SAN ANTONIO, Dec. 30, 2024 – Patients with opioid use disorder can reduce their days of opioid use and stay in treatment longer when using a smartphone app as supportive therapy in combination with medication, a new study by The University of Texas Health Science Center at San Antonio (UT Health San Antonio) shows.
The cohort study of 600 underserved patients found that those who chose to use the app – which combines contingency management behavioral therapy and recovery support from peers – and alongside medication, reduced their days of opioid use by 35% compared with those treated with medication only. Additionally, app users remained in treatment nearly 19% longer than those treated with medication alone.
“These findings suggest that augmenting medication for opioid use disorder with app-based contingency management may provide clinical benefits for underserved patients,” said Elise Marino, PhD, director of research operations at UT Health San Antonio’s Be Well Institute on Substance Use and Related Disorders. “Expanding the availability of app-based contingency management may contribute to decreasing the immense societal, economic and personal burden of opioid use.”
Marino is lead author of the study, titled, “Smartphone App-Based Contingency Management and Opioid Use Disorder Treatment Outcomes,” published in JAMA Network Open. The other authors also are with UT Health San Antonio’s Department of Psychiatry and Behavioral Sciences and the Be Well Institute.
A need to augment medication
Opioid use disorder continues to be a national crisis, contributing to substantial morbidity and mortality. Its annual societal cost in the United States hit $968.9 billion in 2018, the study notes.
Medication for opioid use disorder, or MOUD – including methadone, buprenorphine and naltrexone – is recognized as the only evidence-based treatment for the condition. This first-line treatment has been shown to significantly decrease opioid-related morbidity and mortality, and with consistent cost-saving benefits.
However, some patients still experience difficulties reducing opioid use and staying with their treatment, pointing to a need to augment MOUD. Many conditions benefit from dual treatment of medication and therapy. One therapy is contingency management, or CM, which provides financial incentives for accomplishing treatment goals.
This therapy traditionally has been delivered in clinics, with the goal of an opioid-negative finding from urine drug screens. While findings have been mixed, several reviews and studies have found that individuals treated with MOUD plus CM had better retention and fewer opioid-positive results from urine drug screens.
A long-standing limitation, however, is that patients are required to attend multiple in-person appointments per week for the therapy. With the recent COVID-19 pandemic, many were unwilling to make in-person CM visits. Additional access barriers, such as transportation, distance from the clinic and arranging child care, have supported other options like telehealth and leveraging new technologies.
There’s an app
One such technology is the WEconnect Health CM smartphone app. The app delivers evidence-based CM embedded in a recovery-oriented framework. In addition to providing substance-related behavioral targets, it permits patients to set daily goals that are personally meaningful, both substance use-related and otherwise, like attending a Narcotics Anonymous meeting, going for a walk or reading.
The app also includes a platform for tracking patients’ progress and payment, and provides encouragement for completing their daily goals. Additionally, WEconnect offers 1-to-1 peer support and online meetings facilitated by certified peers. In contrast to traditional CM, the app permits patients to make decisions regarding their own goals for treatment and to explore recovery through peer support services available anywhere and accessible outside of normal clinic hours.
For the new research, the scientists set out to evaluate whether augmenting MOUD with app-based CM is associated with fewer days of opioid use at the end of treatment and greater retention than treatment with MOUD only.
The retrospective cohort study, which refers to research that follows a group of people over time, used data from Nov.1, 2020, to Nov. 30, 2023, collected from opioid treatment programs across Texas. The cohort included 600 individuals aged 18 years or older who were uninsured or underinsured and who chose to receive MOUD only or MOUD plus CM delivered by the WEconnect smartphone app.
Those who chose to receive MOUD plus app-based CM reported a mean duration of 8.4 days of opioid use at the end of treatment compared with 12 days for those who chose to receive MOUD only. Retention analysis showed that patients who chose to receive MOUD plus app-based CM stayed with their treatment for a mean duration of 290.2 days, compared with 236.1 days for those choosing to receive MOUD only.
“These results are promising, and they highlight the potential importance of a patient’s decision to use app-based CM,” the researchers concluded. “Despite the challenges of engaging patients in other app-based interventions, adding recovery-oriented, app-based CM may be one way to enhance clinical care and meet the growing needs of historically underserved patients taking MOUD.”
UT Health San Antonio is a world-class research university, ranking at the top 5% among institutions globally for clinical medicine according to U.S. News & World Report. It is No. 12 in the world among universities for the impact of its discoveries – in normalized citation impact, which compares the number of citations its research receives per paper to the average for similar published work, a recognized core measure of research impact.
Smartphone App-Based Contingency Management and Opioid Use Disorder Treatment Outcomes
Elise N. Marino, Tara Karns-Wright, Matthew C. Perez, Jennifer S. Potter
First published: Dec. 2, 2024, JAMA Network Open
Link to full study: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2827185
The University of Texas Health Science Center at San Antonio (UT Health San Antonio), a primary driver of San Antonio’s $44.1 billion health care and biosciences sector, is the largest academic research institution in South Texas with an annual research portfolio of $413 million. Driving substantial economic impact with its six professional schools, a diverse workforce of more than 8,500, an annual expense budget of $1.46 billion and clinical practices that provide 2.6 million patient visits each year, UT Health San Antonio plans to add more than 1,500 higher-wage jobs over the next five years to serve San Antonio, Bexar County and South Texas. To learn about the many ways “We make lives better®,” visit UTHealthSA.org.
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The Be Well Institute on Substance Use and Related Disorders at UT Health San Antonio is a comprehensive, low-barrier system of care that provides compassionate, evidence-based treatment for substance use and related mental health concerns across Texas. Through its hybrid clinic offering virtual and in-person services, a statewide provider network of more than 140 community partners and wraparound services like peer recovery support, the institute reduces barriers to treatment and supports recovery. It also leads cutting-edge research to advance treatment and conducts workforce training to disseminate best practices. Funded by federal and state sources, the institute is dedicated to expanding access, reducing stigma and improving care for individuals and families affected by substance use disorders. Go to bewelltexas.org.
It was a milestone moment for Corpus Christi native Alexandrea Villa — a small but powerful step in her journey. She bought sheets for her new bedroom set.
“I look at my apartment and wonder if I want to buy something because I won’t be there forever. And then I realize, ‘Shoot, look at that. I’m planning for the future,’” she said. “I keep having those moments the more I keep being positive. It’s cool.”
Since she was 17, Villa misused various substances, including cocaine, marijuana and alcohol. Extra money for purchasing new furniture and gifts for her nieces and nephews was instead used to buy drugs. And her outlook on life was far from positive.
“I would wake up, go to work and drink. That’s all I would put into my day. And now that I’m not drinking or using drugs, I have time to put into different things I want to do,” the 30-year-old said.
After the death of her father from a drug overdose over a year ago, Villa began using drugs more heavily. With the support of her family, she moved to San Antonio and entered a local rehabilitation center. As the end of her rehabilitation loomed, a counselor introduced her to Be Well Clinic, a state-supported initiative within the Be Well Institute on Substance Use and Related Disorders at UT Health San Antonio.
Launched in October 2021, the Be Well Clinic offers in-person and telehealth substance use treatment and recovery services for anyone in the state, regardless of their ability to pay. Since opening, the clinic has served over 2,580 clients. Last year, the program celebrated the grand opening of a 20,000-square-foot facility that brings together medicine specialists, behavioral health experts, researchers and recovery coaches under one roof.
“Thirty years ago, clinicians would say we need to stop the substance use before you can evaluate any other psychiatric problems such as depression or anxiety,” said Van L. King, MD, DFAPA, FASAM, medical director for the clinic. “But now we take the approach that we need to treat both problems at once. They significantly affect one another. It’s not unusual that people with substance use problems also have other mental health problems. It makes tackling one more difficult if you don’t tackle the other.”
King said anyone needing the clinic’s services will find that they will be treated with respect and have an appointment within a week. Additionally, the clinic offers free transportation through a rideshare program, a mail-order pharmacy and 24/7 live peer support to help patients access services when and where they need it. At the clinic, patients are evaluated by a psychotherapist and a physician or nurse practitioner who are experts in substance use disorder treatment.
Patients are then offered a choice of services, including a case manager, should they need help obtaining a state identification card, sober housing, or any number of social services. Patients can also arrange to meet with a peer coach through the clinic.
“Many people find they are sort of lost as to the first step. A therapist can help with that, but sometimes people feel more comfortable with people who can understand them from a more personal point of view,” King said.
Peer or recovery coaches who themselves have misused drugs and are now in recovery can relate to patients through their shared experience. King said the vast network of coaches through partnerships with other agencies is especially helpful in rural communities.
“For some people, misusing substances is their major social connection. If you are going to stop, you have a lot of time on your hands. You have to figure out what you are going to do for socializing and recreation,” said King. Peer recovery coaches can help fill the gap and offer alternatives for socializing to maintain the patient’s sobriety.
Within the peer recovery community, patients will find acceptance of the use of medications to maintain their recovery, said King, noting that patients using methadone maintenance treatment or other medications to help with their sobriety sometimes have a difficult time receiving support in the community.
“There is a stigma of being on an opioid to treat opioid use disorder, and some believe you should just be abstinent from all substances,” he said. However, it is clear from decades of research, that medication plus counseling is the most effective way to treat severe and chronic substance use disorders, King said.
“The peer recovery coaches are educated and accepting of medications. That’s going to have a significant impact on general attitudes toward medications to treat substance use problems as time goes on.” And yet, stigmas are still prevalent outside the recovery community.
“It’s clear that half of the risk for substance use problems is genetics — what you’ve inherited,” he said. “There are a lot of differences in people that folks tend to overlook when they are judging others.”
The use of telemedicine, King said, has been a game changer for the treatment of substance use disorder. With 191 of the 254 counties in Texas considered rural, telemedicine was necessary to expand the reach of the services provided.
“It may be one of the only positive things that came out of the COVID-19 pandemic is this rapid transition to making medical services, including mental health and substance use services, available more readily,” King said. “Not every patient likes to use telemedicine all the time, but it certainly is better to have it available remotely than not have anything available.”
Since inception, the clinic has served over 2,400 clients through telemedicine. King said the future of Be Well Clinic is to broaden services across the state and continue its evidence-based treatment.
“We have research projects that people can participate in to access new approaches to treatment. We have highly experienced clinicians who are academically affiliated and up on the most recent cutting-edge treatments available,” he said.
As for Villa, she sees her future very differently now. She is looking forward to maintaining her sobriety, spending time with her family, and continuing to learn more about herself.
“So far, the biggest thing I’ve learned about myself is that I am worthy,” she said.
Be Well Clinic is funded by the Texas Health and Human Services Commission through federal funding from the United States Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration. To learn more, visit bewelltexasclinic.org.
The article "Hidden Killers: Inside San Antonio's struggle with fentanyl and meth addiction" discusses the sharp rise in fatal overdoses in San Antonio, largely driven by fentanyl, a potent synthetic opioid. It highlights the efforts of outreach workers, like Corazón Ministries, to provide harm reduction services and connect people to treatment. Dr. Jennifer Potter, executive director of Be Well Texas, is quoted saying, “I think we were caught a bit by surprise to have fentanyl in our midst now,” emphasizing how fentanyl's sudden presence has transformed the local drug supply into a dangerous mix."
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View full interview here
SAN ANTONIO – A handful of mothers who lost their children to fentanyl poisoning created an enormous movement, which led to a long line of local, state, and federal leaders vowing to do their part in stopping fentanyl poisoning.
“Two years ago, on June 11, 2022, I lost my youngest son Cody to illicit fentanyl poisoning. He was a beautiful young man,” said Kathy Drago.
“This is what I’m going to do. I’m going to be Jake’s voice,” said Martha Johnson, who lost her son to fentanyl poisoning.
“This is my nephew Ryan Matthew Garcia Jr. He thought he was taking a Percocet, but it was laced with fentanyl,” said Janet Zarate.
These families have taken the bravest step, sharing their pain and anger. And it didn’t take long for Texas leaders from near and far to hear their call.
In 2023, several of the mothers organized the first-ever fentanyl awareness walk, ‘Soles Walking 4 Souls.’ Hundreds of people showed up, and the leaders who jumped on board from the start were there again this year.
Texas Governor Greg Abbott offered a call to action.
“You all know about fentanyl. Far more Texans do not know about it. So, we have a tall task ahead of us to educate all Texans across the state - and if we can do that, we’re going to be far more successful in eliminating deaths,” said Abbott.
“This is not a Democrat or Republican issue,” State Rep. John Luhan said.
Each speaker echoed the same thing: that it’s about all of our futures.
“In the last three and a half years, our state troopers have seized over half a billion lethal doses of fentanyl statewide. That’s enough to kill every man, woman, and child in America,” said Texas Department of Safety Lieutenant Christopher Olivarez.
Programs at the state and local level are creating ad campaigns to display for high school and college students, those who are most at risk.
The Angel Moms join with the state’s One Pill Can Kill campaign, and alongside the Bexar Country Sheriff’s Office.
“We need to get in. Kids are dying every day,” Johnson said.
There’s already one tool, Narcan, which reverses the effects of fentanyl or other opioids. But to save lives, people must carry it and know how to use it.
“Lay them on their back. All you have do is take this, stick it in their nose, and press that red button,” said Dr. Bill Drees with UT Health San Antonio. “Then lay them on their side in the recovery position in case they vomit. If they haven’t responded in a couple minutes, take out the second nasal spray dose and spray it into their other nostril.”
Narcan is available for free in many places. You can get it through Naloxone Texas, of Be Well Texas. Be Well Texas is UT Health San Antonio’s statewide substance use treatment initiative.
You can also email or call the Angel Moms through the Soles Walking 4 Soles website and they will personally deliver it.
View the full interview here
Dr. Jennifer Potter, Senior Vice President for Research at UT Health San Antonio and founding director of the Be Well Institute on Substance Use and Related Disorders, sat down with Randy Beamer at KLRN to discuss the dangers of fentanyl and what communities need to know about substance use prevention and treatment.
An enthusiastic audience of colleagues, volunteers, students and members of the public turned out Monday night for Texas Public Radio’s (TPR’s) “Think Science: Let’s talk about addiction” live question and answer event held in partnership with The University of Texas Health Science Center at San Antonio at the Joe R. and Teresa Lozano Long School of Medicine campus’ Pestana Lecture Hall.
TPR moderator Nathan Cone started the event with some startling statistics about the tragic impact of substance use disorder on the state of Texas:
“It’s clear we are in the midst of a crisis involving both illegal and prescription drugs,” Cone said.
UT Health San Antonio has launched a program to address the crisis with high quality, evidence-based approaches grounded in compassion, built on science and improved by technology.
Expert panelists for the discussion were Jennifer Sharpe Potter, PhD, MPH, vice president for research and founding director of the Be Well Institute on Substance Use and Related Disorders; Van L. King, MD, medical director of Be Well, Texas, and professor in the Department of Psychiatry and Behavioral Sciences; and Brett Ginsburg, PhD, director of the Biochemical Pharmacology Analytical Laboratory (BPAL) and professor in the Department of Psychiatry and Behavioral Sciences.
Ginsburg has conducted basic research on substance use and alcohol use disorders for more than 30 years. He gave an overview of some of the forward-thinking research his lab is doing around substance use and alcohol-use disorders.
One of his current projects is researching a biomarker that can determine if a person has been drinking alcohol over the past several weeks. While there are breath and blood tests to determine very recent alcohol use, the alcohol leaves the body within a few hours and can no longer be detected. The identified chemical biomarker is present after someone drinks and remains detectable weeks later. This chemical biomarker is helpful for research projects related to alcohol use disorders as well as clinical and medicolegal uses because the biomarker will gradually decrease over time as drinking decreases.
A second project pays individuals for drinking less. This surprising technique, called contingency management, is highly effective, Ginsburg said.
“We can reward them for drinking less and hopefully, over time, they learn new habits, new behaviors, new outlets and that can be sustained over time,” he said.
Another project that Ginsburg was recently granted funding for through the Wellcome Leap program uses transcranial magnetic stimulation to reduce alcohol intake. The non-invasive treatment places a high-powered magnet near a person’s head to stimulate specific parts of the brain thought to be involved in the desire to drink alcohol.
This study is also examining brain imaging as a noninvasive biomarker of substance use cravings and potential for return to drug use. This research could determine which individuals are more vulnerable to a recurrence of drug use and may benefit from additional support.
“The common theme here is that we like to work with other groups, other experts, because only by bringing in many areas of expertise are we going be successful in tackling this complicated problem,” Ginsburg said.
King said it was his great fortune to become a part of the Be Well Institute for Substance Use and Related Disorders when Potter began forming it about four years ago.
“It has generated this incredible range of services that is statewide and that we are continuing to develop,” King said.
The Be Well Institute aims to treat all types of drug and alcohol problems in an outpatient setting with low-barrier, evidence-based approaches. Low barrier refers to providing services with the fewest difficulties, he explained. This could mean financial assistance for treatment or medications, transportation assistance to appointments, along with maintaining relationships with agencies like the San Antonio Fire Department and area hospitals for rapid referral to treatment after interactions with people with a substance use disorder. The evidence-based approach means everything they do is backed by research, providing the highest likelihood of success for people with substance use disorders.
King said the services they offer continue to expand based on needs in the area and the state. They recently hired an adolescent substance use expert who will begin in the fall and allow the institute to offer adolescent and young adult services for the first time for this underserved population.
Potter said she enjoys working in mental health and substance use disorders because she gets to see people who have struggled and then recovered from these conditions. She said universities like UT Health San Antonio have three missions — research, education and service. Part of that service is public health service.
Five years ago, she was discouraged that solutions to address substance use disorders based on decades of robust science were not being implemented. Soon after this, Potter said the Texas Department of Health and Human Services (HHS) contacted her to help them bring evidence-based solutions to Texas. The Be Well Institute, she said, provides a platform to continue to invest in and elevate science, education, clinical and public health service to help people.
King said the simplest definition of substance use disorder is when a person is using drugs or alcohol, and it creates a problem in their life. He said at Be Well, they consciously do not use the term “addiction” because of the stigma surrounding this word.
“We make an intentional choice to be stigma-free in the way that we operate because stigma is one of the major barriers and reasons why people do not talk about substance use disorder, and why people do not come forward for help,” he said.
Potter said substance and alcohol use in San Antonio appears to be similar to national trends. Fentanyl is a rising concern and Texas does not currently allow drug supply testing. Anyone using illicit drugs is at risk of taking fentanyl unknowingly because it is being added to counterfeit medications and other drugs. Methamphetamine is also a significant issue in the city. Alcohol and marijuana use continue to be of concern as well.
The Be Well Institute works with HHS and other agencies across the state to distribute federal funding for resources wherever they are needed.
“Our job is to shepherd those dollars and responsibly navigate them to community resources,” Potter said.
She lauded the great work of their peer recovery network that allows them to be a 24-hour program with someone available to answer the phone at any time.
There is no wrong door to enter recovery, Potter said, and they work with each individual to create the treatment plan that works best for them.
While many services are offered at the Be Well Clinic, other times they work with agencies to bring the services where they are needed. Corazon Ministries, a nonprofit organization, provides meals, hygiene kits, healthcare services and more to the city’s unhoused population. Be Well recently received funding to begin a mobile medical team that will focus on helping unhoused people in central San Antonio.
Cone invited audience members to ask the panelists questions. The first question was about the use of technology — especially artificial intelligence — in this field.
Ginsburg said there is research into telephone technology for pinging or geofencing (with a person’s permission) to alert a person about locations that could trigger urges to use drugs or alcohol. Technology is also assisting research through the ability to compile a massive data bank from the Wellcome LEAP project his team is working on as part of an international consortium. Researchers from all over the world are working on related topics and projects in the areas of substance use and alcohol disorders. This information can be leveraged to improve the way health providers diagnose and treat these conditions.
King noted mobile apps that Potter and the Be Well Institute are currently researching. One is for people in early opioid recovery, where individuals can input symptoms and the app software will learn about the individual and provide targeted feedback. Another application uses chatbot technology to assist people in determining whether they might be experiencing problems with substance use and provides constructive feedback.
Potter added that the goal, when using this technology, is figuring out how to use tools on the artificial intelligence (AI) continuum to promote an engaging and informative experience.
Cone wrapped up the evening by asking each of the panelists to discuss what they are looking forward to in the future for their research or programs.
Ginsburg said he aims to continue research into the physical and behavioral aspects of how some people successfully recover from substance- or alcohol-use disorders.
“What we are learning is that recovery changes the way the person responds to those things that used to be triggers, so those things that might have promoted a drug-seeking response or return to drug use no longer do,” he said.
He added that even if there were a drug that eliminated the craving for these substances, the person would still have to find a way to lead a substance-free life.
“Learning how to optimally use these medications to help reduce some of the physiologic hallmarks of substance use disorders, and how to strengthen their behavioral repertoire so that they can learn to live without the substances. That’s my hope for the future is that we get better at understanding how to improve recovery for people,” Ginsburg said.
King said he hopes to continue developing and expanding the Be Well Clinic to increase capacity and expertise to help more people both in San Antonio and across Texas.
Potter said there is still a great deal of work to do because many people are not ready for the help available to them.
“When people are not ready, when they are not at that moment, when they are not ready to connect, is when we lose them,” she said.
Potter said the goal is to have a resilient system in place so that when a person is ready – whether it be the first, second or sixth time – they are there to help.
The “Think Science: Let’s talk about addiction” event is available for listening at https://www.tpr.org/tags/think-science.
For more information about the UT Health San Antonio Be Well Institute visit https://bewelltexasclinic.org/ or call 888-85-BeWell (3935). The Institute is located at 5109 Medical Drive, fourth floor.
Narcan nasal spray at an opioid educational training class with Callie Crow, the founder of Drew's 27 Chains, on March 31, 2022, in Caddo Mills.
Photo Credit: Ben Torres for The Texas Tribune
Texas has tapped more than $45 million in federal funds to get the overdose-reversing drug into the hands of law enforcement, members of the public. But the program has been plagued by supply issues, delays and lack of communication.
After years of struggling to consistently provide the overdose-reversing medication naloxone to organizations that rely on a free supply of the medication, the state government is revamping its centerpiece distribution program.
That program, until recently called More Narcan Please, has been run by the University of Texas Health Science Center at San Antonio. In February, however, following years of supply and distribution struggles, UT Health San Antonio shuttered the More Narcan Please website and shifted distribution to Be Well Texas, a separate initiative within the center that addresses substance use. It’s now branded as Naloxone Texas.
Experts say that offering consistent and reliable care and services is important to building trust with people who use drugs, particularly people who are unhoused, but the state’s inconsistent supply of free naloxone has made that difficult. Officials at UT Health San Antonio say they have improved distribution and communication in recent months.
After the Texas Health and Human Services Commission launched the Texas Targeted Opioid Response in 2017, the state began offering free naloxone to individuals and organizations, including law enforcement agencies, recovery centers and community-based groups working with people who use drugs. The effort is funded by federal grants that have so far sent a total of $45.47 million to Texas. In 2019, HHSC began contracting with UT Health San Antonio to use those funds to purchase and distribute naloxone and conduct training about how to administer the medication.
In its early days, More Narcan Please was able to quickly ship large amounts of naloxone, delivering pallets of medication to harm reduction organizations at the forefront of combating opioid overdoses. Harm reduction is a strategy for providing services to people who use drugs without attaching stigma or strict parameters and involving people who use drugs in planning and implementing that strategy.
But as demand grew, the program struggled. In 2022, it ran out of money; HHSC said that was due to a shortage of the much cheaper injectable version of naloxone. In the fiscal year ending last August, the agency renewed funding to UT Health San Antonio, but More Narcan Please limited organizations to 48 doses and asked them to request more only after those had been distributed.
Distribution has also been unpredictable. At the end of last year, after experiencing long delays for small deliveries of naloxone, harm reduction organizations suddenly received large deliveries courtesy of More Narcan Please, leaving many wondering why shipments had not come sooner. In January, More Narcan Please said it would take between 14 and 45 days to process requests for naloxone. Some harm reduction organizations said they ran out of the state-provided naloxone while waiting for more doses.
UT Health San Antonio said that it made changes earlier this year that addressed those delays, and naloxone is now shipping much more quickly.
Groups handing out the naloxone say the lack of clear communication about when the drug was available made it hard to plan their own distribution strategy.
“A lot of the time when we'd put an order in it would take weeks,” said Bret Flores, executive director of the DFW Harm Reduction Access Movement, a grassroots organization that provides education and resources to people who use drugs. When his organization did receive shipments, “it was just very small quantities,” Flores said.
Naloxone, known under the brand name Narcan, is available as a nasal mist over the counter for about $40. One box contains two doses. But experts say the cost and stigma associated with drug use means many people who use opioids are unlikely to walk into a pharmacy and purchase it. The first person to respond to an overdose is most likely someone who uses drugs or their family member, and free distribution to those populations is considered one of the best ways to reduce opioid overdoses.
The Texas Harm Reduction Alliance, which provides resources and services to people who use drugs, offers naloxone at its drop-in center in Austin, where it also provides education, counseling, wound care and necessities like personal hygiene products and clothes. Last year, the group distributed nearly 13,000 doses of naloxone. After delays from More Narcan Please, the alliance began receiving naloxone from the city of Austin and Travis County.
Mike Prado, the Abilene-based director of West Texas Harm Reduction, distributes naloxone across a swath of the state that stretches about 200 miles. He used to rely heavily on More Narcan Please. In an interview last year, Prado said he was getting about 90 percent of his naloxone from other organizations that donated expired doses, which remain viable long after the expiration date.
“We used to get a nice chunk of naloxone from More Narcan Please,” Prado said. “Then I don’t know what happened.”
Since Be Well Texas took over naloxone distribution in February, shipping to organizations requesting bulk orders is now happening within about five days, said Jennifer Sharpe Potter, UT Health San Antonio’s vice president for research and Be Well Texas’s executive director. Individuals can still request two-dose boxes by filling out a form on the Be Well Texas website.
“I am aware that individuals have expressed concern about the rapidity with which they receive naloxone,” Potter told Texas Community Health News. “This is life-saving work, and we want to make sure that people get naloxone as quickly as possible.”
UT Health San Antonio’s contract with HHSC requires it to distribute at least 120,000 doses a year. with a focus on “individuals that are most likely to experience or respond to an opioid overdose, as well as organizations that directly serve individuals who are most likely to experience or respond to an opioid overdose.”
The contract also directs UT Health San Antonio to implement a “county-level saturation approach,” which HHSC defines as ensuring that every county has 20 times as many doses of naloxone as it does recorded overdoses.
UT Health San Antonio’s contract expires in August and the state is expected to announce who will continue administering naloxone distribution in September.
When More Narcan Please initially launched, about 40 percent of the naloxone it distributed went to law enforcement. Last year, Texas Community Health News found that some recipients of state-funded naloxone were destroying expired doses, although More Narcan Please was encouraging them to donate it to other groups that would use it.
In recent years, UT Health San Antonio began asking recipients not to give away naloxone at conferences and stopped distributing to pharmacies. In its request for the new contract, HHSC instructed applicants to outline a plan for redistributing older doses before they expire, sidestepping any restrictions on handling expired doses.
Flores, with the DFW harm reduction group, said he’s seen an improvement this year, not just in how quickly naloxone is delivered but also in communication. When Naloxone Texas warns him it will be shipping a smaller amount of naloxone, he can make sure he has another source lined up.
“At least now they're letting us know ahead of time we’re not going to get the full order,” Flores said.
Last year, the state expanded its naloxone access programs. The Texas Division of Emergency Management began distributing $75 million in naloxone, provided by a pharmaceutical company as part of a legal settlement with the state government, to county sheriffs.
While the state government has said naloxone access is a key component of its response to opioid overdoses, it has been slow to use state funds to buy the medication. This year marks the first time Texas will be using state funds for the distribution of naloxone after years of relying on federal grants. The Texas Comptroller’s Office, which oversees a $1.6 billion opioid abatement fund generated by legal settlements with pharmaceutical companies. The comptroller’s office is currently accepting proposals for a program that would distribute $18.75 million in naloxone statewide and another $3.13 million for naloxone distribution in counties of less than 100,000.
And last year the Legislature directed an additional $18 million for UT Health San Antonio to purchase naloxone in 2024 and 2025. Those funds have fewer parameters, and Potter said that gives her program flexibility to meet demand, because she can direct applicants who aren’t a priority for one program to the other.
“We have greatly increased the output of naloxone being distributed and been able to fulfill the requests that have come through our door,” she said.
Jason Buch is an Austin-based freelance journalist who works with Texas Community Health News, a collaboration between the Texas State University School of Journalism and Mass Communication and the university’s Translational Health Research Center.
Listen to the full interview here.
Jennifer Sharpe Potter, PhD, MPH, wants UT Health San Antonio’s Be Well Institute on Substance Use and Related Disorders to be the best substance use disorder institute in the world.
"And we're going to do that by developing the very best treatments," she said. "We're going to do that by being a model and a beacon for stigma free, education and service delivery, because every life is worth saving."
Be Well Texas is already revolutionizing how substance use disorder is treated in Texas. "The first thing it's going to sound different is it's outpatient. And it also is different because it's virtual," she said.
This makes services accessible to more people in every corner of the state.
"For something that can be so stigmatizing, the privacy and the safety that's afforded to you when you're doing a telehealth visit or a video visit is actually lowering the barrier to entry into treatment," she said.
Potter wants the institute to advance our understanding of substance use disorders and how to best treat them. For example, they’re testing an app they hope will improve outcomes for those in treatment for opioid use disorder.
"We use science to anchor, and then we act practically and locally, and we try to understand people's struggles and lower the barriers for them to get the help they need," she said. "Because no one should die alone from a preventable condition. And this is preventable."
Science & Medicine is a collaboration between TPR and The University of Texas Health Science Center at San Antonio that explores how scientific discovery in San Antonio advances the way medicine is practiced everywhere.
The city’s health department on Thursday received hundreds of thousands of dollars to address opioid addiction and overdoses in San Antonio through 2025.
Also on Thursday, City Council approved $909,000 in opioid settlement funds — the first allocation of millions of dollars from opioid lawsuit settlements funneled to cities and municipalities — for the Metropolitan Health District to use over two years on substance abuse and harm reduction initiatives.
The dollars come as San Antonio continues to reel from overdose rates, largely driven by methamphetamine, heroin and fentanyl poisoning.
San Antonio anticipates it will get more than $6 million from the settlements, paid out over 18 years, but some funds could be cut, or eliminated, due to pharmaceutical companies declaring bankruptcy.
Here’s how Metro Health plans to use the $909,000: $434,000 will be used for substance use outreach and community capacity building initiatives; $175,000 for harm reduction supplies and Narcan kits; $150,000 for targeted provider education to address stigma for pregnant people with addiction or in recovery. Only $100,000 will go to medical treatment for street outreach clients. Metro Health also plans to use $50,000 to create a substance use resource portal.
Jennifer Sharpe Potter, founding director of the Be Well Institute on Substance Use and Related Disorders in San Antonio, said the need to mitigate opioid deaths is urgent, but so is the need for treatment.
“We can’t treat someone who is dead,” said Potter, who also is a professor of psychiatry and behavioral sciences at UT Health San Antonio.
But those who live with addictions and survive overdoses will often develop substance use disorders, and evidence-based treatment infrastructure needs to be available, she said.
Potter, a national expert in opioid use disorder and researcher on prevention and treatment, said the landscape for addictions in San Antonio has changed over the years to include stimulant use disorders caused by drugs such as methamphetamines and cocaine, often involved in San Antonio’s overdose deaths.
“If we focus the settlement dollars only on opioids, we are missing what we truly need to do to address substance use morbidity or mortality in our community because the landscape has changed,” she said.
Currently, San Antonio isn’t at a capacity to receive people who could benefit from substance abuse treatment, Potter said.
The opioid settlement funds could help fill that gap, at least for street outreach clients in San Antonio. Metro Health plans to partner with the research-focused Addiction Research Institute, Bexar County, Center for Health Care Services, Corazon Ministries, San Antonio Nexus Connection, St. Luke Baptist Church and the Texas Harm Reduction Alliance to do that.
Most of the partners “work closely to refer or connect people with treatment services provided by other organizations,” said Cleo Garcia, public information officer for Metro Health.
Potter said teens are particularly at risk, as they have “no access to treatment.”
“We do not have access in San Antonio, nor do we have that access in Texas for adolescent [substance use disorder] treatment. We have support services, but some young people will need treatment.
At the Be Well Texas Clinic, a UT Health San Antonio clinical program that Potter oversees, people under 18 call, but the treatment isn’t available, she said. Organizations like the San Antonio Recovery Center and Rise Recovery also don’t offer treatment, but the Center for Health Care Services refers teens to other options — like Complex Care at CommuniCare, which has one counselor which focuses on substance use disorders — depending if they have insurance or not.
The clinic is bringing an adolescent addiction medicine specialist to San Antonio, a possible first for the city, she said.
“This very young, very vulnerable group of individuals that are relatively new to substance use … are at risk for death but also at risk for a lifetime disorder that is life-threatening,” she said.
The health department will also present a proposed resolution to designate drug overdoses as a public health crisis in San Antonio and a follow-up on the distribution of funds at the City Council’s June 5 Community Health Committee meeting.
Bexar County has received about $14.4 million in opioid settlement dollars. It has allocated $3.4 million, with $11 million remaining.
In March 2023, a fund policy framework for spending the money included prevention, intervention, treatment and recovery, evaluation and administration.
At a March 12 Commissioners Court meeting, Andrea Guerrero-Guajardo, director of the Bexar County Preventative Health and Environmental Services Department, said the county has allocated $1.5 million to the Casa Mia project, a recovery home for mothers and their children recovering from substance abuse disorders; $95,000 went to hiring a substance use program coordinator; more than $47,000 went to purchasing Narcan for the Bexar County Sheriff’s Office; and $1.7 million funded the Center for Health Care Services contract for the 2024 fiscal year.
Bexar County in March put a call out to organizations interested in applying for funding. Funding awards to area agencies will be presented to commissioners later this year. Organizations focused on Bexar County’s fund policy framework, including prevention, intervention, treatment and recovery and evaluation, will be considered.
The focus on drug overdoses comes from the death rate for opioids in Texas, which has “increased dramatically” over the past 15 years, Metro Health said; It’s now at more than four deaths per 100,000 population in Texas.
Garcia said the rate is higher in Bexar County: Today, there are more than five deaths per 100,000 residents living in Bexar County. In 2022, more than 2,000 people died from fentanyl in Texas — more than five a day.
Metro Health said 246 overdose deaths were reported in Bexar County in 2021.
Applications for the funding are available online through May 28.
UT Health San Antonio is studying an app that it hopes will improve outcomes for people being treated for substance use disorders. The app is called KIOS, and Dr. Jennifer Sharpe Potter described it as a prescription digital therapeutic.
“Which is a long way of saying this could be something that's essentially prescribed by a doctor,” she said.
Potter is the founding director of UT Health San Antonio’s Be Well Institute on Substance Use and Related Disorders, which includes Be Well Texas.
“The app is intended to help you stay in treatment, help you navigate if there are issues or complexities in how you're feeling. It helps with mood and other issues like that,” she explained.
This app is a home-grown product, Potter added.
“This is something that was developed here locally in San Antonio,” she said. “We're testing it here in San Antonio at the clinic and, depending on the results, will be able to introduce that in the marketplace."
Potter is recruiting people locally to participate in a clinical trial. They will use the app as part of their treatment for substance use disorder.
“If it works and then be able to submit to the FDA that this is something that a health care provider could prescribe,” she said.
Learn more about the clinical trial, including how to enroll, here.
