On Senate Floor, Portman Discusses the Opioid Epidemic, Introduction of the Bipartisan CARA 2.0 Act
WASHINGTON, D.C. – U.S. Senator Rob Portman (R-OH) delivered remarks on the Senate floor today discussing the nature of the opioid epidemic gripping our country as well as the introduction of the bipartisan CARA 2.0 Act. This bill will build on the success of the Comprehensive Addiction and Recovery Act (CARA), provide additional resources to help turn the tide of addiction, and put in place policy reforms that will strengthen the federal government’s response to this crisis.
Said Portman in his speech, “This is a national crisis, and the national government needs to be a much better partner with state government, local government, communities, non-profits, those who are out there doing the hard work. This $6 billion commitment that has now been made over the next two years is a real opportunity to help turn the tide…CARA 2.0 gives us that opportunity. It represents the next step towards helping our communities address this epidemic and helping our communities heal.”
Transcript of his speech can be found below and a video can be found here.
“Today I want to talk about the opioid epidemic that is gripping our country. Every state represented in this chamber has had too many communities devastated, families broken apart, and lives taken by opioid overdoses. The Centers for Disease Control (CDC) now tells us that more than 63,000 Americans died from drug overdoses for the last year for which they have records, which is 2016. It also looks like it was worse in 2017.
“More Americans are dying from drug overdoses [in 2016] than the total number of casualties during the Vietnam War. Think about that. It’s a staggering statistic. On average, more than 174 Americans died every single day from a drug overdose in 2016, that’s up from 143 Americans in 2015, and 105 Americans in 2010. In other words, it’s getting worse. 2016 was the deadliest year on record, and for 2017 it is estimated to be even deadlier, including my home state of Ohio. Opioids—prescription drugs, heroin, synthetic forms of heroin—are increasingly the reason why.
“Opioids were involved in over two-thirds of overdose deaths in 2016. Opioid overdose deaths were five times higher in 2016 than they were just back in 1999. In the past 17 years, we have seen a five-fold increase in these overdose deaths. It's a national epidemic, and it has unfolded in three different waves. It started with prescription drugs, overprescribing of prescription drugs, pain pills, the pill mills that we saw in Southern Ohio and around our state. This exploded about 15 to 20 years ago. Next, the heroin deaths. Heroin moved in and spiked as people moved to less expensive and more accessible alternative than prescription drugs. And now, I hate to tell you, there’s a new danger, and a threat, and it is deadlier than ever. It is these synthetic opioids, fentanyl and carfentanil that have moved into our states, overcoming our law enforcement, and the results have been deadly.
“By the way, it is a crisis that does not discriminate. Opioid addiction affects everybody regardless of age, area code, class, and color. In Ohio, drug addiction and acts committed to support it have become the number one cause of crime in our communities—probably the same in your community. Employers, of course, are increasingly pointing to the inability to find workers who can pass a drug test. They cannot fill vacant positions. There is new data of people who are not showing up on the unemployment rolls but have given up looking for work altogether. There are nine million men between 25 and 55 who are considered to be able-bodied who are not looking for work. There are troubling statistics out there indicating that there is maybe as many as half, one study says 48 percent, where those individuals are taking opioids on a daily basis.
“This is affecting all of us. Every aspect of our community is affected. Everyone has a role to play in overcoming this epidemic. There is an urgency in coming up with better strategies to turn the tide on addiction. Although progress has been made recently, and is starting to be made in my state and other states, much more needs to be done—and done urgently.
“Part of that starts with understanding that addiction is a disease and that it is treatable. The appropriate response should include much more aggressive prevention and education, absolutely, more aggressive law enforcement—keeping deadly fentanyl out of our community through the STOP Act and other means, of course—but we also have to get more effective treatment strategies.
“We have a couple hundred thousand people in Ohio who are addicted. We need to get them into treatment, including more effective detox, medication-assisted treatment, and longer-term recovery. We know that, coupled with the right kind of therapy and right kind of support and help, people can get into recovery, get back to their families, get back to work, and get back to being productive citizens. We also know that recovery results are a lot better with that kind of continuous support. Closing the gaps that occur is key to overcoming addiction.
“There’s a gap between the crisis response, which is often a first responder, like the two brave officers I talked about earlier, find someone who has overdosed. Often it’s firefighters as well providing Narcan that reverses the effects of an overdose. That is incredibly important to save lives. But Narcan alone is not sufficient. The key is to then get those people into detox, and into treatment, and into longer-term recovery.
“The gaps we have out there between crisis response, and Narcan, and then going to detox, and then going to treatment, and then going to recovery, is creating a lot of the problems with the inability to solve this problem. I can't tell you how many people I met. I met a couple of thousands of addicts or recovering addicts in the last few years, and what they tell me is, yeah, ‘I tried treatment, but it was for six, seven, eight weeks, and then there was nothing for me. It didn't work for me.’ Or people who overdosed, not once, not twice, but several times, and they were never then in detox and treatment. One young man I spoke to last weekend has been an addict for seven years. Finally, his brother convinced him to seek help. And the last time he overdosed he did go into detox and did go into treatment and through a facility where the gaps were closed, where there was no waiting time, and he was able to get the help rather than going back to his community and his old friends and a situation that was going to lead him back into more use and more addiction.
“The key, again, is to get those who have overdosed into the treatment they need. Overdose reversal provides a second chance at life. Let’s face it. Some of these people who are overdosing come out of this after Narcan is administered and they've seen their life flash before their eyes, and they are ready, ready for something. We have to be ready for them. Overdose reversal provides a second chance at life, it is treatment and longer term recovery that provides them a second chance to live addiction free. Again, to get back to work, back to family, and back to productive life.
“It takes a comprehensive solution because it’s a comprehensive problem. That’s what led some of us here in this body, including my colleague Senator Sheldon Whitehouse and me to introduce the Comprehensive Addiction and Recovery Act, or CARA, back in 2015. We developed that bill over time by relying on experts in the field and those most affected by addiction. Beginning in 2014, when we were in the process of putting together the legislation, we hosted five national forums here in Washington, D.C. We brought experts and practitioners in from around the country. Prevention, treatment, law enforcement, recovery community.
“We wanted to get the best practices to find out what was working and what wasn't working, how we could improve the response, and what role the federal government could play in all of this. We had forums focused on the science of addiction to understand that better, evidence-based prevention strategies actually worked, treating pregnant women who were addicted and babies who were at risk of being born drug dependent. There is nothing more heartbreaking than to go into the neonatal units in the hospitals in my home state and to see these babies who were born dependent, and watching them go through the painful withdrawal process as infants. Every neonatal unit in our country has seen this. If you go to your own hospital, they will tell you this is an increasing problem. We had veterans come in and experts on how to help veterans make that transition because sadly the use of opioids among veterans is also increasing. Sometimes using opioids for injury, for accidents, for PTSD, they become addicted. How do you build support around those veterans? We also had people come in and talk about longer-term recovery, over-housing, and how you can, over time, get better results if you provide those kinds of services.
“Our goal was to leverage the expertise and perspectives of everyone involved in this epidemic, to find best practices and to create an evidence-based education, treatment, and recovery bill that works. With strong bipartisan support, we moved from hearings, to a unanimous committee markup, to Senate passage of this legislation. By the way, it passed with a vote of 92-2. That's not typical around here, certainly not for something so comprehensive. And yet, everybody has experienced this back home and is desperate to figure out strategies to help.
“In July of 2016, President Obama signed CARA into law. It was the first comprehensive addiction reform in more than 20 years and the first time Congress had ever provided any support or help for this longer-term recovery piece. It targets prevention education resources to prevent abuse before it even starts, the most effective way. It helps first responders reverse overdoses to save lives. It devotes resources to evidence-based treatments and recovery programs. It expands prescription drug take-back programs to get addictive pain pills off the bathroom shelves. It authorized more than $180 million to assist communities in these efforts to combat this epidemic. And, frankly, because of this crisis, the appropriation bill that then spent that money decided, you know, we need this so badly we're actually going to appropriate more than the $180 million. They appropriated $267 million this last year, as an example, almost $100 million beyond our authorization. And again, I think it's beginning to make a difference.
“I see it back home in Ohio. I see some of these strategies beginning to work. It's going to take some time, and we need to do more. In Ohio, we have received about $4 million, and I say we—it is groups, it is people who are in the trenches doing the hard work. We have also made progress in this fight with separate opioid legislation that was part of the 21st Century CURES legislation. This is for substance abuse and mental health. Many of us fought successfully to help secure a two-year commitment there of $500 million a year, $1 billion. This goes directly to the states, states that are hardest hit, allowing states to decide how to spend that money. The first installment of that legislation awarded my state of Ohio with $26 million, and we're using every penny of it. I was at a facility over the weekend that gave me hope.
“It’s called the Maryhaven Addiction Stabilization Center in Columbus, Ohio. We talked earlier about the gaps, where people overdose that are provided Narcan, and then they go back to the community, and, what first responders will tell you is that sometimes, in the same week, in the same day in some occasions, there is another overdose and the revolving door continues without any treatment, without any solution. Maryhaven Stabilization Center is a response to that. They use the CURES money we talked about, they use some CARA funding from the county. The county is a broader strategy of where the CARA money went. They said let's put together an institution where we have an emergency room that focuses on overdoses.
“In Columbus, Ohio, I have been to other emergency rooms and seen what they do with the overdoses. They save lives. That's fantastic. But, frankly, these emergency rooms are equipped for everything—they have to be—for gunshot wounds, for car accidents, for trauma. This emergency room was focused specifically on overdoses, which makes it much more cost-effective but also much more effective for those recovering addicts, those addicts who were coming in. But most importantly, then, in that same facility, there is a detox center. In that same facility there are 50 beds for treatment.
“Whereas the typical case is somebody overdoses, goes to the emergency room and ends up going back to the community, back to home, back to the gang, back to the family, in this case, 103 people have gone through in the last month—it’s only been open a month—80 percent of them have gone into treatment. I got the opportunity to meet someone who had been through that process and talked about the difference this makes. You literally walk through the door into treatment, and there is a strong encouragement to do it, and it is working.
So, these are the kinds of things that are going to make a difference in our communities. It seems common sense but, frankly, it’s not happening in other places. Programs like this are what is going to help us overcome addiction and are examples of how federal funds can be used more effectively to leverage, in this case, a lot of private dollars, some state dollars.
“Both of these landmark laws, the CARA Act we talked about and the CURES Act, are providing increased resources to local communities, but again, this problem is not getting better. It’s getting worse. One of the problems is the availability and the low cost of these highly addictive, even more dangerous drugs coming in that are synthetic opioids. Fentanyl is 50 times stronger than heroin, on average. It's coming in through the mail. Again, we need to do more to stop it through law enforcement, but also we need to acknowledge it's being sprinkled in other drugs and creating a lot of these addictions, overdoses, and higher rates of death.
“The degree of damage it’s causing our communities, our families, our budgets locally, our criminal justice system, requires us to take a more aggressive stance, to do more, to figure this out. We need to strengthen our resolve. And again, we made progress recently with the bipartisan budget agreement that President Trump just signed into law a few weeks ago. There we included an additional amount of funding, $6 billion over two years to help combat the opioid epidemic. So, instead of the $500 million a year and the $260 million a year I talked about, it would be $3 billion a year, and then $3 billion the year after.
“I believe that the evidence-based programs we set out in the Comprehensive Addiction and Recovery Act provide a good framework as to how to spend that money effectively. That's why I’m pleased to stand here today as we introduce the next stage of this, CARA 2.0, to help provide a framework for how these funds to combat opioid addiction can be spent wisely. It's a road map for Congress to build on CARA's successes since becoming law.
“The bipartisan CARA 2.0 Act is being introduced by Sheldon Whitehouse and myself again but also six other colleagues, Shelley Capito, Amy Klobuchar, Dan Sullivan, Maggie Hassan, Bill Cassidy, and Maria Cantwell. It’s a bipartisan group of four Republicans and four Democrats who are passionate about this issue. It authorizes $1 billion a year for specific evidence-based drug prevention, education, treatment, and recovery programs.
“Look, it’s very important to have this $6 billion in funding over the next couple of years. We need it, but we have got to be sure it’s spent wisely. It’s not just a matter of throwing money after a problem. It’s a matter of being sure that we are effectively addressing the real issues. As I mentioned earlier, the longer-term recovery programs are what really helped those gripped by addiction to overcome this disease. That's evidence that we have. I have certainly seen a lot of evidence of that firsthand and countless examples of this where this longer-term recovery and the support networks is what gets people back on track, back with their families, back to work. We need to expand access to them, to those communities that are in need and to give everyone a second chance of living up to their own God-given potential.
“That’s why in this new CARA 2.0, we do increase the funding for recovery. In addition to expanding the reach of CARA's evidence-based programs, this bill puts in place new policy reforms to strengthen the government's response in so many ways. We take what some will consider a pretty dramatic step, and that’s to limit opioid prescriptions to three days for acute pain. Some will push back against that, but this is based, again, on good evidence and good research. When someone goes in for a simple procedure, say a wisdom tooth extraction, and that young person is given a bottle of opioids when he or she leaves, too often that leads to addiction. I don't want more parents coming up to me and saying, ‘my kid when he or she was a teenager was given these opioids by a doctor, a dentist, so we thought it was safe. Our child then turned to heroin because the pills became too expensive and less accessible, and then to fentanyl and overdosed and died.’ I have had two such parents come to me and tell me their story from Ohio. You probably know others.
“We need to ensure that these prescriptions are limited. For those who have chronic pain, those who have cancer, it wouldn’t apply. And after those three days you can go back to that doctor and say why you need it and explain it. Experts say about 80 percent of those who overdosed from heroin started on prescription drugs. I'm sure the same is true with regard to fentanyl. So, four out of five heroin addicts who overdose in my state of Ohio started on prescription drugs. We do need to deal with this over-prescription problem. By the way, the evidence says that after that fourth day, fifth day, sixth day, that's when you get into the bigger risk of becoming addicted to prescription drugs.
“As I mentioned, this epidemic started with an explosion of pain pill use 15 to 20 years ago. We need to stop the addiction at the source. For most people, that begins with prescription drugs. By ensuring clinicians prescribe the appropriate strength and supply of pain pills for non-life-threatening injuries, we can help stop so many more people from becoming addicted. The bill also includes legislation very similar to that which passed the Senate in 2015 but was dropped out in the House-Senate conference. It requires hospitals and doctors to use the prescription drug monitoring programs to be sure we're not overprescribing opioids for certain individuals. It helps us identify where the problems are and get people into treatment. It also requires states to share data with other states to prevent people from crossing state lines to get their prescriptions. One of our big problems in Ohio is that people can cross state lines in West Virginia, or Kentucky, or other states and get their prescription filled even though it's already been filled once in Ohio. We need to have across-state-lines prescription drug monitoring programs that work.
“CARA 2.0 is going to help turn the tide with this epidemic. The bill increases federal funds for specific evidence-based programs to better protect vulnerable groups, including infants, young adults, pregnant and postpartum women, veterans, as well as resources for community programs, medication-assisted treatment and first responders.
“As the title indicates, it’s a comprehensive solution. Every aspect of our communities are affected, so every aspect of our communities need assistance. The opioid epidemic is one of the most urgent challenges we face as a country. Ultimately, this crisis, by the way, is not going to be solved here in Washington, D.C. It’s not going to be solved by legislation we pass here. We get that. It’s going to be solved in our communities. It’s going to be solved in our families. It’s going to be solved in our hearts.
“But, this is a national crisis, and the national government needs to be a much better partner with state government, local government, communities, non-profits, those who are out there doing the hard work. This $6 billion commitment that has now been made over the next two years is a real opportunity to help turn the tide. Again, not by just throwing more money at the problem but by being sure that money is well spent on an epidemic that's taking too many lives and devastating too many communities.
“CARA 2.0 will build on our accomplishments and continue to give communities the resources they need to address this issue. Yes, we have made some progress around here, and that’s good, but we need to do much more.
“CARA 2.0 gives us that opportunity. It represents the next step towards helping our communities address this epidemic and helping our communities heal. Thank you, Mr. President. I yield back.”