[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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