[Congressional Record Volume 162, Number 113 (Wednesday, July 13, 2016)]
[Senate]
[Pages S5058-S5066]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 COMPREHENSIVE ADDICTION AND RECOVERY ACT OF 2016--CONFERENCE REPORT--
                               Continued

  Ms. MURKOWSKI. Mr. President, there is a great deal of discussion 
this week on very difficult and hard issues.
  The comments of the Senator from California, which were preceded by 
the comments of our colleague from South Carolina, remind us that as 
lawmakers, as policymakers, our jobs are indeed difficult, as we do try 
to make good on that pledge for a more perfect union because we are 
clearly not there today.
  I am on the floor to speak to another type of killer that we face in 
this country, and that is the killer that comes with drugs, substance 
abuse, illegal drugs, opioids, heroin--this insidious scourge that has 
afflicted us as a nation. We are fortunate in that we have an 
opportunity--hopefully soon--to be voting for the Comprehensive 
Addiction and Recovery Act, CARA.
  I thank all of my colleagues who have been involved in this effort, 
very aggressively pushing this bill. Senator Portman from Ohio, Senator 
Ayotte from New Hampshire are among the many who have stepped forward 
to really shine a light on an area where we know that we need to work 
to develop a comprehensive solution, a community-focused solution to so 
much of what we are dealing with.
  The CARA act touches on all areas of this issue, from education to 
awareness, from access to treatment to preventing and treating 
overdose, from families to veterans to infants with neonatal abstinence 
syndrome, and even teens who may suffer a sports injury. Opioid and 
heroin addiction is a serious threat to our Nation's prosperity, and 
the legislative initiative that we have in front of us is one way to 
fight back.
  The rates of opioid abuse have skyrocketed. Drug overdose-related 
deaths have more than quadrupled since 1999. When an addict can no 
longer afford to get access to opioids, we find, unfortunately, that 
they oftentimes turn to heroin, a cheaper alternative with similar 
effects.
  The rates of heroin overdose have tripled between 2010 and 2014. In 
my State of Alaska, we like to think that sometimes we are far enough 
away geographically that we are isolated or insulated from some of what 
happens in the lower 48. But in fact we have seen instances of heroin 
use, opioid abuse, that have resulted in statistics that are 
shattering. Efforts to prevent those deaths by overdose have resulted 
in many States, like the State of Alaska, passing legislation which has 
removed the liability for a family member to administer the lifesaving 
drug naloxone. CARA does this, as well, through grants that improve 
access to medically assisted treatment, opening access treatment to 
overdose treatment, and it provides for first responder training.
  Over the course of these many months, there have been so many 
personal horror stories about the impact of opioid and heroin addiction 
in our respective States. We have witnessed the sense of urgency and 
desperation as we hear those stories from families who are truly 
desperately seeking help.

[[Page S5059]]

Too often those families face a multitude of different challenges from 
treatment centers that are at capacity, very expensive private 
options--if you can find them--that put families in a financial bind. 
In so many cases, there is just no option. In Alaska our options are 
extraordinarily limited, so what happens is that you have to send your 
loved one outside of the State to find treatment if you can find it. 
There are so many of our families that simply lack the tools or the 
resources to help those they love who are suffering from substance 
abuse. They don't have the resources, and they really don't know where 
to turn. They don't even know whom to talk to.
  Addiction to opioids and heroin does not just harm the individual; it 
breaks the community. It leaves these communities with a sense of 
hopelessness amongst the loss.
  But despite the anguish that we know that addiction brings, I 
actually have been very inspired by several of the communities in my 
State that have really come together to fight back and to deal with the 
levels of addiction that they see in their communities and say: No, we 
are going to be engaged; we are going to come together to make a 
difference.
  In 2014, the community of Juneau lost seven young people--all in 
their early twenties--to drug overdoses. After they lost their loved 
ones, what happened was that these families just kind of closed up. It 
was very difficult, extraordinarily hard, to be able to talk about what 
had happened because, quite honestly, of the stigma that is attached to 
drug abuse.
  By 2015, a year later, that community came together and said: Enough. 
Our silence is not going to help anyone.
  So they came together to help support families. They formed a group 
that provides support, educational tools, and community outreach.
  This group, which is called Stop Heroin, Start Talking, works 
proactively with Alaska's young people, goes into the classrooms to 
talk with the kids early on about drug abuse, and focuses on making 
kids active participants in the discussion, instead of just kind of 
preaching the talk to them.
  In the Matanuska Valley, another group called Fiend 2 Clean runs a 
Facebook page and reaches out to at-risk teens in the community. They 
also run a peer-run support system that really empowers these young 
people by reminding them: Look, you are not alone in this. We are here 
as a resource, we are here to talk to, and we are here with you.
  Fiend 2 Clean works with another organization called MyHouse to 
empower young people and really support them as they are developing job 
skills, building self-worth, and understanding their role in the 
community. These peer-focused programs make the difference. They really 
help make the difference in the day-to-day lives of these young people, 
their families, and their communities. More importantly, these efforts 
highlight the importance of making sure that all members of the 
community are involved in addressing addiction.
  CARA acknowledges that any successful efforts at combating opioid and 
heroin addiction must focus on building community-centered and 
culturally inclusive methods that engage everyone who may be impacted 
by drug abuse.
  The grants within CARA will give States and local communities the 
funding, as well as the tools they need, to build these sorts of 
relationships and work toward not just treating but really preventing 
that abuse up front.
  We have seen rapid rates of prescribing opioids for pain, largely due 
to a lack of consensus on uniformity or prescribing opioids. While many 
State legislative bodies in the Department of Health and Human Services 
have already begun to do their part in addressing prescribing 
guidelines and establishing prescription drug-monitoring programs, CARA 
takes this one step further. The task force on pain management will 
provide more information about pain management practices by supporting 
evidence-based practices as they examine the trends of opioid 
prescription nationwide.
  CARA also offers support for our Nation's veterans by improving 
opioid prescribing safety measures within the VA system through 
education and training on pain management for our providers. I think we 
have all heard far too many stories of concerns from our veterans or 
from their families where, in an effort to get a vet through the system 
and with not enough providers or with a backlog, the easiest thing to 
do is just to provide a prescription for pain medication rather than 
really trying to work to rebuild that body.
  In addition, there are provisions to improve patient advocacy, 
support the integration of care, and enable multiple treatment 
options--depending on that particular veteran's needs--really moving 
away from this rush to prescribe opioid medications.
  CARA provides the support and treatment needed for postpartum mothers 
and infants with neonatal abstinence syndrome and establishes a pilot 
program meant to enhance funding flexibility so that States can support 
the services that will properly benefit women and their children. CARA 
will also improve the reporting and understanding of addiction related 
to youth sports injuries. I think we recognize that kids are out 
playing soccer or basketball, doing things, and they get hurt. Those 
providers who are treating them need to be included in the discussion 
of how to treat sports-related youth injuries. Kids shouldn't just be 
given highly addictive medications, opening them up to possibly future 
addiction. Again, let's look at comprehensive pain management care that 
is focused on different treatment options.
  The families, friends, and communities that are working together to 
address opioid addiction need to know that they are not alone and that 
the situations they face are not hopeless.
  We can provide that hope. We can provide the tools needed to build up 
these communities so they can really come together to fight back 
against the addiction that we see. I think that by moving forward and 
passing CARA, we take the steps to do this.
  This legislation takes into consideration the diversity and the 
magnitude of the opioid epidemic and works to address this issue head-
on through improved research, pain management practices, community-
focused programs, and opening up the dialogue about drug addiction 
because we know that the more we allow ourselves to talk openly and 
honestly about this issue, the more that stigma fades.
  CARA is an encouraging first step. We all know there is much more 
work to be done, and I certainly remain dedicated to the fight against 
substance abuse now and well into the future.
  With that, I yield the floor.
  (At the request of Mr. Lankford, the following statement was ordered 
to be printed in the Record).
 Mr. INHOFE. Mr. President, today we have the opportunity to 
vote on an important piece of legislation that will support efforts to 
combat the opioid epidemic our country is facing. In my home State of 
Oklahoma, we have seen deaths from prescription drug overdose on the 
rise. In 2014, Oklahoma set a new record in the number of deaths by 
overdose. During that time, 864 people lost their lives and 510 of 
those people had prescription drugs as the cause. Oklahoma has 
continuously ranked near the top of the nation in narcotic prescribing 
activity and overdose deaths.
  In 2015, Oklahoma sought to address this problem by introducing House 
bill 1948 that requires doctors to check an online database before 
prescribing opioids. This law went into effect in November and was 
designed to help spot patients who are receiving prescriptions from 
several physicians at the same time, a practice known as doctor-
shopping. Oklahoma is taking an important step in addressing the opioid 
epidemic, but as we know, this does not just affect my State, but the 
entire Nation.
  The Comprehensive Addiction and Recovery Act, CARA, will provide 
grants to States to fight the abuse of prescription pain relievers and 
heroin, as well as grants that address criminal justice activities, 
treatment of pregnant and postpartum women with substance abuse 
problems, first responder education and training and treatment and 
recovery programs.
  In addition, CARA addresses the opioid issue as it affects the 
veterans' community specifically. Our veterans have put their lives on 
the line to protect our Nation, and it is our job to make sure that 
they are getting the

[[Page S5060]]

treatment and prevention services they deserve. Many of our veterans 
come home with painful injuries that will alter their daily lives going 
forward. It is important that, through the Department of Veteran's 
Affairs, we develop best practices for pain management that do not lead 
to addiction. CARA addresses this by requiring that all VA employees 
who prescribe opioids receive education and training on pain management 
and safe opioid prescribing practices.
  This truly is a comprehensive response to the opioid epidemic, and I 
hope my colleagues will join me in support of this bill as we take an 
important step in combating this addiction crisis.
  The PRESIDING OFFICER. The Senator from Delaware.


                                  Iran

  Mr. COONS. Mr. President, tomorrow will mark 1 year since the United 
States, the United Kingdom, France, Germany, Russia, China, and Iran 
reached an agreement to prevent Iran from obtaining or developing a 
nuclear weapon. This afternoon, I intend to review where we are today 1 
year after the deal--also known as the Joint Comprehensive Plan of 
Action, or JCPOA. I am grateful a number of my colleagues will come to 
the floor today as well, or are submitting statements for the Record, 
reviewing where we are 1 year later.
  As I said 1 year ago, roughly--in September--when I ultimately 
decided, after long and thorough and detailed consideration, to support 
the agreement, those of us determined to prevent a nuclear-armed Iran 
have a real, enduring, and ongoing responsibility to undertake 
consistent and clear-eyed assessments of how this agreement fares and 
not just over the course of its first year but over the many years to 
come.
  In short, in my assessment so far, this deal has done what it 
intended to do. Because of aggressive enforcement of the terms of the 
agreement, the JCPOA has cut off Iran's most likely short-term uranium 
and plutonium pathways to building a nuclear weapon. The time it would 
take for Iran to break out, to assemble enough fissile material for one 
nuclear weapon has extended significantly from just 2 to 3 months to 
well over a year.
  The international community, in turn, has upheld its commitments 
under the deal, providing Iran with relief from nuclear-related 
sanctions. More importantly, the agreement has given the IAEA, or the 
International Atomic Energy Agency--the world's nuclear watchdog--
unprecedented searching access to oversee all of Iran's nuclear 
activities with intrusive inspections and round-the-clock remote 
monitoring.
  I will review for a few more minutes all the different ways I and 
some of my colleagues have worked to ensure effective enforcement of 
this agreement.
  First, as to the IAEA inspections I just mentioned. At my urging, the 
Senate State and Foreign Operations Appropriations Subcommittee 
provided nearly $95 million in funding for the IAEA--a $5 million 
increase over the level requested by President Obama. On top of giving 
the IAEA greater resources, this increase, I believe, sends a strong 
signal to Iran and our international partners that we intend to enforce 
the JCPOA; that we intend to encourage voluntary contributions by our 
international partners to strengthen the agency and to sustain its 
ability to take advantage of the unique opportunities under this 
agreement for a searching and continuing insight into Iran's nuclear 
activity.
  Advocating for additional U.S. support for the IAEA is just one of 
the steps my colleagues and I have taken over the past year to ensure 
the nuclear agreement is implemented effectively and enforced strictly. 
In a series of 15 floor speeches since December, during which I have 
been joined by nearly a dozen members of my caucus, I have sought to 
keep this agreement on our radar to ensure that Congress is effectively 
monitoring it and that we are relentlessly enforcing its terms.
  Holding Iran accountable doesn't just mean enforcing the JCPOA. It 
also means pushing back on that regime's bad behavior across the Middle 
East--behavior that falls outside the scope of the nuclear agreement. 
That is why I have called for the Obama administration to strengthen 
its efforts to interdict Iranian arms shipments to the Houthi rebels in 
Yemen, and--like a police department after a successful drug bust--to 
then publicize that those interdictions have occurred and the weapons 
they have seized, demonstrating to the American people and our partners 
in the Middle East the full scope of Iran's destabilizing activities 
and our intention to keep cracking down on those activities, which is 
crucial to building a broad coalition that will sustainably counter 
Iranian aggression.
  That is why I have also worked with my colleagues to provide $117 
million this year for the U.S. Treasury's Office of Terrorism and 
Financial Intelligence, which enforces American sanctions against bad 
actors, including enforcing some of the very sanctions that crippled 
Iran's economy and forced it to the negotiating table in the first 
place. That funding represents a significant increase of $17 million 
since 2013, and I am fighting for an additional $6 million this next 
fiscal year.
  I have also held discussions with foreign leaders, from Israel to 
Saudi Arabia, India, Qatar, Turkey, and Russia, about how we can work 
together to sustainably counter Iranian aggression. I have called on 
the administration to levy new sanctions against an entity affiliated 
with Iran's hardline Revolutionary Guard Corps, known as Mahan Air, and 
I will make the same demand of the next administration.
  I have worked to impose penalties on Iran for its dangerous and 
provocative behavior, which means taking action against their 
destabilizing support for the murderous Assad regime in Syria and their 
promotion of terrorism throughout the Middle East, Iran's ongoing 
ballistic missile tests, and the regime's human rights abuses, from its 
executions of juveniles to its detention of journalists and Iranian-
American citizens.
  I have also joined my colleague Senator Graham in leading a letter to 
President Obama calling on the administration to include a strengthened 
10-year MOU, or memorandum of understanding, on defense priorities with 
our vital ally Israel.
  I am determined to continue these efforts in the months and years to 
come. We cannot avert our eyes from Iran's destructive behavior, even 
as we review what progress has been made in the year since the JCPOA.
  If we are to ensure that agreement remains intact, if we are to 
succeed in our task of preventing Iran from developing or obtaining a 
nuclear weapon, Congress must play an active role. If the agreement 
succeeds, we should recognize those successes. If Iran falls short of 
the terms of the agreement, we need to make certain the international 
community reacts swiftly to bring Iran back into compliance.
  Regardless of whether my colleagues opposed or supported this 
agreement a year ago, regardless of where one stood then, we all have 
an interest today in working together to ensure we prevent Iran from 
ever being able to develop a nuclear weapon. We have a responsibility 
then to review Iran's actions and hold them accountable through 
aggressive enforcement of the deal, pushing back on their bad behavior, 
and maintaining a credible conventional deterrent.
  As my colleagues comments later today will make clear, in addition to 
holding Iran to the terms of the nuclear deal, we have to push back 
against their dangerous nonnuclear bad behavior--as I mentioned, the 
ballistic missile tests, human rights violations, and support for 
terrorism.
  I know my colleagues and I remain committed to overseeing strict 
enforcement of the nuclear agreement with Iran and protecting the 
security of our allies and partners in the Middle East, especially our 
vital ally Israel. I also know we remain committed to showing that 
international engagement and multilateral diplomacy can be effective, 
even with rogue regimes like Iran.
  These commitments are why my colleagues and I are on the floor this 
afternoon and evening. These commitments will continue tomorrow, as the 
Senate Foreign Relations Committee, on which I serve, holds a hearing 
that will review closely where we are 1 year since the JCPOA.
  I thank Chairman Corker and Ranking Member Cardin for regularly 
holding hearings to assess the nuclear deal and for convening 
tomorrow's hearing, which I look forward to attending.

[[Page S5061]]

  Our commitment to overseeing the implementation of this important 
agreement can and must continue for its entire duration. Even if 
another crisis emerges, we must remain vigilant and push for the most 
aggressive enforcement of this deal and not be distracted by 
developments in other parts of the world. That is my commitment for as 
long as I have the honor of representing the people of Delaware in the 
Senate.
  I am grateful to some of my colleagues who will join me on the floor 
later today--Senator Carper, Senator Peters, and Senator Blumenthal. I 
would also like to thank the senior Senator from Pennsylvania, Mr. 
Casey, for his steadfast effort to support our vital ally Israel and 
ensure swift multilateral consequences for JCPOA violations.
  In closing, let me say this. We--this body, this Congress, the people 
of this country--must make a clear distinction between the Iranian 
regime and the Iranian people. The Iran regime deserves scrutiny, 
condemnation, and opposition for a decades-long pattern of human rights 
abuses, support for terrorism, and bad behavior, but the Iranian people 
deserve our support in their fight for freedom, democracy, and human 
rights.
  With that, I am hopeful we will hear soon from my good friend and 
fellow Delawarean, the senior Senator from our State of neighbors, who 
has been a leader in my State for decades. I know later this evening we 
will also hear on these important topics from Senators Peters and 
Blumenthal as well.
  I am grateful to all of my colleagues who have joined me in 
colloquies and statements on the floor on this important topic in the 
past, and I just hope we can, in a sustainable and bipartisan way, 
insist on effective and rigorous enforcement of this deal throughout 
its entire term.
  Mr. President, I yield the floor.
  Mr. CASEY. Mr. President, this week we are marking the 1-year 
anniversary of the signing of the Joint Comprehensive Plan of Action. 
This week, 1 year ago, my colleagues and I began the enormous task of 
reading, analyzing, and making a decision about whether or not we would 
support the deal.
  For me, that task took 6 weeks of careful study, several classified 
briefings, countless meetings with experts and conversations with 
constituents. As I wrote, on September 1 last year, ``This agreement 
will substantially constrain the Iranian nuclear program for its 
duration, and compared with all realistic alternatives, it is the best 
option available to us at this time.''
  We were under no delusions that the JCPOA would be a panacea for all 
of our problems with Iran. Rather, it was envisioned and designed to 
meaningfully address one major issue: Iran's pursuit of a nuclear 
weapons capability.
  In my decision, I wrote, ``We need not, and indeed should not, trust 
the Iranian regime.'' On the 1-year anniversary of the deal, that 
statement remains true.
  One of the strengths of the JCPOA is a robust, arguably 
unprecedented, monitoring and verification mechanism. We need to fully 
fund the International Atomic Energy Agency in support of its efforts 
to monitor Iran's compliance with the JCPOA; that is why I supported an 
increase to the U.S. voluntary contribution to the IAEA in this year's 
budget.
  We also need to see greater transparency from the IAEA. On July 6, 
Ambassador Dennis Ross wrote, ``Recent reports from the International 
Atomic Energy Agency indicate that Iran is in compliance with the 
JCPOA, but the level of information they provide is dramatically less 
than that found in previous IAEA reports on Iran's nuclear program.''
  Specifically, Ambassador Ross identified several key elements of the 
deal that were not included in the IAEA's most recent report: the 
amount of low enriched uranium currently stockpiled in Iran, the number 
of centrifuges still operating at Natanz, and research and development 
activity on centrifuges, to name a few. I urge the administration to 
work with the P5+1 and the IAEA to increase the transparency of these 
reports. If Iran is indeed complying, there should be no need to hide 
the details.
  My decision was also predicated on the assumption that Iran would 
continue to foment instability and support terrorism in the region. The 
JCPOA did not address this issue, and likewise, it in no way curtailed 
our ability to sanction and hold accountable terrorist groups and 
facilitators. These tough sanctions remain in full force and effect.
  Iran continues its aggressive and destabilizing actions in the 
region, including by providing robust financial and material support to 
its terrorist proxies, Hezbollah and Hamas, as well as to the murderous 
Assad regime in Syria and the Houthi rebels in Yemen.
  Iran unequivocally remains the world's leading state sponsor of 
terrorism. The Hezbollah Secretary General Hassan Nasrallah recently 
stated, ``Hezbollah's budget, its income, its expenses, everything it 
eats and drinks, its weapons and rockets, come from the Islamic 
Republic of Iran.'' We know that Hezbollah is seeking advanced rocket 
capability, which could be used against Israel. We know that Hezbollah 
has become the ground force of the Assad regime in many parts of Syria.
  Last week, I introduced bipartisan legislation with Senator Isakson 
called the Stop Terrorist Resources and Money, or STORM Act. This bill 
will authorize the President to designate countries that are not doing 
enough to stop terrorist financiers and facilitators as ``Jurisdictions 
of Terrorism Financing Concern.'' With that designation comes 
significant penalties or the requirement to enter into a technical 
assistance agreement with the United States to improve their capability 
to investigate and prosecute terrorist financiers. Although Iran is 
already designated a state sponsor of terrorism, the President could 
use this new authority to hold accountable jurisdictions where Iranian 
terrorist proxies and their supporters operate with relative impunity.
  When the Iranians complain that they are not getting the influx of 
European business that they anticipated following the deal, maybe they 
need to take a hard look at their support for terrorism. With the 
sanctions on Iran for terrorism and human rights still firmly in force, 
it is no wonder that European financial institutions and other 
businesses are wary of doing business in Iran.
  One year on from the signing of the JCPOA, I continue to believe that 
implementation of this agreement is firmly in our strategic interests. 
We knew that implementation would be difficult and that the Iranians 
could not be trusted.
  Rigorous congressional oversight has been critical in this first 
year. We have pushed for increased sanctions on illicit ballistic 
missile activity, and the administration responded. We have tightened 
sanctions on Hezbollah and introduced new legislation to counter 
terrorism financing more broadly. We have advocated for a 
transformative investment in our defense relationship with Israel, 
which continues to face threats from Iran and its proxies. We will 
continue to ask tough questions and demand answers.
  We will also continue to prepare for the possibility that Iran may 
violate the agreement. This means maintaining the legal architecture 
that would be needed to snap back sanctions in the event of a 
violation; I have said that I will support a clean reauthorization of 
the Iran Sanctions Act. This also means toughening our deterrence 
policy, both here in Congress and in the White House, to ensure, as I 
wrote in my statement last year, ``The Iranian regime should not doubt 
our capability and willingness to respond swiftly should they attempt 
to break out and develop a nuclear weapon.''
  One year after the Joint Comprehensive Plan of Action was signed, we 
should redouble our commitment to ensuring that Iran cannot acquire a 
nuclear weapons capability and be firm in our resolve to counter their 
aggressive actions in the Middle East. But we should also commend the 
wisdom of this body for allowing the agreement to go forward, as it 
remains the best available alternative to constrain Iran's nuclear 
ambitions.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mrs. CAPITO. Mr. President, I ask unanimous consent that 
notwithstanding rule XXII, the only remaining postcloture time be the 
following: Capito-Baldwin, 15 minutes; Carper, 10 minutes; Markey, 10 
minutes; further,

[[Page S5062]]

that following the use or yielding back of that time, that all 
postcloture time be yielded back and the Senate vote on the adoption of 
the conference report to accompany S. 524.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.


                      Congratulating Carla Hayden

  Mrs. CAPITO. Mr. President, I would like to begin my statement first 
of all by congratulating Carla Hayden, who was just confirmed as the 
14th Librarian of Congress. I know she will do a good job. I am very 
proud of her and I look forward to working with her and the Library.
  Mr. President, earlier today I was proud to support cloture for the 
CARA bill. It puts us on track to reverse this epidemic and promises to 
provide help to so many who are impacted by addiction. We will be 
hearing also from my friend and colleague Senator Baldwin because we 
both believe strongly that our veterans are one of those many groups 
this bill seeks to assist.
  A little over a year ago, under the leadership of Senator Baldwin--
and I thank her for that--the two of us introduced the Jason Simcakoski 
Memorial Opioid Safety Act, which provides safer and more effective 
pain management for our Nation's veterans. This legislation, named 
after U.S. Marine veteran Jason Simcakoski of Wisconsin, who died at 
the Tomah Veterans Affairs Medical Center as a result of a mixed drug 
toxicity, is included in the CARA bill. In fact, title IX of the bill 
is titled the Jason Simcakoski Memorial and Promise Act.
  Tragically, stories like Jason's exist all around the country, 
including my own State of West Virginia. Andrew White, another marine, 
returned home to West Virginia only to be placed on a cocktail of 
drugs, including anti-psychotics, over twice the recommended dosage. 
Andrew died in his sleep at the age of 23.
  Far too many of our veterans have returned home from overseas to 
fight another battle here at home. This legislation will update and 
strengthen the guidelines for opioid prescriptions and require--
require--the VA to expand the scope of research, education, delivery, 
and integration of alternative pain management.
  Chronic pain should not be something our veterans are forced to live 
with, and the VA must be on the cutting edge of developing effective 
pain management. Our hope is, this will provide the VA with the tools 
it needs to help prevent these types of tragedies from occurring.
  Again, I thank Senator Baldwin for her very great work in this area.
  So many across the Nation, and particularly in rural States like West 
Virginia, which has the unfortunate distinction of having the largest 
amount of drug-related overdose deaths--more than twice the national 
average--are impacted by addiction. CARA is a comprehensive step 
forward in the national response to this drug epidemic.
  We have heard throughout the day how it expands prevention, 
education, promotes resources for treatment and recovery. It includes 
reforms to help our law enforcement create alternatives to 
incarceration, such as successful drug court programs.
  We have also heard of the many organizations that are in support of 
this--over 200. It may be approaching 300 now. These organizations deal 
with addiction and the results of addiction on a daily basis. I believe 
one of the reasons so many organizations support this bill--and I know 
that part of the reason I am so proud to support the bill--is it 
addresses how addiction affects not only the addict or their family but 
the well-being of an entire community.
  Following a drug prevention seminar I held last year, one of my 
constituents said:

       There is a need for the community to be involved in 
     resolving the drug addiction issue. It is my hope and prayer 
     that we can find community based solutions that will improve 
     the lives of all the citizens in our community, county and 
     state.

  CARA contains many ideas and opens the door for communities to take 
actions to help neighborhoods and schools. It authorizes much needed 
programs for prevention and education.
  Another one of my constituents wrote:

       Our young people are dying off by the dozens and a 
     generation of children think of this as normal.

  Some of the saddest letters I have received have been about those who 
have already lost their battle to the scourge against addiction. A 
grandmother from Martinsburg wrote the following:

       Our granddaughter--that tall, exuberant redhead who laughed 
     her way into our hearts, is now a statistic.

  As a grandmother myself, I love the way she phrased that--laughed her 
way into our hearts.

       Several days ago our son called to tell us that she had 
     died the night before from a heroin overdose. . . . It was 
     that quick. Our granddaughter started her drug journey with 
     prescription drug opiates. When those pills weren't enough, 
     heroin stepped in, and the downward spiral began.
       It isn't just the problem kids . . . who get hooked. Our 
     granddaughter came from a stable, affectionate home. Even 
     though her parents tried their best to save her with 
     countless sleepless nights, multiple trips to re-habs, tough 
     love and loving persuasion, that drug won the battle.
       Now, we are not even allowed to grieve. We must also 
     contend with the many forms of our anger; impatience with our 
     granddaughter for not being stronger, rage at those who sold 
     her the drugs, frustration with the authorities for not doing 
     more to stop the trafficking or establishing more treatment 
     centers, and self-recrimination for maybe not doing enough.
       We are also trying to cope with the guilt of feeling relief 
     that her hell is finally over. There is nothing more we can 
     do for her now, no more treatments that we can try.
       She's gone. Just . . . gone.

  Will the passage of CARA stop all overdoses or ensure that no other 
grandmother or family feels this anguish? No. But it does begin to 
address the frustrations and pain this grandmother and so many others 
feel. CARA attempts to break the cycle of repeated overdoses by 
encouraging the use of followup services for those who have received 
the drug naloxone to reverse the opioid overdose.
  Too many stories of addiction start like this one, with prescription 
pain killers. By allowing the partial fill of certain opioid 
prescriptions, reviewing best practices for acute pain management, and 
expanding prescription take-back days and locations, CARA will reduce 
the number of unused painkillers and hopefully prevent future cases of 
drug abuse and addiction.
  We cannot continue to lose 129 granddaughters, sisters, fathers, 
neighbors, and friends every single day to drug overdoses. As I have 
said before and will say again, we will lose a generation if we don't 
address this crisis now. This cannot be the new normal for our young 
people or for our communities.
  I commend all who have worked on this bill to get us to this point. 
It is time to pass CARA and send it to the President's desk. Our 
communities in West Virginia and across the country cannot afford to 
wait any longer.
  The PRESIDING OFFICER. The Senator from Wisconsin.
  Ms. BALDWIN. Mr. President, Congress is taking a critical first step 
to combat our country's opioid crisis and a major step in providing 
safer, more effective, and higher quality care for America's veterans.
  I want to speak about my bipartisan Jason Simcakoski Memorial Opioid 
Safety Act, which is included in the final version of the Comprehensive 
Addiction and Recovery Act, known as CARA. This bipartisan legislation 
reforms opioid prescribing and pain care at the VA.
  These bipartisan reforms to veterans health care that I authored, 
along with my colleague Senator Shelley Moore Capito, should unite us 
all. They represent our responsibility to honor and care for those who 
have served and sacrificed for our Nation, and their families--and all 
our families.
  This bipartisan legislation is named in honor of Wisconsin Marine 
Veteran Jason Simcakoski. On August 30, 2014, Jason tragically died. He 
died in Wisconsin's Tomah Veterans Affairs Medical Center of mixed-drug 
toxicity. At the time of his death, Jason was on 14 different 
prescription drugs, including opioids.
  Jason's heartbreaking story is just one example of the 
overprescribing and pain care problem within the VA in Wisconsin and 
across the country. I believe the VA's overreliance on opioids has 
resulted in getting our veterans hooked rather than getting them the 
help they need, and it is our job to act now to address this epidemic.
  At this time last year, I joined Senator Capito on the Senate floor 
to introduce our bipartisan measure in honor of Jason and the entire

[[Page S5063]]

Simcakoski family. I was proud to work closely with the Simcakoski 
family, as well as medical professionals and veterans service 
organizations, to craft these reforms to prevent Jason's tragedy from 
happening to any other veteran or their family.
  This legislation, shortly to be approved by the U.S. Senate, will 
provide safer and more effective pain management services to our 
Nation's veterans by strengthening and updating VA opioid prescribing 
guidelines. It will enhance education and training and expand access to 
opioid alternatives. It will create an independent Office of Patient 
Advocacy at the VA to give veterans and their families a stronger voice 
in their care. The bill strengthens VA hiring practices to help prevent 
bad doctors from treating veterans. It will hold VA accountable for 
providing quality care to our veterans by strengthening opioid 
oversight and reporting.

  The story of Jason's bill is a story of Congress doing the job that 
we were elected to do by the families of our States and the communities 
we represent.
  The Simcakoski family called on us to stand up for our brave men and 
women in uniform, and we took action. For more than a year, I have 
worked across the aisle with Senator Capito and leaders of the Senate 
Veterans' Affairs Committee to advance my reforms in the Senate. The 
House of Representatives did their part by moving forward with a House 
companion measure based on our bill. When it came time for my 
colleagues to agree on the final package that we have before us today, 
I worked with the Simcakoski family to ensure that it reflected the 
strongest possible response to the opioid overprescribing and pain 
management problems at VA.
  I thank my colleagues--particularly the 20 Senators who cosponsored 
the bill--for their work and help in passing the Jason Simcakoski 
Memorial Opioid Safety Act today.
  I thank my partner in this bipartisan endeavor, Senator Shelley Moore 
Capito of West Virginia.
  I wish to express my sincere appreciation for Senate Veterans' 
Affairs Committee Chairman Isakson and Ranking Member Blumenthal and 
their staffs for their commitment to combating opioid abuse at the VA.
  I thank Leader Reid and Senators Murray, Schumer, Leahy, Wyden, 
Alexander, and all the members of the conference committee for their 
steadfast support of these reforms. And importantly, I want to thank 
and recognize all of their staffs and my staff for their tireless work 
through late nights and weekends to get this bill to the finish line.
  This legislation is informed by the collaborative efforts of a broad 
range of outside health and veterans organizations, and I am grateful 
for their expert contributions.
  I cannot forget the incredible work of Senate legislative counsel--
specifically Tom Heywood for his expert drafting, redrafting, and 
redrafting, and technical expertise on this bill.
  Today we send major veteran reforms--my Jason Simcakoski Opioid 
Safety Act--to the President's desk for his signature. I am proud that 
Congress put aside differences and joined together to help fix what has 
been broken and help restore the sacred trust with our veterans and 
their families.
  The Simcakoski family has inspired us by showing tremendous courage 
and strength in sharing their tragic story of loss and in working to 
make a difference in the lives of other veterans and their families. I 
believe that today's passage of the Jason Simcakoski Memorial Opioid 
Safety Act marks one of Congress's great accomplishments--to provide 
our veterans and their families with the care they have earned and 
deserve.
  My closing message comes from Jason's widow Heather. Heather said:

       When I look back at the past, I want to know we made a 
     difference. I want to believe we have leaders in our country 
     who care. I want to inspire others to never give up because 
     change is possible.

  I want to say to Marv and Linda, Jason's parents; to Heather and 
Anaya, Jason's wife and daughter; and to Jason: Thank you for inspiring 
me. Thank you for demanding that we stand together to enact the 
strongest opioid safety reforms for veterans and their families. You 
have inspired true change. This change will save lives, and you have 
given us all hope for a brighter future.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Delaware.
  Mr. CARPER. Mr. President, before I talk a bit about the 1-year 
anniversary of the signing of the Joint Comprehensive Plan of Action 
between the five permanent members of the U.N. Security Council, plus 
Germany, with Iran, I want to take a moment to say to the Senator from 
Wisconsin that I am privileged to serve with her on the Senate 
Committee on Homeland Security and Governmental Affairs. I have had a 
chance to see and witness her sincerity, her commitment, and her 
dedication on this front, and I commend her.
  I serve with the Senator from West Virginia--not on Homeland Security 
but on Environment and Public Works. I commend her for her bipartisan 
spirit that we see here and I commend the leadership they have both 
shown to ensure that the right thing is done.


                                  Iran

  Mr. President, I thank Senator Coons, my colleague from Delaware, for 
organizing a floor colloquy of Members to take place this afternoon to 
discuss the 1-year anniversary of something we call the Joint 
Comprehensive Plan of Action--or the Iran nuclear deal--that was signed 
literally a year ago tomorrow by the five permanent members of the U.N. 
Security Council, plus Germany, with Iran.
  At this time a year ago, there were a lot of skeptics as to whether 
Iran would keep its part of the bargain and not go forward with 
developing nuclear weapons. We heard arguments that they would evade 
inspection and that Iran would never live up to their obligations under 
the agreement that we signed a year ago tomorrow. We heard that they 
couldn't be trusted. We heard that they would not keep their word. We 
heard any number of accusations and speculation. We heard that the 
people of Iran wished death upon America and wished to continue the 
antagonistic relationship with the United States that dominated U.S.-
Iranian relations after the Iranian revolution.
  I just want to say a year later that I believe there is good reason 
to believe the critics were proved wrong when Iran took those 
irreversible steps to dismantle its nuclear weapons program--steps that 
were certified by the nuclear watchdogs at the International Atomic 
Energy Agency. For example, national inspectors certified that Iran had 
reduced its stockpile of enriched uranium by 98 percent and that the 
remaining enriched uranium was only enriched at levels consistent with 
peaceful energy uses. Inspectors from the International Atomic Energy 
Agency certified that the nearly 15,000 centrifuges for enriching 
uranium have been dismantled, leaving Iran with only its least 
sophisticated centrifuges that can be used solely for peaceful 
purposes. The inspectors from the International Atomic Energy Agency 
have also certified that the special heavy water reactor that could 
produce the kind of plutonium needed for a nuclear bomb will produce no 
more. Inspectors saw firsthand that the core of that reactor had been 
filled with concrete, rendering it incapable of ever producing 
plutonium again. Inspectors from the International Atomic Energy Agency 
continue to assess that Iran is keeping up with its commitments in the 
nuclear agreement.
  I have never been to Iran. I hope to go someday. But a place I have 
been to is Southeast Asia. I served 3 years in a war in that part of 
the world, with a country with which we were at war--in some cases, 
almost a proxy war but at war for many years, the Vietnam war. The 
names of 55,000 men and women are on a granite wall about 2 miles from 
where we are standing here today, close to the Lincoln Memorial.

  When the war was over--the war was winding down--my Active-Duty tour 
with the U.S. Navy as a naval flight officer came to an end, and I 
resigned from my regular commission and assumed a Reserve commission 
and continued to fly with the Navy as a P-3 aircraft mission commander 
in the Naval Reserve for another 18 years.
  The month after I retired from the Navy as captain, I was a member of 
the House of Representatives. I led a delegation of six of us--all 
Vietnam members of U.S. House of Representatives--back to Vietnam in 
August of 1991. We

[[Page S5064]]

went at a time when, even though we were not at war with Iran, there 
was still great animosity between our two countries. Some of that was 
spurred by the fact that we never found out what happened to thousands 
of American MIAs. They disappeared, in some cases almost without a 
trace. We had very little cooperation from Vietnam to try to find out 
the truth of their demise. There is a lot of speculation that they are 
being held as POWs in Vietnam, Cambodia, or Laos, and there were 
actually photographs of people alleged to be our MIAs who were being 
held in captivity--we didn't know where but the assertion was in 
Vietnam or Cambodia or Laos.
  During our congressional delegation trip in August of 1991, it turned 
out that the pictures that were shown on the cover of Newsweek and TIME 
magazine and on the front pages of newspapers across the country were 
not Americans; they were Soviet nationals. There was an effort by 
people in Cambodia--bad people--to try to extort money from the 
families of the American MIAs who never came home. The people in those 
pictures were actually Soviet nationals, not missing Americans.
  During the midst of all of this back-and-forth about the MIAs from 
America from that war, six of us participated in a congressional 
delegation. We went to Vietnam. We met with the new leader of Vietnam, 
a fellow named Do Muoi, who became the leader in August of 1991 of the 
Communist Party, making him the top leader of Vietnam. We presented to 
him from the George Herbert Walker Bush administration a roadmap to 
normalize relations. This was the deal: Vietnam, if you will open up 
your archives, open up your war museums, allow us to explore, excavate 
crash sites, have free movement around your country to see if Americans 
respond or people believed to be Americans respond--if you will do all 
those things, we will reciprocate, and we will move toward normalized 
relations with your country.
  There was a lot of lack of faith on the sides of both countries, 
Vietnam and us. The Vietnamese were fearful that we would move the 
goalposts, that even if they did all the things they were required to 
do under the roadmap to normalize relations, we would move the 
goalposts and still not normalize relations. For our part, there was 
concern that they would never do those things anyway, so why should we 
bother.
  At the end of the day, we engaged with the Vietnamese, and they 
engaged with us. They did the things they were supposed to do, and we 
did as well. We normalized relations about 4 years later.
  John Kerry and John McCain did good work in the Senate. Our 
delegation did good work in the House. The George Herbert Walker Bush 
administration passed the baton to President Clinton, and normalized 
relations were established about 4 years later. The first U.S. 
Ambassador to Vietnam was a member of our delegation, former POW and 
former Air Force pilot Pete Peterson.
  Fast-forward about 25 years later, a month and a half ago, President 
Obama was nice enough to invite me to join him on a trip to Vietnam, 
along with a couple of Congressmen. A lot changed in those 25 years. 
Today the United States of America is Vietnam's top export market. 
Today Vietnam is part of the 12-member transpacific trade partnership 
we are endeavoring to establish and get approved here and in 11 other 
countries.
  While we were over there a month and a half ago, the Vietnamese 
announced an $11 billion deal with Boeing. They are going to buy 100 
737 jets valued at $11.3 billion from Boeing. They announced that they 
are going to buy from Pratt & Whitney--a big aircraft engine company--
another $3 billion worth of engines to put in 63 Airbuses.
  The President lifted the ban on arms sales to Vietnam, and a lot of 
other announcements were made. While we were over there, we learned 
that a survey of the Vietnamese people done earlier that year indicated 
that 84 percent of the Vietnamese people had a favorable opinion of the 
United States. Another survey indicated that 95 percent of the 
Vietnamese people have a favorable opinion of the United States. They 
like us more in Vietnam than we like us.
  Meanwhile in Iran, Iran is not unlike Vietnam--a young nation. There 
are about 78 million people who live in Iran. More than half of them 
are under the age of 25, and they have a great affection for our 
country. Some of the leaders do not, but many of the people do, 
particularly the younger people. They want a better life with us and a 
better relationship with us.
  They have had elections since the joint agreement was agreed to, 
elections in their Parliament and in the Council of Experts, which 
elects the next Supreme Leader. The moderates, the reformers made great 
strides in those elections earlier this year. There were very 
encouraging results.
  A year later, among other things that have happened, the Iranians 
decided they have had a hard time accessing capital to be able to 
purchase things----
  The PRESIDING OFFICER (Mr. Perdue. The Senator's time has expired.
  Mr. CARPER. I request 1 more minute, Mr. President.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. CARPER. Just as the Vietnamese have finalized a large deal--the 
purchase of American jets--the Iranians announced about 2 weeks ago 
that they will be purchasing a number of 747 jumbo jets built by 
Boeing, 737s, 777s. The value of the deal is worth about $17 billion 
over the next 4, 5, 6 years.
  I would suggest to our colleagues who say we can't trust these guys 
that we still have problems with what they are doing with some of their 
missile testing. We have problems with support of Hezbollah and other 
terrorist groups like that. For the most part, they have kept their 
word on the joint deal we signed, the Joint Comprehensive Plan of 
Action.
  We are starting to see some commerce transact between both countries 
that actually inure to our bottom line to strengthen the economy of 
this Nation.
  I just want to say--is it time for us to spike the football? Is 
everything fine? No. Eyes wide open. That is important. Eyes wide open. 
Having said that, I think most fairminded people would say: So far, so 
good. Let's continue to be vigilant, and hopefully a year from now, the 
second anniversary of the signing of this joint agreement will have 
even better news not just for us but for the rest of the world.
  With that, I thank you, Mr. President, for that extra minute.
  I yield to the Senator from Massachusetts.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. MARKEY. Mr. President, I would like to start my remarks on the 
Comprehensive Addiction and Recovery Act with a story I received from 
one of my constituents, David. He is a patient at Hope House in Boston. 
Hope House is the oldest and one of the largest residential treatment 
programs for adults in Massachusetts. This is what he said:

       Senator Markey: Addiction has totally ruined my life. It 
     quickly took everything from me and my family. It has 
     stripped me of my dignity and self worth along with my self 
     respect. I also lost the trust of my entire family.
       Addiction started late for me. I was 44 years old. I had 
     everything I could possibly dream of. A beautiful wife, a 
     son, two step-daughters that I raised and put through 
     college. We also built a new home in 2000. I had a great 
     career and was a few years away from 20 to retire.
       Then my family and I went on vacation for two weeks and I 
     came home with a parasite in my stomach for which I was 
     prescribed pain medication. That was at the end of April that 
     year. In May, I had my appendix taken out. In June, I had to 
     have my gallbladder out. All the while being prescribed pain 
     meds.
       Before I knew it, I was addicted. It wasn't long after that 
     there were no more scripts to be had. Then I was doing 
     heroin. This was so scary for me because I had not used any 
     drugs my entire life. Within two years, everything was gone. 
     Wife, family, job, house. Everything.
       It has been a real struggle to get out and stay clean 
     between not being able to get a detox bed, or, if I did, 
     after five days, only to be told that there were no beds 
     available for further treatment. Which meant back on the 
     street to start the whole process over again.
       I finally did make it to the Hope House, which I am so 
     grateful for. I know I am going to make it this time; I just 
     feel it. Thank you for the chance.

  I pray for David and all the patients at Hope House. They found the 
help they needed, and we hope they will

[[Page S5065]]

have the strength and the support to achieve long-term recovery.
  I am proud that this opioid legislation contains provisions of the 
TREAT Act--The Recovery Enhancement for Addiction Treatment Act--a bill 
I introduced with Senator Rand Paul of Kentucky and other colleagues 
here in the Senate. The TREAT Act addresses the demand side of the 
opioid epidemic.
  I firmly believe that if we are going to reduce the supply of heroin, 
fentanyl, and illicit prescription drugs, we have to reduce the demand 
through treatment. But for far too long, outdated and scientifically 
unsound Federal restrictions have severely limited access to effective 
medication-assisted treatment like Suboxone for opioid addiction. The 
TREAT Act removes these restrictions. Importantly, the TREAT Act would 
allow appropriately trained nurse practitioners and physician 
assistants to treat patients with these lifesaving therapies.
  These TREAT Act provisions, which are included in the CARA conference 
report, will increase access to treatment, especially in community 
health centers and rural communities across this country. I am grateful 
that these provisions are included in the bill we will vote on today. I 
am hopeful they will have an impact in the future.
  It has been a long haul and hard work over the last few years, but we 
have achieved a measure of success that will impact lives as soon as 
this bill is signed into law. I sincerely thank Senator Murray and 
Senator Alexander for their support on the TREAT Act. I thank Senator 
Hatch and Representatives Pallone and Upton and all the CARA conferees 
who worked to get the TREAT Act provisions included in this final 
package we are voting on today. I would like to express my appreciation 
to Senators Whitehouse and Portman and all of the Senate and House 
cosponsors of the TREAT Act who supported efforts to get the law 
changed so that more people can get the treatment they need.
  In Massachusetts, I am hearing enormous frustration from people who 
don't feel that adequate resources are being brought to bear on this 
enormous epidemic of prescription drug and heroin addiction. Just like 
David, countless people suffering from addiction cannot find a bed for 
detox, and then when they are at their most vulnerable moment in 
recovery, they cannot find a place or provider of long-term treatment.
  For the months that we have been debating CARA in this Chamber, we 
have heard the statistics. Our Nation is experiencing more deaths from 
drug overdoses than from gun violence or auto deaths. Eighty percent of 
people suffering from heroin addiction started on opioid pain 
medications approved by the Food and Drug Administration and prescribed 
by doctors who aren't required to receive education on safe opioid 
prescribing.
  Nearly 30,000 people in the United States died of an opioid overdose 
in 2014. Approximately 1,300 of those were in Massachusetts. Of those 
1,300, 754 had fentanyl in their system. Massachusetts is 2 percent of 
America's population. If you multiply 754 times 50, you are up to 
37,000 people dying from fentanyl in our country. That is like having a 
war in Korea every single year. We haven't even begun this battle on 
fentanyl. But it is coming, and it is coming with an urgency that is 
very difficult to even imagine. The total deaths from opioids in 
America would be equivalent to a Vietnam war every single year, and 
fentanyl is 50 times more powerful than morphine--unbelievable. That is 
how powerful it is--50 times more powerful.

  This is just something that we are going to have to deal with, and 
approximately 2.5 million Americans abused or were dependent on opioids 
in 2012, but fewer than 1 million received treatment for their 
condition. Out of the 2.5 million people who needed help, only 1 
million got it in our country. We are being overwhelmed by a tsunami of 
heroin, prescription drugs, and fentanyl addiction, and we must stop it 
before it drowns any more families in our country.
  We had an opportunity here to make sure we put real funding into this 
bill for more treatment. We are not going to meet that challenge here 
today. We do need funding for those families--funding for treatment 
providers who help put people on the path to recovery and funding for 
our sheriffs, firefighters, and other first responders who carry the 
overdose prevention drugs that save lives. We need funding for the 
public education campaign so that we can prevent addiction before it 
takes hold. We will not save lives and stop this scourge of addiction 
unless we, in fact, ensure that there is full funding for treatment. We 
will save lives with more treatment options, more Narcan, more 
counselors, more education, more beds, and a better continuum of care, 
but we must fund it.
  The bill we are voting on today is a good step, but we still have 
much further to go. Without that funding, this effort will not do the 
full job that our country wants us to do. Our cities are fighting a 
war, and we need to help them. We are hemorrhaging lives by the day. If 
we are to staunch the flow of suffering and death, we desperately need 
funding to implement all of the programs in this bill.
  Ladies and gentlemen, we are at a defining moment in our national 
discussion to address the public health crisis of addiction. Our work 
doesn't stop here. It has only just begun. Let's be clear. Stopping the 
overprescription of opioid pain medication that is fueling addiction 
and overdoses starts with the prescribers. We need to require anyone 
who prescribes opioid pain medication and other controlled substances 
to undergo mandatory training on safe prescribing practices and the 
identification of possible substance use disorder.
  We need to make sure that people who enter the judicial system don't 
arbitrarily have their Medicaid coverage terminated, making it more 
difficult to access treatment once they are released and fueling, once 
again, the vicious cycle of incarceration.
  We need to make sure that all opioids approved by the Food and Drug 
Administration are first reviewed by independent experts to ensure that 
these drugs are not only safe and effective but also won't continue to 
fuel the epidemic of addiction in this country.
  We need to make sure that prescription drug monitoring programs are 
fully utilized and nationally interoperable in order to prevent doctor 
shopping, and we must let Big Pharma know that their army of lobbyists 
on Capitol Hill will be matched by an army of advocates that work every 
day to raise awareness and save lives.
  The Congress has an opportunity to let all those struggling with 
addiction know that help is on the way. We know that we have heard 
their stories, and we will not forget them.
  We must let them know that no matter how dark life seems right now, 
there is hope, and sunlight will grace them once again, and this 
Chamber has not finished this job--this journey--that we must be on 
with every family in our country. Substance abuse is a crisis the likes 
of which we have never seen in America. A decade from now people will 
ask: What did you do to help end this epidemic? That is why I stand 
today congratulating all of those who worked on this bill, and we must 
also pledge to continue to stand up and fight for the funding and other 
investments we need to make.
  We must stand united to end this crisis of addiction in our 
communities now and for generations to come so that children will not 
have to look to the history books to find that there ever was a year 
like 2016 with an epidemic that is raging across the country.
  I yield back the remainder of my time.
  The PRESIDING OFFICER. Under the previous order, all postcloture time 
has expired.
  The question is on agreeing to the conference report.
  Mr. ALEXANDER. Mr. President, I ask for the yeas and nays.
  The PRESIDING OFFICER. Is there a sufficient second?
  There appears to be a sufficient second.
  The clerk will call the roll.
  Mr. CORNYN. The following Senators are necessarily absent: the 
Senator from Mississippi (Mr. Cochran), the Senator from Oklahoma (Mr. 
Inhofe), the Senator from Kansas (Mr. Roberts), the Senator from South 
Dakota (Mr. Rounds), the Senator from Alabama (Mr. Sessions), and the 
Senator from Mississippi (Mr. Wicker).
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
desiring to vote?
  The result was announced--yeas 92, nays 2, as follows:

[[Page S5066]]

  


                      [Rollcall Vote No. 129 Leg.]

                                YEAS--92

     Alexander
     Ayotte
     Baldwin
     Barrasso
     Bennet
     Blumenthal
     Blunt
     Booker
     Boozman
     Boxer
     Brown
     Burr
     Cantwell
     Capito
     Cardin
     Carper
     Casey
     Cassidy
     Coats
     Collins
     Coons
     Corker
     Cornyn
     Cotton
     Crapo
     Cruz
     Daines
     Donnelly
     Durbin
     Enzi
     Ernst
     Feinstein
     Fischer
     Flake
     Franken
     Gardner
     Gillibrand
     Graham
     Grassley
     Hatch
     Heinrich
     Heitkamp
     Heller
     Hirono
     Hoeven
     Isakson
     Johnson
     Kaine
     King
     Kirk
     Klobuchar
     Lankford
     Leahy
     Manchin
     Markey
     McCain
     McCaskill
     McConnell
     Menendez
     Merkley
     Mikulski
     Moran
     Murkowski
     Murphy
     Murray
     Nelson
     Paul
     Perdue
     Peters
     Portman
     Reed
     Reid
     Risch
     Rubio
     Sanders
     Schatz
     Schumer
     Scott
     Shaheen
     Shelby
     Stabenow
     Sullivan
     Tester
     Thune
     Tillis
     Toomey
     Udall
     Vitter
     Warner
     Warren
     Whitehouse
     Wyden

                                NAYS--2

     Lee
     Sasse
       

                             NOT VOTING--6

     Cochran
     Inhofe
     Roberts
     Rounds
     Sessions
     Wicker
  The conference report was agreed to.
  The PRESIDING OFFICER. The Senator from Arizona.

                          ____________________