Texas doles out fewer opioids than most states, but addiction crisis remains

A new CDC report shows opioid prescription rates have fallen since 2010 in Texas and across the country. A new CDC report shows opioid prescription rates have fallen since 2010 in Texas and across the country. Photo: Toby Talbot, STF Photo: Toby Talbot, STF Image 1 of / 1 Caption Close Texas doles out fewer opioids than most states, but addiction crisis remains 1 / 1 Back to Gallery

Opioid prescription rates peaked in 2010 and have fallen steadily since then, a good sign in the public campaign to combat the addiction crisis sweeping the nation.

That was the big headline from a new analysis released Thursday by the Centers for Disease Control and Prevention.

Buried deep in the report, though, was a detail that may surprise Texans who have grown used to reading about the state's various public health shortcomings: Texas doctors, according to the CDC, hand out far fewer addictive painkillers than most other states. In parts of the Midwest, the Florida Gulf Coast, Appalachia and even the Pacific Northwest, per-capita opioid prescription rates are more than double the rate recorded in Texas.

Morphine milligram equivalents of opioids prescribed per capita in...

That news comes a month after the CDC released another report that found Texas recorded fewer opioid-related hospitalizations than nearly any other state.

So, what's with the disparity?

"As with much of the variation across states, we aren't sure," said CDC spokeswoman Courtney Lenard. "Texas has had lower opioid prescribing than most of the U.S. for many years. It also has had lower drug overdose death rates than most states. One factor might be that, prior to widespread use of electronic prescribing, Texas was one of only a few states requiring use of serialized prescription forms for Schedule II drugs."

For a better understanding of what's happening here, the Chronicle reached out to Dr. Asim Shah, the vice chair for community psychiatry at Baylor College of Medicine. As the chief of psychiatry at Ben Taub Hospital and the director of community behavioral health for Harris Health System, he oversees the county's largest outpatient mental health provider and is on the front line of treating the opioid epidemic in Houston.

As usual, Shah said, the data tells only part of the story. (For example, would you believe poor access to health care in Texas might be one factor keeping people from getting their hands on dangerously addictive opioids?)

Below is a transcript of our chat, lightly edited for length:

Dr. Asim A Shah, vice chair for community psychiatry at Baylor...

Hixenbaugh: Why are fewer opioids prescribed in Texas compared to, say, Appalachia?

Shah: There are a couple theories to explain that. First, when you look at the general map of the country, more of the opioid crisis is seen in the northeast, in an area where demographically you see a whiter population. Why is that? Traditionally, for whatever reason, the opioid crisis has not affected the Hispanic populations as much. (The CDC estimates whites are four times more likely to die from a drug overdose compared to Hispanics, and although it's not clear why, experts have some theories.)

In addition, the climate is a possible factor, believe it or not. Arthritis is a much bigger problem in colder places, so it may be that weather has a role to play in the disparity. Texas is hot, and hot weather does not cause that particular pain syndrome, which is a major driver in opioid prescriptions.

H: Does Texas' high uninsured rate play a factor here?

S: Right. Texas has one of the highest rates of uninsured people. It's practically impossible to get on Medicaid in Texas unless you make less than $5,000 a year or if you are pregnant or are on dialysis or something. So, there's a certain percentage of the population that doesn't have access to the doctor.

The problem is, people who are on pain medications or who are addicted, they somehow come up with the cash, just like people who are addicted to cocaine somehow find money to buy cocaine. So, just because it's not being prescribed doesn't mean people are not using it.

H: Reading these CDC reports gives the impression that the opioid epidemic is not as significant in Texas. Is that accurate?

S: No, I think if you read the latest report, they say the opioid crisis is still there everywhere. It's way more than in the 1990s, but it has dipped a little bit in the last few years between 2010 and now. And it is less in Texas as compared to Ohio and those areas.

Part of the reason it has dipped is we have made it more difficult to get prescriptions of the most common pain medicine, which is Vicodin (aka Hydrocodone). In the past, it was easy for doctors to call in Vicodin to a pharmacy, which didn't leave a paper trail. Now they cannot. Now they have to have a triplicate prescription for Vicodin, and that has contributed to this reduction.

H: Last month, CDC released another report that showed opioid-related hospitalizations were lower in Texas than almost any other state. Did that surprise you?

S: Well, that sounds like good news, but one big reason for that is there are not a lot of facilities to treat addiction in Texas, so these patients aren't being hospitalized. It's not that they don't need hospitalization, but we in Texas don't have any place to hospitalize them. That is not a blessing. Instead we deal with them in a non-hospital setting or in an outpatient setting.

H: Based on what you see in your clinic every day, is the opioid epidemic just as bad in Texas as in the Midwest or other parts of the country?

S: It is not as bad here, but it is still a problem. The numbers are way higher in the northeast than in Texas. It doesn't mean we don't have a major problem. We do see it every day.

Several things have been done to address the problem in recent years. There's been so much publicity of this crisis, including celebrity deaths, that doctors are now very aware that these are serious prescriptions. The other thing, in Houston in particular, has been the DEA going after the pill mills that pushed these prescription drugs into the community. And as I mentioned, now you have to write an actual prescription, instead of just calling in. There are more checks and balances today than a few years ago.

All of these things combined have had a positive impact, but it's still a very difficult situation.

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Mike Hixenbaugh writes about health care and medicine for the Chronicle. Follow him on Twitter and Facebook. Send him tips at mike.hixenbaugh@chron.com.