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Miller: Make opioids the ‘last-resort’ treatment

Iowa Attorney General looks at legal action to fight epidemic
Oct 30, 2017

By Rod Boshart, Gazette Des Moines Bureau


DES MOINES — Iowa Attorney General Tom Miller told a conference aimed at combating opioid addiction Thursday that the culture of American medicine needs to change so powerful prescription drugs are viewed as “the very last resort” rather than as a common option for pain.

Miller took aim at large pharmaceutical companies that profited from the rise in painkiller use as having caused a shift in public perception. He later told reporters he is working with other state attorneys general to bring legal action similar to past successful challenges to the tobacco industry.

“What has happened is awful,” said Miller in pointing to a national epidemic in opioid-related deaths and addictions. “Twenty years ago, opioids were used in a very limited way. They were used as a pain remedy of very last resort. They were used with a great deal of caution and respect because of the addictive nature of opioids.”

However, he said, the perception gradually changed in part due to pain associations funded by drug companies that focused on treating injuries with high-strength medications. He applauded new efforts by pharmacies that are limiting opioid prescriptions to only seven-day supplies for acute pain.

“We really have to address this problem and address it dramatically because so much is at stake,” Miller told a conference held as part of Gov. Kim Reynolds’ Opioid Awareness Week. It featured discussions about strategies to reduce opioid misuse and evolving responses to a national epidemic, and a gripping testimonial by a Dubuque man battling his way back from a heroin addiction.

According to the Iowa Department of Public Health, there were 2,274 admissions for opioid treatment in the state in 2016 and 180 opioid-related deaths that year.

Reynolds said Iowa has taken a multifaceted approach to combating the opioid epidemic through prevention, treatment and recovery efforts that include using the state’s prescription drug monitoring program, expanding drug “take back” initiatives in all 99 counties, expanding naloxone access and specialized treatment through local health care providers, and improving specialized professional training and education for health care professionals through licensing boards and medical schools.

“We know that we need to do more,” said Reynolds, who laid out a four-point proposal she hoped would “produce transformational results” once implemented.

Reynolds said she would like to increase prescriber use of Iowa’s prescription monitoring program, which after nine years of operation has only about a 43 percent signup rate. She said efforts are underway to modernize the system. One the technology advances are in place, she expects to see greater participation. But she said she is not ready to make use of the database mandatory for prescribers, as some states do.

“Our hope is that once the program is upgraded and innovations are made that we will see more doctors using it. There’s a growing sense of urgency in the medical community to grab onto this tool and to use it,” said Steve Lukan, director of the Governor’s Office of Drug Control Policy.

Reynolds advocated “Good Samaritan” legislation that would shield drug users from prosecution if they seek help for someone who is overdosing, similar to laws enacted in some form by many other states.

She also promoted efforts to reduce opioid prescribing to prevent misuse in Iowa, improve intervention for Iowans misusing or addicted to opioids and enhance treatment — particularly medication-assisted treatment for opioid-addicted Iowans.

The Iowa conference was held the same day President Donald Trump called the opioid epidemic the “worst drug crisis in American history” and said his administration is declaring it a public health emergency.

The declaration means the federal government will waive some regulations, give states more flexibility in using federal funds and expand telemedicine treatment.

Both Reynolds, a Republican, and Miller, a Democrat, applauded Trump’s announcement.

“Whatever he declared is helpful,” Miller said, “but it’s going to take an awful lot of other things to make this work.”

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