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Iowa fentanyl deaths cause alarm, but solutions controversial

In a 2018 photo, a team leader with Iowa Harm Reduction Coalition sets up a table during a mobile outreach event in downtown Cedar Rapids. The organization gives out free naloxone kits, which can reverse an opioid overdose, as well as risk reduction kits that include sterile water, cookers, ties, antibiotic wipes, band aids and condoms. (The Gazette)

As Iowa grapples with a dramatic increase in overdose deaths involving fentanyl, some experts and activists say the best-proven solutions are currently criminalized in the state.

Advocates of harm reduction — a set of strategies to reduce the negative effects of ongoing drug use — say Iowa’s laws are counterproductive to the goal of lowering overdose deaths and getting people with substance use disorders into treatment.

Democratic Attorney General Tom Miller threw his voice into the discussion last month, when he called on the Iowa Legislature to legalize fentanyl test strips, which can test drugs for fentanyl, and expand access to naloxone, a medication that can reduce the effects of a drug overdose.

Fentanyl is a synthetic opioid that is used in medical settings, often for the treatment of severe pain. It can be up to 100 times stronger than morphine, meaning it takes a much smaller amount to cause an overdose. The presence of illicit fentanyl, and its involvement in opioid overdoses, has shot up in Iowa in recent years, leading officials to search for solutions to the trend.

Allowing for testing would be a welcome policy change, according to Andrea Weber, a clinical assistant professor of psychiatry at the University of Iowa. Weber said legalizing testing strips is “low-hanging fruit” and would allow drug users who aren’t trying to take fentanyl avoid consuming deadly amounts.

Fentanyl test strips are currently classified as paraphernalia under Iowa law, which carries a simple misdemeanor charge, punishable by a fine of up to $855 and 30 days in jail.

Debra Krause, director of the Iowa Harm Reduction Coalition, said fentanyl test strips are not enough to solve the opioid crisis. She said she wants to see broader deployment of naloxone, a more robust good Samaritan law and syringe service programs.

“I’m always going to be for the legalization of fentanyl test strips, it’s just not going to solve the opiate crisis,” she said. “We’ve been talking to the attorney general and (Iowa Department of Public Health) for literally five years, and we have the science. Harm reduction has the science and the evidence-based research.”

Syringe service programs, also known as needle exchanges, are programs that provide clean needles to intravenous drug users to prevent the spread of diseases like HIV and hepatitis C. According to the Foundation for AIDS Research, syringe service programs are legal by state or local law in 39 states. They are illegal in Iowa.

Weber said the programs provide more than just clean syringes for drug users. They often offer counseling, evaluations for substance use treatment and testing for common bloodborne infections.

Why fentanyl is being talked about now

Officials are sounding the alarm now, in part, because the state has seen a dramatic increase in overdose deaths that involved fentanyl and in fentanyl seizures by law enforcement.

Iowa has one of the lowest drug overdose rates in the country, but the rate has been increasing, mostly due to opioids — deaths went up 34 percent between 2019 and 2021, according to the governor’s office. Fentanyl was involved in 83 percent of the state’s 258 opioid deaths last year, and drug overdose deaths increased 120 percent among Iowans under 25 in the last two years.

Fentanyl is often found in illicit pills that are sold on the black market and disguised as real pharmaceutical drugs like OxyContin and Xanax, officials said. It’s also mixed into what’s being sold as heroin, cocaine and methamphetamine.

Pills containing fentanyl are not coming from legitimate pharmacies, but pressed by criminal organizations to look like pharmaceutical drugs. The fentanyl being found in illicit pills and substances is made in clandestine labs, Weber said, which means the potency and purity can vary widely.

According to data provided by the Iowa Department of Public Safety, officials seized more than 7 kilograms of fentanyl by itself in 127 cases last year. In hundreds of other cases, officials found fentanyl in mixtures with heroin or other drugs. It’s an extraordinary increase from 2018, when the weight of fentanyl alone found by law enforcement was only about 10 grams in 34 different cases.

Legislative landscape

Legislation has been proposed in previous years to set up needle exchanges similar to what exists in other states, but none have garnered enough support to get to a floor vote.

A Senate bill sponsored by 10 Democrats was proposed last year, but it didn’t reach a subcommittee meeting. A similar bill creating a pilot program in the House last year did not get to a subcommittee.

In an emailed statement, Senate Majority Leader Jack Whitver, R-Ankeny, said a law around fentanyl testing kits was worth consideration, but he didn’t commit support for them. He noted that needle exchanges have not received enough support to advance.

Iowa House Republicans spokesperson Melissa Deatsch said the caucus was using the time between sessions to learn more about what can be done to curb the rising overdose rates in Iowa.

Gov. Kim Reynolds’ spokesperson, Alex Murphy, didn’t say whether Reynolds would support measures to legalize test strips or set up syringe service programs, but he pointed to her work to raise awareness of the deaths as well as her signing a 2016 law that allowed pharmacists to dispense naloxone without a prescription.

Reynolds also has directed the Department of Health and Human Services to include information about fentanyl in an awareness ad campaign targeting youth.

Murphy and Whitver also cast blame on the Biden administration’s policies around the southern border that they said allowed for the influx of drugs brought in from Mexico.

“This is due in large part from failed policies of the Biden administration to not secure our southern borders,” Murphy said.

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