Ducey headed to Texas border event

Set up in front of the border fence in Douglas, Gov. Doug Ducey on March 19,2021, blames the Biden administration for the crisis along the border. With him is Sen. Rick Scott, R-Florida, who flew in for the event and a 20-minute border helicopter tour. (Capitol Media Services photo by Howard Fischer

Republican governors are gathering Wednesday at the border in Texas to criticize the Biden administration’s policies.

And Arizona taxpayers are picking up the tab to send Gov. Doug Ducey to the event, along with two of his top aides.

Ducey publicist C.J. Karamargin acknowledged that this is an all-GOP event, with Republican governors from nine other states also going to Mission, just down the road from McAllen. A press release from Texas Gov. Greg Abbott said they will have a news conference to discuss the “border crisis.”

Karamargin said Ducey and the governors “have some ideas” they want to share with the media.

He told Capitol Media Services the reason for the all-Republican event is because the president ignored a request by governors — again, all Republicans — to meet with them about the situation. But Karamargin, in justifying making the trip at state expense, denied that this is a political event.

“Border security has been and remains a top concern for all Arizonans,” Karamargin said. And he said that Ducey, as the governor of a border state, is working to figure out a way to strengthen security.

Ducey has done press conferences in front of the border fence before, including one earlier this year in Douglas where he insisted that everything going wrong with illegal immigration is the fault of Biden, his administration and the Democratic Congress. That leaves the question of why he needs to now go to Texas for the all-GOP affair given that there is a border in his own state.

Karamargin, who is going on the trip, said it all comes back to Biden’s snub.

“They requested a meeting with the president,” he said.

“They have not heard back,” Karamargin continued. “So now they’re going to be talking about all the ideas they have about strengthening border security.”

And he brushed aside questions of whether Ducey, who has had other events in Arizona to blast the Biden administration’s handling of the border, can share his ideas closer to home.

“This is an effort by multiple governors from states that have been impacted by the failure to secure our border,” Karamargin said, a list that includes Idaho, Montana and Wyoming.

There was no immediate response from Texas Gov. Greg Abbott whose office organized the event, about why Democrats were not invited.

The event comes as Biden’s popularity is shrinking to new lows. While some of that relates to what some believe was a botched exit from Afghanistan, the daily pictures and videos of migrants gathered at the border to seek asylum also have taken a toll.

“Border security is the No. 1 issue that people call the governor’s office talking about it,” Karamargin said.

Republicans hope to capitalize on that next year in a bid to reverse their fortunes from the 2020 election to potentially regain control of the U.S. Senate, with its 50-50 split, and the House where Democrats hold a 220-212 edge, with three vacancies.

In writing to the president on Sept. 20, the 26 Republican governors told him they can only do so much to deal with the situation on the border.

“The months-long surge in illegal crossing has instigated an international humanitarian crisis, spurred by a spike in international criminal activity, and opened the floodgates to human traffickers and drug smugglers endangering public health and safety in our states,” they wrote. And they sought a meeting within 15 days.

That was up on Tuesday.

Ducey apparently is not interested in having reporters from Arizona attend to ask questions.

Karamargin disclosed the governor’s trip late Tuesday morning. But Abbott’s press office, which is organizing the event, said anyone not registered by 5 p.m. Monday would not be admitted — or even provided with the specific location — with no exceptions or changes allowed.



Opioid crisis fix attracts foreign counterfeit pharmaceutical drugs


The recent Arizona seizure of 73,000 counterfeit pills containing fentanyl by the U.S. Drug Enforcement Administration (DEA) is a microcosm of what is fueling the nationwide opioid crises. President Trump recently touted that 17 percent fewer opioid prescriptions were written this year compared to last year. With the reduction of opioid prescriptions, one would conclude there would be a corresponding reduction of prescription opioid abusers. To the contrary, opioid addiction and overdose incidents continue at epidemic proportions, with no end in sight.

As part of a national strategy, DEA’s tactical diversion squads pursued pharmaceutical manufacturers, distributors, pharmacies, pharmacists, and doctors, whom the DEA determined were abusing their DEA registration when marketing and over-prescribing opioid medication. Criminal, civil, and administrative sanctions have, and continue to reign in the industry. Gov. Doug Ducey signed Arizona’s “Opioid Epidemic Act” enacting stricter controls on the medical industry’s prescribing of opioids, mandatory participation in a prescription monitoring program, limiting the number of prescription opioid pills for first-time patients, and educating the medical industry on opioid addiction.

Douglas Hebert
Douglas Hebert

It appears government successes in reducing available “legal” pain medication generated an unintended consequence. Mexican drug trafficking organizations filled the void, flooding America with foreign counterfeit prescription drugs, fueling the opioid crises. According to the Center for Disease Control and Prevention, U.S. prescription drug overdoses reached a record 72,000 deaths in 2018. What is disturbing is that more than half of the opioid overdose deaths were from fentanyl, a synthetic heroin manufactured in China.

Fentanyl contained in foreign counterfeit medications, sourced in China and smuggled across the Southwest border by Mexican drug trafficking organizations, supplies millions of addicted Americans. With the precipitous reduction of legal prescription pain medication, patients have turned to the black market to get their pain medications. Patients unwittingly purchase foreign counterfeit drugs disguised as low-level pain medication, unaware of the dangers – they end up as an overdose statistic. There is no question, foreign counterfeit opioid drugs are responsible for thousands of deaths. Despite what we are experiencing with the counterfeit opioid crisis, there are proposals to “legally” allow foreign prescription medications to be imported and sold in the U.S.

We are fortunate the U.S. Food and Drug Administration and the DEA have strict policies and controls over the U.S. pharmaceutical industry. From the manufacturer to the end-user, the FDA and DEA ensure Americans their prescription drugs are legitimate, free from contamination, and safe. These government and industry safeguards in the U.S. do not apply to pharmaceutical drugs of foreign origin. According to the World Customs Organization, pharmaceutical drugs are the No. 1 counterfeited item in the world – a $200 billion a year industry.

International drug trafficking organizations have exploited substandard quality management, unwitting suppliers, and corruption to infiltrate international pharmaceutical supply chains and pharmacies. In many countries, patients risk taking prescription medication with the wrong ingredients, no ingredients, or harmful formulations.

While the impulse of lawmakers to search for ways to address prescription drug availability and costs is understandable, policies allowing foreign prescription drug importation fail to address the bureaucratic complexities of creating an international supply chain; requiring large-scale changes in vetting, screening, packaging, labeling, storing, and security practices.

Not unlike the situation with counterfeit opioid drugs, the unwitting public will gravitate to what is most affordable and available, unaware of the risks that “legally” imported pharmaceutical drugs may be counterfeit.

Introducing legal access to foreign pharmaceutical drugs are not solutions, but vulnerabilities easily exploited and viewed by international criminal organizations as new opportunities to expand their counterfeit drug trade in the U.S. market. Americans are experiencing the realities of insufficient border security and addictions fueled by smuggled foreign counterfeit opioid medications.

Based on our counterfeit opioid drug crises, it’s important to “know your source” when it comes to your medication and beware of advertisers offering large discounts on foreign prescription drugs. Lawmakers and citizens should be skeptical of any proposals to “legally” allow the foreign importation of prescription drugs into the U.S. and placing Americans at risk.

— Douglas Hebert is a retired special agent in charge with the Phoenix bureau of the U.S. Drug Enforcement Administration and a senior investigator with the Arizona Department of Economic Security. Hebert wrote this commentary as a private citizen.

Opioid deaths, overdoses on the rise despite states efforts to curb crisis


Two years after Gov. Doug Ducey called a special session to fast-track the Arizona Opioid Epidemic Act, more Arizonans are overdosing and dying from opioid-related overdoses now than any time since the state started recording those figures.

The bill pushed by Ducey and health care advocates, allocated millions for educational outreach and treatment for addicts and changed regulations for how to fill opioid prescriptions. But after two years of following through on that plan, the state has failed to meet its goal of lowering opioid overdoses and overdose deaths – and addiction and recovery experts say the data doesn’t tell the whole story.

Although overdoses and overdose deaths are not decreasing, they at least now have more and better data on the problem, the governor’s spokesman and health director say. 

Gov. Doug Ducey’ spokesman Patrick Ptak said the Governor’s Office, which has maintained a cautious tone since the signing and gave no lofty promises of the proposals, is pleased with the “progress” the state has made in addressing the problem. The fact that numbers haven’t gone down, he said, “proves we have more work to do.”

“[The problem is] decades in the making, but we’ve seen progress in Arizona. We have more tools and data available to us than ever before.”

Cara Christ
Cara Christ

Department of Health Services Director Cara Christ said its goal was to decrease the number of overdoses by 5% each year. Instead, overdoses and deaths have climbed since lawmakers approved the legislation.

Christ, who helped inform and oversee the changes, said these programs and regulatory changes have “allowed Arizona to become the front runner in these issues,” and because of it, the state has a better idea of the scale of the problem, who is primarily affected and how to better treat them.

Christ boasted of the legislation’s success, saying since the bill was signed, the state has seen a 13% decrease in opioid prescriptions and a 95 percent decrease in prescriptions to so-called “opioid-naive” patients – those who have not gotten the drug in the 30 days prior to the injury or surgery. Both of those numbers are promising, she said.

Deaths may be trending up, Christ said, because of drug trafficking trends. Neither Christ nor her spokesman was able to elaborate on this hypothesis in detail and said it is not “in our wheelhouse.”

The effort to stunt skyrocketing overdose deaths started in January 2018, when Sen. J.D. Mesnard, R-Chandler, then-speaker of the House, helped shepherd the Arizona Opioid Epidemic Act, which passed unanimously within a week in a rare display of bipartisanship. The bill limited how doctors can prescribe opioids to new patients, expanded the availability of addiction treatment for the uninsured and added a Good Samaritan law encouraging people to call police during a suspected overdose without fear of prosecution.

It was a quick, however measured, response to an urgent problem that needed a solution, Mesnard said.

“Much of the bill was aimed at trying to prevent addiction from happening in the first place,” Mesnard said. “Even though it’s sort of early in trying to measure the things, that legislation, and I think part of the national discourse as well has led to greater hesitation by prescribers on these drugs, and I think that’s a good thing.”

J.D. Mesnard
J.D. Mesnard

Those efforts to curb new addiction have made a dent, but overdoses are still climbing and while the state can explain how, it can’t definitively explain why.

In 2018, there were 3,433 confirmed overdoses, according to DHS data. Last year, there were 3,668.

The number of people dying from opioid overdoses has also increased, from 959 in 2017, to 1,167 in 2018 – numbers for 2019 are still being verified, according to DHS, and are expected to be released in June. That increase is far from the Department of Health Service’s goal and it’s sobering.

Those trends are one of several interconnected problems fueling this problem, problems that Christ said have been piling up for decades and will take much longer than two years to solve.

Haley Coles
Haley Coles

In order to better tackle the issue, the department has since collected data and displayed it publicly, charting and mapping the total opioid-related overdoses. But people in the addiction and recovery arena like Haley Coles, executive director of Sonoran Prevention works, said DHS data, however helpful, is somewhat limited.

“They only focus on opioids and we know that it’s not just opioids that are killing people anymore,” Coles said. “There always have been people who die from heart attacks and over ramping from stimulants and we know that that’s increasing nationally.”

The map displayed by the department, Coles said, doesn’t tell the whole story because it displays county totals, not rates. If rates were displayed, it would better highlight the disparity of rural or smaller counties with less access to treatment face.

“It’s not useful to tell us that there are more people dying of opioid overdoses in Maricopa than other counties – of course they are,” Coles said. “I think that a lot of misinformed people look at that data and make meaning of it when there really isn’t enough meaning from it.”

Coles also said the state’s approach of curbing new addiction and its hyper-focus on opioids through prescription procedural changes in particular reduced the number of opioid prescriptions, but it’s only pushing people to other cheaper, easier drugs to get, like Fentanyl. This approach, Coles said, is misguided and just shows how out of touch the state is.

While Coles applauded the Arizona Health Care Cost Containment System grant program, which funds addiction treatment for the underinsured and uninsured, more needs to be done to earn the trust of people who still haven’t asked for help. If addiction isn’t treated in a more people-centric way and if public perception doesn’t change, Coles said, the problem could get worse.

One step in the right direction, Coles said, would be to allow cities, towns, counties or any nongovernmental organization to run overdose and disease prevention programs that allow addicts to access clean needles and better educate them — which are currently illegal.

Tony Rivero
Tony Rivero

Coles and others are working with Rep. Tony Rivero, R-Phoenix, to push HB 2608, which would do just that. This is the third year Rivero has pushed for the bill, and he said it was something he and most Democrats wanted included in Ducey’s opioid bill.

Ignorance on the issue of addiction and what fuels it, Rivero said, is what’s kept his bill from getting to the House floor. Perception from lawmakers on these programs, mostly skeptical Republicans, Rivero said, “hasn’t changed completely.” 

This approach shouldn’t be controversial, Rivero said, as a similar program was implemented under then-Republican Governor of Indiana Mike Pence and lauded by his surgeon general and now U.S. Surgeon General Gerome Adams.

These programs are proven to be effective in earning trust of people whose disease has been criminalized, Rivero said. Without trust, the problem may only worsen or plateau at best.

“The goal here is to have access for these individuals to have access to clean needles, but during that process, the nonprofit’s who are going to be overseeing these programs will be engaging these individuals and pushing them in the direction of rehabilitation,” Rivero said. “My goal here is to save costs for taxpayers and in order to decrease the spreading of HIV and Hepatitis B.”

But no matter how much money the state throws at this problem, Mesnard said, there are conflicting federal limitations that make solving it difficult. But above that, he said, seeking recovery is a personal choice, getting addicted isn’t.

There’s only so much the government can do. The opioid bill, Mesnard said, largely aimed to fix the influx of addicts, to help stop people from getting addicted in the first place.

While there was focus, and money spent, on helping those already addicted, there are so many variables in that, including personal choice and mental state, that solving that completely is nearly impossible — and the numbers show that, for now.

“There’s no way always to prevent every conceivable situation, and very few people grow up and think I want to be a drug addict,” Mesnard said. “There’s plenty that we can’t do, the law that we pushed, was always going to be imperfect, but we gave it our best shot.”