Lawmakers lay out plan to combat opioid abuse in Iowa

A House Republican plan to combat opioid addiction in Iowa would put limits on opioid prescriptions, implement Good Samaritan laws for those who report overdoses and require physicians to use an electronic tracking service for prescription opioids.

“This affects all socio-economic groups, and, as I think about it, I hardly imagine a family in this state that doesn’t know somebody that’s suffered from this problem, either a friend or another family member," said House Speaker Linda Upmeyer, R-Clear Lake. "So we know that it’s very destructive and we want to make sure we’re doing what we can to improve that problem in Iowa."

In Iowa, the number of heroin and opioid overdose deaths rose from 28 in 2005 to 61 in 2015, state data show. The number of treatment admissions grew from 608 to 2,505 during that same time frame.

Upmeyer said the House plans to introduce a comprehensive bill early next week. A similar bill will make its way through the Senate.

The proposals include:

Prohibiting controlled substance prescriptions from being filled more than six months after the date prescribed and prohibiting schedule II prescriptions from being refilled

Requiring electronic prescriptions

Requiring first responders to report to an electronic tracking system when they administer opioid antagonists such as naloxone

Providing legal immunity to someone who calls 911 to seek help for a drug overdose and to the person experiencing the overdose, but include some exceptions for drug dealers and repeat offenders

Expanding access to telehealth in rural areas

"Our goal is intervention, not incarceration," said Rep. Jarad Klein, R-Keota, who will help lead the initiative.

But the most controversial proposal is likely to be the proposal to require physicians to use the prescription-drug monitoring program.

The PMP is an electronic system that tracks nearly every time a pharmacy fills a prescription for opioid painkillers, benzodiazepine sedatives or other addictive drugs. The system's goal is to let doctors, nurse practitioners, pharmacists and others see if a patient who is seeking such medications has already received them elsewhere.

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Rep. Shannon Lundgren, R-Peosta, is also helping lead the initiative. She said prescribers will have to check the PMP "every time they prescribe an opioid."

"It’s part of the system to make sure that we’re catching people that may be at risk to abuse opioids," she said.

Physicians' groups say they like having the online registry, but they have opposed past attempts to require them to check it every time they write a prescription for addictive drugs.

Dennis Tibben, director of government affairs for the Iowa Medical Society, said Thursday that his group supports the idea of requiring all prescribers to register for the system when they apply for permits to prescribe addictive medications.

However, Tibben said, "we feel now is not the time to be mandating use of this."

For example, he said, there's no reason for a doctor to check the registry when prescribing pain pills for a patient who lives in a nursing home and has no other physicians. Such a patient would not have the opportunity to "doctor-shop" for another physician to write a duplicate prescription, Tibben said.

Tibben said Iowa's current prescription database system can be balky to use, and its data can be more than a week out of date. He noted the Iowa Board of Pharmacy is in the process of replacing the system with a new one that will be easier to use and whose information will be more timely.

After the upgrade this spring, the new system should attract more voluntary use by physicians and other prescribers, he said.

"I think what we’ve seen nationally as well as here in Iowa that physicians recognize that we certainly are facing a crisis and an issue with opioids," said Lundgren. "So I think we’ll have to wait to see but the ones that we’ve spoken with understand the process and why we’re doing it this way."

One proposal that is unlikely to advance this session, said Upmeyer, is a needle or syringe exchange program. Advocates say those programs can create an intervention point for addicts to receive help and also help prevent the spread of infectious disease like Hepatitis and HIV.

Upmeyer said she's not necessarily opposed, but she said many lawmakers are having conversations and learning about what those programs entail.

"People go in maybe thinking about it in one way. They have a conversation and they leave the room thinking about it a little differently," she said. "So I think it’s really a process for not just legislators but even Iowans to become educated on and think more about. ... It’s certainly something we’re talking about and we’re exploring. I think we need to explore all the avenues that might be out there."