Dr. Edwin Chapman is a physician in Washington, D.C., who specializes in treating addiction.
We have heard the aggregate numbers. How does that track with what you see in your clinic?
So, we have known for some time that our population, which is 95 percent African American, even though, in terms of overdose deaths, even though in the District of Columbia, we account for only 46 percent of the population.
But the difference is that our epidemic started with street Drugs 40, 50, 60 years ago with heroin. But, in 2014, that heroin transitioned to fentanyl. So, we saw 20 percent fentanyl in 2015. And it gradually increased over the next five years to now we’re seeing 95 percent fentanyl in our street drugs. And fentanyl is 50 to 100 times more potent than morphine.
Initially, it was mixed in. And, subsequently, there were those who did seek out the more potent form. But, unfortunately, with fentanyl being so much stronger than heroin or the typical pills, that people were overdosing and dying.
So all of this is really — when we look at it as a whole, we can say that the pandemic really is acting as a barometer for our overall health care system. We can see these structural and public policy issues that have gone for centuries, in fact, coming to the forefront. And they’re exacerbated by housing issues, transportation issues.
So, our patient population, because they have been involved in drug use for so many years, are disenfranchised from the community, disenfranchised from family. So we have a very high homeless population.
Dr. Edwin Chapman:
So, our approach has been really to a team-based approach.
And we realize that 80 percent of the outcomes are related to things outside of the doctor’s office, outside of the hospital. So we really need to have this community education. We need to have advocacy in the community, legal support to oversee to make sure that patients are getting the type of treatment that they need.
And, of course, we need to integrate substance abuse, mental health and primary care services, because these patients have the same issues as everyone else. The fact is that they have had so many difficulties, including their involvement with the criminal justice system, that have to be reversed.
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