Drug money

UNFINISHED BUSINESS - Not breaking news any more

Republicans in the Iowa Legislature have been dragging their feet for years responding to the opioid epidemic. Democrats haven’t made it a high priority, either.

Credit: Getty Images, KLH49

Meanwhile, for multiple years now, an untapped “Opioid Settlement Fund” in the state treasurer’s office has grown to $56 million. Eventually the state will get some $160 million and Iowa counties will collectively get a like amount.

The money -- which is supposed to be used to abate the opioid crisis through education, prevention, recovery and other measures -- comes from legal settlements with drug companies, distributors, pharmacies and others whose practices promoted drug addiction (“opioid use disorders”) resulting in overdoses and deaths from both legal and illegal drug use (think fentanyl).

A spate of overdoses and numerous fatalities in 2016 in Dubuque, my hometown, led me to focus on this issue over my last eight years as a state representative. I helped organize a community “opioid response team” with Malissa Sprenger of Mercy Medical Center. I served on the General Assembly’s Opioid Epidemic Evaluation Study Committee in 2017 (more on that later).

At the same time, Attorney General Tom Miller was successfully suing the drug companies. But Republicans like Rep. Gary Worthan (chair of the House justice systems budget subcommittee) were pissed at Miller for also suing the Trump Administration on a variety of other matters. They retaliated by cutting the attorney general’s budget and taking control of the opioid settlement dollars, which Miller was in the process of allocating (in consultation with legislators).

Until he retired last year, Rep. Joel Fry – chair of the House Appropriations Subcommittee for Health and Human Services on which I served -- personally ensured that nothing happened with the money.

By 2023, the Iowa Department of Public Health – relatively active in responding to the opioid crisis -- was being swallowed by the Department of Health and Human Services (DHHS) and has all but disappeared. I don’t remember the last time I received an “Opioid Update” e-newsletter.

Kelly Garcia is director of the DHHS. When I asked her in 2023 for the department’s recommendations on how the money should be spent, she said they didn’t have any recommendations because they hadn’t been asked for any. Huh? Not asked by whom? By Joel Fry (and apparently not by the governor, either). Seems like a department director wouldn’t need to be asked to deal with a problem of such magnitude.

In 2024, behind the scenes, Rep. Elizabeth Wilson and Rep. Brian Lohse worked to break the logjam. Both had been named Opioid Policy Fellows by the National Caucus of State Legislatures. Fry killed bi-partisan legislation in the House. Senator Mark Costello and Senator Janet Petersen managed to get a bill out of the Senate. But a modest compromise that Rep. Lohse was able to broker died in last-minute monkey business between the House and Senate on other matters.

This last-minute failure (some say the attorney general was involved) finally spurred the governor into action. Since then, she has allocated $17 million in federal American Rescue Plan dollars (thank you, President Biden) for opioid prevention and recovery programs, treatment and infrastructure, including recovery housing. (Find the governor’s news releases here and here.)

Now, in 2025, we are back on square one. The governor has nothing in her budget for the opioid settlement fund. Who’s on first? The Legislature? The governor? The department? Which department? DHHS? The Office of Drug Control Policy in the Department of Public Safety? Would look bad to give control of the money back over to Attorney General Bird, no?

If the Legislature, which committee? Justice Systems (chaired by Rep. Lohse)? Health and Human Services (now chaired by Rep. Ann Meyer)? The new “Federal and Other Funds” subcommittee in the House? Someone in the Senate? (The “joint” budget subcommittees have not met together for years.) Inquiring minds and families with loved ones in hospitals and jails want to know.

Rep. Meyer may have something to prove and will undoubtedly be more receptive than Fry. Previously, as chair of the Health and Human Services policy committee, she once took offense at my comments in debate that she thought suggested Republicans “didn’t care.”

I apologized for the inference because, in fact, it is NOT true that Republicans have done NOTHING on this issue since they attained full control of Iowa state government in 2017. Working with pharmacist and State Rep. John Forbes, Iowa strengthened a program that helps health care providers better monitor their prescribing of opioid painkiller medicines. Working with law enforcement and public health agencies, access to the overdose-reversing drug naloxone has been expanded. And some barriers to medication-assisted treatment have been eased.

We praised these first (baby) steps, but all required more heavy lifting than you would think necessary in a state where more people have died of drug overdoses than die in road accidents (many of which also involve alcohol addiction). A few seemingly simple, life-saving policy changes that require no money and which law enforcement officials embrace in other states have died on the vine: Authorizing syringe service programs, legalizing fentanyl test strips, allowing physician assistants provide medication-assisted treatment even if their supervising physicians don’t.

Side note: Before the settlement funds were confiscated, Attorney General Miller also committed $4.1 million to: 1) The Billion Pill Pledge with Goldfinch Health to partner with hospitals to reduce opioids dispensed for surgeries; 2) The Iowa Harm Reduction Coalition to support treatment of and assistance for individuals with opioid use disorders; 3) UCS Healthcare for treatment, including expanding its medication-assisted treatment facility in Black Hawk County.

Many of the issues and ideas raised by experts in testimony during the 2017 interim committee meetings remain unaddressed. The interim committee itself produced no recommendations. Rep. Timi Brown-Powers, a hospital outpatient therapist from Black Hawk County, and I produced our own recommendations. She continued to support these efforts in her role as ranking member of the House Appropriations Committee. We offered annual amendments to the budget, to the allocation of federal CARES Act and American Rescue Plan dollars, and for the use of opioid settlement funds. All those efforts were spurned and ignored by the majority party.

(By the way, both Rep. Brown-Powers and I were originally appointed to serve on this interim committee in 2016, but the committee never met: Narcotics abuse issue needs legislators' focus, Democrats say.)

I may write again about some of this in the weeks ahead, depending on any discussions that take place at the Capitol (which the House Appropriations Committee chair has promised.) A simple concept to start with: Find ways for the state to partner with counties to leverage each other’s resources to produce more ambitious results. (People with opioid use disorders in our county jails will for sure be a topic I return to.)

(Note to self: Find out what is being done by the Iowa State Association of Counties and various county health departments to coordinate efforts and work together. Pramod Dwivedi, director of public health for Linn County, just finished a term as president of the National Association of County and City Health Officials. I bet NACCHO could help.)

For now, I will leave you with some links in case anyone wants to know more. I hope I am surprised by how many people do. But I won’t hold my breath that this issue will be showing up soon on any candidate cowboy cards.

Legislative Services Agency report on the Opioid Settlement Fund
Information on 2017 Legislative Opioid Epidemic Evaluation Committee
My recommendations to the Committee
A bill we offered in 2023
An amendment we offered in 2023
The modest bill that had unanimous support but nevertheless failed in 2024
Iowa Office of Drug Control Policy
Iowa Harm Reduction Coalition
Police Executive Research Forum, a leading source of law enforcement engagement