LAUREN GILGER: In recent years there has been, for once, good news about opioid overdoses in the U.S. They were going down — all over the place. By a lot.
A new report from the CDC’s National Vital Statistics System showed that this is still true for most states. Almost everywhere, there were decreases in reported drug overdose deaths from 2024-25 of more than 20%.
But not here in Arizona.
In fact, only five states saw increases in deaths in that time, including us. Arizona reported the highest rise in overdose deaths by far — at over 17%, almost the exact inverse of the national average.
For addiction medicine doctor Matt Evans, it’s been a roller coaster.
MATT EVANS: I was so happy that it was going down. My work seemed to be going well, and that’s what the patients have been saying, too, that “things are getting more stable. I’m feeling like this treatment facility is helping me, and you have me on this medication, and I feel like I’m getting stable.”
And then, I don’t know. It was — the data says it’s right at the beginning of 2025. I think a lot of people were in a stress situation because there was a lot of things that were going on in the country, a lot of changes that were happening.
But if it was all just due to some national issue, we would see that across the board nationally — higher overdose rates in every single state. But we’re not seeing that. We’re seeing decreases in most states.
And then Arizona is this anomaly where we’re seeing a sharp upward trend.
GILGER: Dr. Evans is the medical director of addiction medicine for Circle the City as well as director of addiction treatment services at New Hope Behavioral Health Center. His patients are often living on the streets, trying to stay clean.
He told me there are a lot of reasons why Arizona is seeing deaths go up when everyone else is seeing them go down, from displacement to red tape.
Tripti Choudhury is a licensed trauma clinician and volunteer with the harm reduction group Shot in the Dark. She told me it also has to do with what drugs are on the streets.
TRIPTI CHOUDHURY: Well, I mean, one of the biggest things we’re seeing is xylazine, which is a tranquilizer. And it’s looking like a longer-effect heroin high. People are not sure how to respond to it.
GILGER: These kinds of drugs are Narcan-resistant, she said, so you can’t use the opioid overdose reversal drug to save someone who’s taken too much.
Choudhury is a former drug user herself who now works to help drug users stay safe and alive while using. She’s particularly worried about a new parks ordinance from the city of Phoenix that will put restrictions on providing medical care — including harm reduction work — in city parks.
CHOUDHURY: It does put us at risk because now we’re starting to ban. We’re bringing back words that are very hostile. This is the first step in the wrong direction, and that’s what I’m scared of.
GILGER: Sounds like you see this kind of policy at a local level as like the canary in the coal mine of what’s to come.
CHOUDHURY: I do believe that overdose rates are going to be higher because we’re restricting where we can go. When they’re on their feet, on bikes, they’re unhoused, even in their cars, then we can’t serve them.
GILGER: For Dr. Evans, it’s all of these things and more that are leading to this rise in overdose deaths. I sat down with him in our studios recently to talk more about it all — and it’s today’s Deep Dive.
EVANS: As far as what exactly is causing that, I’ve been talking with multiple people. I’ve talked with Arlene Mahoney. She’s the harm reduction director of Southwest Recovery Alliance. She has stated that people are suffering from displacement, so they’re having to go from one place to another.
When that happens, not only are you having a hard time keeping up with your doctor, your addiction treatment facility, but you’re having a hard time keeping up with your friends or even the person who you buy drugs from.
When that happens, people have less stability in their life. And when you have to change drug supply, you’re at increased risk for an overdose. So if you go from one person to another person, this person may have an opioid that is predictable in strength, quantity. The other person that you go to may have a higher potency opioid, or it may have xylazine in it, or it may have another drug that your body’s not familiar with.
So it’s gonna put you at increased risk for overdose. And a lot of the times when people are getting displaced and they’re going from one place to another, sometimes they’re going through withdrawal for a period. And that happens if you go through with opioid withdrawal and then go back to your previous dose of opioid, you’re far higher risk for an overdose.
GILGER: What’s leading to that displacement and that kind of disruption for folks?
EVANS: Yeah, I think that as far as where people are going — you know, I do homeless health care. I work for Circle of the City, and we’re trying to meet people where they’re at. Not necessarily psychologically, not necessarily physically, but all of the above. Sometimes even from a mental health standpoint, we’ll meet them wherever they’re at, we’ll refill their meds and try to get them that care that they need in the place that they’re at.
But there’s a million different reasons for why they may have been displaced. Maybe they were not allowed to stay at the city park that they were allowed to stay at for some period of time. Maybe they were sleeping in an alley and they can’t stay there anymore. Maybe they were just released from jail or prison and they had a follow up appointment that they missed and now they’re back on the streets again.
There’s a lot of reasons for why they would be displaced, but it’s happening. And we’re trying to help fill those gaps.
GILGER: I want to ask about the drugs themselves that folks are using and if that’s changed. I’ve read a lot about how fentanyl now, especially in Arizona, seems to be appearing in a powder form and that might be changing things, making it harder to maybe measure. But fentanyl is so deadly.
Are we just seeing changes in the availability of these drugs that can lead so easily to overdoses?
EVANS: Yeah, I think that that is definitely the case. When they were in pills, even the pills had different concentrations, but at least you could count them and be like, "OK, I’m gonna use two pills" and not just like an unmeasured quantity of powder. I talked with some harm reduction folks and they said that we’re seeing people fall out or have overdoses far more frequently when the dealers switched from pills to powders.
I think it’s definitely harder to measure. The potency is definitely more variable. And we’re finding not only fentanyl, ultraprotent fentanyl, xylazine, but there are these even more ultrapotent opioids called nitazines that are being found in the drug supply.
They’re really hard to test for. So I don’t have a lot of evidence as to how frequently they’re showing up in the drug supply.
But xylazine has been in certain pockets, and we do provide patients with xylazine test strips to test their fentanyl supply to make sure that they are at least not taking a sedative in addition to the fentanyl that they’re using.
So as the trends continue to evolve, there’s this thing called the iron law of prohibition.
And the iron law of prohibition is as long as we continue with the same approach of more and more severe penalties against people who use drugs, the drug supply is going to become more and more unsafe because whatever volume of powder — it could be the most potent — is going to be the one that’s chosen because it’s easier to transport, it’s easier to get into the hands of dealers so you don’t have a big, huge quantity of drugs.
And that’s more dangerous for the user because that tiny amount of drug can cause an overdose.
GILGER: So, Dr. Evans, is this a policy problem, in your opinion? Like from my reporting, at least, it seems like we have done so much in the state in the last couple of years here in terms of harm reduction.
Like, we’ve seen the widespread adoption of naloxone and Narcan and these things that can reverse an overdose being available pretty widely. We’ve seen legalized needle exchanges for folks, so they can have access to clean needles.
We’ve legalized fentanyl testing strips so folks know what is in the drug they’re taking and don’t overdose.
What else needs to happen?
EVANS: I think we need to make getting treatment easier, and we need to make it more available. I was looking at the numbers because you asked me to come on The Show, and I was noticing some concerning trends when an OTP, like an opioid treatment program, were to close down because there wasn’t enough funding or there weren’t enough patients in that small county to support the need for an opioid treatment program.
It is an investment. It’s a lot of money. Staff, counselors, peer support workers, doctors, nurses. But when they close down, you see this surge in overdose. Methadone treatment, Suboxone treatment, they are medications that cause opioid tolerance. So when you have that in your system and you come across fentanyl — whether intentionally or unintentionally — you’re often not going to have an overdose.
So people who are on those treatments: 60% less likely to have an overdose if you’re on methadone, 40-plus percent less likely to have an overdose if you’re on buprenorphine, or commonly known as Suboxone. So we need to somehow fix this bottleneck problem of patients having to see a doctor, having to see their counselor, having to see a case manager before they get their medicine.
Sometimes when we open new OTPs in these rural locations, there’s these, like we can start the patients on treatment as long as they’re seen by their doctor, counselor and treatment team within two weeks. I think we’re in a state of emergency where we need to just put funding down and open these clinics at a much faster rate than we are.
But my opioid treatment program that I work at on Fridays and see patients, it’s the funding to get the staff that we need to take care of the patients is not there. So we’re even thinking about expanding to different states because unfortunately, the funding here in Arizona is not where it should be.
GILGER: So it’s a funding issue, a red tape issue it sounds like for you.
EVANS: It is both a red tape and a funding issue. Yeah, it’s extremely bureaucratic to operate an OTP. It’s very, very difficult to make sure that you’re dotting all your I’s and crossing all your T’s. We do a very good job at it. But a lot of these treatment providers that are operating at scale — like, much bigger patient populations than I have — they have an impossible task to make sure that all these I’s are dotted, all these T’s are crossed to make sure that their treatment facility is in compliance.
And then when they’re not in compliance, sometimes they get shut down. And then that’s gonna make the problem worse because the patients don’t have access to the medicine that saves their life.
GILGER: So you were talking before about the drug supply and the dealers who people can see to get their drugs. And you’re kind of operating under the assumption that people who use drugs are gonna use drugs and we have to kind of meet them where they are before you can try to get them to stop using drugs, right?
But I wonder: Those suppliers, that drug supply, those dealers — that’s all illegal stuff. And you’ll hear lots of folks say, prosecutors in particular, that we just need — maybe among other things — but we also need harsher sentencing for drug traffickers, harsher penalties, so that these people who are supplying the drugs to the people who want them can’t do it anymore.
EVANS: Yeah, I disagree. I read this amazing article by Susan Ousterman. She’s incredible. She’s somebody who addiction has affected her life. I’ll leave it at that. And she basically said that you cannot double down on the same policies that have caused the situation that we’re in.
The more that we criminalize, the more that we penalize, the more that we go to war.
These are all things that are going to cause trauma and hurt and suffering in people’s lives. And that’s the same reason why people use drugs to feel better. And it’s not the right choice. It’s not going to make you feel better.
But it’s what human beings have been doing since time immemorial. Mao Zedong tried to eliminate opiate users with mass murder, incarceration. And they still have a problem.
There’s no way that we can criminalize, dehumanize or end life in a way that’s going to end this problem. So we need to meet people where they’re at, give them the treatments that we know work.
And then over time, as they improve, as they’re seeing our counselors, as they’re processing their trauma and as they’re trying to untangle their life — if they’re ready — we taper them down slowly. Because it is an impossible task to just tell somebody, "Pull yourself up by your bootstraps. Stop using drugs."
If you’ve ever been in the situation of being on a chronic opioid, it is the most difficult thing I’ve heard of. If you hear people describe opioid withdrawals, it is not anything you ever want to go through.
GILGER: Right. So let me end on that note. That kind of human note, right. Like I think we hear these statistics a lot. People are aware that overdoses happen and that people use drugs. But when you have a stat out there, like 17% increase in overdoses in the state, what does that look like for real people on the ground?
How is it affecting people’s lives? Are people scared?
EVANS: Yes, people are terrified. And it hurts me as — not to bring it back to myself — as a treatment provider because I have a lot of great tools. I have these tools, these treatment medications, these even long acting injectables that we can give to patients that cover them for a whole month. And nobody’s going to steal their medicine. They’re not going to lose it.
And then we have this horrible time with getting them the medication that they need. There’s still prior authorization requirements by the insurance companies, and the pharmacy and me work together to get the patient their medicine, but sometimes it’s too late.
They’re leaving treatment. They haven’t got their medication. Then I have to talk with the kid’s mother about how our system has failed them.
And it shouldn’t be this way.
And we are all working together to change things. But we’re in a crisis, and whatever we need to do — remove those prior authorization requirements, hire more peer support workers, allow addiction patients to be peer support workers — to help us get out of this crisis, we need to do now.
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