[Congressional Record Volume 162, Number 29 (Wednesday, February 24, 2016)]
[Senate]
[Pages S970-S971]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                        Prescription Drug Abuse

  Mr. BARRASSO. Mr. President, I come to the floor today to talk about 
a drug abuse problem that is literally hurting millions of Americans. 
There has been a dramatic rise in the use and misuse of prescription 
painkillers. These prescription painkillers--and I tell you this as a 
doctor--are known as opioids.
  Between 1999 and 2013, sales of prescription painkillers in the 
United States have quadrupled. It is no coincidence that over that same 
number of years overdose deaths from these drugs have also quadrupled. 
This is how we know there has been a huge shift from the appropriate 
use to abuse of these medications. People in rural areas like my own 
are almost twice as likely to overdose on prescription painkillers as 
people in large cities. Some people think these problems are only a 
problem in the big cities. That is not the case with these opioids.
  I can tell you as a doctor who practiced medicine in Casper, WY, for 
25 years, treating pain in our patients is one of the most difficult 
things we do. When we have a patient who is in pain, we want to help 
relieve that pain. Opioids are a very effective way to help patients 
with pain, and doctors use these medications through prescriptions to 
help manage the pain. It is important that we have the capacity to do 
that as long as it is done appropriately. This can be a very good 
option for someone suffering from chronic pain, such as pain from 
cancer. It can be appropriate for someone who is suffering from acute, 
temporary pain, such as someone who just had surgery.
  The problem is that these are extremely powerful narcotics. 
Chemically, they are not that different from heroin, and they can 
become addictive. Some patients have no problem at all taking these 
painkillers for the proper amount of time, while other patients might 
develop a problem and actually have trouble getting off the pain pills. 
As they get accustomed to the drugs, sometimes they may seek out 
stronger and more addictive drugs to get the same pain relief. That is 
why doctors have to be very careful about prescribing the right 
medicine for each patient and each situation. They have to balance the 
risk of the drug with the reward of easing the patient's pain.
  Not every doctor in this country has been as careful as they should 
be. We didn't get into this difficult situation because of a handful of 
doctors writing too many prescriptions. These prescriptions are being 
written by doctors in communities all across the country. It is 
happening in emergency rooms, with family doctors, with specialists, 
and even with dentists.
  I believe Washington policies have inadvertently contributed to the 
problem. The Centers for Medicare and Medicaid have made payments to 
hospitals partly based on how well the specific hospital has scored on 
surveys filled out by the patients--the patients who have been in those 
hospitals. Here are some examples of questions that are asked on these 
surveys: During this hospital stay, how often was your pain well 
controlled? Some patients are asked that. They are also asked: How 
often did the hospital staff do everything they could to help you with 
your pain?
  Well, you can see how doctors might feel pressure to prescribe more 
and stronger opioid pain relievers to make sure their hospital doesn't 
get low scores and get penalized by the bureaucrats here in Washington. 
The Department of Health and Human Services is looking into whether 
these surveys are contributing to this rise in prescriptions and what 
can be done about it.
  Earlier this month I was 1 of 26 Senators, Republicans and Democrats 
alike, who wrote to the Secretary of Health and Human Services to make 
sure she keeps us apprised on the effects these regulations might be 
having. If these pain relievers are being prescribed inappropriately, 
they can do more harm than good. That's the problem. Some of these 
people who get these prescriptions for all the right reasons end up 
being addicted. When the prescription runs out, they may actually 
experience withdrawal symptoms, and I have seen it happen.
  So what do the people who become addicted to these opioids do? Well, 
they seek pills on the black market or they turn to other drugs, 
including heroin. Heroin is often cheaper than the actual prescription 
opioid and, of course, more deadly.
  From 2002 to 2013, heroin use in the United States has nearly 
doubled. The deaths from heroin overdoses have quadrupled. Why? One of 
the reasons

[[Page S971]]

seems to be that because heroin has become much cheaper on the street, 
it has also become a more attractive drug for addicts to buy and use. 
At the same time, the heroin today is believed to be much more powerful 
than it used to be, and so it may be that people who use it are much 
more likely to overdose.
  When we see statistics like these--or just talk to people, such as 
those who work in the emergency room, who have to deal with the drug 
addictions, 911 calls, opioid abuse, heroin abuse, and see all these 
problems--it is time for Congress to act. We can't turn a blind eye to 
Americans who are suffering and dying. That is why I think it is 
important that the Senate needs to take up action to help stop the 
damage being done.
  Recently the Senate Judiciary Committee passed the Comprehensive 
Addiction and Recovery Act. It has bipartisan support, and it is one 
more sign that the Senate has gotten back to work on behalf of the 
American people. Just as the name of the legislation says, it actually 
addresses both problems--addiction and recovery. It will increase 
education and prevention efforts to help keep people from becoming 
addicted to painkillers in the first place. It is also going to 
strengthen State programs to monitor prescription drugs and to track 
when these drugs end up in the wrong hands.
  For the people who have already passed from use of the medications to 
abuse and addiction, this legislation will help to launch treatment 
programs that are based on actual evidence of what works. There are a 
lot of treatment programs out there and lots of different opportunities 
to seek treatment. We want to make sure we can identify the ones that 
are actually succeeding and helping people and then make sure these 
programs are available to more people. These are just a few of the 
positive ideas in the legislation.
  Senator Kelly Ayotte, who is one of the main sponsors of this 
legislation, has said that we can't arrest our way out of this problem. 
She is exactly right. The misuse and abuse of these drugs is illegal. 
We must acknowledge that fact. We must still try to do everything in 
our power to keep this misuse from turning into addiction and even 
death. There are States and communities and families suffering because 
of the abuse of these drugs. We can all be part of the solution, and we 
must all be part of the solution.
  I know that the Committee on Health, Education, Labor, and Pensions 
is looking into another aspect of this subject, as is the Finance 
Committee. There are lots of ideas out there, and I am glad to see 
Members taking the issue so seriously. I am glad we are moving forward 
with bipartisan legislations and solutions.
  Senator Ayotte has been a major force in talking about this problem. 
Senators Whitehouse, Kirk, Portman, and others have addressed this 
issue.
  Another good, commonsense idea is looking into changing Medicare Part 
D and Medicare Advantage. This legislation has been introduced by 
Senator Pat Toomey of Pennsylvania. I am a cosponsor of that 
legislation. The bill is called the Stopping Medication Abuse and 
Protecting Seniors Act. That is it: Stopping Medication Abuse and 
Protecting Seniors. It allows Part D and Medicare Advantage plans to 
lock in patients to a single prescriber, a single pharmacy, for their 
opioid pain medicine. This is going to do a couple of things. It will 
deal with the issue of doctor shopping. That is when a patient goes to 
multiple providers to get duplicate prescriptions if they become 
addicted. Many private insurance companies already do this and so does 
Medicaid. So we should allow and encourage Medicare to do it as well.
  These are all ideas with bipartisan support in the Senate. They are 
examples of ways that Democrats and Republicans are working together to 
help Americans who need and deserve help. The abuse of prescription 
drugs and heroin is happening everywhere in America. It is harming our 
Nation. Congress must do what it can to stop it.
  I thank the Presiding Officer and yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Ms. HIRONO. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.