DPAC Meeting Minutes - October 5, 2017
DRUG POLICY ADVISORY COUNCIL MEETING
Date: October 5, 2017 Location: Iowa Judicial Building, 1111 E. Court Ave., Des Moines, Iowa
Called to Order: October 5th at 1:00 p.m.
Adjourned: October 5th at 3:00 p.m.
Voting Members Present: Barb Anderson; Thomas Bower; Paul Feddersen; Matthew Harkin; Jane Larkin; Dave Lorenzen; Steve Lukan; Steve Michael; Jason Sandholdt; Monica Wilke-Brown for Kathy Stone; and Chris Wilson. Non-voting members: Steven Arndt; Chuck Connors and Josh Happe for Steve Larson.
Voting Members Absent:
Vern Armstrong; Warren Hunsberger; Katrina McKibbin; and Jennifer Miller (Excused).
Guest Presenters: Mark Bowden, Iowa Board of Medicine; and Andrew Funk, Iowa Board of Pharmacy.
Other Guests: Nancy Augustine; Jacob Johnson; Heather Schaffer.
Staff: Susie Sher & Dale Woolery
Welcome and Introductions
Director Lukan called the meeting to order and welcomed attendees.
Approval of the May 4, 2017 minutes
Motion to approve minutes. Minutes approved.
Opioid Prescribing and Dispensing in Iowa
Mark Bowden, Director of the Iowa Board of Medicine (IBM), presented the following updates and observations from his position of licensing, regulating and disciplining Iowa physicians:
- About 16% of all IBM investigations of physicians involve the alleged inappropriate prescribing of medicines (Rx), and the number is growing.
- In general, the tendency is for many—but not all—Rx investigations to involve smaller practices in more rural areas.
- Many physicians accused of inappropriate prescribing of opioids or other Rx may have done so innocently, trying to be of help to patients in whom they may place unfounded doctor-patient trust.
- The IBM continues to require continuing education every five years for most of Iowa’s opioid prescribers, and has been encouraging Iowa physicians to adhere to recently revised guidelines from the U.S. Centers for Disease Control (CDC). Those guidelines scale back recommended opioid doses for treating some forms of pain.
- National studies indicate opioid prescribing is declining overall, along with average opioid doses per incident.
- The Iowa Legislature is expected to discuss several policy proposals regarding opioids, potentially including changes to Iowa’s Prescription Monitoring Program (PMP)…the State’s electronic database for tracking all Schedule II-IV controlled substances. Health care provider patient queries of the PMP are currently voluntary. The IBM previously has proposed making those queries mandatory, but without success. It’s unclear what, if any, proposals the IBM may advance for next year.
- Integrating the PMP with Electronic Health Records (EHRs) is now legal in Iowa, and may help boost utilization in the near future.
- The addiction challenge of opioids must be addressed. Currently, doctors spend a great deal of time unwinding patient expectations for the prescribing of opioid pain relievers that, for some, could lead to addiction or even overdose.
When asked by a member of the public in attendance about the possibility of alternative pain treatments, such as “Medical Marijuana,” Mark said several ideas may be discussed by legislators. However, he also noted the opioid epidemic raises a question that’s becoming a common one at the Iowa Legislature: When does the role of the Legislature encroach on medical judgment?
Andrew Funk, Director of the Iowa Board of Pharmacy (IBP), presented the following updates and observations from his position of licensing, regulating and disciplining Iowa pharmacists:
- Health care prescriber and pharmacist utilization of Iowa’s PMP for tracking all Schedule II-IV controlled substances dispensed in the State, is slowly improving.
- Though some advocate for mandatory PMP queries, they may not be the best strategy…because some prescribers may simply check the box to play the system.
- The IBP is currently in the process of upgrading Iowa’s PMP with a new system due to be online by April 2018. This update should make the system more seamless, faster, and generally more user-friendly.
- PMP queries have continued increasing every year since the system was implemented in 2009, and several enhancements have been made to the PMP along the way (e.g., EHR integration and multi-state sharing).
- Details are still being worked out on PMP improvements like EHR integration, such as who pays for the computer upgrades. Iowa’s current PMP is a fragile system, and the IBP doesn’t want to crash it before the system upgrade. Therefore, the IBP may pursue up to six PMP-EHR pilots, before rolling it out statewide.
- In terms of doses of controlled substances dispensed in Iowa, hydrocodone is easily the most common medication…though a nearly 10% reduction is apparent to date so far this year.
- The PMP currently requires weekly reporting by pharmacies, but rules are pending to change that to daily (near real time).
- The IBM may seek policy change to allow automatic proactive alerts of potential inappropriate medication management by patients be sent to prescribers and dispensers of record to that patient. This would notify health care professionals of a possible concern, but leave it up to the health care provider to decide what to do with that information.
When asked about the split between community pharmacies and others (e.g., mail orders), Andrew said it remains about 50/50.
Andrew also talked about the value of Prescription Drug Take Back, for increasing safe the proper disposal of controlled prescription medications. Nearly every Iowa county now has a permanent Take Back receptacle, though challenges remain. The IBP is working to provide more Take Back units to pharmacies, while the Office of Drug Control Policy has been helping locate secure drop-off boxes in local law enforcement centers.
Sheriff Sandholdt said the Take Back program is working very well in Marion County. He mentioned a need to help long term care facilities and families with end-of-life leftover prescriptions with their medication disposal. Asked if a law allowing Hospice workers to help dispose of controlled substances would be a good step, rather than expecting families to deal with it, the Sheriff said that would instill more accountability for medicines that otherwise disappear.
Steve Lukan: (1) Iowa State University will host a first-of-its-kind Digital Literacy Conference on November 10th, to include discussions of how digital literacy among youth can help protect against substance abuse. (2) The number of permanent Take Back sites in Iowa, for safely disposing of leftover controlled prescription drugs, has grown to over 180…with at least one in almost every Iowa county. The next one-day National Prescription Drug Take Back event is Saturday, October 28th. (3) ODCP is working with the Governor’s Office on a half-day opioid forum later this month. Details are forthcoming soon.
Jane Larkin: Youth and Shelter Services of Ames is involved in a community opioid assessment, as part of a new federal grant from the Iowa Department of Public Health. The assessment, which is being conducted in other communities too, could be very telling when it comes to addressing needs and utilizing resources.
Matthew Harkin: Des Moines police officers are finding more heroin, sometimes combined with fentanyl analogs or other illicit opioids, and more naloxone is being deployed to reverse opioid overdoses.
Jason Sandholdt: Iowa sheriffs are reviewing mental health and substance abuse evaluation procedures, and may consider supporting a legislative proposal that would advocate for assessment centers vs. the current localized system. Many of those in Iowa jails are believed to have mental health disorders. When asked by a member of the audience about handling arrestees with disabilities, Sheriff Sandholdt said ideally jails—and law enforcement generally—would have a mechanism for screening individual needs and directing them to the appropriate services (if not jail).
Steve Michael: The NAACP is sponsoring its annual Iowa Summit on Justice and Disparities October 10th in Ankeny.
Thomas Bower: Iowa’s Court of Appeals is seeing more court and termination cases involving substance abuse. In response to a an audience member, Judge Bower acknowledged an important question at the heart of many cases is: At what point do drugs impair one’s parenting abilities to warrant termination, and what else is going on in the home?
Chris Wilson: Johnston Schools is piloting the mental health program “Sources of Strength,” which is due to begin in November. The program will link those at risk of substance abuse or suicide with peer advocates.
Monica Wilke-Brown: (1) The Iowa Department of Public Health (IDPH) is in the process of awarding new federal State Targeted Response grants to help communities address opioid misuse. The process includes community assessments and a focus on expanding. (2) IDPH is also administering a smaller federal grant dealing with opioid misuse among women. (3) The University of Iowa hosted an opioid meeting last week, focusing largely on Hepatitis C and potential HIV concerns related to intravenous opioid use. An official from Utah shared how that state implemented a safe syringe program in response to similar concerns.
Steve Arndt: (1) A couple of new grants of possible interest include a peer mentoring project in Johnson County and an opioid-related Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant. (2) Something to watch for in the near future: mobile apps for those in substance use disorder treatment.
Chuck Connors: The Iowa National Guard’s Counterdrug Unit is available to provide a range of support for a variety of substance abuse program and drug enforcement efforts. Areas of potential assistance include: training, conference support, coalition development, drug trafficking analysis, prescription drug Take Back, etc. (no advocacy). Questions and requests for assistance are welcomed, and will be reviewed on a case-by-case basis.
Barb Anderson: Information on the November 10th Digital Literacy Conference will be shared via educator networks in Iowa.
Paul Feddersen: The opioid overdose reversal drug naloxone was recently deployed to all Iowa Division of Narcotics Enforcement officers and 113 local law enforcement officers who signed up for it at this year’s Iowa Narcotics Officers Association conference. Though opioids are becoming a bigger challenge for law enforcement agencies in Iowa, methamphetamine remains even more problematic, with officers seizing purer forms of meth in larger quantities (e.g., 60 pounds of meth were seized in a single recent case).
Dave Lorenzen: Human trafficking training is coming up for Iowa law enforcement officers. An Attorney General’s Office grant focuses on human trafficking victim outreach to 14-23 year olds.
Nancy Augustine, of Iowa Families Preservation, requested to speak before the Council. She shared that Iowa Department of Human Resources (DHS) child welfare cases involve substance abuse, but added more needs to be done to address drug use by DHS workers.
Ms. Augustine cited a survey of a few years ago that showed as many as 96% of DHS workers admitted to drug use to alleviate stress. She was asked what was included in the 96% figure, but wasn’t sure if it included drugs and alcohol.
Pointing to the survey results, Ms. Augustine said she has called on DHS to drug test its workers to protect children and keep them safe. Previously when she pursued this proposal, she was told union rules prevented consideration of worker drug tests. Now that collective bargaining law has changed and DHS has a new director, Ms. Augustine said she plans to renew her request of DHS Director Jerry Foxhoven, with whom she plans to meet quarterly to discuss issues of mutual interest.
Next meeting will be announced at a later time. There being no other business, the meeting was adjourned.