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How access to opioid treatments has changed in Texas

Drug overdoses are a leading cause of accidental death in the United States. Among all overdose deaths, opioids were the culprit 70.6% of the time in 2019, according to the Centers for Disease Control and Prevention.

Nearly 30 years after the first wave of the opioid epidemic began, roughly 645,000 Americans have died from overdoses where prescription or illicit opioids were involved, according to the CDC. Current estimates indicate that between 6.7 and 7.6 million Americans suffer from opioid use disorder.

Beginning in 2013, the introduction of synthetic opioids like fentanyl and xylazine into the drug supply sparked a surge in opioid overdose deaths. According to the Department of Health & Human Services Overdose Prevention Strategy, drug overdose deaths due to synthetic opioids besides methadone have increased an astounding 103-fold since 1999 and are the primary driver of overdose deaths.

During an overdose, opioids bind to receptors in the brain that control respiratory function, leading to impaired breathing, brain damage, and death due to lack of oxygen. In recent years, drugs to treat substance use disorder and prevent overdose deaths have surged in usage.

Naloxone, available as a nasal spray or injectable medication, can reverse opioid overdoses after they happen. The drug, often known by the brand name Narcan, was made available over the counter in 2023 in an effort by the Food and Drug Administration to increase accessibility. Nearly 1.7 million prescriptions of naloxone were dispensed in 2022, up from 904,000 in 2019.

Buprenorphine, however, must be prescribed by a health care provider as part of a long-term substance misuse treatment plan, often for those addicted to heroin, oxycodone, fentanyl, or other opiates. Buprenorphine works by reducing withdrawal symptoms and curbing drug cravings. As a long-acting opioid, it takes more time to act on the body over a more extended period. Though it's classified as a Schedule III drug due to its addictive properties, at the correct dosage it helps give people suffering from addiction a level of stability by reducing the harms of illicit opioid misuse.

About 16 million buprenorphine prescriptions were dispensed in 2022, slightly higher than in 2019. However, as the epidemic retains its grip on the nation, medical professionals are prescribing opioids for pain relief with less frequency. The rate of opioid prescriptions for pain fell steadily between 2019 and 2022, from 46.8 per 100 people in 2019 to 39.5 per 100 people in 2022. The prescription rate for the opioid treatment drug buprenorphine, meanwhile, slightly increased over the same period from 4.7 to 4.8 prescriptions per 100 people.

Part of this increased access is due to the $50 billion opioid settlement fund distributed to each state for opioid harm reduction and treatment services. Many states are in the process of determining how to deploy settlement funds; the level of access to lifesaving medications thus varies by state and their specific approach to combating the crisis.

Ophelia used CDC data to analyze changes in how Texas distributes common medications that prevent opioid overdoses and treat substance use disorders, comparing how states are responding to the opioid epidemic as part of a broader national analysis.

Naloxone access grows across the US

From 2019 to 2022, access to naloxone grew in every state except New Mexico, where it shrank, and New Hampshire, where it stayed the same. In Texas, an additional 0.1 prescriptions were doled out per 100 residents, below the national average.

Texas provided 0.2 naloxone prescriptions per 100 residents in 2022, compared to 0.5 prescriptions nationwide.

Overall, naloxone prescriptions per resident remain much lower than buprenorphine due in part to the different purposes each drug serves. Naloxone is used in emergencies and is not prescribed as a medication to take on a routine basis. In addition to over-the-counter purchases, the drug is distributed through public health programs and emergency care outside traditional prescription avenues. Buprenorphine, on the other hand, is dispensed only by health care providers for long-term opioid use disorder treatment to ease withdrawal symptoms and cravings, often necessitating refills on a regular basis for complete treatment.

Cost is also an issue. A two-dose packet of Narcan runs just under $50 at many drugstores, and like most over-the-counter drugs, insurance doesn't cover it. While a lifesaving measure might seem worth the price tag, $50 is prohibitive for some. To help reach communities in need, there are several resources available for free naloxone supplies and emergency kits.

Despite efforts to reduce the stigma around substance-related disorders, walking into a Walgreens or CVS and purchasing overdose medication might be challenging for those with OUD.

However, the use of lifesaving treatments is imperative as the opioid epidemic continues to take its toll. Obsolete and incorrect beliefs about the nature of addiction, which liken the disease to moral failure, can prevent people from seeking help and hinder the development of health and public policies. In contrast, a punitive approach to OUD can increase drug use by dehumanizing those who need help while failing to address the underlying cause of the disease.

Some areas see a decline in substance misuse treatment medication distribution

Medication-based treatment has not been a first line of defense in treating opioid misuse disorder long-term. According to a study by the National Institutes of Health and CDC, just over 1 in 5 adults with opioid use disorder received medication-based treatment, namely buprenorphine, methadone, or naltrexone, in 2021. The study also found that Schedule III, II, and unscheduled drugs, respectively, were dispensed for substance use treatment 38 times more often when it was a telehealth appointment.

Texas distributed 1.4 buprenorphine prescriptions per 100 residents in 2022, down 0.1 prescriptions since 2019. The national prescription rate is 4.8 per 100 residents, up 0.1 from 2019.

West Virginia leads in prescriptions per capita, which have increased by 4.4 prescriptions per 100 residents to reach 27.2—over a quarter of the state's total population. Indiana, whose capital city is a national hot spot for opioid overdoses, saw the second-highest increase in buprenorphine prescriptions, reaching 10.7 per 100 residents in 2022.

Despite having the second most overdoses due to opioids, Washington D.C. issued an average of 1.5 fewer prescriptions per 100 people. Prescriptions fell the most in Vermont by 3.1 overall, dropping from 28.6 per 100 people to 25.5 per 100 people. In 2021, the state became the first to decriminalize buprenorphine possession in limited quantities. In a promising outlook for this harm reduction strategy, Vermont is experiencing a three-year low in opioid overdose rates based on 2024 data so far.

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This story features data reporting by Paxtyn Merten, writing by Colleen Kilday, and is part of a series utilizing data automation across 50 states and Washington D.C.