An Opioid Epidemic Within a Pandemic

Texas Harm Reduction Alliance's Cate Graziani speaks during an Overdose Awareness Day Press conference outside the Travis County Commissioners Court building on Aug. 31 (Photo by John Anderson)

A troubling trend has emerged in the overdose calls that Austin medics are responding to lately. Fentanyl, a synthetic opioid 50 times more potent than heroin, "is being found in everything," said Selena Xie, president of the Austin EMS Association.

When Austin medics respond to overdose calls that they believe are because of opiates, they administer Narcan, the brand name of naloxone, a lifesaving medication that can reverse opioid overdose. However, Xie continued, when patients regain consciousness, they aren't always aware of having taken an opiate – suggesting the drug might have been laced with fentanyl, which greatly increases overdose risk.

The increased prevalence of fentanyl is just one contributing factor to the alarming spike in recent years of drug-related overdose deaths across the U.S., including here in Travis County. Xie was among several public health community members, including leaders from the Texas Harm Reduction Alliance, who gathered outside the Travis County Commissioners Court building Downtown on National Overdose Awareness Day (Tue., Aug. 31) to remember the hundreds of local residents who died from overdoses last year. 262 people died in 2020 from drug overdoses in Travis County – a 36% increase from 2019 – according to a new report released by THRA.

Overdose deaths have been attributed to myriad reasons, including people's uncertainty about which drugs they were actually taking and poor access to opioid overdose medication such as naloxone/Narcan, but other risks have since emerged amidst the COVID-19 crisis, too. Increased social isolation, while necessary for helping the fight to contain the pandemic, can be a dangerous situation for some drug users. "We tell folks all the time not to use alone – no one is there to revive you in case you overdose," said Gaby Libretti, who runs THRA's drop-in center. "COVID made us all need to isolate."

Libretti says the camping ban reinstatement this year has also made it difficult for THRA's outreach team to stay connected with Austin's unhoused neighbors and provide them with safe-use supplies, like sterile needles and syringes, as part of their harm-­reduction services. "We don't know where everyone's going to be," said Libretti. "We've seen some folks for a year or two, and [now] we won't be able to find them."

In an effort to prevent overdoses in Travis County, THRA is calling on community leaders, including county commissioners, to formally recognize Austin's opioid overdose epidemic as a public health emergency and invest resources in safety and recovery measures for drug users. First and foremost on the list of requests, says THRA Director Cate Graziani, is expanded community access to naloxone and funding for the widespread distribution of fentanyl testing strips through the local service delivery network. In 2015, the Texas Legislature approved Senate Bill 1462 that legalized naloxone prescriptions for those at risk for experiencing an overdose; previously, naloxone was available mostly in situations where someone who had overdosed could access emergency medical services at a hospital or from emergency medics. With SB 1462, those who might be in the position to respond to overdoses are able to access and carry the medication, too. Expanding access through avenues like homeless services programs, social service agencies, libraries, and health care providers is key to getting naloxone into the hands of folks most at risk of overdose. "We want our public health department and our Health and Human Services Department at the county to be telling the providers they're funding, 'Hey, y'all need to be giving out naloxone.' And they could make that a requirement," says Graziani.

THRA is also advocating for local leaders to adopt an overdose "Good Samaritan" law, which seeks to provide certain legal protections for anyone who reports an overdose and calls 911 for emergency medical attention. Graziani says fear of criminal charges is the number one deterrent to people calling 911 while witnessing an overdose. Last legislative session's House Bill 1694 from John Raney, R-College Station, is a start, says Graziani, but local leaders could expand it considerably: "It would mean we do a local ordinance or some local policy, but it would also require a lot of education, with law enforcement and EMS.

"With people who are most at risk for overdose, the first time someone calls, if they get arrested, then all trust goes out the window. So there needs to be a real commitment from our leaders to follow through."

Adding methadone to Central Health's Medical Access Program list of approved medications is another priority for THRA. Central Health's health care coverage program for low-income residents doesn't cover methadone, although it does include buprenorphine, which like methadone is one of the primary medications used for medication-assisted treatment for opioid addiction. Currently, Integral Care is the only publicly funded clinic in Austin that offers methadone for indigent residents, but the demand exceeds capacity, meaning the waiting list can be nine months or longer. Meanwhile, THRA is helping fill the gap by paying for people to receive weeks of methadone treatment at a private provider, Community Medical Services, while they wait to get a state-funded slot at Integral Care. If MAP covered methadone – or if CMS was an approved Central Health provider – more low-income residents could receive methadone treatment.

Funding to address Austin's opioid epidemic is one of several investments expected to be prioritized in the county's fiscal year 2022 budget. In the preliminary budget released last week, there was a $175,000 increase for methadone and medication-assisted treatment for a total of $250,000. Commissioners are expected to adopt the budget at the end of September.