[Congressional Record Volume 164, Number 163 (Tuesday, October 2, 2018)]
[Senate]
[Pages S6432-S6434]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                            Opioid Epidemic

  Mr. President, let me go back to what is going to be voted on, on 
this floor, I am told, sometime tomorrow. Probably tomorrow afternoon, 
this Senate will take up legislation that has now been passed in the 
House and passed in the Senate. There has been a conference committee 
between the two bodies, and it has come up with a final product. I 
think the final product has a lot of good things in it that will help 
push back against this opioid epidemic that is growing in our country.
  On my way to Washington yesterday, I went by a memorial service for a 
young man who had died of an opioid overdose. I had known him and have 
known his family for a long time. It strikes close to home for pretty 
much everybody in this Chamber, I am sure, and for pretty much 
everybody who is listening. When we have our tele-townhall meetings and 
I ask this question, which I do regularly--I had two tele-townhall 
meetings last month--``Have you been affected by the opioid issue,'' 
most people say yes.
  In fact, in parts of our State, in Southeastern Ohio, where we had a 
tele-townhall meeting recently, two-thirds of the people on the call 
said, yes, they were directly affected. That is because, sadly, this 
issue has grown to the point where last year 72,000 Americans lost 
their lives to the opioid epidemic. That is more people than we lost in 
the entire Vietnam war in 1 year. That many people died from opioid 
overdoses in 1 year. It is a grim statistic, and it is a record level.
  Although Congress has done some good things in the last couple of 
years in passing legislation to help, those legislative efforts to have 
better prevention programs in place, more treatment offered, more 
longer term recovery programs, more first responders with Narcan--this 
miracle drug that can reverse the effects of an overdose--that is 
starting to happen, but it is being overwhelmed with the influx of 
drugs, particularly this new synthetic form of opioid that is coming 
into our communities.
  It is usually called fentanyl, sometimes it is called carfentanil, 
but in my home State of Ohio and in other States around the country, 
this is resulting with a much higher overdose death rate than even the 
horrible drugs like heroin and the prescription drugs that are causing 
these opioid addictions--cocaine, methamphetamines, and crystal meth. 
This drug, fentanyl, is growing and growing rapidly.
  I will tell you, in Ohio, we had about a 4,000-percent increase in 
fentanyl overdose deaths just in the last 5 years. Let me repeat that. 
There was a 4,000-percent increase in deaths from

[[Page S6433]]

fentanyl. About two-thirds of our overdose deaths over time in Ohio are 
due to this synthetic form of opioid.
  By the way, this stuff is coming from overseas, mostly through our 
U.S. mail system. It is outrageous that this is being permitted without 
the proper screening.
  The legislation we are going to vote on this week--probably tomorrow 
afternoon--will finally put in place legislation called the STOP Act 
that we have worked on. Senator Klobuchar and I are the coauthors of 
it. We have worked on this for 3 years now to get it to this point.
  We had hearings. We had an investigation in the Permanent 
Subcommittee on Investigations to understand what was going on and how 
to deal with it, how to stop it. We found out, unbelievably, that the 
U.S. Postal Service is the main conduit for this poison. We also found 
out that the Postal Service is pushing back against putting additional 
screening in place.
  We also found out that private carriers, like FedEx, UPS, or DHL, 
will require every single package to have advanced electronic 
information provided to law enforcement to help stop this poison, to be 
able to find that needle in the haystack, that package out of the 900 
million the post office deals with every year that might have this 
poison in it.
  Under this legislation, the STOP Act, the post office is now going to 
have to do what these other private carriers do, and that is really 
important.
  In our investigation, where we used undercover resources to talk to 
websites, to find out what was being offered, to look behind the 
websites to find out what was really going on with this fentanyl issue, 
we found out that if you shipped it by the U.S. mail system, they 
guaranteed delivery but not if you shipped it through a private 
carrier. Why? Because they knew the private carriers had this 
electronic data that provided in advance what is in it, where it is 
going, where it is coming from, and then law enforcement can use Big 
Data to figure out what packages are suspect and take them offline.
  I have seen that done at the distribution centers of these private 
carriers. I have also spent a lot of time talking to the post office 
about it. They are now going to implement this legislation, I hope, 
aggressively.
  It requires 100 percent of packages, within a couple of years, to 
have this data on it and right away for China. It will be 100 percent 
for China this year because, according to law enforcement, 
unfortunately, China is the country where most of this is coming from. 
It gives us the opportunity to be able to stop some of this poison 
coming into our communities. That is really important.
  To me, getting that passed is just common sense. I think it is 
overdue. I am disappointed it took us this long. How many people had to 
die before Congress stood up and did the right thing with regard to 
telling our own post office, ``You have to provide better screening''? 
So it should be done.
  Having said that, that is not going to solve the problem. Yes, having 
a cutoff of some of the supply of this poison is important. To a 
certain extent, it stops it from coming into our communities, and it is 
going to raise the price on the street because you are cutting the 
supply. That is important because it is so cheap and so powerful. It is 
50 times more powerful than heroin, but that is not the ultimate 
solution.
  The ultimate solution is us, isn't it? It is in our hearts, in our 
families, in our communities to push back by having better prevention 
and education in place, by ensuring people who become addicted, who 
have this disease of addiction, have access to treatment to get them 
better so their lives can be turned around and they can go back to 
their families and to their work and to being productive citizens.
  We need longer term recovery programs because we know shorter term 
treatment isn't very successful. So many people relapse after a short-
term treatment program, but a longer term recovery program with it--
let's say with sober housing--with support from people who are recovery 
coaches who have been in recovery themselves, that is going to lead to 
a more successful result. Drug courts are very important in this.
  This legislation we are going to vote on this week does have the STOP 
Act, but it also has these other pieces. It reauthorizes the drug court 
system, as an example, diverting people out of incarceration into drug 
courts where they agree they are going to go into treatment and stay 
clean or risk going back into prison or jail if they don't. That has 
worked very effectively in parts of my State and around the country, as 
an example, to get people clean.
  The legislation also does something really important that some of us 
have been fighting for years. We have had legislation to do this for 
the last 3 years, but it has really been about a 10-year battle. It is 
this issue of treatment centers that receive reimbursement from 
Medicaid being capped at a certain number of beds with a certain number 
of days that people can stay. It is called the IMD exclusion, or the 
Institutions for Mental Disease exclusion.
  This is an arcane part of Federal law. It is an example where, well-
intended, years ago Congress said: We are going to put this limitation 
in place on treatment centers because we want to deinstitutionalize 
people, particularly in mental health facilities, because we have had 
some examples of abuse in these institutional care settings and people 
aren't getting the help they need so let's limit the number of beds you 
can have in these treatment centers on the mental health side to try to 
deal with the problem.
  Then the opioid crisis came. I would argue even before the opioid 
crisis this was true with regard to cocaine and meth and other things. 
Beds are at a premium in many places in our country. I have spots in 
Ohio that don't have any treatment centers. I have communities that 
literally don't have a place where people can go. So what happens is, 
these people go out of the county or out of their communities to find a 
place or they simply don't find treatment. Other examples are where 
people go to a treatment center, and they are told: Sorry, you have to 
come back in a couple of weeks. We just don't have any beds.
  There is nothing more heartbreaking than talking to a family or 
talking to a parent, as I have done, who talks about, in this case, his 
daughter going to a treatment center with him and his wife. She was 
finally ready--and when you are ready with this disease, with this 
addiction disease, you need to act. You need to get into treatment. She 
was ready, but they told her: There is no room at the inn. There is no 
bed for you. You have to come back in a couple of weeks. It was during 
those 2 weeks that she had a tough time. She overdosed again in their 
home and died.
  That family is really happy about this legislation because this will 
say to these treatment centers: You are not going to be capped at a 
certain number of beds. If you are doing a good job and providing the 
kind of treatment we want to have you provide, we don't want you to be 
capped at a certain number of beds.
  Again, this legislation that is currently in place with the 16-bed 
limit is a vestige of another time. This will enable us to take that 
limit off and provide more treatment to so many Americans
  We also provided in this legislation that those who want to get this 
exclusion lifted also have to provide at least two kinds of medication-
assisted treatment to people, which we know, based on the evidence--
depending on the person--is more successful. So we want to encourage 
people to offer medication-assisted treatment to get people off their 
addiction.
  It also says it is not limited to a certain kind of drug. There was 
some expansion of this in the previous legislation in the House, and 
some of us in the Senate introduced a bill a few weeks ago that is very 
similar to our final product that said: Let's not limit it just to 
those who have opioid addiction or even just opioid addiction and 
cocaine addiction; let's open it up to people who have substance abuse 
addiction--it can be alcohol, it can be crystal meth, which is 
unfortunately growing in some of our States, and it can be opioids. So 
we broadened it for individuals with substance abuse disorders.
  We have said, these institutions need to provide the best possible 
treatment, medication-assisted treatment. Through this legislative 
effort that is going to be voted on here tomorrow, we have been able to 
open up a whole

[[Page S6434]]

other possibility for people who are addicted. It is something we have 
worked on for many years.
  It is important we expand these services. It is important we tell 
people: If you are ready, we are going to find a treatment center for 
you--because we want these people to get better.
  We are told most people who are addicted don't seek treatment--
probably 8 out of 10 don't. One of the tricks is how do you get these 
people into treatment and into treatment in a way that is comprehensive 
where there are not big gaps. So between the overdose and the Narcan 
being applied, you want to be sure there is not a gap before treatment 
because people go back to their old community and, unfortunately, there 
are too many cases of people overdosing again and again. So get them 
into treatment but then from treatment into longer term recovery. We 
have to smooth that gap out so people are handed off to a facility or 
to an outpatient program that can help them ensure a greater level of 
success.
  Then how do you have this ability to say to people, ``We are going to 
be there for you,'' because, unfortunately, particularly with this 
opioid addiction, all the evidence coming in shows that long-term care 
really helps.
  Again, Congress has already taken some steps in the last couple of 
years with the Cures Act and the Comprehensive Addiction and Recovery 
Act, the so-called CARA legislation. There is more going on in our 
States.
  I visited about a dozen different places in our State where they are 
taking advantage of the funding from the Comprehensive Addiction and 
Recovery Act, legislation I coauthored a couple years ago with Senator 
Whitehouse on the other side. It is starting to work. It is closing 
some of the gaps we are talking about.
  The Cures legislation goes right back to the States. Last year, Ohio 
got about $26 million for that. It is very helpful for us because we 
are struggling to provide enough resources for treatment, particularly. 
Then now we have this additional bill to build on CARA and Cures.
  I think over time this will have the effect of reversing what we have 
seen as a terrible and deadly trend, which is more and more Americans 
overdosing, dying, not being in the workplace, not being with their 
families, and not being productive citizens. This is something that 
affects every single one of us.
  If you go to your hospital, you will see that the emergency room is 
overburdened. If you go to your NICU unit where these babies are being 
born who are addicted, babies who have neonatal abstinence syndrome--
these babies can fit in the palm of your hand or your two palms--and 
they have to be taken through withdrawal. How sad that innocent babies 
have to be taken through withdrawal because they were born to a mother 
who was using and who was addicted.
  These are all things that must be addressed and can be. Again, our 
legislation is going to help do that.
  I will say, as much progress as we are making on education, 
treatment, recovery, and with our first responders helping, as long as 
you have this deadly poison coming in, this fentanyl, the synthetic 
opioid that is 50 times more powerful than heroin and relatively 
inexpensive because it is being made by some evil scientist somewhere 
out of synthetics, out of chemicals--as long as you have that 
overwhelming the system, it is hard to see us reversing the trend. That 
is why the STOP Act is so important.
  We also reauthorized the HIDTA Program for high intensity drug 
trafficking areas. We need to push back on the supply side. We need to 
do more in terms of the demand side. With that, I will predict that 
when all of this is implemented properly, we will see some hope at the 
end of this dark tunnel. We will see fewer funerals like the one I was 
at yesterday.
  Instead, what we will see are families beginning to come back 
together, people beginning to have the opportunity to achieve their 
God-given potential in life, whatever it is. God's purpose for these 
addicts certainly isn't to continue to be an addict. His purpose is for 
them to have a meaningful life also, as well as for all of us. It is in 
all of our interests.
  My hope is, we can pass this legislation tomorrow, get it to the 
President, he will sign it, get it out to our States and communities, 
and begin to make the difference that can indeed begin to reverse this 
terrible epidemic and reverse the tide.