Fentanyl is not a histrionic scare tactic. It is not a handy buzzword or an excuse to pivot into xenophobic rhetoric. Nor is addiction a moral failing, a signifier of the rot at the core of society that can only be fixed with bootstrapping and elbow grease.

However, these truisms do not negate the fact that fentanyl and other opioids are a serious public health issue. In 2023, the most recent year for which the Centers for Disease Control has data, opioids accounted for 76 percent of the 105,000 drug overdose deaths in the United States. In Harris County, more than 3,000 deaths involved opioids between 2020 and 2024, with the most occurring in 2022, according to Harris County Public Health (HCPH) data. Seventy-four percent involved fentanyl.

Beneath the fearmongering, punditry, and politicking, there’s layered discussion to be had about access to mental health services, societal marginalization, and the availability of opioids, opiates, and similarly destructive drugs. But the more misinformation regarding these substances proliferates, the harder it gets to solve the issue; the harder it gets to solve the issue, the more people wind up hospitalized or dead.

What’s Happening in Houston

Though visits to opioid-specific healthcare clinics have decreased since 2023, Dr. Rachel Roy, senior noncommunicable diseases manager at HCPH, says the health department recorded over 10,000 adult opioid-involved healthcare facility visits from 2021 to 2025, making “opioids the largest substance-specific contributor to healthcare utilization in Harris County.”

Thomson Ivins, a licensed professional counselor at the Council on Recovery, a Houston-area clinic specializing in substance use disorder, expresses deep concern over kratom, its derivative 7-OH, and their controlled counterparts. Sometimes referred to as “gas station heroin,” these substances can be obtained at gas stations, corner stores, and head shops. The high experienced from 7-OH can be similar to that of fentanyl, but the drug is much more affordable and accessible than prescription opiates and opioids. “For about 35 bucks you’re getting three pills, which people are going through in a single day,” Ivins says. “One single 15-milligram pill is about 20 times stronger than morphine, and we are seeing a massive uptick.”

Legal Doesn’t Mean Safe

Synthesized from a leaf native to Southeast Asia, kratom and its derivatives, including 7-OH, often attract people seeking to manage chronic pain with legal solutions when more traditional over-the-counter options no longer work. The Drug Enforcement Administration released a Notice of Intent to begin scheduling and classification for these substances in July 2026. Still, Ivins and his colleagues at the Council on Recovery say they have long been treating users for what is “essentially opioid withdrawal” after prolonged consumption of kratom and 7-OH.

The terms “opiate” and “opioid” are popularly used interchangeably despite their differences. Opioids, like fentanyl and heroin, are lab-created synthetic or semisynthetic controlled substances derived from opium poppies, while opiates, such as morphine and codeine, are directly crafted from plant materials. Both perform the same painkilling functions with similar side effects, and both are addictive.  

Montorea Thomas, HCPH’s substance abuse prevention program manager, says people can become dependent on either substance, to the point of abuse, addiction, or overdose, for various reasons—comorbid mental health conditions, “social drug use,” and pain management (both with and without a prescription) being some of the most common.

The Two-Spray Second Chance

While several treatments exist to address the different underlying causes, in the case of an overdose, the increasing availability of naloxone, better known as Narcan, saves lives despite the stigma.

Montrose Center recovery support peer specialist Jace Wright says despite naloxone’s ability to reverse the effects of an overdose, many are reluctant to keep it on hand due to stigmas surrounding addiction. But “Narcan is for someone else,” xe says. “It’s not for you. It’s for whoever is doing the opiates—a friend, a family member, somebody on the streets—that may need it. And it’s really easy to administer.”

Montrose Center, HCPH, Center for Recovery, and Santa Maria Hostel keep boxes of naloxone available for anyone who might need it, free of charge, and these organizations are available to teach people how to use the life-saving medication. The sprays come in packages of two, helping account for some overdoses that may need up to four administrations. “I always recommend anybody to carry Narcan,” says Wright, who plans to survey the Montrose neighborhood at night near the bars to see who might need support. Xe encourages others to join. Carrying and administering naloxone offers one of the simplest, more affordable ways to give hope, possibly even a second chance, to someone suffering from an opiate or opioid overdose.

How to Administer Narcan (Naloxone)

1.) Check for signs of overdose: shallow breathing, blue or purple tint to lips and fingertips, unresponsive to pressure on sternum or lips. If the individual appears lucid, ask what they’ve taken. Naloxone only works on opioids. Dial 911 if another substance is involved.

2.) If the individual appears lucid, ask permission to administer naloxone. If they refuse, ask if they prefer you dial 911 for professional medical attention instead.

If the individual either grants permission or is unresponsive, administer naloxone via nasal spray as instructed on the box. Immediately dial 911 and follow instructions—some cases require two to four doses total. You may be asked to do chest compressions as well, so it’s a good idea to brush up on this skill. Note: Naloxone has no adverse effects if given to someone not overdosing on opioids.

3.) If the individual wakes up, they may be disoriented, confused, and defensive. Stand back to avoid getting hurt.

4.) Stay with the individual until medical professionals arrive and clear you to leave.

TIP: Carry Narcan in your purse, messenger bag, or a specialized naloxone pouch. Store in a cool, dry area. A hot car or garage, for example, can reduce its effectiveness.