Why are Orange County retirees dying of opioid overdoses?

The city of Laguna Woods, a retirement community in Orange County where the median age is 77, has the highest drug and alcohol death rate in Orange County. Accidental prescription opioid overdoses account for the majority of those deaths.

Orange County as a whole has more than twice the rate of opioid-related deaths as neighboring Los Angeles County. The epidemic is hitting hardest among people in their golden years. And yet the causes and consequences of Orange County’s opioid problem remain largely out of the public eye.

My project will look at several underreported aspects of the opioid crisis in Orange County, including why elderly people in Laguna Woods and other older communities are dying of overdoses. By mining coroner’s records and data on opioids, and through public engagement activities, I hope to illuminate the breakdowns in an otherwise stellar Orange County health care system.

I also plan to explore the discrepancies in treatment between heroin overdose patients and prescription opioid overdose patients. A recent report from the Orange County health department appears to indicate that people who land in one of the county’s emergency departments because of a heroin overdose are likely to be quickly discharged while those who visit the ED because of a prescription opioid overdose are more likely to be hospitalized for additional treatment. Why?

To answer that question, I’ll want to interview hospital staff and patients, but also examine the hospital data used in the county health department report to look for patterns that could illuminate discrepancies in treatment.  

I also plan to look at why Orange County has one of the state’s highest rates of overdose deaths in which benzodiazepines are involved. Dr. Bharath Chakravarthy, who heads SaferRX OC, a coalition dedicated to reducing drug overdoses in Orange County, told me there’s a local joke that Ativan and Xanax, two benzodiazepines commonly prescribed for anxiety, are in the Orange County water supply.

A major reporting challenge for all of these stories is finding people willing to share their stories of addiction, a highly sensitive topic. But illuminating the reality of OC’s opioid epidemic could save lives. Doctors, local leaders and public health officials I’ve spoken to in the course of my initial reporting are surprised to learn that the county’s opioid epidemic is largely a problem of older, wealthier residents.

Dr. Andrew Kolodny, an expert on the opioid epidemic, has noted that older people are less likely to seek treatment, less likely to have family to coerce them into treatment, and less likely to get arrested trying to obtain drugs because they have more resources.

To further obscure the problem, Dr. Chakravarthy of SaferRX OC told me that primary care doctors often turn a blind eye when older patients request increased dosages of opioids. And they’re loath to prescribe methadone or otherwise treat people for addiction because they’re “worried that their waiting rooms will fill up with addicts.”

Removing the stigma of opioid addiction — and all addiction — is paramount.

*This post has been updated to clarify how Orange County's opioid-related death rate compares to Los Angeles.

[Photo by Alfonso Pierantonio via Flickr.]