Iowa’s Opioid Epidemic

needle and opioid pillsThe 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

Laura McCaughey
Laura McCaughey

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).

MULTIDISCIPLINARY APPROACHES

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.

OPEN CONVERSATIONS

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.”

Related stories:

The Growing Opioid Crisis
Reversing the Tide

This story originally appeared in the fall 2017 issue of InSight.

The Growing Opioid Crisis

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.”

Related stories:

Iowa’s Opioid Epidemic
Reversing the Tide

This story originally appeared in the fall 2017 issue of InSight.

 

Gilbert receives New Faculty Research Award

A portrait of Paul Gilbert, assistant professor of community and behavioral health at the University of Iowa College of Public Health.Paul Gilbert, assistant professor of community and behavioral health, has been selected to receive a College of Public Health New Faculty Research Award of $10,000. The grant funding will be used for a project titled “Natural Recovery from Alcohol Use Disorders in Southeast Iowa.” The project will be funded for the 2017 calendar year.

The purpose of the New Faculty Research Award is to assist CPH primary faculty in collecting preliminary data or pilot studies leading to larger projects.

Project Description

The majority of people in the United States with an alcohol use disorder (AUD) do not receive treatment, and some social groups, such as women and racial/ethnic minorities, are less likely to receive help than their male and White counterparts, respectively. Nevertheless, as many as three-quarters of those with AUD will achieve remission without treatment. This paradoxical phenomenon of unassisted self-change, known as natural recovery, has been long recognized by alcohol scholars but remains poorly understood.

Research over the past three decades has identified a number of factors associated with natural recovery, such as individual psychosocial characteristics, interpersonal networks, individual health status and health events, and environmental circumstances. In turn, these findings have been applied in a wide variety of intervention trials to promote natural recovery, often with only modest success in reducing problematic drinking. Such limited effectiveness may be due to incomplete understanding of the processes at work.

Further, there has been scant attention to variability of this phenomenon. Only one study to-date has examined effect modification by gender, finding differences in the psychosocial and interpersonal factors associated with natural recovery between men and women. To the researcher’s knowledge, there has been no reported investigation of differences between racial/ethnic groups, despite criticism that many early studies of natural recovery relied on overly homogeneous, predominantly White samples.

In response, this study will use qualitative methods to elaborate the processes of natural recovery among White, Black, and Latino men and women in southeast Iowa.

The specific aims of the project are:

  • To identify and characterize the process of natural recovery among adults who have not received treatment for alcohol misuse.
  • To determine the most productive recruitment strategies to reach adults who have experienced natural recovery.

The study’s preliminary data will be used in support of a larger, subsequent study to examine natural recovery.

Walker to speak on American Indian, Alaska Native behavioral health

Spotlight Series LogoNative Heritage—Understanding American Indian/Alaska Native Behavioral Health:
Pursuing the Cause of the Causes

 

Dale Walker, MD, Director of the One Sky Center
Professor Emeritus of Psychiatry, Oregon Health and Science University

Wednesday, Nov. 9
12:30 – 1:30 pm
Callaghan Auditorium

The health status of American Indians and Alaskan Natives is well documented to be far below that of the general population of the United States. Chronic diseases are especially problematic, and behavioral health conditions such as depression, anxiety, addictions, suicide, and family disruption are concerns across all tribes. In addition, the ability to provide adequate, culturally sensitive, evidence-based care in this era of health reform is especially challenging.

In this presentation, Dr. Dale Walker will review the chronic illness issues of Native populations, with a special focus on suicide and substance use disorders. Dr. Walker will examine the use of culturally derived social skills training and social determinants—defined as how and where we live, learn, work and play throughout our life—as powerful integrative tools to assist our efforts in rethinking health care delivery in Native communities.

Dr. Walker is the director of the One Sky Center, a National Resource Center for American Indian and Alaska Native Health, Education and Research. It is dedicated to quality health care across Indian Country.

Free webinar: The Science of Addiction – The Brain on Adolescence

The National American Indian & Alaska Native ATTC is hosting a free webinar presented by Ken Winters, PhD, on  “The Science of Addiction: The Brain on Adolescence.” The webinar will take place Wednesday, Oct. 19 from noon to 1:30 p.m. Central Time.

Registration is free, but pre-registration is required to access the webinar.

To register, please use the following link:
https://naianattc.adobeconnect.com/oct19_16/event/registration.html

 

Training future tribal health leaders

a group shot of Leadership Academy participants
Leadership Academy participants

Leaders of behavioral health programs in tribal communities have expressed concerns about the aging workforce, especially among leaders of substance abuse and mental health prevention and treatment programs.

To help develop future leaders in these professions, the National American Indian and Alaska Native Addiction Technology Transfer Center (ATTC) based in the College of Public Health has created a training program called the American Indian & Alaska Native Leadership Academy for behavioral health professionals.

The yearlong Leadership Academy consists of face-to-face events, webinars, regular conference calls, and mentor support. The curriculum was culturally adapted from an existing leadership training model with the input of tribal leaders. One significant change was to emphasize the role of mentoring in leadership development.

“The mentoring concept is much more in tune with tribal culture than a top-down protégé model of leadership,” says center director Anne Helene Skinstad, who adds that the curriculum was re-tooled to fit broadly shared cultural aspects of American Indian and Alaska Native leadership styles and decision-making processes. “Face-to-face interaction is important as well,” Skinstad notes.

Treatment approaches need to consider American Indian and Alaska Native cultures and healing practices, as well as the generational and historical trauma that affect native communities, notes Skinstad. The Leadership Academy develops culturally informed behavioral health providers who can also navigate the rapidly changing health care environment.

“The goal is for the mentees to go on to leadership positions in behavioral health and in the tribal government,” says Skinstad. “Additionally, it’s important for the mentees to have an understanding of both worlds—tribal and non-tribal— to be successful as leaders.”

This story originally appeared in the Spring 2016 issue of InSight