Arizona's Overdose Deaths Went Up. The Vending Machine That Fights Them Is Empty.

John Koch has been revived by Narcan three times. He says that plainly, the way you’d mention a scar. He is a homeowner now. A taxpayer. A father and a husband. He is also the director of community and public relations at Community Medical Services in the Valley, which means that most mornings he walks past the naloxone vending machine in the lobby — the one that used to be full, that he’d point to when someone asked whether recovery was possible, that now sits empty because the federal grant that stocked it got cut. “I would love to see them full,” he told AZFamily in May. “As a person that’s been revived three times by Narcan, it saves people’s lives.”

Arizona did not run out of overdoses this year. It ran out of the thing that stops them.

That sentence sounds like rhetoric. It isn’t. The country’s overdose deaths fell roughly 15% in 2025, continuing what CDC’s provisional data now shows as a third consecutive year of national decline — the longest sustained drop since the crisis began roughly twenty-five years ago. Arizona went the other direction. Overdose deaths here rose 17% over the same period, a divergence stark enough that Dr. Martín Celaya, chief of the Arizona Department of Health Services’ Bureau of Assessment and Evaluation, has spent the spring trying to explain it. His answer, in plain terms: the drugs got more mixed together, and the safety net got thinner at exactly the moment it needed to hold.

The combination nobody signed up for

Ask Celaya what’s actually killing people in Arizona and he doesn’t reach for a single villain. “Ninety percent of overdose deaths in the state involve polysubstance use,” he told KTAR News, “primarily the combination that is most common in those substances is meth and fentanyl.” That is a plainer sentence than it sounds. It means most people dying in Arizona right now weren’t using one drug that killed them — they were using a stimulant and an opioid that arrived tangled together, sometimes without either person knowing it. “We look at all of these deaths to try to figure out did the individual know their methamphetamine was laced with fentanyl or vice versa,” Celaya said. “Some cases folks just don’t know what they’re consuming.”

If you’ve ever bought something on the street and had no real way to check what was actually in it, you already understand the gap Celaya is describing better than most policymakers do. Fentanyl doesn’t announce itself. It shows up in a meth supply the way a rumor becomes a fact — quietly, and then all at once, in someone’s bloodstream. Methamphetamine has no reversal agent; naloxone can’t touch it. But naloxone can reverse the fentanyl half of that combination, if it’s on hand and someone knows how to use it fast enough. Which is exactly why the empty vending machine in Koch’s lobby is not a side story to Arizona’s overdose numbers. It is close to the whole story.

Here is what makes the numbers especially hard to sit with: naloxone access in Arizona was, by every visible metric, working. Overdose reversals in the state nearly tripled last year, climbing from roughly 2,500 in 2024 to more than 4,000 in 2025. Scott Greenwood, CEO of Sonoran Prevention Works, runs what he describes without exaggeration as “the single biggest distributor of naloxone in the country that is not a government” — a nonprofit doing federal-scale harm reduction work on state-scale funding. “If you include our community partners that are resourced through SPW,” Greenwood said, “that number for us is about 6,000.” His organization has leaned hard into intramuscular naloxone over the pricier nasal spray precisely because “the huge cost differential” lets them stretch dollars into more kits, more hands, more chances.

Overdose reversals in the state nearly tripled last year, climbing from roughly 2,500 in 2024 to more than 4,000 in 2025.

So reversals went up. Deaths went up anyway. That is not a contradiction — it’s what happens when supply lags need. More people are overdosing on a deadlier, harder-to-predict combination of drugs than the naloxone pipeline, even at nearly triple its prior volume, can fully absorb. And now that pipeline has a hole in it.

What the empty machine actually costs

The vending machine at Community Medical Services in the Valley isn’t decorative. It’s a low-barrier access point — no appointment, no intake form, no judgment, just a box of naloxone kits available to anyone who walks in, including people who will never set foot in formal treatment. That kind of access point is precisely what harm reduction research has spent two decades establishing as effective: meet people before the crisis, not after it. It ran on federal grant money. That money got cut, and the box has been sitting empty since.

Kristen Peterson, who works alongside Koch at Community Medical Services and Shot in the Dark, described what the shortage looks like from behind the counter: “Just walking into one of our clinics and someone asks our nurse, ‘Hey, can I get some Narcan?’ And she has to say ‘No.’” Peterson’s stake in this isn’t only professional. “My daughter struggles with chaotic substance use,” she said. “If you were to ask me who my favorite first responder to overdoses is, I would tell you her name is Brianna, and she’s my daughter.” Naloxone, in Peterson’s telling, isn’t an abstraction or a line item — it’s the thing standing between her daughter and a headline. “It’s important for us all to give people another chance at life.”

That is the part of this story that a spreadsheet can’t hold: a mother naming her own child as the “first responder” who might one day have to save someone, maybe even herself, with a kit that’s supposed to be sitting in a vending machine and isn’t.

We have watched this exact mistake before, on a longer timeline. When Congress passed the Comprehensive Addiction and Recovery Act in 2016 and the SUPPORT Act two years later, it built — for the first time at real scale — federal funding lines specifically for naloxone distribution and first-responder training, the infrastructure that turned overdose reversal from a fringe harm-reduction practice into standard public health response. That investment is why a vending machine full of naloxone in a Phoenix clinic lobby became possible at all. What’s happening now isn’t a new problem; it’s the oldest one in addiction policy repeating on a shorter loop — funding gets built specifically because deaths are falling, then gets treated as discretionary the moment it looks like it worked, then the people who depended on it find out how thin “working” really was.

The money exists. It’s just pointed somewhere else.

Here’s what makes Arizona’s situation more infuriating than merely unlucky: money for exactly this problem is moving through the state right now, just not fast enough, and not always to naloxone access specifically. Arizona’s Attorney General allocated $10 million in opioid settlement funds to five rural county sheriffs in June for reentry and recovery programming. Maricopa County has committed roughly $4.3 million in settlement dollars to seventeen local organizations, part of an estimated $80 million the county will receive over eighteen years. In Tucson, Pima County’s Board of Supervisors voted to extend funding for its 24/7 sobering center — a program notable for letting people bring their pets and belongings when they walk in, removing one more reason someone in crisis might not come inside at all. Nationally, SAMHSA opened fifteen grant programs in July worth more than $281 million, including $68.2 million specifically earmarked for opioid medication-assisted treatment.

Maricopa County has committed roughly $4.3 million in settlement dollars to seventeen local organizations, part of an estimated $80 million the county will receive over eighteen years.

None of that money is small, and none of it is nothing. But settlement dollars move on grant cycles and county budget calendars, not on the pace of a fentanyl-contaminated meth supply. And a program built around a national grant that funded, specifically, the naloxone in one specific vending machine in one specific clinic lobby doesn’t get made whole by a sheriff’s reentry grant three counties over. Access this granular — a box in a lobby, restocked weekly, available to anyone who walks past it — lives or dies on funding lines this specific. Arizona has a genuine, well-documented settlement windfall arriving over the next decade. It does not yet have a mechanism that moves fast enough to catch someone the week their local supply runs out.

If you run a program in Arizona right now, here’s the immediate, doable thing: don’t wait on the federal pipeline to refill itself. Sonoran Prevention Works’ non-government naloxone supply, the one Greenwood described stretching dollars through intramuscular kits, is precisely built to be a bridge for exactly this kind of gap — reach out to them directly this week for clients or patients you can’t currently stock for, rather than defaulting to “we’re out.”

What’s still true tonight

If you are reading this because you use, because someone you love uses, or because Brianna is a name that sounds like someone in your own life: naloxone still works. It has not stopped working, and it has not become harder to administer — it has become harder, in some specific places, to find. That is a supply problem, not a chemistry problem, and supply problems have addresses. Sonoran Prevention Works is still distributing statewide, still the largest non-government source in the country, still handing out kits nearly a thousand a week faster than it was two years ago. The gap in Koch’s lobby is real. It is not everywhere, yet, and it does not have to become everywhere.

Arizona’s overdose numbers went up this year while the country’s went down, and the honest answer for why isn’t a mystery drug or a single bad decision. It’s a deadlier supply meeting a safety net that got cut in the wrong place at the wrong moment — measured, this time, in the specific silence of a vending machine that used to make a sound when someone took something out of it that might save a life. Koch still walks past it every morning. He still tells people recovery is possible. He just can’t point at the machine anymore to prove it.