$180K of Narcan will 'blanket' Pima County to stem overdoses from 'ubiquitous' fentanyl

The Pima County Board of Supervisors plans to spend $180,000 from a multi-million dollar settlement with drug manufacturers to purchase and distribute Narcan, "blanketing" the area with the medication that can reverse otherwise fatal opioid overdoses.

The move, approved earlier this month, comes as Pima officials work to reduce overdose deaths as the synthetic opioid fentanyl has become "ubiquitous" here, said they said.

Over the next 18 years, Pima County is set to receive $48.5 million, the result of a settlement that ended a series of lawsuits launched by all 50 state attorneys general against major opioid manufacturer Johnson & Johnson and three pharmaceutical distributors — Amerisource Bergen, Cardinal Health and McKesson.

The three distributors will collectively pay about $21 billion through the next 18 years while Johnson & Johnson will pay up to $5 billion over nine years, with $3.7 billion to be paid during the next three years.

Last September, Pima County received $1.5 million, the first payment from the settlement as part of the One Arizona Plan, a statewide agreement created under former Arizona Attorney General Mark Brnovich that guides distribution of funds.

In a unanimous vote on April 4, the board approved the spending plan, which will provide the county with about 6,000 units of Narcan, the brand name for the overdose medication naloxone.

During a presentation before the vote, Dr. Francisco Garcia, the county's chief medical officer, said that in recent years 50 to 60 percent of overdoses are linked with fentanyl. "What is particularly troubling about fentanyl is the fact that it is so ubiquitous, so affordable, and so readily accessible," he said. "So it has become in many ways the drug of choice for abuse."

In 2017, there were 286 overdose deaths in Pima County, and that rose throughout the next five years until 2021, when the number of overdoses peaked at 497 deaths, according to data from Pima County's Office of the Medical Examiner. In 2022, the number of deaths decreased slightly to 495 deaths, and there have been 103 deaths in 2023—included 66 linked to fentanyl. 

In 2019, fentanyl was linked to 29 percent of fatal overdoses, but by 2022, the synthetic opioid was linked to 61 percent of overdoses in Pima County. 

fentanyl 'priority public health issue'

In a memo the Board of Supervisors, Pima County Administrator Jan Lesher said that the county identified substance abuse as a "priority public health issue" in 2015 as part of the Pima County Community Health Needs Assessment.

"That document and the process that produced it, spurred a series of community conversations and data analyses that sought to describe how this crisis was evolving in Pima County, community treatment resources limitations and priority areas for intervention and investment," she wrote, adding the county has made some progress, especially in treating and supporting pregnant and post-partum women who have opioid addictions.

"The ubiquitous availability of fentanyl in particular and opioids in general are causing very high levels of human suffering and death," Lesher wrote. "It is incumbent upon us to take an all of Pima County approach that engages key partners and stakeholders in developing innovative out of the box solutions to mitigate the human cost of this disease."

In 2017, the county began tracking overdoses, however, public health strategies were mostly aimed at reducing harms associated with pharmaceutical opioids like oxycodone, tramadol, and hydrocodone, she wrote. However, fentanyl has taken hold and helped drive what she called a "relentless upward trend in fatal overdoses" that came to a plateau in 2022  after "three consecutive years of increases."

"However, the overall total on the year remained unacceptably high at 458 and an average of 38.2 deaths per month," Lesher wrote. 

Pima County Health Director Dr. Theresa Cullen said the county is currently disbursing 1,200 to 1,500 doses of Narcan throughout the community, along with fentanyl test strips, which can be used to test other medications for the presence of fentanyl.

Last year, officials with the DEA launched the "one pill can kill" program, warning about fentanyl-laced counterfeit pills. According to an analysis by the DEA, nearly one in six counterfeit pills contain fentanyl, often at lethal doses. This includes counterfeit versions of oxycodone, Percocet, Xanax, and Adderall.

"Every time we are administering Narcan—and while that is saving a life and that is critical—we are creating a need and we have an opportunity to hopefully come up with some interventions that we can use at that time," Cullen said. 

"This is a huge problem," said Cullen. "The Health Department believes we are an important part of the solution, but by ourselves we will be unable to address this," she said, adding that the department is working to set up a "multi-agency collaborative effort" closer to the emergency response the county established for health issues like COVID-19.

"We don't know everything we should be doing. We are working with national experts—some of whom live in the Tucson area—to help inform us," she said. She added the county receives about $450,000 from the state to establish best practices.

"We are using all the resources we have available to us," Cullen said, adding Health Department officials sit on nearly 20 committees in the county and city addressing these issues. "But the numbers themselves speak to the onslaught and devastation that is occurring because of this substance abuse issue."

In March, the CDC said overdoses have risen five-fold over the past two decades, killing 107,622 people in 2021—including 71,238 due to illegal fentanyl.

While fentanyl is regularly used as a powerful painkiller in clinical settings, illegal forms of the drug have killed thousands and the drug has been at the center of state and Congressional efforts, including bills designed to crackdown on the drug's production and punish dealers for deaths linked to illegal heroin.

During his presentation, Garcia noted overdoses rose from in 2019 through 2021. Since 2019, the county has spent $4.2 million, launching a series of new measures— including Narcan distribution, opioid surveillance, and additional public health managers—to mitigate overdoses.

The county has received just over $1.3 million in federal and state grants to address opioid addiction and overdoses, including nearly $375,000 from the CDC for its Overdose Data 2 Action program. During the meeting, Cullen told the board the county is also applying for additional for grant funding under the OD2A program.

Lesher noted that the county has made some headway on overdoses, writing that in 2022 the number of teenage overdose deaths declined by more than two-thirds, or 66.67 percent. Further, deaths linked to heroin dropped to an all-time low of 18 deaths in 2022, a 42 percent reduction from the previous year.

Garcia linked to decrease in some overdose deaths to increased distribution of Narcan, and the county's effort to "blanket the community with this life-saving intervention."

"Narcan nasal spray and fentanyl testing are both important tools for preventing and reversing an opioid overdose," wrote Garcia in the memo. "Making these resources accessible and affordable to members of the public is a critical strategy in our efforts to combat Pima County’s ongoing drug overdose crisis."

Using funds for Narcan a 'no brainer'

Mark Person, program manager with the county's Community Mental Health and Addiction department, said the county has become the central distribution point for Narcan since 2019. He noted that since that time, the program has changed significantly as the county has "strategically pivoted resources" to respond to changing addiction patterns. In 2019, fentanyl was not as prominent, and the agency relied on direct encounters with people who might need Narcan. However, fentanyl has "spiked" that demand,  and now the county distributes at least 1,200 kits—each containing two doses—every month.

This program does not cover law enforcement officers, medics, and hospitals who receive their own Narcan kits through a state program. Instead, the county has shifted to community-wide distribution, giving the kits to community groups, as well as businesses such as convenience stores. Currently, there are 164 partner organizations  working with the county, he said.

"We're trying to partner with as many businesses as we can," Person said. While the majority of overdoses happen in private homes, places with public restrooms and lots of foot traffic are good sites for Narcan distribution, he said.

"Unfortunately, the reality is, some of these business have experienced an overdose," he said.

In the program's first year, the county distributed 2,460 doses of Narcan, Person said. During the program's fourth year in 2022, the county distributed 12,593 doses. Each kit costs about $29, and there are two doses in each kit, Person said.

At the end of March, the FDA approved Narcan for over-the-counter sale without a prescription at more than 60,000 pharmacies, widening access to the drug to counter overdoses.

The county will also look for trends, looking to understand how to funnel more resources to communities that have more fatal overdoses, he said.

"We use that data to divert those resources," he said.

"This is  a good reason to use these settlement funds, we often see the demand exceeded our ability to respond," he said, adding the new allocation will be used to bulk the county's supply. "With narcan being the only life-saving tool, this is a no-brainer," he said. 

"We're a zero-barrier resource, we want to distribute to anyone, and we don't pick and choose," he said. "But we're prioritizing with people who work with individuals or families who struggle with opiates—prescription or illicit."

"We'd love to get a kit in the hand of everyone so we can to fight this epidemic," Person said.