This study examines what factors have influenced the St. Louis homicide spike between 2011 and 2018. The study uses data provided by the U.S. Census Bureau and the St. Louis Missouri Police Department, including information on population, poverty levels, race, homicide demographics, and homicide toxicology reports to analyze possible explanations for the high rates in homicide. In this study, I explore literature on elements associated with homicide that could be responsible for the high levels in St. Louis. Concepts of concentrated disadvantage, drug markets, firearms, regional differences, and the Ferguson Effect are reviewed and then evaluated in regard to the St. Louis data. I found that the high rates of homicide are related to high levels of concentrated disadvantage, increased use of drugs, increased homicide by firearm, and regional differences within the broader context of the city.