HJNO Sep/Oct 2021

CORONERS’ ROUNDTABLE 24 SEP / OCT 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS   trying to get the message out to families that they have this life-saving drug avail- able and to realize that addiction is a medi- cal problem that is amenable to treatment, but that there is no cure at this time. Again, that is why it is so important to have mental health resources available for people suf- fering from substance use disorder so that if they are brought back to life with Nar- can, they can get the treatment they need for their underlying substance use disorder. Cvitanovich Nationally, overdose deaths went up 30% between 2019 and 2020. In JP, overall overdose deaths went up 50%. Fentanyl deaths, on the other hand doubled between 2019 and 2020 and are on track to double again from 2020 to 2021. McKenna We have had a great spike in the number of drug overdoses, specifically with the drug fentanyl. There are obviously many drug-related cases, however, we are seeing fentanyl in approximately 80% of all drug- related deaths. Fentanyl and fentanyl analogues seem to be particularly nasty street drugs. What makes them so dangerous? Preston It is the potency of Fentanyl and its analogues that make them so dangerous. Even a small dose of these drugs can cause a person to stop breathing, and then the heart stops beating. Cvitanovich Fentanyl is 50-100 times more potent than morphine. The incredible potency of Fentanyl makes it extremely difficult for drug dealers to safely cut and mix it. McKenna Simply put, they are respira- tory depressants, which stop people from breathing. If Fentanyl mixtures are causing unnecessary deaths, do you or would you ever recommend legalization of some street drugs, so the drug of choice is monitored by the FDA? Why or why not? Preston The notion of legalizing “street drugs” to be monitored by the FDA is far above the paygrade of the coroner. While this approach has had some measure of success in other countries, I think that it would be met with widespread resistance in the United States. Cvitanovich No — never! McKenna I would support legalization of marijuana but never synthetic opiates or any other drugs. Have you found overdose deaths impacted efforts to increase distribution of Narcan? Preston The increase in overdose deaths has resulted in an increased effort to distribute and educate our population about Narcan. Parish government, with support from my office, was able to apply for a grant to obtain Narcan, and they have worked out a distri- bution systemwith our partner fire districts who have Narcan at every fire house and will distribute it, no questions asked. Nasal Narcan is virtually foolproof, but with the distribution of the Narcan, folks receive a QR code that takes them to a very short online training video. In addition, my office has supported several in-person, online and TV messages to make people aware that Narcan is available and that it can be life-saving. In reality, my message is Narcan gives a second chance at seeking care for the substance use disorder, so people truly have an opportunity to change their lives and survive. Let’s talk about the mental health aspect of your position. Has the pandemic increased the number of calls received by your office for Orders for Protective Custody (OPCs) and/or Coroner Emergency Certificates (CECs)? Preston The numbers of OPCs, PECs and CECs have fluctuated a bit. Our office issued 356 OPCs in 2019, which rose to 485 in 2020, and we have issued 335 year-to- date for 2021. Interestingly, the number of PECs dropped slightly from 2524 in 2019 to “We have had a great spike in the number of drug overdoses, specifically with the drug fentanyl. There are obviously many drug- related cases, however, we are seeing fentanyl in approximately 80% of all drug-related deaths.” DWIGHT MCKENNA, MD Orleans Parish Coroner