Articles, Blog

Revisiting Arizona’s Opioid Epidemic

January 14, 2020


(dramatic music) – [Lorraine] Exploring the
Opioid epidemic in Arizona. Steps taken to curb overdoses. – It is going to take us a
while before we can get there – [Lorainne] And prevent
addictive narcotics from entering the state. – We literally can not inspect 100% percent of the people
traveling into the U.S. – [Lorraine] Plus understanding the lasting pain
addiction creates. – We had to sit and
watch our daughter die over a period of time. (dramatic music) – Hello, and welcome
to Arizona 360. I’m Lorraine Rivera,
thank you for joining us. We begin the new
year by visiting an ongoing issue facing our
state, the opioid epidemic. A crisis that has claimed
live, funded cartels, and left families in turmoil. Its the first of our
series, Arizona Addicted. Over the course of 12
weeks Arizona public media will explore the solutions,
stories, and science behind the ongoing opioid
crisis in Southern Arizona. Our coverage begins with a
look back at how we got here. – The abusive pain
killers derived from
drugs called opioids is and epidemic. – It’s growing and
it’s growing fast. – In 47 minutes there
was already nine deaths. – But the opioid is something that nobody’s seen
anything like it. – [Lorraine] As word
spread about an epidemic taking hold of the country, by 2017 Arizona realized
it too was in it’s grasp. A report from the Arizona
Department of Health Services, or ADHS, found that in
2016 nearly 800 people died from opioid related overdoses, an average about
two people per day. Opioid prescriptions
had also risen by 300% in the last 15 years. It lead Governor Doug Ducey to declare an emergency
in June of 2017 resulting in new
prescribing guidelines, stepped up data collection on
suspected opioid overdoses, and more training
for law enforcement on administering Naloxone to reverse the effects
of an overdose. – When there’s an epidemic,
when people are dying, then we have to act. – [Lorraine] By January
2018 state law makers unanimously passed the
Arizona Opioid Epidemic Act, establishing even
more provisions in hopes of reducing opioid
related overdoses and deaths. From the onset ADHS
has been tasked with implementing many
of those policies. I sat down with the departments
director, Dr. Cara Christ to discuss their impact. – We were able to set up
real time data tracking. We had never had that
for opioids in Arizona and we do that in public
health all the time. We issued a opioid action plan which had 12 recommendations
for things that we thought if we could get such as
Naloxone distribution, setting up emergency rules, setting up a opioid
assistance and referral line, that we thought that would start making a difference in our
opioid epidemic in Arizona. – Arizonans are still
dying every day. One report puts it at at
least two a day on average. So how have you measured
success this far? – So a lot of the policies
that have gone into place since the declaration. We have seen a 95% decrease in the number of
opioid naive people who have been
prescribed opioids. That is huge because that
is a huge prevention effort. We know that a lot of people
who have opioid use disorder never intended to use drugs. They were following
a prescription that
was given to them for a medical condition
by their provider and we know that if you’re
on it over five days you have a higher likelihood of still being on that
opioid a year later. So we worked with physicians. There’s been a pain and
addiction curriculum that has been set up and is
currently being implemented in 70% of our undergraduate
prescribing programs in Arizona and we also hear that
Florida, Minnesota, and a couple of other states are considering adopting
Arizona’s curriculum. We’ve also seen an increase in
the number of Naloxone doses that are being dispensed, but also being picked
up by the pharmacy. So that was another policy
that was put in to place by the legislature,
signed by the governor. So that if you have a loved one and you are fearful that
they could overdose, you can go get the life
saving drug Naloxone, so that you have it on hand. – What’s beyond
the states control? I mean there are other
people and other agencies that have stepped up, or maybe still need
to in this process. – Some of the challenges
we’re seeing now is Arizona’s a health care
workforce shortage area state, in many areas, especially
our rural areas, but there’s not enough substance
abuse treatment providers who are, who can
treat the population that needs to seek services. The other thing that we have
noticed through our data is that we are seeing
increases in fentanyl like we hadn’t seen before. So now there are accounting
for about 25% of the overdoses when before it
was like 20 cases. So we are seeing that
with the rise in fentanyl and another rise in
the number of people who have overdosed
on two or more drugs. That counts for about
50% of our overdoses. So really starting to
partner with law enforcement and show them the data that we
have and what we are seeing, because Arizona hasn’t seen
that significant fentanyl use until about the end of 2018. – Are patients part
of this equation when you look at
solving the problem? – Yes, absolutely. So what we’re trying to
do is reduce the stigma that’s associated with seeking
treatment and getting help. Opioid use disorder is a
chronic medical condition. Just like treating your
high blood pressure, or your diabetes. It’s gonna be a
life long treatment, but there is treatment
available that is successful and so really encouraging people to seek help when you need it. – This has been a multi
million dollar approach on behalf of the state. How long is it sustainable? Where do you rate the
cost moving forward? – So we always like to
say in public health, while it will cost
money to do that you’re saving people’s lives. We have been lucky that we’ve
received lots of federal money through federal grants. So the federal government has
been providing a lot of money. The state legislature
gave a $10 million, what we call the Go SUDS fund. So it’s Substance Use Disorder
for people who are uninsured, or maybe their insurance
doesn’t cover it, so that they can
seek help as well and a lot of agents,
a lot of entities, and stakeholders have also
put resources forward. We know that it took us many, many years to get
where we are today and it’s gonna take us
years to get out of this. – Some communities are
harder hit than others and the resources
aren’t always there and there’s a county
perspective as well. Is the state mindful of
that as it tries this, this approach throughout
the state, where it says we know there’s not enough
resources in some communities? – So yes, and we know that every single county in
Arizona is very different. Their population,
their environment. So what we try to do
in public health is, some of the grants
that we’ve received from the Centers For Disease
Control and Prevention, we’ve tried to pass
that money down to our county health departments so that they can
implement initiatives that they know will work
in their communities and every one of those
has been very different and so when you look at what
Yavapai, or Pinal is doing, that’s different than
what Maricopa is doing, but they’re all targeted to
their specific community. – I know this act really came in to effect a
couple of years ago and it’s not as easy as flipping and saying it, we’re solved, but is there a timeline
that you’d like to say, hey by this point this
is what we’d like to see? – We would like to
see a reduction, probably within, starting
within the next five years. It is going to take us a
while before we can get there, especially with the introduction
of fentanyl into Arizona. So we anticipate that it is still going to
take several years. – Okay, Dr. Cara Christ from Arizona Department of
Health Services, thank you. – Thank you. – As we just heard, the opioid
crisis gave rise to fentanyl, a powerful pain killer
developed in the ’60s that is now
manufactured illicitly. Last year in Arizona fentanyl
factored in to more overdoses than any other drug. Federal agencies
are working together to keep fentanyl from
entering the state. Reporter Judy Alli has more. – So this is the RPM. – [Judy] Chief U.S.
Customs Boarder Protection officer Hector
Nevarro has fought on the front lines
of the war on drugs at the Arizona/Mexico ports
of entry for 15 years. All illegal substances
are the bad guys he says, but in recent years
enemy number one has become a new narcotic. – We initially thought
we were ceasing cocaine because of the quality or the characteristics
of the narcotic, they’re very similar. Visually they look
very, very similar, but we run into a problem when
we doing the field testing and it wasn’t
testing for cocaine. – [Judy] What it did
test positive for was the potent synthetic
opioid fentanyl. – That was a big game changer. The dogs were not trained
to detect fentanyl. There was a big push in
the first quarter of 2018 that where we started
training our dogs and it happened at
the local level. – [Judy] Not only
did the training of drug detection K9s change, but due to the deadly
nature of fentanyl, so did the way CBP officers
intercept narcotics. – We used to get
samples right away where we made the seizure, now we extract all the packages and test them in a
controlled environment so there’s no
additional exposure. – [Judy] Pure fentanyl is about
50 to 100 times more potent than morphine and heroin. Ingesting only a couple tiny
grains can kill a person. Caution is a priority
for CBP officers. Gloves are always
worn and NARCAN, a medication used to block
the effects of opioids is always on hand just in case. – Most of us used
to carry a probe, which was basically a car antennae cut off
with some notches in it and we would probe packages
in a seat, or in a dashboard, wherever we found a
narcotics package, we would probe it
just to get an idea of what it potentially could be and we have put
the breaks on that. – [Judy] Supervisory CBP
officer Hugo Nunez says about 90% of the fentanyl
that enters the U.S. Comes through the
U.S./Mexico ports of entry in the form of powder and pills. Most of that is caught at the San Ysidro port
of entry in San Diego with the Arizona ports of
entry ranking number two. – Last year in January down in
Nogales Arizona port of entry CBP seized the largest
amount of fentanyl in the United States. It was about 254
pounds of fentanyl. – [Judy] Drug Enforcement
Administration Acting Special Agent In Charge,
Apolonio Ruiz Junior says, the chemicals that are
used to make fentanyl usually originate in China, are then mailed to transnational
criminal organizations, or cartels in Mexico with
the ultimate destination being the United States. Mexican TCOs are building
pill press machines, they’re putting them
along the border and also in Sinaloa
and other areas and that is where they’re
getting the fentanyl powder and then they’re lacing
the pills with fentanyl. – [Judy] While the
powder for of fentanyl is still popular with smugglers, officials say they are seeing
an increase in the pill form,, because it’s easier
to transport. – We have made seizures
in stacks of tortillas, inside of pictures, like
large painted pictures. Tables have been hollowed out and then filled with narcotics. So if you can imaging
it, the attempt to smuggle narcotics
using that method has probably been tried. – [Judy] Detecting
fentanyl can be challenging because of the thousands of cars and pedestrians crossing
the boarder each day. – We have to balance between
legitimate trade and travel and the interception
of narcotics. So our mission is
very important. We literally can not inspect 100% of the people
traveling in to the U.S. It would shut down commerce
and it would shut down travel as well as the tourist industry. – [Judy] High tech tools like
radiation portal monitors and drive through passenger
vehicle imaging systems help identify contraband and expedite inspections
and searches. – [Hector] Any anomaly that
we see we can go right to it or bring the dog right to it. – We have to try to hit
them where it hurts the most and if we’re doing
it right there then at least it prevents it
from coming in to an entry. – [Judy] Powerful new
chemical detectors, similar to ones currently used to detect explosives
on airplanes, and narcotics in prisons
are also being tested for use at the boarders. – Any new tool that we
can, that is effective, that we can get our hands on, it just makes our
job easier and safer. It’s not only for our safety, but the safety of
every American. – [Judy] But Officer
Navarro admits machines are not full proof
and dogs can make mistakes. The best tools in the
fight against fentanyl, he says, educating the
public on the dangers of this ominous opioid and the gut instincts
of the men and women who battle on the
boarder every day to keep them from coming
into the communities. – Well the human
factor is number one. The officers experience
as he learns his job and he gets better
and better and better. You can never
replace the officer. – Well North of the boarder
is the Pinal County line, the third largest county
in the state of Arizona. Though not directly
on the boarder, it’s one of the few
counties in the country that receives federal
funding to combat drug and human smuggling. Sheriff Mark Lamb says, like
other law enforcement agencies, he and his deputies have had
to adopt different strategies to combat trafficking
through his county. – You know we are about 67
miles north of the boarder, but just like
everywhere in America, everybody’s being impacted
by the opioid crisis. We’re no different. We had a few weeks
ago, we had a full week where every morning
I woke up to an email where somebody had overdosed. So it’s, we’re not
immune from it. – [Lorraine] The drug
problem, Sheriff Lamb says, has broken records. In 2019 a 75% increase in
fentanyl seizures alone. The drug coming
in multiple forms, nine pounds of powder,
nearly 700 pills. The busts are the results
of narcotic investigations, but some of the most notable
have been traffic stops. – [Mark] Especially on the
I10 freeway and the I8. That is one of the main
corridors for the cartel bringing drugs into this
state and into this country and so we feel a
great responsibility to try to protect not only
Arizona and our county, but the entire country
from these drugs coming in. So we’re seeing those
opioids coming in. We’re seeing the
heroin, the meth. We get it on the boarder, on
the south end of our county. We get it in our communities. So yeah, we’re
seeing it every day. The deputies see it every day. We’ve actually had, I think four deputies in
the last six or eight months that have actually gotten
some exposure to it, while they’ve been dealing
with an arrest person, or a DUI and they’ve had
to give themselves NARCAN, or somebody else
administer NARCAN to ’em. – How prepared are your
deputies to handle that? – I’d like to think
we’re prepared. We try to prepare
for all situations. Everybody carries NARCAN. I carry NARCAN with me and a lot of times
we use that NARCAN to help other people
that are overdosed, but it’s also there for us
to be able to save ourselves if we get an exposure. – [Lorraine] One of the largest and most recent
examples happened March. – We did a traffic stop,
it was a cold traffic stop, which means that one of our
deputies just stopped this car and the driver and then
there was a passenger, she was dressed as nun
with a Bible on her lap. When we started digging into it, because something didn’t
seem right to the deputy. Their answers
weren’t consistent. It was making his
interdiction alarms go off. We ended up finding eight
pounds of granular fentanyl stuffed underneath her dress that she was trying to
struggle into this country. Three grains of
granular fentanyl, like three grains of salt,
if that’s how much you had, three grains of salt, that
amount would kill you and I. One grain of Carfentanil,
which is even more dangerous, could kill somebody. This lady had
eight pounds of it. That would kill
thousands of people if that were to be
released into the public. So very dangerous,
very dangerous drug. – So who do you blame? How can the cartel
penetrate this region and get into your county? How’s this possible? – I’ve never found blame
to be that productive. However, we all
share some blame. The cartel shares blame because
they provide the product, but we as American’s need
to accept some blame, because we tolerated
this drug abuse to enter into our communities
and into our families, into this country, and it’s
a powerful gripping thing. Sometimes you don’t
have control over it when it gets ahold of you and we’ve got politicians
that have failed us. I think a lot of the
responsibility for
what’s happened here should fall on their shoulders, because they’ve failed to
give us the proper tools to protect our boarders,
to protect our communities. So I don’t wanna
really pass blame. We’re all to share some
responsibility in this epidemic that we’re experiencing
in this country. – How do you fix
this sort of problem? – That is a great question. I think a lot of
people answer that and I’m not sure that I
got the answers to that. I always say, I joke that
it’s above my pay grade. I have to focus on what
I can do as the Sheriff, or what we can do as the
Pinal County Sheriff’s Office. I can’t control what
other agencies do. I can’t control
what the feds do. I can tell you we have a
great working relationship with all of our local
law enforcement, with our federal partners, and without that we
wouldn’t be able to get done half of what we do, but still have a huge
fight that we’re fighting here with the drugs
and the cartels. You have to look
at it like this. If you take a large
business, let’s say Walmart. Walmart has an except able
loss that they will tolerate, whether it’s stolen
goods, damaged goods, and let’s say that
loss percentage is 15%. Well the cartel is a
billion dollar business and they also have an
except able loss ratio. We have heard that it’s
between 20% and 25%. So the fact that over
20 years they’ve varied, they’ve changed their
tactics very little says that we’re probably
not even impacting them to that 20% to 25% margin
and that’s what’s scary is to think about I’ve got
Conex boxes full of marijuana and I’ve got a whole top
shelf, the evidence room, that’s full of drugs,
and to think that, that’s maybe only 20% to 25% of what’s coming
into our communities. That’s alarming. – In revisiting
the opioid epidemic we were reminded of the enduring
pain caused by addiction from Jerry and Louise Beitel, a couple we first sat down
with in December of 2018, near months after they
lost their daughter Kelsey. – Kelsey Beitel didn’t
die from an overdose, the coroners report
found she drowned, discovered in a pool
on Tucson’s East Side. As we reported then
her parents described a year long’s addiction
to meth and opioids that put their only
daughter on this fatal path. Now more than a year later
we’ve asked the Beitel’s what they have realized since about the challenges
families face when trying to help a loved
one overcome an addiction. I think we didn’t
realize, at the time, the pain of addiction and the
embarrassment that she had, because she couldn’t control it. – She didn’t wanna let us down. – Treatment is expensive. In hindsight what do you
wish you would have known? – The cost for us
immediately is was, and that was. – Astronomical. – When I called to try
to get her into treatment it was $2,000 a
day they told me, but then they asked me
is she AHCCCS eligible, or does she have an AHCCCS card and I says well she doesn’t, but she certainly
would be eligible. – She’s just returned to
Arizona so she didn’t have time, but we fast tracked it. Probably broke a
land speed record on ever getting her an AHCCCS
ID card in less than 24 hours, which I heard that’s
absolutely impossible, but I was able to pull it off. So they covered, they
scholarshiped her on the 21 day and what I’m thinking
is that money was done and that’s why they
released her out, but I wish we had
more information as far as what the next
steps would have been, because I think she wasn’t
finished, she needed, and she told me she
didn’t feel like she was really ready
to be out there. – I picked her up on
Wednesday before Thanksgiving. They released her a day early and I remember her, at noon I was supposed to be
there to pick her up. I remember with
all her belongings in a plastic bag over her
shoulder she was skipping. Open the double doors, she
literally jumped in my arms. I said, wow she’s all better. It’s like getting over a cold. – At the time she seemed
like she was okay. – How little did we know
that was just the beginning. – That easy to go
right back to it again. – We left, easy. – Kelsey was 27,
very much an adult. So your hands were tied
when it came to helping her. What do you tell
families like yours who are trying to help an adult who’s struggling
with an addiction? – Well that, that’s the problem and I think that’s where I think an involuntary commitment
type law should work. I had her in a doctor’s office. They spent, there was five
people trying to convince her that she needed to go to detox and she just wouldn’t go and that would’ve been
the time to put her in involuntary drug
treatment program. – Did you tell
them what she said, why she didn’t want to go. – She told me she had,
yeah, she told us all that she had to make
peace with the drug. – What does that mean? – Since Kelsey’s death you’ve
met families like yours who are looking for
some sort of answer. What do you tell them about
having hope for the future? – I think those are the
questions that I’m still asking. You know I got my
hair done last weekend and it was found out
that there’s another lady going through the same
thing we went through and he’s in his 40s and
he destroyed her house, because of the paranoia and
going through all of that, but I asked myself
what would I tell her. What is she to do? Honestly I don’t, I don’t know. – I don’t either. – Because he won’t
voluntarily go. – You can’t force them
if they’re an adult. – Let’s say we have
this same conversation in another year or so. What do you expect
will be different then? – I think support systems for the families going
through this situation. I think there should be
some kind of playbook. – We had to sit and watch our daughter
die over a period of time. – I know last time
we spoke you said that Kelsey wanted
to change the world and that has sort
of come her motto. She’s not here anymore so
how can she change the world? – Through us, it’s through us. We’re taking the, what’s
the word for just. – The torch. – We’re taking the torch. – The baton. – In her honor that hopefully
we can help other people from succumbing to this. – [Lorraine] They also
see hope for others in the Arizona Opioid Epidemic
Acts Good Samaritan law that took effect
in April of 2018, which can allow people
to report an overdose without facing prosecution
themselves for drug use. They suspect, if Kelsey
had actually overdosed before ending up
in a swimming pool greater knowledge of this law could have
potentially saved her. – Maybe that law that
nobody knows about might have helped her because somebody was
maybe freaking out, oh my God, oh my God. – Call 911. – Call 911, they may have
come up to the condo unit, rather than be pulling
her out of the pool, trying to restart her heart, but by the time they
started her heart the brain was deprived
of oxygen to long and she had no brain activity. – It was the water that
killed her, not the, I mean the drug, she had a
lot of drug in her system but. – You’ve lived in agony
for the last year, but you sound hopeful
and optimistic. Is that what I’m hearing? – [Both] Yes. – Yes absolutely. Wanna help, we wanna help people so parents who were caregivers, so they don’t have to go
through this nightmare. – I don’t know how much
people really understand, you can look at the
laws and everything, but how, what families
actually go through and again, knowing what to
do, that’s the question. I mean if somebody asked
me today, what do I do. This women who’s son was
going through this right now, exactly what we went through. What do you do? I don’t know what to tell her. – ‘Cause when we went
into this with her, we were completely
stupid about drugs. We had no idea about it. We went crazy. I wish I had done
the research before so I knew exactly what
she was going through and would probably been
a lot more sympathetic about what she was going
through, the pain and everything and then she joined, I’ll let you explain
about a prayer registry, that she joined and was
really helpful for us, and inspired us, and then kind of helped
us get through it too. – Well and in that registry,
I mean a lot of people, they talk about how they’re,
everyone who’s lost children, and a lot of them
are drug overdoses. So I mean it’s. – And she would send me the
links ’cause it’s daily, daily emails and they’d come in and I said Louise do you notice the
similarity in these stories? I said all you do is
erase the person’s name at the beginning and
place a new name in there, and the stories exactly the
same from the previous day, a week, or whatever. It’s insane. – You’re not an expert, yet
you’ve experienced the worst and you still don’t
have the best answer to give a friend who needs
the same help that you did? – It’s not out there yet. – [Lorraine] Beyond
unknowns about addiction this couple is still
anxious for answers about the circumstances that
lead to their daughters death. – I just wanna know if there’s
anybody that’s out there that really knows what happened and wants to come clean to
call either law enforcement, or 88Crime or something ’cause I think there’s
somebody out there who really, really knows truly what
happened to her that night. – Before we go, a reminder
that our coverage this week is part of Arizona Addicted. Over the course of 12
weeks Arizona public media will explore the solutions,
stories, and science behind the ongoing opioid
crisis in Southern Arizona here on Arizona 360 and
across all of our platforms. Look for our coverage on PBS
6, NPR 89.1, and azpm.org and if you have a
suggestion or feedback send an email to
[email protected] That’s all for now. Thanks for joining us. We’ll see you next week. (dramatic music)

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