Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act

Floor Speech

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Mr. NEAL. Mr. Chairman, I yield myself 4 minutes.

Mr. Chairman, I rise in support of H.R. 6.

It has become all too clear that the ongoing opioid epidemic has gripped our Nation's families and communities. It crosses social spectrums and is a public health, safety, and economic crisis as well.

In Massachusetts in 2016 there were 2,083 confirmed cases of opioid- related overdose deaths. This is a 26 percent increase from 2015 and a 54 percent increase from 2014. In 2017 there was a small decrease, but clearly there was still a strong need to address this devastating trend.

This week, the House has considered opioid bills in committee and on the floor, and some of these, in fact, will expand treatment options for the care that is necessary.

However, a number of the Democratic priorities here, I think, really provide real investment and opportunity. For example, it incorporates a bill I introduced that would expand Medicare coverage for opioid treatment programs. Currently, Medicare does not cover this sort of treatment. This would give Medicare beneficiaries access to a broad range of treatment options, leading to opportunities for lasting recovery.

Although many think of opioid use disorders as a problem faced by young people, many may be surprised to learn that it is rapidly growing among our Medicare beneficiaries. Medicare part D spending on opioids for treatment outpaces enrollment, growing 165 percent from 2006 to 2015. In 13 States, the over-65 population has the highest rate of opioid-related inpatient stays.

H.R. 6 also expands coverage of medication-assisted treatments and allows nurse practitioners and physician assistants to prescribe or dispense certain opioid treatment drugs. The measure also provides consistent Medicaid coverage for at-risk youth and expands Medicaid coverage for foster youth until the age of 26.

These bills are pieces of a large, complex puzzle. We need to find realistic solutions with long-term outcomes. Part of this approach is to protect and strengthen Medicaid and the Affordable Care Act.

The ACA guarantees parity and nondiscrimination for people who need substance use disorder treatment and mental health treatment. Thanks to the ACA, millions of previously uninsured adults now have access to health insurance and, I might add, the expansion of Medicaid.

There are many efforts here, I think, time and time again, to dismantle the Medicare proposal, as well as cutting back on many of the initiatives that we have proposed in the past. Instead of strengthening and ensuring a sustainable future for the ACA and for Medicaid, some of our colleagues want to cut them to pay for a $2.3 trillion tax plan. Efforts to sabotage the ACA, coupled with premium hikes, slashing preexisting condition protections, and increasing drug prices will lead to more uncertainty.

Dismantling current health benefits would damage any progress that we are making today with the opioid crisis. It would also increase healthcare costs and lower coverage and quality of life for Americans and their families.

I urge my colleagues to recognize that many families, who are devastated by addiction, are going to need the opportunities that we are embracing today.

The impact of the opioid crisis on the labor participation rates in America should concern all of us. According to a recent report, the economic burden from opioids was estimated at $95 billion.

The American people are facing two-pronged obstacle health challenges. Uncertainty remains one of them. We want to make sure that we don't sabotage the ACA. And part of the path forward today is highlighted by the achievement we are all about to recognize.

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Mr. NEAL. Mr. Chairman, I yield 4 minutes to the gentleman from Illinois (Mr. Danny K. Davis).

Mr. DANNY K. DAVIS of Illinois. Mr. Chairman, I thank Mr. Neal for yielding.

Mr. Chairman, I support H.R. 6 as a step to the puzzle to address substance abuse. However, I think we need to expand this bill in an important way as it moves forward.

To prevent opioid addiction, we must address the social and emotional harm caused by trauma that often underlies opiate use.

Research demonstrates that exposure to four or more adverse childhood experiences, such as neglect, experiencing a parent battling addiction, witnessing violence, or observing domestic violence, makes an individual 10 times more likely to misuse illicit narcotics. These drugs serve as a coping response to traumatic life experiences.

The Senate's bipartisan Opioid Crisis Response Act included provisions from my Trauma-Informed Care Act with Senator Durbin to help improve the Federal response to trauma to help prevent opioid abuse. These provisions would expand the workforce capacity to help children exposed to trauma, they would improve our understanding of trauma by improving Federal data and best practices, and they would increase services for children exposed to trauma to help these young people heal.

Our efforts to prevent the opioid crisis will be insufficient unless we address the role of trauma in it, which is why 28 organizations supported my effort to amend H.R. 6 to focus on trauma--organizations like the Child Welfare League of America, the Jewish Child and Family Services, the National Association of Social Workers, Partners for Our Children with the University of Washington, and the YMCA USA--but my amendment was not made in order.

The science is clear that trauma has devastating effects on a child's healthy development well into adulthood. When children experience traumatic events, stress alters the developing brain, which harms them physically and mentally.

Mr. Chairman, I include in the Record this outline of the research by the Society for Research in Child Development documenting the harm caused by trauma and parental separation.

[From the Society for Research in Child Development, June 20, 2018] Statement of the Evidence--The Science Is Clear: Separating Families Has Long-Term Damaging Psychological and Health Consequences for Children, Families, and Communities

After the United States Department of Justice announced the ``Zero olerance Policy for Criminal Illegal Entry,'' Immigration and Custom Enforcement (ICE--an arm of the Department of Homeland Security) separated approximately 2,000 children from their parents in April and May 2018 as they approached the U.S. border. Children and parents were placed in separate facilities as they were being processed and were not told when or how they would be reunited. This policy and its consequences have raised significant concerns among researchers, child welfare advocates, policy makers, and the public, given the overwhelming scientific evidence that separation between children and parents, except in cases where there is evidence of maltreatment, is harmful to the development of children, families, and communities. Family separations occurring in the presence of other stressors, such as detention or natural disaster, only adds to their negative effects. Evidence on Harmful Effects of Parent-Child Separation

The evidence that family separation is harmful dates back to studies on the effects of parent-child separations on children's well-being during World War II. This research documented far reaching effects of these separations into adulthood, including increased risk for mental health problems, poor social functioning, insecure attachment, disrupted stress reactivity, and mortality (Pesonen & Raikkonen, 2012; Rusby & Tasker, 2009; Mitrani, Santiste-ban, & Muir, 2004). Other research similarly documents the harmful effects of parental separation on child wellbeing in a variety of other child populations including children in Romanian orphanages (Zeanah, Nelson, Fox, et al., 2003), children in foster care (Flannery, Beauchamp, & Fisher, 2017) and children of incarcerated parents (Geller, Garfinkel, Cooper & Mincy, 2009; Miller, 2006). More recent work has documented the increased mental health risk faced by both parents and children when they are separated in the immigration process (Suarez-Orozco, Bang, & Kim., 2011; Rusch & Reyes, 2013). Parent-child separation has long-term effects on child well-being, even if there is subsequent reunification. After being separated, reunited children can experience difficulty with emotional attachment to their parents, self-esteem, and physical and psychological health (Smith, Lalonde, & Johnson, 2004; Gubernskaya & Debry, 2017). For some children, time does not appear to fully heal these psychological wounds (Shonkoff et al., 2012).

Parents Buffer Children from Adverse Effects of Toxic Stress

Parental separation is considered a toxic stressor, an experience that engages strong and prolonged activation of the body's stress-management system (Bridgman, 2014) The physiological and psychological toll of early life stress, including parental separation, changes how the body responds to stress in the long term, disrupting higher-order cognitive and affective processes as well as negatively altering brain structures and functioning (Lupien, McEwen, Gunnar, & Heim, 2009; Pechtel & Pizzagalli, 2011; Kumar et al., 2014). Such stressors put children at greater risk for a multitude of health and psychological impairments, including anxiety, depression, post-traumatic stress disorder, lower IQ, obesity, immune system functioning, physical growth, cancer, heart and lung disease, stroke, and morbidity (Granqvist, Sroufe, Dozier, Hesse, & Steele, 2017, Heim & Nemeroff, 2001; Mamam, Antornadis, & Morris, 2014; Pechtel & Pizza-galli, 2011; Shirtdiff, Coe, & Pollak, 2009; Taylor, 2010).

Children depend on their primary caretakers to successfully navigate stressful and traumatic events. Children's physiological responses to stress can be significantly reduced by access to their primary caretaker (Hostinar, Sullivan, & Gunnar, 2013). The separation of the family unit under extreme conditions of stress worsens the psychological and physiological ramifications of that stressor on children, especially younger children (Masten & Narayan, 2012). Conversely, ongoing contact with primary caregivers under conditions of stress can protect against risk (Rodriguez & Margolin, 2015).

Child-Separation from Parents Impacts Children at All Ages

Much of the research on family separation has focused on the impacts on children early in development. However, puberty is also an especially vulnerable time of rapid change (Doom & Gunnar, 2013). Stressors during adolescence can have lasting impacts--the effects of which may not become evident until adulthood--(Humphreys, Gleason, Drury, et al., 2015; Lupien, McEwen, Gunnar, & Heim, 2009). Further, the effects of traumatic experiences are cumulative; children and adolescents who have already faced previous adversity are particularly susceptible to long term further negative consequences (Brown, Anda, & Tiemeier, et al, 2009, MacKenzie, Bosk, & Zeanah, 2017) Thus, the research shows that across infancy, childhood, and adolescence, child-family separations can be related to negative outcomes across the lifespan. Impact of Border Family Separations on U.S. Citizens

There is also evidence that family separations harm U S. citizens whose family members experience border detention or deportation. Parental separation increases the risk for these U.S. children's mental health problems such as anxiety, depression, behavior problems, and symptoms of post-traumatic stress disorder (Allen, Cisneros, & Tellez, 2015; Rojas- Flores, Clements, Hwang Koo, & London, 2017; Zayas, Aguilar- Gaxiola, Yoon, & Rey, 2015). U.S. citizens of Latino descent also report heightened worries and concerns for their families and their communities as a result of changes in implementation of immigration policies such as the Deferred Action for Childhood Arrivals (DACA) policy (Roche, Vaquera, White, & Rivera, 2018). Moreover, countries with supportive integration policies are more likely to have child populations with better overall health and mental health indicators than those with less supportive approaches (Marks, McKenna, & Garcia Coll, 2018). Thus, there is evidence that policies about parental separations can negatively affect American citizens. The Policy Implications are Clear

The scientific evidence is conclusive. Parent-child separations lead to a host of long-term psychological, social, and health problems that are not necessarily resolved upon reunification. In particular, the disruption of biological stress regulation mechanisms in the body induced by the need to seek refugee or asylum status are further taxed by the absence of parental support. The science is clear: policies that separate immigrant families upon entry to the U.S. have devastating and long-term developmental consequences for children and their families.

Mr. DANNY K. DAVIS of Illinois. That is why the administration's intentional infliction of trauma on children by separating children from their parents is so cruel and inhumane. Causing intentional harm to children is a human rights violation and is un-American. We must stop this appalling policy immediately, reunite parents and children without delay, and provide intensive services to help these families heal.

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Mr. NEAL. Mr. Chairman, I yield myself the balance of my time.

Mr. Chairman, I want to close by thanking Chairman Kevin Brady and acknowledging Chairman Walden and Ranking Member Pallone for their hard work on what is really a good step forward.

As I said earlier in my remarks, this bill is not going to solve the opioid crisis tomorrow, but it does include a number of important provisions that will expand access to treatment and recovery options for all Americans. This was a bipartisan piece of work in our committee. I think we can be proud of it. We know many who need treatment now cannot access it, and this bill will take significant steps to change that.

I want to thank Jessica Shapiro and Karl Hagnauer from the House Legislative Counsel for their hours of work in helping us to put together H.R. 6; the staff of the Centers for Medicare and Medicaid Office of Legislation, in particular Ira Burney and Jennifer Druckman; and the staff of the Congressional Budget Office, including Rebecca Yip and Lara Robillard.

Finally, I want to thank the Ways and Means Republican staffers led by Emily Murry, the Energy and Commerce Democratic staff led by Tiffany Guarascio, the Energy and Commerce Republican staff led by Josh Trent, and my own Democratic staff at Ways and Means, which is always superb, led by Amy Hall, Melanie Egorin, and Rachel Dolin.

A lot of hard work goes into this sort of legislation and a lot of complexities have to be addressed during the process, and oftentimes that is not the sort of information that finds its way to the public light. But acknowledging here those people who helped to put this together as well as the men and women of the committee, I think, frequently is missed, and we want to do that so that they receive the, I think, due praise that they are entitled to.

I hope that this, when matched with Senate provisions, will quickly become law.

One of the things that unites every one of us in this Chamber is that we all know somebody--a family member, somebody who lives down the street, or a coworker--who has an opiate addiction. I think that Congress taking this step today in this direction will provide some sense of hope for those families and friends who find themselves, for a variety of reasons, suffering from the pain economically and physically that comes from opiate addictions.

I think, as we close here, this is a good day for the Ways and Means Committee, Energy and Commerce Committee, and, I think, for the members and the staffers whose work is reflected in this product.

Mr. Chair, I yield back the balance of my time.

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