Iowa lawmaker tries to ‘force negotiations’ over opioid settlement funds

DES MOINES — Rather than waiting for a compromise agreement, a key state lawmaker conducted a legislative hearing Monday in an effort to “force negotiations” over more than $50 million of unspent settlement funds destined for opioid addiction treatment programs in Iowa. Lawmakers for a third consecutive year are working on the state’s plan for Iowa’s share of a national settlement with opioid manufacturers. State law requires legislation that dictates how the settlement funds will be distributed.

Republicans hold agenda-setting majorities in both chambers of the Iowa Legislature, but Senate and House Republicans have been unable to reach an agreement on how to spend Iowa’s settlement funds. Iowa is one of just nine states without published recommendations on opioid settlement spending, according to the National Academy for State Health Policy. Iowa’s Opioid Settlement Fund, collecting the state’s share of the national settlement, had a balance of $55.



5 million as of Feb. 4, according to the nonpartisan Iowa Legislative Services Agency. Sen.

Tim Kraayenbrink, a Republican from Fort Dodge who chairs the Senate budget committee, said Monday that as of April the fund was nearly $57 million. Kraayenbrink has been working with his budget committee colleague in the House, Rep. Gary Mohr of Bettendorf, during this year’s legislative session to come up with an agreement on how Iowa’s opioid settlement funds should be distributed.

Kraayenbrink introduced legislation that would charge the Iowa Department of Health and Human Services and the Iowa Attorney General with distributing most of the settlement funds, and on Monday he held a legislative hearing to foster debate. “I just think rather than holding on, waiting for additional negotiations (with the House), we need to get a bill pushed and get the bill through and force some conversations,” Kraayenbrink said during Monday’s meeting. “And hopefully come to a resolution on what’s going to happen with the money.

” Mohr said he has been working with Iowa HHS, the AG’s Office and behavioral health providers and that the House is drafting legislation. “We’re anxious to get a bill passed this session,” Mohr said Monday. “We pass a lot of bills in the House, and the Senate passes a lot of bills, and once we do that, we get together and come up with a compromise bill.

I see this one, frankly, as no different. ..

. Hopefully we’ll get ours introduced and get ours passed, and there will be a meeting, a compromise so we can get one bill passed before the end of session.” The Senate bill, Senate Study Bill 1226 , would have Iowa HHS allocate 75% of settlement funds and the Iowa AG’s Office 25%.

The bill also includes $12 million in grant funding for the behavioral health nonprofit Community and Family Resources to renovate and expand one of its facilities, and $30 million to Iowa HHS to address opioid addiction. “I’m glad to see that we have this bill before us, because Iowans have been waiting too long with this money stuck in the freezer,” Sen. Janet Petersen, a Democrat from Des Moines, said during the hearing.

Iowa’s Opioid Settlement Fund holds money that comes to the state from national settlements with 10 companies that include opioid manufacturers, distributors and pharmacists. The settlements totaled $26 billion nationally, which will be paid out over 18 years. Iowa was one of 47 states that participated in the lawsuit.

Iowa is expected to receive roughly $325 million through 2039, according to the Iowa Attorney General’s Office. Roughly half the money goes to state government and the other half to local governments. Per the settlement’s terms, at least 85% of the funds going to states and local governments must be used to treat and prevent opioid addiction.

Opioids claimed the lives of 238 Iowans in 2023, according to state figures. Iowa’s annual opioid-related death rate peaked at 258 in 2021. The rate of Iowa’s opioid-related deaths was fourth-lowest in the nation in 2022, at 7.

9 deaths per 100,000 people, according to the nonprofit health care advocacy and reporting organization KFF. The U.S.

average that year was 25, and the highest mark by far was West Virginia’s 70.5 deaths per 100,000. Just $3.

8 million has been allocated from the fund — and that was in 2021, to create a Medication Addiction Treatment Program administered by University of Iowa Health Care. No allocations have been made from the fund since, because state lawmakers have not reached an agreement on how the funds should be distributed. Various proposals were introduced in the 2023 and 2024 sessions of the Iowa Legislature, but none gained enough support to pass into law.

For years, individuals battling opioid addiction have faced a grim choice: get clean or die. But some people now see a third option — harm reduction. (Scripps News) Despite having the highest drug overdose death rate, West Virginia ranked 12th in naloxone prescriptions at 0.

7 per 100 people in 2022. However, the state saw the fifth-highest growth in naloxone prescriptions, growing from 0.3 per 100 people in 2019.

Arkansas dispensed the most naloxone prescriptions, perhaps contributing to its relatively low rate of drug overdose deaths at 21.7 per 100 people. Arkansas saw the biggest jump in naloxone prescriptions, increasing from 0.

1 prescriptions per 100 people in 2019 to 1.7 per 100 people in 2022. After Arkansas, the top states for growth in naloxone prescriptions were: - Kentucky (+0.

8 per 100 people) - South Carolina (+0.8) - Tennessee (+0.6) Access to naloxone grew in every state except New Mexico, where it shrank, and New Hampshire, where it stayed the same.

Overall, naloxone prescriptions per resident remain much lower than buprenorphine due in part to the different purposes each drug serves. Naloxone is used in emergencies and is not prescribed as a medication to take on a routine basis. In addition to over-the-counter purchases, the drug is distributed through public health programs and emergency care outside traditional prescription avenues.

Buprenorphine, on the other hand, is dispensed only by health care providers for long-term opioid use disorder treatment to ease withdrawal symptoms and cravings, often necessitating refills on a regular basis for complete treatment. Cost is also an issue. A two-dose packet of Narcan runs just under $50 at many drugstores, and like most over-the-counter drugs, insurance doesn't cover it.

While a lifesaving measure might seem worth the price tag, $50 is prohibitive for some. To help reach communities in need, there are several resources available for free naloxone supplies and emergency kits. Despite efforts to reduce the stigma around substance-related disorders, walking into a Walgreens or CVS and purchasing overdose medication might be challenging for those with OUD.

However, the use of lifesaving treatments is imperative as the opioid epidemic continues to take its toll. Obsolete and incorrect beliefs about the nature of addiction, which liken the disease to moral failure, can prevent people from seeking help and hinder the development of health and public policies. In contrast, a punitive approach to OUD can increase drug use by dehumanizing those who need help while failing to address the underlying cause of the disease.

Medication-based treatment has not been a first line of defense in treating opioid misuse disorder long-term. According to a study by the NIH and CDC, just over 1 in 5 adults with opioid use disorde r received medication-based treatment, namely buprenorphine, methadone, or naltrexone, in 2021. The study also found that Schedule III, II, and unscheduled drugs, respectively, were dispensed for substance use treatment 38 times more often when it was a telehealth appointment.

West Virginia leads in prescriptions per capita, which have increased by 4.4 prescriptions per 100 residents to reach 27.2—over a quarter of the state's total population.

Indiana, whose capital city is a national hotspot for opioid overdoses, saw the second-highest increase in buprenorphine prescriptions, reaching 10.7 per 100 residents in 2022. Despite having the second most overdoses due to opioids, the District of Columbia issued an average of 1.

5 fewer prescriptions per 100 people. Prescriptions fell the most in Vermont by 3.1 overall, dropping from 28.

6 per 100 people to 25.5 per 100 people. In 2021, the state became the first to decriminalize buprenorphine possession in limited quantities.

In a promising outlook for this harm reduction strategy, Vermont is experiencing a three-year low in opioid overdose rates based on 2024 data so far. Story editing by Alizah Salario. Additional editing by Kelly Glass.

Copy editing by Kristen Wegrzyn. This story originally appeared on Ophelia and was produced and distributed in partnership with Stacker Studio. Stay up-to-date on the latest in local and national government and political topics with our newsletter.

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