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While deaths caused by prescription opiates are falling in Iowa, a potential spike in heroin and synthetic opioid overdoses is looming, a new report from Iowa State University finds.

The report released Feb. 11 by ISU shows opioid deaths are low and stable compared to surrounding states, but within those numbers is a transition from prescription painkillers to heroin and synthetic mixes.

“In Iowa, the problem is shifting ... so our rates have been stable the last few years, but that sort of masks a lot of changes going on within,” said David Peters, an associate professor of rural sociology with Iowa State. “The looming issue in Iowa is these illicit substances — heroin, synthetics and mixes of the two.”

What’s more, a synthetic opioid like fentanyl is 80 to 100 times stronger than morphine, increasing the risk of overdose.

The report, titled “Understanding the Opioid Crisis in Rural and Urban Iowa,” found that Iowa has followed nationwide opioid trends, with the use of heroin and synthetics more concentrated in larger cities.

Prescription opioid use is common in Western Iowa, while heroin and synthetics are more prevalent in Eastern Iowa. Counties with high unemployment, low incomes and extensive poverty have the highest overdose death rates, according to the report.

The report does note that, while the Midwest and Northeast regions of the country have seen the largest increases in opioid use deaths since 2000, Iowa’s opioid death rates have remained among the lowest in the United States. Opioid use deaths include overdoses and mental health or behavioral deaths caused by opioids.

Peters said Iowa’s opioid trends align more with lower-population states like Nebraska and South Dakota, while states with larger metropolitan areas like Illinois, Missouri and Wisconsin have been seeing more drastic spikes in opioid use deaths in the last few years.

Earlier this month, preliminary data from the department’s Bureau of Health Statistics showed that in the first eight months of last year, Iowa saw 89 opioid deaths, compared with 137 in the same time span in 2017.

All told, the number of opioid deaths have tripled in Iowa since 2005, per the state report.

ISU’s study is part of a five-year initiative that also includes the University of Iowa and Syracuse University. This summer, researchers will expand the study nationally to identify patterns in opioid use and overdose rates.

Peters said another goal is to visit communities and counties with high overdose rates to understand how they’ve approached opioid trends.

Peters said the hope is that research leads to more regional, multi-jurisdictional agencies or collaborative efforts to address local opioid issues.

“That’s what we really think is the best approach, rather than having individual communities trying to deal with this or having a statewide task force,” he said.

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In Linn County, efforts began in 2017 to create a steering committee focused on opioid use in the community.

Linn County Public Health Director Pramod Dwivedi said the committee includes officials from several sectors including law enforcement, universities, pharmacy groups and public health.

Dwivedi said education and awareness have been key components so far.

“In public health, we look at prevention, so awareness, education, those active duties are so crucial in terms of prevention,” he said.

Dwivedi said one potential discussion this year will surround a bill in the Iowa Legislature that would create a needle exchange program for people who inject drugs. While it’s illegal in Iowa to distribute needles for drug use, other states have implemented exchange programs with hopes of reducing the spread of infectious diseases and to help drug users get treatment.

“It’s controversial, and we’re trying to have some frank conversations with our law enforcement and first responders on this,” Dwivedi said.

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