Could the heavy media coverage of the national opioid epidemic be drawing attention and resources away from chronic mortality associated with other drugs of abuse? Recent news articles — like “We are not immune: how the opioid crisis is hitting central Texas,” published by the Statesman — amplify municipal and state calls for funding to fight this narrow battle at the expense of one that can touch far more Texas lives.
Centers for Disease Control (CDC) data shows that opioid-related deaths in Texas have indeed risen slightly – from 4.37 to 4.55 deaths per year per 100,000 residents – between 2006 and 2016. But in 2006, the Texas rate stood at 85 percent of the national average; in 2016, we were at just 35 percent of a tragically higher nationwide death rate.
Over the same interval, Texas deaths related to cocaine, methamphetamine and other psychoactive stimulants have risen from 3.86 to 4.82 per 100,000. While some deaths were due to combinations of drugs and contribute to both statistics, it seems these classes of drugs are comparably lethal. Yet, they claim fewer lives than alcohol: CDC estimated that 27.9 deaths per 100,000 Texas residents were attributable to alcohol in 2014.
The devastation the opioid crisis has wrought is real. But I hope that one doesn’t have to be a former abuser of stimulants, as I am, to be concerned that so many other deaths in Texas go relatively overlooked. Or to be troubled by calls to seek federal funding to combat opioids locally if that means diverting effort from fighting our other substance-abuse tragedies. Even if our officials write outstanding grant proposals to request opioid-fighting money, does it belong here in Austin? Ohio, for example, is facing an opioid-related death rate of 31.9 per 100,000 residents – a staggering figure that rises above even our own state’s alcohol-attributable death rate. Why the difference?
Texas is not immune to the opioid crisis. But there are structural reasons why it hasn’t been hitting us as badly as elsewhere — reasons that have little to do with the wisdom of policies set in Austin, or even the hard work of specialists in treatment centers or on the streets.
One factor that has driven the explosion of opioid deaths in the past few years is a spike in the availability of fentanyl, a synthetic opioid as powerful as it is deadly. To use fentanyl is to play with fire, and addicts often do so unwittingly, since fentanyl might have been added to their heroin. Those who survive develop a fierce attachment to its potency, so fentanyl appears to be here to stay. And many pill-users move to heroin once their habit becomes too difficult to support by other means.
There’s one catch: Fentanyl is usually distributed as a powder. For that reason, it doesn’t mix well with the Mexican black tar heroin that predominates in the Western U.S., including Texas. It mixes easily, though, with the South American powder heroin used on the East Coast.
It is no coincidence that so many of the lives lost over the past few years have been in the East. Dividing the states into those lying east and west of the Mississippi River provides a vivid illustration. In 2006, there was no large-scale geographic pattern to the nascent opioid epidemic. Deaths averaged 5.21 per year per 100,000 people in the Western states and 5.14 in the East. By 2016, the death rate in the Western states had ticked upward to 6.97, while in the East it had soared to 17.4. The deadly presence of fentanyl on the east side of the heroin divide is evident.
The message for Texas may be this: There is not one opioid crisis but many. One is caused by cheap heroin on the streets — and the battle against that is ongoing. Another arrived with the era of pill mills and unmonitored prescriptions, and there has been significant progress turning it back. A third was ushered in by powerful synthetic opioids like fentanyl, and we in Texas are largely spared its consequences for now.
Therefore, instead of clamoring for funding solely to fight the opioid wars here — when the numbers show that other places are in more dire need of it — let’s take another look at which drugs are actually killing people in Texas, including alcohol, and create a broad-based strategy that will save more lives.
Schneider is a professor of mechanical engineering at the University of Texas. He is enrolled in the certificate program in addictions counseling at ACC.