Overdose deaths from opioids a complex problem statewide

While entertainer Prince’s death from an overdose of fentanyl has brought more national attention to the potent painkiller, fentanyl is just one of several ways Arizonans are dying of opioid abuse.

Maricopa County released data for the first time earlier this month following a public records request by the Arizona Daily Star. Since no statewide data exists, numbers from the state’s largest county provide a broader look at what’s happening in Arizona.

In April, the Star reported that there were 93 overdose deaths tied directly to heroin in 2015, with nearly 200 additional cases attributed to opiate-based painkillers such as oxycodone, methadone, hydrocodone and morphine. The figures, from the Pima County Office of the Medical Examiner, show there were four times as many heroin-related deaths in 2015 as in 2010.

Both Pima and Maricopa counties received federal funding through the Centers for Disease Control and Prevention to track overdose deaths from all substances including opioids such as heroin, oxycodone and morphine as well as the synthetic fentanyl.

Like Pima County, Maricopa County has seen a significant jump, with 155 deaths from heroin in 2015 up from 54 in 2010.

Fentanyl deaths in Maricopa County rose to 45 in 2015, up from 28 a year earlier. Pima County jumped from seven fentanyl deaths in 2014 to 17 last year.

“What we’re looking at are the total number of deaths that are believed to involve a drug overdose,” said Dr. Rebecca Sunenshine, medical director for disease control with Maricopa County’s Department of Public Health. In some cases, she said, an individual might have died with more than one drug in his or her system.

Fentanyl represents no more than 5 to 10 percent of total opioid-related deaths in Maricopa County, Sunenshine said. Examining the data is important in figuring out how to prevent more people from dying. Officials have said fentanyl should not be seen as a unique problem, but as a feature of a heroin epidemic fueled by prescription painkillers.

“You have to know your baseline,” she said. “You have to follow trends over time to see if the interventions are working.”

Pharmaceutical fentanyl is the strongest opioid available and is used to treat severe pain, producing a euphoria up to 50 times stronger than heroin and 100 times more potent than morphine.

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The CDC launched Prescription Drug Overdose: Prevention for States to fight the nation’s prescription drug overdose epidemic. Sixteen states were selected, including Arizona, with plans to give each $750,000 to $1 million annually to carry out research and bolster prevention efforts.

“There’s a lot of data out there that we didn’t have the opportunity to explore because we didn’t have the funding or the staff,” she said. “Now this has become an issue of national interest.”

Sunenshine said since this is the first time Maricopa County has been able to analyze the data so thoroughly, officials still are determining how to look at trends from year to year.

“When you look at Pima, there are 10 other counties in their report and, overall, they saw the highest number due to opioids,” she said. “It’s safe to say we see a similar trend.”

An Arizona Daily Star story from March examined how fentanyl made by the Sinaloa cartel is increasingly making its way through Arizona, with many fearing a subsequent rise in drug-related deaths.

In recent years, more than 700 people are reported to have died of fentanyl abuse nationwide, but the real number is believed to be higher because many state labs and coroner’s offices were not routinely testing for fentanyl. And most deaths are attributed to the illegally manufactured version of the drug that is mixed with heroin, often unbeknownst to the user.

Opioids, including prescription painkillers and heroin, killed more than 28,000 people in 2014, more than any year on record, the CDC reports. At least half of all opioid overdose deaths involve a prescription opioid.

She said it’s also tricky because some drugs are difficult to decipher in the system. Sometimes heroin can appear to be morphine, for example.

“What I would say overall,” she said, “is that the number of opioid-related deaths has been consistently high since 2012.”