June, 7, 2018 – AAS – While the number of people dying from opioids in Travis County isn’t comparable to the deaths tallied in places in the Northeast, the devastating effects of the drugs are being felt locally. From 2006 to 2016 in Travis County, 590 people died from opioid overdoses, the Austin Public Health Department said.
Austin city officials have asked for more resources as opioid overdoses continue to rise in the region. Texas has not seen increases in opioid deaths like other states, but health experts say data could be skewed. Federal grant money has begun to pour into the state, but officials say more is needed.
The rate of opioid overdose deaths nearly doubled in that time, from 4 deaths per 100,000 people in 2006 to 7.5 deaths per 100,000 in 2016, the data show.
Robert got introduced to opioids the way many people do — from a bottle of prescription pain medication in his home medicine cabinet that a doctor gave his father to help with his kidney stones. He was a junior at McNeil High School. The progression was predictable: hydrocodone, OxyContin, then heroin.
Now a 21-year-old college junior, Robert did not want to share his last name because he is about to graduate from the University of Texas and wants to be a teacher. Sometimes the past can come back to haunt you, he said. Robert has been sober a year and three months.
In the hallways where he attends classes are bathrooms where he used to shoot up. He said he knows other kids he went to school with who did the same thing. It’s happening here in Austin, he said, sometimes where you least expect it.
Austin musicians, in particular, have been affected by the crisis. Triple the number from 2016 sought help last year for opioid dependence, according to the SIMS Foundation, which provides mental health services for the city’s creative community.
The problem cuts deeply enough that the Austin City Council last month commissioned an interdepartmental task force to look at opioid abuse in the region and directed the city manager to consider adding money to next year’s budget for public education, harm-reduction initiatives and treatment, among other things.
“While there are communities around the country that are facing at this point a more severe crisis, more profoundly impacted at this point than Austin, sadly, Austin is not immune,” Mayor Steve Adler said at a news conference in May. “We have the opportunity in Austin to get out in front of a challenge that is now growing here.”
Gauging the opioid problem in Texas
On Friday afternoons, Ignacio Garcia rides his bike to the Planet K gift store on East Cesar Chavez Street and stops next to a multicolored van. He enters through the passenger door and thumbs through containers in the hollowed-out vehicle that contain clean syringes, sterile cotton, tourniquets and other injection supplies.
The nonprofit Austin Harm Reduction Coalition parks at the Planet K every week from 6:15 to 6:45 p.m. — one of its many stops in the city where addicts can trade used syringes for new ones. Technically, needle exchange is illegal in Texas, but Austin police, recognizing its benefits, have long chosen to look the other way.
“Our job is to be real enough to know that this stuff is here, and we should inform people to the best of our ability as human beings to stay as safe as possible until they find a better way,” the coalition’s founder, Mark Kinzly, said. “Dead people don’t ever get to hear the message of hope.”
Garcia, 46, is one of the coalition’s many clients. Born and raised in Austin, he’s used heroin for 20 years and said he’s never seen things so bad. “This is the worse it’s been,” he said. “Everyone is doing it. People coming off of prescription drugs. It gets too expensive. It’s cheaper to get heroin. It’s a lot easier, too.”
Health experts for a long time have attributed the opioid crisis to the overprescribing of pain medication that began in the 1990s. In recent years, the presence of fentanyl, a strong synthetic opioid produced in China and trafficked to the United States, has compounded the problem, resulting in as many as 42,000 deaths, including those from heroin and prescription drugs, in 2016, the deadliest year for opioid overdoses on record, according to the U.S. Centers for Disease Control and Prevention.
In Texas that year, overdoses increased 7.4 percent, a small but significant boost, according to the CDC. By comparison, Pennsylvania saw a 44.1 percent increase, the data show. Experts have differing opinions on what’s kept overdose numbers lower in Texas. The “black tar” heroin sold on the streets in the South is less pure than the white powder pushed in the Northeast. It’s dense and gummy, which makes it more difficult to mix with the fentanyl that makes powder heroin so deadly these days, said Jane Maxwell, a research professor at UT who focuses on drug use patterns.
Whatever the reason for lower overdose numbers in Texas, officials and other experts say the problem here should not be discounted. “We can keep saying things like, ‘Well, we aren’t seeing it at the level of other parts of the country,’ ” said Kinzly, who is a recovering opioid addict. “For me, what that says is that we are OK. We don’t need to be proactive. And that’s not true.”
The data, too, may not accurately gauge the problem. In Texas, with 254 counties and only 13 medical examiners, drug overdose deaths get tallied differently from place to place. Sometimes justices of the peace record a death as “cardiovascular” without specifying whether illicit or prescription drugs were a factor. Austin city officials say this has led to an undercounting of fatal overdoses.
Hospital data also have shortcomings. Austin public health officials can use discharge billing data to provide insight, but it takes months to be released. Officials rely on patient intake data to keep tabs on numerous health concerns nearly in real time, including drug overdose cases, according to Janet Pichette, chief epidemiologist with Austin Public Health. As the state expands use of a newer syndromic surveillance system, which scans algorithms and keywords daily, they will be able to better analyze that data.
Pichette, who also leads the Epidemiology and Public Health Preparedness Division, says her goal is to foster cooperation among local agencies to keep tabs on drug overdoses in the area.
“My goal is to bring all the data groups together so we can have that conversation as a first step. The better you know where the problem is, the better you can be strategic in setting up prevention and treatment strategies.”
Many who work in the addiction field are coming up with their own ways to assess the problem, including relying on word of mouth from addicts themselves.
‘We are not immune’
Joe has suffered back and hip problems as long as he can remember because of four herniated discs in his spine and a pinched sciatic nerve. He didn’t want to use his real name out of fear of retaliation. He started using heroin years ago to treat his pain after he was caught filling prescriptions from two different doctors in Colorado and placed on a do-not-prescribe list, he said.
Joe visits the coalition van at Planet K once a month to get clean needles. He picks up several boxes for his friends who also use heroin, as well as doses of the drug naloxone, also known as Narcan, which can be injected into the body or breathed through the nose to reverse the effects of an opioid overdose.
Joe said he’s had to use the medication nearly a dozen times as he’s watched people around him stop breathing. “I get a hold of some good stuff,” he said. “So I keep that stuff around.” The coalition has been handing out naloxone for several years to get the drug into the hands of addicts, their friends and family members, who are often first at the scene of an overdose.
They also distribute fentanyl test strips that can detect its presence in heroin that’s been melted down to its liquid form, so users know to be careful. Every time a client administers a dose of naloxone to stop an overdose or cooks up a batch of drugs that tests positive for fentanyl, coalition staffers and volunteers write the information down in a binder.
Kinzly said he knows of nearly 1,000 people in Texas since 2013 who have been saved by naloxone through the coalition and other programs. He’s also seen a significant increase in the amount of fentanyl-laced drugs reported, from 30 percent in 2016 to as much as 70 percent this year.
COMMENTARY: How fentanyl got its grip on Texas
“Fentanyl is here,” said Daniel Sledge, a paramedic in Williamson County. “I know that some of the folks in office would probably suggest otherwise, not in my backyard. But it is here. I read the reports. Medics after giving naloxone will say, ‘Hey, what happened?’ People say, ‘Yeah, I snorted fentanyl before work. I guess I overdid it.’ ”
Sledge is part of an innovative program in Williamson County called the Mobile Outreach Team, in which medics follow up with patients who suffer near-fatal overdoses to get them connected to counseling and other treatment services. Health officials say it’s a one-of-a-kind approach using Emergency Medical Services for outreach and is serving as a model for other cities.
From 2016 to 2017, the team has calculated a 39 percent increase in the number of unintentional opioid overdoses in which medics administered naloxone to restore normal breathing.
“We are in the middle of a public health emergency,” Sledge said. “We don’t want to create panic, but we want to say, ‘Don’t be in denial.’ We, like everywhere in the U.S., have fentanyl, and we need to put things in place.”
Cracking down on an epidemic
As much as $209 million has been invested in Texas this year for treatment, which includes a two-year, $27.4 million grant given by the Substance Abuse and Mental Health Services Administration to crack down specifically on the opioid epidemic in Texas.
The mobile outreach program is one of several organizations to receive money that has been largely devoted to overdose prevention efforts, including expanding access to naloxone and other life-saving drugs, Texas Health and Human Services director Lisa Ramirez said. The money also has paid for education programs in schools and new recovery support services.
In Travis County, it helped fund UT’s Operation Naloxone, which has outfitted all campus dorms with the opioid-reversing drug and trained university police and resident advisers to respond to an overdose. The program’s director, pharmacy professor Lucas Hill, said he still hopes to see a standing order for the drug at all pharmacies in Texas so it’s available to anyone who needs it — something he said the Texas health commission has been unwilling to do.
As part of the grant, the university has been tasked with encouraging doctors and other prescribers to sign on to the state’s prescription drug monitoring program, which helps identify patients visiting multiple doctors to obtain prescriptions — often referred to as “doctor shopping.”
Currently, pharmacists in Texas are required to input all prescription drug orders into the system, which is linked across multiple states. But doctors and prescribers aren’t required to use it, and only 40 percent are registered, according to the Texas State Board of Pharmacy. The UT program hopes to boost those numbers, as well as encourage doctors to educate patients about treatment options if they notice a problem.
By 2019, all doctors in the state will be required to use the system before prescribing or dispensing opioids and other highly addictive medications, thanks to House Bill 2561, which was signed into law in 2017.
In Austin, opioid prescribing rates — already lower than the state and national averages — are dropping, from 69.9 prescriptions per 100 people in 2012 to 51.2 per 100 in 2016, according to the city’s public health authority, Philip Huang. “Our physicians and our community is doing better than some places,” Huang said.
The second wave of grant money that became available May 1 will allow the health commission to expand medication-assisted treatment programs, including offices that dispense methadone and buprenorphine, which are used to treat opioid addiction and are severely lacking in Texas.
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“We have really effective medications to treat this disorder,” Ramirez said. “But there is a tremendous amount of stigma.”
When the grant money runs out, Ramirez hopes to find a more permanent source of funding to combat the opioid epidemic in Texas. Lower overdose numbers have made that difficult, since many grants require the state to show sharp increases.
That is why it’s so important to get a handle on the data and make sure cities and counties are recording opioid deaths properly, she said, something Austin officials could address when they decide whether to add money in the 2018-19 budget for surveillance and data collection.
“Historically, we have had problems with opioid use,” Ramirez said. “We are not immune.”
On Second and Comal streets is a methadone clinic that Lawrence “Lench” Martinez remembers from when he was a little boy. Long before his rap song about gentrification called “What Happened to Austin? (My Beautiful City)” made him famous, he would go there with his aunt, who was trying to get off heroin and remembers users scoring drugs on the corner.
Today, when he’s clipping hair at his barber shop on Burleson Road in Southeast Austin, he listens to clients talk about so-and-so and so-and-so, who are “hooked on dope now.”
“It’s always been around,” he said. “It is one of the best-kept secrets in Austin, I guess you could say.” Martinez said it wasn’t until the epidemic hit white America that people started to take notice. Two-thirds of overdose victims in Austin are men and 71 percent are white. More than a third of the victims are between 25 and 39 years old, and most overdose cases involve opioids.
“When it is somebody like that, a kid from suburbia, he doesn’t need prison time, he needs help,” Martinez said.
He said tackling the opioid crisis in Austin will require compassion, for people on the west side as well as those at the Austin Resource Center for the Homeless downtown.
“These people have always needed help,” he said. “At one point, that was somebody’s child, somebody they loved. These people don’t start as an afterthought. God doesn’t make throwaway people. We are going to have to start being compassionate if we are going to tackle this problem head-on.”
By Mary Huber – American-Statesman Staff
