We're finally making a dent in Arizona's opioid epidemic. Here's why

The opioid epidemic shows the life-and-death importance of two things that conservatives and liberals lock horns over.

• One is the need to regulate business for the protection of consumers.
• The other is the importance of aggressive government intervention on behalf of the people.

Conservatives tend to resist both as an intrusion into the free market. Liberals tend to support both as a legitimate role for government.

But sometimes the wires get crossed.

FDA failed; opioid addiction soared

During Bill Clinton’s watch, a lack of sufficient regulatory oversight by the FDA allowed opioid makers to hit the marketplace and aim aggressive advertising at doctors.

“I believe we wouldn’t have an opioid epidemic if the FDA had done its job properly,” Dr. Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University, told reporter Jerry Mitchell of The Clarion-Ledger in Jackson, Mississippi.

Mitchell’s story, which ran under the headline “How the FDA Helped Pave the Way for an Opioid Epidemic,” also quoted Dr. David Kessler, who was head of the FDA in 1995 when OxyContin – the granddaddy of the opioids – was approved and promoted as a safe pain reliever, despite a lack of testing.

“No doubt it was a mistake. It was certainly one of the worst medical mistakes, a major mistake,” Kessler told Mitchell.

We began treating pain as a vital sign

Opioids were being heavily marketed with an FDA seal of approval as doctors were being told to view pain as the “fifth vital sign” (along with blood pressure, heart rate, respiratory rate and temperature) by the Joint Commission, a professional organization that accredits health care organizations and programs.

The federal Centers for Medicare & Medicaid Services also began including questions about pain management in patient satisfaction surveys that were used to determine hospital reimbursement rates.

The pressure was on to relieve pain, and opioids were sold as a safe way to do it.

It was a “perfect storm,” says Arizona Department of Health Services Director Dr. Cara Christ.

From 1999 to 2016, more than 200,000 people nationwide died from opioid overdoses, according the Centers for Disease Control and Prevention.

Arizona's death toll mounts

In 2017, there were 949 confirmed deaths from opioids in Arizona.

That year, Arizona’s conservative Gov. Ducey recognized the need for the state to aggressively intervene.

He a declared a public health emergency and ordered the DHS to come up with a plan.

DHS did – in three months.

In January, Ducey called a Special Session of the Legislature and the Arizona Opioid Epidemic Act of 2018 passed unanimously.

Then government stepped in

That law made important changes, including:

• Expanding access to the overdose reversal drug naloxone.
• Medical education for those who prescribe or dispense opioids.
• A Good Samaritan exception so friends and family won’t be penalized for calling 911 in case of overdose.
• Limiting the amount of opioids that can be prescribed to first-time users.

The changes also led to better data collection, which shows the enormity of the continuing problem.

There were 2,535 reports of suspected opioid deaths in Arizona from June 15, 2017, to Nov. 29, 2018, according a DHS website that offers real-time statistics.

Christ says those are reports of “suspect” opioid deaths. The final, confirmed death toll will be lower when cases are ruled out after toxicology lab results and medical record reviews are complete, she says.

2018 saw significant improvements

“This is far from over,” Christ says.

But she says there have been significant improvements in 2018, including:

• a 36 percent decrease in opioid prescriptions, compared to 2016.
• a 60 percent decrease in the number of patients “doctor shopping” for opioid prescriptions, compared to July 2017.
• a 58 percent increase in overdoses referred to behavioral health providers, compared to July 2017.
• a 296 percent increase in naloxone doses dispensed by pharmacies, compared to September 2017.

Later this month, DHS will launch a youth opioid prevention campaign that includes TV spots and social media. Christ says it’s hard-hitting and kid-tested.

In January, Arizona will require electronic prescribing of controlled substances in Maricopa, Mohave, Pima, Pinal, Yavapai and Yuma counties, with the rest of the state included in the mandate six months later. The idea is to cut down on fraud and forged prescriptions, says Christ.

DHS will also regulate and license pain management clinics for the first time starting in January.

Pain is now a public-health issue

In addition, DHS is “taking on chronic pain as a public health issue,” says Christ. The department will be enhancing its Manage Chronic Pain webpage with additional resources to help people to become actively involved in dealing with their pain. This patient-involvement model has worked well with patients who have diabetes, she says.

“This is not about cutting off opioid pain medication for people who need it,” Christ says.

It is about the state acting in the best interests of its people.

Doug Ducey probably won’t appreciate having me favorably compare his willingness to use the power of government for the people with Bill Clinton’s failure to do so.

Proactive government doesn’t fit the GOP narrative that casts government as part of the problem – and Ducey has styled himself as a loyal member of the Republican choir.

Gov. Ducey gets it. Clinton did not

But that narrative is problematic.

It’s important to put down the ideology and step far enough back to recognize what needs to be done.

Ducey did that for the sake of Arizona. He deserves credit.

As for Clinton? His failure to exercise necessary regulatory control shows how important it is for government to act on behalf of all the people.

After all, it’s the job of business to be self-interested, make money and satisfy the stockholders. Nothing wrong with that. It’s free enterprise and it delivers goods and services we all use.

But it’s the job of government to make sure the best interests of business don’t hurt the people. The opioid crisis is a life-and-death example of why that matters.

Reach Valdez at linda.valdez@arizonarepublic.com.

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