The U.S. Food and Drug Administration recently issued public health advisories about painkillers, including fentanyl and methadone. The methadone warning cited reports of "death and life-threatening adverse events such as respiratory depression and cardiac arrhythmias."

Methadone is popular with insurance companies because it's relatively cheap compared to other painkillers — "pennies on the dollar," says Webster, who believes insurers pressure doctors to choose methadone over more costly medications. "Physicians have in a sense been forced to use methadone by insurance companies, with inadequate training in knowing how to prescribe it. They think because it has been long used for heroin addiction, it's a safe drug. It is, if properly prescribed. I think insurance companies have contributed to the deaths."

Karen Lasrich of Sandy doesn't want methadone taken off the market. She knows that people in pain need something. She knows that chronic pain sufferers who can't get relief sometimes commit suicide. But the public needs to be educated, she says.

In December 2005, Lasrich's brother, Mike Kennedy, took his first and only methadone pill — and died. He was 46, had a 1-month-old baby and was in constant pain from a car accident 18 months earlier. He had been on the pain medication Vicodin, but doctors were weaning him off it in preparation for surgery. He was then prescribed methadone, although Lasrich doesn't know why.

Kennedy was suffering that day from a nasty cough, which may have made the methadone harder for his lungs to handle. At bedtime he had taken an over-the-counter cold remedy. Was it the combination that was lethal? Had he taken too much methadone for his body to handle? According to the autopsy, his sister says, the dose of methadone in his body when he died wasn't more than prescribed.

But methadone is quirky. It's impossible to tell exactly how much of the drug was taken, or when, says epidemiologist Porucznik. That's because different bodies metabolize the drug differently.

How much and why?

One of the hardest things for those trying to track prescription painkiller deaths is figuring out who had valid prescriptions (Porucznik says they can document that half did), who was rigorously following the dosing instructions and what other factors — from an asthma flare-up to a drug interaction — contributed to the death.

One of medical examiner Grey's challenges is trying to figure out intent. A body on the autopsy table can't explain what happened, can't tell him when or how much or why. Rob Lake was a newlywed who loved kids and aquariums and had a gift for making those around him laugh. For some time, he counseled youths battling addictions, and the pages of the guest book at his funeral are filled with "thanks" and "you saved my son's life," written to a man who was perfectly at home holding counseling sessions in a pet store if it made his young charges more comfortable.

A man who died, in his sleep, at age 34.

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E-mail: lois@desnews.com; jarvik@desnews.com