A call to action

Is Iowa successful in combating the opioid epidemic? Depends on whom you ask.

In a recent report on the opioid crisis published by the National Safety Council, a non-profit, non-governmental public service organization, the answer would be no.

Iowa can do better. Iowa should do better.

The report examined all 50 states individually and rated them on a scale of improving, lagging or failing depending how well they fit into six key actions:

• Mandatory prescriber education
• Implementing opioid prescribing guidelines
• Integrating prescription drug monitoring programs into clinical settings
• Improving data collection
• Treating opioid overdoses
• Increasing availability to opioid-use disorder treatment

Iowa, according to the Council, met just two of these criteria — failing.

Despite this ranking, Iowa isn’t alone in the lack of understanding in how to correctly identify a solution to the impending crisis the nation is facing in addressing the issue of opioid addiction and overdose.

This report isn’t to say, however, Iowa isn’t taking steps to address the issue of opioid addiction. During the 2016 legislative session, lawmakers passed a law that made naloxone — an opioid overdose reversal drug — more accessible to Iowans.

Law enforcement officials, including those in Ames, now carry that opioid reversal prescription. Cmdr. Geoff Huff, public information officer for the Ames Police Department, said naloxone had been administered three times in one month.

House File 2377 passed through the Iowa House in February, and if implemented, the bipartisan legislation would place limits on opioid prescriptions and implement a Good Samaritan law for those reporting overdoses.

It would also require physicians to file opioid prescriptions electronically to avoid paper prescription forgeries.

As it stands, however, the bill is stalled in the Senate and its future remains uncertain and unlikely to pass within this legislative cycle.

What does the issue look like in Iowa?

According to data provided by the Iowa Department of Public Health, opioid overdose deaths have increased from 28 in 2005 to 86 in 2016. Opioid-related deaths — meaning opioids were referenced in the medical examiner’s report and may have contributed to the cause of death — has spiked from 59 in 2005 to 180 in 2016.

As for opioid treatment, the rate of admissions has more than tripled in a 10-year time span — from 608 admissions in 2005 to 2,274 admissions in 2016.

Whose responsibility?

During her Condition of the State address in January, Gov. Kim Reynolds expressed her concern in regard to this rising issue.

“In the past decade, opioid-related deaths have more than doubled and will continue to rise unless we take action to reverse this heart-wrenching trend,” she said. “… and today I am calling on the legislature to pass legislation to reduce the number of opioids prescribed in Iowa.”

So, how did we get to this point? What is Iowa doing right? What could it be doing better? Where are we failing?

These are questions the Iowa State Daily asked during a series of interviews with Iowa professionals directly involved in not only combating the opioid crisis, but also finding and implementing solutions to better help communities already impacted.

Read through the pages to discover what they had to say.

Editor’s note: This is the first installment of an ongoing series by the Iowa State Daily to address the issue of substance abuse in Iowa through the lens of the rising opioid epidemic. To counter this crisis, we hope to foster ongoing and continued conversations as a way to find and implement solutions regarding not only Iowa’s successes but also its failures in addressing this national epidemic.

To do this, we want to hear from you. We need to hear from you. To reach out and share your experience in relation to this issue, please email Alex Connor, Iowa State Daily editor in chief for fall/spring 2018-2019 at [email protected].

‘People are still going to have pain’

When discussing the opioid crisis, Peter Komendowski, president of Partnership for a Drug Free Iowa, likes to offer a familiar anecdote: Smokey the Bear.

“What we have is a forest fire,” Komendowski said. “And when you have a forest fire, what do you do? You pour water and everything you can to put the fire out. It’s a big deal.

“But, it took a long time for the National Forest Service to come up with Smokey the Bear to prevent forest fires.”

For Komendowski, discussing opioids and the roots of substance abuse and addiction comes naturally. As president of Partnership for a Drug Free Iowa, he helps foster and implement programs designed to “build healthy communities and a platform to share important resources.”

And currently, he sees Iowa at a pivotal place in addressing the impending crisis of opioid addiction and overdose.

“I think we’re going to do a good job to put as much water on the fire on the opioid crisis as we can. … The problem is, I don’t think we’re doing enough about prevention,” Komendowski said.

He fears if you take away the availability of one item, it’ll just increase the necessity of the next.

“If you take away all the opioids, you still have addicts that need something — heroin,” he said.

“Doctors will prescribe less opioids and they’ll sell less opioids to Americans and they’ll say oh, we dodged that bullet.”

But what, Komendowski wonders, will be the next opioid?

“People are still going to have pain. People are still going to feel like this kind of a medicine will make them better. … Where do we channel all the people that escape with this drug in a realistic way?” he said.

Editor’s note: This is the first installment of an ongoing series by the Iowa State Daily to address the issue of substance abuse in Iowa through the lens of the rising opioid epidemic. To counter this crisis, we hope to foster ongoing and continued conversations as a way to find and implement solutions regarding not only Iowa’s successes but also its failures in addressing this national epidemic.

To do this, we want to hear from you. We need to hear from you. To reach out and share your experience in relation to this issue, please email Alex Connor, Iowa State Daily editor in chief for fall/spring 2018-2019 at [email protected].

One word: Devastating

Cody Smith, former Student Government vice president, grew up around addiction. To him, the opioid crisis wasn’t an abstract, distant issue. It impacted his family — his mom.

Smith grew up on a sheep and cattle farm with his parents and siblings in rural Indiana. When he was a teenager, his mom fell down a flight of stairs. She was put on opioids to help with the pain.

That incident, Smith said, fostered his mother’s addiction to the medication, and later, heroin.

“There were a number of years where she was selling … she got into trouble with the law,” Smith said. “Quite a significant amount of my last few years of high school, she was in jail.”

In one word, he said the impact opioids have had on his family and his community is devastating.

Even in Montgomery County, where Smith is from, the morgue can’t keep up with the crisis. There isn’t enough room to store the bodies due to increased overdoses in the community.

So when Smith came to Iowa State four years ago, he had to watch his community adapt from afar, both for the good and bad. Community members and law enforcement officials now carry narcan — good. Several classmates from high school have overdosed on opioids — bad.

But Smith also started to notice a gap in his own community of Ames. Where were the conversations on substance abuse? Addiction? Opioids?

“There are a lot of things that are being done in a lot of areas,” he said. “Substance abuse is not really one of those things.”

So he began working to help bridge the divide through taking small steps such as partnering with organizations such as Students for Opioid Solutions and integrating it as a topic of discussion during a Student Government monthly town hall.

He said he’s proud of the work he sees the community doing in addressing the epidemic, but because of his background, he remains skeptical.

“All these efforts are really inspiring, but I just worry that it’s going to come and people aren’t going to really know how to deal with it,” he said.

Editor’s note: This is the first installment of an ongoing series by the Iowa State Daily to address the issue of substance abuse in Iowa through the lens of the rising opioid epidemic. To counter this crisis, we hope to foster ongoing and continued conversations as a way to find and implement solutions regarding not only Iowa’s successes but also its failures in addressing this national epidemic.

To do this, we want to hear from you. We need to hear from you. To reach out and share your experience in relation to this issue, please email Alex Connor, Iowa State Daily editor in chief for fall/spring 2018-2019 at [email protected].

Moving beyond a ‘supply-side narrative’

Sarah Ziegenhorn, executive director of the Iowa Harm Reduction Coalition, has taken three approaches to curbing the opioid epidemic in Iowa — a holistic approach to the issue as a means to reduce harm.

An underground needle exchange with the aim of legalizing syringe service programs in Iowa.

Free naloxone kits in an effort to provide the opioid overdose reversal medication to individuals, families and organizations without a prescription.

Outreach services in Iowa City, Cedar Rapids and Des Moines in the hopes of educating communities and users how to safely inject as a means to reduce the risk of HIV and hepatitis C.

“There’s nothing, I think, [that isn’t Iowan] about responding to opioid users with compassion and understanding rather than punishment or authoritarian displays of power,” Ziegenhorn said.

Needle exchanges, or syringe service programs, are not currently legal in Iowa. Ziegenhorn and her organization, however, have been lobbying for legislation — SF 219 — at the Iowa Capitol to change the current policy in relation to drug paraphernalia.

The legalization of a syringe service program would also force a change in language regarding the ways in which Iowans talk about the opioid crisis.

For Ziegenhorn, she feels because the state is emphasizing opioid addiction as a “prescription pill and doctor” issue the state agencies aren’t taking the proper measures to address the rising crisis.

And in regard to HF 2377, the legislation introduced this cycle that worked to place limits on opioid prescriptions and better enforce prescription monitoring, Ziegenhorn is concerned it doesn’t do enough.

“It doesn’t approach the reality that people in Iowa are not just using pills, but more Iowans are using heroin illicitly every day and never even getting started with pills,” she said. “It doesn’t approach the problem that we have so many people who are addicted and at risk of overdose who aren’t able to access naloxone.

So where does Iowa go from here? Ziegenhorn believes the rising epidemic needs to be addressed from a different perspective.

“There are fundamental problems with the way in which our state has expanded access to naloxone and funded access to education around overdose prevention at our community levels and in our public health agencies,” she said.

Instead of emphasizing the supply of opioids, Ziegenhorn believes policy should focus on the demand.

“Why are people getting addicted to drugs in the first place? What is going on in people’s lives that causes the neuro patterns in their brains to be prime to addiction?” she said. “That’s not a conversation that we’re having, and I think until we move beyond a supply-side narrative to drug policy and drug use in Iowa, things are not going to get any better.”

Editor’s note: This is the first installment of an ongoing series by the Iowa State Daily to address the issue of substance abuse in Iowa through the lens of the rising opioid epidemic. To counter this crisis, we hope to foster ongoing and continued conversations as a way to find and implement solutions regarding not only Iowa’s successes but also its failures in addressing this national epidemic.

To do this, we want to hear from you. We need to hear from you. To reach out and share your experience in relation to this issue, please email Alex Connor, Iowa State Daily editor in chief for fall/spring 2018-2019 at [email protected].

‘A piece of it’

In just one month, the Ames Police Department deployed narcan three times. Compared to other states, this is miniscule. But Cmdr. Geoff Huff, public information officer, said the epidemic is coming.

“We’re just starting to see those effects,” he said. “One of the things we know is it will probably get worse before it gets better.”

To properly address the rising issue of opioid addiction, all Ames Police officers have recently been trained to identify opioid overdose and how to properly administer naloxone.

The issue with this, Huff noted, is there still is lagging data and communication between agencies to understand the true extent of the problem in Central Iowa.

“Unless someone comes through a law enforcement channel, we don’t even know anything about it,” Huff said, meaning should an individual overdose and go to the emergency room, the police may never find out about that incident.

“That’s where that communication comes in and becomes very important between all these different agencies so we have a better idea of what the real problem is because we all got a piece of it,” he said.

Editor’s note: This is the first installment of an ongoing series by the Iowa State Daily to address the issue of substance abuse in Iowa through the lens of the rising opioid epidemic. To counter this crisis, we hope to foster ongoing and continued conversations as a way to find and implement solutions regarding not only Iowa’s successes but also its failures in addressing this national epidemic.

To do this, we want to hear from you. We need to hear from you. To reach out and share your experience in relation to this issue, please email Alex Connor, Iowa State Daily editor in chief for fall/spring 2018-2019 at [email protected].

Prescription monitoring as a tool to curb the crisis

Established on March 25, 2009, the Prescription Monitoring Program has been a tool used by Iowa physicians and pharmacists to track their patients’ use of controlled substances without fear of contributing to that patient’s abuse.

With an initial $411,000 federal grant, Iowa budgets about $112,000 annually to keep the program going.

The issue, however, is the program is not being used to its fullest potential.

According to the Prescription Monitoring Program 2017 annual report, the “number of pharmacists and prescribers registering to use” the program is increasing. The number of requests for patient prescription history have steadily increased, as well.

Dale Woolery, associate director of the Office of Drug Control Policy, said enrollment and use is up every year, “but it’s still in the single digits as far as the utilization for [querying] patient information to the point of writing a prescription.”

Meaning, just because it’s available and that prescriber may be registered for the program, it may not have any impact as to whether the prescriber prescribes that medication to an individual.

“All I know is that 47 percent enrolled and utilization in the single digits seems kind of low.”

Overall, Woolery said more use of the Prescription Monitoring Program in Iowa by prescribers will result in what he feels is better patient care and less opportunity for prescription opioid misuse.

He, in contrast to Ziegenhorn, feels the frontline focus needs to be on the supply. In thwarting the demand, he feels heightened education efforts will help raise awareness and curb the issue of opioid addiction in Iowa.

Editor’s note: This is the first installment of an ongoing series by the Iowa State Daily to address the issue of substance abuse in Iowa through the lens of the rising opioid epidemic. To counter this crisis, we hope to foster ongoing and continued conversations as a way to find and implement solutions regarding not only Iowa’s successes but also its failures in addressing this national epidemic.

To do this, we want to hear from you. We need to hear from you. To reach out and share your experience in relation to this issue, please email Alex Connor, Iowa State Daily editor in chief for fall/spring 2018-2019 at [email protected].

The flu

In January, the Central Iowa Drug Task Force hosted a town hall for Ames residents focused on discussing solutions to help curb the rising issue of opioids in Iowa.

More than 100 people showed up, packing themselves into the close-quartered Ames City Council chambers.

Michelle De La Riva, chair of the task force, helped organize the event. She also serves as the executive director of Community and Family Resources in Ames. Her focus is on the treatment and recovery aspect of addiction and the opioid epidemic.

And for those addicted to opioids, withdrawal is one the biggest barriers they face.

She compares withdrawal symptoms to having the flu, but oftentimes longer lasting and more severe. And while there are treatment programs in place, they’re not always accessible.

Options that currently exist include medical-assisted treatment to help the person detox, as well as using a substance abuse treatment professional and counseling services.

“I think recovery for addiction is the same as any other recovery plan. It’s really a day-to-day process,” she said.

Editor’s note: This is the first installment of an ongoing series by the Iowa State Daily to address the issue of substance abuse in Iowa through the lens of the rising opioid epidemic. To counter this crisis, we hope to foster ongoing and continued conversations as a way to find and implement solutions regarding not only Iowa’s successes but also its failures in addressing this national epidemic.

To do this, we want to hear from you. We need to hear from you. To reach out and share your experience in relation to this issue, please email Alex Connor, Iowa State Daily editor in chief for fall/spring 2018-2019 at [email protected].