The Rest of the Country Is Celebrating. In Maricopa County, People Are Still Dying.

In the first four months of 2026, Maricopa County emergency responders logged more than 600 non-fatal opioid overdose events. The medical examiner confirmed at least 30 opioid deaths. These are not numbers from 2023, when the fentanyl crisis was at its domestic peak. They are from this year — after three straight years of national progress, after Arizona began receiving disbursements from a $1.2 billion opioid lawsuit settlement, after the state expanded Medicaid until 97 percent of its treatment facilities accepted it. The people behind those 600 overdose calls did not benefit from the trend line. They were the exception to the headline.

On May 13, the CDC released the provisional overdose data for 2025. The national number was 69,973 deaths — a 14 percent decline from 2024, the third consecutive year of improvement, the lowest total since before the pandemic. Public health officials called it progress. The White House cited it in a press release. Recovery advocates who had worked for years on naloxone distribution and medication-assisted treatment allowed themselves a measured exhale.

Arizona did not appear in that press release.

The state’s provisional overdose death total for 2025 rose approximately 21 percent year-over-year, according to CDC data and reporting by NPR and Filter Magazine. Arizona is among five states that moved opposite to the national trend, and it is the largest state in that group by population and by the sheer volume of the drug supply problem it anchors. The DEA’s Phoenix Field Division reported that three million of approximately five million fentanyl pills seized in the most recent national enforcement action came from Arizona. The state’s overdose crisis is not independent of the national one. It is, in significant ways, generating it.

Understanding why Arizona is bucking the trend requires looking at three converging forces: a drug supply that has grown more complex and more dangerous than anywhere else in the country, the removal of the tools that had been working, and a mismatch between where settlement funds are landing and what people in active use actually need.

The supply chain doesn’t follow national averages

The drug supply picture in Arizona is materially different from what it was two years ago, and materially different from what it is in states where overdose deaths are declining. Fentanyl is not the only threat. It is now the carrier for a cocktail of additional substances that the standard harm reduction toolkit was not built to detect or reverse.

On May 12, the DEA issued a public safety advisory — the kind it reserves for imminent, life-threatening threats — describing fentanyl that is increasingly cut with medetomidine, a veterinary sedative that is 100 to 200 times more potent than xylazine, and with nitazenes, a class of synthetic opioids some variants of which are more potent than carfentanil. Both medetomidine and xylazine are alpha-2 adrenergic agonists — they are not opioids, which means naloxone cannot fully reverse their effects. The DEA also flagged a newer compound, cychlorphine, a synthetic opioid from a different chemical class than fentanyl, appearing in East Tennessee last fall and detected in Chicago drug seizures by spring. Like medetomidine, it may require multiple naloxone doses for reversal.

Medetomidine is the fastest-growing adulterant in the national drug supply. The CDC’s National Forensic Laboratory Information System recorded 247 medetomidine-positive samples in 2023. By 2025, the number was 8,233 — a 950 percent increase in two years. In Massachusetts, it has appeared in every county. In Arizona, where the drug supply enters from the Mexican border at scale, the contamination pattern is not a future problem. It is a present one, and one that makes every traditional harm reduction intervention — naloxone distribution, overdose response training, bystander education — less effective than it was 18 months ago.

By 2025, the number was 8,233 — a 950 percent increase in two years.

Arizona is the primary entry point for fentanyl in the United States. The DEA’s Phoenix Field Division documented a 79 percent increase in fentanyl powder seizures in 2025 compared to 2024. That volume, and the growing practice of adulterating fentanyl with medetomidine and nitazenes, means the people using street drugs in Maricopa, Pima, and Pinal counties are confronting a risk profile that even the best-prepared emergency responder cannot fully address with a single dose of naloxone and a phone call for backup.

The people who would have survived an overdose three years ago are dying now. That’s what a 21 percent increase means.

The tools that were working got pulled

At the Kentucky Harm Reduction Coalition, the organization had specific numbers. In the first three months of 2026, it distributed 48,465 fentanyl test strips. The strips did not cure addiction. They told people what was in the drugs they were about to take. In the context of a supply adulterated with medetomidine, nitazenes, and novel synthetics, that information was the difference between using with naloxone ready and not knowing what hit them.

On April 24, SAMHSA sent a letter to grantees. Federal funds, the letter said, could no longer be used to purchase fentanyl test strips, sterile syringes, sterile water for injection, or anything else that could be described as facilitating drug use. The coalition’s $400,000 federal grant was effectively void the same day. The strips were now, in SAMHSA’s language, incompatible with federal law.

The SAMHSA letter arrived in Arizona at the same time the DEA was warning that the drug supply had become harder to reverse and impossible to read without chemical testing. The practical effect was to remove the primary diagnostic tool at precisely the moment its value had never been higher. Arizona harm reduction organizations that relied on federal grants to stock and distribute test strips had a few weeks of inventory. When it runs out, the people in active use in Maricopa and Pima counties will be left guessing at what’s in the drug they’re about to take — in an era when the answer is increasingly medetomidine, cychlorphine, or a nitazene they have never heard of.

The 2026 National Drug Control Strategy — released the same week by the White House’s Office of National Drug Control Policy — stated explicitly that drug test strips “are an important tool and should be legal and not considered drug paraphernalia.” The ONDCP said strips should be legal and accessible. SAMHSA said they were illegal to fund. Both of those positions are official federal policy simultaneously, in the same week, in the same administration. Arizona’s harm reduction organizations are living inside that contradiction.

Maia Szalavitz, writing in Filter Magazine in April, put it plainly: the test strip ban “arrived precisely as the contaminated supply hit its most dangerous evolution in years. This isn’t policy incoherence. It’s policy that treats the tools that work as the problem.”

$1.2 billion, and the gap it hasn’t closed

Arizona is receiving $1.2 billion in opioid lawsuit settlement funds over 18 years under the One Arizona Agreement. The state share is $526 million; $669 million goes to counties and municipalities. These are genuinely significant resources — larger than most states are receiving on a per-capita basis, and arriving in a state where the crisis is acute and the infrastructure is historically underfunded. Arizona ranks 49th out of 51 jurisdictions in behavioral health access. Fewer than one in 20 Arizonans with opioid use disorder receives medication-assisted treatment.

The Q2 2026 disbursement from AHCCCS and the Arizona AG’s office totaled $8.3 million, distributed across 23 organizations statewide. The allocations followed a reasonable logic: 38 percent to MOUD expansion in justice-adjacent settings, 22 percent to harm reduction, 18 percent to workforce development, 12 percent to peer support programs. These are the right categories. The problem is the pipeline.

The Q2 2026 disbursement from AHCCCS and the Arizona AG’s office totaled $8.3 million, distributed across 23 organizations statewide.

Settlement funds, by design, move through a grant-making apparatus that requires organizational infrastructure to receive. A treatment provider that wants MOUD expansion funding needs staff to write the application, accounting systems to track spending, reporting capacity to demonstrate outcomes. The organizations best positioned to receive settlement grants are the ones that already have that infrastructure — the established nonprofits, the hospital-affiliated programs, the agencies with development staff. The people in active use who need the services, the ones who show up at 2 a.m. at a harm reduction van or call a crisis line during a withdrawal, are not at the end of a straight line from the settlement disbursement table.

AHCCCS data shows that zero percent of Q2 settlement funds went to technology or navigation infrastructure. Maricopa County’s $4.3 million in additional settlement allocations went to organizations including Banner Health Foundation, Community Bridges, and Chicanos por la Causa — all credible, effective organizations. The question is not whether those organizations do good work. They do. The question is whether the person who just overdosed in a Glendale parking lot can find them, can call them, can get to them, can navigate an intake process while in acute withdrawal or PTSD or housing crisis.

That navigation layer is the gap. The money is here. The science is settled. The infrastructure to move both into the hands of people in active use — in the right order, at the right time, with the right clinical guidance — is the thing that hasn’t been funded.

What the next year looks like if nothing changes

The HR1 budget reconciliation bill currently working through Congress would impose Medicaid work requirements beginning January 2027. AHCCCS — Arizona’s Medicaid program — estimates that up to 400,000 Arizonans could be affected. The exemptions for people in SUD treatment are on paper available, but the administrative apparatus required to claim them is the same kind of barrier that already stops most people with addiction from accessing care in the first place: documentation requirements, appointment-keeping, bureaucratic continuity during the period when those capacities are most impaired.

DEA telehealth prescribing flexibilities expire December 31, 2026. The permanent buprenorphine telehealth rule already took effect, but the broader Schedule II prescribing waiver — which covers the full range of controlled substances used in addiction medicine — has a hard expiration date at the end of the year. If Congress does not act, the expansion of telehealth MOUD access that has driven some of the national improvement in OUD outcomes snaps back to pre-pandemic restrictions on the same day Medicaid work requirements take effect.

Arizona will enter 2027 with more restrictions on treatment access than it had in 2024, in a state where overdose deaths are already rising while the rest of the country improves.

The 30 deaths confirmed in Maricopa County in the first four months of this year are not an abstraction. They are people who had families, histories, and reasons for ending up in a county medical examiner’s report. They are also the predictable result of a contaminated supply, withdrawn tools, and a navigation system that is not yet adequate to the scale of the problem. Three years of national progress has not reached them. That is the only number that matters.

---

For Arizona treatment resources and personalized navigation, visit Rize Recovery’s find-help guide. For harm reduction near you, the Arizona Harm Reduction Coalition maintains a statewide resource map.