[Congressional Record Volume 162, Number 32 (Monday, February 29, 2016)]
[Senate]
[Pages S1065-S1068]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               COMPREHENSIVE ADDICTION AND RECOVERY BILL

  Mrs. CAPITO. Madam President, as we are all sadly aware, the United 
States is experiencing an epidemic of drug overdose deaths. The 
statistics are just startling. Since 2000, the rate of deaths from drug 
overdoses has increased 137 percent, including a 200-percent increase 
in overdose deaths attributed to the use of opioids.
  West Virginia has the unfortunate distinction of leading the Nation 
in drug-related overdose deaths--more than twice the national average. 
As I travel across the State, I hear constantly about the devastation 
caused by this epidemic. West Virginia communities are grappling with 
the seriousness and pain of addiction. No family or community--mine 
included--is immune from this pain.
  As one of my constituents put it, ``We must give our young people a 
reason not to start using something that robs them of everything they 
have.''
  Other West Virginians have bravely shared their family's stories of 
addiction's pain with me. In the powerful words of one of my 
constituents, ``It only takes a few seconds to use drugs--but a 
lifetime to fight.''
  Drug addiction is a diseases that knows no boundaries, and West 
Virginia is certainly not alone in this fight. My colleagues in the 
Senate--including, I am sure, the Acting President pro tempore--return 
each week with similar stories. No matter our political party, we 
should all agree on one thing, we must act to change these horrifying 
statistics and to save lives.
  Some steps have already been taken to address this drug epidemic. The 
appropriations bill we passed last December included funding to expand 
prevention efforts. It included improved data collection and new 
treatment services, training for our servicemembers who

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are battling addiction, and training for the first responders who are 
responding to these drug overdoses.
  Today we hope to begin debate on the Comprehensive Addiction and 
Recovery Act. I thank my colleagues Senator Portman, Senator Ayotte, 
and Senator Whitehouse for their leadership on this important 
legislation.
  This bipartisan bill, known as CARA, addresses the opioid epidemic by 
expanding prevention and education. It also promotes the resources 
needed for treatment and recovery. It includes reforms to help law 
enforcement respond to the drug epidemic, and it supports long-term 
recovery efforts--which, as we see in my State of West Virginia, we 
don't have enough treatment options, particularly in the long-term 
recovery area.
  The legislation also expands the availability of naloxone, a 
lifesaving drug that helps to reverse the effects of an overdose, and 
we are also creating disposal sites for unwanted prescriptions.
  CARA provides resources for treatment alternatives to incarceration, 
such as the successful and expanding drug court programs that operate 
in West Virginia and many other States. We just had a graduation the 
other day with some great success stories included in that from the 
drug court. According to the Beckley Register Herald, counties with 
drug courts have already seen cost savings and deep declines of 
recidivism rates among graduates.
  CARA also provides a provision to improve treatment programs for 
pregnant women and mothers who have substance abuse disorder. Another 
startling statistic is the number of babies born with neonatal 
abstinence syndrome that has increased fivefold from the years 2000 to 
the year 2012.
  Last fall, I introduced the Improving Treatment for Pregnant and 
Postpartum Women Act, with Senators Ayotte, Whitehouse, and Klobuchar. 
The CARA act provides a provision that could play a critical role in 
preventing neonatal abstinence syndrome and getting treatment to 
pregnant women and new mothers.
  Also, last fall I worked with Senator Markey and others to help 
restore drug take-back days and keep medications out of the wrong 
hands. We all probably have some medication in our own medicine chests 
that are no longer necessary and that we don't need to have. It might 
have been for a family member. It is time to clean out those medicine 
chests. I participated in last year's program in Charleston, WV, and 
was pleased to see the overwhelming response. CARA focuses on the 
programs that work and will streamline efforts across multiple Federal 
agencies.
  In order to further address the needs of our communities, I am 
working on several bipartisan amendments on this bill. These amendments 
include solutions to improve prescribing practices and prevent 
overprescribing. Too many stories of addiction start with patients 
taking painkillers after a minor surgery or a minor injury.
  That is why I am pleased to be working with Senator Gillibrand on an 
effort that would require clear CDC guidelines for prescribing opioids 
for acute pain--a tooth extraction, maybe a broken arm, something that 
doesn't last forever, but the pain is acute in the beginning but fades 
rather quickly.
  I also am pleased to be working with Senator Warren on an amendment 
that allows doctors to partially fill certain opioid prescriptions. 
These will reduce the number of unused painkillers sitting in our 
medicine cabinets and help to prevent future cases of drug abuse and 
addiction.
  In order to reduce the number of overdose deaths, I am working with 
Senator Kaine to allow doctors to coprescribe the lifesaving drug 
naloxone when they prescribe an opioid. This would make naloxone more 
widely available in Federal health care settings, such as community 
health centers, VA clinics, and DOD facilities. I am also focused on 
tackling one of the saddest realities of this epidemic.

  In my State of West Virginia, babies born exposed to opioids during 
pregnancy are approximately three times the national average. Every 25 
minutes in this country a baby is born with addiction. Nationwide, this 
condition has increased fivefold from the years 2000 to 2012.
  This amendment will provide clear guidelines to encourage the 
creation of residential pediatric recovery centers, like the wonderful 
Lily's Place in Huntington, WV. I am pleased to be working with Senator 
King from Maine and Congressman Evan Jenkins from West Virginia on this 
effort.
  CARA represents a positive step forward in addressing the opioid 
crisis. The four amendments that I have outlined, I believe, will 
strengthen the bill. They would prevent addiction, promote recovery, 
and curb the scourge of drug addiction in my State and in others across 
this country. There is much work ahead for all of us in this area. The 
actions we are hopefully taking here this week in Washington are simply 
first steps.
  This bill builds on the tireless work being done at the State and 
local levels by communities, law enforcement, and health professionals 
all across this country. They are working together. By working 
together, we can change these statistics and stop more tragedies from 
occurring--stop the human tragedy of losing a loved one, of losing a 
mother or father.
  I urge my colleagues to begin debate on CARA this evening and to 
support this important legislation. I am concerned we are in jeopardy 
of losing the next generation. So we have much work to do.
  The ACTING PRESIDENT pro tempore. The Senator from Texas.
  Mr. CORNYN. Madam President, as we have heard from the Senator from 
West Virginia, this week the Senate will begin consideration of a 
bipartisan bill that targets an epidemic that is raging across the 
country, but apparently it is especially hard-hitting in places such as 
West Virginia, Ohio, Pennsylvania, and the like. But this abuse of 
prescription painkillers and heroin is not just isolated to those 
areas, even though the leaders of this particular legislation come from 
places such as Minnesota, Rhode Island, Ohio, and New Hampshire. Sadly, 
Texas has been no exception.
  The Centers for Disease Control and Prevention found that in Texas 
opioid-related drug deaths have increased by 30 percent since 2002. 
Houston is widely recognized by the DEA and law enforcement officials 
as a key hub for the trafficking of illicit prescription drugs. In 
South Texas, right next to the U.S.-Mexico border, the transnational 
criminal organizations are exploiting our porous border to import 
increasingly large amounts of hard narcotics like heroin, which 
ultimately wreaks havoc in towns and cities across America.
  In 2014 alone, drug cartels successfully smuggled more than 250,000 
pounds of heroin across our borders and into the United States at a 
street value of approximately $25 billion. These are the same criminals 
who traffic in human beings, including young girls and boys. These are 
the same people who traffic in illegal immigrants. These are the same 
people who traffic in illegal drugs. Indeed, this has become such big 
business and the network so large that these transnational criminal 
organizations are basically in on everything and anything that will 
make them money, including transporting these terrible drugs like 
heroin across the border.
  As we all know and have heard, this epidemic destroys families, it 
increases the crime rate, and it robs millions of Americans of their 
future. As I mentioned a moment ago, thousands are dying every year. 
That is why the bill we are voting on this afternoon, called the 
Comprehensive Addiction and Recovery Act, is so important. It will help 
give families and law enforcement additional resources to beat drug 
addiction through proven treatment programs. I am proud to cosponsor 
the legislation.
  The reason we have been able to move this bill forward so far--and it 
passed unanimously out of the Senate Judiciary Committee 2 weeks ago--
is because it reflects bipartisan input as well as bipartisan concern 
with this epidemic.
  As I mentioned earlier, I wish to particularly recognize the junior 
Senators from Rhode Island, New Hampshire, and Ohio--Senators 
Whitehouse, Portman, and Ayotte--for their laserlike focus on this 
legislation and making sure that it is at the top of our list of things 
we need to do this legislative session. By highlighting how bad the 
problem is in our country and providing legislation to address it, they

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are helping us attack this epidemic head-on.
  I must say that while so far this legislation has moved forward on a 
strong bipartisan basis, there are some signals on the horizon that 
indicate some potential trouble. At a press conference after the 
Judiciary Committee unanimously passed the bill, several of our friends 
on the other side of the aisle were explicit. They said that if the 
Senate did not add hundreds of millions of dollars in duplicative 
funding, they might withhold their support.
  This legislation is an authorization bill, and it does not 
appropriate funds. Our friends across the aisle know that if an 
appropriation is added to this legislation, particularly if it is 
duplicative, it causes a number of problems. First of all, a spending 
bill can't originate here in the Senate. So it raises a so-called blue-
slip problem. But perhaps just as importantly, this is not an orderly 
process by which we determine what is actually needed and to make sure 
that we are appropriating money in a fiscally responsible sort of way.
  I don't have to remind the Acting President pro tempore or anybody 
else who is listening that we have a $19 trillion debt in our country, 
and recklessly throwing money at a problem rather than carefully 
targeting it in a fiscally responsible way is simply irresponsible.
  It seems to be part of the message: Give us what we want or we might 
hijack a bipartisan bill that would literally save lives. I hope I am 
wrong, and I hope the signals on the horizon don't prove to ultimately 
be true. But it does seem like this is part of a new political 
strategy.
  Earlier this month, we know that our Democrat colleagues blocked a 
bipartisan Energy bill from moving forward on an unrelated issue--
something on which Senator Murkowski has shown the patience of Job, 
trying to work through this process so we can get back on the Energy 
bill rather than having it hijacked by an extraneous subject that could 
well and should well be handled in a different way, certainly 
separately.
  This is not the way the Senate gets anything accomplished. As I have 
said before, playing political games with important issues like 
fighting drug addiction is what lost our friends the majority in 2014. 
I urge the Democratic leadership to listen to those in their own caucus 
who have worked alongside Republicans in a responsible fashion to draft 
and put forward this bill that is so clearly needed in this country.
  This afternoon I hope we will move forward on the Comprehensive 
Addiction and Recovery Act. I hope we will consider it and consider 
amendments that are being offered in good faith on both sides to try to 
improve the legislation. But what we should not do is allow anyone to 
hijack this important legislation for partisan purposes. I think we 
should restrain ourselves from any impulse to do so. It happened, 
unfortunately, on the bipartisan Energy bill. It has been threatened on 
this legislation. But my hope is that cooler heads will prevail.
  I yield the floor.
  I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. MANCHIN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.
  Mr. MANCHIN. Madam President, I rise today to speak in support of the 
Comprehensive Addiction and Recovery Act of 2015, also known as the 
CARA Act. Our country is facing a prescription drug epidemic, and today 
is a good step toward addressing this crisis. This is a crisis I have 
been dealing with since my days as Governor of the great State of West 
Virginia.
  Opioid abuse is not only ravaging my State, it is ravaging the 
country. Drug overdose deaths have soared by more than 700 percent 
since 1999. We lost 600 West Virginians to opioids last year alone. But 
our State is not unique; every day in our country, 51 Americans die 
from opioid abuse, and since 1999 we have lost almost 200,000 Americans 
to prescription opioid abuse. Think about that. That is more people 
than we have in any city in the State of West Virginia.
  This bill is an important first step. First of all, it will authorize 
$77.9 million in grant funding for prevention and recovery efforts. It 
will expand prevention and educational efforts--particularly aimed at 
teens, parents and other caretakers, and aging populations--to prevent 
the abuse of opioids and heroin and to promote treatment and recovery. 
It will expand the availability of naloxone to law enforcement agencies 
and other first responders to help in the reversal of overdoses to save 
lives. It will expand disposable sites for unwanted prescription 
medications to keep them out of the hands of our children and 
adolescents. It will launch an evidence-based opioid and heroin 
treatment and intervention program to expand best practices throughout 
the country. It will also strengthen prescription drug monitoring 
programs to help States monitor and track prescription drug diversion.
  While this bill is a good start and addresses critical problems, 
there is more that needs to be done. I will be offering several 
amendments to improve the bill by changing the FDA's mission, providing 
grants for consumer education, and requiring prescriber training.
  I firmly believe we need cultural change at the FDA, and that is why 
I introduced Changing the Culture of the FDA Act. It simply does 
exactly what it says--it changes that culture. My amendment to CARA, 
based on the Changing the Culture of the FDA Act, would amend the FDA's 
mission statement to include language that will require the agency to 
take into account the public health impact of the Nation's opioid 
epidemic when approving and regulating opioid medications and will hold 
the agency responsible for addressing the opioid epidemic. It is hard 
to believe that right now as all of these new drugs are coming to the 
market and all of these pharmaceutical manufacturers are producing this 
new product, basically the mission statement has never taken into 
account the impact of the opioid epidemic on the public's health in 
this Nation. Now that we see it is truly an epidemic, we think this is 
a much needed change, and hopefully it will be approved.
  This builds on and solidifies the FDA's recently stated goal to 
fundamentally reexamine the risk-benefit calculations for opioids and 
ensures that the agency considers the wider public health effects. We 
need a change in the culture of the FDA, but we also need to make sure 
the advocacy groups that fight this battle every day are armed with the 
resources they need to stem this tide.
  I am also submitting an amendment that will establish consumer 
education grants through the Substance Abuse and Mental Health Services 
Administration to raise awareness about the risk of opioid addiction 
and overdose.
  This epidemic is one that needs to be fought on all fronts, but most 
importantly, we need to fight it on the frontlines with the 
prescribers, those people whom we trust to get the training they need. 
That is why I will also submit an amendment that will require that 
medical practitioners receive the needed training on the safe 
prescribing of opioids prior to renewing their DEA registration to 
prescribe controlled substances. If you talk to any of our medical 
physicians throughout the country, they get very little training as far 
as the effects of these drugs, and we think it is well past time that 
they get the needed education, as well as continuing education, so that 
we can keep ahead of the prescriptions they are putting on the markets 
and basically keep them from harming people every day.
  According to the National Institutes of Health, in 2012, more than 
250 million prescriptions were written in the United States for opioid 
painkillers. That equals one bottle of pain pills for every U.S. adult. 
Can you imagine one bottle of pain pills for every U.S. adult in this 
country? It is unbelievable. We are the most addictive Nation on Earth. 
Five percent of the population in the United States of America--there 
are 330 million of us and 700 billion humans on the planet Earth--
consumes 80 percent of the opioids in the world. It is just unheard of.
  Until we ensure that every prescriber has a strong understanding of 
safe opioid prescribing practices and the very great risk of opioid 
addiction, abuse, and overdose deaths, we will continue to see too many 
people prescribed too many of these dangerous

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drugs which can lead them down a tragic path, and that is why we need 
to educate people.
  There is one other subject I wanted to address, and I hope the FDA 
and this administration will look at it very seriously, and that is the 
professionals on advisory committees. When an opioid is coming to 
market, I believe and I believe a lot of Americans believe that this 
goes through a review process. These professionals basically are 
looking at this, and they make a recommendation as to whether this drug 
should be on the market, the need for this drug, and the effect this 
drug will have on people's lives. If they rule against this drug--and 
let's say they have an 11-to-2 ruling, such as Zohydro did--then the 
request for that drug to come to market should have to come before 
Congress. The FDA--the director and the staff--needs to basically come 
and explain to Congress why this potent drug needs to come on the 
market when basically their advisory committee and those people who are 
the professionals basically agree not to let it come to market.
  This is a conversation that has to be had. We have to make sure we 
understand why we are putting all of these products on the market and 
the effect they are going to have on the public. That is another topic 
we hope to address also as this bill comes to the floor.
  The bottom line is that I am pleased the Senate is working in a 
bipartisan manner. This is how we need to work to solve the major 
challenges our country faces. By working in a bipartisan way, we will 
have, as I understand, an open amendment process which is so needed and 
critical to move this legislation through. I appreciate that.
  I believe my amendments will strengthen this bill, but I also believe 
more needs to be done. We must provide the critical resources needed to 
stem this tide. I look forward to working with my colleagues to 
strengthen this bill and to begin to address this crisis head-on.
  This country has faced every crisis we have ever had, and we have 
overcome it. This is one we haven't attempted. For some reason, it is a 
silent killer--out of sight, out of mind. It will take all of us being 
Americans and basically using our faith that we have that we can fix 
these problems, to save Democrats, save Republicans, save Independents, 
and save everybody. This cannot be a partisan issue because I can tell 
my colleagues that opiates and the addiction of opiates have no 
partisan home. It is truly bipartisan. It attacks us all.
  I appreciate my colleagues, and I look forward to working with them 
to work through this important piece of legislation.
  I yield the floor.
  I suggest the absence of a quorum.
  The ACTING PRESIDENT pro tempore. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BROWN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The ACTING PRESIDENT pro tempore. Without objection, it is so 
ordered.

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