[Congressional Record (Bound Edition), Volume 162 (2016), Part 3]
[Senate]
[Pages 2920-2921]
[From the U.S. Government Publishing Office, www.gpo.gov]




               COMPREHENSIVE ADDICTION AND RECOVERY BILL

  Mr. WYDEN. Mr. President, now that the Senate has passed the 
Comprehensive Addiction and Recovery Act, I wish to take a few moments 
to reflect on what I believe are going to be additional steps that are 
needed to really put an end to the horrible opioid epidemic. This is a 
horrible, horrible health scourge that has carved a path of destruction 
throughout communities in Oregon and across our country.
  Now, over the last several weeks, I have traveled around Oregon to 
spend time listening to experts. We heard powerful testimony in the 
Finance Committee, and I have spoken with colleagues here in the Senate 
about the urgency and the important scale of this national crisis. The 
message has been very clear: Our country is paying for a distorted set 
of priorities. Our citizens get hooked on opioids, there is not enough 
treatment, and enforcement falls short. My view is that is a trifecta 
of misplaced priorities.
  What it says to me is that our country needs a fresh approach where 
prevention, better treatment, and tougher enforcement work in tandem. 
We have to have all three working together to really get on top of this 
horrible, horrible health scourge. The Congress ought to be working 
overtime on policies that start moving our Nation towards this tandem 
approach that I have described.
  Now, my view is that the bill that was passed by the Senate takes the 
first step toward updating the country's out-of-date approach to 
substance abuse. More needs to be done, and that is what I and other 
colleagues have pushed hard to do. I very much hope that more can be 
done in this Congress.
  As ranking member of the Finance Committee, we are required to pay 
for Medicare and Medicaid. I wish to spend a few minutes talking about 
the fundamental role that is going to play in stemming the tide of 
opioid abuse.
  These are bedrock health programs, and they are expected to account 
for over a third of substance abuse-related spending in the upcoming 
years. We are talking about billions and billions of dollars. Medicare 
and Medicaid have an important role when it comes to preventing 
addiction at its source, and talking about prevention has to include 
talking about how these drugs are prescribed in the first place.
  As I visited with citizens around Oregon, I was struck--and I know of 
the Presiding Officer's expertise in health care as a practitioner--by 
what I have come to call the prescription pendulum. Doctors were once 
criticized for not treating pain aggressively enough, and today they 
are criticized for prescribing too many opioids to manage pain. So in 
the days ahead, our country is going to have to look for solutions that 
get the balance right.
  During the debate on this bill, the Senate considered an amendment I 
wrote that would have doubled the penalties for opioid manufacturers 
who give kickbacks to prescribers and put profits over patients. It has 
been well documented in recent years that companies are pushing the 
unapproved use of some drugs at the expense of patient safety. It is 
high time for real accountability when the manufacturers go too far.
  My amendment would also have made significant progress to connect 
those struggling with addiction to appropriate treatment. Some parts of 
the bill the Senate passed crack down on those on Medicare who are 
suspected of abusing opioids. It is an enforcement-only approach, and 
my view is that the story cannot stop there. Without treatment, those 
addicted to opioids might try to get their pills on the street or turn 
to heroin. My amendment would have ensured that those who are at risk 
for opioid abuse are connected to meaningful treatment choices so they 
can better manage their pain and limit excessive prescriptions.
  I also proposed an amendment that would have helped some of the most 
vulnerable Americans, including pregnant women on Medicaid who struggle 
with addiction. The costs of inaction here add up every single day for 
moms and their babies. A recent Reuters investigation found that, on 
average, an opioid-dependent baby is born every 19 minutes. These are 
high-risk pregnancies that can have lifelong consequences for mothers 
and their children. Some of these babies tragically aren't going to 
make it. Many of them are going to be placed in foster care if their 
mothers cannot break their addiction.
  So it is critical that these women have and retain full access to 
pre- and post-natal care as well as addiction treatment. Yet, today, if 
a pregnant woman on Medicaid receives treatment for drug or alcohol 
dependency, in certain in-patient facilities, that woman loses her 
health coverage for the duration of her stay. That just defies common 
sense.
  The good news is, the country has a pretty good idea of a 
straightforward solution. There is no reason someone who is pregnant 
should lose access to their health insurance. This amendment simply 
states that no pregnant woman would lose her Medicaid while she 
receives treatment for addiction. To be clear, this amendment doesn't 
instruct Medicaid to pay for these treatment services. That charge 
requires a broader debate. I do believe, though, in the meantime, 
access to services like prenatal care should not be restricted for 
pregnant women who want to receive care for their addiction.
  It is unfortunate these amendments didn't make it into the Senate 
legislation today, but I have seen a number of times--and I look 
forward to working with my colleagues in the Senate--that sometimes we 
don't win on day one, and you have to come back again and again and 
again. A few weeks ago, a bill I authored well over a decade ago, the 
Internet Tax Freedom Act, finally got passed permanently into law. So 
sometimes when something is important, you just have to stay at it, and 
I want colleagues to know I think the CARA bill is a good start. It 
focuses on enforcement, but unless you get the prevention and treatment 
part of it in addition to enforcement, you are not going to get the job 
done properly.
  The Congress obviously has some tough choices to make. If prevention 
and treatment aren't addressed upfront, the costs are going to be even 
higher--pregnant mothers giving birth to opioid-dependent babies, EMTs 
in emergency rooms dealing with overdose calls every night, county 
jails taking the place of needed treatment, able-bodied adults in the 
streets instead of working at a family wage job. American tax dollars 
need to be spent more wisely, and it is my view the Senate has to come 
back to this issue. It has to come back to this issue and get the job 
done right.

[[Page 2921]]

  I indicated earlier that I am very much aware of the expertise of the 
Presiding Officer in health care and his involvement as a practitioner, 
and I look back, as I said, to how the prescription pendulum has moved. 
It wasn't very long ago when I was of the view that there wasn't enough 
done to manage pain. As patients began to insist on those kinds of 
drugs and therapies to help them with their pain, we saw they were able 
to get relief. The pendulum may have swung the other way now, and there 
is too much prescribing. I don't pretend to be the authority on how to 
get the prescription pendulum right, but I do know from listening to 
practitioners in the field, to citizens, to grieving parents, that you 
have to have more than enforcement. That is what the Senate has done 
with the bill that was passed today. The story must not end there. The 
Senate can do better in the days ahead. The Senate can fill in the rest 
of the story and ensure that in addition to enforcement, there will be 
prevention, there will be treatment, and a sensible policy that ensures 
that these three priorities work in tandem and is what the Senate 
pursues on a bipartisan basis in the days ahead.

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