Final Opioid Package to Include STOP Act, Legislation to Lift IMD Exclusion, the CRIB Act, CARA 2.0 Initiatives 

WASHINGTON, D.C. – On the Senate floor this afternoon, U.S. Senator Rob Portman (R-OH) urged his Senate colleagues to vote in a strong, bipartisan manner for the final House-Senate opioid package, which includes Portman’s bipartisan STOP Act and Improving CARE Act, as well as his bipartisan CRIB Act and a number of initiatives from his bipartisan CARA 2.0 Act. The opioid packaged passed the House last week. Next, the Senate will vote on the final measure before it is sent to the president’s desk for his signature. 

A transcript of his remarks can be found below and a video can be found here

 

“Mr. President, I come to the floor to talk about a few good things that happened here in Washington this week at a time when people are looking at Washington and wondering whether things are getting done. Let me just suggest on the floor this week we’re going to pass landmark legislation that deals with a crisis that we’ve got in our states, every single one of us, and that’s the opioid issue. I’ll talk about that in a minute. 

“Let me go to the one that will be voted on the floor I’m told sometime tomorrow. Probably tomorrow afternoon. This Senate will take up legislation that has now been passed in the House, passed in the Senate, and there’s been a conference committee between the two bodies and they’ve come up with a final product. I think the final product has a lot of good things in it that will help push back against the opioid epidemic that is growing in our country. On my way to Washington yesterday, I went by a memorial service for a young man who had died of an overdose, an opioid overdose. I’ve known him and his family for a long time, and it strikes close to home for pretty much everybody in this chamber, I’m sure, and pretty much everybody listening. When we have our town hall meeting and I ask this question, which I do regularly, ‘have you been affected by the opioid issue?’ Most people say yes. In parts of our state, Southeast Ohio where we had a tele-town hall recently, it was two-thirds of the people on the call said yes. 

“They have been directly affected and that’s because, sadly, this issue has grown to the point that 72,000 Americans lost their lives last year to the opioid epidemic. That’s more people than we lost in the entire Vietnam War. One year that many people died from opioid overdoses. It’s a grim statistic. And it’s a record level. Although Congress has done some good things the past couple of years passing legislation to help, those legislative efforts to have better prevention programs in place, more treatment offered, more longer-term recovery, more first responders with Narcan, this miracle drug that can reverse the effects of an overdose, that’s starting to happen but it’s being overwhelmed with the influx of drugs, particularly this new synthetic form of opioids that’s coming into our communities. Usually called fentanyl, sometimes it’s carfentanil, but this is resulting in my home state of Ohio and other states around the country with a much higher overdose death rate than even the horrible drugs like heroin and the prescription drugs that are causing these opioid addictions – cocaine, methamphetamines, crystal meth. This drug fentanyl is growing and growing rapidly. I will tell you in Ohio, we had about a 4,000 percent increase in fentanyl overdose deaths just in the last five years. Let me repeat that. A 4,000 percent increase of deaths from fentanyl. Over two-thirds of overdose deaths in Ohio are due for the synthetic form of opioids. 

“By the way, this stuff is coming from overseas. Mostly through our U.S. mail system. It’s outrageous that this is being permitted without the proper screening. So the legislation we’re going to vote on here this week, probably tomorrow afternoon, will finally put in place legislation called the STOP Act that we have worked on. Senator Klobuchar and I are the co-authors of it but we have worked on this for three years now to get it to this point. We had hearings. We had an investigation in the Permanent Subcommittee on Investigations to understand what was going on and how to deal with it, how to stop it. We found out unbelievably that the U.S. Postal Service is the main conduit for this poison. We found out the Postal Service was pushing back against putting additional screening in place. We also found out that the private carriers like FedEx, UPS, DHL were required for every single package to have advance electronic information provided to law enforcement to help stop this poison, to be able to find that needle in the haystack, that package out of the 500 million the Post Office deals with every year that might have this poison in it. Under this legislation, the STOP Act, now the Post Office is going to have to do what these other private carriers do and that’s really important. 

“Our investigation where we used undercover resources to be able to talk to websites, to find out what was being offered, to look behind the websites to find out what was really going on with this fentanyl issue, we found out that if you shipped it by the U.S. mail system, they guaranteed delivery but not if you shipped it through a private carrier. Why? Because they knew the private carriers had this electronic data provided in advance, what’s in it, where it’s going, where it’s from. And then law enforcement could use big data and figure out what packages are suspect and take them offline. I’ve seen that done at the distribution centers for these private carriers. I have also spent a lot of time talking to the Post Office about this. They are now going to implement this legislation. I hope aggressively. It requires 100 percent of packages within a couple of years to have this data on it right away. China is unfortunately the country where most of this is coming from, according to law enforcement. And it gives us the opportunity to be able to stop some of this poison coming into our communities. And that’s really important. 

“I will say getting that passed to me is just common sense. I think it’s overdue. I’m disappointed it took us this long. How many people had to die before Congress stood up and did the right thing with regard to telling our own Post Office you have to provide better screening? So it should be done. Having said that, that’s not going to solve the problem. Yes, having a cutoff of some of the supply of this poison is important. It stops it from coming into our communities to a certain extent and it’s going to raise the price on the street because you’re cutting the supply. That’s important because it’s so cheap and so powerful, 50 times more powerful than heroin. But that’s not the ultimate solution. The ultimate solution is us, isn’t it, in our hearts, in our families, in our communities to push back by having better prevention and education in place, by ensuring people who become addicted, who have this disease of addiction, have access to treatment to get them better so their lives can be turned around. They can go back to their families and their work and being productive citizens and longer-term recovery. Because we know shorter-term treatment isn’t very successful. That so many people relapse after a short-term treatment program but a longer-term recovery program with it with support, sober housing, with people who are recovery coaches who have been in recovery themselves that that is going to lead to a successful recovery themselves. Drug courts are very important in this. 

“This legislation we’ll vote on this week does have the STOP Act but also has these other pieces. It does reauthorize the drug court system as an example. Diverting people out of incarceration into drug courts where they agree that they’re going to go into treatment and stay clean with the risk of going back into prison or jail if they don’t. That has worked very effectively in parts of might state and around the country, as an example, to get people clean.

 

“The legislation also does something really important that some of us have been fighting on for years. We’ve had legislation to do this for the last three years but really it’s been about a 10-year battle. And this is this issue of treatment centers that receive reimbursement from Medicaid being capped at a certain number of beds with a certain number of days that people can stay. It’s called the IMD Exclusion, the Institutions for Mental Disease, or IMD, Exclusion. And this is an arcane part of federal law. It’s an example where, you know, well intended, years ago Congress said we’re going to put this limitation in place on treatment centers because we want to deinstitutionalize people, particularly in mental health facilities because we’ve had some examples of abuse in these institutional care settings and people aren’t getting the help that they need. So let’s limit the number of beds you can have in these treatment centers on the mental health side to try to deal with the problem. Then the opioid crisis comes. And I would argue even before the opioid crisis, this was true with regard to cocaine and meth and other things. But beds are at a premium in many places in our country. I have spots in Ohio that don’t have any treatment centers. I have communities that literally don’t have a place people can go. So what happens there is people go out of county or out of their communities to find a place where or they simply don’t find treatment. Other examples where people go to a treatment center and they’re told, ‘sorry, you’ve got to come back in a couple of weeks. We just don’t have any beds.’ And there’s nothing more heartbreaking than talking to a family, talking to a parent as I have done who talks about, in this case, his daughter going to a treatment center with him, with his wife, she was finally ready and when you’re ready with this disease, with this addiction disease, you need to act. You need to get into treatment. She was ready but they told her there is no room at the inn, there’s no bed for you. You’ve got to come back in a couple of weeks. It was during those two weeks that she had a tough time. She overdosed again in their home and died. 

“That family is really happy about this legislation because this will say to these treatment centers, ‘you’re not going to be capped at a certain number of beds. If you’re doing a good job and providing the kind of treatment we want to have you provide, when we want you to be able to not be capped at a certain number of beds.’ So this is again a vestige of another time, this legislation that is currently in place with the 16-bed limit. This will enable us to be able to take that limit off and to be able to provide more treatment to so many Americans. 

“We also provided in this legislation that those who want to get this exclusion lifted also have to provide medication-assisted treatment, at least two kinds to people, which we know based on the evidence, depending on the person, is more successful. So you want to encourage people to offer medication-assisted treatment to get people off their addiction. It also says that it’s not limited to a certain kind of drug because there was some expansion of this in the previous legislation in the House. And some of us here in the Senate introduced a bill a few weeks ago that is very similar to our final product here that said let’s not limit it to just to those who have opioid addiction or just opioid addiction and cocaine addiction. Let’s open it up to people who have substance abuse addiction, which could be alcohol or crystal meth, which is growing in some of our states. It could be opioids. So we broadened it for individuals with substance abuse disorder. We have said that these institutions need to provide the best possible treatment, medication-assisted treatment, and we have been able through this legislative effort to be voted on here tomorrow to open up a whole other possibility for people who are addicted. 

“Again it’s something we’ve worked on for many years. It’s important that we expand these services. It’s important that we tell people that if you’re ready, we’re going to find a treatment center for you because we want these people to get better. Most people who are addicted, we’re told, don’t seek treatment. Probably eight out of 10 don’t. One of the tricks is how to you get these people into treatment and into treatment in a way that’s comprehensive where there are not big gaps between the overdose and the Narcan being applied. You want to be sure there’s not a gap before treatment because people go back to their old community. Unfortunately there’s too many cases of people overdosing again and again so get them into treatment. But then from treatment to longer-term recovery, how to smooth that gap out so people are handed off to a facility or to an outpatient program that can help them to ensure a greater level of success. 

“And then how to you have this ability to say to people ‘we’re going to be there for you?’ Because unfortunately, particularly with this opioid addiction, all the evidence coming in shows that long-term care really helps. So again, Congress has taken some steps already in the last couple of years with the CURES Act and the Comprehensive Addiction and Recovery Act, the so-called CARA legislation. There’s more going on in our states. I visited about a dozen different places in our state where they’re taking advantage of the funding from the Comprehensive Addiction and Recovery Act, legislation I co-authored a couple of years ago with Sheldon Whitehouse on the other side. It’s starting to work. It’s closing some of these gaps we talked about. The CURES legislation goes right back to the states. Ohio got about $26 million last year for that. It’s very helpful for us because we’re struggling to provide enough resources for treatment particularly. And then now we have this additional bill to build on CARA and CURES. This will, I think, have the effect over time of reversing what we’ve seen as a terrible and deadly trend, which is more and more Americans overdosing, dying, not being in the workplace, not being with their families, not being productive citizens. 

“This is something that affects every single one of us. If you go to your hospital, you’ll see the emergency room is overburdened. If you go to your NICU unit where the babies are being born who are addicted, babies who have this neonatal abstinence syndrome, these babies have to be taken through withdrawal. How sad. Innocent babies have to be taken through withdrawal because they’re born to a mother who was using, who was addicted. These are all things that must be addressed and can be, and again our legislation is going to help to do that. But again, I will say that as much progress we’re making on the education and treatment and recovery and with our first responders and helping, as long as you have this deadly poison coming in, this fentanyl, the synthetic opioid that is 50 times more powerful than heroin and relatively inexpensive because it’s being made by some evil scientist somewhere out of synthetics, out of chemicals, as long as you have that overwhelming the system, it’s hard to see us reversing the trend. That’s why the STOP Act is so important here. 

“We also reauthorized the HIDTA program for High Intensity Drug Trafficking Areas. We’ve pushed back on the supply side, we need to do more in terms of the demand side. With that, I will predict that when all this is implemented properly, we will see some hope at the end of this dark tunnel. We will see fewer funerals like the one that I was at yesterday. Instead what we’ll see is families beginning to be able to come back together, people beginning to have the opportunity to achieve their God-given potential in life, whatever it is. God’s purpose for these addicts certainly isn’t to continue to be an addict. His purpose for them is to have a meaningful life and for all of us, it’s in all of our interests. I hope we can pass this legislation tomorrow. Get it to the president. He will sign it, get it out to our states and communities and begin to make the difference that can indeed begin to reverse this terrible epidemic, reverse the tide. I yield back my time, Mr. President.” 

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