Here are some major gaps in prevention, treatment of drug misuse in Tucson

Recent stepped-up attention to the problem of opioid misuse is good but not enough, a group of Tucson health-care professionals told state officials last week.

Gaps in treatment, prevention and awareness still exist, they said.

Specifically, the group told officials with Arizona’s Medicaid program:

• The public needs to know more about how drug misuse changes the brain.
• Vulnerable populations need to know where to get 24/7 medication-assisted treatment for opioid use.
• And pregnant women misusing drugs need more help getting health care as early as possible.

Some attendees said peer support, perhaps on the ground to reach people “hiding in the shadows,” may be an effective way to work with people and get information to them.

About 90 people — most of them providers, including therapists, physicians and first responders — attended Thursday’s meeting at Cenpatico Integrated Care.

For-profit Cenpatico is the regional behavioral health authority overseeing the public system’s behavioral-health care for adults and children in eight Southern Arizona counties, including Pima.

The meeting was hosted by Cenpatico and the Arizona Health Care Cost Containment System (AHCCCS), which is Arizona’s Medicaid program.

AHCCCS officials will take input from the Tucson meeting, and other meetings held around the state, to Gov. Doug Ducey, whose Arizona Opioid Epidemic Act has infused AHCCCS with $10 million in new grant money. The act was signed into law in January.

The money is to be used for direct services so that uninsured and underinsured Arizonans have increased access to treatment for substance misuse.

Those in attendance stressed it’s not just opioids that people are misusing — other substances, including methamphetamine, cocaine and alcohol, remain problems locally, too.

Since June 15, nearly 1,000 Arizonans have died of suspected opioid overdoses and nearly 600 babies have been born with possible drug-withdrawal symptoms, state records show.

Five of the areas of local need identified by Southern Arizonans who attended last week’s meeting:

1. People getting out of the hospital following an overdose need more help and support.

“In our emergency rooms, our hospitals, it’s really insane to me that we have people come in for an overdose, we treat them and then they leave with literally zero information, resources, tools,” said Stacey Cope, overdose prevention coordinator at Sonoran Prevention Works.

Cope called for more dialogue with hospitals about overdose follow-up care, perhaps via peer support. She noted that other states have successful examples of such care.

“That’s a conversation that is being had, but not very quickly,” she said.

2. Not enough Tucson-area residents know where to access MAT (Medication Assisted Treatment) for opioid use.

At a MAT clinic, medications such as Vivitrol, methadone or Suboxone are used for easing symptoms of opioid dependence and withdrawal. The medicines work by reducing cravings and preventing withdrawal so that a person is more able to take part in their treatment.

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In January, CODAC Behavioral Health Services opened a MAT center for adults at 380 E. Ft. Lowell Road (between First and Stone) that’s open 24 hours a day, seven days a week. The phone number is 202-1786.

Tucson’s COPE Community Services has an opioid dependency treatment program for youths 13 to 17, and a MAT program for adolescents 16 and older. The intake number at COPE is 205-4732.

Several people noted the lack of a MAT clinic on Tucson’s south side, though that is expected to soon change. Community Partners Integrated Health Care plans to open a MAT clinic near South Park Avenue and East Ajo Way in May, the nonprofit’s chief strategy officer Neal Cash confirmed Friday.

3. The Pima County jail needs an expanded Medication Assisted Treatment clinic for opioid use, as well as re-entry services for people when they get out of jail.

Maricopa County jails have a MAT clinic, and several people at Thursday’s meeting said it would be beneficial for the Pima County jail to have one, too. The suggestion drew cheers and applause from those in attendance.

The Pima County jail does have a MAT clinic for pregnant women, but not for the general population, noted Dr. Francisco Garcia, assistant Pima County administrator for health services.

And when people are released from jail, there aren’t enough services to support them and prevent them from ending up in jail again, said Byron Gwaltney of the Pima County Sheriff’s Department.

Once people leave the jail it can be difficult to find them and get them into services, Gwaltney said, noting the untapped opportunity that exists at the time when people are leaving jail.

“When someone is released, the door opens and they go outside,” Gwaltney said. “How do we funnel them into the appropriate care without simply putting them into the parking lot? That’s a part that’s really missing.”

4. Too many pregnant women misusing drugs are not getting prenatal care.

One provider asked for more community awareness of neonatal abstinence syndrome, which occurs when babies are born with drug-withdrawal symptoms.

Women with substance-use disorders are still afraid if they get medical care that the state’s Department of Child Safety will take away their babies, said Lisa Grisham of Banner-University Medical Center Tucson.

“I’ve worked a lot with DCS and their culture is changing on how they are handling these situations,” Grisham said. “Give that education to the moms, so that they don’t avoid getting care. We recently had a baby born at a bus stop because they were so afraid that the baby would be taken.”

5. More public awareness, perhaps via a public service announcement, is needed about brain changes that occur as a result of misusing drugs.

Part of the treatment for addiction and substance misuse is allowing the brain to normalize again, one provider said.

The reward circuit of the brain in someone who misuses drugs can become abnormally low, and that person’s ability to experience any pleasure is reduced.

This is why a person who abuses drugs eventually feels flat, lifeless and depressed, the National Institute on Drug Abuse says.

Widespread public education that substance-use disorders are a brain disease would be helpful, said Margaret Higgins of The Haven, which provides outpatient and residential services for women in Tucson recovering from alcohol and drug dependency.