Travis County Declares an Opioid Crisis

A harm reduction package including Narcan (Photo by Lina Fisher)

After years of organizing by Texas Harm Reduction Alli­ance, including an emotional town hall at the beginning of May, the Travis County Commissioners Court unanimously declared the opioid overdose epidemic a public health crisis on May 24. Overdose is now the leading cause of accidental death in the county, and since 2020, fentanyl-related overdoses have almost tripled. The crisis resolution dedicates $350,000 to harm reduction organizations for supplies and outreach staff positions, looks into expanding access to overdose-reversal drug naloxone throughout the county, increases safe syringe disposal systems, and creates monthly check-in meetings for the next six months between directly impacted community members, outreach workers, and county Health and Human Services staff to report progress to the court.

The resolution builds upon prior investments to address the crisis in 2021, including $100,000 to Central Health-contracted providers of methadone treatment (which reduces opioid craving and withdrawal) and $150,000 to Integral Care's Medication Assisted Therapy program, as well as funds from the $100 million in American Rescue Plan dollars earmarked by the county for housing and services to help people exit homelessness. The new $350,000 will likely be offset by an influx of funds from the state of Texas' $1.9 billion settlements with opioid makers; it's intended to go directly to community organizations such as THRA. The county's HHS staff will work with Health Authority Dr. Desmar Walkes to authorize funds for broader naloxone distribution, and commissioners have asked for a report by Oct. 15 with an "asset map" of existing services and resources – though that date could change, as it comes two weeks after the fiscal year 2023 budget is approved.

In addition to the county's resolution, Integral Care made a presentation outlining plans to expand access to methadone, an opioid dependence treatment. Central Health has been providing buprenorphine/naloxone (Suboxone) for use in the MAT program, but in response to advocates' calls for expanded methadone access specifically, Integral Care plans to open new access points sometime this summer. IC's rep said they are in talks with two providers at four sites across the county, but that "going live" with services will likely not happen until after the summer. In the meantime, patients can call 512/472-HELP (4357), IC's 24/7 help line.

THRA and other advocates celebrated the crisis declaration: "As overdose deaths continue to surge, we need to meet this crisis by putting resources into communities most at risk. That's exactly what this declaration does," said THRA's Paulette Soltani. But as the directives are implemented over the next six months, questions remain. Com­mis­sioner Brigid Shea pointed out that the county is short-staffed and may not be able to carry out the resolution's directives with the urgency required. "It won't be as quick as you want it," warned Pilar Sanchez, the county executive over HHS; she requested a new special project staff position from the commissioners, as her department doesn't have a dedicated position for substance use disorder response.

How the $350,000 will be divided up is yet to be delineated. Alongside prioritizing urgent Narcan distribution, advocates asked for funding to increase staff at The Other Ones Foundation and Sunrise Homeless Navigation Center, who have existing relationships with directly affected populations. Many speakers who addressed the court drove home the same message: Harm reduction is about providing medication and supplies, but also about reducing stigma against drug users and building trust – mandates that THRA and other organizations on the ground have been following for years. As David Johnson of Grassroots Leadership put it, "Leave it to the people who are doing the work."