[Congressional Record Volume 162, Number 39 (Thursday, March 10, 2016)]
[Senate]
[Pages S1400-S1402]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               COMPREHENSIVE ADDICTION AND RECOVERY BILL

  Mr. CASEY. Mr. President, I rise to address an issue we are 
confronting in the Senate, and it is an issue folks in Pennsylvania and 
across the country are dealing with every day; that is, the opioid 
crisis. There are a lot of ways to describe this crisis. I am pleased 
to be able to talk about this issue with two of my colleagues who will 
be following me in succession after my remarks have concluded.
  This Senator wants to thank, in a particular way, Senator Whitehouse, 
Senator Shaheen, and our leadership for bringing this issue to the 
forefront within our caucus and here in the Senate. I know the effort 
to pass the Comprehensive Addiction and Recovery Act--known by the 
acronym CARA--is a bipartisan effort. I certainly appreciate that.
  In the case of Senator Whitehouse, he brings a deep reservoir of 
experience as a Federal prosecutor, U.S. attorney, as well as the 
attorney general of Rhode Island. He brings a law enforcement set of 
experience as well as his caring and concern about those who have 
addiction issues. We appreciate his leadership. Senator Brown has 
worked on this for many years in the Senate and as a Member of the 
House of Representatives. This is an issue that confronts all of us in 
our States. Our efforts have to be commensurate to match the severity 
of the problem.
  This week the Senate missed an important opportunity to invest 
substantial resources in our Nation's heroin crisis. The amendment 
offered by Senators Shaheen and Whitehouse would have provided $600 
million in emergency funding to aid public health professionals and law 
enforcement, the two main segments of our society that deal with the 
challenge of addiction on a daily basis. That amendment was defeated, 
and I think that was the wrong conclusion for the Senate and wrong for 
the country.
  While the Senate failed to act on this amendment, there is no reason 
we shouldn't find other opportunities to invest in anti-heroin 
strategies or, expressed another way, strategies that will lessen or 
reduce the likelihood that more people will be addicted to some opioid 
which often leads to other kinds of challenges such as heroin. It too 
often leads not just to the darkness of addiction but literally to the 
darkness of death itself. We have some work to do.
  We know we can pass the Comprehensive Addiction and Recovery Act, the 
CARA Act, as I mentioned before. That is good, but it is not nearly 
enough. We have to do more than simply pass good legislation that will 
authorize policies to better confront the challenge. That will not be 
enough. If we have in place new programs, new approaches, and new 
strategies, that is a measure of progress, but we can't ask medical 
professionals to do more to treat addiction if they don't have the 
resources. We cannot ask law enforcement to do more if they don't have 
the resources.
  Heroin overdose deaths have increased 244 percent from 2007 to 2013. 
In roughly a 6-year timeframe, heroin overdose deaths are up 244 
percent. It is hard to even comprehend that kind of increase of a death 
statistic--not just a number but a number that indicates the increase 
in the number of deaths. That alone should motivate us to do everything 
possible to do whatever it takes. Whatever authority, whatever policy, 
whatever dollars we need to invest in this, we have to do that. There 
are lots of other numbers, and sometimes you can get lost in reciting 
the numbers. I will mention a few that are relevant to Pennsylvania 
before I conclude.
  In addition to just passing the CARA bill, we ought to focus on 
taking measurable steps to solve the crisis. We don't want to just 
address the issue, confront the challenge, we want to solve the crisis. 
It will not happen in 1 year, and it will not happen because of one 
bill or one policy, but we have to put every possible resource or tool 
on the table to actually solve the crisis.
  There are lots of ways to illustrate the degree of the problem. I 
will talk about a couple of communities in Pennsylvania, just by way of 
example.
  The Washington Post--a great newspaper here--went to Washington, PA. 
We have a county and city just below the city of Pittsburgh, just south 
of Pittsburgh, Washington County and the city of Washington. The Post 
went there last summer and began to interview people at the local 
level.
  In one of the more stunning statistics they found in their reporting, 
in 70 minutes there were eight overdoses related to heroin--in this 
case not yet deaths but overdoses. A newspaper could track in 1 hour 10 
minutes, eight overdoses in one community in one State. Then they 
tracked it over a 2-day timeframe. In 48 hours there were 25 overdoses 
in Washington County, PA, and 3 deaths, in a 48-hour period. I cite 
that not just for the compelling nature of those numbers but because of 
where it happened. This is not happening in communities we used to 
think of as having a major heroin or drug addiction problem. We tended 
to think of it, at least in my lifetime, as being an urban issue that 
big cities have this problem and less so in small towns, suburbs, and 
rural communities. In this case, this horror, this evil knows no 
geographic or class boundaries. It is happening in big cities and very 
small towns in Pennsylvania. It is happening in suburban communities, 
high- and low-income communities and

[[Page S1401]]

in middle-income communities. It is happening everywhere. There is no 
escaping it.
  If it is happening in places like Washington County--the city of 
Washington, PA, is not a big city but a moderate-sized city. Other 
parts of that county tend to be more rural, small towns to rural. If it 
is happening there in those kinds of numbers, in 70 minutes or 48 
hours, overdoses and overdose deaths, that gives you an indication of 
the gravity of the problem.
  The Coroners Association in Pennsylvania, which has to track the 
number of deaths in their counties, reported that in just over a few 
years in Pennsylvania, the number of deaths from overdoses went from 
less than 50 to hundreds of deaths in just a couple of years. The 
gravity of this problem is self-evident.
  It is not good enough to diagnose the problem and recite statistics. 
We have to solve the crisis. There is no doubt this is a huge issue for 
the country.
  By not passing the funding that we tried to pass, we are missing a 
chance to support, for example, the substance abuse prevention and 
treatment block grant, the so-called SABG, or the SA block grant. That 
is an existing program--an existing block grant program--that works. 
The only good news here, in this debate about what policy to put in 
place, is that local officials know what they are doing. Addiction and 
medical professionals know exactly what to do. They know exactly what 
works. They know exactly what they need. What they are asking us for is 
a little bit of policy or a significant amount of policy, maybe. But 
they are also asking for research and resources, and we have to give 
those resources to them.
  I conclude with the following. We know that good treatment works. All 
the professionals tells us it works. We know so much more today than we 
did 25 years ago about what works. We know that good treatment works. 
It takes a long time. There is no 90-day program here because it takes 
a lot longer than that. So we know that for sure. There is no dispute 
about that. We also know that good treatment costs money. You cannot 
just have good intentions here.
  Lifesaving overdose reversal drugs such as naloxone cost money. The 
good news is we have a drug to reverse the adverse impact of an 
overdose, and yet a lot of communities cannot afford to get this very 
important drug called naloxone, the so-called reversal drug as some 
call it.
  Intercepting drugs before they reach our streets costs money. The 
worse this epidemic gets, the more these services are in demand.
  So Congress--the Senate and the House of Representatives--must 
provide additional funding to make sure local communities can meet the 
demand. We know that investing in programs that treat addiction and 
save lives is an abiding obligation.
  The PRESIDING OFFICER (Mrs. Fischer). The time of the Senator has 
expired.
  Mr. CASEY. Madam President, I ask unanimous consent for 30 additional 
seconds.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CASEY. It is an abiding obligation that we must fulfill. We have 
to tackle this problem. We can't do it without resources.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Rhode Island.
  Mr. WHITEHOUSE. Madam President, I am delighted to join Senator Casey 
of Pennsylvania and Senator Brown of Ohio on the floor this morning to 
applaud what appears to be the imminent passage of the Comprehensive 
Addiction and Recovery Act. So far we have had less than a handful of 
votes against this bill at any stage through the voting on it, and I 
suspect that some of those votes may have had to do with amendments and 
so forth. We might even do better than that on final passage.
  I thank my cosponsors. This was not a bill that was just dreamed up 
in back offices. We had five national seminars in Washington, bringing 
people in from all around the country to share their experiences, to 
share their advice, to share their best practices, and to inform the 
development of this bill. It has been years of work in the making.
  On our side of the aisle, Senator Klobuchar has been an extremely 
valuable colleague. On the other side of the aisle, Senator Portman and 
Senator Ayotte were our coconspirators on this bill. I thank them and 
extend my appreciation to all of them.
  This truly is a comprehensive bill: everything from at the point of 
overdose getting naloxone into the hands of first responders so that 
lives can be saved; through the prescribing process and the 
prescription drug monitoring process; through a whole variety of new 
treatment programs; and through intervention for people who are 
incarcerated and the prevention of incarceration, particularly for our 
people in veterans courts and so forth, who can be diverted out of the 
prison system through new means of treatment such as medically assisted 
treatment that is emerging as a very promising new strategy; and all 
the way, ultimately, to disposal of excess drugs. This truly is a 
comprehensive bill.
  Its only faults are ones that the Republican leadership are in a 
terrific position to remedy, if they would.
  The first is that there is no additional funding to support any of 
these new programs that I have described. The funding for the accounts 
in question was determined months and months and months ago in the 
Appropriations Committee before anybody could know what this bill was 
going to look like on the floor.
  When the final deal was reached, the numbers actually matched the 
President's budget, and the President's budget was issued even before 
the appropriations measure came out of its relevant subcommittee. So 
the President's budget folks would have had to have been astonishing 
masters of prediction in order to put in money for programs that 
weren't even law at that time.
  There has been considerable commentary from the other side that there 
is funding for this, but what they overlook is that, yes, there is 
funding for these programs, but you would have to take it away from 
other treatment and recovery programs to fund these. It would be 
robbing Peter to pay Paul.
  Now, an argument could be made that under this bill, Paul will be a 
more effective program than the pre-CARA Peter would have been, and, 
therefore, robbing Peter to pay Paul is a net good. But, please, let's 
not pretend there is money for this.
  If there is one indication of how there really isn't new money for 
this, it is the fact that our friends on the other side can't agree on 
how much money there is for this. Some Senators have said that there is 
$78 million for funding CARA. The majority leader has said there is 
$400 million to fund CARA. The deputy majority leader has said there is 
$517 million to fund CARA. If the money were real, I suspect they could 
agree on the amount of it. I think the fact of the matter is that there 
is no new money for this, and the sooner we can get this funded, the 
sooner it will save lives.
  The second problem is that the House, under Republican leadership, 
has taken no action on this bill. No committee has taken it up and 
passed it. So I take this opportunity to call on the leadership here 
and in the House to put money where their proverbial mouth is to pass 
this bill, to get some funding behind it--Senator Shaheen's measure 
would have been terrific--and to get some action out of their 
colleagues in the House. If we pass it in the Senate and the House 
takes no action, this will be a sham, and that will have been a shame.
  With that, I yield the floor for Senator Brown.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. BROWN. Thank you, Madam President. Thank you to my colleagues for 
the terrific work they have done on such an important issue, which in 
my State sort of began in the most rural of the areas of the State and 
spread and spread and spread. This is the right kind of comprehensive 
response for this, but as Senator Whitehouse just said, it means real 
funding for CARA and what we are doing.
  I am pleased we are coming together in a bipartisan way overall, 
finally taking action on the opioid epidemic that is devastating 
communities across our country.
  We know some of the statistics. More people died in my State than in 
the country as a whole in 2015 from opioid

[[Page S1402]]

overdoses rather than they did from auto accidents. We are experiencing 
a record number of fatal overdoses. There is no State and probably 
county untouched by the scourge.
  We need to remember the human cost of addiction. In Warren, OH, a 
couple of weeks ago, there was middle-age woman who now has a child now 
in his midtwenties who has suffered addiction for a dozen years, has 
been in and out and is doing better, and then falls back. His family is 
affluent, so his treatment has been better than some. But she says that 
when there is an addiction, it afflicts the whole family. Nobody is 
really exempt.
  In my State, 2,500 Ohio families in one year lost a loved one to 
addiction. Thousands more continued to struggle with opioid abuse or 
with a family member's addiction. It is not an individual problem or a 
character flaw. It is a chronic disease. Right now, it is placing an 
unbearable burden on families and communities in our health care 
system. That is why we need to tackle this at the national level.
  It is why I am encouraged to see us debate this Comprehensive 
Addiction and Recovery Act, or the CARA Act. The ideas in this bill are 
an important first step in tackling the epidemic, but they are just the 
first step. On their own they are not nearly enough to put a dent in 
this epidemic. The initiatives are going to mean very little--and here 
is the key point that both Senator Casey and Senator Whitehouse made--
without additional funding to back them up.
  My colleagues Senator Shaheen of New Hampshire and Senator Whitehouse 
introduced an amendment that would have provided an additional $600 
million to fight the opioid epidemic. That would be a serious 
commitment in putting the ideas in this bill into place into action.
  But my colleagues on the other side of the aisle blocked this 
investment. Again, they want to do things on the cheap. They want to 
pass things to pat ourselves on the back but not provide the funding to 
actually accomplish things. It would block the investment in health 
professionals and communities who are on the frontlines of this battle.
  You simply can't do a roundtable with health professionals and people 
working toward recovery and families affected by it without hearing 
from them. They need resources locally. The States aren't coming up 
with it adequately. They need resources, and they need real investment 
in prevention programs. We need real investment in treatment options to 
help patients not just get cured and get clean but stay clean.
  Earlier this year, I introduced the Heroin and Prescription Drug 
Abuse Prevention and Reduction Act with my colleague Senator Baldwin of 
Wisconsin. Our bill would boost prevention efforts that would improve 
tools for crisis response. It would expand access to treatment, and it 
would provide support for lifelong recovery, the kind of serious 
investment we need to back up our rhetoric.
  In public health emergencies, we are sometimes, somehow able to come 
up with necessary money--swine flu, Ebola, Zika virus. But addiction is 
not a public health emergency. Addiction is a public health problem, 
but one we need to fund in an ongoing way. You can look at the spike in 
the number of deaths. You can conclude nothing else but that it is a 
long-term public health problem. Too many lives have been destroyed. 
Too many communities have been devastated. I am just puzzled why my 
colleagues won't come up with $600 million for this very important 
public health program. It is time to get serious. It is time to call it 
what it is--the public health crisis that demands real and immediate 
investment, not more empty rhetoric, not more empty gestures.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. BARRASSO. Madam President, I ask unanimous consent to speak for 
up to 10 minutes in morning business.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                          ____________________