Travis County has the highest rate of fentanyl overdoses in Texas

Why it matters: The federal Drug Enforcement Administration has dubbed fentanyl the "single deadliest drug threat our nation has ever encountered," and Texas is no exception.

• Fentanyl overdoses are among the leading causes of death for Americans aged 18-45, experts say.

By the numbers: Nearly 2,400 Texans died of synthetic opioid-related overdoses in March 2023 — a roughly 26% increase from March 2022, according to the latest available CDC data.

• In the first half of 2022, opioid overdoses killed almost 200 Travis County residents, more than twice the number who died from suicide and car wrecks combined, according to county data.

What they're saying: Austin Public Health medical director and health authority Desmar Walkes told Axios it's difficult to say exactly why Travis' rate is higher.

• But it's clear, she said, overdoses are the result of increased demand, which in turn prompted an increased supply of drugs laced with fentanyl.
• Regardless, "whether you're looking at one county or the entire state of Texas, this is a problem that is escalating here," she said.

What's happening: Gov. Greg Abbott has made confronting the crisis a priority and this year signed laws to up penalties for crimes related to fentanyl, increase distribution of overdose prevention treatments like naloxone, and require public schools to teach drug poisoning awareness.

• He dedicated $10 million in federal dollars and opioid settlement funds toward a "One Pill Kills" awareness campaign and a new state dashboard.
• Since the 2021 launch of border security initiative Operation Lone Star, Texas law enforcement has seized over 426 million lethal doses of fentanyl, enough to kill every American, Andrew Mahaleris, spokesman for Abbott, told Axios.

Of note: Austin ISD last year distributed naloxone to school nurses.

Meanwhile, at the federal level, Sen. John Cornyn (R-TX) introduced bipartisan legislation to expand access to fentanyl test strips, but state laws generally stand in the way, Baker Institute drug policy expert Katharine Neill Harris told Axios.

• Texas efforts to decriminalize test strips stalled in the Republican-controlled Legislature this year, despite support from Abbott.

Yes, but: Experts tell Axios that targeting one drug doesn't address the root of the problem.

• Xylazine, for example, is a non-opioid sedative threat emerging in other states that Texas experts are watching warily.
• "As long as there's a demand and as long as we have people that need help with addiction, we will be confronted with trying to stem the supply so we can keep people from dying," Walkes told Axios.

Reality check: "The biggest fight that we're up against, from policy to communities across the board, is stigma," said Ariel Britt, associate director of policy and community impact at the Addiction Research Institute (ARI) at the University of Texas. She is in recovery herself.

• Stigma about substance use disorder affects whether people can access buprenorphine and methadone, regulated opioids that can help prevent withdrawal symptoms and reduce opioid use, Neill Harris said.
• There is a shortage of pharmacies willing to dispense those drugs and offer clean syringe services because of that stigma against a "certain clientele," she said.

Between the lines: Britt said stigma undermines data collection, too. Some people, for example, don't feel comfortable reporting overdoses.

• Plus, data remains decentralized between law enforcement, health care providers and medical examiners.
• "Most good data is a year old," she said, which undermines real-time strategies and justification of funding.
• ARI is working on that with its TXCope database, as is Austin Public Health through its own awareness coalition.

What we're watching: The fentanyl crisis reflects the "beginning of a new era in the unregulated drug market" where more synthetic substances are being used to cut drug costs and increase suppliers' profits, Neill Harris said.

• Fentanyl is "the first of these synthetic opioids. I don't know that it's going to be the last."