The impact of opioid misuse is significant in our communities and on the public health system. On June 1, 2017, the Arizona Department of Health Services (ADHS) released its latest data on opioid overdoses in Arizona showing the highest number of deaths in ten years. In 2016, 790 Arizonans died from opioid overdoses. The trend shows a startling increase of 74 percent over the past four years.
The 2016 opioid report shows over half of the 1,497 drug overdose deaths in that year were due to opioids as the primary cause of death. Opioids include heroin as well as prescription medication. The number of heroin deaths alone has tripled since 2012.
Research has found that approximately 3 out of 4 new heroin users report having abused prescription opioids prior to using heroin. Heroin is an opioid, and both drugs act on the same receptors in the brain to produce similar effects.
STATE OF EMERGENCY IN ARIZONA
On June 5, 2017, Governor Ducey declared a state of emergency in response to the opioid abuse epidemic in Arizona. A portion of the Arizona Department of Health Services (ADHS) website has been dedicated to the emergency response efforts; visit azhealth.gov/opioid to keep up with the latest recommendations for clinicians.
EFFECTIVE JUNE 15: There are now Enhanced Surveillance Requirements for Reporting of Opioid Overdose. These will remain in effect for 60 days from June 15 unless extended.
Pursuant to A.R.S. §36-782, an Enhanced Surveillance Advisory has been issued to track opioid morbidity and mortality.
Required reporting within 24 hours of the items below will go into effect June 15, 2017.
Required Reporters include the following:
• Healthcare professionals licensed under A.R.S. Titles 32 & 36, including physicians, are required reporters.
• Administrators of a healthcare institution or correctional facility
• Medical examiners
• Emergency Medical Services/Ambulance agencies (first response agencies, ground and air ambulance agencies)
• Law enforcement officers
Health conditions to be reported by physicians and other healthcare professionals under A.R.S. Title 32:
• Suspected opioid overdoses
• Suspected opioid deaths
• Neonatal abstinence syndrome
Required reporters, including physicians, must use MEDSIS, for reporting the above listed health conditions. MEDSIS is the communicable disease reporting system, and it has been amended with new reporting fields.
MEDSIS Training is available at www.azhealth.gov/opioidtraining.
Need to set up a MEDSIS account? Contact MedsisHelpDesk@siren.az.gov.
WHAT PHYSICIANS AND OTHER CLINICIANS CAN DO NOW
Here are immediate steps physicians can take to help our patient populations.
- Comply with the enhanced surveillance reporting requirements detailed above.
- Clinicians are urged to apply the practices in the Arizona Opioid Prescribing Guidelines (Acute/Chronic Pain) or the CDC Guideline for Prescribing Opioids (Chronic Pain).
- Check the Arizona Controlled Substances Prescription Monitoring Program (AZ CSPMP) prior to prescribing opioids.
- In 2017, become a Suboxone-waivered provider to help meet MAT needs statewide. An eight-hour buprenorphine training course is required.
- Consider non-opioid pain treatment alternatives first; opioids are not the first-line therapy for most chronic pain.
- If initiating opioids, use the lowest effective dosage and limit initial prescriptions to 7 days (per AHCCCS Policy) or 3 days (per CDC Guidelines).
- Take a detailed medication history. Avoid combined use of opioids and benzodiazepines, and advise patients of the risk of adverse events. Make sure patients understand the dangers of combining opioids with other medications that could cause an overdose.
- Co-prescribe naloxone to patients at higher risk for overdose, including history of overdose or substance use, opioid dosages ≥50 MME/day (calculate) or concurrent benzodiazepine use.