Thursday, January 4, 2024

Across Iowa and nationwide, opioid-related deaths are on the rise, especially among adolescents.

Data from the National Institute on Drug Abuse shows that in 2010, 229 people between the ages of 15 and 24 died from synthetic opioids, primarily fentanyl. In 2020, that number increased dramatically to 5,393.

To address these alarming numbers, Clinical Assistant Professor of Pharmacy Practice and Science Benjamin Miskle partnered with Heidi Wood, pharmacy specialist at the University of Iowa Hospitals and Clinics (UIHC).

Together, they’ve made it their mission to get naloxone — the drug used to reverse opioid overdoses, often referred to by the brand name Narcan — in schools across Iowa.

Miskle’s interest in this project was sparked by his clinical specialty area in substance use disorders. He works twice a week in the Opioid Addiction Clinic at UIHC, so he sees firsthand the impact of opioid use.

Miskle Training

In addition, his wife works as a teacher in the Clear Creek Amana Community School District (CCA). One day she asked Miskle what they should do if a student, staff member, or teacher experienced an overdose at school. He asked if they had naloxone on hand. Because his wife wasn’t sure, she got Miskle connected with the school nurse.

Later, Wood reached out to Miskle saying her husband, a teacher in the Iowa City Community School District (ICCSD), had come to her with similar concerns. It was clear there was a gap in the need for addressing overdoses at area schools that both Miskle and Wood could help fill.

In June 2022, Governor Kim Reynolds signed a bill that allowed schools/school nurses to administer naloxone to someone experiencing an opioid overdose on school grounds.

Following the bill, Miskle and Wood ramped up their work. They met with the Iowa School Nurse Organization (ISNO) to see how they could connect with more schools to provide training sessions on naloxone and how to administer it.

“I see naloxone as something that needs to be in every first aid kit,” Miskle said. “It’s one of those things that if we don’t need it and never use it, that’s great, but if we don’t have it and we do need it, it’s going to feel really bad that we didn’t have it.”

Miskle and Wood started by visiting and providing educational sessions at local schools in addition to their full-time roles. During the training sessions, they covered what an overdose is, who’s at risk, how to recognize an overdose, how to administer naloxone (schools can only use an intranasal device), and more.

“The goal is to reach every single school in Iowa, whether it be public or private.”
          --Ben Miskle

Since their work began last year, Miskle and Wood have provided educational sessions at 45 schools, provided naloxone training for 44 school nurses, and facilitated the purchase of 225 naloxone kits. Miskle and Wood also helped create policies for CCA, ICCSD, and North Union Community School District.

Miskle shared that having these naloxone kits in schools means that not only can students be helped if needed, but so can visitors. For example, say someone is rushing to a kids’ sporting event and accidentally takes a double dose of a medication when they intended to take a different one. This could lead to an overdose that naloxone could immediately treat.  

“The goal is to reach every single school in Iowa, whether it be public or private,” Miskle said.

Heidi Wood UIHC
Heidi Wood

Thanks to the College of Pharmacy adopting this work as a community engagement project, Miskle and Wood now have more time to visit schools and provide these trainings. They also met with school nurses at the ISNO Annual Meeting in April 2023. What they’ve heard across the board is that demand is there: schools in Iowa want to create policies around administering naloxone and have the drug at the ready.  

Miskle and Clinical Assistant Professor Laura Knockel received a grant from the Substance Abuse and Mental Health Services Administration to help fund the Iowa Naloxone EXpansion and Training (IA-NEXT) project. The grant enabled Miskle to hire Wood into a new position – pharmacy specialist, Addiction and Recovery Collaborative in UI Hospitals and Clinics  to focus full-time on expanding this initiative. 

Specifically, the grant will allow Miskle and Wood to implement innovative strategies and partnerships and train student pharmacists, pharmacists, nurses, and other healthcare professionals throughout the State of Iowa on identifying an overdose and naloxone education. Undoubtedly, this work will ultimately lead to improved outcomes for individuals in Iowa at risk for a fatal overdose. 

Wood plans to create a “train the trainer” program.  Students at the UI College of Pharmacy will learn how to go into the community and provide naloxone education to schools and nurses throughout Iowa. Ideally, students could give these educational sessions at their hometown schools.  

“I think the big thing moving forward is getting out to additional schools and districts and working with people to do some education around what this is and what it does and why we need to do this,” Miskle said. “We want to combat the stigma that surrounds naloxone and substance-use disorders in general. We want to make sure we can reach out to all these schools and make sure everyone is safe if they were to need it.”