Iowa's opioid fight: Signs of crisis, signs of hope

Drug overdoses are now the leading cause of death for Americans under age 50, killing roughly 64,000 people in the United States last year. An increase in fatalities is largely fueled by opioids, including fentanyl, a powerful synthetic substance considered up to  50 times more potent than heroin.

Although Iowa has not been hit as hard as some other states by the opioid epidemic, we have not been spared. 

So far this year, 124 Iowans have died from opioid-related causes, according to the Iowa Department of Public Health. Addiction treatment admissions for opioid use have more than tripled over the past decade.

Drug overdoses reduce overall life expectancy in this country. They strain police departments, human services systems, hospitals and paramedics. And they devastate families.

IN IOWA: Epidemic is tragically personal for Iowa public-health expert

Iowa's capital city is “definitely seeing a rise” in overdoses, said Lt. Tony Sposeto, with the Des Moines Fire Department’s emergency medical services team. In 2016, these first responders administered 191 doses of Narcan, a drug used to reverse an opioid overdose. The first nine months of this year, they used it 202 times.

“The number has been steadily increasing,” he said. “We’ve had overdoses in public places, shopping centers, multiple overdoses on one scene.” His department responded to a call where three people at a single location overdosed on heroin.

Paramedics are also seeing more overdoses from fentanyl, which require a larger amount of Narcan to treat. The department has responded by increasing the number of vials workers carry and changing protocols so they can administer more of the drug.

Local government budgets also feel the strain of opioids. Sposeto said the cost of Narcan, also known as naloxone, has more than doubled in recent years. Agencies across Iowa generally pay $23 to $48 per dose, according to a statewide survey. Iowa Attorney General Tom Miller has tried to reduce the cost, recently announcing his office had reached a deal with a drug manufacturer to provide rebates for "public entities." 

“Quite literally, naloxone may be someone’s only lifeline if they overdosed on prescription painkillers or heroin,” Miller said. 

The ultimate goal, of course, is preventing opioid addiction in the first place. Some of that responsibility falls to health professionals who prescribe prescription pain medication.

The heroin and fentanyl crisis can be traced in part to a surge in sales of prescription opioids and then a tightening of restrictions on the pills. When patients cannot secure another script from a doctor, they may turn to illegal drugs.

Fortunately, Iowa health providers are starting to trim prescriptions for opioid painkillers, a top state regulator told lawmakers last week. The number of pills sold this year is on track to hit about 270 million, a 10 percent drop from last year.

That is still a staggering average of 90 pills for each man, woman and child in this state. Doctors are prescribing too many opioid-based pain medications and frequently more than people need.

Dr. Jeff Rodgers, a West Des Moines orthopedic surgeon, recognized this years ago. His study, published in The Journal of Hand Surgery in 2012, concluded the standard prescription of 30 pain pills following outpatient surgery appears "excessive and unnecessary.”

Routinely prescribing 30 pills is not based on research or what a patient necessarily needs. So where did that number come from?

“It’s tradition, what would fit in a bottle, what was easy to write,” Rodgers told an editorial writer this week. Pain can often be controlled by over-the-counter medications instead of opioids, and patients tend to save excess pills, which other family members, including teens, may later swallow.  

While changing the prescribing practices of doctors is important, Iowa still faces the threat of illegal drugs sold on the street. Just this month authorities in Omaha recovered 33 pounds of fentanyl — worth about $15 million — hidden in a suitcase at the city’s train station. 

Preventing opioid abuse and death is multifaceted and requires all Iowans to be vigilant.

Patients should avoid addictive prescription pain medication whenever possible. Parents should refuse drugs, including hydrocodone, on behalf of their children following procedures like the removal of wisdom teeth. Lawmakers and health insurers should ensure Iowans who want addiction treatment can receive it. Law enforcement agencies must have the resources to stop the flow of illegal drugs into the state. 

Drug overdoses are unnecessary tragedies ending the lives of too many young Americans. These deaths are preventable. While Iowa has taken good steps to try to prevent a full-blown opioid crisis here, there is more we can do.

Overwhelmed by overdose deaths, pathologist to enter ministry

Drug deaths from fentanyl, a synthetic opioid many times more powerful than morphine and heroin, more than doubled from 2015 to 2016 in the United States.

Because inhaling even a small amount can be deadly, workers in law enforcement and crime labs increasingly use protective gear, including respirators. Offices stock up on the antidote Narcan in case employees are exposed. Neglected and orphaned children enter the foster care system. 

And then there are the bodies. 

Medical examiners in Ohio have been forced to store corpses in trailers in parking lots. In one Florida county, the medical examiner relies on a private transport service to hold bodies at another location. 

The strain of drug overdoses on these professionals can be overwhelming, as detailed in a recent New York Times story about the chief medical examiner in New Hampshire, a state hit hard by the opioid crisis. 

After two decades in the profession, Dr. Thomas Andrew recently retired to pursue a divinity degree. His goal is to become an ordained deacon in the United Methodist Church, minister to young people and encourage them to stay away from drugs. 

Pathologists, he said, face mortality daily. The people on his table could have lived longer “but for a few millimeters of cholesterol in the wrong blood vessel, a second of inattention by the driver of a car or the lethal potency of a drug obtained on the street.”

Drug users in their 20s and 30s are increasingly dying of endocarditis, a heart-valve infection resulting from the use of dirty needles. He said his office has seen more endocarditis in the last two years than the previous 15 combined.

This editorial is the opinion of The Des Moines Register’s editorial board: David Chivers, president; Carol Hunter, executive editor; Lynn Hicks, opinion editor; and Andie Dominick, editorial writer.