As the single state authority for substance use services in Iowa, the state Department of Public Health maintains a close view of a resurgence in methamphetamine use in both urban and rural communities across the state. At the National Cocaine, Meth & Stimulant Summit in Miami next month, two presenters from Iowa will discuss the state's effort to track and respond to a re-emerging drug crisis, in a Nov. 10 session that also will address current responses to methamphetamine use in the city of Philadelphia.
Addiction Professional interviewed Michele Tilotta, a registered nurse who serves as the substance use treatment and prevention block grant coordinator for the Iowa public health department. Tilotta discusses the populations affected by a powerful drug for which there remain comparatively few evidence-based treatments.
Editor's note: This interview has been edited for length and clarity.
What trends are you seeing in methamphetamine use in Iowa?
In looking at data for Iowans admitted to treatment for a substance use disorder, historically alcohol is always number one, and it used to be alcohol, marijuana and then other drugs of use. In 2018 we saw that kind of flipped. Alcohol was still first with 38.4% of admissions as either the primary or secondary drug, but for the first time we saw meth climb to number two, at 28%. Then that was followed by marijuana at 24%, and opioids are smaller. Meth has really been increasing in the last year and a half. Providers have been telling us this is what they are seeing. We're actually seeing numbers now that are in excess of the peak for methamphetamine use around 2006 and 2007.
Are there affected populations of particular concern?
We're seeing that for many women, methamphetamine is the primary drug. We fund four women and children's programs through our block grant, and we're seeing many admissions of pregnant women. We also partner with child welfare, as we see significant removals of parental authority because of methamphetamine addiction. We see among our rural Iowans that meth accounts for 34% of admissions as the primary or secondary drug.
What challenges does the methamphetamine-affected population bring to treatment?
It is unfortunate that we don't have medication-assisted treatment for methamphetamine. It is such a powerful addictive drug; it changes your dopamine. People are at a loss over what to do about this epidemic. Providers report in general that they are seeing a lot more complex clients than they saw five years ago. There is a great deal of depression and anxiety caused by meth. There are a lot of health concerns, and these patients are now living in a society with more limited support systems.
How is your state agency seeking to respond to the growing methamphetamine problem?
We want to be seen as an agency with health expertise. How can we influence the social determinants of health? How do we drive the process from a data perspective? We've really looked at the methamphetamine work from the angle of prevention. We have had each local community develop a community assessment workbook, showing how we can work together. Our main focus has been in capacity building.
How are you communicating to the public about this crisis?
Our second focus after capacity building is ongoing education and media. We have a campaign that we have worked on with local partners, called “Meth Never Ever.” We try to inform the public about the dangers of meth, and a major area of emphasis is what you might be throwing away if you start taking meth.