The college is tackling Iowa’s increasingly deadly opioid crisis with a multidisciplinary response.
Despite its relatively small population, Iowa is not immune from the opioid epidemic. While prescription drug overdose deaths and rates of opioid prescribing are low in Iowa compared to other states, rates of prescription opioid deaths since 1999 have quadrupled in Iowa, making it only one of four states with such a dramatic increase. Reflecting national trends, the state is also seeing rising rates of heroin deaths.
“Heroin overdose death rates in Iowa have increased more than nine-fold in the past 15 years,” says CPH Associate Professor Carri Casteel, associate director of the UI Injury Prevention Research Center (IPRC). “The rapid growth of heroin death rates in Iowa is two to three times higher than the national average.”
A SECOND CHANCE
Laura McCaughey of Davenport, Iowa, was almost one of those overdose death statistics. McCaughey was introduced to heroin at age 16 by a boyfriend and was soon hooked. “Drug dependency gets out from under your feet before you know it,” she says.
She barely graduated from high school and dropped out of college after one semester. She job-hopped and acquired a criminal record, finding herself stuck in the same cycle for four years even though she sought treatment several times. “Nothing would stick,” McCaughey says.
Heroin addiction nearly took her life. “I OD’ed five times,” she says, recalling how she’d wake up in hospitals throughout eastern Iowa. “Every time my record got worse because I was found with drug paraphernalia.”
In October 2012, at the age of 20, McCaughey was jailed for possession of heroin and drug paraphernalia after being pulled over by Davenport police. “My parents wouldn’t bail me out because they knew I was safe there,” McCaughey says. “I had no stability, I didn’t have anything. I was just defeated.”
McCaughey credits the judge who heard her case for giving her a second chance. “She told my parents, ‘She’s not a criminal, she needs help.’ The judge let me out on the condition that my dad immediately drive me six hours to a treatment facility in Sioux City.”
The treatment stuck, and in 2013 McCaughey returned to Davenport to restart her life. Now 25, McCaughey is working full-time, pursuing a degree in psychology, and raising her two-year-old daughter. “She’s the light of my life,” McCaughey says.
PARTNERING ON A RESPONSE
McCaughey’s story underscores the complexity of opioid abuse and the importance of involving many partners and resources in responding to the crisis.
In November 2015, IPRC co-sponsored the summit “Heroin and Opioids: A Community Crisis.” The event, hosted at the College of Public Health, brought together more than 200 experts to discuss the heroin and prescription opioid epidemic plaguing eastern Iowa.
IPRC also has conducted research on prescription opioid and heroin overdoses and overdose deaths in Iowa using state death certificate records (2002–2014) and insurance claims data (2003–2014). Among the key findings:
- The rate of prescription opioid overdoses in Iowa increased from 2.1 /100,000 in 2003 to 8.8 /100,000 in 2009. This rate declined to 5.1/ 100,000 in 2014.
- In Iowa, prescription opioid overdoses and overdose deaths are decreasing, while heroin overdoses and overdose deaths are increasing.
- Those ages 25 to 49 make up the majority of all opioid-involved overdose deaths in Iowa.
- Males make up the majority of deaths from both prescription opioids and heroin.
IPRC also met with key stakeholders in Iowa to identify priorities to address this growing crisis in the state (see page 6).
College of Public Health researchers are taking a multidisciplinary approach to addressing opioid use and addiction in Iowa.
“We’re doing work on risk factors for overdose and dependence, and thinking about patterns of use,” says Ryan Carnahan, CPH associate professor of epidemiology. Investigators are also looking at patterns of long-term prescription opioid use, especially in conditions unlikely to benefit from it. Future work may involve in-depth evaluations of prescribing patterns for different health conditions.
Natalie Langenfeld, a doctoral student in biostatistics, is conducting research that applies infectious disease modeling to study the path of opioid addiction in communities over time (monthly) and space (Iowa’s 99 counties). The model incorporates data on prescription rates, demographics, overdose death records, possession arrests, distribution and manufacturing arrests, and treatment data. Ultimately, the model can be used to evaluate interventions as new data are made available.
The Iowa Institute of Public Health Research and Policy (IIPHRP) and the CPH Research Office have convened a broad group of researchers from across the university, including public health, pharmacy, and medicine, to identify teams interested in opioid research.
“Bringing together multidisciplinary teams generates new ideas and initiatives that will inform practices and policies related to this important topic,” says Vickie Miene, IIPHRP interim director.
McCaughey encourages more open conversations about opioid use. “If five people are in a room, probably three know someone who is affected by addiction,” she says. “The more we talk about it, the quicker we’ll find solutions and save someone’s life.”
McCaughey is vice president of Quad Cities Harm Reduction, a nonprofit organization working to save the lives of those struggling with substance use disorders. She remains strongly motivated to help others caught in drug dependency.
“I want to be a source for people to come to if they’re ready to be clean, or whatever is going on with them. Addicts are so alone,” McCaughey says. “I didn’t die for a reason. I want my daughter to be proud of me. I want to have a good ending to my story.”
This story originally appeared in the fall 2017 issue of InSight.
Both urban and rural areas are awash in opioids.
The United States is struggling with a worsening opioid epidemic. Since 1999, the number of overdose deaths involving opioids (including prescription painkillers and heroin) quadrupled. Every day, 91 Americans die from an opioid overdose and more than 1,000 people are treated in emergency departments for misusing prescription opioids, the Centers for Disease Control and Prevention reports. The numbers continue to trend upward. In 2015, there were more than 52,000 drug overdose deaths in the United States. That number grew to an estimated 64,000 overdose deaths in 2016, according to provisional data compiled by the National Center for Health Statistics.
The current epidemic of drug overdoses began in the 1990s, driven by increasing deaths from prescription opioids that paralleled a dramatic increase in the prescribing of such drugs for chronic pain, according to a CDC report. In recent years, as health care providers have become more cautious in prescribing opioids, other illicit drugs—including heroin and synthetic opioids such as fentanyl—are driving sharp increases in overdoses and deaths.
“This issue affects all of Iowa,” emphasizes Carri Casteel, associate director of the University of Iowa Injury Prevention Research Center, which is taking part in a CDC-funded project on preventing overdoses. “Our research shows deaths from prescription opioid overdoses are concerns in both urban and rural counties in Iowa. We also found high doses of prescription opioids are dispensed in both rural and urban parts of the state. It crosses all borders.”
College of Public Health researchers from across disciplines are collaborating to provide data about the opioid crisis in Iowa and develop policy and program recommendations to prevent overdoses.
“There’s a lot of interest in Iowa around prescription opioids, heroin, and fentanyl,” says Casteel. “We have many stakeholders—law enforcement, physicians, and others— looking for better ways to communicate ongoing efforts and share data to address the crisis.”
This story originally appeared in the fall 2017 issue of InSight.
A new report from the University of Iowa includes several policy and program recommendations to address the state’s opioid crisis after a review process involving dozens of stakeholders from across the state.
Carri Casteel, associate professor of occupational and environmental health in the UI College of Public Health and report co-author, says the epidemic is affecting all Iowans, whether they live in rural or urban counties. She points to data that show more than 700,000 opioid prescription pain relievers (OPRs) were dispensed by pharmacists to new OPR users between 2003 and 2014.
Meanwhile, heroin deaths have increased more than ninefold in Iowa in the past 15 years, three times higher than the national average. In addition, prescription opioid overdose deaths in Iowa have quadrupled since 1999.
“While the rates of prescription opioid overdose deaths are lower in Iowa than in many states, these are disturbing and tragic trends that mirror the national prescription opioid epidemic,” says Casteel.
The report was compiled with a grant from the United States Centers for Disease Control and Prevention to the university’s Injury Prevention Research Center (IPRC), one of four injury research centers in the country to participate in the grant. The centers gathered hundreds of opioid experts in their states to recommend methods for preventing prescription opioid misuse, overdose, and overdose deaths.
In Iowa, the IPRC convened 33 stakeholders in Des Moines in April to identify public policy and program priorities for addressing the opioid epidemic in the state. The group included representatives from law enforcement, substance abuse treatment, medicine, psychiatry, nursing, public health, nonprofit/advocacy, poison control, insurance, state and local drug-control policy, and pharmacy, as well as elected officials or their representatives. Their top five priorities include:
- Providing evidence-based physician training in pain management and opioid prescription in medical school. For current licensed professionals, developing a presentation that will provide a historical perspective with up-to-date data focusing on evidence-based solutions to alter the course of the epidemic.
- Educating physicians, nurses, pharmacists, and other practitioners to ensure a strong knowledge base in recognizing patients at high risk for opioid abuse and addiction.
- Making the Iowa Prescription Monitoring Program (PMP), a database of all prescriptions of certain types of controlled substances filled by pharmacies in the state, an accurate and effective clinical tool for all prescribers. Stakeholders need to work together to identify and enact measures that will eliminate current barriers preventing Iowa’s PMP from reaching maximum use and effectiveness.
- Strengthening capacity to conduct opioid drug overdose surveillance and prescription opioid monitoring among multiple organizations and agencies.
- Ensuring that Medicaid and other state health programs adequately cover all FDA-approved medication-assisted treatment prescriptions, such as methadone, as well as behavioral interventions. Encouraging or requiring commercial health plans to adopt similar policies.
The committee will discuss the report with the interim study committee tasked with evaluating Iowa’s response to the opioid epidemic on Monday, Oct. 16. The committee wants input from various relevant agencies and entities and plans to submit a report with its findings and recommendations to Iowa Governor Kim Reynolds and the general assembly by Nov. 15, in time for possible action during the next legislative session.
The report also highlights successful initiatives in communities across Iowa. For instance, the Eastern Iowa Heroin Initiative has placed prescription drug drop boxes in nearly every county and trains law enforcement agencies around the state on methods for successful investigation of heroin overdoses. The report also features the Alliance of Coalitions for Change and Iowa Pharmacy Association, which organizes community discussions around the state targeting physicians, pharmacists, dentists, nurses, chiropractors, social workers and representatives from treatment programs to discuss opioid trends and look for collaborative ways to address the issue.
The report is online at www.uiiprc.org.
This article originally appeared in Iowa Now
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