RATES DECLINING Dispensing Montgomery and Harris counties have seen a steady decline in the opioid prescription dispensing rate since 2010, suggesting health care providers have become more cautious in their opioid prescribing practices, according to the Centers for Disease Control and Prevention. PLUMMETING PRESCRIPTION RATES
unnecessary opioid prescriptions have attributed to the county’s falling opioid dispensing rates. “[Law enforcement] worked to arrest those doc- tors and get them out of practice, which has been a huge impact,” Campbell said. With opioid dispensing rates falling over the last decade, Brown said Harris County Public Health’s focus has since shifted to illegally obtained opioids. “Now, the [production] of … lookalikes of prescrip- tionmedication, I think, is overtaking the prescription medications themselves,” Brown said. Illegal pill manufacturers Doug Hooten—CEO of Harris County Emergency Services District 11 Mobile Healthcare, which pro- vides emergency medical services in north Harris County, including parts of the Humble area, said many opioid overdose deaths result from individu- als procuring drugs made by illegal pill manufactur- ers with no knowledge of what the pills contain. “It’s just Russian roulette,” Hooten said. Hooten said illegally manufactured pills often contain fentanyl, a synthetic opioid that is 80-100 times stronger than morphine. He noted fentanyl can be lethal in doses as small as the tip of a pencil. While Hooten said illegal pill manufacturing oper- ations are likely more widespread outside of the U.S., the practice still occurs locally. On Feb. 18, Harris County Precinct 4 constables discovered boxes of bags ¡lled with pills laced with fentanyl at a residence less than 10 miles fromHum- ble as well as the equipment needed to manufacture them, according to ocials with Harris County Pre- cinct 4 Constable Mark Herman’s oce. Telehealth aects treatment At the beginning of the COVID-19 pandemic in 2020, many health care centers were forced to shift to o£ering services remotely. Katy Franklin—a sub- stance use counselor at Tri-County Behavioral Healthcare, which o£ers substance abuse programs in both Harris and Montgomery counties—said the transition was dicult for patients who were strug- gling with addiction. “Treatment was less e£ective for this particular population,” Franklin said. Additionally, Varisco noted confusion among doctors spread in the early months of the pandemic concerning what treatments were acceptable to pre- scribe for opioid use disorders. A 2020 memo from Phil Wilson, the executive commissioner of Texas Health and Human Services, said buprenorphine could be prescribed virtually, but methadone required a face-to-face evaluation before the ¡rst dose could be provided. Both drugs are used to treat opioid use disorders. “I don’t know if [the policy] was well understood by providers, and that led to lapses in our treat- ment,” Varisco said. Telehealth did, however, allow some smaller clin- ics and private practices to expand their coverage areas where patients could not access in-person care. Lori Fiester, clinical director at Houston-based nonpro¡t Council on Recovery, said telehealth gave patients who were without transportation or who were immunocompromised access to care.
Harris County Montgomery County
In 2020, there were enough opioid prescriptions dispensed for one-third of residents in both Harris and Montgomery counties.
0 20 40 60 80 100
81.2
82.6
82.7
80.7
75.5
66.5
60.6
55.2
50.6
46.2
69.1
65.4
37.8
63.3
58.2
55.1
48.3
46.2
42.4
42.4
42.5
37.5
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
While Montgomery County saw an 18% decline in opioid-related emergency department visits from 2016 to 2022, Harris County saw an approximate 26.5% increase over that same time frame. OPIOIDRELATED EMERGENCY TRENDS
HARRIS COUNTY Opioid-related emergency department visits rose nearly 10% from 2019-20.
MONTGOMERY COUNTY Opioid-related emergency department visits fell 12% from 2019-20.
1,290
1,300
250
226 227
1,173
212 211
1,200
1,146
185
200
1,062
1,100
1,020
1,000
150
0
0
2016
2017
2018
2019
2020
2016
2017
2018
2019
2020
SOURCES: CENTERS FOR DISEASE CONTROL AND PREVENTION, NATIONAL CENTER FOR HEALTH STATISTICS, PROVISIONAL DATA FROM NATIONAL CENTER FOR HEALTH STATISTICSCOMMUNITY IMPACT NEWSPAPER
began marketing opioid pain relievers as drugs that were not as addictive as previously thought, accord- ing to the National Institute on Drug Abuse. “I think early on in this crisis, the issue was really misuse of prescriptions, and it still is to some extent,” said Ericka Brown, director of Harris County Public Health’s Community Health and Wellness Division. “Awareness [of medical providers] of alternatives to opioids for pain control … has really done a great job of mitigating that.” According to NCHS data, 81.2 opioid-based pre- scriptions were administered for every 100 people in Montgomery County in 2010. In Harris County, 69.1 prescriptions were administered for every 100 peo- ple in the same year. By 2020, those rates had fallen to 37.5 and 37.8 prescriptions per 100 residents in each county, respectively. “This crisis has exposed cracks in the system and made them a lot more evident,” Varisco said. However, James Campbell, chief of emergency medical services for the Montgomery County Hos- pital District, said he believes recent crackdowns on
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overdose deaths had similarly risen from 764 in July 2020 to 1,041 in July 2021, according to NCHS data. During that same time frame, drug overdose deaths in Montgomery County increased slightly from 116 to 120. “These are diseases of despair that we’re dealing with,” said Tyler Varisco, a health services researcher with theUniversity of Houston. “Whenpeople are eco- nomically challenged or psychologically challenged, … we see increased vulnerability in our communities to opioid use and other forms of substance misuse.” Ocials charged with addressing the rise of opi- oid-related overdoses have attributed the issue to several factors, including opioid addictions aris- ing from legally prescribed medications, illegal pill manufacturing operations and diculties obtaining treatment due to COVID-19. Legally obtained prescriptions In the late 1990s, pharmaceutical companies
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