Pima County Community Health Needs Assessment Priority
Substance misuse is one of the most prevalent public health issues in the country that poses a wide range of safety and health risks impacting physical, social, and emotional well being. Within Pima County, misuse and dependency to legal and illegal substances, such as prescription pain medication and heroin, continue to be increasingly high and contribute to the growing rate of deaths and hospitalizations due to accidental overdose. In 2016, more Pima County residents died from drug overdose than motor vehicle crashes, suicide, and firearms combined. Pima County also performs worse than the state in the number of drug-induced deaths (21.9/100,000 versus 16.9/100,000 statewide); opiate/opioids related deaths (14.9/100,000 versus 7/100,000); pharmaceutical opioids related death (11/100,000 versus 5/100,000); and heroin related deaths (4.1/100,000 versus 2/100,000).
Substance misuse and dependency are complex issues that affect all age groups and sectors of society and impose a huge hardship on individuals, families, and the community at large. While there is no simple solution, community understanding and collaboration to support a comprehensive system change that focuses on both environmental changes and individual strategies can slow current substance misuse trends.
Substance Misuse and Mental Health
Good mental health is a foundation for overall wellbeing and allows people to realize their full potential and contribute to society. By contrast, poor mental health is a leading cause of disability and can be devastating to families and communities. Poor mental health is also associated with an increase in physical illness and has been linked with substance misuse.
The Substance Abuse and Mental Health Services Administration (SAMHSA) reported in 2013 that all substances were consumed more by those with a mental health disorder than those without. Similar sentiments are reflected in the findings from Pima County's 2015 Community Health Needs Assessment noting that mental health disorders are closely linked with substance misuse, chronic health problems, and smoking.
During the planning stages of the 2018 Community Health Improvement Plan, Healthy Pima members identified a pressing need to combat the prevalence of co-morbidity between mental and substance use disorders in Pima County. The need to reduce the stigma associated with the words "abuse" and "dependency" was also voiced and replaced with the single term, "misuse." To achieve the greatest impact in reducing substance misuse, and the growing community concern to address co-occurring mental and substance use disorders, Healthy Pima formed an interdisciplinary alliance of primary and behavioral health providers, pharmacists, law enforcement, faith-based organizations, government, and other crucial work groups, stakeholders, and community members.
Healthy Pima’s Substance Misuse and Mental Health Alliance will work to accomplish the following goals from 2018-2021:
Reduce access to and dependence on prescription medications and illicit substances in Pima County.
Increase public awareness and education on the effects of substance misuse and to promote good mental health for all residents in Pima County.
Increase access to substance misuse and behavioral health services for residents of Pima County.
Encourage individual resiliency and coping skills among members of Pima County with anxiety and depression.
Statewide Declaration of Emergency
On June 5, 2017 Arizona’s Governor Doug Ducey signed a declaration of emergency declaring Arizona’s opioid crisis a public health emergency after newly released data from the Arizona Department of Health Services (ADHS) showed 790 Arizonans died from opioid overdoses in 2016 – a 74% increase since 2013. Following the declaration, ADHS released a statewide strategic report (Opioid Overdose Epidemic Response Report) with recommendations for addressing the opioid epidemic. This report aimed to reduce illegal use and diversion of opioids, promote safe prescribing and dispensing of opioids, and improve access to treatment. This plan was coupled with a call to action from Governor Ducey for collaboration on all fronts to combat the statewide crisis.
In response to the Governor’s call to action, the group working to address substance misuse and mental health in Pima County conducted a throughout review of data collected through state and local efforts on substance misuse deaths. Based on the data reviewed, a unanimous decision was made by the group to develop an action plan to complement and support ADHS’ strategic report. This decision was followed by the restructuring of the group into five task forces led by a single steering committee. Each task force was responsible for developing a portion of group’s 2018-2021 strategic action plan that would address and support ADHS’ recommendations.
Key informants, focus group participants, and community forum respondents from the 2015 Community Health Needs Assessment identified substance misuse as a public health concern within Pima County. Community members and leaders noted that:
- Pima County may bear a high prevalence of substance misuse and dependency due to its geographic proximity to the United States–Mexico border and exposure to narco-trafficking. Many point to poverty and lack of opportunities for employment as increasing stress and subsequent negative coping mechanisms.
- There is an acceptability of substance misuse in Pima County, possibly related to pop culture and/or changing patterns of social norms.
- Influencing factors include easy access to alcohol and drugs in tandem with the potency of addictive ingredients, which is particularly salient for first-time users.
- Pima County lacks preventive activities related to substance misuse, specifically focusing on targeted education for adolescents in tandem with broad-based employment training and skill-building.
- Tobacco use among Pima County adults is approximately 18% (versus 17.7% statewide).
- Pima County experiences higher prevalence rates when compared to statewide and national statistics on the following groups:
- Teens who have smoked (19.3%)
- Teens who use alcohol (31.5%)
- Teens who use marijuana (18.3%)
- Pima County has a higher percentage of adults who abuse alcohol (binge drink) than the rest of the state (17.5% compared to 13.4%).
- The mortality rate for drug-induced deaths are significantly higher in the following Primary Care Areas (in Pima County): Flowing Wells, Tucson Central, and Tucson Foothills.
For more information on the 2015 Community Health Needs Assessment, please contact: HealthyPima@pima.gov