Arizona declares opioid crisis a public-health emergency

Ken Alltucker | The Republic | azcentral.com

With 790 Arizona residents dead from opioid overdoses last year, Gov. Doug Ducey declared a public-health emergency that seeks to bolster the state's efforts to counter the epidemic.

The declaration will soon require hospitals, doctors and other health providers to more frequently update state health officials on overdose deaths and opioid-related encounters.

It also is designed to expand distribution of the overdose-reversal drug naloxone to law enforcement statewide, particularly in communities with clusters of overdose deaths or near-deaths.

The action also aims to develop new guidelines for prescribing opioids and expand access to medication-assisted drug treatment.

The declaration comes after the Arizona Department of Health Services released a report last week showing an average of more than two people died every day last year from prescription opioid or heroin overdoses.

The deaths represented a 74 percent surge since 2012, the report said. State health officials cautioned that last year's death toll might actually be higher because of a lag in reporting deaths.

"The governor is very alarmed about this," Ducey spokesman Daniel Scarpinato said in a call with reporters. "He really sees this as something we need to be even more aggressive on."

Ducey's administration and the Arizona Legislature have taken steps to curtail the epidemic. Those actions include limiting initial opioid prescriptions to seven days for adults insured by Medicaid or the state's insurance plan and legislation allowing pharmacies to dispense the overdose-reversal drug naloxone without a prescription.

This year, state lawmakers passed legislation to create an 11-member drug overdose fatality review team that would review all overdose deaths.

The declaration announced Monday allows ADHS to draw down a $500,000 public-health emergency fund to pay for items such as training costs and supplies of naloxone.

The state would provide training for law enforcement on protocols for carrying, handling and administering naloxone during overdoses.

Dr. Cara Christ, director of ADHS, said her agency will provide a recommendation within one week on ways to implement enhanced surveillance to better track the opioid epidemic.

ADHS now has two main sources of information for tracking opioid-related overdoses: death certificates and twice-a-year discharge reports that licensed health facilities must file with the agency.

With the emergency declaration, Christ said her agency may require hospitals and other licensed health facilities to provide more frequent updates on overdose deaths and opioid-related encounters. State law would allow the state to require daily updates.

Arizona hospital officials said they are willing to work with Ducey's administration on ways to fight opioid overdoses and addiction.

Greg Vigdor, president and CEO of the Arizona Hospital and Healthcare Association, said he welcomes the state's focus on the opioid epidemic.

"Many of our members have developed their own local programs to reduce the abuse that can be affected through their interventions, and we welcome state action that can help advance these efforts," Vigdor said.

Christ said the combination of more-frequent updates and police equipped with naloxone would allow the state to target communities with an emerging problem.

For example, if state heath officials gathered data on clusters of patients that need multiple naloxone doses to counter overdoses, it could be a sign that a particularly potent drug has hit a community's streets.

With tighter prescribing guidelines recommended by the federal Centers for Disease Control and Prevention, it's likely that some patients battling addiction are turning to the black market if they can't obtain a prescription from a doctor.

As it stands now, ADHS can't be certain whether a prescription drug overdose is the result of drugs that were obtained from a pharmacy or purchased on the black market.

In March, the federal Drug Enforcement Administration said it traced 32 overdose deaths since 2015 to black-market drugs that were laced with the powerful synthetic opiate fentanyl.

Christina Corieri, Ducey's health policy adviser, cited a federal study that suggested four out of five heroin users started on prescribed opiates.

She also said people on average visit a hospital emergency room three times for treatment before a fatal overdose.

"That is three missed opportunities," Corieri said, noting the need to work with hospitals to inform patients about drug-treatment options.

While Ducey's order also seeks to expand use of medication-assisted treatment options, some worry it could be too little to offset possible reductions in funding for addiction treatment programs under the GOP's health-reform bill that passed the U.S. House of Representatives.

The nonpartisan Congressional Budget Office estimated federal spending on Medicaid programs would be cut by $880 million over the next decade. That could pressure states to cut Medicaid programs and limit eligibility beginning in 2020.

Vigdor, of the hospital association, said his organization's greatest concern is maintaining the health insurance gains realized under the state's Medicaid expansion.

"The (American Health Care Act) proposal passed by the House would greatly endanger Medicaid coverage and our efforts to get ahead of this health crisis," Vigdor said. "Its passage would greatly damage our state efforts to solve this problem in particular and would be a major setback."

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