I, Surgeon General of the United States Public Health Service, VADM Jerome Adams, am emphasizing the importance of the overdose-reversing drug naloxone. For patients currently taking high doses of opioids as prescribed for pain, individuals misusing prescription opioids, individuals using illicit opioids such as heroin or fentanyl, health care practitioners, family and friends of people who have an opioid use disorder, and community members who come into contact with people at risk for opioid overdose, knowing how to use naloxone and keeping it within reach can save a life.
Kendra Colburn spent a decade uninsured. During those years, she worked as a carpenter near her hometown in rural Vermont, earning just enough that she didn’t qualify for low-income health care, but not enough to afford health insurance on her own. While uninsured, she suffered two major work injuries that landed her in the emergency room—once, a nail shot through three of her fingers, and another time, a piece of wood kicked back on the table saw and sliced her arm. When she was unable to pay the emergency room costs, her credit took a hit for years.
Today, Colburn works on her brother’s farm and is covered by Medicaid. As a manual laborer, Colburn has developed nerve damage, which flares up in her hands and wrists with overuse. “I cut back my hours to deal with it. I can’t afford to not be able to use my hands,” she says. “That’s how I make all of my money.”
As a child who grew up in a farming community, Colburn says she observed that pain is just a part of being a farmer. “It’s taken for granted that your body hurts every day, that your back always hurts.” That’s true for workers employed in some of the most dangerous jobs: Many manual laborers with high rates of injury and repetitive stress injuries are also more likely to be uninsured. In fact, a 2015 study found that 65 percent of commercial farmers identified health insurance costs as the most serious threat to their farms.
Alana Knudson, co-director of the Walsh Center for Rural Health at NORC at the University of Chicago, prefers to discuss rural health care in terms of strengths, but she does recognize the real barriers demonstrated by statistics. “Overall, we know that people who live in rural communities are likely to have lower incomes than their urban counterparts,” she says. Rural residents are also more likely to have multiple chronic conditions and lower educational attainment, and they’re more likely to face barriers in accessing transportation to medical care.
WASHINGTON — The opioid crisis has hit rural Native Americans significantly harder than any group in the nation, and the problem may be even worse because of racial misclassification on death certificates, federal data show.
A report by the Centers for Disease Control and Prevention (CDC) said rural areas as a whole saw a 325 percent increase in overdose deaths between 1999 and 2015, but the death rate for Native Americans living in rural areas jumped 519 percent over the same period.
The disparity held true in urban areas as well, although the increases were not as steep: Overdose deaths in cities rose 198 percent, compared with 261 percent for Native Americans in cities, the report said.
The problem, experts say, has been compounded by a lack of facilities in tribal areas and a shortage of accessible federal funding.
“A lot of tribes were just not ready for this problem,” said Randy’l Teton, public affairs manager for the Shoshone-Bannock Tribe, noting that a lot of medical facilities on reservations did not have a system to reach out and help those suffering from opioid dependency.
“It’s a little overwhelming … you have a large amount of tribal members secretly popping pills,” she said.
Tribes have historically had a hard time accessing money for health care, and that has played a major part in the severity of the epidemic for Native Americans, said John Pietri, senior policy analyst for the National Congress of American Indians.
“I think, you know, it’s rooted in some of the longstanding challenges we had in accessing health care opportunities,” he said. “Congress hasn’t always thought about Indian tribes when they’re looking at distributing money.”
Congress responded to the rising opioid epidemic in December 2016 with the 21st Century Cures Act, which provided $1 billion over two years to help states treat opioid addiction, administer life-saving drugs to those who have overdosed and keep people from getting addicted in the first place.
The bill did not give tribes direct access to that money, which tribal officials said increased the disparity in treatment between Native Americans and everyone else.
“Tribes being self-sufficient, sovereign nations, we just don’t have that money,” Teton said. And she said many tribal members don’t have jobs that provide medical insurance, leaving tribes scrambling to find funding for treatment.
Sam Moose, treasurer and area representative in Bemidji, Minnesota, for the National Indian Health Board, emphasized that shortfall of health care funding on reservations during testimony at a Senate hearing last week.
In written testimony prepared for the Senate Committee on Indian Affairs, he pointed out that the Indian Health Service spends about $3,332 per patient compared with the national average of $9,207 per capita in health spending.
The IHS, an agency within the Department of Health and Human Services, is the principal federal health care provider and health advocate for Native Americans.
Moose also said in his written testimony that the lack of funding means tribal health facilities can’t afford more expensive therapies, leaving both providers and patients in a Catch-22 that ultimately leads to more harm.
Lawmakers have proposed changes to the 21st Century Cures Act for opioid and methadone addiction that would give tribes greater access to federal funding for overdose prevention and treatment, but those bills have yet to get hearings. NCAI said winning approval of those measures is one of their legislative priorities.
“Allowing tribes to have access to direct funding stemming from that grant would give tribes the opportunity to establish culturally relevant programs,” Pietri said. “I think that would be a huge win.”
In the meantime, tribes around the nation are scrambling to fix the problem with whatever money and resources they have on hand.
“It has to do with funding. We as the tribe are trying to figure it out,” Teton said.
In this highly-subscribed webinar, speakers explored strategies to help patients manage pain while minimizing the danger of opioid misuse. They discussed a community-based campaign to reduce access to unused prescription drugs, collaborations to improve adherence to prescribing guidelines for acute and chronic pain, the latest research on alternative pain management treatments, including virtual reality, and more.
Police officers and fire fighter are first responders to get first treatment in training to high the state’s opioid epidemic.
The University of Arizona and Arizona Department of Health Services will use a three-tier approach to what Gov. Ducey declared a “statewide emergency,” the growing opioid epidemic.
“With 100 to 270 overdoses related to opioids a week, this is an issue that reaches all areas,” Dr. Daniel Derksen, director of UA’s Center for Rural Health, said.
One tier will train first responders in administering Naloxone, a drug that blocks opiate receptors in the brain.
“This training addresses that basic life support group,” project overseer Taylor George, section chief of AZDHS Bureau of Emergency Services and Trauma System, said. “Their traditional, initial education does not include assessment of a patient or administration of an invasive procedure, such as Naloxone.”
The second tier of the project will be focused on Naloxone distribution, including areas where transport times are a challenge.
“It may take them a half an hour,” Derksen said of some transports times.
This tier will work to address areas in need of Naloxone and help to supply those, often rural, areas.
“Seconds and minutes can mean the difference between death and permanent brain damage,” Derksen said. “You want to get it reversed with Naloxone as quickly as possible.”
Recently, the University of Arizona Center for Rural Health received a $2.2 million grant to work with the Arizona Department of Health Services.
The Substance Abuse and Mental Health Services Administration awarded the grant to train first responders to administer naloxone, an opioid reversal agent. In the wake of 790 deaths in Arizona alone throughout 2016, Governor Doug Ducey declared a public health emergency.
In response, Taylor George, a UA alum and ADHS section chief of the Bureau of Emergency Services and Trauma System assisted in obtaining the grant and will lead the project.
AzCRH will help with educational elements, teaching police and other first responders how to identify symptoms and use naloxone.
“But we also want to go beyond that,” said AzCRH Director Daniel Derksen. "We want to do screening and brief intervention so we’re not just addressing the immediate issue of the overdose.”
In many cases, when overdoses take place in rural areas the nearest hospital or police station is 30-40 miles away.
“If you overdose with an opioid and stop breathing, it only takes about four minutes to do irreversible brain damage,” Derksen said.
BISBEE — In an effort to address the opioid crisis, Copper Queen Community Hospital plans to fund a year-long youth opioid prevention program for children in local schools.
Jessica Ogiba, marketing and public relations manager for the hospital, said Copper Queen received a $26,000 grant from Tucson Medical Center (TMC) Foundation to help fund the program.
“It’s more than just a drug alternative program, it’s a well-rounded program,” she said. “It also talks about peer pressure and how to handle emotions. It goes a lot deeper than just drugs and smoking and stuff like that.”
TUCSON - The opioid epidemic is killing three Arizonans a day.
Doctors and researchers at the University of Arizona hope a new multi-year $2.2 million dollar grant will go a long way to helping both the patient and the protector.
The university's College of Public Health is now taking the lead across the state to make sure every first responder, no matter where they live knows how to use Narcan, a nasal spray that can reverse the effects of an overdose. Narcan has proven a force in the fight against the crisis.
"When you're a distance from a health facility, the difference between life and death can be seconds and minutes," Dr. Daniel Derksen with the College of Public Health at the University of Arizona said. "If someone recognizes someone is in an opioid overdose situation, administering Naloxone, reverses those effects very quickly that it can save lives."
Brian Keeley is with Northwest Fire in Tucson.
All of its firefighters and first responders are trained and carry Narcan on their trucks.
"When you give this medication, it works within 30 seconds," Keeley said. "This is absolutely the lifesaver for any heroin or opioid overdose. It's the one thing that will instantaneously counteract and save a person's life."
Keeley stresses it should only be used as a last resort.
"It should not be relied upon as it's okay to take or abuse these medications or these drugs because there is something that counteracts it out there," he said.
Tucson.com | By Stephanie Innes Arizona Daily Star
PHOENIX — The issue remains divisive, but dental therapists are closer to becoming a new, licensed profession in Arizona.
Over the objection of dentists, Arizona’s Senate health committee voted 4-3 Wednesday to move forward a bill that would establish dental therapists as “mid-level” providers, who would play a role similar to that of nurse practitioners and physician assistants in the medical world.
The debate pitted dentists from the Arizona Dental Association against a coalition that includes tribes, the conservative Goldwater Institute and the Arizona Rural Health Association, among others.
When a patient came into her practice not long ago with a broken jaw, it wasn’t a difficult diagnosis for Dr. Christina Goldstein-Charbonneau.
“Obviously I could see her jaw was big as anything,” said Charbonneau, a primary care physician in Bullhead City.
Dr. Christina Goldstein-Charbonneau is a primary care physician who practices integrative medicine in Bullhead City.
But she did something that may have seemed overly cautious in years past.
“In today’s climate, the way it is right now, I actually went over there and said ‘I’m sorry I can’t give you anything,’” she said. “‘Let’s hold off, let me go and get your X-rays.’”
The patient had actually gone to the emergency room first where they had refused to give her pain medication. Charbonneau hurried to get the medical records and only once confirmed did she prescribe an opioid.
This hypervigilance has become the norm for doctors in this remote, underserved corner of northwest Arizona — a place hard hit by opioid abuse and overdose deaths.
In 2016, Mohave County had more opioid prescriptions than people.
The vast rural county in northwest Arizona dispensed 127.5 opioid prescriptions per 100 residents that year, making it Arizona's most prolific county by that measure, according to the Centers for Disease Control and Prevention.
The CDC data shows that Arizona's rate of 70.2 opioid prescriptions per 100 people is slightly above the U.S. average of 66.5 per 100 people.
While the figures show that pain-pill prescriptions in Arizona dropped nearly 10 percent over the past decade, they have continued to rise in Mohave County and other rural counties such as Cochise and La Paz since 2007. No data was provided for Greenlee County.
Maricopa County's rate was 68.2 opioid prescriptions per 100 people, down nearly 10 percent from one decade ago.
The CDC data, based on a sample of 59,000 pharmacies nationwide, provides only a ratio of total prescriptions per 100 residents. It doesn't show the number of pills prescribed or the number of people with multiple prescriptions.
Still, the data jibes with what Mohave County health professionals and law enforcement see daily with powerful, addicting opiates such as oxycodone and Percocet widely available in the county of 200,000 residents.
"We have known if for quite a few years," Rusty Cooper, deputy chief of the Kingman Police Department, said of the prevalence of opioids in the community.
A federal grant will allow the state and the University of Arizona to ramp up their efforts to combat the opioid crisis in communities across the state.
Since mid-June, 5,512 people have suffered a suspected overdose from opioids. More than 800 of the cases turned deadly. Click here to see the latest numbers in real time.
The $3 million grant from the Substance Abuse and Mental Health Services Administration will allow state and university workers to help train first responders in rural communities.
First responders will be trained to identify the symptoms of opioid abuse, and they will also be equipped with the drug Naloxone. Also known as Narcan, it’s used to block the effects of opioids especially during an overdose.
But Dan Derksen with the U of A said the grant will allow them to go beyond administering the drug. They will be trained on things like opioid screening, brief intervention, and referral to treatment curriculum.
Derksen said in many cases patients who overdose have overdosed before, so he hopes providing resources will help stop the addiction cycle before it turns deadly.
Derksen said with people in Arizona dying daily, there’s no time to waste.
“We have to be doing something different than we have been doing. There’s been more than two Arizonans dying every single day of opioid overdose. More than half of which are related to prescription overdose,” he said.
The money will also be used to train people in the community. The grant funds will be put into the communities over the next four years.
Vicki Karr | KOLD 13 Tucson News Now | January 31, 2018 | 1min:56sec
The Arizona Department of Health Services and the University of Arizona were awarded a $3 million federal grant by the Substance Abuse and Mental Health Services Administration (SAMHSA) to battle the opioid crisis working with First Responders and Critical Access Hospitals in rural Arizona.
"We have to reduce the morbidity and mortality related to the opioid epidemic...and prevent the more than two Arizonans dying every day because of opioid overdose."
Host: Lorraine Rivera | Producer: Kassandra Lau | Arizona Public Media
In its first major order of business, the Arizona Legislature tackled the opioid epidemic by unanimously passing the Arizona Opioid Epidemic Act in a special session. Gov. Doug Ducey signed the legislation Friday. He initiated the special session to take up the measure on Monday.
He told Lorraine Rivera how new legislation begins to address the crisis: “This is a public health approach to a very difficult issue… If there were two to three people dying per day.. [from] Ebola virus … you would get a whole different level of urgency. The urgency should be just as high for this [opioid] epidemic as it would be for an infectious disease. This isn’t just affecting a certain segment of the population. This has penetrated our high schools, our grade schools, wherever you live in the state – whether it’s rural or urban, Phoenix or Tucson – we have to take this to a whole different level if we are going to make an impact.” Daniel Derksen, M.D.