Iowa AG Bird touts opioid reduction, leadership in Mahaska County

Oct. 20—OSKALOOSA — Iowa Attorney General Brenna Bird made a stop at Mahaska Health to talk about the Billion Pill Pledge, a campaign to reduce leading causes of opioid abuse.

"The opioid crisis has killed more people in America than World War I and II combined."

Bird shared that fact with an audience made up of county officials, law enforcement, healthcare workers, state legislators and more during her visit to Mahaska Health on Thursday, where she touted the results of a new, modernized approach to reduce the use of opioids in recovery after surgery.

"It is a great threat to our whole country, and as a prosecutor, another statistic that really gets my attention, of the people that are found to be using illegal heroin — and heroin is a tough, tough drug that is really hard on people, and it's hard to kick, too — about 80 percent of them got started first using prescription opioids. So they had a legal product they were using, and then eventually got addicted to the horrible drug of heroin," Bird added.

According to Bird's information, if a member of a household receives even a single prescription for opioids, the likelihood that someone in their household will overdose on opioids increases by 60%. If there are two opioid prescriptions in a household within a six-month period, that likelihood soars to a whopping 625%. Bird also says that in the United States, there are more than three billion leftover pills from legal opioid prescriptions per year, and in Iowa there are 10 million.

Bird was joined on her visit by John Greenwood, COO and cofounder of Goldfinch Health, a company focused on modernizing surgery recovery methods so they aren't so reliant on the use of opioids to treat pain.

Goldfinch Health has partnered with Bird's office to use funds from settlements in opioid lawsuits to fund the Billion Pill Pledge, which aims to reduce the number of prescription opioids left in people's houses that often become gateways to drug abuse and addiction.

Greenwood says the approach involves modernizing surgical recovery with better preparation and postoperative care.

"Traditionally ... if anybody's had surgery themselves, they've probably been given the instructions 'Don't eat or drink anything after midnight the night before your operation.' It's been around since the 1940s. If there's one maxim, it's that, and it's the exact wrong way to prepare a patient for surgery," Greenwood says.

"Not only have we lowered your pain tolerance, we've dehydrated you, you don't have any calories," he adds. "You'd never run a marathon without a calorie. Why are we expecting you to go through a hip replacement? And so, also what's going on, is beyond lowering your pain threshold, at a cellular level we're inhibiting your body's ability to heal. It's called insulin resistance. You can't process sugars, and therefore start to rebound the day you've never needed it more. And that's just the start of your day."

The Billion Pill Pledge provides patients with a surgical toolkit that includes a specialized caloric drink meant to be consumed shortly before a procedure. It's designed to be processed quickly and helps nourish the body before surgery.

Greenwood's approach also includes dosing patients with non-opioid pain medications prior to surgery to effectively help patients get ahead of the pain. He says he is not anti-opioid, but that there are more effective, non-addictive ways to treat pain, and opioids should be a last resort, not a go-to.

Postoperative care under the Billion Pill Pledge includes a follow up call from a nurse to check how patients are managing their pain at home. Nursing staff can reiterate directions for medication in case the patient didn't clearly understand straight out of surgery.

Greenwood says this modernized approach to surgical care allows patients to recover from procedures measurably faster.

"People bounce back so much faster," he says. "I don't just mean discharged from the hospital faster. I mean, if there's even any employers in here, it gets people back to work over a month faster."

Greenwood describes the wide use of opioids to treat pain as the crime of the century and says that the modernized results of the Billion Pill Pledge are "remarkable."

"This was the crime of the century that we're trying to solve," he says, "and it's as though we've been walking around with bottle caps for glasses, and we took those down, and the world is so vivid, and the results are so much better. When you get a modern version of surgery, it's remarkable."

Mahaska Health Chief Medical Officer Timothy Breon says he stopped writing prescriptions for narcotics about four years ago, after becoming aware of the negative effects they could have on entire households.

"It really bothered me to find out that I may have been contributing to that just by prescribing narcotics," he says. "About four years ago I was reading, and I realized in some of the literature that sometimes that prescription that I provided after surgery, some people, as we learned, would take that, and that was their first access to a pill that would become a problem for them.

"And I never really had read that, nor did I understand that, because I was brought up thinking we weren't doing a good job unless we were giving people narcotics. And so, about four years ago, I just quit writing prescriptions for narcotics, and haven't written one since."

Bird says Mahaska Health's participation in the Billion Pill Pledge is helping lead the way to prevent opioid addiction in Iowa.

"We know there's a real link here," Bird says. "We know that the crisis is real, and the good news is that we have 11 hospitals in Iowa so far, and more joining, that have participated in [the Billion Pill Pledge], and I'm really proud of the leadership that Mahaska Health has shown in terms of stepping up and being part of this project," Bird says.

Greenwood says Mahaska Health is showing some of the best results in the Billion Pill Pledge program.

"It's similar," he says, "but like a lot of things, Mahaska does things just a little bit better."

He says Mahaska Health's average number of opioids prescribed post discharge is 13, compared to an historic average of 60 doses being written.

"This is exceptional. It's really wonderful," he says.

Traditionally, about 8-15% of postoperative patients return to the emergency room, and the number one cause of the return is pain. Mahaska Health is seeing only a quarter of that percentage return.

Greenwood says the program is on track to eliminate about 15,000 pills in Mahaska County alone.

Bird congratulated Mahaska Health on its impact in the community.

"I hope that also, everybody who works [at Mahaska Health], when you go home tonight, that you just take a moment and pause, and think because of what you did, and this new approach, there are people that we don't even know which ones they are, walking around in your community, who aren't going to get addicted to opioids," Bird says. "Imagine that."

For more information about the Billion Pill Pledge, visit billionpillpledge.com. If you or someone you know is struggling with opioid abuse, visit opioidhelp.iowa.gov.

Channing Rucks can be reached at crucks@oskyherald.com.