What does the typical drug dealer driving the most sweeping addiction crisis the country has seen in decades look like?
If you imagined Walter White, protagonist in AMC’s television show “Breaking Bad,” decked out in the pork pie hat and goatee of his alter ego, Heisenberg, you’d be wrong.
The people slinging gray-market opioids might look more like your grandmother, or the family physician, law enforcement and drug abuse experts say.
This is the state of the opioid trade in Galveston County.
“They don’t look like what you think of drug addicts,” Galveston Sheriff’s Office Lt. Shawn Lozica said. “It’s a lot of older people on limited incomes trying to supplement their income.”
While the opioid crisis has become a common talking point among politicians and others across the nation, local health experts for several years argued the situation wasn’t as dire in Galveston County. But that thinking is starting to change.
“The saying is that everything happens later in Texas,” said Richard Blondell, professor and vice chair of addiction medicine in the Department of Family Medicine at the University of Buffalo in New York.
“The opioid epidemic started in the Appalachian region and spread into the Northeast and the West Coast, and it’s worked its way farther south. It behaves like an infectious epidemic from a public health point of view.”
Drug overdose deaths from opioids in the United States have been on a dramatic rise since 1999. Opioids were involved in more than 47,600 overdose deaths in 2017 alone, about 67.8 percent of the country’s total 70,237 overdose deaths, according to the U.S. Centers for Disease Control and Prevention.
Opioids include heroin and prescription drugs such as oxycodone and fentanyl, among others.
Carisoprodol, more commonly known as Soma, is a muscle relaxer and is particularly popular among people addicted to opioids in Galveston County, Lozica said.
Soma, however, is not an opioid itself.
THE FOUR Ds
Years of overprescribing opioid medication has created a generation of addicts and contributed to the current national crisis, said Kathryn Cunningham, director of the University of Texas Medical Branch’s Center for Addiction Research.
“There was a flood of opioid prescriptions,” Cunningham said.
Drug companies marketed opioids without emphasizing their addictive qualities, but physicians also overprescribed them and pharmacies often filled prescriptions without question, Blondell said.
Generally speaking, there are four Ds to overprescribing doctors today — dated, duped, disabled and dishonest, Blondell said.
Some doctors haven’t kept up with the problems related to opioids and continue to prescribe them; others fall for patients who falsely describe different sorts of pain; some doctors take the drugs themselves and get caught up in the life; and some doctors conspire with patients and turn opioid prescriptions into a lucrative business, Blondell said.
“Elderly people often flew under the radar,” Blondell said. “They would get prescribed opioids for chronic pain, which they often have, and then slowly develop an addiction.
“But no one recognizes it because they’re old people. They aren’t out stealing car radios and partying — they don’t fit that image of a drug addict — and so people miss it.”
Experts for years have pointed to the fact that Texas’ opioid overdose rate is far below the national average, 5.1 deaths per 100,000 people compared with 14.6 deaths per 100,000 people in 2017, according to the National Institute on Drug Abuse’s March report.
But while the state’s numbers lag behind the rest of the country, the sheer number of deaths related to opioids has increased significantly since 1999, from about 291 to 1,174 in 2015, according to a Texas Health and Human Services report.
Galveston County also has a higher rate of opioid prescriptions per 100,000 population than the rest of Texas, said Mukaila Raji, chief of Geriatric Medicine at the medical branch, in a previous interview with The Daily News.
Texas’ opioid prescription rate is about 57.6 per 100,000 population, which is lower than the national average of about 81 per 100,000 population, Raji said.
But in Galveston County, the rate is about 75 prescriptions per 100,000 population, Raji said.
About 20 Galveston County deaths in 2015 were opiate-related, and in 2017 county poison centers said they had 48 cases of opioid exposure, Cunningham said.
But, for all of the upward trends locally, there’s still much experts don’t know, Cunningham said.
“Is there really that much of an increase?” Cunningham said. “People are more aware now. Are you really busting people more, or do you just think you’re seeing it more?”
District Attorney Jack Roady in 2017 said the county’s criminal justice system sees their effects almost daily.
Addiction to opioids such as oxycodone often is a cause in cases of children entering into the state’s child services system, Roady said. Parents become addicted to prescription opioids and stop caring for their children, Roady said.
Researchers at the University of Texas Medical Branch found that cancer survivors were more likely to use opioids long after their diagnosis than they were before, according to an article in The Journal of the American Geriatrics Society.
Local law enforcement officers encounter many different cases of opioid-related crimes, but many of them are hard to prove because the perpetrators all have prescriptions for the drugs, Lozica said.
“You might find 1,000 pills, but they have a prescription for them,” Lozica said.
For addicts and even addicts’ relatives, buying and selling opioids often can turn into a lucrative business, Blondell said.
“Older people will swap drugs with one another,” Blondell said. “Or, sometimes, they’ll ask the doctor for more painkillers than they need, with the idea that they’ll sell some excess to their friends and that will help out paying the rent, medical bills or whatever else.”
Sometimes, people will even turn drugs over to their grandchildren to sell at school, Blondell said.
Deputies recently seized a Soma shipment from India of about 2,000 pills, which might sell for about $6,000, Lozica said. No one was ultimately arrested in that seizure.
To battle the crisis, the U.S. Food and Drug Administration in 2018 ruled that opioid prescriptions should be valid for only three to seven days, Cunningham said.
The hope is that the new limit might decrease the number of cases around the county and country, Cunningham said.
“It’s making primary care physicians skeptical about their ability to identify when a patient requires opioids and not some other kind of drug,” she said.
But that’s only part of the solution. Galveston County officials regularly hold drug take-back weekends to cut down on excess pills and doctors are beginning to pay more attention to who is taking what, Cunningham said.
However, there’s still much work to be done, she said. Texas ranks dead last among the 48 contiguous states in the number of treatment centers, according to an article by James Langabeer and several other doctors in the American Society of Addiction Medicine’s journal.
“I think we should have a national monument remembering the people who died because of the opioid epidemic and getting the word out there,” Cunningham said. “Hopefully, we can come up with a way to stop it.”