2016 Arizona Opioid Report highlights

• 64 percent of the growth in opioid deaths over the last four years and nearly 54 percent in the last two years have been heroin deaths
• Heroin has increased from 11 percent of opioid deaths in 2007 to 39 percent in 2016
• Deaths due to prescription/synthetic opioids since 2014 have increased, reversing a declining trend since 2009
• Nearly 86 percent of all deaths directly resulting from opioids involved other non-opioid drugs.
• While 82 percent of people who died from opioids were seen by a hospital or emergency medical provider during the five years prior to their death, only 32 percent of those people were seen for an opioid-related encounter.

By Cecilia Chan
Independent Newsmedia

White people between the ages of 45-54 far outnumber all other groups when it comes to death by opioids in Arizona.

From 2007-16, 77.5 percent of all opioid deaths in the state were among white non-Hispanics with death rates rising in late teens until they peak at age 45-54, according to an Arizona Department of Health Services 2016 report. Opioids include heroin as well as certain highly addictive prescription painkillers.

“The insidiousness of this particular drug is it takes many forms,” said Mark Casey, spokesman for the Maricopa County Sheriff’s Office. “And it is available to a broader population. It cuts across many socio-economic categories.”

Opioid deaths have reached such an epidemic in the state that Gov. Doug Ducey in June signed an emergency declaration to address it.

Newly released data from the Health Services Department found 790 Arizonans last year died from opioid overdoses — an average of more than two people per day. The trend shows an alarming increase of 74 percent over the past four years, according to officials.

In 2014, Arizona was the 15th highest in the nation in overdose deaths with 1,211, according to the Centers for Disease Control and Prevention. Drug overdoses are the leading cause of injury deaths in Arizona, claiming more lives than vehicle crashes or firearms, according to the CDC.

Nationwide, 91 people a day are dying from opioid overdose, according to experts.

Glendale Police does not track opioid cases as they fall under a general overdose call, according to Sgt. Scott Waite.

“While I can’t give any certain data, we do know there has been a rise,” he said. “We have seen an increase throughout the years in opioid incidents. We have seen the problem range from prescription medications to heroin.”

The governor’s declaration gives Arizona the ability to coordinate efforts between state, local and private-sector partners and allows the state to use all its public health resources, including distributing naloxone, a drug that provides emergency treatment to a known or suspected opioid user, throughout the community to help prevent drug-overdose deaths.

A week later, the governor issued an executive order requiring data such as suspected opioid deaths, overdoses and neonatal abstinence syndrome be reported within 24 hours to the state, which gives a real-time picture. Groups that fall under the order include licensed health-care providers, first-responders, pharmacists and administrators of health care institutions or correctional facilities.

Since the order, 444 possible opioid overdoses have been reported for June 15-29, with 60 percent being men and 40 percent, women. Of the 444 cases, 36 are suspected overdose deaths, according to Health Services.

Additionally for the same time period, 325 doses of naloxone were administered outside of hospitals by emergency medical personnel, law enforcement officers and others.

Heath Services Director Cara Christ said getting timely data instead of working with data that could be up to a year old will help efforts in trying to reduce opioid deaths.

Dr. Christ said her department is looking into improving prescription practices, addressing poly-drug use and analyzing raw data on overdose deaths to see where the problem areas are and learn how changes can be made to save lives.

According to a news release, the department will identify ways to:
• Prevent prescription opioid drug abuse through appropriate prescribing practices,
• Develop guidelines to educate healthcare providers on responsible prescribing practices,
• Expand access to treatment, especially Medication Assisted Treatment (MAT), and
• Reverse overdoses through the distribution of naloxone.

Banner Health, with three facilities in the West Valley — Banner Thunderbird Medical Center, Banner Boswell Medical Center and Banner Del E. Webb Medical Center — has taken note of the epidemic’s impact on the communities it services, according to Tina Aramaki, Banner Pharmacy Services vice president.

“We are developing standard of care practices to assure our patients with pain and pain syndromes do receive the pain relief they need for healing,” Ms. Aramaki said. “We are incorporating the CDC guidelines into our prescribing practices.

“We are educating providers, pharmacists, nurses and patients on the appropriate and safe use of opioid medications and we are giving careful focus to the optimal management of these drugs within our facilities to prevent inappropriate use and diversion.”

Ms. Aramaki said Banner also is developing outreach and education for its patients and customers, to curb the non-medical use of opioid medications.

“For example, we have begun to develop “take-back” programs in pharmacies allowing the safe disposal of unused prescription medications,” she said.

MCSO is on the forefront combating the epidemic.

The department is training all its deputies over the next six to nine months on the use of Narcan, a nasal spray form of naloxone, according to Shannon Scheel, the department’s director of Drug Education,

Prevention and Initiatives. He also was appointed to the governor’s task force with the mission to train officers throughout the state on the use of Narcan.

Arming deputies with Narcan makes sense when oftentimes deputies in the rural outreaches of the county are the first to arrive to the scene, Mr. Scheel said.

Also, the prescription medicine, which blocks the effects of opioids and reverses an overdose, can be used by deputies when they come into accidental contact with the highly potent fentanyl, a synthetic opioid pain medication.

He said accidental exposure to the non-pharmaceutical fentanyl,which is commonly found in powdered form in a plastic bag, generally comes when trying to identify the drug, which has no odor.

“It’s lethal in small doses and exposure to the skin can cause cardiac arrest,” he said.

Earlier this year it was reported an Ohio police office overdosed after brushing off a powder believed to be fentanyl from his shirt after a drug arrest.

Mr. Scheel said so far no MCSO deputies have had to use Narcan on themselves.

Today’s drug user is not the stereotype of a junkie with a needle sticking out of an arm, although it still happens.

“I do see a lot of those deaths are regular Joes, your ordinary citizens, not criminals by day or night,” said MCSO Sgt. Brett Palmer from the District 3 station in Surprise.

“They are trying to be productive members of society and are on prescription pills and end up in an accidental overdose either by trying to mitigate their own pain or looking for some euphoric high and having to take more and more pills.”

Opioid use does not carry the same stigma of other drugs like crack cocaine, meaning they are more acceptable because they were prescribed. Some experts point to causes of the epidemic to drug companies and doctors over-prescribing pain killers.

Earlier this year, the Ohio attorney general filed suit against five major drug manufacturers, blaming them for their role in the opioid epidemic. Prescription opioids also end up in the hands of children going through medicine cabinets and between friends or neighbors sharing medication, according to officials.

Mr. Casey said in rural areas of the county where medical care is not readily accessible, people who get prescription pain killers tend to hold on to the medication to self-treat later or share.

Sgt. Palmer said he is not seeing a dramatic increase in opioid deaths in the West Valley, about one to two deaths a year, which is still not acceptable. District 3 covers 1,600 square miles, the second largest district with the most calls for service. The agency is the main law enforcement for unincorporated communities including Sun City and Sun City West and provides back-up to surrounding police departments such as Glendale, Peoria and Surprise police.

He said when there are opioid-related deaths in the Sun Cities, large retirement communities where seniors are most likely to take prescription pain medication, most of the time it is accidental.

“There is nothing we are seeing as an abusive pattern,” he said. “For myself in the last three years, there has not been an epidemic for the Sun Cities so far. But just because we don’t see an abusive issue doesn’t mean we should be reactionary to this.”

Both Sgt. Palmer and Mr. Scheel credit Sheriff Paul Penzone for taking the lead in trying to stem the opioid tide.

Since taking office, the sheriff has instituted the “Mosaic” program in MCSO jails to treat inmates with opioid abuse.

A significant percentage of those coming into the jail or serving sentences are drug-addicted and must get on a course to beat their habit before release, according to Mr. Casey. Mosaic’s goal is to reduce recidivism and help the addict transition to support services outside jail to keep them from using drugs again.

“We’ve realized through the years that we can’t arrest our way out of the problem, there are not enough deputies and jails,” Mr. Scheel said. “There are people in and out of the justice system, three, four, five times a year. There is a cost that comes in.”

Under Mr. Penzone, there is now a full-time person — Mr. Scheel — devoted to building inter-agency cooperation and delivering education and prevention material by way of classroom-level education in partnership with the Discovery Channel.

Since January, the department also has made nearly 100 presentations to small towns and unincorporated communities in Maricopa County, which may not have the expertise or programs to combat this outbreak, Mr. Casey said.

Surprise Police Department is aware of the resurgence of opioid abuse throughout the nation over the past several years.

“We are constantly evaluating new techniques to prevent opioid abuse from occurring within our community, provide emergency assistance to those who are experiencing an opioid overdose, enforce criminal laws regarding the illegal possession and distribution of opioids, and to protect our staff from accidental exposures,” Sgt. Tim Klarkowski said.

The sergeant gave an example of one of the department’s efforts.

In June of 2015 the Surprise Police launched its MedReturn drug collection program.

“The program was designed around the knowledge that prescription medication abuse, especially that of prescription painkillers, is in many cases a gateway to the use of heroin,” he said. “In the two years the program has been in place, we have collected more than 2,000 pounds of prescription medications. That is literally a ton of medication that is not able to fall into the hands of those that might abuse it.”

Opioid cost to medical care system

• In 2015, there were 41,434 unique opioid-related encounters in Arizona hospitals with an estimated cost of $341.5 million.
• Average cost per opioid-related unique encounter was $8,241.
• The cost of all opioid-related encounters has increased 125 percent from 2009-15.