Angry in the Great White North

From the Toronto Police, via email:

On Friday, December 22, 2006, police received information about lost prescription medication.

The owner of the medication boarded a southbound Dufferin Street bus at St. Clair Avenue West, and got off the bus at Bloor Street.

It is believed that the owner left four 75-milligram bottles of liquid methadone on the bus.

The medication is potentially lethal if ingested.

Anyone with information is asked to contact police at 416-808-1304, or Crime Stoppers anonymously at 416-222-TIPS (8477), or online at www.222tips.com.

Now I have to ask, why is someone carrying methadone around? Methadone is a presciption drug with few legitimate uses:

Methadone is a synthetic opioid, used medically as an analgesic and in the treatment of narcotic addiction.

Methadone was introduced into the United States in 1947 by Eli Lilly and Company as an analgesic (They gave it the trade name Dolophine,® which is now registered to Roxane Laboratories). Since then, it has been best known for its use in treating narcotic addiction, though it is also used in managing chronic pain due to its long duration of action and very low cost. In late 2004, the cost of a one-month supply of methadone was $20, as compared to an equivalent analgesic amount of Demerol at $120.

Was this methadone used for chronic pain treatment? Perhaps, but this is a strange coincidence. Here is a map of the area described in the police bulletin:

The person's bus trip started at "1", and ended at "2", at Dufferin and Bloor. The east-west subway line n Toronto's west end runs along Bloor Street. Buses like the one take by this person transport people to the subway line. Dufferin is a major station for the subway. Two stations west, at Dundas, almost on top of the Dundas West subway station, is the Addiction & Methadone Treatment centre in Toronto.

Coincidence?

If I lived at Dufferin and St Clair, and I wanted to get to Bloor and Dundias West, I would take the bus south along Dufferin and catch the westbound subway.

If this person was on the way to the centre, was he staff or client? Look at the dosages. Four 75mg bottles. Assuming each represents one dose, these are dosages used to treat heroin addiction and not chronic pain. Chronic pain dosages are in the range of 2mg to 10mg, depending on the pain reliever being replaced. When treating heroin addiction, dosages range 25mg to 130mg, depending on the severity of the heroin addiction, the means of heroin delivery, and whether the addict is undergoing detox or is in a stabilization period.

So I have to think these are methadone dosages, probably in the possession of a recovering addict being treated at the centre at Dundas Street West and Bloor.

Health Canada promotes the use of methadone as a treatment for heroin addiction, and quotes the cost savings to citiies like Toronto:

In Toronto, the average social cost of an untreated person who is dependent on illicit opioids has recently been estimated to be $44,600 per year. According to an estimate from the Centre for Addiction and Mental Health in Toronto, methadone maintenance treatment can be provided for approximately $6,000 per year.

Methadone works by alleviating the symptoms of opioid withdrawal. A stable and sufficient blood level of methadone stems the chronic craving for opioids. Since methadone is a much longer acting drug than some other opioids, such as heroin, one oral dose daily prevents the onset of opioid withdrawal symptoms—including anxiety, restlessness, runny nose, tearing, nausea and vomiting—for 24 hours or longer.

When appropriately prescribed and dispensed, methadone is considered a medically safe medication.

Is it appropriate to dispense methadone by give multiple 75mg doses to addicts to take home? Methadone has to be taken daily, and in large doses, in order to keep the worst of heroin withdrawal at bay. Maybe it's unreasonable to ask an addict to make a daily trip to the clinic. Maybe, but is it also unreasonable to ask addicts to treat this dangerous drug responsibly? I mean, addicts by definition do not treat drugs responsibly.

I wonder if the Addiction & Methadone Treatment centre has any data on lossage rates of take-home methadone doses.