Headway and Signs of Hope on Opioids

photo of pill bottle with label - warning: pharmacy law changes effective April 26

Adopting best practices from around the nation, hard-hit Arizona has made "phenomenal" progress against one of the most severe overdose epidemics in the American West -- beginning with new regulations on painkiller prescribing.

Action to abolish 'pill mills,' tighten prescribing practices and get unused pain meds out of circulation show signs of turning the tide in the opioid epidemic in Arizona, experts say

In the first in a series of state forums sponsored by HRSA's Office of Regional Operations, agency staff on the ground said Arizona's progress is all the more heartening because it's happening in a state with chronic healthcare challenges.

Arizona struggles with widespread clinician shortages, hundreds of isolated rural communities and poor access to transportation and basic communication facilities. It's also home to a half-million veterans, more tribal lands than any other state and one of the highest rates of opioid prescribing in the American West.

"Parts of Arizona are extraordinarily rural," said ORO's Valerie Gallo, principal presenter at the Oct. 11 webcast. "Some places don't even have broadband."

But sweeping reforms initiated last year – together with an aggressive campaign by state universities and an infusion of HRSA grant funds and technical assistance – appear to be making a difference in what had seemed a spiraling epidemic with no answer.

 

Left to right, Valerie Gallo; Sheila Sjolander and Dr. Cara Christ of the Arizona Department of Health Services; and HRSA Regional Administrator CAPT John Moroney
Left to right, Valerie Gallo; Sheila Sjolander and Dr. Cara Christ of the Arizona Department of Health Services; and HRSA Regional Administrator CAPT John Moroney met in August at the San Francisco Federal Building for a listening session on the opioid epidemic. The Arizona Department of Health Services shared information on their prevention, data and treatment programs and plans. See the state's Opioid Emergency Response Report HRSA exit disclaimer (PDF - 6 MB).

 

Arizona's health department now has five agencies providing opioid treatment 24 hours a day, 7 days a week, at clinics statewide to serve people who need immediate access to help. In addition, a new law requires opioid prescription bottles to include red cap packaging and warning labels. And "dump the drug" facilities - safe medication disposal sites – now number more than 150.

Strict new prescribing guidelines and a digital prescription registry are now in place to educate clinicians on responsible practices, limit the number of doses that can be given at any one time, and prevent those with misuse disorders from attaining the drugs from multiple sources. And first responders have been trained statewide to administer naloxone in overdose situations, said Gallo of HRSA's San Francisco office.

Mirroring the epidemic in other states, some 431 million opioid pills had been prescribed in Arizona in 2016 alone -- "enough for every Arizonan to have a 2½ week supply" – an ongoing trend that sparked an estimated 74 percent increase in overdoses over four years and a suspected 2,258 deaths, Gallo reported.

 

Two charts. One showing the number of opioid prescriptions per 100 people by western state (2015): AK, 71; AZ, 95; CA, 71; CO, 71; ID, 95; MT, 82; NV, 95; NM, 82; OR, 95; UT, 95; WA, 82; WY, 71. The second chart shows the rate of opioid deaths over the past decade for different age groups. Age 45-54 had the highest death rate at 18.45. The death rate by opioids for all age groups: Age 0-14, 0.09; Age 15-24, 8.63; Age 25-34, 15.76; Age 35-44, 15.08; Age 45-54, 18.45; Age 55-64, 13.74; Age 65-74, 4.25; Age 75 and Above, 1.85.

 

But an emergency declaration by the Arizona governor's office in June 2017 spurred the state's rapid adoption of new laws and counter measures, and drew multiple agencies and medical schools to the cause. The progress over such a short span of months, Gallo said, "really has been quite phenomenal."

The Arizona Opioid Epidemic Act became effective in January. It provides $10 million for treatment and requires electronic prescribing of opioid medication no later than next year.

The estimated number of patients engaged in 'doctor shopping' – patients bouncing from one practice to another seeking new prescriptions for the drugs – already has declined by an estimated 60 percent in the year since the emergency declaration. During that same period, the number of overdose cases referred to behavioral health specialists has increased by 64 percent, and the dispensing of the overdose reversal drug naloxone has spiked more than threefold.

Gallo spoke at the inaugural event of the 2018 State Forum Series. Since then, forums have also been hosted in New Jersey and Minnesota, respectively. HRSA's Office of Regional Operations will convene seven more between now and December that examine the impact of the opioid crisis in individual states.

HRSA grant awards made in recent weeks will bolster efforts to stem the epidemic in Arizona and other parts of HRSA's Region 9, Gallo said. 

The ability of HRSA's Bureau of Health Workforce to place providers in Arizona's neediest communities is especially important, said CAPT Diahann Williams, adding that the agency has recently invested $2 million in training grants at A.T. Still University – with its twin campuses in Missouri and Arizona.

"Practically the entire state of Arizona is in a Medically Underserved Area," she said.   

This fall, licensed substance use disorder counselors for the first time will be eligible to seek loan repayments through the National Health Service Corps, Williams said. Eligible clinicians may receive up to $75,000 in student loan repayments in exchange for a three-year commitment to provide treatment services at NHSC-approved sites.

Already, the NHSC has more than 110 behavioral health providers working in Arizona.

The geographic and economic realities of the state, presenters said, underscores HRSA's central mission as the "access agency" for some the most underserved patients in the nation – helping to drive innovations like telehealth and the Rural Health Opioid Program in particular, said FORHP's Michael Blodgett.

Date Last Reviewed:  November 2018