[Congressional Record Volume 161, Number 165 (Thursday, November 5, 2015)]
[Senate]
[Pages S7819-S7820]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KAINE (for himself and Mrs. Capito):
  S. 2256. A bill to establish programs for health care provider 
training in Federal health care and medical facilities, to establish 
Federal co-prescribing guidelines, to establish a grant program with 
respect to naloxone, and for other purposes; to the Committee on 
Health, Education, Labor, and Pensions.
  Mr. KAINE. Mr. President, I rise to discuss a bill I am introducing 
called the Co-prescribing Saves Lives Act.
  All across the Nation, and certainly all across my Commonwealth, we 
are seeing the scourge of prescription drug abuse and a heroin 
epidemic. These opioids are having major impact in communities 
everywhere in Virginia, from the coal mines of Appalachia to rural 
communities in the Shenandoah Valley, to right here in suburban Fairfax 
County.
  I have heard, as have my colleagues, stories from parents who have 
buried children, from companies that can't find employees who can pass 
drug tests, and certainly from law enforcement officials, including 
judges, prosecutors, police officials, and sheriffs, who talk about the 
dramatic expansion of opioid addiction in this country. The numbers are 
kind of shocking. When I came to the Senate and started doing tours 
around the State in the spring of 2013, I really wasn't schooled about 
this, and I started to hear stories.
  Heroin and opioids now account for 25,000 American deaths a year. In 
Virginia, and in much of the United

[[Page S7820]]

States, the deaths from opioid overdoses are now exceeding deaths from 
motor vehicle accidents. According to the Centers for Disease Control, 
in the United States fatal opioid-related drug overdose rates have 
quadrupled since 1990 and have never been higher than they are right 
now.
  The question is, How do we address this crisis? Obviously, the answer 
is there is no single answer. There are a lot of things that have to be 
done. The Federal Government, State and local communities, faith 
communities, nonprofit organizations, families, individuals educating 
themselves--there are a lot of answers, but we have to move forward 
with steps that we know can reduce overdose deaths.
  There is some good news. There are advances that can help us do this, 
and one of the advances has been the development of a drug called 
naloxone, which is a medicine that is safe and effective as an antidote 
to all opioid-related overdoses, including heroin, prescription 
opioids, and fentanyl. It is a critical tool--it has been proven to be 
a critical tool since its development in preventing fatal opioid 
overdoses.
  One of the neat things about naloxone is if you come across somebody 
who is in respiratory failure from an overdose or for some other 
reason, you can administer naloxone to that individual, and if it is 
not an overdose, it doesn't have any side effects. It can bring 
somebody back from the overdose-caused respiratory failure, but it 
doesn't have any negative side effects if it turns out the person is 
suffering from something else.
  In Virginia there is an organization called Project REVIVE! that 
trains people to administer naloxone. In one of our communities in 
Russell County in Southwest Virginia, about a year ago I took the 
training with a lot of family members and others--just 2 hours of 
training--to learn how to do this.
  Since naloxone has been developed and come into more common usage 
beginning in the late 1990s, it has saved more than 26,000 people who 
have been in the throes of an overdose. Naloxone has brought them back 
to life. I think a lot of professionals--public safety professionals 
and health care professionals around the country--have seen how 
effective it is.
  One answer to our overdose problem is to co-prescribe naloxone when 
someone is getting a prescription for an opioid. Opioids have 
legitimate uses, to manage pain. So when somebody is getting a 
prescription for that, co-prescribe naloxone so they have the antidote 
right there in case of an overdose.
  There are overdoses from people who are using drugs inappropriately 
and grabbing somebody else's prescriptions and using opioids, but there 
are also quite a few overdoses where people who are legitimately 
prescribed the drug--and they are usually prescribed it for pain--they 
develop a tolerance to the drug. The package may say to take one pill 
every 6 hours, but the pain is strong, and after 3 hours they start to 
feel it again and somebody thinks, OK, the drug has worn off now so I 
can take another one. So a person can start to take too many because of 
pain symptoms, and they get into an overdose situation for that reason 
too. If a person has a naloxone co-prescribed, they can have the 
antidote right there that they can administer themselves, or someone 
else can, if they get into an overdose situation.
  Many communities, States, national organizations, and medical 
organizations have supported co-prescribing naloxone to patients who 
are taking opioids as a critical part of this overdose problem, and we 
have guidelines. Not everybody who gets an opioid prescription needs 
naloxone. My wife broke and dislocated her shoulder two Good Fridays 
ago, and she was prescribed a powerful opioid pain killer. She used 
about a day and a half's worth of it. It made her sick to her stomach 
so she quit using it. Not everybody who gets prescribed a prescription 
opioid needs naloxone, but there are certain warning signs--the medical 
profession has developed the warning signs--and if you have the warning 
signs, you should get the co-prescription. Developing these guidelines 
helps physicians, pharmacists, and other providers determine who is at 
risk and whom we should be proactive with regarding a co-prescription.
  What this bill does is the following: It improves access to naloxone 
by encouraging physicians to co-prescribe in a couple of circumstances, 
to co-prescribe this lifesaving drug alongside opioid prescriptions and 
make it more widely available in Federal health settings.
  The Co-prescribing Saves Lives Act would require that the Secretaries 
of Health and Human Services, Defense, and Veterans Affairs would 
establish physician education co-prescribing guidelines for all Federal 
health centers, including VA hospitals, DOD hospitals, the Indian 
Health Service, and federally qualified health centers. So within 
Federal health care facilities, if there is going to be an opioid 
prescription to somebody in a high-risk situation, there would be a 
mandate that naloxone would be prescribed as well.
  This bill is based upon work that has already been done in the 
Federal Government. The VA especially has been a real leader in setting 
up these co-prescription guidelines. In addition, the bill would 
provide a program of grants through State departments of health that 
are interested in doing the co-prescribing guidelines for private 
physicians not in Federal settings in their States. The funding would 
allow States to purchase naloxone, to provide copay assistance for 
uninsured patients, and to fund training for health professionals and 
patients. Grant funding could also support State innovation and provide 
for community outreach. The kind of program where I trained last 
summer, Project REVIVE!, is just a community program trying to battle 
opioid overdose deaths in the coalfields of Appalachia. That would be 
the kind of program that if other States wanted to do that, could be 
eligible for grant funding.
  In closing, this is just one solution. Obviously, the real solutions, 
the important ones, are still around prevention. Why do Americans get 
prescribed so many more opioids than folks in other nations? What do we 
do about prescriptions when the quantities that are given are too big 
and then we end up with a lot of unused opioids that can be taken by 
young people or stolen and sold? There are a lot of issues we have to 
solve, but there is this bit of good news; that naloxone saves lives 
and it is easy to administer. It doesn't have a negative effect. If we 
can broaden access to naloxone for those who have been prescribed 
opioids--we have saved lives in the past and we are going to save a lot 
more.
  I will conclude by saying there is a dad in Northern Virginia--a guy 
by the name of Don Flattery--who has been very public about the loss of 
his son, Kevin, who was a 26-year-old graduate of UVA in 2014. He 
talked about his son, the family, the advantages they had, and his 
educational track record of success at UVA, but then he fell into the 
just bottomless pit of opioid prescription, opioid addiction, and he 
perished in 2014. What Don said is that ``I feel we need to keep 
personalizing what is happening. We are not addressing shocking, obtuse 
statistics--we are speaking about my son, your daughter, our neighbors 
. . . they are real people with real lives, and their losses are the 
face of the epidemic we must stop.''
  That is what this bill intends to play a part in.
                                 ______