Texas is grappling with a worsening opioid crisis, as drug poisoning deaths have surged by more than 75% over the past five years. In 2021, the state recorded 5,489 drug overdose deaths, with an age-adjusted death rate of 18.2 per 100,000 residents. Nationally, over 75% of the 107,000 drug overdose deaths that year involved an opioid, according to the Centers for Disease Control and Prevention. In Austin, fatal opioid overdoses soared by 138% between 2020 and 2022, while fentanyl-related deaths skyrocketed by 600% in the same period. State-wide, synthetic opioids like fentanyl have been a growing driver of overdose deaths since at least 2016.

Texas’ position as a major transit hub exacerbates the crisis. With 17 border crossings, the state is a key entry point for drug trafficking organisations. South Texas, in particular, reports the largest cocaine and heroin seizures along the US-Mexico border, according to the Drug Enforcement Administration. This accessibility fuels the availability of illicit substances, compounding the state’s addiction challenges.

Texas has taken significant steps to address the crisis:

• The state secured $300 million from CVS and $340 million from Walgreens in opioid settlements, with funds allocated for remediation and abatement efforts.
• Walgreens also agreed to a federal settlement of up to $350 million for failing to prevent the diversion and misuse of prescription opioids, prioritising prescription volume and profits over patient safety.
• These agreements are part of broader national settlements, with CVS and Walgreens committing to pay $17.3 billion over 15 years to address their roles in the opioid epidemic.

Despite these financial commitments, access to treatment remains a critical issue. In Austin, 1,014 fatal drug overdoses were recorded between 2020 and 2022, with opioid-related deaths accounting for more than half. State-wide, the rate of opioid polysubstance overdose deaths nearly doubled from 2011 to 2019, while deaths involving synthetic opioids and cocaine tripled from 2016 to 2019. Most fatal overdoses occur among individuals aged 18 to 44, with males comprising the majority, though female overdose rates have also risen in recent years.

Dr Brooke Keels, chief clinical officer at Lighthouse Recovery in Dallas, highlights the complex factors driving addiction. “The brain responds to both environmental and chemical triggers. Our border location creates a perfect storm where availability meets vulnerability. So people struggling with trauma, depression and anxiety find easy access to substances that temporarily relieve their psychological distress,” explains Dr. Keels. “The increased funding in Texas represents recognition that addiction is both a public safety and public health issue.”

Dr Keels also emphasises the value of prescription drug monitoring programs (PDMPs), which have proven effective in reducing inappropriate prescribing and preventing medication diversion. These programs are a cornerstone of Texas’ efforts to curb the misuse of prescription opioids.

Lighthouse Recovery, founded in 2016 in Dallas, is a leading addiction treatment centre offering holistic, evidence-based care. The centre provides personalised, community-oriented programmes and has supported hundreds of families, earning national recognition for its effective aftercare treatment.