(CN) – In Arizona, four out of five heroin users begin their addiction in a doctor’s office, with a prescription for painkillers.
These legal, prescription painkillers come by many names – morphine, oxycodone, fentanyl, tramadol and others – but all come from the same family as a much more dangerous, illegal substance: heroin. The prescription pills are meant to alleviate chronic pain, but they can be so addictive that many people can’t stop using them.
In Arizona, about two people die daily from opioids, 280 since January. More people die from drug overdoses in the state than from car accidents, and opioids account for more than half of those overdoses.
These realities led Gov. Doug Ducey to declare a state of emergency to address the opioid crisis on June 5, making him one of six governors to do so.
The declaration ordered state police and other health care officials to report all deaths to the state Department of Health and Safety. It also prompted a report from the department on how the state should respond to the crisis.
Dr. Cara Christ, director of the agency, says Arizona and the rest of the country haven’t faced an addiction problem like this before.
“You’re given a prescription for seven days, for 10 days, for 30 days,” Christ told Courthouse News. “You take that medication as directed by your physician and all of a sudden you’re dependent on it and you can’t stop. I don’t think that people realize how easy and how addictive opioids truly are.”
Opioids across the Arizona desert
Ashley Null grew up in Kingman, Arizona, a city located in Mohave County that has seen a high rate of deaths due to opioids.
Kingman lies on the historic Route 66, a point of pride for the city. Murals of the historic route and classic memorabilia can be found around the city. The dry, hot desert landscape encourages most people to stay inside during the summer months, but like the rest of Arizona, winters provide a welcome escape from the sweltering heat.
Kingman, population 28,000, lost 10 to 16 people to opioids in 2016. By comparison, the area of North Mountain in the Phoenix metropolitan area experienced 25 to 36 opioid-related deaths, but has a population of over 250,000 people.
According to a 2017 report from the U.S. Centers for Disease Control and Prevention, Mohave County prescribes opioids at rates twice the national average.
When Null was living in Kingman at 12, she tried methamphetamine with a friend without knowing what it was, and afterward vowed to never do it again.
As she grew up, Null developed chronic migraines that left her awake for several days on end.
She was prescribed oxycodone as a temporary solution for her chronic pain.
“When you start getting a headache you take the opioid,” Null said. “When you start feeling withdrawals, you just want to take another one, because you know it’ll help make all that [pain] stop.”
After several years of searching for an alternative solution, she stopped looking altogether.
Null felt she had found a solution with oxycodone. She was sleeping again, and the drug cleared all the migraine pain.
Eventually, however, her tolerance to oxycodone increased. When she ran out of her prescription, the pain and withdrawals would set in.
So Null would get the drug from friends with prescriptions. Even though she was buying oxycodone illegally, she kept her prescription from her doctor.
She didn’t see herself as a drug addict. She was just getting the medicine she needed, the medicine her doctors couldn’t prescribe.
“When you have an opioid addiction, you don’t think it was an addiction because it’s something someone is telling you to do,” Null said. “A doctor tells you ‘You need this,’ and you say ‘OK.’”
That need soon escalated into an addiction.
Null began selling her belongings to make money to buy oxycodone, “Oxy” as she calls it, and she stopped pursuing a degree in graphic design at Mohave Community College.
One day, she went to a friend’s house to smoke Oxy.
When she saw what he had, she thought it didn’t look like the drug. It was black, and a lot smaller than a pill.
He reassured her, so they smoked. She later learned it was heroin.
“‘What the hell! I don’t do heroin! I’m not some kind of drug addict,’” Null said she told her friend. “In my head I’m freaking out: ‘This is stupid. Why would [he] do that?’ Then I realized, this is the same feeling as if I had smoked a whole pill of Oxy, and it took me like a hit.”
Prescription opioids and heroin have similar physiological effects since both are derived from opium. Heroin, however, is often a cheaper alternative to most prescription opioids.
After that, she started using heroin regularly.
Null’s story can be told by many others across Arizona and the United States. Heroin overdose deaths in Arizona have more than tripled in the past four years, from 92 in 2012 to 308 deaths in 2016.
The governor steps in
After Gov. Ducey declared a state of emergency in June, information came flooding into the state’s health department.
A report released on Sept. 6 by the agency lists 12 recommendations to start combating opioid abuse, including improvements to how prescription drugs are prescribed and dispensed, increasing patient and public awareness and overall reducing opioid-related deaths.
According to the U.S. Centers for Disease Control and Prevention, the probability of long-term opioid dependency increases after the first five days of daily usage. One way Arizona’s health department hopes to reduce opioid dependency is by implementing a five-day plan for first-time opioid users: keep these patients from having more than five days’ worth of pills.
“This is for people who may fall down, may get stitches, may have an acute injury and they just need to get through that acute injury,” Christ said. “Most people won’t then require ongoing therapy. This is not designed for people who are already on medication [for chronic issues].”
Christ says one major goal of their proposals is to give more options to health care providers and to assure that federal health care standards don’t work against what states are trying to do to address this crisis.
The U.S. Drug Enforcement Administration is already working on ways to get opioids out of the hands of people who don’t need them.
Erica Curry, a spokeswoman for the agency, says that while the DEA has no intention of coming between a doctor and their patient, the agency intends to make sure that no medical practice illegally diverts pharmaceuticals.
In August, the DEA’s Phoenix field division accomplished the largest fentanyl pill seizure in Arizona history, seizing and destroying over 30,000 pills from a cartel-related drug trafficking organization.
The fentanyl they recovered was designed to look like oxycodone.
“Fentanyl is a potent synthetic opioid drug approximately 100 times more potent than morphine and 50 times more potent than heroin,” the division said in a statement.
By declaring a state of emergency, Ducey ensured that all state agencies are trained and supplied with naloxone, a drug used to stabilize a person during an opioid overdose. Since Ducey’s declaration, the state has bought close to 4,000 extra naloxone kits and over 1,000 law enforcement officers have been trained to carry and administer the drug.
Before the declaration, emergency medical services were the main provider of naloxone in Arizona.
Emergency services have administered naloxone to over 1,200 people at the scene of an overdose, while law enforcement has administered naloxone less than 100 times.
According to the state’s findings, state and healthcare workers are delivering naloxone to people of all ages.
In the two-month period where the state collected data, 100 to 150 overdoses were reported for women in different age brackets from 15 to 64. Men had overdoses much more frequently, with men aged 25 to 34 suffering overdoses over 300 times.
The reality of opioid addiction is that while some people survive it, others won’t.
Some studies suggest there were about 35,000 deaths from opioids across the United States in 2015. However, a study from the University of Virginia says that number may be largely underreported.
As time went on and Null looked at the state of her life, she decided to get sober and go back to school. Some of her friends have made the same choice, but there are still some she wishes she could help get clean. After trying multiple times, she’s concluded that you can’t force someone to stop using drugs.
“The medical profession wants to see these people succeed, and to recover, and get better,” Christ said. “This is really designed to make sure that we have the resources to be able to treat those that want to get treated, that are ready to recover. We’ll provide multiple avenues, so that there is no wrong door into treatment.”
According to Ducey’s spokesman Patrick Ptak, the governor had been briefed on the findings.
“Ducey supports the findings of the report, and I know he’s looking forward to working with legislators and stakeholders to enact and implement these proposals and save lives going forward,” Ptak told Courthouse News.
Due to the varied nature of the proposals, there is no timeline for when they will be implemented.