Texas was one of 27 states with a statistically significant change in the opioid-related drug overdose death rate with a 7.4 percent increase from 2015 to 2016, according to the Centers for Disease Control and Prevention.
While 7.4 percent may not be statistically as high as other states like Pennsylvania, which saw a 44.1 percent increase, the opioid epidemic that has gripped the nation is still prevalent in Fort Bend County. Furthermore, due to lack of reporting and a variety of other factors, the epidemic’s reach on the county could be even worse than local officials and drug abuse experts able to expect.
“When you ask how [opioid abuse]looks [in Fort Bend County,]the answer is we don’t really have strong data,” said Laura Jenkins, director of program compliance for the Fort Bend Regional Council on Substance Abuse. “I think it’s probably a little bit worse than we think because there is a lot of variables that aren’t collected.”
Opioid abuse claimed nearly 40,000 lives in the U.S. in 2016, according to the CDC; 1,500 of those deaths occurred in Texas, according to the Texas Department of State and Health Services. Local officials and drug abuse experts agree these figures are significant and they translate to the local level.
Opioids include prescription painkillers like OxyContin—the brand name for oxycodone—as well as hydrocodone combination products like Vicodin, synthetic opioids like fentanyl and the illicit street drug heroin. Methadone, also considered a synthetic opioid, has been used since the 1960s to treat opioid dependence but can be abused and lead to overdose.
“I don’t think our community … [is]immune to this; if anything, I would guess we are as hit by it as anybody else,” state Rep. John Zerwas, R-Richmond, said.
Underreported opioid abuse
The Fort Bend Regional Council on Substance Abuse has served as the county’s principle resource for substance abuse treatment and information for years, according to county officials. A licensed clinical therapist, Jenkins has worked for the council for 19 years and has experience writing grants for substance abuse treatment programs.
“I’ve got to do a lot of research, so I know that data is hard to come by,” Jenkins said. “Even [in]Texas, you can’t get great data, and when you get down to Fort Bend, there is like nothing.”
There are a multitude of factors that contribute to the lack of reporting on opioid abuse in the county, according to Jenkins. There will always be stigma associated with drug abuse, so users are often fearful to come forward.
Another major factor includes lack of prescription data. Overprescription of opioids is one of the driving forces of the epidemic. Nearly half of all U.S. opioid overdose deaths involve a prescription, according to the CDC.
“The prescription data isn’t there because the prescription drug monitoring program has not been mandated for prescribers … so we don’t know how much is actually out on the streets,” Jenkins said.
The Texas Prescription Monitoring Program allows physicians to view a patient’s prescription history to help monitor the prescriptions of controlled substances. With the passage of House Bill 2561 last June, the 85th Texas Legislature made it mandatory for Texas-licensed pharmacies to report dispensed controlled substance records to the program; doctors, however, are not required to do so.
“Doctors are very scared, too—because all of this stuff going on with liability; they are just terrified,” Jenkins said. “I know doctors personally that have quit writing [opioid prescriptions].”
According to the Texas Board of Pharmacy, the number of dispensed opioid prescriptions in the county in 2016 was 885,625; in 2017, that number rose to 920,608. This 3.95 percent increase coupled with the fact that physicians are not required to report to the program proves it is still unclear what the picture of opioid abuse in Fort Bend County actually looks like since it is not known how many prescriptions are actually being written.
Another factor that leads to underreporting is misunderstanding; Jenkins said the deceptive disguise of a prescription bottle leads people to think they are not in harm’s way when consuming a prescription-level opioid like hydrocodone.
“Some people do not believe if they have a prescription in their hand that that’s drug abuse; they really have that mindset,” Jenkins said.
Zerwas echoed this sentiment and said more people are becoming aware of the fact that prescription opioids are highly addictive and dangerous.
“The risk of addiction to the opioids was not as real as it is [now], and that’s why I think we are where we are today,” Zerwas said. “All those things put together has brought it to a peak here where we are seeing thousands of people die as a consequence of prescription drugs that are given to them.”
Lack of treatment centers
President Donald Trump declared the opioid crisis a National Public Health Emergency in October and is the first administration to do so. Even prior to the declaration though, state and federal agencies started allocating efforts to address the epidemic.
The Texas Health and Human Services Commission received a $27.4 million grant in May 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.
This solution is critical for counties like Fort Bend, where the closest state-funded medical-assisted treatment facility—which is the most effective treatment method for opioid abusers, according to the Substance Abuse and Mental Health Services Administration—is located about 25 minutes from Richmond at Hillcroft Avenue and Hwy. 59 in Harris County.
“We need more resources for medication-assisted treatment; that’s happening, but we compete with New England, we compete with Massachusetts, we compete with New York for that money,” Jenkins said. “And Texas is just emerging into the need.”
Jenkins said there are only two state-funded outpatient substance abuse treatment facilities in Fort Bend County: the FBRC located in Stafford and The Turning Point, which has a satellite office in Rosenberg.
“There are a lot of private providers out here that provide medication-assisted treatment … but you have to have insurance, you have to have money,” Jenkins said. “And there are very few state-funded residential [treatment facilities]in the Greater Houston area period.”
Privately funded AppleGate Recovery is a new opioid-specific outpatient program that opened in Sugar Land in November. While AppleGate is not state funded, the opioid-centered outpatient clinic promotes medication-assisted treatment and is focused on buprenorphine treatment.
“When AppleGate Recovery looked at the Greater Houston area, it became apparent that there were a very limited number of outpatient treatment facilities to the southwest, including Fort Bend County,” said David Hans, senior vice president of operations for AppleGate Recovery.
State, local solutions
Considering the lack of state-funded and opioid-centered treatment facilities, local officials said more resources and solutions are needed.
State-level solutions being made include the 85th Texas Legislature’s decision to pass 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.
Zerwas said he supported a bill that makes it legal for an opioid antagonist called Naloxone, which is sold under the brand name Narcan, to be distributed to people who aren’t paramedics, such as family members of an addict.
“Naloxone is a drug that very quickly, when injected, reverses the effects of the opioid,” Zerwas said. “It’s kind of like the use of an EpiPen.”
While solutions like the Naloxone bill and grants for opioid dependence are being made at the state level, county officials agree more in-depth reporting has to be done.
Connie Almeida, director for Fort Bend County’s Behavioral Health Services department, works with at-risk populations of the criminal justice system who are often victims of opioid abuse. Almeida said she hopes the BHS department can join forces with key stakeholder groups and form an opioid prevention task force in the coming months to gain a better understanding of the epidemic in the county.
“If we don’t address it, we are going to see these individuals in our courts in our jails, in our emergency rooms,” Almeida said. “We all need to stop and think: That’s where this task force could be very beneficial.”