Texas Reps. Sheffield and Coleman discuss the opioid epidemic

State Rep. Garnet Coleman, D-Houston, said Wednesday that he supports treating opioid addiction as a medical problem — not the way the country treated the crack-cocaine crisis of the 1980s.

“[Crack cocaine] was treated as a criminal justice problem,” Coleman said. “We even went to war against it, and I don’t believe we won that war. As a matter of fact, some people might say we lost it.”

Coleman, a member of the House Public Health Committee and the House Select Committee on Opioids and Substance Abuse, was speaking to The Texas Tribune’s health and human services reporter, Marissa Evans, at an event focusing on the opioid epidemic. His sentiment was shared by the other two panelists: state Rep. J.D. Sheffield, R-Gatesville, and Dr. Stephanie Jones, an assistant professor of anesthesiology and pain management at UT Southwestern Medical Center.

Here are a few highlights:

It’s a mental disorder

Jones stressed that people addicted to opioids suffer from a disorder.

“It is a brain disease,” she said.

Sheffield, vice chair of the House Public Health Committee and a member of the House Select Committee on Opioids and Substance Abuse, said that prisoners are being left behind in the opioid addiction conversation, as many suffer from mental health disorders, including substance use disorder.

“You have such a strong connection between substance use disorders and mental health issues,” Sheffield said. “And these folks in our prison system, not getting the proper treatment either in the prison or when first out of prison, they cycle back and forth.”

It is also important to pay attention to mental health patients that self-medicate, Coleman said.

“I have bipolar disorder,” Coleman said. “I used to drink like a fish and then, when I got the proper medication, I don't drink anymore.”

Hospital pain scales

Sheffield, who is also a family practice doctor, said hospitals’ pain scales fueled the fire of the opioid crisis.

Contrary to vital signs like pulse, blood pressure, temperature and respiratory rate, pain can’t be measured, Sheffield said. So doctors frequently asked patients to rate their pain on a subjective scale, which can lead to patients being over- or under-prescribed.

Hospitals were driven to rely on pain scales to keep their accreditation, which placed a heavy burden on doctors to keep patients pain-free, Sheffield said.

“You want to be accredited,” Sheffield said. “To not be an accredited hospital is a very bad thing.”

The Joint Commission, a nonprofit that accredits hospitals and other health facilities, updated their pain management standards in 2018 to include opioid addiction safeguards.

Texas politicians

Texas is starting to treat drug addiction as a mental health disorder, but that didn’t happen out of thin air, Sheffield said.

He said he remembers his first legislative session in 2013 when the Texas House debated a needle exchange pilot program to prevent the spread of diseases like HIV among drug users.

“But I remember some of my colleagues walking around on the floor, stating publicly to other colleagues, ‘Oh, what we are doing is promoting addiction,’” Sheffield said.

As a medical professional, Sheffield said he couldn’t agree less.

“We got very outvoted that night,” he said.

Coleman said Texas politicians ought to focus on all highly addictive substances, not only on opioids.

“People who are addicted, if they can’t find opioids they are going to find crack,” Coleman said. “If they can’t find crack, they are going to find methamphetamine. When we talk about substance abuse disorder we should talk about all of it.”

Disclaimer: The UT Southwestern Medical Center is a corporate sponsor of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.