[Congressional Record Volume 164, Number 154 (Monday, September 17, 2018)]
[Senate]
[Pages S6159-S6179]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  SUBSTANCE USE-DISORDER PREVENTION THAT PROMOTES OPIOID RECOVERY AND 
               TREATMENT FOR PATIENTS AND COMMUNITIES ACT

  The PRESIDING OFFICER. Under the previous order, the Senate will 
proceed to H.R. 6, which the clerk will report.
  The senior assistant legislative clerk read as follows:

       A bill (H.R. 6) to provide for opioid use disorder 
     prevention, recovery, and treatment, and for other purposes.


                           Order of Procedure

  The PRESIDING OFFICER. Under the previous order, the time until 5:30 
p.m. will be equally divided in the usual form.
  The Senator from Utah.
  Mr. HATCH. Mr. President, I rise today to speak on three very 
important topics: first, today's celebration of Constitution Day; 
second, the signing of the Miscellaneous Tariff Bill Act; and finally, 
tonight's vote on the Opioid Crisis Response Act.


                            Constitution Day

  Mr. President, today marks 231 years since the Founding Fathers 
signed a charter that would forever alter the course of human history: 
the U.S. Constitution. This document serves as the foundation of our 
government, and we rightly celebrate its anniversary each year with 
Constitution Day.
  The Constitution establishes guiding principles that have served the 
American people very well. The separation of powers, the rule of law, 
and our system of federalism work together toward the goal of 
preserving liberty. They have worked to secure individual rights 
against encroachment by the government.
  The Framers of the Constitution recognized that the government 
derived its power from the people themselves. The Constitution 
overturned the prevailing wisdom that men are made for governments, 
declaring instead that governments are made for men. These principles 
and our Nation's dedication to them are core to our American ethos. 
Today, they set our country apart as a symbol of freedom and prosperity 
across the globe.
  The Constitution is the culmination of centuries of human progress. 
We have a charge to fulfill its promises. We have a duty to uphold its 
principles. May we commit ourselves today and every day to defending 
the truths so eloquently and essentially articulated in the 
Constitution of our United States.


                 Miscellaneous Tariff Bill Act of 2018

  Mr. President, before I yield the floor, I would like to address the 
passage of the Miscellaneous Tariff Bill Act of 2018, an important 
piece of legislation that was signed late last week by the President. 
Senator Wyden and I introduced the bill on a bipartisan and bicameral 
basis, and it passed unanimously--a great example of how both parties 
feel about relieving Americans from the burdens of job-killing tariffs.
  The Miscellaneous Tariff Bill was designed to help both importers and 
producers by suspending or reducing burdensome tariffs that 
unnecessarily increase manufacturing and operating costs for American 
companies. A Miscellaneous Tariff Bill has not been enacted since 2010, 
and our businesses and manufacturers have been forced to wait too long 
for Congress to act.
  I am pleased that we were finally able to end that wait. I am also 
pleased to report that this is the first MTB, or Miscellaneous Tariff 
Bill, to be enacted in the new process set out in the American 
Manufacturing Competitiveness Act of 2016. This new process was crafted 
to provide a robust consultation that is consistent with both House and 
Senate rules and that would be transparent and open to all.
  The International Trade Commission and the Department of Commerce 
vetted each petition to determine eligibility based on this new 
criteria. Each of these agencies made great efforts to

[[Page S6160]]

evaluate each one of the thousands of petitions against the high 
standards set out in the AMCA. I would like to thank all of the staff 
that worked diligently to do so.
  Senator Wyden and I also worked closely with our colleagues 
throughout this entire process to resolve any concerns that they may 
have had with any of the included products. In the end, I think we 
crafted a bill that we all can be proud of because it will help 
American businesses compete around the world.
  The passage of the Miscellaneous Tariff Bill Act, in conjunction with 
the successful implementation of tax reform, will continue to expand 
the American workforce, improve the American economy, and keep America 
competitive.


                            Opioid Epidemic

  Finally, Mr. President, I am also here to talk about the passage of 
an incredibly important bill that will aid individuals, families, and 
communities confronting an epidemic that is overwhelming our country. 
This is not the first time I have been talking about the opioid 
epidemic, and, unfortunately, it will not be my last. But I am happy to 
say that today's remarks will highlight some very good news.
  As part of a coordinated effort with four other committees, the 
Senate Finance Committee's package will be voted on tonight as a part 
of the Opioid Crisis Response Act, but before I get to what is in that 
bill, I want to give some details of the unfortunate reality our 
country is facing.
  Last year, more than 72,000 Americans died from a drug overdose. The 
majority of these overdoses involved prescription opioids or illicit 
opioids like heroin or fentanyl. I have spoken to many families who 
have witnessed the devastating effects of these addictions firsthand, 
and I have been sadly impressed by the pervasiveness of this rampant 
epidemic. Truly, I promise you that you have more friends, family, and 
coworkers who have been affected by this epidemic than you probably 
realize.
  My home State of Utah continues to be hard hit by this crisis. An 
alarming number of Utahns have undergone hospital stays and emergency 
room visits due to opioid overdoses. In 2017 alone, over 450 Utahns 
died from an opioid overdose.
  As the Presiding Officer may have noticed, Congress has recognized 
this problem for some time. While this package is a significant step 
forward, it isn't the first thing we have done, nor will it be the last 
thing we do.
  Take, for example, the bipartisan Family First Prevention Services 
Act, which was enacted earlier this year in February. Our committee 
also worked together to realize a 10-year extension of the Children's 
Health Insurance Program, which, as a part of its mission, helps moms, 
babies, children, and teenagers struggling with addiction or its 
impacts on families across the country.
  Our work did not stop there. We proceeded to work on ways that our 
committee, with its jurisdiction over Medicaid and Medicare, family 
services, and customs, could work to improve the lives of the millions 
of Americans who have been impacted by this devastating epidemic.
  There are simply too many pieces of this bill to cover them all in 
one speech, but I wish to give some highlights. The bill will make a 
real difference in Medicare, a program in which one in three 
beneficiaries is prescribed an opioid. It will empower patients through 
information on pain treatment alternatives. It will expand treatment 
options for patients suffering from addiction, including through 
increased access to care via telehealth and a pilot program that will 
allow Medicare to cover methadone and wraparound services to treat 
addiction for the first time. The bill also increases the ability to 
track opioid prescriptions to prevent misuse and diversion, while also 
ensuring that beneficiaries promptly get the medications they need.
  We know that many children are in foster care as a result of the 
opioid epidemic, and this bill supports programs that will help parents 
complete treatment for opioid addiction and reunite with their children 
more quickly. It will also increase the availability of family 
residential treatment programs, allowing more parents to receive help 
while still caring for their children in a supervised setting.
  For the first time since Medicaid became law in 1965, pregnant women 
can receive Medicaid coverage for prenatal and postnatal care while 
seeking treatment at institutions for mental disease. New and improved 
prescription-drug monitoring programs allow States to better understand 
the full scope of an individual's prescription use across payments and 
insurers. This bill brings that data into the hands of providers and 
insurance plans to help them develop care plans for those with 
substance use disorders.
  Additionally, this package is not limited to fixes in the healthcare 
space. We also worked with Senator Portman to craft the bipartisan STOP 
Act, which has also been incorporated into this package. That bill sets 
new requirements for the U.S. Postal Service to obtain advance 
electronic data that allows for U.S. Customs and Border Protection to 
effectively target and stop fentanyl and other illegal substances from 
entering the country through our postal system. Getting our law 
enforcement this additional data will bolster efforts to stop dangerous 
opioids at the border and keep them away from American families.
  In short, the Finance Committee's portion of this larger effort is an 
important step forward, but it is made that much more meaningful given 
the wide-ranging provisions included from the Judiciary, Commerce, 
Banking, and HELP Committees. Together, this bill will provide the 
resources, capacities, and direction to State, local, and Federal 
Governments to better assist those who are in such great need right 
now.
  Additionally, I thank the leader, the chairman, the ranking members, 
and all other Members of the four other committees who have been 
involved in this great undertaking. There has been no shortage of 
effort or genuine concern from both sides of the aisle to address this 
painful issue that has hurt so many American families. I appreciate 
this bipartisan push to create a successful piece of legislation. I 
think this bill represents Congress at its best.
  I encourage all of my friends, on both sides of the aisle, to vote 
for this important piece of legislation tonight, and I look forward to 
working with my colleagues in the House to advance a bill that 
addresses the opioid epidemic to the President's desk.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. BOOZMAN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BOOZMAN. Mr. President, the opioid epidemic is a national crisis. 
It has destroyed lives, torn apart families, and strained community 
resources.
  Since the year 2000, more than 300,000 people in the United States 
have died from opioid overdoses. Congress is aggressively working to 
combat this problem by expanding prevention efforts, empowering law 
enforcement, and increasing access to treatment. We passed the 
Comprehensive Addiction and Recovery Act, the 21st Century CURES Act, 
and the Bipartisan Budget Act to improve the tools and resources 
available to fight this epidemic, and we have another opportunity to 
continue turning the tide with passage of the Opioid Crisis Response 
Act of 2018.
  Last week, I met Arkansans who are on the frontlines of this battle. 
They have seen the destruction caused by opioids in our schools, our 
hospitals, and the judicial system. The individuals I spoke with agree 
that more resources are needed in this fight. That is what the Opioid 
Crisis Response Act will deliver. This comprehensive package covers a 
wide range of avenues to attack this problem and get individuals the 
help and support they need to recover. This includes prevention, 
treatment, additional law enforcement tools, and expanding research 
into nonaddictive pain treatments.
  I appreciate the leadership of my colleagues on the HELP, Finance, 
Judiciary, and Commerce Committees to advance this important 
legislation that is necessary to address the ever-growing opioid 
crisis.
  The legislation expands a grant program to train our first responders 
administering naloxone, the drug that

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can be used to block the effects of opioids and prevent deaths from an 
overdose.
  In Arkansas, this is having a very positive impact. Since 2017, the 
Arkansas naloxone project has trained more than 3,300 first responders 
to administer the drug. This effort has saved at least 142 lives. The 
program continues to grow. It is working. Other States can replicate 
the success we have seen in Arkansas by using grant funds to train 
first responders.
  Not only does this legislation help those already impacted by the 
crisis, it also aims to stop even more dangerous drugs, like fentanyl, 
from getting into the country in the first place by improving detection 
of prohibited drugs being illegally imported through the mail.
  These provisions are just a small piece of the puzzle. Together, with 
other measures in this bill, we can make a real difference and change 
the conversations we have around opioid abuse and addiction to focus 
not on the lives taken but on the lives which are being saved. The 
comprehensive response to the crisis shows how committed we are as a 
nation to combating opioid addiction.
  I applaud the U.S. Department of Agriculture with this week's 
announcement of its partnership with communities across the country to 
fight the opioid epidemic in rural America, including Newport, AR. In 
Newport, USDA is investing more than $150,000 to convert the former 
Jackson County Jail into the White River Women's Shelter. This facility 
will help individuals recover from opioid misuse, and provide 
prevention, recovery, and treatment services to combat the opioid 
epidemic in the region.
  We all have a stake in this fight. If individuals are living 
healthier lives, they will be able to be more productive citizens and 
help the community thrive. The Opioid Crisis Response Act of 2018 will 
aid us in this effort.
  I look forward to the Senate passage of this bill and President Trump 
signing it into law so we can reverse opioid abuse statistics.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. PETERS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. PETERS. Mr. President, our Nation is suffering through a public 
health crisis. Our Nation, our neighbors, our families--in fact, very 
few among us can say that we have not been personally impacted by the 
opioid crisis.
  The scope is simply staggering; 116 lives are lost every day to 
opioid overdose. There are 116 sons, daughters, husbands, wives, 
siblings, and parents who will never come home again--116 lives ended 
decades too soon, lost every day.
  Substance abuse disorders do not discriminate. We feel this pain in 
every region of our country--urban and rural areas and red and blue 
States. We know there is no silver bullet that will end this crisis 
overnight, but we do know how to fight it together, and that is what we 
are doing today.
  Tonight the Senate will pass the bipartisan Opioid Crisis Response 
Act, and this body will show a unity of purpose that, frankly, I wish 
we could show more often. As this important bipartisan legislation came 
together, I worked closely with my colleague Senator Shelley Moore 
Capito of West Virginia to make sure that our Nation's youth were not 
left behind.
  We know young adults are more than twice as likely to misuse 
prescription opioid pain relievers as compared to adults. One in five 
high school seniors knows where they can easily get heroin, and the 
problem continues to escalate. In Michigan, the rate of opioid overdose 
deaths among youth under 25 has doubled since 2012. These are empty 
seats at the dinner table, in classrooms, and in workplaces.
  When tackling a problem this large, we need to follow the data and 
invest in what works, especially for adolescents and young adults. 
Health experts, including the American Academy of Pediatrics, recommend 
medication-assisted treatment, or MAT, as the gold standard for opioid 
addiction treatment. While we need to continue investing in research, 
completed studies have shown that youth treated with MAT are more 
likely to reduce opioid misuse, injection drug use, continue their 
medical care, and achieve long-term sobriety.
  The research we have on using medication-assisted treatment to treat 
adults is overwhelmingly positive and shows this course of treatment to 
be safe and effective, especially in comparison to the life-threatening 
risks faced by patients who go untreated. Research shows that 
medication-assisted treatment has the power to cut the mortality rate 
of opioid-addicted patients in half, if not more.
  France instituted a strong MAT strategy in response to a heroin 
epidemic in the 1990s. The death rate due to overdoses there decreased 
by nearly 80 percent over the course of just 4 years.
  Substance abuse disorders are not a personal or a moral failure; they 
are a public health crisis brought on by chemical dependency. We are 
fortunate that our doctors and researchers have developed medication 
that can help end dependency and save lives, and we must get it to 
patients who need it the most. It is troubling that many Americans 
whose lives could be saved do not have enough access to these 
medication-assisted treatments, and it is devastating that American 
youth have hardly any access at all.
  Currently, only about 1 in 12 youth who need treatment for an opioid 
addiction actually receives it. A 2017 study found that one in four 
adults in treatment for heroin received medication-assisted treatment. 
While this sounds low, for adolescents the rate is less than 1 in 40. 
Even for those who are fortunate enough to be in active treatment, MAT 
is not being used widely.
  Similarly, only one in eight adults in treatment for prescription 
opioids receives medication-assisted treatment. For adolescents, it is 
1 out of every 250. That is why the Peters-Capito provisions of the 
Opioid Crisis Response Act are actually crucial. They will support the 
identification and development of best practices for treating opioid 
addiction among youth and point to MAT as a specific strategy.
  In addition, Senator Capito and I successfully added a related 
amendment to the appropriations bill that funds the U.S. Department of 
Health and Human Services. It recently passed the Senate. The amendment 
will require the Substance Abuse and Mental Health Services 
Administration to submit a report to Congress on what steps it takes to 
support MAT. The agency specifically will also identify barriers they 
must overcome to get medication-assisted treatment to eligible youth.
  Young Americans coping with substance use disorders deserve every 
opportunity to recover, to hold onto their future aspirations, and to 
lead stable and fulfilling lives. We must continue working together at 
every level of government as we combat this opioid crisis with 
scientifically proven strategies, including for some of the youngest 
lives at risk.
  An important step in this response is getting these provisions across 
the finish line. I urge my colleagues to act quickly to get this 
legislation to the President's desk to be signed into law. I recognize 
these provisions are just a start, but we are losing 116 lives every 
day. We need to save as many as we can, as soon as we can.
  Thank you.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. MARKEY. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. MARKEY. Mr. President, I rise today to speak about the pending 
legislation to address the opioid epidemic--a crisis the likes of which 
we have never seen in America. All of us know that this crisis is a 
nightmare. It is a scourge. The prescription drug, heroin, and fentanyl 
epidemic is a human tragedy unfolding every day in homes, in alleyways, 
in bathrooms, the back seats of cars, in nearly every city and town of 
our country.
  Preliminary estimates indicate that opioid overdoses claimed an 
estimated

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49,000 lives just last year, including nearly 2,000 people in 
Massachusetts. That is more than gun violence. That is more than car 
accidents. The opioid epidemic is the deadliest drug overdose crisis in 
American history. A crisis of this proportion demands action at all 
levels, and I am pleased that the Senate is taking a step in that 
direction today.
  I would like to thank Senator Lamar Alexander and Senator Patty 
Murray and their staffs, as well as the leadership and staffs of the 
other committees, who worked to create and refine the legislative 
package we will be voting on later this evening.
  This bill contains a number of proposals that will help families and 
communities struggling day in and day out to respond to the opioid 
overdose crisis. One of those proposals is my bipartisan Opioids 
Milestones Act, a bill I authored with Senator Lisa Murkowski and 
Senator Maggie Hassan to create a scorecard for our Nation's response 
to the opioid crisis.
  The Milestones Act will require the Federal Government to both set 
tangible benchmarks for how we are addressing the opioid crisis in our 
country and measure progress on key objectives every single year. When 
people are sick, they get a treatment plan. The United States of 
America needs a nationwide treatment plan for fighting the opioid 
crisis, and that is what this provision will create for our country. 
Those objectives include reducing overdose deaths, expanding treatment 
availability, increasing the number of individuals in sustained 
recovery, and decreasing emergency room visits for overdoses.
  If we don't have a dashboard--a scorecard--to clearly and 
quantifiably show our progress on this epidemic, we will continue to 
fight the same battle over and over again. We urgently need to know 
whether our policies and resources are being used in ways that have a 
measurable impact on the public's health. The Milestones Act provision 
in this bill will provide a national roadmap for ensuring that our 
Federal and State resources pay lifesaving dividends. That is my goal, 
that is Senator Murkowski's goal, and that is Senator Hassan's goal, 
and it is in the bill.
  This type of strategy was put in place to fight the HIV/AIDS epidemic 
in America--another disease that was surrounded by stigma, inaction, 
and the lack of research until advocates, scientists, healthcare 
providers, and policymakers joined forces to chart a path forward and 
to make measurable progress. While that war is not yet won, new HIV 
diagnoses and deaths have declined dramatically over the past two 
decades in the United States.
  When America has a plan, America wins. That is why I am pleased that 
this legislative package includes important bipartisan legislation that 
I introduced with Senator Todd Young and Senator Tammy Baldwin to help 
address increasing rates of infectious diseases like HIV caused by 
injection drug use.
  With more than 220 counties across the United States at risk of a 
hepatitis C or HIV outbreak related to the opioid crisis, we cannot 
afford to wait any longer to arm our States with the tools needed to 
tackle the public health consequences of this epidemic. Massachusetts 
had more reported cases of hepatitis C than any other State in 2015--
the same year we peaked in overdose deaths caused by illicit opioids.
  The public health consequences of the epidemic are life-and-death. 
One recent study published in the American Journal of Public Health 
roughly estimates that 510,000 people could die over the next decade 
due to opioid-related causes, which include overdoses as well as other 
causes of death tied to opioids, such as HIV infections from sharing 
syringes. That is what Senator Young and I are trying to deal with. We 
are trying to deal with this issue so that we can create the tools that 
help us to deal with this growing medical problem in our country.
  This provision will help ensure that the Federal Government works 
with States to improve education, surveillance, and treatment of opioid 
use-related infectious diseases like HIV and viral hepatitis, but we 
have more work to do to combat this crisis. If we are going to reduce 
the supply of heroin, fentanyl, and illicit prescription opioids, then 
we have to reduce the demand through treatment. That must include 
increasing access to effective medication-assisted treatment, or MAT.
  Only about 1 in 10 individuals with a substance use disorder will be 
able to access treatment. That is unconscionable and demands immediate 
action. That is why as part of the Comprehensive Addiction and Recovery 
Act--or the CARA bill of 2016--Senator Rand Paul and I worked together 
to include provisions that would, for the first time, allow physician 
assistants and nurse practitioners to prescribe lifesaving medication-
assisted treatment, like SUBOXONE, for individuals with substance use 
disorders.
  Since these provisions went into effect, more than 8,000 physician 
assistants and nurse practitioners have registered to provide 
medication-assisted treatment. That has resulted in more Americans 
accessing this lifesaving care, especially in community health centers 
and rural communities across this country. For doctors and medical 
professionals, MAT stands for medication-assisted therapies, but for 
those with an opioid use disorder, expanding MAT means more access to 
treatment.

  Nurse practitioners and physician assistants want to respond to the 
demand side of the opioid crisis, and they are stepping up in a major 
way to connect individuals to the treatment they need. Unfortunately, 
the authority nurse practitioners and physician assistants have to 
prescribe this lifesaving treatment expires in a few short years. If we 
don't intervene now, a substantial amount of our current prescriber 
population will no longer be able to treat individuals with substance 
use disorder using this effective treatment. That will further strain 
our already woefully inadequate treatment workforce.
  That is why Senator Paul, Senator Hassan, Senator Collins, and I 
introduced new, bipartisan legislation to provide permanent MAT 
prescriber authority for nurse practitioners and physician assistants. 
Our bill also extends this authority to other nursing professionals 
already playing an important role in our fight against the opioid 
crisis--certified nurse midwives, clinical nurse specialists, and 
certified registered nurse anesthetists. These dedicated nursing 
professionals are irreplaceable members of our healthcare community, 
and we need to make sure they can provide treatment that saves families 
from the suffering of addiction.
  The legislative package we are voting on today in the Senate 
unfortunately does not contain this bipartisan legislation on 
medication-assisted treatment. This is a missed opportunity to build 
upon our commitment to treatment. But the House-passed opioid 
legislation does contain a version of our provision to make the 
prescriber authority for nurse practitioners and physician assistants 
permanent and to expand that authority to the other nursing 
professionals. I will continue working with my colleagues to ensure 
that this lifesaving provision makes it into the final opioid package 
negotiated between the House and the Senate leaders.
  The bill we vote on today cannot be the end of our efforts to help 
solve the opioid overdose crisis. The opioid crisis knows no 
boundaries, and neither should our efforts to combat it. Not only must 
we expand access to treatment, we must also think about how we can help 
to prevent addiction from taking hold in the first place.
  Last week, I introduced bipartisan legislation with Senator Orrin 
Hatch to help ensure that patients and their loved ones understand the 
risks of prescription opioids. I have heard too many stories about 
substance use disorders that began from an opioid prescribed to an 
individual injured on the job who needed to feel well enough to return 
to work the next day, or to help heal a sports injury. That is the 
story of Cory Palazzi from Taunton, MA.
  In high school, Cory was a varsity baseball and football athlete and 
a member of the National Honor Society. He had a love for the game of 
baseball. For him, the baseball diamond was the happiest place on 
Earth.
  In his junior year, Cory suffered a shoulder injury that required 
surgery. After surgery, Cory was prescribed opioid painkillers and 
became addicted to his medication. His painkiller addiction eventually 
became a heroin addiction, and in 2013, Cory suffered a heroin

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overdose, which has left him permanently disabled.
  Cory and his family, Lori and Dave, have turned this tragedy into 
triumph. Today, they share their story in schools and other 
organizations to warn the public about the dangers of drugs and offer a 
message of hope for those who are faced with addiction. We thank them 
for their courage, for their strength, and for their commitment to 
ending this crisis.
  The Palazzi family know firsthand that prescription opioids are 
dangerous, but because of the confusing names and ingredients, many 
families may not know that they have just left the pharmacy with a 
bottle full of danger. The path from one bottle of pills--for patients 
who have had their wisdom teeth removed or suffered a sports injury--to 
addiction needs as many roadblocks put in place as humanly possible.
  The legislation Senator Hatch and I have introduced--the Lessening 
Addiction By Enhancing Labeling Act, or the LABEL Opioids Act--would 
require that all prescription opioid bottles dispensed to a patient 
contain a clear, concise warning that opioids may cause dependence, 
addiction, or overdose.
  In the absence of legislation to ensure that providers across the 
country receive uniform, mandatory education on safe opioid 
prescribing, we need to give patients information on how to safely use, 
store, and dispose of these dangerous medications. In the same way we 
put warning labels directly on cigarettes for being addictive and 
causing potential death, we need labels to caution patients about the 
dangers of prescription opioids. It is important that everyone who 
receives an opioid prescription understand the potential risks, and a 
sticker on an opioid pill bottle is a powerful, consistent reminder of 
that danger.
  We must do all we can to put a stop to this dangerous opioid crisis 
that has ravaged families and communities across the country for too 
long. We are moving in the right direction, but today's vote should not 
be the end of our work on this issue.
  I thank my colleagues in this Chamber for their commitment, and I 
look forward to working with them in the conference and beyond to make 
sure we put everything in law nationally that helps to ensure that 
children will have to look to the history books to find that there ever 
was such an epidemic as this opioid crisis.
  Once again, I thank Senator Alexander and Senator Murray for their 
great work on this issue.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Maine.
  Mr. KING. Mr. President, the discussion today is about the opioid 
crisis, one of the most serious public health crises I have seen in my 
adult life, certainly in the State of Maine. It is an enormous problem 
across the country, particularly in rural areas. In my State, we are 
losing more than one person a day to an overdose death. That is an 
epidemic by anybody's definition.
  There are few rays of hope in this rather bleak picture. The numbers 
continue to get worse. More and more families are being devastated by 
this crisis, and there aren't many answers being provided. There is, 
however, one ray of hope this bill we are going to be discussing and 
voting on this afternoon does provide, and that is, treatment works; 
recovery is possible.
  I was at a rally in Portland, ME, just a week ago, with people of all 
ages from all over the State who were there to publicly say: I am in 
recovery. It works. Treatment saved my life. I think that is what is so 
important about continuing the work we have done in this body.
  The problem is, treatment, particularly in rural areas, is short on 
infrastructure. It is short on people who can deliver the treatment. We 
can fund programs and talk about them here, but if you are talking 
about a rural county--about Milo, ME, in Piscataquis County, you are 
not talking about a tremendous amount of available infrastructure, but 
there is available an army of people who can contribute to the solution 
of this problem.
  The people I am talking about are nurse practitioners. Nurse 
practitioners are, in many ways, among the unsung heroes in the 
healthcare discussion--particularly, again, in rural areas where there 
aren't a lot of physicians. Nurse practitioners were enabled in the 
CARA bill to provide medicine-assisted treatment, but the problem is, 
that authority expires in 2021. Therefore, we need to fix that. It is 
working. It is an important part of our ability to deliver these 
lifesaving services. In Maine, we have nurse practitioners who are 
ready, willing, and more than able, and they have proven that, to 
deliver these lifesaving services--1,700 of them in the State of Maine.
  Unfortunately, the bill we are going to be voting on this afternoon 
does not have this extension in it. I am here this afternoon to urge 
those who are going to be supporting the bill, and then working on it 
in conference with the other body, to see that this small change--
giving the authority for nurse practitioners to deliver medically 
assisted treatment to those people suffering and trapped in the throes 
of addiction--allowing those nurse practitioners to have that 
authority, to not have it expire in 2021 and create the anxiety, both 
in the patient community and in the medical community, that termination 
will create.
  Let's, for once, do something before it is a deadline. Let's do it 
now. I believe we can do it as part of this discussion, as part of the 
final resolution of the bill that is going to be before us this 
afternoon, which I entirely support. I think this is an important 
addition that will strengthen it, and it will particularly strengthen 
the ability to deliver this care, this treatment that is so important 
to so many people and families and communities, particularly in the 
smaller towns of rural areas of America and in my State of Maine.
  So I rise to support the bill but also to suggest this small change 
that I think will dramatically increase the effectiveness of the 
treatment the bill enables and will allow it to be delivered in an 
equitable and direct and important way to people all across the 
country--no matter where they live, no matter what the status of their 
health infrastructure is--because, as I say, nurse practitioners are an 
army of people who are ready, willing, and able to deliver this 
service.
  I hope we can make this one modification to this bill that will allow 
that service to be provided not only between now and 2021 but on into 
the indefinite future when, hopefully, we can rid the country of the 
scourge of this terrible opioid and drug addiction.
  I believe this is something we can and should do. I look forward to 
working with my colleagues to make this happen.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Ms. HASSAN. Mr. President, I thank my colleagues Senator King and 
Senator Markey for their remarks and their work as we all come together 
to battle this terrible opioid epidemic.
  I rise as the Senate considers bipartisan legislation that marks a 
critical step forward in the fight against the fentanyl, heroin, and 
opioid crisis.
  In New Hampshire, and all across our Nation, entire communities are 
being ravaged by this epidemic. In order to turn the tide, we need to 
combat the challenges communities are experiencing from all angles; we 
need to collaborate across traditional boundaries; we need to take a 
truly all-hands-on-deck approach because the magnitude of this crisis 
demands it.
  This crisis does not discriminate. I have spoken to so many 
individuals and families from all walks of life who are heartbroken and 
reeling. Their loved ones were professionals--students, athletes, 
parents--and then they fell victim to this illness, and their lives and 
the lives of those who loved them were never the same.
  Just this morning, I met with a number of grandparents who are now 
the primary caregivers for their grandchildren--a situation that many 
of us at first considered a phenomenon and now realize has become 
commonplace because the children's parents have died or they are in 
prison or they are simply absent or unable to be a caregiver due to 
their substance use disorder.
  I spoke this morning with this group of grandparents, two of whom 
have been raising their grandson for nearly 9 years now, one of whom 
has seen two grandchildren returned to their parents after their 
parents recovered from their addiction. In one case, the grandparent 
whose grandchildren have gone

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back to their parents is, at age 57, starting life completely anew. She 
had given up her job and gone through her entire retirement savings to 
keep her children safe while their parents battled their addiction.
  Another set of grandparents, who again have given up everything to 
keep their grandson safe, are scared of going to court to get permanent 
custody and adopt their grandchild because they are concerned the 
child's father will reappear and contest the custody, and the cost of 
that custody battle will mean they have no money left to care for their 
grandchild.
  Most heartbreakingly, both sets of grandparents said to me they were 
worried about what will happen to their grandchildren should they die 
since the children's parents might not be able to be there for them.
  I was also reminded today that at one of our largest treatment 
centers in New Hampshire, the providers estimate that 40 percent of 
those in treatment have children, which means there will be more and 
more children in our communities who need their grandparents or other 
caregivers to step forward.
  This crisis is also taking a particular toll on first responders who 
respond to overdose after overdose, sometimes reviving the same people 
on the same day.
  This crisis also impacts our workforce and our economy. I have met 
with a number of employers who can't fill jobs because they can't find 
workers who can pass a drug test. There are people now in recovery, 
some with convictions on their record, who wonder if anyone will ever 
give them a second chance.
  There is a lot of collateral damage from this crisis. The good news 
is, just as the ripple effect of this epidemic touches all parts of our 
communities, people from all corners of New Hampshire and our country 
are responding--as communities, as friends and neighbors, and as first 
responders and healthcare providers--in a collaborative manner. This is 
a multifaceted problem, and it requires a multifaceted approach, but 
for too long we haven't seen a Federal response that matches the 
urgency on the ground.
  I am hopeful that by passing this bipartisan legislation, we can move 
forward. We have given communities and families some of the support 
they need and that they have been waiting for, aching for.
  This comprehensive legislation we are considering today includes many 
priorities the people of New Hampshire, particularly those on the 
frontlines, have been urging us to fight for.
  This bill reauthorizes and improves State-targeted response grants to 
ensure that States hardest hit by this crisis--States like New 
Hampshire--continue to get the resources they need.
  This legislation also includes the bipartisan Comprehensive Opioid 
Recovery Centers Act, which I partnered on with Senator Capito, to 
offer grants to expand existing centers of care to provide 
comprehensive coordinated care and support services like housing and 
employment reintegration for those who are in recovery.
  We have also heard loudly and clearly from our healthcare providers 
that we need a more integrated approach in order to combat this complex 
disease on all fronts. So this bill includes legislation Senator 
Portman and I worked on together aimed at the next generation of 
doctors, encouraging medical schools and residency programs to 
integrate addiction medicine and treatment into their curriculum, as 
well as ensuring that doctors who get this training can apply right 
away to prescribe medication-assisted treatment as soon as they are 
licensed and have a DEA number.
  Members of law enforcement have made clear that they need additional 
tools to crack down on bad actors in the pharmaceutical industry whose 
behavior has greatly contributed to this crisis. So Senator Grassley, 
Senator Cruz, and I worked on a provision to make those tools available 
and to help hold industry bad actors accountable.
  This legislation also curbs the importation of deadly fentanyl and 
other synthetic drugs being shipped through the borders to drug 
traffickers in the United States.
  These are just a number of the key provisions included in this bill. 
As the Senate moves forward and moves into negotiations with the House 
of Representatives, I will work with Members of both parties to make 
important improvements.
  For example, we should keep working in a bipartisan way to include a 
provision making permanent prescribing authority for nurse 
practitioners and physician assistants, which were some of the measures 
that Senators Markey and King were just talking about. Nurses and 
physician assistants are vital parts of our care workforce, including 
and especially in rural and underserved areas, and their prescribing 
authority should be made permanent, and we should allow additional 
advanced practice nurses to prescribe.
  I am pleased that we are taking this step forward today, and I am 
grateful for the Senate's bipartisan work that has brought us to this 
point--the consideration of the bill on the Senate floor. I am 
particularly grateful for the work of Senator Alexander and Senator 
Murray.
  This legislation is a vital next step in our efforts to combat this 
crisis. The biggest mistake anyone could make is thinking that our 
efforts are anywhere close to being done. As the families I met with 
this morning made clear, we have a lot more work to do.
  I am encouraged by the progress of this bill, and I believe its 
implementation will help us mount a much more informed and 
comprehensive response to this devastating epidemic. I also remain 
encouraged that we have secured a significant increase in Federal 
funding to combat this crisis through our budget negotiations.
  Let there be no mistake. We will need to continue to work together. 
In particular, we will need to learn about which treatment and recovery 
practices will be successful in the long run, and we will need further 
research to establish best practices for supporting a newly at-risk 
cohort--the children of those with this disorder. We have been 
responding to and learning about this disease as the epidemic unfolded, 
and there is much we do not know and much we still need to tackle.
  I am encouraged that Members of both parties have come together, 
demonstrating that we can put partisanship aside and work together to 
address some of the most dire challenges our communities face. We owe 
it to all of the many stakeholders in this fight to keep listening to 
them, to keep collaborating together, and to keep working on solutions 
so that we can truly make progress and get better. This is a good 
start, but it is and must be only a start.
  I yield the floor.


                   Recognition of the Majority Leader

  The PRESIDING OFFICER. The majority leader is recognized.


                           Hurricane Florence

  Mr. McCONNELL. Mr. President, since the Senate last convened, 
Hurricane Florence made landfall on our Nation's eastern seaboard. 
According to the latest estimates, this terrible storm has already 
claimed more than 20 lives in North Carolina, South Carolina, and 
Florida. With more than 1 million Americans subjected to mandatory 
evacuations, many families have been displaced, and the storm surge and 
historic rainfall have brought communities to their knees with 
crippling flooding.
  The Senate stands with all of those affected, and we stand ready to 
ensure that communities in the storm's path have the resources they 
need to recover and rebuild, once the time comes. For now, we stand in 
solidarity with the Americans who are battling this storm and with 
first responders, who bravely risk their own safety to care for their 
communities.


                 Patient Right to Know Drug Prices Act

  Mr. President, on another matter, today, the Senate will take two 
important actions to help vulnerable Americans. First, we will pass the 
Patient Right to Know Drug Prices Act, spearheaded by Senator Collins.
  This legislation would ban so-called pharmacy gag clauses, which 
prohibit pharmacists from sharing drug pricing information that would 
save consumers money. In circumstances when the out-of-pocket retail 
cost of a medication is actually cheaper than the price through 
insurance, it will allow customers with access to the information they 
need to choose the more affordable route.
  After that, we will vote on major, landmark legislation to address 
the

[[Page S6165]]

opioid crisis that continues to weigh on our country. My fellow 
Kentuckians and I are all too aware of how drug abuse and addiction 
attack families and communities. Overdoses killed 1,500 Kentuckians 
last year alone. That is more than four fatalities per day. Nationwide, 
it is more than 115 fatalities per day.
  The effects of this emergency compound themselves. The crisis can eat 
away at family ties, at community institutions, at economic 
opportunities--precisely the things that are necessary to lift 
Americans out of addiction and into recovery.
  On the one hand, research suggests that opioid use rose the most in 
the very communities where employment fell the most. On the other hand, 
experts blame opioids themselves for a major share of falling workforce 
participation, to the tune of roughly 1 million missing workers.
  A comprehensive crisis demands a comprehensive solution. That is 
exactly what this landmark legislation is. It combines work from 5 
committees and input from 70 Senators.
  First, this legislation will help cut off the opioid crisis at its 
roots. It will stop more drugs at the border, improve interstate 
monitoring, and encourage reform of prescription dosing. It will 
encourage recovery through more resources for State and local 
responders, better access to care for patients, and more support for 
the families and caregivers of those affected. This legislation looks 
to the future by surrounding long-term medical research and economic 
solutions to get our county past this vicious cycle.
  I am pleased that two of my provisions are included--the CAREER Act, 
which expands grants and targets funding for transitional housing and 
job opportunities to help recovering individuals find their footing and 
stay sober, and my Protecting Moms and Infants Act, which will refine 
our Federal efforts to combat the effects of opioids on expecting 
mothers and their unborn children.
  The situation facing Americans and communities is urgent. With this 
landmark legislation, the Senate has risen to the moment. It is no 
wonder that experts and advocates representing 200 organizations on the 
frontlines of the opioid crisis have publicly called on the Senate to 
act. That is exactly what we will do when we pass this landmark 
legislation later today.


                     Nomination of Brett Kavanaugh

  Mr. President, on a final matter, it has been 70 days since the 
President nominated Judge Brett Kavanaugh to fill the current vacancy 
on the Supreme Court. For more than 2 months, the Senate has pored over 
Judge Kavanaugh's professional record.
  We have reviewed the 300-plus opinions he has authored while serving 
on the DC Circuit, more pages of documents than have ever been produced 
for a Supreme Court nomination--more than for the past five nominations 
combined--and testimony from prominent legal scholars and top 
litigators who have praised the nominee's intellect and his exemplary 
performance on the Federal bench.
  We have also considered a wealth of evidence that pertains to Judge 
Kavanaugh's character and his personal integrity. We have heard 
testimony or received open letters from literally hundreds of men and 
women who know Brett Kavanaugh, who have worked alongside him, who have 
clerked for him as a judge, or who have known him and his family 
personally over the years. This is what the Senate has considered for 
the past 70 days. In the Senate and around the country, almost everyone 
who went into this process with an open mind and who was prepared to 
give Judge Kavanaugh a fair hearing has come away impressed.
  But now an accusation of 36-year-old misconduct, dating back to high 
school, has been brought forward at the last minute, in an irregular 
manner. It is an accusation that Judge Kavanaugh has completely and 
unequivocally denied. This is what he said:

       This is a completely false allegation. I have never done 
     anything like what the accuser describes--to her or to 
     anyone.

  It is an accusation that the ranking member on the committee of 
jurisdiction has known about for at least 6 weeks--known about for 6 
weeks--yet chose to keep secret until the 11th hour. Neither she nor 
any of her Democratic colleagues chose to raise this allegation during 
the committee staff's bipartisan background calls with the nominee.
  They did not raise it, even with the name redacted, in the 65 
meetings--65 meetings--that Judge Kavanaugh held with Senators before 
his confirmation hearings, including his private meeting with the 
ranking member. They did not raise it, even with the name redacted, in 
4 days of exhaustive public hearings while Judge Kavanaugh testified 
under oath, even though they chose to raise myriad other matters at the 
hearing, including sometimes bizarre innuendo. They did not raise it in 
the closed session, the proper forum where such an allegation could 
have been addressed with discretion and sensitivity. They did not raise 
it in the thousand-plus followup questions Senators sent to Judge 
Kavanaugh in writing.
  At the 11th hour, with committee votes on the schedule, after 
Democrats have spent weeks and weeks searching for any possible reason 
the nomination should be delayed, now they choose to introduce this 
allegation--not through the standard bipartisan process, not by 
advising the Judiciary Committee colleagues and committee staff through 
proper channels but by leaking it to the press, because the chain of 
custody of this letter runs through the Democratic side of the 
Judiciary Committee. That is the chain of custody.
  I can't explain the situation any better than the senior Senator from 
Maine put it yesterday evening when she said this:

       If they believed [Judge Kavanaugh's accuser], why didn't 
     they surface this information earlier so that he could be 
     questioned about it? And if they didn't believe her and chose 
     to withhold the information, why did they decide at the 11th 
     hour to release it? It is really not fair to either of them 
     the way it was handled.

  As the senior Senator from Texas said earlier today, ``that Democrats 
have so egregiously mishandled this up until now, is no excuse for us 
to do the same.'' Just because the Democrats have egregiously 
mishandled this, said Senator Cornyn, is no excuse for us to do the 
same thing.
  I am glad that Chairman Grassley is following standard practice and 
regular order. As he has stated, he plans to pursue this matter by the 
book, with bipartisan interviews of both Judge Kavanaugh and Dr. Ford. 
I have great confidence in Chairman Grassley and his ability to proceed 
through this process.
  The PRESIDING OFFICER. The Senator from Montana.


                            Opioid Epidemic

  Mr. DAINES. Mr. President, I want to thank my colleagues in this body 
for their hard work and their true bipartisan efforts to address the 
opioid and drug crisis in the United States. The legislation before us 
will help to combat an epidemic that touches the lives of almost every 
person in our country.
  In Montana opioid overdoses have claimed the lives of 700 people 
since 2000. From 2013 to 2014, 42 percent of all drug-related deaths 
were caused by opioids. With easier access and a larger supply on the 
street, we are finding opioids in the hands of more and more people. It 
is tearing families apart. It is devastating our communities.
  While we must focus on combating the opioid crisis, we must also 
continue to address a related but separate epidemic that is wreaking 
havoc in Montana and in many other States; that is, the methamphetamine 
epidemic.
  In Montana, meth is destroying families and communities and 
disproportionately impacting our Tribes. In fact, we have seen a 415-
percent increase in meth cases from 2011 to 2017, and a 375-percent 
increase in meth-related deaths in that same timeframe.
  To put this in perspective, in 2013, law enforcement seized 40 pounds 
of meth. In 2017, that number more than quadrupled to 188 pounds.
  Almost all meth in Montana is smuggled across the southern border. We 
have seen a dramatic increase of that drug flowing from Mexico into our 
communities.
  Meth is linked to more violent crimes and robberies than any other 
drug. Meth is highly addictive. It is destructive; it destroys the body 
both inside and out.
  We are seeing sad story after story on the effects and impacts of 
meth and drug use in Montana making headlines. In fact, just last week, 
a man was charged with leaving a baby in the woods near Lolo Hot 
Springs. He admitted he was high on meth and bath

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salts. According to reports, he left a 5-month-old in the woods because 
``he grew tired of carrying it.''
  While this is a despicable and horrible story, this is just one of 
many we are seeing across Montana. I am thankful--I am thankful for 
those on the ground in Montana for diligently working to combat this 
crisis, including our very own attorney general, Tim Fox, as well as 
our local law enforcement.
  At the Federal level, our goal must be to partner with States and 
communities to overcome this devastating reality, and that is why I 
fought for specific provisions to be included in this opioid bill we 
are going to pass this week.
  My bipartisan legislation, the Mitigating METH Act, expands the 
State-targeted response to the opioid crisis grants to include Indian 
Tribes as eligible recipients and is included in this broader 
legislation that we have before us. This initiative is extremely 
important to curbing substance abuse on Indian reservations.
  The STOP Act, another bipartisan bill that I have cosponsored, is 
included in this package before this body. This bill helps stop illegal 
drugs from crossing the border or being shipped through the Postal 
Service.
  Additionally, programs like the high intensity drug trafficking 
areas, drug courts, and the COPS Anti-Meth Program are all reauthorized 
in this package, and I can tell you something: These are vital 
resources in combating meth use in Montana. Without these tools, we 
will continue down a dark path, but I believe, with these programs and 
by passing this bipartisan bill in the U.S. Senate, we can begin to 
finally curb this problem.
  I truly want to thank my colleagues, and I look forward to passing 
this legislation and sending this to the President's desk.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. CARDIN. Mr. President, shortly we are going to have an 
opportunity to vote on the Opioid Crisis Response Act of 2018, which I 
strongly support. But I want to share with my colleagues a roundtable 
discussion I held in Baltimore just a few hours ago. In an area of 
Cherry Hill, I met with leading experts in regard to the opioid crisis. 
We had leadership from Baltimore city, Baltimore County, Anne Arundel 
County, representatives from the State, and a lot of different other 
organizations.
  It started with Dr. Jason Kletter, who is the president of BayMark, 
giving us a tour of the new facility that he opened up in Cherry Hill. 
This is a wonderful new facility for opioid addiction. It uses 
medicines in order to control a person's addiction, and it is a state-
of-the-art facility. It was just opened last month--or 2 months ago--so 
it is a brandnew facility.
  I asked Dr. Kletter exactly how he was able to do this. The first 
thing he mentioned to me was the importance of the Affordable Care Act. 
Because of the expansion of Medicaid and the coverage for addiction and 
the coverage of essential health benefits within the Affordable Care 
Act, the clinic can get a lot more reimbursement for the people who use 
the facilities, giving them the wherewithal to be able to construct a 
new facility in the community, giving access to care for those who have 
addiction.
  We then heard from Jose Rodriguez, who is the Baltimore City Health 
Department's director of opioid overdose prevention, and he told us 
about a lot of the innovative programs we are looking at in Baltimore 
in order to provide treatment to opioid-addicted individuals.
  One of the innovations that Mayor Pugh of Baltimore wants is known as 
a stabilization center. A stabilization center would be 24/7, which is 
critically important. People who are stressed normally are not during 
normal business hours, and it is important to have availability in the 
inconvenient hours of the early morning. An emergency room provides 
that access, but the problem is that emergency rooms--many--are not 
capable of handling people who have OD'd, and that individual could 
become very disruptive within the emergency room setting, making it 
difficult for the hospital to provide adequate care for the other 
patients.
  So the mayor of Baltimore wants to establish a stabilization center, 
which would be 24/7 and available to handle people who have drug 
problems when they need it and provide the necessary services not only 
to save their life, but to put them on a track to deal with their 
addiction needs.
  We are very proud of the leadership in Baltimore city to move forward 
on this, and I wanted to share with my colleagues some of the 
innovative programs that are being suggested.
  Linda Bryan is the Baltimore County program manager for recovery-
oriented systems of care. She was telling us about a program in 
Baltimore County where they use peer coaches or a peer support system, 
people who have gone through the addiction recovery process. They train 
them under this program, help them to go out and coach those who are 
suffering from addiction, so they not only get treatment, but they stay 
in treatment, and they have a road to recovery. It is an innovative 
program that is working well in Baltimore County.
  We then heard from Jen Corbin, who is the program director for the 
Anne Arundel County crisis response team. Here we have an innovative 
program known as safe stations, and let me explain this. This is 24/7 
also. I have already told you the need for 24/7 programs. What the 
leadership at Anne Arundel County--and this is a county that borders 
Baltimore and borders Annapolis; Annapolis is part of Anne Arundel 
County, so it is an urban area, but it has some rural aspects to it. 
They allow every one of their fire stations--every single one in their 
county--to be accessible 24/7 for any individual who is stressed and 
needs help with regard to their drug problems.
  When they set this program up, which was less than a year ago, they 
were expecting to get about five visits a week. They are getting 5 to 
10 visits a day--a day. People are coming in to get rid of their drug 
paraphernalia. No questions asked--they will take it there. They are 
getting in there to access the system as to how they can deal with 
their drug addiction problems. They are seeking care. They are going in 
there when they are stressed, and they are getting care. First 
responders will provide immediate help, and they have the availability 
of county services to get people into treatment 24/7. It is working.
  It is working so well that we have people from other counties who are 
referring their people to go to Anne Arundel County to go to the fire 
station. Just this past week, one of the private insurers asked one of 
their insured: Why don't you go to the Anne Arundel fire station in 
order to get help?
  We need to expand these types of programs.
  The fire chief told me one other thing, which was very interesting: 
Since they started this program, theft crime in Anne Arundel County is 
down 13 percent. Theft crime, of course, as we all know--a lot of it--
feeds habits, and this program is paying off in the community with 
reduced crime.
  I mentioned today's roundtable. I have had about a dozen in Maryland 
throughout the entire State, from the Eastern Shore to Western 
Maryland, to the Washington suburbs, the Baltimore suburbs, Southern 
Maryland, the northern counties, and there is a common theme. The 
common theme is that there is no simple answer to the opioid crisis. It 
involves not only a health issue--and we need to have services for our 
health--but we also need to recognize that it deals with 
transportation, it is a social problem, and it deals with how the 
courts handle these issues. There are multiple disciplines involved in 
dealing with the opioid epidemic, and that is why I am so pleased that 
we are going to have a chance to vote on the Opioid Crisis Response Act 
of 2018.
  We all know that despite our great efforts here--and we have provided 
billions of dollars of additional Federal support for these programs--
the opioid crisis is still on the rise. The number of OD deaths are 
still increasing in many parts of the country. Every community is 
experiencing challenges with the opioid crisis, so it is appropriate 
that we are taking comprehensive action to deal with this problem.
  The Opioid Crisis Response Act of 2018 reauthorizes and improves the 
21st Century Cures Act. Governor Hogan, the Governor of Maryland, has 
strongly urged us to pass this section. In fiscal year 2017, Maryland 
received $20 million under the Cures Act, and these modifications will 
help States like

[[Page S6167]]

Maryland do even more. It is a true Federal partnership with our State 
and local governments to deal with this crisis by providing greater 
base support for opioid problems.
  Secondly, this bill provides comprehensive opioid recovery centers 
under SAMHSA. Why is this important? This allows for locals to apply 
for Federal grants for innovative new programs.
  I mentioned the stabilization program in Baltimore city. There is 
also one in the Upper Shore. There is no direct funding for 
stabilization centers because they are not hospitals, and they don't 
fit into the normal reimbursements. This program that is included in 
the Opioid Crisis Response Act will allow grants to move forward on 
these innovative programs, such as the one in Baltimore city.
  The legislation provides for us to deal with peer support, an area I 
have championed on the Finance Committee, and I have talked frequently 
on this floor about the importance of peer support programs. This 
legislation will help provide technical assistance in order to provide 
peer support but also asks the GAO to take a look at Medicaid 
reimbursements to see whether we can't have a more comprehensive way to 
deal with peer support reimbursement.
  It expands telehealth, an area that I have been directly involved 
with. I am happy to hear that. That is an important part of dealing 
with the opioid crisis.
  It deals with a new area that we haven't really dealt with before, 
and that is housing. As I said, the problem of opioid addiction is not 
just health, it is also housing, and this legislation will provide a 
way in which we can help the homeless and deal with housing issues in 
order to make people less vulnerable to being left out of opioid 
recovery.
  It does deal with the underlying causes, with research and 
development in nonaddictive pain killers to get CDC grants and to look 
at mechanisms to control prescription drugs.
  It also deals with the killer effect that we have in fentanyl. 
Fentanyl, as you all know, is a synthetic drug that is primarily 
produced in China, but there are other sources that come into this 
country and are mixed with heroin causing, in many cases, instant 
death. This legislation will provide a way in which Customs will have 
greater enforcement to keep fentanyl out of the United States and will 
provide detection for first responders so they can protect themselves, 
because they go on a scene, there may be fentanyl there, and if they 
don't know it, they can become afflicted by this synthetic drug.
  All of this is good news. I have only scratched the surface of a lot 
of the provisions in this bill. It is a comprehensive bill. It is 
bipartisan. It represents the work of several of our committees, 
including the Senate Finance Committee on which I proudly serve.
  I urge my colleagues to pass this legislation, and let's increase the 
government's role and deal with this crisis in all parts of America.


                   Recognition of the Minority Leader

  The PRESIDING OFFICER (Mrs. Ernst). The Democratic leader is 
recognized.


                     Nomination of Brett Kavanaugh

  Mr. SCHUMER. Madam President, over the past few days, new allegations 
have come to light about President Trump's nominee to the Supreme 
Court, Brett Kavanaugh. These allegations ought to be treated with the 
utmost gravity. The allegations are extremely credible. They were made 
by someone who voluntarily submitted to a lie detector test and had 
been discussed in the past--long before Kavanaugh's nomination to the 
Supreme Court--with a family therapist. I believe her, and many, many 
Americans believe her. Many women in America who have been taken 
advantage of certainly believe her. For too long, women have made 
serious allegations of abuse and have been ignored or dragged through 
the mud. It would be a disgrace if this body and our fellow Republicans 
let that happen.
  Chairman Grassley must postpone the vote on Judge Kavanaugh's 
nomination until, at a very minimum, these serious and credible 
allegations are thoroughly investigated. The FBI conducted a background 
check on Judge Kavanaugh before these allegations were known. When they 
did their background check, the FBI had no knowledge of what went on, 
so it is now the FBI's responsibility to investigate these claims, 
update the analysis of Judge Kavanaugh's background, and report back to 
the Senate.
  The FBI is the right place for this investigation for two reasons:
  First, the FBI has the resources, the information, and the legal 
tools to conduct an investigation the right way--far better than some 
staffer talking to Professor Ford on the phone. You cannot lie to the 
FBI--that is a crime. The FBI will get to the truth. They almost always 
do.
  Second, our Republican colleagues have run a transparently partisan 
confirmation process, and then they immediately insinuated that Dr. 
Ford is being untruthful. Republicans and their staff cannot 
impartially investigate these allegations; they have already said that 
they are not true. Republicans and their staff cannot do this in a 
respected way because they have run such a partisan investigation thus 
far. There is no bipartisanship here--none--so to have any credibility, 
this has to be done by an independent, outside body. The FBI is the 
best one.
  The vote must be postponed until it is complete. It would be an 
insult to the women of America to rush this through after these serious 
allegations have been made. It would be an insult to the majesty of the 
Supreme Court to rush this through when these serious allegations have 
come forward.
  In addition, Dr. Ford has said she is willing to testify before the 
Judiciary Committee. Does anyone believe it is better for staff to talk 
to her on the phone--Republican staff only because no Democratic staff 
will participate in this biased, far-fetched process. Does anyone think 
it is not better for her to come testify? Then why can't she? Chairman 
Grassley should provide the American people the forum to hear her out. 
I believe she is credible. A lot of my Republican friends don't. What 
are they afraid of? Are they afraid that she might be very persuasive? 
Well, if she is, it will be a whole different ball game, won't it?
  Chairman Grassley should and must provide the American people the 
forum to hear her out and decide for themselves whether her testimony 
reflects on Judge Kavanaugh's character and fitness for the Supreme 
Court. Of course, he can have a chance to testify again, too, and both 
of them said they would. Why in the Good Lord's Name--why wouldn't we 
do that? Why? There is no reason. No reason. There is no requirement, 
rule, or precedent that says the Judiciary Committee must move forward 
on Judge Kavanaugh's nomination this week--none. What is the reason we 
have to rush it through when these allegations are hanging out there, 
when women who are victimized deserve the right to be heard at the very 
minimum?
  Then the gall of my dear friend the Republican leader, who delayed 
Justice Scalia's seat being filled for 9 months, to say that we can't 
take a couple of extra weeks--unmitigated gall. The seat of Justice 
Scalia was held open for a long time, and now, with no reason, my 
colleague says we can't do that.
  Chairman Grassley has to stop playing games, pretending like the 
nomination can continue to glide through while at the same time the 
Senate conducts a review of these allegations. Hastily arranged private 
phone calls with committee staff members is not even close to 
constituting a fair and thorough review, is not part of any sort of 
regular order, and does not substitute for an FBI background check or 
public hearing.
  Again, let me ask my dear friend the leader, what is the reason, now 
that both Judge Kavanaugh and Professor Ford have said they will come 
and testify, that we won't do it? Give me one good reason. One. It is 
unrelated to how we became aware of these allegations. Whether you like 
it or not, there is a right for them to be heard.
  With allegations as serious as the ones before us, the Senate must 
not--it cannot for the honor of the Senate--conduct a haphazard, 
slipshod review of Dr. Ford's claims or be rushed to a vote. There must 
be time for the FBI to do its work and for the Judiciary Committee to 
properly prepare to hear testimony from Dr. Ford and Judge Kavanaugh.
  There is another issue here. Judge Kavanaugh's credibility has 
already

[[Page S6168]]

been seriously questioned in the aftermath of his testimony regarding 
emails stolen from the Judiciary Committee by a Republican staff 
member, his involvement in the nomination of Judge William Pryor, and 
other controversies. In all of these cases, Judge Kavanaugh's 
credibility was questioned because documents revealed that he was far 
more involved than he led on to when he testified.
  Now, he has unequivocally denied this. So there is an issue of 
credibility here. You have two people with diametrically opposed views 
as to what happened. This is not just an argument for its own sake; it 
is for a nomination to the Supreme Court, the highest Court in the 
land, which determines through their legal rulings the lives of 
Americans and in many instances is seen as the arbiter of right and 
wrong.
  Are we going to let this happen, not even hear what someone who 
believes she was terribly aggrieved--and I believe her--has to say? 
When the credibility of a Supreme Court Justice is on the line, we are 
going to just brush it under the rug--again, after delaying Merrick 
Garland for over 1 year--with no explanation as to why we can't wait a 
much shorter period of time? The double standard, the twisting of this 
body into a cruel, nasty partisanship, unprecedented, in a feverish 
desire to fill the bench with people with whom the other side agrees--
it is one of the lowest points I have seen in my years here.
  I want to applaud my colleagues on the other side of the aisle who 
have called for hearings. I believe one way or another, six have said 
this should be delayed. I hope they will be strong. I hope they will 
tell Leader McConnell he is doing the wrong thing. Dr. Ford deserves to 
be heard. To railroad a vote now would be a deep insult to the women of 
America and a lasting scar on the integrity of the Supreme Court.


                            Opioid Epidemic

  Madam President, now on another matter, tonight the Senate will take 
up legislation that will help our country fight back against the opioid 
epidemic. The bill will help people from all backgrounds and all ages 
and is designed to address the spectrum of opioid addiction. That means 
medical prevention and law enforcement prevention, reversing overdoses, 
helping those in treatment, and enabling those in recovery to get back 
to their lives.
  On this one, we have had real bipartisanship. Democrats and 
Republicans came together to pass major funding increases to fight the 
opioid crisis. When we consider the Labor-HHS appropriations bill this 
week--I hope we will see it signed into law soon by the President--
Congress will have appropriated $7 billion over 2 years to address 
opioid addiction, and that funding is now making its way to the States.
  The legislation we will consider this week is another side of the 
same coin. The funding increases are important, and now this bill will 
complement those efforts by making important policy changes and 
creating new programs to help providers, first responders, law 
enforcement, communities, and families fight back against the scourge 
of addiction. Stopping this crisis will take a multifaceted effort, and 
this bill recognizes that fact.
  I want to thank Members on my side whose legislation is included in 
this bill: Senators Baldwin, Donnelly, Manchin, McCaskill, Nelson, 
Casey, Heitkamp, and Klobuchar. Many more Democratic Senators 
contributed to this bill, as did many Republicans, and I thank them for 
their hard work.
  Addiction has held too many Americans in its grip for too long. We 
cannot let up our efforts to fight this scourge. In the coming days and 
weeks, Congress will work diligently on merging the Senate bill with 
the House bill that has already passed. It is my sincere hope that we 
will come to an agreement and that we will have a new opioid law signed 
in the future.


                           Hurricane Florence

  Madam President, along with so many others, my heart goes out to the 
people of the Carolinas and surrounding States. To see the pictures of 
houses being flooded--it breaks your heart to see the devastation. It 
reminded me of what happened in my State a few years ago with Sandy. 
Our hearts go out to these people.
  The Federal Government always pulls together when part of the Nation 
has a problem. I am not going to look up the voting record of those 
from the other side who are now going to ask for aid when they voted no 
when my State was so beleaguered. I don't believe that is the proper 
way to approach this. They are suffering, and we need to be there for 
them.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Ohio.
  Mr. PORTMAN. Madam President, my colleague from Maryland spoke 
earlier about the opioid crisis and the fact that we are about to vote 
on legislation tonight that is called the Opioid Crisis Response Act. 
He talked a little about some of the innovations going on in the State 
of Maryland.
  We are fortunate, in my home State of Ohio, to have some great work 
going on as well. Like the Stabilization Centers he talked about, we 
now have in Ohio the opportunity for people who are treated for 
addiction to be given this miracle drug, Narcan, which reverses the 
effects of the overdose. They are able to not just go to an emergency 
room, where they can be taken care of for this reversal of the 
overdose, but also get into treatment.
  The Maryhaven Addiction Stabilization Center in Columbus, OH, has 
become a model not just for Ohio but for the country. It is one of the 
early centers where they are taking some of the Federal funds we passed 
here and using them to come up with innovative ways to get people into 
treatment. Their success rate is over 80 percent. Unfortunately, that 
is not true with regard to other instances where someone is given this 
Narcan--usually by a first responder or in an emergency room setting--
then does not go into treatment but rather goes back to the environment 
and the old community or the gang where the addiction happened in the 
first place. In so many instances, first responders are called again, 
and sometimes again and again, to provide that Narcan to the same 
individual. That is not helping anyone. It is certainly not helping 
that individual in taking this disease of addiction and dealing with it 
in a serious way. Stabilization centers are a great idea. We are 
starting to do some of these things back home. It is an innovative way 
that will help us turn the tide.
  This legislation we are voting on tonight will help in that regard. 
It provides additional funding and additional help for some of these 
new approaches that we badly need.
  Sadly, despite some progress based on legislation we passed about a 
year and a half ago, the CARA Act and Cures Act--which we will talk 
about in a moment--things are not getting better; they are getting 
worse.
  Every State in this Chamber has been affected by this issue. This 
chart behind me shows those States which last year had an increase in 
overdoses from opioids and other drugs. If you had an increase, you are 
in orange. If you had a decrease, you are in blue. Sadly, as you can 
see, States, including my home State of Ohio and the Presiding 
Officer's home State of Iowa, saw an increase.
  Overall, there was about a 9-percent increase in overdose deaths last 
year in America. Based on the Centers for Disease Control data we got 
about a month ago, it was 72,000 people. Think about that. That is, of 
course, more individuals than we lost in the Vietnam war, and 72,000 
means that this is the No. 1 cause of death now in America for those 
under the age of 50.
  In my home State of Ohio, it is the No. 1 cause of death, period. We 
are in a crisis. We are in an epidemic. Despite some of these new 
innovations going on back in our States, we continue to see these grim 
records year after year. We need to reverse this. Tonight's legislation 
will help do that. As an example, Franklin, OH, which is in the center 
of Ohio near the Columbus area, just in the past 9 days, recently 
experienced 29 overdose deaths. Do you know what the coroner said? The 
coroner said this spike was caused by a synthetic drug called fentanyl.
  Fentanyl is about 50 times more powerful than heroin. Fentanyl is the 
No. 1 killer now. We need more people to get into treatment to overcome 
the disease of addiction and do more to keep this fentanyl--this new 
scourge--out of our communities.
  This legislation will do both of those things. This is consensus 
legislation. There are five committees that were

[[Page S6169]]

able to provide input for this legislation. They had public hearings. 
They contributed ideas to it. That includes the HELP Committee, 
Judiciary, Finance, Commerce, and Banking Committees. I applaud the 
HELP Committee chairman, Lamar Alexander, because he pulled together 
all these ideas from these four or five different committees and helped 
us come up with this consensus package.
  I would like to thank Majority Leader McConnell and Democratic Leader 
Schumer for agreeing to bring this legislation to the floor tonight. It 
doesn't include everything all of us want to see, but it has important 
new initiatives, and it is a step in the right direction.
  I note this one issue we couldn't include in this broader package is 
the arbitrary cap that is now in place on so many treatment centers. 
They are capped at 16 beds for Medicaid reimbursement, which is really 
a vestige of a previous policy to get people out of institutional care 
with mostly mental health focus, but it is having an effect on this 
opioid crisis we talked about because people who are ready to get into 
treatment are told there is no room. This is for residential treatment.
  We have a solution to it. We will introduce legislation on that 
tomorrow. We are told that in conference, we can try to work something 
out because the House has legislation that addresses this.
  I appreciate Senator Alexander's willingness to do that. Senator 
Cardin, who was on the floor earlier, and I talked about this. He is 
part of a bipartisan group putting our ideas out there to allow these 
good treatment centers to be able to take in more people without an 
arbitrary cap.
  This package builds on two legislative projects I talked about 
earlier--the Comprehensive Addiction and Recovery Act and 21st Century 
Cures Act.
  The CARA legislation, the Comprehensive Addiction Recovery Act, 
provides resources directly to evidence-based programs that are 
working: prevention, treatment, longer term recovery, and helping our 
first responders. The Cures legislation, 21st Century Cures, doesn't go 
straight to the groups--organizations and nonprofits. It goes to the 
States. Then the States decide how that money is spent.
  These laws, again, are beginning to make a difference for the people 
we represent, helping these communities to push back and fight and try 
new things. Even before those bills passed, some in this Chamber got 
together to talk about how can we ensure we have the adequate resources 
to take on this issue. Also, in our appropriations bills, these bills 
are being funded above the amount we approved here or authorized. That 
is good.
  In about 2015, just a few years ago, we began to see this fentanyl 
issue really rise. In my home State of Ohio, by the summer of 2016, it 
had invaded our State at crisis levels. In 2014, we had 503 fentanyl 
overdose deaths. In 2015, that rose to over 1,000 deaths and 2,357 
deaths last year. Fentanyl was responsible for more than half of those 
people who died of overdoses in my State and in the country last year. 
The numbers are now coming in for 2017, and we are hearing it will be 
about two-thirds of the deaths in Ohio as we continue to hear numbers 
for this year, 2018.

  This trend of increasing fentanyl overdoses rings true all around the 
country. Fentanyl overdoses nationally reached nearly 30,000 last year. 
That means they have increased by 850 percent just in the 4 years 
between 2013 and 2017. Between 2013 and 2017, we have seen an 850-
percent increase in overdoses due to this one drug, this synthetic 
opioid fentanyl.
  Here is a chart that talks about this a little bit. It shows that 
with regard to some drugs, as tragic as the overdose rates are, heroin 
as an example, is pretty flat, going from 2015 up to 2018. Here is 
fentanyl--synthetic opioids. As you can see, it has gone up 
dramatically. This is the new scourge of the opioid epidemic. It is 50 
times more potent than heroin. It is relatively inexpensive on the 
streets and relatively accessible. As a result, many traffickers have 
turned to this. Fentanyl is being spread to other drugs. So heroin is 
being laced with fentanyl. Cocaine is being laced with fentanyl, even 
crystal meth. This increases the potency of those drugs, increases the 
chance of an addiction, and with the rise of fentanyl, of course, we 
are seeing more and more deaths because of its power. We are also 
seeing that no street drug is safe from a potential overdose and death.
  I heard a number of tragic examples recently during our last two 
tele-townhall meetings. We have another one tomorrow night. I am sure I 
will hear about it. The first case was last month. Sam from Shelby 
County talked about the fentanyl issue. He was talking about it 
objectively and policywise and then his voice changed and the emotion 
was clear. I asked him if he had a family relationship with this drug 
or if anything had happened. He acknowledged his son died from a 
fentanyl overdose. His son died a few weeks before the call. His son 
didn't know he was taking fentanyl because it had been laced in another 
drug.
  The next tele-townhall meeting, also last month, Pauline from 
Zanesville called in and told me her brother passed away from a 
fentanyl overdose. He was a heroin addict, but he had no idea he was 
taking fentanyl. It was laced in the heroin, and he overdosed and died.
  In both of those cases, they weren't using it knowingly, but the 
autopsy revealed it was fentanyl. This is happening all across our 
country, and it is causing these historically high overdose deaths. 
This historic trend is why we began looking into fentanyl and seeing 
what we can do it about it.
  Senator McCaskill is on the floor. We conducted an 18-month 
investigation into this under the Permanent Subcommittee on 
Investigations, PSI. We asked: Where is this coming from? How can this 
be happening in our country?
  We found out something shocking, which is, it is primarily produced 
in laboratories in China, and it is primarily coming to the United 
States through the U.S. mail system--our own government agency, the 
Postal Service.
  Our investigators identified how easy it was to get these drugs into 
the United States. We had an undercover operation where we posed as 
buyers. Based on that, we found out these overseas sellers essentially 
guaranteed delivery if the fentanyl was shipped through the U.S. Postal 
Service. If you send it through a private carrier, it is not 
guaranteed--FedEx, UPS, DHL, one of those. If they sent it through the 
Postal Service, they guaranteed delivery. Why is that? The Postal 
Service has a weaker screening policy than these private carriers.
  That is because of Congress. After 9/11, Congress said to the private 
carriers, you have to have a better screening policy, including 
providing advanced electronic information to law enforcement on every 
package that comes into America. They were doing it for other 
contraband and explosives more than fentanyl, but that is effective now 
because law enforcement and Customs and Border Protection can identify 
these packages. Otherwise, it is like finding a needle in a haystack. 
Think about that. There are 900 million packages a year in the post 
office alone. We need this data.
  Law enforcement uses it. I have seen them do it. I have gone to the 
distribution center and have seen how they pull things off. They put on 
protective gear to open these packages because fentanyl is so deadly. 
The information tells them where it is from, what is in it, and where 
it is going. They then use Big Data to identify suspicious packages and 
keep some of this deadly drug out of our communities.
  The law does not require the post office to do that. After 9/11, we 
said to the private carriers: You have to do it. We said to the post 
office: You need to study this issue and get back to us. They have 
never gotten back to us. We need to get back to them and say: You have 
to do it too. This is a minimum.
  We at least have to know what is in these packages coming into our 
country so law enforcement can stop some of this poison that is 
overtaking our communities and robbing thousands of Americans of their 
God-given purpose in life. It is not to be an addict. It is not to 
overdose and die. We need to help.
  The STOP Act--legislation I authored with my colleague Senator Amy 
Klobuchar from Minnesota--is included in this larger opioid package, 
which we will vote on this evening. The STOP Act does just that. It 
closes this loophole. It says to these traffickers:

[[Page S6170]]

You are not going to be able to continue to exploit our U.S. Postal 
Service to ship your fentanyl into America.
  It is a commonsense solution. It deals with the most deadly aspect of 
the opioid epidemic and simply requires the Postal Service to get this 
data 100 percent from China now, 70 percent for the rest of the world 
by the end of this year, and by 2020, 100 percent every package.
  This will help stop the flow of this poison coming into our 
communities, but it will reduce the supply and raise the cost, which is 
part of the issue with the accessibility of fentanyl. Once enacted into 
law, it will help.
  Tonight is an opportunity for us to vote on this package. The House 
and the Senate package is identical. If we vote on it tonight and get 
it passed, it will go to the President for his signature. It will help.
  Is it all we need to do? No. We need to continue to fund CARA and 
Cures, as we talked about, to deal with the demand side of this, the 
prevention side, the treatment, and longer term recovery.
  This legislation also has a number of initiatives in that area. Some 
were talked about earlier, others were not. It builds on the CARA 2.0 
legislation we introduced recently, which was the next step after the 
Comprehensive Addiction and Recovery Act.
  For instance, one thing it has in this bill, from CARA 2.0, is a 
national quality standard and best practices for recovery housing. Yes, 
recovery housing and Silver Living is important. There have been too 
many examples of housing that have not had the kind of quality you 
would expect, even allowing drug use within that recovery housing. We 
can't allow that to continue. This ensures that people transitioning 
out of treatment will have high-quality options.
  This legislation also authorizes support for high school and college 
students to help children and young adults recover from substance abuse 
disorders. We have some amazing models in Ohio on this. The Collegiate 
Recovery Community at Ohio State is an example. Columbus is opening its 
first recovery high school next year.
  CARA 2.0's contribution to the opioid legislation also includes help 
for the most vulnerable among us, the babies. There is $60 million for 
a plan of safe care for babies born dependent on drugs. This provides 
treatment to babies born with what is called neonatal abstinence 
syndrome. Their mothers are addicted, and they develop a dependency on 
drugs in the womb. These innocent babies then have to be taken 
literally through the process of withdrawal. I have been to neonatal 
units around our State to see these babies. It is a sad and tragic 
thing to see. We need more help to ensure these babies get the care 
they need so they may get through this withdrawal process.

  To help the newborn babies further, the legislation also includes the 
CRIB Act, which is bipartisan legislation I coauthored that will help 
newborns who are suffering from addiction to recover in the best 
setting possible, and it will provide support for their families. The 
CRIB Act says that families can be reimbursed for providing the love 
and care the children and babies need at that time. It is a very sad 
situation. I see this across my State, but I also know this is 
happening across the country.
  There is a great group called Brigid's Path in Dayton, OH, which I 
have had the opportunity to visit. It provides loving care and support 
for these babies, but it gets no reimbursement for it. This is an 
opportunity to provide as much care and treatment as is necessary to 
help these children achieve their potential in life. The CRIB Act and 
the $60 million in funding will help the babies who have been born 
dependent on drugs. It will help Brigid's Path and other great 
organizations like it to help these kids in need.
  There are a number of other important programs that will be 
reauthorized in this legislation, including the drug courts, drug-free 
communities grants, and high-intensity drug trafficking areas grants, 
to help our law enforcement at every level be able to push back against 
drug traffickers.
  As we pass this legislation, much as we did 2 years ago with the 
passage of CARA and CURES, Congress is committing itself to actually 
putting politics aside--it is not just bipartisan; I think it is 
nonpartisan--to dealing with the real epidemic that is out there, and 
to helping the people we represent. It is not a moment too soon, as 
72,000 lives were lost last year. These are not just statistics; these 
are people with hopes and dreams and families.
  We need to help those who are gripped by addiction to break free from 
those grips. We need to give those in law enforcement the tools they 
need to stop these poisons from infiltrating our country. We need to 
once again commit ourselves to additional resources at the Federal 
level that can help our States and our local communities and our 
private sector respond. The comprehensive opioid legislation we are 
voting on today, including the STOP Act and more, will help to do just 
that.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Louisiana.


                                S. 2554

  Mr. CASSIDY. Madam President, I speak as a Senator who is also a 
physician. In my medical practice, I have learned that if the patient 
has the power, then the patient can make the wisest decision both for 
her health and for her pocketbook.
  I am here to support the Patient Right to Know Drug Prices Act, which 
is legislation that has been put forward by my colleagues Senators 
Collins and McCaskill and which I am privileged to cosponsor.
  Right now, our healthcare system is designed, if you will, to shake 
as much money as possible out of the patient and out of the taxpayer--
all to the benefit of others but not to the patient and not to the 
taxpayer. One of the most egregious examples is the pharmacy gag 
clause. With a pharmacy gag clause, when at the pharmacy, if it will be 
cheaper for you to pay cash for the drug as opposed to through your 
insurance deductible, the pharmacist, through his contract, may be 
restricted from telling you that. If the pharmacist does tell you that, 
the pharmacist will lose his contract with the pharmacy benefit 
manager. So you will pay more by paying your insurance deductible 
instead of less by paying cash for the drug. That money is taken away 
from you and is given to the pharmacy benefit manager. That is wrong. 
This bill, the Patient Right to Know Drug Prices Act, gives that power 
to the pharmacists and to the patients to come up with a solution that 
will be best for the patients' health and their pocketbooks.
  By the way, it does more than that. It also requires that biologic 
and biosimilar drug manufacturers report potential pay-to-delay 
agreements to the Federal Trade Commission and the Department of 
Justice, as is currently done with small molecule grams and generic 
manufacturers. This will allow biosimilars to get to the market 
sooner--again, saving the patient money and saving the taxpayer money.
  Yet there will be an amendment put forward that will dilute the 
impact of this bill and will restrict the provisions of this bill to 
those plans that are self-insured.
  I will point out that the three largest pharmacy benefit managers 
control 72 percent of the market for drug distribution--multibillion-
dollar corporations that operate across all States.
  It clearly falls within Congress's purview, as it regulates 
interstate commerce, to pass a bill such as that. In defeating this 
bill or in watering it down, it is, again, one more way to take power 
away from patients and money away from patients and from taxpayers to 
the benefit not of the patient and her health and her pocketbook but of 
the large PBM.
  The Patient Right to Know Drug Prices Act is a key step in our fight 
to lower drug costs for patients. I ask my colleagues to support this 
bipartisan legislation, which will give patients the power to save 
money on their prescriptions, and to support the bill as is.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Maine.
  Ms. COLLINS. Madam President, I rise in support of the Patient Right 
to Know Drug Prices Act, which is legislation that I have introduced 
with Senators McCaskill, Barrasso, Stabenow, and Cassidy. Our bill has 
also been cosponsored by Chairman Lamar Alexander and 19 other Senators 
from both sides of the aisle. This is one of those rare occasions on 
which we are

[[Page S6171]]

taking up a bill that has widespread bipartisan support and that is 
going to really make a difference.
  This commonsense bill would ban the use of pharmacy gag clauses--an 
egregious practice that prevents pharmacists from telling their 
consumers when they can purchase those prescriptions for less money by 
paying out-of-pocket rather than by using their insurance. This 
legislation is action that we can take right now to help lower the 
costs of prescription drugs for some consumers.
  More than half of Americans, as well as more than 90 percent of 
seniors who are, say, 65 or older, take at least one prescription drug 
each month. Americans have been estimated to spend nearly $45 billion 
out-of-pocket each year for prescription drugs. According to a recent 
poll by the Kaiser Family Foundation, as many as one out of five 
Americans does not fill a needed prescription because they are unable 
to afford it.
  I witnessed this struggle firsthand recently at a pharmacy in Bangor, 
ME. When a couple ahead of me in line received their prescription, they 
were told by the pharmacist that the copay would be $111.
  The husband looked to his wife and said: Honey, we just can't afford 
that.
  They turned around and walked away, leaving the prescription behind.
  I was so upset when I saw that that I asked the pharmacist: How often 
does this happen?
  His reply: Every day.
  Our bill would ensure that pharmacists could volunteer information to 
customers on how to lower their costs for prescription drugs.
  A recent study that was published in the Journal of the American 
Medical Association found that 23 percent--nearly one-quarter of 
prescriptions filled through insurance--ended up costing consumers more 
money than if they had purchased the drugs without using their 
insurance. Who would think that using your debit card rather than your 
insurance card to purchase a prescription drug would be less expensive? 
It is, of course, so counterintuitive that consumers do not think to 
ask this question of the pharmacists, and gag clauses in contracts 
prohibit pharmacists from volunteering this information to patients. 
They prohibit them from telling patients how to obtain the lowest 
prescription drug prices. Thus, consumers are paying more than they 
should unless they ask for specific guidance. Americans have the right 
to know which payment method provides the most savings when purchasing 
their medications.
  By prohibiting gag clauses, our legislation takes concrete action to 
lower the cost of prescription drugs, saving consumers money and 
improving healthcare.
  More than 40 organizations support our bill that will ban this unfair 
restriction, including the National Community Pharmacists Association, 
the American Medical Association, the Alliance for Transparent & 
Affordable Prescriptions, the ERISA Industry Committee, the 
Pharmaceutical Care Management Association, and America's Health 
Insurance Plans. Our bipartisan bill was approved by the HELP 
Committee, with unanimous support, on July 25. The administration has 
also condemned gag clauses and is on record as supporting our bill.
  Despite this widespread support for banning this egregious practice 
that restricts the free speech of pharmacists, Senator Lee has filed an 
amendment that would eviscerate our bill. The Lee amendment would limit 
the gag clause prohibition to only self-insured employer plans. That 
would exclude all other employer group and individual market plans. 
Under the Lee amendment, approximately 85 million Americans would be 
excluded from protection. Think about that. There are 85 million 
Americans who are receiving coverage under employer-sponsored plans or 
in the individual market who would be excluded from this protection. 
The gag clauses that would be banned in our bill are unconscionable 
regardless of the type of insurance plan.
  We know that patients who do not take their medications experience 
greater complications. One study has estimated that medication 
nonadherence costs the healthcare system some $337 billion, not to 
mention there being poorer health outcomes for the individuals 
affected.
  The Patient Right to Know Drug Prices Act prohibits gag clauses from 
being used by health plans that are sponsored by employers or offered 
in the individual market.
  The Federal Government's role in regulating these plans and 
protecting consumers who are served by these markets is already well 
established. The Employee Retirement Income Security Act--better known 
as ERISA--was enacted in 1974. Employers who sponsor insurance plans 
for their employees, as defined by ERISA, are able to deduct the 
expenses associated with these plans. These expenses are also not 
subject to the payroll tax. In 2017, the value of the Federal tax 
benefit for employer-sponsored health insurance was estimated at $260 
billion.
  I strongly support our State-based system of insurance regulation. 
Indeed, I spent 5 years overseeing the Maine Bureau of Insurance as 
Maine's commissioner of professional and financial regulation. Our bill 
does not change the longstanding deference to States on this issue. Yet 
I would note that even though ERISA preserves the authority of the 
States to impose insurance regulations on fully insured plans, these 
plans must still comply with a multitude of provisions that have been 
set by the Federal Government, and it has been that way for many, many 
years. For example, regardless of State law, a fully insured health 
plan must comply with COBRA and must cover minimum hospital stays after 
childbirth, reconstruction after a mastectomy, and students who take 
medically necessary leaves of absence. Also, these plans are prohibited 
from discriminating based on genetic information.
  Unlike Senator Lee's amendment, our legislation would prohibit gag 
clauses in all group health plans so that no matter how the employer 
decides to provide insurance coverage, the employees are able to get 
the best prices for their medications by consulting freely with their 
pharmacists.
  Our bill will also prohibit the use of gag clauses in individual 
health insurance plans, protecting consumers who don't have employer-
provided insurance and who are, rather, purchasing insurance on their 
own.
  Americans who purchase insurance in the individual market may qualify 
for tax credits to help cover the cost of their policies or they may be 
eligible for tax-preferred savings accounts, such as health savings 
accounts established by the Medicare Modernization Act of 2003. Senator 
Lee's amendment will eliminate the protections our bill provides for 
these individuals, many of whom already face growing out-of-pocket 
costs.
  We need this bill as a complement to another bill we passed just 
recently that prohibits these gag clauses for the Medicare Part D 
prescription plans. This is a companion bill to that legislation.
  The bottom line is this: Pharmacists should not be restricted from 
telling customers if there are other ways for them to purchase needed 
prescription drugs less expensively. The administration has made 
banning these clauses a top priority, and this important consumer 
protection should be written into law.
  I urge my colleagues on both sides of the aisle to oppose Senator 
Lee's amendment and to support passage of S. 2554. Today the Senate can 
go on record taking a concrete step to help reduce prescription drug 
prices for some consumers. It makes no sense to exclude 85 million 
Americans from this protection, as Senator Lee's amendment would do. 
Reducing prescription drug prices must be a national priority.
  I am pleased to yield to the leading cosponsor of this bill, Senator 
McCaskill.
  The PRESIDING OFFICER. The Senator from Missouri.
  Mrs. McCASKILL. Thank you, Madam President.
  I thank my friend and colleague, the Senator from Maine. It is always 
such a pleasure to work with her on legislation because she is a 
Senator who does her homework. Don't ever try to get one by Susan 
Collins. She knows what she is talking about, and if she is not sure of 
it, she takes the time she needs to try to find the right way forward.
  What we are trying to do is, is to reassure the American people that 
we are on their side. The frustration out there is so high right now 
with what is going on with the cost of prescription drugs.

[[Page S6172]]

When people find out there is actually a pharmacist who is legally 
prohibited from telling them that you can pay 8 bucks if you just want 
to pay for it, but you will pay 20 bucks if you use your insurance 
plan--that is real money. That matters to Missourians.
  We know the data shows that in 2013 alone, Americans paid about $135 
million more than they should have. Why? Where is that money going? Who 
is making that money and why? We need to get a better deal for people.
  We have so many problems with prescription drugs. This is just the 
tip of the iceberg in terms of the work this body needs to do to bring 
down prescription drug prices. This is low-hanging fruit. The notion 
that we can just simply say: Pharmacists, you have the right to tell 
your customers they can get it cheaper, that is all we are doing. We 
are saying: Pharmacists, you have the right to tell your customers they 
can get it more cheaply. That is why the Lee amendment is so perplexing 
to me. Why would you want to leave 85 million people behind?
  I get the ideology about regulation, but sometimes common sense needs 
to scoot all the ideology out of this place, and we need to just look 
at the barebones issue of how we save people money on prescription 
drugs. That is what this bill will accomplish.
  Today was a big day for me. A bill that I am the Democratic cosponsor 
of, the President of the United States tweeted he supported it. Yowza. 
That is a big deal for me. I am thrilled the President of the United 
States tweeted this afternoon that he supports this legislation. It 
shows you not all is lost in this town. Every once in a while, we can 
get together.
  I see my friend Senator Barrasso over there. He is a cosponsor on 
this bill with Senator Kennedy. It is really exciting to me when we 
have one of these moments where the administration agrees, Secretary 
Azar agrees, Republicans agree, and Democrats agree. If we can do this 
more often, maybe the people in this country will renew their faith in 
us as a body.
  I am thrilled we are going to have a chance to get this done. I hope 
the body listens to the arguments my colleague made about the Lee 
amendment and how misguided it is in leaving so many Americans behind 
in terms of these cost savings.
  While I am on the floor, I would also like to just briefly mention 
another vote that I think is important. I am very glad we are expanding 
grants for first responder training, opioid prevention, and all the 
other important things we are doing in this bill, but I am truly 
disappointed that it doesn't include a commonsense proposal that I 
worked with Senator Cassidy on that would provide more transparency on 
those who are lobbying on opioid-related issues.
  My office did an investigation through the Homeland Security and 
Government Affairs Committee, where we discovered there are all these 
advocacy organizations out there, such as the American Academy of Pain 
Management and others, that are deriving a lot of their budget from the 
opioid manufacturers. The opioid manufacturers are giving money to 
organizations, and, in many instances, they are just fronts for 
lobbying on behalf of opioids.
  For example, we know that over $9 million was given to these 
organizations, with half of that coming from Purdue, the biggest 
manufacturer of OxyContin. I am not saying we should prohibit them from 
doing that, but people ought to know it. We ought to make it 
transparent. That is all the bill does. It just makes payments by 
opioid manufacturers to organizations that are 501(c)(3)s or 501(c)(4)s 
and requires them to just say the opioid manufacturers are behind their 
budget.
  One of these groups actually lobbied CDC about not lowering the 
recommended dosage of opioids. Another one entered a brief in a case 
arguing that a doctor shouldn't be convicted, when he was prescribing 
thousands of pills a day, for moving controlled substances.
  Transparency is always a good thing. I am disappointed and frankly 
confused as to why some of the Members on the other side didn't want to 
include this proposal in this package.
  I certainly want to thank Senator Cassidy for his help. We tried very 
hard to get it in the bill. I hope it is not because Big Pharma has a 
vice grip on this place. I have seen it before, and it worries me that 
this might be the case.
  There is irony in this. Not only is that provision not included but 
guess what is included. There is a provision in the bill that 
authorizes Federal money to one of these advocacy groups. Guess what. 
It is an advocacy group funded by pharma.
  I think it is ironic that we are more comfortable giving Federal 
money to one of these groups that can serve as a front organization for 
the opioid manufacturers that helped create this crisis than we are in 
requiring disclosure of the private funding for these groups. I am 
hopeful we can either get the bill in conference or, more importantly, 
get that other provision out.
  By the way, if we are going to allow Federal grant funding to these 
organizations, it should be all of them on a competitive basis, on 
merit, not name one that gets the money. There is something up there. 
There is something up there when you just name one that gets the money. 
I have learned that around this place.
  I hope the bill passes today.
  I am honored to work with Senator Collins on this important 
prohibition on the gag rule. It will save Missourians money. It 
matters.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Wyoming.
  Mr. BARRASSO. Madam President, I also come to speak on this important 
piece of legislation and in favor of this important piece of 
legislation.
  I just visited with Senator Collins, who knows--as so many Members of 
this body do--that I practiced medicine for a long time before coming 
to the Senate. I took care of a lot of Wyoming families as a practicing 
physician.
  As a doctor, I often prescribed medication to help my patients fight 
disease and to improve their quality of life, so I know the importance 
of prescription medication. I also know the importance that pharmacists 
play in the lives of their patients as well because the same patients I 
am taking care of, the pharmacist is also caring for. In so many ways, 
the pharmacist has to be able to speak freely to their patients about 
information about their medications. Pharmacists are often that last 
line of defense when they place a call to the doctor's office to say: 
Mrs. Jones is here. By the way, you prescribed this, but don't forget 
that she is allergic to this medication, and there might be some 
interaction, or she is already on this medicine, or this patient is on 
that medicine.
  Pharmacists provide vital and important roles to patients on a daily 
basis. It happens all around the country. They need to be able to speak 
freely about those things. They need to be able to speak freely about 
the things that can save a patient's life and also things that can save 
a patient money, and that is what this whole piece of legislation is 
about.
  I know many patients fail to take medications that their doctors 
might prescribe because of the cost involved, the expense of the 
medicines. That is why I am so glad to see President Trump make it a 
priority to find ways to lower the costs that people pay for their 
medicine. The administration actually put out a blueprint for ways we 
could address drug costs.
  Part of the plan was to eliminate the so-called pharmacy gag clauses. 
Pharmacists should not be gagged. They need to be able to talk with the 
patients, whether it is about drug interaction, the drug use, how to 
take it, how to use it properly, and the costs. These are important 
things for a pharmacist to be able to discuss.
  These gag clauses are clauses that are sometimes included in 
contracts that are not between the patient and the pharmacist. They are 
contracts between a drug company and an insurance company. This needs 
to be stopped.
  The gag clause says that if a patient brings a prescription to the 
drugstore to be filled, the pharmacist cannot talk about the cash price 
of the drug. It is not allowed. It is wrong.
  Maybe someone had an insurance plan where their copay for the 
medicine, let's say, was $10, and the prescription they are filling 
actually cost them $5 if they paid in cash, but under the gag clause, 
the pharmacist is not allowed to say anything about it. Pharmacists 
need to be able to speak up. It

[[Page S6173]]

is important. It is important for the patient. It is important for the 
integrity of the process.
  Right now, the pharmacist can't tell the patient: You know, you can 
save a little money if you just paid cash and you didn't bother to use 
the insurance along the way. The way things are now, the insurance 
company would collect its $10 copayment from the patient. They only 
have to pay $5 to the drug company and keep the rest, and the patient 
doesn't know anything about it. The patient is left in the dark because 
the pharmacist cannot share this important information with the 
patient. I believe it is wrong, and that is why I cosponsored the 
legislation that is on the floor right now.
  The Trump administration has taken a close look at the situation, and 
they completely agreed. They said people should know if there is a 
simple way they can save money. As we vote on this legislation today, I 
am hoping Congress agrees.
  Earlier this month, the Senate passed legislation that prohibits the 
gag clauses for Medicare plans, and that was the right thing to do. It 
passed unanimously, and I am so happy to see that. Today we are taking 
the next step. We are going beyond Medicare.
  This legislation we are about to vote on eliminates the gag clauses 
in insurance plans that people get through their employer, through 
their work, or plans they buy on their own. It is not just Medicare 
that we took care of before, this takes it to the next step, giving the 
pharmacists the freedom to speak.
  We are saying with a clear voice today that patients should be able 
to talk with their pharmacists and pharmacists should be able to talk 
with their patients to know if they are paying the lowest price for 
their medications.
  I support this bill. I thank the Members who led this bipartisan 
effort. It was a privilege to work with Senator Collins, Senator 
Stabenow, Senator Cassidy, and Senator McCaskill, who was just on the 
floor, to get this done.
  I appreciate your attention, Madam President, to this important piece 
of legislation. I look forward to voting to support it and getting it 
passed today and getting it down to the President for his signature.
  Thank you.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Ms. CANTWELL. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. CANTWELL. Madam President, I come to the floor to thank my 
colleagues for working so hard on this very important legislation we 
are going to pass tonight to deal with the opioid crisis.
  From Port Angeles to Spokane, I guarantee my colleagues that I have 
heard about this problem, I have seen how our communities are 
struggling, and this is the very help that they have been asking for. 
They want new tools, they want better solutions, and they want us to 
join the fight against drug manufacturers who push these drugs out to 
communities when they should be following a process and reporting so 
that our law enforcement can cut down on the huge amounts of opioids 
streaming into our communities.
  This legislation does many things, and I am glad that it does. The 
STOP Act will help crack down on shipments of fentanyl into the United 
States via the U.S. mail, which is something that is very important 
that we do, and I thank my colleague from Ohio for that.
  It authorizes funding for a new grant program to help train law 
enforcement and protect them against the deadliest opioids, like 
fentanyl, because their exposure to it has been so unbelievable and it 
is a risk to them every day they are out there doing their job.
  This bill reauthorizes the drug courts program, which many people in 
the State of Washington have told me has been beneficial to how they 
deal with this crisis as it relates to the individuals in their States, 
helping nonviolent offenders recover and helping them move forward.
  It reauthorizes the High Intensity Drug Trafficking Area Program, 
which uses Federal resources to help local law enforcement crack down 
on illicit drug rings. We need to help law enforcement, which is 
dealing with this problem every single day, to have the tools to do 
this job. The fact that it reauthorizes the High Intensity Drug 
Trafficking Area Program is just the kind of tool they need.
  This bill also makes permanent the ability for doctors to treat up to 
275 patients with the kind of treatment that is necessary for them, 
which also helps us to get to people faster and to get them into a 
recovery situation faster.
  One thing I really want to draw attention to is this issue of hearing 
over and over about how opioid manufacturers have flooded our 
communities with a product when, in reality, current law says they are 
supposed to monitor and track the distribution of this drug. Well, in 
too many cases, those safeguards have not been followed. Throughout 
their process, they weren't reporting on suspicious orders of opioids 
that prevents them from ending up in the wrong hands, and in some 
instances, they ended up in the hands of a black market, which then 
continued to flood communities with the product.
  In one example, a physician in Everett, Washington, wrote more than 
10,000 prescriptions of opioids. This number of prescriptions was 26 
times higher than the average prescriber in Everett, Washington. So he 
wrote 26 times more opioid prescriptions than the average provider. 
However, the drug manufacturer failed to report this suspicious 
activity.
  When we authorized this drug, we said this process is what has to 
happen. Because of its highly addictive nature, it has to be tracked. 
Law enforcement has to keep track of and be advised of anything that 
looks like suspicious activity. This abnormally high number was a clear 
red flag that should have been reported. Instead, the opioid 
manufacturer turned a blind eye to the negligent distribution.
  In response to those abuses, people in my State and in many other 
States have been critical and have filed lawsuits because they have 
been so concerned about this issue. What is clear, though, is that we 
need to do something now to make sure that opioid manufacturers follow 
the law that is already on the books about the reporting of suspicious 
distribution or volumes of distributions that are suspicious. Today, 
this legislation takes a major step forward on that front by including 
penalties for negligent opioid distribution strong enough to serve as a 
deterrent to those manufacturers against the actions we have seen in 
the past.
  The bipartisan Opioid Crisis Response Act includes provisions from 
legislation that I and Senator Harris from California authored. Our 
provisions increase the civil and criminal penalties on companies that 
fail to take responsible measures to prevent their drugs from entering 
the black market.
  Our legislation increases the civil penalties by 10 times, from 
$10,000 to $100,000 per violation. That adds up very quickly in what we 
think have been transactions that have been very suspicious. In 
addition, the bill increases the maximum criminal penalty to $500,000 
for companies that willfully disregard and/or knowingly fail to keep 
proper reporting on these distribution activities.
  Again, this is what we put into the law because of the highly 
addictive nature of these drugs. We said that they have to be monitored 
and their distribution has to be monitored because prior to today the 
slap on the wrist was not enough of a deterrent, and most of those 
requirements were ignored. Today, we are putting a much more stringent 
requirement in the law to say that they will get serious fines if they 
don't follow the law.
  This is such an important issue that a bipartisan group of 39 U.S. 
state attorneys general sent a letter to the Senate Judiciary Committee 
in support of this effort. Our own attorney general, Bob Ferguson, 
helped in promoting that effort, and I want to thank him. The state 
attorneys general said:

       Diversion of prescription opioids has devastated 
     communities in our states. The consequences for turning a 
     blind eye to suspicious opioid orders cannot merely be a cost 
     of doing business. We urge you to support . . . the CARES Act 
     to ensure that penalties

[[Page S6174]]

     effectively hold manufacturers accountable and help stem 
     diversion.

  So I agree with those state attorneys general, and I am so glad this 
is included in this legislation. Creating a more serious attitude 
toward the illegal distribution of this product and its falling into 
the hands of black markets is so serious. I urge my colleagues to 
support this legislation.
  I yield the floor.
  Mr. DURBIN. Madam President, our Nation is in the midst of the worst 
drug epidemic in its history. There is no town too small, no suburb too 
wealthy to be spared. Every day, more than 115 Americans die from an 
opioid overdose. In the past 3 years, there has been a 53-percent spike 
in drug overdose deaths in Illinois, with more than 2,400 lives lost in 
2016. I am glad we are finally doing something to address this crisis.
  To truly prevent addiction and stop the next drug epidemic, we need 
to look at the factors driving this crisis.
  I am pleased that several of my bills to help prevent opioid 
addiction have been included in the bill before us. Whether it is 
witnessing violence, experiencing a parent's opioid addiction, or 
facing abuse in the home, traumatic experiences can harm a child's 
brain.
  Thanks to the Adverse Childhood Experiences, ACEs, study and 
advancements in brain science, we know that, left unaddressed, these 
events can have an impact on future health problems, mental illness, 
drug use, and the cycle of violence. But with the right care and 
support, we can help heal children who experience trauma and prevent 
serious, negative consequences.
  I want to thank Chairman Alexander and Ranking Member Murray for 
including legislation I introduced with Senators Heitkamp, Capito, and 
Murkowski. Our language will help train more teachers, doctors, social 
services, first responders, and the justice system to recognize signs 
of trauma in children and provide help to those in need.
  Our provisions will improve coordination between Federal agencies, 
ensure more Federal funding is used to promote these skills and 
awareness, and expand the workforce capable to providing care.
  In 2016, Big Pharma produced 14 billion opioid doses--enough for 
every adult in America to have a 3-week supply of opioids. Each year, 
the Drug Enforcement Administration, DEA, sets the amount of opioids 
allowed to be produced in the United States. Between 1993 and 2015, DEA 
allowed production of oxycodone to increase 39-fold and hydrocodone to 
increase 12-fold. The sheer volume of opioids manufactured each year 
increases risk of abuse--four of five new heroin users started with 
painkillers.
  One problem is that, when setting annual quotas, DEA is unable to 
look at how a drug is abused or leads to overdose deaths. Why should 
DEA be handcuffed from considering the real-world misuse of oxycodone 
pills when it sets the production levels? This package includes my 
bipartisan bill to strengthen DEA's ability to adjust quotas to reflect 
the risk of opioid misuse, while improving flexibility to avoid any 
shortages.
  I want to thank Chairman Grassley, Ranking Member Feinstein, and DEA 
for working so closely with me and Senator Kennedy. It is a good thing 
that we are now talking about drug addiction as a treatable disease, 
not a moral failing that should be punished. Sadly, it has taken us too 
long to get here.
  The opioid epidemic also underscores the importance of having quality 
health insurance--coverage that includes mental health and substance 
abuse treatment. But once again, President Trump wants to allow 
insurance companies to discriminate against people with a preexisting 
condition--such as an opioid addiction--and promote ``junk'' insurance 
plans that don't cover substance abuse treatment. I will fight tooth 
and nail against efforts to repeal, gut, or sabotage this quality care 
so that we do not return to the dark days of coverage denials and sky-
high premiums.
  The legislation before us addresses several important factors, and I 
am happy to support it today, but it neglects many more actions we need 
to take.
  This opioid package fails to include my bipartisan bill with Senators 
Brown and Portman, which would lift an outdated barrier to addiction 
treatment that restricts Medicaid from paying for care in facilities 
larger than 16 beds.
  We have worked in a thoughtful, open process to improve this 
legislation and address any policy concerns, and I look forward to 
including our revised bill in conference with the House.
  We must also hold the pharmaceutical industry accountable for its 
role in creating the epidemic through their deceptive conduct. Drug 
companies have profited from flooding the market with painkillers, 
often with misleading information, and should have to pay for the 
addiction treatment that their products have caused. Additionally, 
executives from Perdue Pharma, Janssen, Abbott, Endo, Insys, and other 
manufacturers must testify before the Senate to explain their role in 
this epidemic.
  Today's bipartisan opioid legislation is an important step forward, 
but we need to do more, and quickly, to meet this destructive crisis 
head-on.
  Mrs. FEINSTEIN. Madam President, eight Americans die of a drug 
overdose every hour.
  In 2016, more Americans died from drug overdoses than during the 
entire Vietnam war.
  The 2017 figures are even worse. Preliminary estimates from the 
Centers for Disease Control and Prevention indicate that over 71,000 
individuals lost their lives to drugs. More than 5,000 of those 
individuals were Californians. Addiction has never had such a profound 
impact on our country.
  On October 26, 2017, the Trump administration declared the opioid 
epidemic a public health emergency. However, this has done little to 
stem the tide of overdose deaths or to effect this public health crisis 
that has a stronghold on our communities.
  Our government can and must do more. It is not enough to declare the 
obvious, that this epidemic is an emergency.
  As with any emergency, triage must begin immediately. That means 
swiftly executing and implementing whole-of-government strategy to end 
the devastation. That also means rapidly infusing funds to support this 
strategy and prevent more deaths.
  The Opioid Crisis Response Act of 2018 does just this. It provides a 
roadmap for action and authorizes the necessary funds to allow the 
government to better triage care for those in need while simultaneously 
providing resources necessary to keep these drugs off the street.
  This legislation recognizes that there is no one size fits all 
approach when it comes to effectively addressing addiction. That is why 
it consolidates bills that span five committees, including six from the 
Judiciary Committee.
  The bipartisan Opioid Crisis Response Act establishes a number of new 
drug prevention and treatment programs. It also extends other critical 
agencies and programs, including the Office of National Drug Control 
Policy and the Drug-Free Communities, the High Intensity Drug 
Trafficking Areas, and drug court programs.
  Moreover, the bill provides the Justice Department with new legal 
authority to hold opioid manufacturers and distributors accountable if 
they fail to identify, report, and stop suspicious orders of opioids.
  The bill also preserves legitimate access to pain medications, while 
allowing the Drug Enforcement Administration to consider, for the first 
time, factors like drug abuse and overdose deaths when setting annual 
production quotas for certain opioids.
  The Opioid Crisis Response Act effectively balances prevention, 
treatment, recovery, and law enforcement.
  This legislation bolsters the efforts of our public health experts, 
gives law enforcement and first responders the authority and resources 
they need to combat illicit narcotics, and will help spur the 
development of alternative therapies and drugs to help decrease our 
nation's reliance on opioids.
  The fact that this bill includes proposals that were sponsored or 
cosponsored by more than half of the members of this body illustrates 
that virtually no State, no community, and no family is left untouched 
by addiction. It is also indicative of the fact that we must act, and 
we must act urgently.
  We must treat this public health crisis like the emergency that it 
is. We must stop the devastation.

[[Page S6175]]

  I look forward to continuing to work with my colleagues on both sides 
of the aisle to see that this important piece of legislation, which is 
supported by more than 200 organizations nationwide, is enacted into 
law.
  Thank you.
  Mrs. MURRAY. Madam President, I have heard from people across 
Washington State about the need to respond to the opioid crisis and its 
tragic impact on so many families and communities. I have visited with 
people from communities in Seattle and Everett and Longview, and I have 
heard from families across my State. I know my colleagues across the 
aisle and across the Nation have heard from constituents about the 
urgency of this crisis. So I am really glad today that the Senate is 
able to come together and pass the Opioid Crisis Response Act--the 
bipartisan legislation I have been working on with Senator Alexander 
and so many others.
  This bill is a bipartisan compromise. It is not what I would have 
written on my own, and I know it is not what my colleagues on the other 
side would--have written on their own, but it is the result of more 
than 70 proposals from Members on both sides of the aisle, and that is 
important. The bill we will vote on today does not reflect the full 
agreement struck between Democrats and Republicans.
  I am glad that Chairman Alexander and Republican leaders have worked 
with us as the bill has hit the final stretch here in the Senate and 
that they committed to a number of specific changes beyond the text of 
this bill to make sure we could have this vote tonight and keep working 
to get it signed into law.
  The text of our agreement has been released, and I am hoping that 
Republican leaders live up to their agreement to take this agreement 
into the conference and work by our side in conference to get this done 
in the bipartisan manner it began.
  This agreement goes to show that when we work together, when we focus 
on the problems families are actually facing and when we look for 
common ground and commonsense solutions, we can actually craft and pass 
legislation.
  This agreement is a much needed and long overdue step toward helping 
those families on the frontlines of the opioid epidemic to address its 
root causes and ripple effects, including some of the issues, by the 
way, that I have heard firsthand in my State.
  I heard from hospital staff about how many of the babies they deliver 
are born with neonatal abstinence syndrome, battling symptoms of opioid 
withdrawal, which is why I fought to make sure this agreement includes 
support for State efforts to include plans of safe care for children 
born to mothers battling addiction and also ensures the health 
department is implementing strategies already identified to protect 
moms and babies from the effects of opioid substance abuse.
  I heard from an elementary school principal about how some of his 
students are having trouble focusing in class because they deal with 
the trauma of a family member's addiction at home, which is why I 
worked to make sure this agreement includes provisions to develop a 
task force and grants to help support trauma-informed care programs and 
increase access to mental health care for children in their 
communities, including their schools.
  I heard from many more experts and everyday people, as the HELP 
Committee held a series of bipartisan hearings focused on this crisis. 
We heard about the many different faces of this epidemic and the broad 
challenges we have to consider to make sure we address its root causes 
and ripple effects, which is why I worked with my colleagues to make 
sure this agreement includes provisions to address the economic and 
workforce impacts of the opioid crisis, support for training to help 
the nearly 1 million people out of work due to opioid addiction to gain 
and retain employment. Washington State has already received a grant 
for this important work to get workers back on their feet after they 
battle addiction. So I am glad we could expand this valuable grant 
program.
  This bipartisan package of proposals is an important step forward to 
help our families and communities who are on the frontlines of the 
opioid crisis, and I look forward to continuing to work with my 
colleagues to see it signed into law.
  While this bill is an important step, it is by no means final. We 
have a lot more to do to end the tragedy and address the ongoing issue. 
So even as we work to get this agreement across the finish line, I am 
going to keep fighting for more support, resources, and solutions for 
the families in my home State of Washington and across the country who 
are facing the heartbreak of this epidemic.
  I yield the floor.


                                S. 2554

  Mrs. FEINSTEIN. Madam President, as the Senate debates the Patient 
Right to Know Drug Prices Act, S. 2554, I rise to offer my views on the 
need for transparency in drug prices and to offer my strong endorsement 
of this bill. This legislation that we are voting on today represents a 
serious, bipartisan effort to lift barriers that prevent pharmacists 
from informing consumers about how much prescription drugs cost. I am 
proud to be a cosponsor of this legislation.
  Every day, Americans buy prescription drugs without a true idea of 
how much those drugs cost. Pharmacists should be able to tell you if 
there is a cheaper way to buy prescription drugs, and yet they are 
unable to do so. Due to so-called gag orders, pharmacists can be 
prevented from providing this information proactively to patients. With 
prescription drug costs rising, Americans should have access to 
transparent pricing information, especially when it can lower their 
costs.
  Today, the Senate takes a significant step toward improving drug 
price transparency. With the passage of the Patient Right to Know Drug 
Prices Act, S. 2554, pharmacists would be able to fully inform patients 
of the cost of the medications they are purchasing. It is ridiculous 
for a patient to not be told that their copay is actually more than the 
full cost of the medicine they need. By banning gag clauses, this bill 
ensures that customers have a right to know the lowest possible price 
available for a drug at the pharmacy. This is an important first step 
in advancing drug cost transparency.
  In addition to price transparency, the actual cost of medicine 
continues to be a major issue. Pharmaceutical companies often price 
drugs as high as they believe the market will allow and have no other 
constraints on how much they charge. We see this happening not only in 
branded drugs but in price spikes among generics as well. For example, 
the recent announcement that major hospital systems and philanthropy 
organizations have banded together to create their own nonprofit 
generic drug manufacturing company, Civica Rx, shows just how 
concerning the problem of reasonably priced drugs, as well as drug 
shortages, has become. I'll watch with great interest as this endeavor 
moves forward to produce 14 common drugs used by hospitals--with the 
first due out next year.
  The bill we are voting on today solves just one piece of a very large 
puzzle, and we must do more. In this distinguished body, we should 
advance legislation that would direct the Secretary of Health and Human 
Services to negotiate drug prices in Medicare. I am a cosponsor of the 
Choose Medicare Act, which includes this provision. We should also move 
legislation that provides real financial protection for consumers and 
limits their monthly copays for prescriptions. I am a cosponsor of the 
Consumer Health Insurance Protection Act, which includes a copay cap of 
$250 per month on prescription drugs.
  Let's dig in to the real cost of prescription drugs and look for 
creative solutions that support innovation but ensure that lifesaving 
drugs can reach patients. A cure doesn't matter if it costs too much to 
reach those who need it.
  The problem of prescription drug costs is real, and it impacts 
American families across our country. This problem forces seniors to 
choose between food and medicine. This problem prevents families from 
being able to care for their loved ones due to the high cost of 
expensive drugs. In fact, according to a report by the Kaiser Family 
Foundation, 24 percent of people reported that they or a member of 
their family either did not fill a prescription, skipped doses, or cut 
pills in half due to the cost of the drug. And 44 percent of those 
surveyed said they worried about not being able to afford the 
medications they needed. This is

[[Page S6176]]

wrong, and it must be fixed. Today, we start to right that wrong by 
voting to pass the Patient Right to Know Drug Prices Act. But more is 
expected and more must be done. Let's build on the bipartisan work that 
helped us pass the Patient Right to Know Drug Prices Act tonight and 
make a real difference for American families.
  Ms. COLLINS. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Moran). The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. ALEXANDER. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. ALEXANDER. Mr. President, this morning, in Nashville, as I got on 
the plane, the headlines were not about tweets or collusion with Russia 
or even the Supreme Court nomination. The headline was this: Senate set 
to OK bill on opioids.
  Within a few minutes, we are about to vote in the Senate on 
legislation that Senator McConnell, the majority leader, has called 
``landmark legislation.'' It is legislation that 72 of the 100 Members 
of this body have made a contribution to. They are not just 
cosponsoring it. They have a piece of this bill. This legislation has 
come through five different committees of the Senate, and we have been 
working on it for several months.
  The reason it is on the front page of the newspapers in Tennessee and 
the newspapers in Kansas and the newspapers in Wyoming and the 
newspapers in Maine is because opioids are our most serious public 
health epidemic, and the Opioid Crisis Response Act that we will be 
voting on in a few minutes is the Senate's response to this crisis.
  We will be voting on another important piece of legislation that the 
Senator from Maine, Ms. Collins, who is here, has talked about, and 
Senator McCaskill is a cosponsor. It is the Patient Right to Know Act. 
It basically does something that I think almost every American would 
think is a good idea. It says that when you go into a drugstore, your 
pharmacist must be allowed to tell you that if you can buy your 
prescription for $5 by paying out of your own pocket, you should do 
that, rather than using your insurance, which might require a $100 
copay out of your pocket. Right now, there are contracts between 
pharmacy benefit organizations and pharmacists that prohibit your 
pharmacist from telling you. Senator Collins deserves a lot of credit 
for her leadership in this area, as she does in so many other areas, 
and I fully support what she is proposing. It passed unanimously out of 
our Health, Education, Labor, and Pensions Committee.
  Let's go back for a moment to the Opioid Crisis Response Act, which 
we will be voting on within a few minutes. I mentioned that it is on 
the front pages of the newspapers today, despite a lot of competition 
for other news. I mentioned that Senator McConnell, the Senate majority 
leader, had called it ``landmark legislation,'' and I mentioned that it 
is because the opioid crisis is the most serious public health epidemic 
in our country. It is ravaging virtually every community.
  We all have stories that we have heard, that we know, that we have 
told--stories like the story of Becky Savage, who testified at one of 
the seven hearings before our HELP Committee that her sons had a 
graduation party in her basement. She was happy about that. They were 
not running around town doing other things; they were in the basement. 
Unfortunately, someone had brought opioid pills to the party that got 
mixed with alcohol, and she found both her sons dead the next morning. 
They were not drug addicts. They were not alcoholics. They were good 
boys, but somehow they made a mistake because they and their friends 
didn't know the consequences of this opioid epidemic.
  That is why five different committees in this body have reported 
bills that have made a contribution to the Opioid Crisis Response Act, 
which we are about to vote on. That is why 72 different Senators have 
provisions in this bill. That is why, last June, the House of 
Representatives passed its own version of the bill, also involving 
several committees in the House.
  The PRESIDING OFFICER. The Senator's time has expired.
  Mr. ALEXANDER. Mr. President, I ask unanimous consent for another 5 
minutes.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  Mr. ALEXANDER. Mr. President, that is why we have had so much support 
for this amendment.
  The bill is so large, some people have had trouble seeing the 
significance of it. Let me quickly mention two aspects of it: One is 
money, one is moonshot.
  Some people say: Where is the money? This is not a money bill. This 
is an authorization bill. The money bills are in the Appropriations 
Committee, and they have been generous.
  In March, the Congress addressed $4.7 billion in the omnibus 
appropriations bill toward opioids. In the bill--which we should 
approve tomorrow for the next fiscal year--there will be another $3.8 
billion. So that is $8 billion within a few months for the opioids 
crisis.
  The second is moonshot. Some people say this needs a moonshot. It 
does need the energy and resources of a moonshot, but, unfortunately, 
this isn't a crisis that we can assign to a Federal agency in 
Washington and say: Let's fix it in 10 years. What we can do is 
everything we can think of to do to create an environment so that 
doctors, nurses, judges, patients, parents, and everybody in 
communities that are affected by the opioid crisis can deal with it 
there, and we do our best to do that.
  For example, Senator Portman's STOP Act addresses fentanyl and other 
synthetic, illegal drugs being mailed into this country through our 
Postal Service from China. Fentanyl is 50 times more powerful than an 
opioid pill, 50 times more dangerous. There is a 70-percent increase in 
deaths from overdose by fentanyl in our State of Tennessee.
  Here is what I think is the Holy Grail of this crisis; that is, 
finding a non-addictive pain medicine or treatment. One hundred million 
Americans live with pain; 25 million Americans have chronic pain. They 
need help. They need something other than an addictive pain medicine--
something that works. Dr. Francis Collins at the National Institutes of 
Health and Scott Gottlieb at the Food and Drug Administration have 
advanced research and created fast tracks, and we have provided 
hundreds of millions of dollars to find that Holy Grail.
  A third is to reduce the prescriptions of opioids that can be 
diverted, so you can reduce the chance that you might get a 60-pill 
bottle of opioids, use 12, take it home, put it in your medicine 
cabinet; then your teenager picks it up and takes it to a party, and 
someone is hurt or overdoses. We authorize the Food and Drug 
Administration to require manufacturers to sell opioid pills in blister 
packs of, say, three or seven. Already, two dozen States have 
established their own limits. In Tennessee, it is a limit of three 
days.
  What are the next steps for this piece of legislation, the Opioid 
Crisis Response Act with 72 provisions? We are already working with the 
House of Representatives. We are working very well with them. I 
appreciate the leadership of Senator McConnell and Senator Schumer in 
creating an environment where we can move this bill rapidly. We are 
working with Congressman Walden and Congressman Brady in the House and 
with Democrats on both sides of seven committees in the Senate on this 
phase and several in the House of Representatives.
  Our goal is to have all of our language in a combined bill ready by 
Friday of this week, along with Congressional Budget Office numbers, so 
that the House of Representatives can vote on the bill next week before 
they go home. Then we can vote on it the following week--or whenever 
Senator McConnell can put it on the floor--and send it to the President 
for action.
  There are too many Senators for me to thank at the moment for their 
leadership as chairmen and ranking members of committees or for their 
agreeing to show some restraint in insisting on provisions. Senator 
Portman had provisions, Senator Rubio did, Senator Paul did, and 
Senator Lee did, but they all said: Let's go ahead and vote on this 
today, work out the remaining differences we have over the next few 
days with the House, and hope that the

[[Page S6177]]

final version of the bill that comes back from the House is even 
stronger.
  I am convinced that this piece of legislation, the Opioid Crisis 
Response Act of 2018, will help deal with the worst public health 
epidemic we have had. We have a sense of bipartisan urgency about 
finishing our work in the Senate and combining our efforts with the 
House. Their bill is a good bill. I think combining it with ours will 
help make it stronger, and we will get our bill to the President.
  We may have the same amount of money and the same amount of energy 
that we had for the moonshot in the 1960s, but the real work is going 
to be done on the frontlines because the only way to deal with the 
opioid crisis is community by community by community.
  I thank the President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Connecticut.
  Mr. BLUMENTHAL. Mr. President, I thank my colleague from Tennessee, 
as well as leaders on both sides. This effort has been truly 
bipartisan. It is a profoundly significant beginning but only a first 
step. It needs to be followed by others because we know that this 
epidemic truly is national.
  I especially thank my colleague from West Virginia who will follow 
me, Senator Manchin, for his tireless, relentless efforts on this 
issue. I have been very proud to work with him and to begin working on 
it when I was attorney general of the State of Connecticut in suing the 
painkiller manufacturers and taking action against the sellers of 
prescription opioids, to make sure they are held accountable.
  The communities need our help. We promised action, and we are now 
delivering, in part, on this issue, which has been so devastating and 
deadly for so many families, communities, States, and towns throughout 
Connecticut and our Nation.
  The calls for action tonight are answered in this beginning step with 
money that will go to treatment, prevention, and law enforcement. That 
money is a good first step, but it must be followed by additional 
investments and commitment.
  This measure increases the number of drug take-back programs. I 
visited communities, most recently East Hartford in Greenwich, where 
these take-back programs have provided an anonymous, secure way to rid 
medicine cabinets of drugs that all too often can be a menace. Medicine 
cabinets are a modern-day menace when they provide accessible 
painkillers and opioids to teenagers, children, and others who begin 
lifetimes of addiction.
  This measure is profoundly important in setting standards and 
guidelines for sober houses, a very important resource but one that 
requires some sense of regularity and guidelines. There are many sober 
homes in Connecticut--for example, in Torrington--that do good work. 
But Connecticut is grappling with sober homes operated by bad actors 
who put lives at risk. This prevention is a step in the right 
direction.
  I am very proud of a bill I have led with Senators Grassley and Brown 
to enhance transparency in opioid prescribing. This provision requires 
drug companies to disclose payments made to nurse practitioners, 
physician assistants, and other prescribers, ensuring that they are not 
being inappropriately influenced by these manufacturers. It is already 
required for doctors. It ought to be required for everyone who may be 
involved in prescribing these powerful medicines.
  The bill will also fight back against deadly drug trafficking when it 
involves use of the postal system. Just a few weeks ago, in New Haven, 
there was a mass overdose caused by trafficked synthetic drugs. More 
than 100 people overdosed on K2 brought into this country by China and 
Mexico through the mail. These new law enforcement tools are critically 
important, as is the reauthorization of the Office of National Drug 
Control Policy and its High Intensity Drug Trafficking Areas Program. 
This bill will help protect our citizens. I thank all my colleagues for 
supporting it.
  I am looking forward to a positive, affirmative vote that will help 
communities throughout the country and spare families the heartbreaking 
and gut-wrenching problem that infects so many healthy communities. 
Everyone is affected and touched by this problem. I thank my colleagues 
for supporting this bill.
  The PRESIDING OFFICER. The Senator from Tennessee.
  Mr. ALEXANDER. Mr. President, I ask unanimous consent that when the 
Senate proceeds to S. 2554, amendment No. 4011 be made pending.
  The PRESIDING OFFICER. Is there objection?
  Without objection, it is so ordered.
  The Senator from West Virginia.
  Mr. MANCHIN. Mr. President, I first want to thank the good Senator 
from Tennessee, Lamar Alexander, for basically shepherding this through 
and working in a bipartisan way. It is a most important piece of 
legislation. Also, to all of our colleagues, this is the way 
legislation should work. It is something we have worked on for a long 
time--well thought-out. Senator Blumenthal from Connecticut and 
everyone worked so hard on it.
  The American people are drowning under the weight of the prescription 
drug epidemic. My State of West Virginia has been hit the hardest. More 
than 1,000 West Virginians died of drug overdoses in 2017; 870 of those 
deaths involved an opiate. This is a record number of opiate-related 
deaths, up from 759 opiate-related deaths in 2016, which was a record 
that year as well.
  Let's put this in perspective. For those of us who are old enough to 
remember watching the Vietnam war on television and the outrage--
rightfully so--that came with that and the protests and how we were 
able to bring that to an end, during that entire Vietnam war period of 
close to 10 years, 58,200 young Americans' lives were taken.
  Just last year alone, in 1 year, we lost more than 72,000 people to a 
drug overdose--72,000 in 1 year. Forty-nine thousand people were killed 
by opiates, heroin, and fentanyl in 2017. That is an average of 134 
people dying of an opiate overdose every day. It is a silent killer. If 
we had these types of numbers and were losing them and they were on 
television--they are in every neighborhood; they are almost in every 
family's home, one way or another, that is affected--the country would 
rise up in outrage, as they did with the Vietnam war, watching the 
carnage.
  That is why I am glad to support this bill today, because it will 
take a number of critical steps to help us stop that devastating 
epidemic, many of which I have pushed for. It will reauthorize critical 
State grant funding to address the crisis and ensure this funding is 
going to the hardest hit States, such as my State of West Virginia. It 
will put Jessie's Law in statute, requiring HHS to develop hospital 
standards to flag a patient's opiate addiction.
  It is so simple. You will go into a hospital to be admitted, and they 
are going to ask you if you are allergic and what you are allergic to, 
such as penicillin, and they mark it all the way through.
  Jessie's Law is such a commonsense piece of legislation that it could 
have saved this beautiful young lady, and, hopefully, it will save 
thousands of others. While this language was included in the fiscal 
year 2018 appropriations bill, HHS has not yet acted. This bill will 
force them to do so.
  It will also strengthen the response by our Federal agencies. The FDA 
and NIH will be pushed to encourage the development of nonopiate pain 
treatments. The FDA will also be given the authority to do more work 
with the CBP to stop the flow of illicit opiates like fentanyl, which 
has driven up opiate overdose deaths substantially.
  The DEA will be required to consider diversion abuse and overdose 
deaths when determining their opiate quotas, something that I have been 
pushing for years. It also would allow States to use Federal funding 
for programs like the Handle With Care program in West Virginia, which 
helps to connect traumatized children with the resources they need. It 
would make it easier for Medicare and Medicaid beneficiaries to access 
the treatment they need. These are critical steps.
  So much more has to be done. It must be done. I am particularly 
disappointed that the package does not include the Protecting Jessie 
Grubb's Legacy Act, which makes commonsense changes to the regulations 
for substance use disorder and treatment, known as part 2.

[[Page S6178]]

  We lost Jessie more than 2 years ago for one simple reason. One of 
her physicians did not know she was in recovery from an opiate 
addiction and sent her home from the hospital with 50 oxycodone. This 
could have been prevented very easily.
  I am very pleased that the bill includes Jessie's Law, which was also 
included in the fiscal year 2018 appropriations bill and would help 
hospitals develop systems to flag patients with opiate addiction, but 
it does not include the legacy act, which would solve the larger, more 
systematic problem that is keeping those in recovery from getting the 
coordinated care they need.
  The legacy act is needed because the part 2 regulations are simply 
not compatible with the way we want healthcare to be delivered--in a 
coordinated manner that takes into account the whole patient and all of 
their medical needs. Access to a patient's entire medical record, 
including addiction records, ensures that providers and organizations 
have all the information necessary for safe, effective, high-quality 
treatment and care coordination that addresses all of patient's health 
needs. It also helps to prevent devastating situations like the one 
that took Jessie Grubb's life by helping to ensure that healthcare 
providers can offer medically appropriate care for those in recovery.
  We need to protect people's privacy. The regulations were put into 
place in the 1970s, at a time when we did not adequately protect 
people's medical records. They were necessary then. In the 1990s we 
passed HIPAA. While it isn't perfect, it successfully protects the 
privacy of millions of Americans' medical records every day.
  We simply should not treat substance use disorder treatment records 
differently than every other single type of medical record. It doesn't 
make any sense, and it harms patients.
  The House passed their companion to the legacy act with a strong 
bipartisan vote of 357 to 57 because they recognized that this is 
critical--very critical--for stopping the opiate epidemic. The legacy 
act makes commonsense changes that will save lives and will have strong 
bipartisan support. I urge my colleagues to join me in fighting to 
include these changes in any final opioid package.
  I thank the good Senator from Tennessee. We have to stop this 
epidemic in Tennessee and in West Virginia. People in our States are 
dying. Families and communities are being torn apart. I look forward to 
supporting this bill today, but I will never stop fighting for the 
people of my great State of West Virginia.
  The PRESIDING OFFICER. The Senator from Utah.
  Mr. LEE. Mr. President, I ask unanimous consent to complete my brief 
remarks.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LEE. Mr. President, Americans know all too well the crippling 
costs of healthcare in our country today. On top of the daily struggles 
of ordinary families to put food on the table, skyrocketing costs of 
prescription drugs are getting harder and harder to meet.
  Pharmacist gag rules are only making matters worse for the American 
people--much worse. These contract clauses between pharmacies, on the 
one hand, and insurers and pharmacy benefit managers, on the other, 
prevent pharmacists from telling customers that they can actually save 
money on prescriptions by paying with cash instead of using their 
insurance. Pharmacists are actually prohibited under these clauses from 
helping their customers to get the best price for their medications. 
This is absurd, and it is harmful.
  According to a recent study, about 23 percent of all drug claims in 
2013 involved overpayment, amounting to more than $135 million. Who 
pockets those extra dollars? It is not ordinary Americans. It is, of 
course, the insurers and the benefit managers--in other words, the 
pharma middlemen, you might say.
  We all agree that this is a problem. It is only further evidence of 
our broken drug pricing system that is unnecessarily hurting the 
American people. We all agree this is a problem that needs to be fixed. 
What we must consider is how best to address the problem, who is best 
equipped to do so, and whether and to what extent some of it has 
already been fixed.
  Senator Collins' bill mandates that gag clauses be prohibited under 
all health insurance plans, including individual and group plans that 
are currently administered by the States pursuant to State law.
  The Federal Government can and should prohibit gag clauses within the 
plans it administers and within those plans it oversees, but it cannot 
and should not intervene in plans that it does not.
  Many States already have made some significant progress on this 
issue. In fact, 26 States have already passed laws banning gag rules, 
and another 11 States are currently in the process of trying to pass 
them. I applaud them, and we ought to leave space for them to do that 
very thing.
  Some have suggested that this State action and increased attention to 
the cost of prescription drugs has more or less solved this problem and 
greatly limited the use of gag clauses already. Bear in mind that the 
study that I previously referenced looked at practices from 5 years 
ago. The States were more directly involved because they had more 
directly witnessed this problem, and they were able to nimbly and quite 
capably address it.
  However, even if gag clauses are still in use, where they are, we 
must recognize that it is not always the role of the Federal Government 
to regulate everything. It is not the role of the Federal Government to 
regulate entities under the jurisdiction of the States. However well 
intentioned, when Congress oversteps its authority like this, we can 
end up doing more harm than good. We also end up undermining the very 
oath we took to uphold the Constitution, which has as a structural 
foundation the principle that not all power is invested in Congress. 
Only those powers given to the Congress are vested here. Those that are 
not vested under the Constitution in the Federal Government are 
reserved to the States, respectfully, or to the people.
  The amendment I am offering would narrow this bill to what I believe 
would be its proper scope. Instead of the bill applying to all health 
plans, my amendment would limit its application to only self-insured 
groups plans that are exempt from State regulation. This would close a 
loophole where States are unable to provide Americans additional 
transparency surrounding the cost of their prescription drugs.
  Again, while I very much support the overall goal of the underlying 
bill and applaud my friend and colleague from Maine, Senator Collins, 
we have to remember that it is neither the role nor the duty nor within 
the power of the Federal Government to regulate all aspects of 
commercial activity within the United States or all aspects of the 
lives of the American people.
  The way to help ordinary American citizens with high drug costs is 
not to further concentrate power within Washington, DC. The Federal 
Government's intervention in healthcare has already caused huge 
distortions in the market for which Americans pay a steeper price every 
single year.
  If we truly want to protect the American people from abuses like gag 
rules, we should fight to preserve federalism and our vision of our 
Constitution so that States are empowered to directly and efficiently 
protect their citizens from the injustices they face.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Maine.
  Ms. COLLINS. Mr. President, I ask unanimous consent that I have one 
minute to respond to my friend and colleague.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Ms. COLLINS. Mr. President, it seems very arbitrary to me to exclude 
potentially 85 million Americans from the protections this bill would 
provide when there is such a clear Federal nexus to act in this area.
  According to the Kaiser Family Foundation, 58 percent of workers 
insured in self-insured plans are actually in ``partially insured'' 
plans. The reason this matters is that some States may attempt to 
regulate these plans, believing they can, and then have their State 
laws challenged in the courts and preempted.
  Why not take the commonsense approach our bill does and simply ban 
the use of pharmacy gag clauses--an egregious practice that prevents 
pharmacists from telling their customers

[[Page S6179]]

they could purchase their prescriptions with less money by paying out 
of pocket rather than using their insurance.
  We have the support of 40 medical and consumer groups for this bill, 
and this legislation is action we can take right now to help lower the 
cost of prescription drugs for some consumers. It has widespread 
bipartisan support. It came out of the HELP Committee unanimously, and 
it is supported by the administration. I urge a ``no'' vote on the 
amendment offered by the Senator from Utah and a ``yes'' vote on the 
underlying bill.

                          ____________________