[Congressional Record Volume 165, Number 70 (Tuesday, April 30, 2019)]
[Senate]
[Page S2510]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           THE OPIOID CRISIS

  Mr. ALEXANDER. Madam President, I ask unanimous consent that a copy 
of my opening statement at the Senate Health Education, Labor, and 
Pensions Committee be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                 Managing Pain During the Opioid Crisis

       Mr. ALEXANDER. The Senate Committee on Health, Education, 
     Labor and Pensions will please come to order. Senator Murray 
     and I will each have an opening statement, and then we will 
     introduce the witnesses. After the witnesses' testimony, 
     senators will each have 5 minutes of questions.
       Dan, a constituent of mine who lives in Maryville, 
     Tennessee, recently wrote me about his wife, who has a rare 
     disease that causes her chronic pain. Dan is concerned 
     because it has become more difficult for her to access 
     painkillers. Dan wrote, ``She is not an abuser, and is doing 
     everything right. Now it's harder for her to get the medicine 
     she needs.''
       Dan's wife is one out of 100 million Americans who, 
     according to a 2011 report by what was then the Institute of 
     Medicine, now the National Academy of Medicine, are living 
     with some pain--that is about 30 percent of Americans. 25 
     million of those have moderate or severe pain.
       A new report released in 2018, from the Centers for Disease 
     Control and Prevention, says that about 50 million Americans 
     have chronic pain, and nearly 20 million of those Americans 
     have high-impact chronic pain.
       Here is the reality: we are engaged in a massive effort to 
     make dramatic reductions in the supply and use of opioids--
     the most effective painkiller we have. But on the theory that 
     every action has an unintended consequence, we want to make 
     sure that as we deal with the opioid crisis, we keep in mind 
     those people that are hurting.
       We are holding this hearing to better understand the causes 
     of pain, how we can improve care for patients with pain, and 
     where we are on developing new medicines and ways to treat 
     pain.
       We know that pain is one of the most frequent reasons 
     people see a doctor, and, according to the Mayo Clinic, the 
     number of adults in the United States with pain is higher 
     than the number of people with diabetes, heart disease, and 
     cancer combined. These Americans need more effective ways 
     than opioids or other addictive painkillers to manage pain. 
     Opioids, which are commonly used to treat pain, can lead to 
     addiction and overdose. More than 70,000 Americans died from 
     drug overdoses last year, including prescription opioids, 
     making it the biggest public health crisis in our country.
       Last year, Congress passed comprehensive opioid legislation 
     to combat this crisis, which President Trump called ``the 
     single largest bill to combat a drug crisis in the history of 
     our country.''
       Our legislation included more than 70 ideas from 72 
     Senators, and eight committees in the House and five 
     Committees in the Senate that included: Reauthorizing 
     training programs for doctors and nurses who prescribe 
     treatments for pain; increasing access to behavioral and 
     mental health providers; and encouraging the use of blister 
     packs for opioids, such as a 3 or 7-day supply, and safe ways 
     of disposing unused drugs.
       We also took steps to ensure our new law wouldn't make life 
     harder for patients with pain, but now we need to take the 
     next step to try to find new ways to help them: first--we 
     gave the National Institutes of Health more flexibility and 
     authority to spur research and development of new non-
     addictive painkillers. We also asked the Food and Drug 
     Administration to provide guidance for those developing new 
     non-addictive painkillers to help get them to patients more 
     quickly. I'm pleased to see Commissioner Gottlieb's 
     announcement this morning that the agency is developing new 
     guidances on how FDA evaluates the risks and the benefits of 
     new opioid treatments for patients with pain and to help the 
     development of non-opioid treatments for pain.
       Sam Quinones, a witness at one of our hearings, called new 
     non-addictive painkillers the ``holy grail'' to solving the 
     opioid crisis. We have backed up those new authorities with 
     substantial funding--most recently $500 million to help the 
     National Institutes of Health find a new nonaddictive 
     painkiller.
       Second, we included provisions to encourage new pain 
     management strategies, such as physical therapy. Third, the 
     new law requires experts to study chronic pain and report to 
     the Director of the NIH how patients can better manage their 
     pain. And fourth, the new law requires the Secretary of 
     Health and Human Services to report the impact on pain 
     patients that Federal and State laws and regulations that 
     limit the length, quantity, or dosage of opioid 
     prescriptions.
       Now that we have started to turn the train around and head 
     in a different direction on the use of opioids, everyone--
     doctors, nurses, insurers, and patients--will need to think 
     about the different ways we should treat and manage pain. 
     There are other things the federal government is doing to 
     better understand what causes pain and how we treat and 
     manage it.
       For example, the National Pain Strategy, developed by the 
     Interagency Pain Research Coordinating Committee, which 
     develops recommendations to prevent, treat, manage, and 
     research pain. Through the National Institute on Drug Abuse 
     and the National Institutes of Health's HEAL Initiative, 
     researchers are working to better understand pain and why 
     some people experience it differently than others. This will 
     help us find more ways to more effectively treat pain and 
     help get people the treatment they need.
       For example--physical therapy or exercise may be the best 
     course of treatment for some kinds of back pain. It may also 
     help us understand why some people can take opioids to manage 
     their pain for years without becoming addicted, while others 
     more easily become addicted.
       Today, I hope to hear about how close are we to having a 
     non-addictive painkiller, and how doctors and nurses can 
     better treat people with pain.

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