TRENDS Downward Harris and Galveston counties have seen declines in the opioid dispensing rate since 2010, according to the Centers for Disease Control and Prevention. The declines in opioid dispensing suggest health care providers have become more cautious in their opioid prescribing practices, according to the CDC. PLUMMETING PRESCRIPTION RATES Harris County
Galveston County
patient discharges from treatment for the Substance Abuse and Men- tal Health Services Administration, detoxification discharges decreased from 20% of all discharges to 16% from 2016-19. However, the patient comple- tion rate of detoxification treatment remained stable with fewer than half of patients completing treatment. “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 substance use disorder care through telehealth services as opposed to in-person and personal programs, complicating opi- oid recovery for patients. Jimmy White, the executive direc- tor of AIM Recovery Center, a Dickin- son-based addiction treatment center, said that as a newer center, staff is try- ing to perfect virtual treatment. “We want to be able to provide actual, true outpatient-level care, like intense outpatient-level care, virtu- ally,” White said. “One of the dangers of addiction is oftentimes the home is a very unsafe place for them. That’s one of the giant hurdles if we were ever going to try to actually unveil true inpatient virtual [care] is how do we deal with the safety or lack of safety of the home?” White admits that implementing virtual care would definitely be tricky, and despite not having anymajor ideas on how to proceed in it, he does believe that it can be done in the near future. Despite being less effective, tele- health did allow some smaller clinics and private practices to expand their coverage areas. Lori Fiester, the clin- ical director at the Houston-based nonprofit Council on Recovery, said telehealth allowed patients without transportation access or those who are immunocompromised to receive care they otherwise could not. “We’ve had people across the state in our groups, including in the Austin area, which was really helpful for our groups to stay vital,” Fiester said. At the beginning of the pandemic, Varisco said there was some confusion about what treatments were accept- able. A 2020 memo from Phil Wilson, the Texas Health and Human Ser- vices Commission executive commis- sioner, said buprenorphine could be prescribed virtually, but methadone required a face-to-face evaluation. According to SAMHSA, buprenor- phine and methadone are
0 20 40 60 80 100
95.9
41.24
69.1
37.8
Both counties saw a decline within the last few years.
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Emergency visits increased between 2019 and 2020 for both counties. OPIOID-RELATED EMERGENCIES
1,500 1,200
1,290
1,173
1,146
300 900 600
1,062
1,020
177
160
160
149
134
0
2016
2017
2018
2019
2020
SOURCES: CENTERS FOR DISEASE CONTROL AND PREVENTION, TEXAS DEPARTMENT OF STATE HEALTH SERVICES/COMMUNITY IMPACT NEWSPAPER
Administration] into mislabeling the drug so it was presented as nonaddic- tive,” McColgin said. In 2020, a little more than five pre- scriptions were issued on average for every 15 residents in Harris County in 2020, with a little more than six pre- scriptions being issued for every 15 residents in Galveston County, based on the most recent Centers for Disease Control and Prevention data. On the other hand, the dispens- ing rate declined sharply in Galves- ton County between 2018 and 2019, after steadily decreasing since 2010, and continued to slightly decrease in 2020. Harris County’s dispensing rate has been steadily declining since 2010. Despite declining dispensing rates countywide and across the state, reported opioid overdose deaths rose 25% from 2019 to 2020 in Texas, according to the NCHS. According to the CDC, synthetic opioids, such as fentanyl, have been one of the major driving forces in the rise of overdose deaths. One of the reasons for this, McColgin said, is fentanyl is unknowingly being put into other drugs, such as cocaine and methamphetamine, and showing up in more overdoses and deaths than it had been previously.
“To be honest with you, I was never scared of anything. It didn’t matter; I wanted it as strong as I could get it. [Fentanyl] scares me,” McColgin said. Due to his experience, McColgin has brought attention to the use of Nar- can, a nasal spray that can be admin- istered during suspected overdoses, to the League City Police Department and similar entities. Mary Beth Trevino, the Galveston County community coalition coordi- nator at addiction treatment center Bay Area Council on Drugs and Alco- hol, agreed fentanyl is dangerous. “We have data to support that there has been a significant increase in fen- tanyl showing up [in Galveston and Harris counties],” she said. Pandemic effects on treatment Varisco described several under- lying causes of substance use disor- ders the pandemic has exacerbated, including patient access to treatment, increased financial stresses and iso- lation. Varisco said he believes the drastic changes to health care for indi- viduals experiencing addiction undid recovery work performed for patients before the pandemic. According to the Treatment Episode Data Set, which compiles national
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With increased isolation and finan- cial stresses, the COVID-19 pandemic further exacerbated struggles against the opioid epidemic in Texas. Recov- ery treatment transitioned into less effective online services, and access to quality treatment, such as medi- cation, became more complicated, according to local experts. Opioid usage varies 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 been prescribed only to treat acute pain, became the prescription of choice to treat chronic, long-term pain. Les McColgin, a liaison for the Houston Recovery Center who was addicted to opioids and used them for 35 years on and off, said he witnessed this change firsthand. “Back in the late ’90s, you had the situation with Purdue Pharma and the new drug oxycontin … and that whole situation where they were able to coerce the [Food and Drug
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