[Congressional Record Volume 151, Number 104 (Wednesday, July 27, 2005)]
[House]
[Pages H6679-H6681]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 DRUG ADDICTION TREATMENT EXPANSION ACT

  Mr. DEAL of Georgia. Mr. Speaker, I move to suspend the rules and 
pass the Senate bill (S. 45) to amend the Controlled Substance Act to 
lift the patient limitation on prescribing drug addiction treatments by 
medical practitioners in group practices, and for other purposes.
  The Clerk read as follows:

                                 S. 45

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. MAINTENANCE OR DETOXIFICATION TREATMENT WITH 
                   CERTAIN NARCOTIC DRUGS; ELIMINATION OF 30-
                   PATIENT LIMIT FOR GROUP PRACTICES.

       (a) In General.--Section 303(g)(2)(B) of the Controlled 
     Substance Act (21 U.S.C. 823(g)(2)(B)) is amended by striking 
     clause (iv).
       (b) Conforming Amendment.--Section 303(g)(2)(B) of the 
     Controlled Substance Act (21 U.S.C. 823(g)(2)(B)) is amended 
     in clause (iii) by striking ``In any case'' and all that 
     follows through ``the total'' and inserting ``The total''.
       (c) Effective Date.--This section shall take effect on the 
     date of enactment of this Act.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Georgia (Mr. Deal) and the gentleman from Ohio (Mr. Brown) each will 
control 20 minutes.
  The Chair recognizes the gentleman from Georgia (Mr. Deal).


                             General Leave

  Mr. DEAL of Georgia. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks and include extraneous material in the consideration of 
this Senate bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Georgia?
  There was no objection.
  Mr. DEAL of Georgia. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I thank the Speaker for allowing us to consider the Drug 
Addiction Treatment Expansion Act, S. 45.
  In 2000, Congress passed the Drug Addiction Treatment Act which has 
resulted in improved access to drug abuse treatment. This law has 
allowed qualified practitioners to prescribed addiction treatment 
medications from their office settings so long as the number of 
patients to whom the practitioner provides such treatment does not 
exceed 30 patients.
  However, the Drug Addiction Treatment Act also limited the number of 
patients a group practice could treat to 30 as well. This limitation 
has created an unnecessary barrier to access to drug addiction therapy. 
Under current law, a practice of 500 doctors would still be limited to 
treating only 30 patients in the same way as a single physician. This 
policy effectively limits the ability of patients to get access to 
treatment for their drug addictions.
  This legislation before us today would lift the 30-patient limit for 
group practices, but would still keep in place the 30-patient limit for 
individual physicians.
  I thank the gentleman from Indiana (Mr. Souder) for his leadership on 
this legislation that further expands access to needed addiction 
therapy. The Committee on Energy and Commerce and the Committee on the 
Judiciary have both favorably reported companion bills to S. 45, and I 
urge my colleagues to support this legislation today.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield myself 2 minutes.
  Drug addiction is a problem we must face both at the individual and 
the systemic level. We bear the cost of addiction as a society. These 
costs are measured in lives and unmet human potential; and, frankly, in 
dollars.
  A recent study by the National Institutes of Health found the 
economic cost of drug abuse totaled some $100 billion a year, costs 
borne by all members of society by increased demand on our health care 
system and our criminal justice system.
  H.R. 869, the Drug Addiction Treatment Expansion Act, addresses an 
anomaly in the current law that limits access to an effective drug 
addiction treatment.
  To ensure proper oversight of drug addiction treatment, current law 
limits the number of patients any one doctor can treat. However, this 
restriction inadvertently limits group practices to the same 30-patient 
limit. This legislation clarifies that each doctor in a group practice 
is subject to the 30-patient limit, not the group practice as a whole.
  This bill will expand access to effective addiction treatment. When 
we come together to fight addiction, we must use every means available. 
This bill gives doctors an improved and important tool. H.R. 869 has 
the support of a range of organizations, including the American 
Psychological Association and the Partnership for a Drug Free America. 
I am pleased to support its passage.
  Mr. Speaker, I reserve the balance of my time.
  Mr. DEAL of Georgia. Mr. Speaker, I yield 5 minutes to the gentleman 
from Indiana (Mr. Souder), who is the author of the House companion 
legislation.

                              {time}  1245

  Mr. SOUDER. I thank the gentleman from Georgia, and I appreciate his 
leadership in moving this through his subcommittee. We served together 
on the Drug Policy committee in Government Reform where he served ably 
as vice chairman before moving up to this important subcommittee 
chairmanship over in Energy and Commerce and understands directly the 
need for drug treatment.
  Mr. Speaker, we can work for interdiction. We can work for 
eradication down in Colombia and Afghanistan. We can work to try to 
seize it as it moves through the Caribbean and through the Pacific. We 
can work to try to catch it at the borders. We can try to take down the 
delivery people.
  We will continue to do that. We will continue to work through our 
national ad campaign, through school programs to try to prevent drug 
use. But ultimately many people in America become addicted. The 
question is, How can we treat them? As has already been explained, this 
was an unintended consequence of the original act. I appreciate Senator 
Levin's help on the Senate side in moving this bill that group 
practices were capped at 30 patients as well.
  Between 1997 and 2000, the number of treatment admissions for primary 
heroin abuse increased 21 percent while treatment admissions for 
primary abuse of narcotic painkillers increased at an unprecedented 186 
percent. In view of the skyrocketing numbers of treatment admissions 
for primary opiate addiction in recent years, it is imperative that 
measures be taken at the Federal level to provide adequate treatment 
options. Given this epidemic of drug abuse in America, drug addiction 
treatment programs must effectively correspond to the widespread nature 
of this problem. In order to expand drug treatment programs, please 
support this bill, the Drug Addiction Treatment Expansion Act, which 
will remove the 30-patient limit currently imposed on group practices.
  According to the American Medical Association, the current 30-patient 
cap has limited access to effective substance abuse treatment services. 
There is a broad consensus according to AMA in the medical community 
that buprenorphine is a major new tool to fight addiction and does not 
have a high potential for misuse or fatal overdose. Lifting the cap 
would enable group practices to treat more patients with this highly 
effective drug.
  There are 49 different, well-respected drug treatment organizations 
that back this bill, including the American Medical Association, the 
National Association of State Alcohol and Drug Abuse Directors, the 
American Psychiatric Association, the American Psychological 
Association, the Association of American Medical Colleges, the Alliance 
of Community Health Plans, and the American Medical Group Association.
  And then in addition to all these medical groups, are almost all the 
major anti-drug groups in America, including the Partnership for a 
Drug-Free America, the Community Anti-Drug Coalitions of America, Drug-
Free Schools Coalition, Drug Free America

[[Page H6680]]

Foundation, the Save Our Society From Drugs, Drug-Free Kids, America's 
Challenge.
  I include this list of 49 groups for the Record.
       American Medical Association (AMA)
       National Association of State Alcohol and Drug Abuse 
     Directors (NASADAD)
       American Psychiatric Association (APA)
       American Psychological Association (APA)
       Association of American Medical Colleges (AAMC)
       Alliance of Community Health Plans (ACHP)
       American Osteopathic Academy of Addiction Medicine (AOAAM)
       American Medical Group Association (AMGA)
       American Academy of Addiction Psychiatry (AAAP)
       Partnership for a Drug-Free America
       Community Anti-Drug Coalitions of America (CADCA)
       American Society of Addiction Medicine (ASAM)
       American Association for the Treatment of Opioid Dependence 
     (AATOD)
       Legal Action Center (LAC)
       National Alliance of Methadone Advocates (NAMA)
       National Association of Drug Court Professionals (NADCP)
       National Council on Alcoholism and Drug Dependence (NCADD)
       State Associations of Addiction Services (SAAS)
       National Association of Counties (NACO)
       Kaiser Permanente
       National Association of County and City Health Officials 
     (NACCHO)
       National Association of County Behavioral Health Directors 
     (NACBHD)
       The College on Problem of Drug Dependence (CPDD)
       The Friends of NIDA
       Faces & Voices of Recovery
       Association for Addiction Professionals of New York
       Drug-Free Schools Coalition
       Drug Free America Foundation, Inc. (DFAF)
       Save Our Society From Drugs (SOS)
       Drug-Free Kids: America's Challenge
       Advocates for Recovery Through Medicine (ARM)
       National Families in Action (NFIA)
       National Association of Social Workers (NASW)
       Man Alive, Inc.
       Institute on Global Drug Policy (IDGP)
       International Scientific and Medical Forum on Drug Abuse
       Californians For Drug-Free Youth (CADFY)
       National Alliance of Advocates for Buprenorphine Treatment, 
     Inc.
       Christian Drug Education Center
       New Jersey Federation for Drug Free Communities
       Wisconsin Families in Action (WFIA)
       New York Academy of Medicine (NYAM)
       American Academy of Pediatrics (AAP)
       Association for Medical Education and Research in Substance 
     Abuse (AMERSA)
       Physicians and Lawyers for National Drug Policy (PLNDP)
       Entertainment Industries Council, Inc. (EIC)
       The City of New York, New York
       Providence Breakthrough
       International Study Group Investigating Drugs as 
     Reinforcers (ISGIDAR)
       Housing Works

  I think that we can unanimously support this bipartisan effort to 
make sure that we have another tool in an adequate way with group 
practices to make sure that we can treat the scourge of drug addiction 
and help many family members get back into their families, whether it 
be the mom, the dad, the kids; and this is the way we can in a 
bipartisan way and with the other body show that we really are trying 
to address these difficult questions of drug treatment.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 2 minutes to the gentleman 
from Massachusetts (Mr. Capuano).
  Mr. CAPUANO. Mr. Speaker, I rise to first of all thank the gentleman 
from Indiana (Mr. Souder) for being so dogged on this issue. As we have 
heard already, this is a relatively simple item. We have people who 
need treatment. I thought we were here to try to help people seek 
treatment and to provide it and we have an anomaly in the law that 
prevents them from getting the treatment that they want and that we 
want to provide them. This bill fixes that anomaly. It is very simple.
  I will fully admit that I did not find this on my own. I found this 
because a doctor in my own district called me, Dr. Schmitt from Mass 
General Hospital, who works out of the Charlestown Community Health 
Center. He treats these people. He wants to be able to treat more. 
Unfortunately, he works in a group practice and is limited to 30. He 
will be able to help more people in his own community, which will help 
the community at large.
  This bill is a modest piece of legislation. It simply allows more 
people to be treated. It is not a panacea, it is not going to fix our 
drug problem, but it is going to increase access to these treatments I 
believe that all Americans want us to do for their sons and daughters 
who have fallen victim to the terrible sins of drug abuse.
  Mr. Speaker, I urge the passage of this bill. Again, to repeat, I 
want to thank the gentleman from Indiana for his tenacious push of this 
bill.
  Mr. DEAL of Georgia. Mr. Speaker, I reserve the balance of my time.
  Mr. BROWN of Ohio. Mr. Speaker, I yield 4 minutes to the gentleman 
from Maryland (Mr. Cummings).
  Mr. CUMMINGS. I thank the gentleman for yielding time.
  Mr. Speaker, I rise today in support of S. 45, which amends the 
Controlled Substances Act to lift the patient limitation on prescribing 
drug addiction treatments by medical practitioners in group practices. 
This bill is the companion legislation to H.R. 869, which I have 
cosponsored. On that subject, let me acknowledge the sponsorship of 
H.R. 869 by the distinguished gentleman from Indiana (Mr. Souder). As 
Chair and myself as ranking member of the House Government Reform 
Subcommittee on Criminal Justice, Drug Policy and Human Resources, we 
have worked tirelessly on the issue and are pleased to have it 
considered on the floor today.
  In 2000, Congress passed the Drug Addiction Treatment Act, otherwise 
known as DATA, to expand treatment options for patients addicted to 
opiates. To address concerns about potential abuse or diversion of the 
treatment medications, DATA limited the prescription of this drug to 30 
patients per physician. Unfortunately, DATA also contained language 
that imposed a 30-patient cap on group practices in addition to the 
limit per physician. This resulted in an unintended effect of limiting 
large group practices such as that of Johns Hopkins Medical Center in 
my district from meeting the high demand for drug treatment. However, 
S. 45 would eliminate this disparity by removing the 30-patient limit 
imposed on group practices, thereby expanding access to treatment for 
all patients regardless of where they receive their medical care.
  S. 45 is especially important for my district which includes 
Baltimore City. According to the latest data available, Baltimore has 
the third highest rate per 100,000 people of heroin-related addictions 
among the 21 metropolitan areas reporting this information. Further, 
Baltimore's heroin use ranked at 195, which is much higher than the 
national rate of 37. Heroin abuse counted for the most drug treatment 
admissions to publicly funded facilities in the city from July 1, 2001, 
through June 30, 2002. In addition, mortality data indicate that there 
were 349 heroin/morphine-related deaths in the Baltimore metropolitan 
area in 2001, more than for any other illicit drug.
  I must also note that heroin abuse via injection has contributed 
significantly to the number of HIV cases in the Baltimore area. S. 45 
would greatly reduce these numbers by increasing the availability of 
treatment medications such as buprenorphine or ``bupe'' in institutions 
such as teaching hospitals and community health clinics. Treatment 
medications such as buprenorphine will allow more people to remain 
productive while trying to overcome their drug addiction. Experts say 
that buprenorphine leaves patients more clearheaded than methadone and 
produces less intense withdrawal symptoms. They point out that in the 
brain, buprenorphine behaves like heroin but works more slowly and less 
efficiently than other opiates. In other words, this specific treatment 
reduces or eliminates withdrawal symptoms without producing euphoria.
  When we passed the law in 2000, our legislation limited bupe's 
availability because we wanted to avoid the creation of prescription-
writing mills. It is important to note that this bill will not open 
prescription-writing mills. Rather, it would expand access so that more 
physicians in large group practices would be able to prescribe the 
drug.
  I urge my colleagues to support S. 45. This is an important piece of 
legislation.
  Mr. BROWN of Ohio. Mr. Speaker, I yield back the balance of my time.

[[Page H6681]]

  Mr. DEAL of Georgia. Mr. Speaker, I would simply urge my colleagues 
to support this legislation.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Culberson). The question is on the 
motion offered by the gentleman from Georgia (Mr. Deal) that the House 
suspend the rules and pass the Senate bill, S. 45.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds of 
those present have voted in the affirmative.
  Mr. DEAL of Georgia. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

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