Significantly fewer people died from opioid-related symptoms last year in Iowa, resulting in a 10-year low for the state, according to statistics released this month by the Iowa Department of Public Health.
In 2018, Iowa saw 137 opioid-related deaths, a 33 percent reduction from the 206 deaths in 2017, the Bureau of Health Statistics reported. It reverses, at least for now, what had been a general increase for years in opioid-related deaths in the state, from 168 in 2014, 163 in 2015 and 180 in 2016.
The 2018 total is the lowest number of opioid-related deaths seen in Iowa since 2008. said Kevin Gabbert, the Public Health Department’s opioid initiatives director.
“In 2008 the total number of opioid-related deaths was 135, and then the number started to climb in 2009. So prior to 2008 and since then, the number has always been higher than the 137 we saw in 2018,” he said.
Like Iowa, and for the first time in decades, it is possible the United States as a whole might see a decline in drug overdose deaths in 2018, according to the Centers for Disease Control and Prevention. However, overdose deaths attributed to opioids like fentanyl have increased by more than 45 percent from 2016 to 2017.
The total number of U.S. overdose fatalities in 2018 still is being calculated, but provisional data from the CDC predict it to be around 69,100, down from nearly 72,300 deaths for the year before. If that decline held through December, the annual total of drug deaths will have fallen for the first time since 1990, the CDC said.
Gabbert attributed Iowa’s decline in opioid-related deaths in part to the state’s efforts to curb access through the use of a prescription drug monitoring program and the increased availability of the opioid overdose-reversal drug, Narcan.
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“I think what (decrease in deaths) tells us is that the efforts around the state are showing results,” he said. “I think that we have expanded access and the availability of tools — such as Narcan — across the state — and not only through the actions that we’ve taken here at Public Health with our initiatives, but also through community coalitions and harm-reduction approaches, as well as a variety of other efforts that are taking place across the state. So, I think now we’re starting to see some results.”
Gabbert said the state also has increased access to drug treatment.
“We’ve seen a significant expansion in the availability of medication-assisted treatment in the state over the course of the past year,” he said. “Because it’s not enough for us to reverse an overdose if we don’t have opportunities for these individuals to get help. So, we’ve got medication units opening up in several communities, in addition to a significant increase the number the number of prescribers who are able to prescribe drugs used to treat opioid addiction, such as Suboxone.”
All of which are beneficial resources, said Sarah Ziegenhorn, executive director of Iowa Harm Reduction Coalition, adding that she had a different take.
Iowa Harm Reduction Coalition is a nonprofit public health organization that provides overdose prevention training and medicine, HIV and hepatitis C testing, patient navigation services, safer injection training and housing referrals.
“From the data, yes, it does seem like overdose deaths are decreasing,” she said. “And there’s a number of reasons why that could be happening.”
Ziegenhorn, who has a background in public health policy research, was careful to point out that “correlation doesn’t equal causation.” Looking beyond the data is important, she said, adding the numbers should likely lead to more questions, not conclusions.
“The first thing that could be happening is that there just aren’t enough people that are using opioids left, because so many heroin users have already died, so there are not enough to die at increasing rates every year,” she said.
“Another possibility is that people have voluntarily and intentionally shifted their drug use away from heroin and other opioids to methamphetamine because heroin is so dangerous now.”
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With the risk of fentanyl and other synthetic opioids contaminating heroin supplies, Ziegenhorn said it’s possible users are taking actions in how they protect their lives and make choices about their drug use.
“Another possibility is that the total number of users in the population has decreased,” she said. “And finally, it could mean that something is going right, something we’re doing is contributing to this decline.”
Ziegenhorn said the decline in deaths also correlates with the coalition’s distribution of naloxone, also known under the name brands of Narcan and Evzio.
“We’ve distributed now between 15,000 and 20,000, doses of naloxone since July 1 of 2017,” she said. “And when we distribute those kits, they go almost exclusively into the hands of people who are using drugs.”
The idea, she said, is “to flood the state with as many doses of naloxone as possible.”
“Roughly 85 percent of overdose reversals are completed by people who use drugs and are witnessing an overdose among their friend group or in their social network,” Ziegenhorn said. “So, if you train everybody in the entire community, you equip everyone — law enforcement, people who use drugs, the parents and family members of people who use drugs, first responders, firefighters — it’s likely that we will see a decrease in fatal overdoses.”
Iowa, which has one of the lowest overdose rates in the United States, has launched several initiatives over the past year that aim to curb overdose deaths, Gabbert said, many of which focus on prevention and education.
“We want to make sure we are doing whatever we can to deter Iowa from becoming the next Vermont or West Virginia or Massachusetts,” he said. “And we want to continue to make sure that we’re not looking at this five years down the road and saying, ‘remember when we saw this thing and could have done something,’ and the damage is already done.”
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