by Cara Christ, MD, MS, Arizona Department of Health Services Director
More than 600 Arizonans died from opioid abuse in 2015, averaging almost two deaths per day. This is an issue that has likely touched your practice and maybe even your family. While acknowledging that even one death because of this scourge is too many, Governor Doug Ducey has made it a top priority to turn the tide of Arizona’s opioid epidemic, challenging his cabinet agencies to reduce the state’s opioid deaths by 150 no later than 2018 and to double this decrease by 2021.
To achieve these aggressive goals, the state is applying the same disciplined, data-driven approaches being deployed systematically throughout state government to improve business processes. Indeed, Arizona may be the only state to apply such Lean management methods to address complex social problems like this.
Several agencies, led by ADHS, AHCCCS, and the Governor’s Office of Youth, Faith, and Family (GOYFF), are working collaboratively with other regulatory boards and agencies in partnership with stakeholder communities to combine and expand our mutual efforts to address the epidemic. Our work with community partners, such as professional organizations, healthcare providers, public health, and substance abuse coalitions will assist us in achieving the Governor’s goal.
The team is actively managing the project for success, adhering to weekly work schedules, routinely tracking performance, and reporting progress to the Governor. We have identified the following four major priorities to address:
- improving access to naloxone in our communities to reverse overdoses,
- expanding access to treatment, especially medication-assisted treatment (MAT), and ensuring a pathway to treatment,
- preventing prescription opioid drug abuse through appropriate prescribing practices, and
- educating Arizonans on the dangers of opioid misuse and abuse.
We all know that minutes count when treating an opioid overdose. Administration of the overdose reversal drug, naloxone, can keep someone alive long enough to get them to an emergency room for life-saving treatment. That’s why increasing naloxone access in our communities is one of our main priorities in combatting the opioid epidemic. We are working to educate families, friends, and others at risk of overdosing about the importance of naloxone and the critical steps to take if overdose happens. It is important that those with a loved one who is misusing or abusing opioids talk with their doctor or pharmacist about prescribing naloxone so it is on hand in case of an overdose. Our partnership with AHCCCS, GOYFF, and Sonoran Prevention to get naloxone kits out to the at-risk community has already had a direct impact on our outcomes by reversing over 100 overdoses.
Other steps are being taken to ensure those at risk have access to this medication when it counts. By working with AZPOST and law enforcement agencies, we are helping police and firefighter first responders get trained on how to deliver life-saving naloxone, and to start carrying it with them in the field. Our goal is to have 85 percent of Arizona’s population covered by first responders who carry and are trained to administer naloxone so this life saving medication is on hand when it matters. Currently, 13 law enforcement agencies statewide are trained to carry and administer naloxone, and we are determined to see this number increase as part of this initiative.
Expanding access to treatment is another important strategy. There are currently not enough providers in Arizona to meet existing demand for substance abuse treatment, and we expect the number of patients needing treatment will continue to grow. We are working with healthcare plans and providers to increase the number of MAT providers in Arizona. We are also assisting hospitals, providers and health plans to develop discharge planning guidelines that are evidence-based or promising practices to help get appropriate continuing outpatient treatment for those who present to a hospital with a drug overdose. GOYFF has partnered with the Phoenix Police Department to establish the Arizona Angel Initiative, which allows those who need substance abuse help to present to the Maryvale precinct, turn in their drugs and request treatment without fear of prosecution.
We are continuing to develop new strategies to address appropriate prescribing practices as well as increase awareness of the dangers of opioid misuse and abuse among our patient populations. The Arizona Opioid Prescribing Guidelines, released in 2014, are a set of best practices for prescribing opioids using the expertise of practitioners from across Arizona. Using these guidelines to assess, manage, and monitor patients will help prevent misuse and abuse. Free continuing medical education credits are available for providers interested in learning more about the guidelines.
Of course, stopping opioid misuse and abuse before it starts is ideal, and we’re focusing on several prevention strategies. Education and awareness campaigns have been implemented around the state including: “I’ve got Something Better,” Rethink Rx Abuse, and “Overcome Awkward.” Pilot projects looking at prevention messaging to middle schools and high schools have been implemented in each county and are showing promising results. And, there is currently a request for grant applications for Arizona high schools interested in participating in the health and wellness grant program, which will support our high schools in creating healthy and drug-free learning environments. In addition, the Governor signed Executive Order 2016-06, which placed an initial fill limitation on opioids to reduce the number of opioid-naïve individuals who are exposed to chronic opioid use.
Even with all these activities, there is still a lot to do. Physicians play a critical role in turning the tide on opioid misuse and abuse and we need your help. Here’s what you can do to help stop the opioid epidemic in Arizona:
Doctors, nurses and physician assistants:
- Help fill the treatment gap so more people will get the help they need.
- This year, become a Suboxone-waivered provider to help us to help meet the demand for opioid treatment in Arizona. An eight-hour buprenorphine waiver training course is required for physicians to prescribe and dispense buprenorphine. Resources and information are available at https://www.samhsa.gov/medication-assisted-treatment/training-resources/buprenorphine-physician-training.
- Consider non-opioid alternatives when appropriate, and help safely taper patients on dangerously high doses.
- Make sure patients understand the dangers of combining opioids with other medications that could cause an overdose.
- Consider co-prescribing naloxone to patients at high risk for opioid overdose.
- Utilize the Controlled Substance Prescription Monitoring Program to identify previous opioid use history and assess misuse and abuse risk in your patient.
- Know the Arizona Opioid Prescribing Guidelines.
These steps could very well save our patients’ lives. Together we can prevent people from dying and help us achieve the Governor’s goal.