Even though the opioid crisis has not reached the same severity in Iowa as in some other states, a new report about drug deaths in Iowa provides yet another reminder about the urgent need for legislators to act.
Opioid death rates in Iowa have remained relatively steady since 2011, at about six deaths per 100,000 people, according to a report published this month by the Iowa State University rural sociology program.
Neighboring states Illinois, Missouri and Wisconsin have opioid death rates at least twice as high as Iowa’s. However, a closer look at the data reveals a concerning trend. Prescription opioid deaths have fallen sharply in Iowa in recent years, according to the study, but deaths from synthetic opioids, like heroin and fentanyl, have grown by about 20 percent annually in the last few years.
The report’s authors note, “This runs counter to public perception that prescription users are the face of the opioid crisis.”
Journalists and policymakers often talk about opioid deaths as a single crisis. In many ways, though, opioid abuse represents several different but overlapping crises. Prescription painkiller abuse and illegal drug use each have different causes and demand different responses.
So far, the policy response has largely focused on prescription drugs. A law signed in Iowa last year creates a prescription drug monitoring program, mandating digital records for potentially dangerous pharmaceuticals. The intended purpose is to identify doctors who overprescribe, or patients who seek out prescriptions from multiple doctors.
That bill received overwhelming bipartisan support. Unfortunately, it does not address what may be the more pressing problem.
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Nationwide, the share of opioid-related deaths involving heroin or fentanyl has increased dramatically in recent years, from 28 percent in 2010 to 75 percent in 2017, according to the Centers for Disease Control. The portion of opioid-related deaths involving prescription painkillers alone - that is, without mixing with other drugs - may be as low as 10 percent, according to a study published this month in the Journal of Pain Research.
Of course, illegal drug dealers will not participate in Iowa’s developing prescription monitoring program. Restrictions on prescription medication are unlikely to do anything to prevent overdoses and infections from injection drugs.
The crackdown on prescriptions has made them costlier and less widely available, according to those who work with people using drugs. That sometimes leads them to illicit drugs like heroin.
“A lot of people will talk about how over time they knew fewer and fewer people who consistently had pills available. They might have pills available still, but they can get heroin a lot cheaper,” said Sarah Ziegenhorn, director of the Iowa Harm Reduction Coalition.
When the Iowa Legislature approved the prescription reforms last year, they unfortunately declined to advance a crucial bill to legalize a statewide needle exchange program.
There are at least two needle exchange bills in the current Legislature. Senate File 125 by Sen. Brad Zaun, R-Urbandale, would direct the Iowa Department of Public Health to manage a needle exchange program. Senate File 178 by a group of 11 Democrats, would remove authorized syringes from the state’s list of drug paraphernalia.
Those proposals have drawn support from local governments and health care workers. Even law enforcement professionals, who have sometimes been resistant to harm reduction policy, are coming around to the idea.
Syringe service programs “create a point of contact with people with substance use disorders so they can access detoxification and treatment programs with help from community health outreach workers,” Iowa City Police Chief Jody Matherly said in a statement circulated by the Iowa Harm Reduction Coalition.
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Needle programs have multi-faceted benefits. Most obviously, they prevent infections by offering clean needles. Opioid-related death figures usually do not include infections from needles. While experts disagree about how common those deaths are, there’s no doubt a hepatitis C or HIV diagnoses carries significant impacts for a person’s quality of life, and also to public health care costs.
Perhaps even more importantly, harm reductionists say needle exchange programs are a “gateway to treatment,” connecting drug users with other health resources. If someone is ready to curb their opioid use, needle exchange organizers are in a position to help, since they have a pre-existing relationship.
The alternative is to condemn and isolate people experiencing addiction. They will continue using drugs in dangerous ways and the death count will continue to rise. This choice should not be difficult.
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