Addiction sneaks up on pain patients in the worst opioid epidemic in U.S. history, and their shared battles for recovery are fraught with ironies, tragedies and sometimes shaky success. Meet three people vowing to beat the odds. (Nov. 20) AP
The White House commission on opioids has released its final recommendations for addressing the crisis. Video provided by Newsy Newslook
When it comes to declaring emergencies, the type of emergency it is can determine how much funding the federal government will allocate to solve it. Video provided by Newsy Newslook
This video explains the origin of the opioid fentanyl and what makes it so dangerous to use. Newsy
A volunteer with Sonoran Prevention Works talks about the dangers of sharing syringes. Julianne Stanford/azcentral.com
Doctors are cutting back on opioid prescriptions but not by nearly enough, federal health officials say. Wochit
Methamphetamine is blooming across the country again but isn't getting the attention it deserves, say many researchers, law enforcement officials and health workers. Wochit
To stop the opioid epidemic, the CDC is telling doctors to cut back on opioid painkiller prescriptions, but some people just end up turning to heroin. Video provided by Newsy Newslook
Pleasure. Craving. Withdrawal. When opioids act on the brain, they trigger the same processes that give people feelings of pleasure from activities like eating, but they do it far more intensely. (May 2) AP
The nation’s opioid crisis is forcing doctors and pharmaceutical companies to find alternatives to the highly addictive narcotic painkillers so often prescribed. (April 17) AP
Some of the youngest victims of the nation’s opioid epidemic are children under age 5 who die after swallowing opioids. The number of children’s deaths is still small relative to the overall toll from opioids, but toddler fatalities are up. (March 23) AP
The Associated Press and The Center for Public Integrity found makers of prescription painkillers have tried to kill or weaken state measures aimed at stemming the opioid crisis that has cost 165,000 Americans their lives since 2000. (Sept. 19) AP
Slippery battle for patients addicted to opioids
The White House now has a plan to fight the opioid crisis
Why the opioid crisis wasn't declared a national emergency
Why is fentanyl so dangerous
Volunteer describes dangers of sharing syringes
Opioid prescriptions have tripled since 1999
Some heroin addicts turning to meth
Trying to stop the opioid epidemic is an uphill battle
Science Says: Why Are Opioids so Addictive?
The search is on for opioid alternatives
Toddlers Latest Victims of Opioid Epidemic
Politics of pain: Lobbyists fought opioid limits
In a rare moment of bipartisanship, the Arizona Legislature voted unanimously Thursday night to approve a sweeping plan to combat the state's opioid epidemic that has claimed more than 800 lives since June.
Lawmakers approved the Arizona Opioid Epidemic Act, legislation that would limit initial pain-pill fills to five days for “opioid naive” patients, and impose a maximum dosage limit for many others seeking new prescriptions.
The outcome — the legislation passed 30-0 in the state Senate and 58-0 in the Arizona House of Representatives — was a major victory for Republican Gov. Doug Ducey.
Ducey spearheaded the proposal and called lawmakers into a special session this week, urging them to pass it quickly to halt overdose deaths. He was expected to sign the legislation Friday.
"This is a tremendous example of what we can achieve when we work together,” he said in a statement Thursday night. “I look forward to signing it.”
House Speaker J.D. Mesnard, R-Chandler, said although the bill isn't perfect, it will help save lives. He said patients suffering from chronic-pain conditions will not be hassled to get prescription refills, as some health-care professionals and critics of the bill fear.
“I’m not generally in favor of more regulation," Mesnard said before casting the final "aye" vote. “But when there’s an epidemic, when people are dying, then we have to act."
In addition to capping initial prescription fills, the bill aims to provide more treatment. It includes, at the urging of Democrats, $10 million to provide rehab for people who can't afford treatment because they don't have insurance coverage.
Ducey's plan largely builds off the Arizona Department of Health Services' opioid action plan unveiled last fall after the governor declared a public-health emergency.
'Good Samaritan Law'
Pushing the bill through the Legislature in less than a week required a flurry of meetings and hearings. Some lawmakers said the rushed agenda may not have benefited the product. They raised concerns that dosage limits might infringe on the relationship between patients and doctors.
But after hours of intense debate Thursday, lawmakers eventually passed the bill with minor tweaks.
Democrats championed a portion of the bill dubbed the "Good Samaritan Law," which aims to encourage people to call 911 in case of an overdose. It states that a person who reports an overdose won't be prosecuted for a drug-related crime, though law enforcement could confiscate drugs and paraphernalia and charge the individual for non-drug-related crimes.
House Minority Leader Rep. Rebecca Rios, D-Phoenix, called the negotiations a “true bipartisan effort.” She said she's glad to see a handful of the proposals her party offered were accepted, including the $10 million earmark for addiction treatment.
“This is how you get it done," Rios said. “This is a strong first step, but it is only a first step. We need to get back to work."
Much of the debate over the bill occurred in the Republican House and Senate caucus meetings, where a few members took issue with provision to mark opioid prescription bottles with red caps. They also questioned the Good Samaritan provision and potential impacts on patients with chronic pain.
Concerns about 'unintended consequences'
Two doctors groups, the Arizona Medical Association and the Arizona Osteopathic Medical Association, warned in a December letter to the Department of Health Services about the "unintended consequences" of broadly imposing a five-day limit on fills for new patients.
Sen. Kate Brophy McGee, R-Phoenix, was among those who said the bill could have unintended consequences. She raised concerns about dosage limits, saying a constituent of hers is prescribed more in order to treat chronic pain, so she worries some patients might not have access to the amount of medication they need.
Some medical professional also said they were concerned about limiting opioids to a maximum dosage of 90 morphine milligram equivalents per day for most patients. That's the daily equivalent of about 90 mg of Percoset, 60 mg of oxycodone or 20 mg of methadone, according to the Centers for Disease Control and Prevention.
In their December letter to ADHS, the two doctors groups said they "strongly oppose putting any kind of dose-strength limitation in state law."
Cancer, trauma, burn, hospice, end-of-life care and substance-abuse patients would not be subject to the dosage limits. Doctors also could extend existing prescriptions that exceed the limit.
Lawmakers amended the final bill to state that the 90 morphine milligram equivalents limit does not apply to a patient who is continuing a prior prescription issued within the previous 60 days.
The bill also calls for distributing the overdose-reversal drug naloxone, also known as Narcan, to county health officials and law-enforcement support staff to administer in the event of an overdose.
E-prescription system
Another concern in both chambers was the implementation of an e-prescription system in doctors offices across the state. Brophy McGee said she and many of her colleagues heard concerns from constituents on the issue and are asking for a delayed implementation or an exception in some cases if costs are too high.
Brophy McGee and other lawmakers worried that some offices in rural and urban areas may not be able to pay for or install software in time to be in compliance with the new requirement, saying that some still prefer written prescriptions.
In rural areas, one concern is that “technology and their practice management sophistication is varied,” she said. “So, they would want to have additional time to implement certain parts of the statute, including e-prescribing.”
Lawmakers amended the final bill to require the Board of Pharmacy to grant waivers to heath-care providers who might struggle to comply with the e-prescription filing requirement due to a lack of broadband Internet access or other hardships.
Money for treatment
While the bill allocates $10 million to provide treatment to those without insurance coverage, some lawmakers and health-care providers said they are certain more will be needed.
That $10 million would be distributed through AHCCCS providers for the rest of the year once the bill passes, and once the fund runs out, the Governor’s Office and lawmakers would decide if and how much additional funds were needed. AHCCCS, or Arizona Health Care Cost Containment System, is the state's Medicaid program.
Rios said $10 million is a “good start” and enough to put a dent in the problem, but more funding will likely be needed. Once the funds run out and lawmakers see how long it took and what services were used more than others, she said, only then will they have an idea how much money is needed.
Some already see the demand for treatment in massive lines at rehab centers.
Lee Pioske, executive director of the Crossroads, a Valley rehab provider, said there is a line of people out the door every day. Many of them are young and covered under Medicaid, he said.
Pioske said he applauds Ducey’s efforts to restrict dosage levels and establish stricter refill amounts, but he said there are critical issues the bill does not address. He called the opioid epidemic the “worst health crisis this country has seen in our lifetime.”
Some Democratic lawmakers were disappointed the bill didn't include a clean-needle exchange; such programs aim to reduce transmission of blood-borne viruses by discouraging addicts from sharing used syringes.
But the issue could still be revisited during lawmakers' regular session.
Rep. Tony Rivero, R-Peoria, has proposed House Bill 2389, which would allow counties, cities and private organizations to operate clean-needle programs without fear of prosecution.
Lawmakers and Ducey's top health-policy officials said the opioid epidemic differs from other illicit drug use because it largely started with years of bad prescribing of powerful and highly addictive pain medication, such as OxyContin and Percoset.
"I think most people who get addicted didn’t intend to get addicted," Mesnard said.
The Republic's politics team talks about Gov. Doug Ducey deregulating blowout bars and pay raises to his public relations team along with Rep. Kelly Townsend's post about a topless woman at the women's march on Jan. 23, 2018. Carly Henry/azcentral
The Republic's politics team talks about a bill proposed by Sen. Sean Bowie to ban conversion therapy for minors, Gov. Doug Ducey's proposed education budget and Rep. Martha McSally's bid for U.S. Senate on Jan. 16, 2018. Johanna Huckeba/azcentral
The Republic's politics team talks Joe Arpaio's run for Senate, Gov. Doug Ducey's promises in the State of the State address and Rep. Don Shooter's apology for sexual harassment on Jan. 9, 2018. Johanna Huckeba/azcentral
The Arizona Republic's politics team looks at the most impactful stories that they worked on in 2017 and share predictions for 2018. Johanna Huckeba/azcentral.com
Rep. Trent Franks steps down from Congress amid sex harassment allegations, the Goldwater Institute controls Empowerment Scholarship Accounts and Arizona leaders want to increase sales tax to increase school funding. Hayley Sanchez/azcentral.com
The Republic's politics team talks Jeff Flake's controversial endorsement check, the state's child welfare agency and how the Republican tax plan will impact Arizonans. Carly Henry/azcentral
The Republic's politics teams talks Rep. Grijalva's settlement after an employee accused him of working drunk, the race for State Treasurer and Mesa Mayor John Giles' comment to Jeff Flake insulting Trump on Nov. 29, 2017. Johanna Huckeba/azcentral
The Republic's politics team talks on Nov. 22, 2017, about the "awkward" Senate race and an unusual decision made by the Arizona Court of Appeals to restore parental rights to a mother who had her rights previously stripped. Johanna Huckeba/azcentral
The Republic's politics team talks about the Don Shooter sexual-harassment scandal, how Foster Care Review Boards do not reflect their communities, and how Rep. Tom O'Halleran's office isn't in his district. Johanna Huckeba/azcentral.com
The Republic's political team discusses Rep. Martha McSally entering the 2018 Senate race and more sexual harassment allegations in Arizona's Legislature on Nov. 8, 2017. Johanna Huckeba/azcentral
The Republic's politics team talks Bisbees's plastic bag ban, KidsCare funds drying up and Martha McSally and Paul Gosar entering Arizona's Senate race on Nov. 1, 2017. Johanna Huckeba/azcentral
The Republic's political team discusses Sen. Jeff Flake not running for re-election amidst a changing Republican Party and the allegations of sexual harassment in Arizona's Legislature. Johanna Huckeba/azcentral.com
The Republic's political team discusses Governor Doug Ducey giving raises to the members of his inner circle instead of prioritizing teacher raises as promised. Steve Bannon visits Arizona and Paul Gosar's family feud. Johanna Huckeba/azcentral.com
The Republic's politics team discusses the most recent developments in the race for City Hall, Congressman Paul Gosar's view of the Charlottesville white supremacists rally and the upset after the release of school letter grades on Oct. 11, 2017.
The Republic's political team on Oct. 4, 2017, discusses the class-action lawsuit against the Department of Child Safety, the development of the U.S. Senate race in Arizona and Vice President Mike Pence's visit. Johanna Huckeba/azcentral.com
The Republic's political team talks about President DonalTrump blaming Sen. John McCain for another failed attempt to repeal "Obamacare" and Homeland Security makes an official statement on a hack of voter-registration data. Johanna Huckeba/azcentral
The Republic's political team discusses the cost of President Trump's rally to the city of Phoenix, the Arizona Supreme Court's ruling on same-sex couple's rights and Gov. Doug Ducey trying to repeal 'Obamacare.' Johanna Huckeba/azcentral
The Republic's political team discusses Mark Brnovich suing Arizona Regents over high tuition costs, Trump cutting a deal with Democrats and the Constitutional Planning Convention on Sept. 13, 2017. Carly Henry and Johanna Huckeba/azcentral
The Republic's political team on Sep. 6, 2017, discusses Arizona's school-voucher program potentially reaching the ballot, the future of DACA and the recent House vote on Hurricane Harvey relief. Johanna Huckeba and Carly Henry/azcentral
The Republic's political team on Aug. 30, 2017, talk about Arpaio's pardon, the future of DACA and Jeff Flake's re-election campaign. Johanna Huckeba/azcentral
The Republic's political team on Aug. 23, 2017, talks President Trump's visit to Arizona and if the school voucher referendum will make the ballot. Johanna Huckeba/azcentral.com
The Republic's political team talks on Aug. 15, 2017, about Rep. Kyrsten Sinema's likely Senate run, the drop in investigations into reports of child neglect, and Trump's scheduled visit to Phoenix. Sean Logan/azcentral.com
Sen. Jeff Flake's new book defends Reagan-style conservatism and critiques the Republican Party. Gov. Doug Ducey plays a role in Sen. John McCain's health-care vote. U.S. Rep. Martha McSally helps craft a bipartisan plan for the insurance system. Thomas Hawthorne/The Republic
The Republic's political team on July 26, 2017, talks about Sen. John McCain's dramatic health-bill appearance, the ALEC conference and the saga of Mesa Councilman Ryan Winkle. Hannah Gaber/azcentral.com
In the July 19 episode, the Republic's politics team talks about Sen. McCain's health scare and the health care bill that wasn't, Rep. Martha McSally's big spending, and what's to become of the school voucher petition. Hannah Gaber/azcentral.com
In this week's episode, reporters Yvonne Wingett Sanchez, Dan Nowicki and Rob Hansen discuss the health-care bill, and how it might affect Arizonans, along with the state's school-voucher program. Johanna Huckeba/azcentral.com
The Republic's political team discusses Arizona's congress support of President Trump's agenda, the disconnect between foster families and the Department of Child Safety and a recent request for voter information. Johanna Huckeba/azcentral.com
The Gaggle: Ducey on blowout bars, Townsend's inflammatory post
The Gaggle: Ducey's budget, conversion therapy, bump stock ban
The Gaggle: Arpaio runs for Senate, Ducey's speech, sex harassment
The Gaggle: The year in stories
The Gaggle: Trent Franks, ESAs, school funding increases
The Gaggle: DCS disbands review panels, tax plan
The Gaggle: Rep. Grijalva's settlement, Mesa's mayor faces backlash
The Gaggle: AZ's memorable delegation, voter registration numbers
The Gaggle: Shooter's harassment scandal, foster-care boards
The Gaggle: Sex harassment in AZ's Legislature
The Gaggle: Senate race, Bisbee bag ban, KidsCare
The Gaggle: Flake out; Legislature harassment
The Gaggle: Ducey shows us the money, Bannon's visit, Gosar's family feud
The Gaggle: Arizona elections, school letter grades, Paul Gosar on Charlottesville
The Gaggle: DCS lawsuit, Senate race
The Gaggle: Russia hack, another ACA repeal
The Gaggle: Trump rally costs, gay couple's rights
The Gaggle: Mark Brnovich sues Arizona Regents, Constitutional Planning Convention
The Gaggle: State school vouchers, DACA and Hurricane Harvey relief
The Gaggle: Arpaio pardon, future of DACA and Flake's re-election campaign
The Gaggle: Trump's visit, school voucher referendum update
The Gaggle: Trump's Phoenix rally, Arpaio pardon and Sinema's run
The Gaggle: Flake's new book, health care and bipartiship
The Gaggle: McCain's return to the Senate and more
The Gaggle: School voucher petition, health care and McSally
The Gaggle: Health bill, school-voucher program
The Gaggle: Foster families, Trump's agenda and voter information
READ MORE:
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Phoenix to sue prescription drug makers over costs of opioid crisis
4 Mohave County doctors prescribed 6 million opioid pills in 1 year
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