Spread of opioids

REGIONAL—The opioid ad­­diction epidemic is here, al­­though it might be “kept under the rug.”

Some N’West Iowans are trying to pull that rug back and fight what they see is a growing problem of abuse of the substances used for pain relief.

“It is going on a lot more than what we see,” said Lyon County sheriff Stewart Vander Stoep. “There is increased abuse, and we do not see all of it.”

Vander Stoep has heard about kids getting into the prescribed painkillers of their parents or grandparents. He has received reports during the last few years of people sneaking into friend’s homes and stealing the narcotics.

“In the last two or three years, we even had a couple of overdoses. They died,” Vander Stoep said.

The overdose death rate for the state of Iowa has quadrupled in the last 20 years, according to a report released in August by the University of Iowa Injury Prevention Research Center.

The report, titled “The Prescription Opioid Crisis: Policy and Program Recommendations to Reduce Opioid Overdose and Deaths in Iowa,” included the opioid overdose death rates of each county in Iowa per 100,000 people. Lyon, Sioux and O’Brien counties had the lowest possible rate of 0.00-1.07. Osceola County had a rate of 1.07-2.21.

Sioux County Sheriff’s De­­partment chief deputy Nate Huizenga said opioids are being abused in the county and the department has had several cases of people stealing prescriptions.

Caleb Haverdink, a patrol deputy with the Sioux County Sheriff’s Department, also is a drug recognition expert. In addition to people stealing prescriptions, he said the department has handled a handful of cases of people selling them, even though he is sure there is much more of that activity going on.

“It is difficult to trace it back to the person who has the prescription,” Haverdink said. “People do not want to give them up because of the access. They’re a good source.”

‘It’s coming closer’

The Lyon County Sheriff’s Department is taking extra steps to combat the increasing amount of illegal opiate use.

In cooperation with the federal Drug Enforcement Agency, the department hosted a prescription drop box in the lobby of the sheriff’s station on Oct. 28 in Rock Rapids.

However, if people were unable to dispose of their prescriptions on Oct. 28, they can still take them to the Lyon County Sheriff’s Department at another time. No matter what the prescription is, or what time of day, people can dispose of their medications in the box, because it is available 24 hours per day.

Vander Stoep said it is anon­ymous, and people can be assured that what goes in the box has no way of coming out.

These drop-offs, in conjunction with the DEA, are held every six months. Vander Stoep said they sent off 40 pounds of prescriptions in April, which is a good thing as it helps dispose of medications where young people cannot get them. He said there was a lot of hydrocodone, a common prescription opioid, in the box.

On Wednesday, two of Vander Stoep’s deputies — Mark Dorhout and Kyle Munneke — began carrying Narcan for the first time. Narcan is a nasal spray that blocks the effects of opioids. Vander Stoep said eventually all of the officers will be carrying Narcan. Haverdink said Sioux County deputies began carrying Narcan last week.

Officers carrying Narcan is not only a way to prevent overdoses on prescribed opioids, but also is in anticipation of an illegal opiate that is zeroing in on N’West Iowa. As the crackdown on prescribed and legal opioids increases, there is a concern about an increased amount of heroin use.

Heroin is another opiate and when some people addicted to prescription opioids are not able to get them anymore, they turn to heroin for that same high.

“We know heroin is in the southeastern side of the state. We have seen it in Omaha and Des Moines. We are told it is in Sioux Falls. It is working its way here,” Vander Stoep said. “It is coming closer and closer all of the time.”

Huizenga has heard rumors about the illegal drug in Sioux City and Sioux Falls, SD, and is sure that it has started making its way into Sioux County.

“Whatever they have there, we have here,” he said.

Haverdink has seen a couple cases of local people under the influence of heroin, and said the drug was obtained in either Des Moines or Sioux Falls. Right now prescription drugs are cheaper than heroin, and easier to obtain, he said. That might change.

Heroin, Haverdink said, produces the same intoxicating effects as the prescribed opioids, but thankfully, he said, he has not had any cases of heroin possession.

‘More insidious’

Nancy Dykstra, the executive director of Promise Community Health Center in Sioux Center, said the facility has a mission of education about opioid addiction to help combat the problem. Promise recently was awarded a $166,130 Access Increases in Mental Health and Substance Abuse Services grant from the U.S. Health Resources and Services Administration in September.

Through the grant, Dykstra said the center will be able to offer more mental health and substance abuse services.

How rampant the addiction is can be difficult to determine, but Dykstra said the center has had “seekers,” a slang term for patients wanting to refill prescriptions for opioids.

“We will look up folks to see if they are jumping pharmacies,” she said. “If they get a tooth filled last week, and come in the next week for the pain, we will check on it. If they have frequently been to the emergency room, we will know because there is communication between practitioners.”

Huizenga said the Sioux County Sheriff’s Department has received some occasional reports of “seekers” in the area. Sometimes, they are not from the area, but have come to fill an opioid prescription. Haverdink said it is not illegal for “seekers” to doctor shop, unless they use fraudulent information to get the prescriptions.

He said they have kept some of them in their radar to make sure no one is driving under the influence of opioids.

Vander Stoep said he has not received any reports of “seekers” in Lyon County.

“The persons who get into trouble because of addiction to opioids are not street people,” Dykstra said. “These are not typical drug people. This impacts all sectors and classes. I think that is why it is more insidious and has been kept under the rug, why it’s been difficult to get a response and raise awareness. This could be your brother, sister, teacher — people held in high esteem in the community.”

Dykstra said it is important to educate medical personnel and consumers on how to recognize when someone is highly addicted. She did not deny that people with chronic pain need treatment, but said they need to be treated appropriately.

“We need to get people away from the cycle, away from their reasons,” Dykstra said. “In recent weeks, there has been more talk about this on talk shows, on the news. I saw something on ‘60 Minutes.’ We are going to hear more and more. Our key is to have people become informed so practitioners become knowledgeable.”

‘Did we contribute?’

Dykstra said the reason why the opioid problem is more rampant is because of the strong push in the medical community 30 years ago when she was a nurse to “get ahead of the pain.”

“I remember in the 1980s, when I was going to continuing education, there was a push to rigorously treat pain,” she said. “Did we contribute to the problem? ‘We’ being the professional community?”

Promise medical director Del Lassen, who has been practicing medicine for more than 30 years, said as a result, the physicians also are victims. There were mandates to push the pain treatments. Then, mandates to ask and assess patients on their pain. However, Lassen asked how a person could not be experiencing pain after reaching a certain age.

Lassen sets the tone for narcotic prescriptions at Promise, and he said very little prescribing of that type is done.

“That’s a good thing,” Lassen said. “There are many other things we can use to help someone with chronic pain other than opioids. There is physical therapy, massage, behavioral health. People will not find their answers in a pill. We will have a behavioral health provider down the hallway. Knowing that talent is here will be so nice and useful.”

Something Promise is going to do is screening of dental and medical patients.

If whoever is doing the screening picks up on a potential problem, that patient can then see the behavioral health provider right away.

“The hand-off will occur right here — same place — and we can service them more easily,” Dykstra said.

First, though, Promise has to find the right person to fill the position. Ideally, she said they would like someone who has administration experience, as well as mental health and addiction counseling experience.

“We need someone to take the lead in the educational piece,” Dykstra said.

One important aspect Promise will fill is hiring a bilingual assistant for the administrator/counselor, who will be known as a social work therapist. A large percentage of the patients served at Promise do not speak English, she said.

The terms of the grant states that Promise has to see patients within 120 days of the award.

Fortunately, Dykstra said, they will not be starting from scratch, and they hope to have the full program up and running within four months.

FORMS OF OPIOIDS:

  • Oxycodone, also known by brand names OxyContin and Percocet
  • Hydrocodone, also known by brand names Vicodin, Lorcet and Lortab
  • Codeine
  • Morphine
  • Methadone
  • Opium
  • Heroin

SIGNS OF OPIOID INTOXICATION:

  • Droopy eyelids
  • Constricted pupils
  • Slurred speech
  • Drunken walk
  • "On the nod" which occurs when someone cannot keep their eyes open and they head starts nodding