Data point to middle-aged, not young people, as typical addicts, victims
For nearly two years, the county's top leaders ---- the sheriff, the district attorney, supervisors ---- have declared abuse of the prescription painkiller oxycodone, or OxyContin, to be an "epidemic" among high school students and people in their 20s.
They formed a regional task force and warned of widespread oxycodone abuse, addiction and death among young people, particularly those in the more affluent areas of North County.
"We're seeing more and more teenagers using OxyContin and dying from OxyContin," District Attorney Bonnie Dumanis said at a June 22 panel on public safety.
But prosecution, emergency room and medical examiner's records tell another story.
Data collected from 2006 to 2009 suggest official statements about the extent of the problem and its reach among people under 25 have been overstated and, in some cases, misleading.
Young people, it turns out, are not the primary users and victims of the drug; middle-aged people are.
For example, the medical examiner's office recorded one oxycodone-related death of a person under the age of 26 in 2009, compared with 11 in the 46-55 age group.
In fact, oxycodone has not caused or contributed to the death of anyone under the age of 19 since Jan. 1, 2006, according to a North County Times analysis of county medical examiner data. The drug has killed only two teenagers since the start of 2006 ---- both were 19 and died in 2007.
No teenagers have died since then.
The medical examiner's numbers alone suggest the scope of the problem isn't as widespread as alleged. When asked about the discrepancy, officials acknowledged they may have misstated the gravity of the problem.
Deputy District Attorney Matt Williams, who sits on the task force, said the abuse among teens and young adults was more worrisome because it was a new and potentially explosive problem.
"They’ve always existed, people who got addicted to traditional medications," he said. "What didn’t exist before is successful kids who are suddenly drug addicts. And we’re wondering, 'How the heck did that happen?'
"These are normally kids we don’t have to worry about. The successful kids we thought were going to be our future leaders were suddenly addicts."
An emerging problem
Oxycodone is a synthetic opiate designed to manage severe pain over a long period of time. The drug is the sole ingredient in the brand-name narcotic painkiller OxyContin, but oxycodone also is found in other drugs such as Percocet.
When swallowed, OxyContin releases medication slowly over a period of time. If the drug is snorted, injected, chewed or smoked, the medication is released into the body all at once and creates a euphoric high.
It also becomes far more addictive.
One of the first indications that oxycodone abuse had increased in the county appeared in medical examiner records of oxycodone-related deaths across all age groups. An average of 17 people between the ages of 19 and 80 died each year from 2004 to 2006, according to the records, compared with an annual average of 46 people in the same age range from 2007 to 2009.
The spike in deaths suggested that oxycodone abuse in the county had increased dramatically among the general population, but officials said they were most alarmed by trends reported by narcotics detectives in 2008.
In May 2008, the sheriff's narcotics team saw an increase in oxycodone-related arrests in Santee and Poway, according to a report by Detective Dave Ross. Investigations into the crimes showed increasing use and abuse of the drug among teenagers and young adults, Ross said.
Deputy District Attorney Williams said the trend mirrored what authorities had seen in more hard-hit states such as Florida and Kentucky.
"The reason we were so concerned about this is because when we first started looking into it, we saw that there were problems across the country," Williams said. "We were seeing that same sort of thing starting here and we thought, 'If we can jump out ahead of it, maybe we can stop it from going up.'"
Williams said officials began conducting interviews with high school students, drug rehabilitation professionals and young informants within the criminal justice system.
Using the information gleaned from those interviews, officials at that time identified the drug's "typical user," he said.
"The typical user in San Diego is a kid who smokes marijuana occasionally, tried oxy and really likes it, and then gets addicted to it and then turns onto heroin," he said in a recent interview.
Williams said he used the term "kid" loosely, and that interviews suggested most oxycodone users were between the ages of 16 and 25.
"There’s not a whole ton of 16-year-olds out there (using oxycodone), but they’re out there," he said in an interview late last month.
The lack of juvenile oxycodone-related prosecutions also suggests 16- and 17-year-olds make up a relatively small share of the young abusers officials have mentioned.
Assistant District Attorney Michele Linley of the office's juvenile division, said the division has received few oxycodone-related cases ---- if any ---- in the last couple of years.
Numbers don't add up
That largely anecdotal evidence prompted the district attorney's office to put together the Oxy Task Force in September 2008 to coordinate agencies' efforts to fight OxyContin and prescription drug abuse through education and law enforcement. It was not officially launched until a year later.
"Today, we are dealing with an emerging oxy epidemic," District Attorney Dumanis said at press conference in October 2009. "The ultimate goal of this task force is to stop this runaway train."
Task force members Sheriff Bill Gore, Dumanis and county Supervisor Pam Slater-Price hammered home the message that young people were at the heart of the county's oxycodone problem, though data suggested otherwise.
During her State of the County address this year, Slater-Price hinted at a high number of teen deaths caused by the drug when she said, "OxyContin is a brand-name prescription of the pain killer oxycodone, but it kills more than pain. Teenagers swallow, snort, smoke or inject the diluted pills."
The drug's annual death totals among the 0-25 age group have been in the single digits since at least 2006 and they've declined each year since 2007, according to a North County Times analysis of medical examiner's data.
Last October, Gore was quoted in a news report as saying, "OxyContin is not new, but it is being consumed at a really high rate by kids in our community."
But available data do not support Gore's assertion, and instead point to middle-aged people as the drug's principal users.
Just as young oxycodone users are relatively scarce in juvenile courts and medical examiner's data, it appears emergency rooms also haven't seen a huge influx of oxycodone-related cases among young patients.
People under 25 were absent from emergency room data kept by the federal government's Drug Abuse Warning Network. The network, which collects medical examiner and hospital data to track drug abuse trends, estimates and reports total annual visits broken down by age and the drugs involved.
No emergency room visits caused by oxycodone ---- either by itself or as part of a combination ---- were reported for people under 25 between 2004 and 2008 in the county.
Some visits by people in the age group probably occurred, but the network does not report any emergency room visits if the estimated annual total is under 30 or too small to be considered reliable.
Sheriff's Department oxycodone arrest data couldn't be produced quickly because oxycodone sale and possession arrests would have to be hand-sorted from arrests for other, more common drugs listed under the same section of the California Penal Code, said Kurt Smith, a crime analysis manager with the department.
It's older people
But middle-aged people show up far more frequently in medical examiner, emergency room and prosecution data, suggesting oxycodone use and abuse are far more widespread in that age group than among young people.
Ten people in the 46-55 age group died of oxycodone-related causes in 2006, 16 died the next year and 15 died in 2008. A total of 52 people ages 46 to 55 died from 2006 to 2009, three times the total recorded for people under 26 years old.
Middle-aged people also show up in emergency room data, while young people do not.
The Drug Abuse Warning Network reported 52 oxycodone-related emergency room visits by people in the 45-55 age group in 2005. It reported none the next year, 107 in 2007 and 102 in 2008.
Williams said the number of adults ---- people 18 and older ---- prosecuted by his office has increased dramatically every year since 2007.
His division prosecuted 87 oxycodone-related cases in 2007, compared with 138 in 2008 and 252 last year, but the numbers have not been broken down by age, Williams said.
Behind the numbers
Deputy Medical Examiner Jonathan Lucas confirmed that his office's data pointed to middle-aged people as the county's typical oxycodone user, but he also pointed out various reasons why young people might be underrepresented.
He said emerging abuse among young people might simply be too new to register in the death records.
"It makes sense that the longer a person abuses a drug, the more likely they are to die because of it," he said. "The data means what it means, but you have to remember that we’re looking at biased populations."
A group, or population, is biased when members share characteristics that make them more or less likely to show up in data than other groups.
For example, middle-aged people have more health problems and chronic pain than young people, and are therefore more likely to have been prescribed multiple drugs with abuse potential, Lucas said.
Middle-aged people also have better access to doctors and can more easily manipulate the medical system, Lucas said.
Deputy District Attorney Williams said task force members were right to focus on young people and teens, even though the data suggest middle-aged people might be abusing the drug more often.
"I’m not positive about this, but I don’t suspect that the middle-aged abuser is going to be smoking the drugs," Williams said. "It’s how young people are using it and how they’re getting it."
By MORGAN COOK July 17, 2010
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