Texas Hospitals and the Opioid Epidemic


Every day hospitals and health systems see the effects of the nation’s growing opioid epidemic. Opioids accounted for nearly 70% of drug overdose deaths in the U.S. in 2016—five times higher than opioid-related overdose deaths in 1999.

Hospitals are on the front lines in part because of the increased morbidity and mortality related to prescription opioid drug use.

The Texas Hospital Association has worked diligently to provide member hospitals with the tools and resources they need to address statewide opioid use and abuse from its many contributing factors. The resources that follow describe these efforts in greater detail.

Texas Hospitals’ Holistic Approach to Addressing the Opioid Epidemic

While the state’s opioid problem requires the engagement of physicians, insurers, drug manufacturers, pharmacies and beyond, Texas hospitals have taken a proactive leadership role to address statewide opioid use and abuse by employing a multi-faceted approach that attacks the issue from all angles.

In addition to implementing THA’s voluntary opioid prescribing guidelines for hospital emergency departments, Texas hospitals are consulting a wide array of sophisticated data that identifies potential drug seeking behavior and other patient factors to limit opioid prescriptions across all care settings. Specifically, Texas hospitals are consulting data from:

  • THA and Illumicare’s Smart Ribbon to improve opioid-related outcomes in inpatient settings.
  • The state’s Prescription Monitoring Program to improve opioid-related outcomes for patients in inpatient and outpatient care facilities.

In partnership with the Texas Department of State Health Services, THA also is working with 200 Texas hospitals under the TexasAIM initiative to improve maternal care and reduce preventable maternal mortality and morbidity. As part of the initiative, THA is leading a 10-hospital pilot program to improve obstetric care for women with opioid use disorder. THA and TDSHS will launch the statewide opioid-focused project for inpatient and outpatient facilities by 2020.

THA’s Voluntary Opioid Prescribing Guidelines for Hospital Emergency Departments

Hospital emergency departments have a responsibility to treat every individual who presents for care. Unfortunately, some patients see this as an opportunity to seek medication for non-therapeutic purposes. Despite prescribing a fraction of the opioid prescriptions written nationally, opioid prescriptions from emergency departments account for approximately 45 percent of opioids diverted for non-medical use.

To limit the number of inappropriate opioid prescriptions and help curb opioid use and abuse among individuals who exhibit drug-seeking behavior and to prevent new addictions, THA developed recommended, voluntary prescribing guidelines for hospital emergency departments.

Additional Materials

87th Legislature

86th Legislature

85th Legislature

HB 2561 – Sunset Reauthorization for the Texas State Board of Pharmacy

Opioid-Related Provisions:

  • Requires the agency to work with other agencies to identify potentially harmful prescribing practices and patient prescription patterns that suggest drug diversion or drug abuse.
  • Requires dispensing pharmacists to send all prescription information to the Prescription Monitoring Program by the following business day.
  • Beginning in 2019, all prescribers and dispensers shall consult the PMP prior to dispensing or prescribing opioids, benzodiazepines, barbiturates or carisoprodol. *There is an exception for cancer patients.
  • Each regulatory agency that licenses, certifies or registers prescribers must implement guidelines for responsible prescribing of opioids, and access information submitted to TSBP to determine whether the prescriber is engaging in potentially harmful prescribing practices.
  • Creates a joint interim committee to conduct an interim study on the monitoring of the prescribing and dispensing of controlled substances in this state.

SB 315 – Texas Medical Board’s Requirement to Adopt Opioid Prescribing Guidelines

Opioid Related Provisions:

  • Permits TMB to inspect uncertified pain management clinics or facilities. TMB must establish grounds for inspection, including grounds based on the population of patients served, the volume or combination of drugs prescribed and other criteria that TMB deems sufficient.
  • TMB must adopt guidelines for the prescription of opioid antagonists. (Note: This provision is also included in SB 584.) The guidelines must address:
    • Prescribing an opioid antagonist to a patient to whom an opioid medication also is prescribed.
    • Identifying patients at risk of an opioid-related drug overdose and prescribing an opioid antagonist to that patient or to a person in a position to administer the opioid antagonist to that patient.


Proposed Rules: Practice Guidelines for the Administration of Buprenorphine for Opioid Use Disorder Treatment (1/12/21) | HHS

Texas Hospitals’ Commitment to Addressing the Opioid Crisis

A New Light in the Darkness: Using Hospital-Based Medication-Assisted Treatment to Tackle the Opioid Crisis

CDC’s Pocket Guide: Tapering Opioids for Chronic Pain

National Journal Presentation – Understanding the Opioid Epidemic (May 2018)

TDSHS’ How to Get Help With Substance Abuse

TDSHS’ Outreach, Screening, Assessment and Referral Centers for Substance Use Disorder Treatment

Locations of Substance Use Disorder Treatment Services in Texas

SAMHSA Behavioral Health Treatment Locator

Multimodal Pain Therapy, by Craig D. Rhyne, M.D., Regional Chief Medical Officer, Covenant Health

THA Voluntary Guidelines for Hospital Emergency Department Prescribers of Opioids (February 2018)

2017 Colorado Opioid Safety Pilot Results Report

Massachusetts Health & Hospital Association Substance Use Disorder Prevention and Treatment Task Force

The White House Council of Economic Advisers’ Report on the Underestimated Cost of the Opioid Crisis (November 2017)

The President’s Commission on Combating Drug Addiction and the Opioid Crisis – Final Report (November 2017)

American Hospital Association’s Opioid Tool Kit – Stemming the Tide: Addressing the Opioid Epidemic (October 2017)

CDC White Paper – Guideline for Prescribing Opioids for Chronic Pain

CDC Guideline for Prescribing Opioids for Chronic Pain (March 2016)


Guidance for Treating Pregnant Women or Mothers with Substance Use Disorders