By Emilie Eaton

She walked out of a rundown apartment and approached a nondescript gray minivan stopped in the street on San Antonio’s near West Side. Her name was Stephanie, and she was wearing a gray T-shirt, rolled-up blue jeans and no shoes. In her hands was a metal cash box stuffed with used hypodermic needles. 

She grabbed two fistfuls of needles, used to shoot up heroin and fentanyl, and dumped them into a bright red biohazard container brought by the people in the Ford minivan, outreach workers from Corazón Ministries. In all, she turned in 80 used needles. She got 90 clean ones in return, plus a pack of Narcan, a medication to reverse opioid overdoses.

Depending on your perspective, the exchange was a small victory in the fight against IV-related diseases — or it was a grim illustration of the surge of addiction that has swept South Texas, accompanied by a drastic increase in overdose deaths, many caused by fentanyl, a synthetic opioid 50 times more powerful than heroin.

Fatal overdoses across San Antonio and the rest of Bexar County have gone through the roof, an analysis of state health department data shows. In 2013, there were 197. Last year, there were 501, a 154% increase. In 2023, the county’s rate of overdose deaths was 24 per 100,000 people — double the rate of just five years earlier.
The San Antonio Fire Department responded to 4,276 overdoses in 2023, both fatal and non-fatal. That’s 12 calls a day on average, from every part of the city.

“Overdoses are happening at a much higher rate because of the introduction of fentanyl,” said Andrea Guerrero-Guajarado, who oversees Bexar County’s response to addiction as director of the department of preventative health and environmental services. “There’s a crisis.”  

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