More Accessible Drug Treatment Can Help Fight Fentanyl Crisis, Says Will Humble, Executive Director of AzPHA – The State of Reform

According to Arizona Public Health Association (AzPHA) Executive Director Will Humble, tackling the state’s fentanyl overdose epidemic comes down to distributing Narcan, preventative measures like drug test strips, fentanyl and the introduction of more accessible drug treatment.

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AzPHA notes that while overdose deaths from opioids like heroin and morphine have generally declined since the Arizona Opioid Epidemic Act was implemented in 2018, fentanyl overdose deaths continued to increase exponentially.

The Arizona Opioid Epidemic Act prohibits healthcare professionals from prescribing more than 90 milligram morphine equivalents (MME) of an opioid to a patient and places a 5-day limit on initial opioid prescriptions. The law also increases reporting requirements for opioid prescribers.

The graph below, included in a report published by AzPHA in 2021, shows trends in opioid overdose death rates between 1999 and 2019. According to the report, between 2015 and 2019, synthetic opioid overdose deaths increased annually by 84.2%. From 2013 to 2019, Arizona also saw a 1,350% increase in synthetic opioid-related death rates.

Image: Arizona Public Health Association

Data from the Common Sense Institute Arizona shows that fentanyl is currently implicated in 57% of overdoses in Arizona, up from about 4% in 2017.

“For prescribed opioids in Arizona, there’s now a good grasp of that in terms of the addiction pipeline,” Humble said. “The challenge now is to deal with people in the addiction pipeline who have not been able to get treatment due to the inadequate network and the number of new people becoming addicted to opioids via fentanyl.”

Humble said that in addition to accessible fentanyl test strips and Narcan supplies, the state should increase drug treatment options.

“[A key intervention] expands the Medicaid program formulary to include long-acting drug therapy, [as opposed to labor-intensive methadone],” he said. “But there are long-term injectable drug treatment options that last for weeks, so it’s not like the suboxone movie you have to [keep going back to the clinic to take] or methadone. It’s a great standard practice that we need more of, but most Medicaid systems don’t have that on their form.

Humble added that getting rid of prior authorizations for these long-acting injectables is also an important intervention.

“There has been an organized effort to add the long-acting injectable to the [Arizona Health Care Cost Containment System] form in 2019, but it requires pre-clearance, and that pre-clearance piece is also a problem because you have to get [the medication] prescribed, [and patients often need that medication immediately].”

The Common Sense Institute Arizona notes that the economic costs of the fentanyl crisis in Arizona reached $53 billion in 2021, a 250% increase since 2010. This cost takes into account drug treatment, application of law, health care and declining productivity.

Humble pointed to the labor and personnel issues that Arizona’s fentanyl overdose crisis has presented.

“It has more to do with staffing than pressures on the acute care system because this is such a short-term and easily reversible deal. [as long as Narcan is administered quickly],” he said. “We have all these people who are addicted to either prescribed opioids, which is a decreasing problem, and now fentanyl, and they need drug treatment, and that’s an impact of not not having an adequate network for this treatment for… There is a manpower problem with not enough pain management specialists for the number of dependent people.

Humble said making fentanyl addiction treatment more accessible is also challenging because of Arizonans’ “Not in my backyard” attitudes.

“People don’t want these clinics in their neighborhoods because of property value data, so it’s very difficult to get city zoning approval for these clinics because neighborhoods are stepping up and saying : ‘We don’t want junkies here.’ ”

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