By Jane Maxwell, PhD
The opioid crisis makes national headlines daily, with this week’s news from the Centers for Disease Control that nearly 64,000 Americans died in 2017 of a drug overdose. When it comes to designing and implementing programs to prevent drug misuse and overdose, however, the devil is in the details. Although national in its scope, the epidemic actually takes different shapes in different areas of the country, depending on the opioids available and the way they are combined with other drugs. Accordingly, treatment programs should be tailored to the particular mix of drugs driving overdoses in each region.
In the Northeast and Midwest, highly pure powdered white heroin dominates. This type of heroin is easy to mix with fentanyl, a highly potent synthetic opioid that also comes in powdered form. The heroin/fentanyl combination has led to thousands of overdoses in these regions.
In Texas, the predominant heroin is Mexican black tar, which is gummy and resembles roofing tar. To inject it, users must first dissolve it in water over heat. It would take an extra step to work powdered fentanyl into the mix, and so far users in our state don’t seem to be taking this extra step: last year, less than 4 percent of heroin deaths in Texas also involved fentanyl.
Black tar heroin can be turned into a powder by drying it out and then working in over-the-counter medicines like Benedryl© or Tylenol PM©. Turned into a powder, however, black tar is less potent and thus less attractive to users who are dependent.
The fact that black tar heroin is more difficult to mix with fentanyl — which would make it much more potent — may account for the fact that the death rate due to heroin in Texas has been lower (1.9 per 100,000) than the national rate (4.2 per 100,000).
But there are other drug-related trends in our state that are as worrisome as the heroin/fentanyl epidemic of the Northeast and Midwest.
While there were 539 deaths in Texas due to heroin in 2016, there were 715 deaths due to methamphetamine. And the Drug Enforcement Administration predicts that methamphetamine traffickers are expanding their product line to include heroin. We may already be seeing this trend, since 23 percent of 2016 heroin overdoses in Texas also involved methamphetamine.
These regional differences mean that state and local authorities must constantly monitor their respective drug scenes to identify emerging trends.
Here in Texas, the Department of Health and Human Services has current data on poison center cases, treatment admissions, and deaths. In addition, the Drug Enforcement Administration has data on the drugs seized on the Texas border and how these drugs are combined. And at The University of Texas at Austin, social work researchers produce a yearly report that summarizes substance abuse trends in the state and lists data resources.
Data is available to tailor prevention and treatment efforts and make them appropriate to the particular mix of drugs driving overdoses and dependence, and target programs to high-risk groups such as those misusing opioids for pain. Available options include medication-assisted treatments for opioid users, psychosocial counseling for methamphetamine and cocaine users, harm-reduction approaches to lower the rate of hepatitis C through use of clean needles among drug-injection users, and to lower the HIV infection rate among methamphetamine users through adherence to pre-exposure prophylaxis (PrEP).
We need to quit wringing our hands about the extent of the problem and instead use the available data to target groups at high-risk and deliver time-tested treatment designed to meet their needs.
Jane Maxwell is a research professor in the Steve Hicks School of Social Work, The University of Texas at Austin. This opinion piece was produced for Texas Perspectives. A version of it appeared in the Fort Worth Star-Telegram.