More accessible medication-assisted treatment can help combat fentanyl crisis, AzPHA Executive Director Will Humble says

According to Arizona Public Health Association (AzPHA) Executive Director Will Humble, tackling the fentanyl overdose epidemic in the state comes down to Narcan distribution, preventative measures like fentanyl test strips, and making medication-assisted treatment more accessible. 

 

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AzPHA notes that while overdose deaths from opioids like heroin and morphine have generally been decreasing since the Arizona Opioid Epidemic Act was implemented in 2018, fentanyl overdose deaths have continued to exponentially increase.

The Arizona Opioid Epidemic Act prohibits medical professionals from prescribing a patient more than 90 Morphine Milligram Equivalents (MME) of an opioid, and puts a 5-day limit on initial opioid prescriptions. The act also increases reporting requirements for opioid prescribers.

The graph below, included in a report published by AzPHA in 2021, shows trends in rates of opioid overdose deaths between 1999 and 2019. According to the report, between 2015 and 2019, synthetic opioid overdose deaths increased annually by 84.2%. From 2013 to 2019, Arizona also experienced a 1,350% increase in synthetic opioid mortality rates.

 

Image: Arizona Public Health Association

 

Data from the Common Sense Institute Arizona shows that fentanyl is currently involved in 57% of Arizona overdoses compared to about 4% in 2017. 

“For prescribed opioids in Arizona, there’s a good handle on that now in terms of the addiction pipeline coming in,” Humble said. “The challenge now is to deal with the people in the addiction pipeline that haven’t been able to get treatment because of the inadequate network and the number of new people that are becoming addicted to opioids via fentanyl.”

Humble said that in addition to accessible fentanyl test strips and Narcan supplies, the state should increase medication-assisted treatment options.

“[A key intervention] is expanding the formulary within the Medicaid program to include the longer acting medication-assisted treatment, [as opposed to labor-intensive methadone],” he said. “But there are injectable, long-term, medication-assisted treatment options that last for weeks, so it’s not like suboxone film that you have to [keep going back to the clinic to take] or methadone. That is a great standard practice that we need more of, but most Medicaid systems don’t have that in their formulary.”

Humble added that getting rid of prior authorizations for these long-lasting injectables is also an important intervention.

“There was an organized effort to add the long-lasting injectable to the [Arizona Health Care Cost Containment System] formulary in 2019, but it requires prior authorization, and that prior authorization piece is also a problem because you have to get [the medication] prescribed, [and patients often need that medication immediately].”

Common Sense Institute Arizona notes that the economic costs of the fentanyl crisis in Arizona rose to $53 billion in 2021, representing a 250% increase since 2010. This cost accounts for substance abuse treatment, law enforcement, health care, and reduced productivity. 

Humble emphasized the workforce and staffing issues that the fentanyl overdose crisis in Arizona has presented. 

“It has more to do with staffing than the pressures on the acute care system, because it’s such a short-term, easily reversible deal [as long as Narcan is administered quickly],” he said. “We’ve got all these people that are addicted to either prescribed opioids, which is a decreasing problem, and now fentanyl, and they need medication assisted treatment, and it’s an impact of not having an adequate network for this treatment. There’s a workforce issue with not enough pain management specialists for the number of people addicted.”

Humble said making treatment for fentanyl addiction more accessible is also challenging due to Arizonans with “Not in My Backyard” attitudes.

“People don’t want these clinics in their neighborhoods because of property value data, so it’s very difficult to get city zoning approval for these clinics because neighborhoods get up in arms and are like, ‘We don’t want junkies around here.’”