BACKGROUND: The opioid epidemic remains a significant public health challenge, with a substantial number of overdose deaths occurring annually. Synthetic opioids, particularly illicitly manufactured fentanyl, account for a significant portion of these fatalities, with a notable increase in adolescent deaths. In Texas, despite a decrease in opioid prescriptions, overdose deaths from both legal and illegal opioids have increased. The state's current overdose tracking program lacks comprehensive reporting, suggesting the crisis may be worse than reported due to incomplete data from rural counties affected by border crossings. This paper examines the pattern of opioid overdose deaths in Texas over the last seven years and postulates that the extent of the opioid crisis in Texas may be worse than what is officially reported due to incomplete data from rural counties. METHODS: This study presents a trend analysis based on the Texas Department of State Health Services' surveillance data from 2016 to 2022. The analysis highlights trends in total polysubstance and drug-related deaths, the number of affected counties, and the average number of deaths per county. Additionally, the study identifies counties with increasing death rates over the seven-year period. RESULTS: The analysis revealed a consistent increase in drug-related and polysubstance-related deaths from 2016 to 2022, along with a rise in the number of counties reporting these deaths. Additionally, a statistically significant association was found between the year and the number of deaths. The data indicates the significant impact of the COVID-19 pandemic, as evidenced by a dramatic surge in polysubstance-related deaths from 2019 to 2020. CONCLUSIONS: The opioid crisis in Texas calls for a comprehensive strategy that includes improved data collection, equitable resource distribution, and evidence-based legislative reforms. This approach, which should be guided by empirical data, would not only address the immediate crisis but would also contribute to the broader discourse on public health policy and practice.