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State investigating Baltimore methadone clinic after man's death

The day after her ex-husband's funeral in January, Sabrina Lumpkin started calling every public official she could think of, trying to get someone to pay attention.

Warren Lumpkin, 34, had died in a Southwest Baltimore house of heart complications related to using methadone, the prescription drug typically used to treat heroin addiction, according to an autopsy from the state medical examiner. But Sabrina Lumpkin said he had no such prescription — he took his roommate's methadone the night before he died.

The state health department, which regulates methadone clinics, has confirmed it is investigating Pine Heights Treatment Center, the Baltimore methadone clinic Sabrina Lumpkin named when she filed a formal complaint. Lumpkin said in the complaint that her ex-husband's roommate was a patient of the clinic. State officials said their investigation was triggered by a complaint from the public but declined to confirm it was Sabrina Lumpkin's or provide further details.

Debi Deutsch-Rios, regional director of Pine Heights and other CRC outpatient clinics in the Northeast, said she had no comment and referred all questions to CRC's corporate offices. CRC Health Group, which owns Pine Heights and runs clinics in Elkton and Cumberland, has many safeguards against patient misuse of methadone, CRC spokeswoman Kristen Hayes said in an email.

Patients must be approved for take-home medication by federal and state regulators, are given lockboxes to protect the methadone, and take-home privileges are suspended for a patient suspected of misusing the drug, she said. It is the company's policy not to discuss a specific patient's situation, she added.

Warren Lumpkin's death comes as national public health experts are highlighting a rise in methadone overdose deaths, which officials say were six times higher in 2009 than a decade earlier, according to the Centers for Disease Control and Prevention.

The jump in deaths largely followed increased use of the drug as a painkiller — with more than 4 million methadone prescriptions written for pain in 2009 nationally — despite warnings of associated risks, according to the CDC.

For those addicted to heroin or other opiates, methadone has become a well-established way to overcome addiction without the painful symptoms of opiate withdrawal. It's also highly regulated because of the potential for misuse and the ease of overdose.

"Everyone that I knew growing up and went to school with is in this program," Sabrina Lumpkin said, referring to methadone management for addiction. "This drug has consumed these neighborhoods."

Warren Lumpkin had dabbled in heroin and petty crime before, according to Sabrina Lumpkin and his criminal record, which includes charges for theft, assault, and selling and possessing drugs. But he had been clean since last summer, Sabrina Lumpkin said, and she had begun allowing him to come over to see their two children again.

Warren Lumpkin was staying most days with a woman who lived close to his job as a forklift operator at a warehouse in Halethorpe. According to the complaint Sabrina Lumpkin filed with state health officials, he got the methadone from his roommate, Kimberly O'Connor, who found him unresponsive the next day.

O'Connor said she was on the medication but hadn't given any to Lumpkin, whom she described as her "best friend."

She said that when she left the home that morning, Lumpkin was fine. When she returned, "he was gone." O'Connor said she is trained in CPR and started trying to save him while paramedics responded.

Sabrina Lumpkin said she tracked down the clinic where O'Connor was a patient, Pine Heights Treatment Center on Wilkens Avenue, and told a manager what happened.

Hayes, the CRC spokeswoman, said the company supports prosecution of people who illegally traffic and redistribute their medication. Methadone is a controlled substance, as are other prescription opiates.

"Fortunately, medication-assisted treatment is one of the most regulated health care delivery systems in the country," Hayes said.

Take-home methadone is regulated by both federal and state guidelines, said Lisa Hadley, clinical director for the Alcohol and Drug Abuse Administration under the state health department.

A patient is supposed to get methadone daily from a clinic, and is allowed take-home doses after an initial period, with the length of time they have between required clinic visits becoming longer over time and with proper use. Clinics must randomly check the take-home doses by calling patients to come in and verifying that the proper amount is being taken.

"With a medication like methadone, diversion is always a concern," Hadley said. "It's one of the things that we monitor for in our programs very closely."

On average, three or fewer patients died annually of overdoses in methadone programs in Maryland in recent years, Hadley said.

But the number of methadone-related deaths — in a program or not — was far higher, and has been rising in recent years. The Baltimore region logged 125 deaths — including 63 in the city — related to methadone in 2011, up from 95 in the region in 2009. Statewide, there were 168 methadone-related deaths in 2011, the latest year for which data is available from the state health department.

Health officials believe this mirrors a national trend of increasing deaths from prescription opiates in general.

If someone dies from taking methadone that was not prescribed to them, the provider is required to report that to the state health department, Hadley said. The state agency doesn't report to law enforcement complaints about patients selling or giving away methadone prescribed to them. However, clinic operators may and sometimes do alert police to instances of misused drugs, state health officials said.

More than 30 percent of prescription painkiller deaths nationwide involve methadone, even though the drug only accounts for 2 percent of all painkiller prescriptions, according to the Centers for Disease Control.

Methadone can be risky because its effectiveness can quickly wear off, though the drug can still linger in the body, making overdoses more likely, according to the CDC. For those without a tolerance to opiates, a small dose can be deadly.

The CDC also warns that methadone is increasingly being prescribed as a painkiller because it is cheaper than oxycodone, though not as effective.

A panel of experts convened on the topic in 2010 by the federal Substance Abuse and Mental Health Services Administration called the abuse of methadone and the overdose deaths "a significant public health concern" in a report on the topic. However, federal officials say most of the rise in overdose deaths is a result of doctors overprescribing the drug for pain, not from methadone clinics using it for addiction treatment.

State health officials have investigated the Pine Heights clinic before, according to records. In 2009, the clinic shut down because of "inclement weather" and did not inform patients. The health department told the clinic it is required by law to make those notifications and ordered the clinic to submit a plan to ensure that did not happen again.

State officials also looked into a complaint from a resident of the neighborhood who said too many people loitered outside the building, creating a disturbance. The clinic told state health officials it would hire a security guard.

CRC Health Group, the Cupertino, Calif.-based company that runs the Pine Heights center, is the largest provider of methadone treatment in the country. In recent years, it has been sanctioned by regulators in a couple of states in cases involving deaths of patients.

The company has denied that there are "broad deficiencies" in its practices.

Legislation pending in several other states would increase oversight of methadone clinics, with requirements that clinics keep a certain ratio of counselors to patients, or report to state officials how many take-home methadone doses are prescribed. Many states — including West Virginia and Pennsylvania — have passed measures in recent years to further regulate the use of methadone, particularly for pain, following increases in overdose deaths.

Sabrina Lumpkin is awaiting the results of Maryland's investigation and hopes her ex-husband's death will shed light into what she believes is rampant methadone misuse in Baltimore.

Though the couple divorced several years ago, she said they remained close.

"He still loved me to this day — he would always tell me that," she said. "He was into so much stuff that I wasn't into, and I think I grew up and he didn't want to."

Baltimore Sun reporter Kevin Rector contributed to this article.

cwells@baltsun.com

Copyright © 2014, The Baltimore Sun
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