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Wash Journal   Fairfield Ledger
Neighbors Growing Together | Nov 22, 2017

4 opioid regulations other states have that Iowa does not

Oct 23, 2017

By Erin Murphy, Des Moines Bureau

 

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 because two years ago that addiction claimed his life.

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

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

The number of opioid deaths in Iowa is not as dire as 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 experienced more than 800 opioid-related deaths in 2016, according to the state’s Health Statistics Center.

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

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

Heaton pledged that the committee will produce some form of legislation 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 U.S. states require prescribers to consult the state’s Prescription Monitoring Program, or PMP; Iowa does not. The PMP 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 a program. Advocates say needle sharing programs prevent the spread of infectious disease and create an avenue for people with addiction to seek treatment.

Forty states have a so-called Good Samaritan law, which provides immunity for an individual who contacts the 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 state lawmaker from Dubuque who sat on the legislative panel during the two-day hearing. “I’m pretty confident there are people in Iowa who are dead because we fumbled the ball.”

Of the myriad lawmaking options discussed over the two days, the PMP was most prevalent.

According to state officials, less than half of Iowa prescribers are registered to use the state’s program. Just 4 percent of dentists use the program.

In additional to a general pushback against mandates, 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 state pharmacy board.

The many speakers who advocated for mandating use of the PMP say it can save lives by preventing individuals from accumulating high volumes 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 PMP,” 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 PMP use mandatory.

“If my physician finds checking PMP cumbersome and difficult, I sure as hell don’t want him as my doctor,” Peter said. “That’s very basic.”

Lee Leighter, with the state public safety department, praised the state’s PMP and also encouraged lawmakers to mandate its use.

Leighter also said law enforcement should be able to access the program. Twenty-nine states have no restrictions on law enforcement access to the state’s PMP, 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 the state’s PMP.

Opponents of expanding law enforcement access to PMPs 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 PMP use, but it did not garner sufficient 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 with new laws.

“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 state 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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