[Congressional Record Volume 162, Number 32 (Monday, February 29, 2016)]
[Senate]
[Pages S1074-S1080]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
COMPREHENSIVE ADDICTION AND RECOVERY ACT OF 2015--MOTION TO PROCEED
The PRESIDING OFFICER. Under the previous order, the Senate will
resume consideration of the motion to proceed to S. 524, which the
clerk will report.
The bill clerk read as follows:
Motion to proceed to Calendar No. 369, S. 524, a bill to
authorize the Attorney General to award grants to address the
national epidemics of prescription opioid abuse and heroin
use.
The PRESIDING OFFICER. Under the previous order, the time until 5:30
p.m. will be equally divided between the two managers or their
designees.
The Senator from Vermont.
Filling the Supreme Court Vacancy
Mr. LEAHY. Mr. President, I appreciate the comments of the senior
Senator from Delaware. We have plenty of time to get a nomination to
the Supreme Court from the President and to confirm a Justice, just as
this body has done 12 times in Presidential election years. I think
probably the most recent, of course, was when Democrats controlled the
Senate and we confirmed unanimously President Reagan's nomination in an
election year, his final year in office. So it can easily be done.
Besides, let us just do our job. We get paid to be here and to do our
job. We ought to do it.
We also have the matter that each one of us has taken a very solemn
oath before God to uphold the Constitution. The Constitution says the
President shall nominate and the Senate shall advise and consent. We
ought to do just what we all have solemnly sworn to do. I take my oath
very seriously. I hope other Senators do too.
Now, Mr. President, today the full Senate is going to begin a
discussion about one of the most challenging public health crises of
our time--addiction to prescription painkillers and other opioids. In
my home State of Vermont, there are few issues more pressing than
opioid addiction. It is tearing apart families and communities--
families and communities I have known all my life.
In March 2008, nearly 8 years ago, when I was chairman of the
Judiciary Committee, I first held a hearing in Rutland, VT, about the
challenges this epidemic presents in rural parts of our country. In
subsequent field hearings, we learned about how communities like
Rutland, VT--a beautiful community--were constructively seeking ways to
get ahead of addiction. But we also learned--and I think we knew
[[Page S1075]]
this--that there are no easy answers, and we need a comprehensive
approach. Education, prevention, and treatment are essential if we are
to reverse the tide in this fight.
Vermont's all-hands-on-deck example serves as a model for other
States and communities across the Nation. In fact, just last week an
article in the Christian Science Monitor detailed how Vermont's
pioneering approach has been embraced well beyond Vermont's borders.
So, Mr. President, I ask unanimous consent that the Christian Science
Monitor article entitled ``How one state turned its `heroin crisis'
into a national lesson'' be printed in the Record at the conclusion of
my remarks.
Opioid addiction is not a new issue. It is not new to me, and it is
not new to Vermont. But it is about time that the full Congress gave
this public health crisis the attention it deserves. The bill we begin
to consider today, the Comprehensive Addiction and Recovery Act, or
CARA, represents a positive step forward, and I am proud to be a
cosponsor of it.
For decades, the knee-jerk response in Congress to those who
struggled with addiction was misguided. We embraced harsh and arbitrary
mandatory minimums, we ignored effective treatment options, and we
pushed addicts further underground and away from recovery. Such
policies reflect a complete misunderstanding of the problem of
addiction.
At my hearings and everywhere I went, we saw police officers, faith
communities, educators, medical professionals, parents, and addicts
coming together, saying that no one group had the answer but the
community had to come together. Because we know addiction is a disease,
we know our tools for combating addiction must be the same as other
disease--a commitment to evidence-based education and proven techniques
for prevention, treatment, and recovery programs.
As one who has served in law enforcement, I know that law enforcement
is an important element in a comprehensive approach. That is why I
worked to include in this bill an authorization for funding to expand
State-led anti-heroin task forces. But this legislation is important
because it treats addiction as the public health crisis that it is. The
bill authorizes a crucial program that I helped create that expands
access to medication-assisted treatment programs--programs that have
been plagued by massive waiting lists. The clinic in Chittenden County,
VT--that is the largest of our 14 counties--has seen its wait list
lengthened to nearly a year. What happens when that wait list is long?
Several people have overdosed and died while waiting for treatment.
Those deaths were probably preventable. We shouldn't die waiting for
treatment. We have to do better.
The bill also recognizes the devastating impact that opioid abuse has
on rural communities. Just as in your State and every other State, we
have rural communities. Vermont is predominantly rural communities. My
home where my wife and I have lived since we got married is on a dirt
road. We know rural America. We know it has been hit hard by addiction.
Emergency medical services in rural communities are often limited. I am
glad that the bill we reported out of committee includes my provision
to support our rural communities for the overdose reversal drug
naloxone.
Over the last decade, death rates from opioid overdoses have steadily
climbed across the country. But there is a real disparity between rural
communities and major cities. We found the more rural a location, the
higher the death rate. Getting lifesaving drugs into more hands will
save lives across the country, especially in our rural communities that
are among the hardest hit.
This is not a partisan issue. I thank Senator Whitehouse and Senator
Grassley for working with me on this legislation in our Judiciary
Committee. I hope we will soon see its passage here in the Senate. But
one authorization bill by itself is not going to end addiction. It is
not going to end the deaths that we are seeing in rural America and in
urban America.
We need a significant commitment of targeted funding to implement
this bill. Senator Shaheen's $600 million emergency supplemental
appropriations bill provides those resources, and I am proud to be a
cosponsor of that legislation, as well.
In your State, my State, and the other 48 States right now, we passed
larger emergency supplemental bills that addressed swine flu and Ebola.
We do not have Ebola in our country, but we passed an emergency
supplemental bill to address that. We need to address what we have
right here within our country today. Swine flu and Ebola presented far,
far fewer dramatic health risks to our communities. We need to take
this challenge just as seriously.
The bill we are considering today has received strong bipartisan
support and deservedly so. But I hope all the Senators supporting CARA
today will also support Senator Shaheen's legislation. One goes hand in
hand with the other. We need to authorize these advances in dealing
with the opioid crisis, but then we actually need to fund them.
We cannot pretend that solving a problem as large as opioid addiction
costs nothing. We have an opportunity to equip our communities with the
support and resources they need to finally get ahead of addiction.
Programs will save lives. That is a worthy investment.
It is very easy to say we will pass a law to stop opioid addiction.
We can all feel good about voting for that. Who is going to vote for
legislation to say ``let us continue opioid addiction''? But if we do
not put the money in it, then, basically, we are saying we want to feel
good but we are not going to do anything for you.
We spend money worldwide. Some of it is for good causes, and some of
it is totally wasted. Here we have a problem in the United States of
America, where our priorities are first and foremost to our country. If
you saw some of the people I heard in these hearings all over our
beautiful State, some of the families with whom I have talked across
their kitchen tables, and a young woman who had been addicted and is
now helping to counsel others and the story she told, or if you saw a
movie or TV program, you would say it couldn't be that grim. Well, it
was. It is.
These people go across all income brackets, all brackets of
education. It is tearing apart parts of our communities across the
country. Fortunately, we have had some very brave people stand up. I
hope Senator Shaheen's appropriation goes through because, if it does
not, we are saying all the right things, as we should, except for one
thing: We are not going to pay for it. This is too important to say the
check is in the mail; just wait and wait. We can do better. We can do
better.
There being no objection, the material was ordered to be printed in
the Record, as follows:
[From The Christian Science Monitor, Feb. 23, 2016]
How One State Turned Its `Heroin Crisis' Into a National Lesson
(By Gail Russell Chaddock)
Paths to Progress: Vermont's pioneering focus on treatment
amid an opioid crisis is being embraced by politicians of
both parties--well beyond the state.
America's opioid addiction crisis, now claiming 78 lives a
day, is sweeping aside party lines both at the state level
and even in famously gridlocked Washington.
The nation's governors, from deep-red Alabama to bluest-of-
the-blue Vermont, are moving rapidly to a strategy of
treating illegal drug users rather than jailing them.
It's a shift that runs deep in public opinion, as well.
Some two-thirds of Americans now typically say that they
prefer providing treatment to long prison sentences.
``This is an area where I can get agreement from Bernie
Sanders and Mitch McConnell,'' President Obama said at a
White House meeting with governors on Monday. ``That doesn't
happen that often, but this is one. And it indicates the
severity of the issue.''
But the governors are, in fact, well ahead of Washington on
this issue--as they were on welfare reform in the 1990s and,
more recently, sentencing reform.
Gov. Peter Shumlin (D) of Vermont, a leader in the pivot
from prisons to treatment, says he got into the addiction
fight after talking to people in his state.
``I found we were doing almost everything wrong,'' he told
a forum on opioid and heroin addiction at The Pew Charitable
Trusts in Washington on Friday.
The best hope is to get more people into treatment, he
said. And the best time to do that is ``when the blue lights
are flashing and the handcuffs are on.''
Vermont, like other states in the Northeast, is facing
severe opioid challenges. In 2014, Governor Shumlin devoted
his annual State of the State address entirely to
[[Page S1076]]
Vermont's ``full-blown heroin crisis.'' Annual overdose
deaths from opioids had nearly doubled since 2004. The number
of people seeking treatment for opioid addiction had spiked
770 percent since 2000.
what vermont has done
And so Vermont has taken a hard look at its approach.
Instead of jail, nonviolent offenders are given the option of
going into treatment. They start in one of the state's new
central clinics (hubs) and move on to a family doctor,
counselor, or therapist closer to home (spokes).
Vermont law also shields people seeking medical help for an
overdose from prosecution for manufacturing or selling drugs,
not just for minor crimes. It also was the first state to
legalize the sale of naloxone over the counter in
pharmacies--a drug aimed at reversing overdoses and saving
lives.
Other states have moved toward treatment instead of
incarceration, but Vermont has done it on a grander scale,
experts say.
``You've seen some elected officials support legalizing
marijuana, some want to reform sentencing, some talk about
overdoses, but very few have tied all these together in a
comprehensive narrative,'' says Bill Piper, senior director
of national affairs for the Drug Policy Alliance in
Washington.
``Vermont's governor is at the forefront, and what makes
him unique is that he's one of the few elected officials that
has connected the dots on the various issues,'' he adds.
As a pioneer state, Vermont has also identified some of the
limits of a treatment-centric strategy.
``As you build out treatment, and particularly in rural
America, we can't get enough docs who are able to meet the
demand of our waiting lists,'' Shumlin told the president at
the White House meeting Monday.
But the most important issue, he told Mr. Obama, is to
``come up with a more rational approach to prescribing
prescription drugs.''
a bid to rein in prescriptions
Governors see legal prescriptions for drugs like OxyContin
as the gateway to heroin. ``Overprescribing of opioid
painkillers has fueled the nation's addiction crisis,''
according to a report from the National Governors
Association's Health and Human Services Committee. In a bid
to rein in prescriptions, governors on that committee plan to
develop a list of protocols to present to the full membership
at the next NGA meeting in August.
``The United States represents 5 percent of the world's
population and consumes 80 percent of the world's opioids,''
said Gov. Charlie Baker (R) of Massachusetts, who chairs the
NGA's Health and Human Services Committee, on Saturday.
That's ``fundamentally flawed.''
When prescriptions are too hard to get--or too expensive--
addicts switch to heroin. ``Most of the heroin addicts we
treat started by using prescription opiates,'' says Brian
McAlister, author of ``Full Recovery'' and CEO of the Full
Recovery Wellness Center in Fairfield, N.J.
``Some were prescribed by a doctor or dentist, others were
stolen from family or friends' medicine cabinets, and others
were purchased illegally just to party--but the party ends
very quickly. These drugs are highly addictive, and when the
supply runs out, the problems get worse.''
at the national level
The prospect of politicians reining in pharmaceutical sales
is a stretch in the halls of Congress. In 1993, the GOP-
controlled Congress explicitly barred government from
negotiating lower drug prices with drug companies. Last year,
Big Pharma spent more than $235 million to influence policy
outcomes in Washington--the largest budget of any lobby group
in Washington.
Governors could set protocols on prescribing practices for
painkillers on their own, Shumlin told the president. ``But
it takes time,'' and ``it doesn't apply to all 50 states.''
Instead, he asked Obama to ``consider a national approach
which simply says, for minor procedures, we're going to limit
this to 10 pills and after that you've got to come back for
more.''
``To be candid, the docs, the AMA [American Medical
Association] are resistant to listening to politicians like
us talking about how many pills to prescribe. But is there
something you could do on a national level that would help us
get out of this tragic mess?'' he added. Obama answered, at
length, but in the end deferred to the states. ``A very
specific approach to working with the docs, the hospitals,
the providers so that they are not overprescribing'' can be
done at the national level, he said. ``But it is most
profitably done, I think, if we have bipartisan support from
the governors so that by the time it gets to the national
level, there is consensus and there's not a lot of politics
involved in it.''
In a recent blog, AMA president Steven Stack called the
opioid epidemic a ``defining moment'' for the profession.
``Our nation is needlessly losing thousands of people to a
preventable epidemic, and we must take action for our
patients.''
Mr. LEAHY. I see nobody else seeking recognition, so I suggest the
absence of a quorum, and I ask the time be equally divided.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. JOHNSON. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Cloture Motion
The PRESIDING OFFICER. Pursuant to rule XXII, the Chair lays before
the Senate the pending cloture motion, which the clerk will state.
The legislative clerk read as follows:
Cloture Motion
We, the undersigned Senators, in accordance with the
provisions of rule XXII of the Standing Rules of the Senate,
do hereby move to bring to a close debate on the motion to
proceed to Calendar No. 369, S. 524, a bill to authorize the
Attorney General to award grants to address the national
epidemics of prescription opioid abuse and heroin use.
Mitch McConnell, Daniel Coats, Dan Sullivan, Orrin G.
Hatch, Shelley Moore Capito, John Cornyn, Lindsey
Graham, Roy Blunt, Ron Johnson, Chuck Grassley, Rob
Portman, Susan M. Collins, Jeff Flake, Cory Gardner,
Lamar Alexander, John Barrasso, John McCain.
The PRESIDING OFFICER. By unanimous consent, the mandatory quorum
call has been waived.
The question is, Is it the sense of the Senate that debate on the
motion to proceed to S. 524, a bill to authorize the Attorney General
to award grants to address the national epidemics of prescription
opioid abuse and heroin use, shall be brought to a close?
The yeas and nays are mandatory under the rule.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. CORNYN. The following Senators are necessarily absent: the
Senator from Tennessee (Mr. Alexander), the Senator from Missouri (Mr.
Blunt), the Senator from Arkansas (Mr. Boozman), the Senator from Texas
(Mr. Cruz), the Senator from Florida (Mr. Rubio), the Senator from
Alabama (Mr. Shelby), the Senator from Alaska (Mr. Sullivan), the
Senator from Pennsylvania (Mr. Toomey), and the Senator from Louisiana
(Mr. Vitter).
Further, if present and voting, the Senator from Tennessee (Mr.
Alexander) would have voted ``yea'', the Senator from Alaska (Mr.
Sullivan) would have voted ``yea'', and the Senator from Pennsylvania
(Mr. Toomey) would have voted ``yea.''
Mr. DURBIN. I announce that the Senator from Missouri (Mrs.
McCaskill) and the Senator from Vermont (Mr. Sanders) are necessarily
absent.
The PRESIDING OFFICER (Mr. Lankford). Are there any other Senators in
the Chamber desiring to vote?
The yeas and nays resulted--yeas 89, nays 0, as follows:
[Rollcall Vote No. 27 Leg.]
YEAS--89
Ayotte
Baldwin
Barrasso
Bennet
Blumenthal
Booker
Boxer
Brown
Burr
Cantwell
Capito
Cardin
Carper
Casey
Cassidy
Coats
Cochran
Collins
Coons
Corker
Cornyn
Cotton
Crapo
Daines
Donnelly
Durbin
Enzi
Ernst
Feinstein
Fischer
Flake
Franken
Gardner
Gillibrand
Graham
Grassley
Hatch
Heinrich
Heitkamp
Heller
Hirono
Hoeven
Inhofe
Isakson
Johnson
Kaine
King
Kirk
Klobuchar
Lankford
Leahy
Lee
Manchin
Markey
McCain
McConnell
Menendez
Merkley
Mikulski
Moran
Murkowski
Murphy
Murray
Nelson
Paul
Perdue
Peters
Portman
Reed
Reid
Risch
Roberts
Rounds
Sasse
Schatz
Schumer
Scott
Sessions
Shaheen
Stabenow
Tester
Thune
Tillis
Udall
Warner
Warren
Whitehouse
Wicker
Wyden
NOT VOTING--11
Alexander
Blunt
Boozman
Cruz
McCaskill
Rubio
Sanders
Shelby
Sullivan
Toomey
Vitter
The PRESIDING OFFICER. On this vote, the yeas are 89, the nays are 0.
Three-fifths of the Senators duly chosen and sworn having voted in
the affirmative, the motion is agreed to.
The Senator from Iowa.
Mr. GRASSLEY. Mr. President, an historic epidemic of drug overdose
deaths is gripping our country. Over 47,000 Americans died from
overdoses in 2014, an alltime high. Incredibly, that is more deaths
than resulted from either car crashes or gun violence.
Addiction to opioids, primarily prescription pain killers and heroin,
is driving this epidemic. It is destroying lives, families, and
communities. It is a crisis. And it demands action.
[[Page S1077]]
Thankfully, the Senate can act this week, when we consider S. 524,
the Comprehensive Addiction and Recovery Act, or CARA.
CARA is a bipartisan bill authored by two Democrats and two
Republicans--Senators Whitehouse, Portman, Klobuchar, and Ayotte.
These Senators have shown extraordinary leadership on this issue.
They deserve credit for crafting a bill that addresses many of the
different aspects of this epidemic, through evidence-based solutions
and best practices. This is a complex crisis that requires a
multifaceted solution.
Over the past few months, I have worked hard with the bill's authors
to refine it and move it through the Judiciary Committee. I am proud to
say that a few weeks ago it passed the committee on a voice vote, with
no opposition.
CARA is only the latest bipartisan legislative accomplishment by the
Judiciary Committee this Congress. We have had 21 bills pass the
Committee this Congress, all with bipartisan support. But there are a
few major bills that stand out.
Last April, the committee passed the Justice for Victims of
Trafficking Act unanimously, 19-0. The bill enhances penalties for
human trafficking and equips law enforcement with new tools to target
predators who traffic innocent young people. The bill passed the Senate
99-0 and was signed into law by the President.
In October, the committee passed the landmark Sentencing Reform and
Corrections Act with a strong 15-5 bipartisan vote. My bill would
recalibrate prison sentences for certain drug offenders, target violent
criminals, and grant judges greater discretion at sentencing for lower-
level drug crimes. I am working hard to build additional support for
the bill so that it can be taken up by the full Senate soon.
Then in December, the committee passed my Juvenile Justice and
Delinquency Prevention Reauthorization Act, again without opposition.
The bill will ensure that at-risk youth are fairly and effectively
served by juvenile justice grant programs. Again, we are working hard
to move this bill through the full Senate.
The bipartisan reforms enacted by each of these bills address real
problems that affect the lives of many people across the nation and in
my home state of Iowa. I am proud of the work we have done so far--but
there is a lot more to do.
And that brings me back to the heroin and prescription drug epidemic.
It isn't as bad in Iowa as it is in many areas of the country, but the
eastern part of my State has been hit hard recently.
The human cost of what is happening across so many of these
communities is incalculable. Every life that is lost or changed forever
by this epidemic is precious. Especially for many young people who fall
victim to addiction early in their lives, there is so much human
potential at stake.
Many Iowans have heard the story of Kim Brown, a nurse from
Davenport, and her son Andy. Andy was prescribed pain pills when he had
surgery at age 14. Whether it was connected to abuse of those pain
pills or not, he developed a drug problem as a teenager that he
couldn't shake. He overdosed on heroin a few times but survived. And
finally, at age 33, he died of an overdose, tragically leaving behind
two young sons. Ms. Brown now speaks out around the State about the
heroin epidemic.
Her story reflects a larger pattern. Over the last 20 years or so,
doctors have increasingly prescribed opioids to help their patients
manage pain. For many, these medicines have been the answer to their
prayers. But for others, they have led to a nightmare of addiction.
According to numerous studies, prescription opioid addiction is a
strong risk factor for heroin addiction. In some cases, those addicted
to painkillers turn to heroin to get a similar high, because recently,
it has become cheaper and more easily available.
And as Ms. Brown's story reflects, this epidemic is a matter of life
and death. In fact, nationally, heroin overdose deaths more than
tripled from 2010 to 2014.
But Iowans are fighting back. Last year, with the assistance of a new
Federal grant, the U.S. Attorney's office and the Cedar Rapids Police
Department formed the Eastern Iowa Heroin Initiative.
This partnership is focused on stemming the tide of heroin abuse
through enforcement, prevention and treatment. I have been invited to
participate in a townhall with them to discuss the epidemic, and I plan
to do so soon.
When I do, I want to tell them that the Senate has acted on this
crisis by passing CARA. CARA supports so many of the efforts to help
stem the tide of addiction that are underway in Iowa and across the
country.
As its name reflects, the bill addresses the epidemic
comprehensively, supporting prevention, education, treatment, recovery,
and law enforcement.
CARA starts with prevention and education. It authorizes awareness
and education campaigns, so that the public understands the dangers of
becoming addicted to prescription painkillers.
It creates a national task force to develop best prescribing
practices, so that doctors don't expose their patients to unnecessary
risks of addiction.
The bill encourages the use of prescription drug monitoring programs
like Iowa's, which helps detect and deter ``doctor shopping'' behavior
by addicts.
And the bill authorizes an expansion of the Federal initiative that
allows patients to safely dispose of old or unused medications, so that
these drugs don't fall into the hands of young people, potentially
leading to addiction.
In fact, along with a few other committee members, I helped start
this ``take back'' program in 2010 through the Secure and Responsible
Drug Disposal Act. It has been a highly successful effort. Since 2010,
over 2,700 tons of drugs have been collected from medicine cabinets and
disposed of safely. Iowa also has a similar ``take back'' program
that's expanding rapidly.
CARA also focuses on treatment and recovery. The bill authorizes
programs to provide first responders with training to use Naloxone, a
drug that can reverse the effects of an opioid overdose and directly
save lives. Naloxone was used hundreds of times by first responders in
Iowa in 2014.
Importantly, the bill provides that a set portion of Naloxone funding
go to rural areas, like much of Iowa that is being affected most
acutely. This is critical when someone overdoses and isn't near a
hospital.
The bill also authorizes an expansion of Drug Free Communities Act
grants to those areas that are most dramatically affected by the opioid
epidemic. And it also authorizes funds for programs that encourage the
use of medication assisted treatment, provide community-based support
for those in recovery, and address the unique needs of pregnant and
postpartum women who are addicted to opioids.
Finally, the bill also bolsters law enforcement efforts as well.
Amazingly, in 2007, only 8 percent of State and local law enforcement
officials across the country identified heroin as the greatest drug
threat in their area. But by 2015, that number rose to 38 percent, more
than any other drug.
So the bill reauthorizes Federal funding for State task forces that
specifically address heroin trafficking.
I am also pleased that I was able to include in the bill a
reauthorization of the funding for the methamphetamine law enforcement
task forces as well.
I held a Judiciary Committee field hearing in Des Moines last fall
about the ongoing meth problem across Iowa. And one thing the hearing
made clear is that our friends in State law enforcement need all the
help we can give them on that front, too.
All in all, the bill authorizes about $78 million per year to address
this crisis.
It is no wonder that the bill is supported by a diverse range of
stakeholders, including the Community Anti-Drug Coalitions of America,
the Partnership for Drug-Free Kids, the National District Attorneys
Association, the Major County Sheriffs' Association, the National
Association of Attorneys General, and so many organizations in the
treatment and recovery communities.
I urge my colleagues to support it this week, when the Senate has the
opportunity to act to address this epidemic. We owe it to those, like
Kim Brown, who have lost sons and daughters, brothers and sisters,
coworkers and friends to act now.
[[Page S1078]]
I yield the floor.
The PRESIDING OFFICER. The Senator from Ohio.
Mr. PORTMAN. Mr. President, first I thank my colleague and chairman
of the Judiciary Committee, Chuck Grassley.
Many years ago I went to Iowa with Senator Grassley to set up an
anti-drug coalition. We had done one in Ohio. I was the chair of that,
and Chuck Grassley asked if I would come. This was probably 20 years
ago that Senator Grassley--and I was in the House.
We had a great visit. We had a couple of townhall meetings. Chuck
Grassley is a guy who understands the issue, cares about it, and has
devoted a lot of time and resources to it in Iowa. The people of Iowa
know he is sincere about it because he has been on the ground setting
up these coalitions and dealing with this issue.
Frankly, it is a little disappointing--probably to him and to me--to
see that some 20 years later we are still facing this issue now and
even different issues. He mentioned methamphetamines. He mentioned, of
course, the heroin and opiate addiction problems with prescription
drugs.
Twenty years ago it was more marijuana and cocaine, but I think the
lesson we have all learned is these drugs will come and go in terms of
their severity and their impact on our communities and our families,
but it is always going to be there, and we need to keep up the fight.
Right now we have an urgent problem. That urgent problem was outlined
by Senator Grassley, but it is this growing use of opiates that leads
to a horrible addiction. It has a grip on so many of our constituents,
so many of our loved ones.
Over the weekend I had a townhall meeting. I asked--after we had
talked about taxes, trade, energy, and other issues--if people would
just raise their hands if they had been affected by the heroin and
prescription drug addiction problem. I said: Has anybody in your family
and friends been affected? Half of the hands in the room went up.
Unfortunately, that is the reality of this situation. In Ohio last
year we lost almost 2,400 just to overdose deaths. That doesn't account
for the fact that so many people are being saved now by naloxone--which
is something that is encouraged by our legislation and we will talk
about it in a second. Narcan is being used, but even those who survive
the overdoses, of course, are seeing their families broken apart, their
communities devastated.
I talked to a prosecutor over the weekend in one of our more rural
counties, and he said: Rob, over 80 percent of our crime is directly
related to this issue now, heroin and prescription drugs. Often it is
people committing crimes to pay for their habit.
The people who are the purveyors of these drugs have a business plan;
that is, to get you hooked with a relatively low cost at first and then
you need more and more to be able to feel the same high. It gets more
expensive to the point that it might go from $50 to $100 the first time
to $1,000 or $1,500 a day by the end of your addiction. This is how
horrible it is and it leads to so many collateral consequences.
I am very pleased the Senate voted tonight to proceed to this
legislation called CARA, the Comprehensive Addiction and Recovery Act.
CARA is a Federal response to this issue. It is attempting to make the
Federal Government a better partner with State and local governments,
with nonprofits, to be able to help to reverse this tide to deal with
this urgent problem in our communities. I would call it an epidemic. It
certainly is at epidemic levels in my State of Ohio. Sadly, we are the
top five in the country in terms of overdose deaths, but again it goes
well beyond just those deaths. There are so many people who are
affected by it negatively and so many who have not been able to fulfill
their God-given purpose because of this horrible addiction.
This legislation called CARA is bipartisan. It is comprehensive. As
Senator Grassley said, he got it through the Judiciary Committee. I
appreciate that. He got it through with something very extraordinary
around here, which is a unanimous vote--meaning nobody objected. That
never happens around here. It just means that every Senator is
addressing this issue back home, understands it, and wants to do
something about it. This legislation is built on common sense,
research, and experts from around the country who have come in.
I thank Senator Sheldon Whitehouse, who is the lead Democrat on this
legislation and my lead cosponsor. He and I are the coauthors of this
legislation. I also thank Senators Kelly Ayotte and Amy Klobuchar, who
have been terrific partners. Then there are 34 other bipartisan
cosponsors. I thank them all for their support.
I am excited that if this bill can pass, it will pass in the House as
well because there is companion legislation. In fact, the House bill
has 88 cosponsors right now--also bipartisan. So the idea is to get
this bill passed, get it through the House, and have it signed into law
by the President of the United States. It is urgent we do it.
This is a bill that not only has a lot of support on both sides of
the aisle, but--much more importantly to me--it has the support of
people all over the country who are experts in this field: doctors;
those in recovery; experts in prevention, treatment, and recovery; and
law enforcement.
The legislation actually comes--I hope you can see on this chart, the
words are kind of small--but it comes from the last few years, putting
together these experts from all around the country. We had five
different summit meetings in Washington, DC.
One was with the criminal justice system. We brought in experts from
all around the country to talk about treatment and alternatives to
incarceration. As you will see in this legislation, we have ways to
divert people from incarceration into treatment programs, which we
think is part of the way to solve this problem.
We then had one that focused on women, the special interests and
needs of women who are facing addiction and how to ensure they get into
treatment. As we will talk about later, this has a lot to do with one
of the problems that is out there right now, which is more and more
babies who are born with addiction and having to take those babies
through withdrawal. The care and compassion involved in that is truly
impressive, but that was a good forum for us. We had one on the science
of addiction and addressing the consequences of addiction. There are a
lot of good people around the country who understand the science of
this and what medication might work and what future medication might be
better to deal with it.
We talked about youth drug prevention and developing communities of
recovery. This is a very important aspect of our legislation. We don't
just talk about treatment, as important as that is, we talked about how
you divert people from getting into it in the first place through
better prevention and education.
Finally, we had a forum on veterans focusing on substance abuse and
PTSD and other issues. I recently visited one of our veterans courts in
Columbus, OH, and saw the good work they are doing. Most people going
through that court have mental health issues. Most also now have,
sadly, opioid addiction issues, usually starting with prescription
drugs and moving to heroin.
As I said, there is strong bipartisan support for this legislation in
the House and the Senate. It is endorsed by more than 130 groups
nationwide. By the way, those groups include some groups you might not
expect normally to be together on something such as this--the Fraternal
Order of Police, the American Society of Addiction Medicine, the Faces
and Voices of Recovery, the Coalition for a Drug Free America, the
Children's Hospital Association, the National Association of Addiction
Treatment Providers, the Partnership for Drug Free Kids, the American
Society of Addiction Medicine, the National Association of State
Alcohol and Drug Abuse Directors, groups who are in all of our States,
the National Council for Behavioral Health, and, of course, the Major
County Sheriffs' Association. So law enforcement, treatment, recovery,
education--everybody is coming together on this because we realize this
is going to take that kind of comprehensive approach with all sectors
of our community being involved and engaged.
CARA now has support not only of a lot of these groups from around
the country, but because of these groups--they helped us write a better
bill.
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What does the bill do? Here are the basic elements of CARA:
First, with regard to prevention and education, it does establish new
task forces to develop better practices for prescribers simply because
there has been overprescribing, particularly of prescription drugs.
These narcotics have been overprescribed to the point that many people
end up on heroin as a less expensive alternative to the prescription
drugs to which they have become addicted. The task force is an
interagency task force that is reporting back to the Congress on how to
develop these best practices for the medical community.
The bill also establishes a national awareness campaign with regard
to prevention and education. That is critical for us to get the word
out. It has grants to local coalitions. This is in the Drug-Free
Communities Act area. The Drug-Free Communities Act goes back to the
1990s. Since 1998 there has been $1.3 billion spent under the Drug-Free
Communities Act. I was the author of that in the House. It is good
legislation that helped create over 2,000 community coalitions around
America. I chaired ours in Cincinnati, OH, for 9 years and am still
very involved with it, and they do great work. But, again, we now have
this new issue, this new threat we must address. This helps with regard
to specific grants where there is a high degree of opioid addiction and
the negative consequences of it, to be able to blend with the drug-free
community program.
Law enforcement. The bill provides for training for Narcan--what is
known as naloxone--for first responders to prevent overdoses. I think
everybody in this Chamber has run into this back home. I went to a
firehouse recently because we had lost a brave firefighter in a house
fire, and I went to talk to his shift about him and to thank them for
their service. After talking to them about their fallen comrade, they
wanted to talk about this issue. They told me: Rob, we are spending
more time administering Narcan than we are fighting fires these days.
In other words, they are going out and helping people who are having
overdoses and are saving their lives.
A friend of mine who is a firefighter in Cincinnati told me just a
couple of weeks ago that he was responding to an overdose, saving
someone in front of a house, when, in an entirely different group in
the back of the house, an overdose occurred.
In Toledo last week, there was a response by emergency medical
services to somebody who had hit a telephone pole. They found him with
a syringe in his arm. He had overdosed. While they were responding to
him, there were two other overdose calls in Toledo--one city in Ohio.
There were three at the same time. Two of the three were saved by
Narcan. The third died.
Our folks in law enforcement and our first responders, our
firefighters, are doing a terrific job. They need help. They need more
Narcan and more training to be sure they can continue to do what they
are doing to prevent these overdoses. It is not the answer. Of course,
the answer is prevention, education, and better treatment. But in the
meantime, we have to provide them the help they need.
The law enforcement side also expands these drug prescription take-
back programs. They work very well, as Senator Grassley said, in some
of our States. We need to do more to expand those, and that is usually
done through our law enforcement communities.
It also authorizes a task force to combat heroin and
methamphetamines. These are the law enforcement task forces we talked
about earlier, which will help to coordinate Federal, State, and local
law enforcement to deal with this issue.
On the treatment and recovery side, it expands medication assisted
treatment for opioid and heroin addiction. It creates diversion,
education, and treatment programs in the criminal justice system. We
talked about that earlier. That is so important.
I have been at roundtable discussions all around my State and at a
number of treatment centers talking to recovering addicts about how
they got into the situation they are in and what advice they have. A
young man told me a classic story. He had an injury. He started using
prescription drugs. He got addicted. He needed money to buy these
expensive pain pills. He actually stole from a family member, and he
ended up in the law enforcement system and in jail. It was in jail that
he was told for the first time that it was actually cheaper to buy
heroin. He got out and bought heroin and became a heroin addict. He is
now in treatment. He hit rock bottom, as he said, and I think it was
because he had an overdose.
This is something where we need to figure out a better way to get
people diverted and use the criminal justice system to provide the
incentive to get them into the right treatment program.
It also supports recovery for youth and building communities of
recovery, again focusing on our youth to get them to make the right
decisions but also steering our youth who are addicted into the
recovery they need. Sadly, this is now necessary in many of our high
schools and in our colleges and universities.
It also establishes a task force to review some of the recovery and
collateral consequences. This is an interagency task force that is
going to report back to us on what is truly working and what is not
working in order to do a deeper dive to ensure we are using this money
most effectively in order to make a difference.
It has treatment services for women and veterans included. This is a
special interest of ours in this legislation--expanding treatment for
pregnant women who are struggling with addiction, again to avoid this
horrible situation where babies are born with an addiction.
It also supports care for our veterans. Our veterans right now can
enter treatment, of course, following discharge with this legislation.
This is important. Our veterans have some special needs and special
circumstances--often trauma, PTSD, and other things related to their
addiction. We find these veterans courts are incredibly helpful, to be
able to have them surrounded by fellow veterans in order to make more
progress. That is in here as well.
Finally, the legislation incentivizes the States themselves to enact
comprehensive initiatives to address the opioid and heroin abuse
problem--the prescription drug monitoring program, for instance. This
is very important. The Federal Government has a big role to play here.
Think about it. If you are in one State and you are monitoring
someone's prescription drug medications, knowing where they are going
and how much they are getting to avoid overprescribing, if that person
crosses State lines, it is very difficult. So our legislation expands
on what can be done there to ensure that, for instance, my State of
Ohio knows whether someone has gone to Kentucky, West Virginia,
Pennsylvania, Indiana, or Michigan to get prescription drugs. So the
prescription drug monitoring program will work better for every State.
Prevention and education on heroin abuses--this is to incentivize
States to do a better job on the prevention and education side and, of
course, to prevent overdose and to improve drug treatment.
These are all aspects of this legislation. It is comprehensive
because the problem is complex and requires a comprehensive approach.
Here are some statistics--we have already talked about some this
evening--that are shocking. We know that 28,647 Americans died in the
last year for which we had data, which is 2014, from a drug overdose.
The 2015 numbers will be higher than that. That is roughly 120
Americans dying every day.
There were 27,000 diagnosed cases of neonatal abstinence syndrome in
2013, the last numbers we have. It is even worse this year. This means
babies were born with an addiction. A baby is born dependent on opioids
every 19 minutes in America. So while I am speaking today, there will
be another baby born who is addicted.
I have gone to hospitals in Cincinnati; in Lima, OH, to St. Rita's;
to Rainbow Babies Children's Hospital in Cleveland, OH. They are
incredible caregivers. My wife Jane was at Nationwide Children's
Hospital today, actually, on this very issue. These are babies who are
so tiny, you can almost hold them in the palm of your hand. They need
caregivers to take them through a process where they go through
withdrawal. And we are not
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sure what the long-term consequences are because we don't have the data
yet because this is such a new issue. There has been a substantial
increase over the last several years. In Ohio, the same thing I said
earlier--750 percent increase in the number of babies diagnosed with
neonatal abstinence syndrome since 2004. There has been a 750-percent
increase in babies born addicted.
These are the issues this legislation gets at. Again, it does so in a
way that is not just bipartisan, which is important, and not just House
and Senate, which is important--the House has its own companion bill,
one the President will be able to sign into law--but most importantly,
it is because of the input of people from all over this country, the
experts, people who are recovering themselves, and those who are most
affected by this, that this legislation makes sense, and not just for
my State but for our country.
The Judiciary Committee had a number of good witnesses. One was a
woman named Tonda DaRe. Tonda DaRe is from Ohio. She had a daughter
named Holly. On her 21st birthday, Holly, who had a bright future ahead
of her--she was engaged to be married, and she had been very involved
in her high school and active in sports--tried heroin for the first
time. She became addicted. She went into recovery, and unfortunately,
as in many cases, she had a relapse. At age 23 her young life ended in
an overdose.
Her mom, Tonda DaRe, set up an organization called Holly's Song of
Hope. She testified before the Judiciary Committee about the importance
of her work--talking to other mothers and fathers and sons and
daughters about the devastating consequences of this heroin and
prescription drug addiction. This legislation needs to be passed so
that we can help Tonda. She testified on behalf of this legislation
because she has looked at it and knows it will make a difference in her
life and her community.
This is an urgent problem, as I said earlier. It is also one we have
a lot of bipartisan consensus around. There will be opportunities
during this debate to hear from a lot of different people on a lot of
different ideas on amendments to the legislation. That is good. It is
good to have a debate. But I hope my colleagues on both sides of the
aisle will keep focused on the importance of getting this done. It is
important to get it done in terms of providing immediate help to our
communities and also providing a structure to more effectively spend
funds this year--and yes, we have funds to spend this year that have
been appropriated consistent with CARA--but also next year and the year
after and the year after. Some will support more resources, and that is
fine. We need to have that debate. I myself think it is a priority, and
we should be providing the resources to be able to deal with this
issue.
I would also urge my colleagues to ensure that we get this over the
finish line. It is too important. We can't play politics with it. This
is one of those issues, again, like so few around here, that got out of
the committee without a single dissenting vote. We have done the right
thing on a bipartisan basis to bring in the experts. We have a good
solution to an urgent problem we all face.
I am pleased with the vote tonight, and I urge my colleagues to have
a good debate on the floor. Let's get this done for the sake of Tonda
DaRe and so many other mothers, fathers, and others out there who
deserve to have a little help in their fight against opioid addiction.
I yield the floor.
The PRESIDING OFFICER. The Senate majority leader.
Mr. McCONNELL. Mr. President, I just want to congratulate the Senator
from Ohio for his extraordinary leadership on this issue. This is an
epidemic that affects us all, and he has definitely been at the fore in
providing exceptional leadership on this, and I want to commend him for
that.
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