Texas lawmakers warming to opioid harm-reduction policies they once opposed

Texans looking for assist for substance use can name the Substance Abuse and Mental Health Services Administration’s free help line at 800-662-4357. They may also entry providers of their area by way of the Texas Health and Human Services website.

Texas lawmakers are altering their tune about how to sort out a rising fentanyl disaster within the state forward of the subsequent legislative session beginning in January.

Earlier this month, Republican Gov. Greg Abbott led the way by popping out in favor of legalizing fentanyl check strips, which assist customers determine whether or not the medication they are planning on taking comprise the lethal artificial opioid. Abbott beforehand opposed such a coverage however stated the rise in opioid overdose deaths had introduced a “better understanding” that extra wants to be performed by the state to sort out the issue.

“The message from Abbott that he’s willing to support that is huge because that gives the go-ahead to the House and Senate,” stated Katharine Neill Harris, a drug coverage fellow at Rice University’s Baker Institute for Public Policy. “It signals that if we get this passed, it’s not going to necessarily get vetoed.”

Bills to legalize fentanyl check strips, and different related applications like syringe exchange services that purpose to reduce hurt for these addicted to medication, have been filed prior to now, however had been principally authored by Democrats and had little probability of changing into legislation in a Republican-dominated Legislature. Many tough-on-crime Republicans have opposed such measures, involved that they allow drug use.

Now, among the Capitol’s most conservative names — like state Sen. Bob Hall of Edgewood and Rep. Tom Oliverson of Cypress— are taking over the case for legalizing fentanyl check strips. And the difficulty is getting assist from high legislative leaders.

“I believe that recommendations made by the public health committee will receive broad support in our chamber, such as legalizing fentanyl testing strips, encouraging the availability of naloxone and promoting a more centralized and coordinated data collection effort to better inform law enforcement and emergency medical services,” House Speaker Dade Phelan stated in a press release.

Abbott additionally stated he wished to make Narcan, a drug used to reverse opioid overdoses that is generically called naloxone, more readily available throughout the state. First responders and harm-reduction teams that work with individuals who use medication have problem supplying Narcan due to its price — about $125 for a equipment with two doses.

Republican and Democratic lawmakers are working collectively to go harm-reduction measures. That’s been encouraging for drug coverage specialists who’ve been sounding the alarm concerning the rise of fentanyl within the state for years, however they stated the state nonetheless wants to do extra.

“We are excited about the possibility of legalizing fentanyl testing strips, but that’s one tiny step forward, and we really need to be taking huge strides to get our arms around this crisis,” stated Cate Graziani, co-executive director of the Texas Harm Reduction Alliance.

The proposed coverage modifications come because the opioid disaster continues to batter the nation. Nationwide, the Centers for Disease Control and Prevention reported that more than 107,000 people died from drug overdoses in 2021, the final obtainable yr. Synthetic opioids had been chargeable for 71,000 of these deaths, and they had been largely from fentanyl.

In Texas, the CDC predicts that more than 5,000 people died of drug overdoses between July 2021 and July 2022. Overdose deaths involving fentanyl within the state rose 399%, from 333 folks dying in fiscal yr 2019 to 1,662 in fiscal yr 2021.

The change from Republican leaders in Austin additionally comes practically two years into Abbott’s unprecedented border mission, Operation Lone Star, which has price the state $4 billion for border safety and despatched 1000’s of National Guard members and Department of Public Safety troopers to the border with underwhelming outcomes. One of the operation’s essential objectives is to cease the circulation of medicine throughout the border, however fentanyl deaths have elevated within the state in recent times.

“If 50 years of the war on drugs isn’t enough to prove it doesn’t work, then we can look to the past two years,” Graziani stated. “Those strategies aren’t working. We need public health strategies, and we need to stop criminalizing paraphernalia so we can focus on the care.”

Sen. Nathan Johnson, D-Dallas, who filed a bill for the brand new session to decriminalize strips and different expertise that may assist detect fentanyl, stated the state wants to take swift motion.

“We have a lot of people dying of accidental drug overdoses as a result of taking drugs that they didn’t know contain fentanyl,” he stated. “This affects a lot of people, including college kids, and we, in Texas and nationwide, have suffered devastating overdose losses of life.”

Showing the difficulty’s bipartisan attraction, Johnson has teamed up with Hall to push the invoice by way of. Similar payments have been filed by Oliverson and Austin Democratic Reps. Sheryl Cole and James Talarico.

“We don’t agree on a whole lot of things, but it does show you that sometimes they’re just the right answers,” Johnson stated.

Hall didn’t reply to a request for remark.

A broader bill round legalizing fentanyl check strips and different drug paraphernalia filed by Dallas Democrat Jasmine Crockett didn’t get a listening to on the House flooring final session. But with extra lawmakers having constituents affected by the opioid epidemic, a narrower invoice that offers solely with fentanyl testing instruments, and help from high Republican leaders, the percentages for passage of this yr’s proposals are significantly better.

Marc Levin, a legal justice knowledgeable who has labored on laws in Texas in recent times, stated the change in perspective is “noticeable.”

“It’s not just that opioids have had a significant effect on rural areas, which are represented by Republicans generally, but the connection to China and illegal smuggling across the border — those two things have elevated the issue among Republicans,” stated Levin, chief coverage counsel for the Council on Criminal Justice, a nonpartisan suppose tank.

Still, he stated, it’s useful for lawmakers to reevaluate their previous positions on coverage primarily based on information and new information.

Fentanyl check strips are seen by drug coverage specialists as an essential software in stopping overdose deaths. Drug customers typically have no idea that the medication they are taking are laced with fentanyl.

The check strips permit customers to safely study whether or not the medication they have purchased comprise the damaging drug and head off a probably harmful overdose.

Drug coverage specialists say that offering the check strips to customers and giving them an opportunity to keep away from deadly overdoses opens the door to a continuum of care that would assist get folks off medication.

“If you’re out on the street and giving them care packages with Narcan and fentanyl testing strips, that’s an engagement with a health care worker that these people may not [otherwise] be getting,” Neill Harris stated.

In current years, states have moved toward legalizing fentanyl test strips, together with Republican-dominated ones like Wyoming, Nebraska, South Carolina, Alabama and Tennessee.

Some legislation enforcement teams, which have lengthy been resistant, are warming to the legalization of fentanyl check strips as a software within the battle towards opioid deaths.

Jennifer Szimanski, public affairs director for the Combined Law Enforcement Associations of Texas, stated her group is usually supportive of decriminalizing fentanyl check strips however would have to have a look at particular laws.

Others are nonetheless expressing some apprehension.

Kevin Lawrence, govt director of the Texas Municipal Police Association, stated his group remains to be contemplating the thought.

“Our concern is how widespread is it, what kind of controls will there be and what are the repercussions for abuses of this?” he stated.

Neill Harris stated the reticence towards legalizing check strips is analogous to opposition from legislation enforcement to a 2015 law that allowed folks aside from docs to have and deploy naloxone, an opioid-reversing drug. Opponents on the time argued that investing in elevated entry to naloxone may encourage drug use. That legislation additionally granted authorized immunity to an individual who tried to give the drug to somebody they believed to be affected by an opioid overdose.

Narcan is an intranasal type of that drug, and legislation enforcement officers at the moment are clamoring for the state to make it extra available to them. That’s after years of education from experts have taught police throughout the state how simple the drug is to use, how efficient it’s in saving lives and the legislation’s protections for first responders who use it to strive to reverse an overdose.

“We need to get Narcan in the hands of more police officers,” Szimanski stated. “We’ve had members reach out in the last few months if there’s any way CLEAT can provide Narcan because their administrations are not providing it.”

Another model of naloxone is cheaper, costing between $1 and $25 a unit — however that have to be injected, requiring extra coaching.

This yr, a federally funded state-run program out of the UT Health San Antonio School of Nursing that supplied free Narcan ran out of funds halfway through the year.

The program was additionally a sufferer of its personal success. So many teams had turn out to be depending on it without spending a dime Narcan that it couldn’t fulfill all of the requests it acquired. In 2023, this system, known as “More Narcan Please,” is limiting teams to 48 models per order and emphasizing the necessity to get the lifesaving drug instantly into the arms of these most affected.

Graziani with the Texas Harm Reduction Alliance stated she needs to see extra particulars about Abbott’s plan for making Narcan extra available. Some states have prioritized getting the drug within the arms of legislation enforcement, however some drug coverage specialists say it’s simpler to get Narcan within the arms of drug customers, their relations or harm-reduction teams that instantly work together with drug customers since these are the folks more than likely to have an interplay with an individual experiencing an overdose.

Graziani additionally stated she needs to know extra concerning the state’s plan to disperse the drug equitably to be certain that it will get to rural areas which have much less sources to purchase Narcan, and to hurt discount teams like hers which have direct contact with customers. Having Narcan in colleges and universities can also be an essential a part of the battle, she stated.

“We would love to see a plan in place that prioritizes community-based distributions,” she stated, including that naloxone wants to be “ubiquitous.”

Abbott can also be pushing for stiffer penalties for individuals who knowingly promote medication laced with fentanyl.

“I want it to be categorized as murder for someone to knowingly provide a fentanyl-laced pill to someone who ingests it and dies,” he stated earlier this yr.

Drug coverage specialists oppose such a transfer and say it’s a continuation of “war on drugs” methods that haven’t labored prior to now.

“Our drug supply is more deadly now than ever because we continue to double down on those prohibitionists or tough-on-crime policies, and we know that through research, increasing criminal penalties does nothing to decrease drug use,” Graziani stated.

Levin stated the coverage proposal is “well-intentioned” however has problematic unintended penalties.

“The biggest concern that I’ve seen with other states is that while it is intended to go after drug kingpins, most of the people who have been prosecuted have been family members or other people who were there at the time of the overdose,” he stated.

Studies have shown that with a rise in “drug-induced homicide” prosecutions in jurisdictions that go these legal guidelines, the speed of overdose deaths truly goes up. In an analysis in Wisconsin, 90% of the folks prosecuted on these fees had been mates, family or low-level drug sellers promoting to help their very own drug use. In one other in New Jersey, 25 of the 32 such prosecutions had been mates of the deceased who didn’t repeatedly promote medication.

Experts say lawmakers ought to as a substitute concentrate on policies pushed by public well being analysis. They say the hassle to decriminalize fentanyl check strips ought to increase past that drug to cowl different probably harmful substances. Drug traffickers are already utilizing different substances to improve the facility of avenue medication, and legalizing check strips just for fentanyl may go away customers prey to different medication.

“What I would like to see is the legalization of any drug-checking tools or technology that are used for reducing risk,” Neill Harris stated.

Experts are additionally pushing for different modifications, just like the legalization of syringe trade applications, which swap out used syringes for brand new ones to stop drug customers from contracting illnesses, and modifications to the state’s “overdose Good Samaritan” law, which protects from arrest or prosecution an individual who requires emergency assist — however has steep necessities for folks to obtain that safety.

The Good Samaritan legislation doesn’t defend individuals who have felony drug fees on their legal information or who’ve known as for emergency assist in the final 18 months. Both necessities would rule out a lot of drug customers or their households.

“We understand that regardless of someone’s history, they need to be able to call [for help],” Graziani stated. “It’s punishing the person who might die because someone around them has a [criminal] history.”

Abbott has not indicated help for both of these coverage concepts, which makes their passage by the Legislature much less seemingly.

But drug dependancy specialists say they will proceed to push for a extra holistic method to combating the nation’s opioid overdose epidemic in Texas.

“Narcan access and even fentanyl testing strips are steps in the right direction, but we’re going to need more than that to address this,” Neill Harris stated. “We sort of need everything. We need to throw the kitchen sink at this.”

Disclosure: CLEAT, Rice University, the Baker Institute for Public Policy and UT Health San Antonio have been monetary supporters of The Texas Tribune, a nonprofit, nonpartisan news group that’s funded partly by donations from members, foundations and company sponsors. Financial supporters play no position within the Tribune’s journalism. Find a whole list of them here.