[Congressional Record Volume 162, Number 38 (Wednesday, March 9, 2016)]
[Senate]
[Pages S1355-S1356]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               COMPREHENSIVE ADDICTION AND RECOVERY BILL

  Mr. BLUNT. Mr. President, today the Senate is taking a second step to 
deal with a public health crisis that is destroying lives and damaging 
communities across the Nation, the epidemic of opioid and heroin abuse. 
Step 1 late last year was to reduce spending in other programs and 
increase the dollars available to deal with this addiction.
  An estimated 1.9 million American adults have an opioid-use addiction 
or disorder related to prescription drug pain relievers. Another 
500,860 have an opioid-use disorder related to heroin. Some 2.5 million 
Americans are dealing with this problem. Our Nation's veterans are 
particularly at risk for developing a dependency on opioids. A study 
published in 2014 found a high prevalence of chronic pain among 
veterans because of their service. The chronic pain among veterans was 
44 percent compared to 26 percent in the general public.
  There was a higher prevalence of opioid use, at 15.1 percent, in the 
U.S. military after a combat deployment, after possible injuries in 
training or injuries from an IED attack, compared to just 4 percent in 
the general public. In 2014, more than 1,000 Missourians died from an 
opioid overdose. In St. Louis alone, deaths related to opioid abuse 
have increased nearly three times since 2007.
  Member after member has come to the floor, just as they came to me 
last year as the chairman of the funding committee for health and human 
services and explained what a problem this is in their State. The 
majority leader made a point to me the other day that in Kentucky more 
people died last year from drug overdoses than died from car accidents.
  According to the Centers for Disease Control and Prevention, 4 people 
every day die from an overdose of opioid pain relievers, and 78 people 
die every day from a combination of pain reliever overdoses or heroin 
overdose.
  Many times those prescription opioids have been the pathway to 
heroin. Deaths from prescription opioids have quadrupled in the past 14 
years. These are stunning statistics. The Centers for Disease Control 
and Prevention has rightly labeled this an ``epidemic.'' This should 
get a good vote on the Senate floor today or tomorrow. But just because 
it gets a good vote, it does not mean it was not an important debate to 
have.
  Just because it gets a good vote and is now better funded than it has 
been in the past, that does not mean the Senate and the House don't 
need to weigh in and say: Here is more specific ability to deal with 
these problems in new ways. The good news is that addiction is a 
treatable disease. Those who receive treatment can recover and go on to 
lead full, healthy, and productive lives.
  In Missouri 72 percent of the individuals who had gone through our 
State's opioid treatment program in random tests test drug-free. The 
problem with addiction is that only about 10 percent of individuals who 
are battling drug addiction receive treatment. That is why I am proud 
to be a cosponsor of this bill. That is why it is important that we 
commit ourselves to win the fight against addiction.
  We need to make sure that all of the stakeholders are involved. As to 
first responders, if you are a first responder attached to a fire 
department, for instance, the odds are that you are going to respond to 
three times as many drug overdoses as you do to fires. So whether it is 
first responders, paramedics, or the law enforcement community, we need 
to use all of our resources to try to be sure that we are doing what 
needs to be done here.
  The Comprehensive Addiction and Recovery Act that we are debating 
provides grants from multiple government agencies to encourage State 
and local communities to pursue strategies that we know work. The only 
thing you have to do is be sure and implement those strategies.
  The bill expands the educational efforts to understand addiction as a 
chronic illness. That promotes treatment and recovery and prevents 
opioid abuse from going forward. The bill also expands resources to 
identify and to treat the incarcerated population suffering from 
addiction disorders with evidence-based treatment.
  Finally, it expands disposal sites for unwanted prescription 
medications to help them out of the hands of children and adolescents. 
Way too many unused painkillers are still in people's medicine cabinets 
or their dresser drawer, waiting for somebody else to find them and, 
once they know they are there, to find them again.
  This bill represents a strong bipartisan effort to address this 
epidemic. I filed two amendments that I think will improve the bill. I 
hope to see them in the managers' package. The first amendment will 
just simply expand the efforts that we have already made in a bill that 
Senator Stabenow and I introduced a couple of years ago and that got a 
significant pilot project in the Excellence in Mental Health Act.
  What that does is to provide 24-hour access for people living with 
behavioral health issues--with mental health issues. That would include 
substance abuse disorder. Excellence in Mental Health creates a 
demonstration program that really just simply, in the right kind of 
facilities, requires that mental health is dealt with like all other 
health--that behavioral health is dealt with like all other health.
  When we started that debate, there was a belief that no more than 20 
States would implement Excellence in Mental Health if every State in 
the country were allowed to do it if they wanted to. We now have 24 
States that have applied to be one of the eight State pilots. The 
administration said: Why don't we increase the 8 States to 14 States? 
We have an amendment to this bill that would say: Let's go ahead and 
increase the 14 States to all 24 States, because not only is this the 
right thing to do but what these States will find out is that when you 
deal with mental health like all other health, you probably save money 
because the other health issues that people with behavioral health 
issues have are so much more easily dealt with.
  It has been long said that we have really turned over, in an 
outrageous way, the mental health obligations of our society to the 
local police departments and the emergency rooms. That is no way to do 
this. It is no way to solve this problem. We are about 50 years behind. 
We are beginning now to catch up in the ways we should.
  I also filed an amendment to authorize the Department of Health and 
Human Services to use telehealth to allow this program to work more 
effectively, to allow telehealth to be one of the specifically 
reimbursable opportunities here.
  According to the Centers for Disease Control, individuals in rural 
communities are more likely--not as likely, not less likely, but more 
likely--to overdose on prescription painkillers than people in the 
cities, people in urban areas. In fact, death rates from overdoses in 
rural areas now greatly outpace the rate in large metropolitan areas, 
which historically had higher rates.
  So what do you do to connect those individuals with the kind of help 
they might need on a basis that they can turn to that help when they 
need to? One way to do that, certainly, is telehealth treatment 
options. Telehealth allows individuals in rural or medically 
underserved areas--many of whom just simply don't have other treatment 
options--to receive the care they need, to receive the attention their 
issue needs remotely.
  Additionally, telehealth can be an important component in ensuring 
that those patients receiving treatment for pain management use opioids 
effectively and appropriately and don't get started down the wrong path 
and the wrong way.
  In July 2014, the Journal of the American Medical Association 
published a study that followed patients who reported moderate to 
intense chronic musculoskeletal pain. Of the 250 patients in the study, 
half received the normal standard of care and half received a year of 
telephone monitoring in addition to normal care.
  Patients who were monitored via telehealth were twice as likely to 
report less pain after 12 months, having someone to talk to or being 
able to ask a question about whether they should increase the medicine 
because their pain was worse that day. Researchers

[[Page S1356]]

have clearly noted that fewer telehealth patients started taking 
escalated doses of opioids than people who were simply taking medicine 
on their own. Telehealth holds promise in lots of areas. I believe this 
happens to be one of them. As chairman of the Labor, Health and Human 
Services Appropriations Subcommittee, I was proud to see us increase 
funding at a 284-percent increase. I will say again that we did that by 
cutting funding in other areas. One of the things the government has to 
start doing is to truly prioritize. If everything is a priority, 
nothing is a priority.

  Today, with this piece of legislation, the Senate is telling our 
friends on the other side of the Capitol and around the country that 
this is an epidemic we intend to deal with. I look forward to the 
continuation of this debate, the end of this debate, and passing this 
bill.
  Thank you.
  Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. NELSON. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded
  The PRESIDING OFFICER. Without objection, it is so ordered.

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