A Response to the Ongoing Opioid Crisis

This issue brief is informed by the American Public Health Association’s Policy Statement No. 202113.¹

Summary
The opioid crisis is an ongoing public health emergency. It is essential for the health of the populace to help prevent overdose deaths and support those struggling with addiction.

IPHA supports the following actions, endorsed by the American Public Health Association,¹ to respond to the opioid crisis:

• Increase funding for surveillance of opioid use and IV substance use-associated diseases.
• Exempt hypodermic needles, syringe possession, and fentanyl test strip possession from classification as drug paraphernalia.
• Improve equitable access to comprehensive, integrated Medications for Opioid Use Disorder treatment and overdose prevention.
• Creation and funding for programs that teach family and community members about overdose prevention and harm reduction.

Health Impact
Nationally, both fatal and nonfatal opioid overdoses have been increasing. Between 2017 and 2021, fatal opioid overdoses increased by 69%.² Increasing rates of opioid overdose have led to opioids becoming the leading cause of injury-related death within the United States.³ While rates of prescription opioid overdose have remained steady since the early 2010s, the increasing rates of opioid overdose and associated death can be attributed to synthetic opioids (fentanyl).²

Hepatitis C virus (HCV) is an infectious disease primarily transmitted through shared needle use. Thus, HCV rates often serve as an indicator for monitoring opioid use rates,⁴ given the prevalence of injectable opioid use, and the increased rates of HCV are found among opioid abusers.⁵ Infection with HCV has negative long-term health outcomes, including cirrhosis, liver cancer, liver failure, and is the number one cause of liver transplants.⁶

Health Equity and Minority Impact
Opioid abuse and overdose disproportionately affect vulnerable populations. Populations at increased risk for opioid misuse and abuse include those with less than a high school degree, those making less than $35,000 per year, and minority populations.⁷,⁸,⁹ The Black population has been disproportionately affected, with opioid overdose death rates 4 to 6 times higher than their white counterparts.¹⁰

Iowa Data
Similar to national trends, the state of Iowa has had a steady rise in opioid-involved deaths since 2011.¹¹,¹² As of 2021, the crude death rate was 7.9 opioid-involved deaths per 100,000 population,¹¹ and 60% of all unintentional or undetermined overdose deaths were likely due to opioids.¹³ Illicitly manufactured fentanyl accounts for 84% of opioid deaths in 2021.¹⁴

As previously stated, HCV can serve as an indicator for the burden of opioid use. Among the 234 people under 40 diagnosed with new HCV in Iowa in 2021, 76% reported needle sharing secondary to intravenous drug use as the mode of exposure.¹⁵ Since 2018, there has been a decline in the rates of Iowans diagnosed with chronic HCV, which has been attributed to illegal needle exchange programs within the state.¹⁵,²⁶ Needle exchange programs are currently illegal in Iowa due to syringes and hypodermic needles being characterized as drug paraphernalia when not used for a “lawful purpose.”¹⁷

Additional Information
As the opioid epidemic continues to evolve, public health initiatives also continue to adapt. Currently, there is a shift toward demand-oriented intervention, harm reduction, and treatment. Medications used to treat opioid use disorder have demonstrated efficacy in reducing opioid use, increasing remission, and reducing mortality.¹⁸ Furthermore, programs and policies aimed at reducing stigma associated with Opioid Use Disorder (OUD) contribute to improved outcomes in harm reduction.¹⁹

Vigilant monitoring is crucial for effectively addressing the opioid epidemic. By integrating additional opioid-related metrics into existing surveillance programs, public health officials and policymakers will be better able to respond to the community’s needs.²⁰ It’s important to acknowledge that the context and language employed in data collection and monitoring programs can carry significant consequences if used inappropriately.

Tertiary prevention for people who inject drugs, such as access to syringe and needle service programs, mitigates the risk of blood-borne infections such as HCV and HIV.²¹ The absence of such programs leads to undetected outbreaks of HCV and HIV, whereas access to them (e.g., in Philadelphia, Baltimore, and Scott County, Indiana) significantly reduced injection drug use risk behaviors and rates of new HCV and HIV infections.²² Needle exchange programs also have the potential to reduce overdose deaths when referrals and increased access to OUD pharmacotherapies are included, in addition to other harm reduction strategies (e.g., distribution of naloxone and fentanyl testing strips).²³

Fentanyl test strips are increasingly recognized as a valuable tool in altering substance use patterns, especially in the context of illicitly manufactured fentanyl driving overdose fatalities. 92% of people who use substances are interested in using fentanyl test strips to determine if substances contain fentanyl. Notably, when a test strip is positive for fentanyl, 43% of people who use substances changed their behavior. This includes adjustments like reducing the quantity used and options for alternatives such as snorting instead of injecting drugs.²⁴

• A Response to the Ongoing Opioid Crisis Infographic
• Social Media Image Set

References

1. American Public Health Association. (2021, October 26). An equitable response to the ongoing opioid crisis. APHA Policy Library. https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2022/01/07/An-Equitable-Response-to-the-Ongoing-Opioid-Crisis
2. National Institute of Health. (2023, June 23). Drug overdose death rates. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
3. Centers for Disease Control and Prevention. (2023a, May 8). Understanding Drug overdoses and deaths. Drug Overdose. https://archive.cdc.gov/#/details?q=https://www.cdc.gov/drugoverdose/epidemic/index.html&start=0&rows=10&url=https://www.cdc.gov/drugoverdose/epidemic/index.html
4. Murphy, S. M., Dweik, D., McPherson, S., & Roll, J. M. (2015). Association between hepatitis C virus and opioid use while in buprenorphine treatment: preliminary findings. The American Journal of Drug and Alcohol Abuse, 41(1), 88–92. https://doi.org/10.3109/00952990.2014.983274
5. Schulte, M., Hser, Y., Saxon, A., Evans, E., Li, L., Huang, D., Hillhouse, M., Thomas, C., & Ling, W. (2015). Risk Factors Associated with HCV Among Opioid-Dependent Patients in a Multisite Study. Journal of Community Health, 40(5), 940–947. https://doi.org/10.1007/s10900-015-0016-2
6. Alter, H. J., & Seeff, L. B. (2000). Recovery, persistence, and sequelae in hepatitis C virus infection: a perspective on long-term outcome. Seminars in Liver Disease, 20(1), 17–35. https://doi.org/10.1055/s-2000-9505
7. Iowa Department of Health and Human Services. (n.d.-b). Adult past year prescription opioid misuse data. Iowa Public Health Tracking Portal. https://tracking.idph.iowa.gov/Health/Substance-Use-and-Misuse/Adult-Substance-Abuse/Adult-Past-Year-Prescription-Opioid-Misuse-Data
8. Iowa Department of Health and Human Services. (n.d.-c). Adult past year prescription opioid abuse data. Iowa Public Health Tracking Portal. https://tracking.idph.iowa.gov/Health/Substance-Use-and-Misuse/Adult-Substance-Abuse/Adult-Past-Year-Prescription-Opioid-Abuse-Data
9. Iowa Department of Health and Human Services. (n.d.-d). Youth 30-day illicit opioid use data. Iowa Public Health Tracking Portal. https://tracking.idph.iowa.gov/Health/Substance-Use-and-Misuse/Youth-Substance-Abuse/Youth-30-Day-Illicit-Opioids-Use-Data
10. Gondré‐Lewis, M. C., Abijo, T., & Gondré-Lewis, T. A. (2022). The Opioid Epidemic: A Crisis Disproportionately Impacting Black Americans and Urban Communities. Journal of Racial and Ethnic Health Disparities, 10(4), 2039–2053. https://doi.org/10.1007/s40615-022-01384-6
11. Iowa Department of Health and Human Services. (n.d.-a). Substance-Involved Mortality data. Iowa Public Health Tracking Portal. https://tracking.idph.iowa.gov/Health/Substance-Use-and-Misuse/Substance-Involved-Mortality-Data
12. Iowa Department of Health and Human Services. (n.d.-e). Substance-Involved Mortality data. Iowa Public Health Tracking Portal. https://tracking.idph.iowa.gov/Health/Substance-Use-and-Misuse/Substance-Involved-Mortality-Data
13. Iowa Department of Health and Human Services & University of Iowa Injury Prevention Research Center. (2023). Iowa Overdose Data to Action Grant: Unintentional and Undetermined Overdose Deaths, 2021.