Pape State Office Building, 215 E 7th St, Des Moines, IA 50319
Virtual via Google Meet: meet.google.com/mbo-qhvc-qgz
Called to Order: September 13, 2022 at 1:03pm
Adjourned: September 13, 2022 at 3:28pm
Voting Members Present: Dale Woolery, Terra Kinney, Dave McDaniel, Bob Larson (for Warren Hunsberger), Sharon Greer, Jason Feaker, Vern Armstrong, Patrick Coughlin, Katrina Carter, Steve Michael, Kevin Gabbert, Jeff Wright
Voting Members Absent: Barb Anderson, Chris Wilson, Ryan Moore
Non-Voting Guests Present: Brad Richardson, Miriam Landsman, Ryan Goecke, Flora Schmidt, Michael Heckle (KCCI), Laura Book
ODCP Staff Present: Susie Sher
Director Woolery called the meeting to order and welcomed attendees. Attendees provided introductions. Dale mentioned the legislation that passed this year adding two new DPAC members. He welcomed Jeff Wright and shared that he is an official voting member as of July 1, 2022 and the Police Chief member will be added soon.
Approval of the May 10, 202 minutes
Minutes were approved. Motion by Sheriff McDaniel. Second by Judge Greer.
2023 Iowa Drug Control Strategy
Susie Sher gave an update on the upcoming Drug Control Strategy.
Fentanyl and Emerging Drugs Discussion
Members discussed multiple strategies to address the current substance use and overdoses issues seen in Iowa. Kevin led off by providing IHHS updates on several fronts.
The 24 and under population in Iowa has had a very large increase in deaths related to illicit synthetic opioids (up 289% from 2019 to 2021). IHHS has been working on naloxone access expansion. They have been working with IDOE to make naloxone available in schools. Iowa organizations and businesses initiative – made up to 5 naloxone kits available to organizations and businesses. IHHS will ship kits for free to their locations. Just over 80 requests so far. The IBOP granted a waiver to the organizations so they can have them on hand for administration, not distribution.
Secondary distribution (entities in a position to assist) was discussed. With this model, naloxone kits are distributed to entities, that can then distribute them to individuals. There is a population who will not go into pharmacies due to stigma or having to provide identification. Based on federal modeling programs, in order to get an 80% reduction in OD deaths, IHHS would need to distribute over 42,000 kits a year. Last year, only about 6,000 kits were distributed through IHHS funded initiatives. If we had a larger distribution network, only around 21,000 kits would need to be distributed. It is important to put the kits in the right people’s hands.
IHHS believes utilizing an “entities in a position to assist” model could be help reduce OD deaths. Harm reduction groups, county health offices, etc. Entities that are mission-driven should receive those kits, along with a certification or demonstration of ability to track and report on those kits. The individuals accessing resources through those agencies are more likely to get naloxone from them rather than pharmacies.
Members agree that more men than women enter treatment programs for fentanyl use. Most people begin using prescription opioids that were not prescribed for them (usually a surplus). This serves as a reminder to properly dispose of medications.
Iowa has only had expanded access to naloxone since 2016. It’s been a progression since then to expand access.
A “leave-behind” program was also discussed. This is where EMS, law enforcement, or fire departments on the scene of an OD, could leave behind kits for family members or friends there. Fentanyl and analogs are more and more potent and higher or more doses are needed.
Kloxxado – another form of naloxone, twice the dosage in the administration (8mg instead of 4mg) is now available in Iowa
Patrick shared that they have used naloxone to save two people this year. In both cases they had to use two doses. Kevin reminded the group that naloxone is never a replacement for emergency medical services.
Another suggestion is to increase utilization of recovery coaches in emergency departments and the introduction of buprenorphine in the emergency department. Medical providers have the ability to do that right now and could introduce MAT at the time of the encounter in the ED. The connection between behavioral health and primary care providers could be improved.
Law enforcement members do not have the tools or protocols to deal with ODs. Sometimes by the time they are notified and arrive, it is too late, people are gone or not cooperating. The most cooperation comes from an OD death than from a non-fatal OD.
Good Samaritan law – no one knows of a case in where it has been used. The trust factor is the issue. Jeff Wright shared that he doesn’t know of any case of using it. He said that he could potentially work with the County Attorney’s Association to spread the word about it. Judge Greer suggested bringing the Good Samaritan information to high schools.
Access to treatment – what barriers do we have? Flora shared that workforce and insufficient reimbursement rates are the biggest issues. There are not enough providers to cover, everyone is shorthanded. Many clinics are cancelling walk-ins and are unable to complete assessments. IBHA meets next week to talk about workforce. The pandemic, or when tragedy or crisis hits, there is a period of time after that the need for services rises when people are overloaded and begin to reach out for help. Workforce has been down for 2 years and it is not getting better.
How do we increase access? – increase reimbursement rates. Most Medicaid rates have not gone up in over 20 years. We are so far behind, it will be a long slow process to get providers the rates they need to pay their employees. IBHA is working with IHHS and Iowa Medicaid on regulatory issues. The amount of paperwork required is taking away time to actually provide services. Economic analysis was done over three years – multiple millions of dollars in 3-month snapshots were being lost. Flora will share their legislative points and analysis once they are finalized in the next 30 days. Patrick agreed that reimbursement rates are a huge issue and below their break-even costs. He shared that covid funds are what has got them through the past few years. Bob shared that their program has other income sources that help fund their services. Sheepgate is not a licensed treatment program, they are a faith-based program.
Telehealth – Important, increased participation in some cases. Bob and Patrick agree that access to telehealth has been beneficial. It is here to stay. It’s valuable but should not be the only means for treatment for individuals. Flora shared that providers need to be able to see them, smell them, and experience them in person. Telehealth option is important for rural, transportation, and schedule issues.
988 – crisis line services – Vern shared that 988 started in July. The providers we have in Iowa have been part of the suicide prevention hotline for many years. Currently developing warm-handoff guidelines/protocols. They are taking phone calls, texts, and chat messages. They are coordinating for services after the initial contact. Providers are working on more staffing to be able to respond to more calls and texts locally. The goal is to respond to 90% of local calls. They are currently answering around 65% of calls. They are hoping to go live with warm handoffs in December.
Prevention – we need to use social media to reach kids. There also needs to be education and support within the home or we will continue to fall short. The family dynamic needs to be involved. Education needs to also be done for the parents. Message needed – Strategies need to be researched. Who is the best messenger – IHHS has had great success with ZLR doing ad campaigns. Research may help guide some applicable approaches, such as the Strengthening Families program, consisting of components for parents and youth. A media campaign would need to do the same thing.
Supply reduction – IDOT is seeing a lot of marijuana and people say they bought it somewhere where it was legal. In dealing with commercial motor vehicles, they are seeing less drugs. There is mix of transportation happening - shipping services, cars, etc. Jason stated the purity of the drugs they are seeing is increasing. They are seeing pure fentanyl. Interrupting the supply – the inability to use a K9 in some traffic stops has hindered law enforcement, due to recent court rulings prohibiting prolonging a stop without probably cause in order to call for a K9. The target it always changing and evolving. We have to try to keep up but don’t have the resources or manpower. The border is a huge issue. In stopping the flow over the border, we would see an immediate impact here.
In addition to input from earlier in the meeting, Dale posed the question: If a summit were to be convened to focus on priorities and set goals, what topics and outcomes would you like to see considered?
*Supply from the southwest border
*Education for parents and youth (distribution/platform and message)
*Suggestion to gather all the information on what is being done currently and then take the message to conferences already in place, rather than convene another meeting (businesses, farm bureau, etc)
Legislative Preview, Other Business and Public Comment
Susie gave an update on the “Emerging Substances of Concern” project she is working on. No other business was discussed.
An opportunity for public comment was provided, but no one offered comments.
Dale thanked attendees for their input, and said there may be follow up with council members on some of the many issues raised during the meeting.
Next meeting December 13, 2022.