Recently published article in the Arizona Journal of Pharmacy, Summer 2024

If We Don’t STOP-IT, Who Will?

?AUTHORS

Holly Geyer, MD, FASAM

Chair, STOP-IT

Addiction Medicine and Hospital Internal Medicine, Physician Lead of the Mayo Clinic Opioid Stewardship Program, Mayo Clinic AZ

Christi Jen, RPh

Clinical Pharmacy Specialist, Administrative Lead of the Mayo Clinic Opioid Stewardship Program, Mayo Clinic AZ

Adena Bernstein, J.D.

Assistant Arizona Attorney General, Fentanyl Coordinator

Mike Kurtenbach,

Co-Chair, STOP-IT

Director of School Safety, Arizona Department of Education (ADE)

?

DISCLOSURE

The author(s) declare no real or potential conflicts or financial interest in any product or service mentioned in the manuscript including grants, equipment, medications, employment, gifts and honorarium.

FUNDING

No funding was provided.

ACKNOWLEDGEMENT

The authors gratefully acknowledge the expertise and services of the STOP-IT initiative members.

Our kids are targets.?

?

With more than half of the seized U.S. fentanyl supply coming straight through Arizona, they sit at the epicenter of a three trillion dollar drug war overtaking America.(1)? To put this in perspective, that value equates to more than 11% of our 2023 U.S. gross domestic product (GDP). This past year, the Drug Enforcement Agency (DEA) seized 42 million fentanyl pills in our state alone-a logarithmic increase from the 28 million pills seized in 2022, and 12 million the year prior.(2) Trafficking is directed largely by the Sinaloa cartel operating in Mexico who coordinate product delivery of the lethal synthetic opioid, fentanyl, towards AZ schools, playgrounds, shopping malls and other youth-attracting venues.(3)?

?

There are three trillion reasons why our kids are enticing accompaniments to this crime scene.? They can be buyers and sellers to a generation of fellow youth seeking acceptance, entertainment and relief from mental health ailments.? What they offer beyond the fentanyl is misperception of safety.? Not only has fentanyl been found lacing virtually every other class of abusable drugs, but it’s frequently pressed into pills that mimic legitimate pharmaceuticals (such as oxycodone, Oxycontin?, Xanax?).(4)? Readily accessible online herbal and weight loss supplements are another novel supply chain and an emerging trend is to add flavors and colors that mimic gas station candy. With 7 out of every 10 pills now being confiscated by the DEA containing enough fentanyl to kill the average American adult (2 mg), escaping cartel entrapments seems a delusive venture.(4)

?

Not convinced? Ask the 75,000 people that lost their lives to synthetic opioids in 2023.(5)? That same year, our state observed more than 1900 opioid-overdose deaths and 4000 non-fatal overdoses.(6)? As for our kids, the Arizona Child Fatality Review Program recorded at least eighty deaths in children due to opioids between 2021 and 2022, and 132 overdose events in 2023.(7)? Nationwide, the data shows we lose a classroom worth of teenagers weekly.(8)

?

Schools offer a convenient opportunity to employ interventions. However, current AZ laws (Ariz. Rev. Stat. § 15-341(A)(43)) fall short of enforcing requirements to ensure educational institutions are equipped with naloxone or that staff are trained to administer it.? Likewise, there are no state or federal requirements for schools to train students on the topics of fentanyl, overdose management, or addiction.? Recognizing the investment needed to create an overdose-prevention and management protocol, a number of AZ schools—including public, private and charter—have elected to defer management of overdoses to emergency responders. With a mere three minutes to save a brain deprived of oxygen, few can afford to wait for an off-campus responder. And with no state requirements for schools to report potential overdoses or administration of naloxone, what little data we have on this topic likely underestimates true prevalence. School education is lacking. And the few private 501(c)3 and government agencies offering in-person student training are no match for the 2000 public schools in need of their curriculum.

?

So, what is the solution? The problem is massive, deeply rooted, and growing.? The epidemic is now endemic and fueling statewide discussions on whether ‘too little too late’ is reversible. All can agree that helping our kids escape the entanglement of opioid use disorder (addiction) and overdoses requires we build solutions as big as the problems. And when it comes to our kids, everything is on the table.

?

The STOP-IT Initiative

Solutions are on the horizon.? Thanks to a collaborative effort between the Arizona Department of Education and a team of medical, behavioral health, government and educational specialists, the state of Arizona is in the process of building a comprehensive intervention to tackle drug awareness and overdose prevention in schools.

?

An initiative titled the?‘School?Training?Overdose?Preparedness and?Intelligence?Taskforce’ (STOP-IT) has been authorized to develop a state-wide, sustainable school opioid overdose education and preparation toolkit for AZ schools (Table 1).? In tandem, the project will include tackling school policies, exploratory school surveys, overdose monitoring/reporting systems and naloxone supply chain plans.? The taskforce is comprised of four subcommittees, each addressing specific issues:

?

1.????? Survey and Overdose Monitoring Subcommittee:?Via a statewide school survey (K-12 and post-secondary), the group will thoroughly assess the current state of school opioid overdose preparedness (including availability of naloxone and training requirements), student and staff education processes, barriers to naloxone procurement and school viewpoints on student risks.? The subcommittee will also address the creation of a statewide school opioid overdose reporting system.? Follow-up surveys are planned following the intervention to measure impact.

?

2.????? Best Practices for Staff/Student Training Subcommittee:? This subcommittee will evaluate currently available curriculum for students and staff on the topics of opioids, opioid use disorder (OUD), opioid overdoses and naloxone usage. The subcommittee aims to develop a training product that meets the needs of diverse learners and learning environments, limits the need for in-person training requirements and is adaptable to changing trends in the drug market. Social influencers will be integrated to help sell important points.

?

3.????? Policy Subcommittee:??This subcommittee will review the current school district policies on opioid overdose management and compare to those developed in other states as well as policies written for other medical disorders.? Their goal is to create standardized school district policy language able to be adapted across the state. The group will also correct gaps in the ‘Emergency Guidelines for Schools’ documents and evaluate the necessity of legislation in these activities.?

?

4.????? Opioid Antagonist Procurement Subcommittee:? This subcommittee will address existing barriers to opioid antagonist procurement and develop long-term supply chain solutions to ensure adequate district, staff and student access.?

?

The STOP-IT initiative is readily underway. Commencing its first subcommittee meetings this past May, the team holds to a robust deadline of December 31st.? STOP-IT meetings are held monthly and are open to the public.? With less than six months left ahead of them, the more than fifty members donating their time and energy to this life-saving project are to be commended.? This undertaking represents the first of its kind in the nation and holds the potential to be reproduced in other states.? With careful attention to ensure each intervention is paired with trackable outcomes, the value of this project will ultimately prove self-evident.

?

It’s time we end the generational impact of the opioid epidemic. Equipped with the right tools and knowledge, our youth can make the wise decisions that will save their lives and release the cartel’s grip on their future.? The STOP-IT initiative is a clear call to action for Arizona communities to work together to solve this crisis.? After all, if we don’t STOP-IT, who will?

?

?

Table 1.

STOP-IT Members

ADE

AHCCCS

Arizona Board of Pharmacy

ASU

Attorney General Office

AZ Counterdrug Task Force

AZDHS

Banner Health

Challenge Charter School

Child Mortality Review Committee

Children First Leadership Academy (CFLA)

Cobre Valley Institute of Technology (CVIT)

Community Medical Services

Crestview Preparatory High School

Dysart Schools

Dysart Schools

Flagstaff Unified School District

Governor's Office of Youth, Faith and Family

HIDTA

Honor Health

Kingman Unified School District

MATForce

Mayo Clinic

Northwest Christian School

Phoenix Childrens Hospital

Phoenix City Manager's Office

Student (Basis)

Student (Chapparal High School)

Terros Health

Tucson Unified School District

University of Arizona

University of Arizona

Yuma Union High School District

REFERENCES

1.????? Cheri Oz. More than half of the fentanyl pills seized by the DEA came through Arizona. Here’s why. KJZZ New Report. June 10th, 2024.? https://www.kjzz.org/news/2024-06-10/more-than-half-the-fentanyl-pills-seized-by-the-dea-came-through-arizona-heres-why

2.????? Year in Review:? DEA innovates to fight fentanyl.? https://www.dea.gov/press-releases/2024/01/18/year-review-dea-innovates-fight-fentanyl.? January 18, 2024.

3.????? ?Justice Department Announces Charges Against Sinaloa’s Cartel’s Global Operations. https://www.justice.gov/opa/pr/justice-department-announces-charges-against-sinaloa-cartel-s-global-operation. April 14, 2023.

4.????? DEA.org. Share One Pill Can Kill Materials. https://www.dea.gov/onepill. Accessed June 22, 2024.

5.????? U.S. Overdose Deaths Decrease in 2023, First Time Since 2018.? https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2024/20240515.htm. May 15, 2024.

6.????? Arizona Department of Health Services. https://www.azdhs.gov/opioid/dashboards/index.php#nonfatal-overdoses. Accessed June 22, 2024.

7.????? Fowler, Merilee. Arizona Child Fatality Review Program. Interviewed December, 2023.

8.????? Friedman, et al. The Overdose Crisis among U.S. Adolescents. N Engl J Med?2024;390:97-100. January 26, 2024.

?