Harris County Project Attorney, Texas Criminal Justice Coalition
To access the full paper, download the PDF on the left-hand sidebar.
Since 1999, more than 350,000 people have died from an overdose involving an opioid, resulting in what has been called an epidemic and a crisis, and igniting demands for a comprehensive and well-funded government response. There continues to be significant disagreement about how to deal with the opioid epidemic, but the need for increased drug treatment is one point on which policy experts, public health officials, law enforcement groups, and politicians agree.
Calls for expanding drug treatment are based on data which suggest there are significant gaps in accessibility and affordability, especially for certain populations, such as people who are low income or live in rural areas. The National Survey on Drug Use and Health (NSDUH) finds that only about 10 percent of people who need treatment for a substance use disorder (SUD) actually receive it. This discouraging statistic indicates a general lack of access to drug treatment, but what is less clear is how availability varies depending on a person’s specific treatment needs, insurance coverage, income, or location. Gaps in care may be most visible in areas where treatment is least prevalent; in rural communities that have only a handful of providers it can be fairly simple to identify the very limited options available to residents. Large cities typically have more resources to meet a greater demand, but it can be difficult to identify the full extent of available services, and to connect people with the services best suited to treat their individual needs.
The ability to get people the treatment that will be most effective for them is further complicated by the fact that the drug treatment industry largely operates in a silo, separated from other medical care, and remains highly unregulated, making it difficult to track what options are available to different populations in different communities, and to identify providers that offer high quality care. Limitations on care imposed by insurance coverage or lack thereof add to the complexities of navigating the system.
Harris County, Texas, is home to Houston, the fourth largest city in the country and one of the most diverse. The drug overdose rate in Harris County was 11.4 per 100,000 people in 2016, above the statewide rate of 10.2, but significantly below the national average of 19.7, although it is likely that deaths from overdose are undercounted. Opioid use is a concern for the area, and law enforcement predict that overdose deaths from opioids may increase due to the increasing frequency with which counterfeit prescription pills containing the powerful synthetic opioid fentanyl are found on the streets. But law enforcement officials also report that cocaine and methamphetamine use are more problematic for Harris County, with meth rated as the greatest drug threat for the area. Forty-nine percent of all drugs identified and tested by the Houston Forensics Science Laboratory in fiscal year 2017 were cocaine or methamphetamine, compared to ten percent that were heroin or pharmaceuticals. While heroin and prescription opioids are implicated in more overdoses than methamphetamine or cocaine, deaths involving these drugs are also increasing, as is the tendency to find overdose deaths caused from the use of multiple drugs.
These data suggest that there are several drug trends in Harris County that require a response. At this time, the County does not appear to have the capacity to meet the drug treatment needs of its citizens. Notably, Harris County lacks reliable data on the quantity of drug treatment services currently available in the community. Data on the quality of existing services is also lacking, but the data that are available suggest there are several gaps in care, including availability of medication-assisted treatment, integration of drug treatment services with other critical service areas, and drug treatment services for people on Medicaid or without insurance.
This material may be quoted or reproduced without prior permission, provided appropriate credit is given to the author and Rice University’s Baker Institute for Public Policy. The views expressed herein are those of the individual author(s), and do not necessarily represent the views of Rice University’s Baker Institute for Public Policy.
