[Congressional Record Volume 164, Number 35 (Tuesday, February 27, 2018)]
[Senate]
[Pages S1245-S1247]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. PORTMAN (for himself, Mr. Whitehouse, Mrs. Capito, Ms. 
        Klobuchar, Mr. Sullivan, Ms. Hassan, Mr. Cassidy, and Ms. 
        Cantwell):
  S. 2456. A bill to reauthorize and expand the Comprehensive Addiction 
and Recovery Act of 2016; to the Committee on Health, Education, Labor, 
and Pensions.
  Mr. PORTMAN. Mr. President, I want to address a critical issue today 
in Westerville, OH, and, frankly, every community I represent in my 
State and communities all over the country. Today, I want to talk about 
the opioid epidemic that is gripping our country.
  Every State represented in this Chamber has had too many communities 
devastated, families broken apart, and lives taken by the opioid 
overdoses. The Centers for Disease Control now tells us more than 
63,000 Americans died from drug overdoses in 2016, the last year for 
which they have records. It also looks like it was worse in 2017. More 
Americans are dying from drug overdoses than the total number of 
casualties during the Vietnam war. Every year, more Americans are dying 
from drug overdoses than the total number of casualties from the 
Vietnam war. Think about that. It is a staggering statistic.
  On average, more than 174 Americans died every single day from a drug 
overdose in 2016. That is up from 143 Americans in 2015 and 105 
Americans in 2010. In other words, it is getting worse, and 2016 was 
the deadliest year on record. Initial estimates for 2017 suggest it is 
going to be even deadlier, including in my home State of Ohio.
  Opioids--prescription drugs, heroin, and synthetic forms of heroin--
are increasingly the reason why. Opioids were involved in about two-
thirds of all overdose deaths in 2016. Opioid overdose deaths were five 
times higher in 2016 than they were just back in 1999. In the past 17 
years, we have seen a fivefold increase in these overdose deaths. It is 
a national epidemic.
  It has unfolded in three different waves. It started with 
prescription drugs, overprescribing of prescription drugs--pain pills. 
The pill mills we saw in Southern Ohio and around our State exploded 
about 15 to 20 years ago. Next, there were the heroin deaths. Heroin 
moved in and spiked as people moved to less expensive and more 
accessible alternatives than prescription drugs. Now, I hate to tell 
you, there is a new danger and a threat, and it is deadlier than ever. 
It is these synthetic opioids--fentanyl, carfentanil--that have moved 
into our States, overcoming our law enforcement, and the results have 
been deadly.
  By the way, it is a crisis that does not discriminate. Opioid 
addiction affects everybody, regardless of age, area code, class, or 
color. In Ohio, drug addiction and acts committed to support it have 
now become the No. 1 cause of crime in our communities--probably the 
same in your community.
  Employers, of course, are increasingly pointing to the inability to 
find workers who can pass a drug test. They can't fill vacant 
positions. There is new data out with regard to people who are not 
showing up on the unemployment rolls but have given up looking for work 
altogether. There are probably 9 million men between 25 and 55 who are 
considered to be able-bodied who aren't even looking for work. Some 
really troubling statistics out there indicate that maybe as many as 
half--one study says 48 percent--of those individuals are taking 
opioids on a daily basis.
  This is affecting all of us. Every aspect of our communities is 
affected. Everybody has a role to play overcoming this epidemic. There 
is an urgency coming up with better strategies to turn the tide on 
addiction. Although I believe progress has been made recently--and it 
is starting to be made in my State and other States--much more needs to 
be done and done urgently.
  Part of that starts with understanding that addiction is a disease, 
and it is treatable. Too often it is not treated like that. The 
appropriate response should include much more aggressive prevention and 
education, absolutely, and more aggressive law enforcement keeping 
deadly fentanyl out of our communities through the STOP Act and other 
means, of course, but we also have to get more effective treatment 
strategies. We have a couple hundred thousand people in Ohio who are 
addicted. We need to get them into treatment, including more effective 
detox, medication-assisted treatment, and longer term recovery. We 
know, coupled with the right kind of therapy, the right kind of support 
and help, people can get into recovery and get back to their families, 
get back to work, and get back to being productive citizens.
  We also know recovery results are a lot better with that kind of 
continuous support. Closing the gaps that occur is key to overcoming 
addiction. There is a gap between the crisis response, which is often a 
first responder--like the two brave officers I talked about earlier--
finding someone who has overdosed. Often it is firefighters as well 
providing Narcan, this miracle drug that reverses the effect of the 
overdose. That is incredibly important to saving lives.
  Narcan alone is not sufficient. The key is to get those people into 
detox and into treatment and longer term recovery. The gaps we have out 
there between the crisis response and Narcan,

[[Page S1246]]

then going to detox, then going to treatment, and then going to 
recovery are creating a lot of the inability to solve this problem.
  I have probably met a couple of thousand addicts or recovering 
addicts in the last few years. What they tell me is: I tried treatment, 
but it was for 6, 7, 8 weeks, and then there was nothing for me. It 
didn't work for me. Then there are people who overdosed, not once or 
twice but several times, and they had never been in detox and 
treatment.
  One young man I spoke to last weekend has been an addict for 7 years. 
Finally, his brother convinced him to seek help. The last time he 
overdosed, he did go into detox. He did go into treatment, to a 
facility where those gaps were closed, where there was no waiting time, 
where he was able to get the help, rather than going back to his old 
community and his old friends and a situation that was going to lead 
him back into more use and more addiction.
  The key, again, is to get those who have overdosed into the treatment 
they need. Overdose reversal provides a second chance at life. Let's 
face it. Some of these people who are overdosing come out of this after 
Narcan is administered. They have seen their life flash before their 
eyes, and they are ready for something. We have to be ready for them. 
Just as the overdose reversal provides a second chance at life, it is 
treatment and longer term recovery that provides that second chance to 
live addiction-free--again, to get back with your family, get back to 
work, and get back to a productive life. It takes a comprehensive 
solution because it is a comprehensive problem.
  That is what led some of us in this body, including my colleague 
Senator Sheldon Whitehouse and me, to introduce the Comprehensive 
Addiction and Recovery Act, or CARA, back in 2015. We developed that 
bill over time by relying on experts in the field and those most 
affected by addiction.
  Beginning in 2014, when we were in the process of putting together 
the legislation, we hosted five national forums here in Washington, DC. 
We brought experts and practitioners in from around the country--
prevention, treatment, law enforcement, and recovery communities. We 
wanted to get the best practices to find out what was working, what 
wasn't working, and how we could improve the response. What role could 
the Federal Government play in all of this? We had forums focused on 
the science of addiction to understand it better, evidence-based 
prevention strategies that actually work; treating pregnant women who 
are addicted and babies at risk of being born drug-dependent. There is 
nothing more heartbreaking than going into the neonatal units in the 
hospitals in my home State and seeing these babies who were born 
dependent and watching them go through the painful withdrawal process 
as infants Every neonatal unit in our country has seen this. If you go 
to your own hospital, they will tell you this is an increasing problem.

  We had veterans come in, and we had experts come in to help veterans 
make that transition because, sadly, the use of opioids among veterans 
is also increasing. They sometimes use opioids for injuries, for 
accidents, for PTSD, and they become addicted. How do you build support 
around those veterans? We also had people come in and talk about longer 
term recovery and housing and how, over time, you can get better 
results if you provide those kinds of services. Our goal was to 
leverage the expertise and perspectives of everyone involved in this 
epidemic, to find best practices, and to create an evidence-based 
education, treatment, and recovery bill that works.
  With strong bipartisan support, we moved from hearings, to a 
unanimous committee markup, to Senate passage of this legislation. By 
the way, it passed with a vote of 92 to 2. That is not typical around 
here, certainly not for something so comprehensive. Yet everybody has 
experienced this back home and is desperate to figure out strategies to 
help. In July of 2016, President Obama signed CARA into law. It was the 
first comprehensive addiction reform in more than 20 years. It was the 
first time Congress had ever provided any support or help for this 
longer term recovery piece.
  The CARA law targets prevention and education resources to prevent 
abuse before it even starts--the most effective way. It helps first 
responders reverse overdoses to save lives. It devotes resources to 
evidence-based treatment and recovery programs. It expands prescription 
drug take-back programs to get addictive pain pills off the bathroom 
shelves. More than $180 million was authorized to assist communities in 
these efforts to combat this epidemic. Frankly, because of this crisis, 
the appropriators decided: You know, we need this so badly, we are 
actually going to appropriate more than the $180 million. Last year, as 
an example, they appropriated $267 million--almost $100 million beyond 
our authorization.
  Again, I think it is beginning to make a difference. I see it back 
home in Ohio. I see some of these strategies beginning to work. It is 
going to take some time, and we need to do more. In Ohio, we received 
about $4 million. When I say ``we,'' I mean groups, people who are in 
the trenches doing the hard work.
  We have also made progress in this fight with separate opioid 
legislation that was part of the 21st Century Cures legislation. That 
legislation was for substance abuse and mental health. Many of us 
successfully fought to help secure a 2-year commitment there of $500 
million a year, totaling $1 billion. It goes directly to the States. 
This money goes to States that are hardest hit, and States are allowed 
to decide how to spend that money. The first installment of funding 
from that legislation awarded my State of Ohio with $26 million, and we 
are using every penny of it.
  I was at a facility over the weekend that gave me hope. It is called 
the Maryhaven Addiction Stabilization Center, and it is in Columbus, 
OH. They talked about the gaps, where people who overdose are provided 
Narcan, and then they go back to their community, and what first 
responders will tell you is that sometimes in the same week or even on 
the same day on some occasions, there is another overdose. The 
revolving door continues without any treatment and without any 
solution. Maryhaven Stabilization Center is a response to that. They 
used the Cures money we talked about, they used some CARA funding from 
the county--the county is a part of the broader strategy of where the 
CARA money went--and they said: Let's put together an institution where 
there is an emergency room that focuses on overdoses.
  I have been to other emergency rooms in Columbus, OH, and I have seen 
what they do with the people who overdose. They save lives, and that is 
fantastic, but frankly these emergency rooms are equipped for 
everything, and they have to be--for gunshot wounds, car accidents, 
trauma.
  This emergency room would be focused specifically on overdoses, which 
makes it more cost-effective but also more effective for those 
recovering addicts, those addicts who are coming in. But most 
importantly, in that same facility, there is a detox center. In that 
same facility, there are 50 treatment beds. Whereas in the typical case 
when somebody overdoses, they go to the emergency room and end up going 
back to their community, back home, back to the gang, back to the 
family, in this case, 103 people who have gone through in the last 
month--it has only been open a month--80 percent of them have gone into 
treatment. I had the opportunity to meet someone who had been through 
that process, and we talked about the difference this makes. You 
literally walk through the door into treatment, there is strong 
encouragement to do it, and it is working.
  These are the kinds of things that are going to make a difference in 
our communities. It seems to be common sense, but frankly it is not 
happening in other places. Programs like these are what are going to 
help us overcome addiction and are examples of how Federal funds can be 
used more effectively to leverage, in this case, a lot of private 
dollars, some State dollars.
  Both of these landmark laws--the CARA Act that we talked about and 
the Cures Act--are providing increased resources to local communities, 
but this problem is not getting better, it is getting worse.
  One of the problems is the availability and the low cost of these 
highly addictive, even more dangerous drugs coming in. There are 
synthetic opioids. Fentanyl is 50 times stronger than heroin on 
average. It is coming in through

[[Page S1247]]

the mail. We need to do more to stop it through law enforcement, but we 
also need to acknowledge that it has been sprinkled in other drugs and 
is creating a lot of these addiction overdoses and higher rates of 
death.
  The degree of damage this is causing to our communities, our 
families, our local budgets, and our criminal justice system requires 
us to take a more aggressive stance, to do more to figure this out. We 
need to strengthen our resolve. We made progress recently with the 
bipartisan budget agreement President Trump signed into law just a few 
weeks ago. We included in there an additional amount of funding--$6 
billion over 2 years--to help combat the opioid epidemic. So instead of 
the $500 million a year and the $260 million a year that I talked 
about, it would be $3 billion a year and then $3 billion the year 
after.
  I believe that the evidence-based programs we set out in the 
Comprehensive Addiction Recovery Act provide a good framework as to how 
to spend that money effectively. That is why I am pleased to stand here 
today as we introduce the next stage of this--CARA 2.0--to help provide 
a framework for how these funds to combat opioid addiction can be spent 
wisely. It is a roadmap for Congress to build on CARA's successes since 
becoming law.
  The bipartisan CARA 2.0 act is being introduced by Sheldon Whitehouse 
and me and also by six other colleagues--Senators Shelley Moore Capito, 
Amy Klobuchar, Dan Sullivan, Maggie Hassan, Bill Cassidy, and Maria 
Cantwell--a bipartisan group of four Republicans and four Democrats who 
are passionate about this issue. It authorizes $1 billion a year for 
specific evidence-based drug prevention, education, treatment, and 
recovery programs.
  It is very important to have this $6 billion of funding over the next 
couple of years. We need it. But we have to be sure it is spent wisely. 
It is not a matter of just throwing money at a problem; it is a matter 
of being sure we are effectively addressing the real issues.
  As I mentioned earlier, the longer term recovery programs are what 
really help those gripped by addiction to overcome this disease. That 
is evidence that we have. I have certainly seen a lot of evidence of 
that firsthand and countless examples of this, where this longer term 
recovery and the support networks are what get people back on track, 
back with their families, back to work. We need to expand access to 
them to those communities that are in need and give everyone a second 
chance of living up to their own God-given potential. That is why, in 
this new CARA 2.0, we increase funding for recovery.
  In addition to expanding the reach of CARA's evidence-based programs, 
this bill puts in place new policy reforms to strengthen the 
government's response in so many ways. We take what some would consider 
a pretty dramatic step by limiting opioid prescriptions to 3 days for 
acute pain. Some will push back against that, but this is based on good 
evidence and good research. When someone goes in for a simple 
procedure--say, a wisdom tooth extraction--and that young person is 
given a bottle of opioids when he or she leaves, too often, that leads 
to addiction. I don't want more parents coming up to me and saying: My 
kid, when he or she was a teenager, was given these opioids by a doctor 
or a dentist, so we thought they were safe. Our child then turned to 
heroin because the pills became too expensive and less accessible and 
then turned to fentanyl and overdosed and died.
  I have had two such parents from Ohio come to me and tell me their 
story. You probably know others. We need to ensure that these 
prescriptions are limited. For those who have chronic pain and those 
who have cancer, it wouldn't apply. And after those 3 days, you can go 
back to that doctor and tell them why you need it and explain it.
  Experts say that about 80 percent of those who overdose from heroin 
started on prescription drugs. I am sure the same is true with regard 
to fentanyl. Four out of five heroin addicts in my State of Ohio who 
overdosed started on prescription drugs. We do need to deal with this 
overprescription problem.
  By the way, the evidence is that after that fourth day, fifth day, 
sixth day--that is when you get into the bigger risk of becoming 
addicted to prescription drugs.
  As I mentioned, this epidemic started with an explosion of pain pill 
use 15 to 20 years ago. We need to stop the addiction at the source, 
and for most people that begins with prescription drugs. By ensuring 
that clinicians prescribe the appropriate strength and supply of pain 
pills for non-life-threatening injuries, we can keep so many more 
people from becoming addicted.
  The bill also includes legislation very similar to that which passed 
the Senate in 2015 but was dropped out in the House-Senate conference. 
It is very simple. It requires doctors and pharmacists to use the 
prescription drug monitoring programs to ensure that we are not 
overprescribing opioids for certain individuals. That helps us identify 
where the problems are and to get people into treatment. It also 
requires States to share data with other States to prevent people from 
crossing State lines to get prescriptions. One of our big problems in 
Ohio is people can cross the State lines in West Virginia, Kentucky, or 
other States and get their prescription filled even though it has 
already been filled once in Ohio. Across State lines, we need to have 
prescription drug monitoring programs that work.
  CARA 2.0 is going to help turn the tide of this epidemic. The bill 
increases Federal funds for specific evidence-based programs to better 
protect vulnerable groups--including infants, young adults, pregnant 
and postpartum women, and veterans--as well as resources for community 
programs, medication-assisted treatment, and first responders.
  As the title indicates, it is a comprehensive solution. Every aspect 
of our communities is affected, so every aspect of our communities 
needs assistance. The opioid epidemic is one of the most urgent 
challenges we face as a country.
  By the way, ultimately, this crisis is not going to be solved here in 
Washington, DC. It is not going to be solved by legislation we pass 
here. We get that. It is going to be solved in our communities. It is 
going to be solved in our families. It is going to be solved in our 
hearts. But this is a national crisis, and the national government 
needs to be a much better partner with State government, local 
government, communities, and nonprofits--those who are out there doing 
the hard work.
  The $6 billion commitment over the next 2 years is a real opportunity 
to help turn the tide--not by just throwing more money at the problem 
but by being sure that money is well spent on an epidemic that is 
taking too many lives and devastating too many communities.
  CARA 2.0 will build on our accomplishments and continue to give 
communities the resources they need to address this issue. Yes, we have 
made some progress around here, and that is good, but we need to do 
much more. CARA 2.0 gives us that opportunity. It represents the next 
step toward helping our communities address this epidemic and helping 
our communities heal.
  Thank you.
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