FORUM: Big Country leaders shed light on the Fentanyl crisis

BIG COUNTRY, Texas ( KTAB/KRBC ) — In this week’s Big Country Politics, we spoke to leaders in our community about fentanyl in the region and the urgent need for action to combat the opioid epidemic.

KTAB’s Bob Bartlett and Joni McKinnon hosted a forum with Taylor County Sheriff Ricky Bishop, Abilene Recovery Council Program Director Cindy Frazier, Taylor County Health Authority’s Dr. Gary Holland, Citizens EMS Callahan County Administrator Kellie Batangan, and Nolan County District Attorney Ricky Thompson. The following is a transcript of their conversation:

Bartlett asked, “For those who may need a little background on what fentanyl is and why it’s causing such a crisis, let’s get some of the basics out of the way. First, turn to you, Dr. Holland, as a medical professional, explain what fentanyl is and why people use it.”

Holland replied, “It’s synthetic opioids. Opioids are painkillers. Analgesics. It’s very potent. It’s used. It has some legitimate uses. It’s manufactured neurogenic patches that people sometimes wear. We use it in hospice because sometimes people can’t swallow medications or they’re on something that doesn’t work. So it’s legitimate usage, but it’s being used. It’s being manufactured by labs that are not controlled, not pharmaceutical companies, Mexico, China, and put into pills. It’s been laced into legitimate pills like hydrocodone and oxycodone, as well as illegitimate meds like heroin and morphine. And the reason is that it’s very cheap, and it allows the drug dealers to reduce the cost of their pills but still get the people high. And it’s very, very effective. It’s like 50 times as potent as heroin and 100 times per milligram as morphine. So, for the people who are manufacturing it illicitly. It’s a wonderful thing that helps their bottom line.”

McKinnon asked Frazier, “What do you see in here at the recovery Council? I mean, you’re dealing with these people and trying to prohibit it from going further.”

Frazier responded, “Our assessment and referral for a treatment program, anybody that comes in with any type of opioid use disorder, they really kind of just go to the front of the line as far as assessment and getting them into treatment. We know that they really are going to need the quickest response, so we’re trying to work with them, and then we always try to meet people where they are in their recovery walk. Our recovery coaches will walk the path they want because everybody’s recovery may look different, so they just try to make it work for them and their lives. Then we do a lot of prevention education in the community.”

Bartlett asked, “Kellie, turning to you next, from the EMS position, from Callahan County, someone in the county calls 911 for help. How do your crews know what they’re responding to? And do they not know until they get to the scene? And what do they do after that?”

Batangan replied, “We were normally dispatched, and it gives us an idea if they have an overdose or if they’re unresponsive, but until we actually get on scene to assess that patient, we really don’t know. The signs and symptoms that we look for with a fentanyl overdose or an opioid overdose will be if the patient is unconscious, if they have agonal respirations or shallow breathing if there are snoring respirations as well, and if pinpoint pupils as long as well as cyanosis to the lips.”

McKinnon shared, “A lot of parents around the table, and we are all fearful. I have a teenager myself, and I mean, the thought of our kids coming across this drug in any shape, way, shape or form is just terrifying. I know it is to me and to other parents out there. So, I mean, how do you know if it’s laced with fentanyl? I mean, what can it look like? Are there different forms?”

Frazier explained, “It takes such a small amount to be a potentially lethal dose, equivalent to four to six grains of table salt would fit on the tip of a pencil, and so you can’t see it, that’s in there. You can’t taste it. It’s you’re not going to know it till you’ve ingested it until you possibly go into an overdose. Because every one of those counterfeit drugs is all different, one might have very small amounts of fentanyl, one might have enough to put you in an overdose that’s survivable, and some of them may have an amount that is not survivable. It’s safe to never take anything that you didn’t get from a pharmacy or you didn’t get from a prescription.”

Bartlett asked, “Sheriff Bishop, your deputies out on the streets making traffic stops and responding to other emergency calls. What have they seen so far in this just here in Taylor County?”

Bishop replied, “I’ll expand it over to our Narcotics Division, where roughly seven out of every ten vehicles they pull over has some form of meth or fentanyl in that vehicle. Seven out of 10. Yes, that’s the stats they’re coming up with so far. Just within the last two weeks, they made a traffic stop, got 1,000 fentanyl pills off of a man, and then were able to get a search warrant for his home and found another 4,000 fentanyl pills. He was going to be a dealer for here at Abilene, and we were able to follow on him through the Fed federal system.”

“How much money is it? How much did it cost to get the 5,000 pills? And how much money can he make off of it?” Bartlett responded.

“On average, they’re buying pills for $5 a piece and then selling them for $25, $30 apiece. And Abilene has become the hub for this area, for selling just about any drug you can find, because it all passes through here, goes to the Dallas Fort Worth area, gets cut, gets split up, however they do it. People from here drive there, or the guys from the Dallas Fort Worth area drive here to sell it, and then they drive right back. Then everything gets dispersed from Abilene to the surrounding Big Country,” Bishop answered.

Bartlett asked if there was a way to track dealers down, to which Bishop said, “Through lots of investigations. That one is going to yield more arrests just off of that one guy. I’ve got six, seven guys that work closely with the federal system, Abilene Police Department, and other agencies, and they’re knocking out of the park, doing what they can, but until something happens at the border and shut that down as much as possible, it’s going to keep growing. It’s not going to slow down because they’re moving… across the border. Made in Mexico. Some of your fentanyl, or a lot of it’s coming out of China, getting produced in labs there, goes to Mexico, gets pressed into the pills and different things there, added into whatever, and then it gets brought up here. We’ve even had a few that are here in Abilene, pressing and making those pills themselves, just in homes here, manufacturing on themselves.”

Bartlett asked Thompson if he’s seen that in the courtroom, to which he replied, “I would say 90 to 95% of our caseload can be tied to some form of drug use in itself. Sheriff Bishop is right. It is being saturated. The market is being saturated with methamphetamines, cocaine, heroin, and fentanyl just because it’s coming across the border and it’s just being released on the streets. The amounts are going up. The cost is going down. Like anything, if you have a lot of products, the cost is going to go down, so we’re seeing a lot of them. I would say our caseload, I mean, over the past eight to nine years, has increased at least 40%.”

McKinnon asked, “So once you have the meth busts, and you have these individuals, and they’re in jail. I mean, do they go to therapy? Do they go to prison? What happens with this next? Is that just the tip of the iceberg?”

Thompson answered, “I think the approach we have taken is the demand you have to hit and the supply, and I think you have to treat it differently. I think the supply or the drug dealers, my approach is those who are feeding off people’s addictions need to go to prison. I think that’s my approach. I think people who are actually struggling with drug addiction, as far as the demand side of it, we do take an approach, try to get rehabilitation. Because if we’re able to rehabilitate that individual or get them help, I think that can save us a lot of issues in the long run, you know. And so we do seek rehabs. We have a drug court program at Nolan County that post-adjudication, meaning that they pled guilty, and they’d go into this program and try to get counseling and things like that, and so, and one of the requirements to get into that is that you can’t deal drugs and so, and if they’re known drug dealers, they don’t work, they don’t qualify for that. It does take a two-step approach to that. I do know we’ve utilized a lot of them if we’re able to tie it to multiple individuals who are sharing money and engaging in organized criminal activity. It is a big law we use in my area because it bumps the degree upon drug dealers, and it carries parole issues as far as half time served and carried instead of quarter time served. And so, those are creative ways we try to keep them in longer. In that way, they’re not out dealing in the streets. But I think it is a two-step approach, dealing with the supply and the demand differently.”

Bishop added, “Oh yeah, over the last couple of years, definitely increased. And even heroines made a pretty good comeback in this area, and some of it is because those that want to get off fentanyl, the after-effects are so strong that they go on to heroin because the withdrawals are so much less on heroin than they are if they just quit fentanyl cold turkey, so they’ll get on the heroin and then just quit, quit heroin cold turkey after that, if they don’t jump on the meth and stay on that. But meth and fentanyl are our two biggest drugs in this area.”

McKinnon asked Batangan, “When you guys do go out on these calls, if you think it’s a fentanyl overdose and you take the necessary precautions. What are you looking for? Can you bring someone back if they think they overdosed? And what are the next steps once you arrive on the scene.”

Batangan replied, “If we do suspect a fentanyl overdose or an opioid type overdose, we do use Narcan on the scene, and we do transport the patient because they can always relapse back into that overdose from the use of either whatever opiate they used or fentanyl.”

Bartlett asked how a family can know the signs of an overdose, to which Holland responded, “It depends on the drug. Like Kellie was saying, there are opioids, and then fentanyl is kind of a super drug, so just basically, opioids make you sleepy. You kind of get high. You might get drowsy, but the fentanyl, because it’s so potent and depresses the respiratory drive, makes you breathe slower. You start to gurgle when you breathe. You’re not getting the air in and out. You may have power or cyanosis of your fingers or toes. Just lose consciousness completely. Some people just pass out and quit breathing. So, it’s a severe decrease in neurological function. Anybody that’s really out of it, loss of consciousness, limp, going limp, passing out. You have to wonder if it’s something really strong, like fentanyl, as opposed to just too many hydrocodone or codeine or something. So that could be due to other things besides drugs. So, anybody who has a decreased level of consciousness needs immediate treatment. If you think it could be fentanyl, then Narcan is a great thing. They’ll wake up for a while. They may even be mad at you, for I’ve heard stories of people on a really good high, and they feel awful because if you’re coming off of opioids, you feel pretty bad for a while, but then they can go back into the sedation. Also, they need immediate medical treatment. But you know, the idea is to recognize it might be an overdose, use the Narcan, and look for all the main signs of a decreased level of consciousness, is what we look for.”

Barlett added, “As a doctor, what do you do when they show up in the emergency room?”

Holland replied, “It depends on how bad off they are. If their respirations are poor, they’ll first put them on oxygen. If they’re really poor, they’ll put a tube down their throat and use the ventilator. If they haven’t had Narcan, they’ll certainly get Narcan to try to support their blood pressure.”

Barlett asked, “How do you know if they’ve had Narcan?”

Holland said, “You don’t know if you think they might have had… you can’t really overdose on it. If there’s no history of having had it, you could probably give another dose, but just depending on their level of consciousness and their vital signs, however much help they need, until you’re pretty sure that it’s all worn off, so you have to be really diligent.”

McKinnon asked Frazier, “For someone who’s experiencing or whether it’s them or someone they’re close to, and they’re going through an addiction to it, or maybe they’re reacting to the drug, what would you do?”

Frazier responded, “One of the biggest things we try to educate on is reducing that stigma. We don’t use words like addict or junkie. They have a substance use disorder, they have an opioid use disorder, they have an alcohol use disorder, because if we reduce that stigma of them feeling like that’s who they are, they’re more likely we have found to seek treatment. If this is just one part of who they are versus they’re not just, they’re not just an addict. There’s more to them. They’re a person. We try and talk to people, if they see somebody in a hospital or an emergency situation, look beyond the overdose, because there could be some other traumas or other things happening in their life that is brought them here, or they’ve been given something they weren’t aware of. So you have to look beyond that overdose, and if they are using something they’re buying and using, we want to reduce that stigma so we can get them into some treatment and get them into recovery, so they will be a great part of our community. We want people to be, survive, be prosperous, and be an asset to our community.”

Holland added, “Counseling knowledge is very important before drug use and after. There also are medications, and there are some local West Texas counseling and rehab centers that use methadone, which is a sort of lower-level opioid, to reduce cravings and help people get off the opioid. It has to be under control in a setting with physicians. Buprenorphine is another partial opioid agonist that’s used to help people who are on the really strong stuff, bring it down, and help them get off of it slowly in a controlled setting. So, there are medications that can help. It’s not like you necessarily have to go cold turkey, but between medications, counseling, all that together.”

Bartlett turned to Bishop and asked, “Why are people selling drugs to people who are dying, which seems like it would be killing off their clientele?”

Bishop responded, “This is so addictive; they’ll just go out and get new clientele without any problems. The only thing they care about is making money, making money for themselves, and making money for their cartels back in Mexico so they can expand. You know, their riches and their organizations, so they can be the leaders. Unfortunately, they don’t care what they do. They just want the dollar.”

He added that the cartel is here, saying, “They are here in Abilene. We have linked some people back to the number two guy and the cartel in Mexico. It’s not a Hollywood made-up story. No, it’s not. They are here, and they are doing everything they can to make as much money as they can, any way they can.”

Thompson touched on the new legislation making it so that a dealer can be charged with murder in the case of a drug-induced death, sharing, “September 1 of 2023, so it’s barely been a year that came in, that was that last legislative session that came into work and we’ve actually utilized it at least in four different cases since then. But it’s a pretty broad statute. I mean, just delivering, giving someone drugs, and they overdose and die from that. I mean, that is a broad statute. When you look, it’s just an extra paragraph in the murder statute under that section, and the other sections deal with intent and knowingly. And this is just, hey, you give somebody that, and it’s laced with different narcotics, and they die from that, that that issue, then, then you can charge them.”

However, Bishop shared that he thinks those who sell don’t “really care because some of them don’t think they’re going to get caught, especially those that are driving in from Dallas, Fort Worth to sell their drugs here, and they go right back. They don’t think it’ll get back to them.”

Frazier shared that they no longer call it an overdose death, saying, “We’ve changed that terminology when we do presentations; we don’t call them an overdose death, necessarily. It’s a poisoning death because the people taking it did not know they were taking fentanyl. It kind of changes the way somebody will look at it: if I overdose versus if I was poisoned. Your family member was poisoned, and that takes a whole different perspective on their death.”

Bartlett asked Bishop, “So your deputies are trained to use Narcan if they think that it’s appropriate in that situation, correct?”

Bishop replied, “And we’ve always got an ambulance coming. We had a call not too long ago in Tye where a guy was unresponsive, and they weren’t sure what happened to him. I believe he was an employee at one of the truck stops. They got there, and they immediately, I think, ended up giving him three or four different doses of Narcan before he came. He came too, and he actually started fighting when he came to because he didn’t know he’d been on the floor. He didn’t know they’d already been doing CPR on him. Then we found out that he had actually taken some heroin that somebody had given him about two hours before.”

Frazier added that Narcan is very accessible, saying, “You can buy it over the counter. One thing I wish that Texas would do, and other states do, is they offer some states offer Narcan with every opioid prescription. My dream is that Texas would do that someday. I’d love to see the legislation come on that. However, the Abilene health department provides Narcan for free. Our agency provides it. It’s available in several different ways, in the vending machine. I know that just this morning, we had to refill the vending machine again. So we’ve refilled it twice. We’ve refilled it three times since the Fourth of July weekend… It’s about 40 doses in every box. Every box has two doses. So if you’re getting a box out of the vending machine, you have two doses, they’re four milligrams a piece, and so you can give a total of eight milligrams of Narcan, if needed, for the person.”

Holland added, “It might be something that somebody that’s on chronic pain medication, an older person, you know, something especially strong, like hydrocodone, which you know we’ve used in the past, and it’s still good for pain, we’d want to have on hand just in case somebody got confused or decided to take more than they should have Narcan on hand, just because it’s a possibility.”

Frazier said, “Some schools keep it on campus, whether it be a student who needs it, somebody coming into the school, or somebody attending a football game. Some of them keep it on their buses when they’re transporting students because you just never know where you’re going to come across somebody, and if you’re able to save their life, then it’s worth having it, having it right there in handy.”

Bishop shared, “I think the biggest message that needs to get out there to everybody is not to take something that you don’t get prescribed or buy over from the store. If you don’t know where that pill comes from, don’t take it. You don’t know what’s in it, where it came from, and that person that’s giving it to you may not know either, so stay away from it and take only your own medications.”

Frazier said, “I think the biggest thing that we try and get across is that I feel really personal about is that if you’re able to revive somebody from an overdose from Narcan, you’re giving them the opportunity to get into treatment, into recovery. It’s never wrong to use Narcan. It will never hurt anyone; no one ever goes into an overdose. Get educated, and we’re here to provide any services, and all of our services are free.”

Holland added, “I think in my mind, education is so important before the fact, after the fact, before people overdose, to know that pills are dangerous, any kind of pill, especially something that you don’t know what it is, just kids, especially that don’t know any better, maybe needs to be educated as much as things like what you’re doing here. Then, after the fact, someone who’s addicted to opioids has opioid use disorder, or has a history of addiction, or has overdosed before, knowing that there’s a lot of help available, there’s counseling, there’s cognitive therapy, and there’s also medications that can help, which are a little bit more difficult to get, but there are things to be told to the public before and after the fact, and the more we can get out the message, the better off people will be, and the more chance we have to maybe save somebody’s life.”

Batangan shared, “My final thought is definitely call 911 if you do suspect a fentanyl overdose; even if you did administer a Narcan, we’re still there to help and continue to stay safe out there, really.”

Thompson said, “They’re scared to call because maybe they have drugs, they might have illegal or narcotics on them. They might be worried that they’re going to get in trouble in my area. And I maintain this; I even used it in a closing argument, that it would go a long way for me, and I think in law enforcement in general, if you save a life, if you sit there, no matter what selfish reasons, and you put those aside, and you look at that person, because it is a human being, and you say, I’m going to call, and I’m going to save their life, no matter what’s in here, I think law enforcement and prosecutors will look at that and be like, You know what? That goes a long way. You’re not going to that does not going to carry a punishment like it would with just letting them die. So that’s my final thought. If any people are out there and they think, ‘I can’t call because I have these narcotics on me, I’ve been breaking the law,’ to me that that would go a long way, and that even might be charges not filed that you saved a life, and let’s get you treatment. Let’s get you help. Let’s get them help. We can save two lives in that process. You just letting them die, not calling that; That’s two lives gone. To me, that means a lot. If you could just step up and say, Hey, I’m going to save a life today.”

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