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    Statements on Introduced Bills and Joint Resolutions

    by Former Senator John D. Rockefeller, IV

    Posted on 2013-02-14

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    ROCKEFELLER (for himself, Mr. Manchin, and Mrs. Gillibrand): S. 348. A bill to provide for increased Federal oversight of prescription opioid treatment and assistance to States in reducing opioid abuse, diversion, and deaths; to the Committee on Health, Education, Labor, and Pensions.

    Mr. ROCKEFELLER. Mr. President, I rise today to introduce a piece of legislation that is desperately needed in West Virginia and across the country--the Prescription Drug Abuse Prevention and Treatment Act of 2013. It is an important bill aimed at addressing the rapid increase in deaths and overdoses from methadone and other opioid prescription drugs in the United States. These deaths have hit my home State of West Virginia particularly hard, but I know that every State is struggling with this serious problem.

    In the 111th Congress, Senator Corker and I, along with our colleague, the late Senator Kennedy, introduced the Methadone Treatment and Protection Act of 2009--a similar piece of legislation that stemmed from a disturbing rise in deaths due to methadone, a synthetic opioid prescription drug that had been increasingly used for pain management. Before 1990, it was used primarily to treat opioid addiction. Because of its high efficacy and low cost, methadone is frequently used for pain management. However, if not used correctly, methadone can be a powerful and deadly drug because it works differently than other painkillers. Methadone stays in a person's body for a longer period of time than the pain relief lasts so a person who does not know better might take far too much of the drug, possibly leading to respiratory distress, cardiac arrhythmia and even death.

    Methadone prescriptions for pain management grew from about 531,000 in 1998 to about 4.1 million in 2006--nearly eightfold. During that time, poisoning deaths involving methadone increased nearly sevenfold from almost 790 in 1999 to 5,420 in 2006. Deaths from other opioids have also skyrocketed in the last decade. These deaths may actually be underreported, because there is no comprehensive reporting system for opioid-related deaths in the United States.

    Overdoses from methadone are part of a larger disturbing trend of overdoses and deaths from prescription painkillers, or opioid drugs--a trend driven by a knowledge gap about how to treat serious pain in a safe and effective manner, by misperceptions about the safety of prescription drugs, and by the diversion of prescription drugs for illicit uses. In 2009, there were nearly 4.6 million drug-related emergency department, ED, visits of which nearly one half, 45.1 percent, or 2.1 million were attributed to prescription drug misuse or abuse, according to data from the Drug Abuse Warning Network, DAWN. Emergency department visits involving misuse or abuse of pharmaceuticals nearly doubled between 2004 and 2009, to more than 1.2 million visits.

    This bill takes multiple steps to address these problems. First, with respect to the knowledge gap about safe pain management, the bill includes a training requirement for health care professionals to be licensed to prescribe these powerful drugs. Currently, the Controlled Substances Act requires that every person who dispenses or who proposes to dispense controlled narcotics, including methadone, whether for pain management or opioid treatment, obtain a registration from the Drug Enforcement Administration, DEA. But, there is no requirement as a condition of receiving the registration that these practitioners receive any education on the use of these controlled narcotics, including methadone. Physicians struggle every day with determining who has a real need for pain treatment, and who is addicted or at risk. They struggle with our failure to provide adequate treatment facilities for those who are addicted. This bill will help physicians get the information they need to prescribe safely and better recognize the signs of addiction in their patients.

    Second, this bill addresses the knowledge gap among consumers--with a competitive grant program to States to distribute culturally sensitive educational materials about proper use of methadone and other opioids, and how to prevent opioid abuse, such as through safe disposal of prescription drugs. Preference will be given to states with a high incidence of overdoses and deaths.

    Third, this bill creates a Controlled Substances Clinical Standards Commission to establish patient education guidelines, appropriate and safe dosing standards for all forms of methadone and other opioids, benchmark guidelines for the reduction of methadone abuse, appropriate conversion factors for transitioning patients from one opioid to another, and guidelines for the initiation of methadone and other opioids for pain management. A standards commission will provide much- needed evidence-based information to improve guidance for the safe and effective use of these powerful and dangerous controlled substances.

    Fourth, this bill provides crucial support to state prescription drug monitoring programs. As of 2008, 38 states had enacted legislation requiring prescription drug monitoring programs and many states were able to fund these initiatives in part from grants available through the Harold Rogers Prescription Drug Monitoring Program. A second program created in 2005 through the National All Schedules Prescription Electronic Reporting Act, NASPER, would provide even more assistance, and requires interoperability among states to reduce doctor shopping across state lines and diversion. Unfortunately, NASPER has only recently been funded with $2 million in the fiscal year 2009 Omnibus legislation and $2 million in fiscal year 2010.

    Here is just one example of why NASPER funding matters: recently, the governor of Florida announced a [[Page S780]] budget that would not fund a planned prescription monitoring program in his State, due to State budget difficulties. This directly affects States in Appalachia because of the rampant drug trafficking between the two regions. In fact, the roads from West Virginia to Florida are well-travelled by drug traffickers and people seeking pain medication. It is crucial to finally give NASPER the funding it needs, and this legislation would do so, with $25 million a year to establish interoperable prescription drug monitoring programs within each state.

    Fifth, this bill requires that quality standards be developed across the range of providers engaged in the prevention and treatment of prescription drug abuse. It is essential as we move ahead that quality always be front and center in our efforts. With lives at risk, this is, if anything, only more important in the areas of addiction prevention and treatment. Every effort to address this problem must be as effective as possible, and the development of quality standards required by this bill will make sure that each provider, regardless of his or her background or approach, can provide high caliber services to their patients.

    Finally, this bill would help solve the data gap when it comes to opioid-related deaths. Right now there is no comprehensive national database of drug-related deaths in the United States, nor is there a standard form for medical examiners to fill out with regard to opioid- related deaths. Since there is no comprehensive database of methadone- related deaths, the number of deaths may actually be underreported. To truly reduce the number of methadone-related deaths, quality data must be collected and made available. This bill would create a National Opioid Death Registry to track all opioid-related deaths and related information, and establish a standard form for medical examiners to fill out which would include information for the National Opioid Death Registry.

    Today we have an opportunity to change the harrowing statistics and stem the rising tide of deaths from methadone and other opioids by supporting the Prescription Drug Abuse Prevention and Treatment Act of 2013. This legislation provides a multifaceted approach to preventing tragic overdoses and deaths from methadone and other opioids. This is exactly what we need to improve the coordination of efforts and resources at the local, state, and federal levels.

    I urge my colleagues to support this timely and important piece of legislation. In doing so, we will be on our way to saving lives and reducing the needless deaths that otherwise will continue to cause so much suffering for too many individuals, families, and communities in this country.

    ______ By Mr. REED (for himself, Mr. Blumenthal, Mr. Whitehouse, and Mr. Murphy): S. 349. A bill to amend the Wild and Scenic Rivers Act to designate a segment of the Beaver, Chipuxet, Queen, Wood, and Pawcatuck Rivers in the States of Connecticut and Rhode Island for study for potential addition to the National Wild and Scenic Rivers System, and for other purposes; to the Committee on Energy and Natural Resources.

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