HJBR Sep/Oct 2021

HEALTHCARE JOURNAL OF BATON ROUGE I  SEP / OCT 2021 11 East Baton Rouge Parish set an all-time homicide rate, in the history of the par- ish, at 136 homicides. What’s scary about that, when we look at 2021, we’re well on our way of setting a new record again this year. When it comes to accidental over- doses, in 2020, we had 242 overdose deaths, the majority of which (greater than 90%) are related to opioids and the opioid epi- demic. So far this year, midway through the year, we’re at 145. Again, 2021 is looking like another record-breaking year in the over- dose category. I have great concern with both of these statistics, because it doesn’t look like we’re heading in the right direc- tion for either. Editor What do you think is triggering the homicide rate? Clark It’s always multifactorial. It has to do with, on one hand, the level of law enforce- ment pressure that is put on the community, especially the criminal element. We know that a majority of our homicides that occur in this parish are related to drug trafficking and, so to speak, drug turf wars that exist. We certainly have our random acts of vio- lence that lead to a homicide. Those really are somewhat unpredictable and not very preventable, but the other ones are; mean- ing, if the criminal element sees the pressure of law enforcement trying to prevent them from doing their drug trade, they really don’t have an opportunity to try to shoot at each other, because they’re more worried about getting caught by the police. So, robust drug enforcement becomes very crucial in how that number shifts from year to year. I think COVID plays a role in that, because from a law enforcement perspective, at the very beginning, we didn’t really know what we were dealing with, so I’m not sure that the law enforcement community was as hands-on as they were in the past for fear that the virus could create an issue for them. Editor Speak to us about what East Baton Rouge is experiencing in overdose cases. Clark In 2012, when I took office, was when I first sounded the alarm that we were in the midst of the opioid epidemic, namely because that was the year that we saw a precipitous increase in heroin overdoses. It caused me to do a little research, and on my website, there’s a presentation I gave several years ago that really explained the genesis of the opioid epidemic in Louisiana — how it all began. As we progressed through the opi- oid epidemic (which really is very similar in East Baton Rouge to other areas in the state, maybe different numbers, statistically, maybe different volume of individuals, but the same story and the same scenario some- what exists; if you expand beyond the state borders to other states, their stories are very similar as well), heroin comes on the scene. It’s a cheaper product. People that are suf- fering from opioid use disorder can’t afford the few narcotic pills that are on the street, so they turn to heroin. Heroin, obviously, is illicit and unregulated; therefore, when you buy that drug from your drug dealer, you have no idea the dosage or the purity of the drug, and you can have a pretty significant, massive overdose, because your body may not be accustomed to what it’s receiving in the drug. That’s why we saw this increase, and year to year, it kept increasing more and more until finally around 2016, what we saw was illicit fentanyl started coming into America, and you would see doses that were combinations of fentanyl and heroin. You take one very powerful opioid like heroin, and you mix it with a super powerful opi- oid like fentanyl — disaster and death occur after that. 2016, we saw that trend, and then a few years later, we saw heroin start to fade away, still present sometimes, but mostly become a fentanyl issue. That’s where we’re left today, and it’s gotten so bad that we’re starting to see people overdose from illicit fentanyl that are normally not opioid abusers. They normally abuse cocaine and methamphetamine, which are stimulants. As an aside, if you consider the people with substance abuse disorder, they typically fit into one of two categories: they either like to abuse depressant drugs like alco- hol, benzodiazepines and opioids, or they like to abuse stimulants like methamphet- amine and cocaine. Typically, they don’t live in both camps. We started to see mas- sive fentanyl/opioid overdoses in known cocaine and methamphetamine users, which I found curious, because it would not make a whole lot of logical sense for a person who has abused cocaine, metham- phetamine (abused stimulants) their entire life to one day decide, “Well, I’m just going to switch to opioids.”That just doesn’t make any sense. What our understanding is is that these individuals actually go to purchase their stimulant, their cocaine and their meth- amphetamine, and actually are given fen- tanyl instead — not necessarily on purpose, maybe just accidentally. Of course, if you’re not used to opioids, if your system and your body is not used to that type of drug, then the purity or the percent of that drug pres- ent doesn’t need to be very high for you to have a fatal overdose. I think that’s why we’re now starting to see this massive surge in fentanyl overdoses, because it’s occurring not only in opioid abusers who were there seeking the opioids, but also in individuals who are not seeking it but getting it acciden- tally. It’s causing our numbers to increase pretty drastically. Editor Are the fentanyl mixtures causing un- necessary death? Clark I’m not going to say that; you cer- tainly can overdose and die from cocaine and methamphetamine, but usually that doesn’t happen in an instant. Typically, what you see is that someone will overdose from the opioids because they’re naive to it. They’ve never had opioids before, and they are given it accidentally. Now, I’ve got a known stimulant/cocaine/methamphet- amine abuser that is overdosed on fentanyl, and, of course, they go down to the over- dose-fentanyl category.