Comprehensive Addiction and Recovery Act of 2015--Motion to Proceed
Floor Speech
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Mrs. SHAHEEN. I thank the Presiding Officer.
I am pleased to join my colleague from New Hampshire on the floor and the others who have spoken this morning so eloquently about the heroin and opioid epidemic that is ravaging families and communities in every one of our States.
As Senator Ayotte said so well, we have seen in New Hampshire that we are at ground zero for this epidemic. In terms of the percentage of people affected in New Hampshire, we are losing a higher percentage than almost every State in the Nation. This is an issue we need to work together to address. I think we have to respond much more robustly than we have done at the Federal level because this epidemic is becoming a pandemic. It is affecting young and old, urban and rural, rich and poor, Whites and minorities.
As others have said, the Senate is now considering the Comprehensive Addiction and Recovery Act or CARA. I want to congratulate the sponsors of the legislation because this is a good bipartisan bill. It is important as we look at what we need to do to address the epidemic we face.
In addition to the authorizations and the good work that is in the CARA legislation, we also need to provide the resources that law enforcement and health professionals who are on the frontlines of dealing with this crisis are going to need. Despite heroic efforts, law enforcement and treatment professionals are increasingly overwhelmed by the sheer scope and scale of the opioid and heroin crisis. Everywhere I go in New Hampshire, the lack of resources is abundantly clear. Our communities need additional funding--and they need it urgently.
So this is why I have submitted an amendment cosponsored by the author of CARA, Senator Whitehouse, and I am pleased my colleague from New Hampshire has also joined in cosponsoring this amendment. This amendment would provide $600 million in emergency funding for critical programs that we know will help address this crisis.
I am on the floor to urge the majority leader and the leadership of the Senate to allow a vote on this legislation because this is a nationwide emergency of the first order, and it is time for us in Congress to treat it like a nationwide emergency.
In 2014, more than 47,000 Americans died from lethal drug overdoses-- more fatalities than from car accidents. Each day 120 Americans die of drug overdoses--2 deaths every hour. In our State of New Hampshire, where we have 1.3 million people, we are losing more than a person a day to drug overdose deaths.
Here we have a map of America that shows the increases in deaths from drug overdoses. We can see in 2003 the majority of the map is lighter colored, so it means it doesn't have the same number of deaths. In 2008 we can see this dark red color which shows the deaths from drug overdoses increasing. Here, in 2014, we see the impact of those 47,000 people lost.
The State of the Presiding Officer, like in New Hampshire, is at ground zero in the State of Arizona. In West Virginia, in Tennessee, and in Kentucky, they are seeing the same dramatic increase in the number of deaths from drug overdoses. This chart represents overdose deaths per 100,000 people. Again, it demonstrates how truly national in scope the crisis has become. No State is immune from the scourge.
Across the country, our communities are asking why this is happening. They are asking why so many of our family members and neighbors are overdosing on these drugs. Sadly, as we have heard from people who have spoken on the floor, one of the primary reasons is because so many people are becoming addicted to prescription opioid drugs, better known as painkillers. In 2012, 259 million prescriptions were written for these drugs--almost 1 for every American. That is more than enough to give every American adult their own bottle of pills. During a 3-month stretch in 2015 in New Hampshire, 13 million doses of schedule II painkillers were dispensed at New Hampshire pharmacies in just one 3- month period--13 million pills in 3 months for a State with a population of 1.3 million, and nearly 80 percent of these prescriptions were for heavy painkillers like oxycodone, morphine, and fentanyl.
If we look, we can see how this graph dramatically tracks the increase in drug prescribing and the number of deaths that resulted. The number of drug overdose deaths has risen as opioid prescriptions have increased. This orange line is the number of deaths. The green line is the number of prescriptions that are being written. We are missing the data for the year 2012, but there is no doubt that those deaths track the number of prescriptions for painkillers that are being written.
The National Institutes of Health have found that people who are addicted to opioid painkillers are 40 times more likely to be addicted to heroin. So when someone gets addicted to pain pills and can no longer get prescriptions, they turn to drugs like heroin and fentanyl.
What I heard from law enforcement in New Hampshire and from the medical community is that people turn to heroin because it is cheaper and easier to get than prescription drugs after they become addicted. Of course, we have seen that drug traffickers are taking advantage. They are flooding our streets with these drugs. In many of our communities, that bag of heroin is cheaper than a six-pack of beer. Of course the end result is a staggering increase in overdose deaths, which we can see on this chart.
Again, in 2014, nearly 21,000 people died from opioid abuse. There were more than 10,000 deaths from heroin. That is a 222-percent increase from 2009 levels.
So we can see that these are opioid deaths, these are deaths from cocaine, and these are deaths from heroin. We can see the red line and the green line have gone up dramatically.
A professor at Johns Hopkins School of Public Health, Brendan Saloner, describes opioid addiction as ``a chronic relapsing illness, just like diabetes.''
We know treatment is the only effective answer. Again, what I have heard from law enforcement in New Hampshire is that they know they can't put drug users in jail. That is not the answer to deal with this challenge. We need to put the bad guys in jail, but we need to provide treatment to the people who need it because that is the only effective answer. Unfortunately, it is a tragic reality that nationwide nearly 9 out of 10 people with substance use disorders don't receive treatment. They are being turned away and denied treatment due to a chronic lack of resources.
My colleague from New Hampshire spoke very eloquently about some of the people she heard from. We have heard from people in the same way in New Hampshire. Of the 1.3 million people in our State, it is estimated that 100,000 people--almost 10 percent--are currently seeking treatment for substance use disorders. We are able to offer services to only a small fraction of that total.
Over the last decade the number of people admitted to State treatment programs increased 90 percent for heroin use and 500 percent--500 percent--for prescription drug use, with the largest increases occurring in the past several years.
As we can see from this chart, lack of treatment is a national problem: the darker the green, the more people in that State who are not receiving treatment for addiction. Sadly, New Hampshire is a very dark green, as is Arizona, the Presiding Officer's State. You can see this dark green line coming down the east coast and going up the west coast.
In 2014, in Kentucky, 82,000 people needed addiction treatment but failed to get it--in Tennessee, 116,000 people; in Arizona, 157,000; in Nevada, 55,000; in North Carolina, 200,000 people. These are all people who needed treatment who didn't get it. When people don't get treatment, they are overdosing in overwhelming numbers.
Sadly, this map of the United States shows where the overdose death rates are the highest. Where the darkest colors are shown the death rates are greater than 19 per 100,000 of population. We can see many of the same States, such as New Hampshire, that have the most difficulty in people finding treatment. Those are the States where we are finding the highest death rates. In 2014 in Kentucky, 1,100 people died from a drug overdose; in Tennessee, 1,200 people; in Arizona, 1,200 overdose deaths; in Nevada, 500; and in North Carolina, 1,300.
In recent days I have had a chance to visit three treatment centers in my home State, Headrest in Lebanon, Serenity Place in Manchester, and Seacoast Youth Services in Seabrook. These treatment centers are staffed by skilled, dedicated professionals. They are saving lives every day, but they tell me that for every life they save, many more are being lost for lack of treatment capacity, lack of facilities, and lack of funding.
I had a chance on some of those visits to meet with some of the people in recovery. I can remember one young man up in Lebanon at Headrest who had been in and out of prison because of crimes committed when he was using. He said to me that it costs thousands of dollars to keep someone in prison. The figure he used was $35,000. He said: Don't you all know that it is cheaper to give somebody treatment? It is absolutely more cost effective for us to provide treatment for people who are in recovery, people who need help.
I heard from a young woman in Manchester who said that she had been arrested for drug use. She said: I am not a criminal. My problem is I need treatment to deal with these drugs.
Another young woman who was in her early twenties who had been in and out of the Manchester jail--the Valley Street jail--said: You know, they don't provide treatment in the Valley Street jail. I learned when I got picked up that I don't tell them that I have a drug problem or that I have mental health issues because if I do, they put me in the bubble where I get observed 24 hours a day, regardless of what I am doing. What I need is treatment. I don't need to be in the bubble.
Well, that is why this supplemental amendment would increase resources for treatment and recovery--because the answer is treatment. Our amendment includes $300 million for the Substance Abuse Prevention and Treatment Block Grant Program. This program is the premier Federal initiative to boost State and local resources for prevention, treatment, and recovery support. In 21 States this block grant program represents at least 75 percent of the State agency's substance abuse prevention budget. In some States, sadly, it is the only funding for substance abuse prevention. If we are going to get a handle on this problem, we are going to have to provide some additional resources for the treatment that these programs need. This funding will result in an immediate increase in the number of addicted individuals who will receive lifesaving treatment. It will also save taxpayer dollars in the future, just as I heard from that young man at Headrest, who said it is cheaper to provide treatment than to build prisons. He is absolutely right.
The National Institute on Drug Abuse estimates that for every dollar spent on substance use disorder treatment programs there is a $4 to $7 reduction in the cost of drug-related crime. An outpatient treatment program can result in savings that exceed costs by a factor of 12 to 1.
I live in Stratford County in New Hampshire. It has used the modest funding from this block grant program, the Substance Abuse Prevention and Treatment Block Grant Program, to accomplish important things, including expanding the peer-based addiction recovery efforts and working at schools to engage at-risk students in the middle school years. If we can prevent addiction, that is obviously the best thing we can do.
Unfortunately, many prevention and treatment efforts in Stratford County remain chronically underfunded. I recently learned about one local woman, a mother and waitress, who overdosed in front of her 2- year-old child. Fortunately, she received inpatient treatment, and now she is doing well. Others have not been so lucky. Like cities and counties all across America, Stratford has a months-long waiting list for those needing treatment. When people with substance use disorders are turned away, they remain on the streets--desperate, often committing crimes to support their addiction, always at constant risk of a lethal overdose.
Vice News in New Hampshire recently profiled the opioid epidemic. The reporter interviewed one desperate user who said this:
I tried to get help and stop, but at the treatment center they said I would have to wait 3 months. I had to go to the hospital and tell them I was going to kill myself just to get admitted.
That should not happen in America.
Another critical tool in the effort to stem the tide of this crisis is prescription drug monitoring programs. These State-run programs collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. We know that monitoring works. We have the data to show that it works, but only half of the 50 States are receiving Federal support.
The emergency supplemental amendment would include $50 million for the CDC to expand and bolster State drug monitoring programs. Our amendment also allocates $10 million to improve access in high-risk communities to medication-assisted treatment services for heroin and prescription opioids because numerous studies have shown the effectiveness in including medication in the treatment of some individuals with substance use disorders. Medications like methadone, buprenorphine, and naltrexone have been shown to reduce opioid use.
Our supplemental spending amendment would also speed emergency resources to law enforcement agencies. This Senator has heard from police in New Hampshire. They can't solve this problem by putting people in jail. They can help to solve it by putting traffickers in jail and by breaking up those networks that are supplying drugs.
In recent years, the opioid epidemic has spread to small towns and rural areas in every part of the country. If we went back to that first map of the United States, we could see just how much the spread has been to rural parts of this country. Heroin traffickers in New York expressly target New Hampshire, Vermont, and Maine--all States with a large rural population. We don't have any real urban areas in our States, but we can see the spread of those drugs in northern New England.
This amendment will provide $230 million in emergency funding for Edward Byrne Memorial Justice Assistance Grants, and $10 million for COPS Anti-Heroin Task Force Grants. The Byrne JAG Grant Program is the Nation's cornerstone crimefighting program. It has proved its effectiveness in each of our States, which is why it enjoys such strong bipartisan support. But the program has suffered cuts. In New Hampshire, we received $1.7 million in Byrne funding in 2007. Last year we received less than $1 million--almost a 50-percent reduction.
I had the chance to travel with Senator Hoeven down to our southern border of Texas last spring because we both are on the Appropriations Subcommittee on Homeland Security. We talked with some of our Customs and Border Patrol employees who were down on the border in Laredo and were interdicting drugs down on our southern border. One of the things they talked about is that drugs are coming across our southern border and they are going up the Interstate Highway System. They are going up Interstate 95 to northern New Hampshire. They are going up Interstate 35 through the middle of the country. We have to provide law enforcement with the funds they need to interdict those traffickers. We need an infusion of new funding to mobilize so that the programs are more aggressive for stopping opioid traffickers and dealers.
Our amendment requires that Byrne JAG funds be used directly to combat the opioid crisis for this emergency funding. That will allow for programs that emphasize treatment over incarceration, such as drug courts.
In New Hampshire we have seen what a difference it can make to have well-resourced, ambitious law enforcement initiatives. From May to December of last year, the High Intensity Drug Trafficking Areas Task Force, or the HIDTA Task Force, based in Bedford, NH, carried out Operation Trident. They draw on Federal, State, and local law enforcement resources in New Hampshire and Massachusetts. It makes sense because the more we cooperate, the more we can respond.
Operation Trident resulted in 240 arrests. They took down four major heroin fentanyl trafficking organizations. They dismantled three processing mills, and they seized more than $1.2 million in assets. What we have to do is continue to recreate these successes all across the country by moving aggressively to take down the gangs and other trafficking organizations that are feeding the opioid epidemic. To do that we have to provide the resources.
This emergency funding amendment doesn't create any new programs. Instead, we fund proven and effective initiatives like Byrne JAG and the substance abuse preventive and treatment block grants. These initiatives have earned bipartisan support because Senators have seen the good work it has done in each of our States. By allocating these emergency resources to these proven programs, this amendment will provide law enforcement and treatment professionals with the resources they need to go on the offensive to mobilize a real war on opioid trafficking and addiction.
Perhaps most importantly, our emergency supplemental funding amendment funds the programs that are included in the CARA bill. I want to thank Senator Whitehouse and other drafters of CARA, who have made important statutory steps and programmatic changes to improve programs that help treat addiction.
But CARA, as important as it is, is an authorization bill that doesn't provide any funding. If we support making the changes in the law that are included in the CARA bill, then we should also support the funding needed to make these programs work.
This chart shows a quote from the National Governors Association. Recently, they came together and they endorsed emergency appropriations to address this crisis. They wrote:
Governors applaud the introduction of legislation that would provide emergency assistance to states working on the front lines of the opioid crisis. . . . [I]nvestment is needed to help states mount an effective response to opioid addiction, from increasing prevention and education regarding the dangers of illicit drugs to strengthening state prescription drug monitoring programs, expanding access to addiction treatment and enhancing support for law enforcement.
The Fraternal Order of Police has endorsed this amendment, saying:
This bill will help our State and local law enforcement officers by giving them the necessary funding and tools to battle their communities' heroin and opioid problems. Something needs to be done.
Hon. Jeanne Shaheen, U.S. Senate, Washington, DC.
Dear Senator Shaheen: I am writing on behalf of the members of the Fraternal Order of Police to advise you of our support for your bill S. 2423, the ``Opioid and Heroin Epidemic Emergency Supplemental Appropriations Act.'' This legislation will make available $210 million to help law enforcement fight the heroin and opioid epidemic that is destroying our communities.
This bill will help our State and local law enforcement officers by giving them the necessary funding and tools to battle their communities' heroin and opioid problems. This funding will be used for expenses relating to drug treatment and enforcement programs, law enforcement programing, and drug addiction prevention and education programs. Something needs to be done and Congress is correct to provide law enforcement with the resources we need to combat this epidemic.
On behalf of more than 330,000 members of the Fraternal Order of Police, I thank you for your continued leadership and support of law enforcement. I look forward to working with you and your staff to get this bill through Congress to put an end to the heroin and opioid epidemic. If I can be of any additional assistance, please do not hesitate to contact me or my Executive Director Jim Pasco at my Washington office. Sincerely, Chuck Canterbury, National President.
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Mrs. SHAHEEN. We have also received support from groups such as the American Academy of Pain Management; the American Public Health Association; the American Society of Addiction Medicine; the Association of Women's Health, Obstetric and Neonatal Nurses; the Partnership for Drug-Free Kids; the American College of Physicians; and the National Association of State Alcohol and Drug Abuse Directors.
Connecticut Certification Board, Friends of NIDA, IC & RC, Illinois Alcoholism and Drug Dependence Association, California Consortium of Addiction Programs and Professionals, National Association of State Alcohol and Drug Abuse Directors, Partnership for Drug-Free Kids, Physician Assistant Education Association, SAI, Trust for America's Health. National Governor's Association Statement
Provide emergency supplemental funding to help states and communities turn the tide on the opioid epidemic. Governors applaud the introduction of legislation that would provide emergency assistance to states working on the front lines of the opioid crisis. Congress has provided billions in emergency aid to address natural disasters, security threats and other crises, including more than $5 billion last year to combat Ebola at home and abroad. A similar investment is needed to help states mount an effective response to opioid addiction, from increasing prevention and education regarding the dangers of illicit drugs to strengthening state prescription drug monitoring programs (PDMPs), expanding access to addiction treatment and enhancing support for law enforcement.
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Mrs. SHAHEEN. The question is, Why do we need emergency funding? Some of my colleagues have argued that additional funds are not needed because there was enough money for the opioid crisis in last year's omnibus. Yes, it is true there is additional funding for these programs in the omnibus. I sit on the Appropriations Committee; I was one of many on that committee who worked very hard to fight for those dollars. But with spending caps in place, these increases are modest at best.
The majority of my supplemental amendment appropriates resources to two programs: the substance abuse prevention and treatment block grant and the Byrne JAG Program. These programs have been critically underfunded in recent years. For example, the substance abuse prevention and treatment block grant received a small increase in the omnibus. That was good, but the reality is that over the last 10 years, funding for this program has not kept up with health care inflation. So we have a 26-percent decrease in the real value of funding despite the small increase we got in the appropriations process. In order to restore the block grant to its purchasing power from 10 years ago--10 years ago, before we had the explosion of the opioid and heroin crisis--just to get back to that level, Congress would need to allocate an additional $483 million for fiscal year 2017. My amendment provides $300 million for this program. It is a downpayment--only a downpayment--on where we need to be. The Byrne JAG Program has been flat-funded for the last 3 years.
Fifteen years ago--again, before the explosion of the heroin and opioid crisis--Congress provided more than $1 billion in support to State and local law enforcement through Byrne JAG and block grant funding. By 2015 that number had been reduced to $376 million. Right now, despite the explosion in this heroin and opioid crisis, we are providing only about one-third of the support we provided 15 years ago.
The reality is that criminal justice and prevention and treatment have been chronically underfunded and, as a result, deaths have continued to rise.
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Mrs. SHAHEEN. Thank you, Mr. President. I should be finished shortly.
We have talked to the Department of Justice and to Health and Human Services, and they are ready to get this funding out the door immediately because there is no time to wait. Law enforcement and health care providers on the frontlines need this money, and they need this money now.
In the past, Congress has risen to the challenge of epidemics. In 2009, Congress appropriated nearly $2 billion in emergency funding to fight swine flu, which claimed the lives of about 12,000 Americans. That emergency appropriations bill passed the Senate 86 to 3. Mr. President, 51 Senators who voted for that bill are still serving in this Chamber, including 23 Republican Senators and every Member of the Republican leadership. Last year, Congress approved $5.4 billion in funding to combat the Ebola outbreak in West Africa, an outbreak that killed only one American. Surely we can come together now, this year, in this session, to fight a raging epidemic here at home. We cannot avert our eyes from 47,000 Americans who are being killed by lethal overdoses each year. We cannot accept that 9 out of 10 Americans with substance abuse disorders go without treatment. We cannot avoid the fact that law enforcement officers in communities across this country are overwhelmed by aggressive drug traffickers and a rising tide of opioid-related crimes.
CARA will help fight the heroin and opioid epidemic in the longer term, but I urge my colleagues to also support this emergency supplemental funding amendment because it will provide urgent emergency funding to ramp up this fight in the months immediately ahead. This is a nationwide crisis, and it is time we mobilize a nationwide response that is equal to the challenge.
I urge my colleagues, I urge the majority leader to allow a vote on my amendment and to pass this out so we can give our local communities and States the resources they need.
The bill clerk proceeded to call the roll.
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