[Congressional Record Volume 162, Number 32 (Monday, February 29, 2016)]
[Senate]
[Pages S1103-S1104]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            OPIOID ADDICTION

  Mr. WYDEN. Mr. President, tonight the Senate voted to turn its 
attention to the issue of opioid addiction. Clearly, what we know now 
is that opioid addiction has carved a path of destruction across 
America--a path of destruction from Medford, OR, to Manchester, NH.
  During a number of community forums I held across my State just a few 
days ago, we talked about how we are going to grapple with this great 
challenge and what it is going to take to really turn the problem 
around.
  My home State has the dubious distinction of ranking fourth worst for 
abuse and misuse of opioids in America. In my State, citizens made it 
very clear: They are not going to accept being fourth worst.
  I know from talking with many of my colleagues that a whole host of 
States are dealing with this challenge, and what I have been struck by 
is how opioid addiction keeps manifesting itself in ways we certainly 
wouldn't have known about even 10 or 15 years ago.
  At home in Oregon, I was particularly struck with parents who told me 
about high school athletes struggling with addiction to opioids. When I 
played basketball, dreaming of playing in the NBA, there was never any 
talk in the locker room about opioids. Now the next generation of young 
athletes seems to be getting caught up in this. If they have an injury, 
young people get down when they are not able to play sports. They get 
depressed. Maybe they go to a party. Maybe it starts with some alcohol. 
Maybe it starts with a prescription. But all of a sudden, it mushrooms 
and grows. This is what parents were telling me at home, and it is 
clear that Congress cannot sit on the side lines while the opioid 
addiction problem continues to mushroom.
  In the coming years, Medicare and Medicaid are expected to account 
for over a third of substance abuse-related spending. We are talking 
about billions of dollars each year. As the ranking member of the 
Senate Finance Committee, which is required to pay for these bedrock 
health programs, I want to talk just for a little bit tonight about the 
critical role these programs are going to play in stemming the tide of 
opioid abuse.
  I would like to begin by saying that it is my view that the American 
people are paying for a distorted set of priorities. Our people are 
getting hooked on opioids, there is not enough treatment, and vigorous 
enforcement is falling short. That, in my view, is a trifecta of 
misplaced priorities. And while it is not all going to be done this 
week, beginning this week the Congress has the opportunity to develop 
fresh policies that will begin to right the ship.
  Last week the Senate Finance Committee held a hearing to discuss the 
opioid crisis. As I listened to the debate, there was a sense that 
policymakers are sort of lined up to choose between two sides. One is 
tough enforcement, which means cracking down on pill mills, fraudsters 
bilking Medicare and Medicaid with unneeded prescriptions, and 
unscrupulous abusers who doctor shop for their next bottle of pills. 
Then there is another side that believes there should be more focus on 
social services. My own view is that what is needed is a better 
approach that includes three priorities: more prevention, better 
treatment, and, yes, tougher enforcement. True success is going to 
require that all three work in tandem.

  When it comes to preventing addiction, any discussion has to include 
how these drugs are prescribed in the first place. I have come to feel, 
as I got around Oregon and I listened to the testimony in the Finance 
Committee here recently, what has happened is America, for the last 15 
or so years, has been on a prescription pendulum, where doctors were 
once criticized for not treating pain aggressively enough, today they 
seem to be criticized for prescribing too many opioids to manage pain.
  In my view, our challenge is to work on a bipartisan basis to get 
this balance right. Of course we want our people to have an opportunity 
for science-based pain management, and we also don't want 
indiscriminate prescribing of opioids. It is about getting the balance 
right with respect to this prescription pendulum that our country has 
been on for the last 15 or 20 years.
  I am pleased the Centers for Disease Control and Prevention is 
breaking new ground with their guidelines for prescribing opioids. If 
successful, I believe they could provide a meaningful reduction in 
overprescribing. I have also been concerned about the influence opioid 
manufacturers have on prescribing practices. So I have sent to the 
ranking Democrat on the Finance Committee an inquiry to Secretary 
Burwell to ensure that any potential conflicts of interest have been 
properly disclosed for members of government panels who are evaluating 
the Centers for Disease Control guidelines as a result of funding they 
receive from drug manufacturers.
  Our physicians ought to have the best information on prescribing 
these powerful drugs without undue influence from the companies that 
are manufacturing. In my view, a key piece of solving the opioid 
addiction puzzle has to be prompt and effective treatment of those who 
are dealing with an addiction to opioids.
  The Finance Committee had three witnesses last week: a witness who 
was chosen by our distinguished chairman, Senator Hatch, a witness I 
chose, and an expert who was well thought of by all sides. The question 
was, How do you solve this opioid addiction challenge if you just 
restrict access to opioids?
  I personally believe that kind of enforcement regime should be part 
of a solution, and I support that, but if all you do is restrict access 
to opioids, each of these experts--the one chosen by Chairman Hatch, 
the one I chose, independent expert, all of them said if all you do is 
restrict access to opioids, the addiction does not go away. The 
addiction doesn't just magically disappear.
  I hope we can emphasize this as the Senate begins our debate. Any 
lasting solution is going to have to have enforcement, which this bill 
focuses on, but it is also going to have to have treatment and 
prevention. We are going to have to improve access to addiction 
treatment and mental health services.
  I know the distinguished President of the Senate, like my State, has 
a lot of rural communities, and it is going to be particularly 
important to ensure that they are served. I think the distinguished 
President of the Senate knows it is not a surprise that some of the 
rural communities have some of the highest rates of abuse and opiate 
overdose in the country.
  Mental health treatment for addiction certainly has gotten short 
shrift for too long. It is too important to have that kind of policy, 
and it is high time for a change. For example, Congress ought to also 
be taking a look at what is called the IMD exclusion, an out-of-date 
policy from the 1960s that says services like rehab or some emergency 
mental health stay in an inpatient setting can't be covered by 
Medicaid. That is a big policy change. I think it is important that we 
debate it, and I think we all understand finding the vast sums needed 
for those services would be a unique challenge.
  Like so many other important issues, at the end of the day, this 
requires that our Congress make some tough choices. Yet if prevention 
and treatment are not locked in upfront, we ought to realize that if 
those are our choices, to not give adequate emphasis to prevention and 
treatment, the overall bill is going to come in even higher--pregnant 
mothers giving birth to opioid-dependent babies, EMTs and emergency 
rooms dealing with overdose calls every night, county jails taking the 
place of needed substance abuse treatment, able-bodied adults in the 
streets instead of working in the private sector at a family wage job. 
America's tax dollars ought to be spent more wisely. So as we begin 
this debate, we begin

[[Page S1104]]

the debate by tackling the opioid scourge that has carved the path of 
destruction, a path of destruction from one end of the country to 
another.
  The Senate has to find the right mix between prevention, treatment, 
and enforcement. It is going to be that kind of strategy, a fresh 
strategy where prevention, treatment, and enforcement work in tandem. 
That is going make a real difference for our families and our 
communities struggling to heal.
  I hope those who may have followed this speech will recognize that I 
haven't talked about Democrats and Republicans. I have been talking 
about a set of approaches we can all work on together. In fact, all 
three of the witnesses who were before the Finance Committee made it 
clear that you had to have those three approaches--prevention, 
treatment, and enforcement--work in tandem if you want to solve the 
problem.
  I think it is important Democrats and Republicans recognize what 
those experts and others have said is going to be necessary to help our 
families and communities across this country heal. We can do it in a 
bipartisan fashion. I am committed to working in just that manner.
  With that, I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. Will the Senator withhold his request?
  Mr. WYDEN. Yes.

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