Energy and Water Development and Related Agencies Appropriations Act, 2016

Floor Speech

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Mr. DURBIN. Mr. President, I am honored to represent the State of Illinois. It is a big State. From Chicago to Carroll at the southern tip of our State is 400 miles, and, of course, there is more State north of Chicago. I traveled the State over the last several months, and last week I went to the southern tip of the State, worked my way through, came back through central Illinois, and was in the city of Chicago. There is one recurring challenge I find all across the State: No matter what community I visit, I have learned that there is no town too small, no suburb too wealthy, no city that has escaped the opioid and heroin epidemic we are now facing. America is losing more people to heroin overdose than we are to traffic accidents. It has become that common.

I try to have roundtables around the State--rural areas, suburban towns--and really try to get the picture of what is happening. I think I have come to understand it a little better because of this effort, and I would like to discuss it today.

The opioid/heroin crisis demands our immediate attention. It demands a comprehensive response involving local, State, and Federal Government, law enforcement agencies, and the private sector. For too long we have focused our efforts almost exclusively on responding to and treating addiction. That is a critical element, and I am not going to diminish it, but we need to look beyond that.

Yes, we need to make sure substance abuse treatment is available. Right now there are some archaic laws in the Medicaid Program that restrict the number of beds one can have in a treatment facility. I see Senator Alexander from Tennessee has come to the floor, and he is chair of the committee that may consider this issue. He may be aware of the fact that many years ago we restricted the number of treatment beds in substance abuse treatment facilities to 16 beds. If we can imagine, for facilities treating the city of Chicago, 16 beds doesn't even touch the problem we are facing with addictions today, so I hope we can increase that number. I talked to Senator Collins of Maine, and she has run into the same thing in her home State, and I bet others have as well.

When it comes to treatment, there are things we must do, and this is one when it comes to Medicaid. But we have to do more than that. Simply dealing with substance abuse treatment, as important and critical as it is, is not enough. We need to look at the root causes of the issue.

Each year in America, the pharmaceutical industry produces 14 billion opioid pills--14 billion. That is enough to provide every adult in America a 1-month prescription of opioid painkillers. There is a definite need for these painkillers and pain management. The Centers for Disease Control estimates that 14 to 16 percent of Americans face chronic and acute pain. I want to be sensitive to their needs and make certain they have the kind of pain relief and pain management they desperately need every single day, but what we have now is a market in America flooded with these opioid pills. The number of opioid prescriptions has risen dramatically, from 76 million prescriptions in 1991 to 245 million in 2014--more than triple the amount. The United States is the largest consumer of opioid pain pills, accounting for almost 100 percent of the world's total consumption of hydrocodone and 81 percent of OxyContin.

There are a number of reasons we have seen the sharp rise in the number of opioids being prescribed over the last two decades: There is increased attention on identifying and treating pain; there is perceived financial incentive in some cases to overtreat pain; and there is a lack of insurance coverage for alternative pain treatment modalities. However, the single largest reason behind the dramatic increase is the production on the pharmaceutical side.

The dramatic increase in prescriptions for these addictive pain killers can be directly linked to Purdue Pharma introducing OxyContin in the late 1990s. Between 1996 and 2002, Purdue Pharma funded more than 20,000 pain-related educational programs for doctors through direct sponsorship or financial grant and launched a multifaceted campaign to encourage long-term use of OxyContin for chronic, noncancer pain. They, of course, promoted their pills to doctors and patients on the false promise that these powerful painkillers could relieve pain for up to 12 hours in many patients. When clinical trials and physicians' and patients' feedback showed that OxyContin didn't last for that full period, Perdue Pharma refused to explore other dosing intervals. Instead, they urged doctors to increase the dosage, leading to highs and lows of crippling addiction and overdose.

The recent guidelines released by the Centers for Disease Control and Prevention recommended against using opioids for chronic, noncancer pain management, but by this point Perdue Pharma had opened the door for others to follow. From 1972 to 2015, the Food and Drug Administration has approved more than 400 different opioid products-- 100 brand-name drugs and more than 300 generic versions. The pharmaceutical industry is flooding our communities with greater and greater quantities of these drugs. Between 1993 and 2015, the production of hydrocodone increased twelvefold, the production of hydromorphone increased twenty-three-fold, and the production of fentanyl increased twenty-five-fold. As I mentioned earlier, there are approximately 14 billion prescription opioid pills on the market in America every year.

What has been the result of this overproduction and overprescribing? Nearly 2 million people in the United States are currently addicted to opioids. We have seen alarming increases in opioid-related emergency room visits and treatment admissions for abuse. In 2014 opioids were involved in 28,647 deaths in America. In 2014 Illinois had 1,652 opioid-related drug overdose deaths--a nearly 30 percent increase over 2010. Each week in Illinois, we average eight deaths due to prescription drug overdose.

And it doesn't stop there. In so many cases, prescription opioid abuse leads to heroin addiction. Four out of five current heroin users say their addiction began with prescription opioids. It is heartbreaking to have these roundtables in communities and to sit across the table from recent graduates from high school who tell the story of having been addicted in high school for years, and then when they couldn't afford the expensive pills, they switched to heroin, which was cheaper and in many cases for their friends, deadly.

The United States currently has 467,000 heroin addicts. Between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled, with more than 8,200 people dying from heroin in 2013.

It is time to change. We need a comprehensive solution. We need it now. We have to prevent these drug companies from flooding the market with excessive amounts of addictive pills. We can't sit idly by while they tell us these powerful painkillers are safe. We know better. We must encourage the Drug Enforcement Agency and the FDA to use their authority to keep unnecessary, unsafe drugs off the market, and we must crack down on doctors and providers who are overprescribing.

Let me repeat. People suffering chronic and acute pain need help. They need pain relief, and they need pain management. I will never stand in their way. But we know from the volume of painkillers that are being prescribed that there are many people who are abusing.

I shared with four major medical societies a recent letter asking them to help us help our Nation combat this epidemic. I want them to endorse mandatory continuing medical education programs for those who prescribe opioids--doctors and dentists. They should support proposals to require that physicians and dentists check prescription drug monitoring databases before they prescribe opioids to patients, ensuring that these patients aren't just doctor shopping, and they should increase awareness and transparency in physician- prescribing practices, as well as proper accountability and intervention.

Every stakeholder in this complex opioid epidemic has played a role in reaching this dreadful point, and now every stakeholder has a responsibility to help us address this crisis.

The Senate passed a bill earlier this year that has some good provisions and authorizes new programs, but it did not go far enough. It didn't provide additional funding for the crisis. Simply passing an authorizing bill and giving stirring speeches on the floor of the Senate is not going to solve the problem. It didn't address the overprescription of opioids, and it is time for us to be honest about this. I recently heard one of our leaders on this subject tell us: Well, we are going to start teaching the new doctors in medical school not to make the same mistakes. I am sorry, but that is not good enough. Those who currently have the legal authority to prescribe have to change their ways to stop this epidemic. And the bills we considered didn't address the overproduction of these addictive drugs.

We can't solve this massive American problem with half measures. We need to come together--Congress, local government, law enforcement, health care providers, drug companies, doctors--to help solve this problem, and we need to do it as soon as possible.
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