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Wellness Expo presents fun, facts

Community meeting on the opioid crisis follows expo

October 27, 2017
Amy H. Peterson - Staff Writer ( , Estherville News

The Third Annual Wellness Expo at the Regional Wellness Center in Estherville featured health facts and fun activities Tuesday afternoon.

The featured exhibit was "Hidden in Plain Sight," an indicator exhibit to see what drug related items can easily be overlooked in a teenager's bedroom. From soda cans, or any container that can be retrofitted from the bottom, to clothing, to showing what seemingly decorative or everyday items could actually be paraphernalia, participants learned what to look for if they suspect drugs could be an issue.

After the expo, Sara Derr, PharmD, of the Iowa Healthcare Collaborative presented a community meeting on the opioid crisis.

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The typical opioid addict in Iowa, Derr said is a woman, age 65 or older with low income living in the metro areas of the state.

Derr told the often-told public health story called Moving Upstream.

A man and woman fishing downstream. Suddenly a child comes down the river struggling for life. The fisherfolk pull her out. Then another comes and again must be rescued. This happens all afternoon and the fisherfolk are getting very tired from constantly pulling people from the river.

Eventually they think, "We need to go upstream and find out why so many people are falling in the water."

Others gather to help, and they're upset when the couple starts moving away to walk upstream.

When they go upstream, they find that people are drawn to the edge to look at the river, but there is no safe way to do this. Many of them fall. The fisherfolk go to the community leaders and report the number of people who have fallen into the river. They also report that this is due to the lack of a protective barrier on the cliff. Community leaders build a wall behind which people may safely view the water. Some still fall, but there are many fewer victims to rescue.

Derr said, "We are trying to get in front of opioid abuse at the source, preventing the issue before we have to treat the addiction."

When dealing with pain, Derr said, the standard has been to try to get the patient's pain to zero, and doctors are graded on how well they control a patient's pain.

Hence, opioids, which were once considered safely non-addictive, became popular.

Derr said a better measure of health than having a patient assign a number to their pain level is considering their measure of comfort and functionality.

"The goal of pain management does not have to be getting the pain to zero. It's whether they're comfortable doing the tasks of daily life. People might say, 'I just want to go to my kids' soccer games,' or 'I just need to get through the workday,'" Derr said.

There are many options for pain management besides opioids, including chiropractic care, acupuncture, TENS units, biofeedback, and counseling, Derr said.

Many times, the pain management plan skips acetaminophen and other non-opioid medications and goes straight to an opioid, and the prescriptions are given out liberally with 60 or 90 pills in a bottle, Derr said.

"Most people have a comfort level that's not in need of opioid support by three to seven days after surgery, Derr said.

Derr said the crisis is here. "Each day 1,000 people are seen in the ER because they've taken an opioid other than as prescribed."

Opioid medications, including oxycontin, hydrocodone, and codeine, are appropriate for severe short term pain, some cases of severe long term pain, cancer, end of life treatment.

For other uses, Derr said patients with their health care providers should discuss the benefits versus the risks, and make a plan to try lowering the dose each visit.

A patient turns into a heroin addict through the use of opioids by prescription. Lortabs are $5-7 per pill. Percocet is $7-10, Oxycodone is $30-40. When the patient cannot get any more prescriptions, they might try getting the pills on the street with Oxycontin going for $80 per tab. As the patient takes more, the sensitivity to pain increases, so they need more to control the pain. Having exhausted their financial ability to acquire enough, they're increasingly turning to heroin, which provides the same effect for $10 per bag.

One in five new heroin users started out as prescription opioid patients. One in four opioid users struggles with addiction. The number of opioid prescriptions quadrupled between 1999 and 2010, and in 2012, there were 259 opioid prescriptions, enough for every American adult to have a 30 day supply.

Avera Holy Family Hospital is one of 23 hospitals serving in the Collaborative.



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