Stern said Smith helped his mother get to the bathroom several times during the night.
�At one point, Daniel said to me, �How come I�m so tired?� And, in hindsight, I wish that I had seen that as some sort of a signal and seen that something wasn�t right,� Stern said in the Tuesday interview.
Smith fell asleep in a chair next to his mother�s bed. Shortly after 9:30 a.m. that morning, Anna Nicole Smith woke up to find her son unresponsive. Hospital staff tried unsuccessfully to revive him.
Methadone has a unique ability to kill patients who are not used to strong painkillers, said Chris Terpening, doctor of pharmacy at West Virginia University�s Charleston Division.
�Methadone is a classic double-edged sword. It is very different from other opioid drugs, like OxyContin or morphine,� Terpening said. �It has a very long half-life, which means you don�t need to take it as frequently. The bad news is, the drug can accumulate in your system if you take too much too soon.�
Like Smith, most methadone overdose victims had more than one drug in their system at the time of their death, according to studies in West Virginia, Maine, North Carolina and Utah.
In 2004, a combination of methadone and cocaine killed 17-year-old Brandi Bragg, granddaughter of West Virginia�s biggest lottery winner, Jack Whittaker. She did not have a prescription for methadone, according to her death certificate.
But not all victims had multiple drugs in their system. In West Virginia, one in five methadone overdose victims had no other drug in their system, according to a Gazette-Mail analysis of state toxicology and vital statistics data. Others victims had trace, usually harmless amounts of alcohol or acetaminophen.
Methadone can interact in dangerous ways with �downers� such as alcohol, Valium or Xanax, Terpening said. They combine with methadone to make it harder to breathe.
Other drugs can inhibit methadone�s breakdown, which can lead to a toxic buildup. Certain blood pressure medications and even grapefruit juice can have this effect. So can Zoloft, but not usually to a dangerous extent, he said.
�It�s a little surprising, but not unheard of, that combination resulting in death,� he said.
To be safe, people without a prescription should never take methadone, he said. Doctors who prescribe it should begin patients at low doses until they are used to the drug.
�The rule of thumb is, start low, go slow,� Terpening said.
To contact staff writer Scott Finn, use e-mail or call 357-4323.