The Local Fentanyl Threat in Harris County

The Fentanyl Threat in Harris County and the Greater Houston Metropolitan Area

Fentanyl has become central to the overdose crisis in the Houston area, mirroring the threat in Texas and throughout the nation. In Harris County, the most populous county in Texas, there has been an astounding 457% increase in fentanyl involved deaths over the past four years, from 104 in 2019 to 579 in 2022. In 2022, almost half (49%) of drug-related deaths in Harris County involved fentanyl, fentanyl analogs or another synthetic opioid. This death data represents only a portion of the overall threat picture as the number of non-fatal overdoses is still not well-captured. Because of this missing data, it is likely that we are seeing just the “tip of the iceberg” of this crisis.

The data in this chart is from the Houston HIDTA’s analysis of data received from the Harris County Institute of Forensic Sciences (HCIFS) but is not official HCIFS reporting.

What to Know about the Fentanyl Threat in the Houston Metropolitan Area

The main factor driving the rise in this threat is that fentanyl is increasingly being identified in a broader number of illicit drug types. Regional crime laboratory testing of seized drugs indicate that fentanyl is being found mixed with heroin, methamphetamine, cocaine, and in counterfeit prescription pills. Drugs suspected to be heroin or cocaine are also more frequently testing positive solely for fentanyl. Of seized counterfeit pills, fake oxycodone tablets are the primary type in which fentanyl is identified. However, taking any pill obtained illicitly is analogous to playing a game of Russian roulette as other types of seized tablets also sometimes contain fentanyl. Among the most common drug types used to varying degrees, the only drugs fentanyl has not yet been found in within the Houston area are marijuana and synthetic cannabinoid products.
Drugs containing fentanyl are becoming even more dangerous because some drugs that contain this lethal substance have been found to also contain xylazine, a strong animal tranquilizer (known on the streets as “Tranq.”) Fortunately, this trend has yet not become as prominent as is being seen in other parts of the country. In 2022, only a small proportion of seized pills and powders with fentanyl were found to contain xylazine. Fentanyl-xylazine mixtures are contributing to rise in overdose deaths nationally because though life-saving naloxone can reverse the effects of opioids, they do not reverse the sedative effects of xylazine or other tranquilizers.
Fentanyl is being used both inadvertently and intentionally in the Houston area. Many individuals have reported that they don’t know if the drugs they are using are laced with fentanyl. However, treatment providers report that there has been an increase in individuals seeking drugs that contain fentanyl or choosing to use fentanyl as a drug of choice. There has been a corresponding rise in patients entering treatment specifically for fentanyl addiction.
Deaths involving fentanyl in the region are being seen across a broad age, race, and socioeconomic spectrum. Although the number of accidental drug-related deaths involving fentanyl among adolescents has remained very low in comparison to other age groups, it is rising, as is the trend nationally. This is thought to stem from drug use becoming more dangerous rather than more common. There is cause for concern that this upward trend may steepen.
A new class of synthetic opioids called nitazenes was newly identified in counterfeit oxycodone, hydrocodone, and Xanax tablets in the Houston Metropolitan Area in 2022. Some nitazenes are more potent than fentanyl and multiple doses of naloxone may be needed to reverse a nitazene-involved overdose. Two nitazene-involved deaths have been identified in Harris County to date. One of them occurred as recently as January of 2023.