JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Amphetamines, cocaine, and non-heroin opioids, including fentanyl, grew in prevalence throughout each year, while heroin and benzodiazepines fluctuated or remained constant. Benzodiazepines dropped from being in approximately 52% of overdoses from 2013-2015 to being present in only 27% of overdoses in 2016. Fentanyl overdoses grew exponentially from one case in both 2013 and 2014, to six in 2015, and then nearly tripled to 17 in 2016. The prevalence of amphetamines and methamphetamines in overdoses rose from being in 8% of overdoses in 2013 to 33% in 2016.
and a rapid response by law enforcement and health officials to stem its growth before it develops into an even larger problem.
Our finding that heroin and benzodiazepines are nearly identical in their prevalence in overdoses is a disturbing trend. No drug was more common than benzodiazepines, except for opioids when heroin was included in their total count. In fact, Benzodiazepine associated overdoses in EBR would be more common than heroin overdoses if it were not for the sudden drop in benzodiazepine overdoses in 2016. The problem is so significant that EBR’s average rate of fatal overdoses involving combined benzodiazepines and opioids of 51.86% was over double the national average of 23%.³ A follow up study is necessary to determine if there has been a continued drop in combined opioid and benzodiazepine overdoses since the CDC started advising physicians to not concurrently prescribe the two drugs and required a black box label stating the dangers of combined usage be placed on the drugs’ packaging in March 2016. Going forward, benzodiazepine abuse should receive as much focus as heroin due to its equally, if not greater, impact on the drug abuse epidemic. The high prevalence of benzodiazepines in EBR could be due to over-prescription of the drug to patients throughout the state of Louisiana itself. A recent study by the CDC ranked Louisiana 7th in prescribing rates for both benzodiazepines and prescription opioids.⁴ In our study we found that those overdoses which involved prescription opioids, but not heroin, were 20% more likely to include benzodiazepines than heroin involved overdoses. Since these are prescription drugs, healthcare professionals should be at the center of curtailing the benzodiazepine overdose rates through patient education and informed prescribing practices. The high average age of female non-heroin overdoses relative to all other overdoses is noteworthy. This trend necessitates further investigationtodeterminewhatunderlyingfactorsmightexplain this finding, and whether this is a regional anomaly confined to EBR or part of a broader national trend. For instance: is this an outgrowth of females having a greater diagnosis and prescribed treatment rate for depression and anxiety than males?⁵ Ergo, if they have more access due to a higher rate of prescription, is there a greater likelihood that females will overdose on these traditional anti-anxiety or anti-depressant medications? The skew of non-female heroin overdose victims to favor the ages 40-55 is especially interesting since it evenly brackets the average age of women in the U.S. who undergo menopause, approximately 50 years old.⁶ While substance abuse can contribute to the beginning of menopause, it is not known if the changes which occur during menopause cause an increased likelihood of substance abuse.⁷ It is the belief of the authors that this population is possibly acting independently of the much larger drug abuse epidemic and should be studied specifically in future studies.
If an individual overdosed on benzodiazepines they also used opioids concurrently in 93% of cases.
From 2013-2016 ZIP code 70816 had the most heroin involved overdoses at 22, and the most overdoses overall with 38 total. ZIP code 70815 had the most non-heroin overdoses at 17, and the second most overdoses overall with 30. Seven ZIP codes in EBR had over 20 fatal overdoses from 2013-2016: 70808 (21), 70810 (22), 70805 (23), 70806 (24), 70809 (27), 70815 (30), and 70816 (38). 101 (73.72%) of individuals who overdosed on heroin were White, 34 (24.82%) were Black, and two (1.46%) were Hispanic. 115 (72.33%) of individuals whose overdoses did not involve heroin wereWhite, 44 (27.67%) were Black, and one (0.63%) was Hispanic.
DISCUSSION
As evidenced by these findings, EBR is caught amid the nationwide prescription drug and heroin epidemic, with growth rates surpassing those of many states, which can be seen in the spike in heroin deaths between 2014-2015.¹ Of the sevenZIP codeswhere themajority of overdoses occurred, only one (70805) was more than $10,000 had an average household income below Louisiana's average of $45,000. The remaining six ZIP codes average incomes were evenly split between those with average income within $10,000 of the state average (70806, 70815, and 70816), and those with an average income $10,000 greater than the state average (70808, 70810, and 70809). This spread in average income across the ZIP codes shows that the overdose epidemic is hitting the middle and upper class portions of EBR the hardest. The rapid growth in 2016 in fentanyl’s presence among fatal overdoses is alarming. 2016 saw more fentanyl related overdoses than the previous three years combined. The fact that over half of the overdoses which involved fentanyl occurred in the final four months of the year is noteworthy. This dramatic spike appears to herald the arrival of fentanyl and high potency synthetic opioids to EBR, a problem which until now EBR had largely avoided, unlike Acadian and the Greater New Orleans Area which began seeing fentanyl overdoses much earlier in 2016.² This sudden rise in fentanyl related deaths necessitates further research to determine the etiology of its proliferation
CONCLUSION
J La State Med Soc VOL 170 JULY/AUG 2018 105
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