Drug Crisis: What is the Texas State Doing to Control the Epidemic?

Pre-Conditions for the Growth of Addiction

Drug use and addiction remain widespread in the United States, with tens of millions of Americans reporting recent illegal drug use and more than 76,000 drug overdose deaths nationally in recent annual totals during the mid‑2020s, driven largely by synthetic opioids such as fentanyl.

In Texas, drug‑related fatalities rose through 2022–2023 then declined in 2024, but still remain above pre‑pandemic levels, and fentanyl has been a principal driver of U.S. overdose mortality even though a smaller share of Texas overdoses involve fentanyl compared with the national average.

The crisis grew from multiple, interacting causes: overprescribing of opioid pain medications in earlier decades created wide exposure to opioids; illicit markets later supplied heroin and much more potent synthetic opioids (fentanyl and nitazenes), increasing overdose risk.

Social and structural drivers — including economic dislocation, untreated substance use disorder (SUD), inadequate access to treatment and harm‑reduction services, and the rapid spread of potent clandestine synthetic opioids through illicit supply chains — amplified misuse and fatal overdoses across many communities.

Social and Economic Impacts

Opioid, marijuana, and broader drug addiction impose substantial burdens on the healthcare system: emergency departments and ambulance services face increases in overdoses and nonfatal events, hospitals provide repeated acute care for overdose reversal and complications, and long‑term treatment demand for substance use disorder outstrips available capacity in many regions, increasing costs and wait times for care.

On public safety and productivity, drug addiction influences crime patterns (drug trafficking, property crime linked to substance use) and strains law enforcement resources while employers and workplaces suffer absenteeism, decreased productivity, and higher insurance and disability costs; communities also bear intangible social costs such as family disruption and increased foster‑care placements where parental substance use is involved.

Federal Countermeasures

The following five federal actions are recent, concrete, and high‑impact measures used to reduce opioid and related drug harms across the United States.

• Expanded Funding for Treatment and Recovery Services (American Rescue Plan & subsequent appropriations)The federal government has provided large, targeted funding streams to expand access to evidence‑based treatment for opioid use disorder (OUD), including medication‑assisted treatment (MAT) and recovery support services; these funds target states, tribes, and community providers to increase treatment capacity and workforce.

  By directing billions toward treatment expansion and recovery supports, the initiative aims to reduce unmet treatment need and lower overdose risk by making effective therapies (buprenorphine, methadone, naltrexone) more available in primary care, correctional settings, and community programs.

• Federal Distribution and Support for Naloxone (Narcan) Access Laws and PurchasesFederal and state actions have expanded legal access to naloxone and funded large purchases and distribution programs so that first responders, community organizations, and sometimes the public can obtain naloxone to reverse opioid overdoses.

  Research and state experience indicate naloxone access laws and distribution are associated with measurable declines in opioid mortality; federal support also supplies corrections and EMS with naloxone and funds training for use, directly reducing deaths in the short term.

• Allocation of Opioid Settlement Funds and Creation of State Abatement ProgramsFollowing multi‑state litigation against manufacturers and distributors, federal and state settlement dollars have been directed to abatement funds that finance prevention, treatment, harm reduction, and recovery services; states (including Texas) have created councils or funds to allocate these resources over multi‑year schedules.

  These settlements provide sustained, dedicated funding for evidence‑based programs and infrastructure improvements such as treatment capacity building, public education, and surveillance — enabling long‑term planning beyond annual appropriations.

• Enhanced Federal Surveillance, Forensic, and Threat Assessment (DEA & CDC partnerships)Federal agencies (DEA, CDC, and NIDA) have enhanced drug‑supply monitoring, forensic testing, and national threat assessments to detect emerging synthetic opioids and novel compounds rapidly and to share real‑time intel with states and localities.

  Better surveillance enables targeted interdiction, public‑health warnings about contaminated supplies (e.g., fake pills containing fentanyl or nitazenes), and quicker deployment of harm‑reduction responses where new toxic substances appear in local markets.

• Investment in Harm Reduction and Community Programs (grants for syringe services, harm‑reduction, and prevention)Federal grant programs have funded harm‑reduction services such as syringe‑service programs, community distribution of fentanyl test strips, and public‑education campaigns to reduce risky use and avert overdoses, targeting high‑need jurisdictions and marginalized populations.

  By reducing infectious disease transmission, providing linkage to treatment, and offering tools to detect fentanyl contamination, these programs lower both short‑term mortality and long‑term health harms while creating bridges into treatment and recovery supports.

Texas Case – The Numbers Speak for Themselves

Texas experienced rising drug‑related mortality through 2022–2023 with a decline in 2024, yet overall drug deaths remain above pre‑pandemic levels and the state continues to face significant opioid and stimulant threats, including https://www.methadone.org/drugs/texas-drug-alcohol-statistics/ fentanyl‑involved deaths and emerging nitazene detections in some metro areas.

From 1999–2023 Texas averaged roughly 11 overdose deaths per 100,000 population (with a peak near 19 per 100,000 in 2022), a lower rate than many states but with recent increases prompting expanded state responses and investments in abatement funds and harm reduction.

Mortality: Recent statewide counts vary by year and locality, but Texas authorities and analyses report hundreds to thousands of county‑level overdose deaths annually; for policy and program planning Texas uses both state vital statistics and regional HIDTA reporting to quantify fatal and nonfatal overdoses.

State programs

• Opioid Abatement Fund and Council (Texas)The Opioid Abatement Fund Council, created to allocate approximately $1.6 billion in opioid settlement proceeds over an 18‑year period, directs funds to prevention, treatment, recovery, and enforcement activities across Texas; the Council sets priorities and awards grants to programs that expand treatment access and harm‑reduction services.

  It operates by soliciting proposals from regional providers and public agencies and funds initiatives intended to reduce overdose deaths and increase treatment capacity throughout the state.

  Early allocations have supported community treatment expansion, naloxone distribution, and prevention education with the aim of producing measurable reductions in overdose morbidity and mortality over time.

• Texas Overdose Data to Action (OD2A) and Surveillance EnhancementsTexas participates in CDC‑funded OD2A efforts and state surveillance dashboards to improve real‑time overdose data, identify hotspots, and guide rapid public health responses; the program emphasizes linking overdose survivors to treatment and tracking trends like fentanyl and nitazenes.

  By improving data flows between hospitals, public health, and public safety, OD2A enables quicker deployment of outreach, naloxone distribution, and targeted education campaigns in affected communities.

  Expanded surveillance has allowed Texas agencies to detect emerging drug threats earlier and tailor interventions where they will have the greatest impact.

• Hospital‑based Outreach and Peer Navigation InitiativesSeveral Texas jurisdictions have implemented hospital emergency department (ED) response teams and peer‑navigator programs that engage overdose survivors in the ED, provide immediate linkage to medication‑assisted treatment, and connect patients to recovery supports.

  These programs target high‑risk individuals at a critical intervention point and have been associated locally with increased treatment uptake and fewer repeat overdoses when combined with follow‑up care.

  Local HIDTA and county efforts emphasize peer navigators, ED initiation of buprenorphine, and warm handoffs to community providers as scalable tactics to reduce mortality.

Approaches in Neighboring Regions

• OklahomaOklahoma has implemented aggressive treatment expansion and integrated criminal‑justice diversion programs that emphasize rapid access to medication‑assisted treatment for individuals arrested for drug offenses, reducing barriers to care and lowering recidivism; these programs link people to community providers and provide case management to sustain engagement in recovery services.

  State grants and federal funds are used to increase treatment beds and outpatient programs, while harm‑reduction pilots have been used in urban areas to reach high‑risk populations.

  Oklahoma’s strategy highlights rapid treatment starts, close partnerships between public safety and public health, and targeted funding toward rural treatment deserts.

• LouisianaLouisiana has focused on expanding naloxone distribution statewide, improving overdose surveillance, and investing settlement funds into community‑based treatment and recovery housing to reach populations with high overdose rates.

  Programs emphasize outreach to vulnerable communities and coordination between Medicaid, behavioral‑health providers, and harm‑reduction services to reduce barriers to MAT.

  The state also prioritizes training first responders and community groups in naloxone use and post‑overdose linkage to care.

• New MexicoNew Mexico has emphasized broad access to medication treatment (including mobile and telehealth MAT), harm‑reduction services, and use of statewide data to prioritize interventions in rural and tribal areas where overdose risk is high.

  The state’s strategy includes funding for syringe exchanges, fentanyl‑testing access, and investment in culturally competent programs for Native American communities.

  New Mexico’s approach pairs expanded access to evidence‑based treatment with community engagement and surveillance to rapidly detect and respond to changing drug threats.

Is It Possible to Stop the Crisis? Looking to the Future

Approaches with strong potential for effectiveness:

• Investment in evidence‑based treatment and workforce expansionScaling access to medication for opioid use disorder (buprenorphine, methadone, naltrexone) and expanding trained providers reduces overdose risk and improves long‑term recovery outcomes by treating the medical condition of addiction rather than relying on punitive measures alone.
• Early intervention and school‑based preventionPrograms that teach substance‑use literacy, build social resilience, and provide early screening in schools and primary care can lower initiation and progression to disorder when combined with family supports.
• Interagency cooperation and data sharingReal‑time surveillance linking public health, healthcare, and law enforcement (e.g., overdose mapping, wastewater analysis) enables rapid responses to emerging drug threats and efficient allocation of resources.
• Harm reduction and low‑barrier servicesNaloxone distribution, fentanyl‑testing access, syringe‑service programs, and mobile outreach reduce mortality and infectious disease transmission while creating pathways into treatment for people otherwise disconnected from care.
• Long‑term recovery supports and social servicesEmployment programs, stable housing, and sustained case management reduce relapse risk and address social determinants that drive substance use and poor recovery outcomes.

Approaches likely to be ineffective or harmful when used alone:

• Repressive measures without treatment (arrest/incarceration alone)Criminalization without linkage to evidence‑based treatment typically fails to reduce overdose deaths, disrupts continuity of care, and can increase risk after release due to reduced tolerance and lack of aftercare.
• Isolation of patients from community supportsDetaching individuals from peer support, family, and community services undermines long‑term recovery; social reintegration and aftercare are essential components of effective treatment.
• One‑off short‑term programs without sustained fundingPrograms that lack long‑term financing and data‑driven evaluation cannot maintain gains; sustained investment is required to build capacity and measure outcomes over years rather than months.

Conclusions and Recommendations

Addressing the drug crisis is a public‑health responsibility that requires reliable data, open dialogue among stakeholders, and sustained long‑term support for people with substance use disorders; while each state must tailor strategies to local conditions, successful approaches consistently combine evidence‑based treatment, harm‑reduction services, surveillance, and social supports to reduce deaths and restore lives.