WATERLOO — For the last three years, the number of people fatally overdosing on either prescription opioids or their street drug counterpart, heroin, had been falling.

In 2014, 264 Iowans died of a drug overdose, most of which were from opioids, according to the Centers for Disease Control and Prevention. It went up to 309 in 2015, 314 in 2016 and 341 in 2017.

But with congressional legislation in 2018, growing awareness of the problem among both health care providers and patients and a variety of lawsuits against opioid manufacturers since 2000, that number began falling.

In 2018, 287 people in Iowa succumbed to a fatal drug overdose, the last year for which the CDC had data — mirroring the national downward trend.

“For about three years, we were seeing a reduction in opioid overdoses,” said Jackie Preston, a community prevention educator at Pathways Behavioral Services in Waterloo and chair of the local chapter of Community Resources United to Stop Heroin.

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And then 2020 — and an isolating, worrisome pandemic — hit. Now, Preston says fatal overdoses in Iowa are rising again, surpassing their 2019 number last month.

“There’s so much anxiety and depression,” she said. “We don’t want people choosing a pain management strategy that has a really high rate of dependence and addiction.”

Much of the reason people become addicted is because opioids themselves are easy to get addicted to — in as little as five days for certain patients, Preston said. Even though financial incentives to prescribe opioids were removed in federal legislation in 2018, providers still may feel pressure to prescribe opioids for severe pain, particularly after surgery.

“We need to explore what the alternative options can be, and be able to find a way to make these services accessible, especially to our older adults and differently abled populations, and to those in rural Iowa,” said Amy Bonebrake, an alcohol and drug counselor at Access in Waterloo.

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A bill in both the U.S. Senate and House of Representatives called the Non-Opioids Prevent Addiction In the Nation Act, or NOPAIN Act, would do just that. It amends the Social Security Act to incentivize insurers to cover alternative pain treatments, like relaxation therapy, chiropractic care and other categories of drugs besides opioids.

“We’re making a push right now for it to be part of a year-end package,” said Chris Fox, executive director of the national group Voices for Non-Opioid Choices, who noted that fatal overdose deaths from opioids in the U.S. were “as much as 11% higher” than last year.

The bill has fairly broad bipartisan support, including among Iowa legislators. Outgoing First District U.S. Rep. Abby Finkenauer, a Democrat, is among the 62 co-sponsors of the House’s bill and “remains hopeful” the legislation would come up this year, her office said.

U.S. Sen. Joni Ernst, a Republican, is one of 24 Senate co-sponsors of the bill, “a major priority,” according to her office. U.S. Sen. Chuck Grassley, also a Republican, generally supports the effort but is awaiting a Congressional Budget Office score, his office said.

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Despite the support, NOPAIN languishes in committees.

“The support is so broad that it kind of seems like, why is this not happening?” Preston said.

Negotiations around a potential COVID relief bill and the year-end omnibus bill are also taking priority, legislators say. But advocates say they remain hopeful.

“I think some of these pieces take time,” Fox said. “But we can’t afford to wait another minute — 130 Americans die every day from an overdose.”