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The Best Of Two Worlds

‘The story is yet to be written’: How a County leader helped secure millions to fight opioid addiction 

More than 2,000 people in Pima County have had their lives cut short due to opioid overdoses within the past five years.

Those deaths are the direct result of a much larger, complex opioid epidemic that took root in the United States in the 1990s, largely due to increases in the sale and use of prescription opioid medications.

Many of those patients became addicted to prescription drugs like OxyContin and Percocet, before turning to illicit drugs – mainly heroin – to feed those addictions. Fentanyl, a synthetic opioid that is 50 times stronger than heroin and often mixed with other illicit drugs, hit the street nearly 20 years after the start of the epidemic and has since spurred a sharp increase in opioid-related deaths.

Pima County’s battle against opioid addiction, and the social and economic problems that come with it, are far from over. But thanks in part to the concerted efforts of Chief Medical Officer and Deputy County Administrator Dr. Francisco Garcia, the County can continue to meet the ever-growing need for resources that can save lives and foster recovery.

County leaders and the attorneys who worked with them during the litigation process say Garcia served as their most knowledgeable resource on the opioid crisis as it related to Pima County.

“Dr. Garcia was involved from the earliest stages. He was present in all the meetings with County Administration and outside counsel, and offered assistance directly to outside counsel,” said Community & Workforce Development Department deputy director Andrew Flagg. Flagg was the County’s chief civil deputy county attorney at the time of the settlement. “In particular, I remember he helped prepare for and was at the executive session in which we sought authority to approve joining the litigation … and I believe the Board of Supervisors valued his contributions to that discussion and recommendation above anybody else’s.”

Garcia has worked for decades in the public health sector and is internationally recognized as an expert in public health emergency preparedness, border health and women’s reproductive health.  He currently holds the academic title of Professor Emeritus of Public Health from the University of Arizona and serves on the National Academies Committee on Sustaining Essential Health Care Services Related to Intimate Partner Violence During Public Health Emergencies.

He served from 2013 to 2017 as the director of the Pima County Health Department and continues to serve as the County’s Chief Medical Officer.

Garcia is no stranger to tackling health issues at the national level. From 2016 to 2019 he chaired the U.S. Department of Health & Human Services’ Breast and Cervical Cancer Early Detection and Control Advisory Committee.

He also served from 2010 to 2013 as president of the Hispanic-Serving Health Professionals Schools, a national group that promoted the recruitment and advancement of Hispanic health care workers and examined public health issues facing the Hispanic population.

Prior to his transition into the government sector, Garcia was a tenured Distinguished Outreach Professor of Public Health, Obstetrics & Gynecology, Clinical Pharmacy, Nursing and Mexican-American Studies at the University of Arizona.

Garcia got involved back in 2017 on the opioid issue when County leadership began talks on the possibility of joining future litigation against the opioid manufacturers, distributors and pharmacy chains that had a hand in starting the epidemic. Garcia said that was around the time that County leaders began seeing a notable rise in opioid use disorder in the community – particularly fentanyl.

“It’s ubiquitous, it’s cheap and it’s highly available,” Garcia said of the drug. “We started seeing an impact on emergency department admissions early on in about 2017, and we also started seeing a rise in the number of babies who were born with withdrawals because their moms had been using.”

In 2021, the County joined the One Arizona Distribution of Opioid Settlement Funds Agreement under the Attorney General’s Office, which is designed to distribute Arizona’s $1.14 billion share of settlement money among the state, counties, cities and towns over the course of 18 years.

Joseph “JoJo” Tann, One Arizona’s lead counsel, said he and Garcia worked closely to determine what portion of the settlement money Pima County would receive, using data from the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control and Prevention and ARCOS Retail Drug Summary Reports.

“My job was to rely on people who deeply understand addiction, abatement and these complex health care issues. He was my top resource when it came to understanding that data and, once we got the funds, how they could be used most effectively and equitably,” Tann said.

Under the agreement, local health departments were charged with deciding how the money is spent.

“Rather than use the money to fix potholes or fill holes in budgets, we chose local health departments to lead in the stewardship of these dollars,” Tann said. “We’re not going to be judged by how much money we brought in, but by how many lives we saved.”

As of March, Pima County had received $16.8 million, with $8.5 million coming in March alone. Garcia said he expects the County to get about $90 million overall as more companies settle.

“In some ways, it seems like a lot of money,” Garcia said. “But given the cost of what it takes to treat people with opioid use disorder and given the cost of what it takes to prevent people from using, it isn’t that much. The magnitude of the problem is such that it requires a hell of a lot of resources, and this is just a small, but significant, contribution to that approach.”

So far, that approach has involved creating a $100,000 grant for a local organization to provide services to pregnant and parenting women struggling with addiction and a $300,000 grant to provide mobile medication-assisted treatment (MAT) services to remote areas. Those MAT funds also assist those who are held in the Pima County Adult Detention Complex and are set to be released soon.

In addition, the settlement funds will help ensure that naloxone, a life-saving medication capable of reversing an opioid overdose, is readily available to the public in the form of Narcan, or the nasal-spray version of the drug.

But because this litigation is so complex, with multiple jurisdictions battling companies that are settling, filing for bankruptcy or continuing to fight, determining when the County receives its portion and how much it gets at a time is unpredictable. That makes it difficult for the County to anticipate its next moves in the opioid crisis.

“We got four different payments in March after not having anything for many months, so it’s really hard to plan for how this money will be used when we don’t know how it’s coming in,” Garcia said. “This is a good problem to have, but it does present a unique set of challenges.”

Despite the scope of the epidemic and the inconsistency of when the money earmarked to combat it will arrive, Garcia has already seen improvements in certain areas. He expects that the settlement funds, as they come in, will cultivate more.

Of the 2,000 overdose deaths in Pima County, he noted, the number has plateaued over the past three or four years and 2024 is on track to have fewer opioid-related deaths than 2023.

“I think that’s because we have undertaken a strategy that involves flooding the community with Narcan, so people aren’t dying from these overdoses the way they are in some other places,” Garcia said. “We’re using an all-hands-on-deck kind of strategy, because that’s the primary tool that we have right now that seems to be helping out.”

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