Interview with an expert: The ongoing opioid crisis in Arizona

The opioid crisis in Arizona has been devastating, affecting individuals, families, and communities across the state. In 2020, there were 1,914 suspected opioid deaths in Arizona, a 27% increase from the previous year.  This mirrors national overdose rates. In the US, opioid overdose deaths increased 30% from 2019-2020 and 15% from 2020-2021 (CDC) . The opioid crisis remains a significant public health issue that requires ongoing attention and effective solutions. We asked expert Benjamin Brady, DrPH, the Director of Education and Policy at the Comprehensive Pain and Addiction Center, about the current opioid crisis in Arizona. 

AZHEALTHTXT: What factors have contributed to the opioid crisis in Arizona, and how have they interacted with one another?

• Dr. Brady: The opioid crisis is a problem of increasing use of synthetic opioids and an increasing number of overdose deaths. Multiple factors are causing both. The use of illicit synthetics like fentanyl is being driven by reductions in access to prescription opioids, changes in international drug supply, contamination of fentanyl with other drug supplies, and numerous social factors that increase demand for use (COVID stress, social vulnerability, social isolation, mental health challenges, etc.). The main driver of overdose deaths is the use of more dangerous types of opioids (synthetics/fentanyl). Limited access to treatment and harm reduction services also contributes. 

AZHEALTHTXT: What are some of the unique challenges facing Arizona in its efforts to address the opioid crisis?

• Dr. Brady: Challenges include the difficulty to intervene upon demand factors (see above), limited access to opioid use disorder (OUD) treatment, legal barriers and resource limitations to offering harm reduction services, and stigma against people who use drugs (PWUD) that leads to distrust and less engagement with OUD support services. These challenges are not entirely unique to Arizona, but they are present in our communities.

AZHEALTHTXT: How has the COVID-19 pandemic affected the opioid crisis in Arizona, and what steps are being taken to mitigate the impact of the pandemic on individuals struggling with addiction?

Dr. Brady:  COVID had a disproportionately larger impact on members of society who are more likely to use opioids. Life and health struggles from COVID increased the demand for drug use for some and reduced ability to access help for others. To help, federal and state agencies relaxed several medication-for-OUD-treatment regulations to make it easier for individuals to engage with treatment, including telehealth laws and the ability to take more medication doses home (reducing the number of visits to clinics)

AZHEALTHTXT: What are some of the most promising interventions and treatments being used to address opioid addiction in Arizona, and how are they being implemented in practice?

• Dr. Brady: Destigmatizing OUD is at the top of the list, but systemic reform is needed, informed by a recognition that past and many current laws were built using law enforcement approaches instead of health and social-service approaches to address drug use. For example, Arizona recently passed a law to make harm-reducing tools more available, like fentanyl test strips. State and federal regulatory changes that facilitate easier access to medications and resources now make it possible to implement more client-centered and client-empowering care systems within clinics.

AZHEALTHTXT: How can communities in Arizona come together to prevent opioid addiction and provide support to those who are struggling with addiction?

• Dr. Brady: Destigmatizing efforts can reorient professional attitudes from trying to control drug use behavior and instead focus on reducing risk and harm exposures. Stigma creates trauma and distrust. We cannot help individuals struggling with drug use or addiction if our systems were designed to threaten them (legal and criminal justice structures). Once we remove the punishment, that opens the doors for trust and collaboration.

AZHEALTHTXT: What are some of the most common misconceptions about the opioid crisis, and how can we address these misconceptions to promote greater understanding and empathy for those affected by addiction?

• Dr. Brady: Early in the opioid crisis, we viewed the crisis too narrowly as a problem of overprescribing. When we controlled and reduced access to this supply, without reducing use demand AND without reducing illicit drug supplies (both of which are very difficult to change), we increased overdose risk. Reducing opioid prescribing prevented the onset of harm for some, but it dramatically increased opioid harm and overdose risk for those who were already misusing opioid pills. They had to quit or shift to a more dangerous source (heroin/fentanyl). Because quitting is difficult, many shifted. I believe in the principles of harm reduction, where the focus is on helping people meet their self-directed goals. These can be cheap and effective, while also being uncomfortable and undesirable to many (e.g., providing sterile syringes, providing overdose reversal medication, and helping people test their drug supply for fentanyl). As communities and health professionals shift our views towards seeing these options as helping people live safer lives (harm reduction mentality) instead of enabling them in ruining their lives,  we will be better positioned to connect,  understand, and better serve each other.