ACROSS West Virginia and the nation, patients consume a powerful painkiller called methadone, and an alarming number of them die.The drug ? once used mostly as a heroin substitute to help addicts wean themselves from their habit ? is increasingly prescribed for pain, sometimes because of its effectiveness, sometimes because it?s cheap.Nationally, death certificates show that 2,992 Americans were killed by the drug in 2003. But that?s a conservative count. Not every family asks for an autopsy and not every cause of death is discovered. The number of deaths has climbed, nearly quadrupling from 790 in 1999. Eighty-two percent of those fatalities were declared accidental.Reporters Scott Finn and Tara Tuckwiller found that West Virginia?s rate of accidental methadone overdose deaths in 2003 was four times the national rate. Across the country, there were 0.8 deaths per 100,000 people, while in West Virginia, there were 3.7, according to the National Center for Health Statistics.Relatives tell painful stories of young parents and spouses who took the medicine as their doctors instructed and died of it. Most West Virginia overdose victims between 2001 and 2005 had other drugs in their systems ? either prescription medications, illicit drugs or alcohol. Still, medical examiners found that 19 percent who died had only methadone in their bodies.Usual adult doses listed on the packaging and approved by the U.S. Food and Drug Administration are much too high to be safe, doctors say.Because methadone remains in the body longer than other painkillers, it is effective against debilitating, ongoing pain. But because it lingers longer, it can build up to toxic levels. A dose that provides relief for one person may be deadly to another.The FDA has been tragically slow in responding to these deaths. The agency increased warnings on the intravenous form administered in hospitals, but has not required a label change for pills ? the form people take home and administer themselves. An FDA spokeswoman said the agency feared that stronger warnings would scare off drug treatment patients. However, addicts or not, people should be well advised of their risks.FDA?s attitude on this issue does not inspire confidence. After the record 2003 deaths, the federal government convened a conference on the danger, but has acted on few recommendations. The government hired an industry-funded writer to draft the report from that effort.Methadone is an old drug, developed by Germans during World War II as a substitute for morphine. Its unintentional deadliness is well documented. Doctors and researchers around the country have recorded the mounting deaths and called for caution. North Carolina launched a public health effort to educate patients and doctors. England went through a similar problem about a decade ago.The FDA, the pharmaceutical industry and medical community must act quickly to better dispense this valuable but dangerous drug. Until they do so, patients must be wary and ask a lot of questions before consuming even one tiny, harmless-looking pill.