Deaths from drug overdoses in Texas have nearly tripled over the last 18 years, according to new federal statistics that highlight the country’s growing opioid crisis.

The Lone Star State’s increase — up to 2,979 last year from 1,087 — reflects a significant spike in fatalities from all types of drugs, according to the estimates by the Centers for Disease Control and Prevention. While cocaine and meth are the leading causes of overdose deaths in Texas, synthetic opioids are the newest growing threat here.

“Those numbers are striking,” said Joy Schmitz, an addiction specialist with UTHealth in Houston. “We’re all pretty well aware of the size of the epidemic, but the way that’s been put out there is eye opening. Maybe that’s what it takes to bring awareness so change can be made.”

Reported overdose deaths in 2016 tracked 584 to cocaine, nearly double the number in 1999; 577 to meth, up from just 15; and 530 to heroin, up from 107. Pain pills, such as Oxycontin and Vicadin, accounted for 501 deaths, up from 108; and synthetic opioids, such as fentanyl, were responsible for 250 deaths, an increase from 49 in 1999, according to CDC numbers.

The CDC’s new 2017 estimate show that drug overdoses killed nearly 72,000 Americans last year, more than peak yearly totals from guns, car crashes or HIV. The record number, a 9.5 percent hike over 2016, comes nearly a year after President Donald Trump declared the opioid crisis a national public health emergency.

The same five states continued to show the highest death rates — West Virginia, Washington, Pennsylvania, Ohio and Maryland— though the numbers have started to fall in parts of New England and other areas where the crisis was historically bad. Unlike Texas, those states’ numbers were largely dominated by opioids.

This state has never been considered a hotbed of opioid abuse, but the recent appearance of fentanyl in the drug supply is changing the landscape. Available for cheap thanks to internet ordering, fentanyl is often mixed with other drugs, which can take even experienced drug users by surprise. Fentanyl by itself is some 50 times more potent than heroin.

Now that it’s more plentiful in Texas, officials fear fentanyl and fentanyl combinations will explode in popularity.

“The acceleration of it is really frightening,” said Peter Stout, CEO of the Houston Forensic Science Center. “It’s as if we’re just at the start of that exponential curve.”

Lisa Ramirez, opioid response project director for the Texas Health and Human Services Commissioners, said the rise in drug-related deaths can be attributed to “the availability of more potent opioid and stimulant drugs” and said the state agency is “taking a closer at the CDC data to fully understand the different factors that may be unique to Texas.”

The agency, which is responsible for oversight of substance abuse issues, has initiated a number of programs in response to the overdose crisis, tapping new grant money aimed at the opioid epidemic. The responses include opioid prevention activities, the creation of a mobile crisis outreach team and expanded treatment and recovery support programs.

In another response, the Texas Hospital Association issued guidelines this year urging emergency departments to consult the state prescription monitoring program before writing opioid prescriptions; to only prescribe short-acting opioids for the shortest duration possible to patients being discharged; and to institute a system in which the patient’s primary-care or primary opioid prescriber is notified of the visit and prescription.

Sara Gonzalez, THA’s vice president of advocacy and public policy, said the association is hopeful the guidelines are beneficial because they were modeled on a program in Massachusetts, where numbers declined in the CDC’s latest estimates.

Heroin never exerted a stranglehold on Texas because the supply here, brought in by Mexican cartels, is a black tar form that’s expensive, weaker and doesn’t mix easily with fentanyl. In the parts of the U.S. hit harder by the opioid epidemic, the markets are flooded with Afghani heroin, which is stronger, cheaper and easier to mix.

“Heroin is 10 times the price of meth in the Southwest,” said Houston police Lt. Stephen Casko. “People may want heroin, but when it’s 10 times as much, they just don’t get started on it.”

Still, the Houston area is one of Texas’ centers of heroin overdose deaths. According to the Harris County medical examiner’s office, such deaths increased to 149 in 2017 from 79 to 2015.

Fentanyl deaths are also spiking. In 2012, just nine people in Harris County died of fentanyl overdoses, according to the medical examiner. That number escalated to 56 in 2017.

The drug, typically ordered from China by dealers, is often mixed with meth or cocaine or counterfeit pharmaceuticals, a particular danger in a city known for its pill mills.

Meth’s explosion has been well documented. It first appeared in large numbers in Texas and the Southwest and rural America in the early 2000s, produced in domestic labs like those depicted in the popular television show “Breaking Bad.” The problem seemed fixed a decade later after legislation cracked down on the easy drug-story availability of pseudoephedrine, the cold and allergy decongestant used to make it.

But meth roared back this decade. Mexican drug cartels’ super labs stepped up to fill the vacuum, producing a new version, more intoxicating and addicting, that by 2015 accounted for more than 95 percent of meth tested in forensic labs in the U.S.

In addition to the 577 meth deaths in 2016, 8,238 meth users were taken to Texas health department-funded substance abuse treatment centers, and Texas poison centers received 320 calls for help for meth patients.

The increase in cocaine-related overdose deaths was more of a surprise given the drug’s heyday was the 1980s and 1990s, but University of Texas drug expert Jane Maxwell said it’s likely to continue rising as the peace in Colombia has facilitated the planting of more crops.

“We’re really expecting cocaine to hit us because of the amounts that are being harvested,” she said.

todd.ackerman@chron.com

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