Pima County is on target to strike another record for opioid-related deaths, and no region is immune — including the Interstate 19 communities of Sahuarita, Green Valley and Amado in northern Santa Cruz County.
If deaths continue on pace with this year’s trajectory, it’s “highly likely” Pima County will set another all-time high since numbers began rising three years ago, said Mark Persons, manager of Pima County’s Community Mental Health and Addiction Program.
So far, 333 deaths have been recorded this year through Sept. 30, eight in the Sahuarita/Green Valley area. He fears the 2021 toll could reach 550.
Until three years ago, annual countywide numbers were in the 250-275 range, before spiking to 337 in 2019, then to 446 in 2020, Persons said.
Eight overdose deaths were recorded along the I-19 corridor south of the Tohono O’odham Nation’s San Xavier District — three in the Sahuarita area; two east of Sahuarita near Corona de Tucson; two in Green Valley; and one near Amado — from January through June, according to the county’s monthly surveillance reports.
Just south in Santa Cruz County (population 47,670), there were seven documented cases in which Narcan (used to block opioid effects) was used on apparent overdoses, said Commander Gerardo Castillo of the Santa Cruz County Sheriff’s Office. In 2020’s January-September time frame, it was used on 11 calls.
“We’ve been successful in (saving lives) in all but one case, who was DOA,” Castillo said. Sheriff’s personnel have been trained for more than two years on Narcan use. General overdose-death statistics from that county weren’t readily available.
South and central Tucson has the largest concentration of fatalaties, as has been typical, with more than 100 deaths within the same time period. The county’s overall population is roughly 1 million; Sahuarita and Green Valley’s combined total, about 56,300, per the 2020 census.
In the last few weeks, Sahuarita police have administered Narcan at on-scene calls seven times, and has also had fentanyl-related deaths among the younger and middle-age groups, SPD Chief John Noland said. Narcan has been standard department issue for about two years.
It’s unknown if any of the deaths are intentional, but according to a 2019 Salt Lake Tribune report, 90 percent of all opioid deaths in the United States are accidental, analysis suggests. That number jibes with findings Pima County has cited.
“Our officers are running into people using/abusing drugs, and making arrests for using, possession of paraphernalia and sales,” fentanyl included, Noland said.
Rural/Metro Fire, which covers portions of Sahuarita, did not respond to requests for information.
Green Valley appears to have experienced fewer deaths, according to the Green Valley Fire District, whose response crews have been carrying naloxone (Narcan generic) for “possibly decades,” as far as anyone recalls.
While the district doesn’t track instances where lives have been saved through its use, it isn’t called for on many emergency runs, nor is supply-demand rising, Operations Chief Joey Kosiorowski said. Starting in June 2017, when reporting mandate began, GVFD has reported 14 uses of naloxone, some administered per protocol where a patient is down of unknown circumstances.
“Give or take 50,000 calls in five years, that is like 0.028 percent of our calls,” Kosiorowski said.
Nationally, “it used to be that 26 percent of the fentanyl (being trafficked) contained a possibly lethal dose,” said DEA spokeswoman Jodie Underwood of the agency’s Phoenix Division, which released a nationwide public safety alert Sept. 27. “Now it’s 42 percent.”
“Blues” — a popular reference to illicit versions made to resemble the real thing – originate largely in Mexico and are often mixed with cocaine and/or meth in varying formulas, Persons said. “You can die of a fraction of one of those pills. They are completely unpredictable as to content.”
The short answer: shifting origins and content of illicit opioid varieties, particularly fentanyl.
Persons attributes the recent influx of non-pharmaceutically produced opiates and methamphetamine accounting for 80 percent of all overdose deaths. Noland characterizes them as those manufactured in garages, tents and often sold through black-market trade routes — here, mostly from Mexico. Ingredients may come from China.
Castillo in Santa Cruz County said he believes the uptick is partly due to COVID last year, when aid calls included a bit of everything. People were more isolated, and those who’d gotten through rehab might have been doing things they were doing prior to COVID closures.
“If they used to do two-tenths of a gram before, then get clean, then realized when they went back to the same amount (with the higher concentrations), it might be too much,” he said.
SPD gets ongoing supply of Narcan and periodic refresher training in its use, for free through programs that help stock law-enforcement agencies, Noland said. The department also receives help through federal funds earmarked for border security.
Over the years, Operation Stonegarden grants have supplied hundreds of thousands of dollars for staff overtime, mileage and equipment and promote cooperation between local and federal agencies tasked with securing international borders, he said.
“We’ve received funds every year as an enforcement multiplier to address trafficking of products and people (and I’m) extremely glad the Town Council understands the importance of this.”
Without those and funds from the Governor’s Office on Highway Safety to combat impaired driving, “we’d be hurting and would have to figure out how to address that with current staffing and budget.”
After accepting Operation Stonegarden grant money for 12 years, Pima County is now rejecting the funds because it cannot be used for humanitarian aid. The Tucson Police Department also has rejected the grant.
In addition to illegal pills being a concern, officers are also on the lookout for marijuana, which carries a much higher THC concentration and psychologically impairs to a much greater degree than even five years ago, Noland said, noting that both it and synthetic opioids laced with other drugs are geared for the younger market.
According to Pima County statistics, “We still do see deaths due to prescription painkillers but it’s a small percentage,” Persons said. “Most are accidental; some are knowing they’re illicit (varieties); some are from getting their medications mixed up.”
Young people die
The highest-priority concern is rising opioid overdose deaths among those ages 19 and under, the largest group affected, due to fentanyl, Persons said. It’s commonly prescribed to treat pain and with other medications for anesthesia, and highly addictive. By recent census statistics, 26.6 percent of Sahuarita’s population fall in that age category.
Among that 19-and-under age group in Pima County, ingesting fentanyl is the leading cause of death, exceeding car crashes, firearm-related incidents or any natural means, Persons said.
Fentanyl is so toxic that first-responders are now equipped with protective gear – gloves, painters-type masks and more – when searching arrestees, handling suspected product as evidence and getting it to a lab for analysis, Noland said.
They use body cameras but even getting a whiff of concentrated toxin, ingredients of which vary, within two feet, “they can go code blue,” signaling life-threatening emergency, he said.
The biggest driving factor is that illicit opioid-based products are readily available, easy to smuggle and cheap, Persons said. They run $2 to $5 per pill; dealers are contacted via social media, which can create a roadblock if privacy walls are used, but may also provide law enforcement some ability to find them.
Drug-dealing has evolved a lot, said Underwood of the DEA.
“We don’t have time or resources because of the way (officials) collect data, by state. Transactions use emojis and code-words and are done in private chat rooms, and even if we were to see them, we wouldn’t recognize them. An emoji with popcorn might be code.”
Until about three years ago, their biggest threat involving opioids came from within the United States, where allegedly phony prescriptions were being filled by unquestioning pharmacists at catastrophic rates, sending overdose death and addiction numbers soaring. Related legal claims against drug makers and distributors have either already been settled for in some cases, billions of dollars, or are wending their way through courts.
Migrant activity to Arizona likely isn’t helping the trafficking, Noland said.
“I would have to be extremely naïve to believe criminals don’t see that migrants crossing the border right now aren’t a prime opportunity to move these,” he said. “A lot of these people have been waiting for a month in Mexico. Smugglers know there’s money in transporting from point A to point B, and I think there are people taking advantage of the detaining.”
“A sad point in this is that we’re trying to address use and abuse, and some folks are only willing to do prevention and treatment,” Noland said, basing his opinion on 38 years in police work. “Right now, we’re having an extremely difficult time having prosecutors try cases.”
“When you tell people (illegal substance) possession is no longer a crime, that we’re only going to treat it by sending you to services, it sends a message that ‘I can do this, there’s no repercussion.’
“There’s a difference between four grams and four ounces of meth in your pockets. Four grams is personal use; four ounces, you’re going to sell it. The vast majority are treated as possession cases” instead of dealing or trafficking. “I’d prefer that prosecutors were at least prosecuting those in possession of ounces of methamphetamine, heroine, fentanyl and other dangerous drugs for at least possession of a dangerous drug.”
In June 2017, Gov. Doug Ducey declared an opioid state of emergency, granting the state ability to coordinate public health efforts, partner with private providers and employ all public health resources to prevent overdose deaths. That year, Arizona saw 790 deaths from opioid overdoses, following an increase of 74 percent over the previous four years.
Numbers didn’t budge much in 2018, ticked up in 2019, then came COVID.
The opioid dashboard is still out there, numbers are just worse, Persons said.
“It’s the nature of the epidemic. Before, we were talking about pharmaceutical opioids. Those are now a minor factor.
“This is where the cartels come in, seeing that, ‘If the U.S. isn’t going to produce pills, we’re getting into the action.’ The pandemic is why (emphasis) fell by the wayside.”
He isn’t surprised parents are talking about safety in schools — there hasn’t been a child death from COVID but there has with fentanyl, he said.
The health department’s message: opioids transcend every demographic, toddlers to seniors. We all must be vigilant.
“Sometimes they’re accessible in the house, but because of how lethal and common these are, we’re telling anybody if you have a school-age child, to be aware this is incredibly lethal, even for those without a lengthy drug-taking history, as well as addicts and those arrested.”
Also at risk are first-time users and party-goers in communities where you don’t see it as much, he said. “Fentanyl can be in anything — think of it like a contaminant — and 100 times the strength of heroin.”
To stem the tide, the county applies for three different grants yearly, fostering work with prevention services, educational campaigns, full-time health workers working with families and schools.
“Throughout the pandemic, all that stuff was sidelined,” Persons said. “Now that school’s back, where we need to expand and prioritize is the need address the access.”