Heroin's hold: Iowa legislation allows responders to use 'opioid antagonists'

Protecting those who help

A 2-milliliter injection vile of Naloxone Hydrochloride, a drug that is highly effective in halting opiate overdoses, at Mercy Medical Center in Cedar Rapids on Wednesday, October 15, 2014. (The Gazette)
A 2-milliliter injection vile of Naloxone Hydrochloride, a drug that is highly effective in halting opiate overdoses, at Mercy Medical Center in Cedar Rapids on Wednesday, October 15, 2014. (The Gazette)

DES MOINES — Iowa lawmakers took steps this year to better equip emergency first responders and medical technicians to help deal with people experiencing a life-threatening drug overdose.

Under legislation that took effect April 6, law officers, firefighters, emergency medical personnel and others are authorized to procure, possess and administer emergency drugs known as opioid antagonists — such as naloxone hydrochloride — to people who are experiencing an overdose. Senate File 2188 also provided immunity from legal liability for people providing the drugs, so long as they acted reasonably and in good faith.

An opioid antagonist could be administered under the supervision of physicians, nurse practitioners and physician assistants in cases of an overdose of medications, such as hydrocodone, oxycodone, morphine and codeine generally used as painkillers.

Heroin's hold: Read the full series.

The new law also allows “people in a position to assist” — such as family members, friends, caregivers and health care providers — to possess and administer the opioid antagonist if they believe it is necessary. The state Department of Public Health has the responsibility for establishing standards and procedures for prescribing, distributing, storing and maintaining a supply of the antagonist, as well as for the training and authorizing people to administer it.

Steve Lukan, director of the Iowa Office of Drug Control Policy, said he supported the measure after some provisions were removed that made him uncomfortable in going too far in relying on an overdose reversal that is not a “miracle cure” or “silver bullet” in dealing with problems best addressed with prevention, education and less reliance — where possible — on powerful prescription drugs.

“We, like many other states, have seen a significant increase in overdose deaths. I definitely think the challenge exists,” said Lukan, who noted he is formulating legislative proposals he hopes to bring to lawmakers next year.

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They face funding challenges as Iowa was denied federal requests for money that went to states with bigger opioid-related problems.

“We are a big believer that a lot of these problems can be prevented inside the home,” Lukan said.

He applauded public health agency efforts to alert parents to potential problems and continuing education by the state Board of Medicine to encourage physicians to limit the prescribing of narcotic painkillers in the wake of a report indicating Iowans bought 300 million addictive pills last year in a state with just slightly more than three million residents.

“That’s a boatload of controlled substances. There’s a ton of drugs being prescribed,” Mark Bowden, executive director of the Iowa Board of Medicine. “You wonder where all this medicine is going and who’s getting it.”

Iowa has an estimated 15,000 health care professionals who can prescribe write controlled substances, with about one-third who have registered with a voluntary prescription drug monitoring program that was launched in 2009 to reduce the potential of patients “doctor shopping” for pills from other sources, Bowden noted.

Efforts to make registration mandatory have been resistance in the legislative process, he added, but legislation was enacted in 2014 that allows Iowa prescribers to check similar prescription monitoring programs in bordering states.

Need help?

Area Substance Abuse Council residential treatment: (319) 390-4611, asac.us

Cedar Rapids Comprehensive Treatment Center: (866) 289-0045, www.cedarrapidsctc.com

UnityPoint Health-St. Luke’s Hospital chemical dependency program: (319) 363-4429, www.unitypoint.org

Mercy Cedar Rapids Sedlacek Treatment Center: (319) 398-6476, www.mercycare.org

Prelude Behavioral Services: (319) 351-4357, www.preludeiowa.org

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