'Fentazona': A cheap and deadly drug brought in by cartels has hijacked Arizona's opioid crisis
An alarming rise in opioid overdose deaths led then-Arizona Gov. Doug Ducey to declare a public health emergency in 2017. Since then, the problem has gotten worse.
Health experts, medical examiner's reports and law enforcement data suggest the proliferation of the synthetic opioid fentanyl into the state's illicit drug supply has been driving a rising tally of opioid fatalities in Arizona, as it has in numerous states across the U.S.
Also, stressors associated with the COVID-19 pandemic, including boredom and loneliness, likely exacerbated the problem, as has ongoing stigma associated with illicit drug use, health experts and treatment providers say.
Fatal and non-fatal opioid overdoses increased every calendar year after passage of the much-publicized Arizona Opioid Epidemic Act of 2018, according to Arizona Department of Health Services data through the end of 2021.
State health officials say fentanyl is now the most commonly identified drug in opioid overdoses.
The Opioid Epidemic Act, which followed Ducey's declaration of a public health emergency because of the opioid crisis in 2017, was a series of initiatives to combat the rise in opioid overdose deaths.
The Arizona act took steps to reduce opioid deaths by expanding access to treatment, providing the opioid overdose reversal medication naloxone to law enforcement and first responders and increasing oversight of Arizona providers who write opioid prescriptions.
But those initiatives did not stop the deaths. Arizonans have continued to die of opioid overdoses and illicit fentanyl increasingly is to blame. Fentanyl, a potent, cheap and highly addictive synthetic opioid, is up to 50 times stronger than heroin and 100 times stronger than morphine, the federal government estimates.
Pharmaceutical-grade fentanyl, often administered through transdermal patches, is effective for severe pain from surgery or late-stage cancer. However, most opioid overdoses are linked to fentanyl that's illegally manufactured by drug traffickers, according to the U.S. Centers for Disease Control and Prevention.
Fake pills that resemble prescription medications and contain fentanyl can cost $1 to $5 each in Arizona, creating a new wave of the opioid crisis and a spike in deaths because of their potency.
Jennifer Govan, clinical director for the Scottsdale Recovery Center, which has inpatient and outpatient treatment for opioid use disorder in adults, said nearly all the patients her center is seeing are primarily struggling with fentanyl.
"For us to see anything but fentanyl is extremely rare," she said. "Once or twice a month we might see someone still using heroin."
And fentanyl comes in a powder form that illegal drug manufacturers can put into anything, not just pills.
Some patients will say they aren't using fentanyl, not realizing that it's been added to the methamphetamine or cocaine or whatever it is that they have been taking, Govan said.
"It's being added to everything, hence the increase in addiction. ... It is extremely addictive," she said. "They don't necessarily know they are getting fentanyl in their methamphetamine or MDA (methylenedioxyamphetamine) or whatever it might be, but they are."
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In 2017, prescription pill use and heroin were fueling opioid overdoses in Arizona, including prescription pills that made their way into the illicit drug market. While crackdowns on prescribing have significantly reduced the circulation of pharmaceutical-grade opioids, drug cartels have been able to capitalize on a continued demand for them.
"The cartels are entrepreneurs. It's (fentanyl) more concentrated so it's easier to transport. It's easier to get into the drug supply. It's super-cheap," said Nick Stavros, who is the CEO of Community Medical Services, an Arizona-based company that provides outpatient medication-assisted treatment for opioid misuse in 11 states, including several locations across Arizona.
While fentanyl is a problem nationwide, Arizona is one of the cheapest places in the country for buying pills containing fentanyl, said John Koch, director of community engagement for Community Medical Services.
"'Fentazona', that is what they are calling Arizona on the streets," he said.
Rob Best, founder of a Phoenix workout program called The Barbell Saves for people in recovery from substance use disorder, said illicit drugs are much cheaper and more dangerous now than when he was struggling with a dependence on opioids and crystal meth more than a decade ago.
"My habit was easily $150 or more a day. I had to rob, steal, do a lot of work to keep that going," Best said. "Now to get an equal amount I'd need to maybe make $30 per day. It's really cheap."
Best said at the height of his drug dependence, he would "take anything." The difference between then and now is that drug users in 2022 who will "take anything" are gambling with their lives, he said.
During spring 2021, Chandler residents Lindsay and Matt Taylor found out that their 17-year-old son, Alex, was taking pills containing fentanyl that he was purchasing on the street. Alex previously had vaped marijuana concentrates and had tried Xanax, too.
"Basically, by experimenting with other drugs he became careless, and that all led to trying fentanyl," Lindsay Taylor said.
Alex, a high school senior and former elite gymnast, knew that fentanyl could kill him and wanted to quit. He was seeing a therapist and his family was desperately trying to get him more help. His family believes the lethal dose he took was an accident.
"We don't think he took very much because his levels on his autopsy were not very high," his mother said. "So I think it was probably a one pill thing."
In 2017 there were 923 opioid overdose deaths in the state, or an average of two deaths per day. By 2021, the number of opioid overdose deaths in the state had more than doubled to 2,006 deaths, or an average of five deaths per day.
"The data lags obviously; we don't get real-time information. But everything we're seeing is that it just continues to get worse," said Kim Humphrey, executive director of the national nonprofit Phoenix-based Parents of Addicted Loved Ones.
"The vast majority of the individuals losing their lives, they are not doing it on purpose. ... The problem now is they get their hands on some of this stuff and there's no second chance."
The most deadly month for opioid overdoses in Arizona to date was July 2020, when the state reported 211 overdose deaths. July 2020 also was a lethal month for COVID-19, with 2,340 COVID-19 deaths: the third-highest monthly death toll of the pandemic in Arizona, state data shows.
It's not just Arizona's problem. Overdose deaths involving fentanyl have been skyrocketing across the U.S. Many areas of the country, such as West Virginia and Washington, D.C., had much higher rates of fentanyl deaths in 2020 than Arizona.
Rates of overdose deaths involving synthetic opioids other than methadone, which is a category primarily of fentanyl and fentanyl-related compounds and derivatives, jumped by 56% nationwide between 2019 to 2020, CDC data shows.
Pills' path to US leads through China, or India, and Mexico
Fentanyl is showing up in Arizona in round, blue counterfeit pills that look like they were legitimately manufactured by a pharmaceutical company, fueling more emergency room visits for drug overdoses, in addition to deaths.
To fentanyl users, the appeal is similar to heroin in that it blocks pain and is associated with initial feelings of euphoria. The added appeal of fentanyl is that it's cheaper and a lot more powerful.
"In 2016, there was almost no fentanyl in Arizona," said Cheri Oz, special agent in charge of the U.S. Drug Enforcement Administration's Phoenix field division. "We're on pace to set records this year with fentanyl seizures."
Precursor chemicals to make fentanyl are developed in China, and drug cartels in Mexico are manufacturing it and sending it to the U.S., Oz said. The cartels use pill presses that make the pills indistinguishable from pills from a pharmacy, she said.
"I can't tell a difference between a fake pill and a real pill. Nobody can," Oz said. "It's not until we get to a lab and break down the components of that pill that we are able to tell which pill contains fentanyl."
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Col. Heston Silbert, former director of the Arizona Department of Public Safety, in 2022 told the state House health committee that precursor chemicals for the fentanyl are getting to Mexico from India, too, but primarily from China.
"Without the precursor chemicals from these countries, the cartels in Mexico could not produce in the quantities they do," he said. "So when you are getting upset with what the Mexican cartels do and the complicity of the Mexican government, you have to look at the governments in both China and India, and particularly that of China."
Stavros said one reason that fentanyl has flourished is that law enforcement cracked down on heroin.
"The more we crack down on the supply, the more it forces innovation on the part of the cartels or countries manufacturing precursors. We have fentanyl today because heroin was illegal in the past; it still is illegal," Stavros said.
"Now we have something worse than heroin, which is fentanyl. ... Once we start cracking down on fentanyl, what's going to be next? There are all these different fentanyl analogs that are coming up constantly and seem to be exacerbating the problem more."
Indigenous and Black populations are disproportionately affected
Among people dying of opioid overdoses in Arizona, state data shows the hardest-hit age group is those ages 25 to 34, and nearly three-quarters who die are men. Slightly more than half are white and nearly 32% are Hispanic. Race and ethnicity was unknown for 5.2% of those who died in 2021, according to state data.
In Arizona, those with the highest rate of opioid and non-opioid drug overdose deaths overall in 2020 were Black people followed by Native Americans and Alaska Natives, data from the CDC shows.
"There's a trust issue," said Tara Sundem, founder and director of the Phoenix-based nonprofit Hushabye Nursery, which cares for babies who have been exposed to opioids in the womb.
"If you need behavioral health care, if you are stigmatized and not treated well, you are not going to reach out for that care. ... I truly think that stigma is huge and probably one of those main factors in just not feeling comfortable."
Hushabye has a program, funded by the Blue Cross Blue Shield of Arizona, with moms and babies who are members of the White Mountain Apache Tribe.
"Look at the social determinants of health — housing, food, transportation, the basic needs for any of us — and how indigenous and Black families are marginalized," Sundem said.
Nearly 8% of those who died of an opioid overdose in Arizona in 2021 were Black, although Black people comprise about 5.4% of the state population, according to the most recent U.S. Census data.
"They really don't have access to health care, that is why. They are not seen in the same way that other populations are seen. That's always been an issue," said Dora Jackson, interim program manager for the women's 10-bed residential program at Ebony House, a Phoenix nonprofit that was created to help Black people and other minorities with substance use disorder and other health challenges.
"It's about the attitude of the health care system. ... It's not just the Black population, it's the Hispanic, the indigenous, the non-white."
Jackson said she sees firsthand that minority pregnant women tend to get less prenatal care than white women, for example. Her observation is backed up by data: In 2018, non-Hispanic Black mothers in the U.S. were twice as likely to receive late or no prenatal care compared with non-Hispanic white mothers, according to the U.S. Department of Health and Human Services' Office of Minority Health.
Overall overdose rates per 100,000 people jumped 44% among Black people nationally between 2019 and 2020, and 39% among Native American and Alaska native people, according to a CDC Vital Signs report released in July. Among white people, the increase was 24%.
"Against the backdrop of the COVID-19 pandemic, disruption in access to prevention, treatment, harm reduction, and recovery support services has likely contributed to this growth in overdose deaths," CDC officials said in a statement when the report was released. "Recent increases in deaths were largely driven by illicitly manufactured fentanyl and fentanyl analogs."
TJ Pattea, a 32-year-old member of the Fort McDowell Yavapai Nation, said that in his experience, shame and stigma about substance use disorder are barriers to addressing the problem among indigenous people.
Pattea, who grew up on the reservation northeast of Phoenix, is in recovery from opioid use disorder. He lives in Tempe, is a married father of two and is studying to become a social worker with a goal of working with Indigenous populations.
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"There were a lot of moments in my experience where I felt wronged. ... I want to be someone to make a positive change in the system, like in the justice and health care systems," he said. "One thing I learned later on is that I had a lot of options that could have helped me."
Pattea used marijuana as a youth, which led to an arrest at 16. He moved onto other substances, including Percocet and heroin, after graduating from Fountain Hills High School in 2008 and said he felt tremendous guilt and embarrassment about his drug use.
He now tells other indigenous people, particularly youths, about the opioid overdose reversal drug naloxone and about the philosophy of "harm reduction," which refers to strategies aimed at reducing the negative consequences of drug use with compassion and without judgment.
Knowing about harm reduction when he was younger might have helped restore the self-esteem and confidence he lost and could have helped him enter recovery earlier, Pattea said.
Are opioid overdose deaths still on the rise?
The most significant jump in opioid overdose deaths in Arizona over the past five years occurred in 2020, when the deaths increased by 46% over 2019, state data shows.
There are signs the increase that happened in 2020 is at least leveling off, said Sheila Sjolander, assistant director for the Arizona Department of Health Services.
Between 2020 and 2021, the number of opioid overdose deaths statewide again increased, but by a much lower 6%, the data shows.
"The number of deaths has remained high, but we're not seeing the same rate of increase," Sjolander said. "So even though the number of deaths increased again in 2021, it appears to be leveling off."
The death tally listed on the state opioid dashboard shows 1,930 opioid overdose deaths in 2022, a decline of about 4% from 2021 but still more than double the number in 2019.
Govan of the Scottsdale Recovery Center said she's observed no decline in the number of people needing treatment.
"I just don't know how it's going to get any better, because it feels like it's just gradually, day by day, getting worse," she said.
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In Maricopa County, which is Arizona's most populous county, fentanyl-related deaths jumped nearly sevenfold in four years, to 1,303 in 2021 from 192 in 2017, according to data from the Maricopa County Medical Examiner's Office.
In Pima County, which includes Tucson, the number of fentanyl-related deaths jumped eightfold, to 298 in 2021 from 34 in 2017, records from the Pima County Medical Examiner's Office show.
Fentanyl was listed as a cause of death in 16% of all drug overdose deaths (opioid and non-opioid) in Maricopa County in 2017. By 2021 that had jumped to 60%, county data shows.
'It's finding its way into everything'
Five years ago, Community Medical Services was more likely to be treating clients dependent on heroin and prescription opioids such as oxycodone, said Dr. Robert Sherrick, the company's chief medical officer.
Now, about 70% to 75% of all new intakes at Community Medical Services locations across the country are testing positive for fentanyl, Sherrick said.
"Going back five years ago it was probably about zero. There was more of it east of the Mississippi, initially in places like Ohio, Kentucky and West Virginia. But now it's across the entire country," said Sherrick, who estimates Community Medical Services every week takes in about 275 new clients nationwide.
"Just within the last year or so the vast majority of fentanyl people are obtaining is in the form of these blue pills, sometimes called Mexican blues, and they look like a 30 milligram oxycodone. They don't have oxycodone in them. They have fentanyl in them."
Today, even if people want heroin, they often can't find it, he said. More common are the illicit pills that look like prescription opioids.
Another troubling aspect of the newest wave of opioid overdose deaths across the U.S. is that they often involve not only fentanyl but stimulants like methamphetamine and cocaine, which can make the opioid antagonist naloxone, often known by the brand name Narcan, less effective, according to a recent study from researchers at Northwestern University that was published July 28 in JAMA Network Open.
"One of the things we've heard is that people are turning to methamphetamine to avoid fentanyl because fentanyl is obviously more dangerous and deadly and it doesn't produce as good of a high," said Stavros of Community Medical Services. "So patients are actually steering away from it. ... But even meth is contaminated with fentanyl. It's finding its way into everything."
Data from Community Medical Services indicates people who are dependent on fentanyl may be less likely to finish treatment for opioid use disorder than people who are dependent on other drugs like heroin, Sherrick said.
"What we're seeing is, it's harder to get people to completely stop using fentanyl, whereas for heroin we have a higher percentage of people who would stop using heroin over time," he said. "Part of that has to do with the fact that fentanyl is just so powerful."
Stavros said leaders at Community Medical Services are studying the rates of treatment compliance.Those who test positive for fentanyl are dropping out of treatment at higher rates, the program's preliminary data shows.
"It could mean that the medication is not as effective at treating fentanyl," he said. "It might be harder to stabilize patients but we are researching it internally to try to understand it. ... Retention rates even at the 30-day mark are worse for people who have been testing positive for fentanyl and 70% are testing positive for fentanyl, so that's pretty disconcerting."
'Addiction thrives in isolation'
State health officials and law enforcement experts say there's no one solution to a problem that appeared to spike during the first year of the COVID-19 pandemic in 2020, when there was less social interaction and for some people, more feelings of isolation, as well as financial and health worries.
"It's really challenging to find solutions," Sjolander of the state health department said. "We are doing some things to work more upstream in terms of tackling the whole issue around loneliness and social connectedness, social isolation."
The Arizona Department of Health Services in 2021 launched a campaign called "Start a Conversation" that's focused on social connectedness and the negative effects that loneliness can have on a person's health. The campaign emphasizes, among other things, that heavy social media use is not a substitute for social connectedness and, in people with underlying social anxiety, it correlates with feelings of loneliness and isolation.
"There's been a lot of isolation. Addiction thrives in isolation," said Govan, the clinical director of the Scottsdale Recovery Center.
"Alcohol consumption and marijuana consumption all got worse (during the pandemic). Everything got worse," Stavros said. "Addiction is a way people try to cope with lack of community. And so there was a lot of lack of community during COVID."
Dr. Gary Kirkilas, a general pediatrician at Phoenix Children's Hospital, told the Arizona House health committee earlier this year that blue M30 pills are "almost ubiquitous" in the Valley and that many kids "aren't just using for the fun of it." They are self-medicating, he said, and reiterated his comments in an interview with The Arizona Republic.
Kirkilas said he's noticed that in the past three or four years, an increased number of kids have been disclosing use of "prescription drugs that are not prescribed to me," which often starts a conversation about what his patients call "blues" or M30s — drugs they believe to be prescription pills but are typically illicit drugs with fentanyl in them.
"Some may think it's OxyContin. Some know very well it's fentanyl. ... Some kids are using just for experimentation purposes," he said.
Many of the patients Kirkilas sees say they are using drugs for some sort of mental health issue, often the result of childhood trauma. He's seen patients using fentanyl whose parents kicked them out of the house, or who were sexually or physically abused, and say drugs help with anxiety. Substance use becomes a "Band-Aid for the hurt they are going through," Kirkilas said.
"In a sense they are self-medicating their own mental health issues," he said. "A lot of the mitigation measures that we had to do and were rightfully done disrupted the daily routines of kids. ... There are many more mental health issues when you disrupt people's daily activities."
Pinal County, which is Arizona's third-most populous county, has launched its own fentanyl awareness campaign. In 2021, fentanyl for the first time overtook methamphetamine in Pinal County as the most common substance returned by toxicological analyses for suspected overdoses, the Pinal County Medical Examiner's Office says.
"We've seen in our county just unbelievable amounts of pills — tens of thousands of pills," Pinal County Attorney Kent Volkmer says in a recent county-sponsored fentanyl awareness video. "I don't know what the solution is. That's the scariest part. There's not an easy solution. I can't snap my fingers and cure this problem. ... We're really struggling to figure out how this is ever going to end."
Law enforcement can't fix the problem solely with arrests, Volkmer said during a fentanyl awareness event in Queen Creek on Aug. 20. And he cautioned parents against assuming that their child would never try an illicit pill.
"Unfortunately, a lot of the deaths and a majority of the overdoses that we're seeing are actually happening in family homes," he said. "The only way we can fix this is if we continue to talk about it as a community. The stigma has to go away. ... Every one of us has an obligation to talk to our kids, to talk to our nieces, our nephews, our grandchildren."
Policies, messaging and laws concerning illicit drugs should not be focusing solely on fentanyl, says Haley Coles, executive director of Sonoran Prevention Works, which is an Arizona nonprofit that promotes harm reduction.
"We've been dealing with this fentanyl crisis in Arizona for three or four years. Give it six years and it's going to be something different. So us trying to chase a specific drug is not going to help, and by the time the next drug hits we're going to be ill-prepared because we've been so focused on fentanyl," she said.
"The most important thing is that people know what they are taking, and that they are aware of overdose prevention strategies. ... The issue is that people don't know what's in their drugs."
People also should not use drugs alone, no matter what kind of substance they are using, Coles said.
Former elite gymnast died from fentanyl during the pandemic
On May 9, 2021, Chandler resident Alex Taylor, 17, was two weeks away from his Hamilton High School graduation ceremony when he died of a fentanyl overdose.
Alex's drug use began with vaping marijuana concentrates, which have high levels of tetrahydrocannabinol (THC), the main psychoactive ingredient in marijuana. The vaping eventually led to other substances, including fentanyl, said his mother, Lindsay Taylor.
"The marijuana was a gateway into other things," she said. "I'm certain that had Alex never gone down that path with the marijuana, he wouldn't have ended up trying fentanyl."
Growing up as an elite gymnast who competed at the national level, Alex followed a disciplined schedule — three hours of gymnastics per day, six days per week. During competition season, he frequently traveled and was often away on weekends.
"Gymnastics was his whole life. ... He was so talented," Taylor said. "Finally, by the end of his sophomore year he was getting burned out, and he was done. It was really hard for us because he did have so much talent and it kept him on a good path. It kept him busy and disciplined. ... But he was done and we didn’t want to force him to stay in something he wasn’t happy with anymore."
When he quit the gymnastics in 2019, Alex poured his energy into skateboarding and diving. In fall 2019, Alex, the eldest of four children, competed on the Hamilton High School diving team and talked about one day becoming a physical therapist.
In 2020, COVID-19 hit. Unlike some kids, Alex did not appear to be lonely during the pandemic, as he was always with his friends, said his mother. He did, however, have a lot of free time, which was something he'd rarely ever experienced. He struggled being out of school and not having the structure and routine.
"March of 2020 was really when things went downhill with him. ... He really got into the vaping more frequently and just went downhill from there," Taylor said. "He was never really that isolated, but (the pandemic) allowed him to have more time on his hands and be with friends. It gave him more opportunity to get into drugs."
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Alex began taking pills that contained fentanyl during the spring of 2021 and told his family he needed help. He was regularly seeing a therapist, and his family frantically searched for a residential substance use treatment program, though they struggled to find one because of two major barriers: cost and Alex's young age.
His mother, a social worker, was reaching out to every resource she knew to get him help, and finally found a nonprofit wilderness therapy program for teens and young adults.
But before Alex had a chance to go to the wilderness program, fentanyl ended his life. His mother isn't entirely clear about what happened, but he was out with some friends, took a pill and passed out. Taylor believes that had his friends not waited an hour to call 911 after he passed out, Alex might still be alive.
"Every minute when you are unconscious like that counts," Taylor said. "By the time they got him to the hospital, he didn't have a pulse."
Health providers at the hospital revived him and placed him on a ventilator, but Alex had no brain activity because he'd gone too long without oxygen.
Arizona's good Samaritan law allows individuals who call 911 to report an overdose without the fear of being arrested for drug possession, but Taylor believes more people need to be aware of it.
"I think it truly would have been a lifesaver in Alex's situation, and probably so many others," she said.
The rise in deaths caused by fentanyl among Arizonans of all ages led Ducey to sign a law legalizing fentanyl test strips in the state in 2021. Ducey signed the law nine days after Alex Taylor's death and during the same week that he signed into law a bill decriminalizing sterile needle exchanges for people who use injectable drugs.
The fentanyl test strips, available for purchase online and from health outreach groups, can tell drug users whether or not there's fentanyl in the drug they are about to take. The original bill that led to the law was sponsored by state Sen. Christine Marsh, D-Phoenix, who lost her 25-year-old son, Landon Marsh, to a fentanyl overdose in June 2020.
While she applauds the legalization of the fentanyl test strips, Taylor isn't so sure it would have made a difference for Alex.
"For him specifically, probably not, because he was so young and not in the right mindset," she said.
'It's just getting worse instead of better'
Goodyear resident Andrea Cantrell turned to a nonprofit group called GRASP, which stands for Grief Recovery After Substance Passing, about six months after her 24-year-old son, Brandon Copeland, died of a fentanyl overdose on March 5, 2021.
"I don't know how educated he was on the drug and the effects. I can't imagine he knew the risks. I was never educated on it at all. I'm learning more about it," she said.
Cantrell estimates about 95% of the people in her support group have lost someone to fentanyl. The group has provided her with a much-needed place to talk freely without a fear of being judged, she said.
"Unfortunately, we've had a lot of new members join us lately," she said.
Initially, Cantrell was secretive about her son's cause of death. She has since decided that being open is better for her emotionally and has also enabled her to offer support to other parents, some of them outside of the GRASP group, who are going through similar struggles.
Copeland, who worked in construction, was a father of two who at one time enjoyed football and martial arts. He used marijuana as a teenager and later began smoking fentanyl by crushing up pills, putting it in tinfoil and smoking it, Cantrell said. Eventually he lost custody of both his children.
Cantrell said her son was desperate to get sober and to be a better father. He attempted to quit fentanyl several times but ended up relapsing, his mother said. The family regularly visits three benches in the White Tank Mountains they dedicated in Copeland's memory.
An ongoing frustration with the wide availability of fentanyl in the Phoenix area is that drug dealers are often peddling their cheap, illicit pills to people trying to recover from opioid use disorder, Koch said.
As he did a recent cleanup outside the Community Medical Services' 24/7 treatment facility near I-17 and Cactus Road in Phoenix — with his infant daughter strapped to his chest — Koch recalled being approached by someone offering him "blues." Blues typically refer to illegally manufactured pills that often contain fentanyl.
"It's constant," Koch said as he recently walked through the facility. "There's not enough policing in this area to get the drug dealers off the street. You and I can leave here right now and buy fentanyl. For sure. No doubt."
At the location, which typically takes in 70 new people seeking treatment per week, patients receive one of three federally approved medications for opioid use disorder: methadone, buprenorphine (Suboxone) and naltrexone (Vivitrol). The facility only treats people age 18 and older; the average age is 37, and slightly more men than women are clients.
By the time people struggling with opioids get to Community Medical Services, the euphoric effects of the drugs they are taking have usually turned into more of a desperate dependence — a craving for fentanyl or heroin or whatever it is they are taking, just to avoid feeling very, very ill (another term for this is dopesick).
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Koch, who was once dependent on heroin, says when people first start using opioids, there is a fear of dying. Once the use increases and persists, the opioid users begin seeking the feeling of their first high, something often referred to as "chasing the dragon," Koch said. That's when the need for more opioids often overtakes health fears, including the fear of death, he said.
"In the drug-using community, sometimes you hear somebody died (of an overdose) and you think, that's really good stuff," Koch said. "You've been getting high for so long that you are not really getting that high anymore and you are really just looking to fill that void."
One advantage for people struggling with an opioid use disorder in Arizona is that the state has an expanded Medicaid program, which enables a wide range of low-income people with opioid use disorder to get free health coverage that pays for programs such as medicated-assisted treatment, Koch said.
The Community Medical Services treatment includes other components, too, such as counseling and peer support. Still, without more community compassion, education, awareness and efforts to expand treatment options, Koch predicts the overdose deaths will continue.
"It's getting worse and worse and worse," Koch said.
Further complicating the situation is that drug cartels are always changing their products.
Newer, emerging synthetic opioids similar in chemical structure to fentanyl, with varying levels of potency, have been identified.
"Drugs just constantly evolve. ... There's carfentanil out there, too, which we haven't begun to see much of, which is even worse than fentanyl," Stavros said. "At least with the opioids, it's just getting worse instead of better."
Reach the reporter at [email protected] or at 602-444-8369. Follow her on Twitter @stephanieinnes
This article originally appeared on Arizona Republic: How fentanyl is driving Arizona's increase in opioid overdose deaths
