Group develops strategy to combat opioids, prescription drug abuse

Hayley Nemmers asked members of the Jasper County Substance Abuse Coalition during its meeting Monday to brainstorm signs of victory over opioid and prescription drug abuse among youths and young adults.

“Imagine the day after the (Strategic Prevention Framework for Prescription Drugs) grant ends in 2020. We’re just now entering year two and we have about three years to work on all of these strategies,” Nemmers said of the county’s inclusion in the program. “What does victory look like?”

She transcribed the group’s responses inside a large circle she had hand-drawn onto a dry-erase board in room 105C of the Newton Community School District:

Less ER visits. Fewer suicidal students. Fewer community complaints related to drugs. Open communication. Support network. People trying alternate forms of pain management. Changed perception of (high school) students getting opioids. No denial. Awareness of the issue. No overdose deaths. A lot less scripts written.

The Strategic Prevention Framework for Prescription Drugs (SPF Rx) grant coordinator soon ran out of room in her “victory circle,” eventually writing a new list to incorporate further idealistic goals. Nemmers' demonstration not only compiled objectives for the coalition but also illustrated the obstacles Jasper County currently faces combating the expanding “opioids and prescription drug epidemic.”

Prompting group members to work together on the spot during the Monday meeting, Nemmers helped guide the Jasper County Substance Abuse Coalition to develop a well-thought-out strategy to reduce the misuse of prescription drugs for youths aged 12 to 17 and young adults aged 18 to 25.

Local awareness

During the Monday meeting, Newton Police Chief Rob Burdess addressed the coalition made up of local law enforcement from across the county, businesses, healthcare professionals, state and local government officials, religious organizations, media, youth-serving organizations and substance abuse prevention treatment and recovery professionals, among other volunteers.

“A lot of participation needed today so we can kind of figure out a strategy to prepare for the future here in Jasper County,” he said.

When the City of Newton released its biennial Comprehensive Plan survey about a month and a half ago, Burdess added, a common citizen complaint different from previous years’ survey responses was the use of drugs in town. However, the grievances were vague. Burdess also specified Newton residents may not necessarily see drugs or drug use.

“They’re seeing people walking down First Avenue with backpacks and they may not be the most attractive folks in the world in terms of they have old clothes on, maybe look dirty or they may have some actions or behaviors that don’t seem right. And so it may just be that look that people are making assumptions on,” Burdess said. “Obviously, on the enforcement end, we can enforce to the best of our ability and still not solve the problem. So that’s where this type of group comes in.”

County statistics

As a recipient of the SPF Rx grant — described by the Substance Abuse and Mental Health Services Administration (SAMHSA) as a program "designed to target the priority issue of prescription drugs misuse" — the Jasper County Substance Abuse Coalition is tasked with completing a "five-step, data driven process."

Since the coalition already completed Steps 1 and 2, assessing needs and building a capacity, Monday’s meeting marked the beginning of Step 3: engage in a strategic planning process. In time, the group will complete the remaining steps by implementing its strategic plan and then evaluating processes and outcomes.

Nemmers prepared three sets of statistics and posted the findings on poster-sized paper for coalition members to read aloud:

According to Nemmers’ information gathered from the Iowa Youth Survey in 2016, “over (one) in (five) 11th graders in Jasper County reported they had contemplated suicide in the past 12 months.” Year-old data from the Iowa Department of Public Health (IDPH) stated “in 2016, there were 51 opioid-related emergency room visits in Jasper County. In 2015, there were 28.” Nemmers cited IDPH once more, informing the group that “Jasper County had 88 prescriptions for opioids per 100 people in 2016. The state of Iowa had 72.8 per 100.”

Nemmers said, “Those were three that really stood out us. Obviously we have a few other things to keep in mind as a county. Most 11th graders reported that they felt it would be very easy to get a prescription opioid from somebody in the community. Not from a doctor. All of these data points are things we are going to keep in mind as we start to imagine what strategies we’re going to start implementing.”

Required strategies

The SPF Rx grant, provided by the Iowa Department of Public health, requires the Jasper County Substance Abuse Coalition to implement two types of strategies.

The first required strategy is Centers for Disease Control and Prevention (CDC) Guidelines for Prescribing Opioids for Chronic Pain and SAMHSA Toolkit to Prevent Opioid Overdose. This program, split into two parts, would allow the usage of CDC and SAMHSA materials to educate prescribers about the benefits of using a Prescription Monitoring Program and also educate the public — mainly parents or guardians, patients, teachers and community members — about the potential dangers of using prescription drugs other than what is instructed.

“We already have the materials, which is great, (but) we just need to figure out how to disseminate these in a way that makes sense for our community,” Nemmers said. “We would need to figure out how to talk to prescribers and maybe get prescribers engaged in ways they haven’t yet.”

The material cost of the CDC Guidelines and SAMHSA Toolkit strategy is free, but the way in which the information is dispersed — whether it be a billboard, a print ad or radio advertisement, for example — is a variable price. Nemmers said the coalition’s grant has allowed the group to spend approximately $65,000 this year.

The second required strategy is the IDPH Media Campaign to Reduce the Misuse of Prescription Drugs: “Prescription Drugs are Still Drugs.” Primarily carried out by media, the information dissemination campaign created by the SPF Rx grant aims to inform the priority age group of the dangers of missing prescription drugs.

“There is a billboard for it, currently, off the exit as you head to Des Moines … it’s been out there for a little while so you may have seen it,” Nemmers said. “We have posters like this and then brochures. They are Iowa specific. They talk about Iowa’s Prescription Monitoring Program and talk about Iowa stats. Again, materials are free. We get them for free at the (IDPH). It’s just a matter of how we disseminate them.”

Voted strategies

In tandem with the two required strategies, the coalition voted between five other actions; the two with the most votes would be adopted as additional procedures to raise awareness about the dangers of prescription drug abuse.

The first to be introduced was the LifeSkills Training Program to be utilized by health curriculum teachers, school administrators and prevention specialists. According to the information packet distributed among Substance Abuse Coalition members, the program’s objective is to integrate “personal self-management skills, general social skills and drug resistance skills,” as well as inform students to the consequences of substance abuse and misuse.

At a cost of $795, the LifeSkills Training Program requires educators to learn and use proper materials in the classroom and undergo additional training.

“I currently do LifeSkills with eighth graders at Berg Middle School, and so if we chose this strategy we wouldn’t be able to do more eighth grade LifeSkills because EFR’s (Employee & Family Resources) other grants already covers that. But we can do it with high school students with our grant that we currently have. This would be with ninth or 10th graders,” Nemmers said.

The second strategy introduced was the Strengthening Families Program for Parents and Youth 10-14, specifically targeting middle school students and their respective parents or guardians. Designed mainly for high-risk and general population families, the seven-session prevention program“elevates positive parenting skills, children’s social skills and family relationships.” The program approximately costs $1,400 and would cover seven to 10 families for seven weeks and would require three training facilitators with evening availability.

Ultimately, the Jasper County Substance Abuse Coalition almost unanimously voted for the first two strategies.

The Generation Rx program allowed the use of resources to enhance medication safety for high schools, colleges and employers to utilize. The Drug Recognition Expert (DRE) Training program would need a select few law enforcement to take 72 hours of additional training and a seven-night, out-of-state certification to recognize driving impairment “under the influence of drugs other than, or in addition to, alcohol.” The final program was the Screening, Brief Intervention and Referral to Treatment (SBIRT) for healthcare and treatment providers to make use of, increasing the awareness of the SBIRT screening process for early detection and intervention “to decrease non-medical use of prescription drugs.”

Upon selecting the LifeSkills Training Program and the Strengthening Families Program for Parents and Youth 10-14, Nemmers said Iowa State University has a project called Program for Sustainable Pavement Engineering & Research (PROSPER), which is meant to enhance the quality of prevention activities.

“We would have access to all of the PROSPER resources as well, and there are a lot of educational resources,” she said. “It can only be used a support.”

Likewise, if the coalition chose DRE and SBIRT, then the group would be eligible for Project Lazarus, another prevention program.

Refining the plan

Near the end of the meeting, the coalition divided itself into four groups to tackle the four strategies head on. Each group wrote down its launch strategy, resources, coordinator and expected victory, as well as other month-to-month actions.

The Prescription Drugs are Still Drugs program coordinators would like to disseminate its information through newspapers, radio, posters in schools, movie advertisements and social media in hopes to reach more than 50 percent of the target audience, increasing awareness and decreasing use of prescription drugs and opioids.

Members tending to the CDC Guidelines and SAMHSA Toolkit also aimed to spread its information through traditional and social media platforms, in addition to BlitzMailing educational emails and invitations to a big kickoff event. The group also wanted a community presence at events and maintaining a booth at parent-teacher conferences. Their goal is to increase the number of educated providers and awareness in public education.

Supporters of the Strengthening Families Program for Parents and Youth 10-14 would launch its plan by contacting Iowa Department of Human Services, juvenile judges, school counselors and healthcare providers before connecting with PROSPER at Iowa State University by October. Afterward, the group would like to acquire and train volunteers to be facilitators, create an application to recruit families and use donations as incentives. The group would like to review participants sometime after the class has concluded and skills are put into effect.

The LifeSkills Training Program launch would like to identify and use champions to reach out to schools with educational materials and thereby negotiate a memorandum of understanding with schools. Near the end of the current school year, group members would like to find and train its program facilitator before classes start again in August 2019. The goal is to recruit every school in Jasper County.

"What I'm going to do (after) this meeting is take all of this great information you all came up with together and I'm going to write a big long paper about it called the Strategic Prevention Framework for Prescription Drug Abuse Planning Workbook," Nemmers said. “We’ve done the Assessment Workbook, we’ve done the Capacity Workbook, (so) this is all going to go into our Planning Workbook.”

The newly comprised workbook will be submitted to the IDPH by Oct. 26 in order to review it. The workbook will likely be returned for language revisions. If there is anything substantial, Nemmers said, she will notify the Jasper County Substance Abuse Coalition.

“I’ll make sure we’ll all still on the same page,” she said. “Once that has been approved, then by then I’ll know what the next steps look like for implementation … Well then, we have a plan. You are a coalition with a plan!”

Contact Christopher Braunschweig at 641-792-3121 ext. 6560 or cbraunschweig@newtondailynews.com