Will Humble Opioids, Professional Development, Wills Blog

Register Today for AZPHA’s 2024 Conference: Addressing Arizona’s Opioid Crisis

AzPHA Annual Conference

Addressing Arizona’s Opioid Crisis

Desert Willow Conference Center

4340 E Cotton Center Blvd, Phoenix, AZ 85040

Thursday, February 29, 2024 (Leap Day)
8:30am – 4:30pm
View Our Conference Agenda*

*Subject to invitation acceptance by presenters

Sponsorship Opportunities

Register Here!

Conference Topics Subject to Final Speaker Confirmation
  • Opening Remarks by Arizona Attorney General Kris Mayes (confirmed)
  • Closing General Session: AHCCCS Policy, Programs and Resources Targeting the Opioid Epidemic; Increasing Service, Support and Cross-sector Engagement  –Catherine Dobler, Polly Knape, et.al. AHCCCS
  • Rates & Trends of Opioid/Fentanyl Overdose Deaths in Arizona, 2003-2023: Implications for Public Health Policy – Allan Williams, PhD & Will Humble, AZPHA
  • Statewide overdose surveillance: strategies from the overdose data to action program at the ADHS – Martín Celaya, MPH , ADHS & Charles Katz, PhD – Arizona State University
  • Findings from a Mixed-Methods Needs Assessment of People Who Use Drugs — Maricopa County, AZ, April–June 2023 – Christina Mrukowicz – Maricopa County Department of Public Health
  • Risks from opioid use during extreme heat-  Marisa Domino – ASU, Center for Health Information and Research
  • Collaborative problem solving in rural communities to address the opioid crisis – Rocio Torres – Arizona Center for Rural Health & Christy Crowley – Easter Seals
  • Collaborative efforts in rural consortium of SUD/OUD partners to support youth and young adults along the US-Mexico border – Yara Castro & Tsion Meles Mariposa Community Health Center
  • Perceptions of overdose risks among persons who use illicitly manufactured fentanyl in Phoenix, Arizona – Raminta Daniulaityte & Kaylin Sweeney – ASU College Health Solutions
  • From Stigma, to Hope, to Healing: Maricopa SHIFT: Safe, Healthy Infants and Families Thrive Clay Jones, M.Ed., IMH-E Maricopa County Department of Public Health
  • A Citywide Approach to Opioid Response Planning – Nicole Witt, MPH & Yanitza Soto – City of Phoenix Public Health Advisor Office of Public Health
  • A Tale of Two Cities: An Overview of Opioid Use Prevention Initiatives in Phoenix, AZ and Kansas City, KS – Jeffery Hanna, MPH, MSc & –Justin Zeien, MD, MPH  Zeihan Prohealth Consulting, LLC
  • Evidence to Action: Reducing Opioid Overdoses in Arizona through Medical and Pharmacy Practice Change- Beth Meyerson – Harm Reduction Research Lab, UArizona College of Medicine-Tucson
  • Expanding MOUD Prescribers: How the Arizona State University Edson College of Nursing is addressing the Opioid epidemic – Ann Guthery PhD, PMHNP-BC & Matthew Martin– ASU
  • The Yavapai County Connection Center: Serving recently incarcerated individuals, addressing the challenges of housing-employment-food insecurity, mental health needs, and substance abuse. James Tobin & Beya Thayer – Yavapai Community Health Services
  • MCDPH Fellowship: Catalyst for Change in Maricopa County’s Correctional Health Services- Tori Osmundson Maricopa County Department of Public Health & Megan Baker – Maricopa County Correctional Health Services
  • Access to treatment for incarcerated individuals experiencing opioid withdrawal in the Maricopa County, Arizona Jail System – Matthew Martin, PhD &Swetha Gansan, MS- ASU College of Health Solutions
  • Using Overdose Data to Transform Care: What Data Matters- Amanda Sapp – Pima County Health Department
  • Data to Action: Opioid Surveillance, Fatality Review, and Prevention Measures in State Public Health – Ginger Dixon & Mercedeh Reamer, MPH – ADHS
  • From Overdose to Treatment & Recovery – Andy Sparks Director of Commercial Development at Integrative Strategies: Combining Medicine, Peer Support, and Care for Opioid Recovery – Riley Monahan & Barbara Lee – Crossroads
  • Beyond Free Narcan. A Proposal for Meaningful Legislative Changes to Combat the Opioid Crisis – Hon. Gary E. Donahoe Judge of the Arizona Superior Court (ret.) & Jahanzeb Ali Khan, MD – Crossroads
  • Perinatal Harm Reduction – Danielle Treiber Sonoran Prevention Works
  • The Impact of Opioids on Maternal and Child Health and Strategies to Improve Outcomes in Arizona – Aubrianna Perez & Morgan Anderson – ADHS
  • Public Health & Libraries Harm Reduction Partnership – Mark Person & –Kate DeMeester-Lane – Pima County Health Department
  • Turning the Page on Opioids: Libraries as Community Partners – Dana Abbey Network of the National Library of Medicine, Engagement Specialist
  • Saving Lives: Strategies and Successes of the City of Phoenix Naloxone Program – Yanitza Soto, MPH City of Phoenix Special Project Administrator Office of Public Health & Dominic Orso, MBA – Maricopa County Public Health
  • Naloxone Leave Behind in Arizona – Julia Vinton & Adam Rodriguez– ADHS
Will Humble Social Determinants, Wills Blog

ADHS Awards First Round of Justice Reinvestment Grants to Arizona Nonprofits

The Arizona Department of Health Services (ADHS) was charged with creating the Justice Reinvestment Program through the passage of Prop 207 (retail marijuana) in November 2020. The proposition legalized recreational marijuana use for adults 21 and older as well as created initiatives to increase safety and community resilience around arrest and incarceration, including the Justice Reinvestment Program.

The Office started by completing a statewide data and funding landscape analysis to decide which local communities were most impacted by drug enforcement, arrest, and incarceration. The analysis found priority communities across the state, where 18 listening sessions were held. Listening session participants expressed the following services would be beneficial for their communities:  

  • Neighborhood safety and community gathering infrastructure (such as parks, community centers, etc.)
  • Cultural awareness training
  • Accessible options for healthy food
  • Affordable and accessible housing 
  • Stigma reduction and culturally proper health services
  • Technology re-training for people who have been formerly incarcerated
  • Positive youth development 
  • Substance use education and prevention

The Office of Health Equity then released a competitive grant application open to qualified Arizona nonprofits to support Justice Reinvestment programming this year.

The awarded projects address all of the key focus areas outlined in the statute and in the community listening sessions and represent communities from across the state of Arizona. ADHS is proud to announce the following grant awardees:

  • Northland Family Help Center
  • Hushabye Nursery
  • Axiom Community of Recovery
  • Cihuapactli Collective
  • Stuck Community Acupuncture, Inc
  • Phoenix Indian Center
  • Arouet Foundation
  • Friendly House
  • Jobs for Arizona’s Graduates (JAG)
  • Persevere
  • Constructing Circles of Peace
  • Regional Center for Border Health, Inc. – Yuma
  • Regional Center for Border Health, Inc. – Parker
  • Arizona Democracy Resource Center 
  • Southern Arizona Legal Aid, Inc.
  • The Bambi Fund 
  • Just Communities Arizona
  • Our Sister Our Brother

Additional Justice Reinvestment funding will be made available in the near future. Earlier and new applicants are encouraged to apply. Visit the ADHS Office of Health Equity’s Justice Reinvestment Program page for updates.

Will Humble State Legislature, Wills Blog

Legislative Session Kicks Off Today with the Governor’s State of the State Address

Monday marks the beginning of the 2024 legislative session. Governor Hobbs will give her State of the State address in the House at 2pm on Monday. You can attend the speech live from the top floor of the House (take the stairs/elevator to the top floor and go to the Gallery’.

It’s usually pretty packed so your best bet is to watch it on Capitol TV. Several media outlets will no doubt be covering it live as well.

I expect the Governor to talk about statutory changes and resources needed to improve the performance of ADHS’ Licensing Division, who is responsible for assuring the health and safety of Arizonans residing in assisted living and skilled nursing facilities as well as medical facilities, clinics, residential group homes, sober living homes etc.

Look for proposals to:

  • Hike the limit the ADHS can assess against facilities for noncompliance. Right now only fine facilities $500 for each violation.
  • Give ADHS additional authority to revoke licenses for cause.
  • Close some loopholes like the law that allows assisted living facilities to skip annual inspection if they have a clean inspection the year prior. She may even propose eliminating ‘deemed status’ licenses, although I doubt it. 
  • Appropriations to hire more licensure staff.
  • Create a quality rating system for nursing homes, assisted living and long-term care facilities.

Editorial Note: When you hear these proposals take note that they are a DIRECT result of the series by reporters Caitlin McGlade, Sahana Jayaraman and Melina Walling focusing unaddressed senior living violence and sexually assaults and a piece about how senior living facilities are often understaffed, endangering workers and residents. 

It’s possible the governor may mention mental health care as well given the solid series of stories via Stephanie Innes about AZ’s behavioral health system – especially the Arizona State Hospital: Arizona is in a mental health crisis. Here’s what needs to improve.

About 200 bills have already been filed in the House, but only about 40 in the Senate so far. Those numbers will go up into the several hundred range in the coming days as legislators file their bills. You can find the inventory of bills in both chambers on the AZLEG website here: Introduced Bills.

So far we’re tracking about 12 of the pre-filed bills. That will dramatically increase in the coming days.

Bill # Description
HB2042 food preparation; sale; cottage food
HB2081 cremation.
HB2111 licensed facilities; transfer; sale; prohibition
HB2112 insurance coverage; hearing aids; children
HB2130 counties; maximum acreage; energy production
HB2137 infants; toddlers; developmental delays
SB1002 drug paraphernalia; testing; analyzing; repeal
SB1002 drug paraphernalia; testing; analyzing; repeal
SB1003 prohibition; photo radar
SB1024 spina bifida, developmental disabilities
SB1028 medical assistance; drugs; prohibited arrest
SB1037 AHCCCS, comprehensive dental

The days and times for the House and Senate Health & Human Services committees aren’t posted yet – but by this time next week you’ll be able to calendar those events.

Our Public Health Policy Committee has a discussion board on Basecamp and that’s also where we post information, research and documents related to public health policy.  Let me know if you’d like to sign up for that Basecamp site at [email protected].

Our policy committee also has conference calls every other Friday at 2pm starting in mid January. Details are in our policy committee basecamp (email me at [email protected] to get access to the members policy committee Basecamp).

Arizona Legislative Session Begins Monday, January 8: Here’s Our Advocacy Approach

Let Legislators Know What You Think: Here’s How

Learn How the Arizona State Legislature Works by Listening to this Consumable Podcast

Will Humble Reproductive Health, Wills Blog

2022 Was Tumultuous for Access to Abortion in Arizona: New Report Provides Surveillance Detail

2022 was a tumultuous year for access to abortion care in Arizona. The chaos began when the US Supreme Court overturned the 1972 Roe v Wade ruling that had guaranteed the legal right to abortion care up to viability on June 24. Shortly after the Roe ruling, then AZ Attorney General Mark Brnovich filed a motion in Pima County Superior Court to make abortion illegal in AZ.

Nearly immediately, most abortion providers in Arizona stopped providing the procedure in late June and July. An abortion surveillance report published earlier this month shows the immediate impact of the Roe decision, with abortions going from about 1,200 in June to only 216 in July, as clinics and providers waited to find out exactly what was legal.

Arizona Supreme Court to Decide the Fate of Abortion Care in AZ: Oral Arguments December 12, 2023

Prior to Roe being overturned, the AZ Legislature passed and then Governor Ducey signed a law banning abortions after 15 weeks of gestation “absent a medical emergency” with no exceptions for rape or incest. While that law passed before Roe was overturned, it didn’t take effect until September 23, 2022, so between June 24 and September 23, the main law on the books, from Arizona’s territorial era, stated that all abortions are illegal to perform “unless it is necessary to save her life”.

Originally called ARS 13-211, 13-212, and 13-213, those 1901 anti-abortion laws were later renumbered 13-3603, 13-3604, and 13-3605. Statute 13-211 made it illegal for anyone to provide an abortion. Statute 13-212 made it illegal for any pregnant woman to solicit or receive any procedure that caused an abortion. Statute 13-213 made it illegal to advertise contraception or abortion services.

Almost immediately after the 15-week law took effect Pima County Superior Court Judge Kellie Johnson sided with Brnovich and reinstated the 19th-century law. The state appellate court quickly put the law on hold pending the outcome of Planned Parenthood Arizona’s appeal of Johnson’s decision.

Abortion care somewhat resumed by August. For the rest of 2022 abortion services were still limited as reflected in the new surveillance report, An average of 640 abortions were performed per month between August & December 2022 vs. an average of 1,300/month before Roe was overturned.

While abortions were down 18% in 2022 vs. 2021, the number of births was mostly unchanged between 2020, 2021 and 2022 (76,781, 77,857 & 78,355 respectively). This suggests many Arizona residents sought abortion care in neighboring states like CA, NV, CO, or NM

Abortion Report in Arizona – 2022
Report snapshots:
  • The vast majority of abortions were performed prior to 15 weeks’ gestation (96%)
  • Half of all abortions were medication and half used surgical procedures
  • There are several graphs in the report with data for marital and educational status, age distributions, race and ethnicity, pregnancy history, geography, maternal medical conditions cited for obtaining an abortion, and doctor’s field of specialty
View the Full Report

If you’d like to sign the petition to guarantee access to abortion care, visit the Arizona for Abortion Access website.  Follow the link under the volunteer section to “Mobilize” and look for opportunities to sign the petition or volunteer to collect signatures (which requires training).

Will Humble Medicaid, Wills Blog

ASTHO Update: Strengthening the Role of Public Health Agency Officials in the Health Safety Net System

ASTHO and the Center for Health Care Strategies interviewed or surveyed staff from public health and Medicaid agencies in Arkansas, Massachusetts, North Carolina, and Oregon to understand the ways in which the two agencies collaborate to deliver clinical services and shape and implement policies in the healthcare safety net system. You can view how those states included public health principles into their contracts with Medicaid managed care providers to improve health outcomes in their states.

Massachusetts opts to use CHIP administrative funding to help support its Health Services Initiatives (HSIs). To implement the HSIs, the Centers for Medicare & Medicaid Services (CMS) allows states to use up to 10% of their total CHIP spending for activities designed to protect public health, including public health programs and certain preventive services, including clinical and supportive services, for children in CHIP and other low-income children otherwise ineligible for CHIP.

Leveraging Partnerships Between Public Health and Medicaid to Strengthen the Healthcare Safety Net

Will Humble Public Health, State Legislature, Wills Blog

Learn How the Arizona State Legislature Works by Listening to this Consumable Podcast

The Arizona State Legislature will convene on Monday, January 8, 2024. Many legislators will hit the ground running with bills that they already have in the hopper. See the bills that have been pre-filed so far

That means we need to be ready to fight for good bills, fight against bad bills, and be prepared to advocate for adjustments for bills somewhere in the middle right out of the box.

You can prepare your advocacy chops before the legislative session starts by listening to the Arizona Common Ground podcast, an eight-episode educational podcast series that gives a behind the scenes glimpse of the state legislative system and learn how bills can become laws. The Consumable Podcast Series is Available as:

ARIZONA COMMON GROUND on Apple Podcasts

ARIZONA COMMON GROUND | Podcast on Spotify

Krista Romero-Cardenas, MPH, a former senior instructional specialist for the Western Region Public Health Training Center and alumna of the Mel and Enid Zuckerman College of Public Health is the creator and host of the Arizona Common Ground podcast – an eight-episode educational podcast series that will take you through the process of how bills are passed in Arizona.

This is a must-listen to podcast for anybody interested in learning how the Arizona State Legislature makes the sausage!

ARIZONA COMMON GROUND

By AzPHA Member Krista R. Cardenas, MPH & former AZPHA Intern

The podcast series is available as ARIZONA COMMON GROUND on Apple Podcasts

ARIZONA COMMON GROUND | Podcast on Spotify

Will Humble Public Health, State Legislature, Wills Blog

Let Legislators Know What You Think: Here’s How

The Arizona State Legislature uses the ‘Request to Speak’ (RTS) system facilitate tracking of bills proposed and allowing the public to register an opinion on bills and to request to speak on a bill in a committee.

It replaces the old slips of paper used back in the day and lets committee chairperson know you want to speak to the committee. Under the old paper system, you could only sign in to speak or register an opinion if you were physically at the capitol.

Tutorial: Using the Request to Speak Program

After the initial setup at a kiosk located in the House or Senate, the RTS program allows you to participate from your home or office. When the committee is in session, the committee members and the public will see a list of names of people who have registered an opinion.

It also shows whether you want to speak or not, who you represent. You can also leave more detailed comments or links to resources in comment boxes. This information is also available if a person searches past committee agendas. Legislators, journalists and the public will see your bill position throughout the process.

A catch is that you’re required to come to the capitol the first time you use the RTS system. When you come to the Capitol, you create an account and sign in on one of the Kiosks in either the House or Senate.

If you create an account at home, you’ll only be able to use the Bill Status Inquiry application to track activity on a bill, not register an opinion or create a request to speak until you come to the capitol and sign in on one of the Kiosks here.

Here’s a tutorial summarizing how to get set up and use Arizona’s RTS system: Using the Request to Speak Program

Using RTS has a bit of a learning curve, but if I can become proficient at using it- anybody can!

Will Humble State Legislature, Wills Blog

Arizona Legislative Session Begins Monday, January 8: Here’s Our Advocacy Approach

January 8 This week marks the beginning of the 2024 legislative session. The kickoff will be the Governor’s address to the legislature where she’ll outline what she sees as priorities.

Our Advocacy Approach

AzPHA will follow the session closely and express our support or opposition to bills based on a simple core principle…  we support bills that will have a positive impact on public health especially when they are evidence-based or evidence-informed.  We will oppose bills that are likely to have a negative impact on public health. 

Our support or opposition to bills is located on the https://www.azleg.gov/ site under RTS Current Bill Positions. We have a host of Resolutions that also guide our advocacy which are posted on our website.

The fact that we have Resolutions on so many core public health priorities make it easy for us to be swift with our support or opposition. Our Resolutions go all the way back to the 1930s. They are initiated by either the Board or our members and all resolutions have been voted on and approved by our members.

Our Public Health Policy Committee has a discussion board on Basecamp and that’s also where we post information, research and documents related to public health policy.  Let me know if you’d like to sign up for that Basecamp site at [email protected].

Our policy committee also has conference calls every other Friday at 2pm starting in mid January. Details are in our policy committee basecamp (email me at [email protected] to get access to the members policy committee Basecamp).

Will Humble Firearm Safety, Injury Prevention, Wills Blog

Straw Purchase of Firearms in Arizona is a Huge Problem, and the Interventions Are Low-hanging Fruit

  • Guest blog by Mike Humphrey, Pima County Board of Health

Firearm-related violence is a public health and safety threat to all Pima County residents.  According to the Pima County Health Department, in 2022, 226 persons died as a result of firearm violence in Pima County. Thus far in 2023, 146 have perished.

AzPHA Report: Firearm Violence in Arizona: Data to Support Prevention Policies

Firearm-related violence represents a staggering human and economic cost locally. In 2022, there were 533 hospital and emergency visits costing $33,107,484. 70% of these costs were covered by public funds. 

In 2010, the Centers for Disease Control estimated that medical and work loss costs for firearm-related violence in Arizona averaged over $1 million per victim.  Other significant firearm-related violence costs that are not accounted for in this estimate include:  emergency response, law enforcement, criminal justice, incarceration, and quality of life. 

Straw purchasers – those persons who illegally sell or transfer a firearm – are a major source of firearms to prohibited possessors – those individuals who cannot legally own a firearm. Prohibited possessors commit a significant percentage of firearm-related crimes in Pima County, according to the Pima County Attorney’s Office.

The criminal use of firearms contributes to high numbers of deaths and/or injuries, constituting a public health crisis on both sides of the international border. 

Arizona Revised Statutes 13-3102 A (5) specifically prohibits the selling or transfer of a firearm to a prohibited possessor – also known as a straw purchase or gift. This state statute gives local law enforcement not only the authority, but the responsibility to enforce this law.

While the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF&E) is responsible for enforcing federal straw purchase laws, this agency has been without a permanent director until recently and has been grossly underfunded for many years. The agency’s staffing for southern Arizona has been reduced from 6 to 3 agents.

The most current data available provided by the U.S. Government Accountability Office reports that only 12 persons were prosecuted nationally for straw purchases by the ATF&E in 2017. 

In Pima County, it has been estimated that a straw purchase is attempted daily at local Federal Firearm License (FFL) dealers. This estimate does not include firearms obtained from private sellers. Clearly, the problem is growing and of such magnitude that local law enforcement agencies, working in conjunction with State and Federal authorities, must take a more active role in the apprehension and prosecution of these offenders. 

Policy Recommendation

A joint task force should be created, comprised of federal, state and local law enforcement agencies to identify and charge persons engaged in transferring or selling firearms to prohibited possessors, using all applicable state and federal laws.

Prior to this enhanced enforcement of straw purchase laws, it is recommended that an Arizona- specific public information campaign be implemented aimed at warning potential straw purchasers of the legal and financial ramifications of their activities. 

Unlike most Second Amendment related issues here in Arizona, this does not require the passage of new legislation.  Also noteworthy is that people from all sides of the Second Amendment issue want to see firearms taken out of the arms of criminals. which is what enhanced enforcement of straw purchase laws would accomplish. 

These steps, if implemented would help reduce the incidence of straw purchase of firearms and thereby reduce the ability of prohibited possessors to obtain these weapons.  These actions would have a positive impact on reducing firearm-related violence in our community.

– Mike Humphrey, Pima County Board of Health

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