The Morning Report
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To borrow a phrase from the world of homicide detectives, Jonathan Lucas’s day begins when yours ends. He’s the county’s chief deputy medical examiner, responsible for performing dozens of autopsies each year and helping to monitor trends in San Diego death.
You’re not actually likely to meet Lucas or his fellow pathologists after you shuffle off this mortal coil. Some 20,000 people die in San Diego County each year, but the Medical Examiner’s Office only deals with about 3,000 of them — mainly those who died unexpectedly, suspiciously or violently.
Lucas isn’t in the news much unless there’s a major murder case or deadly catastrophe. But each year, he surfaces in the news when his office releases an annual report about the previous year’s deaths.
This year’s annual report, covering 2012, arrived a bit belatedly last month. It says the office performed autopsies on 1,924 people and gave external examinations to another 899.
The office doesn’t have explanations for some trends, like a huge drop in motor-vehicle fatalities over the last quarter-century. (They fell from 451 in 1988 to just 270 last year, although that’s up from a 24-year low of 211 in 2010.)
But Lucas was able to offer theories on rising rates of drug-related deaths and suicides.
The annual report says the number of deaths due to prescription drugs has skyrocketed from 135 in 2000 to 269, a record for recent years, in 2012.
Can you describe the typical person who dies due to prescription drugs?
There’s two types.
One is somebody in their 40s, 50 or 60s who has chronic pain and uses pain medications. It could be a back problem, fibromyalgia, neck pain or cervical disc problems.
If you take your pain medication as prescribed, you shouldn’t have any problem. But some people will get their prescriptions correctly and over-medicate or get multiple prescriptions from unknowing doctors.
Or they’ll mix their alcohol with medications. I’d say easily over 90 percent of these cases are from mixing medications with alcohol. The combination of prescription drugs with alcohol is a big component of what we’re seeing.
The other kind of cases we see, a smaller number, are people who seek out and abuses these things: younger individuals who are out parting, mixing Xanax with alcohol or illicit drugs.
In the vast majority of these cases, we’re talking about meds that are mixed with something else. You hardly see a Xanax overdose that’s not a suicide. Usually it’s Xanax with some Oxycontin and a shot of alcohol.
How do these overdoses kill people?
These drugs are typically sedatives. In the higher doses, they’ll put you to sleep and cause respiratory failure. Their breathing will slow and eventually stop.
Sometimes they sleep a day and a half and someone keeps checking on them but they don’t wake up. Or sometimes they live alone and fall asleep on the couch.
Why do you think prescription drugs are killing so many more people than in the past?
Access to these medications is a very important part of the puzzle. But I don’t want to paint the picture that these are bad drugs. They’re very effective medications, but the access has to be controlled. Physicians need to be aware that there’s a black market in Oxycontin and they need to be careful about how many pills they’re prescribing.
Is there a specific prescription drug that’s more of a problem than others?
It fluctuates from year to year. We see this switching to whatever is cool with the kids.
Oxycontin has the bad rap in 2007 and 2008, when we saw a big jump in fatalities — a tripling from one year to the next. (Deaths related to oxycodone (Oxycontin) rose from 17 in 2006 to 45 in 2007.)
We still see Oxycontin cases, but it’s sort of flattened out.
Now, we’re seeing hydrocodone (Vicodin) deaths, and Xanax has been re-emerging. There’s other things too like the muscle relaxant Soma, which is mixed with pain relievers.
(Hydrocodone-related deaths rose from 21 in 2005 to 49 in 2012. Deaths related to alprazolam (Xanax) have shot up from six in 2004 to 55 in 2012.)
Let’s talk about illegal drugs. Methamphetamine deaths are up from 83 in 2009 to 142 in 2012. What sorts of cases are you seeing?
Most of these people are middle aged, in their 40s and 50s, and have been using for years. The factor that starts to come into play is cardiac disease.
A significant portion will have high blood pressure or coronary disease. I don’t know if there’s data to support this, but I think meth accelerates the development of coronary issues.
It’s a stimulant, and it’s like drinking 100 cups of coffee a day. When you start taking it on top of your high blood pressure, you develop complications like a stroke or a ruptured aneurysm when someone who didn’t have the cardiac problems may not have passed away.
Meth is also like induced exercise. It will increase heart rate and metabolism. That taxes the heart, and you may not have a lot of reserves to be able to handle that stress.
Suicides are also up: In 2012, they reached their highest rate since 1997. A total of 413 people killed themselves last year.
However, the annual report says the suicide rate in the county for people ages 35-64 in 2012 was at nearly the same level — 17.6 per 100,000 — as it was nationally in 2010.
Among age groups, the highest suicide rate, by far, is among men age 85 and older. What’s going on there?
Historically, they’ve always had the highest rate of suicide, and I think most often with firearms. I picture the elderly guy who’s just tired of it, and he takes matters into his own hands.
Sometime they have a history of depression, but they have a lower percentage compared to other groups. It’s more related to health concerns and things that are changing in their lives.
The Medical Examiner’s Office was unable to determine the cause of death of 26 people — 1 percent of cases — in 2012. What were those cases like?
Sometimes we can tell a case is a natural death, but we don’t exactly know why. That’s just the nature of the game considering the limits of a dead body and our own limits.
We may not see an physical or anatomic cause if somebody has some sort of electronic abnormality in their heart. It’s a limitation. Cardiac arrhythmias, sudden abnormalities of the heart and seizures are particularly challenging.
Is 1 percent a good number to have?
This may sound very strange, but it’s healthy for a medical examiner’s office to have some degree of undetermined cases.
If it’s too high, you probably don’t know what you what you’re doing. But if it’s too low, you’re probably kidding yourself. Sometimes we have to say that we just don’t know.