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Goes Local Events Identify Local Strategies to Combat the Opioid Crisis in Iowa

2017 IPA Goes Local events brought together pharmacists and stakeholders together in eight Iowa communities to discuss local solutions to address the opioid crisis.
Throughout 2017, the Iowa Pharmacy Association (IPA) coordinated eight local meetings to discuss the opioid use public health emergency. By collaborating with local pharmacy organizations and various statewide groups, these meetings brought together community members to openly discuss solutions and strategies at the local level. While “IPA Goes Local” events occur every year, the focus for 2017 was the opioid crisis. In addition to state level discussions and strategies, IPA saw a need for candid conversations on the topic at the local level.
In partnership with the Alliance of Coalitions for Change (AC4C) and the Cedar Rapids Police Department, participants engaged in a 90-minute presentation, which used didactic learning and interactive roundtable discussions. The target audience included pharmacists, physicians, other prescribers, dentists, nurses, social workers, law enforcement, substance abuse coalitions, community members, and other interested stakeholders. Combining the experience and unique perspectives of a multitude of professional backgrounds, the programs have helped increase awareness to the evolving public health crisis of opioid abuse while also generating feasible action steps to help combat the trends of increasing abuse at the local, community level.
These eight meetings were held in Council Bluffs, Davenport, Des Moines, Dubuque, Iowa City, Mason City, Waterloo, and Spencer from March to October 2017. While each local event held unique discussions, common themes were identified by attendees from across the state. The most consistent concerns expressed by participants of IPA Goes Local included the need for community education, enhancement of the Prescription Monitoring Program (PMP) platform to increase utilization, and promoting provider education. These summary points will be useful to understand how the opioid crisis and current strategies are impacting Iowa communities. A comprehensive synopsis of the strategies discussed is reviewed:
Themes Identified at IPA Goes Local 2017
1. Education
Education was identified as the most predominant need at all eight IPA Goes Local events. Opportunities for education included efforts targeted to patients, communities, and providers. It was emphasized that all parties involved need to have a consistent, collective message regarding the opioid crisis.

Patient education needs to focus on counseling on the appropriate use of opioids, the dangers of opioid medications, and the potential for abuse. It was also discussed that patients can legally obtain a lower quantity of an opioid prescription than the prescription was written for (a partial fill), and return to the pharmacy to obtain the remaining quantity if needed. This opportunity stems from the passage of the Comprehensive Addiction and Recovery Act (CARA) of 2016. This practice would decrease the potential for misuse and diversion, however much of the population, patients and providers, is not aware of this practice. It was recognized that pharmacists need to fulfill an important role in educating patients on the appropriate use of opioid medications, availability of medication disposal options, and risk factors that would make a patient or caregiver eligible for naloxone.

Community education opportunities exist to share information on the risks associated with opioids, local resources for treatment options, and proper indication/administration of naloxone. Many IPA Goes Local sessions also discussed ongoing educational meetings for the community through open forums or information sessions, as well as creating local opioid abuse prevention task forces such as the Community Resources United to Stop Heroin (CRUSH). Education through media outreach was also identified by most groups as an avenue to educate communities on the dangers of opioid abuse, advertise against the sharing of prescription medications, and to end the negative stigma around opioid addiction. The costs associated with such education was identified as one primary barrier.

Areas identified for provider education are discussed in the next section.
2. Pain Management Practices
All IPA Goes Local events discussed the need for prescribers to practice appropriate, evidence-based prescribing of opioids. In many cases, this concept was referenced in conjunction with encouraging the use of non-opioid and non-pharmacological treatment alternatives for pain management. It was suggested that technology be used to assist with appropriate prescribing, such as with the Prescription Monitoring Program (PMP) and electronic prescribing of controlled substances. Electronic prescribing of controlled substances, although allowed by the DEA at the federal level, is still an uncommon practice in many Iowa institutions and clinics due to technology limitations and the financial burden of upgrading current technology. It was recognized that individual providers can advocate for making electronic prescribing of controlled substances a priority within their health care setting.  
3. Iowa's Prescription Monitoring Program (PMP)
The Iowa PMP is a centralized tracking system of controlled medications dispensed and serves as a tool for prescribers and pharmacists to prevent over-prescribing and dispensing of opioid products. During the discussions, healthcare professionals noted when accessed the PMP can be especially helpful when patients see multiple prescribers or use multiple pharmacies. However, attendees determined that the utilization of the PMP was too low amongst providers. Some attendees suggested mandatory utilization of the PMP for all providers, while others suggested at least mandatory registration for the PMP so that all would have access to the platform. Improved functionality of the PMP interface was also suggested as an area of improvement that should be considered in order to increase utilization of the PMP by providers.

4. Access to Treatment Programs for Substance Abuse
The majority of locations identified a shortage or lack of awareness of programs available in their region for those individuals seeking recovery from substance abuse and misuse. Many patients have difficulty accessing these services even when the need is identified. It was recognized in these communities that adequate funding for comprehensive treatment programs and prevention strategies should be a priority.

5. Medication Storage and Disposal
Healthcare professionals play an essential role in reducing the potential for addiction and diversion through proper storage and disposal of medications. Half of the IPA Goes Local locations identified a need for increased access to disposal sites for controlled substances in their communities, as well as a need to better inform the public regarding the disposal options available. Furthermore, this conversation was accompanied by the need to educate patients on proper storage of medications in an effort to decrease diversion of opioids in the home setting.


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