In order to address a surge in deaths tied to synthetic opioids, Texas must take a comprehensive approach that includes revamping state regulations related to pain management clinics and prescription monitoring, and expanding mental health treatment, Mesquite pain management specialist C.M. Schade, MD, told members of the Texas House of Representatives’ Committee on Public Health.
“The ‘opioid crisis’ is no longer just about curtailing perceived over-prescribing of opioids,” Dr. Schade testified on behalf of the Texas Medical Association and the Texas Pain Society. Instead, it is about finding ways to combat illicitly produced fentanyl and giving physicians more leeway to prescribe opioids for legitimate pain.
The 11-member committee met to address an interim charge by House Speaker Dade Phelan (R-Beaumont) to study fentanyl-related overdoses and deaths.
Opioid deaths in Texas continue to rise despite some of the strongest state and federal opioid regulations in recent history, Dr. Schade says. Those regulations have caused a sharp drop in prescriptions for opioid medications. But patients who cannot get legitimate pain relief medication from their physicians are now seeking relief by taking pills that look just like their pain medication but actually contain illegally manufactured fentanyl.
“These people are at risk for going to the street and buying some pain pills,” he said. “And they have the risk of dying.”
In 2018, Texas saw 210 deaths associated with fentanyl, but that rose to 1,612 by 2021, according to the Department of State Health Services. In 2021, fentanyl made up 97% of all synthetically produced opioids in the state, the agency says. Fentanyl can be 50 times stronger than heroin and 100 times stronger than morphine, according to the Centers for Disease Control and Prevention. It is often mixed with other drugs to make them more potent and more addictive.
TMA proposed several recommendations to address the current crisis, the most important of which is to establish a workgroup to revisit current state laws on the classification of pain management clinics and the inspection process they face, Dr. Schade said.
For instance, Occupations Code Section 168 was written more than a decade ago and was needed at the time because the state did not have a prescription monitoring program (PMP), Dr. Schade says.
Now, the PMP, which came online in 2020, allows physicians to check a patient's prescription history for indications of illicit activity, drug abuse, drug diversion, and doctor-shopping. With the PMP in place, many aspects of the old law simply discourage physicians from prescribing opioid medications, even when they are medically necessary, Dr. Schade says.
“What was done last decade no longer applies to this decade,” he said.
Continuing those protections requires funding physicians' use of the PMP, which was recently discontinued.
“It’s a very powerful tool, but it’s not free [to physicians],” Dr. Schade said. “So, we need to consider using the Opioid Abatement Fund, licensing fees, or other fees to fund this so it is readily accessible to all [health care professionals].”
In the same vein, TMA recommends that the state invest in effective data mining software to compare pharmacy purchases with pharmacy PMP sales to spot illegal prescribing and dispensing, Dr. Schade says.
TMA’s other recommendations are to:
- Improve education and prevention programs about opioids;
- Reduce the chance of overdoses by making the opioid antidote naloxone available over the counter and legalizing fentanyl test strips, which help identify the presence of fentanyl in medications;
- Use some of the $4 billion available to Texas through the American Rescue Plan to expand mental health and substance use disorder services;
- Improve data collection to identify at-risk populations; and
Create community-based syringe service programs, which in turn can connect people with addiction to the larger heath care system for services like treatment and vaccination for infectious diseases like hepatitis C.
TMA also urged lawmakers to look at opioid-related within a larger behavioral health strategy that may include collaboration with the U.S. Department of Health and Human Services, community-based agencies, and schools to implement a comprehensive plan in response to the June passage of the Bipartisan Safer Communities Act, which improves mental health funding.
Read the full testimony.