[Congressional Record Volume 162, Number 101 (Thursday, June 23, 2016)]
[Senate]
[Pages S4518-S4521]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
OPIOID ADDICTION EPIDEMIC
Mr. MANCHIN. Madam President, the Presiding Officer and I are
colleagues from the same State, so she knows as well as I know about
the problems we have with opioid addiction, prescription drug abuse
throughout our State and all over this country. We have come to a
crisis point in this country.
In 2014, 18,893 people died from a prescription opioid overdose.
These are legal prescription drugs that are made by outstanding
pharmaceutical manufacturers. They are approved by the Food and Drug
Administration. They are prescribed to us by the most trusted person
outside of our family--our
[[Page S4519]]
doctor. It has created an epidemic of unbelievable proportions. Every
day 51 people die from legal prescription drug abuse. Worse yet, the
trend is going in the wrong way. It is not reducing; it is increasing.
Sixteen percent more people died in 2014 than died in 2013. We have
lost almost 200,000 since 1999. If we don't take action soon, this
epidemic will become of mammoth proportion that we have done very
little, if anything, to control.
Unfortunately, a major barrier for those suffering opiate addiction
is insufficient access to substance abuse treatment. I, like many
people in public service 20 years to 30 years ago when this epidemic
hit--we basically treated it as a crime. It is a crime if it is a
violent crime that was committed because of drugs, or a sexual crime,
but most likely that is not the case. It is mostly stealing. To support
their habit, an addict usually steals from their family, their extended
family, and their friends. Once everyone realizes the problem they have
is addiction, then they usually start stealing anywhere they can, which
usually results in an arrest, incarceration, found guilty of larceny,
and then they get a felony on their record.
But knowing how difficult this is, without treating it as an
illness--between 2009 and 2013, only 22 percent of Americans suffering
from opioid addiction could find treatment centers. If this was any
other epidemic which is a health crisis, we have ways of treating that.
You will find a hospital. You will find someone who basically will give
you treatment for the illness you have. Not with opiates.
In 2014, 42,000 of our fellow West Virginias, including 4,000
children, sought treatment for illegal abuse but failed to find any
treatment.
Think about this. If you were a parent of a child who is addicted and
that child wanted help and you wanted to get help for that child, there
is no place to put that child. Compare that to what we do as far as
incarceration.
My cousin Michael Aloi is a Federal magistrate judge. Michael and I
were talking.
He said: Joe, you know, I have never ever been turned down for
someone I have had to put in jail or in prison or had someone tell me
``I am sorry, Judge, you can't put them in jail because we don't have a
jail cell.'' We have always been able to find a jail cell for somebody
we want to incarcerate.
Then he said: Guess what, Joe. For probably 8 out of 10 times a
person is recommended for treatment by the court, I have no beds to put
them in, no places to send them for treatment. I can find a jail cell
for them and a jail bed; I can't find a treatment bed.
That is what we are dealing with in America, so we have to change.
In West Virginia, our largest long-term facility has more than 100
beds, and that is Recovery Point in Huntington, WV. They do an
unbelievable job.
In 2014, about 15,000 West Virginians received some form of drug or
alcohol abuse treatment, but nearly 60,000 West Virginians who were
identified as being in need of substance abuse treatment couldn't find
it.
Based on conversations with our law enforcement--and you can check in
any of your towns, wherever you may live in this great country of ours,
and you will find out that probably 7 to 8 out of 10 people who are
picked up for any crime or charged with a crime--it is drug-related. It
is having a tremendous effect on our economy and the lives of our
people.
What I have done is I have come up with a piece of legislation which
has bipartisan support, and we are hoping to get much more. Basically,
it is a lifeboat. What it really says is this: We need this treatment.
How do we fund it? In these tough times we have, it is hard to find the
finances, and we have to have pay-fors. So I looked at it in a very
practical way, and I said: We have a fee or a tax, if you will, on
cigarettes. We have a fee or a tax on alcohol. These are things that
are detrimental to society and to human beings themselves. Basically, I
looked at a one-penny-per-milligram fee on opiates for every opiate
that is produced in America or sold in America--one penny per
milligram. Unbelievably, that is spinning off about $1.5 billion to $2
billion if we enforce this. That gives us a funding stream so these
judges can place a person who needs treatment. We can have adequate
treatment centers with a continual funding stream.
I would hope that we would not get a penny, not one dollar from these
fees because that would mean we are not out pushing opiates. But that
is not the case. So this lifeboat is exactly what it says it is--it
gives people a lifeboat, gives them a chance to clean themselves up.
Mr. DURBIN. Through the Chair, will the Senator from West Virginia
yield for a question?
Mr. MANCHIN. Absolutely.
Mr. DURBIN. First, I thank him for his leadership on this issue. I
know it is personal to him and the Presiding Officer.
In my State, I think the death rate from opioids and heroin is
somewhere around 12 per 100,000; in your State, I understand it is 25;
in the State of New Hampshire, 35. So you have twice the problem we
have, just in strict statistical terms, and New Hampshire, for some
reason, has three times. And you have been outspoken on this issue. I
am pleased you have been because it is not just local to you, it is a
national problem.
Yesterday we had the Acting Administrator for the Drug Enforcement
Administration come before the Judiciary Committee. Most people are not
aware, although I know you and the Presiding Officer are aware of the
fact that each year the Drug Enforcement Administration approves the
production of opioids by pharma. In other words, the pharmaceutical
companies cannot produce these pills that are classified as narcotic,
pain reliever pills, without the approval of the Drug Enforcement
Administration.
I am sure the Senator from West Virginia is aware of the fact that
when they set the annual production quotas for opioids by U.S.
pharmaceutical companies--there has been a dramatic increase. Between
1993 and 2015, a 22-year period of time, oxycodone production jumped
dramatically 40 times, from 3\1/2\ tons to over 150 tons of oxycodone
approved by the Drug Enforcement Administration. During the same
period, the production of hydrocodone went up 12 times; hydromorphone,
23 times; and fentanyl, the drug that killed Prince, 25 times.
I asked Acting Administrator Rosenberg: We are trying to destroy the
opioid beast, and you are feeding it. The production levels--do you
take into consideration what is happening with these drugs once they
are produced by pharma and what happens to them next? Under the
ordinary course of events, they are prescribed by doctors and dentists
or, in some cases, some other medical professionals, and they make it
to the street.
He said that he was aware of it and he understood that his agency was
bearing some responsibility for what has happened. Well, that is an
understatement. They are certainly bearing some responsibility.
So I ask the Senator from West Virginia, who has been outspoken and a
real leader on this issue, when we look at the Food and Drug
Administration's role on the types of opioids and we look at the Drug
Enforcement Administration's role when it comes to the volume of
production, is it clear that our government has some responsibility for
where we are today with this opioid epidemic?
Mr. MANCHIN. Absolutely, I say to the Senator. I have been working on
trying to change the culture of the Food and Drug Administration. I
have been working with the DEA because not only does the DEA basically
set the allotment, they also are the ones who give the license to the
doctor and make sure that doctor is certified to dispense it. If you
have a doctor who is abusing it, if you have a doctor who is basically
putting 10 times to 20 times more on the market in a certain section or
region of our State or our country--more than the other doctors--maybe
that person is irresponsible, maybe they should be questioned and taken
off the list for prescribing.
Absolutely. It is a cultural change.
This all came about in the eighties when basically pain--your element
of pain was one of--the fifth criteria of wellness. It was the
Veterans' Administration that brought the product on, so the genie got
out of the bottle. How do we put it back? We can if we continue to
fight it, but it is a horrible scourge on us.
[[Page S4520]]
Mr. DURBIN. Through the Chair, if the Senator will yield further for
a question?
Mr. MANCHIN. Sure.
Mr. DURBIN. The Senator and I will both concede that there are people
with chronic, acute pain who need relief every single day, and we are
not quarrelling with that, that it should be prescribed and there is a
definite need. Pain is an issue in the lives of many people, and we
need to deal with it responsibly, in medically responsible ways.
I guess the question that comes to mind is, when I ask my local
doctors in Illinois about this, some have shown extraordinary
leadership--the Chicago Medical Society, for example. I commend them. I
have written to all the medical associations saying: What are you doing
in training your doctors to know when they are prescribing too much or
too many pills?
I give special credit to the Chicago Medical Association. They have
stepped up and said: With our members, we are educating them.
But this is what I hear repeatedly, and I would like the Senator's
response to it. Three percent of the doctors are responsible for 50
percent of the prescriptions. That is probably true. I can't quarrel
with it, nor would I. But then someone said: But that is not the whole
story. Many times a person going to one of the 97 percent of physicians
ends up starting down the path toward opioid addiction, and then that
first physician says ``No more,'' and then they turn to the 3 percent
who are just doling out the prescriptions right and left.
So it seems to me that if 3 percent are the worst offenders and the
ones who are really feeding the system in volume, we still can't look
beyond the 97 percent and their responsibility to make sure their
prescriptions do not start a person down the path toward opioid
addiction.
I ask the Senator from West Virginia, have you encountered this 3
percent or the irresponsible physicians?
Mr. MANCHIN. Well, yes, when this became the problem we know it is
today--my brother is a doctor. He went through medical school in the
1970s. They weren't schooled on this. They weren't trained on this.
Most doctors will tell you they got very little training on substance
abuse and what it could do. What they find out about it is that the
salesmen from the pharmaceuticals is selling it to their office and
giving them free samples, saying it is a miracle drug: Try it; I think
you will like it. They are people running pill mills. It is basically a
business for them.
The other thing is that the doctors who don't have that knowledge and
haven't been trained in this--we have finally gotten the CDC, or the
Centers for Disease Control, to put out, basically, prescription
guidelines. A schedule II narcotic, which is basically oxycodone,
Vicodin, Lortab--some of the most renowned ones we know of--have a
``30-day,'' a doctor can prescribe for you 30 days. I have young people
in my office who go get a tooth extraction, and they get a 30-day
prescription. They might need a 2-day or 3-day prescription. So this is
what we are cracking down on--the 97 percent who should not be giving
you a 30-day prescription just because that is what they are allowed to
do. They should be using good common sense. Listen, you are a young,
strong person. You may need this for 2 or 3 days. If it is worse, come
back to see me.
Mr. DURBIN. If the Senator will yield further for a question, through
the Chair, in the year 2014, the Drug Enforcement Agency of the United
States approved the production of 14 billion opioid tablets in the
United States--2014, 14 billion--enough opioid pills for every adult in
America to have a 1-month prescription.
So I asked a doctor in DuPage County in Illinois why. Why would
doctors prescribe, as the Senator said, a 30-day prescription for a
patient who may only need 2 or 3 days, and it could be renewed if they
needed more? He said: Some of them are not trained well enough and some
of them don't want to get a phone call on a weekend.
Now, that was a pretty grim analysis by another doctor. But it really
calls into question, first, pharma's producing 14 billion--14 billion--
opioid pills for America, and doctors handing to patients a 30-day
prescription when, in good conscience, a few days would have been more
than enough.
The question is this: How do we at the Federal level--and I am asking
the Senator because he is a moderate-to-conservative Democrat, and I
know he is not looking for the big hand of government to solve all our
problems--deal with pharma overproduction and how do we deal with
doctors overprescribing?
Mr. MANCHIN. Basically, I truly believe it has been a business plan.
That is being very cynical, if you will.
We have a lawsuit going on in the southern part of West Virginia
right now, in Boone County. There has been a judge there, Judge
Thompson, who has been more active than anybody I have ever seen. He
has a case before him now, and it basically involves four or five
distributors.
So you have pharmaceutical manufacturers that go to the distributors
and basically spread it out to the pharmacies. They sent, in a very
small period of time, over 200 million pills into a little part of our
State. Now, you are telling me they didn't think they were
oversupplying an area. Shouldn't somebody have raised a flag there? A
moral conscience would say: There is no way they can consume this much.
There is no way that a small rural area can consume this much
narcotics. Something is wrong.
Are you telling me that wasn't a business plan? So I am going to
testify. They asked me. I said I am most happy to. I would love to be
on the stand. I want them to question me about what has happened to our
State. I am happy to be accountable for that because I want someone to
look me in the eye and say: You didn't know we only have X amount of
people. We only have 1.85 million people in the whole State. If you
take 6 or 7 of these counties, you might be talking a couple hundred
thousand people. You are sending 200 million pills to a couple hundred
thousand people--to every man, woman, child, and baby? Something is
wrong with you, and I want to hear that answer.
So yes, it doesn't matter whether you are a Democrat or Republican,
whether you are conservative or liberal. This doesn't have a home. This
is a killer. It doesn't matter whether you are at the low end of the
socioeconomic ladder or at the top end. It is hitting everybody.
Mr. DURBIN. I want to thank the Senator for yielding for questions
through the Chair, and I would just say to him that I know the problem
he faces and the Presiding Officer faces.
Mr. MANCHIN. We are both fighting it.
Mr. DURBIN. It is twice the intensity and the problem of my State,
and I feel it personally. There is no town too small and no suburb too
wealthy to avoid the opioid addiction, leading to heroin in 80 percent
of the cases and heroin overdoses and deaths.
If you pick up an obituary column in downstate Illinois, my home
area--small towns and rural areas, much like West Virginia--and you see
the name or photograph of someone between the ages of 18 and 30, I have
to tell you that in most instances, it is this--a heroin overdose. It
is a sad reality all across my State.
Mr. MANCHIN. Let me tell you what we are dealing with, I say to the
Senator from Illinois and the Presiding Officer, my colleague from West
Virginia. We face it every day.
I am going to read a letter here from another family. I do it once a
week because it puts a real family with it. But we have such a
situation that we now have people who, because of the hard financial
time some States are hitting, are saying: Why don't you just legalize
marijuana? Just legalize it, they are telling me. That will help all
your problems with all the taxes you will receive. I can tell my
colleagues that 99 percent of the addicts I talk to, when I ask them
how they got started--how did you go down this path of destroying your
life--they say: It started with recreational marijuana.
I have people coming to me and saying: You are a public leader. You
are in the political arena. Don't you think we need this revenue? I
know we need revenue, but I don't think we need it by fostering more
addicts. If an addict is telling me not to do it, and then I have other
people saying the opposite, I am not going to do it. I can't do it in
all good conscience.
So this is what we are facing right now. If they think of the revenue
from
[[Page S4521]]
narcotics--the revenue from these destroying drugs we have--and if the
doctors don't understand it, here is the problem, as I have just said.
We have top-notch pharmaceutical manufacturing companies doing many
good things for us and improving our lives by producing a product, and
we have, basically, the Federal Government--the DEA and the FDA--
approving it and allowing it to get into the market. Then, we have the
doctors, the most trusted people next to our family, saying: Take it;
it will help you; it will be good for you. Then, we have a full-flown
epidemic.
We are fighting Zika now. We have Ebola and all these other things.
We are concerned about epidemics, and here we already have one that is
full-blown and matured, and we are not doing anything. So I am hoping
that common sense will prevail.
We found a pay-for--a lifeboat, basically. It is one penny. Opponents
are saying it is going to be passed onto the consumer. Well, it can't
be. The CDC basically controls the pricing. So they can't gouge the
people. Trust me, it is as profitable as anything they make in the
pharmaceutical arena. One penny on a milligram is not going to bankrupt
anybody, and it is not going to keep any product off the market that is
needed. Tell me how else we are going to get $1.5 billion to $2 billion
every year to help people get off of this horrible epidemic.
I thank the Senator for helping.
I want to continue reading a letter from one of our constituents. My
colleague gets them the same as I get them, and we talk about this all
the time. I want to thank her for helping me fight this because
together we are going to make a difference.
The letter goes like this:
I reach out to you in hopes of possibly making a future
I've worked really hard for a little brighter. My name is
Kayla, and I am a recovering addict. My sobriety date is
February 13, 2013. I struggle with addiction to pain
medication of all sorts. It started out as drinking and
smoking when I was 13. That's basically all I ever did until
I turned 17 and tried my first pill.
It blew me completely out of control from there. While in
active addiction, I got in trouble with law enforcement for
stealing and received a charge for grand larceny. This is
when I was only 20, and that was the first and last time I've
been in trouble with the law.
This was a nonviolent crime, basically, for stealing.
Continuing with her letter:
I've changed so much since the day I took the first pill. I
completed rehabilitation at Crossroads Recovery Home in
Gilbert, West Virginia, along with my dear friend Jessica
Grubb who sadly lost her battle to this horrible disease.
My colleague and I have sponsored ``Jessie's Law,'' and so we know
about this tragedy.
Continuing with the letter:
It truly saved my life. When I completed treatment, I came
home to start Drug Court in Greenbrier County, West Virginia.
I completed that without any sanctions the whole course of
the year I was in the program.
I recently moved to Washington State with my husband and
children. I want more than anything to take my recovery and
life a step further by starting college. Ever since I was a
little girl my dream has been to become a veterinarian. That
has never changed in my almost 26 years of life. Due to my
felony, that dream more than likely can't come true. I would
not be able to hold a license unless otherwise approved by
the Board of Veterinary Medicine. It's not likely they would
approve me.
I have worked so hard to be where I'm at today. My dream is
to apply to Ohio State University in August of 2016 for the
spring 2017 semester. I know I can be a vet. I want to prove
to addicts everywhere that there is light at the end of that
tunnel. The pain can be stopped. You can go from having to
have a fix to get out of bed to having a Doctorate of
Veterinary Medicine.
I want to show everyone that this small town West Virginia
opioid addict made it, and not only that she make it, but
that she pushed the limits and reached the stars. The rumor
is true. We do recover.
Now, let me tell my colleagues the rest of the story. Right now,
unless we change the laws, unless we change our attitudes about how we
treat addiction and look at it as an illness that needs to have
treatment--unless we can do that and find the treatment--we will have
people like this person, who got sober--she has been sober for over 6
years--and turned her life around and wants to be a doctor of
veterinary medicine, which she doesn't think she can do now because she
ruined her life at a very young age and for which she is now paying the
consequences. But it was a nonviolent crime. It was a nonviolent crime.
What we have said, and what we are trying to forge into a piece of
legislation, is that if you have a felony on your record from a drug
addiction and it was not violent--you didn't do it with a violent crime
of guns and weapons and harming people, it wasn't a horrible sexual
crime, and none of those things happened; all you did was steal, which
is a crime, and you have a felony on your record--and if you go through
drug rehabilitation, if you become a mentor for at least another year--
so that is a 2-year recovery--you then qualify to go before a review
panel, which will probably be made up of your sentencing judge, the
arresting officers, and the addiction treatment center personnel, who
can say you deserve to have one chance in life to clear your record, to
expunge your record and now to be a productive citizen, to be a doctor
of veterinary medicine, or to be able to be anything you want.
Yes, you did screw up. You made a heck of a mistake. But now we are
going to give you that second chance because you have fought forward
and become clean. You are sober, and you are helping other people
become clean and sober. If not, we are going to throw a whole
generation of absolutely productive Americans out.
What I am asking for is consideration on both sides of the aisle,
Democrats and Republicans. Forget about being Democrats and
Republicans, and let's be Americans. Let's reach out and help people
who want to be productive Americans and who want to contribute to
society.
These are the things we have to do that are common sense. I am hoping
all of us will come together, and I know we will.
(Mr. PERDUE assumed the Chair.)
Mr. President, I thank the Chair for allowing me to speak on this
subject. I do it every week. I am going to continue to do it until we
make changes. This affects your beautiful State of Georgia the same as
it affects West Virginia. This is one thing we all agree on. We must
end this opioid drug addiction, this drug-infested addiction this
country has. We are the most drug-infested Nation on Earth.
When you consider that 80 percent--80 percent--of all the opioids in
the world that are produced are consumed in a country that has less
than 5 percent of the world's population--in the United States of
America--something is wrong. We are better than this. We are better
than this.
Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant bill clerk proceeded to call the roll.
Mr. DURBIN. 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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