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More than two Arizonans died every day on average from opioid overdoses in 2016, according to a new Arizona Department of Health Services report.
A total of 790 Arizonans died from overdoses of opioid prescription medications and heroin last year, a 74 percent surge since 2012. And state health officials cautioned that last year's death toll might be higher because of a lag in reporting these deaths.
The opioid epidemic has prompted a state and national public-health response with measures to raise awareness about the dangers of overprescribing pain pills and to make the overdose-rescue medication naloxone more widely available.
However, public-health officials said the growth in overdose deaths is a troubling sign that opioid abuse continues to cut down older teens and young and middle-age adults in alarming numbers, and creates an economic burden on families and the health-care system.
"It certainly is discouraging to see that our number continues to trend up, given all the work we are putting into trying to curb the opioid epidemic," said Dr. Cara Christ, director of ADHS.
The report showed that heroin deaths have tripled since 2012, a much faster growth rate than overdose deaths from prescription pain pills such as oxycodone and Vicodin. That could be a sign that some people addicted to pain medications are seeking other sources of relief for their dependency as doctors limit prescribing opioids for chronic pain, officials said.
Heroin accounted for 39 percent of all opioid deaths last year, up from 11 percent in 2007.
Arizona adults aged 45 to 54 had the highest overdose rates at 18.1 deaths per 100,000 people.  The death rates were slightly lower for young adults.
Although the report did not break down types of death by age, Christ said that data suggests that heroin death rates are higher among teens and young adults and prescription-pill overdoses are higher among middle-aged Arizonans.
A possible explanation, Christ said, is that middle-aged adults may have more chronic diseases that require multiple medications that could create harmful interactions.
An example: Mixing benzodiazopenes such as Valium or Xanax with pain pills such as oxycodone or Vicodin can be fatal.
"That significantly increases your risk of death," Christ said. "You may not be aware of that if you have two different prescribers."
Hospital doctors also have noticed more young adults seeking emergency care for drugs that are purchased on the street.
In March, the federal Drug Enforcement Administration said it traced 32 overdose deaths since 2015 to black-market drugs that were laced with the powerful synthetic opiate fentanyl.
Doctors say oftentimes patients believe they are buying oxycodone only to find out the drug was much more powerful and dangerous.
"They come in and they are really sick," said Dr, Michelle Ruha, a medical toxicologist with Banner Poison and Drug Information Center. "Some say they thought they were taking oxycodone, but in fact it was much stronger."
The ADHS report said there were more than 51,000 "opioid-related encounters" at hospitals in 2016, more than double the comparable number of visits in 2010. The report said those encounters cost the health-care system more than $341 million in 2015. No figure was available for 2016.
Arizona takes steps against epidemic
Gov. Doug Ducey's administration has taken several steps seeking to curb the opioid epidemic in Arizona, including limiting initial prescriptions to seven days for adults insured by Medicaid or the state's insurance plan. Ducey also signed legislation allowing pharmacies to dispense the overdose-reversal drug naloxone without a prescription.
Arizona also has passed legislation requiring a board to investigate every drug-overdose death. The legislation aims to mimic a similar review board for child fatalities.
Both Christ and Ruha said doctors and other prescribers have greater awareness about problems from inappropriately prescribed opioids.
Last year, the federal Centers for Disease Control and Prevention issued sweeping guidelines that recommended doctors limit opioid prescriptions for acute pain to a three-day supply. Doctors rarely needed to prescribe a supply of more than seven days, the guidelines said.
But those guidelines can create testy discussions between a doctor and a patient who has long depended on opioids to manage pain.
Public-health officials recognize that can be challenging for doctors and patients.
"You can't just cut off those who are on opioid therapy for chronic pain," said Christ, who said doctors and non-cancer patients must work together to prescribe lower dosages of opioids and identify other alternatives to manage pain.
Christ added that families and friends of a person grappling with prescription-opioid or heroin addiction should purchase and keep the naloxone in the event of an overdose.
Ruha added that people who are addicted to pain medication need the support to wean themselves off opioids with treatment programs that may include medication and behavioral-health therapy.
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