Cassandra Collins, senior clinical director of treatment services, stands for a portrait Aug. 25 in her office at the Area Substance Abuse Council in Cedar Rapids. (Nick Rohlman/The Gazette)
Iowa is grappling with a dramatic increase in overdose deaths involving fentanyl.
While the state has one of the lowest drug overdose rates in the country, overdose deaths increased 34 percent between 2019 and 2021, according to the Iowa Governor’s Office. Fentanyl was involved in 83 percent of the state’s 258 opioid deaths last year, and drug overdose deaths increased 120 percent among Iowans under 25 in the last two years.
Fentanyl is a synthetic opioid painkiller many times more powerful than morphine, and typically prescribed to treat severe pain. It often is found in illicit pills sold on the black market disguised as real pharmaceutical drugs, and is mixed into heroin, cocaine and other drugs to increase their potency.
Cassandra Collins is a clinical director of treatment services for the Area Substance Abuse Council. Cedar Rapids-based ASAC provides substance use and gambling disorder prevention, treatment and recovery programs in Linn, Jackson, Jones, Clinton, Benton, Delaware and Dubuque counties.
She recently spoke with The Gazette about the rise in drug overdose deaths and fentanyl use.
Q: How serious is the fentanyl problem locally, and what public health strategies are being implemented to address opioid abuse?
A: “I think the biggest thing we’re running into with fentanyl, especially, is that it’s being laced with other, more popular drugs that people are taking. And they don’t even know they’re ingesting fentanyl,” which increases depending and risk of overdose.
ASAC has a prevention department that works with state, community and rural agencies to gather data to tailor prevention strategies to each community, including awareness and prevention campaigns in schools and businesses.
She said ASAC also uses state grants to provide medication-assisted treatment and encourage long-term recovery.
Q: How does Iowa law make it difficult to curb overdose deaths and provide treatment? What changes are needed to state law and why?
A: “Allowing nonprofits like ASAC to dispense (the opioid overdose reversal drug) naloxone” by staff who are trained would be helpful, she said.
“Currently, we can give vouchers that people can take to pharmacies to receive the product, but we can’t dispense it on our own. Sometimes I think there’s a stigma … to take that voucher to the pharmacy to receive it; whereas, if we could distribute it as part of our practice, we could educate patients in real time. If they’re experiencing (overdose symptoms), or someone you know is experiencing this, you can use this and save their life in an instance of an overdose and make it more accessible for people.”
Collins said legalizing testing strips would also be a welcome policy change. Doing so would allow drug users who aren’t trying to take fentanyl to avoid consuming deadly amounts.
Fentanyl test strips currently are classified as drug paraphernalia under Iowa law, which carries a simple misdemeanor charge.
Q: Harm reduction advocates have also advocated for needle exchange programs. What are your thoughts on that?
A: “I think it’s part of a harm-reduction strategy that we see as beneficial that we don’t currently have.”
Q: According to the Iowa Department of Health’s Bureau of Substance Abuse, alcohol-involved deaths among older Iowans are on the rise. The American Public Health Association as well has reported increases in alcohol intake and heavy drinking among women, older adults and those in low-income brackets. What are you seeing locally in the Cedar Rapids area related to heavy drinking and alcohol-involved deaths?
A: “We are seeing a large increase in alcohol-related use, and the severity of the use. … I think the pandemic had a lot to do with that, especially in rural areas, (with) the isolation that came along with the pandemic and the accessibility of alcohol … and relatively low cost as well.”
Q: What are some of the public health strategies that might be needed or are being implemented to address excessive alcohol consumption?
A: “Substance abuse disorders are a medical diagnosis and people have a right to equitable treatment, and it should be treated in alignment with other medical needs. It also goes hand in hand with mental health, and we are seeing a large increase in individuals with mental health needs that are unmet. And they’re having difficulty accessing those services. So making sure that there are enough services for our patients to really combat substance abuse disorders and help the treatment.”
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