[Congressional Record (Bound Edition), Volume 152 (2006), Part 18]
[Senate]
[Pages 23604-23607]
[From the U.S. Government Publishing Office, www.gpo.gov]




   OFFICE OF NATIONAL DRUG CONTROL POLICY REAUTHORIZATION ACT OF 2006

 Mr. HATCH. I rise today to congratulate my Senate colleagues 
on the passage of a tremendously important piece of legislation, the 
Office of National Drug Control Policy Reauthorization Act of 2006, 
H.R. 6344. This act contains numerous provisions whose implementations 
are vital, and would provide specific goals and measurement standards 
to evaluate the effectiveness of our national drug control policy.
  I want to highlight a specific provision of this bill that, when 
enacted, will benefit thousands of Americans who are struggling with 
addiction to drugs. As our country seeks to develop better treatments 
for drug abuse, countless Americans continue to fall prey to illicit 
drugs. As their lives are torn apart by these addictions, many find the 
strength to call out to doctors for help. Unfortunately, some of these 
calls for help go unanswered due to limitations placed on physicians 
with regard to their treatment options.
  In 2000, I worked with Senators Levin and Biden to pass the Drug 
Addiction and Treatment Act. This groundbreaking legislation allowed 
certified physicians to prescribe appropriate medication to patients 
suffering from drug addiction. Under this law, physicians are 
prescribing the drug buprenorphine to patients fighting their addiction 
to heroin and other opiates. The results have been tremendous, and 
countless lives have been saved by breaking the addiction cycle.
  However, current law caps the number of patients a qualified 
physician can treat with this medication at 30. Unfortunately, many 
doctors are at their cap and are forced to turn patients away due to 
this artificial limitation.
  I have spoken with numerous doctors who have relayed amazing stories 
of patients turning their lives around by using this medication and 
participating in treatment. These patients have gone on to return to 
the workforce and continue their lives as productive citizens, free of 
the scourge of drug abuse.
  This bipartisan provision included in this bill would expand the 
number of patients whom qualified doctors are allowed to treat. Passage 
of this legislation will provide immediate assistance to countless 
Americans who are fighting for their lives.
  It is clear this cap needs to be raised. To make an analogy, a doctor 
would not turn away a broken arm because he or she had already fixed 30 
arms that month! The doctor would not stand for it, and neither would 
society. The same should be true for physicians treating drug 
addiction. Given that the destructive effects of drug addiction are so 
much greater than a broken arm, we should strive to ensure that the 
healing hands of doctors are not bound by unintended mandates. Doctors 
should be allowed and encouraged to help as many as possible, and this 
legislation allows them to treat many drug addicts that are otherwise 
being turned away. This provision will immediately help countless 
Americans get the treatment they seek and so desperately need.
  I highlight this provision as a sample of the meaningful substance in 
this measure, and I applaud the efforts of lawmakers in both Chambers 
of Congress whose tireless efforts produced this bill.
  Mr. LEAHY. Mr. President, I support reauthorization ONDCP and passage 
of

[[Page 23605]]

the Office of National Drug Control Policy Reauthorization Act of 2006. 
This bill recognizes and strengthens the Office of National Drug 
Control Policy as the lead agency in the fight against illegal drug 
use. It also includes important modifications and clarifications that 
will improve the lives of all Americans by reducing the presence of 
drugs in our society. I am very pleased that five of my recommendations 
to improve the bill are included in this legislation.
  I commend Senator Biden, who has long been a leader in the fight 
against illegal drugs, and Chairman Specter, the lead sponsor of this 
legislation. The authorization for ONDCP expired 3 years ago, and it is 
long passed time for Congress to act. Illegal drug abuse, drug 
addiction, and drug-related violence continue to exact an enormous toll 
on our society. Nationwide, drug abuse kills 52,000 Americans each 
year, and more than 20,000 Americans will die as a direct consequence 
of illegal drug use this year alone. Drug abuse costs our society 
nearly $116 billion annually. It has strained the capacity of our 
criminal justice system and our medical facilities and brought violence 
and tragedy to families, schools, and communities throughout the 
country.
  This bipartisan legislation will reauthorize ONDCP for 5 years and 
provide ONDCP with the necessary tools and resources to develop a 
national drug control policy and coordinate and oversee the 
implementation of that policy.
  This legislation includes a number of reforms that provide 
clarification concerning the most significant objectives and duties of 
ONDCP. It allows Congress to be vigilant in our oversight by requiring 
the President to submit to Congress a yearly national drug control 
strategy, expanding ONDCP's reporting requirements to Congress on 
numerous areas of ONDCP responsibility; requiring ONDCP to give a full 
accounting of the budget; and requiring ONDCP to develop a new 
performance measurement system that includes 2-year and 5-year targets 
for each of the strategy's objectives.
  In addition, this legislation improves essential information sharing 
by requiring that various Government agencies, including the Attorney 
General, the Department of Homeland Security, and the Departments of 
Agriculture and Defense, submit to ONDCP and Congress reports relating 
to their agencies' drug control efforts.
  I want to take a moment and address several specific provisions. 
First, as a strong supporter of the National Guard, I am pleased that 
this legislation authorizes $30 million a year for the Chief of the 
National Guard to establish five National Guard Counterdrug Schools to 
train personnel from Federal agencies, State, and local law enforcement 
agencies, community- based organizations, and other groups in drug 
interdiction and demand reduction activities.
  I am pleased that this legislation will require greater diligence on 
methamphetamine. The bill calls for the creation of a National 
Methamphetamine Information Clearinghouse, an idea which I have long 
supported, including cosponsoring legislation to set up the 
clearinghouse. This toll-free number and Web-based source of 
information will promote sharing of ``best practices'' regarding law 
enforcement, prevention, treatment, environmental, social services, and 
other programs related to combating the scourge of methamphetamine.
  I am pleased that this legislation embraces a comprehensive policy 
that reduces the demand, as well as supply, of drugs. It reduces the 
demand for drugs by ensuring that programs to expand access to drug 
treatment are adequately supported in the Federal drug control budget 
and by providing greater uniformity and accountability in assessing 
ONDCP's effectiveness in drug treatment programs. On the supply side, 
the bill takes steps to disrupt markets at home and abroad. It requires 
ONDCP to develop comprehensive strategies to address the severe threats 
posed by South American heroine and drug smuggling across the southwest 
border.
  This legislation also includes a good provision by Senators Levin and 
Hatch that amends the Controlled Substances Act to raise the number of 
opioid addicted patients a physician may accept from 30 to 100. In the 
last 5 years, the number of heroin-related arrests and the number of 
people seeking treatment for heroin use in Vermont has more than 
doubled. This provision will expand treatment options for thousands of 
patients who have been denied access to critical addiction treatments 
in Vermont and across the country.
  I am also pleased that the bill includes several of my recommended 
improvements. I continue to support the National Youth Anti-Drug Media 
Campaign, but I want to make sure that the campaign is run in a way 
that uses funds efficiently and gets out its antidrug message 
effectively. I therefore recommended inclusion of comprehensive 
standards for evaluating what type of media campaigns and information 
are effective, as well as a prohibition on the expenditure of antidrug 
media campaign funds for political purposes.
  The campaign will be better for these changes, as well as the 
legislation's additional step of creating an independent agency to 
conduct annual evaluations of effectiveness. The bill also adopted my 
recommendation to eliminate two unnecessary provisions which could also 
hinder international diplomacy and drug control efforts.
  I continue to have concerns about the safety and predictability of 
mycoherbicides against drug crops. While this bill only calls for a 
scientific study on the use of mycoherbicides, I am pleased that the 
bill includes my recommendation to prohibit testing in any foreign 
countries. I believe this provision will prevent souring diplomatic 
relations between the United States and countries around the world.
  I am disappointed that my recommendations to remedy a few weaknesses 
in the bill were not adopted. Among other issues, I am concerned by 
provisions that prohibit the expenditure of more than 5 percent of the 
Federal funds appropriated for High Intensity Drug Trafficking Area 
Programs for drug prevention programs and that prohibit the use of any 
Federal HIDTA funds to establish new or expand existing drug treatment 
programs. The State, local, and Federal law enforcement officials in 
the HIDTA Program should have the discretion to use the programs that 
work best in their areas.
  I am also troubled that the Bush administration and the Republican 
Congress have not sufficiently addressed the international drug trade, 
particularly the rising instability in opium production in Afghanistan. 
Three months ago, the United Nations released a report concluding that 
opium cultivation is surging in the southern region of Afghanistan and 
warned that the southern region was verging on collapse. Just this past 
weekend, the Washington Post also reported that opium production in 
Afghanistan reached a historic high in 2006, despite ongoing 
eradication efforts. These reports are particularly troubling 
considering that this administration has increasingly described the 
drug trade as a problem that rivals the Taliban and threatens to derail 
the stability and reconstruction of Afghanistan.
  While I applaud this bill's inclusion of a provision that requires 
the ONDCP to submit to Congress a comprehensive strategy that addresses 
the increased threat from Afghan heroin, I fear that this provision may 
not go far enough. Afghanistan provides more than 90 percent of the 
world's heroin. Without seeking accountability from the President, the 
State Department, and the Attorney General on the rise of Afghan 
heroin, we cannot sufficiently discharge our duty to address the 
international supply of heroin.
  Nevertheless, I am confident that this legislation will strengthen 
ONDCP, its component programs, and our national comprehensive antidrug 
effort. This legislation balances the goals of drug enforcement and 
prevention, while providing Congress with additional oversight tools. I 
support its passage.
  Mr. LEVIN. Mr. President, according to the Office of National Drug 
Control Policy, approximately 1 million people in the United States are 
addicted to heroin; more than 3 million individuals

[[Page 23606]]

over the age of 12 have used heroin at least once; and an estimated 4.7 
million people are dependent on or abusing other opiate drugs, 
including prescription painkillers according to a 2005 survey of the 
Substance Abuse and Mental Health Services Administration.
  The Drug Addiction Treatment Act of 2000, DATA, which I authored 
along with Senators Hatch and Biden, makes a dramatic change in the way 
America fights heroin addiction. DATA permits, for the first time, FDA 
approved drug treatment medications to be prescribed and dispensed in 
an office-based setting under strict conditions by specially trained 
physicians. The medication in question is called buprenorphine--bup. It 
blocks the craving for heroin. This new law essentially brings the 
treatment of opiate dependence into the mainstream of medicine. It 
allows both primary care and addiction specialists to treat patients 
who want to get rid of their addiction, but are unable to because of 
distance or their unwillingness to seek medical treatment at 
centralized methadone clinics, where their appearance amounts to an 
announcement of their addiction.
  This new law has brought tens of thousands of patients into 
treatment, who would never have sought treatment in methadone programs. 
Now in its fourth year, DATA has proved highly beneficial. The success 
of DATA in extending treatment has resulted in waiting lists for 
treatment with physicians who have signed up to treat addicts. Those 
physicians are currently limited to 30 patients.
  The great success of buprenorphine has been borne out by firsthand 
accounts by physicians and addiction experts from across the country, 
as well as the director of the National Institute on Drug Abuse, Dr. 
Nora Volkow and the director of the Center for Substance Abuse 
Treatment, Dr. H. Westley Clark, who participated in an August 3, 2006 
Senate Symposium on DATA, which I sponsored along with Senator Orrin 
Hatch.
  The legislation before us, S. 2560, which reauthorizes the Office of 
National Drug Control Policy, includes an important amendment to DATA 
that will more than triple the number of patients specially trained 
physicians may treat in their private offices. The across-the-board 30-
patient limitation has resulted in denials of treatment and even deaths 
of patients who were not able to enter treatment because a physician 
had reached the 30-patient limit. For many such persons, their hope of 
treatment is dashed while they wait on a physician's waiting list.
  In an effort to remedy this, the Senate Judiciary Committee's 
modification of DATA in section 1102 of S. 2560 addresses this problem 
by permitting physicians who have been certified to utilize 
buprenorphine in their office-based practice for at least one year, to 
notify the HHS Secretary of their intention to begin treating 
additional patients, in accordance with section 1102.
  The bill with our amendment raises the number of patients who may be 
treated by an individual physician from 30 patients to 100 patients. 
This change--increasing the patient limit from 30 to 100 per 
physician--is supported by the medical community at large as well as 
the addiction speciality associations, including: The American Medical 
Association, the American Osteopathic Association, The American 
Psychiatric Association, The American Psychological Association, The 
American Academy of Addiction Medicine, The American Society of 
Addiction Medicine, The Association of American Medical Colleges, and 
several large health providers such as Kaiser Permanente.
  In addition to establishing a process through which trained 
physicians can dispense or prescribe buprenorphine, the Drug Addiction 
Treatment Act of 2000 required the Secretary of HHS to evaluate the 
impact of office-based buprenorphine treatment. In compliance with this 
requirement, the Secretary directed the Substance Abuse and Mental 
Health Services Administration--SAMHSA--to conduct a survey to 
determine (1) the availability of the office-based treatment, (2) the 
effectiveness of the office-based treatment, and (3) the potential 
adverse public health consequences.
  The preliminary findings of the HHS evaluation were presented and 
discussed during the August 3 Senate Symposium which I have previously 
mentioned. The HHS-SAMHSA evaluation showed that buprenorphine 
treatment is clinically effective and well-accepted by patients; the 
program has increased the availability of medication-assisted 
treatment; adverse effects have been minimal; and that the 30-patient 
limit established in DATA, as well as cost reimbursement issues 
decrease potential access to treatment under the program. The 
experiences articulated by the health care professionals who 
participated in the August 3rd Senate Symposium are reflective of the 
findings of the HHS-SAMHSA evaluation, which were presented by CSAT 
Director Dr. Westley Clark and that were echoed by NIDA Director Dr. 
Nora Volkow, based on her own expertise and observation of 
buprenorphine office-based treatment.
  It is tragic if the personal and community benefits of this new anti-
addiction medication, combined with treatment in the private office of 
certified physicians are limited because of artificial limits on its 
use. The legislation before us brings us close to full utilization. I 
am pleased that the Senate has adopted this life-changing, lifesaving 
legislation as part of the ONDCP reauthorization bill, as well as the 
free standing bill, S. 4115, which I introduced along with Senators 
Hatch, Biden and Collins.
  In closing, I would like to share with my colleagues in the Senate 
the names of the distinguished physicians, addiction experts and agency 
officials who participated in the August 3, 2006, Symposium and Press 
Conference Senator Hatch and I hosted on the success of the Drug 
Addiction Treatment Act of 2000, and the subsequent FDA approval of 
buprenorphine for the treatment of heroin addiction in 2002. Of 
particular note are Dr. Charles Schuster of Wayne State University, a 
past Director of NIDA who has conducted clinical trials with 
buprenorphine and who has been a great resource and guide on this issue 
from the very beginning and his advice and expertise continues today; 
and Dr. Herbert Kleeber, Professor of Psychiatry at Columbia University 
and one of the Nation's foremost experts on drug addiction and 
treatment, who provided invaluable assistance to me and to Senators 
Hatch and Biden in putting together this new system of office-based 
treatment utilizing buprenorphine. Dr. Nora Volkow's expertise and 
tutoring have led us all to a better understanding of the science of 
addiction. Dr. Volkow is the Director of the National Institute on Drug 
Abuse--NIDA--where buprenorphine was developed under a Cooperative 
Research and Development Agreement between NIDA and a private 
pharmaceutical company; Dr. H. Westley Clark, Director of the Center 
for Substance Abuse Treatment under the Substance Abuse and Mental 
Health Services Administration. Dr. Clark has contributed great 
understanding of buprenorphine's therapeutic effects in the treatment 
of heroin abuse and dependence, and in understanding that drug 
addiction is a public health problem.
  Mr. President, I ask unanimous consent that the following brief 
remarks of two participants who experienced treatment with 
buprenorphine, Ms. Tess Walker and Mr. Odis Rivers, and the list of the 
August 3, 2006 DATA Symposium and Press Conference participants, be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                               Symposium

         Convened by Senator Orrin Hatch and Senator Carl Levin


                               Presenters

       Dr. Nora Volkow--Director, National Institute on Drug 
     Abuse.
       H. Westley Clark, M.D., J.D., MPH--Director, Center for 
     Substance Abuse Treatment/Substance Abuse and Mental Health 
     Services Administration.
       Charles R. Schuster, Ph.D.--Distinguished Professor of 
     Psychiatry and Behavioral Neuroscience, Wayne State 
     University School of Medicine.
       Jim Finch, M.D.--Family Practice physician from Durham, 
     North Carolina.
       Thomas Kosten, M.D.--Baylor College of Medicine, Department 
     of Psychiatry.

[[Page 23607]]

       Dr. Herbert Kleeber--American Psychiatric Association's 
     Council on Addiction Psychiatry, Professor of Psychiatry and 
     Director, Division of Substance Abuse, Columbia University.
       Elinore McCance-Katz, M.D., Ph.D.--Professor of Psychiatry 
     and Medical Director, Virginia Health Practitioners' 
     Intervention Program, Virginia Commonwealth University.
       David Fiellin, M.D., ASAM--Yale University School of 
     Medicine, Medical Director, SAMHSA/CSAT Physician Clinical 
     Support System.
       Michael Shore, M.D., F.A.P.A.--Psychiatry and Addiction 
     Medicine, Cherry Hill, New Jersey.
       Charles O'Brien, M.D., Ph.D.--University of Pennsylvania/VA 
     Medical Center, Psychiatry.
       Terry Horton, M.D.--Phoenix House Treatment Program, 
     Medical Director Phoenix House Foundation.
       Karen Sees, DO--Fellow, American Osteopathic Academy of 
     Addiction Medicine, Co-director, first AOAAM sponsored 
     training-of-the-trainers for Office Based Opioid Treatment 
     trainers.
       Margaret Kotz, DO--Case Western University, Addiction 
     Psychiatry.
       Michael Brooks, DO--President of the AOAAM and Director of 
     Psychiatric Services, Brighton Hospital, Brighton, Michigan.
       Tess Walker--College Student, Recovering from heroin 
     addiction.
       Odis Rivers--Korean Veteran, In Recovery.
                                  ____



                    Mr. Odis Rivers, Korean Veteran

       Dr. Schuster: I would next like to introduce Mr. Odis 
     Rivers. A while back at Wayne State University we were doing 
     a trial of buprenorphine as a treatment medication for opiate 
     addiction, and Mr. Rivers was one of the volunteer 
     participants in that study.
       He was successful in terms of stopping using drugs when he 
     was on buprenorphine, and we were able to extend the period 
     of time that he was on buprenorphine, and subsequently taper 
     him off of it, and I'm proud to say that he still comes past 
     my office regularly and he is still totally drug free. And 
     he's going to briefly tell you about his life.
       Mr. Rivers: Hi, how is everybody? You know, I'm going to 
     get straight to the point. I am proud to be up here to talk 
     about buprenorphine, because it has really made a change in 
     my life. You know, being an addict is a terrible, terrible 
     situation, but being clean from buprenorphine, it just 
     changed my life like night and day. I can get along with 
     people I couldn't get along with before, and it's just a 
     miracle.
       Like my sister, I had one sister, she's a Sheriff, I have 
     another sister, she's a doctor in California, and due to my 
     addiction, I could hardly get along with either one of them. 
     But since my experience with buprenorphine I get along just 
     fine with both of them, and all of my friends and everything, 
     you know, as a matter of fact, I have a lot of new friends 
     because I've changed so much. I don't take buprenorphine in 
     any kind of way or anything and so life is just wonderful and 
     grand, and I have to give that thanks to the medication 
     buprenorphine. Because it just helped me so tremendously in 
     my life. And so I would like to see everybody that needs an 
     opportunity, get an opportunity to use this medication, 
     because it does work, and I'm a living witness that it does.
       I'd like to say thank you for listening to me. Thank you 
     very much.
                                  ____



                    Ms. Tess Walker, College Student

       My name is Tess Walker and I'm 24 years old, and I'm about 
     to graduate from Berkeley School of Music. I grew up in 
     Cambridge, Massachusetts and went to school there, and was 
     sort of going to school and doing well and had an after-
     school job and graduated when I was 17, and when I was 18 I 
     started using heroin. And it seems like a very big leap, but 
     at the time, it didn't.
       I was using heroin for three and a half years, and 
     basically doing nothing but, it was pretty much a day in, day 
     out thing. I was living with my mother. After awhile things 
     were really bad.
       I was trying to get clean, and going into detoxes, 
     methadone detoxes for five days at a time and coming out and 
     going out and going back in and coming out, and during this 
     period of time, which was probably a year and a half, two 
     years into my using, my mother got in touch with a physician 
     named Dr. Daniel Alfred in Boston. He was involved in the 
     research with buprenorphine, and he basically convinced her 
     that she shouldn't throw me out of the house--so thanks, Dr. 
     Alfred--and about a treatment that he was working on, but it 
     wasn't available yet.
       And I continued sort of on the path that I was on until I 
     had expended methadone detoxes ten times. And I want to focus 
     when I'm talking to you on that, the last experience that I 
     had with methadone detox.
       I went in and took my first dose, and five days later I 
     took my last dose, and on that day left and I went to New 
     York to my friend's farm, because I knew that it was going to 
     get bad eventually and I was at the end of my rope and I 
     wanted it to end. When I got to New York things got really 
     bad, and I wound up being in a situation where it was like--
     drugs, death.
       I think about myself now and who I am now, and thinking 
     about being in a situation in which that's a viable option at 
     all is really scary.
       I drove back to Boston at probably about 100 miles per hour 
     and got back to the city and got my drugs and went back home 
     and I was just completely at the end of my rope, my mother 
     was probably more at the end of hers, and she called up Dr. 
     Alfred--this was years after all of the process and 
     everything and the methadone and nothing working and trying 
     and trying and trying--and he basically told her that, 
     buprenorphine had been approved, and that I could come in on 
     that Monday.
       We had so much hope at that point, and we went in and he 
     explained the process to us, and it kind of seemed really 
     unbelievable to me at the time. I went home with 
     buprenorphine and started taking my dose and there was a 
     moment where, I'm sorry, where sitting at my kitchen table in 
     Boston when I felt normal for the first time in three and a 
     half years. And I've been clean for almost three and a half 
     years now, and it changed my life. It was--after going 
     through years of trying and failing and trying and failing, 
     to have something--a drug that did not feel like a drug and 
     make me feel like a human being again, and to have people 
     around you who are treating you that way, was amazing.
       I went back into college after I was six months clean, I've 
     been on the Dean's List ever since. I'm graduating in the 
     spring, I've been recording music and playing music and all 
     of my family is back in my life and it's an amazing thing. 
     And I've learned a lot standing back here today and I think 
     that it's a massively important thing for buprenorphine to be 
     in any community, especially in communities where you 
     wouldn't expect that this is a huge issue, because it is. And 
     for me to go from a nice high school in Cambridge with 
     amazing love and a huge support system to the places that I 
     went to, I mean, it can happen to anyone. And this is 
     working, it's really working. So I hope that I've given you 
     something to think about and thank you so much for letting me 
     come and speak here. Because this is a really major thing, 
     and I think that everyone needs to be aware that there's an 
     alternative to five days in methadone detox out there, and 
     that it works. Thank you so much.

                          ____________________