Opioid abuse claimed nearly 40,000 lives in the United States in 2016, according to the Centers for Disease Control and Prevention; 1,500 of those deaths occurred in Texas, according to the Texas Department of State and Health Services.

As a result, officials are seeking prevention and recovery tactics to help keep Montgomery County clean.

According to a study completed earlier this year by Ling Ren, a Sam Houston State University criminal justice professor, for the Montgomery County District Attorney’s Office, Montgomery County had the third-highest average prescription drug mortality rate among Texas’ 10 most populous counties and the second-highest average prescribing rate from 2011-15.

According to the study, Montgomery County also experienced 310 drug overdose deaths from 2012-16, 224 of which involved a prescribed controlled substance, making prescription drug overdose the second-leading cause of death in the county, just behind fatal traffic crashes.

Dr. Jason Powers, chief medical officer for The Right Step, a nationwide substance-abuse treatment facility with an outpatient facility in Conroe, said the addiction specialists have observed the opioid crisis on the brink of explosion for years.

“Doctors, like myself, who work in  addiction medicine, we’ve been saying that this is only the tip of the iceberg starting ten years ago,” Powers said. “We’ve been seeing an exponential increase in people who are coming in either primarily addicted to an opiate or opiates plus other drugs.”

In response, local law enforcement and health care professionals are working together to make opioids harder to get while making recovery resources  more accessible.

Assessing the problem

In the late 1990s, pharmaceutical companies began marketing prescription opioid pain relievers as drugs that were no longer 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.

Years later, physicians discovered the opioid pain relievers were not as safe as had been previously marketed, said Matt Fehery, CEO of the Memorial Hermann Prevention and Recovery Center, a Houston-based facility that works to treat pain and addiction simultaneously.

“Medications can be  good when used appropriately, but this particular class is very potent and the belief now is that they have been overused and overprescribed for far too many different conditions, where a less addictive medication could have worked,” Fehery said.

Today, 1 in 12 people who are prescribed opioid pain relievers will become addicted to opioids, Fehery said. Additionally, 80 percent of opioid users transition to become first-time heroin users and are 40 times more likely to become addicted to heroin, Fehery said.

“There has been a shift from historically illicit drugs to the abuse of prescription pain medications,” Conroe ISD Police Department Sgt. Matt Blakelock said. “Opioids seem to be appealing because of the easy access kids have by finding them in medicine cabinets.”

However, Tamara Holland, Montgomery County assistant district attorney, said in some cases, physicians can also be at fault.

“There are just some unscrupulous doctors who want to treat the pain itself rather than the underlying cause,” Holland said. “I think those doctors are probably few, but the ones that are doing it are making a huge impact.”

Seeking a solution

In May, the Texas Health and Human Services Commission received $27.4 million in federal funds to prevent and treat opioid dependence. The money is expected to help 14,000 people over two years by expanding access and capacity at treatment centers and enhancing recovery services, THHSC officials said.

The state of Texas has also started to address the issue. In the 85th Texas Legislature, lawmakers passed Senate Bill 584, which called for the Texas Medical Board to develop guidelines for the prescription of opioid antagonists—drugs that block the effects of opioids.

Texas House Speaker Joe Straus formed the House Select Committee on Opioid and Substance Abuse in late October to study the issue before the next session kicks off in January 2019.

With the results of Ren’s study, Holland said the county is applying for grants to hire personnel to focus solely on identifying so-called pill mills—doctors, clinics or pharmacies that prescribe or dispense opioids inappropriately—as well as doctor shoppers, or patients who visit multiple physicians seeking opioid painkillers.

One initiative Fehery said has helped crack down on doctor shoppers is the Texas Prescription Monitoring Program, which allows physicians to view a patient’s prescription history.

With the passage of House Bill 2561 on June 9, the 85th Texas Legislature made it mandatory for Texas-licensed pharmacies to report dispensed controlled substances records to the program by the next business day after the prescription is filled, effective Sept. 1. The requirement previously allowed for seven days to send information, according to the Texas State Board of Pharmacy.

Although pharmacists are required to view a patient’s prescription history prior to dispensing certain drugs, Fehery said it is not mandatory for doctors to consult the program before prescribing opioid painkillers to a patient.

In addition to prescription opioids becoming more difficult to get, they are also becoming more expensive, making heroin the next choice for users, Powers said.

“For the most part what has happened is the DEA cracked down on doctors and pill mills,” Powers said. “People who were addicted to opiates found that the pill supply dried up, and heroin became a cheap alternative.”

Powers estimates that roughly 70-80 percent of opiate addicts he sees at The Right Step are seeking treatment for heroin addictions.

“When I was a kid I never knew anyone who did heroin,” Powers said. “Now I see that the people who [use] are policemen; they are athletes; they are mothers and soccer moms; they are teachers. They are functioning people.”

With the number opiate overdoses increasing, first responders keep opioid overdose-reversal medication in stock to stabilize patients until they can be treated at a hospital, said Joseph Fioretti, Emergency Medical Services Information Technology specialist for the Montgomery County Hospital District.

“Any time we transport a patient where we suspect an opiate overdose, our clinical department and community paramedic team automatically receive a notification of the incident,” Fioretti said. “This allows them to follow up with that patient after the event and attempt to provide resources for them to avoid reoccurring hospital stays, sometimes within 12-24 hours of the call.”

Reaching recovery

While officials address the epidemic, there are several local rehabilitation facilities working to help existing addicts recover.

Memorial Hermann’s PaRC program has offered detox and residential treatment programs in Houston for 30 years. PaRC also had eight outpatient offices in the region, including one in The Woodlands, which opened in 2004. 

“At PaRC we treat chronic pain and addiction simultaneously,” Fehery said. “We combine traditional behavioral therapies while also introducing patients to alternative pain-management techniques, from acupuncture and meditation to virtual reality.”

Other local treatment options in the Conroe area include the New Dimensions Day Treatment Center, Conroe Treatment + Recovery and Zebrant. The Right Step-Conroe is also implementing a new treatment curriculum called Positive Recovery, an evidence-based treatment that focuses on the goals of individual addicts, Powers said.

“We try to get them to a place where their life is more rewarding than the promise of a relapse,” Powers said. “When that happens they stay sober, so a lot of [treatment] is finding out who they are, what their values are [and] what their goals are.”

With more treatment options becoming available locally, officials are hoping to begin reversing the opioid epidemic trends in Montgomery County.

“We [need to] focus on the disease aspect [of addiction] and realize that these are people who have addictions, and the problem isn’t opiates, it’s addiction,” Powers said.

Additional reporting by Vanessa Holt and Danica Smithwick