Dec. 10, 2018 – Statesman.Com — As Texas lawmakers wrestle with some of the state’s core issues related to substance use, a new House panel report is offering nearly 100 recommendations, including more treatment options, improved prescription drug monitoring and expanded access to detox medications.
While opioids remain at the forefront of drug discussions nationwide, the 108-page report from the House Select Committee on Opioids and Substance Use also found that methamphetamine was the state’s biggest problem, saying it should be labeled a “Texas crisis.”
More people died from methamphetamine use in Texas in 2016 than from opioids, according to data from a recent University of Texas report. Seizures of methamphetamine at the Texas-Mexico border have increased by 103 percent since 2014, and methamphetamine users made up 17 percent of admissions to treatment programs in the state in 2016, compared to 3 percent in 1995, the report found.
Overdoses from all drugs continue to rise in Texas, according to preliminary 2017 numbers from the U.S. Centers for Disease Control and Prevention.
“I do think that in some areas methamphetamine and alcohol abuse is probably every bit a problem as opioid addiciton,” the committee’s chair, Rep. Four Price, R-Amarillo, said. “We spend a lot of time on opioids because it’s an area that hasn’t received a lot of legislative attention.”
The lawmakers’ recommendations released Nov. 30 come after hearing months of public testimony from criminal justice experts, law enforcement professionals and addiction specialists on a range of topics, including: the rate of concurrent mental health and substance use disorders; the effect of drug use on hospitals, health care systems and policing; the prevalence of drug use among pregnant women, veterans and the homeless; and how the criminal justice system, child protective services and courts are affected by drug use and drug policy.
At times, emotions peaked during the summer hearings, as parents spoke about losing their children to overdoses and when pain patients pleaded with legislators not to take away their opioid medication.
Need for treatment resources
What emerged as the biggest challenge, legislators said, was a lack of available resources for those seeking treatment in the state. They found an insufficient number of medication-assisted treatment programs that offer methadone and Suboxone to patients detoxing from opiates and immediately available treatments for people trying to get sober.
In October, the average wait for a person seeking state-funded residential inpatient treatment was 31 days, according to data from the Texas Health and Human Services Commission.
The wait to get into a detox program was between six and 22 days. Addiction experts have said these long wait times often prove deadly for drug users.
Justin Logan, who works with the North Austin Foundation to shelter addicts while they wait to get into treatment, said people often must detox on their own on the streets, navigate a mountain of paperwork, and endure long waits and bureaucratic red tape to get state funding, or travel far to get a bed in a treatment facility, which lessens the chance they’ll get help.
“It’s very important when you decide to get help to go forward with it and not wait around,” he told the American-Statesman in November. “We run into so many roadblocks along the way that it’s like fighting a never-ending battle. … People give up in the process …And it’s pretty heartbreaking.”
The lack of treatment resources has proved particularly devastating for people in rural areas, women and those with co-occurring mental health disorders, the report found.
Lawmakers are advocating for a range of different treatment services, including: expanding access to medication-assisted treatment by making sure more physicians can prescribe detox drugs; adding those medications to the state’s Medicaid Preferred Drug List; expanding medication-assisted treatment programs into often neglected rural areas; and increasing options for recovery housing and coaching.
Lawmakers say the state could create matching grants and partnerships with treatment facilities to expand services.
Better data collection sought
The report also pointed out concerns about the state’s data collection efforts, which experts say often don’t relay accurate and timely information.
Poor data collection might have led to an undercounting of fatal overdoses in the state. In 2016, 2,831 people in Texas died from drug overdoses, according to CDC data. However, state medical examiners and justices of the peace say these numbers could be even higher because drug toxicity information is often not included on death certificates.
Other concerns included:
- An increase in the amount of the strong synthetic opioid fentanyl, which has created problems for law enforcement officers and led to the sharpest rise in overdose deaths nationwide.
- Problems with the state’s prescription drug monitoring program, which prescribers use to track people visiting multiple doctors to obtain medication. They say it’s complicated and time-consuming to navigate.
- Continued overprescribing of opioid medication.
- A lack of education about drug take-back programs and safe disposal of prescription drugs, which has made it easy for people to obtain leftover medication.
- Insufficient access to naloxone, a drug that is used to reverse the effects of an opioid overdose.
Lawmakers have recommended standardized reporting across state agencies to improve data collection and that justices of the peace be trained to recognize a drug overdose and list it correctly on death certificates. They also have urged: improvements to the state’s prescription drug monitoring program, so it is cheaper and easier to use; making naloxone available by a standing order at all pharmacies; enhancing the punishment for the use, possession or manufacture of fentanyl; and supporting more specialty drug courts and programs to divert low-level criminal offenders to drug treatment.
The report does suggest enacting a good Samaritan law that would protect people who call police to report a drug overdose from prosecution for some offenses. A similar bill passed the House and Senate with wide support in 2015, but was vetoed by Gov. Greg Abbott because he said it didn’t include adequate protections to prevent misuse by habitual drug users and dealers. New data presented by the Texas Department of State Health Services during the hearings showed similar laws in other states have resulted in as much as a 15 percent drop in opioid overdoses in the past five years, despite nationwide increases.
The committee itself will not refer bills for the upcoming session that starts in January. Its report will merely be used by lawmakers as they consider legislation.
So far, no bills have been filed to
directly tackle the opioid crisis or substance use in the state.
However, Price said he expects that committee members will file some
type of draft legislation after the new year, when the session begins.
“It
is such a broad and expensive crisis both in human life costs and
indirect productivity costs,” Price said. “We can do a lot on the front
end to prevent problems from getting worse.”
The report does point out the potential unintended consequences any legislation to curb overprescribing opioids. Such policies can hurt patients who rely on the medications to function daily, including those with chronic pain.
Several people testified during a public hearing on Aug. 8 about the effect that new CDC guidelines were having on doctors’ prescribing practices, which caused them to cut back medications they rely on to treat pain associated with arthritis, degenerative disc disease, multiple sclerosis and other chronic conditions. These patients have said they have few viable alternatives to narcotic medication, resulting in an increasing number considering suicide.
