By Tim Fleischer, Editor-in-Chief

Being near the bottom of the list is a good thing sometimes.

For Texas, being in the bottom three of the United States for opioid-related overdose deaths is a very good thing.

“West Virginia is the number one state in terms of opioid overdose deaths,” District Judge Rebecca Depew told the Salado Area Republican Women at their Jan. 24 luncheon meeting.

“It’s a major problem nationwide,” she said, adding that earlier in the morning she saw CBS News started a two-part series on the opioid crisis, click here to get online treatment.

“States are suing the pharmaceutical companies because of the problems with people becoming addicted to opioids,” she said.

“We in Bell County have a methamphetamine and cocaine and alcohol epidemic coming through our courts,” she said.

Some of the reason that illegal opioids, particularly Fentynal, have not become epidemic in Texas is because of the kind of heroin that is popular throughout the state.

Fentynal is distributed in white powder format. In most other parts of the country, it can be easily mixed with heroin, cocaine and methamphetamines in powder form.

But Mexican black tar heroin is the most popular form of heroin in Texas. “They haven’t figured out how to mix Fentynal with it,” Judge Depew, “but they will. When they do, then we may end up dealing with the opioid crisis the rest of the nation faces.”

Depew predicated her remarks with a historical look at past opioid epidemics in America, beginning with the Opium epidemic in the late 1800s, the Heroin epidemic in the early 1900s and in the 1950s and 1970s. 

Judge Depew said that many of the opioid overdoses happen when an addict quits a drug like Fentynal and then goes back to it. “They take the same amount that they took when they quit and it kills them,” she said, “that is how powerful and potent these newer opioids are.”

Fentynal is 50 to 100 times more potent than opium, she said. 

Many times, people become users and then addicts following surgery and other medical events. “They get prescribed these painkillers and end up addicted to them,” she said. “When they go back to the doctor, the doctor sees a pattern of overuse and may stop the prescription.”

At this point, the addict often turns to street versions, including Fentynal. The judge discussed the difference between drug dependence and drug addiction. With dependence, a user may end up before the courts and after going through the withdrawal stages can stop usage. For an addict, it is different. “They just can’t do without it,” she said, “despite harm to themselves or others.”

With addicts it may take more than two years for them to successfully quit and graduate from drug addiction programs “with a lot of slips ups along the way.”

Texas is fortunate in that it has the third lowest drug overdose rate in the country. The state has an average of 10.1 overdose deaths per year per 100,000 population. “This is half of what the national average is and a fifth of what the highest state, West Virginia, is,” Judge Depew said.

Opioids represent about half of those total drug overdoses, or 4.82 per year per 100,000 population. “Lots of the times it is a combination of several different drugs,” Judge Depew said.

In Texas, different regions struggle with overdose rates. Baylor County (Wichita Falls) in the Red River valley has an overdose rate of 30 per 100,000 population.

“Legally prescribed painkillers are involved in half of the overdose deaths,” Judge Depew said. “They start with a prescription and then move to opioids like Fentynal when they can’t get the prescriptions renewed anymore.”

The number of deaths related to Fentanyl overdoses doubled from 2015 to 2016.

“Opioids are one piece of the puzzle, though,” she said, adding that there are “more deaths from methamphetamines than from opioids.”

“Methamphetaine, cocain and alcohol are the problem here in Bell County,” Judge Depew said. She should know. Depew is the Bell County Court at Law (No. 3) Judge.

In Bell County, of the 1,021 felony probations, methamphetamines leads the list, followed by cocaine and marijuana.

Of the 394 drug probationers, alcohol was the top cause.

Of the 401 midsdemeanor probationers, alcohol was the leading contributor, followed by Xanax. 

Judge Depew discussed drug treatment programs in the criminal justice system.

She talked about the DOSE of Reality program to prevent prescription painkiller misuse in Texas. She also talked about the data collection system in all levels of courts in relation to opioids and other drugs and how that data is used for decision in the courts.

Judge Depew told the group that Texas has joined in the class action lawsuits against drug companies. The state is suing Purdue Pharma, the manufacturer of oxycontin and other prescription opioids. “This is still in the discovery stage,” she said.

Judge Depew talked about the Sandra Bland Act and mental health in the courts and justice system.

Sandra Bland was a 28 year old who was pulled over by a state trooper. After a heated interaction, she was removed from the car and arrested for resisting. She was taken to jail. Three days later she refused breakfast one morning. Three hours later she was found dead, having hanged herself in her jail cell with a plastic garbage bag.

As a result of that, Senate Bill 1849 was passed in Texas as an unfunded mandate.

“The Legislature is great about doing that,” she said. Depew added that she thinks Bell County has done excellent work to implement this complicated and complex approach to answering a serious problem.”

Due to the Sandra Bland Act, there are now screening forms at the Bell County Jail. “They are filled out for every defendant,” she said and reviewed a couple of the questions. “They may still be really high on drugs when they arrive, so their answers may not be the best at the time,” she said. “It is our job in the system to determine whether they are a danger to themselves or others due to their mental state at the time.”

The forms are screened by mental health social workers to determine “Is there reasonable belief that the person has a mental health issue” so that the justice system might help in directing the person to get mental health care.

For most of the individuals who go through the drug courts and find help with their addiction, “the longer they are in the program and able to stay clean, the more apt they are to get something out of it. These programs work. I have seen it work. I have seen them at the beginning and at the end of these programs. If there is a willingness to change we can help them.”

Treatment courts are an important part in keeping communities safe, Depew said. “With our veterans treatment court, many of them come out on the other side as productive members of our society,” she said. “The average for these defenders is three tours of duty. In most other parts of the country, it is one tour or less. These people have seen significant trauma and gone through significant trauma themselves.”

“They have had a lot on their plate,” she said, “and if we can help them then we help to keep our community safe.”