Engaged communities can help stop the opioid epidemic

The opioid crisis in Iowa continues as a public health menace, killing hundreds of people a year and causing untold economic damage.

But there is good news, with new laws that provide more tools local communities can use to help people who struggle. Now, it’s time to direct resources to these communities so they can take the next important steps.

While the opioid crisis has not reached the levels in Iowa that it has in some other states, it’s still causing significant health problems. In 2018, 137 Iowans died from opioid overdoses, and while that’s down from 206 deaths in 2017, the prescribing rates for opioids in the state are still dangerously high. Death rates involving prescription opioids, heroin, and synthetic narcotics such as fentanyl all increased between 2014 and 2017.

Also disturbing is the number of deaths caused by polysubstance use, or the use of opioids combined with some other drug. Between 2008 and 2017, 287 people who died of a drug overdose died of an opioid mixed with another drug such as methamphetamine.

In 2017, the University of Iowa’s Injury Prevention Research Center convened a group of stakeholders to consider actions to address the crisis. Health care providers, law enforcement officers, public health officials, and others developed a list of priorities that lawmakers and policy makers could consider.

Some of those priorities were included in a new law passed in 2018. Among them are a requirement that practitioners check the state’s prescription monitoring program before prescribing an opioid to a patient, and strengthened prescriber education requirements on prescribing medications for chronic pain.

This past fall, the Injury Prevention Research Center convened a second group of stakeholders to consider the most important next steps the state and communities can take in response to the latest developments. We recently released a report, “Policy and Program Recommendations to Reduce Overdose Deaths in Rural Iowa,” that identified the five most important priorities:

• Develop programs that take a holistic view of treatment and recovery, incorporating support for employment, housing, and other social needs rather than focusing on medication-assisted treatment alone.
• Develop timely communication networks between pharmacists, law enforcement officials, employers, and other stakeholders. The opioid epidemic is a multifaceted issue that requires collaborative efforts from members of the community.
• Provide funding for naloxone access and distribution. Naloxone is a drug that has proved effective at helping people who have overdosed on opioids, but it’s expensive and not widely available.
• Combat stigma around opioid use disorder. People with substance use disorders are often stigmatized by language used to describe them or their disorder, or the reluctance of medical providers to offer services. In addition, misunderstandings of the effectiveness of medications used to treat opioid use disorder limits the impact of treatment and support.
• Consider polysubstance drug use in surveillance, prevention, and treatment efforts.

Some communities and organizations in Iowa are already taking steps to address the crisis locally that could be used as models for others. The city of Clinton developed a response team that meets every two weeks to discuss updates about drug issues in the community while identifying specific individuals who struggle with a substance use disorder and encouraging them to seek treatment. In its first six months, the team offered treatment resources to 40 people.

University of Iowa Hospitals and Clinics has also partnered with the Johnson County Sheriff’s Department to provide medication to treat the opioid use disorder of inmates in the county jail. Inmates in all jails often lack access to treatments and therapies that prevent severe withdrawal, but the Johnson County Jail Recovery Program increases their availability to people who need them.

The Iowa Healthcare Collaborative, a Des Moines-based health care quality improvement and patient safety organization, convened the Iowa Opioid Use Disorder Consortium to develop and execute strategies in rural Iowa. The organization has also developed an array of educational materials that can be used by clinicians and others, such as a pain management toolkit and comfort scale resources, and convened town hall meetings in 15 communities to educate health care providers and communities about the opioid epidemic.

The Iowa Board of Pharmacy is working to place medication disposal sites in pharmacies and law enforcement offices in all 99 counties where people can dispose of their controlled substances with no consequences.

But much more needs to be done. Iowa is fortunate that the opioid epidemic has not yet ravaged the state as it has others. Proactive steps by state and community leaders can ensure it does not.

Carri Casteel is associate professor of occupational and environmental health in the University of Iowa’s College of Public Health and associate director of the university’s Injury Prevention Resource Center. Jennifer Brockman is division director of health services at the Iowa Healthcare Collaborative.