Reporting from the New York Times has found the death rate from drug overdoses in Arizona has overtaken that of West Virginia for the first time in a few decades.
The paper found Arizona and New Mexico have the highest rates of drug deaths in the lower 48 states. And a key contributor to that appears to be Arizona's summer heat.
Rebecca Sunenshine, medical director of the Health Observatory at Arizona State University, joined The Show to talk about it.
Full conversation
MARK BRODIE: Rebecca, good morning.
REBECCA SUNENSHINE: Good morning. Thank you for having me.
MARK BRODIE: Thank you for being here. So, does what the Times found and what the CDC numbers found sort of reflect your experience here and what you’ve seen over the years?
REBECCA SUNENSHINE: Well, I think sort of attributing the increase of the increase in overdose-related deaths directly to the heat might be a bit of an oversimplification. I think what we do see every year in Arizona, and particularly in Maricopa County, is that we see a high number of heat-related deaths that also involve substances. And they are definitely connected. It’s almost always in July. And it’s typically polysubstance abuse, but the vast majority actually involve methamphetamines.
So what we know is that methamphetamines, like other drugs, they sort of decrease your ability to know that you’re hot and to get out of the heat. But in addition, methamphetamines also decrease your ability to know that you’re hungry or thirsty, and so that leads to more dehydration. And most importantly, it increases your metabolism, which actually increases your core body temperature.
So all of those things combined mean that when somebody is using methamphetamines, either alone or in addition to other drugs, they are at much higher risk of dying from heat-related death.
MARK BRODIE: Do we know what percentage of the ... overdose deaths that we see in, let’s say, Maricopa County involve meth as one of the substances that users might have been taking?
REBECCA SUNENSHINE: So ... looking at heat and overdose deaths, when you look at the heat-related deaths, we know that about 50% typically in a year involve substances, and 80% of those involve methamphetamines. Just under half of them include fentanyl — or, excuse me, some type of opioid, which is typically fentanyl. But it’s almost always polysubstance, and methamphetamines is 80% of the time involved in the cause of death. And so we do believe that it’s the methamphetamines that is pushing the heat-related overdose deaths ... to be incredibly high in the summer.
But I do want to mention separately that our overdose deaths took a dip in Arizona in 2024 — it was about 1,651 — and then in 2025, it was up to almost 2,200. And I think that while heat is a factor in that, I think there are other possible reasons why Arizona might be going up while the rest of the country is going down. And I think part of that has to do with the proximity to Mexico, where a lot of the fentanyl comes from.
Unfortunately, what we’re hearing is that the fentanyl has turned to an even more potent, powdered form. And when you’re closer in proximity to Mexico, the likelihood of the drugs being cut is lower. And so we probably are seeing more potent fentanyl exposures here than perhaps in the rest of the country. And I do think that might also be a factor in our increasing overdose numbers.
MARK BRODIE: That would certainly at least appear to indicate why Arizona and New Mexico would be moving in a direction opposite the rest of the country. Are there other factors, do you think, that might be leading to what we’re seeing in Arizona relative to the rest of the country?
REBECCA SUNENSHINE: Well, again, it’s not really known. It’s just what people are thinking about. ... We certainly have gone a long way in getting the distribution of naloxone, which is an opioid reversal agent, out into the community. However, we definitely can do more opioid distribution, particularly our EMS programs — so our fire and ambulance services. When they go to an overdose throughout the state, the Arizona Department of Health Services has done an incredible program to have them actually give naloxone to a person who’s overdosed so that if it happens again, there is naloxone available. But we can always do more of that. And of course, there’s also fentanyl test strips that we might be able to do a better job distributing.
MARK BRODIE: Is it too simplistic to say that if we were to reduce the amount of methamphetamine being used, that we would be able to reduce the number of overdose-related deaths that also involve the heat?
REBECCA SUNENSHINE: I think it is more complicated than that. ... When you talk about heat and substance use, you have to think about homelessness as well. They all intersect. And what we’ve learned from studies that Maricopa County has actually done is that sometimes people don’t actually use substances. And then when they become homeless, they actually begin to use substances because they are homeless. And methamphetamines becomes very attractive because it can keep you awake through the night when your safety is threatened.
So there are so many complicating factors that involve availability of housing, our increasing levels of homelessness, and access to methamphetamines that really make this heat-related death with substances involved problem very complicated. That being said, there is an evidence-based treatment for methamphetamine addiction, and it’s definitely something we could be doing more of in Arizona.
MARK BRODIE: All right. We’ll have to leave it there. That is Rebecca Sunenshine, medical director of the Health Observatory at ASU. Rebecca, thanks so much. I really appreciate it.
REBECCA SUNENSHINE: Thank you very much.
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