DENHAM SPRINGS – The medical field is fighting what some call a perfect storm, one that strikes the largest cities and the smallest of towns across America.
The spike in opioid and heroin addiction has risen to epidemic levels, one which has triggered a spike in deaths related to drug abuse.
A record of autopsies provided by Livingston Parish Coroner Dr. Ron Coe shows 33 deaths related to opioid or heroin abuse thus far in 2018. Outside of one case in September, at least two deaths each month have been linked to heroin or opioid abuse. It accounted for six deaths in May.
“Anytime you have a number of people dying a certain way, it’s a problem, and our parish is not spared by the opioid epidemic,” Dr. Coe said.
Drug poisonings involved meth, Fentanyl, heroin, morphine, buprenorphine, Percocet and Restoril, among others.
The roots of the epidemic date back approximately 20 years, when the medical profession was in a push to provide medications for instant pain relief, which led to a proliferation of opioid narcotics such as hydrocodone, oxycodone, Percodan, and other drugs.
“The complaints from patients were taken care of, so I think there was a big push to care for that – maybe too much,” Coe said.
“There were a lot of bad apples as far as physicians overprescribing, and clinics opening merely for the reason to become “pill shops.”
The “perfect storm” involves a crack-down on prescribing narcotics through the pharmacy and a decrease in the severity of sentencing for heroin possession - both of which lead to opportunity for the businessman-drug dealer, said East Baton Rouge Parish Coroner Dr. Beau Clark.
Clark spoke on the issue at the Nov. 30 meeting of the Denham Springs Kiwanis Club and during a summit on opioid abuse presented Dec. 5 by Capital Area Human Services.
Clark’s office assists with the autopsies Livingston and Ascension parishes.
Heroin has become the viable alternative for those addicted to painkillers, he said.
The number of opioid deaths across Louisiana was 150 times higher in 2017 than it was in 2012, according to the Louisiana Opioid Surveillance Initiative compiled by the Louisiana Department of Health.
Across the state, deaths involving synthetic opioids have rapidly increased. The fatalities involving synthetic opioids, including fentanyl, spiked at 500 percent between 2014 and 2017.
According to the National Institute on Drug Abuse, 346 opioid-related deaths were reported in Louisiana in 2016 – a rate of 7.7 deaths per 100,000 persons.
While the main driver of the deaths in 2012 stemmed from prescription opioids, heroin and synthetic opioids have surged drastically. From 2012 to 2016, heroin and synthetic opioid-related overdose deaths spiked from 51 to 149 deaths, and from 19 to 80 deaths, respectively.
All prescriptions – including opiates – are regulated by the Food and Drug Administration, which set them apart from heroin.
“Heroin is illicit, and therefore, it’s not regulated in a laboratory, but made by the dealer,” Dr. Clark said. “It’s strength or potency is quite variable.”
In pharmacology, potency is a measure of drug activity in terms of the amount required to produce an effect of given intensity. The potency of seized heroin varied between 12 percent and 47 percent, he said.
Adding to the problem the Louisiana Legislature, in an effort to reduce the number of nonviolent criminals in state prisons, struck down the mandatory life sentences for distribution of heroin.
Convicted offenders now receive sentences between five and 10 years.
“That was one of the worst things our state could have done,” Clark said.
Coe said he believes mental health issues and the scarcity of drug treatment play a major role in the ongoing growth of the epidemic.
“A lot of the people we’re seeing are those who have called our office saying their family members are using drugs, and many tend to be repeat offenders,” he said. “There’s not a whole lot of treatment out there, especially if you’re indigent. Ultimately one person ends up overdosing.”
Dr. Coe said he favors an expansion of treatment options, but the process can become a revolving door for addicts.
“There needs to be something put there to help people, but we can’t just continue to throw money and throw money and see the same persons in and out of treatment,” he said.
At the same time, the addiction drags down an entire household in the process.
“One family member can bring the whole family down with drug or mental health issues,” Dr. Coe said. “As I always tell people, you’re only as happy as your saddest kids, so a lot of families are affected adversely by drugs, alcohol, depression and suicidal tendencies.”
One change in terms of the prescription narcotics involves the quantity, Dr. Clark said. Gone are the days when doctors would prescribe 30- and 60-day supplies to patients.
In 2015, Louisiana providers wrote 103.2 opioid prescriptions per 100 persons. During the same year, the average U.S. rate was 70 opioid prescriptions per 100 persons.
New federal laws also require physicians to look up a patient’s prescription history on a national prescription database, which ensures patients are not “doctor shopping.”
The database may remove one route of availability for addicts, but abusers have gone to a much more dangerous direction to satiate their need. Many now purchase the drugs from street peddlers and traffickers who do not test the potency as pharmaceutical makers do through the FDA process.
The street peddlers open the user to a much more dangers situation, Dr. Clark said.
On the streets, users commonly request a drug and they are given a bag of white powder for which the dealer does not know about the contents.
“We have had cases where a known cocaine addict buys a baggy of white powder and overdoses, and later we find out through post-mortem toxicology that the substance was fentanyl,” he said. “This is a common example that the dealer is only interested in making money regardless of the substance they sell or the danger they put the ‘customer’ in.
“It also illustrates the danger the addicts put themselves in by consuming an unknown substance of property.”
Dr. Clark said he believes law enforcement should target the drug dealer and give them long prison sentences upon conviction.
Residents in Livingston Parish must not assume that illicit drugs are found mostly in larger cities, Dr. Coe said.
“You can find it anywhere,” he said. “We had a case earlier this week where they arrested four individuals from a sober house in Baton Rouge, and that included two who purchased narcotics here in Livingston Parish.”
“It’s everywhere,” Dr. Coe said. “We have to pray and teach our kids how to be high on life and just try to live right.”