[Congressional Record Volume 150, Number 47 (Tuesday, April 6, 2004)]
[Senate]
[Pages S3793-S3794]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Ms. COLLINS:
   S. 2288. A bill to amend the Public Health Service Act to assist 
States in establishing, maintaining, and improving systems to reduce 
the diversion and abuse of prescription drugs; to the Committee on 
Health, Education, Labor, and Pensions.
   Ms. COLLINS. Mr. President, the abuse of prescription drugs has 
reached epidemic proportions in this country. In many States, including 
my home State of Maine, deaths from prescription drug overdoses now 
exceed deaths from illicit drugs. Nationwide, emergency room visits for 
prescription drug problems more than doubled in the last decade.
   The number of Americans who divert prescription drugs from their 
intended purposes and abuse them was estimated at 4 million in 1998. 
Today, the estimate is 11 million Americans. At a time when, according 
to the National Institute on Drug Abuse, our young people are turning 
away from marijuana, cocaine, ecstasy, and even alcohol, they 
unfortunately are turning to the medicine cabinet.
   Nearly one in five of our Nation's high school juniors and seniors 
say they abuse prescription drugs.
   The cost of drug abuse to our society in treatment, health care, 
lost productivity, crime, and incarceration exceeds $150 billion a 
year. The cost to its victims is incalculable. That is why today I am 
introducing the Prescription Drug Stewardship Act. I use the word 
``stewardship'' to emphasize our responsibility as individuals and as a 
society to see that these beneficial medications are used for their 
intended purposes, not to cause addiction, disability, and even death.
   This legislation attacks the spiraling cycle of diversion and abuse 
with three key stewardship activities:
   First, computerized prescription drug systems to better track the 
flow of medications.
   Second, ongoing practitioner training to help our busy medical 
professionals keep current with the trends in diversion treatment and 
abuse.
   Third, and perhaps most important, public education to help our 
citizens better understand the dangers posed by the misuse of these 
drugs.
   I have found in talking with experts in this field that many 
individuals who would never think of trying heroin, for example, will 
take leftover prescription drugs that may, in the long run, be equally 
addictive and just as harmful.
   Combined with improved and more accessible substance abuse treatment 
programs, the legislation I am introducing would help to stem the 
rising tide of abuse and addiction that has swamped families and 
weakened communities in my State and across the country.
  My bill would authorize per year for each of the next 3 years to fund 
prescription drug monitoring and education programs at the State level. 
It would create competitive grant programs which would be administered 
by the Substance Abuse and Mental Health Services Administration. They 
would require States to demonstrate their commitment to stewardship 
with matching funds and also to meet the privacy requirements under 
current law as they carry out these important activities.
  What we have found is that the most abused medications are those that 
relieve pain and anxiety. For millions of legitimate patients suffering 
from illness or injury, these medicines are

[[Page S3794]]

vital and their availability is proper and humane. They can make the 
difference between suffering and the ability to carry on with a normal 
life for people who are in serious pain or suffering from serious 
disease or injury. It is tragically clear, however, that these 
medications, many of them as powerful or as addictive as illegal drugs, 
increasingly are being diverted from their legitimate use to 
trafficking and abuse.
  I want to emphasize that the problems is not with these medications 
when they are prescribed, dispensed, and consumed responsibly. In fact, 
we know that pain is still undertreated in this country, and that most 
physicians are extremely responsible in trying to relieve pain felt by 
their patients. The problem is what happens when the chain of 
responsibility breaks.
  Oversight of the licensing and practices for prescribing and 
dispensing of these medications has long been a matter of State 
jurisdiction. As a former State regulator who was in charge of 
licensing boards for physicians and pharmacists, for example, I 
certainly have no desire to change that system. The States have not 
shirked their stewardship responsibility. They simply have been 
overwhelmed by this epidemic of diversion and abuse, and they need some 
Federal assistance, not to take over their programs, but to help them 
in a partnership to make them more effective.
  This national calamity has hit rural States particularly hard. The 
Presiding Officer's home State of North Carolina is one of those States 
that has felt the devastating impact of this epidemic. Kentucky, 
Virginia, West Virginia all report prescription drug abuse at epidemic 
levels. But no State, unfortunately, has been hit harder than my State 
of Maine.
  From 1997 to 2002, the number of accidental deaths in Maine from all 
drugs soared from 19 to 126, an increase of more than 500 percent, and 
prescription drugs were present in 60 percent of these deaths.
  The 2002 Main Youth Drug and Alcohol Survey found that a disturbing 
25 percent of my State's high school juniors and seniors abuse 
prescription drugs. That is an astonishing number and a very disturbing 
statistic. In the last 5 years, enrollment in Main clinics that treat 
opiate addiction has increased tenfold.
  These shocking numbers from Main demonstrate that drug abuse and 
addiction is not longer a big-city problem. It is a problem that 
afflicts our citizens no matter where they live, whether it is Los 
Angeles, CA, or Calais, ME. In fact, a hearing I helped put together 
last year demonstrated that there is a terrible problem in Washington 
County in Downeast, ME. Some estimates are that as many as 1,000 of the 
citizens of this county of only 35,000 citizens are struggling with 
drug addiction and abuse. This was a hearing before the HELP Committee. 
It actually was 2 years ago. But last August, I chaired a committee 
meeting of the Governmental Affairs Committee in Bangor, ME, where we 
heard from law enforcement officers, from drug treatment counselors, 
and from many others who are expert in drug addiction and abuse. The 
picture they painted was a startling one. It showed that drug abuse, 
and abuse of prescription drugs in particular, is a problem throughout 
the entire State of Maine.

  My legislation would provide States, such as Maine, with the 
resources to carry out three critical stewardship activities. The first 
would help States to monitor the flow of prescription drugs from 
practitioner to pharmacy to patient. We know that prescription drugs 
often find their way to the street when unscrupulous individuals obtain 
multiple prescriptions from multiple doctors. These so-called doctor 
shoppers operate in every State. Sometimes they act alone and sometimes 
they act in concert with organized gangs of criminals. Each can divert 
hundreds, even thousands, of pills per day. Many of these drugs have a 
street value 10 times the cost at the pharmacy.
  Twenty States now have prescription tracking systems. Maine began 
operating such a system or putting it together just this summer. About 
half of these systems use the latest computer technology and have 
proven that illegal diversion can be curtailed without reducing access 
to these medications by legitimate patients and without breaching that 
essential doctor-patient confidentiality.
  We want to make sure any system we put in place does not chill a 
doctor's ability to prescribe legitimate medication for patients who 
are suffering and need help with their pain.
  These systems have also demonstrated an effective prescription drug 
system more than pays for itself by reducing the tremendous costs 
associated with drug abuse and addiction. Thirty States, however, have 
no system whatsoever for monitoring or tracking prescription drugs in a 
way that would help us identify and put a stop to doctor shopping. My 
legislation would provide the States with the resources to start up 
such a system to help improve its quality or to maintain it.
  The testimony I heard last August in Bangor, ME, before the 
Governmental Affairs Committee, along with my colleague Senator Sununu, 
provided the basis not only for that provision of our bill but also for 
two others. The testimony we heard that day from those who are on the 
front lines, law enforcement, hospital emergency room physicians, and 
treatment clinic personnel, was alarming. They told us medical 
practitioners need our help. Our doctors, our physician assistants, our 
nurses are busy professionals, often far too busy. Many simply do not 
have the time to travel to seminars where they would receive 
information about the latest trends in drug abuse, learn how to 
recognize drug-seeking behavior, dependence, or addiction among their 
patients. The most effective and efficient way to provide that kind of 
training to medical personnel is to take the education to them through 
one-on-one small group mentoring in their offices or in their 
hospitals.
  The second part of my legislation would provide grants for such 
mentoring projects so practitioners with special training in drug abuse 
issues can pass along this vital knowledge to their colleagues who are 
practicing in communities all over America. Experts also tell us a 
major reason so many Americans with no history of abusing illegal drugs 
now are abusing prescriptions drugs is many people have a terrible 
misconception that these prescription drugs are somehow safe to abuse, 
that it is safe to take someone else's prescription. After all, they 
think they are researched in high-tech laboratories, manufactured in 
modern factories, prescribed and dispensed by highly trained medical 
experts; therefore, they must be safe. When they are used properly, 
they are, but as the overdose and addiction statistics prove, when used 
improperly they can be fatal.
  We need an aggressive public education campaign to warn our citizens 
about the dangers of abusing prescription drugs. The reduction in 
smoking rates, in illicit drug use, even in drunk-driving deaths is 
testament to the progress we can make with seemingly intractable 
problems when we commit the resources for public education campaigns in 
partnership with the States. I believe the same approach can help our 
citizens become better stewards of prescription medications.
  I urge my colleagues to join me in support of the legislation I am 
introducing today to address the increasingly devastating problem of 
prescription drug abuse.
                                 ______