Congressional Record, Volume 163 Issue 110 (Tuesday, June 27, 2017)

[Congressional Record Volume 163, Number 110 (Tuesday, June 27, 2017)]
[House]
[Pages H5221-H5228]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

{time} 1645
OPIOID ADDICTION CRISIS

The SPEAKER pro tempore. Under the Speaker's announced policy of
January 3, 2017, the gentleman from Pennsylvania (Mr. Murphy) is
recognized for 60 minutes as the designee of the majority leader.
Mr. MURPHY of Pennsylvania. Mr. Speaker, tonight, I am joined by a
number of Members here to talk about one of the most insidious problems
our Nation has faced in a long time. It is the problem of opioid abuse.
We are in a crisis mode.
We have now reached a point where we will have more deaths from drug
overdoses this year than there are names on the Vietnam Veterans
Memorial Wall in Washington. That is a frightening concept.
There is almost no county, no State in America, that is not affected
by this. Some areas have much more. Places in eastern Kentucky,
southern West Virginia and up the Ohio Valley, and places in New
England and out West have seen this as a growing problem as death rates
rise.
There are things we can do about this. But in order to have some
discussion of what we can do about this, we are going to talk about how
we got to this problem and then what we can do to go beyond that.
I want to start off by yielding to the gentleman from Oregon (Mr.
Walden), the chairman of the Energy and Commerce Committee, to talk
about what this means in one State alone, the State of Oregon.
Mr. WALDEN. I thank the gentleman, who chairs our Oversight and
Investigations Subcommittee and is so passionate in not only finding a
solution to the opioid epidemic, but also his great work on mental
health reform as well, as was passed into law in the 21st Century Cures
legislation.
As you know, the year before, the Energy and Commerce Committee also
passed legislation to begin to address this issue. We will be doing a
lot of work, going forward, to look at what is working on the ground
and what is not.
Addiction, as you well know from your clinical experience, is an
equal opportunity destroyer. It is a crisis that doesn't pick parties.
It doesn't pick people because of their race, age, or socioeconomic
status. We all know someone impacted by the opioid epidemic. It has
literally touched every corner of our country and every community in
our States.
The epidemic has hit close to home in my home State of Oregon, where
more people now die from drug overdoses than from deaths in automobile
accidents. I have met with community leaders, first responders,
doctors, police officers, patients, and those on the front lines of
this fight against opioid addiction.
At roundtables throughout the Second District of Oregon, I have heard
firsthand accounts of the impact of the opioid epidemic. It didn't
matter if I was in a rural eastern Oregon community or a more populated
city in southern Oregon. The tragic stories were all too similar and
all too familiar.
Medical professionals across Oregon told me about the rapid
acceleration of the opioid epidemic over the last 20 years. They have
witnessed patient after patient fall into the traps of addiction.
I heard from Oregonians who have struggled with the epidemic
themselves. At our roundtable, a woman in Hermiston talked about how
she became addicted to painkillers. After a minor foot injury, she got
a prescription for an opioid-based painkiller. In her decades-long
battle with this addiction--trying to get off of this addiction--she
was forced to travel more than 5 hours into Washington State just to
find a provider who could help her with Suboxone and get off of her
addiction. There was nobody locally who could help her.
I heard from a father whose son was a high school athlete. He was
prescribed opioids after a sports injury. Tragically, he became
addicted. Soon, he transitioned to what we know as a cheaper and more
deadly version of the drug known as heroin.
Sadly, this young man would not survive his addiction. He died from
heroin. It devastated the family and stole another American in the
prime of his life. This story is repeated all too often.
Combating the opioid epidemic in Oregon and every State of the union
is going to require a real bipartisan team effort to continue, from
elected officials with the input from healthcare experts and those on
the front line of this fight in our local communities.
In the Energy and Commerce Committee, we stand shoulder-to-shoulder,
all of us together, saying: What can we do more to help in this crisis;
to seize the opportunity before us; to look at the legislation that was
enacted in the last Congress to make sure that the grants are getting
to the ground, as they are in my State; and that we are getting the
help and that it is actually working?
It is one thing to pass a bill. It is another to make sure it is
implemented correctly and that it actually works effectively.
I commend my colleague from Pennsylvania, Chairman Murphy, for the
work that he is doing on this and the compassion he has for those
families who are tragically caught up in this addiction. Together, we
are going to find our way through it.
Mr. MURPHY of Pennsylvania. I thank the chairman for his passion and
hard work on the Energy and Commerce Committee. We know this is a life-
and-death issue. This is one of those things where Members are coming
together from both sides of the aisle to deal with.
Let me lay out the background here. How did we get here?
About 80 percent of addictions begin with a prescription. When we see
what has happened here on this chart of heroin increased use and
prescription opioids, there is something that occurred at the beginning
of this millennium where things really began to take off.
On this next poster, seeing here how this is increasing at such a
rate--about 9 or 10 percent--it is understandable you are looking at
some of these rates increasing severalfold just in the last decade,
with increasing jumps. As fentanyl has gotten here, it is even worse.

Back in 1980, Dr. Hershel Jick, a Boston doctor, wrote a letter in
The New England Journal of Medicine, and he said this: ``Out of nearly
40,000 patients given powerful pain drugs in a Boston hospital, only
four addictions were documented.'' Since he published that letter, it
has been cited again about 600 times. Doctors, academics,
pharmaceutical companies, and others use it as evidence of the
unlikeliness of developing addiction.
But it has been criticized soundly, saying that never should have
been said. In fact, The New England Journal of Medicine took the
unusual step of posting a one-sentence warning over the so-called
Porter and Jick letter to the editor that the Journal published in
1980, and it says: ``For reasons of public health, readers should be
aware that this letter has been heavily and uncritically cited as
evidence that addiction is rare with opioid therapy.''
Accompanying this note was an analysis from Canadian researchers
exploring the frequency the letter had been cited, which was almost 600
times.
Here is the tragedy of this. Many physicians and many pharmaceutical
companies said: See, prescribe these opioids; people will be okay. That
was found not to be the case.
Jump ahead to 2001, when The Joint Commission released their pain
management standards, and then shortly after that the American Medical
Association said: let's make pain one of the

[[Page H5222]]

vital signs. The other vital signs being blood pressure, heart rate,
respiratory rate, and temperature. But when pain was also made one of
those as well, doctors began asking questions about that, and basically
screening people along the lines of: On a scale of 1 to 10, what is
your pain level?
Everything else is measured with an instrument objectively, but pain
is subjective. In fact, it is so subjective that it was found that 51
percent of people who are on an opioid have a mood disorder, such as
depression or anxiety. There is a huge amount there.
The thing about this, if a person fails to screen for presence of a
mood disorder, along with other aspects, you really increase their risk
for addiction.
About 50 million Americans, for example, have low back pain. Twenty-
five million of those are on an opioid. Of that group, about 40 percent
have been found to have depression. If you combine depression and
opioid use, you could triple or quadruple your risk for misuse, abuse,
and addiction. It would make sense that before a doctor prescribes in
these cases, concurrently they would also be screening for mood
disorders. That does not appear to be the case.
Here is another part of the problem. Under the Affordable Care Act,
hospital payments are tied to patient pain satisfaction surveys, which
reward hospitals financially when patients give them a high rating for
managing pain. In turn, the hospitals get less money if the patient
says: my pain was not handled.
That is actually question 14 of the Hospital Consumer Assessment of
Healthcare Providers and Systems survey. It asks the question: How
often did the hospital or provider do everything in their power to
control your pain? Doctors feared negative responses, as did many
hospitals, and it was found that probably had an impact on increasing
prescriptions.
Another part of the problem is treatment access. Quite frankly, if
you want to get help, you can't find it. Unfortunately, getting access
to high-quality treatment is unlikely in the United States. Of the 27
million Americans suffering from addiction, less than 1 percent receive
evidence-based treatment.
We have a shortage of trained providers, and half the counties in
America have no psychologists, no psychiatrists, and no clinical social
workers.
Let me add to this also that medication-assisted treatment is one of
those things put up here as a treatment method. If I show you here,
medication-assisted treatment is when a person is replacing their
illegal drug with something like methadone or Suboxone, which Chairman
Walden just referred to.
But here is part of the problem. It is supposed to be the doctor
writing the prescription and then the patient is getting other
treatment. But as is found with medication-assisted treatment, just in
Pennsylvania alone, nearly 60 percent had no counseling in the year
they received the buprenorphine. Forty percent were not drug-tested in
the year they received the buprenorphine.
This is important because a person may receive a prescription but
still remain on heroin or another drug. Thirty-three percent have
between two to five different prescribers writing them a prescription
for this. Where do all those prescriptions go?
This is one of the top diverted drugs. Many times, the patients
simply take those drugs, sell them, and buy the street drugs. Twenty-
four percent of those buprenorphine prescriptions didn't see a
physician in the prior 30 days.
In other words, with medication-assisted treatment, we simply have a
failure to provide other treatment and a low expectation for
improvement, in many cases thinking we will replace one addiction with
another.
Another part is in the area of hospital care. When treating opioid
and heroin addiction, inpatient and residential treatment is crucial
for full recovery, but there are simply not enough treatment centers
and beds. Today, our Nation suffers a shortage of 100,000 inpatient
treatment beds.
Further, we don't have enough providers. When we do have providers,
many times they end up overprescribing.
There was a law in the United States back in the Nixon era called 42
C.F.R., consolidated federal registry. Basically, it made it so that
physicians could not find out in the record if a patient was on other
opioids, in treatment for that, or taking buprenorphine or methadone.
So what happened? Someone shows up in the emergency room, they are in
pain, perhaps a doctor looks in the record and doesn't see anything
there, and writes a prescription. If that person was in treatment and
was recovering from an addiction, and at that point not taking other
drugs, look at what just happened. The doctor may prescribe some
opioids for that patient who was used to taking quite a few at any
given time to have an effect. Now they have this, and they are no
longer thinking: I will take just one or two. They may take more. So
you risk overdose.

The second thing you do is risk a relapse. That person was perhaps
clean for months or years. Now they have OxyContin or some other
opioid, they take it, and they have a relapse.
But there is a third problem that goes with that, and that is the
person may be on other drugs, such as benzodiazepines or other
respiratory suppressants, and that becomes a problem because then the
doctor doesn't know about drug interactions.
So we have this law in place which prohibits sharing of information
about substance abuse treatment between doctors. Doctors unknowingly
prescribe these for people. It causes more problems. We need to deal
with this.
Another level here is fentanyl. Fentanyl is a synthetic opioid which
is a staggering 50 times more potent than heroin and 100 times more
potent than morphine. It has a high potential for abuse. A mere 2
milligrams is fatal. A single packet of sweetener for your coffee is
1,000 milligrams. Take two of those and that is enough to kill you.
Since last 2013, fentanyl has contributed to at least 5,000 overdose
deaths in the U.S., and that is soaring. However, due to gaps in the
data collections, it is likely the number of overdose deaths in the
U.S. is actually much higher.
A low-cost, high-profit, hard-to-detect profile of fentanyl is
increasingly more trafficked to traffickers and relatively easy to
manufacture. China is a major part of this, in that the illegally
manufactured fentanyl shipped to the U.S. via labs in Mexico, smuggled
across the border, then hits our streets.
One other thing I want to point out here, in terms of this problem.
If we look at what some have analyzed in terms of areas that are
hotspots for substance abuse, you can see in here for persons on
disability, look at the sections in Kentucky, West Virginia, Virginia,
along the Mississippi Valley, up the Ohio Valley, and parts out West.
This isn't the only causal factor. Many times you have people on
disability and pain, and what happens is they may be prescribed opioids
as part of that.
When you look here, where age-adjusted death rates occur for drug
poisoning--those overdose deaths--look at the hotspots in America. It
is just about the same out here in the Mississippi-Ohio Valley,
portions out West, where you have these problems.
All of these come together in terms of crime, in terms of drug
cartels, in terms of fentanyl, in terms of poor access to treatment.
I mentioned the hospital beds. By the way, over half the counties in
America have no psychiatrist, no psychologist, no social worker, and no
licensed drug treatment provider.

{time} 1700

It is no wonder we are in this mess. We will talk more about some
solutions here, but I wanted to recognize a number of Members who might
want to talk about this.
Let me first go to the gentleman from Georgia (Mr. Carter).
Representative Carter is also a pharmacist. Let's hear some of his
perspective.
Mr. Speaker, I yield to the gentleman from Georgia (Mr. Carter).
Mr. CARTER of Georgia. Mr. Speaker, I thank the gentleman for
yielding, and I thank the gentleman for hosting this Special Order.
This is certainly a very important subject, one that I am very
familiar with. It is indeed an epidemic in our country. There is not a
State nor a district that hasn't been touched by this problem.
Countless people have succumbed to this issue. That issue is the

[[Page H5223]]

use of opioids and the devastating impact on our communities.
Recent data showed that overdose deaths have jumped by over 50
percent in the decade leading up to 2015. In addition, nearly 1,300
people died in Georgia in 2015 from drug overdoses. These are
statistics that need to be urgently addressed. We have made great
progress with the passage of the Comprehensive Addiction and Recovery
Act, but we have an opportunity to do more.
One staggering statistic is that last year it is estimated that
roughly 60,000 people died from drug overdoses--a number that is far
too high. Just earlier this month, four people in central Georgia died
in a matter of 2 days due to opioid overdoses from falsely labeled
drugs. That instance is not only troubling because it reflects growing
painkiller use in the rural parts of my State, but because it also
represents another problem: counterfeit and fake drugs.
An issue that I have been working on is the growing trend of drugs
and drug ingredients being ordered abroad and delivered through the
mail to addresses around the country.
A recent Wall Street Journal article mentioned the synthetic opioids
that are being brought into this country and the methods by which they
are doing it.
An example of one of those drugs is fentanyl, a synthetic opioid that
is wreaking havoc across the country.
We must not only look at the types of drugs that are being used, but
also how people are acquiring them and how to effectively limit that.
Our enforcement personnel are working diligently with the Postal
Service to find ways to curb this trend, such as using advanced data.
But it is a topic that needs more work. By cutting off their ability to
purchase these dangerous synthetic opioids, we can help to limit this
epidemic.
As a lifelong pharmacist, I have seen firsthand the dangers and
problems associated with opioid abuse and its impact on our
communities. I look forward to working with my colleagues on both sides
of the aisle to counter this trend in hopes of saving lives.
Again, I want to thank the gentleman for hosting this tonight. It is
so very vital to our country. Thank you for allowing me to speak.
Mr. MURPHY of Pennsylvania. As a pharmacist, when people come into
the pharmacy, for example, if they want to get Sudafed, a cold
medication, they have to go through some special process. It is behind
counter. Is that right?
Mr. CARTER of Georgia. That is correct.
Mr. MURPHY of Pennsylvania. Now, what if they wanted to pick up an
opioid prescription? Do they have to show an ID? Are they required by
law to have the same kind of restrictions?
Mr. CARTER of Georgia. Yes, they are. They have to show an ID in
order to pick it up. Now, the prescription itself is a C2 prescription,
so if we don't recognize them at the pharmacy, we have to ask them for
their ID to make sure that is indeed the person who is picking it up.
We also have a program in Georgia, in fact, a program that you are
very familiar with, a prescription drug monitoring program, that allows
us to go and check a database to see if that person has actually been
doctor shopping or is pharmacy shopping and getting it at other places.
That has helped us. It is a great tool in fighting this epidemic.
Mr. MURPHY of Pennsylvania. But as the gentleman knows, that is data
within the State, but across State lines, that data is still not
populated.
Mr. CARTER of Georgia. That is one of the major problems. For
instance, in my practice, I practiced in Savannah, Georgia, which is on
the South Carolina line, and only 2 hours from the Florida State line.
That was a constant problem for us. I could look at my data all day
long, but I wouldn't know whether they had gotten something filled in
South Carolina or in Florida.
Mr. MURPHY of Pennsylvania. I appreciate that. That is a problem we
are going to have to fix in our committee.
I want to call up the gentleman from Ohio (Mr. Johnson), eastern
Ohio. Speaking of being able to jump across State lines and have
prescriptions filled, minutes away from the Pennsylvania/West Virginia
border, could travel down there, and also part of that deadly area
along the Ohio Valley where so much of this is occurring.
Mr. Speaker, I yield to Mr. Johnson.
Mr. JOHNSON of Ohio. I want to thank my colleague, Representative
Murphy, for holding this Special Order on such a critically important
topic.
And you mention that my district borders the State of Pennsylvania,
and it does. And I have had so many incidents of engagement with my
constituents on the opioid addiction issue. Several of them really
stick out.
Representative Murphy, one of those happened in Pennsylvania.
Occasionally, because my district goes all the way up to the top into
northeast Ohio, occasionally I fly in and out of Pennsylvania. I was
there a couple of years ago, and I was sitting in the lounge waiting
for a flight. I happened to be on a phone call, and I noticed that a
gentleman began to look my direction. He very patiently waited until I
got off the telephone, and then he came over, introduced himself. He
recognized me, and he said: I am not one of your constituents, but I
know that you represent a district just across the border in Ohio. He
said: But I want to implore you, to beg you and your colleagues in
Congress, please do something about the opioid addiction. He said: Our
21-year-old son died of an overdose in January. He had just gotten out
of a rehab, was doing well, had gotten a job. He came home one Friday
night, said he was going out with some friends. The next morning his
mother and I found him dead in his room.

I hear stories like that all of the time.
I can tell you that the opioid addiction epidemic that is streaking
across our country is not one that we are going to be able to arrest
our way out of. It is not one that we are going to be able to
incarcerate our way out of. It is an issue, my dear colleagues, that is
going to take everybody from the top to the bottom, from the President
of the United States all the way down to the family members. I am
talking about local government officials, law enforcement, the
judiciary, faith-based organizations, community organizations. This is
something we are going to have to all be engaged in.
We have appropriated, as you know, Representative Murphy, hundreds of
millions of dollars, billions, in fact, to attack the opioid epidemic.
More is needed. We are not going to be able to simply throw money at
this problem. It is going to require a cultural change within our
country.
I have so many other stories, but I don't want to take up more time
because I know I have other colleagues here who want to testify on this
very important issue.
Just know that I am with you. We take this issue very seriously in
our district. Back in Ohio, we are constantly reaching out to law
enforcement, mental health providers, healthcare providers, faith- and
community-based organizations, and families on how to attack this
problem.
I thank you for giving me a chance to speak on it.
Mr. MURPHY of Pennsylvania. I thank the gentleman from Ohio.
I want to next recognize the gentleman from Indiana (Mr. Bucshon).
Certainly he sees this issue, too. As I mentioned before, one of the
problems physicians have, if they do not know what kind of
prescriptions that person is on, for example, a medical record may show
if a person has an allergy to penicillin or something, but you may have
no idea that that patient may, for example, be taking buprenorphine or
methadone unless they tell you or you test for it. And as a surgeon,
what happens when they go to get anesthesia and the complications come
from that, but it is part of the reasons why we have to make sure that
you as a physician have access to these records, things we can clean
up.
Mr. Speaker, I yield to the gentleman from Indiana (Mr. Bucshon).
Mr. BUCSHON. Thank you, Mr. Chairman. Thank you for holding this
Special Order tonight to talk about this really important subject on
behalf of the American people.
The opioid abuse disorder and drug addiction have impacted every
community in our Nation. The epidemic knows know boundaries; does not
discriminate based on age, gender, or socioeconomic status.
According to the Centers for Disease Control and Prevention, 91
American lives are lost every day from an opioid

[[Page H5224]]

abuse overdose. Unfortunately, drug overdoses in Indiana have increased
fivefold over the past decade, and southern Indiana and the Wabash
Valley, the area I represent, are bearing the brunt of this
devastation.
This year in Vigo County, Indiana, population around 108,000
citizens, authorities have responded to over 16 opioid- or heroin-
induced overdoses already this year.
Vanderburgh County, Indiana, 182,000 citizens, saw 29 deaths from
overdose in 2016, which is a fourfold increase from the prior year.
This year, the county has seen 25 confirmed heroin- or fentanyl-related
overdoses already, but the coroner thinks it may be more.
Just this month, we have seen reports of instances of an opioid-based
drug called gray death in Evansville, Indiana.
We are working here in Congress with our States and local communities
to finally bring relief to these families, but a lot of work has to be
done. While we still have much to do, over the past couple of years, we
have actually made significant progress to bring hope to our
communities and expand access to treatment for those who need it.
I was proud to be part of our efforts that we put into law, the
landmark legislation, the Comprehensive Addiction and Recovery Act, or
CARA, and I had the opportunity to author a portion of CARA that
expanded access to medication-assisted opioid use disorder treatment,
ensure patients have wider access to more comprehensive-based treatment
options, and helped minimize the potential for diversion.
As Congressman Murphy mentioned, the key here is ongoing therapy,
counseling, and monitoring. Medication-assisted treatment is not a
panacea, but it is a component of a more comprehensive treatment plan
for each individual.
Through our work in implementing the 21st Century Cures Act, Congress
has provided significant funding for the States. In fact, Indiana
recently was granted nearly $11 million from the Department of Health
and Human Services to help us with this epidemic.
Again, most of us know someone, a family member, a friend, a
neighbor, who has been impacted by this epidemic in some way. As a
physician, I have seen the power of addiction up close and have focused
on shaping real policy solutions here in Washington, D.C., to improve
access to treatment for patients who are battling their problem every
day. We all share in this fight, and we can't end this epidemic through
policy changes alone. It is ongoing, and it is going to take all of us
working together as a community to meet this challenge.
In that respect, I have met with and have been working with people
who represent medical schools and residency programs in our country to
help better educate the physician on prescribing habits as it relates
to pain, whether that is surgical pain or chronic pain. It is a
multifaceted approach, and I commend Congressman Murphy for his
dedication to helping end this crisis in our country, and I thank him
for yielding.
Mr. MURPHY of Pennsylvania. I thank the gentleman for his impassioned
words and dedication here.
I want to refer back to my map here a moment. Dr. Bucshon was
referring to his district in southern Indiana here, which, on this 2014
map, was already showing high mortality rates for those who have drug
overdoses.
Look here in the State of Washington, also an area that, on this 2014
map, showed a lot of problems, and now the problem is getting worse.
Mr. Speaker, I yield to the gentleman from Washington (Mr. Newhouse)
to speak on this issue.

{time} 1715

Mr. NEWHOUSE. Mr. Speaker, I thank the gentleman from Pennsylvania
for his leadership on this important issue and for the opportunity to
address the House on this very important topic.
Mr. Speaker, as you have heard, our Nation is facing an epidemic.
Over the past two decades, opioid overdoses have quadrupled. Think
about that. They have quadrupled in the United States. My home State,
as Dr. Murphy has just mentioned, has faced significant increases in
drug overdose death rates, including a 70 percent increase in synthetic
opioid overdose deaths in just the last 10 years. It is clear that this
is a crisis, which is why we in Congress are committed to combating
this growing epidemic.
Late last year, Congress passed sweeping legislation, called the 21st
Century Cures Act. It was bipartisan legislation that authorized $6.3
billion in funding to bring our healthcare innovation infrastructure
into the 21st century. This legislation included $1 billion for opioid
intervention and prevention treatment programs throughout all 50
States. Earlier this spring, the Federal Government began awarding
grants in order to confront this crisis, including $11.7 million to the
State of Washington.
While these funds will help expand treatment options, there is still
much more work to be done at the Federal level, which is why I
cosponsored legislation like H.R. 1057, the Synthetics Trafficking and
Overdose Prevention, or STOP, Act. Designed to stop dangerous synthetic
drugs like fentanyl, which you heard about, and carfentanil from being
shipped through our borders, this legislation will combat bad actors
from China and India who have been taking advantage of weaknesses in
international mail security standards to break U.S. customs laws and
really wreak havoc on our communities.
This is just one step of the opioid crisis that we must address. We
need to combat the illicit drugs coming into this country as well as
equip doctors, nurses, and first responders with the resources they
need to treat pain appropriately.
We also need to support better access to care for individuals
suffering from psychiatric and substance abuse disorders. And, most
importantly, we must ensure these drugs are not falling into the hands
of our Nation's children.
My colleagues in Congress and I are committed to combating this
epidemic to keep it from causing further harm to our Nation's families
and communities.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I appreciate the gentleman's
comments and his dedication to helping his State of Washington.
Mr. Speaker, I yield to the gentleman from Pennsylvania (Mr.
Rothfus), whose district is just north of Pittsburgh, Pennsylvania, to
talk about some of the problems, in his experience, and his thoughts
about what we should be doing about substance abuse.
Mr. ROTHFUS. Mr. Speaker, I thank the gentleman for yielding, and I
thank him for his long work in this field, not just the last 2 years
but, really, a lifetime in this space. I commend him for that work.
Also, with mental health issues, he has been helping educate Congress
about moving toward solutions.
My colleague has outlined the scope of the national problem we have,
and each of us can talk about our respective districts and what has
been going on there.
In my district, just over the border from my colleague's, western
Pennsylvania has been especially hard hit. In Beaver County, we saw 102
overdose deaths related to opioids in 2016, up from 30 in 2013. In
Cambria County, we lost 94 people to overdose deaths in 2016, a
startling 62 percent increase from 2015.
The stories just keep coming. A story of the mother who lost her 10th
child, her youngest child, to this epidemic, who insisted that the
words ``damn heroin'' be put in her son's obituary. Or the couple we
learned about before Christmas, who overdosed, and 3 days later their
infant died from neglect, all three being found 4 days after that.
Mr. Speaker, it is all hands on deck to address this crisis. We are
coming together at the Federal, State, and community level to develop a
comprehensive strategy to stop this epidemic and to share best
practices at every level. That is what a big part of our Comprehensive
Addiction and Recovery Act, passed last year, was all about--an
important first step.
Another asset we have, Mr. Speaker, is the Office of National Drug
Control Policy. This week, I led a bipartisan group of my colleagues,
in a letter to President Trump requesting that the Director of the
Office of National Drug Control Policy be re-elevated to a Cabinet-
level position.
Since its inception, this Office has played a central and critical
role in fighting drug trafficking and drug addiction. Both the Office
of National

[[Page H5225]]

Drug Control Policy and its Director have played, and should continue
to play, a central role in this effort.
The Office was created in 1988 with the Anti-Drug Abuse Act. Its
mission is to fight the Nation's drug problem through three areas:
prevention, addiction recovery, and enforcement.
The Office's Director, commonly referred to as the ``drug czar,'' was
elevated to the Cabinet in 1993 by President Clinton, who wanted to
raise the Office's profile in order to coordinate and emphasize
legislative efforts on the Hill. More importantly, he wanted to focus
and emphasize efforts within the administration for the antidrug
efforts of the Department of Justice, the Drug Enforcement
Administration, the Department of Education, and the Department of
Health and Human Services. The Obama administration removed the Office
from the position it had in the Cabinet.
When it comes to drug addiction as well as to the illicit drug trade
occurring across our southern border, the challenges have never been
greater. This is no time to retreat in our efforts, and it is time to
restore the Office of National Drug Control Policy to the Cabinet.
The Office is a very important part of the fight against the opioid
epidemic, particularly because it plays a crucial role in coordinating
efforts at various levels of government. In addition to the legislation
that we are passing here in Congress, the administration has a crucial
role to play, as do leaders at the State and local level.

We all want to end this crisis, and this common cause unites us,
perhaps more than any other issue, across party and partisan lines.
Again, I thank my colleague from Pennsylvania for giving me this
opportunity, and I thank him for his work in this area.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank my colleague and
friend for his dedication on this issue. And, yes, he is right: we have
to cross party lines and work on this together.
Mr. Speaker, I yield to the gentleman from Ohio (Mr. Chabot), another
friend, who has seen these problems, as well, in his district and knows
full well how these problems have merged well into the Ohio area, as it
is an insidious problem.
Mr. CHABOT. Mr. Speaker, I thank the gentleman for yielding and for
his leadership in this most important area.
Mr. Speaker, the heroin and opioid scourge is running this country
into the ground, and, unfortunately, the problem appears to be getting
worse, not better. That grim reality is particularly true in my
district in Cincinnati, where, during a single week last summer, city
health officials reported 174 overdoses in 1 week.
Deaths caused by opioids have doubled in my district, where, during
the first 4 months in 2017, the Hamilton County Coroner's Office had
already logged in hundreds and hundreds of opioid overdoses--
heartbreaking numbers.
But numbers only tell part of the story. The circumstances
surrounding the spike in overdoses can, at times, be horrifying.
A couple of months ago, in Cincinnati, Ohio, a 9-year-old girl called
911 about both of her parents, who overdosed on heroin in their SUV.
She told the dispatcher she was scared and that her parents wouldn't
wake up. The girl didn't know where she was or what was wrong with her
parents, but she, fortunately, knew how to call 911. That call saved
her parents' lives.
But no little girl--or little boy, for that matter--should ever be
placed in that situation by their parents, or by anyone.
These types of stories are becoming all too common. Opioids don't
discriminate based on age or race or socioeconomic class. Opioids can
kill anyone, in any neighborhood. Every day, there are more headlines
about how heroin and other opioids are basically taking over the
country.
The simple fact is that nearly every Member of Congress could come to
the floor today and share a similar story from their own district. That
is why, Mr. Speaker, it is imperative that we work together to find new
and more successful ways to combat the opioid epidemic. We need to put
politics aside and help people in need.
Last year, we came together in a bipartisan manner to pass the
Comprehensive Addiction and Recovery Act, or CARA, and I think there is
a good chance that the expanded treatment and recovery options that
legislation created will help some of those suffering from addiction to
turn their lives around.
While CARA will give local law enforcement and healthcare officials
more resources to fight opioid addiction, we need additional
legislation to help combat the importation into the United States of
extremely dangerous synthetic drugs like fentanyl and carfentanil,
which many have blamed for the spike of heroin overdoses. According to
the DEA, much of the supply of these two dangerous drugs on our streets
originates overseas, particularly from China and India.
Bipartisan legislation is being led by Representative Tiberi and
Senator Portman, the Synthetics Trafficking and Overdose Prevention, or
STOP, Act. It would update the customs process to require that advanced
electronic notice of all packages, large or small, be provided to
Customs officials. Providing this information to Customs before the
packages arrive will help them, meaning the Customs agency, to
intercept more illegal shipments and prevent these dangerous drugs from
reaching drug traffickers within our borders.
I am hopeful that this legislation will be embraced with the same
bipartisan enthusiasm that we saw with CARA because the heroin and
opioid problem in this country is too serious, too significant, and too
widespread for us not to work together at every level of government to
find a solution to this epidemic. It is way overdue. We need to work
together in a bipartisan manner about this.
I again want to thank the gentleman from Pennsylvania for his
leadership in this area.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank the gentleman from
Ohio.
I point also on this map here to the Cincinnati area in southern
Ohio, which is one of the hot spots in 2014 that has continued to grow
as a problem. We recognize this is both a local problem and a
nationwide problem.
I want to tell a story here.
Last December, when the President was signing into law the 21st
Century Cures Act, which included my legislation, the Helping Families
in Mental Health Crisis Act, a former State Senator from West Virginia
took the stage to introduce it. David Grubb talked about his daughter,
Jessie, who, herself, had been in rehab, in treatment, something like
three or four times, had had several drug overdose instances and had
been revived. But what happened to her also is part of what they called
the loaded gun that never should have happened.
She went into the hospital for some surgery, but the doctors and
nurses never told her discharging doctor that she was in recovery for
heroin addiction. The point we made before about the NASPA list, or the
other lists there, or the 42 C.F.R., blocks information from going into
the medical record. So while someone was out to protect her privacy,
they didn't protect her from death.
She was given a prescription of 50 opioid painkillers. Remember, I
said before that when a person is given this prescription, they run the
risk of relapse, overdose, or bad drug interactions. In her case, it
was an overdose that finally took her life--another important reason
why we have to deal with this 42 C.F.R. and get rid of that arcane and,
quite frankly, deadly law.

Let me talk about some other recommendations of what I believe
Congress can do to help.
The references made before by Dr. Bucshon and others about the
prescription drug monitoring program--and also Buddy Carter of Georgia
mentioned this, too--where a pharmacist or a physician can say, ``Is
this person on other opioids? Have they jumped across the border? Have
they seen four, five, or more physicians for some opiates?'' by having
a better PDMP, prescription drug monitoring program, or National All
Schedules Prescription Electronic Reporting program, we have to make
sure that all States use the same system and that it collects data from
across borders so doctors can easily see this.
But part of this, too, in dealing with the 42 C.F.R., is
understanding Federal

[[Page H5226]]

law prohibits including buprenorphine and methadone in the PDMP. How
absurd and how cruel that is that a doctor would not even be able to
know that a patient is taking one of those prescriptions.
Also, some of these drugs can end up being a respiratory suppressant,
and when the patient takes another drug such as benzodiazapine, it can
add to that effect and add to further complications.
Another aspect, too, which we must be further engaged with is
vigorous public education programs across all age groups, beginning
with early elementary school.

{time} 1730

When schools have some of these programs--and we will bring forth
some models that talk about these programs in a future hearing I will
be holding in the Oversight and Investigations Subcommittee--these are
very, very important to help students, early on, understand the dangers
of this.
This is not just recreation, but it is so easy to slip into
addiction. Given that 80 percent of drug abuse begins with a
prescription, whether it is a student, athlete, perhaps a football
player who injures a leg or something and he is given some of these
drugs, it is essential the whole family be counseled from the onset,
understanding the concerns and dangers of continuing to take these
drugs.
We also have to have drug take-back programs and public education
programs stressing the importance of proper disposal of unused opiates
and pain prescriptions to prevent them from being stolen or misused.
For example, if a family is selling their home and they are having an
open house and strangers come into the house and while they are there
they say, ``Can I use your restroom?'' and the family lets them do
that, don't be surprised if that person has no intention of buying a
house but does have an intention of going into the bathrooms and
checking the medicine cabinets and finding any medication and taking
it.
Also, when teens come over to the house for parties or socializing,
don't be surprised if they also go into medicine cabinets, look in
drawers in the bathrooms or drawers in other places of the house
looking for some of those drugs which they, themselves, will take or
sell.
We have to make sure we have vigorous patient education programs
about doctor-prescribed opioids to make sure people know about that
before the addiction takes foot. And taking one of these prescriptions
may only take 3 or 4 weeks before it begins to kick in and cause
problems.
I know myself, back in 2005, I was in a rollover accident in Iraq
with a couple of other Members of Congress. Our vehicle rolled, and as
a result of that accident, I ended up having a mild concussion,
snapping my neck, having some temporary paralysis, and a great deal of
pain. Well, battlefield medicine is one that gets you out of the area,
stops the bleeding, stops the pain, and ships you off to some other
hospital, and that was the case for me.
But I know what happens. Everywhere I landed in a helicopter or an
ambulance, appropriately so, the physicians would ask me a number of
orienting questions, but also say: ``Are you in pain? On a scale of 1
to 10, how much pain are you in?'' And when I proceeded to say that
number, immediately, as they would do for many other people in the
battlefield, they would administer morphine or some other pain reliever
and move you on from there.
What happened, though, returning to the United States, where pain
continued for me, I was prescribed some pills for that pain, but I was
also prescribed fentanyl. Never once was it ever described to me: ``Be
careful with this. This is highly addictive. This is a problem.''
Now, after a few weeks on this and recognizing it was hard to even do
my job because I couldn't keep my head clear, I just said: ``That it
is. I am not taking this anymore.'' But at that point, my body had
already begun to develop some tolerance for this, and when I stopped
taking it, I had some reaction.
Granted, it was not as severe as some of those who have been taking
these drugs at a higher dosage and longer, but I could feel myself
actually saying I understand what people mean when they say their skin
feels like it is peeling off of them and they feel a sense of nausea
and other problems as well.
Now, I can't even imagine what it is like for someone who is taking
higher doses for longer periods of time. But it is extremely important
that, every time a prescription is written, pharmacists have an
opportunity to counsel patients and doctors are also doing more than
simply passing out a prescription.
Pharmacists should do what Buddy Carter was saying before: make sure
they have the person showing a photo ID. Is this, indeed, a
prescription they are picking up for themselves or claiming they have
it for someone else? Perhaps that prescription was stolen from someone.
We have to make sure that we also understand, for those out there
trying to legalize marijuana, I caution you, because the marijuana that
is out there on the streets or presented in many areas can cause
tremendous psychiatric problems for those who are already at risk. The
longer you are on some of the types of marijuana, the greater risk you
have for things like delusional behavior.
We have to make sure we also eliminate Medicaid payments for those
question 14 responses I made reference to before when you are in the
hospital to ask if the hospital adequately addressed your pain.
In the area of treatment and recovery, we have to expand the mental
health workforce. As I said before, half the counties in America have
no psychiatrists, no psychologists, no drug and alcohol counselors, and
those who are out there likely have their schedule so filled, they
don't even have room to treat someone. Not all of them even know how to
treat addictive disorders.
The fact that a majority of people who may have an addiction disorder
also have a concurrent mental health disorder is another reason why we
have to increase this workforce by tens of thousands. Just for child
and adolescent psychiatrists alone, we need another 21,000 of those.
We need tens of thousands more psychologists. It is important that
the schools of medicine, schools of psychology, and schools of social
work are graduating more people with these degrees and getting them
into our workforce.
I have had legislation before, and we passed some things in the 21st
Century Cures Act and in my Helping Families in Mental Health Crisis
Act, to provide more funding so that more of these folks can continue
with their education. It is essential. It is like trying to fight a war
without soldiers, trying to fight this war, which is killing more
people every year than the entire war in Vietnam, but we do not have
the soldiers to fight this.

We also have to make sure that, with regard to the government-
sponsored medication-assisted treatment which I referred to before, we
cannot simply rely on synthetic opioid maintenance alone. We have to
make sure there are requirements to have that person in counseling and
treatment.
I have heard from some persons that go to those treatment programs
that they have no counseling at all, and some have great counseling. In
some cases, sitting in the waiting room, perhaps a nurse or someone
simply checks up on them: ``What are you doing? How are you doing?''
That is considered and written down as group therapy. That is not
acceptable in any way, shape, or form.
We need 100,000 more inpatient psychiatric beds, and we have to make
sure insurance companies recognize that an addictive disorder is a
chronic disorder. Simply giving someone a weekend or a few days for
withdrawal and then putting them back on the street is not an answer.
That is why we have to encourage private insurance companies and
Medicaid and Medicare. And I say Medicare because a large number of
people who are having some of these problems are also the elderly.
We have to make sure that we increase the availability of fast-acting
opiate blockers for first responders, such as Narcan. But let's keep
this in mind: In some cases, we hear of some of those pushers of these
drugs who also give an accompanying dosage of Narcan, recognizing that
the drug will bring that person to a near-death experience.

[[Page H5227]]

We have heard from first responders and others, law enforcement,
where someone may actually have a party where someone will remain there
expecting that someone will actually have an overdose and die in order
to bring them back to life. That is how some of these people are
seeking some of those experiences.
We have to make sure that States review their laws, as some are
doing, that if you take one of these opiates and you do have that near-
death experience, perhaps that should be treated the same as a suicide
attempt, that that person is in imminent danger of harming themselves
or someone else and perhaps determine if they need an inpatient
psychiatric stay.
We have to make sure we have support of employment for those in
recovery to break the cycle of recovery and reexposure. Many times,
persons who are trying to stay clean, they can't get a job because they
can't pass the drug test, so they may be in a job and have exposure to
other people who still end up with substance abuse.
We have to make sure they have higher standards and increased
accountability for payment models that require evidence-based treatment
in halfway houses, three-quarter houses, and residential treatment
facilities.
We have to deploy certified addiction counselors to emergency rooms
because we know that, when a person comes to an emergency room, if they
see an addiction counselor there, they are not just simply given a
business card and told, ``Call someone next week and we hope you get
treatment''; but if they see an addiction counselor in the emergency
room, they increase their chances of follow-up by 50 percent, according
to a Michigan study.
We must make sure the FDA is working with companies to find
alternatives to opioids and that, again, Medicaid and other physicians
are educated on some of those aspects.
Physician training has to also be ramped up: require them to have
training in opioid prescribing practices on risk for addiction and
abuse and prescribing limited dosages. Instead of prescribing dosages
for a month, perhaps just a couple of days. In many cases, they are not
adequately trained in alternatives to opioids and the potential harm of
overprescribing.
We have to increase training requirements for healthcare providers
who deliver this medication-assisted treatment. Right now, in many
cases, they only have a few hours of training, and then they can go and
prescribe this and have very little, if any, training at all in drug
addiction counseling. Before doctors write a prescription, we can make
sure they are looking at the NASPER list or other lists as well.
In the area of law enforcement, it is critical that what is called
the High Intensity Drug Trafficking Areas program is made more
available, with greater access around the country.
Mr. Speaker, how much time do I have left in our segment here?
The SPEAKER pro tempore (Mr. Hollingsworth). The gentleman has 7
minutes remaining.
Mr. MURPHY of Pennsylvania. We have to make sure we have more border
security so that we are intercepting these drugs as they come across
the border.
We need funding for the post offices because, in many cases,
unwittingly, the letter carriers are the ones who are delivering to
people's homes fentanyl and other drugs.
In the incarceration system, we have to make sure we are testing
inmates for the presence of drugs in their system during their
incarceration. We can offer them medications which, upon discharge,
actually block any effects of some of these drugs.
We need to also make sure that Medicaid and other insurance
companies' payments resume immediately upon release from their
incarceration to prevent them from relapsing or returning to the drug
culture.
We also have to make sure we have solid data collection. In many
cases, when we show the charts about death rates around the country,
the charts may be grossly inaccurate. In many cases first responders,
paramedics, and coroners do not keep accurate data on these rates. The
persons themselves may not even be tested to see if they died from a
drug overdose.
There are several items in here listing what we can be doing here as
a nation, and there are many more. The point is we have fallen short
and we have seen some problems with this. There is more that we can do
and we must do in order to save lives.
I know I just have about 3 minutes left, Mr. Speaker, am I correct?
The SPEAKER pro tempore. The gentleman has 5 minutes remaining.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield to the gentlewoman
from Ohio (Ms. Kaptur) to talk about some of the issues dealing with
substance abuse.
Ms. KAPTUR. Mr. Speaker, I thank Congressman Murphy for his
incredible leadership on this important topic and for holding this
Special Order this evening.
I can tell you, the citizens of the State of Ohio are paying
attention. The opioid epidemic continues to intensify with over 2
million people addicted to prescription opioids and more than half a
million addicted to heroin in 2015, alone.
According to an estimate from The New York Times, drug overdoses are
now the leading cause of death for Americans under 50; and drug
overdoses are the leading cause of accidental death in our country,
with prescription opioids responsible for more than 20,000 deaths in
the United States just in 2015, according to the American Society of
Addiction Medicine.
I have to mention that Medicaid plays an important role in addressing
this epidemic because it is a lifeline program, providing coverage to
over 650,000 non-elderly adults with opioid addiction and covering a
range of treatment services.
Ohio, tragically, leads the Nation in opioid overdoses in 2014.
Sadly, deaths have continued to rise with increased use of heroin and
fentanyl. Many States have expanded Medicaid, including Ohio, to cover
adults who make a modest $16,500 a year per individual. By broadening
coverage of adults, the Medicaid expansion reaches many low-income
adults with opioid addiction who were previously ineligible for
coverage and facilitates access to treatment.
The opioid epidemic is so bad that even librarians are learning how
to treat overdoses for individuals who come into libraries.
Mental health can be comorbid with opioid abuse, and those suffering
from that duality are truly an American tragedy. For an addict to
complete rehab and recovery successfully, they need to work in concert.
And over half of uninsured non-elderly adults with an opioid addiction
had a mental illness in the past year, with over one in five operating
with a serious mental illness, such as depression, bipolar disorder, or
schizophrenia.
To address the gravity of the challenge, I want to put on the Record
the work that Lucas County, my home county, is doing with their DART
program, which engages hospitals, mental health centers, and businesses
in the community.
Believe it or not, according to Sheriff Tharp, the DART program has
helped nearly 2,300 overdose victims and has a 74 percent success rate
of getting people into detox and treatment programs at a total cost of
about $370 per individual. This is truly an amazing record, and I wish
to include in the Record the information about other counties in the
district that I represent.
The opioid epidemic does not just affect the addicted. Lucas County
Children Services is struggling to help children displaced by the
opioid epidemic.
The agency has been repeatedly forced to do the unimaginable tasks of
comforting children as first responders work to save their parents from
a heroin or fentanyl overdoses. On several occasions, it has had to
break the terrible news to these children that their parents succumbed
to their addiction.
LCCS is also coping with a dramatic increase in the number of
children placed in protective custody because their families have been
blinded by substance dependence. The State's current budget proposes no
increase for this program, which is a shame. This is no time to short
change children.
Finally, I submit for the Record a story of the Guest family of
Lorain, Ohio, whose daughter Tera died of a heroin overdose at the age
of 24.
According to the Cleveland Plain Dealer: ``Tera Guest, 24, died Jan.
29, 2014, shortly after she and her sister used painkillers and a
heroin-fentanyl mix. Her death marked the end of a two-year period that
included stints in treatment and losing custody of her two children to
her mother.

[[Page H5228]]

``Tera is among the hundreds who have died of overdoses within the
last three years in Lorain County. The county coroner's office said a
record 67 people died in 2013, followed by 60 in 2014 and 62 in 2015.''
Lori took her tragedy and turned it into action and formed the Lorain
Community Task Force, which is a group that raises awareness and
provides assistance to addicts and their families.
Lori stepped up, and now Congress must do the same. We cannot turn
our back on these people now. We must fight, we must work together, we
must put politics aside. Only then can we begin to heal our Nation from
this crisis.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I yield to the gentleman
from Wisconsin (Mr. Gallagher).
Mr. GALLAGHER. Mr. Speaker, I thank the gentleman for yielding and
for his leadership on this critical issue.
As was laid out, communities across this country, communities like
mine in northeast Wisconsin, are in the midst of a public health
crisis. It is not a Republican or a Democratic issue. It is an American
issue, one that should bring us all together.
Opioid abuse is wreaking havoc on our homes, our schools, our
churches. Its devastating effects are destroying our families and the
lives of our loved ones.
As was pointed out, more Americans will have died from drug overdoses
in 2017 than there are names on the Vietnam War Memorial. That is
alarming. That should put it into sharp relief.
As a Marine veteran, I am acutely aware that servicemembers are more
susceptible than the average person to addiction. In fact, veterans die
from accidental drug overdoses at a 33 percent higher rate than the
rest of the population, and something must be done to reverse this
awful trend.
I commend our State lawmakers in Wisconsin who are doing aggressive
work on this front, and I commend the gentleman and everyone who has
spoken out for doing the same thing at the national level, and I look
forward to working with him.
Because headline after headline reminds us of the tragic loss of life
that has resulted from our Nation's opioid and addictions risk, we have
to step up. We have to take action.
Mr. MURPHY of Pennsylvania. I yield to the gentleman from Oregon (Mr.
Blumenauer).
Mr. BLUMENAUER. Mr. Speaker, I deeply appreciate the gentleman
convening this Special Order this evening. It has been fun working with
him in the past on creative, bipartisan efforts to try and make sure
the Federal Government is a better partner on this.
I look forward to working with him on legislation that will make it
easier to be able to have the information available that people need
for integrated treatment and his commitment to trying to bring people
together to understand the problem and the fact that we are agreed more
than we are divided on these things. I look forward to working with him
on some progress in the months ahead.

{time} 1745

Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank my friend from
Oregon, and I thank all the Members speaking here tonight. I want to
say, as you saw, this was a bipartisan coalition of Members. We are
much better off working hand in hand to pass legislation that changes
issues than standing next to each other as pallbearers for another
59,000 people in our Nation next week.
Mr. Speaker, with that and with some hope that we can pass this
legislation and save some lives, I yield back the balance of my time.

____________________