Opioid deaths increasing in Iowa, driven by fentanyl

DES MOINES — Increasingly driven by fentanyl, opioid-related deaths continue to surge in Iowa and across the country at a “shocking” rate, Iowa Attorney General Tom Miller said Thursday.

“The deaths that we’ve seen have just been heartbreaking,” Miller said during a news conference, which he called after seeing the latest national drug overdose statistics issued by the U.S. Centers for Disease Control and Prevention. “The pain and suffering of people that are addicted, and their families and their friends, is just enormous.”

The Iowa Public Health Department estimates that deaths in Iowa due to fentanyl, a synthetic opioid, rose from 31 percent of all overdoses in 2016 to 87 percent in 2021.

While there is pharmaceutical fentanyl for treating severe pain — 50 to 100 times more potent than morphine — the most recent cases of fentanyl-related harm, overdose and death in the United States are linked to illegally made fentanyl, according to the CDC.

According to Iowa public health officials, all opioid-related deaths including those caused by fentanyl in the state increased by over 18 percent between 2018 and 2020, hitting a total of 213 that year. The state reported another 73 opioid-related deaths between January and April 2021.

Nationally, the nearly 64,000 fatal fentanyl overdoses from April 2020 to April 2021 were 32 times higher than the 2,000 that were recorded just 10 years earlier, in 2011.

“What we think happens, and we’re not positive but relatively sure, is the manufacturers, which are almost exclusively in China, are the ones that bring this about,” Miller said. “A couple of theories about why they put fentanyl in: One is that it’s cheaper than the other products that they’re doing. So they’re saving themselves a small amount of money and putting people at enormous risk of fentanyl.”

Miller invited to the news conference a pair of experts from the University of Iowa and the UI Hospitals and Clinics.

Dr. Gerard Clancy, a professor of psychiatry and senior associate dean for external affairs at UI’s Carver College of Medicine, said the COVID-19 pandemic has added stress to the state’s mental health care system. Clancy estimated that over the course of the pandemic so far, the share of emergency room visits to UI Hospitals that are related to psychiatric conditions has gone from 10 to 30 percent.

“So the pandemic is changing, and the stress of the pandemic is becoming additive,” Clancy said. “And in the midst of that is the fentanyl issues, which have made things much more complicated.”

Dr. Alison Lynch, a professor of psychiatry and family medicine and director of the UIHC opioid addiction clinic, said it can be more difficult for health care workers to resuscitate someone who has overdosed on fentanyl.

“In the past, if someone had a heroin overdose, we could use Narcan and often one dose or maybe a couple doses would work,” Lynch said. “Now that fentanyl is in the drug supply, it can take multiple doses of Narcan or Naloxone, and even then it can be really hard to get somebody out of that overdose. It’s again made it just more scary.”

Miller said his office has worked to address the opioid crisis by joining lawsuits against opioid manufacturers and distributors.

Iowa was set to receive roughly $25 million from a $4.3 billion settlement with the owners of Purdue Pharma, the company that made the opioid painkiller OxyContin.

But a court rejected that settlement, and Miller said that decision will be appealed in federal court and could ultimately wind up before the U.S. Supreme Court.

“Unfortunately the money that’s available there to Iowa … is not available at this time,” Miller said. “But the larger settlement, hopefully up to $170 million (from a settlement with opioid distributor Johnson & Johnson), will be available this summer. And eventually we’ll get money from Purdue Pharma and the Sacklers (family that owns the company). But it’s a very complicated case that continues to go on.”

Comments: (515) 355-1300, erin.murphy@thegazette.com