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Texas Matters: How Bad Is the Opioid Crisis In Texas?

David Martin Davies
Narcal and other naloxon drugs that can stop an opioid overdose

According to data collected by the Centers for Disease Control drug overdosing is the top cause of death in America for those under 50 years of age.

The opioid epidemic continues to grow worse and that is also true for Texas.

Mark Kinzly is the co-founder of the Texas Overdose Naloxone Initive (TONI) and he's is seeing how street heroin spiked with fentanyl and other synthetic opioids are causing more people to overdose.

Texas Matters Host David Martin Davies asked Kinzly how bad is the opioid crisis in Texas.

MK: It's an interesting question David because I think that we're still starting to gather appropriate data that gives a better picture of it. But every indication shows that the epidemic that has hit mostly the Midwest in other parts of the south southeast and northeast is certainly here in Texas. We've seen a pretty steep incline and You know synthetic opioid seizures over the last 18 months about a 250 percent increase according to the DEA. But we're also seeing a large increase in opioid fatalities being reported. So we're at a place where we currently are number two in the United States for health care costs associated with opioid abuse. And we have for the top 25 cities in the country for prescription opioid abuse so there's a large problem in the state of Texas. And when you look at David you look at the fact that we border Mexico where about 80 percent of all the clandestine opioids sort of coming into the United States or are being produced in and comes through Mexico. So since we border it we've got the cross hairs on this right now.

DMD: I wonder if the opioid epidemic that we have in Texas is going largely undetected

MK: I think because of some of the unintended poor data collection. I think that you could say that it's going on you know undetected in the sense that if you look at the maps and the fatalities because of the board that poor data collection and you would think that there isn't an issue. And in fact it's more of an issue of poor data collection than it is that we don't have a problem and that's partially why I think you know Joe Citizen doesn't realize that we are in a place that is. You know as bad as in regards to the opioid epidemic as it is in Texas because the numbers of the you know the national numbers don't look as bad because of how we collect death certificate data as it's associated with opioid overdoses.

DMD: So it's likely, it's possible that there are many many more Texans who are dying either from prescription drug overdoses or opioid use. Also maybe from heroin or from synthetic opioids that are now hitting the streets with the rage.

MK: Correct. We do know that that is being under reporting. There's been a number of stories done and some of the Texas newspapers in regards to the poor data collection and around the overdose epidemic done here. Yeah it's a bigger issue than I think most people would want to even admit to. And you know being on the streets all day almost every day of the week I can tell you for a fact that there was an enormous uptake opioid use in the communities that I do work with.

DMD: Let's talk about your point of view and where you occupy on your point your business card says a “streetologist” as your title. What does that mean?

MK: So I spent a number of years at Yale faculty at Yale doing epidemiologists So, basically what I did was just took that phrase and because of the work that we do on the street and document and tracking certain trends of negative outcomes. On the street level in particular around drug use and misuse.

DMD: Before you were at Yale you got a different sort of point of view. You learned about things differently.

MK: Yeah I did some personal research. You know, I'm someone that grew up in New York and unfortunately was introduced to narcotics at an early age. And so I have about a 23 year personal history of opioid abuse. And then in long term recovery for a long time. And so I have my own personal experiences and background. And I also have about 30 years of working in the field of public health and harm reduction in regards to particular drug use.

DMD: You have a unique perspective I mean you've seen it up close firsthand personally and also you've done the academic research. We have this stigma about this addiction crisis that we have in America. How can we try to remove that? Well like it or not I mean almost every American is addicted to something. Maybe we could ask everyone to stop being addicted to one thing in their life whether it be cigarettes, alcohol, sugar or something.. the internet? And just see what that's like. And now imagine if you were addicted to this substance that was created specifically with the intent to make you addicted you would have a better understanding of what it's like. Is that a reasonable experiment?

MK: It is a reasonable experiment and I think you know one of the things that's happened in our culture is that we have been inundated with fast quick and in a hurry and one of the things that delivers fast quick and in a hurry as well if not better than anything is narcotics or you know drugs themselves.

And so it's not it's not surprising that the United States is as addicted as they are with a lot of things. You know we are five percent of the world's population and yet we consume 82 percent of the world's hydrocodone.

You know there's that there's an issue that we need to be looking at right now is the opioid crisis. Is it preparing to get a lot worse.

So doing a lot of national work and working with the DEA and the CDC and a lot of federal agencies that track this stuff is that what we're what we're seeing as a trend is that currently we last year lost almost 60000 people to overdoses.

And what they're estimating is by the year 2020 that will lose about 100000 people a year from overdoses.

DMD: If we had a virus or something that was going to be eating through a population at those numbers would people be treating this differently?

MK: Well, I think so David and I think that there there's a fear factor that comes in with you know the hysteria that the war on drugs has inundated us with over the last 40 years. So we have been propagandized for many years. You know, “drug users are bad and they do bad things” and “they're just morally deficient” and in fact that's probably as far from the truth as can be.

Now there are some bad things that people do. But I think that if individuals would take a better look at what we were taught many years ago around. You know how we treat one another. You know be kind to your neighbor. Love thy neighbor and things like that I think we'd be in a much better place than what we have done is just because if you look at addiction David it's a disease of separation. And so the antidote for separation is connection. And basically what we've done David is we've continued to separate people further and further and further which drives people into more and more dangerous behaviors. And so instead of continuing to disconnect people we need to start working on connecting people and that means from families clergy our communities that are you know deteriorating rapidly need to come together to address this problem in an appropriate way.

DMD: Fentanyl, What is that? What's that doing to the opioid crisis?

MK: Fentanyl is about 100 times more powerful than morphine and about 60 times more powerful than heroin. And then an incredibly small amount when I say small amount of it I'm talking about. If you look at three grains of salt. Three grains are lethal. And and what's happening is that Fentanyl is being mass produced in clandestine laboratories. You know and other parts of the world. But I also will tell you it's probably being manufactured here in the United States as well. And being shipped over here because of our incredible thirst and hunger for opioids and so fat and all because it's so powerful and because it only has a halflife it's a very short acting opioid. What happens is that people are use and much more frequently than we have seen in the past. And so as a result of that we're starting to see more and more fatalities that are directly correlated with fentanyl because of people use and much more much more rapidly. And as a result they're introducing that you know respiratory depressant into their system to the point where their brain is telling them to stop breathing.

DMD: The accessibility of fentanyl. I went online was easy just one Google search and POW. You are able to order it from China. Easy. Less than a hundred dollars. You're able to get multiple doses of it. I went to other sites and I saw places explaining how to use it how to mix it how to put it into other drugs. The people who know about drugs, who are into drugs. They know this already. No one is going to learn about this by listening to this program. We're just trying to make this information more available to the general public so you know what we're dealing with. So fentanyl is easy to get hold of.

MK: It's very easy to get a hold of David and I think the other thing is that the CDC just came out with the report now says that opioid overdoses are the leading cause of death for people under 50 years old. And so what we are seeing as a trend is that younger and younger and younger people are being introduced to these very strong opioids at a younger age.

And part of that is a direct result of their knowledge and ways of getting around the Internet. They know how to find things through the Internet. You know back in the day we wouldn't have known to do that well first of all it wasn't available like that but now it's very easy to get on line and find like you did.  Fentanyl. You can have this poison delivered to you within days.

DMD: All you need is a credit card number and it shows up at your house. What is carfentanil?

MK: Carfentanil is actually an animal tranquilizer. We are seeing some of it in parts of the United States. And to my knowledge David we have not had any toxicology reports of carfentanil here in Texas. However carfentanil is about 10000 times more powerful than morphine. It's a fatality waiting to happen. And so you know they are finding and in different pockets throughout the United States Ohio and Pennsylvania and certainly some of the parts of the northeast and southeast are starting to see some more carfentanil. Now Florida is really having a hard time with it right now.

DMD: So when you say it's an animal tranquilizer I've heard it described as an elephant tranquilizer.

MK: Yeah. Large large animals. So not like dogs and cats we're talking about you know hippopotamuses and elephants.

DMD: And so you say that it's not showing up on toxicology but if you're not looking for it you're not going to find it. And we're talking about a drug that would be present in the system at such a micro level that even if you were looking for it and it was there it would be difficult to find.

MK: Yeah. I mean you would specifically have to do a toxicology screening for looking for that in order to find it does have specific testing for it. However you know to my knowledge but I don't think that we've seen any of that here in Texas as of yet. But let me just say this we also five or six years ago could have said that we hadn't seen fentanyl in Texas while that is no longer the truth either. We are inundated with fentanyl on the streets of and the rural communities of Texas as we speak.

DMD: There are people who are buying street heroin and fentanyl has been incorporated into that dose.

MK: That's correct. That is correct.

DMD: And that increases the likelihood that that person may overdose?

MK: Yes it does because heroin when give you a quick example of it pharmacologically well. So heroin lasts between six and eight hours before you start to go into opioid withdrawal fentanyl. You start to go into opioid withdrawal in about two hours. And so what's happening is that people are you know use on a lot more and a lot more frequently in order to stave off the withdrawal that comes along with opioid use.

DMD: But also there are people who will go buy their drugs from a vendor that they know of, their connection. And the level of fentanyl from one hit to the next could vary. If a person is using at a normal that they feel that their dosage that could change suddenly become a lethal dose correct.

MK: There certainly is no quality control on the streets for street medications like heroin and such. And so what you get from a regular supplier on a Tuesday and you go back to that same supplier on a Thursday what you get on a Tuesday maybe 30 percent. And once you get on that Thursday thinking you're getting the same thing maybe 80 percent pure and so that is exactly what's happening is that people are not sure what they're buying.

And you know and that's part of the big issue and that's why we may see a big increase in the number of overdose deaths fatal overdoses in Texas as fencing all becomes more and more part of routine drug use.

DMD: This is Texas matters from Texas Public Radio. I'm speaking with Mark Kinsley about the opioid epidemic in Texas.

What is Gray Death?

MK: So Gray death is...It's a combination of. It dependent on where you get it. Grey Death is starting to show up in the southeast. And now it's showing up in other parts of United States like Ohio. It is fentanyl and it's also has often times Xanax and things like that mixed in and it has very little other opioids in it. Every once in a while you'll get some Great Death from what we understand that may have some Hydrocodone in it.

But you know it's is a really powerful mix of opioids that's being sold on the street as heroin. But it's a great it looks like cement. And that's why they call it a great death. Yeah. And it'll kill you.

DMD: I've heard that police officers who actually get some of the stuff on their hands me they might get fentanyl on their hands. And they will start overdose. Is that true?

MK: It is very true. So what's happening and we're asking our law enforcement to do an impossible job.

I mean we're talking about a group of people that are asked to do a task that quite honestly at this point is impossible to do. And so what's happening is they're going into these places where you know they've been you know watching and they know there's sales going on there and they go in there to arrest some people and they seize this particular narcotic and they get some of it on them and it potentially can seep in through the skin or you can inhale this in a way that can put them at risk for an overdose. We've seen a number of these happen in different parts of the country. And so I will tell you that we have been able to supply a number of law enforcement agencies here in the state of Texas with naloxone so that when their officers come across that that they have this medication that can save their lives for doing their job.

DMD: Naloxone. Your organization is the Texas Overdosed Naloxone initiative. What is your mission?

MK: Our mission is to educate and the state of Texas about the epidemic, the opioid epidemic. But our mission is also to supply every Texan that needs the benign medication called naloxone. To supply them with the medication so that if there is a negative event whether it's from prescription opioids or from illicit opioids that they have the opportunity to have this medication and apply it to a friend or a loved one to so that they can stay alive long enough to raise their families and go to work and have some hope.

DMD: If a person is experiencing an overdose right there in front of you and you have naloxone and you're able to administer it to that person I mean they're on the ground they're having trouble breathing. It looks like they are really in bad shape. You give them this pharmaceutical. And what happens?

Mk: So the way that naloxone works; When you take an opioid it sits on the opioid receptor and it works on the part of the brain to slow down slow down… slow down. So it's telling your respiratory system to slow down.

So what naloxone does is that it comes in when administered it comes in between the opioid and the opioid receptor and it kicks the opioid off the opioid receptor blocking the receptor. Now the thing with this medication is that it's short acting and the last 30 to 90 minutes so when you administer this medication somebody usually will come out of that overdose within three to five minutes. However we have to be vigilant around calling 911 and getting medical attention there because somebody potentially could go back into an overdose again. It doesn't happen very often David But it does happen.

DMD: So if you're not suffering an overdose and you are given a dose of Naloxone what happens to you?

MK: So if you have no opioids on board if you have not ingested any opioids and you ingest the lock zone it would be like ingesting water. So the only thing that locks homework's on is opioids. It's not good for any anything else.

DMD: But there are people out there that say let them overdose.

MK: Yeah. That there is. You know I just I don't you know really come from that school of thought. And it's always interesting to me whether they you know a pro-life state that people could come out of their mouth with a statement like that. And it's always easier to say stuff like that David when it's not your brother or your friend or your son or your daughter or your father who's the one that may have had a negative event with that particular issue. One thing that we know is that initiatives like the overdose prevention initiatives that we're doing and that we are much more inclined to connect people to other services that won't get them into a place where they can either go to drug treatment or get connected and get their lives back so that they're not caught up in that vicious cycle of addiction.

DMD: How would someone get hold of Naloxone?

MK: So there's a couple of ways that you can get a hold of naloxone in the state of Texas. Governor Greg Abbott signed Senate bill 1462 last legislative session which allows for people to obtain naloxone in your pharmacy a standing order has been signed by a couple of doctors which will allow any individual that needs this medication.

So if somebody's grandmother happens to be prescribed an opioid and you want to have naloxone in the house in case something happens to grandma that you can go into the pharmacy and tell the pharmacist that you would like some of naloxone that pharmacist has a standing order in place so that you do not have to go to your private physician in order to get a prescription for this medication. So you can get it that way you can go to the pharmacy and get the medication that way. The other way that you can get this medication is that there is a bill right now that is on the governor's desk and hopefully the governor Abbott will sign it and it's for code prescribing and what it's going to do is it will encourage physicians that are writing opioids for whatever reason whether that's for chronic pain or for the acute pain that depended on the doctor that they will also write a script for the locks on so that an individual code prescribed these medications.

The other way that you can get naloxone is that you can reach out to the Texas Overdose Naloxone Initiative and we will get you whatever medication that you need. If you're someone that is dealing with a friend or a loved one or you someone that wants to have this medication on hand just in case there's a negative event.

DMD: If I had someone in my house maybe a son or daughter who could be involved in this world should I go get some and just keep it in my medicine cabinet?

MK: So here's the thing David is that I you know it's such a benign medication and it does nothing else it has no street value and has no ability to get somebody high. Unfortunately every teenager since the beginning of time experiments with things. And so if there's the potential for something to happen I say we should have it in every medicine cabinet in our state.

I'd be a lot better off to not need it and have it then it would be to need it not have it. That's for sure.

DMD: Never before have we had drugs this powerful this cheap accessible. It's everywhere.

MK: It is everywhere. David you know I grew up in a place then in 1978 the accessibility was and is great but I've been working on the streets around this country and other parts of the world since the late 80s and I'm going to tell you there has never been more availability and a lower cost at a higher priority than what we're seeing with opioids right now. My son I have an 18 year old son who just got a full scholarship to Princeton who told me this weekend that it is easier for him to access heroin than it is for him to access alcohol and marijuana. That is a scary statement.

DMD: People found themselves addicted -- they did not know that they were taking opioids. They did not know it would be like this. They were following doctor's orders and they found themselves in a trap.

MK: Yeah I think that Purdue pharmaceuticals the maker of OxyContin along with another a number of other pharmaceutical companies need to really take an honest look at what they've done. They have introduced something into our society that they were not honest about it.

David Martin Davies can be reached at dmdavies@tpr.org and on Twitter at @DavidMartinDavi