[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.

[[Page S1079]]

  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

[[Page S1080]]

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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