Iowa lawmakers scrutinize opioid law options

'There are people in Iowa who are dead because we fumbled the ball'

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DES MOINES — Lori Peter shares her devastating experience with opioid addiction often, and all over Iowa.

Everywhere she goes, she brings her son.

Kelly John Peter is forever 24 years old and cannot tell his own tale of heroin addiction. Two years ago, that addiction claimed his life.

“This is my son,” Lori said, holding up an urn and fighting back tears while speaking this past week at a hearing on opioid addiction, hosted by legislators at the Iowa Capitol, “because of the opioid epidemic.”

Kelly became addicted to heroin after abusing painkillers that he took from his parents’ medicine cabinet, Lori said.

The number of opioid deaths in Iowa is not as dire as in most other states. Iowa ranks near the bottom of the country in the rate of opioid deaths per capita, far below the worst-hit state, West Virginia, which saw more than 800 opioid-related deaths in 2016, the state’s Health Statistics Center found.

In Iowa, there were 180 opioid-related deaths in 2016, according to the state public health department. But that number is more than triple Iowa’s opioid-related deaths in 2005.

“We do have an epidemic in this state,” said David Heaton, a Republican lawmaker from Mount Pleasant. Heaton led the hearing on opioid addiction and co-chairs the Legislature’s health care budget committee.

Heaton pledged that the committee will produce some form of legislation to combat the epidemic for the 2018 session, which starts in January. He said unlike previous attempts, he hopes lawmakers are successful in passing some measures that will help address opioid addiction in the state.

More than half of the states require prescribers to consult the state’s Prescription Monitoring Program; Iowa does not. The program can help prescribers catch individuals who attempt to obtain opioid painkillers from multiple sources.

At least 17 states have established limits on the length of opioid prescriptions, according to the Washington Post; Iowa has no limit. Limiting the length of opioid prescriptions can drive down the number of prescriptions.

There are needle exchange programs in 33 states; Iowa does not have one. Advocates say they prevent the spread of infectious disease and create an avenue for people with addiction to seek treatment.

Forty states have a “Good Samaritan” law, which provides immunity for an individual who contacts authorities or emergency personnel to notify them of another individual who has overdosed; Iowa does not.

“I think we really fumbled the ball this last session,” said Chuck Isenhart, a Democratic lawmaker from Dubuque who sat on the legislative panel during the hearing. “I’m pretty confident there are people in Iowa who are dead because we fumbled the ball.”

Of the lawmaking options discussed over the two days, the Prescription Monitoring Program was most prevalent.

State officials say fewer than half of Iowa prescribers are registered to use the state’s voluntary program. Just 4 percent of dentists use it.

In additional to a pushback against mandates in general, some prescribers have complained Iowa’s program is too cumbersome. The state is in the process of upgrading the system.

“We are operating with an Atari when there is a PlayStation 4 available,” said Andrew Funk, executive director of the pharmacy board.

The many speakers who advocated for mandating use of the monitoring program say it can save lives by preventing individuals from accumulating large amounts of opioid painkillers.

“This is a tool that they can use for more information about the patient. So we would certainly support any way that makes it easy to register and easy to access” the program, said Mark Bowden, executive director of the Iowa Board of Medicine.

Lori Peter, who lost her son to opioid addiction, said she also worked in health care for 22 years doing prior authorizations for a Dubuque medical clinic. She implored lawmakers to make the monitoring program mandatory.

Lee Leighter, with the state public safety department, also encouraged lawmakers to mandate use of the program.

Leighter also said law enforcement should be able to access the database. Twenty-nine states have no restrictions on law enforcement access, or allow for access during active investigations, according to Temple University’s Policy Surveillance Program.

Iowa is among 15 states with the most restrictive access: law enforcement must obtain a warrant to access it.

Opponents of expanding law enforcement access to the database cite privacy concerns.

“I think, practically, it would save some lives,” Leighter said. “The taxpayers of Iowa have been paying me for 24 years. If you can trust me with criminal histories, but not the PMP, then there is a problem.”

Legislators have in the past introduced a bill mandating its use, but it did not get enough support. Neither did a bill introduced last year by Isenhart that would create immunity for individuals who call authorities to report an overdose.

Multiple speakers at the hearing advocated for lawmakers to try again so Iowa can join the 40 states with Good Samaritan laws for opioid overdose reporters.

Among the testimonies also were some calling for caution. Some speakers warned against lawmakers overcorrecting and causing unintended consequences.

“This is a big deal and I don’t want to minimize that,” said Dr. Bret Ripley of Des Moines University. “But I also want to remind you that the vast majority of doctors, your doctors, are people of good will who are trying to help you.”

A similar caveat was issued by Thomas Greene, a Republican senator from Burlington and a pharmacist.

“I’ve been a patient advocate for 45 years and I will continue to be,” said Greene, who was part of the legislative panel. “We have got to address abuse and misuse issues. ... But we cannot take a position that all opioid use is wrong. I mean, there are people who need it, who have chronic pain issues.”

Heaton was adamant lawmakers will proceed carefully and thoughtfully, but that they will craft legislation that he said must pass.

“We will put a bill together and this time we will not be turned back,” Heaton said forcefully. “There’s so many things to look at, but I’ll be damned if I’m going to back off this time.”

Lori Peter said the cost of inaction is high. She implored lawmakers to act when they convene in January.

“Please, in the name of my son and all the other people that have died and are suffering, please make changes,” Peter said. “All it can do is save lives.”

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