There has been some rare good news in the battle against opioid overdose deaths: They’re dropping pretty sharply.
For years now, fentanyl has been a scourge in the battle against opioid addiction, killing tens of thousands of people across the country. The drug is incredibly potent. The phrase “one pill can kill” has become synonymous with it.
But now, across the country, we’re seeing a dramatic improvement in efforts to reverse the devastating impact of the drug. And the reasons remain cloudy.
So, what does this drop look like in Arizona? And what might be behind it? Will Humble, executive director of the Arizona Public Health Association, joined The Show to talk about it.
Conversation highlights
Let's start with the numbers. You crunched the data here in Arizona compared to the rest of the country. What did you find?
WILL HUMBLE: So as you said at the top, we are making progress nationally at lowering the number of opioid deaths — really mostly fentanyl across the country — but it's not evenly distributed. So we see a lot, really, most of the states in the Midwest and in the eastern part of the U.S. and the South are really having, substantial and sometimes dramatic drops. So, for example, you know, Arkansas, Louisiana have seen drops really pretty — North Carolina — big drops in opioid deaths. In Arizona, we're at about a wash. Looks like it's peaked a little bit, and at least it's not getting worse in Arizona. But then there's other states like Alaska, Nevada, Washington and Oregon that are still having more and more opioid deaths from fentanyl. So as you said, it's, it's a little bit nebulous as to — there's some theories as to why ... it's different in the West than the rest of the country. We can get into that if you want into that in a moment.
Those kind of numbers you're talking about are the numbers over the last several years looking at maybe up to 2023. You also looked at the 2024 data, which is where some these major drops are really materializing. These are not finalized numbers yet, but it looked like it's pointing like toward more of a drop in Arizona in this year.
HUMBLE: Yes, slightly. But remember, from a huge peak. I mean, it's been a 15, 20 year runup in these opioid deaths. In those early years, right after 2000, it was mostly prescribed opioids. And then over the last 10 years, it's really been street fentanyl.
Let's talk a little bit about what the difference might be between some of those states that you mentioned that have seen very large drops in opioid overdoses and some states like ours. What are the major theories out there?
HUMBLE: Well the dominant theory is something I read in Scientific American — it's not a study, but it's more of a hypothesis — that the Midwest and the Eastern states had a really bad fentanyl crisis before the Western states did. And so those states, like their Medicaid agencies, their law enforcement, the ... connection with the justice system, the agencies at the state, local and county level began to coordinate and collaborate to get ahead of this this fentanyl crisis in the Midwestern and Eastern states because it was such a crisis.
And meanwhile, the Western states were kind of sitting back saying, "Hey, this is a Midwest and East place problem." And the Western states were slower to get these interventions underway. And so that is a working theory. Although ... in my blog, I sort of invite academics to really dive into the details and figure out: Is there an association between how states are using their opioid settlement money and the results that you're seeing in the field?
I have to ask you about the role of naloxone here, which has been a game changer.It can reverse an overdose as it's happening. How has that looked here?
HUMBLE: Well, it's across the country. It's gotten a lot better. So naloxone is a inject, it's something you just inject into the nose and it, if someone who's having an opioid crisis ... it reverses that almost immediately, very quickly. So it's in the hands of law enforcement, firefighters, first responders and now even bystanders in Arizona. You could get naloxone at a regular drug store or pharmacy without a prescription now. So making that more available, having it in people's purses and people's pockets and have it with law enforcement and EMS is making a real difference. I liken it to the bottom of the waterfall. ... With naloxone, you're catching people at the bottom of the waterfall, they're in an opioid crisis and you can reverse that and save their life right then and there. The real key to this whole thing is getting people at the top of the waterfall before they come off.
And that really is dependent on getting people into treatment for their opioid use disorder with ... medication-assisted drugs so that they don't go off that waterfall and you don't need to use that naloxone at the end.
I want to ask you about state-level interventions and what else you think might need to be done here or maybe is being done here that might accelerate this drop in opioid overdose deaths.
HUMBLE: Yeah. So with the settlement money ... about 40% of that opioid settlement money goes to the county health department and county level. So Pima County is doing a terrific bunch of things. Maricopa County is as well. Where we have some real opportunities is with the state portion of that settlement money, which has been under used. You could do another story about how it was used to balance the budget last year, which I don't think was appropriate, but that's what ended up happening.
One of the things I'd really love to see is for that opioid settlement money to go to AHCCCS, our state Medicaid agency, so they can start paying for — or actually removing the prior authorization that they have in place for the drug called Naltrexone and buprenorphine, which are long-acting. And in case of Naltrexone, an injectable opioid antagonist ... so that you're not relying on, you know, methadone clinics for your treatment, which are — that's a daily thing.
