Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens

METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT
December 11-13, 2011

seattletimes.com/methadone

EXHIBIT 1

December 11, 2011

METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT

State pushes drug that
saves money, costs lives

MIKE SIEGEL / THE SEATTLE TIMES

Sara Taylor, mother of former King County 911 dispatcher Angeline Burrell, describes
her daughter’s battle with excruciating chronic pain. In early 2008, Burrell’s metha-
done dose was doubled. She died two days later. At left is Taylor’s husband, Dale.

First of three parts 2003, there are 2,173 of these dots.
That alone is striking, a graphic
BY MICHAEL J. BERENS illustration of an ongoing epidemic.
AND KEN ARMSTRONG
Seattle Times staff reporters
But it’s the clusters that pop out
— the concentration of dots in

M
ap the deaths and you see places with lower incomes.
the story. Everett, whose residents earn
Assign a dot to each per- less than the state average, has 99
son who has died in Washington by dots. Bellevue, with more people
accidentally overdosing on metha- and more money, has eight. Work-
done, a commonly prescribed drug ing-class Port Angeles has 40 dots.
used to treat chronic pain. Since Mercer Island, upscale and more


METHADONE and the politics of pain A SEATTLE TIMES SPECIAL REPORT EXHIBIT 1

populous, has none.
For the past eight years Washing-
ton has steered people with state-
subsidized health care — Medicaid
patients, injured workers and state
employees — to methadone, a nar-
cotic with two notable characteris-
tics. The drug is cheap. The drug is
unpredictable.
The state highlights the former
and downplays the latter, cutting
its costs while refusing to own up
to the consequences, according to
a Seattle Times investigation that
includes computerized analysis of
death certificates, hospitalization
records and poverty data.
Methadone belongs to a class of
narcotic painkillers, called opioids,
that includes OxyContin, fentanyl
and morphine. Within that group,
methadone accounts for less than
10 percent of the drugs prescribed
— but more than half of the deaths,
The Times found.
Methadone works wonders for
some patients, relieving chronic
pain from throbbing backs to
inflamed joints. But the drug’s
unique properties make it unforgiv-
ing and sometimes lethal.
Most painkillers, such as OxyCon-
tin, dissipate from the body within
hours. Methadone can linger for
days, pooling to a toxic reservoir
that depresses the respiratory sys-
tem. With little warning, patients
fall asleep and don’t wake up. Doc-
tors call it the silent death. needed pain relief. One, with pri-
In Washington, the poor have vate insurance, received OxyCon-
been hit the hardest. While Medic- tin, an expensive drug. The other,
aid recipients make up about 8 per- on Medicaid, received methadone
cent of Washington’s adult popula- — and within a week, overdosed
tion, they account for 48 percent of and died.
the methadone deaths. “I kept telling her not to go on
A case from 2009 epitomizes this methadone,” said the surviving
divide. Two sisters, injured in a sister, who asked that the family’s
car accident in South King County, name not be used, for privacy.



Washington’s methadone death cials more inclined to rationalize
rate ranks among the country’s than reckon.
highest. California, with more than
five times the people, has fewer Losing it all
deaths. Doctors expected Angeline
But year after year, Washington Burrell’s surgery to be routine. But
health officials have proclaimed when Burrell, a 911 dispatcher for
methadone to be just as safe as King County, had her gall bladder
any other painkiller. They have removed in 2004, she was left with
disregarded repeated warnings, excruciating pain, mystifying physi-
obscured evidence of harm, and cians.
failed to adopt simple lifesaving Doctors prescribed painkillers,
measures embraced by other states, but the pain wouldn’t go away. The
the Times investigation shows. more Burrell sought help, the more
Jeff Rochon, head of the Wash- doctors suspected she was a pill
ington State Pharmacy Association, seeker, a prescription addict scam-
says pharmacists have long recog- ming for drugs.
nized that methadone is different “She tried to find a doctor to
from other painkillers. “The data believe her,” says her mother, Sara
shows that methadone is a more Taylor. “She became depressed,
risky medication,” he says. “I think and it just kept getting worse.”
we should be using extreme cau- Co-workers pitched in, donating
tion to protect our patients.” sick days to Burrell.
Washington’s methadone deaths Two years passed before doctors
tell a story of the politics of health diagnosed surgical-related nerve
care in a slumping economy. Tight damage. By then, Burrell had lost
budgets force tough cuts. Often, her job, her house in Spanaway
those hurt the most can afford it and her private insurance. She
least. And often, the suffering is moved into her mother’s home in
met with silence, with public offi- Renton, destitute and on Medicaid.



JOHN LOK / THE SEATTLE TIMES

The safety of methadone will be on the agenda — again — when the Washington Pharmacy
and Therapeutics Committee meets later this month. Above, the committee, which has huge
influence over patient care, meets in SeaTac in October.

Her pain made walking unbear- has a respiratory disorder. Burrell
able. She gained weight. Her did. State guidelines warn against
eyesight dimmed. She spent long giving methadone to someone also
hours in bed, reading Patricia Corn- receiving other long-acting painkill-
well crime novels, anguishing over ers. Burrell was.
her lost prospects of ever becoming In early 2008 Dr. Anna Samson
a sheriff’s deputy. doubled Burrell’s methadone dose
The Roosevelt Clinic at the Uni- to 10 milligrams every six hours,
versity of Washington Medical according to her medical notes.
Center prescribed drugs for her Samson’s notes also said she would
pain, insomnia, nausea, depression be tapering Burrell off oxycodone,
and anxiety, according to medical a more expensive painkiller that
records Burrell’s family provided to she began taking while on private
The Times. insurance. But in the meantime
“I was so scared about what all Burrell remained on both.
the pills were doing to her,” Taylor Samson’s notes made no men-
says. tion of Burrell’s sleep apnea
One of those drugs was metha- — involuntary pauses in breathing.
done. Methadone can compound apnea’s
Federal regulators say it can be effects; federal regulators have tied
dangerous to give methadone to combining the two to hundreds of
someone on anti-anxiety medica- preventable deaths.
tions. Burrell was. They say metha- But Samson’s notes did mention
done can disrupt breathing and the dangers of Burrell’s pharma-
heart beat, especially if a patient cological mix: “I advised her that



combinations of these medications
can depress her respiratory rate
and cause her to stop breathing.”
Samson’s notes were dated Feb.
13, 2008.
Two days later, Burrell was found
in a nightshirt, slumped on her bed,
arms dangling with open hands.
She had stopped breathing, her
respiratory muscles paralyzed with
stunning speed.
The King County Medical Exam-
iner’s Office found methadone and
three other prescription drugs in
her body, consumed at normal
doses. The medications had com-
bined into a toxic cocktail. The case
was ruled an unintended death.
University hospital officials
reviewed Burrell’s case and con-
cluded her care was “appropriate,”
according to a written statement to
The Times.
At age 32, Angeline Burrell
became another dot on the map.
The origins of Washington Rx most important decisions get made
not by legislators on the House or
Starting a decade ago, states
Senate floor, but by easy-to-miss
discovered a new way to save
committees meeting in mundane
money on prescription-drug costs,
places. That’s the case with Wash-
which were increasing about 17
ington’s Pharmacy and Therapeu-
percent a year. All but four created
tics Committee — or P&T com-
a Preferred Drug List, a register of
mittee, for short — a group with
medications the state will pay for
enormous influence over patient
in cases where it covers a patient’s
care.
care.
Under Washington Rx, a P&T
The goal is to steer patients
committee comprising doctors,
toward less expensive drugs with-
pharmacists and other medical
out sacrificing safety; plus, by
experts evaluates drugs in various
consolidating purchases, states can
classes, weeding out any found to
often negotiate better deals with
be less safe or effective. After that
drug companies.
initial cut the state draws up its list,
Washington’s list took effect in
taking into account cost.
2004, the year after Gov. Gary
No state officials sit on the com-
Locke signed the state’s new pre-
mittee, an arrangement designed to
scription-drug program, Washing-
protect the panel’s independence.
ton Rx, into law.
But the committee’s members
Often, in state government, the
are hand-picked by the three state



Dr. Jeff Thompson,
chief medical officer
of the state Medic-
aid program, has
defended methadone
during meetings of
the state committee
that evaluates drugs.
MIKE SIEGEL / THE SEATTLE TIMES

agencies or programs with a finan- Committee meets: 2004-05
cial stake in the panel’s winnow- To Dr. Stuart Rosenblum, a pain
ing process: Medicaid; Labor & specialist in Portland, what he
Industries, which handles workers’ had to say was worth the six-hour
compensation; and the Health Care round trip.
Authority, which administers medi- In June 2004, Rosenblum drove
cal benefits for state employees. to the Holiday Inn SeaTac and told
Though not committee members, Washington’s P&T committee that
officials from these three entities Oregon had seen a 400 percent
attend committee meetings and increase in deaths associated with
often dominate discussions. With methadone. He advised the commit-
methadone, two doctors in particu- tee to exclude the painkiller from
lar — Jeff Thompson, chief medical Washington’s preferred drug list.
officer of the Washington Medicaid “Virtually no response,” he says of
program, and Gary Franklin, medi- the reaction. “It was like, ‘Thanks
cal director for L&I — have repeat- for testifying.’ ”
edly deflected concerns about the The committee ruled that metha-
drug, a review of meeting tran- done was as “safe and effective” as
scripts shows. any other painkiller, allowing the
In May 2004, when Washington’s state to keep it as a preferred drug.
preferred drug list for long-acting In June 2005, at the Radisson
painkillers took effect, only two Hotel near SeaTac, Oregon’s meth-
drugs were included: morphine adone deaths came up again. One
and methadone. member of the P&T committee, Dr.
Across the country, 31 states have Carol Cordy, asked the right ques-
methadone on their preferred list. tion: “And does Washington have
But most offer a broad inventory of numbers like Oregon?”
other pain medications, expanding But Jeff Thompson, of Washing-
the options available to physicians, ton Medicaid, sidestepped it. He
according to a Times survey of talked about measures the state
these formularies. was taking to address overdoses
for painkillers in general — “We’re



doing a lot. ... In my mind, I think poisonings linked to methadone.
it’s working” — but provided no They included a 30-year-old nurs-
numbers for methadone-related ing assistant from Spokane, a
deaths. 43-year-old waitress from Puyal-
One committee member seemed lup and a 44-year-old welder from
to think Washington had nothing to Vancouver.
worry about, saying: “I know with The day after the committee met,
methadone we don’t really encour- a 38-year-old database special-
age it as a preferred drug.” Citing ist from Shelton who was on both
“issues” with doctors not knowing methadone and antidepressants
how to use methadone, she claimed overdosed and died.
physicians were directed to mor-
phine instead. A methadone primer:
Another member wondered if any cheap but complex
effort was being made to look at For decades, methadone — a
Washington’s methadone overdose synthetic opioid developed in the
rate. But then he dismissed the 1930s by a German company —
thought: “Sounds like in our state, was associated not with pain relief
methadone’s just not used much. ... but with weaning addicts off heroin
So it may be just a moot point.” and other drugs. The word sum-
In fact, the point was anything moned an image of clinics, often in
but moot. Washington’s problems seedy parts of town.
with methadone weren’t minor But when the medical communi-
compared to Oregon’s. Washing- ty’s philosophy on pain shifted, so
ton’s were much worse. did its take on methadone.
In 2004, the amount of metha- As recently as the mid-1990s,
done used in Washington had Washington discouraged doctors
soared to about 224,000 grams. from prescribing narcotic painkill-
Oregon, meanwhile, used about ers to noncancer patients. Pain
157,000 grams. was considered a symptom, not
While Oregon’s methadone-asso- an ailment. But in the late ’90s, as
ciated deaths leveled off in 2002, patients protested, the health-care
Washington’s became a dramatic system switched course, viewing
fever chart, shooting up. Deaths untreated pain as unnecessary
linked to methadone went from suffering. By 2001, the nation’s
140 in 2002, to 166 in 2003, to top hospital-accreditation agency
256 in 2004, according to a Times mandated treatment of pain.
analysis of death certificates. Ore- In this new environment, metha-
gon, by comparison, had 99 deaths done emerged as an attractive
in 2004. option. Less than a dollar a dose,
Washington’s deaths were among the drug was three to four times
the highest in the country — sur- cheaper than its closest competitor
passed, in 2004, by only North and 12 times cheaper than brand-
Carolina and Florida, both more name OxyContin.
populous states. From 1999 to 2005, the use of
In May 2005, the month before methadone in the United States
the meeting at the Radisson, 28 went from 965,000 grams to 5.4
people in Washington died from million grams, according to the



U.S. Drug Enforcement Administra-
tion.
But then there are the drug’s com-
Methadone: What patients
plicating factors. need to know
While the pain relief from metha-
done might last four to eight hours, Methadone can be more difficult to
the drug’s half-life can extend for manage than other drugs. Experts say
days. Various studies have placed it’s important to tell your health-care
the high end at 59 hours, or 91 provider and pharmacist about all
hours, or even 128 hours. That drugs you are taking, including vita-
means the drug’s dangers — main- mins.
ly, its effect on the respiratory
system — last long after its benefits • Methadone can slow your breathing
have worn off. A patient in pain even long after the drug’s pain-relief
might be tempted to take another effect wears off. Never take more
pill without being aware of the methadone than your doctor has pre-
toxic buildup. scribed. Death can occur if breathing
Most prescription drugs harbor becomes too weak.
risks when mixed with alcohol or
other medications. Methadone can • Drinking alcohol while taking meth-
be particularly hazardous when adone can cause serious side effects,
combined with drugs called ben- even death.
zodiazepines, used to treat anxiety
disorders. • Without your doctor’s approval,
Patients struggling with pain don’t take methadone with other nar-
often become depressed or anxious, cotic painkillers, sedatives, tranquiliz-
doctors say, making this risk factor ers, or any medicines that slow breath-
a critical one. For 2009, The Times ing or make you sleepy.
documented 274 methadone-relat-
ed deaths in Washington. Death • Methadone may not be the right
certificates show that 119 patients, drug for you if you have certain medi-
or 43 percent, also consumed pre- cal conditions. Let your doctor know
scription medications for anxiety or first if you have asthma; sleep apnea;
other mental-health disorders. other breathing disorders; diseases
In its regulation of addiction of the liver, kidneys or gallbladder;
clinics, the federal government has underactive thyroid; a history of head
long recognized methadone’s dan- injury or brain tumor; seizure disor-
gers. Under the mantra “start low, ders; low blood pressure; adrenal-
go slow,” federal law requires tight gland disorders; enlarged prostate; or
controls. Addicts, for example, must mental illness.
visit the clinic daily at the begin-
ning of treatment. That’s because If you have questions, contact the state
the drug’s effects on individuals can Department of Health’s Customer Ser-
vary dramatically. vice Call Center at 360-236-4700
But with pain patients, many doc- or painmanagement@doh.wa.gov.
tors prescribe a month’s worth of
methadone, with little or no follow-
up.



As the use of methadone has
climbed, so have the overdoses.
From 1999 to 2005, methadone-
associated deaths in the United
States climbed from 786 to 4,462,
according to the Centers for Dis-
ease Control and Prevention.
Of course, not all those deaths
can be attributed to prescribing
practices. Some overdose victims
obtain methadone without a pre-
scription or combine it with illegal
drugs such as cocaine. The Times
found that up to 20 percent of
methadone-related deaths in Wash-
ington involved a combination
with illicit substances, suggesting
the overdoses were a byproduct of
abuse.
In November 2006, the U.S. Food
and Drug Administration sounded
an alarm about methadone, fol-
lowing an investigative report in
a West Virginia newspaper, The
Charleston Gazette. The FDA
lowered its dosage guideline for
methadone and issued a public-
health advisory with this headline:
“Methadone Use for Pain Control
May Result in Death and Life-
Threatening Changes in Breathing
and Heart Beat.”
Committee meets: 2006
Once again, committee member
Carol Cordy asked the right ques-
tion. Gary Franklin, L&I’s medical
When the P&T committee met director, cited a study of workers’
in December 2006 at the Seattle compensation recipients that found
Airport Marriott, it had been three 32 overdose deaths between 1995
weeks since the FDA issued its and 2002. “They were half metha-
methadone alert. Cordy, a family done and half oxycodone,” Franklin
physician in Seattle, brought up said.
methadone and morphine — the But those numbers didn’t answer
state’s choices as preferred painkill- Cordy’s question. The L&I study
ers — and asked: “Has there been applied only to a small popula-
any increase in accidental over- tion. More important, its time span
doses?” preceded the start of Washington’s
preferred drug list. “No,” Cordy



said. She wanted to know about ferred drug list with the long-acting
any increase after 2003. opioids, OxyContin represented 70
“Yeah, I guess we haven’t looked percent of our utilization. Today ...
at that,” Franklin said. He kicked we’re down to less than 3 percent.”
the question to L&I’s pharmacy Washington’s death toll from
manager, who talked up the chal- methadone was soaring. But the
lenges of doing such analysis, state was realizing its goal of mov-
saying death certificates often list ing people off more expensive
more than one drug: “So it’s kind painkillers.
of hard to divvy out, you know, the
particular.” ‘Very little data’
Cordy’s question was not an In evaluating drugs for safety and
impossible one to answer. The state effectiveness, the P&T committee is
Department of Health analyzes required to rely on the best avail-
death certificates and reaches con- able science. To find it, the state
clusions even when multiple drugs hired Oregon Health & Science
are listed. The Times did the same University, a teaching hospital and
and found these numbers: In 2003, research center based in Portland.
the year before the preferred drug The OHSU researchers collect and
list took effect, the state recorded analyze medical studies, looking
166 deaths linked to methadone; for the best clinical trials, ones that
by 2006, that number had more compare drugs head-to-head and
than doubled, to 342. are randomized, controlled and of
Just as telling, those 342 deaths long duration.
were three times the number In the case of long-acting opioids,
attributed to any other long-acting however, researchers have had only
painkiller. a few studies of poor or fair quality
Cordy wasn’t the first to question to consider.
methadone in 2006. A doctor from At a P&T committee meeting in
the Seattle Cancer Care Alliance, 2005, Dr. Roger Chou of OHSU
Dermot Fitzgibbon, appeared at a told members there is “a continued
P&T committee meeting that sum- lack of good study on methadone.”
mer and urged the state to offer In 2006 he said, “There’s no evi-
more choices than methadone and dence that one long-acting opioid
morphine, calling methadone “par- is superior to others,” to which the
ticularly problematic.” But Wash- committee’s vice chair said, “Thank
ington refused to change course. you, Roger, that was excellent.” In
At the end of the December 2006 2008 Chou said, “We really have
meeting, Siri Childs, pharmacy very little data on methadone’s
administrator for Washington Med- use.”
icaid, told the committee what she In the absence of top-notch
called a “good story.” clinical trials, Washington officials
“Do you all want me to tell you adopted the position that metha-
how many OxyContin users we done is just as safe and effective as
have in Washington nowadays?” other drugs in its class.
“Sure,” came the answer. Franklin, the L&I medical direc-
“You’re going to be just amazed, tor, told The Times that “if it wasn’t
because when we started the pre- methadone killing people” in



Washington, it would be another despite its low cost. North Carolina,
long-acting painkiller — oxycodone like Washington, has consistently
or fentanyl or something else. He ranked among the top five states
said prescribers and patients have in methadone-associated deaths.
become too quick to turn to long- When North Carolina adopted its
acting painkillers in general, a first preferred drug list last year,
shift fueled by “weak science” and the state rejected methadone.
support from the pharmaceutical North Carolina had analyzed
industry. the drug’s toll and did not want to
“The overall problem — the pub- “encourage its use,” said Dr. Lisa
lic-health emergency in this coun- Weeks, chairwoman of the state’s
try — is a dosing problem,” Frank- Preferred Drug List Review Panel.
lin said. “It is not a methadone
problem.” Committee meets: 2009
Thompson, the Medicaid chief “Quite frankly, I’m at a loss of
medical officer, said: “If you’re what to do,” Thompson told the
looking for a single villain, you committee at its February 2009
could make methadone that villain. meeting.
But I think it’s more complex than His consternation traced to a
that.” recent Department of Health study
Methadone, he said, “is a safe that produced some alarming num-
drug if used correctly. ... If it’s an bers about Medicaid.
unsafe drug, why have we been Analyzing all prescription-opioid
using it for 40 years?” fatalities in Washington from 2004
For Washington, the preferred to 2007, department researchers
drug list has yielded financial discovered that a stunning 64 per-
rewards. In fiscal year 2008, the cent involved methadone.
Medicaid program’s estimated sav- And of the people whose deaths
ings came to $45.5 million, accord- were linked to methadone, 48 per-
ing to an audit by the state’s Joint cent were on Medicaid.
Legislative Audit & Review Com- The findings highlighted meth-
mittee. Looking only at long-acting adone’s “prominence” in opioid
opioids — the class with methadone overdoses, the Health Department
— that year’s savings amounted to study said, and indicated “the Med-
$3 million. icaid population is at high risk.”
Some other states, meanwhile, “I think this is a distinction that
have treated methadone’s mortality we don’t want, and it just keeps
figures and complex properties as growing,” Thompson said of the
sufficient grounds to urge caution. Medicaid population’s dispropor-
New York issued a health advi- tionate share of the state’s prescrip-
sory in January 2009 about tion-drug deaths.
methadone’s dangers. Five months In medical circles, the depart-
later, Oregon alerted doctors that ment’s findings about methadone
methadone’s “safety is of increasing and Medicaid broke new ground. In
concern,” and the drug “should not the fall of 2009, the Centers for Dis-
be considered a first-line agent.” ease Control and Prevention — the
Fifteen states have left metha- federal agency assigned to protect
done off their preferred drug lists, public health — published the



study in its Morbidity and Mortality potent painkillers.
Weekly Report. One of the state’s broadest ini-
But in Washington, state officials tiatives to save lives, Thompson
have done little to spread the word. said, is a “lock-out” program that
When the P&T committee met in requires about 3,800 Medicaid
December 2009, Bill Struyk, a phar- patients to use only one practitio-
maceutical representative, brought ner for prescriptions in order to
up “Generic News,” a newsletter avoid “doctor shopping.”
produced by state Medicaid officials
for health-care professionals. He ‘Elephant in the room’
said the newsletter told only half In December 2010, Dr. Michael
the story of methadone: Officials Schiesser, a pain specialist in Bel-
publicized how cheap it was, with- levue, wrote a letter to the P&T
out saying how many deaths it was committee, retracing the state’s
linked to. history with methadone and crying
“Without disclosure of that fact, foul.
are we making informed deci- When it comes to
sions?” Struyk asked. methadone, Schiesser
Thompson jumped to metha- is the closest thing
done’s defense, pointing to other the state has to a
drugs — for example, ones used whistle-blower. Three
in mental-health treatment — also years ago he joined a
linked to fatal overdoses. The state Dr. Michael
Health Department
should be “very careful” about Schiesser, a work group on acci-
“picking on a drug,” he said. Bellevue pain dental poisonings.
“If you look at the dangers, it’s specialist After that he became
not just methadone,” Thompson involved in legislative
said. deliberations about pain manage-
How about a note, Struyk sug- ment.
gested, advising methadone pre- He reviewed transcripts of P&T
scribers to be cautious? committee meetings and swept
“It’s not only due just to metha- up reports about methadone. The
done,” Thompson said. more research he did, the more
“No,” Struyk said. “But 64 percent troubled he became.
are.” Schiesser uses the word “creep”
Thompson said he would include to describe methadone’s grip on
methadone’s toll in a future news- Washington. As more years passed
letter. “Because it is important,” he with the P&T committee saying the
said. But he never did. drug was as safe as any other, the
Alarmed by the Health Depart- harder it became for the state to
ment study, state officials launched reverse course or hedge by issu-
an internal monitoring program to ing special alerts to physicians of
track practitioners who prescribe potential complications with meth-
high volumes of narcotics to Med- adone.
icaid patients, Thompson told The “So you start to ignore the ele-
Times. In addition, the state now phant in the room, which is the
educates hundreds of Medicaid mounting evidence,” Schiesser
patients on the risks and use of says.



His letter challenged a 2008 ity has allowed the state to keep
report that Oregon Health & Sci- saying there’s no evidence of meth-
ence University provided to the adone being especially risky — and
committee, saying it “contains to the state, no news is good news.
errors, deficient logic, and relevant He describes the result as: “Because
omissions.” we don’t know, therefore it ain’t
The report said one study “found so.”
no differences” between metha- In Washington, medications can
done and other drugs for overdose go on and off the Preferred Drug
risk, when, in fact, the opposite List as more evidence develops.
was true, Schiesser wrote. The The P&T committee meets later
report mentioned a “black-box this month, when its members will
warning” from the FDA about evaluate — once again — the safety
OxyContin but not one from the of methadone.
same agency about methadone, he
wrote. Database reporter Justin Mayo and news
In a written reply, an OHSU doc- researchers David Turim and Gene Balk
tor downplayed Schiesser’s points, contributed to this report.
saying, for example, that FDA Michael J. Berens: 206-464-2288
black-box warnings are “not evi- or mberens@seattletimes.com;
dence.” Ken Armstrong: 206-464-3730
To Schiesser, such hyper-selectiv- or karmstrong@seattletimes.com.


Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens

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Methadone and the Politics of Pain: A Pulitzer-winning series by Michael J. Berens