Fentanyl overdoses in Iowa have increased fivefold over a 10-year timespan, catching the attention of Iowa lawmakers, residents, and community behavioral health professionals.
The rise has elicited a number of harm reduction strategies and legislative actions — some of which have come in the form of life sentences.
Iowa House File 792 aims to sentence an individual who has delivered, dispensed, or otherwise provided fentanyl or a fentanyl-related substance that resulted in the death of a person to life in prison.
In 2022, 384 overdose deaths were recorded, with 86 percent involving fentanyl, according to the Iowa Department of Public Safety.
However, nationwide trends show these numbers falling. Of the 107,000 opioid overdose deaths in 2023, 70 percent were attributed to fentanyl, according to the U.S. Drug Enforcement Administration.
While on the rise in the state, the rate of fatal drug overdoses in the U.S. has decreased by 1.3 per 100,000 people from 2022 to 2023, according to the Centers for Disease Control and Prevention.
Passing the House
House File 792 passed on March 26, 69-27, mostly along party lines. The bill has since made its way to the Senate Judiciary Committee, headed by State Sens. Matt Blake, D-Urbandale, Jason Schultz, R-Schleswig, and Mike Bousselot, R-Ankeny, where it has not progressed.
Iowa Rep. Jon Dunwell, R-Newton, drafted the bill and said during debate in March, the bill for him was known as “Kristen’s Law.”
Dunwell said the bill was first brought to him by a Newton mother who lost her daughter to a drug overdose. Her daughter, Kristen Ewing, had overdosed on a substance that was 98 percent fentanyl, lending the bill its name.
“This is a very stiff and harsh penalty, but the consequences of fentanyl deaths are even more tragic and are even more costly,” Dunwell said.
Iowa Rep. Charley Thomson, R-Charles City, said the idea behind the bill is to impose strict liability for anyone who is handling fentanyl, whether it is labeled fentanyl, declared fentanyl, or known to be fentanyl, due to the dangers of the substance.
“If you are involved in the trading of these illicit substances that are sometimes laced with fentanyl, you should know that there’s a chance of maybe killing somebody,” Thomson said.
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The bill makes distribution leading to death a first-degree murder charge, which is a Class A felony in Iowa punishable by life in prison with no possibility of parole or early release. A Class A felony is the highest level of felony in the state.
Thomson said the sentence is the strongest weapon the legislature can wield against the fentanyl trade.
“[The bill] is putting everybody who’s involved on notice,” Thomson said. “This is a highly serious criminal activity, and there’s no such thing as someone who is innocently involved in the drug trade.”
Colin Murphy, a criminal defense attorney with Gourley, Rehkemper, and Linaholm and an active member of the Iowa Association for Justice’s Criminal Defense Section, said if a person delivers fentanyl to another individual and they die as a result of ingesting, absorbing, or injecting the substance, the distributor would be charged.
Murphy attributed the stalling of the bill in the Senate with the unintended consequences of the bill as currently written.
One such consequence falls on young individuals or kids, Murphy said, as they could be sentenced to life in prison for murder.
“What they thought of as a party drug, OK, they had no idea that it contained fentanyl,” Murphy said.
The importance of addressing the dangers of fentanyl and the overdoses overconsumption can lead to are not lost on the attorney, however, he emphasized the importance of “beyond a reasonable doubt.”
“If you are going to punish those associated with a fentanyl overdose, then the state should be able to show beyond a reasonable doubt that the person who shared that substance knew there was a detectable amount of fentanyl,” Murphy said.
Iowa Rep. Brian Meyer, D-Des Moines, and former assistant Iowa attorney general, echoed Murphy’s sentiment, arguing the bill was written in a broad manner with no intent or knowledge requirements, meaning an individual who is actively distributing the drug does not have to know the substance itself is fentanyl to be charged with a Class A felony.
“Say you are a nurse in a hospital and you accidentally give someone too much fentanyl. That is a Class A,” Meyer said. “Say you had a back injury and were given fentanyl patches that your child later got hold of and dies as a result. That is a Class A felony.”
The definition of murder in the first degree under the Homicide and Related Crimes in the state legislature states, “a person willfully, deliberately, and with premeditation kills another person.”
Meyer said first-degree murder would be willful and intentional killing of another human being, and under this bill, fentanyl distribution would be on par with murder.
According to the Controlled Substances Act in Iowa, the manufacturing, possession, and delivery of fentanyl is prohibited.
Murphy said there are a number of derivatives of fentanyl that fall under this act, making it difficult to acquire evidence or any indication of the person who is sharing the substance knowing the product had fentanyl in it.
“Outside an admission, text message, or other indication, it would be very difficult to prove that the person knew, and that is dangerous,” Murphy said. “People would be unaware.”
Meyer said the fentanyl epidemic is severe and has advocated for increasing penalties for intentionally giving individuals fentanyl that results in their death.
“I have no problem with upping the penalty to a Class A felony if there was a knowledge or intent to sell element in it [the bill],” Meyer said. “I just cannot support somebody in prison who had no knowledge that fentanyl existed in their drugs.”
The dangers of fentanyl
Kayla Borja Frost, regional director for Community and Family Resources based in Iowa City, said fentanyl can come in many different forms, including in the form of a prescription pill.
Fentanyl is a synthetic opioid, according to the National Institute on Drug Abuse. A synthetic opioid, Frost said, is a man-made substance with different types of chemical configurations and has become more prominent.
“Fentanyl can be mixed and laced with other substances, and whatever substance you think you might be getting may in fact contain fentanyl or another synthetic opioid,” Frost said.
Frost said fentanyl is easily and cheaply produced, and the U.S. is beginning to see production growth following the increased prominence of heroin, a natural opioid synthesized from the seeds of a poppy plant.
Synthetic opioids such as fentanyl are 10 to 100 times more potent than heroin, Frost said.
At the Community and Family Resources Center in Iowa City, staff routinely screen test for fentanyl when patients come in because of its prevalence, even if they don’t think they’ve taken fentanyl.
The center sees 5 to 10 percent, or roughly 40 to 80 clients, of its patients report a primary substance use issue involving opiates, annually.
“As quickly as we find out about one, people are making another different formulation, and that makes it hard to really know what people are consuming,” Frost said.
Frost said anyone can buy a pill press to make a pill look like a Percocet, commonly referred to as oxycodone, and a prescription medication primarily used as a painkiller, for example.
Similar to Percocet — morphine, also a natural opioid derived from poppy plants — has been used for pain, surgeries, and other serious injuries.
Often, Frost said, individuals may become addicted to their prescribed opioids, such as morphine. However, in their search, they may unknowingly buy fentanyl or a product laced with fentanyl.
Opioid overdoses, in a similar vein, are on the rise in Iowa. According to the Iowa Department of Public Safety, the number of opioid-related deaths in 2022 was found to be 237. Of that, 89 percent were found to have implications of illicit, or illegal, fentanyl use.
Similarly, the department found a rise in the production of substances laced with fentanyl and other synthetic opioids.
Frost said opioid overdoses look different for everyone depending on the level of the drug in one’s system, weight, metabolism, and how the body breaks down the substance. Respiratory failure is most commonly associated with overdoses, leading to death.
“If someone is overdosing, they will turn blue and stop breathing,” Frost said. “This is what we [Community and Family Resources] are trained to look for so they can be revived.”
Treatment and harm reduction
Murphy explained the production of a pill containing fentanyl that mimics something else, and the dangers associated with its consumption.
“There are probably different ways to approach it [the dangers], especially with respect to clandestine pill mills and manufacturing,” Murphy said. “Addressing the bill with some type of knowledge element would be a step in the right direction from a law enforcement perspective.”
Murphy said when there is a new drug that comes onto the scene and into the market, there is always an attempt to address it through criminalization.
According to a Substance Abuse and Mental Health Services Administration 2023 survey conducted in Iowa, 313,000 individuals aged 18 or older engaged in illicit drug use, with the number of individuals aged 26 and older being 239,000.
Frost highlighted the importance of harm reduction and getting individuals the treatment they need.
“Harm reduction is absolutely essential because if people are not alive to make the choice to get into treatment and to try and recover, then we don’t have a place to start from,” Frost said.
The Community and Family Resource Center offers opioid misuse, opioid abuse, and opioid addiction treatment services.
A medical oversight program, Frost said, allows those individuals experiencing withdrawal to have treatment from medical providers and make them more comfortable, particularly for those difficult withdrawals that come from opioid consumption.
“If we can reduce the number of overdoses, and people are alive another day to make a different choice, then we have all of these treatment options available to them whenever they might want to come and access it,” Frost said. “That is what we want to provide so that we can be here when people make that choice.”