Travis County Chief Medical Examiner Keith Pinckard shared data showing that overdoses have been steadily rising the last three years, with a 38% increase in accidental deaths from 2019 to 2020, and another 20% increase in 2021. From 2020 to 2021, fentanyl deaths tripled, even as deaths from other drugs, like heroin, were decreasing.
On March 10, after a weekend of a dozen overdoses and three deaths from fentanyl, a synthetic opioid 50 times more potent than heroin, public officials briefed the Travis County Commissioners Court in a work session. Heidi Abraham, deputy medical director at Austin-Travis County EMS, said paramedics are responding to around 30 opioid overdoses a day. “Fentanyl is still by far the biggest threat – what we’re hearing from folks on the street is that everything is laced with fentanyl.”
Abraham and Health Authority Dr. Desmar Walkes explained that the three most commonly laced drugs are heroin, cocaine, and pressed pills like Percocet or Xanax – and the people most likely to be taking pressed pills are teenagers. Narcan, the most common brand of the overdose-reversing drug naloxone, is one of the most effective ways to prevent deaths, and EMS, community health paramedics, and Austin Police Department officers all carry it. Abraham encouraged the court to provide the Travis County Sheriff’s Office with Narcan as well, especially as EMS response times are slower to the rest of the county outside Austin. “Fentanyl makes patients stop breathing – if they’re still alive when EMS gets there, they stay alive. The overdose deaths we’re seeing are those who never make it to health care,” explained Abraham. She warned that Narcan may wear off after a short time, requiring robust Good Samaritan laws that provide legal amnesty for 911 calls in an overdose scenario. The Travis County District Attorney’s Office tweeted on March 19, as SXSW parties raged, “If you call 911 to help someone experiencing an overdose, you will NOT be prosecuted by our office.”
All of these tactics – increased access to Narcan, a local Good Samaritan law, etc. – have been recommended by Texas Harm Reduction Alliance, which has provided lifesaving supplies to low-income users since 2019. “We have been asking for the commissioners to convene this meeting long before this surge happened,” says Paulette Soltani, organizing director at THRA. Their key demands are for the court to declare a public health emergency; for methadone treatment to be expanded in addition to Central Health’s current buprenorphine program (in which the court invested $175,000 in the last budget); and most importantly, increased access to fentanyl testing strips, which are currently illegal in Texas.
Soltani says testing is one of the best ways to prevent an overdose, but in response to County Judge Andy Brown‘s questions about it, Abraham and Walkes expressed skepticism. “Some of these people are desperate enough that they are willing to take the risk, even if they know there’s fentanyl. [Testing strips] may help some, but I don’t think it’s gonna completely eliminate the problem,” said Abraham. THRA tweeted that those comments left them “far from satisfied with the conversation” – Soltani says testing strips are “a very basic harm reduction tool that everybody should be on the same page about.”
THRA lacks the resources to “do the work that’s necessary in the way that it’s necessary,” she says. “We’re doing patchwork for a worsening crisis. If the county and city leaders could come together, declare this a public health emergency, and put together a plan with some of the recommendations that we have,” perhaps these spikes could be curbed in the future.
