On a Monday afternoon in October, a panel of Iowa state legislators gathered in the Statehouse to discuss the opioid epidemic.
Doctors, law enforcement officials and health insurers took turns at the lectern.
One of the witnesses was Deborah Thompson.
She had testified in front of state legislators plenty of times. As the legislative liaison for the Iowa Department of Public Health, she is often asked to give legislators a window into what the epidemic looks like in Iowa. The information can be wonky at times, like how many morphine-equivalent milligrams are prescribed each year, or can consist of cold facts, like that year's death toll.
Last year in Iowa, there were 180 opioid-related deaths. In 2017, there are projected to be 201.
This time, there was something else she wanted to share.
"Today would have been my seventh wedding anniversary," she told the panel. "My husband, Joe Thompson, passed away from an accidental heroin overdose last September. He left me and his 1-year-old son, Lincoln."
For years, Thompson had worked on policy related to the opioid crisis in Iowa while keeping her own family's struggle with addiction in the background. She had told a couple of state legislators with whom she had close relationships, but sharing her story in public was a big moment.
Thompson went back and forth about whether she could keep this to herself. She saw her role as the policy expert working in the background, not as a face of a national problem.
"I wasn't really sure I was going to, and I just couldn't shake the fact that it was our wedding anniversary, and that had to mean something," she tells NPR's Robert Siegel. "The coincidence was too great. Joe had always gravitated toward the helping professions, he wanted to be a nurse or a counselor or something like that, and it would be quite an anniversary gift to give him, to be able to maybe grant that wish through me, if it helped a lot of people. It was probably one of the better gifts I gave him. I was never very good at our anniversary gifts."
Joe Thompson's struggle with opioids started in 2004. After he was in a serious car accident, Thompson says her husband was likely overprescribed medication to treat the pain. He started going from doctor to doctor, a practice called doctor shopping, to get new prescriptions or refills. At his job as a package handler for UPS, he started swiping prescription drugs being shipped through the mail.
Joe tried to get help. He enrolled in an outpatient facility. Several times, he got sober, sometimes for several years at a time. He even went back to school and got his nursing degree. But then he would relapse again.
"I think it's hard to understand that," Deborah Thompson says. "I think logically your mind can get there, but your heart hurts ... the way the disease manifests itself, it's selfish, things are done to you, money was stolen from me, lies were told to me, and it's hard to wrap your mind around the idea that it's a disease causing this behavior while you're in it."
It took Thompson awhile to really grasp that her husband was sick — that his addiction was not just a bad habit he couldn't kick, but a disease that was really hard to climb out from.
"I just kind of equate it to, when my mother had brain cancer, we could see the tumor on the X-ray scans, we knew that something was growing and taking over her brain," she says. "I wish I'd known more about the science when we were in it. ... I felt like I was finally ready to deal with Joe's addiction, and then time ran out."
Joe Thompson died in September 2016 from a heroin overdose. He was 35.
Joe may not have beat his addiction, but Thompson is confident Iowa can.
She says new funding has helped as have changes in the law that gave states additional flexibility to respond to the crisis. One policy change that she says could help save lives right now is to require doctors in every state to check prescription monitoring databases, which would prevent doctors from prescribing or refilling opioids to people who don't actually need it or are dealing with an addiction. She says waiting for doctors to voluntarily adopt best practices simply isn't enough.
Deborah Thompson is also hoping her unique position at the crossroads of policy and personal experience can help move her state just a little bit closer to curbing the epidemic.
"Just looking at how many community partners that are involved, that run the gamut of law enforcement, the health care community, public health professionals, community agencies, coming together in Iowa to fight this, I can't imagine we'll lose," she says.
ROBERT SIEGEL, HOST:
On a Monday afternoon back in October, a panel of Iowa state legislators met to discuss the opioid epidemic. They heard from doctors, from law enforcement officials, health insurers. And one of the witnesses was Deborah Thompson. She's testified in front of state legislators plenty of times. As the legislative liaison for the Iowa Department of Public Health, she has a lot of the facts and data points about the opioid crisis in Iowa. But that is not what she talked about.
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DEBORAH THOMPSON: Today would've been my seventh wedding anniversary. My husband, Joe Thompson, passed away from an accidental heroin overdose last September. He left me and his 1-year-old son, Lincoln.
SIEGEL: In 2017, we have seen policy makers across the country grapple with how to stop opioid deaths. The Trump administration has declared a public health emergency. And yet have we made any progress? Deborah Thompson joins us now with "The View" from Iowa. Welcome to the program.
THOMPSON: Thank you, Robert. Thank you for having me.
SIEGEL: Is the state of Iowa any better off now than it was a year ago in terms of opioids?
THOMPSON: I'm going to say we are headed in a very positive trajectory. We have really good momentum right now. And I do believe if a few of the policy pieces fall into place we're well positioned to fight off the worst of the opioid epidemic.
SIEGEL: How will you measure that? How will you measure success in fighting the opioid epidemic?
THOMPSON: Well, the data, of course. We will monitor the amount of morphine equivalent milligrams that are being prescribed by our doctors. We will, of course, monitor the vital records, deaths to understand how well we're doing.
SIEGEL: You're talking very fluently about this as a policy professional.
SIEGEL: Going back to that October day at the Iowa Statehouse, I understand that was the first time that you had shared this story about your husband with lawmakers. And it obviously took some courage. Why did you do it?
THOMPSON: You know, I wasn't really sure I was going to. And I just couldn't shake the fact that it was our wedding anniversary. And that had to mean something. The coincidence was too great. And so I felt - you know, Joe had always gravitated toward the helping professions. He wanted to be a nurse or a counselor or something like that. And that would be quite an anniversary gift to give him, to be able to maybe grant that wish through me if it helped a lot of people. It was probably one of the better gifts I gave him (laughter). I was never very good at our anniversary gifts.
SIEGEL: How had your husband Joe become addicted? What happened?
THOMPSON: So he was in a serious car accident in 2004 and was I would say overprescribed for a little too long, and then started to do doctor shopping, and then had access to prescription drugs through his job at UPS as a package handler and was smuggling them out of the UPS facilities.
SIEGEL: And did he seek treatment and find treatment during the time of his addiction?
THOMPSON: He did, but not until the first time he quit because, you know, this wasn't, like, an everyday thing or an every-year thing. He had years of sobriety in between his addiction cycles. He weaned himself off, was able to go back to school, get that nursing degree. And then when he relapsed he did enroll himself into an outpatient program where he was getting counseling support, but also medication-assisted treatment.
SIEGEL: I mean, one piece of wisdom that people who work with addicts will tell others is this is a condition in which there are relapses and we should expect that. That's part of the problem.
SIEGEL: You think people get that, I mean, the way you experienced it?
THOMPSON: Well, I think it's hard to understand that. I think logically your mind can get there, but your heart hurts when somebody is - the way the disease manifests itself, it's selfish. It's - things are done to you. Money was stolen from me. Lies were told to me. And it's hard to wrap your mind around the idea that it's a disease causing this behavior while you're in it.
I always kind of equate it to when my mother had brain cancer, we could see the tumor on the X-ray scans. We knew that something was growing and taking over her brain. I wish I'd known more about the science when we were in it compared to how much I know now because I think I could have gotten there. I don't know. I guess I felt like I was finally ready to deal with Joe's addiction and then time ran out.
SIEGEL: Having experienced the crossroads of both being involved in policy and dealing with opiate addiction and living with a husband who had this problem, is there some particular bit of wisdom that you wish everybody could get and some policy move that would flow from that wisdom that would help us deal with this problem better?
THOMPSON: I suppose I would say the stigma is very real, I think, inside the addiction and outside the addiction looking in. I understand that no profession wants to be told how to practice their craft. I get that. However, I don't know - opioids take over so fast, like we've seen on the East Coast and in Ohio, that I'm not sure how much time the rest of us are supposed to wait until the standards of practice and standards of care change in the medical profession and in the prescription drug, you know, companies. That's the attractiveness about requiring certain behaviors like requiring doctors to check the prescription monitoring program when they're first prescribing opioids to a patient or if the patient has asked for a refill. Does that make sense?
SIEGEL: I think so. I think so. I'm - I've been surprised over the past couple of years in doing reporting trips around the country to hear how many people have somebody in either the immediate family or the extended family who's had a very serious addiction problem or has had a fatal overdose. And I wonder, when you talk to a panel of state legislators, do you feel like you're describing something alien to them? Or is everybody a couple of degrees of separation away from this experience?
THOMPSON: I think it's both. There were several who came up to me afterwards and shared with me a personal story. But I have experienced the reactions - skeptical that I would be mixed up with somebody like that. So that told me that perhaps they needed a face - some of them, not all of them.
SIEGEL: You're pretty confident about the trend line for Iowa. But actually, I think, this year there are more opioid-related deaths than there were in 2016, about 20 more.
SIEGEL: Whence the confidence? Where does it come from?
THOMPSON: (Laughter) Well, I believe in the professionals we have at my department. I'm floored by what public health professionals are capable of doing when they're properly funded. And I just celebrate Congress' bipartisan effort with the CARE Act and then the Cures Act that made policy more flexible and then brought funding into the states. And then just looking at how many community partners are involved that run the gamut of law enforcement, the health care community, public health professionals, community agencies coming together in Iowa to fight this, I can't imagine we'll lose. I know it probably sounds naive, but I just - I'm really proud of the work that we're doing in Iowa.
SIEGEL: Well, thank you very much for telling your story with us. It can't be pleasant. And I think it's important for people to hear, so thank you for that.
THOMPSON: I appreciate the opportunity very much. Thank you.
SIEGEL: Deborah Thompson is the legislative liaison for the Iowa Department of Public Health.
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