Iowans die as lawmakers dawdle on plan to spend opioid settlement money

State sits on $56 million that could help prevent overdoses and treat addiction

UPDATE: In the final hours of the session, Iowa lawmakers finally passed a compromise on spending opioid settlement money.

Sen. Janice Weiner was among the Democrats criticizing lawmakers’ delay in crafting a better way to distribute $56 million – and more to come.

"It's their (Iowans') futures and their kids' futures, and they deserve a good, clean process, which we could have done," Weiner said. "We've had 122 days. I don't wish on anyone the feeling of waking up every day wondering if it's going to be the day you find out your child's died of an overdose, and then trying to figure out how you explain that to your grandchild."

The irony is the Legislature took away the AG office’s authority to spend the funds in 2022, and then gave part of it back the night before the session ended.

For a state government that claims to have mastered DOGE-like efficiency, the Iowa Legislature sure knows how to waste money, time, and opportunities.

With time running out on the Legislative session, lawmakers could once again fail to pass a plan to distribute opioid settlement money, as Jason Clayworth of Axios reported May 6.

The failure could bring more death and suffering for Iowans. That money could prevent fatal overdoses, treat people with opioid use disorder, and help them recover and avoid relapse.

Iowa sits on $56 million collected from settlements with drug makers, distributors, chain pharmacies, and other companies that contributed to the opioid crisis, according to the Des Moines Register. The state expects to see tens of millions more over the next two decades.

In total, the state, including counties and cities, will receive $345 million from the settlements. According to the terms of the settlements, the bulk of the funds must be used to abate the crisis.

I have witnessed this issue from two vantage points. In the Polk County Attorney’s Office, we regularly see the ravages of fentanyl, a powerful opioid, as it poisons our community.

In March, our office secured a 30-year prison sentence against a 19-year-old woman who had given a pill containing fentanyl to a 15-year-old, William Anthony Pippins II. The Hoover High School sophomore died of an overdose on Aug. 23, 2023.

Last week, I participated in a restorative dialogue with a woman who had racked up several theft and drug charges, including possession of fentanyl. She admitted she had been shoplifting to support her addiction. She was getting treatment in a residential rehabilitation facility. While we talked, she fed and coddled her fussy 3-week-old son.

Earlier, I worked in the Iowa Attorney General’s Office as Attorney General Tom Miller and his staff fought hard in negotiations to win these settlements. He also secured agreements with local governments to split the funds.

We also came up with the beginnings of a plan to spend the money. We worked with Iowa Department of Public Health (now Iowa Department of Health and Human Services), the Iowa Board of Pharmacy, Governor’s Office of Drug Control Policy, and other agencies.

With AG Miller and others, I visited the Opioid Addiction Clinic at the University of Iowa Hospitals and talked with doctors, counselors, and peer support specialists who have overcome opioid use disorder themselves.

In 2021, we announced a plan to use $3.8 million of the settlement money to help UI Hospitals hire two physicians and additional staff. UI used the resources to train physicians and other health care providers across the state on how to treat opioid addiction using Medications for Addiction Treatment (MAT).

In 2022, we launched a website — IowaOpioidHelp.com — to direct Iowans to treatment centers and other resources near them.

Tom Miller: “We can treat the opioid crisis, and we're making resources more available to Iowans to help”

We also launched the “Billion Pill Pledge” with Goldfinch Health, promoting new prescribing principles among doctors to reduce opioid use after surgery.

This was just a start. We created a list of recommendations, including:

• Preventing accidental overdoses by legalizing fentanyl test strips, which detect the presence of the drug in pills, powder, or injectables.

• Increasing access to naloxone, which can reverse overdoses and prevent death.

• Helping treatment providers retain and attract staff.

• Subsidizing the cost of MAT.

• Increasing availability of housing and other services for Iowans recovering from opioid use disorder.

Legislators, however, stripped AG Miller’s ability to spend the money, passing a bill in 2022 saying only the Legislature could allocate funding.

Fine, if only they would have done something. Instead, lawmakers have dawdled and bickered for three, going on four, sessions about who gets to decide how to spend the money.

This year, two bills came out of committee with two different approaches. The Senate version would give DHHS and the AG’s Office annual appropriations of opioid money to use with input from Behavioral Health Districts. The House bill would create a competitive grant process overseen by an evaluation panel.

Any process must tap into the expertise of people on the ground, such as health-care providers and people in recovery. The Legislature has plenty of red-state models to follow: Tennessee, Texas, and other states have created councils of public officials and health care experts to decide how to use the money.

Meanwhile, some counties have been busy allocating their share of the settlement money. Clay and Dickinson counties banded together to create an adult drug treatment court. Polk County has awarded grants to organizations to hire peer-support specialists and clinicians, create programs serving people leaving jail and prison, and provide naloxone and harm-reduction supplies, among other projects.

This crisis is too big, however, for a piecemeal approach. Iowa needs a statewide plan to make a difference. Nationally, opioid overdoses have started to decline, but data isn’t available to show whether Iowa has reversed its steep increases. Overdose deaths climbed in Iowa by 77% from 2014 to 2022, according to the CDC, and the toll of drug-related deaths now nearly match the number of fatal traffic accidents annually.

As Iowans suffer and die, lawmakers are guilty of a dereliction of duty.

Explore the impressive lineup of writers, plus Letters from Iowans, in the Iowa Writers’ Collaborative. They are from around the state and contribute commentary and feature stories of interest to those who care about Iowa.