OVERSTATING THE OXYCODONE PROBLEM

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."