[Congressional Record Volume 168, Number 188 (Monday, December 5, 2022)]
[House]
[Pages H8745-H8750]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
{time} 1530
RURAL OPIOID ABUSE PREVENTION ACT
Ms. JACKSON LEE. Mr. Speaker, I move to suspend the rules and pass
the bill (S. 2796) to amend the Omnibus Crime Control and Safe Streets
Act of 1968 to provide for the eligibility of rural community response
pilot programs for funding under the Comprehensive Opioid Abuse Grant
Program, and for other purposes.
The Clerk read the title of the bill.
The text of the bill is as follows:
S. 2796
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Rural Opioid Abuse
Prevention Act''.
SEC. 2. ELIGIBILITY OF RURAL COMMUNITY RESPONSE PILOT
PROGRAMS FOR FUNDING UNDER THE COMPREHENSIVE
OPIOID ABUSE GRANT PROGRAM.
Section 3021 of title I of the Omnibus Crime Control and
Safe Streets Act of 1968 (34 U.S.C. 10701) is amended--
(1) in subsection (a)(1)--
(A) in subparagraph (F), by striking ``and'';
(B) in subparagraph (G), by striking the period at the end
and inserting ``; and''; and
(C) by adding at the end the following:
``(H) a pilot program for rural areas to implement
community response programs that focus on reducing opioid
overdose deaths, which may include presenting alternatives to
incarceration, as described in subsection (f).''; and
(2) by adding at the end the following:
``(f) Rural Pilot Program.--
``(1) In general.--The pilot program described under this
subsection shall make grants to rural areas to implement
community response programs to reduce opioid overdose deaths.
Grants issued under this subsection shall be jointly operated
by units of local government, in collaboration with public
safety and public health agencies or public safety, public
health and behavioral health collaborations. A community
response program under this subsection shall identify gaps in
community prevention, treatment, and recovery services for
individuals who encounter the criminal justice system and
shall establish treatment protocols to address identified
shortcomings. The Attorney General, through the Office of
Justice Programs, shall increase the amount provided as a
grant under this section for a pilot program by no more than
five percent for each of the two years following
certification by the Attorney General of the submission of
data by the rural area on the prescribing of schedules II,
III, and IV controlled substances to a prescription drug
monitoring program, or any other centralized database
administered by an authorized State agency, which includes
tracking the dispensation of such substances, and providing
for interoperability and data sharing with each other such
program (including an electronic health records system) in
each other State, and with any interstate entity that shares
information between such programs.
``(2) Rules of construction.--Nothing in this subsection
shall be construed to--
``(A) direct or encourage a State to use a specific
interstate data sharing program; or
``(B) limit or prohibit the discretion of a prescription
drug monitoring program for interoperability connections to
other programs (including electronic health records systems,
hospital systems, pharmacy dispensing systems, or health
information exchanges).''.
The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from
[[Page H8746]]
Texas (Ms. Jackson Lee) and the gentleman from Ohio (Mr. Jordan) each
will control 20 minutes.
The Chair recognizes the gentlewoman from Texas.
General Leave
Ms. JACKSON LEE. Mr. Speaker, I ask unanimous consent that all
Members may have 5 legislative days in which to revise and extend their
remarks and insert extraneous material on S. 2796.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from Texas?
There was no objection.
Ms. JACKSON LEE. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, let me acknowledge that this legislation is from Senator
Jon Ossoff. I know how important these issues are to him. At the very
beginning, I thank him for his leadership. We have worked together as
members of the Judiciary Committee, he in the Senate and myself in the
House. I applaud him and look forward to more work on this constructive
approach to drug use.
S. 2796, the Rural Opioid Abuse Prevention Act of 2022, is bipartisan
legislation that would establish a pilot program for rural communities
within the Comprehensive Opioid Abuse Grant Program.
The pilot program would make grants to rural areas to implement
community response programs in order to reduce opioid overdose deaths.
These community response programs would involve collaborations between
public safety, public health, and behavioral health systems. The
program will seek to identify gaps in current treatment availability
and establish treatment programs to reduce opioid overdoses in rural
areas.
Data from the Centers for Disease Control and Prevention's National
Center for Health Statistics indicates that in 2021 there were an
estimated 107,622 drug overdose deaths. The data also shows overdose
deaths, including opioids, increased from an estimated 70,029 in 2020
to 80,816 in 2021.
Mr. Speaker, what compounds this, as I proceed in my debate here
today, is that, just this morning, I read an article that says Texas
rural hospitals are closing by the dozens, impacted by the pandemic and
lack of personnel. We have an emerging, surging, if you will, synergism
of default: individuals who need care, can't get care, and hospitals in
rural communities that are closing.
With more than 200 Americans still dying of drug overdoses each day,
it is even more important that we pass this critical legislation to get
in the way, if you will.
In my hometown of Houston, overdose deaths have been exacerbated by
strained access to treatment caused by the COVID-19 pandemic. Opioid
overdose deaths have increased throughout the State of Texas, rising
from 4,154 deaths in 2020 to 4,831 deaths in 2021.
When we wanted to get the antidote to opioid, unfortunately, we
couldn't get State funding. Police officers and recovery entities, they
just couldn't get it because there was a philosophical disbelief that
that had anything to do with some of the dangerous drugs out there to
be able to help some of those who are in need.
S. 2796 would enable local communities and community organizations to
develop and expand initiatives targeting rural and low-resource
communities. Eligible applicants of the grant program would be required
to have a documented history of providing services in rural communities
or regions highly impacted by substance use disorder.
The programs supported by this legislation would be able to identify
gaps in treatment access for rural communities, leverage Federal
resources to expand treatment options, and ensure rural and remote
communities are not forgotten in our effort to address the ongoing
impact of opioid abuse disorder across the country. The point that
should be made is that rural communities are north, south, east, and
west.
Building on the successful Comprehensive Opioid Abuse Grant Program,
this bipartisan bill would expand it to include a pilot program
targeting rural communities.
Mr. Speaker, I thank Congressman Lamb and Senator Ossoff for
introducing this important legislation. I urge all of my colleagues to
support the bill, and I reserve the balance of my time.
Mr. JORDAN. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, this bipartisan legislation codifies into law an
existing Department of Justice pilot program known as the Rural
Responses to the Opioid Epidemic initiative, established during the
Trump administration.
In 2020, the Trump administration created the new initiative to
improve the opioid response and to reduce opioid overdose deaths in
America's high-risk rural communities. The initiative enables 21 rural
communities to receive existing Department of Justice funding to
develop responses in opioid prevention treatment and recovery services.
While this work is important, it is also critical that we not lose
sight of the dangerous drugs like fentanyl that are so easily
trafficked across our southern border.
The Biden border crisis is making America's drug crisis worse. We
have seen record numbers of drug seizures like fentanyl, encounters of
illegal aliens, and apprehensions of suspected terrorists at the
southern border.
For example, in fiscal year 2022, Customs and Border Protection
seized over 14,000 pounds of fentanyl at the border and up to 10,000
pounds in fiscal year 2021 and 4,500 pounds in fiscal year 2020.
Oh, by the way, these drugs are only what CBP officers catch. We do
not know the amount of dangerous drugs that have slipped through the
gaps due to President Biden's open border policies, but there is no
mistake that drug cartels and illegal aliens are taking advantage of
the crisis at our border.
Meanwhile, our drug crisis continues to spiral out of control. We
have seen the sad reality that overdose deaths in America reached an
all-time high last year. An estimated 107,000 Americans died from drug
overdoses in 2021, an increase of approximately 15 percent from the
previous year.
Overdose deaths involving both opioids and synthetic opioids like
fentanyl sharply increased in 2021 compared to the year before. These
dangerous drugs are killing Americans at record levels and destroying
families and communities across America. Communities in rural America
have been particularly hard-hit by the opioid crisis.
While passage of this legislation will continue the important work
started by President Trump's administration to help rural communities
combat this crisis, we must do more. We must also take actions to
address the Biden border crisis and stem the flow of illicit drugs
flowing into our country.
Mr. Speaker, I reserve the balance of my time.
Ms. JACKSON LEE. Mr. Speaker, I yield myself such time as I may
consume.
Let me, first of all, again acknowledge Senator Ossoff and
Congressman Lamb. This is an important piece of legislation, but my
good friend knows that I am going to have to add to this discussion by
saying that, again, the question of fentanyl, no one wants to see that
proliferated and causing the disastrous conditions that we have.
But listen to the story of Ms. Alfaro, who was 19 years old. She
lived in Appleton, Wisconsin, and ``was a recent high school graduate
raising a toddler and considering joining the Army when she and a
friend bought what they thought was the antianxiety drug Xanax in
December 2020.''
The pills were fake and contained fentanyl, an opioid that can be 50
times more powerful.
One of the things that we should understand is fentanyl is
everywhere, and it has been determined that most of the fentanyl that
comes across the border is brought over by U.S. citizens.
The other aspect that is very important that doesn't specifically
cover this bill, but at least this bill provides what the mother
indicated, she didn't know anything about these drugs. She wished she
could have helped her daughter. Yes, her daughter did lose her life.
The point this legislation is making is let's provide information to
these rural communities, but also let's understand some of the
techniques that some States and local communities were not providing
law enforcement or anyone else. Certainly, that is the fentanyl test
strips and Narcan. That
[[Page H8747]]
certainly was a problem and continues to be a problem in the State of
Texas.
We have to look at this holistically, and I think this legislation
focuses, certainly, on getting families information, particularly in
the rural areas. This was Appleton, Wisconsin. At least, minimally,
there would have been information about this, maybe in a broader way,
because the mother of the 19-year-old said, ``Two years ago, I knew
nothing about this.''
We have to do a better job of telling the facts about fentanyl that
we all want to see be extinguished from causing the loss of life.
I think this legislation for rural communities is a very good start,
but we need to make sure that our facts are accurate as we talk about
this deadly drug, which we want to get off the streets of this Nation.
We need to find ways that can be very effective, and we need to keep
working.
Mr. Speaker, I reserve the balance of my time.
Mr. JORDAN. Mr. Speaker, I yield such time as he may consume to the
gentleman from Iowa (Mr. Feenstra), my good friend.
Mr. FEENSTRA. Mr. Speaker, I rise today in support of this Rural
Opioid Abuse Prevention Act.
I am from rural America. I am from rural Iowa, and I have seen the
effects of opioids. It affects all ages. Those that are in high school
that get hurt, that have a knee go out or a shoulder, they get affected
by taking opioids.
This bipartisan legislation, which I introduced with my colleague,
Conor Lamb, will help prevent opioid abuse and overdoses in rural
America.
In 2021 alone, nearly 100,000 Americans died from some drug overdose.
This is unacceptable. This bill can do something about it.
My legislation will help the most vulnerable in rural America, in
rural communities, recover from addiction and provide our first
responders with the support they need to save lives.
There are too many barriers to rural healthcare right now, and we
need to ensure that our Federal programs can efficiently reach
communities in rural America that can make a difference when it comes
to opioid abuse, and that is exactly what this bill does.
I urge my colleagues to support this important program because too
many families have lost loved ones to the opioid epidemic, and they
have also been affected by a family member's addiction. That needs to
change.
Mr. Speaker, I ask my colleagues to support this bill.
Ms. JACKSON LEE. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I would like to offer a number of articles that speak to
the importance of this legislation. I thank the gentleman from Iowa for
his comments in support, and I know that the gentleman from Ohio will
likewise, hopefully, join us.
It is important to speak the obvious. U.S. overdose deaths in 2021
increased half as much as in 2020 but are still up. We know that we
need legislation specifically in communities in rural areas that would
close or identify the gaps in prevention, treatment, and recovery
services for individuals who interact with the criminal justice system
in rural areas and create new efforts to address the opioid crisis.
Mr. Speaker, I include in the Record an article from the Centers for
Disease Control's National Center for Health Statistics.
[From the Centers for Disease Control and Prevention, May 11, 2022]
U.S. Overdose Deaths in 2021 Increased Half as Much as in 2020--But Are
Still Up 15 Percent
Provisional data from CDC's National Center for Health
Statistics indicate there were an estimated 107,622 drug
overdose deaths in the United States during 2021, an increase
of nearly 15 percent from the 93,655 deaths estimated in
2020. The 2021 increase was half of what it was a year ago,
when overdose deaths rose 30 percent from 2019 to 2020.
The data is featured in an interactive web data
visualization. The 2021 data presented in this visualization
are provisional--they are incomplete and subject to change.
The new data show overdose deaths involving opioids
increased from an estimated 70,029 in 2020 to 80,816 in 2021.
Overdose deaths from synthetic opioids (primarily fentanyl),
psychostimulants such as methamphetamine, and cocaine also
continued to increase in 2021 compared to 2020.
The biggest percentage increase in overdose deaths in 2021
occurred in Alaska, where deaths were up 75.3 percent, while
overdose deaths in Wyoming did not increase at all in 2021
and deaths in Hawaii declined 1.8 percent from the same point
in 2020. The visualization includes:
Reported and predicted (estimated) provisional counts of
deaths due to drug overdose occurring nationally and in each
jurisdiction.
U.S. map of the percentage changes in provisional drug
overdose deaths for the 12-month period ending in December
2021 compared with the 12-month period ending in December
2020, by jurisdiction.
Reported and predicted provisional counts of drug overdose
deaths involving specific drugs or drug classes occurring
nationally and in selected jurisdictions.
NCHS releases both reported and predicted provisional drug
overdose death counts each month. They represent the numbers
of these deaths due to drug overdose occurring in the 12-
month periods ending in the month indicated. These counts
include all seasons of the year and are insensitive to
variations by seasonality. Deaths are reported by the
jurisdiction in which the death occurred.
Ms. JACKSON LEE. Mr. Speaker, I think it is important to emphasize
that, really, treatment works, and this is an example. ``Thomas Gooch
has spent more than 30 years struggling with illegal drugs. The 52-
year-old Nashville, Tennessee, native grew up in extreme poverty. He
was first incarcerated in 1988 and spent the next 15 years in and out
of jail for using and selling narcotics. `Until 2003,' Gooch says.
`That was the first time I went to treatment and the last time I
used.'''
This has to also be a component, which is the treatment of
individuals whose conditions put them in this way.
Mr. Speaker, I include in the Record ``The Opioid Epidemic Is Surging
Among Black People Because of Unequal Access to Treatment.''
[From Scientific American, Dec. 1, 2022]
The Opioid Epidemic Is Surging Among Black People Because of Unequal
Access to Treatment
(By Melba Newsome and Gioncarlo Valentine)
In one way or another, Thomas Gooch has spent more than 30
years struggling with illegal drugs. The 52-year-old
Nashville, Tenn., native grew up in extreme poverty. He was
first incarcerated in 1988 and spent the next 15 years in and
out of jail for using and selling narcotics. ``Until 2003,''
Gooch says. ``That was the first time I went to treatment and
the last time I used.'' Since then, for most of 19 years,
Gooch has been trying to get others into recovery or just
keep them alive. He handed out clean needles and injection-
drug equipment--which reduce injuries, infections and
overdose deaths--in Nashville's hardest-hit communities. In
2014 he founded My Father's House, a transitional recovery
facility for fathers struggling with substance use disorder.
But despite Gooch's long experience, the opioid epidemic
recently has brought a level of devastation to the Black
community that has shocked him. ``I had never seen death the
way I've seen death when it comes to opioid addiction,'' he
says. ``There's been so many funerals, it doesn't even make
sense. I personally know at least 50 to 60 individuals who
died from overdoses in the last 10 years.'' That staggering
body count includes Gooch's recently estranged wife in 2020
and a former partner in 2019.
A million people in the U.S. have died of opioid overdoses
since the 1990s. But the face--and race--of the opioid
epidemic has changed in the past decade. Originally white and
middle class, victims are now Black and brown people
struggling with long-term addictions and too few resources.
During 10 brutal years, opioid and stimulant deaths have
increased 575 percent among Black Americans. In 2019 the
overall drug overdose death rate among Black people exceeded
that of whites for the first time: 36.8 versus 31.6 per
100,000. And with the addition of fentanyl, the synthetic
opioid that's 50 to 100 times more powerful than morphine,
Black men older than 55 who survived for decades with a
heroin addiction are dying at rates four times greater than
people of other races in that age group.
The reasons for this dramatic change come down to racial
inequities. Research shows that Black people have a harder
time getting into treatment programs than white people do,
and Black people are less likely to be prescribed the gold
standard medications for substance use therapy. ``If you are
a Black person and have an opioid use disorder, you are
likely to receive treatment five years later than if you're a
white person,'' says Nora D. Volkow, director of the National
Institute on Drug Abuse at the National Institutes of Health.
``Treatments are extraordinarily useful in terms of
preventing overdose death so you can actually recover. Five
years can make the difference between being alive or not.''
Black people with substance use problems are afraid of being
caught up in a punitive criminal justice system and are less
likely to have insurance good enough to allow them to seek
help on their own. And the COVID pandemic disrupted many
recovery and harm-reduction services, particularly for people
of color.
Gooch blames straight-out racial discrimination in the
health-care system, too. ``When we call different places to
try to get people into treatment, the question they ask is
`What drug do they use?' '' he recounts with
[[Page H8748]]
exasperation. ``If you say `crack,' all of a sudden they
ain't got no bed available. If you say opioids and heroin,
they will find a bed because that's the demographic they
want. A couple of times I told patients that the only way
they're going to get help is to get drunk and turn themselves
into Vanderbilt Hospital because Vanderbilt will hold them
for five days, and that'll get them into treatment.''
Gooch is one of the people trying to improve access to
therapies for addiction and change the overall dysfunctional
dynamic. Other groups are bringing more effective addiction
treatments within prison walls, reducing the chances of
recidivism on release. A proposed federal law would make
therapy with the commonly used addiction medication methadone
less onerous for an impoverished population, as well as less
stigmatizing. And Volkow is using her platform at the NIH to
highlight the overwhelming research-based evidence for better
ways to understand and treat addiction.
ACCESS TO TREATMENT
The nation's historic reluctance to treat addiction as a
health-care issue rather than a criminal justice one has
resulted in a health-care system where too few people of any
race--just 10 percent--receive treatment for substance use
disorder. Several factors, such as stigma and an inability to
afford or access care, make the numbers considerably more
dismal among people of color. Even after a nonfatal overdose,
Black patients are half as likely to be referred to or access
treatment as non-Hispanic white patients, according to
federal government data.
A growing recognition that criminalization and
incarceration do little to curb illegal drug use or improve
public health or safety has led to harm-reduction policies
such as Good Samaritan laws--statutes that provide limited
immunity for low-level drug violations and increase
availability of naloxone, a drug that can reverse overdose.
But racial disparities have emerged in the application and
effectiveness of both measures. A study from RTI
International found that Black and Latino intravenous drug
users have inequitable access to the medication.
Loftin Wilson, program manager for the NC Harm Reduction
Coalition in Durham, N.C., who has worked in the field for
more than a decade, says the problems with inequality lead to
distrust in the system, which creates a vicious cycle in
which people who need help won't go to institutions that can
provide help. People entering treatment worry, with good
reason, that dealing with the social service system can cause
them to lose their employment, housing or even custody of
their children. ``That's another example of the negative
experiences people who use drugs have. They definitely don't
land equally on everybody, and people don't experience them
all the same way. It is a vastly different experience to be a
Black drug user seeking health care than for a white
person,'' Wilson says
University of Cincinnati psychologist Kathleen Burlew
notes, as Volkow does, that when Black patients enter
treatment, they are more likely to do so later than white
people and are less likely to complete it. In addition to
mistrust, she says, the less favorable outcomes result from
factors such as clinician bias and lack of racial and ethnic
diversity among treatment providers.
Federal resources, such as grants to support local opioid
use disorder clinics and programs, also tend to favor white
populations. According to 2021 data from the Substance Abuse
and Mental Health Services Administration, 77 percent of the
clients treated with grant funding were white, 12.9 percent
were Black and 2.8 percent were Native American. The
disparity is even more pronounced in some states. For
example, in 2019 North Carolina announced that white people
made up 88 percent of those served by its $54-million federal
grant, compared with 7.5 percent for Black people. Native
Americans accounted for less than 1 percent of those served.
MEDICATION INEQUALITY
Research has shown that there is a bias among health-care
providers against using medication-assisted treatment (MAT),
which combines FDA-approved drugs with counseling and
behavioral therapies. Substance use specialists consider it
the best approach to the opioid use problem. Yet a study
published in JAMA Network found that about 40 percent of the
368 U.S. residential drug programs surveyed did not offer
MAT, and 21 percent actively discouraged people from using
it. Many addiction treatment programs are faith-based and see
addiction as a moral problem, which leads to the conclusion
that relying on medication for abstinence or sobriety simply
trades one form of addiction for another. Many general
practitioners who lack training in addiction medicine have
this misconception.
The three medications approved by the FDA are
buprenorphine, methadone and naltrexone. Buprenorphine and
methadone are synthetic opioids that block brain opioid
receptors and reduce both cravings and withdrawal. Naltrexone
is a postdetox monthly injectable that blocks the effects of
opioids. Very few insurance providers in the U.S. cover all
three medications, and according to the Centers for Disease
Control and Prevention, the full range of medications is far
less available to Black people.
Research suggests that economics and race influence who
receives which medications. Buprenorphine, for instance, is
more widely available in counties with predominantly white
communities, whereas methadone clinics are usually located in
poor communities of color.
To use methadone, patients must make daily visits to a
clinic to receive and take the medication under the
supervision of a practitioner. This requirement makes it
difficult to do things that build a normal life, such as
attending school and obtaining and maintaining a job. There
is also the stigma of standing in a public line known to
everyone passing by as a queue for addiction treatment. ``The
treatment model was developed [during the Nixon
administration] based on racism and a stigmatized view of
people with addiction without any thought of privacy or
dignity or treating addiction like a health problem,'' says
Andrew Kolodny, medical director of the Opioid Policy
Research Collaborative at Brandeis University. The stigma is
made worse by methadone's classification as a Schedule II
controlled substance, which is defined as a substance with a
high potential for abuse, potentially leading to severe
psychological or physical dependence. This categorization
pushed the medication into a quasicriminalized status and the
clinics into minority communities.
Buprenorphine, however, is a completely different story.
When opioid use problems increased in white communities,
Congress acted to create less stigmatizing treatment options.
The Drug Addiction Treatment Act of 2000 (``DATA 2000'')
lifted an 86-year ban that prevented treating opioid
addiction with narcotic medications such as buprenorphine,
which today is sold under the brand names Subutex and
Suboxone. The majority of doctors who got special federal
licenses to prescribe it accept only commercial health
insurance and cash, so the drug is usually offered to a more
affluent population, which in the U.S. means white people.
About 95 percent of buprenorphine patients are white, and 34
percent have private insurance, according to a national study
of data through 2015.
John Woodyear is an addiction treatment specialist in Troy,
a small rural town in south central North Carolina where the
epidemic is exacting an increasingly heavy toll on the Black
and Native American populations. Overall overdose death rates
increased 40 percent from 2019 to 2020, but death rates among
those two groups in particular went up 66 and 93 percent,
respectively. Yet Woodyear, who is Black and practices in a
town that is 31 percent Black, says his patients are 90
percent white. People come to the clinic through word of
mouth or referrals from friends. As long as Woodyear's
patients are mostly white, new patients will be mostly white
as well, he says.
One exception to this racial pattern is Edwin Chapman's
clinic in the Northeast neighborhood of Washington, D.C., one
of the district's predominantly Black and most impoverished
communities. Chapman, a physician, often prescribes
buprenorphine to his patients with opioid use problems, and
the overwhelming majority of them are Black. He says that to
prescribe the drug, physicians like him must get past certain
roadblocks. ``The insurance companies in many states put more
restrictions on patients in an urban setting, such as
requiring prior authorization for addiction treatment,'' he
says. Further, ``to increase the dose above 16 or 24
milligrams, you may have to get a prior authorization. The
dosing standards were based on the white population and
people who were addicted to pills. Our surviving Black
population often needs a higher dose of buprenorphine.''
Chapman says few physicians in private practice are willing
to treat these patients. ``They don't really feel comfortable
having these patients in their office, or they aren't really
prepared to deal with the economic and mental health issues
that come with this population,'' he explains; those
disorders include bipolar disorder and schizophrenia, among
others.
People have their own biases that keep them away from
medication such as buprenorphine, Wilson says. Many view it
as simply trading one drug for another. ``They think, `If I'm
going to take this step, why not just go to detox and not
take any medications at all' '' he says. ``There's a big
cultural misunderstanding about the fact that [these]
medications are the only evidence-based treatment for (opioid
use disorder. Short-term detox isn't the most appropriate
intervention for most people.''
Gooch agrees that the bias is real. He facilitates recovery
groups at a program operated by a group from Meharry Medical
College, a historically Black institution. Yet ``I haven't
seen one Black person yet,'' Gooch says. ``Some think it's a
setup. There's so much distrust, they have a hard time
thinking it's legal. It's just the culture of Black people.
Many are religious and think [taking the drug] is wrong.''
``Those [misconceptions] are holdovers from our having been
miseducated from the outset,'' Chapman says. ``Whites have
done a tremendous job educating their community that this is
a medical problem, a disease. In the African American
community, drug addiction has always been and continues to be
seen as a moral problem, and incarceration was the
treatment.''
HOPE FOR CHANGE
In the November 2021 issue of Neuropsychopharmacology,
Volkow argued that it is long past time for a new approach to
drug addiction that would address these misconceptions within
the most affected populations
[[Page H8749]]
and biases among providers. ``We have known for decades that
addiction is a medical condition--a treatable brain
disorder--not a character flaw or a form of social
deviance,'' she wrote.
Volkow argues that treatment reform should start with
prison and the criminal justice system. Even though there is
no difference along racial lines in who uses illegal drugs,
Black people nonetheless were arrested for drug offenses at
five times the rate of white people in 2016. The racial
disproportionality in incarcerated drug offenders does not
reflect higher rates of drug law violations, only higher
rates of arrest among racial and ethnic minorities. Currently
the number of arrests for heroin (which more Black people
use) exceeds the arrests for diverted prescription opioids
(which more white people use), even though the latter is more
prevalent.
These unequal arrests and incarcerations add to the racial
inequalities in drug treatment and survival rates. An
estimated two thirds of people in U.S. correctional settings
have a diagnosable substance use disorder, and approximately
95 percent will relapse after their release. In the two weeks
postrelease, the risk of overdose increases more than 100-
fold, and the chances of death increase 12-fold.
Paradoxically, that makes prisons and jails--institutions
with the most obvious and overt racial disparities--the
places with the greatest potential to bring about effective
change. Volkow points to a recent NIH study as proof that
starting substance disorder treatment during incarceration
lowers the risk of probation violations and reincarcerations
and improves the chances of recovery. But only one in 13
prisoners with substance use problems receives treatment,
according to a Pew data analysis.
Some local programs have started to tackle some of these
issues. In Pittsburgh, the Allegheny Health Network's RIvER
(Rethinking Incarceration and Empowering Recovery) Clinic
opened in May 2021. Its goal is to reduce recidivism among
people with addictions by providing care for the formerly
incarcerated immediately on their release from jail,
regardless of their ability to pay. Since opening, the
clinic's caregivers have engaged with hundreds of people.
New York City recently became the first municipality in the
country to sanction overdose prevention centers where people
with substance use disorder can use drugs under medical
supervision. Two sites, one in East Harlem and the other in
Washington Heights, opened in December 2021. They have had
more than 10,000 visits and prevented nearly 200 overdoses by
administering the medication naloxone.
There are other signs of change, too. California signed a
law that requires every treatment provider in the state to
provide a ``client bill of rights'' to notify patients of all
aspects of recommended treatment, including no treatment at
all, treatment risks and expected results. And federal
authorities loosened methadone regulations during the
pandemic. Instead of daily in-person visits, more patients
were allowed to use telehealth consultations and take doses
home. Senators Ed Markey of Massachusetts and Rand Paul of
Kentucky have introduced a bill that would make that change
permanent. Among other programs and initiatives across the
country, these are an indication that drug treatment policy
may be headed in a more equitable, evidence-based direction.
Ms. JACKSON LEE. Mr. Speaker, I also include in the Record the
article regarding the tragic young lady who died in Appleton,
Wisconsin, and even now give sympathy to that family and make sure that
we have the basic facts.
``Advocates warn that some of the alarms being sounded by politicians
and officials are wrong and potentially dangerous. Among those ideas:
that tightening control of the U.S.-Mexico border would stop the flow
of the drugs, though experts say the key to reining in the crisis is
reducing drug demand.''
She was looking for Xanax. Someone made phony Xanax, and then
fentanyl was in it. That is just heartbreaking. It is tragic. We have
to know where to spend our resources.
Mr. Speaker, I include in the Record this article: ``Myths about
fentanyl persist as opioid continues to cause overdose deaths.''
[From the PBS News Hour, Oct. 28, 2022]
Myths About Fentanyl Persist as Opioid Continues To Cause Overdose
Deaths
Lillianna Alfaro was a recent high school graduate raising
a toddler and considering joining the Army when she and a
friend bought what they thought was the anti-anxiety drug
Xanax in December 2020.
The pills were fake and contained fentanyl, an opioid that
can be 50 times as powerful as the same amount of heroin. It
killed them both.
``Two years ago, I knew nothing about this,'' said Holly
Groelle, the mother of 19-year-old Alfaro, who lived in
Appleton, Wisconsin. ``I felt bad because it was something I
could not have warned her about because I didn't know.''
The drug that killed her daughter was rare a decade ago,
but fentanyl and other lab-produced synthetic opioids now are
driving an overdose crisis deadlier than any the U.S. has
ever seen. Last year, overdoses from all drugs claimed more
than 100,000 lives for the first time, and the deaths this
year have remained at nearly the same level--more than gun
and auto deaths combined.
The federal government counted more accidental overdose
deaths in 2021 alone than it did in the 20-year period from
1979 through 1998. Overdoses in recent years have been many
times more frequent than they were during the black tar
heroin epidemic that led President Richard Nixon to launch
his War on Drugs or during the cocaine crisis in the 1980s.
As fentanyl gains attention, mistaken beliefs persist about
the drug, how it is trafficked and why so many people are
dying.
Experts believe deaths surged not only because the drugs
are so powerful, but also because fentanyl is laced into so
many other illicit drugs, and not because of changes in how
many people are using. In the late 2010s--the most recent
period for which federal data is available--deaths were
skyrocketing even as the number of people using opioids was
dropping.
Advocates warn that some of the alarms being sounded by
politicians and officials are wrong and potentially
dangerous. Among those ideas: that tightening control of the
U.S.-Mexico border would stop the flow of the drugs, though
experts say the key to reining in the crisis is reducing drug
demand; that fentanyl might turn up in kids' trick-or-treat
baskets this Halloween; and that merely touching the drug
briefly can be fatal--something that researchers found untrue
and that advocates worry can make first responders hesitate
about giving lifesaving treatment.
All three ideas were brought up this month in an online
video billed as a pre-Halloween public service announcement
from a dozen Republican U.S. senators.
A report this year from a bipartisan federal commission
found that fentanyl and similar drugs are being made mostly
in labs in Mexico from chemicals shipped primarily from
China.
In New England, fentanyl has largely replaced the supply of
heroin. Across the country, it's being laced into drugs such
as cocaine and methamphetamine, sometimes with deadly
results. And in cases like Alfaro's, it's being mixed in
Mexico or the U.S. with other substances and pressed into
pills meant to look like other drugs.
The U.S. Drug Enforcement Agency has warned that fentanyl
is being sold in multicolored pills and powders--sometimes
referred to as ``rainbow fentanyl''--marketed on social media
to teens and young adults.
Jon DeLena, the agency's associate special agent in charge,
said at the National Crime Prevention Council summit on
fentanyl in Washington this month that there's ``no direct
information that Halloween is specifically being targeted or
young people are being targeted for Halloween,'' but that
hasn't kept that idea from spreading.
Joel Best, an emeritus sociology professor at the
University of Delaware, said that idea falls in with a long
line of Halloween-related scares. He has examined cases since
1958 and has not found a single instance of a child dying
because of something foreign put into Halloween candy--and
few instances of that being done at all.
``If you give a dose of fentanyl to kids in elementary
school, you have an excellent chance of killing them,'' he
said. ``If you do addict them, what are you going to do, try
to take their lunch money? No one is trying to addict little
kids to fentanyl.''
In midterm election campaigns, fentanyl is not getting as
much attention as issues such as inflation and abortion. But
Republicans running for offices including governor and U.S.
Senate in Arkansas, New Mexico and Pennsylvania have framed
the fentanyl crisis as a result of Democrats being lax about
securing the Mexican border or soft on crime as part of a
broader campaign assertion that Democrats foster lawlessness.
And when Democrats highlight the overdose crisis in
campaigns this year, it has often been to tout their roles in
forging settlements to hold drugmakers and distributors
responsible.
Relying heavily on catching fentanyl at the border would be
futile, experts say, because it's easy to move in small,
hard-to-detect quantities.
``I don't think that reducing the supply is going to be the
answer because it's so easy to mail,'' said Adam Wandt, an
assistant professor at John Jay College of Criminal Justice.
Still, some more efforts are planned on the U.S.-Mexico
border, including increasing funding to search more vehicles
crossing ports of entry. The bipartisan commission found
those crossings are where most fentanyl arrives in the
country.
The commission is calling for many of the measures that
other advocates want to see, including better coordination of
the federal response, targeted enforcement, and measures to
prevent overdoses for those who use drugs.
The federal government has been funding efforts along those
lines. It also publicizes big fentanyl seizures by law
enforcement, though it's believed that even the largest busts
make small dents in the national drug supply.
The commission stopped short of calling for increased
penalties for selling fentanyl. Bryce Pardo, associate
director of the RAND Drug Policy Research Center and a
commission staff member, said such a measure would not likely
deter the drug trade. But, he said, dealers who sell the
products most likely to cause death--such as mixing
[[Page H8750]]
fentanyl into cocaine or pressing it into fake Xanax could be
targeted effectively.
One California father who lost his 20-year-old daughter is
pushing for prosecutors to file murder charges against those
who supply fatal doses. Matt Capelouto's daughter Alexandra
died from half a pill she bought from a dealer she found on
social media in 2019, while home in Temecula, California,
during a college break. She was told the pill was oxycodone,
Capelouto said, but it contained fentanyl.
The dealer was charged with distributing fentanyl resulting
in death, but he reached a plea deal on a lesser drug charge
and will face up to 20 years in prison.
``It's not that arresting and convicting and putting these
guys behind bars doesn't work,'' Capelouto said. ``The fact
is we don't do it enough to make a difference.''
While some people killed by fentanyl have no idea they're
taking it, others, particularly those with opioid use
disorder, know it is or could be in the mix. But they may not
know how much is in their drugs.
That was the case for Susan Ousterman's son Tyler Cordiero,
who died at 24 in 2020 from a mixture that included fentanyl
after years of using heroin and other opioids.
For nearly two years, Ousterman avoided going by the gas
station near their home in Bensalem, Pennsylvania, where her
son fatally overdosed. But in August, she went to leave two
things there: naloxone, a drug used to reverse overdoses, and
a poster advertising a hotline for people using drugs to call
so the operator could call for help if they become
unresponsive.
Ousterman is funneling her anger and sorrow into preventing
other overdoses.
``Fentanyl is everywhere,'' she said. ``You don't know
what's in an unregulated drug supply. You don't know what
you're taking. You're always taking the chance of dying every
time.''
Ms. JACKSON LEE. Mr. Speaker, I reserve the balance of my time.
{time} 1545
Mr. JORDAN. Mr. Speaker, I thank Mr. Feenstra for his work on the
legislation. We support the litigation, and I yield back the balance of
my time.
Ms. JACKSON LEE. Mr. Speaker, I yield myself the balance of my time.
I thank the gentleman from Ohio for his work on this bill and
indicate that we are pleased to, likewise, support and thank
Congressman Lamb and the gentleman from Georgia, Senator Ossoff, for
introducing this legislation.
I urge all of my colleagues to support this bill, as well, and to
ensure that we provide really deep collaboration in our rural
communities to help people who don't have access either to this kind of
treatment, knowledge or prevention, and then, as I indicated, to
medical care because hospitals are closing.
This is an important legislative initiative. I am hoping that we will
support the Rural Opioid Abuse Prevention Act because it is bipartisan
legislation. It is time for our Nation to face the increased overall
overdoses and deaths in everyday communities large and small.
With more than 200 Americans dying of drug overdoses each day,
Congress must act to support small and rural communities in addressing
this crisis.
Mr. Speaker, S. 2796, the ``Rural Opioid Abuse Prevention Act of
2022,'' is bipartisan legislation that would establish a pilot program
for rural communities within the Comprehensive Opioid Abuse Grant
Program.
The pilot program would make grants to rural areas to implement
community response programs in order to reduce opioid overdose deaths.
These community response programs would involve collaborations between
public safety, public health, and behavioral health systems. The pilot
programs would seek to identify gaps in current treatment availability
and establish treatment programs to reduce opioid overdoses in rural
areas.
Data from the Center for Disease Control and Prevention's National
Center for Health Statistics indicates that in 2021 there were an
estimated 107,622 drug overdose deaths. The data also shows overdose
deaths involving opioids increased from an estimated 70,029 in 2020 to
80,816 in 2021.
With more than 200 Americans still dying of drug overdoses each day,
it is even more important that we pass this critical legislation. In my
hometown of Houston, overdose deaths have been exacerbated by strained
access to treatment caused by the COVID-19 pandemic. Opioid overdose
deaths have increased throughout the state of Texas, rising from 4,154
deaths in 2020 to 4,831 deaths in 2021.
S. 2796 would enable local governments and community organizations to
develop and expand initiatives targeting rural and low resourced
communities. Eligible applicants of the grant program would be required
to have a documented history of providing services to rural communities
or regions highly impacted by substance use disorder. The programs
supported by this legislation would be able to identify gaps in
treatment access for rural communities, leverage federal resources to
expand treatment options, and ensure rural and remote communities are
not forgotten in our efforts to address the ongoing impact of opioid
abuse disorder across the country.
Building on the successful Comprehensive Opioid Abuse Grant Program,
this bipartisan bill would expand it to include a pilot program
targeting rural communities.
I want to thank Congressman Lamb and Senator Ossoff for introducing
this important legislation. I urge all of my colleagues to support the
bill.
Mr. Speaker, I urge my colleagues to support this bill, and I yield
back the balance of my time.
The SPEAKER pro tempore. The question is on the motion offered by the
gentlewoman from Texas (Ms. Jackson Lee) that the House suspend the
rules and pass the bill, S. 2796.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds
being in the affirmative, the ayes have it.
Mr. ROSENDALE. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this motion will be postponed.
____________________