Fentanyl-related deaths in Travis County have more than doubled since 2022 (art by Zeke Barbaro / Getty Images)

Travis County is extending the public health crisis designation for overdose deaths another two years until October 2026. The declaration was first made in 2022 after drug overdoses became the leading cause of accidental deaths in the county, according to the Travis County Medical Examiner's Office.

Since then, the issue has only grown worse. The most recent data shows that fentanyl-related deaths have more than doubled since the beginning of the health crisis, motivating local leaders to further extend the designation in November.

"The influx of fentanyl into our streets has not slowed," said Mark Hilbelink, the executive director of Sunrise Homeless Navigation Center. "My anecdotal guess is that if we didn't put these methods into place, we would be dealing with a much, much, much higher number [of deaths] at this point."

Crisis conversations have centered mostly on how local leaders should utilize opioid settlement dollars, which commissioners have put toward funding an increase in the supply of Narcan, peer recovery support, methadone services, and the Santa Maria Hostel for women in recovery, as well as disposal bins for needles.

So far, Travis County and the city of Austin have received $3.59 million from Texas lawsuits against pharmaceutical companies and consultants for deceptive marketing and their role in the opioid crisis nationwide. The full amount Travis County expects to receive is $4.7 million distributed over 18 years.

In the most recent meeting, commissioners chose to expand into a new area: funding harm reduction groups that build relationships with people who use drugs. These groups provide supplies, support, education, and a stigma-free environment.

The commissioners also replenished funds for Narcan, but just $100,000 this year, because other sources like the city, state, and Central Health have built up more reliable supplies too.

"I would bump it up to $300,000. The money is sitting there," said Commissioner Ann Howard. "To me it's sort of an oxymoron to be working under a crisis and yet planning how to neatly spend the money out over the coming years ... the long-term sustainability can be figured out."

Attendees applauded.

"I think the availability of Narcan has probably been the biggest [improvement]," said Hilbelink with Sunrise, where clients can request Narcan or pick it up at a vending machine on-site. "It was a much bigger issue two years ago. We really did lack a coordinated supply of Narcan in our community. That has not 100% improved, but it has improved."

Travis County distributed over 8,700 doses of Narcan nasal spray last fiscal year.

Several harm reduction workers reflected on a time when they had to scramble to find doses to meet the demand. That meant going to a wide array of sources, resorting to expired medication or forking the money out of their own organization's budget.

"There were known stockpiles in [county] warehouses and sometimes [the Narcan] would expire, while there were people in town needing it," said Hilbelink. "You don't hear those stories as much anymore."

A stable supply is something Texas Harm Reduction Alliance is still working toward, said Steve Smith, who does outreach. He's supportive of the county and city funding for Narcan but thinks too much of the supply goes to institutions.

"It's mostly in the wrong hands - to me that's the biggest problem," Smith said. "Clinics and hospitals have Narcan, but most of the time when clients go there, they lie [about their drug use] because they get treated badly."

Harm reduction groups that distribute Narcan from the county must also agree to a set of conditions. One is to recite a short script educating clients on substance use disorder. Em Gray with the NICE Project says that requirement poses a barrier and runs counter to the values of harm reduction. Her nonprofit runs four vending machines across Austin that are free and anonymous. For that reason, the machines cannot be stocked with county supplies.

"First, not everybody who uses Narcan has a substance use disorder," Gray said. "Plus, we're a harm reduction organization that honors all pathways. We can't talk to everybody about substance use disorder because that would lose trust in our program."

Gray also questions who is really benefiting from the special attention that a crisis declaration brings. Law enforcement have removed people living in homeless encampments in a series of sweeps this year. Gray said during sweeps, people sometimes lose their medications. One peer-reviewed study found that overdose deaths spike in the aftermath of encampment sweeps.

Lily Hughes with Texas Harm Reduction Alliance echoed these feelings. Her group previously did outreach work at camps but many of them have disappeared. The sweeps have forced her to change the approach to pop-up events only.

Future solutions need to include a housing-first model, meaningful drug checking practices, and, above all, dismantling a culture of stigma and shame, she said.

"Narcan is just the tip of the iceberg, and the money that they're putting into this community is just barely scratching the surface," Hughes said. "Narcan is not going to save people who are using alone because they are stigmatized and ashamed. Without addressing that, Narcan can never be fully effective."