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Identify, Prevent, Recover: Gov. Reynolds outlines priorities to combat opioids in Iowa

Kim Reynolds

DES MOINES – Gov. Kim Reynolds outlined her priorities this week on combating the opioid epidemic.

Iowa has taken a multifaceted approach to combat the opioid epidemic through prevention, treatment and recovery efforts. Iowa’s multifaceted approach includes: utilizing the prescription drug monitoring program, expanding drug “take back” day in all 99 counties, expanding naloxone access, expanding specialized treatment through local healthcare providers and improving specialized professional training and education for healthcare professionals through licensing boards and medical schools.

“For those Iowans suffering with substance abuse today, I want you to know there is help, and we hear you,” Gov. Reynolds said. “I want to thank the thousands of Iowans who are supporting our efforts to identify early the growing threats, help us prevent further destruction in the lives of families and help the recovery of those needing it most.”

The priorities outlined by the governor are a call to action for various medical and provider professionals, boards and organizations to reexamine existing policies and practices to identify and prevent opioid abuse in Iowa.

“So many Iowans from all walks of life have been afflicted with the disease of addiction, and there is no one-size-fits-all approach,” Lt. Gov. Adam Gregg said. “The governor’s comprehensive list of initiatives will go a long way toward saving lives and having a meaningful impact in our communities.”

The governor’s plan centers around four major priorities:

1. Increase Prescriber Use of Iowa’s Prescription Monitoring Program (PMP)

· Expand Prescriber Usage – Today, 45 percent of prescribers in Iowa are signed up with the prescription monitoring program. The Iowa Board of Pharmacy and stakeholders should identify ways to improve participation from prescribers while minimizing the administrative burden. This should include the goal of getting all prescribers to report any controlled substance dispensing activities to the PMP.

· Proactive Notifications – The Iowa Board of Pharmacy and stakeholders should identify ways to automatically notify prescribers and pharmacies to check the PMP when patients exceed reasonable prescription opioid doses to prevent prescription drug shopping. Addiction helpline information should be included in those alerts.

· Expand Prescriber Knowledge – The Iowa Board of Pharmacy and stakeholders should identify ways to provide prescribers routine, confidential reports, so prescribers can be aware of their prescribing practices.

· Expand the Type of Prescriptions Reported – The Iowa Board of Pharmacy and stakeholders should identify ways to have Schedule V prescription drugs added to the prescription monitoring program. Right now, Schedule II–IV are reported, but other opioid prescriptions are not captured (e.g., codeine cough suppressants).

· Explore Integration – Healthcare information technology is ever expanding, and seamless data integration is critical to improving value in our healthcare system. The Iowa Board of Pharmacy and stakeholders should explore easier-to-use integration of the prescription monitoring program with electronic health records (EHRs), including pharmacy processing software and the Iowa Health Information Network (IHIN).

· More Education – Licensing boards, medical schools and stakeholders should continue expanding education and encouragement of health care professionals to use the prescription monitoring program.

2. Reduce Opioid Prescribing to Prevent Misuse in Iowa

· More Prescriber Education on Prescribing – According to the Iowa Board of Pharmacy, controlled substance prescriptions, including opioids, are down 10 percent this year compared to last year. We are making progress. Licensing boards, medical schools and stakeholders should work to expand education and training to bring prescribing down while maintaining patient access to necessary care.

· Encourage Adherence to the Centers for Disease Control and Prevention (CDC) Opioid Prescribing Guidelines – In 2016, the CDC developed guidelines for prescribing opioids. While medical professionals are best equipped to know what a patient needs, licensing boards, medical schools and stakeholders should work to expand knowledge and adherence to the CDC guidelines.

3. Enhance Intervention for Iowans Misusing or Addicted to Opioids

· Expanding Naloxone Access – In 2016, Iowa expanded Naloxone access, issued a standing order and improved affordability for law enforcement, EMTs and patient advocates. Iowa should build on that and explore options to expand Naloxone access. Intervention helps prevent the spread of communicable diseases.

· Good Samaritan Law – Iowa should explore joining 36 other states in enacting a Good Samaritan Law that promotes timely overdose reporting by immunizing other drug users from criminal prosecution if they call 911 when an overdose is occurring. However, drug dealers or other victim crimes should not be immunized from criminal prosecution.

4. Enhance Substance Use Disorder (SUD) Treatment, Particularly Medication Assisted Treatment (MAT) for Opioid Addicted Iowans

· Improve Patient Access to Medication Assisted Treatment – Currently, Iowa is participating in a multi-year grant administered by the Iowa Department of Public Health for Medication Assisted Treatment focused on prescription drug and opioid addiction in 10 of the highest need counties in the state. Iowa Medicaid, Public Health, local medical professionals and stakeholders should utilize evidence-based practices from this grant to improve Medication Assisted Treatment in underserved counties where opioid prevalence is high.

· Expanding Rural Access – Iowa Medicaid, Public Health, local medical professionals, and stakeholders should work creatively with federal guidelines to expand methadone treatment access in rural Iowa, especially in areas where opioid addiction is most prevalent.

· Reduce Barriers to Medication Assisted Treatment Drugs – Public and private insurance payers, along with safety-net payers, should work collaboratively to reduce barriers and improve access for Iowans needing Medication Assisted Treatment drugs based on evidence-based policies.

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