The national rise of opioid overdose deaths has not been felt as heavily in North Texas, but substance abuse prevention officials say more work needs to be done to address the effects of addiction. The number of deaths nationally from opioid overdoses climbed to 42,000 in 2016, according to the Centers for Disease Control and Prevention. However, Collin County overdose deaths have maintained more steady rates, dropping by about 8 percent between 2005 and 2015 even as the county’s population grew by nearly 40 percent, according to the Texas Department of State Health Services. Still, in 2015, the latest year for which data was made available by the state, 24 people died in Collin County from opioid overdoses. Denton County saw 27 opioid overdose deaths the same year. The opioid-related death rates in Collin and Denton counties are also lower than those in Dallas and Tarrant counties, which are two of the most populated counties in North Texas. Nationwide, however, the rise in deaths continues to concern public health officials.

Opioid overdose death rates

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, which was 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 condition that starts slowly and worsens gradually. “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.” Tammy Mahan, the behavioral health director at LifePath Systems, which is the behavioral health authority for Collin County, says her staff’s patients who use heroine often started on prescription pills. “Opioids and heroine [are]  very alluring,” Mahan said. “It doesn’t take long to get hooked, especially if they do come across the fentanyl. That’s just a one-time use and you’re immediately hooked.” Fentanyl is a synthetic opiate between 50 and 100 times more potent than morphine, and is typically used to treat severe cancer pain, according to the CDC. 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.”

Declining prescriptions

Although overdose deaths are up nationally, the number of opioid prescriptions issued to patients has been in decline nationally and locally, according to the CDC. The CDC reports that physicians in Collin and Denton counties prescribed opioids at a lower rate than 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 nonprescription solutions—like chiropractic therapy—for acute pain. 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,” Holiner 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 became 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.

Opioid prescription rates

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 drug that can treat the effects of an overdose. Naloxone comes in three forms: an injectable—which requires professional training—an autoinjectable and a nasal spray. During an overdose, opioids block brain receptors that tell the body to breathe, according to the Harm Reduction Coalition, a group advocating for people with drug addictions. Naloxone can reverse this effect. According to the National Institute on Drug Abuse, emergency personnel should observe patients for at least two hours after naloxone is administered. 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 the Plano and Frisco fire departments, carry naloxone. Capt. Peggy Harrell, spokesperson for Plano Fire-Rescue, said all department vehicles, including fire engines, fire trucks and ambulances, carry naloxone. 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 begin with addressing symptoms of depression and anxiety that could contribute 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.”