Opioid 1

Rachael Keating/Clinton Herald

Pharmacy Director for Mercy Medical Center in Clinton, Christine Swyres, talks during a community opioid epidemic roundtable at the hospital in February.

Editor's Note: Over the five Saturdays in March, the Clinton Herald is publishing a series about the use and abuse of opioid drugs in Clinton and how those statistics fit into the state and national scope of the opioid abuse crisis. Today's installment is part five of the series. All five stories can be found in a collection on Clintonherald.com.

When President Donald Trump in October declared the opioid epidemic a public health emergency, it didn't represent much of a shock to those who have been witnessing the problem first-hand for years. 

What it did do, though, was create an avenue for not only more discussion of opioid abuse nationwide, but open the floodgates for possible solutions, and most importantly funding, to combat the crisis. 

Trump's signature late last week on the $1.3 trillion appropriation bill included a record $4.6 billion this year being spent to fight the nation's opioid crisis. 

In Iowa, opioid abuse has gotten attention from legislators through the prescription monitoring program, something highlighted by Mercy Medical Center in Clinton as one of the ways the hospital is combating the issue locally. 

According to information from the legislature, 45 percent of prescribers are registered to use the current program. The law, which passed 98-0 in the Iowa House of Representatives, requires prescribers to register for the monitoring program and use it when prescribing controlled substances. 

Prescribers having just pockets of information was a contributing factor in pushing this crisis along, Christine Swyres, Mercy's pharmacy director, said. 

"The only person who knew all the information was the patient," Swyres said. "And some of them knew how to work the system. They were seeking or not getting enough pain management. There's a lot of things playing into pain management, so now pharmacies and physicians can go in and see (the prescriptions)."

The law also attempts to decrease doctor shopping and offers some immunity to a person calling 911 in situations where a drug overdose has occurred. 

While Iowa hasn't had this Good Samaritan law on the books in the past, Clinton Police Department Capt. Joe Raaymakers said the department hasn't been in the habit of arresting those who phone emergency responders when an overdose has occurred. 

"Some states have a Good Samaritan law in their books," Raaymakers said. "We don't have that law, but that's the standard we keep."

The attention locally just doesn't stop with the measure passed by the Iowa House or the funding being allotted by the federal government. U.S. Rep. Dave Loebsack (Clinton's U.S. House representative) pitched a plan late last year in fighting the opioid epidemic. And Clinton County is one of several Iowa counties that has joined an opioid lawsuit filed in January in the Northern District of Ohio. The Clinton County Board of Supervisors in December unanimously approved the resolution that seeks litigation against opioid manufacturers. 

The complaint lists five causes of action against all defendants, alleging illegalities involving Iowa’s Private Right of Action for Consumer Frauds Act Violations of Iowa Code 714H.3, public nuisance, violations of the Common Law prohibition on unjust enrichment, intentional misrepresentation and civil conspiracy.

"If all goes to plan, we will have bipartisan solutions down the road," said Loebsack, a Democrat, who has served in the U.S. House of Representatives since 2007. "How far down the road, I don't know. This crisis is like the mental health crisis. There's a lot of things to consider. It doesn't ask whether you're a Democrat or Republican. It affects all social classes. It's not just poor folks. It's not just wealthy folks who can afford the opioids. It's everybody that is affected by this."

That mantra is a regular sentiment expressed by treatment officials. It's why people like Debbie Diaz, whose daughter is addicted to heroin, is hoping for better solutions in fighting prescription opioid and heroin abuse. 

The current structure isn't working for her daughter, Diaz said, and that's not lost on local and national treatment specialists. 

"They're thrown in (jail) and thrown back out," Diaz said. "That's how it is. I just think there should be no guns, no drugs."

Diaz knows that's not possible, but hospital and treatment specialists point to a proven model as being a high priority for necessary funding in the future. 

Medication-assisted treatment options are often cited by those in the know about opioid-related issues and those options are well-known by those same people to be limited in Clinton. Only one Clinton doctor, Dr. Odauh Osaro, is a provider of medication-assisted treatment in Clinton, and as already discussed in part 1 of this series, his options are limited in Clinton.

That's something Mercy Medical Center and treatment officials want to see change in the near future. 

"Funding is probably why we don't have a provider," Swyres said. "Funding is the big thing. Once we get the funding, we have to have the provider help us with this. Honestly, this is a long haul thing, too. It's not like taking an antibiotic. We're talking years and it's two steps forward and one step back on a good day."

Medication-assisted treatment is the use of medications in combination with counseling and behavioral therapies for the treatment of substance use disorders. 

Osaro is licensed to not only offer patients a pill for treatment, but also can implant the medication for patients, eliminating the need to take daily pills. The implant allows patients to feel the effects of treatment for six months. 

Osaro believes Suboxone, a narcotic drug that eases the withdrawal symptoms associated with heroin and other opiate additions, is the best treatment option. That doesn't come with some setbacks, though. 

"Do I have some issues?" Osaro said. "Yes I do. Some people have a physical dependence with it. But it's the best we have. I've seen people turn around. I've seen people about to die kept alive. If I had a drug issue and knew Suboxone existed, I would use it."

Treatment isn't an overnight success. It may take years or an entire lifetime to stave off the habit, Osaro said.

"Can it be for the rest of your life?" Osaro said. "If you have diabetes, are you on insulin for life? Then the answer is yes."

Lengthy treatments and creating more awareness are some of the reasons why Clinton Substance Abuse Council's Kristin Huisenga believes this area hasn't seen the height of this crisis yet. 

She cites expert opinions that say areas like Clinton have another five years before the crisis reaches its maximum level. 

"We've started putting policies and practices in place, but it takes awhile to start trickling down," Huisenga said. "It took us a long time to get here and it won't be fixed overnight. It will take awhile."

One of those policies initiated years ago by Clinton County is the medication disposal drop-box. Starting in 2006, the Gateway Impact Coalition, along with Seniors vs. Crime, sponsored a Clean Out Your Medicine Cabinet event. Beginning in October 2012, the coalition obtained four disposal sites in Clinton County, open 365 days of the year, where anyone can drop off unneeded or outdated prescription drugs in disposal bins. The sites are located at the Clinton County Sheriff's office, and the Clinton, Camanche and DeWitt police departments. 

The coalition has collected more than three tons of medication since its inception and the disposals are increasing every year, Huisenga said.

"We were one of the first in the state of Iowa that implemented these," Huisenga said. "Last year alone, we disposed of 1,000 pounds of medication. It's important that we do not want people to flush the medication down the toilet. Take it to the proper place."

With all this attention and desire for solutions to the local problem, Leslie Mussmann, who is the prevention director with the Area Substance Abuse Council in Clinton and Jackson counties, is hoping local, state and federal officials don't eliminate funding for other problems that are bigger issues in Clinton. 

In terms of drug abuse, marijuana and methamphetamine far outpace prescription opioid and heroin abuse. 

"A concern of ours is that we don't want the substance treatment dollars already available to get siphoned into an opioid treatment solution," Mussmann said. "Our issue may not be opioids right now and it may be methamphetamine, so we don't want to have dollars that are earmarked only for opioid issues and then have this whole population of people that we can't serve."

Even with those concerns, Mussmann, along with the rest of the people working to rid the community of opioid abuse, are hopeful for continued attention and better access to funding. 

"Once you made that first choice to use substances, for some, that's the last choice you've made," Mussmann said. "Some people will be able to use substances recreationally. But there's also the portion of the population who are going to have substance abuse issues the first time they use. I think it's something we need to help the community be aware of. Yes it can be frustrating that this person keeps coming back and needing this treatment, but they right now are in a chronic health situation and what we need to do is support them in order to be able to find some balance and get that under control. We certainly wouldn't want them to die in the meantime."

Scott Levine can be reached at scottlevine@clintonherald.com or on Twitter @ScottLevineCH