[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.

                          ____________________