Title
One Arizona Opioid Settlement Update
Description
This report provides the Community and Cultural Investment Subcommittee an update on the One Arizona Opioid settlement and the City of Phoenix opioid and substance use response planning.
THIS ITEM IS FOR INFORMATION AND DISCUSSION.
Report
Summary
Opioid related harms and overdoses are continuing to have a significant impact on people who use substances, their families and communities across the country. In 2021, approximately 107,622 people died from a drug overdose in the United States, which continues as a leading cause of injury related death (CDC, 2022). In Arizona, the Arizona Department of Health Services (AZDHS) tracks opioid specific related fatal and non-fatal overdoses; the rate of non-fatal opioid overdose for Maricopa County was 46.7 per 100,000, and the rate of fatal opioid overdose was 22.3 per 100,000 (AZDHS, 2023). The estimated overdose death rate for all drugs was 41.9 per 100,000 in Maricopa County (MCDPH, 2023).
Fatal Overdoses
Based on provisional cause-of-death toxicology data (CODT) provided by the Maricopa County Department of Public Health (MCDPH), there were an estimated 991 fatal overdoses in the City of Phoenix in 2022. Phoenix accounted for approximately 54.2 percent of the total overdose deaths for Maricopa County in the same year. Males (78.6 percent) and individuals between the ages of 25 and 65 (86.2 percent) accounted for majority of the total overdose deaths in the City of Phoenix, and 28.8 percent of all overdose deaths were among persons experiencing homelessness (MCDPH, 2023).
The following information was provided by the MCDPH on fatal overdose counts for 2022 by City Council District:
District One: 111
District Two: 53
District Three: 118
District Four: 175
District Five: 121
District Six: 54
District Seven: 189
District Eight: 170
The City of Phoenix zip codes with the highest rate (per 100,000) of fatal overdoses in 2022 include the following;
85007: 430.40
85034: 291.38
85004: 158.78
85003: 122.25
85009: 119.10
85017: 112.17
85029: 104.44
85021: 95.92
85020: 95.51
85012: 93.78
85051: 93.53
85006: 91.66
Emergency Medical Service Responses:
In 2022, Phoenix Fire responded and administered naloxone to 3,869 individuals. Naloxone, also commonly known as Narcan, is a medicine that rapidly reverses opioid overdose. Of the 3,869 nonfatal overdose responses, 60.3 percent were transported to a hospital (Phoenix Fire, 2023).
Nonfatal Overdoses:
Data for nonfatal overdoses were provided by the MCDPH. This information comes from hospital discharge data (HDD) and excludes federal facilities, such as the Veteran Affairs hospitals, and individuals who experienced an overdose but were not transported to a hospital. Based on the most recent year available (2021), there were 4,903 nonfatal overdose related visits in Phoenix to hospital/emergency departments, which accounted for 35.2 percent of the total visits for Maricopa County.
The following information by the MCDPH on fatal overdose counts for 2021 by City Council District:
District One: 544
District Two: 375
District Three: 566
District Four: 686
District Five: 706
District Six: 394
District Seven: 768
District Eight: 864
In August 2021, 90 Arizona cities and towns and all 15 counties signed on to the One Arizona Opioid Settlement Memorandum of Understanding (One Arizona Agreement). The One Arizona Agreement outlines the distribution of the estimated $542 million dollars that Arizona will receive over 18 years. As part of the spending framework, 56 percent of the total settlement will be disbursed to local governments (21.28 percent to the City of Phoenix) and 44 percent of the total settlement will remain with the State to fund future opioid programs and response efforts.
Under the One Arizona Agreement funds must be used for future opioid strategies that are nationally recognized. Approved uses include evidence-based, evidence-informed strategies regarding:
Treatment of Opioid Use Disorder (OUD)
Support for people in treatment and recovery
Support for people who have or are at risk of developing OUD
Prevention of overdose deaths and other harms
Prevention of opioid misuse
On June 15, 2022, Council approved the City Manager to enter into an Intergovernmental Agreement (IGA) with MCDPH for a Public Health Fellowship Program. The goal of the program is for MCDPH to work with the City supporting the development of a plan to utilize the opioid settlement funds to best address issues in Phoenix and to coordinate on regional plans.
Through the Office of Public Health, the City is working collaboratively with MCDPH and neighboring cities on opioid response planning through the support of the Fellowship and regular communication. The goal of this collaboration is to share expertise, reduce duplication and ensure that work across regions is aligned to maximize community resources and community benefits.
Current Planning
A comprehensive opioid response plan addressing identified strategies in the One Arizona Agreement requires collaboration across many sectors including social services, health care, public health, education, behavioral health, law enforcement, faith communities and more.
The Office of Public Health has recommended the adoption of a Four-Pillar framework to guide opioid response planning in alignment with the One Arizona abatement strategies. A Four-Pillar approach assists in organizing interventions and acknowledges that to achieve a comprehensive approach to address the opioid crisis, local actions must be equitable, integrated and occur in each area of the following:
Prevention and education efforts aim to prevent problematic substance use and improve community knowledge and awareness of substance use related issues and harms.
Treatment and recovery include a broad range of services aimed to support people who use substances to manage harmful substance use.
Harm reduction services are intended to “meet people where they are at” and aim to reduce harms and adverse health effects of substance use including injury, infectious disease, overdose and stigma.
Community safety and justice includes a broad range of interventions, including law enforcement and judicial systems, intended to increase public safety.
Comprehensive Needs Assessment
To ensure that actions and resources are best positioned to address community needs, a comprehensive needs assessment is the first step in the planning process. A needs assessment allows for an understanding of the issue, including contributing and mitigating factors, and supports the ability to evaluate actions and interventions including the following phases:
Assess
Plan
Implement
Evaluate
The MCDPH has contracted LeCroy & Milligan Associates to complete a county-wide needs assessment. The assessment will aim to:
Improve understanding of underlying causes of and experiences with substance use in Maricopa County, especially among high-risk and underserved populations.
Identify the perceptions, successes, and challenges to addressing Substance Use Disorder/Opioid Use Disorder (SUD/OUD).
Provide a summary of the current state involving opioid/substance use overdose deaths and opioid/substance use prevalence and identifying trends by geographic regions and subpopulations.
Present a range of recommended strategies and prioritized needs relevant to Maricopa County.
The assessment will include key informant interviews, a survey and community listening sessions with providers and systems stakeholders. The assessment will focus along the continuum of interventions including prevention, treatment, harm reduction and recovery. In addition to primary data collection, the MCDPH led needs assessment will incorporate existing data on substance use, review of current funding and resources, and examine evidence-based practices for SUD/OUD in Maricopa County.
In addition to the county-wide needs assessment, the MCDPH will also complete an evaluation of the community services available to vulnerable populations focusing on people who use substances and people who are experiencing homelessness. The goals of the evaluation include:
Understand the experiences and barriers in accessing existing community services.
Perspectives on services and resources that are needed from people with lived experience.
Determine best strategies for ensuring services are aligned to reach vulnerable populations.
Data collection for the assessment and accompanying evaluation will occur between January and May of 2023 with results expected to be available in June 2023.
City of Phoenix Planning
To support planning, the Office of Public Health has convened an internal working and advisory group. The purpose of the committee is to work across City of Phoenix departments to advise and coordinate comprehensive and evidence informed opioid education, planning and response for the City of Phoenix. Departments currently represented include:
Police
Fire/EMS
Housing
Office of Homeless Solutions
Office of Heat Response and Mitigation
Library Services
Human Services
Neighborhood Services
Volunteer Services
Youth and Education Office
Parks and Recreation
City Prosecutor’s Office
As part of the initial assessment and planning phase and in accordance with the One Arizona abatement strategies the Office of Public Health staff, with support of the Public Health Fellow, have outlined the following key activities to begin January to June of 2023:
Environmental scan of existing departmental policies and practices related to substance use and strategies identified in the One Arizona Agreement.
Development of trainings and professional development opportunities for City employees related to opioid prevention, treatment, harm reduction and evidence-based strategies.
Review and investigate opportunities to expand naloxone (Narcan) access through city departments and outreach opportunities.
Develop a dashboard to improve opioid related surveillance including fatal and non-fatal overdoses to inform planning, future actions and evaluation.
Development and implementation of a resident survey.
Planning and implementation of community information and feedback forums.
Department Environmental Scan
The Office of Public Health will complete an environmental scan across city departments to determine current practices, policies and procedures in place related to opioids and the opioid abatement strategies. The scan will provide an overview of internal practices, strengths, and opportunities for interventions and practice changes.
Staff Training and Professional Development
The One Arizona abatement strategies includes the following recommendations:
Provision of training and development of procedures for government staff to appropriately interact and provide social and other services to current and recovering opioid users, including reducing stigma; and
To develop and support best practices on addressing OUD in the workplace.
To support this work the Office of Public Health will lead an internal staff assessment to determine awareness, knowledge and attitudes related to opioids and OUD. Based on internal assessment results and working with experts in the field of SUD and OUD, the Office of Public Health will lead the develop comprehensive training and professional development, tailored to staff and departmental needs.
Naloxone Accessibility
Naloxone is a medication that can reverse an opioid overdose including fentanyl. Naloxone works to restore normal breathing in individuals experiencing an overdose. The Office of Public Health is reviewing best practices for the administration and distribution of naloxone within local municipalities and will develop recommendations for the expansion of naloxone access within the City of Phoenix.
Data Collection and Ongoing Surveillance
Office of Public Health is working collectively with Police, Fire, Office of Homeless Solutions and the MCDPH to increase public health surveillance and data collection related to opioids including overdose data, crime related data etc., to inform ongoing and future priorities, enable real time alerts and responses for overdoses, and evaluate short- and long-term strategies to implement as part of the opioid response.
Resident Survey
To compliment the needs assessment led by the MCDPH, the City of Phoenix will administer a resident survey focused on the opioid crisis. The intent of the resident survey will be to assess community awareness of opioid related issues, knowledge and support for opioid abatement strategies and gain community perspectives on key priorities for opioid response. The survey will be available at minimum in English and Spanish.
Community Information and Feedback Forums
Community information and feedback forums will be held in all City Council Districts. The intent of these sessions will be to provide residents an opportunity to engage with experts within each pillar of prevention, harm reduction, treatment and recovery, and community safety and justice. Sessions will also include opportunities for residents to ask questions and provide feedback to the city on the opioid crisis, strategies for abatement and resident priorities.
Information gathered from community forums and the resident survey will be combined with the information gathered through the MCDPH community-wide needs assessment to determine key priorities for the City of Phoenix and inform a local opioid response and action plan.
Financial Impact
The funding associated with this work will come from the Opioid Settlement dollars as part of the One Arizona Agreement. The City received its first installment of funding from the Distributer settlement, in the amount of $2,149,951.10, and the Janssen settlement, in amount of $1,352,346.80. Additional dollars will be received on an annual basis in accordance with the settlements.
Department
Responsible Department
This item is submitted by Assistant City Manager Lori Bays and the Office of Public Health.