5 priorities to reduce opioid overdose deaths

Prescription opioid drug overdose death has become an increasingly well-documented epidemic in Iowa and across the country in the last 15 years. More and more, people are using prescription opioid medications, often transitioning to heroin, destroying families and lives. Too often, it proves fatal.

The University of Iowa Injury Prevention Research Center recently convened a meeting of stakeholders in Des Moines to address methods of countering this growing crisis. Representatives from more than a dozen fields, including law enforcement, substance abuse treatment, medicine, public health and pharmacy, in addition to elected officials or their representatives, met in April to identify priorities that government leaders and policy makers could consider to address the epidemic.

The numbers in Iowa are disturbing, in both rural and urban areas. As many as 1,239 people died from an overdose of prescription opioids in Iowa between 2002 and 2014, and heroin deaths have increased nine-fold in 15 years. While rates of prescription opioid deaths are low in Iowa compared to other states, the death rate has quadrupled in the past 20 years. This makes Iowa only one of four states with such a dramatic increase. Prescription opioids account for the most overdose deaths among all opioid-involved deaths in Iowa.

The nine-fold growth of heroin deaths is two to three times higher than the national average. While prescription opioid overdose deaths have decreased in recent years, heroin deaths have risen as prescription opioid users switch to the more accessible and affordable drug.

In response, the stakeholders brought together by the university arrived at five priorities to address the crisis. Specifically, the stakeholders identified the need to:

? Provide evidence-based physician training in pain management and opioid prescribing to medical students while still in medical school. For current licensed professionals, develop a presentation that will provide a historical perspective with up-to-date data focusing on evidence-based solutions to alter the course of this epidemic.

? Educate physicians, nurses, pharmacists and other practitioners to ensure a strong knowledge base in recognizing patients at high risk for opioid abuse and addiction

? Make Iowa's Prescription Monitoring Program, a database of selected controlled substance prescriptions dispensed by Iowa pharmacies, an accurate and effective clinical tool for all prescribers

? Strengthen capacity to conduct opioid drug overdose surveillance and prescription opioid monitoring among multiple organizations and agencies

? Ensure that Medicaid and other state health programs adequately cover all FDA-approved medication assisted treatment and evidence-based behavioral interventions, and encourage or require commercial health plans to adopt similar policies.

We discussed these recommendations in more detail on Oct. 16 with the legislative interim study committee tasked to comprehensively evaluate Iowa's response to the opioid epidemic. This committee wants input from various relevant agencies and entities and plans to submit a report with its findings and recommendations to Gov. Kim Reynolds and the general assembly by Nov. 15, in time for action during the next legislative session.

The next step is for stakeholders across Iowa, including our political leadership and policy makers, to work together to identify ways to curb the opioid epidemic. We hope our report is an important part of that process.

The report, "The Prescription Opioid Crisis: Policy and Program Recommendations to Reduce Opioid Overdose and Deaths in Iowa," was funded by a grant from the U.S. Centers for Disease Control and Prevention. The full report is available online at uiiprc.org.

- Carri Casteel is an associate professor of occupational and environmental health in the College of Public Health at the University of Iowa. Kevin W. Techau is an attorney with the Scheldrup Blades Law Firm. He served as United States Attorney for the Northern District of Iowa from 2014 to 2017.