[Congressional Record Volume 164, Number 187 (Wednesday, November 28, 2018)]
[Senate]
[Pages S7175-S7178]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                            Opioid Epidemic

  Mr. PORTMAN. Mr. President, I wish to speak tonight about the opioid 
crisis that has gripped my State of Ohio and our country and talk about 
some lessons learned.
  There was an article in the New York Times that some might have seen 
on Sunday about a town in Ohio--Dayton, OH--and the progress they have 
made in combating this opioid crisis, including a reduction in overdose 
deaths, which is really significant. Dayton is a city that has had some 
of the highest overdose death rates in our entire State of Ohio, and 
Ohio is No. 3 or No. 4 in the country in terms of overdose deaths. They 
have seen in Dayton, OH, over the last year, about a 50-percent 
decrease in overdose deaths. It is still totally unacceptable. 
Unfortunately, there are still hundreds of people who are dying every 
year. But from this high-water mark, progress has been made. Why is 
that happening?
  Well, I am going to talk a little bit about that tonight and talk 
about some of the things that are actually working back in our 
communities and perhaps give us a little sense of optimism about what 
might be able to happen over the next couple of years as we try to turn 
the tide on this epidemic.
  For a little context, last year we had the highest rate of overdose 
deaths in the history of our country. Some 72,000 Americans--72,000--
lost their lives to overdoses from drugs. In my State of Ohio, that 
number is particularly high, to the point that it is the No. 1 cause of 
death now in our State.
  I met with the director of the CDC, or the Centers for Disease 
Control, today and talked about the opioid epidemic and talked about 
the tragedy he is seeing in places like southwest Ohio, Dayton, and 
Cincinnati, my hometown, where we see incidences of hepatitis C 
increasing and even hepatitis A. These are diseases that are primarily 
increasing because of the sharing of needles and the opioid epidemic.
  So we have our work cut out for us, don't we?
  In Dayton, OH, by the way, over the last few years, the death rate 
had gotten so high that the coroner's office was literally running out 
of space. There wasn't enough room to put all the bodies.
  I have held roundtable discussions in Dayton and Montgomery County, 
which is the county around Dayton, over the past several years and 
heard the bad news. I have often been with Montgomery County then-
Sheriff Phil Plummer, who has been tireless in trying to focus law 
enforcement, the social workers, the treatment community, the business 
community, and other community leaders on how to respond to this 
problem. Our first responders, of course, are as desperate as anybody 
to address this.
  It has been tough. Again, I have been in Dayton, OH, and had to talk 
about the fact that we had the worst rates in the country of deaths 
and, therefore, one of the worst in the entire country.
  So what has happened? How has Dayton made this progress, this 50 
percent reduction?
  Well, the New York Times highlights a number of reasons for it. They 
talk about greater community involvement, the ability for more Medicaid 
recipients to get treatment, and more

[[Page S7176]]

Narcan being distributed throughout the community. Narcan, of course, 
is this miracle drug that reverses the effects of an overdose.
  They talked about helping to deal with the stigma. In other words, by 
reducing the stigma that is associated with addiction, more people will 
step forward to get treatment for it, and their families will be more 
willing to push them forward. That helps to unite communities against 
what is the biggest public health crisis we face in Ohio and around the 
country.
  I would like to highlight tonight some of the things we have done 
here in this body just in the last couple of years that contribute to 
some of the success that we are seeing.
  Again, are we there yet? No, we are not. Last year was worse than the 
year before, but I do believe that we are going to begin to make 
progress, and, frankly, I think we would already have seen some of 
these efforts at the Federal level, State level, and local level, which 
are taking root, make a bigger difference but for one thing, and that 
is this big influx of synthetic opioids--fentanyl. Fentanyl, 
carfentanil, and other synthetics have taken over.
  I remember being in Dayton, OH, the city we are talking about 
tonight, about 4 years ago when, for the first time, I heard from a law 
enforcement official that fentanyl was pushing out heroin. At that 
time, the big issue was heroin. It wasn't fentanyl. In fact, very few 
people knew about fentanyl. Fentanyl has hit my State and our country 
so hard over the past several years--the last 3, 4, 5 years--that it 
has sort of overwhelmed the system. So as we have begun to make 
progress on better education, better treatment, better recovery 
options, and more Narcan, we have also had this big influx of this 
incredibly powerful drug that is 50 times more powerful than heroin on 
average--an inexpensive drug.
  We will talk in a minute about what we are doing about fentanyl, but, 
again, I think if we had not seen that influx, we would already be 
seeing more progress because of some of the things that we will talk 
about that are happening in Dayton, OH.
  Back in 2016, this body, after 4 years of work, passed legislation 
called the Comprehensive Addiction and Recovery Act. I was proud to 
coauthor that with my colleague Sheldon Whitehouse. It was bipartisan. 
It was nonpartisan. It was based on evidence. It was based on four 
conferences we had here in DC. We brought in people from all over the 
country to talk about this: What is the best treatment option? What is 
the best way to ensure somebody gets through treatment successfully? 
How can we do a better job with our veterans? How can we ensure that we 
are bringing our first responders into this, working with them, and 
helping them to be able to deal with this crisis? All of that led to 
this Comprehensive Addiction and Recovery Act legislation.
  The first thing the legislation did, actually, was it said: Let's 
look at this like a disease. That may be--of all the things that are in 
that legislation, including significant new funding for our 
communities--maybe the most important thing, and it is beginning to 
change the paradigm, so that we don't look at this as a moral failing 
but rather look at it as something that is a disease. Something changes 
in your brain when you become addicted.
  I can't tell you the number of people I have met in my home State of 
Ohio who because of an accident or an injury took an opioid, became 
addicted--physically addicted--shifted to heroin or fentanyl because 
the prescription drugs were hard to find or too expensive, and then 
overdosed, and, in some cases, overdosed and died.
  But having said that, this legislation--this Comprehensive Addiction 
and Recovery Act legislation--focusing on prevention, focusing on 
treatment, focusing on recovery, focusing on providing Narcan to our 
communities, has made a difference. There will be $608 million spent 
this year on these CARA programs. Our first year it was about $182 
million. It has gone up every year since. Why? Because it is working. 
It was based on good evidence, and it is helping to offer innovative 
solutions to this stubborn addiction challenge we face in our country.
  Dayton, OH, and Montgomery County have received $3.5 million in CARA 
funding. So part of the reason they have had some success is that they 
have taken this funding and used it in innovative ways. It includes $2 
million for first responders and about $500,000 for the city of Dayton 
to develop partnerships between first responders and treatment 
providers responding to overdoses as a team.
  Somebody overdoses, Narcan is applied, and their lives are saved. 
Unfortunately, still in America in most cases, the person goes back to 
the community, to the old team, the old gang, and often there is no 
followup.

  In Dayton, what they have said is this: Do you know what? If somebody 
overdoses and Narcan is applied, we are going to follow up with them, 
and the team will include law enforcement, but it also will include 
treatment providers and maybe social workers. This funding has allowed 
them to pursue that.
  Also, there is $1 million from Montgomery County Public Health to 
analyze substance abuse issues and identify potential solutions to come 
up with more innovative and creative ways to deal with this.
  Also, in 2016, this Congress passed another piece of legislation. The 
Comprehensive Addiction and Recovery Act, remember, is funding that 
goes straight to programs to help on prevention, education, and 
innovative solutions. The second one was called the 21st Century Cures 
Act, and this provides funding directly back to the States, and the 
States then decide how it is spent. That funding is also making a big 
difference.
  In each of the last 2 years, Ohio has received $26 million in Cures 
funding to affect the opioid crisis. All of your States have received 
funding too. The funding is based on the degree to which you have a 
problem. So the States like my State of Ohio, West Virginia, and 
Kentucky have gotten significant amounts of money from this because we 
need it.
  Again, the Montgomery County Alcohol, Drug Addiction, and Mental 
Health Services Board, or the ADAMHS Board, has received about $2 
million in Cures funding over the last 2 years in Dayton, OH. I have 
seen and heard about how that funding is being put to good use.
  Just a couple months ago, I was in Dayton. I took part in a 
roundtable discussion with the Montgomery County ADAMHS Board and 
discussed how they are using their Cures money and their CARA money. 
They are using their Cures money to fund a community-based treatment 
team. They are partnering with Dayton and Montgomery County Public 
Health Addiction Services to provide 24/7 ambulance withdrawal 
support--a community treatment team to help people gripped by addiction 
get treatment in their own homes and primary care for high-risk 
addicts, including pregnant women and more.
  They are finding that is working. It is working not just to have 
people be saved from an overdose by Narcan but getting these people 
directed into treatment to actually help them with their addiction 
problem longer term.
  They are implementing impressive programs to help with some of the 
most vulnerable groups that are affected by this crisis, and that is 
mothers who are addicted and their babies, who are too often being born 
with what is called neonatal abstinence syndrome. Because the mom is 
addicted, the baby is born with this syndrome which requires the baby--
tiny innocent babies--to go through withdrawal. It is a very sad 
situation. It is happening in hospitals all over our country. Go to 
your neonatal unit in your hospital, and you will find out that, 
unfortunately, the numbers of these babies has increased dramatically.
  We don't know the impact longer term on these babies who are born to 
moms who are addicted, but there is a great risk there. What we do know 
is that hospitals across the country are being filled up with these 
innocent babies, and they need our help.
  After these babies get out of the hospital, by the way, often they 
can't go back to their moms or their dads because they are addicted, 
nor should they.
  The moms and dads sometimes are in treatment. They can't take their 
babies with them. What happens to these kids? Well, there are some 
groups that have started. Community volunteers have stepped up in 
Dayton, OH, as an example, and started a group called Brigid's Path. 
Brigid's Path is a shining example of an organization that is

[[Page S7177]]

dedicated to helping newborns who are dependent on drugs be able to 
recover longer term. As these innocent babies are taken through the 
withdrawal, they also need to be surrounded by love and support.
  Earlier this year, I had the opportunity to visit Brigid's Path. It 
provides short-term inpatient care in a home-like setting for these 
newborns who are suffering from prenatal drug exposure.
  A lot of volunteers are involved. Some of the volunteers do something 
really important and really simple. You know what it is? They hold the 
babies. Literally, it is the human contact. Based on all of the 
psychological studies and looking at how you create a healthy, well-
adjusted baby, you have got to have that human contact. For these 
babies who can't be with their parents because their parents are 
addicted or maybe the dad isn't around and the mom is addicted, 
volunteers come in and literally hold the babies, love these babies, 
and support these babies. We need to provide as much care and treatment 
as possible to help these kids so that they can achieve their God-given 
potential in life.
  By the way, the opioid legislation that the President signed into law 
just last month, which this Congress passed, provides for the first 
time that organizations like Brigid's Path in Dayton, OH--entirely 
funded up to this point with volunteers, with money from the community, 
but, frankly, they don't have the resources they need to take care of 
all the babies who need the help--for these babies whose families 
qualify for Medicaid, will now be able to get Medicaid reimbursement 
under what is called the CRIB Act, which the President just signed into 
law.
  It provides $60 million in funding for babies and recognizes 
residential pediatric recovery facilities like Brigid's Path as 
providers under Medicaid. This is a huge difference. It is going to 
enable not just Brigid's Path but other organizations like this to pop 
up around our State.
  So that may not be affecting the overdose rate per se, but that is 
affecting something really important, which is the ability for these 
infants--these babies--to be able to have a normal life and to be able 
to achieve whatever God has in mind for them in their life, which is 
not to be growing up in a family with addiction but rather to be able 
to escape the grips of addiction.
  I believe, perhaps most importantly, that the legislation we just 
passed in Congress recently--adding to Cures, CARA and the CRIB Act--is 
dealing with fentanyl and will help in Dayton, OH, and around our 
country.
  I mentioned fentanyl earlier, a synthetic opioid 50 times more 
powerful than heroin and inexpensive. Sadly, while, again, Dayton has 
made progress, fentanyl remains the No. 1 killer in Dayton.
  They told me when I was there a couple months ago that cocaine and 
meth deaths--crystal meth--are rising in the Dayton area. That is 
deaths from cocaine and crystal meth. Why is that?
  Typically, you don't hear about people overdosing on cocaine, but you 
certainly do when fentanyl is mixed in with cocaine, and that is what 
law enforcement is telling me around Ohio is happening.
  These drugs, often mixed with fentanyl, are now deadlier than ever. 
Fentanyl was involved in more than 70 percent of Ohio's overdose deaths 
last year. From January until April of this year, despite the overall 
reduction in overdose deaths, about 77 percent of the overdose deaths 
in Montgomery County, in Dayton, OH, involved fentanyl.
  So, again, we are making progress, but not nearly as much as we all 
want to make, and a major reason for this is this influx of this deadly 
synthetic substance. Unbelievably, we know that fentanyl is mostly 
manufactured in China, and mostly comes to our country through our own 
United States mail system. Up to now, up until last month when the 
President signed this legislation, we did not have a way to screen 
these packages coming in from overseas, specifically from China, coming 
in through the mail system into our communities, causing all of these 
deaths and destruction. Now we have in place something that closes the 
loophole in the international mail screening. It requires the post 
office to do what the other carriers have had to do since 9/11, which 
is to provide law enforcement with advanced electronic data to be able 
to identify these suspect packages and get them offline. I think that 
is going to make a huge difference, not just because it is going to 
stop drugs from coming into our country but because, by reducing the 
supply, you are going to see the costs go up on the street, which has 
been one of our great challenges.

  That is not the ultimate answer. The answer is prevention and 
education, reducing the demand for these drugs, better treatment and 
longer term recovery options--all of those things we talked about in 
terms of taking care of those moms and babies. But we also have to do 
everything we can to reduce the supply of these drugs, and that 
legislation that the President just signed is going to help.
  We are also going to be helped by a new law that the President just 
signed last month which says that with regard to residential treatment 
programs, they are no longer going to be capped by an arbitrary limit 
of 16 beds. This is a vestige of the 1960s and 1970s, when we wanted to 
deinstitutionalize these people, and we said: You can't get 
reimbursement from Medicaid unless you have less than 16 beds for 
mental health and substance abuse treatment.
  Then the opioid crisis hits us, and suddenly we find ourselves with 
no room at the inn. Literally, people are being turned away at 
treatment centers and, in the period they are waiting to get in, 
overdosing and dying. I have heard these stories. I have heard the moms 
and dads talk about the pain of a child who finally says: I am ready.
  In one case, a dad takes his daughter to a treatment center. This was 
in a tele-townhall meeting I had. We have them every month, and I hear 
these stories. These are people who aren't calling to tell these 
stories, but they end up telling it because we are talking about this 
issue. In this case, the dad's heart was heavy. He said: We took her. 
She was ready. There was no room. They couldn't accept her in the 
treatment center. So we took her back home.
  In the 4 weeks that she was waiting to get a slot in the treatment 
center, what happened? She succumbed, once again, to shooting up--in 
her case, heroin--and an overdose in her own bedroom.
  So this arbitrary limit doesn't make any sense. If the treatment 
center is doing a good job, don't limit it to 16 beds. If it is not 
doing a good job, by the way, it shouldn't be getting any 
reimbursement. But if it is doing a good job and successfully helping 
people to get beyond their addiction and into recovery, we shouldn't be 
limiting it. This legislation does that. It actually takes off the cap. 
It has a 5-year life because it has a cost to it, and I am convinced it 
is going to work well. Five years from now, we will extend that even 
further, but this is something some of us have been working on for many 
years, and it is now done. So, again, progress is being made 
incrementally. Some of this legislation we talked about tonight is 
contributing to that.
  We need to ensure that if we implement this, we cannot at this point 
take our eye off the ball. I think when we look back at this year, 
2018--and we are coming to the end of the calendar year now--we will 
see for the first time in the last dozen years a reduction in overdose 
deaths. I predict that is going to happen. I say that in part because I 
spoke to the Director of the Centers for Disease Control and 
Prevention.
  I also say that because back in Ohio I am seeing these programs work. 
I am seeing us finally beginning to turn the tide, despite the influx 
of fentanyl. But I would just state tonight, if that is true, and if we 
begin to see some progress--and I see it on the ground and see it in 
reports from coroners and medical directors around Ohio--if that 
happens, let's not take our eye off the ball. We succeeded. Let's move 
on.
  We did that back in the 1990s with regard to cocaine; we had solved 
the problem. We never solved the problem. It is like the tide. It keeps 
coming in. We have to be vigilant. We have to maintain the support we 
have provided here in the U.S. Congress to push back against this 
terrible addiction, this disease, and we have to ensure that we are not 
just pushing down on one drug and having another drug pop up.
  As we make progress on fentanyl or make progress on heroin, let's 
also be

[[Page S7178]]

mindful of the disastrous impact of cocaine, crystal meth, and drugs we 
haven't even heard of yet--the new synthetic drugs that are coming our 
way.
  I believe that Federal programs like CARA and Cures are making a 
difference. We are working with our States that are passing their own 
legislation and helping in many ways. Our local communities are jumping 
in and figuring out innovative and creative ways of taking that Federal 
dollar and leveraging it with private sector money and with State and 
local money.
  I believe we are going to make progress with the STOP Act in reducing 
the supply and therefore raising the cost of the drug on the streets. I 
think what you have seen in Dayton, OH, which was reported in the New 
York Times, can continue--and not just in Dayton, but in Toledo, 
Columbus, Akron, Cincinnati, and St. Clairsville--all over our State 
and all over our country.
  We have a role to play here, and that is to continue to be better 
partners, as we have been over the last 2\1/2\ years here in Congress--
better partners with our States and with our local communities and with 
our families because, ultimately, this is an issue of the heart, isn't 
it? This is about the future.
  We have some pages with us tonight. They are young people who are 16, 
17 years old who come to this town because they are selected as bright, 
young people. They are listening--at least they are acting as though 
they are listening tonight; thank you. It is about you. It is about 
what kind of future you are going to have and what kind of future we 
are going to have, having safe and healthy communities.
  Thank you.
  I yield back my time.
  The PRESIDING OFFICER. The Senator from Ohio.

                          ____________________