AZ makes significant strides in opioid crisis 

A national public emergency, the opioid crisis is also devastating local lives at an alarming rate. More than five people in Arizona die each day from opioid overdose, according to the Arizona Department of Health Services. To address the crisis, state administrators, behavioral health providers, prevention specialists, educators and researchers have made remarkable progress. We highlight just a few successes here:

In 2017, the state government declared the opioid epidemic a public health crisis, which initiated a coordinated effort across public health, state Medicaid and the Governor’s Office. The Arizona Opioid Epidemic Act was signed in 2018, providing $10 million in funding to support uninsured and underinsured Arizonans in need of treatment. The state has also developed the Arizona Pain and Addiction Curriculum to support clinical workforce development.

The State Opioid Response (SOR) II provided $63.2 million over two years for medication-assisted treatment and recovery support services. SOR III is set to provide resources to increase medication access, support prevention initiatives and enhance the Opioid Services Locator tool. A significant portion of these SOR funds were used to increase the availability of medications for opioid-use disorder (MOUD) to those in need of treatment.

While MOUD is the gold standard of care for people suffering from opioid use disorder (OUD), the majority of states are lacking treatment facilities that offer this modality of treatment. From 2017 to present, the number of opioid-treatment programs (OTPs), like Community Medical Services, offering methadone treatment, increased from 33 programs to 67 programs.  Furthermore, SOR grants funded the first ever 24/7 OTP intake centers in the country.

Community-based harm reduction has also been effective in reducing overdose deaths in Arizona. Sonoran Prevention Works (SPW) has been a key player in this area since 2010, providing syringe access and naloxone since 2011 and 2014, respectively. SPW has recently expanded their services to include a mobile service van and RV in Maricopa and Cochise counties, which offer HIV and Hepatitis C testing rooms, syringe and supply services, counseling services and a heat respite area.

Hushabye Nursery has been providing prenatal and postnatal education in Phoenix since 2017. Their mission is to provide compassionate, evidence-based care to substance-exposed infants and their caregivers. In November 2020, Hushabye Nursery opened an innovative and trauma-informed medical care model to treat Neonatal Abstinence Syndrome (NAS). As an inpatient detox nursery, Hushabye Nursery provides intensive outpatient family services as part of prenatal and postnatal continuous care.

Health care providers are encouraged to utilize opioids as a last resort, at the lowest effective dose and for the shortest amount of time possible. The Arizona Prescription Monitoring Program has seen rapid adoption among health care providers, allowing for more accurate medication management and a safer treatment environment.

Arizona State University has demonstrated leadership by establishing a Medical Advisory Board related to opioid initiatives, which has produced and disseminated concise information guides related to MOUD, which are widely distributed to treatment providers and patients across the state. ASU has also shaped workforce development in more direct ways. Natasha Mendoza developed the Interdisciplinary Training Academy for Integrated Substance/Opioid Use Disorder Prevention and Healthcare, a federally funded program that provided holistic training for new behavioral health practitioners. Another important program is ASU’s Project ECHO (Extension for Community Healthcare Outcomes) for MOUD, designed to increase the capacity and confidence of providers to effectively practice using MOUD.

Arizona-based researchers including Raminta Daniulaityte, Rolf Halden, Beth Myerson, and Michael D. White have provided valuable insights to inform policy and understand opioid use trends across the state. ASU’s Substance Use and Addiction Translational Research Network (SATRN) is a group of researchers, community practitioners and policymakers in Arizona working to reduce death and distress caused by substance use disorder. SATRN promotes communication and collaboration, provides access to evidence-based programming and resources, supports interdisciplinary learning and collaboration and conducts innovative research to improve outcomes related to substance use.

Overall, Arizona’s treatment providers, prevention and harm reduction methods and researchers have made significant strides in addressing the opioid crisis. Collaboration, systemic coordination and translational science will be essential to building momentum for continued progress in the foreseeable future. While there is still work to be done, these efforts demonstrate that progress is possible and that continued collaboration and innovation are necessary to combat the opioid crisis.

Authors represent the Arizona State University, State Opioid Response, Medical Advisory Board: Natasha Mendoza, associate professor, School of Social Work, ASU; Nika Hernandez, researcher, Southwest Interdisciplinary Research Center, ASU; Darwyn Chern, chief medical officer, Copa Health; Melissa Kelsey, attending physician and clinical associate professor, Dignity Health; Nick Stavros, chief executive officer, Community Medical Services; Randy Gelow, physician, Banner Health; and Tara Sundem, executive director, Hushabye Nursery.