- Associated Press - Monday, October 23, 2017

Des Moines Register. October 19, 2017

To prevent full-blown opioid crisis, Iowa needs overdose of vigilance

Drug overdoses are now the leading cause of death for Americans under age 50, killing roughly 64,000 people in the United States last year. An increase in fatalities is largely fueled by opioids, including fentanyl, a powerful synthetic substance considered up to 50 times more potent than heroin.

Although Iowa has not been hit as hard as some other states by the opioid epidemic, we have not been spared.

So far this year, 124 Iowans have died from opioid-related causes, according to the Iowa Department of Public Health. Addiction treatment admissions for opioid use have more than tripled over the past decade.

Drug overdoses reduce overall life expectancy in this country. They strain police departments, human services systems, hospitals and paramedics. And they devastate families.

Iowa’s capital city is “definitely seeing a rise” in overdoses, said Lt. Tony Sposeto, with the Des Moines Fire Department’s emergency medical services team. In 2016, these first responders administered 191 doses of Narcan, a drug used to reverse an opioid overdose. The first nine months of this year, they used it 202 times.

“The number has been steadily increasing,” he said. “We’ve had overdoses in public places, shopping centers, multiple overdoses on one scene.” His department responded to a call where three people at a single location overdosed on heroin.

Paramedics are also seeing more overdoses from fentanyl, which require a larger amount of Narcan to treat. The department has responded by increasing the number of vials workers carry and changing protocols so they can administer more of the drug.

Local government budgets also feel the strain of opioids. Sposeto said the cost of Narcan, also known as naloxone, has more than doubled in recent years. Agencies across Iowa generally pay $23 to $48 per dose, according to a statewide survey. Iowa Attorney General Tom Miller has tried to reduce the cost, recently announcing his office had reached a deal with a drug manufacturer to provide rebates for “public entities.”

“Quite literally, naloxone may be someone’s only lifeline if they overdosed on prescription painkillers or heroin,” Miller said.

The ultimate goal, of course, is preventing opioid addiction in the first place. Some of that responsibility falls to health professionals who prescribe prescription pain medication.

The heroin and fentanyl crisis can be traced in part to a surge in sales of prescription opioids and then a tightening of restrictions on the pills. When patients cannot secure another script from a doctor, they may turn to illegal drugs.

Fortunately, Iowa health providers are starting to trim prescriptions for opioid painkillers, a top state regulator told lawmakers last week. The number of pills sold this year is on track to hit about 270 million, a 10 percent drop from last year.

That is still a staggering average of 90 pills for each man, woman and child in this state. Doctors are prescribing too many opioid-based pain medications and frequently more than people need.

Dr. Jeff Rodgers, a West Des Moines orthopedic surgeon, recognized this years ago. His study, published in The Journal of Hand Surgery in 2012, concluded the standard prescription of 30 pain pills following outpatient surgery appears “excessive and unnecessary.”

Routinely prescribing 30 pills is not based on research or what a patient necessarily needs. So where did that number come from?

“It’s tradition, what would fit in a bottle, what was easy to write,” Rodgers told an editorial writer this week. Pain can often be controlled by over-the-counter medications instead of opioids, and patients tend to save excess pills, which other family members, including teens, may later swallow.

While changing the prescribing practices of doctors is important, Iowa still faces the threat of illegal drugs sold on the street. Just this month authorities in Omaha recovered 33 pounds of fentanyl - worth about $15 million - hidden in a suitcase at the city’s train station.

Preventing opioid abuse and death is multifaceted and requires all Iowans to be vigilant.

Patients should avoid addictive prescription pain medication whenever possible. Parents should refuse drugs, including hydrocodone, on behalf of their children following procedures like the removal of wisdom teeth. Lawmakers and health insurers should ensure Iowans who want addiction treatment can receive it. Law enforcement agencies must have the resources to stop the flow of illegal drugs into the state.

Drug overdoses are unnecessary tragedies ending the lives of too many young Americans. These deaths are preventable. While Iowa has taken good steps to try to prevent a full-blown opioid crisis here, there is more we can do.

Drug deaths from fentanyl, a synthetic opioid many times more powerful than morphine and heroin, more than doubled from 2015 to 2016 in the United States.

Because inhaling even a small amount can be deadly, workers in law enforcement and crime labs increasingly use protective gear, including respirators. Offices stock up on the antidote Narcan in case employees are exposed. Neglected and orphaned children enter the foster care system.

And then there are the bodies.

Medical examiners in Ohio have been forced to store corpses in trailers in parking lots. In one Florida county, the medical examiner relies on a private transport service to hold bodies at another location.

The strain of drug overdoses on these professionals can be overwhelming, as detailed in a recent New York Times story about the chief medical examiner in New Hampshire, a state hit hard by the opioid crisis.

After two decades in the profession, Dr. Thomas Andrew recently retired to pursue a divinity degree. His goal is to become an ordained deacon in the United Methodist Church, minister to young people and encourage them to stay away from drugs.

Pathologists, he said, face mortality daily. The people on his table could have lived longer “but for a few millimeters of cholesterol in the wrong blood vessel, a second of inattention by the driver of a car or the lethal potency of a drug obtained on the street.”

Drug users in their 20s and 30s are increasingly dying of endocarditis, a heart-valve infection resulting from the use of dirty needles. He said his office has seen more endocarditis in the last two years than the previous 15 combined.

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Quad-City Times. October 20, 2017

Iowa GOP is slowly turning on Trump

Iowa’s top-ranking Republicans may have made the mother of all Faustian bargains this past year when they jumped on Donald Trump’s bandwagon. And, as proven in the past three weeks, they know it.

But there’s a bright side to the president’s recent swipes at Iowa’s most sacred of cows. Slowly and quietly, Iowa’s most influential Republicans aren’t rolling over for the president anymore.

The past week saw an all-hands push to scuttle Environmental Protection Agency Administrator Scott Pruitt’s call to reduce the amount of corn ethanol in the country’s gas tanks. No state has benefited more from the Renewable Fuel Standard than Iowa. U.S. Sens. Chuck Grassley and Joni Ernst, and Gov. Kim Reynolds were especially loud about their displeasure.

No one should be surprised about Pruitt’s maneuver. The man spent his career in the oil industry. But the political peril that reductions to RFS pose to Iowa GOP’s brand cannot be overstated.

Any deal with the Devil is perilous.

Trump promised to protect RFS while campaigning in Iowa. Anything else would be political suicide in a state that’s built an entire economy around biofuels. But he proceded to stock his cabinet almost exclusively with oil industry executives, a slew of generals and the executive team from Goldman Sachs.

Thing is, Trump’s word isn’t worth much. The man wants applause. He has just two real goals: Elevating himself and scrubbing his predecessor from the history books. That pesky policy bit bores him, evidenced by the fact that, in a matter of hours, he came out for, and then against, a bipartisan Senate deal to prop up the very Affordable Care Act that Trump himself threw into chaos by executive order. His opinion on any given issue depends entirely on whom last had his ear. As such, Trump may be waffling on Pruitt’s RFS rollback after Iowa’s full-court press, according to Bloomberg News.

In the past few weeks, Trump and his administration have repeatedly targeted Iowa. Pruitt proposed drastic reductions in ethanol. He argued against tax credits for wind energy, another cash cow for Iowa’s economy, hated by the vaunted coal industry. Trump reportedly personally intervened against Iowa’s proposal to stabilize its health insurance marketplace.

Iowa went for Trump in November. Its Republican officials stumped for him. Ernst championed him at the Republican National Convention. To this day, Iowa GOP Chairman Jeff Kaufmann lambastes anyone - Republican, Democrat or Martian - who criticizes the president.

But, slowly, the very criticism Kaufmann detests is beginning to bubble among Iowa GOP’s most powerful elected officials. Grassley, chairman of the Senate Judiciary Committee, vowed to hold up Trump’s nominees for key EPA posts if Pruitt continues to move toward gutting RFS. On Thursday, Grassley co-authored a letter to the Trump administration lampooning its proposed withdrawal from agricultural regulations designed to keep small farms competitive with factory farms. This week, Reynolds lobbied Trump by phone and is scheduled to next week fly to Washington for a sit-down with Vice President Mike Pence to talk health insurance and ethanol.

Such gripes aren’t on par with the likes of Sens. Bob Corker or John McCain. Corker, a Tennessee Republican, this month labeled the president a threat to peace and stability. No, Iowa Republicans, still clinging to a hope that the president suddenly reinvents himself, are taking a less feverish approach. It’s a form of criticism that’s strongly worded but grounded in the specifics of policy, not an area the president has shown much interest. It’s a form of critique that’s unlikely to raise the president’s ire and fuel an early morning Twitter rant.

Again, these are officials who carried Trump in Iowa. And, quite literally, they’re having to beat back his anti-Iowa agenda just to save face.

Mainline Republicans in Iowa ignored their instincts and backed Trump this past year. They focused on isolated issues - especially judicial nominations - instead of Trump’s temperament, character and basic lack of curiosity. They promised that the gravity of the presidency would change him.

It hasn’t.

So, they’re stuck fighting weekly battles against pro-oil and pro-coal policies that would be catastrophic for Iowa.

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Sioux City Journal. October 18, 2017

A new chapter begins for Tyson Events Center

In all honesty, we saw advantages and disadvantages to both proposals for future management of our community’s signature entertainment venue - the Tyson Events Center. We believe a convincing case was made to the City Council in support of continued public management as well as conversion to private management, and we would have been comfortable with either one.

As a result, we do not criticize the council’s decision in a 4-0 vote on Monday for a move to private management of Tyson, as well as the Orpheum Theatre, under Philadelphia-based Spectra by sometime late this year or early next year.

We believe the public was well-served by this process. The decision was reached at the end of a what we view as a thorough study conducted over several months, including recommendations from the Orpheum Theatre Board of Directors, the Events Facilities Advisory Board and a four-member committee formed by City Manager Bob Padmore.

In other words, the decision to make what is a significant change in direction for management of Tyson wasn’t rushed.

In an Oct. 1 editorial, we suggested 10 questions the City Council should ask before deciding on management of Tyson. In our minds, the answers to these questions remain unclear:

- What happens to employees of the Events Facilities Department under private management? A representative of Spectra told the council on Monday the company plans to offer a job to all Events Facilities Department employees. Our hope is Spectra holds to this pledge.

- What will happen to the tourism arm of the Events Facilities Department under private management? In other words, who will absorb these responsibilities? We believe it’s important for the city to remain engaged in tourism and do not wish to see those duties abandoned or forgotten in this transition.

From the beginning, we have supported this dialogue because it was focused on making Tyson better for today and tomorrow. Simply put, a robust Tyson is crucial to local quality of life and strong local quality of life is essential to economic growth and prosperity.

Under Spectra, we look forward to what we hope is a new era of even greater success, at less taxpayer cost, for a building so key to the future of our city.

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Fort Dodge Messenger. October 18, 2017

STEM evaluation shows progress

During her years a lieutenant governor, Gov. Kim Reynolds took a leading role in promoting a multifaceted state initiative that is designed to strengthen education in Iowa concerning science, technology, engineering and mathematics - usually referred to by the acronym STEM.

Consequently, it was with a good deal of pride that Reynolds and Lt. Gov. Adam Gregg released the results earlier this month of an independent evaluation of the program’s impact. This assessment was overseen by the Governor’s STEM Advisory Council. It was conducted by an inter-university consortium that included Iowa State University’s Research Institute for Studies in Education, University of Iowa’s Iowa Testing Program and the University of Northern Iowa’s Center for Social and Behavioral Research.

The 200-page report contains much useful information that will help make STEM efforts even more successful in the years ahead. Some of the highlights of this analysis make it clear, however, that much is already being accomplished. Here are some of the positive findings that the governor emphasized regarding the study:

. Students who participated in STEM Scale-Up programs scored an average of three percentage points higher on the Iowa Assessments in math and reading and four percentage points higher in science compared to all students statewide.

. For minority students, the growth was even stronger: six percentage points higher in math and reading and seven percentage points higher in science.

. Students participating in STEM Scale-Up programs were also more interested in someday working in Iowa compared to all students statewide.

. More than 75 percent of all students statewide indicated they were very or somewhat interested in science, technology, engineering or pursing a STEM career.

One of the goals of the state’s STEM project is to develop the workforce skills that will be needed to keep Iowa’s economy thriving in the years ahead. Much yet remains to be done, but the early indications are that the Hawkeye State is on the right track.

The Messenger applauds Reynolds and her team as well as the many others across the state who are turning the STEM initiative into a remarkable success story.

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