OUTOFREACH 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. PLUMMETING PRESCRIPTIONRATES 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. A
She said local treatment services 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 flour- ish,” 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. “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,” she said. In 2010, about 69 opioids were prescribed for every 100 residents of Harris 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 average for every three county residents in 2020, the latest data available. 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 med- ications and fentanyl, a highly lethal opioid. The use of fentanyl in Harris County has risen by more than 100% since 2019, she said. When the HFD responds to an opi- oid call, responders are more often finding victims are overdosing on drugs that were laced with synthetic lab-made compounds. Sounders said these can be far stronger than heroin or morphine and can have wildly vari- able effects. During an opioid overdose, the opi- oid acts as a respiratory depressant, which stops the body’s mechanism
that helps a person breathe, Sounders said. Since 2018, all HFD apparatuses— including fire engines and ambu- lances—have been outfittedwith nasal spray versions of Narcan, a device that dispenses naloxone, which can help treat narcotic overdoses in emer- gency situations. “You need to be really careful about buying stuff off the streets,” Sounders said. “They can be so strong that we don’t even carry enough Narcan to reverse them.” 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. In addition to chronic stress, the pandemic also affected some people’s sense of self in ways that made them more open to engaging in recreational drug use, said Daryl Shorter, medical director of addiction services with the Menninger Clinic. Based in southwest Houston near the Willowbend area, Menninger provides withdrawal man- agement services to people who come to the clinic from all over the world. “More people are more likely to use substances, and among those who are more likely to use substances, there is now a subset of those who are more likely to develop a substance abuse disorder,” Shorter said. According to the Treatment Episode Data Set, which compiles national patient discharges from treatment for the Substance Abuse and Men- tal Health Services Administration, detoxification 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. Moving forward, it will be crucial to treat substance use disorders like medical conditions as opposed to moral failures on behalf of those who are suffering, Shorter said. Under the moral model, patientsmay not receive the treatment they need because of an unconscious bias that patients need to suffer as part of the detoxification process, he said. The push to make Narcan more
KEY
Texas Harris County
0 20 40 60 80 100 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 42.5 37.8 Local officials said while prescription restrictions tighten, users are seeking opioids from alternative sources. 42.1 37.9
Opioid-related emergency department visits in Harris County rose roughly 26% from 2016 to 2020, the most recent data available. OPIOID-RELATED EMERGENCIES RISE
1,300
1,290
1,200
1,146
1,062
1,173
1,100
1,020
0 1,000
2016
2017
2018
2019
2020
0-17
18-44
45-64 65-74 75+
Visits by age in Texas
54%
27% 10%
4%
5%
Visits by race/ ethnicity in Texas
White Black Hispanic All other races
61%
12% 20% 7%
SOURCES: CENTERS FOR DISEASE CONTROL AND PREVENTION TEXAS DEPARTMENT OF STATE HEALTH SERVICES/COMMUNITY IMPACT NEWSPAPER
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, which oversees the countywide Opi- oid Overdose Prevention Program.
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of opioid overdose deaths increased from 1,431 in November 2019 to 2,628 in November 2021, the most recent data available. “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
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