In the same month as Arizona witnesses a dramatic rise in the prevalence of heroin overdoses across the state, one of the largest drug enforcement operations in Arizona’s Mohave County ended successfully this week when local, state, and federal law enforcement officials made dozens of arrests in what was later described as an “international heroin and methamphetamine smuggling enterprise.”
The often now forgotten “American War on Drugs” still goes on and on. Now over 4 decades in duration, with many battles lost and only small victories won, like the one described above in Mohave County, as ever, there is still no foreseeable end in sight.
In fact, along with a change in the U.S. Presidency, this month has also seen another important decision made that may well trigger a complete re-think, or even, in time, a reversal of national drug policy. Oregon, another state on the western side of the U.S., has historically voted to decriminalize the possession of illegal drugs, including heroin, cocaine, and methamphetamine.
With the latest sharp rise in drug overdoses now being seen in Arizona – this time heroin-specific, and many of which have sadly proved fatal – addiction industry experts are asking the question:
Is it time for the state to be as radical with its drug policy as its near-neighbor Oregon, and look to decriminalize drug possession, and, like Oregon, see addiction as a health issue (as opposed to one of law and order) and advocate drug treatment services to the drug user over sentencing them to actual jail-time?
Arizona & The Spike in Heroin-Specific Overdoses
Last year, the Arizona Department of Health Services’ opioid dashboard showed that heroin was found in nearly 29% of drug overdoses across the state. So far this year, it has spiked to an alarming 43%. Furthermore, the state health department’s dashboard shows that the number of drug overdose cases involving the synthetic opioid fentanyl has slightly decreased, while those involving cocaine or hydrocodone have seen greater decreases.
“Their intention was not to overdose. They thought that they could control what they were using.” – Christina Orellana, Arizona-based primary addiction therapist
However, there has also been a rise in the number of drug overdoses involving only one drug – statistics from last year showed it was 52%, and so far this year, it’s 62%.
Christina Orellana, a primary addiction therapist, based near Phoenix, interviewed by one of the city’s news outlets, gave her views as to why Arizona is witnessing such a sharp rise in heroin-only overdoses: “One thing that I’ve heard now a few times is this false belief that heroin is not going to cause an overdose as long as it’s not laced with fentanyl. The flaws in that is, one, you don’t know if it’s going to be laced with fentanyl and, two, you can overdose and die from heroin without it being laced with fentanyl.”
She went on to say that accidental drug overdoses, particularly heroin, “happens all the time. I’ve worked with many patients who have overdosed and have, thankfully, been revived and come into treatment. Their intention was not to overdose. They thought that they could control what they were using.”
Illegal Drug Supply Chains Disrupted by COVID-19
One of the little-known effects of the coronavirus pandemic has been to disrupt the usual supply routes of illegal drugs coming into the state – a situation mirrored across the rest of the nation. A primary consequence of this has been that the drugs – heroin included – that addicts are being supplied by their normal dealers have been manufactured by different drug syndicates elsewhere, leaving the addict clueless as to what they’re getting, ie. what has actually been cut (mixed) into the substance along with the heroin.
This could very well be either stronger opioids, like fentanyl, or other ingredients, such as baking soda, crushed over-the-counter painkillers, laundry detergent, and even rat poison.
Arizona is Not Alone: The Rising Fatal Overdose Rates in the U.S.
Worryingly, Arizona is not alone in its dramatic rise in drug overdoses, particularly opioids like heroin. In fact, the Advocacy Resource Center of the American Medical Association updated an issue brief only last month, in which it reported that the U.S.’s opioid epidemic is still causing needless overdoses and deaths across the U.S., with fatal opioid overdoses now rising in 40 of the nation’s states just this year.
Additionally, according to the latest data from the U.S. Overdose Detection Mapping Application Program (ODMAP), responsible for collecting real-time overdose numbers nationally, suspected drug overdoses in the U.S. have risen by 18% this year – that’s nearly a fifth – since the country has been battling, relatively unsuccessfully, with the coronavirus pandemic.
Arizona: The Declines in Mental Health & Hospital ICU Availability
Furthermore, there are other factors at play in this latest rise in fatal and non-fatal heroin overdoses in Arizona, Like many other regions of the U.S., the state population’s mental health has taken a sizable hit during the coronavirus pandemic, which, in part, can explain the increase in the number of drug overdoses, fatal or otherwise.
More and more people and this includes those suffering with substance use disorders (SUDs), are also reporting the primary symptoms of both depression and anxiety-related disorders. According to the latest data from the U.S. Household Pulse Survey, the latest surge in the coronavirus has led to decreasing mental health in Arizona across many demographics.
With regard to the continuing pandemic, the University of Arizona Mel and Enid Zuckerman College of Public Health has warned of a possible major crisis on the immediate horizon if current COVID-19 trends remain as they are. According to their report summary, “If this ‘surge’ is not quickly addressed, new COVID-19 cases will overwhelm our capacity to provide optimal hospital care within a matter of weeks.”
It is worth remembering at this point that the last time hospitalizations were rapidly climbing, earlier in the year, Arizona actually became the first state in the nation to trigger “crisis care” standards – a protocol that helps medical staff decide who gets treatment as a priority. An identical situation is now looming ever closer across Arizona hospitals.
Arizona: Opioid Drug Abuse & Addiction Treatment Statistics
In the U.S., only a couple of years ago, the opioid epidemic, although not by any means over, was showing significant improvements in both opioid abuse, including prescription medications, and in fatal opioid-related overdoses – a decrease of 4.1%. However, nearly 70% of all overdose deaths still involved opioids.
Not including methadone, deaths involving synthetic (laboratory-manufactured) opioids such as fentanyl and fentanyl analogs (meaning the physical structure is similar, but not the chemical makeup), however, did continue to rise in 2018.
“We still don’t have the majority of Americans who have opioid use disorder on the gold standard medication assisted treatment.” – Dr. Anand Parekh, Chief Medical Adviser, Bipartisan Policy Center
Dr. Anand Parekh, Chief Medical Adviser at the Bipartisan Policy Center, a Washington DC-based think-tank, which has recently completed an in-depth study of how 2019 federal funding to fight the opioid epidemic was actually spent. The Bipartisan Policy Center also reports that provisional data is suggesting overall drug overdose death rates actually rose by 4.9% in 2019, thus erasing the slight decline observed in 2018.
Dr. Anand Parekh stated that this is down to a number of factors:
- Synthetic opioids like fentanyl are driving more deaths
- More people are using multiple substances
- Usage rates among communities of color are increasing, and
- The concern that federal dollars are not getting through to the treatment for the highest risk groups
He further commented, “At the end of the day, there is still too much stigma out there when it comes to substance abuse disorders and the opioid epidemic. This is a public health challenge. We still don’t have the majority of Americans who have opioid use disorder on the gold standard medication-assisted treatment, so that’s really important.”
Arizona Opioid Action Plan: Now on Version 2.0
Additionally, in Arizona, the level of addiction treatment and medication provided by the state’s health services after a reported opioid overdose, including heroin, has now come sharply into focus, and, to be honest, it doesn’t look as good as it should do – by law.
Somewhat hidden away in the state’s “Arizona Opioid Action Plan v.2.0, July 2019-June, 2021” publication are the statistics for patients who entered hospital due to a confirmed opioid overdose, and how these hospitals actually medically intervened in the patient’s opioid use disorder (OUD), as they are required to do by law – the U.S. Opioid Epidemic Act.
Unfortunately, referrals are still not being made for all of these patients, and very few of them are being prescribed naloxone or provided naloxone at discharge. The Arizona Department of Health Services (ADHS) opioid surveillance data indicates hospitals reported that 25% of overdose survivors were not referred to either behavioral health or substance abuse treatment in 2019.
Furthermore, the same hospitals reported that the number of people given a naloxone prescription to fill at a pharmacy after being discharged home after a verified, non-fatal opioid overdose only increased from 3% in 2018 to 9% in 2019.
Is Oregon’s New Drug Policy the Way Forward for Arizona, Too?
The state of Oregon made history during this term’s U.S. Presidential election. Along with their “party vote,” Oregonians were asked to vote on whether to decriminalize the possession of all illegal drugs, including heroin, cocaine, and methamphetamines. Additionally, they were also asked to vote on whether psilocybin or psychoactive (“magic”) mushrooms, should be legalized for therapeutic use.
Resoundingly, Oregon voted “Yes” – to both.
Drug Possession Decriminalization: Portugal’s Radical Initiative
Oregon, however, is not taking a leap into the unknown here. Portugal (in a first for Europe) actually decriminalized the personal possession of all drugs back in 2001, meaning that it is no longer a criminal offense to possess drugs for personal use; however, it is still considered an administrative violation. This violation is punishable by penalties, such as fines or community service.
The reality is that it’s unlikely any penalty is enforced. While the police still refer the case to the “Commissions for the Dissuasion of Drug Addiction” (regional panels made up of legal, health, and social work professionals), the vast majority have their cases “suspended,” effectively meaning they receive no penalty.
Drug-dependent people are only encouraged to seek treatment (they are rarely sanctioned if they choose not to); the objective of these commissions is for people to enter treatment voluntarily.
Prior to this new initiative, Portugal’s main opioid hurdle was heroin.
And the result of this new drug policy? Portugal’s drug issue has improved significantly in certain areas – most notably:
- HIV infections and drug-related deaths have decreased
- The overall number of overdoses is down to only 30 per year
- The number of people dying in Portugal from any form of drug abuse is 4 times lower than the overall European average
- The predicted sharp rise in drug use failed to materialize, and
- The initiative has been further assisted by Portugal’s shift towards this more health-centered approach to drugs
Arizona’s Continuing Tough Stance on Illegal Opioids
To understand if Arizona would ever go down the route of drug decriminalization, you only need to look at which direction new policies and Bills are heading. In January of this year, Republican lawmakers in Arizona proposed that people caught with even small amounts of heroin, fentanyl, fentanyl analogs, and carfentanil (an opioid even stronger than fentanyl) be imprisoned for a statutory minimum of 5 years.
Understandably, the proposal has met strong resistance, though the Bill (House Bill 2036, to be exact) is currently “retained on calendar.” Opponents fear it would be sanctioning those people in need of substance-abuse treatment, instead of effectively targeting major drug dealers. Currently, dealing narcotics only carries a 4-year minimum sentence under Arizona law, with certain low-level offenders eligible for probation.
Rep. Jay Lawrence, the Scottsdale Republican, however, saw no problem with the legislation: “We’re not talking about marijuana* dealers. You may want to have lower penalties for them – OK, I’ll think about that. But as far as fentanyl, I won’t think about that. If you’re dealing fentanyl, you’re dealing a drug that kills.”
Note: *Arizona also voted this year – 60% to 40% – to legalize marijuana, meaning it is legal to possess and use marijuana for adults, age 21 years or older, and also permits individuals to grow up to 6 marijuana plants in their residences.
As to Arizona ever going down the route of drug decriminalization? With this current thinking, definitely not. However, that may well change, with the state of Arizona now Democrat following the 2020 election, for the state that, at the moment, is perceived to have an “incarceration crisis” – with way too many offenders now in overcrowded prisons – after its decades-long “tough on crime” approach.
Arizona: The Long Road to Addiction Treatment for All
According to the latest government survey statistics, less than a fifth of those in need of the addiction treatment for SUDs receive the medical care they so desperately need; this is particularly concerning in a state like Arizona, where the prevalence of the disorder is greater than the U.S. national average. Additionally, when you look at other related factors in the data tables, such as those with thoughts of suicide or those who have experienced a major depressive disorder in the past year, you’ll see that Arizona is again much higher than the national averages.
Whatever direction the state heads in with its current drug policies, and its current ability to get those drug addicts into actual treatment programs, whichever way they finally decide to go, the road will be a long and arduous one.
Learn more about drug addiction treatment at SpringBoard Recovery, located in Scottsdale, AZ., by contacting us either: