Guest Columnist

Lawmakers can do much more on opioids

A pharmacist counts tablets of Hydrocodone at a pharmacy on June 21, 2017. (Bryan Woolston/Reuters)
A pharmacist counts tablets of Hydrocodone at a pharmacy on June 21, 2017. (Bryan Woolston/Reuters)

Zach’s Laws. Abby’s Laws. Terry’s Laws. Ryan’s Laws. Kelly’s Laws. If the Iowa Legislature wanted to honor the memories of people who have died of opioid overdoses, the laws could go by many names, just based on people I know from my own community.

Two years ago, the Iowa Legislature offered a slice of bread in response to the hunger of Iowans to deal with the opioid/heroin public health emergency in our state. We expanded access to naloxone, the overdose reversal drug.

After two years of dragging our feet — despite a near unanimous 2016 compact by state governors to address the crisis — the General Assembly convened a study committee on which I served to “evaluate” the epidemic in Iowa.

With the passage of House File 2377 — now awaiting action in the Senate — legislators are offering Iowans half a loaf, if that. Most notably, the bill creates “good Samaritan” legal protections for overdose victims who receive emergency treatment and for overdose reporters who call 911 to help others.

The bill requires drug prescribers to register for and use an improved prescription monitoring program (PMP) to identify and address the misuse and overuse of powerfully addictive drugs such as oxycodone.

HF 2377 contains few other recommendations related to prevention, harm reduction and treatment that I made following two days of exhaustive testimony in October (the study committee itself failed to deliver any findings or recommendations to the Legislature, as required by our mandate).

One omission: No limits on opioid prescriptions, such as a seven-day quantity limit on first-time prescriptions proposed by Gov. Kim Reynolds and Attorney General Tom Miller.


But the chief shortcoming is the lack of funding to expand treatment capacity and services for people with substance use disorders, such as medication-assisted treatment. “MAT” and associated mental health and social services now are provided by a limited number of providers to a limited number of patients, available in only a few areas of Iowa.

The services now are supported by unstable federal grant dollars. Dubuque County recently committed $300,000 from property taxes to sustain a program at Mercy Medical Center in Dubuque. Iowa can dedicate $20 million to $40 million for substance use treatment with a 5 percent wholesale tax on opioids and other controlled substances (which Rep. John Forbes and I have proposed) or a nickel a bottle increase in the beer excise tax (which Rep. Terry Baxter has proposed).

The Iowa Harm Reduction Coalition has argued that needle exchange programs would save lives and save insurers millions of dollars. How: Reduced expenses treating HIV, hepatitis, heart infections and other maladies associated with dirty needles used by people who turn to heroin because of their inability to withdraw from an opioid addiction. Iowa Medicaid has paid out close to $10 million since April 2017 treating people with these diagnoses.

Bonus: People who use needle exchange programs are five times more likely to voluntarily seek treatment for their addictions. Double bonus: Increased safety for law enforcement and first responders at risk for needle sticks.

I offered to add other slices to the legislative loaf with a detailed amendment that the floor manager of HF 2377 declined to entertain. Among them:

• Set an aspirational goal to increase the number of people with substance-use disorders who are receiving treatment from 10 percent (current reality) to 80 percent, by ensuring that comprehensive coverage is provided by both private and public payers;

• Establish surveillance standards and requirements for overdose and substance addiction data to be collected by county boards of health;

• Require substance use disorders to be addressed in all county health needs assessments and health improvement plans;


• Provide continuing education regarding mental health and substance use for emergency room physicians;

• Instruct the Department of Administrative Services and Iowa Medicaid Enterprise to create and, where possible, implement model benefit plan designs to optimize the delivery of substance use disorder care to people covered under state-sponsored health benefit plans;

Naloxone is like the “Jaws of Life” for people who are overdosing. Bringing down the cost of naloxone to make it more available remains a challenge.

House Democratic minority leader, Rep. Mark Smith, has committed to join Speaker of the House Linda Upmeyer to advance a more comprehensive “leadership bill” exempt from legislative deadlines. As “minority whip” on this issue, I have guaranteed that House Democrats would combine with Republicans to provide supermajority support to enact these and other measures.

House Democrats want to act now to address the multifaceted opioid emergency in all its dimensions, lest the headlines start looking like those in Ohio, New Hampshire, West Virginia and other states.

Stakeholders ranging from the Farm Bureau to the construction industry are taking note of how wide-ranging the effects of the opioid addiction have become. No one is immune.

So this is not a political, much less a partisan matter. No one is going to win or lose an election because of what we do. But no one should lose his or her life — and no parent should lose a child — because of what we fail to do. To honor the memories of those we already have lost, the time to act is now.

• State Rep. Chuck Isenhart, D-Dubuque, serves on the General Assembly’s Opioid Epidemic Evaluation Study Committee.

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