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Roy B.
Republican MO

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  • Comprehensive Addiction and Recovery Bill

    by Senator Roy Blunt

    Posted on 2016-03-09

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    BLUNT. Mr. President, today the Senate is taking a second step to deal with a public health crisis that is destroying lives and damaging communities across the Nation, the epidemic of opioid and heroin abuse. Step 1 late last year was to reduce spending in other programs and increase the dollars available to deal with this addiction.

    An estimated 1.9 million American adults have an opioid-use addiction or disorder related to prescription drug pain relievers. Another 500,860 have an opioid-use disorder related to heroin. Some 2.5 million Americans are dealing with this problem. Our Nation's veterans are particularly at risk for developing a dependency on opioids. A study published in 2014 found a high prevalence of chronic pain among veterans because of their service. The chronic pain among veterans was 44 percent compared to 26 percent in the general public.

    There was a higher prevalence of opioid use, at 15.1 percent, in the U.S. military after a combat deployment, after possible injuries in training or injuries from an IED attack, compared to just 4 percent in the general public. In 2014, more than 1,000 Missourians died from an opioid overdose. In St. Louis alone, deaths related to opioid abuse have increased nearly three times since 2007.

    Member after member has come to the floor, just as they came to me last year as the chairman of the funding committee for health and human services and explained what a problem this is in their State. The majority leader made a point to me the other day that in Kentucky more people died last year from drug overdoses than died from car accidents.

    According to the Centers for Disease Control and Prevention, 4 people every day die from an overdose of opioid pain relievers, and 78 people die every day from a combination of pain reliever overdoses or heroin overdose.

    Many times those prescription opioids have been the pathway to heroin. Deaths from prescription opioids have quadrupled in the past 14 years. These are stunning statistics. The Centers for Disease Control and Prevention has rightly labeled this an ``epidemic.'' This should get a good vote on the Senate floor today or tomorrow. But just because it gets a good vote, it does not mean it was not an important debate to have.

    Just because it gets a good vote and is now better funded than it has been in the past, that does not mean the Senate and the House don't need to weigh in and say: Here is more specific ability to deal with these problems in new ways. The good news is that addiction is a treatable disease. Those who receive treatment can recover and go on to lead full, healthy, and productive lives.

    In Missouri 72 percent of the individuals who had gone through our State's opioid treatment program in random tests test drug-free. The problem with addiction is that only about 10 percent of individuals who are battling drug addiction receive treatment. That is why I am proud to be a cosponsor of this bill. That is why it is important that we commit ourselves to win the fight against addiction.

    We need to make sure that all of the stakeholders are involved. As to first responders, if you are a first responder attached to a fire department, for instance, the odds are that you are going to respond to three times as many drug overdoses as you do to fires. So whether it is first responders, paramedics, or the law enforcement community, we need to use all of our resources to try to be sure that we are doing what needs to be done here.

    The Comprehensive Addiction and Recovery Act that we are debating provides grants from multiple government agencies to encourage State and local communities to pursue strategies that we know work. The only thing you have to do is be sure and implement those strategies.

    The bill expands the educational efforts to understand addiction as a chronic illness. That promotes treatment and recovery and prevents opioid abuse from going forward. The bill also expands resources to identify and to treat the incarcerated population suffering from addiction disorders with evidence-based treatment.

    Finally, it expands disposal sites for unwanted prescription medications to help them out of the hands of children and adolescents. Way too many unused painkillers are still in people's medicine cabinets or their dresser drawer, waiting for somebody else to find them and, once they know they are there, to find them again.

    This bill represents a strong bipartisan effort to address this epidemic. I filed two amendments that I think will improve the bill. I hope to see them in the managers' package. The first amendment will just simply expand the efforts that we have already made in a bill that Senator Stabenow and I introduced a couple of years ago and that got a significant pilot project in the Excellence in Mental Health Act.

    What that does is to provide 24-hour access for people living with behavioral health issues--with mental health issues. That would include substance abuse disorder. Excellence in Mental Health creates a demonstration program that really just simply, in the right kind of facilities, requires that mental health is dealt with like all other health--that behavioral health is dealt with like all other health.

    When we started that debate, there was a belief that no more than 20 States would implement Excellence in Mental Health if every State in the country were allowed to do it if they wanted to. We now have 24 States that have applied to be one of the eight State pilots. The administration said: Why don't we increase the 8 States to 14 States? We have an amendment to this bill that would say: Let's go ahead and increase the 14 States to all 24 States, because not only is this the right thing to do but what these States will find out is that when you deal with mental health like all other health, you probably save money because the other health issues that people with behavioral health issues have are so much more easily dealt with.

    It has been long said that we have really turned over, in an outrageous way, the mental health obligations of our society to the local police departments and the emergency rooms. That is no way to do this. It is no way to solve this problem. We are about 50 years behind. We are beginning now to catch up in the ways we should.

    I also filed an amendment to authorize the Department of Health and Human Services to use telehealth to allow this program to work more effectively, to allow telehealth to be one of the specifically reimbursable opportunities here.

    According to the Centers for Disease Control, individuals in rural communities are more likely--not as likely, not less likely, but more likely--to overdose on prescription painkillers than people in the cities, people in urban areas. In fact, death rates from overdoses in rural areas now greatly outpace the rate in large metropolitan areas, which historically had higher rates.

    So what do you do to connect those individuals with the kind of help they might need on a basis that they can turn to that help when they need to? One way to do that, certainly, is telehealth treatment options. Telehealth allows individuals in rural or medically underserved areas--many of whom just simply don't have other treatment options--to receive the care they need, to receive the attention their issue needs remotely.

    Additionally, telehealth can be an important component in ensuring that those patients receiving treatment for pain management use opioids effectively and appropriately and don't get started down the wrong path and the wrong way.

    In July 2014, the Journal of the American Medical Association published a study that followed patients who reported moderate to intense chronic musculoskeletal pain. Of the 250 patients in the study, half received the normal standard of care and half received a year of telephone monitoring in addition to normal care.

    Patients who were monitored via telehealth were twice as likely to report less pain after 12 months, having someone to talk to or being able to ask a question about whether they should increase the medicine because their pain was worse that day. Researchers [[Page S1356]] have clearly noted that fewer telehealth patients started taking escalated doses of opioids than people who were simply taking medicine on their own. Telehealth holds promise in lots of areas. I believe this happens to be one of them. As chairman of the Labor, Health and Human Services Appropriations Subcommittee, I was proud to see us increase funding at a 284-percent increase. I will say again that we did that by cutting funding in other areas. One of the things the government has to start doing is to truly prioritize. If everything is a priority, nothing is a priority.

    Today, with this piece of legislation, the Senate is telling our friends on the other side of the Capitol and around the country that this is an epidemic we intend to deal with. I look forward to the continuation of this debate, the end of this debate, and passing this bill.

    Thank you.

    Mr. President, I suggest the absence of a quorum.

    The PRESIDING OFFICER. The clerk will call the roll.

    The senior assistant legislative clerk proceeded to call the roll.

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