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

Floor Speech

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Mr. MARKEY. Mr. President, I rise today to speak about the pending legislation to address the opioid epidemic--a crisis the likes of which we have never seen in America. All of us know that this crisis is a nightmare. It is a scourge. The prescription drug, heroin, and fentanyl epidemic is a human tragedy unfolding every day in homes, in alleyways, in bathrooms, the back seats of cars, in nearly every city and town of our country.

Preliminary estimates indicate that opioid overdoses claimed an estimated 49,000 lives just last year, including nearly 2,000 people in Massachusetts. That is more than gun violence. That is more than car accidents. The opioid epidemic is the deadliest drug overdose crisis in American history. A crisis of this proportion demands action at all levels, and I am pleased that the Senate is taking a step in that direction today.

I would like to thank Senator Lamar Alexander and Senator Patty Murray and their staffs, as well as the leadership and staffs of the other committees, who worked to create and refine the legislative package we will be voting on later this evening.

This bill contains a number of proposals that will help families and communities struggling day in and day out to respond to the opioid overdose crisis. One of those proposals is my bipartisan Opioids Milestones Act, a bill I authored with Senator Lisa Murkowski and Senator Maggie Hassan to create a scorecard for our Nation's response to the opioid crisis.

The Milestones Act will require the Federal Government to both set tangible benchmarks for how we are addressing the opioid crisis in our country and measure progress on key objectives every single year. When people are sick, they get a treatment plan. The United States of America needs a nationwide treatment plan for fighting the opioid crisis, and that is what this provision will create for our country. Those objectives include reducing overdose deaths, expanding treatment availability, increasing the number of individuals in sustained recovery, and decreasing emergency room visits for overdoses.

If we don't have a dashboard--a scorecard--to clearly and quantifiably show our progress on this epidemic, we will continue to fight the same battle over and over again. We urgently need to know whether our policies and resources are being used in ways that have a measurable impact on the public's health. The Milestones Act provision in this bill will provide a national roadmap for ensuring that our Federal and State resources pay lifesaving dividends. That is my goal, that is Senator Murkowski's goal, and that is Senator Hassan's goal, and it is in the bill.

This type of strategy was put in place to fight the HIV/AIDS epidemic in America--another disease that was surrounded by stigma, inaction, and the lack of research until advocates, scientists, healthcare providers, and policymakers joined forces to chart a path forward and to make measurable progress. While that war is not yet won, new HIV diagnoses and deaths have declined dramatically over the past two decades in the United States.

When America has a plan, America wins. That is why I am pleased that this legislative package includes important bipartisan legislation that I introduced with Senator Todd Young and Senator Tammy Baldwin to help address increasing rates of infectious diseases like HIV caused by injection drug use.

With more than 220 counties across the United States at risk of a hepatitis C or HIV outbreak related to the opioid crisis, we cannot afford to wait any longer to arm our States with the tools needed to tackle the public health consequences of this epidemic. Massachusetts had more reported cases of hepatitis C than any other State in 2015-- the same year we peaked in overdose deaths caused by illicit opioids.

The public health consequences of the epidemic are life-and-death. One recent study published in the American Journal of Public Health roughly estimates that 510,000 people could die over the next decade due to opioid-related causes, which include overdoses as well as other causes of death tied to opioids, such as HIV infections from sharing syringes. That is what Senator Young and I are trying to deal with. We are trying to deal with this issue so that we can create the tools that help us to deal with this growing medical problem in our country.

This provision will help ensure that the Federal Government works with States to improve education, surveillance, and treatment of opioid use-related infectious diseases like HIV and viral hepatitis, but we have more work to do to combat this crisis. If we are going to reduce the supply of heroin, fentanyl, and illicit prescription opioids, then we have to reduce the demand through treatment. That must include increasing access to effective medication-assisted treatment, or MAT.

Only about 1 in 10 individuals with a substance use disorder will be able to access treatment. That is unconscionable and demands immediate action. That is why as part of the Comprehensive Addiction and Recovery Act--or the CARA bill of 2016--Senator Rand Paul and I worked together to include provisions that would, for the first time, allow physician assistants and nurse practitioners to prescribe lifesaving medication- assisted treatment, like SUBOXONE, for individuals with substance use disorders.

Since these provisions went into effect, more than 8,000 physician assistants and nurse practitioners have registered to provide medication-assisted treatment. That has resulted in more Americans accessing this lifesaving care, especially in community health centers and rural communities across this country. For doctors and medical professionals, MAT stands for medication-assisted therapies, but for those with an opioid use disorder, expanding MAT means more access to treatment.

Nurse practitioners and physician assistants want to respond to the demand side of the opioid crisis, and they are stepping up in a major way to connect individuals to the treatment they need. Unfortunately, the authority nurse practitioners and physician assistants have to prescribe this lifesaving treatment expires in a few short years. If we don't intervene now, a substantial amount of our current prescriber population will no longer be able to treat individuals with substance use disorder using this effective treatment. That will further strain our already woefully inadequate treatment workforce.

That is why Senator Paul, Senator Hassan, Senator Collins, and I introduced new, bipartisan legislation to provide permanent MAT prescriber authority for nurse practitioners and physician assistants. Our bill also extends this authority to other nursing professionals already playing an important role in our fight against the opioid crisis--certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists. These dedicated nursing professionals are irreplaceable members of our healthcare community, and we need to make sure they can provide treatment that saves families from the suffering of addiction.

The legislative package we are voting on today in the Senate unfortunately does not contain this bipartisan legislation on medication-assisted treatment. This is a missed opportunity to build upon our commitment to treatment. But the House-passed opioid legislation does contain a version of our provision to make the prescriber authority for nurse practitioners and physician assistants permanent and to expand that authority to the other nursing professionals. I will continue working with my colleagues to ensure that this lifesaving provision makes it into the final opioid package negotiated between the House and the Senate leaders.

The bill we vote on today cannot be the end of our efforts to help solve the opioid overdose crisis. The opioid crisis knows no boundaries, and neither should our efforts to combat it. Not only must we expand access to treatment, we must also think about how we can help to prevent addiction from taking hold in the first place.

Last week, I introduced bipartisan legislation with Senator Orrin Hatch to help ensure that patients and their loved ones understand the risks of prescription opioids. I have heard too many stories about substance use disorders that began from an opioid prescribed to an individual injured on the job who needed to feel well enough to return to work the next day, or to help heal a sports injury. That is the story of Cory Palazzi from Taunton, MA.

In high school, Cory was a varsity baseball and football athlete and a member of the National Honor Society. He had a love for the game of baseball. For him, the baseball diamond was the happiest place on Earth.

In his junior year, Cory suffered a shoulder injury that required surgery. After surgery, Cory was prescribed opioid painkillers and became addicted to his medication. His painkiller addiction eventually became a heroin addiction, and in 2013, Cory suffered a heroin overdose, which has left him permanently disabled.

Cory and his family, Lori and Dave, have turned this tragedy into triumph. Today, they share their story in schools and other organizations to warn the public about the dangers of drugs and offer a message of hope for those who are faced with addiction. We thank them for their courage, for their strength, and for their commitment to ending this crisis.

The Palazzi family know firsthand that prescription opioids are dangerous, but because of the confusing names and ingredients, many families may not know that they have just left the pharmacy with a bottle full of danger. The path from one bottle of pills--for patients who have had their wisdom teeth removed or suffered a sports injury--to addiction needs as many roadblocks put in place as humanly possible.

The legislation Senator Hatch and I have introduced--the Lessening Addiction By Enhancing Labeling Act, or the LABEL Opioids Act--would require that all prescription opioid bottles dispensed to a patient contain a clear, concise warning that opioids may cause dependence, addiction, or overdose.

In the absence of legislation to ensure that providers across the country receive uniform, mandatory education on safe opioid prescribing, we need to give patients information on how to safely use, store, and dispose of these dangerous medications. In the same way we put warning labels directly on cigarettes for being addictive and causing potential death, we need labels to caution patients about the dangers of prescription opioids. It is important that everyone who receives an opioid prescription understand the potential risks, and a sticker on an opioid pill bottle is a powerful, consistent reminder of that danger.

We must do all we can to put a stop to this dangerous opioid crisis that has ravaged families and communities across the country for too long. We are moving in the right direction, but today's vote should not be the end of our work on this issue.

I thank my colleagues in this Chamber for their commitment, and I look forward to working with them in the conference and beyond to make sure we put everything in law nationally that helps to ensure that children will have to look to the history books to find that there ever was such an epidemic as this opioid crisis.

Once again, I thank Senator Alexander and Senator Murray for their great work on this issue.

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