Public Health – Tarrant County Physician Online

Keep Patients Prepared with Good Medical Recordkeeping

Originally published by Texas Medical Association on July 25, 2023.

Hurricane season in the Atlantic Ocean opened June 1 and typically runs through November, and Texas physicians and patients alike may be bracing for the possibility of property damage and displacement.

With electronic health records (EHRs) proliferating, it’s never been easier for a patient to take agency over their own health care by having access to their documentation. Physicians and medical staff can help by aiding patients in accessing their patient portal and knowing what information to find there, and quickly.

“It is wise for every person to have their own medical information, including a current list of any medications they are taking,” said Gary W. Floyd, MD, immediate past president of the Texas Medical Association. “Such information can be very helpful, if not critical, if the patient is displaced due to a natural disaster or public health emergency.”

As part of regular emergency preparations, use TMA’s flyer to encourage patients to log in to your practice’s online patient portal to download and save or print their medical records summary. The flyer is customizable to include your practice’s web address for portal access.

Patients are urged to compile and save current information on their:

Medications and vaccinations;
Allergies;
Recent diagnoses and treatments; and
A primary physician contact.

This information is important when a patient sees any new physician but is especially useful in times of crisis.

“What happens when a disaster happens, and [patients] get displaced? Or they get in a traffic accident on a highway – who would know their information?” asked Sunny Wong, MD, a gastroenterologist and internist in Laredo and a member of TMA’s Committee on Health Information Technology. “[Patients] ought to have access to the record.”

Physicians who use a web-based EHR can rest assured that even if their practice is damaged by disaster, sensitive health information will remain safe. EHR vendors use networks of redundant servers to protect data if a hub goes down, says Shannon Vogel, TMA’s associate vice president of health information technology.

TMA surveys indicate most Texas doctors (89%) have electronic medical records; physicians who do not use a web-based EHR should have policies to back up and access medical records offsite.

The Office of the National Coordinator’s Information Blocking Final Rule requires that patients be given immediate access to their electronic health information, structured and/or unstructured, at no cost.

TMA staff also remind physicians that their role in medical recordkeeping continues even after a patient is out of their care or a physician has made a career change, such as moving or retirement. For instance, even when records are accounted for, physicians have a duty to inform any patient whose record they have that the practice is closing, explains TMA’s whitepaper on medical record maintenance, which details other requirements and exceptions.

For more information on good medical recordkeeping practices, visit TMA’s Medical Records page.

Tarrant County Public Health: Health Advisory Alert

An original message by Tarrant County Public Health announced on June 9, 2023.

Tarrant County Public Health (TCPH) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians about a confirmed measles case in a Hood County resident in a Tarrant County Hospital. TCPH has worked closely with the facility to identify exposure to some patients and staff that occurred before measles was suspected. All exposed people have been contacted and advised to watch for signs and symptoms through June 22nd. TCPH collaborated with the facility and Texas Department of State Health Services (DSHS), to investigate and respond to this measles case and exposures.

Below is a forwarded HAN from DSHS with background information about the current measles case, information on measles and the importance of early recognition, diagnosis, and appropriate treatment. TCPH recommends that clinicians be on the alert for cases of measles that meet the case definition.

Due to the highly contagious nature of this disease, additional cases may occur. We advise clinicians to follow the recommendations below and report any suspected cases immediately to Tarrant County Public Health’s 24-hour reporting line at (817)321-5350, preferably while the patient is present.

Background

A young child who is a resident of Hood County was recently diagnosed with measles. The child had no history of travel to an area where measles is spreading and no known exposure to a person with measles. The child has been treated and is recovering.

This is the first confirmed case of measles in Texas since travel-related outbreaks in 2019, which led to 23 cases. Completion of the two-dose series of the measles vaccine is highly effective at preventing measles, however even vaccinated people may occasionally become infected.

Measles is a highly contagious respiratory illness. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air for up to two hours after an infected person leaves an area. The illness usually starts a week or two after someone is exposed with symptoms like a high fever, cough, runny nose and red, watery eyes. A few days later, the telltale rash breaks out as flat, red spots on the face and then spreads down the neck and trunk to the rest of the body. A person is contagious about four days before the rash appears to four days after. People with measles should stay home from work or school during that period.

The best way to prevent getting sick is to be immunized with two doses of the measles- containing vaccine, which is primarily administered as the combination of measles-mumps- rubella (MMR) vaccine. DSHS and the Centers for Disease Control and Prevention recommend children receive one dose at 12 to 15 months of age and another at 4 to 6 years. Children too young to be vaccinated or who have only had one dose of vaccine are more likely to get infected and more likely to have severe complications if they do get sick.

Recommendations For Health Care Professionals:

Healthcare providers should consider measles in patients presenting with the following symptoms, particularly those who have traveled abroad or had contact with known measles cases:

• Fever ≥101°F (38.3°C) AND
• Generalized maculopapular rash lasting ≥3 days AND Rash begins at the hairline/scalp and progresses down the body
• Cough, runny nose, conjunctivitis OR Koplik spots (bluish-white specks or a red-rose background appearing on the buccal and labial mucosa usually opposite the molars)

Immediately report any suspected cases of measles to Tarrant County Public Health at our 24 hour hotline (817)321-5350) (dshs.texas.gov/idcu/investigation/conditions/contacts). If possible, please report while the patient is present to facilitate testing and the public health investigation, including follow-up of potential exposures.

Infection Control Precautions

Airborne precautious should be followed to reduce possible exposures in healthcare settings.
In urgent/emergency healthcare settings, suspected cases should be masked with a surgical mask and triaged quickly from waiting areas into a room with a closed door, airborne isolation precautions recommended. In other outpatient settings, suspected cases should be scheduled at the end of the day, if possible. Healthcare workers caring for patients suspected of having measles should use airborne infection control precautions. (www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html)
Since measles is so highly transmissible and can spread in health care settings, people who work in places like a doctor’s office or emergency room should have evidence of measles immunity to prevent any potential outbreak. (https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07- measles.html#f21).

Diagnostic Testing

Testing for measles should be done for all suspected cases of measles at the time of the initial medical visit:
Measles PCR and serology (IgM and IgG) testing is available at both the Texas DSHS Laboratory in Austin and at commercial laboratories.
The Texas DSHS Laboratory can perform PCR testing on throat swabs (preferred) or nasopharyngeal swabs placed in viral transport media and serology on serum specimens.
DSHS strongly encourages providers to submit PCR specimens to the DSHS Laboratory because genotyping will be performed on positive PCR specimens, which can be helpful during outbreaks.
Providers should work with their local health department or DSHS regional office to coordinate testing at the DSHS laboratory to ensure specimens are submitted correctly and meet testing requirements.
Unless coordinated in advance, specimens may only be received during normal business hours Monday through Friday.

Recommendations for Public Health:

Control and Prevention Measures

Measles vaccination may prevent disease in exposed people if given within 72 hours of exposure. People 6 months and older who have not been fully vaccinated would be eligible for vaccination under those circumstances. It may provide some long-term protection but should be followed with a second vaccination at least one month later. Immune globulin (IG) may be indicated for some people but should not be used to control an outbreak.
Pregnant women, people with severe immunosuppression, and anyone with a previous anaphylactic reaction to a vaccine component should not get a measles vaccine.

Controlling Outbreaks in Group Settings

People with confirmed or suspected measles should stay home from school, work, and other group settings until after the fourth day of rash onset.
During an outbreak, people without documented immunity from vaccination or previous measles infection should be isolated from anyone with measles to protect those without immunity and control the outbreak. Additional information on school exclusion and readmission can be found at dshs.texas.gov/idps- home/school-communicable-disease-chart

Recommendations for the Public

If you think you have measles or have been exposed to someone with measles, isolate yourself from others and call your healthcare provider before arriving to be tested so they can prepare for your arrival without exposing other people to the virus. Measles is extremely contagious and can cause life-threatening illness to anyone who is not protected against the virus.

For More Information:

Public Health Notes

Health Equity Through a Public Health Lens

by Catherine Colquitt, MD, Tarrant County Public Health Medical Director, and Yvette M. Windgate, ED.D.

This article was originally published in the March/April issue of the Tarrant County Physician.

As we turn the page on 2022 and our “tripledemic” surge recedes, let’s take a moment to reflect on health equity and disparities through the crucible of COVID-19.

Healthy People 2030 defines health disparities as “a particular type of health difference closely linked to social economic, and/or environmental disadvantage.” It further asserts that health disparities “adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, physical disability, sexual orientation or gender identity, geographic location, or other characteristics historically linked to discrimination or exclusion.”1 Our collective goal is health equity, described by Healthy People 2030 as “the attainment of the highest level of health for all people.” Achieving health equity requires valuing everyone equally, with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”1

In the early 2000s, U.S. Surgeons General began to issue reports on disparities in tobacco use and access to mental health care based on racial and ethnic demographics. Since those ground-breaking reports, issues including infant mortality, pregnancy-related seats, chronic disease prevalence, and overall measures of physical and mental health have been examined through the prism of health equity. Part of the impetus of the Affordable Care Act (ACA) was to provide strategies for securing access to healthcare for traditionally underserved groups. Impactful gains were made in numbers of persons insured and access to higher quality care. However, those gains were somewhat eroded in the former presidential administration by cuts to funding for AVA navigators and outreach efforts, and the authorization of state waivers, which allowed some states to decline Medicaid expansion by instead offering their own wavers.

COVID-19 further impacted healthcare coverage losses through lost jobs and wages, resulting in increasing economic hardships, housing difficulty, and food insecurity, disproportionately affecting Black and Hispanic workers, especially those in essential in-person jobs (i.e., transportation, manufacturing, grocery, pharmacy, retail, warehouse, food processing, and healthcare). Due to healthcare workforce shortages and operational changes (e.g., video clinic visits requiring patients to have internet access), these same groups also experienced challenges to healthcare access.

During COVID-19, certain groups (i.e., Alaskan Native, American Indian, Black, and Hispanic individuals) experienced higher death and illness rates than their White or Asian counterparts, likely due in part to their work in essential jobs, higher prevalence of preexisting comorbidities for poor COVID-19 outcomes, use of public transportation, and crowding at work or home.

Additionally, according to the Kaiser Family Foundation’s survey data (The Undefeated), Black adults are more likely than White adults to report certain negative healthcare experiences, such as a provider not believing them, or refusing a test, treatment, or pain medicine the patient believed he or she needed. the Undefeated survey data revealed that Black and Hispanic individuals were less likely to have been vaccinated against COVID-19 as of April 2021. While vaccination rates against COVID-19 have risen on all ground, the gaps between White, Asian, Black, and Hispanic demographic groups have not narrowed. The effect of the health disparities laid bare by COVID-19 has been profound and predated the pandemic. For example, in 2018, the average life expectancy was four years lower in Black individuals than in White individuals, with the lowest life expectancy in Black men. That unfortunate trend continues today. In Tarrant County, the 76109 zip code in Fort Worth, a majority White neighborhood, holds a life expectancy of 82.4 years. Nearby 76104, host to historically Black neighborhoods, like Morningside, has a life expectancy of 66.7, and it is even lower for Black men at 64 years.

What can we do to address these disparities and improve the health of our county and county? The Biden administration has prioritized initiatives aimed at addressing health disparities at the federal level through several executive orders and proclamations. Locally, Tarrant county Public Health (TCPH) has created a Community Health Equity and Inclusion (CHEI) division to promote health literacy and address health equity issues concerning county residents, with the greater goal of decreasing health disparities and inequities in Tarrant County. The CHEI division educates residents and public health professionals regarding health disparity and inequity issues and engages community partners (i.e., Fatherhood Coalition of Tarrant County, Mental Health Connection of Tarrant County, My Health My Resources of Tarrant County, United Way of Tarrant County, and Brave/R Together) to find solutions that promote diversity and health equity.

TCPH continues to collaborate with community partners on annual events, such as the African American Health Expo, the North Texas Wellness Fair, and the Senior Synergy Expo. We are also participating in community celebrations, school events, and COVID-19 testing and vaccination pop-up clinics. Recently, TCPH and fifty-sic agencies- including hospital systems, institutions of higher education, city and county governmental entities, charitable organizations, and faith-based organizations- have joined forces as the Tarrant County Unity Council. This council’s purposes are:

To identify and address health equity challenges for those disproportionately affected.
To build, leverage, and expand fair resource allocation to safe, affordable, and accessible health, housing, transportation, and communication that advance racial equity and address other inequitable social conditions, with the purpose of reducing or eliminating health disparities and health inequities.

References:

Health Equity in Healthy People 2030, https://health.gov/healthypeople/priority-areas/health-equity-healthy-people-2030
L Hamel et al, Kaiser Family Foundation: Key Findings from the KFF/Undefeated Survey on Race and Health 10/2020
Life Expectancy by ZIP code in Texas, https://www.texashealthmaps.com/lfex
Tarrant County Public Health, Family Health Services, Community Health Equity and Inclusion, Community Involvement, https://www.tarrantcounty.com/en/public-health/family-health-services/health-equity–community-outreach/previoud-activities.html?linklocation=Button%20List&linkname=Community%20Involvement
Tarrant County Unity Council, https://www.tarrantcounty.com/en/public-health/family-health-services/health-equity–community-ooutreach/tarrant-county-unity-council.html

DEA Proposed Rules Address Telehealth Prescribing Post PHE

by Sean Price

Originally published by Texas Medical Association on March 8, 2023.

Physicians found new flexibility in prescribing controlled substances via telemedicine during the COVID-19 pandemic.

Now that the public health emergency is ending, the Drug Enforcement Administration (DEA) has proposed new rules for prescribers it says could preserve some of those flexibilities “with appropriate safeguards.”

Among other things, the new rules – if finalized – would allow physicians and health care professionals to prescribe, without a face-to-face visit, a 30-day supply of Schedule III and Schedule IV non-narcotic controlled drugs, after which an in-person follow-up would be needed for any refill. This class of drugs is the least likely to result in drug abuse, according to DEA. The proposal also would allow for prescribing a 30-day supply of buprenorphine to treat opioid use disorder without an in-person evaluation or referral.

“Improved access to mental health and substance use disorder services through expanded telemedicine flexibilities will save lives,” Department of Health and Human Services Secretary Xavier Becerra said in the announcement. “We still have millions of Americans, particularly those living in rural communities, who face difficulties accessing a doctor or health care provider in person.”

The agency emphasized that the rules do not affect telehealth services that do not involve controlled substance prescriptions. The Texas Medical Association is reviewing how the proposed regulations could interact with other federal and state regulations, says Shannon Vogel, TMA’s associate vice president of health information technology.

DEA has released summaries for both healthcare professionals and patients explaining how the proposed rules would affect prescription practices.

“This is a very good thing that they’re doing and a necessary thing” for access to care, said Mesquite pain management specialist C.M. Schade, MD, a former president of the Texas Pain Society.

Before the pandemic, physicians were limited in their telemedicine prescribing ability by the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, he says. The act requires physicians to conduct at least one in-person medical evaluation of the patient before prescribing a controlled substance by means of the “internet,” which is defined to include telehealth.

“COVID did great things for telehealth, and one of them was breaking through the Ryan Haight Act,” Dr. Schade said.

Some policymakers and behavioral health advocates have expressed concern, however, that patients who need continuous medication therapy may have challenges obtaining an in-person visit within 30 days.

The rules were proposed on Feb. 24 and public comments are due on March 31. The agency has no set timeline for publishing the rules, though it is likely that will come before the PHE ends on May 11.

Physicians with questions and comments about the DEA changes or relevant state regulations can contact Ms. Vogel.

Feds to End COVID-19 Public Health Emergency in Mid-May

by Emma Freer

Originally published by Texas Medical Association on February 7, 2023.

After nearly three years and 11 extensions, the Biden administration recently announced the COVID-19 public health emergency (PHE) will finally expire May 11, fulfilling its commitment to give states at least 60 days’ notice of its expiration.

“If the PHE were suddenly terminated, it would sow confusion and chaos into this critical wind-down,” the Executive Office of the President wrote in a Jan. 30 statement.

Still, the end of the PHE has significant consequences for Texas physicians and their patients.

The federal Families First Coronavirus Response Act temporarily increased federal Medicaid matching dollars by 6.2% for states that agreed to maintain Medicaid coverage for anyone enrolled in the program from March 2020 through the end of the PHE.

That included Texas, where more than 2.5 million residents, predominantly postpartum women, and children, benefited from continuous Medicaid coverage.

These matching dollars will phase out between April and December, according to a provision in the Consolidated Appropriations Act of 2023, a $1.7 trillion spending package that President Joe Biden signed into law on Dec. 29, 2022.

To continue to receive these funds through the end of the year, states must comply with certain federal requirements, including agreeing not to terminate enrollment based on returned mail due to an incorrect address.

In the meantime, state Medicaid officials have a plan for unwinding this coverage, but it requires redetermining millions of patients’ Medicaid eligibility in just eight months. The Texas Health and Human Services Commission (HHSC) will begin sending notices in March reminding patients to update their information.

The Texas Medical Association has met regularly with HHSC over the past year to provide input on the state’s plan with the goal of achieving as smooth a transition as possible. Despite progress, such as streamlining the ways in which Medicaid patients can complete their eligibility applications, TMA remains very concerned about a looming coverage cliff.

Fortunately, the end of the PHE coincides with some recent policy developments, including increased federal funding for navigators – community organizations that connect eligible consumers to federal marketplace health plans – and extended subsidies for the same plans. TMA experts say these changes could help some Texans who lose Medicaid coverage enroll in a different plan.

The Consolidated Appropriations Act also makes permanent an option for states to provide 12 months of continuous Medicaid coverage to postpartum women.

TMA would like to see the Texas Legislature take advantage of this option, one of the association’s top priorities this session.

Moreover, the law requires states to provide 12 months of continuous Medicaid coverage to children, beginning Jan. 1, 2024. TMA is urging HHSC to align this provision with its redetermination process to minimize the burden on families and to prevent gaps in care.

In addition, the Consolidated Appropriations Act extended certain pandemic-era telehealth flexibilities for Medicare patients through 2024, disentangling them from the status of the PHE. These flexibilities include:

Waiving geographic site restrictions, which allow patients to access care from their homes; and

Allowing physicians to use audio-only telehealth services.

TMA and others in organized medicine recently wrote a letter to the Centers for Medicare & Medicaid Services (CMS), requesting the agency issue an interim final rule to align its telehealth policies and timeline (to expire 151 days after the end of the PHE) with those in the Consolidated Appropriations Act. Not doing so, they wrote, could create “an unintended barrier to vital health care services, as well as potential confusion” among clinicians and patients.

Prior to the act’s passage, CMS made permanent the same telehealth flexibilities for Medicare patients accessing mental and behavioral health services as well as coverage of video-based mental health visits at federal qualified and rural health centers.

Finally, the PHE’s end means physicians not using a HIPAA-compliant platform for telehealth will need to switch to one by May 12.

Physicians can refer to CMS’ fact sheet regarding PHE waivers and flexibilities for more information.

For more detailed coverage on how the end of the PHE will affect Texas physicians and patients, check out the January/February issue of Texas Medicine magazine.

COVID-19 Vaccine Clinics for the Week of January 14

January 13, 2023 – (Tarrant County) – Tarrant County Public Health hosts numerous pop-up COVID-19 clinics across Tarrant County each week in partnership with public and private organizations listed below. Each site has the Moderna, Pfizer, and Novavax vaccines. Infants six months and older are eligible for the vaccination. Parents need to bring proof of the child’s age and their own ID for the vaccination. Booster vaccinations are available at all of the vaccination locations.

TCPH would like to bring a COVID-19 vaccination clinic to businesses, churches, and organizations in the community that are interested in hosting a pop-up clinic. It’s easy and free to host a clinic.

In addition to the vaccination opportunities below, the cities of Arlington, Fort Worth, Mansfield, North Richland Hills, Hurst, and Tarrant County College have also added opportunities for vaccinations. To find a local vaccine site, the County created a vaccine finder page: VaxUpTC website.

Pop-Up COVID-19 locations:

Baker Chapel AME Church
Saturday, Jan. 14: 10 a.m. to 2 p.m.
1050 E. Humboldt St.
Fort Worth, TX 76104

Advent Health Care Center of Burleson
Tuesday, Jan. 17: 9 a.m. to 11 a.m.
301 Huguley Blvd.
Burleson, TX 76028

Vaxmobile-Southside Community Center
Thursday, Jan. 19: 9 a.m. to 4 p.m.
959 E. Rosedale St.
Fort Worth, TX 76104

Tarrant County Public Health CIinics:

Northwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3800 Adam Grubb Road
Lake Worth, TX 76135

Bagsby-Williams Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3212 Miller Ave.
Fort Worth, TX 76119

Southeast Public Health Center
Monday to Friday: 9 a.m. to 12 p.m. and 1 to 5 p.m.
536 W Randol Mill
Arlington TX, 76011

Main Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
1101 S. Main Street
Fort Worth, TX 76104

Southwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6551 Granbury Road
Fort Worth, TX 76133

Watauga Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6601 Watauga Road
Watauga, TX 76148

For more information go to coronavirus.tarrantcounty.com or call the Tarrant County Public Health information line, 817-248-6299, Monday – Friday 8 a.m. to 6 p.m.

COVID-19 Vaccine Clinics for the Week of January 7

January 5, 2023 – (Tarrant County) – Tarrant County Public Health hosts numerous pop-up COVID-19 clinics across Tarrant County each week in partnership with public and private organizations listed below. Each site has the Moderna, Pfizer, and Novavax vaccines. Infants six months and older are eligible for the vaccination. Parents need to bring proof of the child’s age and their own ID for the vaccination. Booster vaccinations are available at all of the vaccination locations.

Pop-Up COVID-19 locations:

Beth Eden Baptist Church
Saturday, Jan. 7: 10 a.m. to 4 p.m.
3308 Wilbarger St.
Fort Worth, TX 76119

Cityview Nursing and Rehabilitation
Tuesday, Jan. 10: 10 a.m. to 2 p.m.
5801 Bryant Irvin Rd.
Fort Worth, TX 76132

Vaxmobile-Watauga City Hall
Thursday, Jan. 12: 9 a.m. to 4 p.m.
7105 Whitley Rd.
Watauga, TX 76148

Tarrant County Public Health CIinics:

Northwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3800 Adam Grubb Road
Lake Worth, TX 76135

Bagsby-Williams Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3212 Miller Ave.
Fort Worth, TX 76119

Southeast Public Health Center
Monday to Friday: 9 a.m. to 12 p.m. and 1 to 5 p.m.
536 W Randol Mill
Arlington TX, 76011

Main Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
1101 S. Main Street
Fort Worth, TX 76104

Southwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6551 Granbury Road
Fort Worth, TX 76133

Watauga Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6601 Watauga Road
Watauga, TX 76148

For more information go to coronavirus.tarrantcounty.com or call the Tarrant County Public Health information line, 817-248-6299, Monday – Friday 8 a.m. to 6 p.m.

Texas Physicians Warn: Don’t Let Accidental Overdose Ruin Your Holidays (and Your Life)

Originally published by Texas Medical Association on December 13, 2022.

The holidays are a time of joy and celebration for many, but they could turn tragic if someone takes one pill they should not. Substance misuse – especially unwittingly taking street drugs that contain fentanyl – can destroy a life.

“The use of mind-altering substances is always more prevalent during the holidays. Unfortunately, this holiday season the risks of death are much higher because so many pills contain illegally manufactured fentanyl (IMF),” said CM Schade, MD, member of the Texas Medical Association (TMA) and past president of the Texas Pain Society (TPS). A very small amount of IMF is deadly, and people taking drugs laced with IMF are completely unaware that the pill they are consuming could kill them.

As uncomfortable a subject as it might be to address, Dr. Schade urges parents to discuss this with teenagers and young adults at home on the holiday school break. He also suggests adults heed this advice, too.

“If you got a pill from a friend or bought it off the street and it has IMF in it, it could seriously harm or kill you. If it was in the medicine cabinet but not prescribed to you, it could seriously harm or kill you as well,” said Dr. Schade. “Don’t take a chance on these; it’s just not worth it.”

Dr. Schade has some tips for Texans to stay safe:

Don’t take pills containing opioids unless prescribed to you by a physician for a health issue like chronic or severe pain relief. The U.S. Drug Enforcement Administration warns that six out of 10 fake pills contain lethal doses of fentanyl. It is very difficult to tell counterfeit drugs from legitimate ones, so the danger is very real that someone may consume a pill that could be deadly.

During gatherings with loved ones, it is important to be vigilant with prescription medication. Lock up your medication. You don’t want anyone taking your prescription drugs knowingly or unknowingly.

If someone is struggling with opioid use disorder and is at risk of an overdose, be proactive and have the opioid antidote naloxone available in case of emergency. In Texas, naloxone is available at most pharmacies under a standing order from a physician.

Additionally, physicians point to resources for young people who might consider turning to drugs because of depression and anxiety, as well as resources for people who need help with substance use disorder and behavioral health needs.

Throughout the year, TMA and TPS physicians have been raising awareness about the dangers of illegally manufactured fentanyl. In September, Dr. Schade testified before the Texas House Committee on Public Health presenting new legislative solutions to address the problem. Among other recommendations, TMA and TPS advocated for relaxing opioid prescribing guidelines so patients with chronic pain get the help they need and don’t turn to street drugs, making naloxone available over the counter, and legalizing fentanyl testing strips so someone could test whether a pill has IMF in it.

“Whether someone unwittingly took a bad pill for recreational use, or to sleep better, or because they feel depressed, or for whatever reason, it’s simply a bad decision to take something off the streets or not prescribed to you,” Dr. Schade said. “The result could be tragic anytime, but even worse during the holidays.”

TMA is the largest state medical society in the nation, representing more than 56,000 physicians and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans.

TPS is a 501c6 nonprofit organization that represents over 350 pain specialists in Texas. It is the largest state pain society in the nation.

COVID-19 Vaccine Clinics for the Week of December 10

December 9, 2022 – (Tarrant County) – Tarrant County Public Health hosts numerous pop-up COVID-19 clinics across Tarrant County each week in partnership with public and private organizations listed below. Each site has the Moderna, Pfizer, and Novavax vaccines. Infants six months and older are eligible for the vaccination. Parents need to bring proof of the child’s age and their own ID for the vaccination. Booster vaccinations are available at all of the vaccination locations.

Pop-Up COVID-19 locations:

FWISD-Eastern Hills High School
Saturday, Dec. 10: 9 a.m. to 2 p.m.
5701 Shelton Street.
Fort Worth, TX 76112

R.D. Evans Community Center
Tuesday, Dec. 13: 12 p.m. to 4 p.m.
3242 Lackland Rd.
Fort Worth, TX 76116

Federacion Zacatecana
Wednesday, Dec. 14: 10 a.m. to 2 p.m.
4323 East Lancaster Ave.
Fort Worth, TX 76103

Patriot Pointe Apartments
Friday, Dec. 16: 12 p.m. to 2 p.m.
2151 Southeast Loop 820
Fort Worth, TX 76119

Tarrant County Public Health CIinics:

Northwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3800 Adam Grubb Road
Lake Worth, TX 76135

Bagsby-Williams Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3212 Miller Ave.
Fort Worth, TX 76119

Southeast Public Health Center
Monday to Friday: 9 a.m. to 12 p.m. and 1 to 5 p.m.
536 W Randol Mill
Arlington TX, 76011

Main Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
1101 S. Main Street
Fort Worth, TX 76104

Southwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6551 Granbury Road
Fort Worth, TX 76133

Watauga Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6601 Watauga Road
Watauga, TX 76148

For more information go to coronavirus.tarrantcounty.com or call the Tarrant County Public Health information line, 817-248-6299, Monday – Friday 8 a.m. to 6 p.m.

COVID-19 Vaccine Clinics for the Week of December 3

December 1, 2022 – (Tarrant County) – Tarrant County Public Health hosts numerous pop-up COVID-19 clinics across Tarrant County each week in partnership with public and private organizations listed below. Each site has the Moderna, Pfizer, and Novavax vaccines. Infants six months and older are eligible for the vaccination. Parents need to bring proof of the child’s age and their own ID for the vaccination. Booster vaccinations are available at all of the vaccination locations.

TCPH would like to bring a COVID-19 vaccination clinic to businesses, churches, and organizations in the community that is interested in hosting a pop-up clinic. It’s easy and free to host a clinic.

In addition to the vaccination opportunities below, the cities of Arlington, Fort Worth, Mansfield, North Richland Hills, Hurst, and Tarrant County College have also added opportunities for vaccinations. To find a local vaccine site, the County created a vaccine finder page: VaxUpTC website.

Pop-Up COVID-19 locations:

Mount Olive Baptist Church
Saturday, Dec. 3: 10 a.m. to 2 p.m.
301 Sanford St.
Arlington, TX 76012

Como Community Center
Tuesday, Dec. 6: 9 a.m. to 1 p.m.
4660 Horne Street.
Fort Worth, TX 76107

Diamond Hill Community Center
Tuesday, Dec. 6: 9 a.m. to 1 p.m.
1701 Northeast 26^th St.
Fort Worth, TX 76106

Chisholm Trail Community Center
Saturday, Dec. 6: 10 a.m. to 12 p.m.
4936 McPherson Blvd.
Fort Worth, TX 76123

Haltom City Senior Center
Wednesday, Dec. 7: 10 a.m. to 2 p.m.
3201 Friendly Ln.
Haltom City, TX 76117

Highland Hills Community Center
Thursday, Dec. 8: 10 a.m. to 2 p.m.
1600 Glasgow Rd.
Fort Worth, TX 76134

Polytechnic Community Center
Friday, Dec. 9: 9 a.m. to 1 p.m.
3100 Avenue I
Fort Worth, TX 76105

Tarrant County Public Health CIinics:

Northwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3800 Adam Grubb Road
Lake Worth, TX 76135

Bagsby-Williams Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
3212 Miller Ave.
Fort Worth, TX 76119

Southeast Public Health Center
Monday to Friday: 9 a.m. to 12 p.m. and 1 to 5 p.m.
536 W Randol Mill
Arlington TX, 76011

Main Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
1101 S. Main Street
Fort Worth, TX 76104

Southwest Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6551 Granbury Road
Fort Worth, TX 76133

Watauga Public Health Center
Monday to Friday: 8 a.m. to 12 p.m. and 1 to 5 p.m.
6601 Watauga Road
Watauga, TX 76148

For more information go to coronavirus.tarrantcounty.com or call the Tarrant County Public Health information line, 817-248-6299, Monday – Friday 8 a.m. to 6 p.m.