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Back2Basics, Coconino County provide response to continued opioid crisis

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Back2Basics

Roy DuPrez, right, founder of Back2Basics, sits with Francisco Rendon, left, Laini Roberts, and Natalie Randolph.

Though it is not the health crisis most on people's minds lately, opioid overdoses have been rising nationwide and in Coconino County. The county and local programs have been continuing their work to help solve the problem. 

Back2Basics is an outdoor adventure recovery program for men between the ages of 18 and 30 located in Flagstaff. Transition coordinator Joe McNamara said it offered two consecutive six-month treatment programs, one focused on inpatient residential treatment and another on transitional living.

Founder Roy DuPrez said the program is meant to help clients “not only create a buy-in for recovery, but also process whatever got them there.”

Back2Basics programs use a mix of therapies to address different needs that clients have. They include individual and group therapies, and long-term community service work as well as weekend trips to outdoor recreation sites like Zion or Sedona.

Programming covers five days for residential clients and two for those in the transitional program.

The transitional program uses a step-down model, which gradually gives clients more responsibility and higher expectations in preparation for leaving the program. Back2Basics does weekly check-ins throughout the program and provides services to help with credit and rental or criminal history.

“A big part of the training in this transition program is how do you do these adult things and what areas do you need help in supporting so we can push you to a completely independent sober adult by the time you graduate,” McNamara said.

The year 2020 saw a record number of opioid overdoses, according to McNamara, who’s studying nationwide trends as part of a master’s degree in social work at Northern Arizona University.

The United States reported more than 100,000 drug overdose deaths in 2020, he said, 30,000 more than in 2019. Coconino County Health and Human Service’s (CCHHS) website cites the same statistic, with an additional detail that nationwide, around 75,000 deaths were due to opioids between May 2020 and April 2021.

Arizona’s opioid epidemic was first declared an emergency by Gov. Doug Ducey in 2017, and it lasted through May of 2018. The state’s most recent opioid action plan went from June 2019 to June 2021.

Between June 15, 2017, and Jan. 7, 2021, Arizona had reported 11,698 suspected opioid deaths and 84,792 suspected opioid overdoses, according to ADHS.

Coconino County’s most recent overdose fatality review covered deaths occurring between October 2018 and December 2019. Of the 28 deaths reviewed in the report, the majority were white (82.14%), male (82.14%), and living in the Flagstaff area (71.43%). Fatalities were more evenly divided by age for residents older than 20, with 40- to 49-year-olds accounting for 25% of cases and those 60 and older accounting for 14.3%.

The county’s annual medical examiner report for 2020 listed 48 overdose deaths for the year, 23% higher than in 2018 (39) and 50% higher than in 2019 (24, according to this report). Most were white (60%), male (67%) and in either their 30s or 50s (27% for each decade). Of these overdoses, 18 involved opioids, 12 of which also involved fentanyl.

Commonalities among these individuals included history of chronic pain, prior treatment for substance use disorder and mental health diagnoses, among others, according to the overdose fatality report.

Focus on fentanyl

McNamara and DuPrez both attributed the rise in overdose to the increased presence of fentanyl in a variety of recreational drugs.

“The amount [of fentanyl] that could potentially be fatal to a non-chronic drug user is measured in nanograms,” McNamara said. “... A couple grains of sugar could potentially be the difference between life and death.”

He recommended that those planning to use recreational drugs test them with strips from local agencies or outreach programs beforehand.

Prevention measures recommended by CCHHS are similar to those in the state action plan, and are divided into six key domains. These include stigma and harm reduction, education, prescriber engagement, access to care and care coordination.

The county has a page dedicated to opioid overdose prevention on its website, offering resources such as an opioid crisis response program, free naloxone and information on how to store and dispose of medication.

CCHHS’s report’s conclusion mentioned COVID-19, saying its recommendations “were further illuminated” by the pandemic.

“During 2020, while the community coped with quarantine and separation from social support networks, among other stressors, the innate need for human connection has never been clearer. Yet it was also fractured because of the pandemic, thus heightening vulnerability and risk of overdose,” they wrote.

The pandemic didn’t hit Back2Basics too heavily, McNamara said. The program usually has between 15 and 20 clients and currently has around 17.

“Not much has changed since we started almost 12 years ago as far as what we do,” he said. “We’re just better at it.”

They’re planning to continue providing services in Flagstaff, especially since they expected the increase to continue.

“We're trying to tap more into planting seeds and watching them initially grow and thrive, because we're setting them up in scenarios where they have opportunities to succeed or fail, and when they do get those bumps in the road, we're able to redirect or process what's holding them up," DuPrez said.

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