Building Dissemination into Your Research: A Framework for Success
Tuesday, September 25
Noon to 12:30 pm Lunch
12:30 to 1:30 pm Presentation
Learn from our partners at the Center for Injury Research and Policy at Nationwide Children’s Hospital (Columbus, OH) about their experience getting injury prevention work out of the journals and into the hands of policymakers, corporations, parents, teachers, and coaches.
They will discuss the importance of sharing your program’s successes and research beyond journals and conferences, discuss ideas and a framework for doing so, and present a case study.
Sponsored by the UI Injury Prevention Research Center
Individuals with disabilities are encouraged to attend all University of Iowa-sponsored events. If you are a person with a disability who requires a reasonable accommodation in order to participate in this program, please contact the College of Public Health in advance at (319) 384-1500.
Strategies to End Fatal Bicycle Crashes in Iowa: Policy, legislative, and infrastructure solutions
Presented Wednesday, December 20, 2017
This webinar provides an overview of where Iowa stands in terms of bicyclist crashes and fatalities, the status of the Iowa DOT Bicycle and Pedestrian Long Range Plan, engineering and policy solutions, and priorities and recommendations for the 2018 legislative session. The mother of Sylvia Clark-Hansen, who was killed in a bicycle-motor vehicle crash in October, also shares her story.
Webinar Panelists (in order of presentation)
Cara Hamann, MPH, PhD, Policy Fellow, University of Iowa Institute of Public Health Research and Policy; Core Faculty, University of Iowa Injury Prevention Research Center
Garrett Pedersen, CPM, Planning Team Leader, Office of Systems Planning, Iowa Department of Transportation
Researchers and advocates outline priorities for responding to the opioid epidemic in Iowa.
States and communities across the nation are grappling with how best to respond to the surging opioid crisis. In April 2017, the UI Injury Prevention Research Center (IPRC) sponsored a meeting in Des Moines to identify priorities for addressing the opioid epidemic in Iowa. The meeting was part of a larger national project funded by the Centers for Disease Control and Prevention, with the UI IPRC being one of four injury centers in the country participating in the grant.
Carri Casteel, IPRC associate director, led the meeting to discuss recommendations developed by the John Hopkins Center for Injury Research for reducing the opioid epidemic in several areas, including prescription monitoring programs, prescribing guidelines, overdose education, and community-based prevention. One goal of the meeting was to review these evidenced-based strategies and compare them to what is happening in Iowa.
“It was an opportunity for those working in fields affected by opioids to take an inventory of our successes and to identify gaps specific to Iowa that need to be addressed to move forward on this issue,” Casteel says.
Stakeholders at the meeting represented law enforcement, psychiatry, emergency medicine, public health, nursing, non-profit/advocacy, poison control, substance abuse treatment, pharmacy, insurance, drug control policy, elected officials, and others.
IDENTIFYING IOWA’S PRIORITIES
Among the barriers stakeholders identified were lack of training for health care providers on opioid addiction and treatment, lack of timely state data on opioid supply and overdose, and limited and unequally distributed addiction treatment services in Iowa.
The top five priorities for Iowa that stakeholders identified were:
Provide physicians with evidence-based training in pain management and opioid prescribing.
Educate physicians, nurses, pharmacists, and other practitioners to recognize patients at high risk for opioid abuse and addiction.
Make the Iowa Prescription Monitoring Program a more accurate and effective tool.
Strengthen opioid overdose surveillance and prescription opioid monitoring among multiple organizations and agencies.
Improve health coverage for medical-assisted treatment and evidence-based behavioral interventions.
IPRC published the report “The Prescription Opioid Crisis: Policy and Program Recommendations to Reduce Opioid Overdose and Deaths in Iowa” that contains details about the five priorities, county-level statistics on opioid overdose death rates and prescribing practices in Iowa, along with highlights of initiatives in Iowa communities that have had some success in slowing the epidemic. The report is available online at cph.uiowa.edu/iprc.
The report was sent to Iowa policy makers and other state leaders, and the proposals were discussed with a legislative interim study committee tasked with evaluating Iowa’s response to the opioid epidemic. This committee submitted a report with its findings and recommendations to Iowa Gov. Kim Reynolds and the general assembly to inform possible action during the next legislative session.
REDUCING HARM AND STIGMA
Community-based prevention efforts that focus on education, advocacy, and harm reduction strategies are also garnering attention. The national organization Harm Reduction Coalition defines harm reduction as “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. … Harm reduction incorporates
a spectrum of strategies from safer use, to managed use, to abstinence, to meet drug users ‘where they’re at,’ addressing conditions of use along with the use itself.”
“Much like substance use, harm reduction has a long but stigmatized history,” says Paul Gilbert, CPH assistant professor of community and behavioral health. “People often thought it was too permissive or even encouraged drug use. But high-quality, rigorous evaluations have shown that harm reduction strategies are associated with substantial benefits, such as fewer wounds and abscesses, reduced hepatitis and HIV infections, and lower risk of overdose and death. Given the scientific evidence that’s accumulated, it belongs in our repertoire of public health responses to substance use.”
Kim Brown of Davenport, Iowa, is president and co-founder of Quad Cities Harm Reduction (QCHR). She helped form the nonprofit organization after losing her 33-year-old son Andy to an unintentional heroin overdose in May 2011.
“All of these overdose deaths are preventable,” says Brown, who is a registered nurse. “Addiction is a medical disorder. It should be firmly entrenched in public health. As long as we criminalize a medical condition, we have shame and stigma. We need true, realistic drug education.”
Andy’s death was shrouded in stigma, Brown recalls. “Nobody would talk to me about what happened to my son. But I wanted to do something to bring awareness to the community and legislators and law enforcement.”
INCREASING NALOXONE ACCESS
Brown has been advocating since 2012 for increased naloxone access in Iowa. Naloxone is a medication administered as a nasal spray or injection to reverse the effects of an opioid overdose.
In late 2016, a new Iowa law coupled with a standing order issued by Dr. Patricia Quinlisk, Iowa Department of Public Health Medical Director, allows naloxone to be purchased at a pharmacy without a prescription. Pharmacists are authorized to dispense naloxone to individuals at risk of opioid overdose, a family member or friend in a position to assist an at-risk person, and first responders.
More recently, University of Iowa emergency medicine physician and CPH alumnus Chris Buresh (12MPH) provided a standing order that allows QCHR and the Iowa Harm Reduction Coalition in Iowa City to dispense naloxone without prescription to Iowans at little to no cost. The standing order went into effect June 1, 2017.
But Brown would like to see even more done. “The state needs a standing distribution order to community and harm reduction organizations. We need a syringe exchange program to prevent people from getting HIV or hepatitis C and to keep used needles out of public bathrooms and off the ground.
“We need to get naloxone to the folks who really need it,” she continues. “Overdoses are often reversed by friends and family. I can’t have my son back, but I can help others keep their children alive.”
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.”
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.”