Arizona is up 17%. The country is down 21%. The gap is not random.

For the 12-month period ending September 2025, Arizona was one of only five states to record an increase in overdose deaths — and the largest of them. The state was up roughly 17%. The country was down roughly 21%.

The gap between those two numbers is the entire story. The fentanyl saturation hypothesis that researchers are using to explain the national decline — fentanyl has so completely replaced other illicit opioids that there are fewer naive users left to overdose — does not appear to be playing out the same way here. Maricopa County data shows that in 2024, fentanyl was involved in 59% of fatal overdoses and methamphetamine was involved in 67%. Reported fentanyl deaths rose every month from October 2024 through September 2025.

The polysubstance pattern is the part that’s hard to look away from. When the supply has fentanyl in 59% of cases and methamphetamine in 67%, you are no longer dealing with two separate epidemics. You are dealing with one supply chain whose products contain both, often without the user’s knowledge. Overdose response that assumes a single drug class is going to keep mismatching the reality of what’s actually in someone’s body when they collapse.

The state isn’t standing still. The Hikma settlement is sending 6,599 naloxone units (each = two nasal doses) to Arizona in 2026, with the September shipment scheduled. Maricopa County’s harm reduction infrastructure — Shot in the Dark and several smaller orgs — has been steadily growing. The opioid settlement money continues to flow, with full implementation expected in FY2026.

But naloxone reverses an opioid overdose. It does not reverse the stimulant half of a polysubstance event. And the matching from a person’s first call for help to the right level of care still takes longer in Arizona than in almost any other state. Arizona ranks 49th of 51 for behavioral health access — a fact that hasn’t moved in five years.

Why this matters for people in recovery

If you live in Arizona, you are living in a state where the curve is going up while the country’s curve goes down. That is not a reason to despair. It is a reason to insist that the response gets faster. Naloxone in your home and your car. A treatment plan written down somewhere your family can find it. A phone number for a person — not a hotline — who knows your situation.

If you are family or a caregiver, the pattern in Maricopa is that the person who collapses most often does not know what was in their supply. Treat every overdose as polysubstance until proven otherwise. Get to medical care.

For Arizonans looking to navigate treatment, Rize Recovery is in private beta and built specifically for this state. If you need help today, call 988 or the SAMHSA helpline at 1-800-662-HELP.