In near-apocalyptic terms, U.S. Sen. John Cornyn described the rising tide of American opioid abuse at a Senate Judiciary Committee hearing earlier this year.
“Opioid prescription drug and heroin addiction is ripping away at the fiber of our homes and our communities in our nation,” Texas' senior senator said. “It’s destroying families, increasing crime, making our communities less safe, hurting our economy, and robbing millions of Americans of their future.”
On Friday, President Barack Obama signed the Comprehensive Addiction and Recovery Act after the bill — with Cornyn among 14 cosponsors — sailed through the Senate on a 92-2 vote. The 85-page law addresses everything from youth sports injuries to overdose prevention in a bipartisan effort to curtail an epidemic that contributed to a record 50,000 overdose deaths nationwide in 2014, according to the U.S. Centers for Disease Control.
The sense of crisis that propelled the bill, however, was not strong enough to guarantee that Congress will put money where its mouth is. In a statement after signing the bill, Obama said he was disappointed that the law didn't include actually funding the $920 million Democrats had hoped to allocate.
"This legislation includes some modest steps to address the opioid epidemic. Given the scope of this crisis, some action is better than none," said Obama, who called on Congress to "finish the job" when it returns from summer recess.
Legislators, including Cornyn, insist they plan to fund the legislation when it comes time to appropriate money in September. Until then, the Texas addiction treatment community must wait to see if the law will bring a flood of cash to the state's underfunded addiction treatment programs.
The state is spending $325 million this biennium on substance abuse programs, according to the Department of State Health Services. The Congressional Budget Office estimates that if the federal bill is funded, national spending on addiction treatment and prevention will increase $725 million. State-by-state breakdowns of the funding aren't yet available, but earlier this year, the Obama administration estimated that Texas would get $48 million from its proposed $1.1 billion opioid crisis budget.
Before making any plans to spend money, the state must see how much Congress actually ponies up, said Chris van Deusen, a spokesman for the state health department.
Texas is not exactly ground zero in the nation’s opioid addiction crisis — the rate of drug overdose death is 9.7 per thousand people, compared to rates above 25 in states like New Hampshire and West Virginia. But Texas opioid deaths have risen 80 percent in the last two decades, and per capita spending on substance abuse treatment programs is substantially below the national average. Just 8.6 percent of people with a drug problem have received treatment, compared to 14.1 percent nationally.
Amy Granberry, CEO of Charlie’s Place Recovery Center in Corpus Christi, which serves mostly people in south Texas, said that at her facility the wait for one of the 60 beds set aside for people receiving state funding is generally between six to eight weeks, sometimes stretching up to 12.
“There’s just not a great deal of treatment available right now, so anything we can do to expand that treatment and get people in is going to help,” Granberry said.
Lengthy wait times can be frustrating for patients who finally decide to seek treatment, only to find it is not immediately available.
Kelly Procter, 24, waited a month for a bed to become available at Charlie’s Place after she was approved for state funding in 2014. She started using heroin in 2010, and soon was planning her days around when and where she could get the drug. While waiting to enter rehab, she was nervous about the difficulty of fundamentally changing her life, but even more worried that she wouldn’t get the chance to try.
“I was afraid that if it took too long that I might not make it to rehab,” Procter said. “It’s always jail, death or institutions when it comes to drugs.”
For Procter, it took a second trip to rehab in 2015 to stay sober. She also joined Communities for Recovery, an Austin nonprofit, where she has a peer coach who is also in recovery from addiction, and access to free classes, a computer lab and people who understand what she means when she talks about the challenges of learning how to lead a drug-free adult life for the first time.
The federal legislation authorizes competitive grants of $1 million annually to local organizations for “building communities of recovery,” according to an analysis by the Washington-based Federal Funds Information for States, so programs like the one that helped Procter could get a boost.
Part of the bill would create easier access to medication-assisted treatment by making nurses and physicians’ assistants, not just physicians, eligible to prescribe buprenorphine, a medication that causes some of the same euphoric effects as stronger opioids like heroin and oxycodone, but has less potential for dependency.
According to the federal Substance Abuse and Mental Health Services Administration, Texas has 60 physicians certified to treat 30 patients with buprenorphine, and 24 certified to treat 100 patients. Those figures are significantly higher in other states: Florida has 110 doctors with 30 patients and 46 with 100, and New York has 190 and 46.
Wafaa Farag, a Houston psychiatrist who treats 100 patients with buprenorphine at her private practice, said she has a long waiting list of people she can only treat if someone else moves, finishes their treatment, or dies. Farag thinks the patient cap reflects continuing stigma towards drug addiction.
“Why didn’t we put a cap on pain pills?” Farag asked.
The passage of CARA, however, may be evidence that that stigma is eroding at the national level. Howell said he hopes to see the shift take hold at the state level.
“I’m hoping that we can take that framework of addiction is a disease, that national discussion, and bring that momentum to Texas,” Howell said. “Because I don’t feel that mind-shift at the Texas level that I do feel at the national level.”
There’s some evidence that attitudes are evolving in Texas: in 2015, Gov. Greg Abbott signed a bill making it easier for people to get naloxone — a drug that can mitigate the effects of an opioid overdose — without an individual prescription.
But Abbott vetoed another bill with strong bipartisan support that would have encouraged people to call 911 if they witnessed an overdose by allowing them to avoid drug possession charges. Over half of states already have such laws on the books.
State Sen. Charles Schwertner, R-Georgetown, chair of the Senate Committee on Health and Human Services, said he anticipates bills in the next legislative session that address addiction as a public health issue.
“We need to look at how can we repair the individual, rather than lock them up,” Schwertner said.