They watched "Everybody Loves Raymond," then he fell asleep and she went to bed. In the morning, Shannon McQuade discovered her bright and funny young husband dead on the couch.

Rob Lake's autopsy found a combination of medications: Lortab, Xanax, Wellbutrin and an antibiotic. The Xanax was for a long-standing problem with anxiety, the Wellbutrin was for depression, and the antibiotic and the Lortab were for an abscessed tooth pulled a few days earlier.

"Non-illicit drug poisoning death" is the way his passing will find its way into Utah's statistics — one more number to add to the state's growing list of deaths caused by prescription pain medications.

It only takes a glance at the Utah Department of Health's graphs of drug deaths to see what's happening: While suicides from prescription medications have been pretty much steady in the past 15 years, the line representing "unintentional or undetermined" prescription drug deaths has been going straight uphill since 1999. The number of those deaths also eclipses deaths from illicit street drugs.

"The number of prescription drug deaths has exploded, up over 1,400 percent since 1999," says Dr. Todd Grey, the state medical examiner. In 2005 there were 268 prescription drug deaths, more than during the years 1991 through 1998 combined. That's one death every 32 hours, the majority of them involving pain medications.

"It's an epidemic. And each death is a little island," Grey says. Although the increases have alarmed health experts, "the community is not making the connection."

While some of these deaths occurred in healthy young people just looking for a high, victims increasingly are what Grey describes as middle-aged adults with a history of chronic pain. They are often patients under a doctor's care with a legal prescription for drugs that end up killing them. They're divided nearly evenly between men and women, dotted across Utah's smallest towns and biggest cities. Often the victims are overweight.

The drugs that kill them include pain relief staples such as hydrocodone, fentanyl and oxycodone. And, increasingly, methadone. For both 2004 and 2005, says a state epidemiologist, Christy Porucznik, Ph.D., methadone was the one drug most often associated with a fatal overdose.

"Patients do not appreciate the power and potential lethality of these drugs," says local pain management physician Dr. Lynn Webster. "Too often patients use pain medication as if it is aspirin or ibuprofen — if one pill helps a little, then two must help a lot."

Educating the public