Watch a Texas Tribune conversation about efforts to address fentanyl abuse in Texas

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The lethality of the fentanyl crisis has spurred a rare sense of bipartisanship in the Texas Capitol, but experts say the synthetic opioid might be unique in this regard.

State Reps. Tom Oliverson, R-Cypress, and James Talarico, D-Round Rock, have been working together these past couple of months to pass a bill that would decriminalize fentanyl test strips, which warn people if a drug they are about to take contains traces of the deadly synthetic opioid.

The House voted 143-2 to approve House Bill 362 by Oliverson. The bill will now head to the Senate and, if passed, would take fentanyl test strips off the state’s “drug paraphernalia” list, meaning it would no longer be a crime to carry them.

“I think what you see is there’s been a recognition nationwide, on both sides of the aisle recently, that this drug really is sort of the exception of exceptions,” Oliverson said Tuesday at a Texas Tribune event.

Talarico agreed with this premise.

“We can’t afford for this to be tainted by partisanship,” Talarico said. “And that goes both ways. Democrats, I think, have to be more willing to talk about these issues and to be more willing to come to the table with our Republican colleagues to find common ground.”

These comments were part of an hourlong panel discussion that featured Cate Graziani, executive director of the Texas Harm Reduction Alliance, along with Oliverson and Talarico. The “What Should Texas Be Doing About Fentanyl?” event was moderated by Tribune politics reporter James Barragán and was held at The Texas Tribune’s Studio 919 in downtown Austin. The discussion was centered around combating opioid overdose deaths, specifically fentanyl.

Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. Prescription fentanyl can be taken safely when prescribed by doctors. But a rise in its illicit use began during the COVID-19 pandemic and continues today.

“It’s an extremely hard drug to use and abuse because the amount that’s needed to produce a high, but not stop a person from breathing, is a fraction,” Oliverson told the audience. “It’s an incredibly dangerous narcotic that is essentially just doing what is in its nature to do.”

Makers of illegal drugs often use fentanyl as a booster for other drugs they are selling because it is cheap to make and makes drugs more addictive. Powdered fentanyl is commonly mixed with drugs such as heroin, cocaine and methamphetamine and made into counterfeit pills that resemble prescription drugs.

Just 2 milligrams of fentanyl can be a lethal dose depending on a person’s body size, tolerance and past usage, according to the U.S. Drug Enforcement Administration.

A majority of people who ingested a fatal dose of fentanyl had no idea the synthetic opioid had been laced into other drugs they were attempting to use.

Oliverson compared consuming an illegal pill in Texas right now to stepping on a trap door in an Indiana Jones film.

“The next thing that you step on could be the thing that just brings the roof down on your head, and you have no warning whatsoever,” he said.

Nationwide, the Centers for Disease Control and Prevention reported that more than 107,000 people died from drug overdoses in 2021. Synthetic opioids were responsible for 71,000 of those deaths, and they were largely caused by fentanyl.

In Texas, the CDC predicts that more than 5,000 people died of drug overdoses between July 2021 and July 2022. Overdose deaths involving fentanyl in the state more than quadrupled in two years, rising from 333 people dying in fiscal year 2019 to 1,662 deaths in fiscal year 2021.

The synthetic opioid has become a main talking point across the nation due to the number of school-aged children dying from overdoses after taking pills laced with fentanyl.

Gov. Greg Abbott, who previously opposed decriminalizing fentanyl test strips, came out in favor of the policy late last year.

Oliverson said Abbott led the way in changing the Republican party’s perspective on fentanyl testing strips. He said personal conversations with people at the Texas Pain Society changed his perspective on the issue. Oliverson is a board-certified anesthesiologist based in Cypress.

“I had friends, who are all chronic pain management physicians, saying we’re losing our patients to fentanyl, and they’re not getting it from us,” Oliverson said. “They’re going out on the street because they can’t get a prescription for OxyContin or for hydrocodone like they used to be able to.”

Eight bills calling for some sort of opioid emergency training for school personnel have been filed by Democrats: state. Sen. José Menéndez of San Antonio and state Reps. Philip Cortez of San Antonio, Bobby Guerra of Mission, Jolanda Jones of Houston, Erin Zwiener of Driftwood, Sheryl Cole of Austin; and Talarico.

These bills cover a wide range of topics regarding the use of overdose reversal medications, including allowing physicians to dispense such medication to schools without requiring identification of the user and setting training standards for school personnel.

Abbott announced last week a $10 million fentanyl awareness campaign titled “One Pill Kills” and a plan to distribute doses of Narcan, the overdose-reversing medication, to all 254 counties in the state.

“Believe me, I disagree with Gov. Abbott on many things, maybe most things, but the fact that we agree on this and it can save people’s lives means I, as a public servant, not as a Democrat, but as a public servant, I have a moral obligation to sit down at the table with him,” Talarico said.

These bills and policies have been heralded by some as a step forward, but drug policy experts say they don’t go far enough.

Graziani said the state’s “overdose Good Samaritan law,” which protects a person from arrest or prosecution if they call for emergency help, has received less support this year than in previous legislative sessions, but it would be a way to address the crisis.

The Good Samaritan law does not protect people who have felony drug charges on their criminal records or who have called for emergency help in the last 18 months. Both requirements would rule out a large number of drug users or their families, she said.

“So we’re actually moving backward in some areas, unfortunately, and those are the areas that would have the biggest impact on overdose deaths,” Graziani said. “It’s really hard to work in harm reduction because our state doesn’t support it and doesn’t invest in it and doesn’t authorize it, and we’re facing an uphill battle when it comes to overdose deaths because of that.”

Graziani said the state needs to move away from penalty enhancements and punitive strategies when it comes to drug addiction and move toward more public health approaches.

“There are lots of harm reduction tools that will help fight this overdose crisis and keep people alive, but a lot of it has been limited or restricted [and] underfunded, and many of our harm reduction experts are afraid to speak up right now because they don’t want to be in conflict with the state,” Graziani said.

Oliverson warned that fentanyl might be the exception when it comes to passing legislation on harm reduction policies.

“I don’t want to paint an overly rosy picture with respect to all types of harm reduction and all the different things that are out there,” Oliverson said. “I want to be clear that I think fentanyl itself is a fairly unique nexus for policymakers because of its potency, because of its narrow therapeutic index and because of the fact that the vast majority of people who are taking it don’t realize they’re taking it.

The full conversation is available to view on demand.

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