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Abusing Prescription Drugs

Audio

Aired 2/3/10

The face of a drug addict is changing from the neurotic junkie to the average upper-class high school student. We talk to a local deputy district attorney and a physician about the growing problem of prescription drug abuse in San Diego.

MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh. You're listening to These Days on KPBS. Many parents routinely take a look in their teenagers' rooms for drug paraphernalia. They check for plastic bags or pipes, powders, anything that looks suspicious and could mean their kids are experimenting with illegal drugs. But the place where more parents might want to start checking is in their own medicine cabinets. Law enforcement officials say prescription drug abuse continues to increase in San Diego, and the abusers are often kids who raid their parents’ prescriptions or pay by the pill for powerful and addictive pain medication. Joining me to talk about prescription drug abuse in San Diego are my guests. Matt Williams, he’s a Deputy District Attorney and founding member of the county’s Oxy Task Force. Matt, welcome to These Days.

MATT WILLIAMS (Deputy District Attorney, County of San Diego): Good morning, Maureen.

CAVANAUGH: And Dr. David Smith with the San Diego Comprehensive Pain Management Center. And, Dr. Smith, good morning.

DR. DAVID SMITH (San Diego Comprehensive Pain Management Center): Good morning.

CAVANAUGH: I want to let our listeners know that they’re invited to join the conversation. Do you know someone who has abused prescription painkillers? Can you share their story with us? Or would you like to know the signs of prescription drug abuse? Call us with your questions and your comments. Our number is 1-888-895-5727. Matt, it seems we’ve heard about prescription drug abuse for some time now. Is it a growing problem in San Diego?

WILLIAMS: Yeah, actually it’s an extremely big problem here in San Diego. We noticed about a year and a half ago an increase in the number of oxycodone or OxyContin related cases. Now prior to that, obviously there was an issue with prescription drugs as a whole, but we saw kind of an increase in the OxyContin or oxycodone related cases and we noticed kind of a connection to sort of a different group of abusers that we hadn’t previously seen. And so that’s kind of why we got started on the oxycodone/OxyContin specifically. But, yeah, as a whole, prescription drug abuse is on the rise and is actually I think now the second highest drug of abuse, or prescriptions as a whole, next to marijuana. And that’s for the age range of, I’d say, 12 to 17 year old teenagers and then for that 12 to 13 year old range, prescription drugs is actually higher than marijuana.

CAVANAUGH: Have you been able to compile any hard numbers in San Diego, especially among young people who are abusing prescription drugs?

WILLIAMS: It’s hard to compile the numbers specifically that are abusing it and that’s simply because when they go into treatment, that’s all confidential information. What we can look at is the number of cases that the District Attorney’s office is now prosecuting over the last three years or so and then the number of deaths that were seen that are associated with oxycodone. I can tell you that in the last three years, basically we’ve seen a threefold increase in the amount of oxycodone related cases. And I, you know, I didn’t look at the specific numbers for prescriptions as a whole but we know for a fact that that number is rising as well.

CAVANAUGH: Why? Do you have any idea why it is rising the way it is?

WILLIAMS: You know, I think access is probably the biggest problem. They can go right into the parents’ medicine cabinets and they’re just kind of testing it out, seeing what it is. I think possibly that some of the drug campaigns that we’ve tried in the past have actually taken hold in that kids are turning away from kind of those traditional street drugs, cocaine, heroin, methamphetamine—there’s always going to be a group that are going to go do that stuff—but I think traditionally the kids are now kind of turning away from that and kind of opting for trying out these prescription type drugs which they perceive as not as dangerous, not as deadly, and so that’s become a big problem.

CAVANAUGH: You know, Dr. Smith, we’re talking specifically here or primarily about OxyContin but I wonder, what kind of prescription drugs are being abused especially by young people?

DR. SMITH: I would say the oxycodone family, which is simply the short-acting form or immediate release of OxyContin. OxyContin is simply oxycodone with a shell, if you will, that was developed in the mid-nineties that made it a long-acting medication and was initially marketed for once-a-day, twice-a-day. So that is by far probably the most prevalent opioid analgesic that is being abused. Vicodin also tends to be highly abused in my opinion and, again, it has to do with the access and, you know, Matt’s right, it’s so available out of the medicine cabinets. It became a very popular drug in the mid-to-late nineties by physicians, pain physicians included, because it does work. It is a good opioid medication for chronic malignant or nonmalignant pain. By that I mean cancer pain or non-cancer pain. The problem is, it is so easily abused in many forms, smoked, snorted or injectable. And what kids don’t realize is when this medication is combined with alcohol, there’s a almost synergistic effect on their respiratory system and that’s why you’re having – and I’m sure my colleague here will attest that a lot of these accidental overdoses, there’s alcohol involved as well.

CAVANAUGH: What does OxyContin do to the body?

DR. SMITH: Well, it’s an opioid agnate so it’s readily absorbed into the systemic bloodstream. It crosses the blood/brain barrier fairly easily and then it binds to what are called the opioid mu receptors. Those are the most common and prevalent opioid receptors in the central nervous system. There’s actually several others but the mu receptor’s been the one most studied. And it inhibits the release of a neurotransmitter, amongst other things, known as substance P which is a powerful mediator of pain in what we call the ascending pain pathway from the spinal cord to the – (beeper tones) On, there I go. See, that’s…

CAVANAUGH: The doctor is beeping.

DR. SMITH: I apologize.

CAVANAUGH: That’s quite all right.

DR. SMITH: …the most prevalent neurotransmitter in the central nervous system that helps to transmit pain to the brain, and that’s where the conscious perception of pain is. So by binding to the opioid mu receptor, it inhibits pain. It also, though, has some other effects such as inhibits or slows respiratory breathing centers. It can, in certain cases, although not frequently, cause lower extremity edema, urinary retention, and then, of course, the physical dependency side, which is a dependent aspect that any patient, any human, will feel or will have after taking any type of narcotic analgesic for several weeks at a time and that’s simply a physiological change in the central nervous system characterized by withdrawal with rapid cessation or immediate discontinuation of the drug.

CAVANAUGH: And that, of course, is the addiction.

DR. SMITH: Well, that’s the physical dependence.

CAVANAUGH: Umm-hmm.

DR. SMITH: Addiction is a bio-psychosocial condition that is more than just the physical dependence. You and I, everybody, will have a physical dependence if we take, ingest, an opioid for two to three weeks at a time on a regular basis but not all of us will become addicted. Addiction, as you probably know, has many different psychosocial aspects.

CAVANAUGH: Absolutely.

DR. SMITH: Gambling addiction, you know, nicotine addiction and drug addiction just to name a few.

CAVANAUGH: We are talking about the Oxy Task Force. We’re talking about prescription drug abuse and really sort of focusing in on oxycodone. And my guests are Dr. David Smith and Matt Williams. Matt Williams is the founding member of the County’s Oxy Task Force. We’re taking your calls with your questions and your comments at 1-888-895-5727. And let’s take a call right now. Brad is calling from San Diego. Good morning, Brad, and welcome to These Days.

BRAD (Caller, San Diego): Hey, thanks for having me. Yeah, I just wanted to share a quick story about a friend of mine who, you know, these kids today, they just don’t know the dangers of oxy. They think that it’s something that, you know, maybe along the lines of Vicodin, which is still bad but oxy, I mean, it just puts a grip on you like heroin. And a lot of these people that start with oxy find themselves shooting up heroin not too long after. And so kids, I think we really need to get the word out to kids and, you know, to pharmaceutical companies, too, that we kind of need to make a change. I mean, this isn’t working. You know, I lost a really good friend to heroin addiction and it’s a real sad story.

CAVANAUGH: Well, thank you. Thank you, Brad, for calling in and telling us about that. Matt, can you tell us a little bit about the history of OxyContin abuse? How did it make its way here to San Diego?

WILLIAMS: Sure. What happened is basically about a year and a half ago we started getting reports of OxyContin increase here in San Diego and that originated from a sheriff’s deputy named Dave Ross, who is also another founding member. And we got together and we realized we really didn’t know all that much about this drug. We’d seen a few cases trickle in. And Dave started noticing an increase in the number of kids he was seeing on the street that were buying the stuff, smoking it right in their cars, right in broad daylight and being kind of cavalier about it. And so we met up, we decided we better get educated on this, and we started looking east. We realized that this drug basically was marketed in the northeastern United States, starting in West Virginia. It then worked its way south, kind of the Florida area, and then came west. And so when we started looking historically at those areas, we started noticing a pretty scary trend and that is that these areas had identified a real bad problem upwards of ten years ago. They realized that we’re dealing with a very addictive, dangerous drug here, and it’s becoming kind of our main focus. And so for ten years, upwards of ten years, these areas had been dealing with this problem, had identified it, had been working on trying to combat it, and really nothing they were doing was working. We looked at death data from the state of Florida and we found that the number of deaths with OxyContin far surpassed really any other drugs in that state. And that was, I think, death data from 2008. And we always like to compare it to methamphetamine because meth is kind of that drug we’ve all been talking about for the past five, ten years and how dangerous it is and how deadly it is. And so we looked at Florida and we said, well, how does oxycodone real – measure up to methamphetamine? And what we found was that in 2008, the first six months of 2008, Florida saw something like 57 or 52 methamphetamine deaths where methamphetamine was present in the system and a contributing factor to the death. Then we looked at oxycodone. There were 705…

CAVANAUGH: Oh, my God.

WILLIAMS: …deaths related, you know, where oxycodone was present and a contributing factor. And so we started looking at that and, frankly, it scared us. And we said, well, that’s happening out there. It – That can’t be what’s happening here. Well, lo and behold, we started talking to kids, kids that we were arresting, kids that we were prosecuting, kids that basically had law enforcement connections that were just willing to talk to us about the problem. And what we found is, it’s alive and well here in San Diego and it’s actually becoming – it’s actually catching on and becoming more and more the preferred drug in this young, sort of affluent community, sort of age range.

CAVANAUGH: Let me ask you both, if I can, how are teenagers, young people, getting ahold of this stuff? Doctor, is it all from prescription drugs in their parents’ medicine cabinets? Where is it coming from?

DR. SMITH: A lot of it is the mom and dad’s medicine cabinet. A lot of it also, there’s certain pharmacies that have been broken into and these perpetrators know exactly what to go for. They go for the OxyContin and Matt can, you know, talk about the street value. The other aspect, from a physician viewpoint, is diversion where patients will come in and will get a doctor that may believe them and give a prescription for OxyContin to control the pain and then the patients take that and then they sell it. To counteract that, most interventional or most pain physicians now in San Diego have implemented opioid maintenance contracts, informed consent, and random urine drug screens so that we can help prevent diversion and abuse and also look for signs of addiction. So I think that a lot of it does come from the physicians who, you know, prescribe it with a good motive to decrease the pain and then from there kids get it out of the medicine cabinet. I think there’s then the unscrupulous patients that will divert it. And then there are some physicians, I have to state frankly, that don’t do a good job in screening their patients and may be a little too liberal in how they prescribe the medication to the patients and that’s another contributing factor to this prevalence on the street.

CAVANAUGH: And Matt.

WILLIAMS: And I just wanted to add to that, you know, from our perspective we – this is the major problem with prescription abuse is that there are so many different ways to get it. It’s not like your typical street drug where they go on the corner and they meet up with a drug dealer or in the streets or anything like that. These kids are getting it from their homes, they’re getting it out of the medicine cabinets. When they can’t find it there, they’re going to a friend’s house and getting it from there. From the internet, they can order it online in certain – with certain criteria that they meet, they can get it online. There’s employee theft with pharmacies. We have loads of undercover video of pharmacists who are stealing the stuff. There’s employee theft. There’s foreign diversion and smuggling into the United States. Interestingly enough, OxyContin 80s, which are the most popular on the streets, are not shipped to Mexico and yet we have what seems to be an unlimited supply right in Tijuana, just over the border, and so we’re looking into that but that’s another source of it all coming into the area. Inappropriate prescribing, there’s doctors that we’ve actually – are investigating that are just writing prescriptions for a fee, you know, just basically just, you know, handing them out. And I’m not saying that that’s happening a lot but it does happen here and there. Doctor shopping, as Dr. Smith alluded to. We’re seeing a lot of people that will go to five, six, seven doctors all in one day…

CAVANAUGH: Right.

WILLIAMS: …and then go fill all of these prescriptions at one time. And so by the time we catch it, we’re already behind the ball. They’ve already gotten all these drugs, they’re already out on the street.

CAVANAUGH: There are a lot of people who want to join the conversation. We are taking your calls at 1-888-895-5727. And Dr. Rob Epstein is calling from UCSD. Good morning, Dr. Epstein, welcome to These Days.

DR. ROB EPSTEIN (Caller, UCSD): Hi. Very nice to be with you. I just have a couple of comments. First of all, your guests were asked how they know that this problem is getting worse and the response was arrest data. But actually there are better data because we have very good data from emergency rooms around the country which confirm what your guests have, in fact, said, that there’s a dramatic increase now in problems related to recreational use of prescription drugs by teens. But the main thing I wanted to point out was that when your guests were asked why is this happening, they responded, well, because it’s available, you can get it out of medicine cabinets. But these drugs have always been available that way and so that does not explain the dramatic increase. And actually in a book I have coming out in April, I think I make a good case to explain why this increase is occurring and it really has to do with what I call infantilization, the fact that we’re actually – with most people not paying attention to it, we’re actually putting teens under greater and greater restrictions, controlling them more than ever. Literally, there are ten times as many restrictions for teens as there are for mainstream adults, and we’re putting more and more into effect on a daily basis. And they react to it sometimes with depression and sometimes with anger and very often with drug abuse.

CAVANAUGH: Dr. Epstein…

DR. EPSTEIN: I think that’s the main problem.

CAVANAUGH: Thank you for that. Thank you for contributing to that. And we’d love to hear from you when your book comes out. Thank you so much. Right now, we have to take a short break. When we return, we will continue to talk about prescription drug abuse, continue to talk about San Diego County’s Oxy Task Force, and continue to take your calls at 1-888-895-5727. You’re listening to These Days on KPBS.

CAVANAUGH: I'm Maureen Cavanaugh. You're listening to These Days on KPBS. We’re talking about prescription drug abuse, most specifically OxyContin drug abuse in San Diego. My guests are Matt Williams, Deputy District Attorney and founding member of the county’s Oxy Task Force, and Dr. David Smith with the San Diego Comprehensive Pain Management Center. We’re taking your calls at 1-888-895-5727. Dr. Smith, I’d like to start off this part of our program by talking about there was a reference made to the various ways that people can ingest oxycodone, OxyContin and it’s not just pill form, it’s not just taking a pill like, let’s say, Vicodin. Is that right?

DR. SMITH: Correct. You know, Vicodin has acetaminophen in it which would be very dangerous to try and inject or to smoke whereas OxyContin is a long-acting oxycodone and so once the exterior shell is compromised by crushing it, then that long-acting 80 milligrams that Matt had spoken about earlier becomes immediate acting and causes a almost heroin-like high, and it can be smoked, it can be snorted and it can be injected. And I think a lot of the kids think that because it’s a pharmaceutical grade product with an FDA approval that it’s safe, and that’s where I think one of the – and I think Matt would agree, where one of the biggest dangers are. It is a very, very lethal drug. But the multiple ways that it can be abused make it just so easy for kids to utilize it.

CAVANAUGH: And where, Matt, do teenagers, young adults, usually first come in contact with this drug?

WILLIAMS: From speaking with, as I said earlier, the kids that we’ve been able to debrief on this issue, it seems that they’re being introduced to it mostly at high school parties. They are kids who have tried marijuana, who maybe smoke it occasionally, not necessarily heavy marijuana users but it’s being offered to them as kind of – or marketed to them as, you know, this is just like marijuana only it’s ten times better. They oftentimes, as the doctor alluded to, have the feeling that because it’s a pill, it’s not dangerous and so -- and, you know, my parents take this stuff and nothing happens to them so why don’t – why can’t I try this. And, unfortunately, that’s really the worst thing about it, is we’re talking about an 80 milligrams – 80 milligrams of oxycodone and that’s what separates it from the other oxycodone products. OxyContin 80s, it’s the time-release caplet but they’re finding a way to get all of that, you know, 24 hour or 12 hour time release in a matter of seconds.

CAVANAUGH: Right.

WILLIAMS: And so other oxycodone products come in, you know, 5, 10, 20 milligram doses but they’re getting an 80 milligram dose all at one time.

CAVANAUGH: Let’s take a call. Sasha is calling from San Diego. Good morning, Sasha, and welcome to These Days.

SASHA (Caller, San Diego): Hi. Yeah, I grew up with quite a few kids in my high school taking Vicodin, Hydromet Syrup, OxyContin, whatever have you. And I think really it kind of stems down to a point where parents have been giving their kids Ritalin and telling them this is good for them so they’re desensitized to taking pills, prescription medication in general.

CAVANAUGH: And basically they don’t think it’s going to be a problem or it’s not going to be dangerous?

SASHA: Well, yeah, I mean, if you’re a five year old kid and you’re taking Ritalin and you’re being told this is fine, it’s – you grow up thinking prescription medication is not something that’s really going to harm you in general.

CAVANAUGH: Thank you for that, Sasha.

WILLIAMS: And, you know, I think Sasha hit it on the head. We kind of grow up – This whole society now has a whole generation of kids that have grown up with just that, take this pill, it’ll solve this problem. If you watch TV, every day there’s how many commercials that are involve – that talk about this magical pill that can solve all your problems. And so we have a whole generation of kids that are coming up, growing up in a different way than maybe some of us did. Instead of putting the bandaid on that owie, they just say, hey, take this pill. And so we’re all desensitized a little bit to maybe respecting the dangers of these pills.

CAVANAUGH: Let’s take another call. Richard is calling from San Diego. Good morning, Richard, and welcome to These Days.

RICHARD (Caller, San Diego): Good morning. I just want to comment on a couple things. I blew my knee out and I got hooked on the OxyContin and the doctors were just pushing it on me at the time. And during that addiction, I went around and was doctor shopping, and I was busted by the DA task force about two years ago for that exact stuff that we’re talking about. And that stuff’s on the street everywhere and they’re selling it just left and right and, you know, it’s bad. I’ve been off stuff two years and I lost everything, my house, everything, just because of that addiction problem that I had with the OxyContin.

CAVANAUGH: Did you go into a program, Richard?

RICHARD: Yes, I did. I went into a program and got clean and sober off the stuff. I did the Suboxone thing and used that, which is a – the doctor can explain that.

CAVANAUGH: Yeah, he’ll have to.

RICHARD: I can’t but… Yeah, the Suboxone is a good thing. I think it’s better than the methadone that they’re pushing on people nowadays, too, to get off the drugs but, you know, you lose a lot of stuff on that pill, those drugs.

CAVANAUGH: Richard, thank you so much for your call. I appreciate the comment. And so, Dr. Smith, can you explain to us what Suboxone is?

DR. SMITH: Yes, Suboxone is buprenorphine and naloxone and there’s another medication, Subutex, which is just the bupreno – buprenorphine, I’m sorry. Buprenorphine. And essentially it is a – it is the most powerful binder to the opioid receptors that exists. So the analogy used to the patients is if you’ve got a bunch of little kids on a swing set, the big bully can come along and knock off all those kids and take whatever seat the bully wants, and that’s what Suboxone and Subutex are like. They – if there is a oxycodone molecule on the opioid mu receptor, that Suboxone molecule will displace that. And so it is a agonist/antagonist in the sense that it’ll knock off the other opioid molecule, in this case, oxycodone, but it has very weak analgesic properties. However, by having that molecule on the receptor, it prevents the withdrawal.

CAVANAUGH: I see.

DR. SMITH: So you have a medication that immediately will reverse withdrawal but if you’ve got a real pain issue, you’re not going to get great analgesia with Suboxone or Subutex. Now the advantage of Suboxone is it has the naloxone in it, which, of course, prevents any type of heroin abuse or opiate abuse. So if you try to shoot up or smoke the narcotic, the naloxone in the Suboxone will prevent that from binding. So it really does help patients who are addicted to get off and stay off of opioid or heroin.

CAVANAUGH: Matt, when people are arrested, as part of your task force, since there are seldom any real dealers involved, you know, the kind of illegal drug dealers that we’re used to, does prison come up a lot for people who are abusing these drugs? Or do you more or less guide them into rehab?

WILLIAMS: Well, I wouldn’t say that we don’t have your classic dealer because we do. There are some people who are dealing in large quantities, and those people are in a different class than the ones you’re talking about. The individuals you’re talking about would be probably your typical kid who’s trying to support their own habit, selling on the side. This is a very expensive street drug and so to make…

CAVANAUGH: How much does it cost?

WILLIAMS: When we started the task force, they were actually going for up to a dollar a milligram. And so an 80 milligram tab could cost up to $80.00. I think the last – at the last check, they were going for about $35.00, which is scary because that just means the supply’s up in the area. So – But, yeah, so I forget what I – we were…

CAVANAUGH: I was talking – Do you – A lot of people you arrest, do you put into rehab instead of prison?

WILLIAMS: Oh, right. The kids that we’re seeing, you know, a lot of them are – have no criminal record. They’re first time offenders. And so we’re looking at typically probation. I kind of hold a hard stance on it because I know how dangerous this drug is. I don’t want them to go in and do 90 days of jail and then walk out and go right back to using. I want them to be in a long term, in-patient, residential rehab facility and so the kids that have no record, that are coming to us for the first time, I try to make them – I try to get them into, you know, a 180 to 365 day residential treatment facility, longterm in-patient. We’ve found time and time again that outpatient just doesn’t work. Your typical AA/NA meetings aren’t going to work for this drug. This is basically heroin. It’s a heroin addiction. And that’s one of the worst ones out there. And so these kids can’t do it on their own. They have to get some serious help.

CAVANAUGH: Let’s take another call. Craig is calling from San Diego. Good morning, Craig, and welcome to These Days.

CRAIG (Caller, San Diego): Yes, good morning. I have a question. My son was diagnosed with ADD and my concern is that his doctor doesn’t follow any methodology to figure out if it’s really working for him. You know, he’s gone through Adderall, Strattera, and he’s taken Ritalin, he’s currently still taking Ritalin, and it’s just – each doctor visit is always like, hi, how you doing? Good. What’s going on? Not much. Okay, here you go. I’m like is this the way this type of medication is prescribed? I’m really thinking about maybe going through something else, maybe more research on figuring out is there a better way.

CAVANAUGH: Craig, thank you so much. And, Dr. Smith, the way that doctors prescribe medication, is there a methodology that you use in order to try to find out if you’re giving a patient too much or too little?

DR. SMITH: Yes, there is. Let me just respond to that last caller. Probably you may want to see if your child will qualify for some type of special ed at school. There’s good counselings (sic), and also a behavioral program may also be advantageous instead of just the medication alone. In regards to your question, Maureen, specifically, usually you start off with low doses and you try to titrate to the maximum amount of functional improvement and the quality of life. And you’re always going to evaluate for any type of side effects such as dysphoria and euphoria. Now in the mid-nineties, we never did urine tests but now doctors, pain doctors and any doctor that prescribes this, I think you have to do the DEA CURES, which is now online. That allows us to see what patients are getting medication from what doctors and at what pharmacies.

CAVANAUGH: Umm-hmm.

DR. SMITH: And you’ve got to do your random urine screens to protect the patient and to also protect your own liability as a physician. I write less OxyContin now than I did ten years ago because of this problem. I’m very leery of it. A lot of patients come to me on it from a previous doctor and we’ll usually maintain that provided that they’re compliant. But, you know, there’s a few patients—we probably have 5% of our patients in the pain population, if you look at the literature, about 5%, plus or minus 2%, that have addiction problems. So it is not prevalent amongst our chronic pain patients and yet this medication has really permeated the community.

CAVANAUGH: I’m wondering, Matt, for parents listening out there, you know, I guess lots of parents know the signs of kids who are on illegal drugs. Is there anything specific they should look for about kids who’re perhaps abusing prescription drugs or oxy?

WILLIAMS: You know, the thing I always like to tell parents especially in these affluent communities is please don’t fall into the trap of that’s not my child, they’d never do that, because time and time again, we see that they are classic. They come from those good families, they have great support. These are the kids that are achievers. They’re the athletes. They are the student government. They are the kids that are – you know, that all the other high school kids look up to. And so, please, parents, don’t fall into that trap of, well, my kid’s not like that. Think about the things that are happening in their life. Ask questions. I have a list of things that, you know, it’s easy for a parent to make excuses for or explain away. But if you’re starting to see, you know, more than one of these things occurring, look into it, find out what’s going on. If your child withdraws from the family, if they start to lose interest in things that were once important to them, if there’s a drop in academic work, and a drop in their performance. Check with their teachers. Ask why. A lot of kids are going to say, well, my teacher just doesn’t like me but if you ask the teacher, the teacher may tell you, well, your kid’s sleeping in my class. Your kid’s ditching my class.

CAVANAUGH: Yeah.

WILLIAMS: Loss of motivation and things – loss of motivation and they’re always tired. Are they sleeping until noon? Why are they sleeping until noon? Does it – Do their activities justify them being tired? They frequently find ways to get away, just short little I need to run and get – meet my friend at Starbucks. You know, just quick things where they can get away, get high and get back.

CAVANAUGH: And, Matt, if I may, can – if I can stop you there because we’re kind of running out of time.

WILLIAMS: Sure.

CAVANAUGH: I know that the county has, on at least one or two occasions, urged people to come and drop off the prescription drugs that they have in their medicine cabinets at a particular place so that nobody has to, you know, no kid, no stranger, no visitor, can go and steal what they have in their medicine cabinets. Anything like that coming up in – any time soon?

WILLIAMS: Yeah, we actually organized our first one in October and it was a success even though we didn’t really have much in the way of media, you know, exposure. The next one we are planning, I believe, is going to be in late March or April of this year. And, hopefully, we’ll get a lot more press this time and we’ll make it a much better event. We should be at – I think we’re planning on six or seven locations across the county so wherever you live, you should be able to find one of those locations, so listen for that.

CAVANAUGH: Okay, we will. I want to thank you both so much for talking with us today. Do you have a website?

WILLIAMS: Maureen, I just wanted to put out there, if there’s any parents or anyone who needs information on this stuff, we do have a hotline for abuse. It is the same phone number as the Meth Strike Force. It’s 1-877-662-6384, if you want to get involved or you want to find out information, please call.

CAVANAUGH: Thank you so much. Matt Williams, Deputy District Attorney, Dr. David Smith of San Diego Comprehensive Pain Management Center. Thank you. And stay with us for the second hour of These Days coming up in just a few minutes here on KPBS.

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