Issac Mercado was born in an overdose hot spot located in the heart of San Antonio, near Alazán Courts. Born with an addiction to heroin, he figured he would also die from his addiction.
“If it wasn’t for Narcan, I wouldn’t be alive, as a matter of fact,” he said on Monday while volunteering at Grace Lutheran Church, which houses a day center where people can exchange used needles for clean ones and get two doses of the lifesaving overdose intervention drug for free. “I was shooting up and suddenly, I woke up and they told me they gave me CPR and two shots of Narcan.”
After 40 years battling addiction, Mercado is six months sober. He met his recovery coach while addicted and on the streets, and eventually decided to start his road to recovery. He’s working a steady job for the first time since 1989 and got a scholarship to become a certified recovery coach.
“This recovery is like walking on air. It feels great. I work now. … Now look at me,” Mercado said.
The City of San Antonio wants to use millions of dollars from statewide opioid lawsuit settlements for harm reduction strategies, like bringing more Narcan to San Antonio to prevent drug overdose deaths and to develop and fund treatment for babies born with addictions.
Texas received $1.6 billion in lawsuit settlements from opioid manufacturers and distributors, some of which has gone to local municipalities. Settlement funds have restrictions but can be used broadly to address addiction.
The city anticipates it will get more than $6 million from the settlement, to be paid out in less than $300,000 a year over 18 years. The city has received $1.4 million from the settlement so far. Bexar County got $14.5 million from the settlement to fund similar efforts, which a group of stakeholders will discuss with commissioners next month.
“There’s people [overdosing] left and right, falling like flies. [Corazón San Antonio street outreach] right now is walking through there with needles,” Mercado said, adding that there are only two people on the outreach team. “They need more people, because if it wasn’t for them, I would’ve never known about this place.”
District 5 Councilwoman Teri Castillo is requesting to designate drug overdoses as a public health crisis in San Antonio by May and wants to develop a plan to use the settlement money mostly on harm reduction and prevention, a proactive approach to reduce overdose deaths and the harms associated with drug use, like skin wounds and ulcers.
The drop-in center at Grace Lutheran Church shows there’s a need: Harm prevention techniques by Corazón San Antonio helped collect 600,000 used needles in 2023 and provided Narcan for more than 1,700 overdose reversals.
The council’s Community Health Committee recommends using the funds to: Allocate resources to harm reduction efforts like clean syringes for drug users; expand the availability of Narcan, a drug that reverses opioid overdoses, to nonprofits and workers in all public-facing city departments and properties; and create a program for pregnant people and babies born with drug addictions.
And that’s what volunteers say works for San Antonio. On Monday, used needles were being exchanged for clean needles, and volunteers packed safety kits which include sterile water, a tourniquet, alcohol pads and bandages.
Bexar County’s opioid-related mortality rate is below the national average but above the state average — and it rose rapidly from 2021 to 2022, increasing from 10 deaths per 100,000 people to 13.7 deaths per 100,000 in just a year, Metro Health data shows.
“The inventory goes like nothing,” Mercado said.
Addiction can start with the mismanagement of prescribed pain medication, like Percocet, OxyContin, Vicodin, heroin and fentanyl. Illicitly made opioids like fentanyl and heroin are cheaper and more accessible on the streets. Most people who visit the day center at Grace Lutheran Church use opioids and stimulants like meth, said Madelein Santibañez, director of harm reduction at Corazón San Antonio.
Jessie Higgins, chief mental health officer for the San Antonio Metropolitan Health District, said stress and isolation increased overdose deaths: In San Antonio, suspected toxic opioid indigestions increased by 27.4% from 2019 to 2022. It was also hard for people to access in-person treatment.
Drug overdoses in Bexar County
Before the pandemic, the city and county’s Joint Opioid Task Force had been reducing the number of drug overdose deaths in San Antonio by administering Narcan. According to a 2018 report, the task force created in 2017 helped Bexar County first responders save 1,869 lives that year by administering Narcan.
The program operated from June 2017 to 2018, and in early 2023, evolved into the Opioid “Tiger Team” after organizational changes in 2022 when Bexar County created the Department of Preventative Health and Environmental Services, according to Bexar County Preventative Health and Environmental Services Department Director Andrea Guerrero-Guajardo.
Community stakeholders on the Tiger Team discuss existing resources and gaps to address opioid addiction in Bexar County and will make its recommendations on how to spend the county’s share of settlement funds in about one month, Guerrero-Guajardo said.
People dying of drug overdoses in Bexar County tend to have used a combination of drugs, according to 2022 data from the Bexar County Medical Examiner.
“People right now are oftentimes not expecting they’re using opioids, they think they’re using a different substance, but fentanyl has been shown to be in all sorts of things you weren’t expecting,” Higgins said. “It’s not necessarily people’s drug of choice. Maybe it’s in their meth, in their marijuana.”
Castillo, who chairs City Council’s Community Health Committee, said having a multiyear budget and plan would decrease the number of people dying, hospitalized and calling for service related to opioids.
It also would increase the enrollment of pregnant people in recovery programs and decrease the number of babies born with neonatal abstinence syndrome and other diagnoses related to opioid addictions, she said.
The committee’s recommendation also suggests a public education campaign to promote mental health, youth education and dangers of fentanyl and more referrals to treatment programs.
“What I think needs to come up is education … [and] outreach,” said Jesus Martinez, a volunteer with Corazón San Antonio who is in recovery and wants to become a recovery coach. He showed scars from wounds on his arms, showing what happens when clean syringes aren’t available to drug users.
“There’s help now … there’s a way you can save a life with Narcan,” he said.
The city’s 2024 budget also allocated money to focus on the opioid addiction in San Antonio: $638,000 of federal pandemic relief money went to nonprofits for harm reduction measures aimed at substance abuse, like the work happening at Corazón.
“If somebody dies, they don’t have the chance to become sober, but if we can save their life, they have another chance to become sober,” said Erika Borrego, the organization’s CEO.
The plan to use the funds on the city side will be presented to City Council in February. Bexar County said Metro Health’s role in the Tiger Team ensures that city resources aren’t duplicated by the county, and both governmental entities will work together against the same issue in the community.
