[Congressional Record Volume 159, Number 24 (Thursday, February 14, 2013)]
[Senate]
[Pages S779-S780]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER (for himself, Mr. Manchin, and Mrs. 
        Gillibrand):
  S. 348. 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 a piece of 
legislation that is desperately needed in West Virginia and across the 
country--the Prescription Drug Abuse Prevention and Treatment Act of 
2013. It is an important bill aimed at addressing 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. 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 one half, 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. 
Emergency department visits involving misuse or abuse of 
pharmaceuticals nearly doubled between 2004 and 2009, to more than 1.2 
million visits.
  This bill takes multiple steps to address these problems. First, with 
respect to the knowledge gap about safe pain management, the bill 
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. But, 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. 
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 transitioning 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 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 among 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

[[Page S780]]

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 roads from West Virginia to Florida are 
well-travelled by drug traffickers and people seeking pain medication. 
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.
  Fifth, this bill requires that quality standards be developed across 
the range of providers engaged in the prevention and treatment of 
prescription drug abuse. It is essential as we move ahead that quality 
always be front and center in our efforts. With lives at risk, this is, 
if anything, only more important in the areas of addiction prevention 
and treatment. Every effort to address this problem must be as 
effective as possible, and the development of quality standards 
required by this bill will make sure that each provider, regardless of 
his or her background or approach, can provide high caliber services to 
their patients.
  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. 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 
2013. 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 levels.
  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 for too many individuals, families, and communities in 
this country.
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