[Congressional Record Volume 157, Number 34 (Tuesday, March 8, 2011)]
[Senate]
[Pages S1408-S1409]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER:
  S. 507. A bill to provide for increased Federal oversight of 
prescription opioid treatment and assistance to States in reducing 
opioid abuse, diversion, and deaths; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. ROCKEFELLER. Mr. President, I rise today to introduce an 
important piece of legislation, the Prescription Drug Abuse Prevention 
and Treatment Act of 2011--an important bill that is needed to address 
the rapid increase in deaths and overdoses from methadone and other 
opioid prescription drugs in the United States. These deaths have hit 
my home state of West Virginia particularly hard, but I know that every 
State is struggling with this serious problem.
  In the 111th Congress, Senator Corker and I, along with our 
colleague, the late Senator Kennedy, introduced the Methadone Treatment 
and Protection Act of 2009 a similar piece of legislation that stemmed 
from a disturbing rise in deaths due to methadone, a synthetic opioid 
prescription drug that had been increasingly used for pain management. 
Before 1990, it was used primarily to treat opioid addiction. Because 
of its high efficacy and low cost, methadone is frequently used for 
pain management. However, if not used correctly, methadone can be a 
powerful and deadly drug because it works differently than other 
painkillers. Methadone stays in a person's body for a longer period of 
time than the pain relief lasts so a person who does not know better 
might take far too much of the drug, possibly leading to respiratory 
distress, cardiac arrhythmia and even death.
  Methadone prescriptions for pain management grew from about 531,000 
in 1998 to about 4.1 million in 2006--nearly eightfold. During that 
time, poisoning deaths involving methadone increased nearly sevenfold, 
from almost 790 in 1999 to 5,420 in 2006. Deaths from other opioids 
have also skyrocketed in the last decade. And, these deaths may 
actually be underreported, because there is no comprehensive reporting 
system for opioid-related deaths in the United States.
  Overdoses from methadone are part of a larger disturbing trend of 
overdoses and deaths from prescription painkillers, or opioid drugs--a 
trend driven by a knowledge gap about how to treat serious pain in a 
safe and effective manner, by misperceptions about the safety of 
prescription drugs, and by the diversion of prescription drugs for 
illicit uses. In 2009, there were nearly 4.6 million drug-related 
emergency department, ED, visits of which nearly \1/2\, 45.1 percent, 
or 2.1 million, were attributed to prescription drug misuse or abuse, 
according to data from the Drug Abuse Warning Network, DAWN. And, 
emergency department visits involving misuse or abuse of 
pharmaceuticals nearly doubled between 2004 and 2009, to over 1.2 
million visits.
  This bill begins to address these problems. First, with respect to 
the knowledge gap about safe pain management, the bill for the first 
time includes a training requirement for health care professionals to 
be licensed to prescribe these powerful drugs. Currently, the 
Controlled Substances Act requires that every person who dispenses or 
who proposes to dispense controlled narcotics, including methadone, 
whether for pain management or opioid treatment, obtain a registration 
from the Drug Enforcement Administration, DEA. Unfortunately there is 
no requirement as a condition of receiving the registration that these 
practitioners receive any education on the use of these controlled 
narcotics, including methadone. Physicians struggle every day with 
determining who has a real need for pain treatment, and who is addicted 
or at risk. And yes, they struggle with our failure to provide adequate 
treatment facilities for those who are addicted. This bill will help 
physicians get the information they need to prescribe safely and better 
recognize the signs of addiction in their patients.
  Second, this bill addresses the knowledge gap among consumers--with a 
competitive grant program to states to distribute culturally sensitive 
educational materials about proper use of methadone and other opioids, 
and how to prevent opioid abuse, such as through safe disposal of 
prescription drugs. Preference will be given to states with a high 
incidence of overdoses and deaths.
  Third, this bill creates a Controlled Substances Clinical Standards 
Commission to establish patient education guidelines, appropriate and 
safe dosing standards for all forms of methadone and other opioids, 
benchmark guidelines for the reduction of methadone abuse, appropriate 
conversion factors for transition patients from one opioid to another, 
and guidelines for the initiation of methadone and other opioids for 
pain management. A standards commission will provide much-needed 
evidence-based information to improve guidance for the safe and 
effective use of these powerful and dangerous controlled substances.
  Fourth, this bill provides crucial support to state prescription drug 
monitoring programs. As of 2008, 38 states had enacted legislation 
requiring prescription drug monitoring programs

[[Page S1409]]

and many states were able to fund these initiatives in part from grants 
available through the Harold Rogers Prescription Drug Monitoring 
Program. A second program created in 2005 through the National All 
Schedules Prescription Electronic Reporting Act, NASPER, would provide 
even more assistance, and requires interoperability between states to 
reduce doctor shopping across state lines and diversion. Unfortunately, 
NASPER has only recently been funded with $2 million in the fiscal year 
2009 Omnibus legislation and $2 million in fiscal year 2010.
  Here is just one example of why NASPER funding matters: recently, the 
governor of Florida announced a budget that would not fund a planned 
prescription monitoring program in his state, due to state budget 
difficulties. This directly affects states in Appalachia because of the 
rampant drug trafficking between the two regions. In fact, the road 
from West Virginia to Florida is so well-travelled by drug traffickers 
and people seeking pain medication that it has been renamed the 
``OxyContin Highway,'' and flights from Huntington to Florida have been 
nicknamed ``the Oxy Express.'' It is crucial to finally give NASPER the 
funding it needs, and this legislation would do so, with $25 million a 
year to establish interoperable prescription drug monitoring programs 
within each state.
  Finally, this bill would help solve the data gap when it comes to 
opioid-related deaths. Right now there is no comprehensive national 
database of drug-related deaths in the United States, nor is there a 
standard form for medical examiners to fill out with regard to opioid-
related deaths. Since there is no comprehensive database of methadone-
related deaths, the number of deaths may actually be underreported. In 
order to truly reduce the number of methadone-related deaths, quality 
data must be collected and made available. This bill would create a 
National Opioid Death Registry to track all opioid-related deaths and 
related information, and establish a standard form for medical 
examiners to fill out which would include information for the National 
Opioid Death Registry.
  Today we have an opportunity to change the harrowing statistics and 
stem the rising tide of deaths from methadone and other opioids by 
supporting the Prescription Drug Abuse Prevention and Treatment Act of 
2011. This legislation provides a multifaceted approach to preventing 
tragic overdoses and deaths from methadone and other opioids. This is 
exactly what we need to improve the coordination of efforts and 
resources at the local, state, and federal level.
  I urge my colleagues to support this timely and important piece of 
legislation. In doing so, we will be on our way to saving lives and 
reducing the needless deaths that otherwise will continue to cause so 
much suffering among the people of this country.
                                 ______