As in most of the country, opioid abuse is a serious problem in Texas. A growing number of people in the state are becoming addicted to and even dying from the use of heroin and prescription pain medications.
Last year, state lawmakers passed a bill aimed at curbing opioid overdoses, but some advocates say the state has been moving too slowly—especially since the problem doesn't seem to be getting any better.
A group called the Texas Overdose Naloxone Initiative (TONI) is on the frontline of the opioid crisis in Austin. Naloxone is a relatively inexpensive medication that will speedily reverse the effects of opioid use—it's administered to individuals in immediate or near-immediate danger of overdosing.
Mark Kinzly and Charles Ray Thibodeaux with TONI have been giving demonstrations and distributing Naloxone to folks all over Texas. They say one good spot they've staked out for these demonstrations is along a stretch of Guadalupe Street, near the UT Austin campus, known as "the Drag."
Kinzly says he’s saved a lot of lives on the Drag. He hopes folks who are also hanging out on the Drag and possibly using will be able to save a friend who is about to OD.
“I’ve seen too many go to sleep and not wake back up, man,” says Robbie, one of the folks who hangs out here. “It’s not for me. It’s too easy to take too much, from what I understand, so I don’t want to mess with it.”
Robbie explains that he uses drugs, but he has stayed away from heroin because he’s seen things go really bad.
“People disappear,” he says. “You know, just, ‘Oh, so where’s so and so? He hadn’t been around for a week, you know. Well, what happened? Oh, she overdosed. Oh man, yeah.’ If someone had been there with her and she had the stuff to take care of it she would be alright.”
This is why the Texas Legislature passed Senate Bill 1462 last year.
That bill was supposed to expand the availability of Naloxone. When it passed, advocates saw the new law as a major step forward.
But, since the law went into effect last September, things have moved slowly.
Kinzly and Thibodeaux say, their group is doing the brunt of the work that the state should be doing.
“We are sending the medication all over the state of Texas,” Kinzly says. “We’ve distributed well over 10,000 doses of Naloxone, with a documented well over 400 reversals and rescues with this, all with no help of the people that should be helping.”
It’s been about five months since the law went into effect, Kinzly says, and the state should be working harder and faster to make sure Naloxone and educational materials are distributed among at-risk communities to better educate about overdose prevention.
They say that’s not happening. And one reason Naloxone isn’t more accessible—which was the whole point of SB 1462—is because there hasn’t been a doctor to sign an open prescription, or a standing order, yet.
“If we could get a doc to write a prescription for the whole state, then the way it works is, if someone wants Naxolone they don’t have to go to the doctor’s office to ask for a prescription,” he says. “The script is already written.”
Thibodeaux says he’s been told for months that a state health official would sign a standing order. The only requirement for that standing order is that pharmacies have to have documentation on file at their pharmacy showing that they have the open prescription. Whoever writes the standing order has to be a doctor, and they have do it through the State Board of Pharmacy.
But it hasn’t happened, yet. A spokesperson for the state’s health department says this is something they are looking at as a definite possibility. But advocates like Thibodeaux and Kinzly say there should be more urgency—especially since the problem is only getting worse.
“We have had upticks in all levels of opioid use over the last several years,” says Dr. Carlos Tirado, an addiction psychiatrist in Austin and the Director of Travis County’s methadone program.
Tirado says he sees a growing number of people getting addicted to opioids.
“We have a six-month waitlist for people to get in to get medication-assisted therapy for chronic opioid addiction."
Dr. Tirado says this kind of therapy is just about the only thing that will help people stay off opioids. He says the physical toll of an opioid addiction is so bad that the relapse rate of going through a traditional recovery program without medication is as high as 95 percent.
“So it’s not just that these people are weak or poorly motivated,” he said.
Getting a handle on the scope of this problem has been hard for both advocates and lawmakers. Texas has notoriously bad reporting practices, which has led to undercounting of opioid overdose deaths in the state.
According the Houston Chronicle and The Austin American Statesmen back in April 2015, "only 622 deaths reported across Texas in 2013 were specifically blamed on opioids - mostly painkillers... but 798 prescription-drug related deaths were recorded by local medical examiners that year in just 17 of the state's 254 counties."
What experts do know, though, is that most of the people addicted to opioids in Texas are not taking heroin – they are taking prescription pain killers such as Oxycodone and OxyContin.
In an effort to address that, Texas is in the process of beefing up its drug monitoring program. It’s about to become easier for physicians to track who is obtaining large amounts of prescription opioids in the state. Dr. Tirado explains that, on its face, this is great news.
But, he says, there's a possibility of "some unintended consequences."
Those unintended consequences are that people hooked on pills lose access to them while still having a crippling addiction. In some cases people turn to illegal opioids like heroin.
Back on Guadalupe, Mark Kinzly says this could exacerbate the overdose problem here.
“One of the things about pills that is halfway decent is that, at least you know the quality and quantity you are getting,” Kinzly says. "When you go to the street, it differs from day to day on the quality in strength.”
Another issue is that when it comes to the nationwide opioid epidemic, Texas isn’t exactly ground zero. For the most part, the Rust Belt, Great Lakes region and Northeast region of the United States have been the hardest hit by the opioid epidemic. So, the sense of urgency here is not the same.
But Kinzly argues the state has an opportunity here—an opportunity to get out ahead of the problem, so it never has to get that bad.