Austin Monthly – Deaths went up in Travis County, too, which ranked fourth among Texas counties for accidental opioid fatalities in 2019. A report from the Texas Harm Reduction Alliance revealed 262 people died of a drug overdose in Travis County the following year, a 36 percent increase. That December, UT’s campus was alight when students were revealed to be targets of a drug ring selling laced counterfeit prescriptions.
It’s just before Thanksgiving, and Mike Sasser, a community health paramedic with Austin-Travis County EMS, sits in his car talking about the recent surge in emergency opioid overdose calls when a new entry flickers onto his vehicle’s mobile data computer list of active calls. “Pretty much every time I look at the computer, there’s one happening,” he says. “It’s multiple times a day.”
Emergency calls involving opioids were rising in Travis County before COVID-19 arrived, but their frequency spiked in the first year of the pandemic, Sasser reports. The novel coronavirus and its cascading effects—unemployment, isolation, mental distress, disruptions to health services—are certainly driving overdose numbers, he says. So is the increasing prevalence of fentanyl, an inexpensive but potent synthetic opioid 50 to 100 times more powerful than morphine, which is fueling fatal overdoses nationwide. Sasser says overdose calls involving drugs cut with fentanyl are now a common occurrence. “The person thinks they’re doing cocaine or Xanax or meth or heroin, but it’s laced with fentanyl,” he says. “It’s a much more life-or-death situation than ever before.”
U.S. overdose deaths hit crisis proportions years ago, quadrupling since the start of the millennium. But the pandemic helped push that toll to grim new records. More than 100,000 people died from an overdose between April 2020 and April 2021, according to provisional data the Centers for Disease Control and Prevention released in November. That’s an almost 30 percent increase over the previous year—and considered an optimistic assessment. Synthetic opioids such as fentanyl were the main driver, and agencies are raising the alarm. Last fall, the Drug Enforcement Agency disclosed the number of seized counterfeit pills containing fentanyl, such as fake Oxycontin and Adderall, had jumped 430 percent since 2019.
Last November, in response to the rise, Travis County District Attorney José Garza announced a new prevention-focused strategy, which included expanding the use of naloxone, a medicine that can reverse an opioid overdose if given in time. Cate Graziani, executive director of the Austin-based alliance, says she’s happy to have a local DA who supports a public health approach to the overdose crisis, instead of a punitive one. “But we need our leaders to go further and declare it an emergency,” she adds. “We can’t wait until the next [state] legislative session in 2023.”
Using a harm-reduction framework—which aims to prevent overdose fatalities while rejecting shame and stigma—the alliance’s street-based outreach team visits hundreds of people each week, most of them unhoused, to give out lifesaving resources like naloxone and wound care kits. Graziani says there are other tools available to reduce fatal overdoses and data to support their safe use. But even in the face of rising deaths, considerable obstacles stand in the way.
For example, fentanyl testing strips—cheap tools people can use to test their drugs—can fall under Texas’ paraphernalia law despite not being specifically listed. (Austin is fortunate that current local prosecutors don’t go after the strips.) The alliance is the only group distributing the testing strips locally, as far as Graziani knows, but it can’t keep up with demand and can’t spend public dollars on them.
Access to medication-assisted treatment for opioid addiction, such as methadone and buprenorphine, which are also shown to reduce the risk of fatal overdose, is similarly stacked with unnecessary barriers. Securing a spot at the small handful of local clinics that administer methadone, which is often most effective for people using opioids, can take months, Graziani says. And Travis County’s health coverage program for low-income residents, run by Central Health, only covers buprenorphine. “This is a public health emergency, but one of the toughest things is actually getting lifesaving meds in people’s hands,” Graziani says.
The logjam is why some like Sasser aren’t waiting on the system. About four years ago, the paramedic helped launch an EMS overdose response effort in Austin that follows up with survivors to offer naloxone and connection to support services. He says it quickly became clear that the lack of rapid access to methadone and buprenorphine was a huge missed opportunity.
In response, he and his team began administering regular buprenorphine treatments in the community, helping people stabilize while they wait for an opening at a clinic. In its first year, the new Buprenorphine Bridge Program managed more than 100 cases, with many of the people going on to long-term recovery. “This is a medical issue, and that’s what people aren’t realizing,” Sasser says of the overdose crisis, which he predicts may likely worsen. “For us, it’s a medical problem, not a legal one.”
