[Congressional Record (Bound Edition), Volume 160 (2014), Part 7]
[Senate]
[Page 9414]
[From the U.S. Government Publishing Office, www.gpo.gov]




                      APPROACH TO OPIOID ADDICTION

  Mr. LEAHY. Madam President, it is no secret that communities across 
the country are struggling to break the cycle of addiction to powerful 
opioids, including heroin. We are now seeing addiction creep into 
neighborhoods and communities of all sizes, both rural and urban. My 
home State of Vermont has not been spared, and it in fact has attracted 
much attention for its struggles with addiction. However in many ways, 
Vermont is ahead of much of the Nation when it comes to responding to 
the opioid epidemic. We long ago recognized the problem, and 
communities in Vermont have spent the better part of a decade coming 
together to address opioid addiction.
  In March I had the privilege of chairing a field hearing of the 
Senate Judiciary Committee in Rutland, VT. It was the fourth time in 
the past 6 years that I brought the committee to Vermont to explore 
issues related to drug abuse. I heard powerful testimony discussing how 
communities are responding to addiction, rethinking decades-old 
approaches to prevention, treatment, and law enforcement efforts. Dr. 
Harry Chen, the Vermont Department of Health commissioner and a career 
emergency room physician, described what it means to recognize 
addiction as a public health issue, expanding evidence-based prevention 
and treatment services to all corners of the State.
  Vermont hospitals are also rethinking best practices in light of this 
epidemic. Recently, the Office of National Drug Control Policy 
published an article entitled ``How a Vermont Hospital Fights the 
American Opioid Epidemic.'' The article was authored by Dr. Stephen 
Leffler, the chief medical officer at Fletcher Allen Health Care in 
Burlington, VT. In the article, Dr. Leffler describes how Fletcher 
Allen is on the leading edge of modernizing health care practices to 
minimize abuse and addiction, while still providing necessary pain 
management. The hospital provides clear, standardized protocols for 
treating pain, defines a maximum daily dosage as guided by the latest 
research, and measures patients' risk for addiction. This approach 
ensures consistency in treatment and may help to stem the flow of 
prescription opioid users from sliding into addiction.
  The approach described in Dr. Leffler's article could potentially 
serve as a model for the rest of country, and I would encourage other 
States grappling with addiction to look at what Fletcher Allen is doing 
in Burlington. If we are to find legislative solutions that may finally 
break the cycle of opioid addiction, then surely we must carefully 
consider promising, novel approaches such as this. I ask unanimous 
consent that Dr. Leffler's article be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

     [From The Office of National Drug Control Policy, May 9, 2014]

       How a Vermont Hospital Fights the American Opioid Epidemic

                      (By Dr. Stephen M. Leffler)

       Over the course of my more than 20 years as an emergency 
     physician, I have seen thousands of patients with painful 
     conditions. During that same time, I have witnessed the 
     remarkable evolution of modern pain medication--its potential 
     and its pitfalls. We can now help patients manage both short-
     term and long-term pain. Yet, while medications--particularly 
     opioids--have helped us heal patients, we have also seen 
     their detrimental effects, chief among them addiction.
       Opioids can be very helpful for patients with conditions 
     such as broken bones and kidney stones, and they are also 
     useful after many types of surgery. They may also be used to 
     treat those with chronic pain--people who experience pain 
     carrying out normal, daily functions of life that others take 
     for granted. Used for short periods of time at the proper 
     dosage, opioids are safe medications and excellent choices 
     for a wide variety of acute painful conditions.
       While opioids work well for pain control, they have a 
     number of potentially serious side effects: They can hinder 
     or stop breathing, cause constipation, result in drowsiness, 
     and act as central nervous system depressants. That's why 
     your doctor tells you it is not safe to drive after taking 
     opioids.
       Another devastating side effect is addiction. The body 
     develops a tolerance to opioids and, after only a couple of 
     weeks, may require higher doses to control pain. Over time, 
     increasing doses of opioids may be needed to manage the same 
     level of pain. Patients may develop dependence--their bodies 
     will crave it. They will exhibit a strong desire or 
     compulsion to take the drug for reasons beyond simple pain 
     control. At this stage, if they stop taking opioids, they 
     will experience withdrawal. This is how opioid use can lead 
     to addiction and all its inherent problems for the individual 
     and society.
       As providers, our responsibility is to carefully manage the 
     side effects of opioid therapy. Dependence, tolerance, and 
     addiction must be discussed with patients, and a careful 
     well-planned strategy is crucial for their extended use of 
     opioids.
       That is exactly what we are doing at Fletcher Allen Health 
     Care in Burlington, Vermont. Recently, providers and pain 
     management experts from multiple specialties (Anesthesia, 
     Emergency Medicine, Family Medicine, Internal Medicine, and 
     Surgery) converged to standardize how we care for patients 
     with painful conditions and to develop best practices for our 
     patients.
       What did we do? Here is an overview:
       Systems Approach. We built standardized protocols so that 
     patients will get similar treatment in various settings. We 
     believe this standardization will help our patients and 
     providers. There will be clear, defined expectations and 
     goals for treating our patients' pain.
       New Rules & Tools. We use processes and tools such as pain 
     agreements with patients and surveys to assess how patients 
     are functioning with their pain and to measure their risk for 
     addiction.
       Defining Maximum Daily Dosage. We are one of the first 
     hospitals in the country to define the maximum daily dose of 
     opioids. Research shows that beyond certain doses, patients 
     experience no additional benefit. We know that very high 
     doses of opioids increase the risk of dangerous side effects 
     but offer no additional pain control.
       This approach helps ensure that we are more reliable and 
     consistent in our approach to pain in our patients and that 
     our patients will know what to expect from their providers.
       Gil Kerlikowske, then-Director of ONDCP, recently visited 
     Fletcher Allen Health Care to discuss our new approach and 
     tools. He lauded our systems-level strategy and our 
     standardized protocols. I believe that the current dialogue 
     in Vermont and elsewhere on how to better manage opioid abuse 
     will be productive and lead to changes across the country in 
     how these drugs are prescribed and how acute and chronic pain 
     is managed. Fletcher Allen Health Care is on the leading edge 
     of this transition and could be a model for other health 
     systems managing this complex issue. I hope that sharing our 
     practices here is the first step toward being that model.

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