Opioids in Texas and How the State is Responding

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Drug Overdose in Texas

• In 2016, 2,799 Texans died due to drug overdose

• More than the population of a Texas 6A high school

• More than the population of nearly 60 percent of the cities and towns in Texas

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Sources: CDC (2017). Provisional counts of drug overdose deaths, as of 8/6/2017. Available at: https://www.cdc.gov/nchs/data/health_policy/monthly-drug-overdose-death-estimates.pdfU.S. Census Bureau (2017). Annual Estimates of the Resident Population in Texas: April 1, 2010 to July 1, 2016. Available at: https://www.census.gov/data/datasets/2016/demo/popest/total-cities-and-towns.html

Number of Drug Poisoning Deaths in Texas: 1999—2016

3

0

200

400

600

800

1999 2003 2007 2011 2015

Num

ber

of D

eath

s

Psychostimulant

Cocaine

Heroin

Natural and Semi-

Synthetic Opioids

Benzodiazepines

Synthetic Opioids

Source: Preliminary Data from CDC/NCHS WONDER-National Vital Statistics System, Mortality File.

Past Year Opioid Misuse

• In 2016, nearly 12 million people aged 12 or older misused opioids in the U.S.

• Among Texas students in grades 7-12

• 9 percent misused codeine cough syrup

• 4 percent misused other opioids

• Among Texas college students

• 4 percent misused opioids (including codeine)

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Sources: SAMHSA, National Survey on Drug Use and Health, 2016Texas School Survey of Drug and Alcohol Use, 2016Texas College Survey, 2017

Past Year Opioid Misuse

Source: SAMHSA, National Survey on Drug Use and Health, combined 2015-20165

0.1

0.6

0.3 0.3

0.04

0.4

0.2 0.2

0

0.2

0.4

0.6

0.8

1

12 to 17 18 to 25 26 or Older 12 or Older

Heroin Use

U.S. Texas

3.7

7.8

4.04.54.2

6.9

4.14.5

0

2

4

6

8

10

12 to 17 18 to 25 26 or Older 12 or Older

Pain Reliever Misuse

U.S. Texas

6

0

1

2

3

4

5

1999 2003 2007 2011 2015

Death

s p

er

100,0

00 P

opula

tion

Texas

Natural and Semi-Synthetic Opioids Heroin Synthetic Opioids

0

1

2

3

4

5

1999 2003 2007 2011 2015

United States

Opioid-Related Overdose

Death Rates: 1999-2015

Proportion of Opioid-Related Deaths in United States Attributable to Texas: 1999-2015

7

0

2

4

6

8

10

12

1999 2003 2007 2011 2015

Perc

enta

ge o

f U

.S.

Opio

id-R

ela

ted

Death

s f

rom

Texas

Heroin

Natural and Semi-

Synthetic Opioids

Synthetic Opioids

Opioid Treatment Services Locations

8

Treatment without

Medication

86%

MAT14%

Texas Targeted Opioid Response: Core Strategies

• Increased access to care and supports

• Reduction of service gaps within the continuum of care

• Increased awareness for the public through education and outreach

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10

Texas Targeted Opioid

Response

(TTOR)

Training

Texas PDMP

Safe Rx Disposal

Expand Primary

PreventionExpand Outreach

and Engage-

ment

Expand MAT

Job Training

Peer Re-entry

Recovery Support Services

Prevention

PartnersProjects

• Distributing federal guidelines and related materials to all prescribers in Texas

• Developing marketing campaign to increase Texas PMDP registration and utilization

• Supporting safe prescription drug disposal

• Expanding universal prevention programming

Substance Misuse

Prevention Providers and

Coalitions

Community Organizations

Schools

Law Enforcement

PharmacistsPhysiciansDentists

Veterinarians

Media

Training

Projects

• “Opioid 101”

• Opioid Misuse Prevention Summit

• Comprehensive Overdose Prevention

• MAT Advocacy

• Suicide Prevention

Partners

Substance Misuse

Prevention Providers and

Coalitions

Community Organizations

Schools

Law Enforcement

PharmacistsPhysiciansDentists

Veterinarians

Criminal Justice

Oxford Houses

LMHA/ LBHA

MAT Providers

Public Health

Recovery Coaches

Intervention and Treatment

PartnersProjects

• OSAR expansion

• HIV Early Intervention expansion

• Adding LCDCs to MCOTs

• Expanding Medication Assisted Treatment

• Expanding Office-Based Opioid Treatment (OBOT)

• Adding treatment for comorbid conditions such as hepatitis C

Public Health

LMHA/ LBHA

MAT Providers

Recovery

Projects

• Hiring additional Recovery Coaches

• Expanding sober living

• Expanding peer re-entry program

• Adding supported employment programs to partner with MAT providers

Partners

Criminal Justice

Oxford Houses

LMHA/ LBHA

MAT Providers

ED EMS

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Interagency Alignment with HHS Strategy to Address the Opioid Crisis

Improving access to treatment and recovery

support

Promoting use of overdose-reversing

medications

Strengthening our understanding of the

epidemic through better public health surveillance

Providing support for cutting edge research on

pain and addiction

Advancing better practices for pain

management

Current Barriers to SUD Treatment

Barriers Recommendations

Consistency in SUD-related policy and guidelines across state systems

Lack of geographic access to the full SUD service array

Address gaps by providing SUD treatment on demand

Lack of engagement and retention of patients with SUD

Improve linkage from health systems to recovery support services

Lack of screening and appropriate referrals to treatment in healthcare systems

Increase training and implementation of SBIRT includingavailable resources

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Thank You

Lisa Ramirez TTOR Project Director

Lisa.Ramirez@hhsc.state.tx.us

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