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Three years later, opioid treatment funds set for distribution in Iowa
The state fund contains $56 million from state and national settlements with companies over lawsuits stemming from the opioid crisis
May. 15, 2025 10:04 am, Updated: May. 16, 2025 8:25 am
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DES MOINES — After three years of failures, Iowa lawmakers late Wednesday reached an agreement on how to spend tens of millions of dollars that have been sitting idle in a state account, waiting to be used for the prevention and treatment of opioid addiction.
In the waning hours of the 2025 legislative session, Iowa lawmakers finally agreed on a spending plan for $56 million in national opioid settlement funds, as well as the tens of millions more expected to come to the state over the next decade and beyond.
Under a compromise among House and Senate Republican leadership and the governor’s office, lawmakers passed House File 1038, which would allocate $29 million to fund 10 specific projects suggested by the Iowa Department of Health and Human Services to address immediate needs or to help expand services that are showing results in addressing opioid abuse.
The projects include funding to:
- Support the development of a recovery-focused high school and workforce training center;
- Expand access to medication-assisted treatment in rural and underserved areas of the state through colocated and mobile recovery units;
- Provide recovery housing and posttreatment support for individuals in addiction recovery, including for those experiencing homelessness and released from prison;
- Provide screening, assessment, diagnosis and treatment service providers to county jails to ensure inmates receive necessary mental health and substance use care in jail.
The remaining $27 million would be split between the Health and Human Services Department and the Iowa Attorney General’s Office, with 75 percent of settlement funds going to the department and 25 percent to the attorney’s general’s office for crisis response, early intervention, treatment and recovery for opioid addiction.
Both would be required to consult with the state’s seven behavioral health districts on how best to use those funds and analyze local government usage to prevent duplicating programs and services already being offered by local efforts.
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.
‘We are way late to the game’
In the Senate, Democrats levied heavy criticism at majority Republicans for their failure to pass an opioid settlement fund distribution fund much sooner.
Sen. Janice Weiner, a Democrat from Iowa City and the Senate Democrats’ leader, became emotional when talking about the bill. During debate last year on an opioid settlement proposal, she spoke on the Iowa Senate floor about her daughter who has a substance use disorder.
“For too long the majority party has failed Iowans on this issue,” Weiner said, choking back tears. “Think of the good those funds could have done. … We are way late to the game.”
Weiner said 1,103 Iowans died from opioids from 2020 to 2024. And while opioid-related deaths in the state have slowed, it’s not been nearly as much as in surrounding states “that have put settlement funds to good use.”
Senate and House Democrats also lamented what they say is a lack of oversight and transparency over how the funds will be used, noting the bill does not name the organizations that would receive money for earmarked projects in the bill.
“How can we have the transparency we need to make sure that these vital resources are going to the most appropriate places when we don't have that information?” asked Rep. Megan Srinivas, D-Des Moines.
Sen. Tim Kraayenbrink, a Republican from Fort Dodge who has been working on opioid settlement fund legislation for multiple years, said he believes the new proposal provides proper transparency and accountability and offered assurances that the bill was thoughtfully crafted.
“I am so happy that we’re able to do this,” Kraayenbrink said. “I truly hope you know that I feel that, because it’s been a long time for me as well.”
What is Iowa’s Opioid Settlement Fund?
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.
Iowa was one of 47 states that participated in the lawsuits, and 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 percent of the funds going to states and local governments must be used to treat and prevent opioid addiction.
Just $3.8 million has been allocated from the fund, 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 — as is required by state law. Various proposals were introduced in the 2023 and 2024 sessions of the Iowa Legislature, but none gained enough support to pass.
Republican leaders in the House and Senate have disagreed over the need for an advisory council to administer the treatment funding. House lawmakers said that was an important piece of the proposal — to ensure oversight over how the funds are spent. Senate leaders did not think a council was needed and worried it would add unnecessary steps to the process.
Rep. Gary Mohr, a Republican from Bettendorf and chair of the House budget committee, said the compromise ensures the funds will be distributed quickly to help Iowans and communities address opioid abuse, with local input and consideration of how local governments are using their shares of the national settlements.
State will measures effectiveness of funding awards
Health and Human Services the Attorney General's Office will set performance measures to evaluate the effectiveness of the awards in addressing the opioid crisis, and will be required to submit an annual report to lawmakers and the governor on disbursements from the fund, intended outcomes and whether they were achieved, input from each district behavioral health advisory council and recommendations for future disbursements.
Moneys disbursed for earmarked projects must be spent no later than June 30, 2027.
Remaining settlement funds would be available to use through the budget year ending June 30, 2030, after which lawmakers would have to reauthorize the spending plan.
Mohr said the funds are for one-time awards, not to become a recurring funding source for programs or facilities.
“I think it's a good solution to the opioid funds, and I look forward to spending dollars to help Iowans either stay away from opioid addiction or help get them off their opioid addiction.”
Comments: (319) 398-8499; tom.barton@thegazette.com
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