[Congressional Record Volume 167, Number 35 (Wednesday, February 24, 2021)]
[Senate]
[Pages S870-S872]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                            OPIOID EPIDEMIC

  Mr. PORTMAN. Mr. President, I am here on the floor today to talk 
about the need for all of us to redouble our efforts to combat drug 
addiction. One of the top priorities I have had in my time in public 
service has been to combat this crisis, which has devastated so many 
families, destroyed so many communities, and impacted us in so many 
negative ways.
  Unfortunately, under the cover of the coronavirus pandemic, there is 
an epidemic that is growing, and that is the drug addiction epidemic. 
It is heartbreaking because we actually had several years of progress. 
We were making progress, finally, in turning the tide, and now, it is 
coming back with a vengeance to the point that overdoses and overdose 
deaths, hospitalizations, and all the other negative consequences of 
drug addiction is being raised up again in the context of the 
coronavirus.
  Here, in the Congress, we have taken a leadership role on addressing 
this issue. Over the last several years, Congress has appropriated 
billions of dollars--and not that money solves everything, but the 
money has been pretty well spent on programs that are actually tested, 
evidence-based programs on prevention, on treatment, and longer term 
recovery.
  Once called the Comprehensive Addiction and Recovery Act, which I 
authored with my colleague, Sheldon Whitehouse, on the other side of 
the aisle, there is other legislation, too, called the 21st Century 
Cures Act. All of this has provided help that goes down to the local 
level, the community level, to be able to create a network, to be able 
to push back against the addiction crisis.
  In 2017, Ohio's overdose opioid death rate was almost three times the 
national average. Ohio was one of the worst States in the country in 
terms of our opioid addiction. In terms of opioid deaths, we were top 
three in the country. It is not something you want to be at the top of. 
Nearly a dozen Ohioans were dying from these dangerous drugs every 
single day. This is in 2017. It surpassed car crashes as our country's 
No. 1 killer among young people and, for Ohio, the No. 1 overall.
  But that next year, in 2018, much of what we were doing here in 
Congress, the work again on the CARA Act, the Cures Act, and other 
things that were being done at the State level and local level that 
were being supported by our Federal legislation, they were starting to 
work. So, in 2018, Ohio led the country again, but this time it wasn't 
in overdose deaths. It was in the reduction of overdose deaths. We 
actually had a 22-percent reduction from 2017 to 2018.
  By the way, the same thing happened nationally. We had a reduction in 
overdose deaths nationally in 2018 for the first time since 1990. Think 
about that. From 1990 until 2018, every single year, we had more people 
dying from overdoses in this country, driven in large part by opioids, 
and, more recently, by the most deadly of opioids, synthetic opioids 
like fentanyl and Carfentanil.
  Unfortunately, again, under the cover of this coronavirus pandemic, 
drug addiction has flourished, and that positive progress has been 
reversed. It is heartbreaking. While we need to remain committed to 
solving the healthcare challenges of COVID-19, there is increasing 
evidence that the stresses of this unprecedented time are driving a 
spike in drug abuse and subsequent overdoses, this making 2020 the 
worst year in the history of our country in terms of overdose deaths 
and other measurements of drug addiction.

  Why? Well, I have asked a lot of people that. Common sense would tell 
you people are lonelier. Many people are distraught. Maybe they have 
lost their job. Maybe they have had someone in their family die of 
COVID-19. People are feeling anxious. People are unable to access 
recovery programs in person, so they can't go sit down with their 
recovery coach, which they might have been able to do but for COVID-19 
and the isolation that is required. Many of those in recovery from 
addiction are stalled in their progress, or they are suffering from 
relapses.
  There is a story that ran last week about a record number of overdose 
deaths in my home State of Ohio. It was on FOX 8 in Cleveland. One of 
the people they interviewed was a Cleveland woman who had lost her son 
to an overdose. It was pretty powerful. She talked about how important 
it is for people fighting addiction to have that network of support. It 
was hard to find during COVID-19. She said: ``An addict needs to talk 
to someone, they need constant reassuring from their support group.''
  She is right. There are a lot of troubling statistics out there that 
should be a cause for concern and a call to action for all of us. The 
Centers for Disease Control reported that more than 81,000 people died 
of drug overdoses in the 12 months ending in May 20 of 2020, the 
highest 12-month total in our Nation's history. So, again, it looks 
like 2020 is going to be the worst year ever.
  The American Medical Association reports that more than 40 States 
have reported an increase in opioid-related deaths during the COVID-19 
pandemic. A recent study in the JAMA Psychiatry journal found that a 
45-percent increase was the overdose death increase in emergency rooms 
from April to October of 2020 compared to that same time in 2019.
  It would be worse, in my view, without the Federal response to the 
coronavirus pandemic, including some measures to ensure those suffering 
from addiction can continue to get the care they need through 
telehealth. We have cut redtape. We have provided some regulatory 
relief to expand telehealth and telehealth options specifically for 
opioid treatment, like eliminating requirements for in-person visits 
before prescribing lifesaving drugs like buprenorphine.
  Without these expanded services, I believe the overdose spike would 
be even worse. Although there is no substitute for face-to-face 
interaction to help along an individual's journey to recovery, 
telehealth has kept patients in touch with their doctors at least and 
allowed physicians to prescribe medication-assisted treatment remotely.
  In talking to those who are recovery coaches or those doctors back 
home who specialize in addiction, they tell me they believe that the 
telehealth option has been extremely important, so even though it has 
gotten worse, it would have gotten even worse if people had not had at 
least the ability to access their recovery program through a remote 
means.
  Interestingly, these telehealth options for addiction treatments were 
put in place temporarily, but they have proven to be such a viable 
option for addiction treatment that now people are talking about making 
them permanent. I agree with that. I don't think it makes sense to get 
away from them as this pandemic goes away, which is why yesterday, 
along with my colleague, Sheldon Whitehouse, I entered this legislation 
called the Telehealth Response for E-Prescribing Addiction Services 
Treatment Act. The reason that is such a long name is we wanted to make 
the acronym TREATS, which it is. The TREATS Act makes permanent a 
number of temporary waivers for telehealth services and bolsters 
telehealth options for addiction treatment services.
  Let's turn to a couple of things specifically. First, it allows for a 
patient to be prescribed lower-scheduled drugs like Suboxone through a 
telehealth visit on their first visit, as opposed to having to go in 
person for that first visit.
  Current law requires an in-person visit when you need an initial 
prescription for controlled substances, but this has been a real 
deterrent for patients in crisis and in urgent need of treatments from 
Schedule III or Schedule

[[Page S871]]

IV drugs like Suboxone or certain drugs for reoccurring mental health 
conditions, so our bill is important in that regard.
  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 keep the existing requirements for in-person 
visits when prescribing Schedule II drugs like opioids or stimulants 
that are more prone to being abused during these telehealth visits. So 
we have provisions in there to avoid abuse, but it is important to 
continue this telehealth option when other options just aren't there.
  Second, our bill would allow for Medicare to bill for audio-only or 
telephone telehealth services for mental health and substance abuse 
treatment if it is not the patient's first visit. Due to distance or 
access to broadband, in-person visits or even video appointments aren't 
always possible for our seniors. We still need to focus on safety and 
robust treatment options, but in order to balance the needs of 
patients, we propose to allow our Nation's seniors under Medicare to 
use phones for subsequent mental health or behavioral health visits 
when they don't have access to the internet and where face-to-face 
interaction just isn't as necessary.
  I believe this TREATS legislation will make a difference in the 
addiction treatment space and will help us prevent more untimely 
overdoses, but it is also important that we ensure that law enforcement 
officials can continue to go after the supply of lethal drugs coming 
into our communities, lethal drugs that are fueling these overdoses.
  The most important thing, in my view, is reducing the demand dealing 
with prevention, treatment, and recovery, but by stopping some of the 
flow of these drugs, among other things, you are reducing the supply, 
which raises the cost of these drugs on the street. And, unfortunately, 
some of these drugs are unbelievably inexpensive, given how incredibly 
powerful and deadly they can be.
  Data from the Center for Disease Control shows that the biggest 
driver of these surge in overdose deaths has been the class of drugs 
called synthetic opioids. We talked about that a moment ago. They are 
far deadlier than the traditional opioids like heroin but still cause 
far too many overdoses.
  The most well known of these drugs, fentanyl, is about 50 times 
deadlier than heroin, and it is often less expensive. It is illegally 
manufactured primarily in China, and then it is smuggled across our 
southern border or through the U.S. mail. A pound of fentanyl is lethal 
enough to kill half a million people. Think about that. One pound is 
enough to kill half a million people.
  We have made some progress keeping it out of the mail system. The 
STOP Act is now in effect. We are working with the Postal Service and 
also working with Customs and Border Protection to properly implement 
that legislation, which I authored on a bipartisan basis here several 
years ago, and it is finally being implemented to keep our mail system 
from delivering poison into our communities.
  But the traffickers have changed patterns, and a lot of it is now 
going to Mexico and then coming over land across our southern border.
  Across the country, law enforcement have had their hands full trying 
to stop the flow of synthetic opioids. Ohio State Patrol troopers 
seized a total of 129 pounds of fentanyl last year, enough to kill more 
than 60 million people. We have 11.8 million people in Ohio, but our 
troopers, just in Ohio, seized enough fentanyl to kill 60 million 
people.
  In one Ohio county, Cuyahoga County, there were more than 1,700 
seizures of fentanyl by law enforcement in 2020. One DEA initiative to 
fight drug trafficking that started just last August of 2020 has 
resulted in the seizure of nearly 440 pounds of fentanyl.
  Fentanyl itself is a schedule II drug, which means that law 
enforcement is able to take appropriate actions to crack down on it, 
and that is good. But there is a hidden challenge with fentanyl, and 
that is that manufacturers can alter its chemical makeup in a lab to 
make what is known as a fentanyl analog or a copycat. It is all 
synthetic. So if some evil chemist somewhere can adjust the formula and 
make it an analog, it is not subject to the schedule II charges that 
law enforcement can bring. Because the chemical makeup is different in 
fentanyl, it is not automatically illegal at all, in fact. What is 
worse, these copycats can often be deadlier than fentanyl--take, for 
instance, carfentanil, which is 100 times as deadly as fentanyl and 
about 10,000 times more deadly than morphine. Just handling 
carfentanil, if you were to spill some on yourself, can kill you.
  In 2018, the Drug Enforcement Agency, DEA, made the right call by 
temporarily making these fentanyl-related substances illegal to 
possess, transport, or manufacture. Thanks to that designation, our law 
enforcement officials have been better able to protect our communities 
by seizing and destroying these fentanyl-related substances.
  Unfortunately, the temporary extension by DEA ends in only a few 
months. After May 6, 2021, these incredibly dangerous substances will 
no longer be subject to strict regulation by law enforcement. It will 
be easier for drug manufacturers in China and elsewhere to flood the 
United States with carfentanil and other synthetic opioids. We can't 
allow that to happen.
  Of course, we can't allow that to happen, which is why yesterday I 
introduced the bipartisan Federal Initiative to Guarantee Health by 
Targeting Fentanyl, or FIGHT Fentanyl Act, along with my colleague 
Senator Joe Manchin from West Virginia, another State that has been 
devastated by the opioid epidemic. Our bill simply codifies the 
existing DEA precedent to permanently schedule fentanyl-related 
substances, allowing our law enforcement officials to continue to crack 
down on synthetic opioid in all of its forms. Let's provide some 
certainty, some predictability here, and make this permanent.
  Just as importantly, it is going to send a signal to both the 
American people and the manufacturers and smugglers that produce 
synthetic opioids that we have not forgotten about this threat, and we 
are going to do everything in our power to keep these deadly drugs out 
of our communities.
  The FIGHT Fentanyl Act and the TREATS Act are a couple of things that 
we could do right now on a bipartisan basis, and we should. I urge my 
colleagues to support them.
  But we have a lot more work to do in the months ahead. The 
authorization for the Comprehensive Addiction Recovery Act, the CARA 
bill we talked about earlier, expires in fiscal year 2023. And Senator 
Whitehouse and I will soon introduce a CARA 2.0 Act to build on the 
successes of CARA with an unprecedented investment in expanding access 
to proven treatment and recovery programs--again, programs that are 
shown to work by evidence for treatment and recovery than longer term 
recovery.
  CARA 2.0 includes dozens of provisions to address addiction from all 
fronts--research and education, treatment and recovery, criminal 
justice reform, dealing with prescription drugs--making it the most 
comprehensive legislation in our country's history. When added with the 
existing CARA programs that are reauthorized through 2023, we would be 
investing well over $1 billion to address this longstanding epidemic, 
again, at a time when under the pandemic the epidemic is growing.
  We need to be sure that as we continue to invest in the coronavirus 
vaccine development and distribution, we are also focusing on this 
epidemic. As we come out of this coronavirus pandemic--and I believe we 
are starting to see some signs of that--let's be sure we are not 
leaving in its wake more and more deaths and more and more addiction 
with regard to the drug addiction crisis.
  We need to all recognize the urgency of working to reverse this surge 
and nationwide overdoses and overdose deaths. As we emerge from this 
coronavirus pandemic, let's act now to ensure we have the tools in 
place to also turn the tide on this disease and get those affected the 
help they need.
  I yield my time.

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