How will Iowa use new federal funding to tackle opioid crisis?

State public health officials say more than a thousand Iowans struggling with opioid addiction would be served by expanded access to treatment and recovery support services under new federal funding.

The Iowa Department of Health and Human Services will receive $9 million in a state opioid response money, as part of $1.5 billion in nationwide funding announced last week by the White House to help states, territories and tribes combat the nation’s opioid epidemic.

The funding also allows states to invest in better overdose education and increase the accessibility of Food and Drug Administration-approved naloxone products used to help reverse an opioid overdose, according to the White House.

The Iowa Department of Health and Human Services estimates at least 1,100 Iowans will receive treatment and/or recovery support services during the two years of the grant funding, with an additional 11,000 Iowans receiving prevention and/or harm reduction services.

“Continued media efforts will reach even more through a variety of campaigns aiming to reduce stigma and inform Iowans about the risks associated with the opioid crisis,” Iowa Department of Health and Human Services Public Information Officer Sarah Ekstrand said in an email. “Although Iowa is considered a low-incidence state compared to many others, the increases in opioid-related deaths are concerning.”

Last year, 258 Iowans died of opioid overdoses, up from 157 deaths in 2019 and 213 deaths in 2002, according to the state Health and Human Services Department. About 83 percent of those deaths involved fentanyl or other synthetic narcotics.

“Increasing instances of these synthetics being detected in combination with other drugs such as stimulants, indicate that some people who think they are taking something other than an opioid are also dying due to contamination of those substances with illicit fentanyl,” Ekstrand wrote. “The recently announced award comes as a follow-up to previous opioid grants and will allow for continuation and expansion of the prevention, treatment and recovery efforts in the state.”

Opioid settlements

Additionally, Ekstrand said the department’s staff has been working closely with the Iowa Attorney General’s Office to coordinate efforts on ways to use money from legal settlements with opioid makers.

Iowa Attorney General Tom Miller has joined multiple lawsuits across the nation alleging drug manufacturers deceptively marketed opioids and contributed to the opioid addiction crisis. Several companies have settled in those cases.

The biggest chunk of money will come from settlements with opioid maker Johnson & Johnson and the nation’s three major pharmaceutical distributors: Cardinal, McKesson, and AmerisourceBergen. Over the course of 18 years, Iowa expects to receive $177.74 million from those two settlements combined.

The money will be split evenly between the state and counties and cities. Under the settlement, the money must be used for opioid abatement, including prevention, treatment and recovery, according to the Attorney General’s Office.

Iowa’s portion of a combined $6.6 billion nationwide settlement with opioid makers Allergan and Teva Pharmaceuticals has not yet been determined, said Lynn Hicks, chief of staff for Miller.

And other settlements with opioid makers, most notably Purdue Pharma, remain outstanding.

A settlement and bankruptcy plan with Purdue, the maker of OxyContin, is before the Second Circuit Court of Appeals. The Iowa Attorney General’s Office has reached an agreement in principle with Ireland-based pharmaceutical company Endo International, with other cases under litigation or negotiation that the office said it could not disclose.

“The (White House) announcement was great news and bring much-needed resources into the state,” Hicks said in an email. “We will continue to coordinate with (the state Health and Human Services Department) as these new dollars arrive.”

Hicks said money from Johnson & Johnson and the distributors have started to be distributed to the state and its counties. The office has also received money from the McKinsey settlement, reached in February 2021.

A portion was used to launch opioidhelp.iowa.gov, a dashboard that allows Iowans to find locations to seek treatment from providers that have contracted with the state.

Last year, the Iowa Attorney General’s Office signed an agreement with University of Iowa Health Care to develop a comprehensive, statewide opioid treatment program using $3.8 million in settlement funds.

'A game changer’

Rod Courtney of CRUSH (Community Resources United to Stop Heroin) of Iowa called the White House announcement of the funding “encouraging” — in particular, a planned $104 million investment to expand prevention services for substance use disorder in rural communities.

The federal funding will allow states to increase investments in overdose education, peer-support specialists in emergency departments and other strategies Courtney said can help save lives in hard-hit communities.

The Cedar Rapids-based not-for-profit provides support, resources, education and referrals for individuals with substance use disorders.

CRUSH opened a peer-led recovery community center in June in Cedar Rapids’ Human Services building downtown. The drop-in center uses a peer-centered approach that promotes recovery through support groups and services, advocacy, outreach and treatment and resource referrals.

“Personally, I think that would be a game changer,” Courtney said of the funding to help create new sites to provide medication-assisted treatment for opioid use disorder in rural communities, “because it brings the cost of care down and accessibility up.”

Courtney’s son, Chad, died of a fentanyl overdose in November 2016.

“For somebody that dedicated their life to fighting the opioid epidemic, it’s hopeful. It’s encouraging,” Courtney said. “I very much look forward to see what else comes out of this.”

A crisis ‘growing by leaps and bounds’

Susan Brafford is a 25-year opiate user who completed opioid and opiate addiction treatment in Cedar Rapids in July and currently serves as a peer-recovery coach at CRUSH of Iowa.

Brafford said increased funding for peer-support specialist, as well as employment and housing assistance and counseling services for those exiting the criminal justice system and transitioning into recovery, is critical.

“Our dark past can be what saves somebody’s life,” Brafford said of having coaches “with lived experience” helping support other Iowans.

“As addicts, we’re way less likely to tell our entire story, or tell our truths, to somebody who has never been through that,” she said. “And when you find that in a fellowship or a facility like CRUSH, this is what’s going to keep you sober.

Brafford said her addiction began with pain pills “and then it transitioned to heroin.”

In the beginning, 20 years ago, Brafford said it was not uncommon to walk into a treatment center and be the lone heroin addict, or one of two, among a group of 30 people.

“Now, you walk in and it’s about 50 percent or more sometimes,” she said of the growing prevalence of heroin and synthetic narcotics in the state. “It’s very acceptable and its very easily accessible. Before, it was very hard to come by. Now, you can get about anywhere.”

Tightened restrictions on prescribing opioid pain medicine has also meant more people are turning to heroin, Brafford said, “and whatever they can to not be sick” from opioid withdrawal.

“That has made the heroin epidemic grow in such a huge way,” she said. “The more funding we get, the better it would be. And it’s necessary, absolutely necessary.”

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