The Arizona Prescription Drug Initiative: A Multisystemic Approach for Targeting Prescription Drug Misuse and Abuse

JRSA Forum. September 2012. Volume 30, Number 3.

In November 2011, the Centers for Disease Control and Prevention (CDC) issued a report indicating that deaths from prescription (Rx) pain relievers have reached epidemic proportions in the United States. It is estimated that 40 deaths per day are due to prescription drugs. This exceeds the number of deaths related to heroin and cocaine combined. For the first time in history, drug poisoning has become the number one cause of accidental death in America.

Arizona is not immune from Rx drug misuse and abuse. According to data from Arizona's Prescription Drug Monitoring Program, from 2009 to 2011, there were approximately 10 million Class II-IV prescriptions written each year in Arizona, with Rx pain relievers accounting for more than half of the drugs dispensed (controlled substances are classified into five possible schedules, or classifications, based on the drug's identified potential for abuse and other medical and safety standards- the higher the likelihood of abuse, the lower the schedule class).

As the access to and availability of Rx narcotics grow, so too does the likelihood of misuse and abuse, and, moreover, costly associated outcomes. In 2010, 13% of Arizona adults reported some type of Rx drug misuse in the past 30 days, with half of the misuse related to Rx pain relievers. Likewise, in 2010, 10.4% of Arizona youth reported some type of Rx drug misuse in the past 30 days, with 76.7% of the misuse involving Rx pain relievers. Arizona has also seen a corresponding, and dramatic, increase in opioid-related cases presenting in emergency departments and a similar increase in drug poisoning deaths involving Rx drugs (Arizona Department of Health Services).

Prescription Drug Reduction Initiative
As the single statewide council on substance abuse-related issues, the Arizona Substance Abuse Partnership (ASAP) seeks to ensure community-driven, agency-supported outcomes to prevent and reduce the negative impacts of alcohol, tobacco, and other drugs by building and sustaining partnerships. Through coordination and collaboration among its members and their respective agencies and organizations, the ASAP strives to ensure that substance abuse is addressed in a comprehensive and collaborative manner. To address the growing concern over Rx drug misuse and abuse in Arizona and its associated consequences, the ASAP has endorsed a data-driven Prescription Drug Reduction Initiative (Initiative) cochaired by staff of the Arizona Criminal Justice Commission and Arizona's High Intensity Drug Trafficking Area.

Percentage of Class II-IV Pills Prescribed in Arizona by Type, 2011

The Initiative is designed as a pilot project in three Arizona counties. Selection of the geographic areas was based on the following criteria:

  1. The severity of Rx drug misuse, as indicated by prevalence and consequence data.
  2. The willingness of the county to use a data-driven decisionmaking approach and for its efforts to be evaluated.
  3. Capacity for strategy implementation, including evidence of multisystemic work across the three domains (i.e., medical/treatment, law enforcement, and prevention).

With the Initiative a grassroots effort, it was critical for each county to select its own lead agency/point of contact and to engage one or more community prevention coalitions in the work. Counties with coalitions that had demonstrated efficacy in substance use prevention and intervention were considered to be high capacity, and those counties with coalitions that had participating members or committed networks from the three domains (i.e., prevention, law enforcement, and medical) were considered to have the highest capacity.

Based on these factors, Yavapai, Pinal, and Pima counties were selected as pilot sites. The start date for the activities in the three areas are staggered, with the goal of having each successive wave (i.e., county) incorporate lessons learned from the preceding county or counties. The first pilot site, Yavapai County, kicked off the Initiative on July 1, 2012. The pilot counties will act as a learning community in that the three sites will share information about successes, failures, and lessons learned to help one another as the Initiative moves forward.

The following strategies and goals were developed to decrease the misuse and abuse of prescription drugs in Arizona:

Strategy One: Reduce illicit acquisition and diversion of prescription drugs.

Strategy Two: Educate prescribers and pharmacists about "Rx drug best practices." Strategy Three: Enhance Rx drug practice and policies in law enforcement. Strategy Four: Increase public awareness about the risks of Rx drug misuse. Strategy Five: Build resilience in children and adults.

Both process and outcome evaluation measures will be tracked by staff of the Arizona Statistical Analysis Center, housed in the Arizona Criminal Justice Commission, as a means of monitoring success and for determining the feasibility of implementing the Initiative on a statewide basis.