The answer is D. It turns out that methadone -- a potent, prescribed pain-reliever -- is responsible for more overdose deaths in Spokane County than the other three illicit drugs combined.
Police and medical examiners say it is nearly impossible to pull a clear number from the death reports, except to say methadone shows up as a factor in more autopsies than other drugs.
Methadone kills people because it is a hard-core opiate/sedative that, in excess, dangerously slows blood flow, heart rate and breathing. Essentially, victims lose consciousness and suffocate. A hit stays in the body three or four times longer than other opiates, such as oxycodone, and unsupervised users tend to take too much, leading to overdose.
"The absolute classic pattern," says Spokane major crimes Det. Mark Burbridge, is that the victim of a methadone overdose conks out. Friends or family members are awakened "by ungodly snoring. They try to wake the person up. Can't. Decide to let the person 'sleep it off,' and in the morning the person's dead."
Patrol officers, Burbridge says, have been trained to recognize signs of methadone overdose when they attend to calls about intoxicated or unresponsive persons.
This alone shows that methadone - used illegally by people who are "self-medicating" to try and kick pain or other opiate addictions, or by the party crowd - has reached dangerous levels, cops and doctors say.
"This is not the kind of thing people should try at home," says Spokane County Medical Examiner Dr. Sally Aiken. "Because it's a prescription drug, there is a misunderstanding that somehow [it's] safe." Reactions vary widely; a doctor needs to monitor dosage.
Or there is the outdated perception that since methadone helps heroin addicts quit, it must be a "good" drug. Methadone simply creates a longer-lasting "nod," so junkies don't need to shoot up several times a day, thus reducing associated crime and health risks and allowing enough stability for someone to have a better chance to kick an addiction.
Aiken, as the region's forensic medical examiner, gets a front-row seat to area drug trends because she dissects dead people. Aiken and her staff perform more than 400 autopsies a year.
"When I first came here," Aiken says, "heroin caused a lot of overdose deaths, with or without cocaine. Now the majority of ODs are from prescription drugs."
Especially methadone. It was rarely observed during autopsies just a few years ago, but lately is present in "four to six autopsies every month," Aiken says. "That doesn't mean it was the cause of death ... but that it was present in the toxicology report. This year I've seen heroin in one tox report, and it had nothing whatsoever to do with the death."
The level of recreational methadone use and overdose has placed Spokane among the state leaders, behind King County but ahead of Pierce and Snohomish, Aiken says.
There are at least two methadone overdose deaths in Spokane this year, each involving a high school student who obtained the drug from friends. Spokane Police have filed (the rarely used) controlled-substance homicide charges in each case. "We want to send the message about how dangerous this is," Det. John Miller says.
Two years ago, methadone flooded the late-summer party scene in Spokane and Coeur d'Alene with serious consequences. In North Idaho alone that September, three teenage boys died of methadone overdoses. None of the boys knew each other.
Spokane city police made 17 arrests for illegal possession of methadone that year, up from five in 2003. The medical examiner found traces of methadone in 48 autopsies (out of 436), more than double the '03 number.
Det. Terry Morgan of the Idaho State Police inherited the North Idaho OD investigation and began trying to backtrack the history of 5,000 hits of methadone that were found in the apartment of one of the dead teens. Stories began to emerge of pharmaceutical break-ins in the Seattle area and a shadowy middleman.
Leads dried up, Morgan says, when the Drug Enforcement Administration refused to share information. "DEA has been no help at all. I have been physically escorted out of their office," he says.
Pharmacy break-ins seem to be the rare "big event" that lands a large supply of methadone on the local party scene. Unscrupulous doctors are another source of supply -- two area docs have been investigated by the FBI recently -- as are people somehow acquiring another person's prescribed meds.
"I read a lot of death investigations," says Ann Marie Gordon, director of the Washington State Toxicology Lab. "I remember one where the mother gave her son methadone because he had a bad headache. I remember another where a father gave his daughter [the drug] as a present and told her to be careful. He pleaded guilty to homicide by controlled substance."