The opioid epidemic in Iowa will be the subject of a new interim legislative study committee to which State Rep. Chuck Isenhart (D-Dubuque) has been appointed. Isenhart is one of six state senators and representatives on the panel that must report findings and recommendations to the governor and General Assembly by November 15.
The charge of the committee is to comprehensively evaluate the state’s response to the opioid epidemic, including a review of the protocols and practices relating to the prescribing of opioid medications and the treatment options available, including medication-assisted treatment.
Input will be received from representatives of licensing boards for professionals who prescribe controlled substances, representatives of public safety and public health, representatives of medical providers and health insurance payers, as well as people touched by the epidemic.
The committee will review the status of the state prescription monitoring program (PMP), according to Isenhart. Medical providers and pharmacists use the PMP to help control access to opioid drugs by patients.
Research shows that many people who develop addictions and turn to heroin or other street drugs “started out” using prescription drugs like oxycodone and hydrocodone to treat pain associated with surgeries or acute conditions such as broken bones. However, at the end of 2016, just 41.9% of Iowa’s drug prescribers were registered to use the PMP, Isenhart noted, and only 14.2% of the 535 licensed prescribers in Dubuque County were registered.
Data supplied to Isenhart by the state Board of Pharmacy shows that, in 2016, the typical Iowa provider registered to use the PMP queried the program an average of 43 times. In Dubuque County, the average use was 35 times per provider.
Meanwhile, from 2014 to 2016, the total doses of opioid medications dispensed in Dubuque County increased by 23.6%, from 2,859,264 doses to 3,534.090.
By comparison, total doses of opioid medications dispensed statewide increased 11.6% from 2014 to 2016. That represents 44% of all dispensed drugs in both years. In Dubuque County, dispensed opioids accounted for 34% of all dispensed drugs in 2016, up from 30%.
“These trends no doubt have multiple explanations,” Isenhart observed. “We need to investigate and account for those changes, and we need to deal with the impacts of these dangerous drugs, including the explosion of heroin and other opioid-related overdoses, by offering better prevention and treatment options for those who become addicted.”
Isenhart will start by challenging 100% of medical professionals authorized to prescribe drugs in Dubuque County to register to use the PMP by January 1, 2018. That is when the state Board of Pharmacy is targeted to complete an overhaul of the monitoring program’s system and software to make it simpler and more seamless to use – for example, by offering integration with health care providers’ electronic medical records for patients.
“Medical providers must update themselves and establish protocols for when and how to use the program, as well as how to respond when potential problems are identified with individual patients, such as doctor-shopping,” Isenhart said.
Doctor shopping occurs when people with addictions approach several physicians and pharmacists until they find ones who will write or fill a prescription for the drugs their brains are craving.
“I understand that Medical Associates Clinic is working with Dubuque’s two hospitals to take up this challenge and offer continuing education for providers in October,” Isenhart said.
Following the sessions, Isenhart will send a personal letter to physicians and other prescribers in Dubuque County, asking each to return a postcard indicating if they are registered to use the PMP and if they have used the program. “This approach is necessary because the Board of Pharmacy considers the list of PMP users to be “program information” that state law requires be kept secret.
In 2018, Isenhart said he would embark on a similar effort to promote registration with 100% of Dubuque County pharmacists, who are may use the prescription monitoring program.
“The alternative is a state mandate requiring use of the PMP by all medical professionals,” Isenhart said. “I am sure that proposal will come up when the legislative study committee meets. I would support that, but voluntary participation by willing providers, with leadership coming from communities like Dubuque, is always the preferred route, and the most successful.
“At the same time, we must put in place well-funded and easily-accessed treatment options to help people struggling with addiction, however they come to our attention or seek assistance,” Isenhart asserted.
Dubuque-area residents who would like to provide testimony or recommendations to the study committee may contact Isenhart at (563) 557-1261 or firstname.lastname@example.org.
As director of the Dubuque Area Labor-Management Council for 17 years, Isenhart started the Tri-State Health C.A.R.E. Coalition to address community health care needs from an employer and worker perspective. At that time, he served on the Dubuque County Mental Health/Development Disabilities Stakeholders Committee.
Editor’s note: This article was provided by Chuck Isenhart.