UI leads project to address prescription opioid and heroin epidemic in Iowa

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.