A national epidemic of opioid use has ignited the deadliest drug crisis in American history. Today, opioid overdoses kill an average of 115 Americans daily. Fatal overdoses are on the rise in nearly every state, and the impact has been nothing short of catastrophic in Appalachia and the Midwest. But how is the opioid epidemic playing out in Texas? And will the crisis continue to escalate?
While the opioid crisis is driving increases in drug overdose mortality nationwide, rates in Texas have not trended upward as sharply as other states. As a result, Texas ranks 48th of all states in drug overdose mortality, with a rate of 10.1 deaths per 100,000 population in 2016. Texas’ rate is about half the national average (19.8) and less than one-fifth that of the highest ranked state, West Virginia (52.0). Opioids account for about half of all drug overdose deaths in Texas, whereas they account for two-thirds of drug overdose deaths nationally.
Though Texas’ opioid overdose mortality rate is relatively low overall, county-level data reveal areas of the state where opioid use is a major concern. Opioid-related hospital admissions and accidental poisoning deaths are concentrated in North and East Texas, including many rural counties. Drug overdose mortality in some southeast Texas counties exceeded 24 deaths per 100,000 in 2016. Several counties along the Red River also have high rates of drug overdose deaths, including Baylor County (near Wichita Falls) with over 30 deaths per 100,000, highest of any county in the state.
Many people with opioid use disorders first become addicted to opioid pain medication prescribed legally by a doctor. Emergency physicians, primary care physicians, dentists, and surgeons are leading sources of opioid prescriptions. Drug overdose mortality rates tend to be highest in areas where opioid prescribing rates are also highest.
In 2017, roughly two-thirds of opioid related drug exposure calls to the Texas Poison Center Network were made for commonly prescribed opioids, while most of the remaining one-third were for synthetic opioids. Of 1,174 deaths in Texas involving opioids in 2015, 517 involved commonly prescribed opioids, 516 involved heroin, and 153 involved synthetic opioids.
While illicit drugs laced with fentanyl are driving a recent wave of overdose deaths nationally, fentanyl was involved in only 4% of heroin deaths in Texas in 2017. Texas has been insulated from the lethal impact of fentanyl primarily because the most commonly used type of heroin in Texas, black tar, is harder to mix with fentanyl than the white powder heroin most prevalent in the Midwest and Appalachia.
But that could soon change. According to experts, white powder heroin use is increasing in Texas, drug suppliers are developing new ways to mix fentanyl with black tar heroin, and fentanyl is increasingly being mixed with drugs other than heroin. An uptick in opioid overdoses and deaths in Texas becomes more likely under these conditions.
5. Opioids are only one piece of the substance use crisis in Texas.
The current opioid epidemic has alarmed public health leaders and captured substantial media attention. But by several measures, opioids are hardly the leading addictive substance threatening the health of Texans.
Methamphetamine has long been the state’s top illicit drug threat, and currently more methamphetamine deaths occur annually than opioid deaths in Texas. Deaths involving prescription benzodiazepines (sedatives like Valium and Xanax) have quadrupled nationally from 2002 to 2016, and since they are often prescribed with opioids, have been described as an “epidemic within an epidemic.” And for many decades, alcohol has been the most frequently misused substance in Texas and the nation, responsible for 88,000 premature deaths per year nationwide and shortening the lives of those who die by an average of 30 years. People with an opioid use disorder are 8.4 times more likely to have alcohol use disorders than those without.
The common thread uniting these challenges is addiction, which has long been stigmatized as a behavioral illness or personal failing rather than a chronic, relapsing, and treatable disease. The emerging opioid threat is not the first substance use crisis Texas has faced, nor will it be the last. However, with the current urgency surrounding opioids, public health leaders in Texas have an opportunity to take a thoughtful approach to preventing and treating substance use, staying ahead of a problem that – at least for now – shows few signs of slowing.