1. Increase in Methadone Related Deaths Lon R. Hays, M.D., M.B.A. Greg Davis, M.D.

2. Is the increase related to methadone used for pain management or its use in opioid treatment programs? Is the increase related to methadone used for pain management or its use in opioid treatment programs?

3. 4.5 – 5.0 fold increase in the amount of methadone manufactured and distributed from 1997-2002 4.5 – 5.0 fold increase in the amount of methadone manufactured and distributed from 1997-2002

4. DAWN: Hospital Emergency Department visits involving methadone increased by 176% from 1995-2002 DAWN: Hospital Emergency Department visits involving methadone increased by 176% from 1995-2002

5. DAWN: ~500,000 Emergency Department visits involving non- medical use of pharmaceuticals in 2004 DAWN: ~500,000 Emergency Department visits involving non- medical use of pharmaceuticals in 2004 21.9% involved Opioids 26.8% involved Hydrocodone 23.1% involved Oxycodone 20.1% involved Methadone

6. 1999 – Methadone was cited in 4% of overdose deaths. 1999 – Methadone was cited in 4% of overdose deaths. 2004 – Methadone was cited in 13% of overdose deaths. 2004 – Methadone was cited in 13% of overdose deaths.

7. Ratio of Increase in Methadone Deaths by States (1999-2004) Ratio of Increase in Methadone Deaths by States (1999-2004) West Virginia25:1 Kentucky15:1 Florida14:1 North Carolina 7:1 Virginia 6:1

8. Kentucky leads the nation in that 7% of Kentuckians have used narcotic pain relievers for non-medical purposes in the last year. Kentucky leads the nation in that 7% of Kentuckians have used narcotic pain relievers for non-medical purposes in the last year.

9. 9.5% of Kentucky 12 th graders have used prescription narcotics in the last 30 days. 9.5% of Kentucky 12 th graders have used prescription narcotics in the last 30 days.

10. SAMSHA named three possible scenarios for Methadone deaths. SAMSHA named three possible scenarios for Methadone deaths.

11. 1) Illicitly obtained Methadone 1) Illicitly obtained Methadone to achieve euphoria. to achieve euphoria.

12. 2) Illicit or licit Methadone 2) Illicit or licit Methadone used in combination with Alcohol, other Opioids, or Benzodiazapines.

13. 3) Accumulation of Methadone 3) Accumulation of Methadone to harmful serum levels in the to harmful serum levels in the first few days of treatment for first few days of treatment for addiction or pain, before addiction or pain, before tolerance is developed. tolerance is developed.