Texas is facing a drug‑poisoning crisis that continues to change faster than many communities can keep up with. Behind the headlines are real people, families, and neighbors navigating the heartbreaking realities of overdose. Drug‑poisoning deaths in Texas have risen more than 68% since 2019, a surge that has touched rural towns, major cities, and every region in between. For many Texans, the crisis feels both urgent and deeply personal. While the urgency of this crisis provides important context, the work of understanding and responding to it requires sustained, evidence‑driven research.

In 2024, the Texas Department of State Health Services (DSHS) partnered with the Public Policy Research Institute (PPRI) at Texas A&M University to conduct a multi‑year evaluation of the Texas Overdose Data to Action (TODA) program.

TODA, funded by the Centers for Disease Control and Prevention (CDC), is designed to strengthen statewide overdose‑prevention efforts by improving data quality, supporting community strategies, and expanding access to lifesaving resources.

A Research Approach Rooted in Community Insight

PPRI’s evaluation is grounded in a mixed‑methods research framework that centers both quantitative data and lived experience. Qualitative interviews and focus groups are systematically coded using thematic analysis, while quantitative datasets are integrated to identify statewide trends and emerging risk patterns. This approach ensures that prevention strategies reflect real-world conditions across Texas’s diverse communities.

• Mapping prevention efforts across the state: As part of its statewide landscape analysis, PPRI catalogues local partnerships and service distribution to understand where gaps exist.
• Analyzing publicly available data: PPRI reviews opioid‑related data from multiple state sources including morbidity and mortality surveillance (the ongoing tracking of deaths), emergency department trends, and prescription monitoring data, to assess patterns of risk across Texas.
• Listening to organizations working on the front lines: Through interviews and focus groups, PPRI gathers insight from community coalitions, first responders, health professionals, educators, and service providers who confront changing drug‑use patterns and barriers to care every day.
• Engaging individuals with lived and living experience: Recognizing the value of personal expertise, PPRI is creating a lived‑experience workgroup that informs evaluation design, identifies emerging needs, and shapes recommendations for statewide prevention.

What Texans Are Sharing and Why It Matters

So, what are Texans saying? Themes emerging from PPRI’s ongoing interviews and focus groups highlight the evolving realities of overdose prevention in Texas. Topics include:

• confusion and concern related to fentanyl contamination,
• growing risks among youth,
• limited access to treatment options in rural or underserved areas,
• and the difficulty of keeping pace with rapid changes in the illicit drug supply.

Read the full TODA Landscape Analysis published by PPRI in December 2024.

Strengthening Decision‑Making Through Data: The Texas Opioid Risk Index

As part of its work, PPRI also developed the Texas Opioid Risk Index, a publicly accessible tool that integrates multiple datasets to show county‑level opioid‑related risks and available resources. This map helps local and state leaders identify vulnerable regions and allocate prevention resources more effectively.

 PPRI’s evaluation of TODA will continue through the duration of the program, with researchers conducting annual interviews, updating datasets, and refining analytic models to reflect new trends. This ongoing research supports Texas in building a more coordinated, data‑informed, and community‑responsive approach to overdose prevention.

PPRI’s work is helping Texas refine its prevention strategies and move toward a more informed, compassionate statewide response. Urgency is clear. Since 2019, Texas has lost more people to drug poisoning than the entire population of Angleton, Texas; a staggering level of loss that mirrors the disappearance of an entire community. With each story shared and each insight uncovered, Texas moves one step closer to saving lives.