Substance Abuse in  
Coconino County, AZ

The Coconino County Public Health Services District conducted an in-depth analysis of  

substance abuse trends among Coconino County residents from 2012-2016

Substance Abuse

Substance abuse is the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.  It is an issue that can impact the mental and physical health of all persons; leaving no age, race, ethnicity, culture, gender, or geographic region immune.  It can also lead a person to suffer economic losses, criminal consequences, social isolation, long-term health effects, and death. Beyond the individual, substance abuse, can be viewed as a family disease, with the repercussions bleeding into the lives surrounding substance users.    

Whether from accidental poisoning, complications from long-term chronic use, or intentional self-harm; alcohol and drugs took the lives of 88,574 people in the U.S. in 2016 and cost $440 billion related to crime, lost work productivity, and health care. Harder to measure is the toll substance abuse takes on the family members and loved ones impacted. Substance abuse exasperates economic hardships as well as increases the likelihood of violence, abuse, and neglect in the home. Without effective intervention, substance abuse can quickly become deadly for both the user as well the people around them. Unfortunately for many, treatment for substance abuse can be hard to access and difficult to maintain.

Substance abuse in Coconino County

Like many communities across the United States, Coconino County is not invulnerable to substance abuse.  Compounded by high rates of poverty, with 22.2% of residents living below the federal poverty line, and limited access to mental health providers, substance abuse injury and death have been increasing among county residents. 

From 2012-2016 alcohol was linked to 8.9% of deaths among residents and drugs were linked to 3.3%. They were also responsible for 13% of all hospital visits over a 5 year period. In all, substance abuse has cost residents 8,256 years of life lost and $98.4 million in hospital charges. This is in addition to the incalculable impact it has taken on the quality of life for many Coconino County residents. With rates continuing to rise, substance abuse is a present threat to the community's health and further resources are needed to support those currently struggling and prevent future injury and death. 

Alcohol

Coconino County experienced the highest rate of emergency room visits for alcohol abuse in Arizona in 2016

Drinking practices in Coconino County

Among all substances, alcohol is the most common and most deadly among Coconino County residents. In the 2015 Behavioral Risk Factor Surveillance System Survey (BRFSS), 18.4% of Coconino respondents reported on average consumption of four or more (females) and five or more (males) drinks. High rates of excessive drinking, as described by Coconino County residents, are linked to higher rates of cirrhosis, liver cancer, stroke, depression, heart disease, injury, and death. Of particular concern are racial disparities among reported alcohol use, with Native American residents more likely to be impacted by alcohol abuse. Additionally, Coconino County youths had the highest rate of reported alcohol use in Arizona with 35.9% reporting use compared to 22.4% among youths statewide.

The impact of alcohol use

The high rates of alcohol use among residents is reflected in the degree of alcohol-related injuries and deaths seen in Coconino County. In 2016, the age-adjusted alcohol-related death rate was 2.8 times higher than Arizona and 5.2 times higher than the U.S.   A majority of alcohol-deaths were a result of alcoholic liver disease indicating an impact of prolonged, chronic abuse. Native Americans were 10 times more likely to die from alcohol as a non-Hispanic Whites, and were also more likely to die at younger age, 47 compared to 56.

Similar trends are observed among alcohol-related hospitalization rates. In 2016, Coconino County experienced the highest rate of emergency room visits for alcohol abuse in Arizona (58.6 per 10,000 residents), 3.8 times the statewide rate (15.6). Among these hospital visits, 52% were by a patient that went to the hospital more than once that year for an alcohol-related reason. On admittance, 38% were acutely intoxicated and 7% of alcohol-related visits were transferred to the hospital by law enforcement. In 2016, Native American were 5.3 times more likely than non-Hispanic whites to have an alcohol-related hospital visit, making alcohol abuse the number one cause for Native American hospitalization/emergency room visit.

Since 2012, the cost alcohol extracts on the community's health and life continues to grow and impact has not been felt equally among all segments of the population. Targeted interventions are needed to address that nature, rates, and social determinants influencing this rising tide of injury and death.  

Drugs

Drugs were the among the top 10 causes of death for Coconino County residents age 15-54 years

Drug use in Coconino County

Although drug use and abuse in Coconino County is not as prevalent as alcohol, over the past five years drug abuse hospitalizations are increasing at a rate 3.9 times quicker than alcohol. Among Arizona youths, the percentage with experience using ecstasy, methamphetamine,  non-medical over the counter drugs, cocaine, non-medical pain relievers, and hallucinogens were higher than that what was reported across the state. From 2012-2016 the number of drug-related hospital visits have nearly doubled and the number of drug-linked deaths have increased as well, although at a much slower rate. 

Drug abuse trends

Although in 2016 there were 2 times as many deaths caused by alcohol as drugs, drug-caused deaths have increased at rate 1.6 times faster than alcohol. Most of these deaths, 68%, were an accidental overdose,  14% were a suicide, and 17% were undetermined. The majority of drug-caused deaths from 2012-2016 were among non-Hispanic white residents although, in 2016, drug-caused deaths among Native Americans surpassed non-Hispanic Whites.  Drugs were among the top ten causes of death for Coconino County residents aged 15-54 years-old in 2016.

Similar trends are reflected among drug-related hospitalizations, with ever-rising rates primarily impacting non-Hispanic white males. Emergency room visits were 3.5 times more common than inpatient visits.  With rates on the rise, as well as a growing significant impact among vulnerable populations, an integrated approach is needed to meaningfully impact this threat. 

Commonly abused drugs

Commonly abused drugs  include both prescription and illicit substances that people can obtain legally with a prescription, from friends and family, or purchase illegally. Categories of these drugs include stimulants (amphetamines, cocaine, analeptics), opioids  (opium, heroin, methadone, fentanyl, Vicodin), sedatives (barbiturates, benzodiazepines, methaqualone) and hallucinogens (ecstasy, PCP, LSD). Among the above specified categories, opioids were linked to the most drug-related deaths, accounting for 1/3 of all drug-deaths.  Opioids were also the most commonly abused drug linked to hospital visits accounting for 1/7 of drug-associated hospital visits. 

Taking a Closer Look

The report 

In light of the high stakes surrounding substance abuse, the Coconino County Public Health Services District has released a 2018 report titled, Injuries and Deaths related to Substance Use in Coconino County 2012-2016. The report overviews a five year trend of alcohol and drug-related deaths and hospitalizations among Coconino County residents with the intention of identifying emerging patterns as well high risk populations impacted by substance abuse. 

Key findings from the report

Analysis of alcohol/drug morbidity and morality identified the following trends among Coconino County residents:

-  Alcohol and drugs were linked to 13% of hospital visits and 11% of deaths in the past five years.

-  From 2012 to 2016 alcohol and drug hospital visits increased by 44% and deaths increased by 121%.

-  Alcohol was the most abused substance, making it the leading cause of death among residents aged 35-54 years-old and the second leading cause of death among American Indian/Alaskan Natives residents.

-  Drug-related deaths have increased at rate 1.6 times faster than alcohol deaths.                                                                       

For more details, the full report can be downloaded at the link below.

Next Steps

The Coconino County Prescription Drug Overdose Prevention Program

In partnership with community stakeholders and ongoing epidemiological input, the Coconino County Prescription Drug Overdose Prevention Program is developing strategies to address opioid abuse in Coconino County. The strategies will address needs in the following five categories:

                     - Improve prescription drug disposal

                     - Promoting new prescribing policies

                     - Improve law enforcement access to Naloxone

                     - Increase community awareness

                     - Increase the number of referral to substance abuse treatment

As an ongoing collaborative effort, resources and strategic plans can be combined to address the growing threat of substance abuse in Coconino County and protect communities most at risk of injury and death.  

The Coconino County Public Health Services District is committed to designing interventions that address the social determinants of health that are often the root cause of poor health outcomes

By adopting an evidence-based public health approach, America has the opportunity to take genuinely effective steps to prevent and treat substance-related issues. Such an approach can prevent substance initiation or escalation from use to a disorder, and thus reduce the number of people suffering with addiction; it can shorten the duration of illness for sufferers; and it can reduce the number of substance-related deaths.

—The Surgeon General's Report on Alcohol, Drugs, and Health, 2016