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.

And with the explosion in prescription opiate use and abuse, the number of Utahns standing in the methadone lines is on the rise.

Ten months ago, the state's top official over methadone use reported 2,500 methadone users; today there are 200 more. A few years ago, there were only a few clinics in Utah. Today there are 10.

When Walton started at Discovery House eight years ago, the company had 65 patients and one clinic.

"Now we have three clinics and 600 patients combined," said Walton. "Part of that is our good business practices, but we are also seeing kids younger and younger getting into opiate dependency."

Constant scrutiny

It is a delicate, complicated phenomenon these methadone doctors and treatment providers are trying to address.

Proponents of the drug, which has been around for nearly 40 years, say it helps stabilize an addict's life — helps him or her focus on job skills, counseling, relationships and responsibilities.

"When all of that's resolved," said Joel Millard, director of Project Reality, "that's the time to talk about tapering someone off methadone."

The philosophy at Project Reality is to use a closely supervised system of methadone and counseling to change the behavior that led to the drug addiction in the first place. The staff uses it to facilitate "emotional management." Say an opiate addict comes in for counseling. "They know they are going to be in withdrawal in a few hours," Millard said. "We are trying to talk to them about positive life changes and the 12 steps, and they are worrying about the withdrawal that is coming."

As medical director for Discovery House, Walton has watched the uptick in methadone treatment as OxyContin use has skyrocketed.

Methadone treatment has sustained much scrutiny in 40 years as the premier intervention for opiate addiction. But methadone remains a relatively inexpensive, long-lasting, predictable treatment. Still, some say methadone maintenance is substituting one addiction for another, and a recent wave of methadone overdoses — most of which resulted from doctors prescribing the drug as a painkiller — have intensified the scrutiny.

A new alternative

When "Dave" was in his late 20s, he was working in construction, had a family and also a heroin drug habit. He was working in construction when a propane tank exploded in his hand. He was burned over 60 percent of his body. His long history with drug abuse started about then.