Why aren’t Texans using opioids?

Credit: Wikimedia Commons.

Interesting article on Medication-Assisted Therapy for opioid addiction in the Chronicle last week. The most interesting part to me were the local opioid stats. They seemed…underwhelming:

In 2016, out of 444 overdose hospitalizations in the county, 88 involved opioids and opiates (including heroin).

Huh. Only 20% of overdoses involve opioids? What the hell else are people ODing on?

And from 2006 to 2016, 590 deaths in Travis County were reported as due to opioid overdoses, or 42% of all OD deaths.

I looked up national overdose figures and found this chart from the National Institute on Drug Abuse, a federal agency. I learned that a lot more people are overdosing on cocaine than I ever would have imagined. But it also shows that the great majority of overdose deaths are linked to opioids. Of the 72k OD deaths in 2017, 49k involved opioids. Even the sharp rise in coke overdoses appears to be linked to opioid use.

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Could the local numbers include alcohol? They probably should. It’s a pretty popular drug. But while booze is a big killer, the overdose is not its preferred murder method. Only 2,200 people died from alcohol poisoning in the U.S. last year. So that’s not the reason the numbers are different.

It’s not just Travis County. Texas as a whole has largely been spared the ravages of the opioid epidemic:

Looking at age-adjusted mortality rates from opioid overdose shows how the epidemic has exploded nationally yet stayed flat in Texas and probably also in Travis County. For the U.S., in 2016 it was 13.3 per 100,000 – well over half of all OD deaths and a 28% jump in a single year. In West Virginia, it was a whopping 43.4 per 100,000, also a huge increase over 2015. In Texas, though, it was only 4.9 – 48th among the 50 states, less than half of all OD deaths, and only up 4% in that year.

That Texas is weathering the opioid epidemic so much better than other places in the country –– including other places with lower levels of poverty and crime and higher rates of health care coverage and educational attainment –– is surprising. It may hint at the fact that the opioid epidemic has disproportionately impacted rural, white communities. Texas certainly has plenty of communities that share the economic and demographic profile of the communities that have been hit hardest by opioid addiction in the midwest and northeast, but it’s also a majority-minority state whose population is concentrated in its major urban areas.

But while it’s clear that opioid addiction is a much smaller problem in Texas, it’s still not clear why the majority of overdoses in Travis County are coming from other drugs. Are we stuck in 2006, back when meth was the biggest killer in the U.S.? What’s going on?

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