Between 2014 and 2015, Denton County opioid-related overdose deaths increased from 15 to 27 deaths, according to the Texas Department of State Health Services. Collin County overdose deaths increased from 20 to 24 deaths between 2014 and 2015.
In 2016 opioid overdose deaths in the United States killed about 42,000, according to the Centers for Disease Control and Prevention.
Collin and Denton counties’ opioid-related death rates are some of the lowest in the area. Still, substance abuse prevention officials said work needs to be done to address addictions and prevent more deaths.
Local effects
According to the National Institute on Drug Abuse, the nationwide opioid crisis began in the 1990s when pharmaceutical companies reassured the medical community that prescription opioid pain relievers were not addictive. Health care providers began prescribing opioids at greater rates followed by widespread misuse and abuse of the drugs as a result of addictions.
William Solari, a Collin County Substance Use Prevention Coalition board member and Frisco ISD student assistance coordinator, said addiction is often a process.
“No one wakes up and says, ‘Today, I want to become a heroin addict,’” Solari said. “It’s a progression of starting with prescription drugs, marijuana, alcohol and then it just progressing to the harder drugs.”
Lauren Titsworth, Denton County MHMR mobile substance abuse counselor, said some people begin taking prescription pain pills and progress to heroin.
Those wanting to overcome an opioid addiction often turn to treatment facilities for help, but Jana Jansson, Collin County Substance Use Prevention Coalition director, said there are not enough facilities in Collin County, especially for adolescents.
“Oftentimes you can call multiple facilities before finding an available bed,” Jansson said. “This can certainly delay the treatment process and getting the help that is needed for all ages.”
Titsworth said patients seeking recovery sometimes are referred to services in another county because there are not enough resources in Denton County.
“A lot of the resources we have in Denton County focus on outpatient substance abuse and treatment,” she said. “There’s definitely a lack of resources within our county for 30-day programs or 90-day programs that really are intensive and affordable.”
Declining prescriptions
Although overdose deaths are up, opioid prescriptions are declining nationally and locally, according to the CDC. The CDC reports that physicians in Collin County prescribed opioids at a lower rate than Denton County as well as the national average.
A growing awareness of the opioid crisis has led to physicians prescribing fewer opioids and pharmacists limiting first-time prescriptions, said Malini Ghoshal, a registered pharmacist and president of Plano-based Inspirra Healthcare, a research company for the health care industry.
Ghoshal said physicians are turning to other pain-relieving drugs and non-prescription solutions—such as chiropractic therapy—for acute pain. And some pharmacies, such as Walmart and CVS pharmacies, are limiting the amount and dosage of an opioid prescription they will fill.
Dr. Joel Holiner, the executive medical director for both Medical City Green Oaks Hospital and the Holiner Psychiatric Group, said he believes there are three players responsible for what he sees as an overprescription of opioids: pharmaceutical companies, physicians and government officials.
“I think [pharmaceutical companies] are definitely part of the problem, and continue to be part of the problem with their marketing and minimization of the risks and dangers of these medications,” he said.
A physician himself, Holiner said doctors share part of the blame for the high opioid prescription rates, as they are the ones writing the prescriptions.
Holiner also said the state and federal government could do more to slow prescription rates and encourage other forms of pain relief.
As part of the state’s efforts to curb opioid prescription rates, state Sen. Van Taylor, R-Plano, sponsored House Bill 2561, which was written into law in September. The law places stricter requirements on both prescribers and drug regulatory agencies to use the Prescription Monitoring Program database.
“I think what’s important is for the Legislature to remain engaged, to monitor what’s going on, to listen to the people who are using the Prescription Monitoring Program to see what we need to do to improve it,” Taylor said.
The overdose-reversal drug
Local and national entities have ramped up prevention efforts to address opioid overdose deaths. In April, U.S. Surgeon General Jerome Adams called on more Americans to carry naloxone, a prescription that can reverse the effects of an overdose.
Naloxone comes in three forms: an injectable—which requires professional training—an autoinjectable and a nasal spray. Naloxone is often known by its prescription names: Narcan nasal spray and Evzio autoinjector.
During an overdose, opioids block brain receptors that tell the body to breathe, according to the Harm Reduction Coalition. Naloxone can reverse this to get the body to breathe again. According to the National Institute on Drug Abuse, emergency personnel should observe a person given naloxone for at least two hours to make sure an overdose does not occur again.
In 2015 the Texas Legislature allowed naloxone to be prescribed to those at risk for an opioid overdose or those who are in a position to assist someone experiencing an overdose.
Many first responders, including Frisco Fire Department, carry naloxone. FFD EMS Chief Jake Owen said when the department uses naloxone, it is often for patients that have overdosed on prescription opioids.
Titsworth said it is beneficial for anyone to have naloxone on hand.
“We all know someone that’s struggling with addiction, whether we talk to them every day or whether they’re an acquaintance,” she said. “If people are willing to go to the pharmacy and get [naloxone], if people have the money … I would absolutely encourage it.”
Beyond having naloxone available, fighting opioid addictions begins with addressing symptoms of depression and anxiety that could lead to addiction, Solari said.
“I think we still have a lot of people who don’t seek a mental health professional,” he said. “… You break your arm, and because it’s a physical illness, it’s, ‘Hey, go to the doctor right away.’ You come down with symptoms of a mental illness, and people just don’t look at it in the same way.”
