UPDATE 2 – NO, METHADONE IS NOT THE NEW METHADONE
High-risk use and opioid overdose continue to worsen, even after dissipation of pandemic stressors, and with expanded provision of methadone. Arizona tried it.
by Clark Miller
Published March 12, 2023
Things aren’t going well in Arizona.
More than 2,000 people died from opioids in Arizona last year. This follows a 120% increase in opioid overdose deaths since 2017, according to a new report from the state Department of Health Services.
The state has worked to combat this crisis through numerous initiatives, such as the 2018 Arizona Opioid Epidemic Act, a Good Samaritan law, and the Arizona Angel Initiative. The state has also seen a significant increase in the dispensing of naloxone, a lifesaving drug used for overdoses, by pharmacies during 2020-2021 when compared to other years.
And?
Arizona went all in on medication assisted treatment (MAT), including expansion of methadone provision, beginning about 5 years ago, in 2017, described here.
From that previous post –
Arizona was granted $24 million dollars for opioid treatment and prevention from the SAMHSA State Targeted Response (STR) Grant, the funds implemented for OST programming in October of 2017. Immediately, those and state funds were used to quickly expand access to bupe and methadone, at clinics open all hours, seven days a week, 24/7, and with new clinics with the same expanded hours.
But according to this state report other services prior to the expansion of dispersal of substitute opioids – a campaign focused on expanding availability and use of the OD death-reversing drug naloxone – began earlier, by June of 2017. It included widespread training of law enforcement personnel, provision of naloxone kits, and increased availability of naloxone to responders as well as private citizens.
[That expansion of America’s “proven”, “life-saving” addiction medicines should have, was desperately hoped to, reverse the lethal opioid crisis there, and everywhere, or at least moderate it, but not worsen it over 5 years of implementation – over pre-pandemic, pandemic, now post pandemic period with any fabricated stressors dissipated.]
Back to our previous post –
But how the treatment program has worked in Arizona, actually, is to have predictably – based on longstanding evidence bearing on OST – increased instead of decreased high-risk opioid use as clearly illustrated by a measure of high risk use: non-lethal opioid-related overdoses – non-lethal overdoses to factor out confounding effects of changes in use of naloxone to prevent OD deaths.
Let’s look at the timeline and epidemiology.
For both non-lethal and lethal opioid-related overdose prevalence, the numbers decrease after the naloxone campaign is implemented, and prior to OST expansion, through October 2017 – that’s when rapid increase in provision of substitute opioids buprenorphine and methadone was initiated.
Then things change. For non-fatal overdoses – a measure of high-risk opioid use – prevalence then shows a steady increase through January of this year, over a period of 13 months.
Surprised ?
Here, as described by Sam Quinone’s in Dreamland (p 190), is what happened with expansion of medically-provided methadone about two decades ago –
Generic methadone, for years strictly an addict-maintenance drug, suddenly started killing, too. As media reports of OxyContin abuse and overdoses spread, some doctors began prescribing methadone for pain instead. . . some doctors figured that methadone was an equally long-lasting painkiller. Plus methadone was generic and cheap; insurance companies covered it. Methadone prescriptions more than quadrupled – from under a million in 1999 to 4.4 million in in 2009 nationwide – mostly for headaches and bodily pain.
. . .
As methadone prescriptions rose, so did overdose deaths involving methadone – from 623 in 1999 to 4,706 in 2007.
Back to our current post –
The predictable worsening of high-risk opioid use, overdose, and lethal overdose with expanded methadone provision and relaxed safety controls was recently outlined here.
Predictably and importantly, in Arizona nonlethal overdose, unlike lethal overdose a valid measure of high-risk opioid use, has increased through the first 6 months of 2022, after dissipation of any presumed (fabricated and invalidated) COVID stressors used to rationalize a worsening opioid crisis.
From this report –
Statewide officials reported 2,871 overdoses — a rate of 40 per 100,000 — in the first six months of 2022. The state also reported 1,400 overdose deaths — a rate of 19 per 100,000.
2,871 nonlethal opioid overdoses – a measure of high-risk opioid use – in the first half of 2022. That’s compared to a total of 7.448 nonfatal opioid overdoses for the years 2020 and 2021 combined. That’s an average per 6-month period of 1,862 over 2020 through 2021.
That is, high-risk opioid use increased in the first half of 2022, with dissipation of COVID stressors and interruptions and after 4 years of expanded provision of MAT opioids methadone and Suboxone in Arizona.
Surprised?
You thought they were providing truth this time?
