The drug grew in popularity after the Oregon Health Plan approved it for pain because it was less expensive than other pain meds

Treating pain is one of the most difficult challenges in any physician’s practice because pain defies measurement.

Anesthesiologist Dr. Erich Weber uses a simple diagram to explain pain management. He writes "despair" toward the bottom of a sheet of paper, "normal" in the middle and "euphoria" toward the top.

"People in chronic pain are down here," he says, pointing his pen to "despair."

"We’re not trying to make them feel good," he says, raising his pen toward the center of page. "We’re just trying to make them feel normal."

Weber helped pioneer the use of methadone locally in the early 1990s when physicians were looking for a drug that was effective, inexpensive and long-acting.

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Methadone filled the bill.

Cost is still an important factor because many people in Southern Oregon lack health insurance. Methadone costs barely 10 to 15 percent of drugs such as OxyContin, the trade name for oxycodone hydrochloride, one of the most popular time-release pain medicines.

Cost concerns also prompted the Oregon Health Plan to choose methadone as an approved pain medicine. OHP’s decision to use methadone helped fuel a dramatic rise in consumption locally, says neurosurgeon Dr. Paul Amstutz.

"We didn’t use methadone much in this business until OHP decided it was the only long-acting (pain) medicine they’d pay for," says Amstutz.

Methadone use in Southern Oregon grew more than three-fold between 2001 and 2003, according to data compiled by the federal Drug Enforcement Administration. In January 2001, Jackson and Josephine county pharmacies sold about 1,000 grams of methadone per month. By midsummer 2003, they were selling 3,500 grams a month.

Physicians typically try other treatments before prescribing narcotics such as methadone because patients eventually will become dependent on the drugs.

"Narcotics are basically the last step," Weber says.

Patients who take opiates also must learn to live with side effects such as chronic constipation, loss of appetite, anxiety, depression, irritable mood and drowsiness.

"They’re not drugs most people would want to take," says Duane Martin of Phoenix, who takes methadone for pain relief from hepatitis C.

On a scale of 1 to 10, Martin rates his pain without methadone around 7 or 8. "I’d be in a sad state of affairs if I couldn’t have it," he says. "I couldn’t afford anything else that’s out there."

Reach reporter Bill Kettler at 776-4492, or e-mail bkettler@mailtribune.com