Escalation of Drug Overdose Deaths Includes Increased Presence of Prescription Medications

As Santa Barbara County confronts a growing challenge from drug abuse, fatal overdoses from prescription medications are creeping ever higher, forcing authorities to revise the ways they track the trends.

“The realities are that a legally prescribed drug taken recklessly will kill you just as quickly as an illicit drug,” Santa Barbara County Sheriff Bill Brown said.

The county Coroner’s Office knows what drug overdoses look like. The staff even has pictures it uses in educational presentations of people with “foam cones,” a red-tinged foam around the victim’s nose or mouth that’s indicative of a drug-related death.

In an overdose from opiates or another depressant, breathing slows, blood pressure drops, and fluids pool and gather in the lungs, explained sheriff’s Sgt. Sandra Brown, supervisor of the Coroner’s Office, which is operated by the Sheriff’s Department. Brown’s office rarely sees people with just one drug in their systems, and some toxicology reports show the presence of as many as 15.

County drug- and alcohol-related deaths nearly doubled from 2005 to 2009. In that five-year period, there were — respectively — 60, 46, 62, 71 and 111 deaths recorded with the cause related to overdose or accident apparently influenced by drug or alcohol use.

Most of Santa Barbara County’s prescription drug-related deaths aren’t from toddlers accidentally ingesting a pill or elderly people mixing up their many medications; they’re teens or adults who intentionally or accidentally abuse multiple drugs, including prescription, illicit and alcohol.

Prescription medications are involved in more U.S. overdose deaths than heroin and cocaine combined, according to the Centers for Disease Control and Prevention.

In 2009, for the first time, drug deaths exceeded motor vehicle accident deaths in the United States, according to a recent Los Angeles Times story. Drugs were implicated in at least 37,485 U.S. deaths that year, the newspaper reported. For years before that, California and 22 other states had more drug-related deaths than traffic fatalities but the trend became national in 2009, according to the Times.

Santa Barbara County reported 143 unintentional poisonings in 2009, making them the third cause of nonfatal hospitalizations in the most recent year of available data. That year there were a total of 485 emergency room visits for poisonings in the county, meaning people who were treated and released instead of hospitalized.

Self-inflicted and/or suicide poisonings in the county totaled 226 in 2009 and 189 in 2008, statistics show.

This year, the three Cottage Health System emergency departments — in Santa Barbara, the Goleta Valley and the Santa Ynez Valley — reported 117 accidental poisonings between Jan. 1 and June 30, although there is no further breakdown into type of substance, according to the California Office of Statewide Health Planning and Development.

In 65 percent to 75 percent of the emergency department cases, there was no principal cause of injury reported — a trend seen every year, the OSHPD said.

Health-care practitioners and law-enforcement personnel say the availability, stigma and lack of education regarding prescription drugs are part of the problem.

As more prescriptions are issued each year, taking a pill to feel better is increasingly accepted behavior in society, whereas using an illegal drug like heroin is not.

Sgt. Sandra Brown worries about the number of accidental overdoses in adults between the ages of 30 and 60. There’s a need for authorities to look into whether these deaths are the result of recreational use or being ill-informed, she said.

Major risks for overdose come from combining drugs with each other or combining drugs with alcohol.

Alcohol on its own can be lethal from a blood-alcohol concentration of .03 or above, but combining it with prescription medication is much more common.

It’s no coincidence that so many of the alcohol and drug deaths included ethanol in combination with other drugs.

County coroner reports list the drugs found in each deceased person’s system and the cause of death is either a lethal amount or lethal mixture of drugs and/or alcohol.

There are many overdose risk factors connected to the method of delivery.

Many strong drugs like Adderall and OxyContin have time-release formulas, but if the pills are crushed and snorted, the effect is felt all at once — and the effect is a rush completely unlike what the drug is intended to do, according to Jackie Kurta, director of UCSB’s Alcohol and Drug Program.

“The faster it goes to the brain, the faster it leaves, so they need to do more, more often, in bigger doses” to get the same feeling, she said.

Injecting a drug is the quickest way to get it into one’s system, and the most dangerous, said Sgt. Sandra Brown. As seen in her work at the Coroner’s Office, people have been known to take a drug orally, rectally, by snorting, or by injecting under the skin (known as “skin popping”) or into a vein.

People “sometimes think, ‘it’s not as if I’m putting heroin in my arm with a needle; it’s a legitimate drug so it won’t be that bad,’” Sheriff Bill Brown said.

The drugs found most often in overdose cases from 2005 to 2009 are methamphetamine, morphine, hydrocodone, methadone, Diazepam, cocaine, Nordiazepam, marijuana, Codeine and hydrocodol.

Should morphine turn up in an autopsy toxicology report, its presence could mean there was pharmaceutical morphine or heroin in the body. Because of the way the drugs are metabolized, there is no way to know which drug was taken merely from a blood test, Sgt. Brown said. Unless authorities can determine the drug from investigating the personal history, it remains a mystery.

Methadone, originally used to help people get off heroin, is now being prescribed as a pain reliever. The drug is relatively inexpensive for how strong it is and it remains in the body a long time, which increases the risk of overdose, Sgt. Brown said.

According to the National Institutes of Health, methadone can be habit forming and cause life-threatening irregular heartbeat or slowed breathing. To prevent withdrawals, doctors generally want to decrease the dose gradually.

Acetaminophen is widely used in over-the-counter painkillers and is one of two components of Vicodin, the other being hydrocodone. Vicodin is one of the most abused drugs in the country.

The Coroner’s Office changed the way it reports alcohol- and drug-related deaths in 2010, only including overdoses. Until then, records included deaths with a more indirect link to drugs or alcohol, like crashing into a tree while driving impaired or falling down while intoxicated.

The change came about because individual factors like tolerance make it nearly impossible to determine how much of a role the drug or alcohol played in the death, Sgt. Brown said.

Her office also designates whether the cause of death is an accident or a suicide, which is investigated by looking into a person’s medical history, stressors, family interviews and toxicology report results. With that methodology, there were 63 drug- and alcohol-related deaths in 2010, of which 52 were designated accidental, she said.

— Noozhawk staff writer Giana Magnoli can be reached at gmagnoli@noozhawk.com. Follow Noozhawk on Twitter: @noozhawk or @NoozhawkNews. Connect with Noozhawk on Facebook.