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Transparency the reason for success of Arizona’s opioid action plan

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Since June 2017, 1,233 Arizona residents have died from opioid overdose – the highest reported number of opioid deaths in our state in 11 years. The opioid scourge in Arizona is very real. Data reveal that in one Arizona county, four physicians wrote more than 6 million prescriptions for opioids in a one-year period. That county has a population of 200,000.

The level of transparency Arizona’s health department provides around the impact of opioid addiction goes a long way toward educating our citizens on the need for action. But last year, state officials went a step further in their efforts to bring transparency to the epidemic.

Caroline Carney

Caroline Carney

They convened stakeholders from multiple disciplines to develop a 360-degree view of why the opioid crisis exists and how best to tackle this epidemic. This effort culminated in the creation of Arizona’s Opioid Action Plan.

Many states have opioid action plans, but Arizona’s is unique for the high number of stakeholders — 1,350 – who have helped shape the state’s response so quickly (three months). I participated in this process, both as an Arizona resident and as a behavioral health and internal medicine physician with expertise in opioid addiction, recovery and prevention.

Among the 12 recommendations released by the Arizona Department of Health Services, three stand out to me as major successes for Arizona and its people:

Good Samaritan Law

Arizona became the 41st state to enact a law that protects people from arrest or prosecution if they come to the aid of an overdose victim. The law – part of the Arizona Opioid Epidemic Act – went into effect in April. In other states, Good Samaritan laws have reduced opioid overdose deaths by 9 percent to 11 percent. Given the record number of people not only struggling with, but dying from opioid addiction in Arizona, it’s critical that Good Samaritans have the power to save a life by calling for help without fear of retribution. The law also increases the ability of first responders to administer naloxone, an opioid overdose reversal medication, to those experiencing an overdose.

Enhanced reporting of opioid deaths

In mid-2017, the Arizona Department of Health Services began an initiative to report opioid deaths in real time with the goal of reducing opioid deaths by 10 percent in two years and 25 percent over five years. The impact has been eye-opening:

In 2016, 790 Arizona residents reportedly died from opioid overdose – a 74 percent increase in four years, and the highest number of opioid deaths in 10 years. The increase prompted the state to declare an opioid epidemic.

Until 2017, opioid death numbers were based on death certificate data, which primarily attributed such deaths to organ failures, for example.

Leveraging real-time reporting instead of death certificate data, the numbers have surged. From June 15, 2017, to May 17, 2018, 1,233 suspected opioid deaths have been reported, in part from the direct attribution of the death to opioids rather than the organ failures that ultimately led to death.

Correct reporting of opioid deaths raises awareness of the need for opioid intervention in our state and in gauging the effectiveness of prevention and recovery efforts. With this information, health officials can more effectively target resources especially to those areas that have been hit hardest.

Medical education

Arizona’s Opioid Action Plan requires undergraduate and graduate medical education programs to incorporate training on evidence-based pain management and substance use disorder into their 2018-2019 curriculum by September 30, 2018. The need for education on this topic is critical — physicians need to develop an understanding of the risks and benefits in prescribing opioids, the trajectory into dependence and addiction, and how to recognize, treat, and/or refer individuals misusing opioids.

This education initiative is a step forward for future medical practice in our state that takes into account alternatives to opioid therapy, recommended dosage limits and more.

Closing the gap for treatment

Today, real-time data on the impact of opioid abuse in Arizona is available online through the Arizona Department of Health Services.

The transparency with which the state engaged community partners around opioid abuse was critical in forming a cohesive, evidence-based plan for response.

The opioid epidemic cuts to the very fabric of our society. The time for action is now, and Arizona’s Opioid Action Plan initiatives are a strong start.

— Caroline Carney, MD, MSc, FAPM, CPHQ, is chief medical officer, behavioral health and specialty medicine, Magellan Healthcare, CCarney@MagellanHealth.com

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The views expressed in guest commentaries are those of the author and are not the views of the Arizona Capitol Times.

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