On the center of the wall in Maria Montano’s apartment living room is a big display of photos of her brother Brandon – a family trip to the beach, a few silly selfies, and in the middle, a big closeup of his face, his brown eyes gazing upward.
“I just remember him always smiling and being happy,” Maria said.
Maria said when they were kids, she loved to take care of Brandon. He was only five years younger than her, but she thought of him like her little son. When they grew up, Brandon struggled with addiction. But still, Maria always tried to look out for him.
“I tried to get him to go to rehab, tried to get him to go therapy, talked to a lot of his probation officers about how we could get him help,” Maria said.
And Maria let Brandon stay with her sometimes, since he didn’t have stable housing. On July 20 last year, Brandon left Maria’s place for the last time. It was one of the hottest days in Phoenix history – 119 degrees.
Later that day, a passerby found Brandon unresponsive on the street. Paramedics took him to a hospital, where his body temperature was recorded as 106. He didn’t survive.
It was days before Maria found out Brandon had died and months before she received the medical examiner’s report about his case. It listed Brandon’s cause of death as methamphetamine and fentanyl toxicity. But what surprised Maria was that another cause was listed, too: environmental heat exposure.
“I always just thought [heat-related deaths were] like people hiking, out exercising, that they’re not used to it,” Maria said.
She and Brandon grew up in Arizona, they were used to heat. But Maria had no idea that extreme temperatures would make her brother’s drug use more dangerous. She doesn’t think Brandon knew that either.
“I don't really think he thought about it,” Maria said.
The circumstances that led to Brandon’s death are increasingly common. Heat-related deaths in Maricopa County have been soaring in recent years. Last year, a record-shattering 645 deaths were attributed to heat. Rising summer temperatures driven by climate change are partly to blame for the trend. And an increase in unsheltered homelessness has left more people vulnerable to heat. But another major factor behind the growing number of fatalities is substance use. As the number of heat deaths in Maricopa County has skyrocketed, so has the percentage of those deaths involving drugs or alcohol. Last year, substances were involved in two out of every three heat death cases.
Methamphetamine – one of the drugs Brandon used – was most often the substance to blame.
“I have personally seen an increase in meth use with the population that we serve,” said Jonathan Garcia, clinical director with Community Bridges, Inc., a behavioral health organization that runs several shelters and crisis response programs in metro Phoenix and contracts with the city for substance use intervention programs.
“I would say methamphetamine tends to be the top [substance] we see,” Garcia said.
Garcia said methamphetamine is growing in popularity because it’s relatively cheap and easy to obtain. And for the homeless populations he works with, he said the powerful stimulant offers an appealing burst of energy.
“They say they have to stay up to protect themselves, they have to watch their belongings,” Garcia said.
Garcia said his clients might stay awake on methamphetamine for days at a time. That alone is dangerous. But the drug also raises the heart rate, increases the body temperature, reduces thirst, and even alleviates the feeling of overheating. When combined with Arizona’s scorching summer weather, just a small amount of methamphetamine can be lethal.
In Maricopa County, 330 died last year as a result of methamphetamine use and heat exposure — nearly triple the number of deaths attributed to meth and heat just three years earlier, Maricopa County records show.
“Opiates, fentanyl, heroin are getting a lot of the publicity – rightfully so, overdoses are happening from that. But I think methamphetamine tends to get swept under the rug, and there’s not much attention that’s paid toward it,” Garcia said. “I think more education for methamphetamine could be out there, more resources.”
Arizonans die from methamphetamine use at one of the highest rates in the nation, according to the Centers for Disease Control and Prevention’s State Unintentional Drug Overdose Reporting System.
Nicole Witt, public health advisor for the city of Phoenix, thinks climate is part of the reason why.
“I do think we are on the front-lines in Arizona in talking about this issue,” Witt said.
Witt said when you look at CDC data on all deaths from drug overdoses across the U.S., typically, the numbers are fairly even month-to-month. That’s not the case in Arizona.
“It’s a very unique curve for Arizona – this huge spike that we see associated with those summer months, in particular, July,” Witt said.
Phoenix officials this year wanted substance use to be a bigger focus of the city’s plan for preventing heat-related deaths. But Witt said when she and her colleagues went looking for resources to guide the city’s approach to this growing public health problem, there was almost nothing out there.
“What we do in public health is we look at evidence-based practice and peer-reviewed research around topics to inform what we need to do and tailor those to our local circumstances,” Witt said. “In this case, there really are not a lot of examples of strategies for this particular topic of this combination of heat and substance use.”
So Witt and her colleagues started from scratch to make a new pamphlet they are distributing this summer through drug intervention organizations across metro Phoenix. The pamphlet recommends people who use stimulants stay well hydrated and learn to recognize symptoms of heat stroke. It also gives tips like limiting drug use to air conditioned spaces, and never using substances alone.
But, Witt said, it will take time to raise awareness of the dangers of drugs and heat and for officials to understand what the most effective interventions are to prevent these deaths.
“We really are creating something from nothing,” Witt said.
So far this year, Maricopa County has confirmed 23 heat deaths and officials are investigating more than 300 other possible heat deaths. Those numbers are 54% higher than they were at the same point last summer. Among heat deaths confirmed this year, more than half have involved drug use, County records show.
As triple-digit temperatures drag on, Maria said it’s troubling to think about all of the Arizonans struggling with substance use, like her brother did.
“I just feel like there’s a lot of people out there right now going through the same thing he was and not really getting help,” Maria said.
Brandon was just 25 years old when he died. Maria knows he wanted a better future for himself.
“He would tell me that he wanted to change, but that he couldn't,” Maria said.
She wishes he’d gotten that chance.
-
We were breaking heat records all summer long. But now that it’s winter, it can be easy to forget that it’s actually way hotter than it usually is this time of year. -
One listener asked how the advent of air conditioning affected Arizona’s population growth. As it turns out, the answer isn’t as easy to pin down as it seems. -
January is off to an unseasonably warm start, and Phoenix could even break a heat record Friday. -
Phoenix is known for heat, but it’s never been this hot in the Valley before. The National Weather Service confirms 2024 was Phoenix’s hottest year on record. -
Scientists are trying to figure out better ways to water trees, in an effort to both conserve the limited resource and preserve tree health and the shade trees provide.
