[Congressional Record Volume 166, Number 122 (Thursday, July 2, 2020)]
[Senate]
[Pages S4205-S4207]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                            Opioid Epidemic

  Mr. President, I am here on the floor today to talk about some recent 
troubling statistics that ought to serve as a call to action for every 
single one of us.
  Last Friday, in observance of World Drug Day, the United Nations 
Office on Drugs and Crime released its annual world report detailing 
the impact of drug use and trafficking across the world. Frankly, the 
report paints a grim picture that reminds us that America has a unique 
addiction crisis, especially as it relates to opioids.
  The report says that in recent years the United States has lost more 
men, women, and children to drug overdose deaths--60,000 to 70,000 per 
year--than the next 20 countries combined.
  Let me say that again. The United States has lost more people to drug

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overdose deaths than the next 20 countries combined. That is 
unacceptable. This sad comparison of the United States to other 
countries is a reminder that we have to do better and we can do better.
  Even more concerning to me is the recent data we are now receiving 
about what is happening as a result of the current coronavirus 
pandemic. It was bad enough, as the world drug report shows, but now, 
during the last few months, during this pandemic, things have gotten 
worse.
  The Overdose Detection Mapping Application Program is a collaborative 
Federal organization that tracks overdose data from more than 3,300 
emergency agencies. According to data that has been obtained by the 
Washington Post, fatal and nonfatal overdoses were 18 percent higher in 
March of this year as compared to March of 2019. They are 29 percent 
higher this April compared to a year ago and 42 percent higher this May 
than they were a year ago, in 2019. These are overdoses that are being 
tracked through EMS, ambulance, hospitals, and emergency rooms. This is 
really concerning.
  One of the findings of this U.N. report was that the most dangerous 
class of drugs worldwide were opioids, including prescription pain 
killers, heroin, and the synthetic opioids like fentanyl. These drugs 
were the cause of about two-thirds of the overdose deaths in the world 
in recent years, according to the U.N.
  The recent data shows that fentanyl use, in particular, has gone up 
in the United States during this pandemic, especially when it is laced 
with other drugs, such as heroin, meth, and cocaine. As many of my 
colleagues know, one of my top priorities in Congress over the last 
several years has been to combat this opioid addiction crisis that has 
hit communities in my home State of Ohio so hard. This new information 
about the resurgence of addiction is particularly discouraging because 
in recent years we have made great progress. We had actually, finally, 
after years and years of increased overdose deaths every single year--
finally, in the last few years, we had begun to see a reversal of that, 
and here we have, during this pandemic, the opposite happening.
  In 2017, Ohio's opioid overdose death rate was almost three times the 
national average. We were one of the top three States in the country in 
terms of overdose deaths. Nearly a dozen Ohioans are dying from these 
drugs every day, surpassing car crashes as our country's top killer 
among young people and, for Ohio overall, the State's No. 1 killer. But 
that next year, in 2018, we were one of the leaders in turning the tide 
with a 22-percent reduction in 1 year in overdose deaths. That was the 
same year, by the way, when national overdose deaths also declined for 
the first time since 1990. Think about that. From 1990 to 2018, it 
increased every year, and finally we saw a reduction. In Ohio it was a 
significant reduction.
  Over the last couple of years, prior to the coronavirus, we continued 
to make steady progress--not 22 percent, but we made steady progress in 
declining. We achieved these strides, in part, thanks to legislation we 
passed in this Congress--a significant commitment of new resources by 
the Republicans and Democrats on this floor and by the administration. 
The CARA Act and CARES Act provided local and State governments and 
nonprofit groups with additional resources to help use proven 
prevention treatment and recovery programs effectively.
  I was the author of the CARA legislation. We spent 4 years putting it 
together, with national folks coming in from all over the country 
helping us, and we put together something that made sense and that was 
actually working.
  We have also ensured that our first responders on the frontlines of 
this crisis had the resources they need, including the miracle drug 
Naloxone, which reverses the effects of an overdose.
  This kind of continued support was critical for our communities 
making the progress we have made in combating the disease of addiction, 
and I have been proud to help lead the effort at the Federal level, 
although at the State level and local level everybody has kicked in, 
including so many volunteers and so many families, and it has made a 
difference.
  But these new reports show that now we are going the other way. We 
have a long way to go in this fight against the addiction crisis in 
America, and I am afraid we are in danger now of taking a step 
backward.
  Thanks to the coronavirus, our lives have changed in so many ways. 
Many individuals who have lost their jobs have had to radically change 
the way they work. Unfortunately, the disruptions have extended to this 
field of addiction treatment as well.
  As States have begun to order a suspension of elective procedures--
this happened back in March and April--people were not able to get 
elective procedures in hospitals, and there was a shift toward more 
telehealth to help preserve the personal protection gear, the PPEs, for 
frontline workers. Many patients and caregivers who relied on face-to-
face interaction and around-the-clock care to be able to stay the 
course on recovery from drug addiction and from mental health issues 
have lost vital access to care. I think that is one of the reasons we 
see this uptick. Some have fallen off their treatment plans, and some 
have relapsed.
  Unfortunately, this is happening right now as we talk. If we combine 
that with the feelings of isolation so many people feel being 
quarantined or being isolated, the feeling of frustration, the feeling 
of despair many Americans have felt with these dual healthcare and 
economic crises, you have a perfect storm for the resurgence in opioid 
deaths. That is exactly what has happened in Ohio and around the 
country.
  Officials in Hamilton County, which is Cincinnati, OH, where I am 
from, stated there were 42 overdose deaths in May and that at least 23 
people died in June. In Cuyahoga County, our State's most populous area 
and the home of Cleveland, the medical examiner's office has reported 
235 fatal drug overdoses so far in 2020 and at least 66 fatal heroin, 
fentanyl, and cocaine overdoses in May alone. Those figures, by the 
way, match the deadliest months for overdoses on record in the county, 
and that would be back in 2017.
  Remember, we talked about how the deaths are going up year after 
year, and 2017 was the peak, and then they went down in 2018. Well, 
this year already, in Cleveland, we are back up to where we were in 
2017. The Columbus coroner's office has had to move to a space three 
times larger than its old office to accommodate the increases in 
overdoses and overdose deaths. We are not alone in this uptick. 
According to the Center for Optimal Living, 30 States have seen an 
increase in overdose deaths during this pandemic.
  The Federal response to the coronavirus pandemic has included certain 
measures to ensure those suffering from addiction can continue to get 
the care they need, and I am glad we were able to provide some 
provisions both in the CARES legislation that was passed about a month 
ago but also the other legislation we passed around that time.
  We have done a number of things to cut redtape and the regulatory 
relief to expand telehealth and telehealth options specifically for 
opioid treatment, as well as increasing the number of alternate 
delivery methods for patients quarantined at home so they can maintain 
their access to opioid treatment providers. These reforms have been 
helpful in offering a lifeline for those working hard to stay sober and 
clean, and, in some instances, according to addiction and mental health 
leaders from across the State, these reforms have even allowed 
addiction specialists to reach new patients who were hesitant to come 
into the doctor's office in the first place, sometimes due to the 
stigma that attaches to addiction.
  These aren't perfect solutions, of course, because the numbers show 
that addictions are actually up, but ultimately, they have been 
helpful. We are going to have to find a way to get a handle on this 
coronavirus pandemic in a way that we can resume these traditional in-
person addiction treatment services that have helped so many recover 
from this debilitating disease. We are going to have to ensure that we 
can get away from some of this isolation and sense of disparity that 
people feel.
  One thing we do know is, the benefits of telehealth for treating 
addiction are real, and I think we should act now in this next COVID-19 
bill that we are talking about passing next month or maybe even later 
this month. That legislation, in my view, should include provisions 
that allow providers to have

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the flexibility to continue to offer alternative forms of care via 
telehealth to people when this pandemic is over so the providers can 
readily adapt in the event that another pandemic or another disaster 
forces us to shift healthcare services back to virtual care. We need to 
continue telehealth now and provide the reimbursement but also ensure 
that it is going to be there for the future because it is working.
  I am committed to working with my colleagues on bipartisan solutions 
to the challenges we talked about today. Yesterday, I introduced 
legislation called the Telehealth Response for E-prescribing Addiction 
Treatment Services Act, or TREATS Act, to make permanent a number of 
temporary waivers for telehealth services and bolster telehealth 
options for addiction treatment services. Specifically, the bill is 
going to do a couple of things.
  First, it will allow for a patient to be prescribed lower scheduled 
drugs like Suboxone or buprenorphine through telehealth on their first 
visit. Current law requires you go to an in-person visit when needing 
any controlled substances, but this has been a deterrent to patients in 
crisis and in urgent need of treatments from schedule III or IV drugs.
  Our bill is important. By the way, it also limits abusive practices 
by limiting telehealth visits to those who have both audio and video 
capabilities to be able to interact with the treatment providers to 
reduce fraud and abuse when it is your first visit. It would also 
prohibit prescribing schedule II drugs like opioids that are more prone 
to being abused through these telehealth visits. So we have provisions 
in there to avoid abuse, but it is important to continue this 
telehealth when the other options aren't there
  Second, our bill would allow for Medicare to bill for audio-only or 
telephone telehealth visits if it is not the patient's first visit. In-
person visits or telehealth visits with video components are important, 
and I think it is important to have that on the first visit because 
they can allow for more robust checkups and evaluations.
  Due to distance or access to broadband, these types of appointments 
aren't always possible. We still need to focus on safety and robust 
treatment options, but in order to balance the needs of patients, we 
have proposed to allow our Nation's seniors to use phones for 
subsequent behavioral health visits when they do not have access to the 
internet.
  There is no question that the greatest priority facing our country at 
this moment is this unprecedented coronavirus pandemic, but this new 
U.N. report and the rising number of overdoses in Ohio and around the 
country show that there is even more at stake here than we realize. We 
know of the direct impacts of the coronavirus pandemic, but losing 
ground on addiction and behavioral health is one of the indirect 
casualties. Not only must Congress ensure our addiction health services 
have the resources they need to adapt to this new reality, but we also 
have to redouble our efforts to slow the spread of the coronavirus so 
we don't lose ground on this addiction crisis just as we were making 
progress and that we don't keep more Americans from achieving their 
God-given potential.