Every day before dawn, men and women line up in front of a building at 150 East and 700 South in Salt Lake City to get a daily dose of methadone to stave off the excruciating symptoms of opiate drug withdrawal.

Throughout the state, 2,700 people queue up like this every day for the drug that is part of treatment for addiction to OxyContin, heroin, Lortab, codeine or morphine. Each is registered with a substance-abuse treatment clinic approved to dispense methadone, such as Project Reality in downtown Salt Lake City.

Nearly 500 people will go through the line on this particular day. All over the state, the number of people using methadone is on the rise — a factor causing some state officials and treatment providers to take a hard look at the conditions under which Utahns use the powerful drug.

"I am concerned about these issues," says Victoria Delheimer, the methadone expert within the Utah Division of Substance Abuse and Mental Health.

"We are committed to the very highest standard of care, and we may have some work to do to get there."

Those approved to get methadone to help with opiate withdrawal are a very different group from those whose doctors prescribe methadone for pain relief. They must go to a special facility to get the drug. Each will check into a system regulated closely by the federal Drug Enforcement Agency. Each will pay an average $11 and get a plastic cupful of clear liquid methadone with a bitter, nasty taste that most dilute with Kool-Aid to get down.

Most do so happily.

Without methadone — which is not to be confused with the illegal drug methamphetamine — each of them faces the intensity of an opiate withdrawal, which people say ranges from "hell on earth" to "the worst flu you've ever had."

Symptoms include shaking, sweats, chills, diarrhea and aching so bad one man said it felt like someone was pulling his bones apart. This goes on for about a week. The fact is, say treatment experts and addicts, most just won't do it. They'll stay on the drugs, keep stealing or forging prescriptions to get them, stay high, keep drugging.

The use of methadone aims to stop that cycle.

The abuse explosion

"Methadone has been a wonderful medication," says Dr. Charles Walton, medical director for Discovery House, which dispenses the drug. "It still is. It's saved thousands of lives. I wish we could get rid of the public perception of it."

At the ideal dose, methadone will suppress withdrawal for 24-36 hours. It doesn't make a user feel high, just normal and able to fix their attention on recovery.

Of the people waiting in line at Project Reality, some are trying to taper off the methadone and some will be on it the rest of their lives. Some will try to kick their addiction too fast, and studies show they will end up back in the drug world.