Travis County has the highest rate of fentanyl deaths in Texas. Why is Austin a hot spot?

Lisa Wheeler struggled to sleep. She tossed and turned and finally woke up at about 8 a.m. on Sept. 15, 2022. Following her normal routine, she went upstairs to wake her 17-year-old son, Spencer.

She opened the door and saw him lying in bed, his mouth and eyes open. She leaped on top of him and cried out: “Spencer! Spencer! Spencer! Wake up!”

He didn’t.

She rushed downstairs. Snatched her phone. Grabbed Narcan. Then called 911 and dashed back upstairs.

Following the paramedics' instructions, she heaved Spencer off the bed to start performing CPR. Then she administered Narcan, a life-saving medicine that, if taken soon enough, can reverse the effects of an opioid overdose.

But it was too late. Spencer died that day. The cause of death: a pill laced with fentanyl.

“It's a miracle he lasted as long as he did in some ways,” Wheeler said of her son, who had been struggling with substance abuse issues at a time when fentanyl's prevalence in the local drug supply spiked.

Spencer is one of hundreds of Travis County residents who died of a fentanyl-related overdose in 2022 — a year that state data show the county had a significantly higher rate of such deaths than other Texas metro counties and began what appears to be a potentially disturbing local yearslong trend.

For instance, Dallas County’s rate of these deaths that year was 7.26 per 100,000 people. Travis County’s was double at 14.56, according to data from the Texas Department of State Health Services .

Preliminary state data for 2023 doesn’t indicate a substantial change in Travis County's rate of fentanyl deaths.

The Travis County medical examiner’s office will likely present its data for 2023, which will include accidental drug deaths, to the Travis County Commissioners Court in the coming weeks.

So far, 2024 isn’t showing too many signs of improvement either, as Travis County just saw the deadliest overdose outbreak in a decade with 79 overdoses in three days including nine deaths possibly caused by fentanyl.

The American-Statesman spent months investigating why the county’s rate of fentanyl deaths is higher than that of other major counties in Texas, examining the issue with dozens of government leaders, advocates and family members who lost a loved one to fentanyl.

Through dozens of interviews, the publication found no single cause of why the county’s fentanyl death rate is higher than other Texas counties. Experts cited the city’s party scene, county demographics and a lack of treatment resources as some of the reasons.

“I don't believe that there is one smoking gun, that if we were to fix that one thing, it would solve our problem,” said Steve White, assistant chief of Austin-Travis County Emergency Medical Services. “There are so many factors that go into how you address the opioid crisis, that you kind of have to hit it from a lot of different angles ... to make things better. Availability of the resources really is key to fighting this crisis.”

Unlike many parents, Wheeler and her ex-husband, Hunter, both knew about fentanyl. Their son began experimenting with substances in the sixth grade. They later learned that Spencer was the victim of a now-convicted sexual predator.

As Wheeler notes, their family was privileged enough to send him to get help: three stints in rehab, boarding school and, finally, a decision to move to Costa Rica.

This last-ditch effort — leaving the country — was the only solution the family believed they had to save their son from fentanyl’s grip. But it never came, as Spencer died a month before their planned move.

“He just kept sliding back into just using whatever he could find to feel different inside or just to address what was hurting for him,” Wheeler said. “I look back on that time ... and it was really, really difficult and so scary as parents.”

What is fentanyl?

Fentanyl is a synthetic opioid, meaning there’s no poppy plant or organic substance in the drug. It’s much more powerful than other opioids: Fentanyl is 50 times stronger than heroin and 100 times stronger than morphine.

Two milligrams, just enough to sit on the tip of a pencil, can kill a person.

The materials to make the drug come from China. It’s then shipped to Mexico or sometimes Canada. It’s largely distributed by the Sinaloa and Jalisco cartels.

Users ingest the drug in any way possible: snorting, smoking, intravenously or orally. Most choose the oral route, buying pills laced with the drug.

Those pills are often made to look identical to Percocet or Xanax pills, with drug dealers using pill presses to make the pills and stamp them with the labels often seen on the actual pills, such as the “M-30” of an oxycodone pill.

Fake pills are what Spencer acquired the day before his death. His parents didn’t give him access to money, but he traded a gaming system for the pills instead, Wheeler said.

These days, fentanyl is found or said to be in most other illicit drugs, including amphetamines. During the recent deadly surge of overdoses in Austin, EMS said some of the people who overdosed weren’t seeking out opioids.

Fentanyl’s spread started on the East Coast in the 2010s and gradually became pervasive everywhere.

In the beginning, many were taking the drug unknowingly. While that’s still a possibility, especially for teenagers or nonhabitual users, many addicts now actively seek the drug.

The Wheelers didn’t hear about fentanyl until at least 2020, and by that point, Spencer had already been slipping further into using drugs at a time when the supply was becoming tainted with the deadly, potent chemical.

Once the Wheelers learned about fentanyl, they began to keep things like Narcan on hand. But it also put them in a state of constant anxiety and made them realize it didn’t matter where in this country they lived; the only option to save their son was to leave the U.S., they decided.

“We just thought, well, we have to go somewhere where there's no fentanyl,” Wheeler said.

Why does Travis County have such a high rate?

Initially, many experts and advocates in Travis County said they could not cite a particular issue driving the local fentanyl death rate.

Others identified several possible factors, including the closing of a 50-year-old nonprofit treatment center , Austin Recovery, at the start of the pandemic. This facility provided services to people who could pay out of pocket or with insurance and those who couldn’t. Since it shuttered in 2020, nothing has replaced this type of service.

Austin Recovery, which at the time of closing was serving about 50 people annually, was unable to break even after a federal law was passed over a decade prior. This law made insurance companies cover addiction treatment similarly to other health needs, which in turn allowed for more private treatment centers all over the country.

Austin Recovery’s closing is emblematic of what Kasey Claborn, director of the Addiction Research Institute at the University of Texas, called a “dearth” of treatment options in the Austin region compared with other large counties such as Bexar, Dallas and Harris.

“That is a gap in the health care system here in Travis County that is unique across the state in urban areas,” Claborn said.

Wheeler knew about these issues all too well as a licensed therapist, especially when it comes to treatment options for minors. At the time, the only option in the region was Phoenix House, which provided services for low-income teens. That center closed last year.

Each time Spencer went to rehab, it was outside of Austin, and two of the three times it was outside of Texas.

Wheeler noted that the city doesn’t have any place for teens to medically detox, recalling a time that her son came to her terrified after he ran out of pills. She said the hospital didn’t offer much help.

In addition to Austin’s lack of treatment, local policies have made implementing a successful harm reduction strategy more difficult than in some other metro counties in the state, Claborn said.

The main organization providing harm reduction to Travis County is the Texas Harm Reduction Alliance. The organization has a street outreach team of only four people who largely serve the city’s homeless population by providing Narcan, safe injection supplies and other resources to help save the lives of the most vulnerable.

But four people for one of the largest cities in the nation isn’t enough, workers for the alliance told the Statesman. And with continuous sweeps of homeless camps , doing their work is becoming even harder because they're constantly guessing where they’ll have to go next.

Austin has also become a notorious party destination, with people coming here to enjoy one of its many festivals or celebrate their momentous occasions in one of the city’s entertainment districts. With that reputation comes an increase in drug use, which many people the Statesman spoke with said they believe is contributing to the county’s higher rate of deaths.

“With all of these people coming in from all over trying to buy or just use (drugs) to have a good time, and that’s why we see such a surge in overdoses in Travis County,” said Maggie Luna, executive director of the Texas Harm Reduction Alliance.

Plus, the county’s demographics already make it more susceptible to having a higher overdose rate. Compared with places such as Bexar, Dallas and Houston counties, Travis County has a larger percentage of people ages 18-45, which is the age group most likely to die of an overdose.

Travis County also has a lower percentage of minors and elderly residents compared with those other counties, according to the latest numbers from the U.S. Census Bureau.

A tough fight

For law enforcement, fighting a tasteless, odorless and potent drug comes with a significant challenge, but agencies are stepping up efforts to fight fentanyl.

At the Travis County sheriff’s office, almost all resources of the Vice Unit are now dedicated to fighting the influx of fentanyl.

Brian Cole, assistant special agent in charge of the Drug Enforcement Administration’s Austin District Office, told the Statesman the DEA is working to combine efforts with local law enforcement agencies, such as the Austin Police Department, to help combat the problem.

But that’s difficult when illicit substances can easily be purchased with a variety of apps such as Snapchat or Telegram.

And fentanyl is cheap: Law enforcement pointed out a website where M-30 pills were $10 each.

The sheriff’s office noted that its unit could use more officers, but that's not all — it has to be supplemented with more treatment options to help people suffering from addiction. Essentially, you can’t just attack the “supply” without also providing resources to curb the demand, the sheriff's office said.

Cole said a big part of what the DEA is trying to do is education based. The hope is to deter people from using prescription drugs not prescribed by a doctor by going into schools and telling kids and parents how deadly this drug is.

For Wheeler, everything needs to be increased: enforcement at the border and locally; more education on the dangers of fentanyl; more harm reduction; and making fentanyl testing strips available.

“There has to be a way our government can stop this from happening,” Wheeler said.

Police arrested 27-year-old Alexander Sonnier nearly a week after Spencer’s death, and they believe that he’s the dealer who sold Spencer the deadly pills.

Sonnier has been in jail since then and faces two felony charges: delivery of a controlled substance to a minor and the manufacturing and delivery of a controlled substance greater than or equal to 4 grams and less than 200 grams.

What’s being done?

In addition to launching educational campaigns about the dangers of fentanyl, local leaders are also finding other ways to try to combat the rising deaths from overdoses.

During a special meeting of Austin’s Public Safety Committee on March 25 , Austin City Council members heard a presentation from Austin-Travis County EMS about how the county had the highest rate of fentanyl-related deaths in the state for 2022.

White told the committee about a program run by EMS in which a couple of community paramedics administer buprenorphine daily to people after an overdose until they can get into long-term treatment.

Buprenorphine is a medically assisted treatment option for people who have an opioid dependency. Local community paramedics offer the medicine to people who have gone through an overdose and want to get help. They also help set those people up with other services.

White said during the committee meeting that there is currently only enough funding for two and a half staff members for the buprenorphine program.

White told the committee that EMS would benefit from having more full-time people working in the program. During an interview, White said the number of opioid overdose calls rose from about 30 a month in 2018 to 120 a month currently.

The buprenorphine bridge program recently helped its 500th patient since it began, with White stating it has a 93% success rate of getting people into medicated assisted treatment.

In addition, Travis County Judge Andy Brown told the Statesman he hopes the mental health diversion facility , a pilot program of which is expected to begin soon, will help provide treatment options to people who interact with the criminal justice system.

Brown said in January he expected the pilot to start in the coming weeks, but at a recent Commissioners Court meeting, it was noted that the pilot still hasn’t begun.

The county released data last year that said people who were recently released from jail were more likely to die of an overdose.

Additionally, Claborn said Travis County is slated to begin a new countywide overdose data reporting program, TxCOPE , which will make it the first county in the state to implement the program across its entire county.

Part of Claborn’s work is to gather and distribute better data to organizations on where overdoses are happening. Between 50% and 70% of people who overdose never interact with EMS, which is currently the primary source of data on overdoses available for the county.

State lawmakers also passed numerous laws last year aimed at curbing fentanyl’s destruction, from mandatory education requirements to increasing the charge to murder for any dealer who sold a fatal dose of fentanyl.

But the changes won't bring back the hundreds of people lost to families such as the Wheelers.

Wheeler remembers her son as outgoing and caring, and she said he had a special connection with animals. The family adopted a stray dog, Pumpkin, who wouldn’t go near anyone except Spencer during a trip to Puerto Rico.

Wheeler decided to go ahead with the move and is living with Spencer’s sister, Brooklyn, in Costa Rica. She said the country's sense of adventure and natural beauty embody her son's spirit.

“I never know when I'm going to cry,” Wheeler said. “The tears are always just right there. … Your grief is always just right underneath the surface.”

This article originally appeared on Austin American-Statesman: Travis County has the highest rate of fentanyl deaths in Texas. Why is Austin a hot spot?