More than two Arizonans died each day from opioid-related causes in 2016, according to the Arizona Department of Health Services. And since June, there have more than 950 suspected opioid-related deaths in the state and more than 6,200 overdoses.
Given that background, the city of Phoenix has engaged in a battle against big drug companies to try to recoup some of the money it's spent fighting the opioid epidemic.
“We recently decided that Phoenix would join the nationwide effort that involves not only cities but also counties and states around the U.S., to aggressively go after the opioid manufacturers and distributors, who have misrepresented the addictive nature of the products they are putting out on market,” Phoenix Mayor Greg Stanton said in a recent interview. “Because of that misrepresentation, it’s obviously had devastating impacts on people’s lives.”
The crisis led both major parties in the state Legislature to join forces and pass the Arizona Opioid Epidemic Act in January. The bill restricts prescriptions to five days for first-time "opioid naive" patients and requires a maximum dosage for many other cases.
PhRMA, the industry group representing pharmaceutical companies, does not comment on pending litigation. In December, the group issued a recommendation for seven-day prescription limits on opioids for acute pain except for “certain conditions or patients, such as chronic pain, pain associated with cancer diagnosis or treatment, palliative care, hospice or end-of-life care, residents of long-term care or nursing facilities and individuals receiving medication-assisted treatments for addiction” or when a medical professional determines that a case warrants more than the initial supply.
Stanton says the nearly 1,000 opioid-associated deaths in Arizona over the past nine months are by far the most heartbreaking indicator of the epidemic's toll. But Phoenix has also incurred large legal costs paying to jail addicts and offenders.
“We pay a lot of money when we arrest somebody for a crime associated with addiction or drug abuse or selling drugs,” Stanton said. The mayor says that, through legal action, the city hopes to recover some of those resources, mainly so that it can do more in the area of treatment.
It’s clear that Phoenix has suffered a heavy financial burden due to the opioid crisis. While the mayor is reluctant to provide an exact figure at this time, noting that it will come out in the legal process of discovery, he said it was “millions and millions and millions of dollars every year.”
Although jail costs are the most direct expense borne by the city, another is for naloxone, a medication designed to rapidly reverse opioid overdose, which Stanton says the city’s firefighters now carry out of necessity. All of these expenses are paid out of the city’s coffers.
“There’s no secret pot of money,” Stanton said. “When we have to pay jail fees for someone we’ve arrested as a result of committing a crime due to their addiction, that comes right out of the general fund, which means it competes with park services, library services and transportation. Other priorities of the city, unfortunately, can’t be funded because of the extra cost associated with this epidemic.”
The opioid crisis is affecting local businesses as well, according to Stanton. Aside from the reallocation of tax revenue away from other vital needs, businesses have to deal with increased crime, as well as workers who are either addicted themselves or have to take time off from work to care for family members who are in some way affected by the epidemic.
At the local Chambers of Commerce, it’s become a hot topic of conversation. The combination of lost productivity and additional healthcare costs has gotten their attention, the mayor says.
“They have to be,” asserted Stanton. “This opioid crisis cannot continue to grow as exponentially as it has over the last few years. To be perfectly honest, I think it caught a lot of us off guard, as to just how expansive it was and how dangerous it is. We’re playing a little catch-up, but we plan to play catch-up very aggressively and successfully.”
One area business that is dealing with the opioid crisis each day is North Scottsdale-based Blue Door Therapeutics, which claims to be the first treatment center in the world to combine the use of medical cannabis along with traditional medicine as an exit strategy for opiate use disorder.
Blue Door was founded by Dr. Gina Berman, a former emergency room physician who, in the course of treating increasingly greater numbers of patients for opioid use and dependence, became disenchanted with what she calls a dysfunctional cycle. That experience led her to try a different treatment path.
“What we try to do is provide a place where patients can get a whole host of services,” Berman said. “Anything in our toolkit that we feel can be helpful to a patient that wants to get off opioids. That involves things that the traditional medical community might shun, such as acupuncture, cannabis or massage therapy and things that naturopaths might shun, such as buprenorphine. Each of the medical specialties kind of looks down its nose at the others, so we tried to remove those barriers.”
In between her job as an emergency room physician and founding Blue Door Therapeutics, Berman became the medical director of a medical marijuana dispensary, which finally made her feel like she was part of the solution. Rather than prescribing addicts even more opioids and continuing the abuse/addiction cycle, she was able to treat patients with something less habit-forming, less dangerous, with fewer side effects and that helped them overcome their addictions, she said.
While the treatment protocols at Blue Door Therapeutics may seem unconventional, there is some evidence backing their usefulness. Berman notes that there are studies pointing to the efficacy of acupuncture in treating addiction, as well as some research backing the benefits of massage therapy. Testing of cannabis, however, is more problematic.
“The problem with cannabis is that once you start getting into real research — which for me is a double-blind, randomized, controlled trial — you can’t get institutional review board approval for it,” Berman said.
One of the most significant hurdles for cannabis testing is that marijuana is still classified as a Schedule 1 drug by the DEA, just like heroin, which means it is restricted by law. This makes testing more challenging, according to Berman, who says she would like to do a head-to-head study, comparing buprenorphine and cannabis for the treatment of opioid dependence.
Berman applauds the state for placing a limit on first-time prescriptions. “I think that gathering the data, making sure that we’re fully aware of what the issue is, limiting prescriptions, increasing access and reimbursement for patient services, and making sure that patients have access to real, meaningful healthcare are the things that really matter,” Berman said.