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Ron W.
Democrat OR

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  • Comprehensive Addiction and Recovery Bill

    by Senator Ron Wyden

    Posted on 2016-03-10

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    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 [[Page S1431]] 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    Now, my view is that the bill that was passed by the Senate takes the first step toward updating the country's out-of-date approach to substance abuse.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.

    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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