Issue: 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.”

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.”

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.

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.

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.”