Throughout Texas the rate of overdose deaths and prescriptions written for opioids, such as oxycodone, hydrocodone and heroin, are falling, according to a 2016 University of Texas study, but in Hays County, addiction counselors and law-enforcement officials report a steady increase in recent years in the number of cases they see related to opioids and prescription painkillers.

Tori Bowman, a licensed addiction counselor and therapist based in Kyle, said one out of every four patients she sees is dealing with abuse or mismanagement of an opiate. Most of the patients she sees who are addicted are between ages 16-25.

“Over the past two years it’s gotten worse,” Bowman said. “If I look at my schedule of 25 people for this week, I have eight of them that are within that age range, and they’re dealing with prescription addiction.”

Those Hays County residents dealing with addiction face a lack of resources to overcome their need for drugs. There are eight substance-abuse treatment facilities in Hays County that have been licensed through the Texas Department of Health and Human Services and accept walk-in patients. Of those facilities, six offer inpatient rehab services, and none are located in the city limits of San Marcos, Kyle or Buda.

Worsening the problem is the fact that inpatient rehab facilities throughout the county do not accept Medicare or Medicaid. That means that for the 10.5 percent of Hays County residents who rely on Medicare or Medicaid as their primary insurance, few drug treatment options are readily available.

“The sad fact of it is there’s no inpatient sober facility here in Hays County unless you have private insurance,” said Wade Parham, commander of the Hays County Narcotics Task Force, a collaboration among the sheriff's office and Hays County cities.

Addiction in Hays County

The issue of heroin use, which Parham said has been on the rise in Hays County in recent years, is strongly tied to prescription drugs.

“If a person who is addicted to prescription drugs can for whatever reason no longer get their prescription drugs, then they turn to heroin and vice versa,” Parham said. “Sometimes a heroin user will supplement that with prescription drugs. They’re both morphine, opioid-based, so they go together.”

A 2016 University of Texas study of narcotics in Texas found that increased education and awareness among patients and doctors, as well as the use of a prescription-monitoring program, which allows doctors to see what prescriptions patients have recently been given, have contributed to the decline in statewide incidences of opioid abuse since their peaks in the late 2000s and early this decade.

Despite those improvements, Bowman said she believes doctors need to be more discerning when considering whether to write a prescription.

After her husband recently underwent knee surgery, the orthopedic doctor offered a prescription for pain that her husband was not experiencing. The doctor did not ask for her husband’s history with prescription pain medication and did not seek to find out if he might be at risk for addiction or abuse, Bowman said.

Bowman said doctors and patients need to be better educated about opioids.

“[The tendency to overprescribe opioids] is deeply rooted, and it goes back to medical school,” Bowman said. “[Physicians] need to spend more time on pain management and look at this opiate-abuse problem we have and understand it’s education on both sides.”

Most of the patients Bowman sees have dual diagnoses, meaning they are experiencing an issue, such as depression, in addition to addiction, she said.

Milton Brown, a counselor with Care Counseling Services-San Marcos, a subsidiary of the Hays Caldwell Council on Alcohol and Drug Abuse, said that is a common trait among those who are addicted to drugs or alcohol.

There is growing consensus among addiction counselors and mental health professionals that the two maladies are often linked.

“That is considered to be the rule rather than the exception,” Brown said. “Most of the people who have developed a substance-dependency problem also have a diagnosable mental health problem to go along with it.”

Grace Davis, director of outpatient and prevention services with Cenikor,  a non-profit organization that merged with the Hays Caldwell Council on Alcohol and Drug Addiction in 2016, said access to addiction services remains an issue.

In early June a woman called the Cenikor from Dripping Springs seeking treatment services, but because she was unable to find transportation to her appointment, Davis said.

Despite a reported lack of options for those without private insurance, Davis said Cenikor has the ability to work with all patients—insured or otherwise.

"I think it’s critical people understand we are going to work with anyone who gives us a call," Davis said.

Alternatives to opioids

Dr. Mark Malone, a pain specialist with Austin-based Advanced Pain Care, said some counselors and rehabilitation facilities will push for “abstinence is the best policy” in relation to opioids that could help a patient deal with pain. 

That ignores the reality that many patients with legitimate medical issues need treatment to help them deal with pain and lead a normal life, Malone said.

“These people really do need a multidisciplinary approach to pain, which that includes in some cases painkillers,” he said.

Advanced Pain Care, which has offices in Austin, Round Rock, Killeen and other areas, favors treatment using suboxone, Malone said. The medication relieves pain but is not considered addictive and is nearly impossible to overdose from.

Advancements in medical technology have also improved the efficacy of spinal cord stimulation, whereby Malone inserts a device into a patient’s spine that can block pain signals from nerves to the brain.

Treatment options

In 2016, Seton Medical Center Hays surveyed a group of Hays County residents and organizations about their concerns related to community health. One of the recurring themes throughout the survey was concern about the lack of resources available to those “who require extensive treatment and case management” for a substance-abuse issue.

Licensed professionals such as Bowman offer addiction counseling services, and groups such as the Hays Caldwell Council on Alcohol and Drug Abuse provide outpatient counseling and can connect clients with inpatient service providers.

But Brown said the lack of nearby inpatient service providers presents a challenge for low-income people addicted to opioids or other drugs. Those seeking treatment without private insurance or the means to foot the cost of intensive inpatient rehab, which in 2014 averaged $18,000, according to the National Institute on Drug Abuse, often end up on waiting lists for one of the public drug treatment facilities in the state.

“Not many places have the capacity to drop what they’re doing and off the clock take care of that client, put them in their car and drive them to San Antonio” Brown said. "Or the state-funded facility [can’t] drop what they’re doing, drive over to San Marcos and pick that person up because of course the state-funded programs are running on a shoestring budget.”

In May the state of Texas announced it had received help in addressing the “shoestring” issue and capacity issues at drug treatment centers. On May 19, the Texas Department of Health and Human Services announced it received a $27.4 million grant from the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services. The grant is expected to directly help 14,000 people during a two-year period through expanded access and capacity at state treatment centers, increasing training and technical assistance for providers and prescribers, enhancing recovery and support services, and boosting outreach activities.

Ruben Garza, director of the Southside Community Center in San Marcos, said he is skeptical that a lack of intensive inpatient rehabilitation options keeps people from pursuing help with their addiction.

Garza said he believes it is more likely that many people who are addicted to drugs such as hydrocodone, oxycodone and heroin refuse to be honest with themselves.

“It’s always somebody else’s fault,” Garza said. “Until they look in the mirror and say, ‘It’s my fault, I have to fix it,' it’s never going to get fixed.”