Iowa opioid settlement dollars are starting to come in, but most remain unspent

Ann Breeding knew something was wrong right away when a police officer pulled into her driveway in Bondurant the morning of Nov. 1, 2020.

The officer had a detective in Ankeny on speakerphone. The detective explained to Breeding that police had found her son, Daniel Bailey, dead of an overdose at a Super 8 motel.

" My entire life shattered right then and there, and everything has been completely different since then,” Breeding said.

Daniel’s death was a tragic conclusion to a more than a decade-long battle to get his addiction under control. He was 29. His death was one of 213 opioid-related overdoses in Iowa that year, according to state public health data.

Through her grief, Breeding founded Steps of Hope , a nonprofit to support the families who have lost someone to substance use disorder.

As money from multiple legal settlements with opioid manufacturers and distributors starts to arrive in Iowa, she believes the dollars should go to prevent more tragedies like Daniel’s from happening.

Breeding has applied to use some of the money to help distribute naloxone, the opioid-reversal drug.

“It's blood money, and that money needs to go to the people who are suffering because of the opioid […] epidemic,” Breeding said. “Those are the people that need the help.”

‘There's no guardrails in the settlement’

Iowa is expected to receive about $174 million in opioid settlement funds over the next 18 years.

The majority of that money — 70% — is supposed to go to “ opioid remediation efforts ,” according to the settlement agreements.

Even though there are guardrails in place written into the settlement, the language surrounding the suggested uses for funding is broad , which concerns public health experts.

“There isn't a national watchdog. The federal government is not playing a role and kind of overseeing this. There's no guardrails in the settlement, so it really is up to the state and to the jurisdictions to oversee themselves,” Sara Whaley , senior practice associate at the Johns Hopkins Bloomberg School of Public Health, said.

Whaley said officials need to start planning how to best use those funds now to make sure they go toward evidence-based initiatives. Otherwise, dollars could end up diverted elsewhere, as happened with a lot of the tobacco settlement money , she added.

“There's this pressure to spend the money. There's this pressure to get the money out the door,” she said. “I think we're going to see it start to split, of who's making thoughtful investments versus who's just writing a check.”

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Iowa’s settlement funding is split evenly between the state and its counties. Half goes to the state opioid abatement fund to be distributed by the legislature. The other half goes to Iowa’s 99 counties directly. Allocations are based on their population size, according to the state’s Opioid Allocation Memorandum of Understanding .

Though Iowa started receiving millions of dollars last year, so far most of those dollars are just sitting in bank accounts.

Seventy-two of Iowa’s counties didn’t spend a dime in fiscal year 2023, according to records from the Attorney General’s office. And of those that did, the majority have spent just a fraction of their available funds on small projects like buying extra naloxone kits or training staff on substance abuse prevention.

Some exceptions include Lee County, which spent $230,000 on hiring ten new emergency medical technicians following the closure of the Keokuk hospital , and Louisa County, which spent $35,000 on a machine that scans drugs to tell police officers what they are without physically handling them, as well as puncture proof gloves and storage containers.

Polk County — Iowa’s most populated — is just starting to distribute some of the $4 million it’s received so far in the form of grants to local organizations after developing a strategic plan for spending.

“Our main goal is to have the greatest impact on those folks with lived experience, and making sure that we're creating systems that are going to work long after we stopped receiving payments,” Gabbie Ruggiero , program planner at Polk County Behavioral Health and Disability Services, said.

Some small counties have reached out to her, uncertain of how they can spend the money, she said.

“They might be worried that they're not going to follow the requirements of the settlement, that they might spend them in other areas,” Ruggiero said. “So a lot of the questions are just, ‘Can we spend money on XYZ?’”

Getting state opioid dollars distributed

In the meantime, the Iowa Treasurer’s office reports nearly $50 million is sitting in the state’s opioid abatement fund after a bill in the legislature that would have allocated some of it to treatment and prevention programs failed to pass.

The bill failed because the House and the Senate disagreed on whether to have an advisory board. Iowa is one of 11 states that does not have one, according to an analysis by KFF.

Following the end of the session, Iowa House Speaker Pat Grassley told Iowa PBS in April that he wanted to set up the advisory board so that Iowa Health and Human Services has to have some input from the legislature as to where the money goes.

However, Senate President Amy Sinclair disagreed.

“We don't need to add a layer of bureaucracy to do good work, especially since the settlement itself outlines how those dollars need to be spent,” Sinclair told Iowa PBS in May .

Sinclair made her comments the same month as Gov. Kim Reynolds signed a law eliminating 83 state boards and commissions , including the Iowa Drug Policy Council .

Following the failure of the opioid bill, Reynolds used American Rescue Plan Act dollars to cover what was supposed to be funded through the bill.

The Ember Recovery Campus outside of Cambridge is one of the projects that received $3 million in ARPA money . It had initially been allocated that money in the opioid bill.

YSS , a nonprofit that provides youth addiction and mental health resources, is constructing the 70-bed, nature-based substance use treatment facility for adolescents and young adults on 53 acres of farmland.

It’s the first program in the state focused on young adults as well as adolescents, YSS President and CEO Andrew Allen said.

The project could have been delayed without the ARPA funding, he said.

“We would have really been struggling to meet the needs, from a construction standpoint, on this campus without the funds from the opioid settlement,” Allen said.

He said it should be a top priority for the legislature to get opioid dollars out next session because the epidemic is only getting more dangerous — and deadly.

“For $10, you can get the highest high you've ever had, or cut wrong, it could kill you,” he said.

Ember Recovery Campus is scheduled to open in Oct. 2024.