My name is Jaclyn Brown, and I’m writing this letter because my brother Marc can’t.
It was 2010, and he was a 21-year-old junior studying business at the University of Arizona. That’s when Marc was involved in a serious car accident that broke his pelvis. Doctors prescribed Oxycodone for the pain.
This was a different time. People didn’t understand the danger in taking these drugs for an extended period, and prescription guidelines were nothing like today. My brother’s use of Oxycodone soon became an addiction.
Marc’s experience isn’t uncommon. After his access to prescription opioids became too difficult, he transitioned to the street equivalent: heroin. My parents and I did everything we could, and Marc fought to recover. He was on AHCCCS and attempted rehabilitation twice, but was limited both in the length of rehab stay that AHCCCS would cover and the treatment medication it provided.
Opioid dependency is difficult to beat. That’s why most addiction medicine specialists favor a combination of drug counseling together with a buprenorphine medication that helps dull cravings. If you’re an Arizonan with private insurance, chances are good that you and your physician have access to a menu of buprenorphine options that have come on the market to treat opioid addiction.
But if you’re an AHCCCS enrollee, like my brother, there’s just a single buprenorphine product: Suboxone. Marc and other patients who don’t succeed with Suboxone have no easy access to an alternative for a second chance.
By 2018, Marc had been battling substance use disorder for the better part of a decade. But he was trying to get his life together, living with our parents in Sierra Vista and working to finish his degree at UA-South.
My brother died of a heroin overdose on Nov. 16, 2018. He was 29.
I want to be clear that I don’t blame AHCCCS for Marc’s death. He was an adult and made his own choices. But I’ve spent the last six months wondering whether my brother could have been saved, whether a different buprenorphine treatment could have made the difference for him.
It’s too late for my brother, but there’s still time for countless other AHCCCS enrollees struggling with opioid addiction. They deserve the best possible chance of recovery. And their physicians are owed the broadest possible arsenal of medications to fight this battle.
Thankfully, on May 23, the Pharmacy & Therapeutics Committee has an opportunity to right this wrong. It can recommend that AHCCCS make available all or at least a wider range of FDA-approved buprenorphine products for the purpose of treating opioid addiction.
I urge the committee and AHCCCS to take this important step. You never know whose life it may save.
Jaclyn Brown is a member of an Arizona family that has experienced the trauma of opioid addiction. She lives in Mesa.
Nearly half of Arizona’s pregnancy related deaths in 2022 were tied to mental health or substance use disorders, with 98% deemed preventable, according to the Arizona Department of Health Services. And communities of color and rural communities see disparate effects and a lack of perinatal care.
The legislature passed a law in 2021 establishing a maternal mental health advisory committee. Last year, health care agencies, providers and nonprofits convened to study mental health and maternal mortality, and in January, the committee issued proposals to stem the tide.
And at the beginning of June, the first recommendation came to fruition.
Dr. Kathryn Emerick, a perinatal psychiatrist, now serves as the co-director of the Arizona Perinatal Psychiatry Access Line, a hotline designed to create further accessibility by assisting all medical providers in treating mental health and substance use disorders in pregnant patients.
“We’re talking about something that fundamentally, foundationally impacts moms and children and families and communities on this massive scale,” Emerick said. “And with this illness that is treatable, and with these deaths that are completely preventable, we don’t have to have this level of suffering and death that we have in the state.”
The Arizona Health Care Cost Containment System issued a $1.6 million grant to the University of Arizona to make APAL possible.
Emerick said in the first month, they have seen a consistent stream of calls from care providers across the state. And in her time manning the line, the questions have primarily centered around diagnoses, as symptoms of perinatal mental health disorders vary, and around safe prescriptions, as the research on safe medications for pregnant women continues to evolve.
She’s also fielded quite a few questions on treating mothers with substance use disorders, specifically about safe medications to avoid withdrawals.
Emerick said disparate health services across the state, combined with a severe lack of perinatal psychiatrists create vast gaps in care.
Eight counties in Arizona lack a perinatal mental health specialist. And a lack of care disproportionately effects people of color, namely Black and Indigenous communities.
ADHS found Black women are twice as likely to experience perinatal mental health conditions but half as likely to receive treatment.
Lakisa Muhammad, founder of Arizona Birth Workers of Color and executive director of Phoenix Birth Foundation, discussed the importance of ensuring “we have mental health professionals that reflect the population they will be serving.”
Muhammad worked with Elizabeth Wood, chairperson at Postpartum Support International Arizona, to create a training led and attended by care providers of color.
Muhammad said the training brought together birth workers of all disciplines to discuss diagnoses and treatment of mental health.
“We can take this information from the evidence-based curriculum because PSI offers and we can transmute that information, transform it and turn it into a language that our community relates to,” Muhammad said. “Oftentimes the messages aren’t geared toward BIPOC communities.”
She said within the conference, care providers, “can get really real and really raw and address those things that we see in the families that we serve.”
Muhammad said the overall goals were to see more care workers of color certified in perinatal psychiatric care and ultimately, to have mental health care covered by insurance to make care more accessible and affordable.
And in the short term, Muhammad discussed the power of community. AZBOC partners with 4th Trimester to create a support group for Black mothers and to lead conversations about mental health care for communities of color in particular.
Jennie Bever founded 4th Trimester, an organization dedicated to creating a network of care providers and communities where she said none existed before.
The organization created “villages” or localized support groups for new parents. The groups connect parents with each other, and health care providers and specialists in their area to support the physical, mental and emotional health of the mother.
Bever said they currently run groups across Maricopa County, including the Black mothers support group. The organization is relaunching a Spanish-speaking village in the fall.
Overall, Bever said she wants Fourth Trimester to change the ways of thinking about pre-and post-partum support and care.
“We want to disrupt your thought process on whether or not there’s diversity in support for moms, we’re going to disrupt your thought process on whether it was handled right,” Bever said. “So that we can begin to think about, if we were going to do something different, what would that look like?’”
Emerick, Muhammed and Bever all emphasized the fact maternal deaths associated with substance use disorder or mental illness are preventable, and it often just takes one person, one health care provider, friend or family member to make a difference.
Emerick said she hopes greater educational tools will help to dispel misconceptions and stigmas in pre-and post-partum care and noted the danger of chalking signs of mental illness or SUDs up to “baby blues” or avoiding medications for the health of the baby.
“What we know is that untreated psychiatric illness and untreated substance use disorders actually carry really significant lifetime risks for the baby,” Emerick said. “So that idea of ‘if you just white knuckle it, you’re protecting your baby,’ it’s just not true.”
Muhammad said, “From my vantage point that we are in the midst of a paradigm shift around that, I think a lot of mothers or the people that I work with are embracing this idea of resisting resilience.”
“Why is it so hard? Why do I have to be so strong all the time?” Muhammad said. “Organizations like AZBOC, 4th Trimester and PSI AZ, we’re starting to create systems and create a framework that supports that way of thinking that it doesn’t have to be so hard and we’re here to help you, to make it easier, to lighten the load a bit so we don’t have to be so resilient. We can be soft. We can get the support and help that we need.”
Gov. Doug Ducey proposed boosts to mental health services at schools, a greater law enforcement presence on school campuses and fixing some, but not all, loopholes in background checks on gun sales in response to a mass shooting a month ago in Florida.
Ducey’s plan, which he’ll need to convince the state Legislature to approve, focuses on school safety following the shooting at Marjory Stoneman Douglas High School in Parkland. It includes some new dollars to help pay for school psychiatrists, a program that would allow former cops to act as armed, volunteer security guards at schools, and an unspecified amount of state funding to help more schools hire school resource officers.
It also provides an opportunity to have guns seized from people deemed to be a danger to themselves or others, a legal process Democrats in Arizona have been calling for all legislative session.
But while it addresses some faults with the states criminal background check system, Democrats say Ducey’s proposal falls far too short, particularly in one area that undermines some of the governor’s other efforts: A lack of universal background checks.
Ducey wants to create a Severe Threat Order of Protection, or STOP order, by which law enforcement, family members or other individuals can petition the court to order that a person’s firearms be temporarily confiscated. Depending on the circumstance, the court would have to determine if there is clear and convincing evidence that a person is a severe threat. Those orders would be valid for 14 to 21 days, and could be extended by up to 6 months if necessary.
A person under a STOP order would be barred from possessing a firearm, punishable by up to three years and nine months in prison. Ducey’s plan, which also calls for faster updates to Arizona’s criminal background check system, also means that gun retailers would be alerted that a person with a stop order could not be sold a firearm.
But there’s nothing to stop that person from using the gun show loophole to purchase a firearm without the state’s knowledge.
That’s one of several reasons why Democrats called Ducey’s proposal “missed opportunity.”
“The governor acknowledges that there are clearly dangerous situations where violent people should not have guns. Yet he knowingly leaves a gaping loophole for these same violent people to go to a gun show and rearm,” said House Minority Leader Rebecca Rios, D-Phoenix.
Rios would not say if the governor’s plan will ultimately have their support without first seeing legislation, but that didn’t stop her and other representatives from demanding more from Ducey’s plan.
The governor has resisted using language as strong as “gun safety,” instead referring to his proposal as a school safety plan. But Rep. Randy Friese, D-Tucson, insisted there is still time for negotiations and for Democrats’ full concerns to be represented in the governor’s plan, such as a ban on bump stocks.
“This is a gun safety plan no matter what he wishes to call it,” Friese said.
Ducey spokesman Daniel Scarpinato repeatedly dodged questions about Ducey’s position on the gun show loophole, though his staff claimed that no stakeholders asked for universal background checks in meetings with the governor, save for Democrats.
As for the Democrats’ opposition, Scarpinato said that there’s much to gain from both parties supporting the governor’s agenda on school safety.
He said that the court-ordered ability to have guns seized or turned over is a policy Democrats have called for in the wake of the Parkland shooting. It even goes further than the measure sponsored by Senate Minority Leader Katie Hobbs, D-Phoenix, by allowing school administrators, teachers, social workers and behavioral and mental health specialists to petition the court for a person’s guns to be taken away.
“The governor’s top priority here is public safety, and this protects public safety and balances that with the Second Amendment rights of Arizonans,” Scarpinato said. “We think this is something that both sides can come together on. These are ideas that a lot of them, as recently as this session, have been proposed by Democratic lawmakers. And we think this is a package that really will make a difference for Arizona schools.”
Democrats aren’t the only ones who aren’t buying into Ducey’s plan. Student leaders with the March For Our Lives Movement also said Ducey’s plan falls short of what’s necessary to truly address school shootings, but also gun violence at large.
“The time has come to stop the mass killings, not confront that problem with half-hearted measures designed to offer window dressing to the issue and appease the National Rifle Association’s and Citizens Defense League’s corrupting influence on the process,” said Jordan Harb, a junior at Mountain View High School in Mesa.
As for Republicans, legislators such as Senate President Steve Yarbrough, R-Chandler, have expressed concern with the potential cost of measures that were floated around as possible additions to Ducey’s proposal. The governor’s plan offers a minimal hit to the General Fund — $2 million for school psychiatrists, $1.8 million for modernizing the criminal background database, and an undetermined amount to help pay for more school resource officers.
That spending amount may be frugal enough for some Republicans, but it’s another area that Democrats may criticize as lacking. Without concrete figures on the governor’s financial commitment to hiring more SROs, it’s impossible to report how many schools would be able to afford hiring an officer.
It’s also unclear how many schools would benefit from increased mental health funding in schools, given that those dollars — $2 million from the General Fund and a $6 million federal match — would be available only to schools serving students who qualify for Medicaid or KidsCare.
Schools would have two options for utilizing those dollars. Some could contract with the Arizona Health Care Cost Containment System, or AHCCCS, to provide psychiatrists at schools on a limited basis for those students in families that fall below 200 percent of the federal poverty level.
For schools that want to hire a full time psychiatrist, a part of that salary could be covered by AHCCCS as long as 50 percent of students in the school are covered by AHCCCS or KidsCare.
For instance, if 80 percent of students a school psychiatrist treats qualify for AHCCCS, then AHCCCS will pay for 80 percent of that staffers salary, freeing up school dollars at the local level, according to Dawn Wallace, the governor’s education policy advisor.
Gubernatorial staff emphasized that the plan is not a one-size-fits-all solution, and that it provides schools with options. Ducey legislative director Gretchen Martinez said schools that don’t qualify for AHCCCS-funded behavioral and mental health services could use new district additional assistance funding.
That money is meant to restore previous cuts to district additional assistance under the Ducey administration.
In addition to more mental health resources, Ducey also proposes increasing law enforcement’s presence on school campuses — basic administrative tasks , like filling out paperwork, could be completed by cops on school grounds, in an effort to deter violence simply through a police officer’s presence.
A voluntary program would also allow former peace officers to carry guns on campus while acting as security, an effort meant to supplement or replace the role of school resource officers. Teachers and administrators, even those who are ex-law enforcement, would not be eligible for the program, continuing Ducey’s opposition to arming school officials.
Ducey’s staff said those two ideas came from talks with school officials, who asked for a greater amount of law enforcement on campus. But those proposals aren’t pleasing to students, who’ve been critical of calls for more guns in schools.
“The proposal to increase police presence at schools will only add to stress children live under every day, especially in schools and communities where children of color already feel under siege by the police,” Harb said.
Ducey’s plan also calls for a confidential, statewide tip line for reporting possibly dangerous behavior, and for the Department of Public Safety to work with schools on creating universal best practices for schools to better prepare for a shooter.
It’s unclear when Ducey’s ideas will become a bill. Ducey’s staff said they’re in active negotiations with legislative leaders over key aspects, like how much funding will be provided to hire more school resource officers.
But as of Monday afternoon, leaders like Yarbrough downplayed the extent of those negotiations. The Senate president still needed to read the governor’s full proposal before he could comment.
As they did a week ago, students announced they’ll come to the Capitol on Wednesday and are again seeking a meeting with Ducey. They were denied a sit down with the governor on March 14.
Each September during Suicide Prevention Awareness Month, I reflect on the progress Arizona has made in addressing a critical public health issue. On average, 1,400 Arizonans die by suicide each year, a number that has wide-reaching consequences for families and our larger communities.
These deaths are preventable. I’m heartened, however, by new momentum, energy, and funding that Arizona has to address this public health issue.
In August, the Arizona Health Care Cost Containment System, Arizona’s Medicaid agency, received an $800,000 Substance Abuse Mental Health Services Administration emergency suicide prevention grant to bring together behavioral health and domestic violence providers in Pima County.
With this funding, domestic violence providers will be able to screen for suicidal ideation, and behavioral health providers will be able to screen for indications of domestic violence.
This coordinated approach recognizes that there is often more than one social determinant of health at play – individuals who are survivors of domestic violence may also be fighting depression, substance use, and suicidal thoughts.
With the Arizona Department of Education, the AHCCCS suicide prevention team oversees the 5-year Project AWARE grant to bring suicide prevention and behavioral health resources to schools, particularly useful this school year as public and charter schools implement the Mitch Warnock Act. Effective this fall, that law requires all school staff who work with students between 6th and 12th grades to be trained in an evidence-based suicide prevention training. The AHCCCS team has published a list of approved training courses on their website, and works with schools to implement and track the new training requirement.
As your children head back to school, whether online or in person, ask about partnerships with behavioral health providers. We have seen a remarkable increase in Medicaid-eligible students receiving services on campus (more than 15,000 students in the last school year, statewide) and hope to continue to see these partnerships grow. Serving students where they are has been proven to reduce barriers to accessing behavioral health care.
How is your student’s school implementing the new law? Do they have a behavioral health provider available to students? Do they have a suicide prevention or postvention policy listed on their website? School leadership should be able to answer these questions.
Suicide prevention cannot be accomplished by one team or one state agency. It is up to all of us to know the warning signs and what to do next. Check on your neighbor or family member who lives alone. Get rid of unnecessary prescriptions or over-the-counter medications. Store firearms under lock so they cannot be used without your permission. Get trained in suicide prevention. And if you are worried about someone who is suicidal, never leave them alone. Call the National Suicide Prevention Lifeline at 800-273-8255 and you will be transferred to a local behavioral health provider. Store this number in your phone. You’ll never know when you may be in a position to save a life.
Together, we can reduce – even end – suicide in Arizona!
Kelli Donley Williams is the state suicide prevention specialist at Arizona Health Care Cost Containment System.
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