide range of ages, often crush and snort methadone with other drugs, or dissolve them in liquid and inject them. The combination can produce a lethal high by leading to respiratory failure or a heart attack, coroners said.
With a prescription, 90 tablets of methadone are available for about $40 at a pharmacy, Smoot said, and one methadone tablet on the street sells for around $12. Methadone wafers — large sheets of the drug used at, and sometimes stolen from, methadone clinics — sell for $50 on the street.
`Deadly cocktail'
Karen Engle, executive director of Operation UNITE, referred to methadone and certain sedatives as a "deadly cocktail." 
Thorpe, the Breathitt County coroner who has a locker full of methadone pills taken from overdose scenes, said most of the deaths there were attributed to methadone tablets prescribed by doctors and either given
to the victims or trafficked on the street. The increase in methadone prescriptions and deaths related to the drug come at a time when OxyContin has become less available, partly because of publicity about the abuse epidemic that included the conviction of at least seven Eastern Kentucky doctors for overprescribing the powerful painkiller. But the methadone-related deaths have received little of the fanfare associated with Oxyfest, a 2001 operation that led to the arrest of 207  drug dealers. In announcing Oxyfest in February 2001, authorities said OxyContin had killed 59 Kentuckians in the previous year. Some coroners pointed out that OxyContin abuse is still a problem. Lawrence County Coroner Mike Wilson said six people in his county have died of OxyContin-related overdoses in the past 16 months, but the county has had only one methadone-related death in that time.
Last month, officials announced the largest drug crackdown in the state. Smoot said about half of more than 200 arrests involving eight Eastern Kentucky counties were for possession or trafficking of methadone.
Medical fallout
Elsewhere, a Louisville doctor had his medical license suspended last year after 10 patients in his care died from methadone overdoses, said Handy, the chief deputy coroner.
The doctor, David Thurman, has since had his license restored by the Kentucky Board of Medical Licensure, but he is prohibited from prescribing controlled substances pending a full hearing scheduled for later this month.
Thurman also is under state investigation stemming from the patient deaths, said Alex Dathorne, an assistant commonwealth's attorney in Jefferson County.
Thurman declined to comment, but his attorney, J. Fox DeMoisey, said the case is a good example of how doctors are made scapegoats when patients in their care overdose.
"The simple fact is that methadone in prescribed dosages should not have this effect," DeMoisey said. "When a physician gives medicine and says you should take it in a certain way and a patient doesn't listen, how does a doctor bear responsibility?"
Grady Stumbo, a Hindman physician and former chairman of the Professional Activities Committee at ARH Hazard Regional Medical Center, said doctors need to recognize when patients seek prescriptions for illegitimate purposes.
"We're part of the problem because we're making too many of these drugs available," Stumbo said. "But we're part of the solution, too, if we take a greater stand and speak out and keep that from happening."
Some prosecutors hope that methadone cases lead to criminal charges against doctors and other people who knowingly give someone a fatal combination. "If we start bringing charges for murder, it'll scare the hell out of people," said Perry Commonwealth's Attorney John Hansen. Some pharmacies, meanwhile, are watching how
many methadone prescriptions they fill, and in what doses. Brenda Turner, a Breathitt County pharmacist, said her pharmacy plans to stop stocking 10-milligram methadone tablets starting in June in response to the high number of deaths.
Rural areas hit hard
Other Appalachian states also have seen an increase in methadone-related deaths. Dr. William Massello III, Virginia's assistant chief medical examiner in Roanoke, said 85 methadone-related overdose deaths were reported last year in southwestern Virginia, an area with around 1.5 million people. "Methadone is a very deadly drug," Massello said. "And this seems to be happening in many rural areas in America." A report released in March by the federal Substance Abuse and Mental Health Services Administration said that nationwide, most methadone-related deaths are a result of diverted pharmaceuticals and not from methadone taken at or from treatment centers. Mac Bell, the state narcotic authority commissioner at the Cabinet for Health Services, said strict regulation and monitoring of Kentucky's methadone clinics indicates that drug abusers are getting methadone elsewhere. "From the reports I'm getting from the field, the methadone is not coming from our clinics," Bell said. "It's coming from pain management clinics." Methadone clinics dispense the drug in liquid form on site, and clients are permitted to take home doses only after showing an ability to remain clean. Of Kentucky's 12 methadone facilities, 10 are private clinics and two are publicly funded, Bell said. But the number of Kentuckians receiving methadone treatment for opiate addiction has increased from 200 in 1995 to more than 1,500 this year, Bell said.  In Breathitt County, only one of the 40 people who died from a methadone-related overdose in the past 16 months was a client at a methadone clinic, Thorpe said.

Rogers, U.S. Drug Czar Kick-Off Operation UNITE 11-24-03
***Manager Named for Kentucky River Task Force***
HAZARD, KY – U.S. Congressman Harold “Hal” Rogers (KY-5), United States Drug Czar John P. Walters, and others joined together tonight to officially kick-off Operation UNITE, a new comprehensive counter-drug initiative to combat drug abuse in southern and eastern Kentucky. 
“For far too long our schools, communities, and people have been held hostage by the devastating effects of substance abuse,” Rogers said. “We’ve watched as illegal drugs have destroyed lives, overwhelmed our treatment centers, and stretched the resources of our law enforcement agencies to the max. We’ve also discovered the painful truth that the drug epidemic is larger than any one group or person. Operation UNITE is going to help us do together what we could never do alone. We are equipping our law enforcement officers, citizens groups, and medical professionals with the resources necessary to tackle this problem once and for all. This is a monumental day for southern and eastern Kentucky. UNITE is going to help this region kick the drug habit.” 
John Walters, Director of National Drug Control Policy stated, "Residents of Eastern Kentucky know all too well the misery and suffering caused by drug abuse.  I commend Congressman Rogers and the community leaders who are working to make the drug problem smaller by implementing a balanced drug strategy based on preventing drug use before it starts, healing those who have become addicted, and disrupting the market for illegal drugs. We look forward to strengthening our partnership with local and state officials in Kentucky to reduce the violence and addiction caused by drugs.  We cannot allow dangerous drugs to destroy our communities and rob our children of their futures."
Operation UNITE, which stands for Unlawful Narcotics Investigation Treatment Education, serves 29 counties in southern and eastern Kentucky. The region-wide program has three core components:
Law Enforcement Investigations – UNITE is creating three narcotics task forces – the Big Sandy, Kentucky River, and Southeastern - to focus on drug interdiction, confiscation, and undercover operations within their coverage area. Task forces will target street level dealers, corrupt health care professionals, and Medicaid/Medicare fraud. Additionally, U.S. Attorney Greg Van Tatenhove will assign six Special Assistant US attorneys to help overworked prosecutors quickly bring drug cases to court.
Drug Treatment Programs – UNITE has partnered with Kentucky’s Chief Justice, Joseph Lambert and the Administrative Office of the Courts to provide Drug Courts in communities that are not served. Currently, there are only seven funded Drug Courts in the Fifth Congressional District. UNITE’s goal is to begin an additional 22 courts on a regional basis. The first courts are scheduled to begin operation in February 2004.
Education –UNITE will encourage citizens to become involved in the areas of prevention, intervention, and treatment. While partnerships with educators are an important part of the effort, the goal is to reach beyond school walls to empower communities to no longer tolerate the scourge drug abuse causes.
Manager Named for Kentucky River Task Force
At a press conference in London Monday afternoon, Representative Rogers announced that Dan Smoot, a Narcotics Detective with the Kentucky State Police Post in Hazard, has been chosen to head the Kentucky River Task Force for Operation UNITE. 
“Dan is an excellent choice to lead the Kentucky River Task Force,” Rogers said today. “With more than twenty years of experience in law enforcement and an extensive background in drug investigation, Dan knows first hand the unique problems facing eastern Kentucky. As Manager, he will coordinate drug investigations in a seven county area and oversee the day-to-day operations of the Task Force. We’re counting on Dan to use his know-how and contacts within the law enforcement community to put street level drug dealers and corrupt doctors out of business.”
A graduate of Eastern Kentucky University with a BS in Police Administration, Smoot began his law enforcement career in 1982 as a Kentucky State Police Trooper. Smoot was promoted to Narcotics Detective in 1989 and continued to serve in that position with KSP Post 13 in Hazard until October 31st. Smoot has extensive experience and training in the field of drug investigation. His experience includes coordinating Operation Oxyfest 2001, a drug round up that resulted in over 200 arrests, including 50 charges in federal court. 
The Kentucky River Task Force serves Letcher, Leslie, Perry, Knott, Breathitt, Lee, Owsley and Wolfe Counties. Kentucky River is currently working to hire a detective for each county. The Task Force is expected to be operational by December 15. 
Operation UNITE was created by Rogers after he successfully included $8 million in this year’s federal budget to establish a new counter-drug initiative. Rogers became heavily involved in fighting substance abuse after hearing from numerous Kentuckians about the devastating effects of illegal drugs, particularly prescription drugs such as OxyContin.

Center NIJ Narrative
Eastern and Southern Kentucky is a rugged, hilly region of southern Appalachia with a history of poverty and low education. Recently, the area has become known for its production of marijuana, illegal diversion of prescription medication and growing methamphetamine problems. 
Currently, the primary law enforcement in each county is the county sheriff and the Kentucky State Police. The sheriffs’ departments do not employ drug enforcement officers and traditionally the city police departments are understaffed. Most have one or two general investigation detectives with no drug enforcement officers. City police officers are overwhelmed by thefts, homicides, burglaries and assaults, which leaves few resources for drug investigations. The Kentucky State Police currently has only fourteen drug detectives in Eastern and Southern Kentucky, which consists of 681,930 residents. Based on the national average of one narcotics agent per 10,000 residents, the twenty-nine counties are under served by approximately 80%. 
Too often, the well-intended efforts against illegal drugs are redundant and at times, counterproductive. A comprehensive, community-focused initiative incorporating law enforcement, treatment and education objectives have been created: Unlawful Narcotics Investigations, Treatment and Education (UNITE). With all three components under one organizational roof, the program will allow for greater effectiveness. Furthermore, UNITE will be able to adapt core component programs as information is shared between the law enforcement, treatment and education initiatives.
The Center for Rural Development will provide UNITE with one million dollars through its Law Enforcement Program. The purpose of the contract is to provide $500,000 per year for personnel over a two-year period, which will be used for UNITE’s undercover agents.
The mission of the law enforcement component is to measurably impact street-level trafficking of illegal drugs. The large-scale investigations that involve organized activity or multi-states will be turned over to the Kentucky State Police, Appalachian HIDTA or the Drug Enforcement Agency. The primary focus of the law enforcement component will initially be the interdiction of prescription drugs and methamphetamines.
Three regional law enforcement task forces will be created for the twenty-nine (29) county jurisdiction: Cumberland Valley Narcotics Task Force, Kentucky River Narcotics Task Force, and the Big Sandy Narcotics Task Force (herein “Narcotics Task Forces”). In total, there will be twenty-nine (29) agents, three (3) task force managers, and three (3) administrative assistants. The purpose of the Narcotics Task Forces is to combat the sale and use of illegal drugs, to investigate trafficking and submit to proper authorities investigative reports thereto.
The Narcotics Task Forces will be formed through the jurisdiction of inter-local agreements. While the task force agents will be employed by local law enforcement agencies, the Kentucky State Police will help coordinate the task forces. This will build a relationship between agencies while at the same time providing multi-county jurisdiction and sovereign immunity. In addition, each local agency will have an agent as a liaison to the Narcotics Task Force. The agents will work to develop a rapport with the local officers and keep them advised on investigations. Third, UNITE will act as a liaison between all law enforcement agencies, striving to improve and coordinate communication.
The primary technological enhancements will focus on intelligence collection and management as well as improved investigations. The Narcotics Task Forces will emphasize intelligence gathering through a centralized database as well as cross matching and information sharing. Cross-matching will be done with existing databases to locate possible prescription abuse. A database from anonymous tips and arrest records will be cross-matched and shared, in accordance with applicable law, by all law enforcement agencies concerned. The taskforces will be trained in the latest drug enforcement techniques and technologies to provide technical support to local agencies. In addition, a partnership with HIDTA and the Rural Law Enforcement Training Center (RULETC) and Eastern Kentucky University has been established. UNITE plans to fully utilize the resources available from each institution.
Law enforcement personnel will assist communities in gathering, analyzing and interpreting data. Assessments and evaluations will include:
Data gathered from arrest warrants and court records;
Interviews and surveys of elected officials and community leaders for the purpose of recording concerns and issues;
Surveys and research to build a clear picture of the drug use in the community and schools;
Reviews of the annual Kentucky State Police Report on drug arrests, which reports county-by-county statistics.

On April 22, 2003, U.S. Congressman Rogers announced details of a new counter-drug initiative that will help combat drug abuse in Southern and Eastern Kentucky. Called “UNITE” (Unlawful Narcotics Investigation Treatment & Education), the program will bring together regional leaders, law enforcement officials, health care professionals, and concerned citizens to fight the drug epidemic sweeping through the region. 
Operation UNITE serves 29 counties in southern and eastern Kentucky. The region-wide grant program has three main tasks: 
Creating Three Regional Drug Task Forces – UNITE will create three narcotics task forces: Southeastern, Kentucky River, and the Big Sandy (broken down geographically). Each will focus on drug interdiction, confiscation, and undercover operations within their coverage area. These task forces will work with local law enforcement agencies and provide the most current narcotic training for greater effectiveness. Task forces will target street level dealers, corrupt health care professionals, and Medicaid/Medicare fraud. Additionally, U.S. Attorney Greg Van Tatenhove has assigned six assistant commonwealth attorneys to assist overworked prosecutors to quickly prosecute drug cases. In addition, UNITE will fund two chemists at the state crime lab to analyze UNITE cases.
Drug Treatment Programs – In the past there has been a lack of coordination between state and private organizations providing drug treatment services. UNITE will help coordinate those efforts to maximize the effectiveness of these groups. 
A large component of the UNITE Treatment program includes beginning drug courts in all UNITE counties. A regional approach will be utilized to maximize funding.
Community Coalitions/Education – UNITE will work to enhance existing organizations and develop new community coalitions to expand drug awareness and education programs. Coalitions will concentrate on a grassroots effort in prevention, intervention and treatment.
Coalitions will also reach out to the faith-based community to begin mentoring programs and after-care programs.
Congressman Rogers secured $8 million in the FY’03 Omnibus Appropriations bill to create this new counter-drug initiative.

Are drugs destroying your life or the life of someone you love?
Call the UNITE toll-free treatment referral line if you need help with finding treatment or have questions about substance abuse.
1-866-90UNITE
or
1-866-908-6483
Treatment referral line is manned from 9:00 to 5:00 weekdays; leave a message after hours and someone will return your call.
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