A higher number of people in San Antonio are overdosing on opioids and stimulants, a lethal combination that’s overwhelming local emergency rooms — and on Wednesday a City Council committee reviewed a resolution that would declare local overdoses as a public health crisis.
The crisis declaration would set the issue as a priority for the city, and comes on the heels of nearly $1 million in opioid settlement funds the city got to reduce overdoses through 2025.
Bexar County’s annual Medical Examiner’s Office Report said that 35% of more than 550 overdose deaths in 2022 happened among those who combined cocaine, heroin and meth. Another 32% of San Antonians who died of overdoses during that same time combined meth and other amphetamines.
In addition to the city dollars, which were allocated to Metropolitan Health District to administer, last month, Bexar County was accepting requests for proposals for organizations to apply for nearly $14.4 million available in opioid settlement funds.
The application period closed on Tuesday and the county will announce its recommendations for opioid dollar recipients in July. Recommendations will be presented to the Commissioner’s Court.
Meanwhile, the city and Bexar County will announce a joint resolution to ensure resources aren’t duplicated and to make sure funding is used to treat people, said Jessie Higgins, chief mental health officer for Metro Health.
The overdose issue is much more complex than just opioid overdoses, experts said.
“A combined use can be very lethal and needs to be treated very differently,” said Jelynne LeBlanc Jamison, CEO of the Center for Health Care Services, which provides resources for mental health disorders. “A lot of our emergency departments are not equipped to deal with that issue, and [overdoses] are burdening emergency departments.”
CHCS applied for $1.2 million of Bexar County’s opioid settlement funds, Jamison said, which it would use to create an emergency response system to establish medical protocols for all health care settings, like local hospitals and emergency rooms, to address what Jamison called “wave four” of Bexar County’s overdose problem.
In 1990, San Antonio was hit with “wave one” of prescription opioid use, she said. Wave two occurred in 2010, dominated by heroin overdoses and was the result of unavailability and unaffordability of prescription opioids. Wave three in 2013 was the emergence of synthetic opioid overdoses, which accelerated during the pandemic.
“Now we are calling this wave four, which is the ingestion of the combination of opioids and the use of stimulants, [such as] methamphetamine,” Jamison said.
Jamison said combined overdoses are very different: People can’t detox, and require medical treatment or medications when people experiencing overdoses present in the hospital.
“If we are successful, … we would help community hospitals in lessening a burden, giving them protocols and access to treatment once these individuals present in hospitals,” she said.
In San Antonio, 46% of the population lives in poverty, and a share of those people live with a mental health or substance use addiction, Jamison added.
What San Antonio really needs is a psychiatric center or campus with inpatient or outpatient services for mental health and substance use to get people stable enough for successful outpatient care, she said.
The non-binding resolution to declare a public health crisis would ask the city to commit to expanding harm reduction strategies and training to use Naloxone. It would also call for a new program targeted at education and addressing stigma around people with addictions.
As part of the resolution, slated for approval in November, the city will adopt the use of the original multi-year plan that shows how Metro Health will use its opioid settlement funds, and commits the City of San Antonio to developing an education campaign to focus on overdose awareness, reducing mental health stigma and youth education.
The resolution also recommends a framework for prevention, harm reduction treatment and recovery and highlighted the value of a coordinated response with the county.
“We are really trying to address an issue that prohibits this community from fully realizing its full potential,” Jamison said.
Correction: This story has been updated to note that after committee approval, the full City Council is considering the resolution in November.
