OUTOFREACH A cure Harris County has seen a steady decline in the opioid dispensing rate since 2010 and has had a lower rate than the state during much of that time, according to the Centers for Disease Control and Prevention. The decline in opioid dispensing suggests health care providers have become more cautious in their opioid prescribing practices. PLUMMETING PRESCRIPTION RATES While the rate of opioid prescriptions in Harris County has slowed over time, opioid-related emergency department visits rose through 2020. Opioid overdose deaths statewide nearly doubled during the pandemic with experts citing a lack of access to care as a barrier.
average for every three residents in Harris County in 2020. While prescription misuse is still an issue to some extent, Brown said the county is seeing a rise in street drugs, such as lookalike prescription medi- cations and fentanyl, a highly lethal opioid. The use of fentanyl in Harris County has risen by more than 100% since 2019, she said. Reed said the supply of heroin and other drugs coming in from outside the country is often laced with fen- tanyl, which has led to inadvertent overdoses locally. According to the NIDA, nearly 80% of heroin users reported using prescription opioids prior to heroin. “Because of increased regulation on those prescription pills, [people who are addicted] either can’t get what they’re normally supplied, or they’re completely cut off, and so they’re switching to heroin to get their fix and then starting that down spiral into being addicted to heroin,” Reed said. Pandemic effects on treatment Varisco said the pandemic exac- erbated several underlying causes of substance use, including patient access to treatment, increased finan- cial stresses and isolation. He said he believes the changes to health care for individuals experiencing addiction undid recovery work performed for patients before the pandemic. According to the Treatment Episode Data Set, which compiles national patient discharges from treatment for the Substance Abuse and Mental Health Services Administration, detox- ification treatment discharges became less common from 2016-19, when detoxification discharges decreased from 20% of all discharges to 16%. “When you have a destabilizing event like a global pandemic, [vulner- abilities in health structures] become more evident,” Varisco said. With in-person treatment at risk due to the coronavirus, health care centers went remote in 2020. Many centers were limited to offering sub- stance use disorder care through telehealth services as opposed to in-person programs, complicating opioid recovery for patients. Beth Welka, a licensed chemical dependency counselor at Positive Recovery Center in Jersey Village, said the outpatient substance use treat- ment program was forced to operate virtually at the start of the pandemic. She said she believes relapse rates were likely higher during that time. “It’s difficult to treat substance
KEY
Texas Harris County
0 20 40 60 80 100
42.1
37.9
Local officials said while prescription restrictions tighten, addicts are seeking opioids from alternative sources.
42.5 37.8
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
SOURCE: CENTERS FOR DISEASE CONTROL AND PREVENTION/COMMUNITY IMPACT NEWSPAPER
Opioid-related emergency department visits in Harris County rose roughly 26% from 2016 to 2020. Statewide, most opioid-related emergencies are among white individuals between the ages of 18-44. OPIOID-RELATED EMERGENCIES RISE
Visits by age in Texas
1,300
0-17
18-44
45-64 65-74 75+
4%
1,200
1,290
54%
27% 10%
1,146
1,062
5%
1,173
1,100
White Black Hispanic Other Visits by race/ethnicity in Texas
1,020
0 1,000
61%
12% 20%
2016 2020 SOURCE: TEXAS DEPARTMENT OF STATE HEALTH SERVICES/COMMUNITY IMPACT NEWSPAPER 2017 2018 2019
0%
20% 40% 60% 80% 100%
CONTINUED FROM 1
which oversees the countywide Opi- oid Overdose Prevention Program. She said treatment services locally were limited during the pandemic’s peak, but several federally funded programs aim to provide resources to mitigate drug use in high-risk areas locally. “While we don’t specifically name that as a public health crisis, ineq- uity across not just Harris County, but across the country, as we look at those who are underserved and the lack of resources for them is really a public health crisis. And unless and until we address that, we’re going to continue to see some of these epidemics flourish,” Brown said. Opioid use over time In the late 1990s, pharmaceutical companies began marketing prescrip- tion opioid pain relievers as drugs that were not as addictive as previously thought, according to the National Institute on Drug Abuse. As a result, these drugs, which had formerly only
been prescribed to treat acute pain, became the prescription of choice to treat chronic, long-term pain. Brown said countywide, white men are the most likely demographic to misuse opioids, although the epi- demic also affects communities of color. While Reed said even high school students can access highly addictive drugs locally, the age group with the highest number of opioid overdoses in Cy-Fair is 36-50 followed by the over-50 age group. “These are the folks who, through multiple surgeries and just regular health-related incidents, have been addicted to prescription opiates and are now switching to illicit supplies of it causing the overdoses,” he said. In 2010, about 69 opioids were pre- scribed for every 100 residents of Har- ris County. A decade later, the number had fallen 45%, according to data from the Texas Department of State Health Services. However, a little more than one prescription was still issued on
reported opioid overdose deaths nearly doubled in Texas from January 2019 to January 2021. “These are diseases of despair that we’redealingwith,” saidTyler Varisco, a health services researcher with the University of Houston. “When people are economically challenged or psy- chologically challenged as many of us have been over the past two years, we see increased vulnerability in our communities to opioid use and other forms of substance misuse.” With increased isolation and financial stresses, the COVID-19 pan- demic further compounded struggles against the opioid epidemic in Texas, experts said. Recovery treatment transitioned into less effective online services, and access to quality treat- ment, such as medication, became more complicated. Dr. Ericka Brown is the director of Harris County Public Health’s Com- munity Health and Wellness Division,
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