Substance Use

Understanding Substance Use

Substance use is the use of substances, including drugs (prescription or illegal) or alcohol, that can change how a person’s body and mind work. Substances such as marijuana and tobacco also are considered drugs. Continued use of the substance may lead to changes in the brain’s structure and function. This can result in intense cravings, withdrawal symptoms, learning and memory problems, and personality changes.

Substance use disorders occur when someone continues to use drugs or alcohol even when it causes problems, such as trouble with work or school, family, or their health. Many factors can influence a person’s chance of developing a substance use disorder.

Treatment and Recovery

Learning to recognize the signs and symptoms can be the first step toward seeking help and receiving treatment. Unfortunately, many people who could benefit from treatment don’t receive help. Some may avoid or delay seeking treatment due to concerns about being treated differently, fears of losing their jobs and livelihood, or feelings of guilt and shame. Find resources here.

Removing the stigma around addiction is one of the first steps to addressing this growing problem.  People with addiction should not be blamed for suffering from the disease. Research shows the language we use contributes to stigma and discrimination against people with substance use disorders, including by healthcare professionals. For example, stigmatizing words such as “addict” reduce a person to only their drug use. Using person-first language, i.e., a person with substance use disorder, shows that a person “has” a problem, rather than “is” the problem.

For Providers

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Fentanyl and Mixed Drug Use Trends

Since 2012, overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl, have dramatically—and steadily—increased, nationwide.

Additionally, most overdose deaths involve more than one drug.  This mixing of substances, either intentionally or unintentionally, is referred to as polydrug or polysubstance use. 

In Maricopa County:

  • Drug overdose deaths involving heroin or natural and semi-synthetic opioids (which includes prescription opioids such as oxycodone) have been slowly declining since about 2017.
  • From 2012-2021, the overdose death rate for synthetic opioids (e.g., fentanyl) increased by over 6,000%.
  • In both 2020 and 2021, about 91% of drug overdose deaths among those ages 15-24 involved synthetic opioids. 
  • Stimulant involvement in drug overdose deaths involving opioids has steadily increased since 2019. In 2021, 51.9% of overdose deaths involved methamphetamines.

For more overdose data, see our community data page.

Prevalence and Dangers of Fentanyl

According to CDC, most cases of fentanyl-related overdose are linked to illicitly manufactured fentanyl, which is distributed through illegal drug markets for its heroin-like effect. Illicitly made fentanyl is increasingly found in counterfeit prescription medications, heroin, cocaine, methamphetamine, and other illicit drugs. Teens are often the target of drug trafficking organizations who use social media to market and distribute counterfeit pills (view the Maricopa County Attorney’s Office blog post: The Connection Between Snapchat and Fentanyl).

fentanyl powder next to a penny
Photo illustration of 2 milligrams of fentanyl, a lethal dose in most people. Credit: U.S. Drug Enforcement Administration

Fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine. It is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous.

The high potency of fentanyl greatly increases risk of overdose, especially if a person who uses drugs is unaware that a powder or pill contains it. They can underestimate the dose of opioids they are taking, resulting in overdose. Two milligrams of fentanyl can be lethal depending on a person’s body size, tolerance and past usage.

Harm Reduction Strategies

It is nearly impossible to determine if drugs have been laced with fentanyl because it cannot be seen, smelled, or tasted. Because it is difficult to identify, harm reduction strategies are important for reducing overdoses.

Harm reduction strategies like rapid fentanyl test strips can help individuals to stay safe while using illicit substances to prevent unintentional fentanyl exposure and accidental opioid overdose.

Naloxone is a life-saving medication that can be administered intramuscularly by injection or by nasal spray. It can reverse an overdose from opioids, including heroin, fentanyl, and prescription opioid medications. Learn more about where to get free naloxone in Maricopa County and how to use it.

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OD2A Initiatives

Launched in 2019, Overdose Data to Action (OD2A) is a nationwide Centers for Disease Control and Prevention (CDC) funded program aimed at enhancing overdose surveillance in order to develop data informed overdose prevention activities. OD2A also encourages evidence-based prevention education and training be implemented in communities of high need and those who are at increased risk for overdose and substance use disorder. 

As part of this program, the Maricopa County Department of Health is collaborating with state and local entities on a number of initiatives, including:

  • Improving timeliness of tracking and reporting of nonfatal and fatal drug overdoses, including toxicology to better track polysubstance-involved deaths
  • Developing resources to increase awareness of and create linkages to care among Maricopa County faith-based organizations to support their efforts to address substance use disorders in their communities.
  • Enhancing linkage to care for justice-involved individuals with opioid use disorder and risk for opioid overdose, including recovery support through peer navigators.
  • Implementing a collaborative approach of family support and substance use disorder professionals to improve outcomes for pregnant individuals with a substance use disorder, their newborns, and families. 
  • Improving access to educational materials, training, and/or resources for Maricopa County stakeholders related to fentanyl test strips and naloxone kits.
  • Providing training and other systems support to clinicians and providers for clinical support of patients with chronic pain including the use of non-opioid pain treatment modalities, screening for OUD, prescribing guidelines, and motivational interviewing that supports trauma-informed care. View AACHC video series on stigma, an OD2A funded project.

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The Importance of Harm Reduction

Harm reduction programs are designed to keep people who use opioids and other substances safe. Research has identified a variety of strategies (described below) shown to be effective in reducing the harm produced by opioid misuse, including overdose.

Naloxone

Naloxone, or Narcan, is a medication used to reverse the effects of an opioid overdose then allows the individual to breathe normally once administered. Naloxone can be injected in the muscle and/or sprayed into the nose, depending on the type used. Naloxone has no potential for abuse.

For Providers

The Arizona Department of Health Services has naloxone available at no cost for law enforcement agencies, hospital and medical center emergency departments, community-based organizations such as substance use prevention coalitions, harm reduction organizations, family and homeless shelters. Order Naloxone for your organization here.

For the Public

The medical director of Arizona Department of Health Services (ADHS) issued a standing order on November 11, 2017, that allows any Arizona-licensed pharmacist to dispense naloxone to any individual without a prescription. If you need naloxone for yourself, a family member, or friend, you may ask for naloxone at your local pharmacy. Your health care provider may also prescribe naloxone if you are taking certain pain medications. Most insurance plans cover naloxone, and many community-based organizations provide the drug for free.

Medication-Assisted Treatment

An opioid use disorder may require medication as the first course of treatment. Medication-Assisted Treatment, or MAT, is medically supervised use of prescription medication (methadone, buprenorphine, or naltrexone) combined with counseling and behavioral therapies to treat dependency on opioids.

MAT tapers patients off opioid dependency. Treatment is designed based on the individual’s needs through careful collaboration with trained medical professionals.

MAT helps ease the symptoms of withdrawal, normalizes body functions, and blocks the addictive effects of opioids. 

For Providers

For the Public

Fentanyl Test Strips

Illicit fentanyl is responsible for an increasing number of drug overdoses. Fentanyl test strips can identify the presence of fentanyl but not how much fentanyl a substance contains or its potency. They can be used to test injectable drugs, powders, and pills.

Being aware if fentanyl is present allows people to make informed choices regarding their drug use and help to prevent accidental overdose.

Syringe Access and Exchange Programs

Syringe access and exchange programs have been shown to be effective in reducing risky behaviors associated with injection drug use (such as sharing syringes and reusing syringes). When people who inject drugs lack access to safe supplies, they can be exposed to unnecessary risk of contracting infectious diseases like HIV and hepatitis C.

Syringe services programs (SSPs) can provide a range of services, including access to and disposal of sterile syringes and injection equipment, vaccination, testing, and linkage to medical care, mental health services, and substance use treatment.

Additional Resources

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