Congressional Record, Volume 162 Issue 34 (Wednesday, March 2, 2016)

[Congressional Record Volume 162, Number 34 (Wednesday, March 2, 2016)]
[Senate]
[Pages S1171-S1218]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

COMPREHENSIVE ADDICTION AND RECOVERY ACT OF 2015

The PRESIDING OFFICER. Under the previous order, the motion to
proceed to S. 524 is agreed to.
The clerk will report the bill.
The legislative clerk read as follows:

A bill (S. 524) to authorize the Attorney General to award
grants to address the national epidemics of prescription
opioid abuse and heroin use.

Thereupon, the Senate proceeded to consider the bill, which had been
reported from the Committee on the Judiciary, with an amendment to
strike all after the enacting clause and insert in lieu thereof the
following:

S. 524

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title.--This Act may be cited as the
``Comprehensive Addiction and Recovery Act of 2016''.
(b) Table of Contents.--The table of contents for this Act
is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Definitions.

TITLE I--PREVENTION AND EDUCATION

Sec. 101. Development of best practices for the use of prescription
opioids.
Sec. 102. Awareness campaigns.
Sec. 103. Community-based coalition enhancement grants to address local
drug crises.

TITLE II--LAW ENFORCEMENT AND TREATMENT

Sec. 201. Treatment alternative to incarceration programs.
Sec. 202. First responder training for the use of drugs and devices
that rapidly reverse the effects of opioids.
Sec. 203. Prescription drug take back expansion.
Sec. 204. Heroin and methamphetamine task forces.

[[Page S1172]]

TITLE III--TREATMENT AND RECOVERY

Sec. 301. Evidence-based opioid and heroin treatment and interventions
demonstration.
Sec. 302. Criminal justice medication assisted treatment and
interventions demonstration.
Sec. 303. National youth recovery initiative.
Sec. 304. Building communities of recovery.

TITLE IV--ADDRESSING COLLATERAL CONSEQUENCES

Sec. 401. Correctional education demonstration grant program.
Sec. 402. National Task Force on Recovery and Collateral Consequences.

TITLE V--ADDICTION AND TREATMENT SERVICES FOR WOMEN, FAMILIES, AND
VETERANS

Sec. 501. Improving treatment for pregnant and postpartum women.
Sec. 502. Report on grants for family-based substance abuse treatment.
Sec. 503. Veterans' treatment courts.

TITLE VI--INCENTIVIZING STATE COMPREHENSIVE INITIATIVES TO ADDRESS
OPIOID AND HEROIN ABUSE

Sec. 601. State demonstration grants for comprehensive opioid abuse
response.

TITLE VII--MISCELLANEOUS

Sec. 701. GAO report on IMD exclusion.
Sec. 702. Funding.
Sec. 703. Conforming amendments.
Sec. 704. Grant accountability.

SEC. 2. FINDINGS.

Congress finds the following:
(1) The abuse of heroin and prescription opioid painkillers
is having a devastating effect on public health and safety in
communities across the United States. According to the
Centers for Disease Control and Prevention, drug overdose
deaths now surpass traffic crashes in the number of deaths
caused by injury in the United States. In 2014, an average of
more than 120 people in the United States died from drug
overdoses every day.
(2) According to the National Institute on Drug Abuse
(commonly known as ``NIDA''), the number of prescriptions for
opioids increased from approximately 76,000,000 in 1991 to
nearly 207,000,000 in 2013, and the United States is the
biggest consumer of opioids globally, accounting for almost
100 percent of the world total for hydrocodone and 81 percent
for oxycodone.
(3) Opioid pain relievers are the most widely misused or
abused controlled prescription drugs (commonly referred to as
``CPDs'') and are involved in most CPD-related overdose
incidents. According to the Drug Abuse Warning Network
(commonly known as ``DAWN''), the estimated number of
emergency department visits involving nonmedical use of
prescription opiates or opioids increased by 112 percent
between 2006 and 2010, from 84,671 to 179,787.
(4) The use of heroin in the United States has also spiked
sharply in recent years. According to the most recent
National Survey on Drug Use and Health, more than 900,000
people in the United States reported using heroin in 2014,
nearly a 35 percent increase from the previous year. Heroin
overdose deaths more than tripled from 2010 to 2014.
(5) The supply of cheap heroin available in the United
States has increased dramatically as well, largely due to the
activity of Mexican drug trafficking organizations. The Drug
Enforcement Administration (commonly known as the ``DEA'')
estimates that heroin seizures at the Mexican border have
more than doubled since 2010, and heroin production in Mexico
increased 62 percent from 2013 to 2014. While only 8 percent
of State and local law enforcement officials across the
United States identified heroin as the greatest drug threat
in their area in 2008, that number rose to 38 percent in
2015.
(6) Law enforcement officials and treatment experts
throughout the country report that many prescription opioid
users have turned to heroin as a cheaper or more easily
obtained alternative to prescription drugs.
(7) According to a report by the National Association of
State Alcohol and Drug Abuse Directors (commonly referred to
as ``NASADAD''), 37 States reported an increase in admissions
to treatment for heroin use during the past 2 years, while
admissions to treatment for prescription opiates increased
500 percent from 2000 to 2012.
(8) Research indicates that combating the opioid crisis,
including abuse of prescription painkillers and,
increasingly, heroin, requires a multi-pronged approach that
involves prevention, education, monitoring, law enforcement
initiatives, reducing drug diversion and the supply of
illicit drugs, expanding delivery of existing treatments
(including medication assisted treatments), expanding access
to overdose medications and interventions, and the
development of new medications for pain that can augment the
existing treatment arsenal.
(9) Substance use disorders are a treatable disease.
Discoveries in the science of addiction have led to advances
in the treatment of substance use disorders that help people
stop abusing drugs and prescription medications and resume
their productive lives.
(10) According to the National Survey on Drug Use and
Health, approximately 22,700,000 people in the United States
needed substance use disorder treatment in 2013, but only
2,500,000 people received it. Furthermore, current treatment
services are not adequate to meet demand. According to a
report commissioned by the Substance Abuse and Mental Health
Services Administration (commonly known as ``SAMHSA''), there
are approximately 32 providers for every 1,000 individuals
needing substance use disorder treatment. In some States, the
ratio is much lower.
(11) The overall cost of drug abuse, from health care- and
criminal justice-related costs to lost productivity, is
steep, totaling more than $700,000,000,000 a year, according
to NIDA. Effective substance abuse prevention can yield major
economic dividends.
(12) According to NIDA, when schools and communities
properly implement science-validated substance abuse
prevention programs, abuse of alcohol, tobacco, and illicit
drugs is reduced. Such programs help teachers, parents, and
healthcare professionals shape the perceptions of youths
about the risks of drug abuse.
(13) Diverting certain individuals with substance use
disorders from criminal justice systems into community-based
treatment can save billions of dollars and prevent sizeable
numbers of crimes, arrests, and re-incarcerations over the
course of those individuals' lives.
(14) According to the DEA, more than 2,700 tons of expired,
unwanted prescription medications have been collected since
the enactment of the Secure and Responsible Drug Disposal Act
of 2010 (Public Law 111-273; 124 Stat. 2858).
(15) Faith-based, holistic, or drug-free models can provide
a critical path to successful recovery for a great number of
people in the United States. The 2015 membership survey
conducted by Alcoholics Anonymous (commonly known as ``AA'')
found that 73 percent of AA members were sober longer than 1
year and attended 2.5 meetings per week.
(16) Research shows that combining treatment medications
with behavioral therapy is an effective way to facilitate
success for some patients. Treatment approaches must be
tailored to address the drug abuse patterns and drug-related
medical, psychiatric, and social problems of each individual.
Different types of medications may be useful at different
stages of treatment or recovery to help a patient stop using
drugs, stay in treatment, and avoid relapse. Patients have a
range of options regarding their path to recovery and many
have also successfully addressed drug abuse through the use
of faith-based, holistic, or drug-free models.
(17) Individuals with mental illness, especially severe
mental illness, are at considerably higher risk for substance
abuse than the general population, and the presence of a
mental illness complicates recovery from substance abuse.

SEC. 3. DEFINITIONS.

In this Act--
(1) the term ``medication assisted treatment'' means the
use, for problems relating to heroin and other opioids, of
medications approved by the Food and Drug Administration in
combination with counseling and behavioral therapies;
(2) the term ``opioid'' means any drug having an addiction-
forming or addiction-sustaining liability similar to morphine
or being capable of conversion into a drug having such
addiction-forming or addiction-sustaining liability; and
(3) the term ``State'' means any State of the United
States, the District of Columbia, the Commonwealth of Puerto
Rico, and any territory or possession of the United States.

TITLE I--PREVENTION AND EDUCATION

SEC. 101. DEVELOPMENT OF BEST PRACTICES FOR THE USE OF
PRESCRIPTION OPIOIDS.

(a) Definitions.--In this section--
(1) the term ``Secretary'' means the Secretary of Health
and Human Services; and
(2) the term ``task force'' means the Pain Management Best
Practices Inter-Agency Task Force convened under subsection
(b).
(b) Inter-Agency Task Force.--Not later than December 14,
2018, the Secretary, in cooperation with the Secretary of
Veterans Affairs, the Secretary of Defense, and the
Administrator of the Drug Enforcement Administration, shall
convene a Pain Management Best Practices Inter-Agency Task
Force to review, modify, and update, as appropriate, best
practices for pain management (including chronic and acute
pain) and prescribing pain medication.
(c) Membership.--The task force shall be comprised of--
(1) representatives of--
(A) the Department of Health and Human Services;
(B) the Department of Veterans Affairs;
(C) the Food and Drug Administration;
(D) the Department of Defense;
(E) the Drug Enforcement Administration;
(F) the Centers for Disease Control and Prevention;
(G) the National Academy of Medicine;
(H) the National Institutes of Health; and
(I) the Office of National Drug Control Policy;
(2) physicians, dentists, and non-physician prescribers;
(3) pharmacists;
(4) experts in the fields of pain research and addiction
research;
(5) representatives of--
(A) pain management professional organizations;
(B) the mental health treatment community;
(C) the addiction treatment community;
(D) pain advocacy groups; and
(E) groups with expertise around overdose reversal; and
(6) other stakeholders, as the Secretary determines
appropriate.
(d) Duties.--The task force shall--
(1) not later than 180 days after the date on which the
task force is convened under subsection (b), review, modify,
and update, as appropriate, best practices for pain
management (including chronic and acute pain) and prescribing
pain medication, taking into consideration--
(A) existing pain management research;
(B) recommendations from relevant conferences;
(C) ongoing efforts at the State and local levels and by
medical professional organizations to develop improved pain
management strategies, including consideration of
alternatives to opioids to reduce opioid monotherapy in
appropriate cases;
(D) the management of high-risk populations, other than
populations who suffer pain, who--

[[Page S1173]]

(i) may use or be prescribed benzodiazepines, alcohol, and
diverted opioids; or
(ii) receive opioids in the course of medical care; and
(E) the Proposed 2016 Guideline for Prescribing Opioids for
Chronic Pain issued by the Centers for Disease Control and
Prevention (80 Fed. Reg. 77351 (December 14, 2015)) and any
final guidelines issued by the Centers for Disease Control
and Prevention;
(2) solicit and take into consideration public comment on
the practices developed under paragraph (1), amending such
best practices if appropriate; and
(3) develop a strategy for disseminating information about
the best practices to stakeholders, as appropriate.
(e) Limitation.--The task force shall not have rulemaking
authority.
(f) Report.--Not later than 270 days after the date on
which the task force is convened under subsection (b), the
task force shall submit to Congress a report that includes--
(1) the strategy for disseminating best practices for pain
management (including chronic and acute pain) and prescribing
pain medication, as reviewed, modified, or updated under
subsection (d);
(2) the results of a feasibility study on linking the best
practices described in paragraph (1) to receiving and
renewing registrations under section 303(f) of the Controlled
Substances Act (21 U.S.C. 823(f)); and
(3) recommendations for effectively applying the best
practices described in paragraph (1) to improve prescribing
practices at medical facilities, including medical facilities
of the Veterans Health Administration.

SEC. 102. AWARENESS CAMPAIGNS.

(a) In General.--The Secretary of Health and Human
Services, in coordination with the Attorney General, shall
advance the education and awareness of the public, providers,
patients, and other appropriate entities regarding the risk
of abuse of prescription opioid drugs if such products are
not taken as prescribed.
(b) Drug-Free Media Campaign.--
(1) In general.--The Office of National Drug Control
Policy, in coordination with the Secretary of Health and
Human Services and the Attorney General, shall establish a
national drug awareness campaign.
(2) Requirements.--The national drug awareness campaign
required under paragraph (1) shall--
(A) take into account the association between prescription
opioid abuse and heroin use;
(B) emphasize the similarities between heroin and
prescription opioids and the effects of heroin and
prescription opioids on the human body; and
(C) bring greater public awareness to the dangerous effects
of fentanyl when mixed with heroin or abused in a similar
manner.

SEC. 103. COMMUNITY-BASED COALITION ENHANCEMENT GRANTS TO
ADDRESS LOCAL DRUG CRISES.

Part II of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (42 U.S.C. 3797cc et seq.) is amended by
striking section 2997 and inserting the following:

``SEC. 2997. COMMUNITY-BASED COALITION ENHANCEMENT GRANTS TO
ADDRESS LOCAL DRUG CRISES.

``(a) Definitions.--In this section--
``(1) the term `Drug-Free Communities Act of 1997' means
chapter 2 of the National Narcotics Leadership Act of 1988
(21 U.S.C. 1521 et seq.);
``(2) the term `eligible entity' means an organization
that--
``(A) on or before the date of submitting an application
for a grant under this section, receives or has received a
grant under the Drug-Free Communities Act of 1997; and
``(B) has documented, using local data, rates of abuse of
opioids or methamphetamines at levels that are--
``(i) significantly higher than the national average as
determined by the Attorney General (including appropriate
consideration of the results of the Monitoring the Future
Survey published by the National Institute on Drug Abuse and
the National Survey on Drug Use and Health published by the
Substance Abuse and Mental Health Services Administration);
or
``(ii) higher than the national average, as determined by
the Attorney General (including appropriate consideration of
the results of the surveys described in clause (i)), over a
sustained period of time; and
``(3) the term `local drug crisis' means, with respect to
the area served by an eligible entity--
``(A) a sudden increase in the abuse of opioids or
methamphetamines, as documented by local data; or
``(B) the abuse of prescription medications, specifically
opioids or methamphetamines, that is significantly higher
than the national average, over a sustained period of time,
as documented by local data.
``(b) Program Authorized.--The Attorney General, in
coordination with the Director of the Office of National Drug
Control Policy, may make grants to eligible entities to
implement comprehensive community-wide strategies that
address local drug crises within the area served by the
eligible entity.
``(c) Application.--
``(1) In general.--An eligible entity seeking a grant under
this section shall submit an application to the Attorney
General at such time, in such manner, and accompanied by such
information as the Attorney General may require.
``(2) Criteria.--As part of an application for a grant
under this section, the Attorney General shall require an
eligible entity to submit a detailed, comprehensive, multi-
sector plan for addressing the local drug crisis within the
area served by the eligible entity.
``(d) Use of Funds.--An eligible entity shall use a grant
received under this section--
``(1) for programs designed to implement comprehensive
community-wide prevention strategies to address the local
drug crisis in the area served by the eligible entity, in
accordance with the plan submitted under subsection (c)(2);
and
``(2) to obtain specialized training and technical
assistance from the organization funded under section 4 of
Public Law 107-82 (21 U.S.C. 1521 note).
``(e) Supplement Not Supplant.--An eligible entity shall
use Federal funds received under this section only to
supplement the funds that would, in the absence of those
Federal funds, be made available from other Federal and non-
Federal sources for the activities described in this section,
and not to supplant those funds.
``(f) Evaluation.--A grant under this section shall be
subject to the same evaluation requirements and procedures as
the evaluation requirements and procedures imposed on the
recipient of a grant under the Drug-Free Communities Act of
1997.
``(g) Limitation on Administrative Expenses.--Not more than
8 percent of the amounts made available pursuant to
subsection (i) for a fiscal year may be used by the Attorney
General to pay for administrative expenses.''.

TITLE II--LAW ENFORCEMENT AND TREATMENT

SEC. 201. TREATMENT ALTERNATIVE TO INCARCERATION PROGRAMS.

(a) Definitions.--In this section:
(1) Eligible entity.--The term ``eligible entity'' means a
State, unit of local government, Indian tribe, or nonprofit
organization.
(2) Eligible participant.--The term ``eligible
participant'' means an individual who--
(A) comes into contact with the juvenile justice system or
criminal justice system or is arrested or charged with an
offense that is not--
(i) a crime of violence, as defined under applicable State
law or section 16 of title 18, United States Code; or
(ii) a serious drug offense, as defined under section
924(e)(2)(A) of title 18, United States Code;
(B) has a current--
(i) substance use disorder; or
(ii) co-occurring mental illness and substance use
disorder; and
(C) has been approved for participation in a program funded
under this section by, as applicable depending on the stage
of the criminal justice process, the relevant law enforcement
agency or prosecuting attorney, defense attorney, probation
or corrections official, judge, or representative from the
relevant mental health or substance abuse agency.
(b) Program Authorized.--The Secretary of Health and Human
Services, in coordination with the Attorney General, may make
grants to eligible entities to--
(1) develop, implement, or expand a treatment alternative
to incarceration program for eligible participants,
including--
(A) pre-booking, including pre-arrest, treatment
alternative to incarceration programs, including--
(i) law enforcement training on substance use disorders and
co-occurring mental illness and substance use disorders;
(ii) receiving centers as alternatives to incarceration of
eligible participants;
(iii) specialized response units for calls related to
substance use disorders and co-occurring mental illness and
substance use disorders; and
(iv) other pre-arrest or pre-booking treatment alternative
to incarceration models; and
(B) post-booking treatment alternative to incarceration
programs, including--
(i) specialized clinical case management;
(ii) pre-trial services related to substance use disorders
and co-occurring mental illness and substance use disorders;
(iii) prosecutor and defender based programs;
(iv) specialized probation;
(v) programs utilizing the American Society of Addiction
Medicine patient placement criteria;
(vi) treatment and rehabilitation programs and recovery
support services; and
(vii) drug courts, DWI courts, and veterans treatment
courts; and
(2) facilitate or enhance planning and collaboration
between State criminal justice systems and State substance
abuse systems in order to more efficiently and effectively
carry out programs described in paragraph (1) that address
problems related to the use of heroin and misuse of
prescription drugs among eligible participants.
(c) Application.--
(1) In general.--An eligible entity desiring a grant under
this section shall submit an application to the Secretary of
Health and Human Services--
(A) that meets the criteria under paragraph (2); and
(B) at such time, in such manner, and accompanied by such
information as the Secretary of Health and Human Services may
require.
(2) Criteria.--An eligible entity, in submitting an
application under paragraph (1), shall--
(A) provide extensive evidence of collaboration with State
and local government agencies overseeing health, community
corrections, courts, prosecution, substance abuse, mental
health, victims services, and employment services, and with
local law enforcement agencies;
(B) demonstrate consultation with the Single State
Authority for Substance Abuse;
(C) demonstrate consultation with the Single State criminal
justice planning agency;
(D) demonstrate that evidence-based treatment practices,
including if applicable the use of medication assisted
treatment, will be utilized; and
(E) demonstrate that evidenced-based screening and
assessment tools will be utilized to place participants in
the treatment alternative to incarceration program.
(d) Requirements.--Each eligible entity awarded a grant for
a treatment alternative to incarceration program under this
section shall--

[[Page S1174]]

(1) determine the terms and conditions of participation in
the program by eligible participants, taking into
consideration the collateral consequences of an arrest,
prosecution, or criminal conviction;
(2) ensure that each substance abuse and mental health
treatment component is licensed and qualified by the relevant
jurisdiction;
(3) for programs described in subsection (b)(2), organize
an enforcement unit comprised of appropriately trained law
enforcement professionals under the supervision of the State,
tribal, or local criminal justice agency involved, the duties
of which shall include--
(A) the verification of addresses and other contacts of
each eligible participant who participates or desires to
participate in the program; and
(B) if necessary, the location, apprehension, arrest, and
return to court of an eligible participant in the program who
has absconded from the facility of a treatment provider or
has otherwise violated the terms and conditions of the
program, consistent with Federal and State confidentiality
requirements;
(4) notify the relevant criminal justice entity if any
eligible participant in the program absconds from the
facility of the treatment provider or otherwise violates the
terms and conditions of the program, consistent with Federal
and State confidentiality requirements;
(5) submit periodic reports on the progress of treatment or
other measured outcomes from participation in the program of
each eligible participant in the program to the relevant
State, tribal, or local criminal justice agency;
(6) describe the evidence-based methodology and outcome
measurements that will be used to evaluate the program, and
specifically explain how such measurements will provide valid
measures of the impact of the program; and
(7) describe how the program could be broadly replicated if
demonstrated to be effective.
(e) Use of Funds.--An eligible entity shall use a grant
received under this section for expenses of a treatment
alternative to incarceration program, including--
(1) salaries, personnel costs, equipment costs, and other
costs directly related to the operation of the program,
including the enforcement unit;
(2) payments for treatment providers that are approved by
the relevant State or tribal jurisdiction and licensed, if
necessary, to provide needed treatment to eligible
participants in the program, including medication assisted
treatment, aftercare supervision, vocational training,
education, and job placement;
(3) payments to public and nonprofit private entities that
are approved by the State or tribal jurisdiction and
licensed, if necessary, to provide alcohol and drug addiction
treatment and mental health treatment to eligible
participants in the program; and
(4) salaries, personnel costs, and other costs related to
strategic planning among State and local government agencies.
(f) Supplement Not Supplant.--An eligible entity shall use
Federal funds received under this section only to supplement
the funds that would, in the absence of those Federal funds,
be made available from other Federal and non-Federal sources
for the activities described in this section, and not to
supplant those funds.
(g) Geographic Distribution.--The Secretary of Health and
Human Services shall ensure that, to the extent practicable,
the geographical distribution of grants under this section is
equitable and includes a grant to an eligible entity in--
(1) each State;
(2) rural, suburban, and urban areas; and
(3) tribal jurisdictions.
(h) Priority Consideration With Respect to States.--In
awarding grants to States under this section, the Secretary
of Health and Human Services shall give priority to--
(1) a State that submits a joint application from the
substance abuse agencies and criminal justice agencies of the
State that proposes to use grant funds to facilitate or
enhance planning and collaboration between the agencies,
including coordination to better address the needs of
incarcerated populations; and
(2) a State that--
(A) provides civil liability protection for first
responders, health professionals, and family members who have
received appropriate training in the administration of
naloxone in administering naloxone to counteract opioid
overdoses; and
(B) submits to the Secretary a certification by the
attorney general of the State that the attorney general has--
(i) reviewed any applicable civil liability protection law
to determine the applicability of the law with respect to
first responders, health care professionals, family members,
and other individuals who--

(I) have received appropriate training in the
administration of naloxone; and
(II) may administer naloxone to individuals reasonably
believed to be suffering from opioid overdose; and

(ii) concluded that the law described in subparagraph (A)
provides adequate civil liability protection applicable to
such persons.
(i) Reports and Evaluations.--
(1) In general.--Each fiscal year, each recipient of a
grant under this section during that fiscal year shall submit
to the Secretary of Health and Human Services a report on the
outcomes of activities carried out using that grant in such
form, containing such information, and on such dates as the
Secretary of Health and Human Services shall specify.
(2) Contents.--A report submitted under paragraph (1)
shall--
(A) describe best practices for treatment alternatives; and
(B) identify training requirements for law enforcement
officers who participate in treatment alternative to
incarceration programs.
(j) Funding.--During the 5-year period beginning on the
date of enactment of this Act, the Secretary of Health and
Human Services shall carry out this section using funds made
available to the Substance Abuse and Mental Health Services
Administration for Criminal Justice Activities.

SEC. 202. FIRST RESPONDER TRAINING FOR THE USE OF DRUGS AND
DEVICES THAT RAPIDLY REVERSE THE EFFECTS OF
OPIOIDS.

Part II of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (42 U.S.C. 3797cc et seq.), as amended by
section 103, is amended by adding at the end the following:

``SEC. 2998. FIRST RESPONDER TRAINING FOR THE USE OF DRUGS
AND DEVICES THAT RAPIDLY REVERSE THE EFFECTS OF
OPIOIDS.

``(a) Definition.--In this section--
``(1) the terms `drug' and `device' have the meanings given
those terms in section 201 of the Federal Food, Drug, and
Cosmetic Act (21 U.S.C. 321);
``(2) the term `eligible entity' means a State, a unit of
local government, or an Indian tribal government;
``(3) the term `first responder' includes a firefighter,
law enforcement officer, paramedic, emergency medical
technician, or other individual (including an employee of a
legally organized and recognized volunteer organization,
whether compensated or not), who, in the course of
professional duties, responds to fire, medical, hazardous
material, or other similar emergencies; and
``(4) the term `Secretary' means the Secretary of Health
and Human Services.
``(b) Program Authorized.--The Secretary, in coordination
with the Attorney General, may make grants to eligible
entities to allow appropriately trained first responders to
administer an opioid overdose reversal drug to an individual
who has--
``(1) experienced a prescription opioid or heroin overdose;
or
``(2) been determined to have likely experienced a
prescription opioid or heroin overdose.
``(c) Application.--
``(1) In general.--An eligible entity seeking a grant under
this section shall submit an application to the Secretary--
``(A) that meets the criteria under paragraph (2); and
``(B) at such time, in such manner, and accompanied by such
information as the Secretary may require.
``(2) Criteria.--An eligible entity, in submitting an
application under paragraph (1), shall--
``(A) describe the evidence-based methodology and outcome
measurements that will be used to evaluate the program funded
with a grant under this section, and specifically explain how
such measurements will provide valid measures of the impact
of the program;
``(B) describe how the program could be broadly replicated
if demonstrated to be effective;
``(C) identify the governmental and community agencies that
the program will coordinate; and
``(D) describe how law enforcement agencies will coordinate
with their corresponding State substance abuse and mental
health agencies to identify protocols and resources that are
available to victims and families, including information on
treatment and recovery resources.
``(d) Use of Funds.--An eligible entity shall use a grant
received under this section to--
``(1) make such opioid overdose reversal drugs or devices
that are approved by the Food and Drug Administration, such
as naloxone, available to be carried and administered by
first responders;
``(2) train and provide resources for first responders on
carrying an opioid overdose reversal drug or device approved
by the Food and Drug Administration, such as naloxone, and
administering the drug or device to an individual who has
experienced, or has been determined to have likely
experienced, a prescription opioid or heroin overdose; and
``(3) establish processes, protocols, and mechanisms for
referral to appropriate treatment.
``(e) Technical Assistance Grants.--The Secretary shall
make a grant for the purpose of providing technical
assistance and training on the use of an opioid overdose
reversal drug, such as naloxone, to respond to an individual
who has experienced, or has been determined to have likely
experienced, a prescription opioid or heroin overdose, and
mechanisms for referral to appropriate treatment for an
eligible entity receiving a grant under this section.
``(f) Evaluation.--The Secretary shall conduct an
evaluation of grants made under this section to determine--
``(1) the number of first responders equipped with
naloxone, or another opioid overdose reversal drug, for the
prevention of fatal opioid and heroin overdose;
``(2) the number of opioid and heroin overdoses reversed by
first responders receiving training and supplies of naloxone,
or another opioid overdose reversal drug, through a grant
received under this section;
``(3) the number of calls for service related to opioid and
heroin overdose;
``(4) the extent to which overdose victims and families
receive information about treatment services and available
data describing treatment admissions; and
``(5) the research, training, and naloxone, or another
opioid overdose reversal drug, supply needs of first
responder agencies, including those agencies that are not
receiving grants under this section.
``(g) Rural Areas With Limited Access to Emergency Medical
Services.--In making grants under this section, the Secretary
shall ensure that not less than 25 percent of grant funds are
awarded to eligible entities that are

[[Page S1175]]

not located in metropolitan statistical areas, as defined by
the Office of Management and Budget.''.

SEC. 203. PRESCRIPTION DRUG TAKE BACK EXPANSION.

(a) Definition of Covered Entity.--In this section, the
term ``covered entity'' means--
(1) a State, local, or tribal law enforcement agency;
(2) a manufacturer, distributor, or reverse distributor of
prescription medications;
(3) a retail pharmacy;
(4) a registered narcotic treatment program;
(5) a hospital or clinic with an on-site pharmacy;
(6) an eligible long-term care facility; or
(7) any other entity authorized by the Drug Enforcement
Administration to dispose of prescription medications.
(b) Program Authorized.--The Attorney General, in
coordination with the Administrator of the Drug Enforcement
Administration, the Secretary of Health and Human Services,
and the Director of the Office of National Drug Control
Policy, shall coordinate with covered entities in expanding
or making available disposal sites for unwanted prescription
medications.

SEC. 204. HEROIN AND METHAMPHETAMINE TASK FORCES.

Part II of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (42 U.S.C. 3797cc et seq.), as amended by
section 202, is amended by adding at the end the following:

``SEC. 2999. HEROIN AND METHAMPHETAMINE TASK FORCES.

``The Attorney General may make grants to State law
enforcement agencies for investigative purposes--
``(1) to locate or investigate illicit activities through
statewide collaboration, including activities related to--
``(A) the distribution of heroin or fentanyl, or the
unlawful distribution of prescription opioids; or
``(B) unlawful heroin, fentanyl, and prescription opioid
traffickers; and
``(2) to locate or investigate illicit activities,
including precursor diversion, laboratories, or
methamphetamine traffickers.''.

TITLE III--TREATMENT AND RECOVERY

SEC. 301. EVIDENCE-BASED OPIOID AND HEROIN TREATMENT AND
INTERVENTIONS DEMONSTRATION.

Part II of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (42 U.S.C. 3797cc et seq.), as amended by
section 204, is amended by adding at the end the following:

``SEC. 2999A. EVIDENCE-BASED OPIOID AND HEROIN TREATMENT AND
INTERVENTIONS DEMONSTRATION.

``(a) Definitions.--In this section--
``(1) the terms `Indian tribe' and `tribal organization'
have the meaning given those terms in section 4 of the Indian
Health Care Improvement Act (25 U.S.C. 1603));
``(2) the term `medication assisted treatment' means the
use, for problems relating to heroin and other opioids, of
medications approved by the Food and Drug Administration in
combination with counseling and behavioral therapies;
``(3) the term `Secretary' means the Secretary of Health
and Human Services; and
``(4) the term `State substance abuse agency' means the
agency of a State responsible for the State prevention,
treatment, and recovery system, including management of the
Substance Abuse Prevention and Treatment Block Grant under
subpart II of part B of title XIX of the Public Health
Service Act (42 U.S.C. 300x-21 et seq.).
``(b) Grants.--
``(1) Authority to make grants.--The Secretary, acting
through the Director of the Center for Substance Abuse
Treatment of the Substance Abuse and Mental Health Services
Administration, and in coordination with the Attorney General
and other departments or agencies, as appropriate, may award
grants to State substance abuse agencies, units of local
government, nonprofit organizations, and Indian tribes or
tribal organizations that have a high rate, or have had a
rapid increase, in the use of heroin or other opioids, in
order to permit such entities to expand activities, including
an expansion in the availability of medication assisted
treatment and other clinically appropriate services, with
respect to the treatment of addiction in the specific
geographical areas of such entities where there is a high
rate or rapid increase in the use of heroin or other opioids.
``(2) Nature of activities.--The grant funds awarded under
paragraph (1) shall be used for activities that are based on
reliable scientific evidence of efficacy in the treatment of
problems related to heroin or other opioids.
``(c) Geographic Distribution.--The Secretary shall ensure
that grants awarded under subsection (b) are distributed
equitably among the various regions of the United States and
among rural, urban, and suburban areas that are affected by
the use of heroin or other opioids.
``(d) Additional Activities.--In administering grants under
subsection (b), the Secretary shall--
``(1) evaluate the activities supported by grants awarded
under subsection (b);
``(2) disseminate information, as appropriate, derived from
the evaluation as the Secretary considers appropriate;
``(3) provide States, Indian tribes and tribal
organizations, and providers with technical assistance in
connection with the provision of treatment of problems
related to heroin and other opioids; and
``(4) fund only those applications that specifically
support recovery services as a critical component of the
grant program.''.

SEC. 302. CRIMINAL JUSTICE MEDICATION ASSISTED TREATMENT AND
INTERVENTIONS DEMONSTRATION.

(a) Definitions.--In this section--
(1) the term ``criminal justice agency'' means a State,
local, or tribal--
(A) court;
(B) prison;
(C) jail; or
(D) other agency that performs the administration of
criminal justice, including prosecution, pretrial services,
and community supervision;
(2) the term ``eligible entity'' means a State, unit of
local government, or Indian tribe; and
(3) the term ``Secretary'' means the Secretary of Health
and Human Services.
(b) Program Authorized.--The Secretary, in coordination
with the Attorney General, may make grants to eligible
entities to implement medication assisted treatment programs
through criminal justice agencies.
(c) Application.--
(1) In general.--An eligible entity seeking a grant under
this section shall submit an application to the Secretary--
(A) that meets the criteria under paragraph (2); and
(B) at such time, in such manner, and accompanied by such
information as the Secretary may require.
(2) Criteria.--An eligible entity, in submitting an
application under paragraph (1), shall--
(A) certify that each medication assisted treatment program
funded with a grant under this section has been developed in
consultation with the Single State Authority for Substance
Abuse; and
(B) describe how data will be collected and analyzed to
determine the effectiveness of the program described in
subparagraph (A).
(d) Use of Funds.--An eligible entity shall use a grant
received under this section for expenses of--
(1) a medication assisted treatment program, including the
expenses of prescribing medications recognized by the Food
and Drug Administration for opioid treatment in conjunction
with psychological and behavioral therapy;
(2) training criminal justice agency personnel and
treatment providers on medication assisted treatment;
(3) cross-training personnel providing behavioral health
and health services, administration of medicines, and other
administrative expenses, including required reports; and
(4) the provision of recovery coaches who are responsible
for providing mentorship and transition plans to individuals
reentering society following incarceration or alternatives to
incarceration.
(e) Priority Consideration With Respect to States.--In
awarding grants to States under this section, the Secretary
shall give priority to a State that--
(1) provides civil liability protection for first
responders, health professionals, and family members who have
received appropriate training in the administration of
naloxone in administering naloxone to counteract opioid
overdoses; and
(2) submits to the Secretary a certification by the
attorney general of the State that the attorney general has--
(A) reviewed any applicable civil liability protection law
to determine the applicability of the law with respect to
first responders, health care professionals, family members,
and other individuals who--
(i) have received appropriate training in the
administration of naloxone; and
(ii) may administer naloxone to individuals reasonably
believed to be suffering from opioid overdose; and
(B) concluded that the law described in subparagraph (A)
provides adequate civil liability protection applicable to
such persons.
(f) Technical Assistance.--The Secretary, in coordination
with the Director of the National Institute on Drug Abuse and
the Attorney General, shall provide technical assistance and
training for an eligible entity receiving a grant under this
section.
(g) Reports.--
(1) In general.--An eligible entity receiving a grant under
this section shall submit a report to the Secretary on the
outcomes of each grant received under this section for
individuals receiving medication assisted treatment, based
on--
(A) the recidivism of the individuals;
(B) the treatment outcomes of the individuals, including
maintaining abstinence from illegal, unauthorized, and
unprescribed or undispensed opioids and heroin;
(C) a comparison of the cost of providing medication
assisted treatment to the cost of incarceration or other
participation in the criminal justice system;
(D) the housing status of the individuals; and
(E) the employment status of the individuals.
(2) Contents and timing.--Each report described in
paragraph (1) shall be submitted annually in such form,
containing such information, and on such dates as the
Secretary shall specify.
(h) Funding.--During the 5-year period beginning on the
date of enactment of this Act, the Secretary shall carry out
this section using funds made available to the Substance
Abuse and Mental Health Services Administration for Criminal
Justice Activities.

SEC. 303. NATIONAL YOUTH RECOVERY INITIATIVE.

Part II of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (42 U.S.C. 3797cc et seq.), as amended by
section 301, is amended by adding at the end the following:

``SEC. 2999B. NATIONAL YOUTH RECOVERY INITIATIVE.

``(a) Definitions.--In this section:
``(1) Eligible entity.--The term `eligible entity' means--
``(A) a high school that has been accredited as a recovery
high school by the Association of Recovery Schools;

[[Page S1176]]

``(B) an accredited high school that is seeking to
establish or expand recovery support services;
``(C) an institution of higher education;
``(D) a recovery program at a nonprofit collegiate
institution; or
``(E) a nonprofit organization.
``(2) Institution of higher education.--The term
`institution of higher education' has the meaning given the
term in section 101 of the Higher Education Act of 1965 (20
U.S.C. 1001).
``(3) Recovery program.--The term `recovery program'--
``(A) means a program to help individuals who are
recovering from substance use disorders to initiate,
stabilize, and maintain healthy and productive lives in the
community; and
``(B) includes peer-to-peer support and communal activities
to build recovery skills and supportive social networks.
``(b) Grants Authorized.--The Secretary of Health and Human
Services, in coordination with the Secretary of Education,
may award grants to eligible entities to enable the entities
to--
``(1) provide substance use recovery support services to
young people in high school and enrolled in institutions of
higher education;
``(2) help build communities of support for young people in
recovery through a spectrum of activities such as counseling
and health- and wellness-oriented social activities; and
``(3) encourage initiatives designed to help young people
achieve and sustain recovery from substance use disorders.
``(c) Use of Funds.--Grants awarded under subsection (b)
may be used for activities to develop, support, and maintain
youth recovery support services, including--
``(1) the development and maintenance of a dedicated
physical space for recovery programs;
``(2) dedicated staff for the provision of recovery
programs;
``(3) health- and wellness-oriented social activities and
community engagement;
``(4) establishment of recovery high schools;
``(5) coordination of recovery programs with--
``(A) substance use disorder treatment programs and
systems;
``(B) providers of mental health services;
``(C) primary care providers and physicians;
``(D) the criminal justice system, including the juvenile
justice system;
``(E) employers;
``(F) housing services;
``(G) child welfare services;
``(H) high schools and institutions of higher education;
and
``(I) other programs or services related to the welfare of
an individual in recovery from a substance use disorder;
``(6) the development of peer-to-peer support programs or
services; and
``(7) additional activities that help youths and young
adults to achieve recovery from substance use disorders.''.

SEC. 304. BUILDING COMMUNITIES OF RECOVERY.

Part II of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (42 U.S.C. 3797cc et seq.), as amended by
section 303, is amended by adding at the end the following:

``SEC. 2999C. BUILDING COMMUNITIES OF RECOVERY.

``(a) Definition.--In this section, the term `recovery
community organization' means an independent nonprofit
organization that--
``(1) mobilizes resources within and outside of the
recovery community to increase the prevalence and quality of
long-term recovery from substance use disorders; and
``(2) is wholly or principally governed by people in
recovery for substance use disorders who reflect the
community served.
``(b) Grants Authorized.--The Secretary of Health and Human
Services may award grants to recovery community organizations
to enable such organizations to develop, expand, and enhance
recovery services.
``(c) Federal Share.--The Federal share of the costs of a
program funded by a grant under this section may not exceed
50 percent.
``(d) Use of Funds.--Grants awarded under subsection (b)--
``(1) shall be used to develop, expand, and enhance
community and statewide recovery support services; and
``(2) may be used to--
``(A) advocate for individuals in recovery from substance
use disorders;
``(B) build connections between recovery networks, between
recovery community organizations, and with other recovery
support services, including--
``(i) substance use disorder treatment programs and
systems;
``(ii) providers of mental health services;
``(iii) primary care providers and physicians;
``(iv) the criminal justice system;
``(v) employers;
``(vi) housing services;
``(vii) child welfare agencies; and
``(viii) other recovery support services that facilitate
recovery from substance use disorders;
``(C) reduce the stigma associated with substance use
disorders;
``(D) conduct public education and outreach on issues
relating to substance use disorders and recovery, including--
``(i) how to identify the signs of addiction;
``(ii) the resources that are available to individuals
struggling with addiction and families who have a family
member struggling with or being treated for addiction,
including programs that mentor and provide support services
to children;
``(iii) the resources that are available to help support
individuals in recovery; and
``(iv) information on the medical consequences of substance
use disorders, including neonatal abstinence syndrome and
potential infection with human immunodeficiency virus and
viral hepatitis; and
``(E) carry out other activities that strengthen the
network of community support for individuals in recovery.''.

TITLE IV--ADDRESSING COLLATERAL CONSEQUENCES

SEC. 401. CORRECTIONAL EDUCATION DEMONSTRATION GRANT PROGRAM.

Part II of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (42 U.S.C. 3797cc et seq.), as amended by
section 304, is amended by adding at the end the following:

``SEC. 2999D. CORRECTIONAL EDUCATION DEMONSTRATION GRANT
PROGRAM.

``(a) Definition.--In this section, the term `eligible
entity' means a State, unit of local government, nonprofit
organization, or Indian tribe.
``(b) Grant Program Authorized.--The Attorney General may
make grants to eligible entities to design, implement, and
expand educational programs for offenders in prisons, jails,
and juvenile facilities, including to pay for--
``(1) basic education, secondary level academic education,
high school equivalency examination preparation, career
technical education, and English as a second language
instruction at the basic, secondary, or post-secondary
levels, for adult and juvenile populations;
``(2) screening and assessment of inmates to assess
education level, needs, occupational interest or aptitude,
risk level, and other needs, and case management services;
``(3) hiring and training of instructors and aides,
reimbursement of non-corrections staff and experts,
reimbursement of stipends paid to inmate tutors or aides, and
the costs of training inmate tutors and aides;
``(4) instructional supplies and equipment, including
occupational program supplies and equipment to the extent
that the supplies and equipment are used for instructional
purposes;
``(5) partnerships and agreements with community colleges,
universities, and career technology education program
providers;
``(6) certification programs providing recognized high
school equivalency certificates and industry recognized
credentials; and
``(7) technology solutions to--
``(A) meet the instructional, assessment, and information
needs of correctional populations; and
``(B) facilitate the continued participation of
incarcerated students in community-based education programs
after the students are released from incarceration.
``(c) Application.--An eligible entity seeking a grant
under this section shall submit to the Attorney General an
application in such form and manner, at such time, and
accompanied by such information as the Attorney General
specifies.
``(d) Priority Considerations.--In awarding grants under
this section, the Attorney General shall give priority to
applicants that--
``(1) assess the level of risk and need of inmates,
including by--
``(A) assessing the need for English as a second language
instruction;
``(B) conducting educational assessments; and
``(C) assessing occupational interests and aptitudes;
``(2) target educational services to assessed needs,
including academic and occupational at the basic, secondary,
or post-secondary level;
``(3) target career technology education programs to--
``(A) areas of identified occupational demand; and
``(B) employment opportunities in the communities in which
students are reasonably expected to reside post-release;
``(4) include a range of appropriate educational
opportunities at the basic, secondary, and post-secondary
levels;
``(5) include opportunities for students to attain industry
recognized credentials;
``(6) include partnership or articulation agreements
linking institutional education programs with community sited
programs provided by adult education program providers and
accredited institutions of higher education, community
colleges, and vocational training institutions; and
``(7) explicitly include career pathways models offering
opportunities for incarcerated students to develop academic
skills, in-demand occupational skills and credentials,
occupational experience in institutional work programs or
work release programs, and linkages with employers in the
community, so that incarcerated students have opportunities
to embark on careers with strong prospects for both post-
release employment and advancement in a career ladder over
time.
``(e) Requirements.--An eligible entity desiring a grant
under this section shall--
``(1) describe the evidence-based methodology and outcome
measurements that will be used to evaluate each program
funded with a grant under this section, and specifically
explain how such measurements will provide valid measures of
the impact of the program; and
``(2) describe how the program described in paragraph (1)
could be broadly replicated if demonstrated to be effective.
``(f) Control of Internet Access.--An entity that receives
a grant under this section may restrict access to the
Internet by prisoners, as appropriate and in accordance with
Federal and State law, to ensure public safety.''.

SEC. 402. NATIONAL TASK FORCE ON RECOVERY AND COLLATERAL
CONSEQUENCES.

(a) Definition.--In this section, the term ``collateral
consequence'' means a penalty, disability, or disadvantage
imposed on an individual who is in recovery for a substance
use disorder (including by an administrative agency,
official, or civil court ) as a result of a Federal or State
conviction for a drug-related offense but not as part of the
judgment of the court that imposes the conviction.
(b) Establishment.--

[[Page S1177]]

(1) In general.--Not later than 30 days after the date of
enactment of this Act, the Attorney General shall establish a
bipartisan task force to be known as the Task Force on
Recovery and Collateral Consequences (in this section
referred to as the ``Task Force'').
(2) Membership.--
(A) Total number of members.--The Task Force shall include
10 members, who shall be appointed by the Attorney General in
accordance with subparagraphs (B) and (C).
(B) Members of the task force.--The Task Force shall
include--
(i) members who have national recognition and significant
expertise in areas such as health care, housing, employment,
substance use disorders, mental health, law enforcement, and
law;
(ii) not fewer than 2 members--

(I) who have personally experienced substance abuse or
addiction and are in recovery; and
(II) not fewer than 1 one of whom has benefitted from
medication assisted treatment; and

(iii) to the extent practicable, members who formerly
served as elected officials at the State and Federal levels.
(C) Timing.--The Attorney General shall appoint the members
of the Task Force not later than 60 days after the date on
which the Task Force is established under paragraph (1).
(3) Chairperson.--The Task Force shall select a chairperson
or co-chairpersons from among the members of the Task Force.
(c) Duties of the Task Force.--
(1) In general.--The Task Force shall--
(A) identify collateral consequences for individuals with
Federal or State convictions for drug-related offenses who
are in recovery for substance use disorder; and
(B) examine any policy basis for the imposition of
collateral consequences identified under subparagraph (A) and
the effect of the collateral consequences on individuals in
recovery from resuming their personal and professional
activities.
(2) Recommendations.--Not later than 180 days after the
date of the first meeting of the Task Force, the Task Force
shall develop recommendations, as it considers appropriate,
for proposed legislative and regulatory changes related to
the collateral consequences identified under paragraph (1).
(3) Collection of information.--The Task Force shall hold
hearings, require the testimony and attendance of witnesses,
and secure information from any department or agency of the
United States in performing the duties under paragraphs (1)
and (2).
(4) Report.--
(A) Submission to executive branch.--Not later than 1 year
after the date of the first meeting of the Task Force, the
Task Force shall submit a report detailing the findings and
recommendations of the Task Force to--
(i) the head of each relevant department or agency of the
United States;
(ii) the President; and
(iii) the Vice President.
(B) Submission to congress.--The individuals who receive
the report under subparagraph (A) shall submit to Congress
such legislative recommendations, if any, as those
individuals consider appropriate based on the report.

TITLE V--ADDICTION AND TREATMENT SERVICES FOR WOMEN, FAMILIES, AND
VETERANS

SEC. 501. IMPROVING TREATMENT FOR PREGNANT AND POSTPARTUM
WOMEN.

Part II of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (42 U.S.C. 3797cc et seq.), as amended by
section 401, is amended by adding at the end the following:

``SEC. 2999E. IMPROVING TREATMENT FOR PREGNANT AND POSTPARTUM
WOMEN.

``(a) In General.--The Secretary of Health and Human
Services (referred to in this section as the `Secretary'),
acting through the Director of the Center for Substance Abuse
Treatment, may carry out a pilot program under which the
Secretary makes competitive grants to State substance abuse
agencies to--
``(1) enhance flexibility in the use of funds designed to
support family-based services for pregnant and postpartum
women with a primary diagnosis of a substance use disorder,
including opioid use disorders;
``(2) help State substance abuse agencies address
identified gaps in services furnished to such women along the
continuum of care, including services provided to women in
non-residential based settings; and
``(3) promote a coordinated, effective, and efficient State
system managed by State substance abuse agencies by
encouraging new approaches and models of service delivery
that are evidence-based, including effective family-based
programs for women involved with the criminal justice system.
``(b) Requirements.--In carrying out the pilot program
under this section, the Secretary--
``(1) shall require State substance abuse agencies to
submit to the Secretary applications, in such form and manner
and containing such information as specified by the
Secretary, to be eligible to receive a grant under the
program;
``(2) shall identify, based on such submitted applications,
State substance abuse agencies that are eligible for such
grants;
``(3) shall require services proposed to be furnished
through such a grant to support family-based treatment and
other services for pregnant and postpartum women with a
primary diagnosis of a substance use disorder, including
opioid use disorders;
``(4) shall not require that services furnished through
such a grant be provided solely to women that reside in
facilities; and
``(5) shall not require that grant recipients under the
program make available all services described in section
508(d) of the Public Health Service Act (42 U.S.C. 290bb-
1(d)).
``(c) Required Services.--
``(1) In general.--The Secretary shall specify minimum
services required to be made available to eligible women
through a grant awarded under the pilot program under this
section. Such minimum services--
``(A) shall include the requirements described in section
508(c) of the Public Health Service Act (42 U.S.C. 290bb-
1(c));
``(B) may include any of the services described in section
508(d) of the Public Health Service Act (42 U.S.C. 290bb-
1(d));
``(C) may include other services, as appropriate; and
``(D) shall be based on the recommendations submitted under
paragraph (2).
``(2) Stakeholder input.--The Secretary shall convene and
solicit recommendations from stakeholders, including State
substance abuse agencies, health care providers, persons in
recovery from a substance use disorder, and other appropriate
individuals, for the minimum services described in paragraph
(1).
``(d) Duration.--The pilot program under this section shall
not exceed 5 years.
``(e) Evaluation and Report to Congress.--
``(1) In general.--Out of amounts made available to the
Center for Behavioral Health Statistics and Quality, the
Director of the Center for Behavioral Health Statistics and
Quality, in cooperation with the recipients of grants under
this section, shall conduct an evaluation of the pilot
program, beginning 1 year after the date on which a grant is
first awarded under this section. The Director of the Center
for Behavioral Health Statistics and Quality, in coordination
with the Director of the Center for Substance Abuse
Treatment, not later than 120 days after completion of such
evaluation, shall submit to the relevant Committees of the
Senate and the House of Representatives a report on such
evaluation.
``(2) Contents.--The report to Congress under paragraph (1)
shall include, at a minimum, outcomes information from the
pilot program, including any resulting reductions in the use
of alcohol and other drugs, engagement in treatment services,
retention in the appropriate level and duration of services,
increased access to the use of drugs approved by the Food and
Drug Administration for the treatment of substance use
disorders in combination with counseling, and other
appropriate measures.
``(f) State Substance Abuse Agency Defined.--For purposes
of this section, the term `State substance abuse agency'
means, with respect to a State, the agency in such State that
manages the substance abuse prevention and treatment block
grant program under part B of title XIX of the Public Health
Service Act.''.

SEC. 502. REPORT ON GRANTS FOR FAMILY-BASED SUBSTANCE ABUSE
TREATMENT.

Section 2925 of the Omnibus Crime Control and Safe Streets
Act of 1968 (42 U.S.C. 3797s-4) is amended--
(1) by striking ``An entity'' and inserting ``(a) Entity
Reports.--An entity''; and
(2) by adding at the end the following:
``(b) Attorney General Report on Family-Based Substance
Abuse Treatment.--The Attorney General shall submit to
Congress an annual report that describes the number of grants
awarded under section 2921(1) and how such grants are used by
the recipients for family-based substance abuse treatment
programs that serve as alternatives to incarceration for
custodial parents to receive treatment and services as a
family.''.

SEC. 503. VETERANS' TREATMENT COURTS.

Section 2991(j)(1)(B)(ii) of title I of the Omnibus Crime
Control and Safe Streets Act of 1968 (42 U.S.C.
3797aa(j)(1)(B)(ii)) is amended--
(1) by inserting ``(I)'' after ``(ii)'';
(2) in subclause (I), as so designated, by striking the
period and inserting ``; or''; and
(3) by adding at the end the following:
``(II) was discharged or released from such service under
dishonorable conditions, if the reason for that discharge or
release, if known, is attributable to drug use.''.

TITLE VI--INCENTIVIZING STATE COMPREHENSIVE INITIATIVES TO ADDRESS
OPIOID AND HEROIN ABUSE

SEC. 601. STATE DEMONSTRATION GRANTS FOR COMPREHENSIVE OPIOID
ABUSE RESPONSE.

(a) Definitions.--In this section--
(1) the term ``dispenser'' has the meaning given the term
in section 102 of the Controlled Substances Act (21 U.S.C.
802);
(2) the term ``prescriber of a schedule II, III, or IV
controlled substance'' does not include a prescriber of a
schedule II, III, or IV controlled substance that dispenses
the substance--
(A) for use on the premises on which the substance is
dispensed;
(B) in a hospital emergency room, when the substance is in
short supply;
(C) for a certified opioid treatment program; or
(D) in other situations as the Attorney General may
reasonably determine;
(3) the term ``prescriber'' means a dispenser who
prescribes a controlled substance, or the agent of such a
dispenser; and
(4) the term ``schedule II, III, or IV controlled
substance'' means a controlled substance that is listed on
schedule II, schedule III, or schedule IV of section 202(c)
of the Controlled Substances Act (21 U.S.C. 812(c)).
(b) Planning and Implementation Grants.--
(1) In general.--The Attorney General, in coordination with
the Secretary of Health and Human Services and in
consultation with the Director of the Office of National Drug
Control Policy, may award grants to States, and combinations
thereof, to prepare a comprehensive plan for and implement an
integrated opioid abuse response initiative.
(2) Purposes.--A State receiving a grant under this section
shall establish a comprehensive response to opioid abuse,
which shall include--

[[Page S1178]]

(A) prevention and education efforts around heroin and
opioid use, treatment, and recovery, including education of
residents, medical students, and physicians and other
prescribers of schedule II, III, or IV controlled substances
on relevant prescribing guidelines and the prescription drug
monitoring program of the State ;
(B) a comprehensive prescription drug monitoring program to
track dispensing of schedule II, III, or IV controlled
substances, which shall--
(i) provide for data sharing with other States by statute,
regulation, or interstate agreement; and
(ii) allow for access to all individuals authorized by the
State to write prescriptions for schedule II, III, or IV
controlled substances on the prescription drug monitoring
program of the State.
(C) developing, implementing, or expanding prescription
drug and opioid addiction treatment programs by--
(i) expanding programs for medication assisted treatment of
prescription drug and opioid addiction, including training
for treatment and recovery support providers;
(ii) developing, implementing, or expanding programs for
behavioral health therapy for individuals who are in
treatment for prescription drug and opioid addiction;
(iii) developing, implementing, or expanding programs to
screen individuals who are in treatment for prescription drug
and opioid addiction for hepatitis C and HIV, and provide
treatment for those individuals if clinically appropriate; or
(iv) developing, implementing, or expanding programs that
provide screening, early intervention, and referral to
treatment (commonly known as ``SBIRT'') to teenagers and
young adults in primary care, middle schools, high schools,
universities, school-based health centers, and other
community-based health care settings frequently accessed by
teenagers or young adults; and
(D) developing, implementing, and expanding programs to
prevent overdose death from prescription medications and
opioids.
(3) Planning grant applications.--
(A) Application.--
(i) In general.--A State seeking a planning grant under
this section to prepare a comprehensive plan for an
integrated opioid abuse response initiative shall submit to
the Attorney General an application in such form, and
containing such information, as the Attorney General may
require.
(ii) Requirements.--An application for a planning grant
under this section shall, at a minimum, include--

(I) a budget and a budget justification for the activities
to be carried out using the grant;
(II) a description of the activities proposed to be carried
out using the grant, including a schedule for completion of
such activities;
(III) outcome measures that will be used to measure the
effectiveness of the programs and initiatives to address
opioids; and
(IV) a description of the personnel necessary to complete
such activities.

(B) Period; nonrenewability.--A planning grant under this
section shall be for a period of 1 year. A State may not
receive more than 1 planning grant under this section.
(C) Amount.--A planning grant under this section may not
exceed $100,000.
(D) Strategic plan and program implementation plan.--A
State receiving a planning grant under this section shall
develop a strategic plan and a program implementation plan.
(4) Implementation grants.--
(A) Application.--A State seeking an implementation grant
under this section to implement a comprehensive strategy for
addressing opioid abuse shall submit to the Attorney General
an application in such form, and containing such information,
as the Attorney General may require.
(B) Use of funds.--A State that receives an implementation
grant under this section shall use the grant for the cost of
carrying out an integrated opioid abuse response program in
accordance with this section, including for technical
assistance, training, and administrative expenses.
(C) Requirements.--An integrated opioid abuse response
program carried out using an implementation grant under this
section shall--
(i) require that each prescriber of a schedule II, III, or
IV controlled substance in the State--

(I) registers with the prescription drug monitoring program
of the State; and
(II) consults the prescription drug monitoring program
database of the State before prescribing a schedule II, III,
or IV controlled substance;

(ii) require that each dispenser of a schedule II, III, or
IV controlled substance in the State--

(I) registers with the prescription drug monitoring program
of the State;
(II) consults the prescription drug monitoring program
database of the State before dispensing a schedule II, III,
or IV controlled substance; and
(III) reports to the prescription drug monitoring program
of the State, at a minimum, each instance in which a schedule
II, III, or IV controlled substance is dispensed, with
limited exceptions, as defined by the State, which shall
indicate the prescriber by name and National Provider
Identifier;

(iii) require that, not fewer than 4 times each year, the
State agency or agencies that administer the prescription
drug monitoring program of the State prepare and provide to
each prescriber of a schedule II, III, or IV controlled
substance an informational report that shows how the
prescribing patterns of the prescriber compare to prescribing
practices of the peers of the prescriber and expected norms;
(iv) if informational reports provided to a prescriber
under clause (iii) indicate that the prescriber is repeatedly
falling outside of expected norms or standard practices for
the prescriber's field, direct the prescriber to educational
resources on appropriate prescribing of controlled
substances;
(v) ensure that the prescriber licensing board of the State
receives a report describing any prescribers that repeatedly
fall outside of expected norms or standard practices for the
prescriber's field, as described in clause (iii);
(vi) require consultation with the Single State Authority
for Substance Abuse; and
(vii) establish requirements for how data will be collected
and analyzed to determine the effectiveness of the program.
(D) Period.--An implementation grant under this section
shall be for a period of 2 years.
(E) Amount.--The amount of an implementation grant under
this section may not exceed $5,000,000.
(5) Priority considerations.--In awarding planning and
implementation grants under this section, the Attorney
General shall give priority to a State that--
(A)(i) provides civil liability protection for first
responders, health professionals, and family members who have
received appropriate training in the administration of
naloxone in administering naloxone to counteract opioid
overdoses; and
(ii) submits to the Attorney General a certification by the
attorney general of the State that the attorney general has--
(I) reviewed any applicable civil liability protection law
to determine the applicability of the law with respect to
first responders, health care professionals, family members,
and other individuals who--

(aa) have received appropriate training in the
administration of naloxone; and
(bb) may administer naloxone to individuals reasonably
believed to be suffering from opioid overdose; and

(II) concluded that the law described in subclause (I)
provides adequate civil liability protection applicable to
such persons;
(B) has in effect legislation or implements a policy under
which the State shall not terminate, but may suspend,
enrollment under the State plan for medical assistance under
title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
for an individual who is incarcerated for a period of fewer
than 2 years;
(C) has a process for enrollment in services and benefits
necessary by criminal justice agencies to initiate or
continue treatment in the community, under which an
individual who is incarcerated may, while incarcerated,
enroll in services and benefits that are necessary for the
individual to continue treatment upon release from
incarceration;
(D) ensures the capability of data sharing with other
States, such as by making data available to a prescription
monitoring hub;
(E) ensures that data recorded in the prescription drug
monitoring program database of the State is available within
24 hours, to the extent possible; and
(F) ensures that the prescription drug monitoring program
of the State notifies prescribers and dispensers of schedule
II, III, or IV controlled substances when overuse or misuse
of such controlled substances by patients is suspected.
(c) Authorization of Funding.--For each of fiscal years
2016 through 2020, the Attorney General may use, from any
unobligated balances made available under the heading
``GENERAL ADMINISTRATION'' to the Department of Justice in an
appropriations Act, such amounts as are necessary to carry
out this section, not to exceed $5,000,000 per fiscal year.

TITLE VII--MISCELLANEOUS

SEC. 701. GAO REPORT ON IMD EXCLUSION.

(a) Definition.--In this section, the term ``Medicaid
Institutions for Mental Disease exclusion'' means the
prohibition on Federal matching payments under Medicaid for
patients who have attained age 22, but have not attained age
65, in an institution for mental diseases under subparagraph
(B) of the matter following subsection (a) of section 1905 of
the Social Security Act and subsection (i) of such section
(42 U.S.C. 1396d).
(b) Report Required.--Not later than 1 year after the date
of enactment of this Act, the Comptroller General of the
United States shall submit to Congress a report on the impact
that the Medicaid Institutions for Mental Disease exclusion
has on access to treatment for individuals with a substance
use disorder.
(c) Elements.--The report required under subsection (b)
shall include a review of what is known regarding--
(1) Medicaid beneficiary access to substance use disorder
treatments in institutions for mental disease; and
(2) the quality of care provided to Medicaid beneficiaries
treated in and outside of institutions for mental disease for
substance use disorders.

SEC. 702. FUNDING.

Part II of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (42 U.S.C. 3797cc et seq.), as amended by
section 501, is amended by adding at the end the following:

``SEC. 2999F. FUNDING.

``There are authorized to be appropriated to the Attorney
General and the Secretary of Health and Human Services to
carry out this part $77,900,000 for each of fiscal years 2016
through 2020.''.

SEC. 703. CONFORMING AMENDMENTS.

Part II of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (42 U.S.C. 3797cc et seq.) is amended--
(1) in the part heading, by striking ``CONFRONTING USE OF
METHAMPHETAMINE'' and inserting ``COMPREHENSIVE ADDICTION AND
RECOVERY''; and
(2) in section 2996(a)(1), by striking ``this part'' and
inserting ``this section''.

SEC. 704. GRANT ACCOUNTABILITY.

(a) Grants Under Part II of Title I of the Omnibus Crime
Control and Safe Streets Act of 1968.--

[[Page S1179]]

Part II of title I of the Omnibus Crime Control and Safe
Streets Act of 1968 (42 U.S.C. 3797cc et seq.), as amended by
section 702, is amended by adding at the end the following:

``SEC. 2999G. GRANT ACCOUNTABILITY.

``(a) Definitions.--In this section--
``(1) the term `applicable committees'--
``(A) with respect to the Attorney General and any other
official of the Department of Justice, means--
``(i) the Committee on the Judiciary of the Senate; and
``(ii) the Committee on the Judiciary of the House of
Representatives; and
``(B) with respect to the Secretary of Health and Human
Services and any other official of the Department of Health
and Human Services, means--
``(i) the Committee on Health, Education, Labor, and
Pensions of the Senate; and
``(ii) the Committee on Energy and Commerce of the House of
Representatives;
``(2) the term `covered agency' means--
``(A) the Department of Justice; and
``(B) the Department of Health and Human Services; and
``(3) the term `covered official' means--
``(A) the Attorney General; and
``(B) the Secretary of Health and Human Services.
``(b) Accountability.--All grants awarded by a covered
official under this part shall be subject to the following
accountability provisions:
``(1) Audit requirement.--
``(A) Definition.--In this paragraph, the term `unresolved
audit finding' means a finding in the final audit report of
the Inspector General of a covered agency that the audited
grantee has utilized grant funds for an unauthorized
expenditure or otherwise unallowable cost that is not closed
or resolved within 12 months after the date on which the
final audit report is issued.
``(B) Audit.--Beginning in the first fiscal year beginning
after the date of enactment of this section, and in each
fiscal year thereafter, the Inspector General of a covered
agency shall conduct audits of recipients of grants awarded
by the applicable covered official under this part to prevent
waste, fraud, and abuse of funds by grantees. The Inspector
General shall determine the appropriate number of grantees to
be audited each year.
``(C) Mandatory exclusion.--A recipient of grant funds
under this part that is found to have an unresolved audit
finding shall not be eligible to receive grant funds under
this part during the first 2 fiscal years beginning after the
end of the 12-month period described in subparagraph (A).
``(D) Priority.--In awarding grants under this part, a
covered official shall give priority to eligible applicants
that did not have an unresolved audit finding during the 3
fiscal years before submitting an application for a grant
under this part.
``(E) Reimbursement.--If an entity is awarded grant funds
under this part during the 2-fiscal-year period during which
the entity is barred from receiving grants under subparagraph
(C), the covered official that awarded the grant funds
shall--
``(i) deposit an amount equal to the amount of the grant
funds that were improperly awarded to the grantee into the
General Fund of the Treasury; and
``(ii) seek to recoup the costs of the repayment to the
fund from the grant recipient that was erroneously awarded
grant funds.
``(2) Nonprofit organization requirements.--
``(A) Definition.--For purposes of this paragraph and the
grant programs under this part, the term `nonprofit
organization' means an organization that is described in
section 501(c)(3) of the Internal Revenue Code of 1986 and is
exempt from taxation under section 501(a) of such Code.
``(B) Prohibition.--A covered official may not award a
grant under this part to a nonprofit organization that holds
money in offshore accounts for the purpose of avoiding paying
the tax described in section 511(a) of the Internal Revenue
Code of 1986.
``(C) Disclosure.--Each nonprofit organization that is
awarded a grant under this part and uses the procedures
prescribed in regulations to create a rebuttable presumption
of reasonableness for the compensation of its officers,
directors, trustees, and key employees, shall disclose to the
applicable covered official, in the application for the
grant, the process for determining such compensation,
including the independent persons involved in reviewing and
approving such compensation, the comparability data used, and
contemporaneous substantiation of the deliberation and
decision. Upon request, a covered official shall make the
information disclosed under this subparagraph available for
public inspection.
``(3) Conference expenditures.--
``(A) Limitation.--No amounts made available to a covered
official under this part may be used by the covered official,
or by any individual or entity awarded discretionary funds
through a cooperative agreement under this part, to host or
support any expenditure for conferences that uses more than
$20,000 in funds made available by the covered official,
unless the covered official provides prior written
authorization that the funds may be expended to host the
conference.
``(B) Written authorization.--Written authorization under
subparagraph (A) shall include a written estimate of all
costs associated with the conference, including the cost of
all food, beverages, audio-visual equipment, honoraria for
speakers, and entertainment.
``(C) Report.--
``(i) Department of justice.--The Deputy Attorney General
shall submit to the applicable committees an annual report on
all conference expenditures approved by the Attorney General
under this paragraph.
``(ii) Department of health and human services.--The Deputy
Secretary of Health and Human Services shall submit to the
applicable committees an annual report on all conference
expenditures approved by the Secretary of Health and Human
Services under this paragraph.
``(4) Annual certification.--Beginning in the first fiscal
year beginning after the date of enactment of this section,
each covered official shall submit to the applicable
committees an annual certification--
``(A) indicating whether--
``(i) all audits issued by the Office of the Inspector
General of the applicable agency under paragraph (1) have
been completed and reviewed by the appropriate Assistant
Attorney General or Director, or the appropriate official of
the Department of Health and Human Services, as applicable;
``(ii) all mandatory exclusions required under paragraph
(1)(C) have been issued; and
``(iii) all reimbursements required under paragraph (1)(E)
have been made; and
``(B) that includes a list of any grant recipients excluded
under paragraph (1) from the previous year.
``(c) Preventing Duplicative Grants.--
``(1) In general.--Before a covered official awards a grant
to an applicant under this part, the covered official shall
compare potential grant awards with other grants awarded
under this part by the covered official to determine if
duplicate grant awards are awarded for the same purpose.
``(2) Report.--If a covered official awards duplicate
grants to the same applicant for the same purpose, the
covered official shall submit to the applicable committees a
report that includes--
``(A) a list of all duplicate grants awarded, including the
total dollar amount of any duplicate grants awarded; and
``(B) the reason the covered official awarded the duplicate
grants.''.
(b) Other Grants.--
(1) Definitions.--In this subsection--
(A) the term ``applicable committees''--
(i) with respect to the Attorney General and any other
official of the Department of Justice, means--

(I) the Committee on the Judiciary of the Senate; and
(II) the Committee on the Judiciary of the House of
Representatives; and

(ii) with respect to the Secretary of Health and Human
Services and any other official of the Department of Health
and Human Services, means--

(I) the Committee on Health, Education, Labor, and Pensions
of the Senate; and
(II) the Committee on Energy and Commerce of the House of
Representatives;

(B) the term ``covered agency'' means--
(i) the Department of Justice; and
(ii) the Department of Health and Human Services; and
(C) the term ``covered official'' means--
(i) the Attorney General; and
(ii) the Secretary of Health and Human Services.
(2) Accountability.--All grants awarded by a covered
official under section 201, 302, or 601 shall be subject to
the following accountability provisions:
(A) Audit requirement.--
(i) Definition.--In this subparagraph, the term
``unresolved audit finding'' means a finding in the final
audit report of the Inspector General of a covered agency
that the audited grantee has utilized grant funds for an
unauthorized expenditure or otherwise unallowable cost that
is not closed or resolved within 12 months after the date on
which the final audit report is issued.
(ii) Audit.--Beginning in the first fiscal year beginning
after the date of enactment of this Act, and in each fiscal
year thereafter, the Inspector General of a covered agency
shall conduct audits of recipients of grants awarded by the
applicable covered official under section 201, 302, or 601 to
prevent waste, fraud, and abuse of funds by grantees. The
Inspector General shall determine the appropriate number of
grantees to be audited each year.
(iii) Mandatory exclusion.--A recipient of grant funds
under section 201, 302, or 601 that is found to have an
unresolved audit finding shall not be eligible to receive
grant funds under those sections during the first 2 fiscal
years beginning after the end of the 12-month period
described in clause (i).
(iv) Priority.--In awarding grants under section 201, 302,
or 601, a covered official shall give priority to eligible
applicants that did not have an unresolved audit finding
during the 3 fiscal years before submitting an application
for a grant under such section.
(v) Reimbursement.--If an entity is awarded grant funds
under section 201, 302, or 601 during the 2-fiscal-year
period during which the entity is barred from receiving
grants under clause (iii), the covered official that awarded
the funds shall--

(I) deposit an amount equal to the amount of the grant
funds that were improperly awarded to the grantee into the
General Fund of the Treasury; and
(II) seek to recoup the costs of the repayment to the fund
from the grant recipient that was erroneously awarded grant
funds.

(B) Nonprofit organization requirements.--
(i) Definition.--For purposes of this subparagraph and the
grant programs under sections 201, 302, and 601, the term
``nonprofit organization'' means an organization that is
described in section 501(c)(3) of the Internal Revenue Code
of 1986 and is exempt from taxation under section 501(a) of
such Code.
(ii) Prohibition.--A covered official may not award a grant
under this section 201, 302, or 601

[[Page S1180]]

to a nonprofit organization that holds money in offshore
accounts for the purpose of avoiding paying the tax described
in section 511(a) of the Internal Revenue Code of 1986.
(iii) Disclosure.--Each nonprofit organization that is
awarded a grant under section 201, 302, or 601 and uses the
procedures prescribed in regulations to create a rebuttable
presumption of reasonableness for the compensation of its
officers, directors, trustees, and key employees, shall
disclose to the applicable covered official, in the
application for the grant, the process for determining such
compensation, including the independent persons involved in
reviewing and approving such compensation, the comparability
data used, and contemporaneous substantiation of the
deliberation and decision. Upon request, a covered official
shall make the information disclosed under this clause
available for public inspection.
(C) Conference expenditures.--
(i) Limitation.--No amounts made available to a covered
official under section 201, 302, or 601 may be used by the
covered official, or by any individual or entity awarded
discretionary funds through a cooperative agreement under
those sections, to host or support any expenditure for
conferences that uses more than $20,000 in funds made
available by the covered official, unless the covered
official provides prior written authorization that the funds
may be expended to host the conference.
(ii) Written authorization.--Written authorization under
clause (i) shall include a written estimate of all costs
associated with the conference, including the cost of all
food, beverages, audio-visual equipment, honoraria for
speakers, and entertainment.
(iii) Report.--

(I) Department of justice.--The Deputy Attorney General
shall submit to the applicable committees an annual report on
all conference expenditures approved by the Attorney General
under this subparagraph.
(II) Department of health and human services.--The Deputy
Secretary of Health and Human Services shall submit to the
applicable committees an annual report on all conference
expenditures approved by the Secretary of Health and Human
Services under this subparagraph.

(D) Annual certification.--Beginning in the first fiscal
year beginning after the date of enactment of this Act, each
covered official shall submit to the applicable committees an
annual certification--
(i) indicating whether--

(I) all audits issued by the Office of the Inspector
General of the applicable agency under subparagraph (A) have
been completed and reviewed by the appropriate Assistant
Attorney General or Director, or the appropriate official of
the Department of Health and Human Services, as applicable;
(II) all mandatory exclusions required under subparagraph
(A)(iii) have been issued; and
(III) all reimbursements required under subparagraph (A)(v)
have been made; and

(ii) that includes a list of any grant recipients excluded
under subparagraph (A) from the previous year.
(3) Preventing duplicative grants.--
(A) In general.--Before a covered official awards a grant
to an applicant under section 201, 302, or 601, the covered
official shall compare potential grant awards with other
grants awarded under those sections by the covered official
to determine if duplicate grant awards are awarded for the
same purpose.
(B) Report.--If a covered official awards duplicate grants
to the same applicant for the same purpose, the covered
official shall submit to the to the applicable committees a
report that includes--
(i) a list of all duplicate grants awarded, including the
total dollar amount of any duplicate grants awarded; and
(ii) the reason the covered official awarded the duplicate
grants.

Committee-Reported Substitute Amendment Withdrawn

The PRESIDING OFFICER. Under the previous order, the committee-
reported substitute is withdrawn.
The Senator from Iowa.

Amendment No. 3378

(Purpose: In the nature of a substitute.)

Mr. GRASSLEY. Mr. President, I call up the substitute amendment No.
3378.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Iowa [Mr. Grassley] proposes an amendment
numbered 3378.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The amendment is printed in the Record of March 1, 2016, under
``Text of Amendments.'')

Amendment No. 3362 to Amendment No. 3378

Mr. GRASSLEY. Mr. President, I call up the Feinstein-Grassley
amendment No. 3362.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Iowa [Mr. Grassley], for Mrs. Feinstein,
proposes an amendment numbered 3362 to amendment No. 3378.

The amendment is as follows:

(Purpose: To provide the Department of Justice with additional tools to
target extraterritorial drug trafficking activity, and for other
purposes)

At the end, add the following:

TITLE __--TRANSNATIONAL DRUG TRAFFICKING ACT

SEC. _01. SHORT TITLE.

This title may be cited as the ``Transnational Drug
Trafficking Act of 2015''.

SEC. _02. POSSESSION, MANUFACTURE OR DISTRIBUTION FOR
PURPOSES OF UNLAWFUL IMPORTATIONS.

Section 1009 of the Controlled Substances Import and Export
Act (21 U.S.C. 959) is amended--
(1) by redesignating subsections (b) and (c) as subsections
(c) and (d), respectively; and
(2) in subsection (a), by striking ``It shall'' and all
that follows and inserting the following: ``It shall be
unlawful for any person to manufacture or distribute a
controlled substance in schedule I or II or flunitrazepam or
a listed chemical intending, knowing, or having reasonable
cause to believe that such substance or chemical will be
unlawfully imported into the United States or into waters
within a distance of 12 miles of the coast of the United
States.
``(b) It shall be unlawful for any person to manufacture or
distribute a listed chemical--
``(1) intending or knowing that the listed chemical will be
used to manufacture a controlled substance; and
``(2) intending, knowing, or having reasonable cause to
believe that the controlled substance will be unlawfully
imported into the United States.''.

SEC. _03. TRAFFICKING IN COUNTERFEIT GOODS OR SERVICES.

Chapter 113 of title 18, United States Code, is amended--
(1) in section 2318(b)(2), by striking ``section 2320(e)''
and inserting ``section 2320(f)''; and
(2) in section 2320--
(A) in subsection (a), by striking paragraph (4) and
inserting the following:
``(4) traffics in a drug and knowingly uses a counterfeit
mark on or in connection with such drug,'';
(B) in subsection (b)(3), in the matter preceding
subparagraph (A), by striking ``counterfeit drug'' and
inserting ``drug that uses a counterfeit mark on or in
connection with the drug''; and
(C) in subsection (f), by striking paragraph (6) and
inserting the following:
``(6) the term `drug' means a drug, as defined in section
201 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C.
321).''.

Mr. GRASSLEY. Mr. President, I am pleased we are considering the bill
before us entitled the ``Comprehensive Addiction and Recovery Act''--
acronym CARA--and that we are on the floor discussing this very
important issue.
Since I spoke about the bill earlier this week, I will not have any
more opening remarks at this point. I look forward to a bipartisan
process where we are able to consider many amendments and move this
bill forward.
Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. BARRASSO. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Cotton). Without objection, it is so
ordered.
Mr. BARRASSO. Mr. President, I ask unanimous consent to speak as in
morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.

ObamaCare

Mr. BARRASSO. Mr. President, I come to the floor today to discuss
more of the troubling news that has come out on how the health care law
has affected the people of this country. A new poll just came out from
National Public Radio as well as the Robert Wood Johnson Foundation.
This is what they found: According to the poll, 26 percent of Americans
are telling us that the health care law--ObamaCare--has directly hurt
them. Twenty-six percent of Americans say that ObamaCare, the health
care law, has directly hurt them. Only 14 percent of the people in the
poll said that their personal health care has gotten better under
ObamaCare. So it is just one in seven who say it is better; over one-
quarter say they have personally been hurt. So almost twice as many
people have been directly hurt by the law compared to the people who
have been helped.
American taxpayers are also being hurt by ObamaCare because of the
waste and the fraud in the health care system. There is a new report
just out from the Government Accountability Office. It came out last
week. It found that the Obama administration is still failing to stop
the fraud in health care subsidies.

[[Page S1181]]

Here is how the law was designed to work: People must have
government-approved insurance because of the law. It is a mandate.
There are a lot of people who have been forced to buy very expensive
insurance to comply with the law, and in many cases it is far more
coverage than they want, that they need, or that they can afford. So
the health care law, which the Democrats voted for and the Republicans
voted against, said that the government will give subsidies to people
to help them pay for this Washington-mandated, expensive insurance.
To get the subsidy, people are supposed to be able to prove they are
eligible for the subsidy. There are various criteria to make sure
people are eligible. That means things like proving they make a certain
income or how many people are in their family or that they are citizens
of the United States or that they are here legally.
Washington then pays the subsidy directly to the insurance company.
Then later, the government comes around and tries to figure out if the
person even qualified for the money, so there is a huge potential for
fraud and for wasting taxpayer dollars.
This new report from the Government Accountability Office found that,
despite the billions of dollars at stake, the Obama administration has
taken what they describe as a ``passive approach'' to identifying and
preventing the fraud. The Obama administration has taken a ``passive
approach.'' It says the Obama administration has struggled--struggled
to confirm the eligibility of millions of people who applied for
subsidies. This is a report from the Government Accountability Office.
We want accountability in government.
The report found that there are 431,000 people who still had
unresolved issues with the subsidy paperwork more than a year after
they first applied. The cases amount to over $1.7 billion in taxpayer
subsidies. Now, the insurance coverage that these people had for that
year has already ended. The Obama administration still did not know if
they should have gotten the money that was sent out to the insurance
companies on their behalf.
There are another 22,000 cases where it still is not clear if the
person who got the subsidy was serving time in prison. How can
Washington not even know if someone is in prison? This should be one of
the easiest things to find out. But there are millions of cases where
the administration is taking this passive approach to figuring out if
there is fraud occurring with these subsidies.
People all around the country are asking: Where is the accountability
from the Obama administration? They are spending billions of taxpayer
dollars. Where is the accountability to make sure that it is being
spent properly and not wasted? There is no accountability because the
Obama administration does not seem to care about protecting taxpayer
money. It cares more about getting a large number of people enrolled in
insurance. That is what they want, no matter what the law says, no
matter how much money they waste to do it.
This report from the Government Accountability Office came out last
Wednesday. The very next day, there was more bad news for taxpayers
because of the health care law. There was an article in the Wall Street
Journal on Thursday, February 25, under the headline ``Insurance Fight
Escalates.'' It goes on to say: ``Health co-op leaders say the effort
to recoup Federal loans will come up short.''
This is taxpayer money. Remember, the health care law gave out
billions of dollars--billions of dollars in loans to set up these
health insurance co-ops across the country. They set up 23. Already,
more than half of them have collapsed and have gone out of business, 12
out of 23 have gone bust, and 700,000 Americans lost their insurance
because these co-ops failed.
Now it looks as if hard-working taxpayers are going to lose the money
that the government loaned to these failed insurance businesses.
According to this Wall Street Journal article, leaders of the co-ops
say that taxpayers are going to lose more than $1 billion in the failed
co-ops. They say it is because most of the money has already been
spent.
The article quotes the head of the co-op in New Mexico as saying:
``Will there be any money left?''
``Yeah, maybe.'' That is what he said. That is his answer: ``Yeah,
maybe.'' Maybe there will be a little money left out of more than $1
billion in taxpayer loans. It is outrageous. It was not supposed to be
a bailout of the insurance company. These were supposed to be loans.
Is that how the administration thinks loans are supposed to work?
Does the Obama administration think that if they lend out money and
people borrow it from the taxpayers and spend it, then they don't have
to pay it? Where is the accountability from these co-ops for the
American people? Where is the accountability for the Obama
administration to make sure that they loan this money responsibly and
don't waste it? Reports like this paint a very bad picture of health
care and the health care law in this country.
We talked about these 23 co-ops and half of them have failed. This
was headlined yesterday: ``Losses deepen for remaining ObamaCare co-
ops.''

Losses snowballed in the fourth quarter at four co-op
health plans [that have now reported their numbers for 2015].

The article says:

The nonprofit startups based in Illinois, Wisconsin, Ohio
and Maine lost about $270 million last year. . . . That's
more than five times the level of losses those plans recorded
in 2014.

That was the first year they operated. They are still waiting for the
updated financial reports on the other seven remaining co-ops that have
not yet posted their returns.
Here we are. Six years ago, there was a debate in Congress about the
Americans' health care system. Everyone in this body agreed we had a
problem. Everybody agreed we needed to do something to help Americans.
Republicans presented our ideas on the floor of the Senate. We went to
meetings at the White House. We offered President Obama solutions.
Democrats and the President rejected our ideas, and they came up with
their own massive plan.
Washington took on too much power over the health care decisions of
American families. More Washington control, less Washington
accountability--they are never the right answers for our country. If
Washington can't protect taxpayer dollars, it shouldn't be collecting
so many of these dollars in the first place.
Republicans warned that ObamaCare would be bad for patients, bad for
providers, and terrible for the taxpayers. The news keeps coming out,
showing that we were exactly right. Republicans are going to continue
to talk about our health care ideas and will continue to talk about
ideas that will actually hold Washington accountable as Washington
spends taxpayers' dollars. We will continue to talk about ideas such as
giving families more control over their health care and their health
care decisions and giving Washington less control. That is what
Americans want.
This new report out from the National Public Radio poll showed 26
percent of Americans say that the health care law, ObamaCare, has
directly hurt them. They didn't want this kind of health care reform
that directly hurts them, instead of helping them; they wanted to be
helped. They don't want an approach like we have; they want an approach
that gives them control and, certainly, not a passive approach to
preventing fraud. The American people do not want ObamaCare.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from New Hampshire.

Amendment No. 3345 to Amendment No. 3378

Mrs. SHAHEEN. Mr. President, I wish to call up amendment No. 3345,
which is my supplemental amendment to address the heroin and opioid
epidemic.
The PRESIDING OFFICER. The clerk will report.
The senior assistant legislative clerk read as follows:

The Senator from New Hampshire [Mrs. Shaheen] proposes an
amendment numbered 3345 to amendment No. 3378.

Mrs. SHAHEEN. I ask unanimous consent that the reading of the
amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To make appropriations to address the heroin and opioid drug
abuse epidemic for the fiscal year ending September 30, 2016)

At the end, add the following:

[[Page S1182]]

TITLE VIII--ADDITIONAL APPROPRIATIONS FOR FISCAL YEAR 2016

SEC. 801. DEPARTMENT OF JUSTICE.

(a) State and Local Law Enforcement Assistance.--
(1) In general.--In addition to any amounts otherwise made
available, there is appropriated, out of any money in the
Treasury not otherwise appropriated, for fiscal year 2016,
$230,000,000, to remain available until expended, to the
Department of Justice for State law enforcement initiatives
(which shall include a 30 percent pass-through to localities)
under the Edward Byrne Memorial Justice Assistance Grant
program, as authorized by subpart 1 of part E of title I of
the Omnibus Crime Control and Safe Streets Act of 1968 (42
U.S.C. 3750 et seq.) (except that section 1001(c) of such Act
(42 U.S.C. 3793(c)) shall not apply for purposes of this
Act), to be used, notwithstanding such subpart 1, for a
comprehensive program to combat the heroin and opioid crisis,
and for associated criminal justice activities, including
approved treatment alternatives to incarceration.
(2) Emergency requirement.--The amount appropriated under
paragraph (1) shall be designated by the Congress as an
emergency requirement pursuant to section 251(b)(2)(A)(i) of
the Balanced Budget and Emergency Deficit Control Act of 1985
(2 U.S.C. 901(b)(2)(A)(i)).
(b) Heroin and Methamphetamine Task Forces.--
(1) In general.--In addition to any amounts otherwise made
available, there is appropriated, out of any money in the
Treasury not otherwise appropriated, for fiscal year 2016,
$10,000,000, to remain available until expended, to the
Department of Justice to carry out section 2999 of title I of
the Omnibus Crime Control and Safe Streets Act of 1968, as
added by section 204 of this Act, to be used to assist State
and local law enforcement agencies in areas with high per
capita levels of opioid and heroin use, targeting resources
to support law enforcement operations on the ground.
(2) Emergency requirement.--The amount appropriated under
paragraph (1) shall be designated by the Congress as an
emergency requirement pursuant to section 251(b)(2)(A)(i) of
the Balanced Budget and Emergency Deficit Control Act of 1985
(2 U.S.C. 901(b)(2)(A)(i)).

SEC. 802. DEPARTMENT OF HEALTH AND HUMAN SERVICES.

(a) Substance Abuse and Mental Health Services
Administration.--
(1) In general.--In addition to any amounts otherwise made
available, there is appropriated, out of any money in the
Treasury not otherwise appropriated, for fiscal year 2016--
(A) $300,000,000, to remain available until expended, to
the Substance Abuse and Mental Health Services Administration
of the Department of Health and Human Services, for
``Substance Abuse Treatment'', to address the heroin and
opioid crisis and its associated health effects, of which not
less than $15,000,000 shall be to improve treatment for
pregnant or postpartum women under the pilot program
authorized under section 508(r) of the Public Health Service
Act (42 U.S.C. 290bb-1), as amended by section 501 of this
Act; and
(B) $10,000,000, to remain available until expended, to the
Substance Abuse and Mental Health Services Administration of
the Department of Health and Human Services, for grants for
medication assisted treatment for prescription drug and
opioid addiction under section 2999A of title I of the
Omnibus Crime Control and Safe Streets Act of 1968, as added
by section 301 of this Act.
(2) Emergency requirement.--The amount appropriated under
paragraph (1) shall be designated by the Congress as an
emergency requirement pursuant to section 251(b)(2)(A)(i) of
the Balanced Budget and Emergency Deficit Control Act of 1985
(2 U.S.C. 901(b)(2)(A)(i)).
(b) Centers for Disease Control and Prevention.--
(1) In general.--In addition to any amounts otherwise made
available, there is appropriated, out of any money in the
Treasury not otherwise appropriated, for fiscal year 2016,
$50,000,000, to remain available until expended, to the
Centers for Disease Control and Prevention of the Department
of Health and Human Services, for prescription drug
monitoring programs, community health system interventions,
and rapid response projects.
(2) Emergency requirement.--The amount appropriated under
paragraph (1) shall be designated by the Congress as an
emergency requirement pursuant to section 251(b)(2)(A)(i) of
the Balanced Budget and Emergency Deficit Control Act of 1985
(2 U.S.C. 901(b)(2)(A)(i)).

Mrs. SHAHEEN. Mr. President, I am not going to speak to this
amendment right now because I hope to do it later. I spent a fair
amount of time yesterday talking about the need to provide the
resources to address the heroin and opioid epidemic, but I am very
pleased to see my colleague from Maine on the floor to speak to it. He
has been a cosponsor of the legislation and a huge advocate for
addressing the challenge that Maine--like New Hampshire and so many
other States--is facing from the heroin and opioid epidemic. I look
forward to his remarks and to the opportunity for us to vote on this
amendment later today.
The PRESIDING OFFICER. The Senator from Maine.
Mr. KING. Mr. President, this week, this body is talking about one of
the most serious problems facing our country. The word ``epidemic''
really isn't strong enough to represent what we are seeing in terms of
drug addiction--opioids and heroin, in particular. The bipartisan
support for the bill that is on the floor this week is an indication of
the belief of Members of both parties, of all parties of all parts of
the country, that this is a critically important question.
We have heard the appalling figures in committees and caucuses and on
the floor. In the State of Maine, there are 200 deaths a year from
overdoses. This is an eightfold increase in the last 3 years. The
figure that got my attention most dramatically was that a year ago in
Maine, we had 12,000 babies born, and of that number over 950 were
addicted to a substance. That is almost 1 in 12 babies born in my
State.
Nationally, the figures are just as shocking and as bad. In my
neighboring State of New Hampshire, the number of overdose deaths is
now over 380 a year. It is more than one a day. Nationally, there are
47,000 overdose deaths--more deaths than are caused by automobiles.
If this were Ebola or ISIS or any other kind of national crisis, we
would be in 24-hour session to find a solution. We would be doing
everything the equivalent of the Manhattan Project to deal with
something that is killing so many of our citizens, particularly our
young people.
Like any other problem that gets to this body, this is complicated.
There isn't any single solution. It involves law enforcement. It
involves national security--stopping drugs at the border. It involves
treatment of mental illness. It involves treatment of drug addiction
and figuring out what works. It involves figuring out prevention. It
involves dealing with the overwhelming number of opioid prescription
drugs that we now know lead to heroin and other addictions.
It is a very complex problem. There is no single answer, but there
are some things we do know about this problem:
The first thing we know is that law enforcement alone isn't enough.
Essentially, we have tried that for 25 years. Law enforcement alone
isn't enough. It is important. It is a critical part of our defense
against the scourge, but it is not the entire answer.
The second thing we know is that this epidemic is directly related to
the dramatic rise of prescription painkillers based upon opioids. The
data is that four out of five new heroin users started with
prescription drugs. This is something we need to discuss. We need to
discuss it with the medical community. We need to discuss it with the
educational community, and we need to understand that when these drugs
are prescribed, there are risks--serious, undeniable, dangerous risks
that are taking an enormous toll on our society.
Four out of five new heroin users started with prescription drugs. I
met a young man in Maine who was in treatment, who was trying to
recover, who had become an addict. He got there starting with a high
school sports injury, and he was prescribed opioid treatment--opioid
pills--and he ended up in the drug culture that was destroying his
life.
That is the second thing we know. We know that law enforcement isn't
enough. We know that a big part of our focus has to be on opioids and
prescription drugs.
The third thing we know is, there are some treatments that appear to
work. We don't know for sure. One of the things that I think we need to
do in this body is to provide for the research and the data sharing and
the data collection from around the country so we can find out what
works. It appears that medication and counseling together are something
that works, but we need more research and more data.
The fourth thing we know is that treatment resources are grossly
inadequate. This epidemic has exploded in the last few years, but the
resources in terms of treatment have, in some cases, actually
diminished. There are fewer beds today than there were 3 years ago
because of budget cuts, because of policy changes, and we end up

[[Page S1183]]

with young people and people generally that have this terrible problem
eating up their lives with no place to go.
The greatest tragedy is when we have someone who is suffering from
addiction and wants treatment and is ready to take the step and say ``I
need it,'' and there is no place to go. The estimates are that among
teenagers who are caught in this trap, only 20 percent have treatment
available to them.
All these numbers and statistics and policy prescriptions aren't
really my subject today. I don't want to talk about politics or even
policy. I want to talk about people. In particular, I want to talk
about this little boy. This picture is of a young man from Maine named
Garrett Brown. There was an extraordinary story about Garrett in the
Bangor Daily News late last week. A reporter, Erin Rhoda, an editor at
the Bangor Daily News--one of our great newspapers--got to know this
young man named Garrett Brown and spent a lot of time interacting with
him over the last 3 years and recounted it in this extraordinary piece
of journalism. It is the story of this young man's attempts to survive
and what happened in his life.
This isn't politics. It isn't policy. It is people. In reading this
story as I sat in my darkened office late last week--as my staff went
home, they thought there was something wrong with me. The lights were
dimmed, the sun was setting, and I read this story. It was like reading
the story of the Titanic or of the Lincoln assassination. You knew how
it was going to come out, but you hoped it wouldn't happen. You kept
seeing moments when it could have been avoided; the tragic end could
have been avoided, but it didn't happen. That was what was so gripping
to me about this story. It was so real, and it was so close to home.
I have four boys of my own. I venture to say that every family in
America that has a son has a picture like it or just like it somewhere
in their family scrapbooks or stored on their telephone or in their
computer. This is a wonderful Maine kid--a smiling 8-year-old, happy,
and ready to go to school with his backpack. Then, about 15 years
later, he is with his mom, and he is on his way out. He had a mom who
loved him, but he had a system that failed him.
He took responsibility, by the way. He said: It's not that my mom or
my stepdad didn't care. They tried. My grandparents tried everything
they could. They were devout Christians. There was nothing they would
have done to change it.
He took responsibility. But when he took responsibility, we didn't
provide the means for him to effectuate that and save his own life. He
had to want to beat it, but he also had to have the means, the
resources to take that step.
The Bangor Daily News quite accurately laid out the issue: ``Opioid
addiction like Garrett's requires treatment.'' We have this idea in our
society that it is just a choice. You make the choice; you don't have
to take that pill. Well, the way these drugs work on your brain, they
hijack the very parts of your brain that enable you to make that
decision. They actually go to the parts of the brain that deal with
executive function, decisionmaking, and fear, and derail those parts of
the brain. It requires treatment. I am sure that occasionally there are
people who can do this by themselves, but that is very rare. Most
people require treatment, and odds are that those with an addiction to
drugs or alcohol won't get any treatment at all. As I mentioned, only
one out of five teenagers who needs treatment has it available to them.
If they do go through treatment, they are likely to get the wrong
treatment. There is a world of different theories on treatments
options, and that is why I say we need to have the research so we can
understand what works and put our resources into the things that will
actually bring results. Often it means they die, and that is what
happened to young Garrett.

Between 2010 and 2014, the number of overdose deaths in Maine
involving heroin overdose increased eightfold. This is Maine. This
could have been any State in the country. It seems to be striking rural
States now as strongly or even worse than urban areas of the country.
I didn't know Garrett Brown, but he was a brave kid. I could tell by
his conversations with Erin Rhoda and by his conversations with us. He
knew he was talking to us. He knew this was going to be public. He knew
he was communicating with us, and here is what he said:

If this changes one kid's life, saves one kid from being in
jail, saves his family the pain of seeing him go through it--

This is a guy with an addiction saying this. It is extraordinary.
He continued:

If this . . . saves one kid from overdosing and dying, then
all that I've done hasn't been in vain. I guess that's why I
keep doing this with you?

This is a tragedy. It is not a tragedy of numbers. It is a tragedy of
real people. It is a tragedy of young lives lost, of treasures
squandered, and of hearts broken. I have never in my adult life seen a
problem like this that is facing my State and every State in this
country. We can't solve it all at once. There is no magic wand. But if
we find young people like Garrett who are ready to take a step toward a
cure--if not a cure, at least have an ongoing recovery--we need to meet
them halfway. We need to meet them halfway through the support of
treatment, the support of creating options that are available, by
understanding the relationship between addiction and the criminal
justice system, and ultimately by loving our neighbors as ourselves.
People sometimes ask me: What is so special about Maine? I tell them
Maine is a small town with very long streets. We know each other, care
about each other, think about each other, and we try to help each
other. I think this country can also be a community--should be a
community where we think about and care about each other.
Young lives lost, treasures squandered, and hearts broken. I hope we
can start to change that tragic trajectory that is breaking so many
hearts in this country this week so we can make a difference, not for
Garrett but for the young people to whom he was desperately sending
this message. We can, we should, and we shall.
I thank the Presiding Officer and yield the floor.
Mr. GRASSLEY. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The senior assistant legislative clerk proceeded to call the roll.
Mr. CORNYN. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

Commemorating Texas Independence Day

Mr. CORNYN. Mr. President, I rise to speak about a very important day
in the history of my State of Texas, a day that inspires pride and
gratitude in the hearts of all Texans. I rise to commemorate Texas
Independence Day.
In a moment, I wish to read a letter that was written 180 years ago
from behind the walls of an old Spanish mission called the Alamo--a
letter written by a 26-year-old lieutenant colonel in the Texas Army,
William Barret Travis--and in doing so, I carry on a tradition that was
started by the late Senator John Tower, who represented Texas and this
body for more than two decades. This tradition was upheld by his
successor, Senator Phil Gramm, and then by Senator Kay Bailey Hutchison
after him. So it is an honor today to carry on this great tradition.
On February 24, 1836, with his position under siege and outnumbered
nearly 10-to-1 by the forces of the Mexican dictator Antonio Lopez de
Santa Ana, Travis penned the following letter:

To the people of Texas and all Americans in the world:
Fellow citizens and compatriots, I am besieged by a
thousand or more of the Mexicans under Santa Ana. I have
sustained a continual bombardment and cannonade for 24 hours
and have not lost a man.
The enemy has demanded a surrender at discretion.
Otherwise, the garrison are to be put to the sword if the
fort is taken.
I have answered the demand with a cannon shot, and our flag
still waves proudly from the walls. I shall never surrender
or retreat. Then, I call on you in the name of Liberty, of
patriotism and everything dear to the American character, to
come to our aid, with all dispatch.
The enemy is receiving reinforcements daily and will no
doubt increase to 3,000 or 4,000 in 4 or 5 days. If this call
is neglected, I am determined to sustain myself as long as
possible and die like a soldier who never forgets what is due
to his own honor and that of his country. Victory or death.

[[Page S1184]]

Signed:

William Barret Travis.

Of course, we know in the battle that ensued, all 189 defenders of
the Alamo lost their lives, but they did not die in vain. The Battle of
the Alamo bought precious time for the Texas revolutionaries allowing
General Sam Houston to maneuver his army into position for a decisive
victory at the Battle of San Jacinto.
With this victory, Texas became a sovereign nation, and so today we
celebrate the adoption of the Texas Declaration of Independence on
March 2, 1836. For 9 years, the Republic of Texas thrived as a separate
nation. In 1845, it was annexed to the United States as the 28th State.
Many Texan patriots who fought in the revolution went on to serve in
the U.S. Congress, and I am honored to hold the seat of one of them,
Sam Houston. More broadly, I am honored to have the opportunity to
serve 27 million Texans, thanks to the sacrifices made by these brave
men 180 years ago.

Return from Space of Commander Scott Kelly and Manifest For Human Space
Flight Act

Mr. President, on a separate matter, one thing William Barret Travis
and the other early settlers of Texas had in common was a thirst for
adventure and a hunger for the great next frontier. It is an attitude
of optimistic perseverance that has become a trademark of Texans for
generations. So I think it is fitting today that we also celebrate a
man who has devoted his life to expanding our footprint in space.
Last night Scott Kelly returned to Earth after almost a year in
space--one of the longest lasting space flights of all time. By
tomorrow Scott should be back in Houston, home to the Johnson Space
Center.
In June I was able to tour the Johnson Space Center and meet some of
the men and women who made Scott Kelly's mission possible. They make
their work look easy. They literally have a hand in sending someone to
space, ensuring their safety, and executing multiple projects all at
the same time. Yet for them it is all in a day's work. They are doing
an outstanding job, not only for Houston but for Texas and the United
States. As you might expect, Texans view the space center with a
particular pride. The world has turned to it as a leader in space
exploration and research for more than 50 years. As one of NASA's
largest research centers, it continues to keep the United States in the
forefront of innovation and research related to science, technology,
engineering, and medicine as well.
Importantly, the Johnson Space Center also leads our commercial space
partnerships--a growing sector in my State--and helps design and test
the next generation of exploration capabilities and systems. The space
center also trains members of our brave astronaut corps, people such as
Scott Kelly, to ensure they are prepared for the incredible challenge
they face.
A real highlight of my most recent visit to the Johnson Space Center
was my ability to actually speak to Scott Kelly while he was in space
in the International Space Station. As you can tell from his social
media presence--and I follow him on Twitter; he publishes pictures of
his incredible view from space on his Twitter feed--he is an optimistic
guy, and it is easy to see that he loves his job, but I am sure he is
looking forward to being back home.
Scott's mission aboard the International Space Station was about
something much bigger than just he, which I am sure he would say if he
were here. It was about an investment in the next generation and a
commitment to new discoveries and exploring new frontiers. The research
he was a part of, included studies to evaluate the effects of living in
space on the human body. Scott is actually a twin. His twin brother was
here on Earth while he was in space for a year, and I am sure there
will be a lot of extensive studies, given the fact that they are twins,
on what changes Scott experienced in his own metabolism, body, and the
like. They also grew plants in zero gravity in space and much more,
which will lay the groundwork for preparing future Americans to go
farther, explore more places, and push the outer limits of human space
exploration safely without endangering their health and well-being.
The work Scott Kelly accomplished, along with all of the men and
women at the Johnson Space Center and with NASA, is so important
because it secures America's position as the global leader in space
exploration. As important, this research and development impacts more
than our space program. It helps applications in the medical field, for
our military, and other scientific endeavors. I remember growing up,
when we landed the first astronaut on the Moon and what an inspiration
it was to me as a young person. I think space exploration has a way of
opening the eyes and the imaginations of young people even today about
the future--a future perhaps in space exploration or other fields of
science, lured as they are to work in the forefront of discovery or
help engineer the next great innovation.
Developments like this don't occur automatically and they don't occur
overnight. We have to task our space program with taking on new
challenges to reap the full benefits, technological breakthroughs, and
scientific advancements, and that is why we needed a long-term strategy
for the U.S.-manned space mission.
Today I am introducing legislation called the Manifest for Human
Space Flight Act that would require NASA to provide Congress with a
clear goal and thoughtful strategy. This would include outlining our
exploration goals and selecting destinations for future manned space
missions that fully utilize our existing assets, provide opportunities
to work with commercial and international partners, and position our
overall space program on a more focused and stable trajectory. This
legislation would also, for the first time, designate a human presence
on Mars as a long-term goal of NASA.
Lieutenant Watley was perhaps an American on Mars in a great movie
``The Martian,'' but I believe actually establishing a human presence
on Mars would be a worthy goal that would then necessitate the strategy
to accomplish that goal. With this bill, I hope we can rightly
prioritize space exploration and confirm our commitment to discovering
the next great frontier.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Vermont.
Mr. LEAHY. Mr. President, while the distinguished senior Senator from
Texas is still on the floor, he mentioned the astronaut and his year in
space. As one who has a hobby of photography, I was envious as I looked
at all those. I am sure the distinguished Senator from Texas has the
same feeling I had seeing these photographs and seeing what an amazing
country we are in all times of days and nights and seasons. So I thank
him for raising that issue.
Mr. President, this week we are considering the Comprehensive
Addiction Recovery Act or as they call it CARA. There are few problems
in this country that have had more of a devastating impact on American
families than opioid abuse. Communities across the country are
struggling and they are seeking help. Vermont is no exception, and I
found this as I held hearings around the State.
Finally, after years of a misguided approach, Congress now sees
addiction for what it is, a public health crisis. We have before us a
bipartisan bill we are considering that demonstrates strong bipartisan
support by Senators for addressing addiction.
CARA authorizes a critical public health program that I helped create
to expand access to medication-assisted treatment programs. Some
Vermonters who have been struggling with addiction have had to wait
nearly a year to receive treatment. In fact, several died waiting.
Unfortunately, the story is not unique.
The bill also includes my provision to support rural communities with
the overdose reversal drug naloxone. Rural locations have the highest
death rates in the country from opioid poisoning, talking about my
small State of Vermont, but every State, no matter how large or how
small, has rural areas. I want people to know that rural locations have
the highest death rate. Now, if we can get naloxone into more hands, we
can save lives.

Last week, the police in Burlington, VT, were equipped with naloxone,
and they were able to save a man's life with this impactful treatment.
In fact, the man was unconscious. They saved his life, and Police Chief
Brandon del Pozo

[[Page S1185]]

called it ``a textbook case of how police save lives using naloxone.''
Now, CARA recognizes that law enforcement will always play a vital
role. That is why I worked to include an authorization for funding to
expand State-led anti-heroin task forces.
These are important efforts, but I can't emphasize enough that one
authorization bill alone is not going to pull our communities out of
addiction--not the communities in my State, in the distinguished
Presiding Officer's State or in anybody else's State. We can't pretend
that solving a problem as large as opioid addiction does not require
more resources.
That is why the amendment proposed by Senator Shaheen is so
essential. It puts real dollars behind the rhetoric. It is going to
ensure that the important programs authorized in CARA can actually
succeed.
We can all feel good about going on record saying we are against the
problem and that we want to solve the problem of opioid addiction. But
if we say we are not going to give you any money to do it, it sounds
more like empty rhetoric.
In fact, Congress has approved much larger emergency supplemental
bills addressing Ebola and swine flu. Even though we didn't have a
single Ebola case in this country, we had supplemental funds addressing
it, while we have thousands of opioid addiction cases across the
country. These efforts were appropriate--but for Ebola and swine flu.
Now we have a public health crisis that is here in our own country, and
we must respond. Of course, we have responded to epidemics in other
countries, but this is an epidemic here at home.
I think everybody agrees that opioid addiction is an epidemic. We
should start treating it like one. The Shaheen amendment provides that
commitment. I urge every Member who supports CARA--and that is a strong
bipartisan group in this body--every Member who is concerned about
addiction in their community--and I have to assume that includes every
Senator--to put real resources behind CARA.
I think of the different hearings I have held around our State. In
one city, where some had suggested maybe we shouldn't have a hearing
yet because we shouldn't talk about what is going on, the mayor of that
city took just the opposite view. He said: We have a problem; so we
should talk about it to see what we can do about it. He was happy I
came there. Although he is a Republican and I am a Democrat, we both
said there is no politics and partisanship in this and we ought to face
it.
But here is what happened. We scheduled that hearing, and we thought
we could use a hall of such-and-such a size. As the days toward the
hearing kept coming, we found we needed a bigger and bigger hall
because more and more people wanted to come there. We found we had the
faith community, law enforcement, the medical profession, mothers and
fathers, addicts, and educators. All of these people came together and
said: We have a problem, and we need the resources to work together.
Law enforcement can't do it alone. The medical profession can't do it
alone. The faith community can't do it alone. Educators can't do it
alone. But together, with the resources, we might be able to do
something.
For another hearing I held--again, the very same thing in a small
town--we had to keep enlarging the place where we were going to meet. I
recall several people testifying, but one was a now-retired but highly
respected, decorated pediatrician. He told us about talking to a
couple. He didn't identify them for obvious reasons. But he said: You
know, we have this opioid problem here in our city. We have young
teenagers who come from very good families--families that are well
educated, prosperous, have good income, nice homes. But these teenagers
are addicts, and they are getting some of this right from their home
medicine cabinet. In this hall with hundreds of people, you could hear
a pin drop. He stopped and paused for a moment, and he said: The
parents thanked me and said: This is something we should watch out for.
He said: No, I am talking about your daughter. Your 14-year-old
daughter is an addict. I am talking about her. There are a lot of
others in this community, but I am talking about her. I am talking
about her.
To this day, I can hear the collective gasp in that room.
I later had the opportunity to meet the parents and the doctor and
see the things they were doing. They had the ability, and to the extent
that there were things available, they could pay for them, but most
people couldn't.
Yes, we should pass CARA, but we should also acknowledge that we have
this problem in every single State in the Union, across every
demographic, every income level, every area of education. Let's pass
some appropriations so that we are not just giving empty words and we
are not addressing a terrible problem with just empty words. But the
Senate is saying: We will stand up for a problem in our own country, as
we have in other countries when we have helped other countries, and we
will stand up for a serious problem right here at home, and we have the
courage to spend the money to do it.
I yield the floor.
The PRESIDING OFFICER (Mr. Sasse). The Senator from New Jersey.

Filling the Supreme Court Vacancy

Mr. MENENDEZ. Mr. President, I appreciate the distinguished ranking
member of the Judiciary Committee for yielding at this time. I agree
with him on the issue of the legislation before us, but I felt
compelled to come to the floor to speak about the vacancy in the U.S.
Supreme Court.
I rise to support this President's obligation--any
President's obligation--to name a Supreme Court nominee to fill a
vacancy, no matter when that vacancy occurs--election year or not. We
should rightfully expect any President to fulfill his or her
constitutional duty and send an eminently qualified nominee to the
Senate. All logic, all reason, and the Constitution itself dictates
that every President has the duty to do so, under any interpretation of
constitutional law. Likewise, we should rightfully expect the Senate to
do its job and send that name to the Judiciary Committee, hold a
hearing, debate the nomination on the floor, and take a vote.

We are not talking about a vague clause that invites interpretation.
We are talking about a very clear and concise clause--article II,
section 2, clause 2--that states: ``The President. . . . shall
nominate, and by and with the Advice and Consent of the Senate, shall
appoint . . . Judges of the Supreme Court. . . . ''
It does not say: except in an election year. It does not say: except
when it does not suit the political agenda of the majority party in the
Senate. It does not say: No appointments can be made in the final year
of a President's term. And it does not say: The Senate can arbitrarily
and preemptively choose to obstruct the President's responsibility to
make appointments.
The point is, the Constitution is clear. In fact, in the last 100
years, the Senate has taken action on every Supreme Court nominee,
regardless of whether the nomination was made in a Presidential
election year.
But this goes far beyond the filling of a Supreme Court vacancy. This
goes to the very heart of the constant and continuous attacks this
President has had to endure. For more than 7 years, some Republicans
have, time and again, questioned the legitimacy of this President. From
his election, beginning with the legitimacy of his birth certificate to
accusing the President of lawlessness, having a Republican Member of
Congress shout ``liar'' during the State of the Union to questioning
his legitimate authority in his final year in office to fill the
vacancy left by the death of Justice Scalia. It begs the question of
why this President is being denied the opportunity to fulfill his
constitutional obligation.
Why are constitutional standards, backed by history and precedent,
being questioned for this President's Supreme Court nominee? If we were
to rely on pure logic and simple consistency, the question to ask is,
Would our friends on the other side deny a President of their own party
the right to make that appointment? I think not.
The only conclusion we can draw is that this is yet another
validation of their strategic decision 7 years ago at a Republican
retreat to make Barack Obama a one-term President and obstruct this
President at every turn, and then claim political victory for their own
misguided inaction and refusal to govern.
What is most astonishing is that they claim, like Justice Scalia,
that the

[[Page S1186]]

Constitution is carved in stone, that it is undeniable and impervious
to interpretation. Yet, somehow, they can completely ignore what it
clearly states in yet another effort to obstruct this President's
ability to govern.
So I say to my friends on the other side: This President was elected
twice to serve two full terms. It has only been 7 years. It is time to
accept it and move away from obstructionism and on to governing.
The President and I may have differences on certain policies, but we
are in complete agreement that he should not be denied the ability to
fill this vacancy on the Court. Democrats did not deny President Reagan
the ability to confirm Justice Kennedy in an election year, and the
Republicans should not deny this President the same ability under the
same circumstances. We should have the decency and respect for the
Constitution to let the unambiguous wisdom of article II, section 2,
clause 2 to determine our actions today, as we did then.
So let's stop the political posturing. Let the President fulfill his
constitutional responsibility and the Senate fulfill its advice and
consent role. Let's fulfill one of the most basic and solemn duties we
have. Let's have a hearing and take a vote. The American people deserve
a fully functioning Supreme Court.
There is a bipartisan tradition of giving full and fair consideration
to Supreme Court nominees. Even when a majority of the Senate Judiciary
Committee has not supported the nominee, the committee has still sent
the nominee to the full Senate for a floor vote. And it should be noted
that at no time since World War II has the Court operated with fewer
than nine Justices because of the Senate simply refusing to consider a
nominee.
Now, every day when I come to work, I pass the Supreme Court, and the
words over the portal of the Supreme Court say: ``Equal Justice Under
Law.'' Equal justice under law demands that the judicial branch be
fully functional.
When we have a Supreme Court deadlocked in a decision, the decision
in the lower court stands and the highest court in the land has no
precedential value. Let's be clear. When there is a difference between
different Federal courts in our country in different jurisdictions, it
is the Supreme Court that determines what is the law of the land so
that Federal law is not different in New Jersey than it is in Texas.
But if the Court is deadlocked in two similar cases and the decision
reverts to the finding of the lower court, there could be differences
in how a person in New Jersey is treated than a person is in Texas
under the same Federal statute. It is not equal justice under the law.

To have equal justice under the law, the Nation needs the Supreme
Court to be fully functioning. Justice Scalia himself spoke of the
problems with an eight-Justice Court. In 2004, in explaining why he
would not recuse himself in a case involving former Vice President Dick
Cheney, he said:

With eight Justices, [it raises] the possibility that, by
reason of a tie vote, the Court will find itself unable to
resolve the significant legal issue presented by the case.
Even one unnecessary recusal impairs the functioning of the
Court.

So I believe that in life, Justice Scalia, as a textualist, would say
the President has an obligation to nominate a Supreme Court Justice. In
1987, before the Democratic Senate confirmed Justice Kennedy, it was
President Reagan who said: ``Every day that passes with the Supreme
Court below full strength impairs the people's business in that
crucially important body.''
I ask my Republican colleagues: How long are you willing to impair
the people's business? How long are you willing to stick to a strategy
of obstructionism over good governance? How long are you willing to
deny this President his constitutional authority and obligation to
appoint a nominee to satisfy your political agenda? How long are you
willing to deny equal justice under the law?
It was John Adams who reminded us that this is ``a government of
laws, not of men.''
It was Justice Felix Frankfurter who said: ``If one man can be
allowed to determine for himself what is law, every man can. That means
first chaos then tyranny. Legal process is the essential part of the
democratic process.''
Let's not in this Chamber be the ``one man.'' Let's respect the
Constitution and do our jobs. In this case, the Constitution is settled
law. Let's not unsettle it through a misguided determination to score
political points to undermine the legitimacy of this President.
The American people understand that our obligation in this process is
to advise and consent, not neglect and obstruct. The American people
will see the harm to our country and our courts if the majority
continues these political tactics. Let's do the right thing. Let's do
our jobs and respect this institution and the Constitution by holding
hearings and voting on a Supreme Court nominee.
Let's provide for equal justice under the law.
With that, I yield the floor.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. GRASSLEY. Mr. President, we just heard some very legitimate
questions from the previous speaker that ought to be answered, and I am
going to go back to the familiar to answer that--to the so-called Biden
rules.
By now everyone is pretty familiar with the Biden rules, so I am not
going to take time to go over all of them again, but they boil down to
a couple basic points.
First, the President should exercise restraint and ``not name a
nominee until after the November election is completed,'' or, stated
differently, the President should let the people decide. But if the
President chooses not to follow this model, but instead, as Chairman
Biden said, ``goes the way of Fillmore and Johnson and presses an
election-year nomination,'' then the Senate shouldn't consider the
nomination and shouldn't hold hearings.
It doesn't matter, he said, ``how good a person is nominated by the
President.'' So the historical record is pretty clear. But we haven't
talked as much about one of the main reasons Chairman Biden was so
adamant that the Senate shouldn't consider a Supreme Court nominee
during a heated Presidential election. It is because of the tremendous
damage such a hyperpolitical environment would cause the Court, the
nominee, and the Nation. In short, if the Senate considered a Supreme
Court nominee during a heated Presidential election campaign, the Court
would become even more political than it already is.
That is a big part of what was driving Chairman Biden in 1992 when he
spoke these strong words. Here is how Chairman Biden described the
problem in an interview--not the speech on the floor that I have quoted
in the past--about a week before his famous speech of 1992:

Can you imagine dropping a nominee . . . into that fight,
into that cauldron in the middle of a Presidential year?

He continued:

I believe there would be no bounds of propriety that would
be honored by either side. . . . The environment within which
such a hearing would be held would be so supercharged and so
prone to be able to be distorted.

As a result, Chairman Biden concluded:

Whomever the nominee was, good, bad or indifferent . . .
would become a victim.

My friend the Vice President--but a friend when he was in the
Senate--then considered the tremendous damage that thrusting a Supreme
Court nominee into a frenzied political environment would cause and
weighed it against the potential impact of an eight-member Court for a
short time. He concluded that the ``minor'' cost of the ``three or four
cases'' that would be reargued were nothing compared to the damage a
hyperpoliticized fight would have on ``the nominee, the President, the
Senate, and the Nation, no matter how good a person is nominated by the
President.''
The former chairman concluded that because of how badly such a
situation would politicize the process, and based on the historical
record, the only reasonable and fair approach--or as he said, the
``pragmatic'' approach--is to not consider a nominee during a
Presidential election.
He said.

Once the political season is underway . . . action on a
Supreme Court nomination must be put off until after the
election campaign is over. That is what is fair to the
nominee and is central to the process. Otherwise, it seems to
me, Mr. President, we will be in deep trouble as an
institution.

He concluded:

[[Page S1187]]

Senate consideration of a nominee under these circumstances
is not fair to the President, to the nominee, or to the
Senate itself.

This, in part, is why Chairman Biden went to such lengths to explain
the history of the bitter fights that occurred in Presidential years.
He said: ``Some of our Nation's most bitter and heated confirmation
fights have come in Presidential election years.''
I will state this about the discussion we are having today and will
probably have every day for the next several months: Everyone knows
that this nominee isn't going to get confirmed. Republicans know it,
Democrats know it, the President knows it, and, can you believe it,
even the press knows it. That is why the Washington Post called the
President's future nominee a ``judicial kamikaze pilot,'' and the New
York Times noted that the nominee would need an ``almost suicidal
willingness to become the central player in a political fight that
seems likely to end in failure.''
So the only question is, Why would the other side come to the floor
to express outrage about not having a hearing? It is because they want
to make this as political as possible.
The press has already picked up on it. For instance, CNN reported
that the other side hopes to use the fight over a Supreme Court nominee
to ``energize the Democratic base.'' They are already using the Supreme
Court and the eventual nominee as a political weapon. They want nothing
more than to make the process as political as possible. That is why the
President wants to push forward with a nominee who won't get confirmed.
That is why the other side is clamoring for a hearing on a nominee
everyone knows won't get confirmed. Making the Court even more
political is absolutely the last thing the Supreme Court needs.
The Court has been politicized enough already. A recent Gallup poll
documents the frustration I hear expressed even at the grassroots of my
State of Iowa. In the 6 years since President Obama has appointed two
Justices, the American people's disapproval of the Supreme Court jumped
from 28 percent disapproval in 2009 to 50 percent disapproval in 2015.
That is what happens when Justices legislate from the bench. This
Senator might say there is even a Republican nominee sitting on that
bench that has legislated from the bench as well.
That is what happens when Justices make decisions based on their
personal political preferences or what is in their heart rather than
what is in the Constitution and the law. The last thing we need is to
further politicize that process and the Court.
I just want to make sure that everyone understands what all of this
outrage is really about. It is about making this process as political
as possible.
We aren't going to let that happen to the Court, the nominee or the
Nation, to follow the suggestion of then-Senator Biden. We are going to
have a debate--a national debate--between the Democratic nominee and
the Republican nominee about what kind of Justice the American people
want on the Supreme Court. That is what the American people deserve,
and that is why we are going to let the people decide.
But beyond one Justice, there is an even more basic debate occurring.
At my town meetings, often somebody will come in very outraged about
why I won't impeach Supreme Court justices. They say: ``They're making
law, instead of interpreting law. How come you put up with that?''
So we can have a debate between the Republican nominee and the
Democrat nominee on what the constitutional role of the Court is. And
we can have a debate about whether we want a Justice who expresses
empathy and understanding of people's problems--the President's
standard. As we all know, that is not the purpose of the judicial
branch of government. That branch of government isn't supposed to let
their personal feelings be involved whatsoever. And the President
should not encourage the Justices he appoints to let their feelings
decide cases. Their job is to look at what the law says, what the
Constitution says, what the facts of the case are, and to make an
impartial judgment.
Consider a Justice appointed to the Supreme Court by a Republican
president, who wrote that the Affordable Care Act didn't fit into what
Congress could do in regards to regulating interstate commerce--because
that reasoning could not be upheld under the Constitution. Instead,
that Justice decided the Court could uphold the Act under the
Congressional taxing power and found a way to sustain this President's
legacy. It was also a Republican Justice who said: Find all kinds of
ways to do what you want to do as opposed to what the Constitution
requires or what Congress intends in legislation.

It would be nice to have a debate between a Democratic nominee and a
Republican nominee, whether we have two, three, or four national
debates or whether they have hundreds of appearances around the
country, to have these basic constitutional issues discussed. And then
we should let the people decide not only who appoints the next Justice
but who will decide the direction of the Supreme Court for generations
to come.
I yield the floor.
The PRESIDING OFFICER. The Senator from Vermont.
Mr. LEAHY. Mr. President, I found this interesting. When my children
were little, I would read fairy tales to them, and they especially
loved ``Through the Looking-Glass'' and ``Alice in Wonderland.'' And
listening to this speech, I thought of ``Through the Looking-Glass''
and ``Alice in Wonderland.''
It is interesting how President Obama gets blamed for everything.
``Oh, the approval rating of the Supreme Court has gone down.'' The
majority of the Supreme Court Justices have been appointed or nominated
by Republican Presidents. And we are going to blame President Obama
because the Republican Justices, nominated by Republican Presidents,
are bringing down the approval rating of the U.S. Supreme Court?
According to my dear friend from Iowa--he is saying President Obama
should be blamed for what those Republican Justices on the Supreme
Court did. This is ``Alice in Wonderland.''
I don't care what happens; President Obama has to get blamed for it.
Even if we have a hurricane or something, it must be President Obama's
fault. But this is about as far a stretch as I've ever heard. If the
approval rating of the court goes down because of the five Republicans
who constitute the majority of it, it is about as farfetched as ``Alice
in Wonderland'' to blame President Obama for it.
Let's talk about facts. I like to talk about facts. It's the way
Democrats have handled Republicans' nominees. What my distinguished
friend doesn't point out, even though it has been pointed out to him by
the Vice President and by the President personally, certainly in my
presence, Vice President Biden's speech--you should read the whole
speech--he is talking about what happens after the election. Vice
President Biden as Chairman Biden put through, in an election year, a
Republican nominee to the Supreme Court and got a unanimous vote of
Democrats and Republicans in this body. Those are the facts. The fact
is that we now use a different standard, it appears. In President
Bush's final 2 years, Democrats controlled the Senate. I was chairman.
We confirmed 68 of his nominees. In President Obama's final years in
office, Republicans have allowed only 16. These are facts. This isn't
rhetoric, these are facts. We allowed 68 for a Republican President and
Republicans allowed only 16 for a Democratic President, and then they
are going to blame the state of the judiciary on President Obama?
Then he talked about Vice President Biden when he was chairman and
what he might have said during President H.W. Bush's last year in
office. Do you know what Vice President Biden did? They tried to imply
that he blocked judges. He put through 11 Republican nominees for the
circuit court and 53 Republican nominees for the district court--11 for
the circuit court, 53 for the district court. Do you know what
Republicans have allowed? Five lower court nominees this year. So if
you say we want to follow the Biden rule, I wish we would. We put
through 53 district court nominees and 11 circuit court nominees, and
during a Democrat President's last year in office the Republican-
controlled Senate has allowed only five. Come on, let's be fair.
The fact is, in a Presidential election year, we have never blocked a
Supreme

[[Page S1188]]

Court nominee because it was a Presidential election year. In fact,
since the Judiciary Committee began holding confirmation hearings for
Supreme Court nominees in 1916, it has never denied a nominee a
hearing.
I tell you this because the Constitution requires the President to
make a nomination--it is very clear--and then it says that we shall
advise and consent. Well, they are saying: ``No, we won't advise; we
won't consent; we won't even have a hearing.''
Mr. President, I have taken the oath of office here seven times. It
is a moving, thrilling moment. I am sure the distinguished Presiding
Officer, when he was sworn in, knew it was a solemn moment. You promise
to uphold the Constitution, so help me God. The Constitution says the
President shall nominate. It says we shall advise and consent.
I took my oath very, very seriously. That is why--just as Vice
President Biden did when he was chairman--I moved a significant number
of Republican judges through, even in the last year that President Bush
was in office. And that is so different from what we see now.
Just think about it. They criticize Vice President Biden. The last
year President George H.W. Bush was in office, Vice President Biden was
chairman of the Judiciary Committee. He put through 11 circuit court
judges and 53 district court judges. If you want to talk about the
Biden rule, the Republicans have allowed only five lower court judges.
Come on, let's get this out of partisanship. By any standard
whatsoever, when there has been a Republican President and a
Democratically-controlled Senate, we have treated that Republican
President far better than they have treated Democratic Presidents.
But then to hear that because the five Republican-appointed majority
members of the Supreme Court are bringing down the approval rating of
the Supreme Court for the American people, telling the American people
it must be President Obama's fault--even if those five members were
nominated and approved before President Obama's Presidency--that goes
too far. That is ``Through the Looking-Glass.'' That is ``Alice in
Wonderland.''
I see the distinguished senior Senator from Rhode Island on the
floor.
I yield the floor.
The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. WHITEHOUSE. I thank the distinguished ranking member of the
Judiciary Committee very much. While he is on the floor, let me thank
him for his leadership, support, and passion for the Comprehensive
Addiction and Recovery Act, which was shepherded through the Judiciary
Committee under his guidance and with his wise and benevolent support.
I am very grateful.
I am on the floor to talk about the Comprehensive Addiction and
Recovery Act today because it has been said by several of my colleagues
that there is funding to implement this bill and that that funding is
already in the government's accounts, that if we pass the CARA bill, we
will be able to fund it and put it to work right away. Let me say with
regret that I disagree with that assertion.
I am sorry to have a disagreement with my colleagues over this
funding question after all the very excellent bipartisan work we have
done to get this bill to this point. This really has been a legislative
model. For years we worked on the statute. We had five different full-
on national seminars in Washington, bringing people in from all around
the country to advise us on all the different aspects of the opioid
problem. We had an advisory committee that supported us which was
broadly represented from all the different interests that are affected
by the opioid crisis. We came up with a bipartisan bill which came
through committee in regular order, without objection from anyone, and
which is now on the Senate floor awaiting passage. That is the way it
is supposed to work. But on this question of whether it is funded, I
must disagree, and I wish to explain why.
For openers, let me explain that in Congress, there are committees
that authorize funding. In the case of this bill, the relevant
committees are the HELP Committee and the Judiciary Committee. But it
is the Appropriations Committee that actually determines what funding
will go into which accounts. The Appropriations Committee, in turn, is
broken up into subcommittees, which determine the funding of different
accounts in different areas of government. So one subcommittee has
jurisdiction in one set of accounts and another subcommittee has the
appropriations authority over other accounts.
The funding my colleagues have referred to as the funding for this
CARA bill was appropriated by what we call in the Senate the Labor-HHS
Appropriations Subcommittee. The Labor-HHS Appropriations Subcommittee
appropriates two accounts that generally correspond to the authorizing
power of the HELP Committee. So there are three committees involved:
Judiciary, HELP, and Appropriations. The subcommittee on Appropriations
that appropriated this money generally correlates to the authorizing
power and jurisdiction of the HELP Committee. There are other
Appropriations subcommittees. For instance, there is one that we refer
to as CJS. CJS appropriates to, among others, the accounts within the
authorizing power of the Judiciary Committee. So that is the
background.
Now let's go through the problems. One problem with my friend's
argument that the bill is funded is that the funding measure to which
they refer originally passed out of its Appropriations subcommittee
last June. We didn't even take up the CARA bill in the Judiciary
Committee until this February. So there is a timing problem. How could
the appropriators last June have predicted this state of affairs on the
floor right now? The appropriators would have had to have had an
astonishing, wizard-like ability to read the future in order to fund
back then an unpassed bill--indeed, a bill that then didn't even have a
committee hearing scheduled, let alone markup, passage, and the choice
to bring it to the floor. Clearly, in June the Labor-HHS appropriators
were funding existing programs, and when the omnibus passed in
December, these same programs were funded at an even higher level. In
fact, Democrats demanded they be funded at nearly the identical level
proposed in the President's budget. The President's budget goes even
further back in time. The President's budget certainly could not have
foreseen CARA, the Comprehensive Addiction and Recovery Act. So there
is a timing problem.

Second, this CARA bill, back when these appropriations were passed in
June, was funded through different accounts than the accounts it is
funded through now as we see it on the floor. When the appropriations
were passed, it was funded through accounts that would be funded by CJS
appropriators. So there is a committee mismatch as well as a timing
problem to any claim that these funds were intended for the CARA bill.
The bulk of the CARA bill back then--in fact, 10 out of its 13
programs--authorized funding through Judiciary Committee programs,
which is why the bill was sent by the Parliamentarians here to the
Judiciary Committee. So if back then the intention was to fund CARA, it
would have been CJS that would have funded 10 of those 13 programs. The
appropriators for the funds my colleagues speak of were not the CJS
appropriators but the Labor-HHS appropriators. Again, there is a
committee mismatch.
Here is what happened that explains the shift. After the fiscal year
2016 omnibus had passed, we were informed--the sponsors and authors of
the legislation--that in order to get our bill out of the Judiciary
Committee, the CARA bill had to be rewritten so that it operated only
through existing Federal programs. There are Republicans, as the
Presiding Officer well knows, who live by the principle of no new
Federal programs, even for new crises, and we were asked in the
Judiciary Committee to accommodate them. So we accommodated them. We
rewrote the bill in January to accommodate those concerns.
So this February, when CARA came before the Judiciary Committee, it
had been revised to move the bulk of its new programs out of the
Judiciary Committee accounts and into accounts under the jurisdiction
of the Committee on Health, Education, Labor, and Pensions. Now, of the
10 programs remaining in the bill, 8 are located at

[[Page S1189]]

the Department of Health and Human Services, in the jurisdiction of the
HELP Committee. But that move was long after these appropriations were
made. You cannot connect them.
I should interject that this change created an intrusion by our
Judiciary bill into the jurisdiction of the HELP Committee. All here
today who support the CARA bill owe a great debt of gratitude and
appreciation to Chairman Alexander and to Ranking Member Murray for
allowing this bill to proceed, even though it now involves a
considerable number of accounts under their committee's jurisdiction.
They have done so very graciously, without demanding further hearings
or otherwise asserting their HELP Committee's turf. So to both of them
I offer, and we should all offer, our sincere and heartfelt thanks.
It does seem a stretch to think that the appropriators in the
Appropriations subcommittee that funds these HELP accounts could have
foreseen last June not only that CARA would pass out of the Judiciary
Committee in February and not only that it would come to the floor now,
but also could have foreseen that so many of its programs would have
been transferred from Judiciary Committee to HELP Committee accounts.
That would have been an astonishing--indeed, truly magical--feat of
prediction.
The simple fact is that the Labor-HHS appropriations that my friends
rely on as the funding for this CARA bill passed out of the relevant
subcommittee with little or no regard for CARA.
Mr. President, I ask unanimous consent to have printed in the Record
a letter dated April 2, 2015, regarding this matter.
There being no objection, the material was ordered to be printed in
the Record, as follows:

U.S. Senate,

Washington, DC, April 2, 2015.
Hon. Richard Shelby,
Chairman, Subcommittee on Commerce, Justice, Science and
Related Agencies, Committee on Appropriations,
Washington, DC.
Hon. Roy Blunt,
Chairman, Subcommittee on Labor, Health and Human Services,
Education, and Related Agencies, Committee on
Appropriations, Washington, DC.
Hon. Barbara Mikulski,
Ranking Member, Subcommittee on Commerce, Justice, Science
and Related Agencies, Committee on Appropriations,
Washington, DC.
Hon. Patty Murray,
Ranking Member, Subcommittee on Labor, Health and Human
Services, Education, and Related Agencies, Committee on
Appropriations, Washington, DC.
Dear Chairman Shelby, Chairman Blunt, Ranking Member
Mikulski, and Ranking Member Murray: As you may know, heroin
use and prescription opioid abuse are having devastating
effects on public health and safety across the United States.
According to the Centers for Disease Control and Prevention
(CDC), drug overdoses now surpass automobile accidents as the
leading cause of injury-related death for Americans ages 25
to 64. Every day, more than 120 Americans die as a result of
drug overdose. Over half of these drug overdoses are related
to prescription drugs. While addiction is a treatable
disease, only about ten percent of those who need treatment
receive it.
We write to express our strong support for fiscal year (FY)
2016 funding for programs that would support the integrated
strategies for addressing opioid abuse included in the
Comprehensive Addiction and Recovery Act of 2015 (CARA, S.
524). This bipartisan legislation was developed over the past
year and a half through a cooperative process involving key
national stakeholders in the public health, law enforcement,
criminal justice, and drug policy fields, and is designed to
fight prescription opioid abuse and heroin use holistically--
from expanding prevention to supporting recovery.
Among other objectives, CARA would:
Expand prevention and educational efforts--particularly
aimed at teens, parents and other caretakers, and aging
populations--to prevent prescription opioid abuse and the use
of heroin.
Expand the availability of the overdose reversal drug
naloxone to law enforcement agencies and other first
responders.
Expand resources to promptly identify and treat individuals
suffering from substance use disorders in the criminal
justice system.
Expand disposal sites for unwanted prescription medications
to keep them out of the hands of children and adolescents.
Launch an evidence-based prescription opioid and heroin
treatment and intervention program to expand best practices
throughout the country.
Launch a medication-assisted treatment and intervention
demonstration program.
Strengthen prescription drug monitoring programs to help
states monitor and track prescription drug diversion and to
help at-risk individuals access services.
As you begin consideration of the FY 2016 appropriations
bills, we urge you to provide sufficient funding for the
provisions included in CARA, which would provide the
resources and incentives necessary for states and local
governments to expand treatment, prevention, and recovery
efforts for the millions of Americans who are affected by
substance use disorders. Among other things, we ask that you
ensure adequate funding for CDC's prescription drug
surveillance and monitoring activities and the Substance
Abuse and Mental Health Services Administration's Medication-
Assisted Treatment for Prescription Drug and Opioid Addiction
program. Because we know that medication-assisted treatment
should be an important component in treating those suffering
from opioid abuse in the criminal justice system, we urge you
to continue your support for the Medication-Assisted
Treatment Pilot Program at the Bureau of Prisons.
Only through a comprehensive approach that leverages
evidence-based law enforcement initiatives, treatment, and
support for recovery can we reverse the current skyrocketing
numbers of heroin and prescription opioid overdoses and
deaths. Thank you for your consideration.
Sincerely,
Kelly A. Ayotte,
Susan Collins,
Christopher A. Coons,
Sheldon Whitehouse,
Amy Klobuchar,
United States Senators.

Mr. WHITEHOUSE. Mr. President, the letter I have submitted was
written to bring CARA to the attention of both the CJS and the Labor-
HHS subcommittees. But those subcommittees, when they got this letter,
had no idea the bulk of this would move from the Judiciary Committee to
the HELP Committee. Back then, CARA was mostly funded through another
subcommittee--CJS. Back then, CARA had not even been scheduled for its
hearing in Judiciary.
So why was the funding for the opioid crisis put in and, indeed,
increased by the appropriators of the HELP accounts? Obviously, because
47,000 people died last year--in 2014, the last year we have on
record--of opioid overdose deaths. This is a national crisis. They were
paying attention to it. They were putting resources in, but not
resources to implement the bill that we are about to vote on in the
next few days.
Indeed, as we speak, SAMSHA, the relevant agency, is gearing up its
grant applications to go forward and solicit bids for all the money the
appropriators approved and that was dialed up in the omnibus. And
SAMSHA is proceeding under the pre-CARA laws. SAMSHA intends to spend
every dollar of the appropriated funds, CARA or no CARA. That means if
this CARA bill passes, every dollar that goes this year to fund a CARA
program will take away funds from that pre-CARA grant array that SAMSHA
is preparing right now. In that case, we will necessarily be robbing
Peter to pay Paul. You cannot count the same funding twice, and there
is no new money for CARA.
One can make the argument, and, indeed, I would accept the argument
that though we are robbing Peter to pay Paul, CARA's Paul is better
than pre-CARA's Peter. CARA is, after all, a very good bill, but the
funding math is still undeniable. We are, in fact, robbing pre-CARA
Peter to pay for a new CARA-improved Paul. So one can argue that funded
programs may improve because of CARA, at least to the extent the
funding goes to new CARA-authorized purposes. But that is an argument
that the same money will be better spent. It is not a fair argument
that there is new money for CARA programs. There is no new money.
In sum, the timing does not support the argument that there is new
funding for CARA. That money was appropriated long ago. Indeed, this
bill will not even be law if we get it through the Senate. There is
still the House, the Conference, and the President. What kind of
wizards do we think our appropriators must have been 8 months ago at
seeing a future for this bill which we even now cannot see?
On top of that, the jurisdictional problem between Judiciary and HELP
shows that the HELP appropriations had to be intended back in June for
other programs, specifically for the HELP grants now underway at
SAMSHA, which we would be robbing to fund CARA programs.
Unless they were time-traveling wizards, if the appropriators had
intended to add extra money for CARA for this fiscal year, they would
have added the money to the Judiciary accounts that were what CARA
authorized back then

[[Page S1190]]

when it was introduced and when the appropriators passed the
appropriations in the subcommittee.
Finally, it is a fact that all of this appropriated money my friends
speak of is already on its way to being spent. It will be spent even
without CARA. It will be spent even if, for some reason, CARA fails. It
may even be spent before CARA becomes law, and it will be spent in
programs to support addiction recovery.
That is the logic of my conclusion that there is no funding for CARA.
That is the logic of my conclusion that to fund CARA without robbing
other addiction recovery programs, we would need new funding, not just
last year's appropriations. And that, my friends, is why Senator
Shaheen's emergency funding bill is so important.
With that, I see my distinguished chairman on the floor, and I yield
the floor.
Mr. GRASSLEY. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. MARKEY. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. MARKEY. Mr. President, I would like to start my remarks on the
Comprehensive Addiction and Recovery Act today by complimenting all of
the Members--Senator Whitehouse, Senator Grassley, Senator Portman,
Senator Ayotte, Senator Shaheen, and all the Members who have been
working so hard on this legislation to produce something which is very
much needed by our country.
I will start my remarks by telling a little story of a constituent
who wants to remain anonymous. This is her story:

On July 20, 2009, I was the passenger in a vehicle with my
close friend at the time behind the wheel. The light turned
green and as expected he hit the gas. While he was hitting
the gas, the oncoming car never hit their brakes to stop at
the red light they were approaching.
I was painfully pinned in the passenger's seat. All I could
hear was my friend asking me if I was OK. Upon arriving in
the ER I was quickly poked, prodded, and injected with high-
level painkillers. This is where it all began.
Walking out of the hospital, I wasn't only walking out with
crutches, but a prescription that changed the next 5 years of
my life. I was prescribed OxyContin to help manage the pain I
was experiencing. With continuing follow-up appointments and
check-ins, also came more prescriptions for ``pain management
prescriptions.''
Two months after getting into a car accident, I was a
heroin addict. How quickly all things I knew changed. In
September of 2009 I not only began shooting heroin but I also
began my first semester of college. I was a freshman at UMass
Boston, worked full time, but, secretly, I was also a heroin
addict. I kept my addiction a secret from everyone I knew
including my close friends and family.
On August 31, 2014 I woke up and said to myself ``enough is
enough.'' It took three overdoses in order to open my eyes.
Since leaving treatment in November of 2014, my recovery has
not stopped; I continue to learn and to grow daily. I have
also learned of the medical issues and complications that my
heroin use has led to. I now suffer from seizures because the
excessive drug use over 5 years has led to minor brain
damage. Along with the seizures, I have tested positive for
Hepatitis C and HIV, which is common with injection drug
users.
At the end of the day, all I want to do is to help others
who are struggling because I know what they are going
through.

Mr. President, she is one of the fortunate ones. She found the help
she needed and had the strength and support to get clean. But I am
hearing enormous frustration from people who don't feel that sufficient
resources are being brought to bear on this enormous epidemic of
prescription drug and heroin addiction.
All week we have heard the statistics here in this Chamber. Our
Nation is experiencing more deaths from drug overdoses than from gun
violence or auto accidents. Eighty percent of the people suffering from
heroin addiction started with opioid pain medications approved by the
FDA and prescribed by doctors, with 27,000 people dying from an opioid
overdose in 2014 and 1,300 of those coming from the State of
Massachusetts.
This issue is one that doesn't just affect the Bay State. America is
drowning in a tsunami of heroin and prescription drug addiction that we
must stop before it drowns any more families and communities.
Let us compare what we are did as a nation when confronted with other
deadly epidemics. A bipartisan majority in Congress funded more than $5
billion to respond to Ebola. We dispatched the medical community and
public health experts. Today the Obama administration is asking
Congress for $1.8 billion in emergency funding to fight the Zika virus.
Imagine if we applied the same commitment, the same urgency, and the
same level of resources to the prescription drug and heroin epidemic.
We need an immediate and comprehensive strategy that requires
commitment from all levels of government--State, local, and Federal.
That means Congress must step up to respond with leadership and with
resources. We need to stop the overprescription of opioid pain
medication, we must prevent addiction before it takes hold, and we must
provide the funding necessary to ensure that we stem this tide of
deadly addiction.
The Food and Drug Administration must change its decision not to seek
expert advice about the risks of addiction before it approves abuse-
deterring opioids. Abuse-deterring opioids is a contradiction in terms.
Whether an opioid is used as a deterrent or not, it has not prevented
tens of thousands of people who have had their wisdom teeth removed or
experienced lower back pain from getting addicted to these painkillers.
By refusing to convene the advisory committee to inform all of its
opioid approval decisions, the FDA continues to ignore outside experts
who could help stem the tide of tragic deaths and overdoses plaguing
this country.
That is why I have filed an amendment to require the FDA to convene
advisory committees of outside experts for all opioid approval
decisions--period. Now is the time to implement effective and
commonsense solutions, but we need funding to do that; funding for
families, funding for treatment providers, funding for our sheriffs and
firefighters who carry overdose prevention drugs that save lives. We
need to provide the real resources necessary to address a crisis that
is only growing in numbers and severity, and that comes in the form of
emergency funding. We are hemorrhaging lives by the day, and
supplemental funding is the first step needed to staunch the flow of
suffering and death.
Ladies and gentlemen, we are at a watershed moment in this national
debate to address the public health crisis of addiction. So let us be
clear. Stopping the overprescription of pain medication that is fueling
opioid addiction and overdoses starts with the prescribers. We need to
require anyone who prescribes opioid pain medication and other
controlled substances to undergo mandatory training on safe prescribing
practices and the identification of possible substance abuse disorders.
That is why I have filed an amendment that requires prescribers to get
the education needed to help staunch this wall of suffering and death.
The doctors will say they don't want education to be mandated; that
it should be voluntary. Well, the FDA has had voluntary education for
opioid prescribers in place since 2013 and has been actively
encouraging doctors to take these voluntary education modules, but in
more than 2 years, less than 12 percent of prescribers have actually
completed the FDA's voluntary education program. A survey of 1,000
physicians nationwide found that nearly one-half of doctors erroneously
reported that abuse-deterrent formulations were less addictive than
their counterparts. It is unconscionable that our doctors know so
little about these potentially deadly painkillers.
I intend to call up amendment No. 3382 later so we can make
consideration of the bill. The amendment would ensure that as a
condition of receiving a license to prescribe opioids, the recipient of
the license is educated in the best practices for using opioids and the
connection with addiction and with diversion. I intend to call up that
amendment later, asking for consideration.
From my perspective, if we are going to have a real strategy, then we
have to make sure there is a requirement that there is continuing
education. We also need to remove the barriers to effective treatment,
including outdated Federal restrictions on medication-assisted
therapies like SUBOXONE.

[[Page S1191]]

Medication-assisted therapy for opioid addition is cost-effective, it
decreases overdose deaths, and it reduces transmission of HIV and
hepatitis C. That is why I have filed an amendment that would lift the
caps that are limiting the number of patients doctors can treat with
medication-assisted therapy. If we are going to reduce the supply of
heroin and illicit prescription drugs, we have to reduce the demand
through effective treatment. I have been working with Senator Paul from
Kentucky on that amendment.
Also, fear of a lawsuit should not deter anyone from trying to save
the life of someone suffering from an overdose. That is why I have
filed an amendment that creates a Federal Good Samaritan provision that
shields from civil liability family members, friends, and other
bystanders who administer opioid prevention treatments like Narcan.
The debate we are having on this legislation this week is just the
beginning. We must let prescribers know that unless they get basic
education in opioids, they will have to turn off the spigot of
painkillers that are flooding this country and leading to deadly
overdoses. We must let law enforcement and the judicial system know we
cannot incarcerate our way out of this problem. We must let Big Pharma
know we are going to work to ensure that we have a lifting of awareness
of this issue every single day. Enough is enough in this country.
Enough is enough. We have just seen an explosion in terms of this
problem.
We must now let all of those struggling with addiction know that help
is on the way and that no matter how dark life seems right now, there
is hope and the Sun will rise for them once again.
I thank the Presiding Officer for giving me the opportunity to speak
for some time, and I yield the floor.
The PRESIDING OFFICER (Mrs. Ernst). The Senator from Oregon.
(The remarks of Mr. Merkley pertaining to the introduction of S. 2621
are printed in today's Record under ``Statements on Introduced Bills
and Joint Resolutions.'')
The PRESIDING OFFICER. The Senator from Virginia.

Filling the Supreme Court Vacancy

Mr. KAINE. Madam President, I rise to offer some thoughts about the
current discussion over a vacancy on the Supreme Court.
I had high hopes yesterday for the meeting in the White House between
the majority leader, the chairman of the Judiciary Committee, President
Obama, and Vice President Biden. I had high hopes that meeting might
lead to an opening and a willingness to entertain the important
business of filling a vacancy on the Supreme Court, but the
announcements made directly after that meeting suggested--a phrase we
sometimes use back home--that the schoolhouse door is going to stay
closed. There will not be a debate. There will not be a vote. There
will not be a committee hearing. In fact, there was even a suggestion,
a commitment, that the majority would refuse even to entertain courtesy
office visits with the nominee that President Obama is expected to send
up soon.
I was disappointed in that, and I wanted to take the floor to offer a
simple message. It is very important that the Senate do its
constitutional duty and do its job with respect to the Supreme Court
vacancy. The job is pretty plain. We have a job description, as most
people do who have jobs. The job description is contained mostly in
article I of the Constitution, but there are also descriptions of what
we must do in the Senate in article II. Article II, section 2, clause 2
of the Constitution says the President ``shall nominate, and . . . with
the Advice and Consent of the Senate, shall appoint'' a variety of
officials, including Supreme Court Justices.
This is part of our job description, to entertain Presidential
nominations for Supreme Court Justices. We volunteer for the job. We
take an oath to do the job. We cash a paycheck written by the American
people to pay for us to do the job. Frankly, we don't have the option
of refusing to do the job.
Is there anything unusual about this situation, a vacancy on the
Supreme Court occurring during the last year of a President's term? The
answer to that is no.
On 17 occasions, this body has entertained and had a confirmation
vote on a Supreme Court Justice in the final year of a President's
term--17 times. When this happened, people thought it seemed rare, but
when you go back and look at the historical record, it is not rare at
all. On each of those occasions in a Presidential election year, the
Senate has done its job under article II, section 2, clause 2, and
entertained a nominee. There is no reason why this Senate should not do
exactly the same thing, follow that historical precedent.
As I have traveled around Virginia in the weeks since the vacancy
became open, I have talked to a lot of citizens about this. Sometimes
it is helpful for us in this body to think about the way others--
especially our citizens--look at what we are doing or not doing here.
Citizens ask me: What possibly could be the reason why the Senate would
not follow its clear historical precedent and do a job description that
is contained in the Constitution and would refuse a vote, refuse
debate, refuse committee hearings, refuse even to meet with a nominee?
Why would Congress not do its job? Why would the Senate not do its job?
I have been thinking about that, and I can only conceive of two
reasons why this Senate would not do its job, and both of the reasons
are highly illegitimate, in my opinion.
The first reason--and this is a reason that occurs to many citizens,
and they are very concerned about this--is that the Senate is
announcing that it will not do its job because of the identity of this
particular President. The Senate has been willing to do the job for
other Presidents, but is there something about this particular
President that is making the Senate decide to break its historical
traditions and violate article II, section 2, clause 2, and not do the
job?
This question has given some added oomph because of another recent
event. In early February, President Obama sent his budget to the
Congress. Pursuant to the Budget Act of 1974--and this has been
followed uniformly by the Senate and the House--when the President
sends up a budget, the Budget Committees have a hearing about the
President's budget--even if they do not like it, and they often don't
like it, but that is what you do. You have a hearing about the
President's budget. If you don't like it, you criticize the budget and
then you write a different budget. That is what has happened for every
President since the Budget Control Act of 1974 passed.
In the last year of the Bush administration, when there were
Democratic majorities in both Houses when President Bush sent up his
budget, hearings were held on the budget. But in this instance, just
within the last month, when the budget was sent up from President
Obama, both committees said: For this President--breaking the statute,
breaking all tradition--we will not even have a hearing on this
President's budget.
So if we are going to break a constitutional command and break a
history in which 17 Justices have been confirmed in a Presidential
year, and if we are going to break it for this President, and if we are
going to break the Budget Control Act and break a uniform history since
1974 by not according even a hearing for the budget submitted by this
President, then a question that is being asked by the citizens of this
country--certainly the citizens of this Commonwealth--is whether the
actions taken here on this Supreme Court nomination to not allow a
vote, not allow a debate, not allow a committee hearing, and not even
allow courtesy office visits, is actually not about the Supreme Court
at all, not even about the nominee, whosoever it shall be, but it is a
particular mark of disrespect for this President that is unprecedented
in the history of this body. That is an explanation which many of my
citizens are deeply worried about and which many of my citizens are
talking about and asking about, and frankly I don't have a good answer
to that concern.
There is a second reason that suggests itself to me with respect to
breaking all of the historical precedent on this particular Supreme
Court vacancy. It connects to another concern that I have taken to the
floor many times to talk about as a member of the Foreign Relations and
Armed Services Committees. There is another clause of the Constitution
that I care deeply

[[Page S1192]]

about, and that is article 1, section 8, clause 11. We should not be at
war without a vote of Congress.
We are now in the 20th month of a war, and Congress hasn't even
voted--this war against ISIL. I go to hearings all the time where
Members of the Senate criticize the President for what he is doing or
not doing in the war, but I see a complete unwillingness in this House
and the House of Representatives to actually do what the Constitution
commands and have a vote on the war.
This circumstance reminds me of that: a clear constitutional command
in article 2, section 2, clause 2; a clear historical precedent of the
Senate engaging; but now, for this President, on this vacancy, a
decision: Hold on a second. Maybe we can just avoid voting yes or no.
If we vote yes for a nominee the President might send up, we will make
some people mad. If we vote no on a nominee the President sends up, we
will make some other people mad. Maybe we can just avoid the commands
of article II, section 2, clause 2, avoid the uniform history of this
body, and not vote at all. If we can avoid voting at all, maybe we can
evade accountability; maybe we can evade the criticism that might come
to us from our constituents.
That is also highly troubling.
I can't think of any other reasons why this body would violate the
clear commands of article II, section 2, clause 2, and violate a
uniform history of approving 17 Supreme Court Justices during a
Presidential year other than, A, it is fundamentally a sign of
disrespect for this particular President or, B, it is a desire by a
Senate that certainly has the votes to confirm or deny, consistent with
the constitutional provision, to avoid taking a vote and thereby think
we can avoid the accountability to our citizens for casting a vote on
something that might be controversial. Needless to say, both of those
reasons are highly illegitimate and, in my view, are really beneath
what we should be doing in this Chamber.
The last thing I will say is this: The job description of a Senator
is laid out in the Constitution, but there are other parts of the job
that may not be laid out so plainly but that we all understand to be
our job. For example, I don't think it is laid out that we should
passionately represent our citizens and do constituent service for
them, but we all understand that is part of the job.
Well, another part of the job of a U.S. Senator that may not be
spelled out as directly as the power to advise and consent on
nominations or the power to declare war is that we are elected
guardians of this institution, and more than just the institution of
the Senate, we are elected to be guardians of the Democratic traditions
that are set out in the Constitution, in this marvelous Constitution
that establishes three branches of government that have checks and
balances against each other.
We should always act, regardless of our disagreements, regardless of
our debates or arguments, and the differences of opinion are
legitimate. We should always act to promote respect for our
institutions, not only the institution of the Senate but the
institution of the court system, which has a vacancy right now on the
Supreme Court, the institution of the Presidency, toward whom we are
sending a signal of disrespect by the actions that are being undertaken
in this body. It is part of the job we need to do to build up the
respect for the institutions of our government. If Senators don't
respect the institutions of our government, why would anyone else
respect them? If we act in a way that subverts or tears them down, why
would we expect anyone else to respect the institution?
I came here to this body because I do respect the institution. I
respect its history. We are all humans; we can make mistakes. Votes
have been cast that in the light of day you could look at and expect to
be different. But compared to other systems in the world--and I lived
in a country that was a military dictatorship when I was a young man,
and I can certainly see the great blessing it is to live here in this
country and serve here in this body. I deeply fear that the actions we
are embarking on in connection with the Supreme Court nomination are
expressing a profound disrespect for the article III branch, the
courts; a profound disrespect for the article II branch of the
Presidency; and, frankly, a profound disrespect for our own history,
traditions, and job description in this article I branch of the
legislature.
It is not too late for us to turn this around. It is not too late for
us to take a pause and, when the President sends over a nomination for
the Supreme Court, to do what justice demands. If justice demands
anything, it should be that we would analyze an individual on that
person's own merits instead of just saying that the blanket rule is
that no matter who you are, no matter what your qualifications, because
you were sent by this President, we will create a unique rule for you
and refuse to entertain you.
We still have time to turn this around. I have no idea when the
President will send a nominee over, and I have no idea who that nominee
will be, but when that nominee is delivered and recommended to the
Senate, it is my prayer that this body will do what article II, section
2, clause 2, demands; that we will do what we have done in every other
instance when a President has sent a nominee over in a Presidential
election year; that we will not bar the schoolhouse door but we will
open the doors to our office to accord a nominee the courtesy of a
discussion; that we will have hearings in the Judiciary Committee; and
that we will have a robust debate and a vote on this floor. If that
vote is a yes, that will be great. If that vote is a no, that will
still be fully in accord with the constitutional job description of
this Congress. But to not entertain a nominee at all, in my view, would
violate our oath, would violate the Constitution, and would express a
significant disrespect for all three branches of government.
Madam President, I yield the floor.
The PRESIDING OFFICER. The Senator from Iowa.

Amendment No. 3367 to Amendment No. 3378

(Purpose: To establish a life-saving program to prevent
drug and opioid abuse in Medicare.)

Mr. GRASSLEY. Madam President, I call up the Toomey amendment No.
3367.
The PRESIDING OFFICER. Without objection, the pending amendment is
set aside.
The clerk will report.
The senior assistant legislative clerk read as follows:

The Senator from Iowa [Mr. Grassley], for Mr. Toomey,
proposes an amendment numbered 3367 to Amendment No. 3378.

Mr. GRASSLEY. I ask unanimous consent that the reading of the
amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
(The amendment is printed in the Record of March 1, 2016, under
``Text of Amendments.'')
Mr. GRASSLEY. I yield the floor.
The PRESIDING OFFICER. The Senator from Oregon.

Amendment No. 3395 to Amendment No. 3378

Mr. WYDEN. Madam President, I call up amendment No. 3395.
The PRESIDING OFFICER. Without objection, the pending amendment is
set aside.
The clerk will report.
The senior assistant legislative clerk read as follows:

The Senator from Oregon [Mr. Wyden] proposes an amendment
numbered 3395 to amendment No. 3378.

Mr. WYDEN. Madam President, I ask unanimous consent that the reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment is as follows:

(Purpose: To provide for comprehensive provisions for the prevention
and enforcement of opioid abuse and treatment of opioid addiction)

At the appropriate place, insert the following:

SEC. __. INCREASED ANTI-KICKBACKS PENALTIES.

Paragraphs (1) and (2) of section 1128B(b) of the Social
Security Act (42 U.S.C. 1320a-7b(b)) are each amended by
inserting ``(or, beginning January 1, 2017, $50,000)'' after
``$25,000''.

SEC. __. CENTER FOR MEDICARE AND MEDICAID INNOVATION TESTING
OF OPIOID ABUSE TREATMENT PROGRAM MODEL FOR
PART D PRESCRIPTION DRUG PLAN ENROLLEES.

Section 1115A of the Social Security Act (42 U.S.C. 1315a)
is amended--
(1) in subsection (b)(2)(A), by adding at the end the
following new sentence: ``The models

[[Page S1193]]

selected under this subparagraph shall include the model
described in subsection (h).''; and
(2) by adding at the end the following new subsection:
``(h) Opioid Abuse Treatment Program Model.--
``(1) In general.--The Secretary shall test a model
requiring prescription drug plans under part D of title XVIII
to have in place, directly or through appropriate
arrangements, an opioid abuse treatment program for
applicable enrollees in lieu of the medication therapy
management program under section 1860D-4(c)(2) with respect
to such applicable enrollees.
``(2) Start date.--The model under this subsection shall
start in plan year 2018.
``(3) Selection.--The Secretary shall select a limited
number of Medicare part D regions in which to the model,
giving priority to regions based on the number of total
opioid prescriptions in the region.
``(4) Requirements for program.--Under an opioid abuse
treatment program, the PDP sponsor offering the plan shall--
``(A) establish a care team that includes at least--
``(i) a pharmacist;
``(ii) a physician; and
``(iii) an individual licenced in a State with expertise in
behavioral health (as determined by the Secretary), which may
be the physician described in clause (ii); and
``(B) develop, in consultation with the applicable enrollee
and with input from the prescriber to the extent necessary
and practicable, a care plan for the applicable enrollee that
is intended to treat the applicable enrollee's pain and limit
any unnecessary opioid prescriptions when possible.
``(5) Payment.--
``(A) In general.--Under the model under this subsection,
the Secretary shall make a monthly payment to the PDP sponsor
offering the prescription drug plan for each applicable
enrollee who receives services under the opioid abuse
treatment program.
``(B) Shared savings.--Under the model under this
subsection, the Secretary shall (using a methodology
determined appropriate by the Secretary) make payments (in
addition to the payments under subparagraph (A)) to the PDP
sponsor offering the prescription drug plan if the Secretary
determines that total spending under parts A, B, and D of
title XVIII (and including the payments under subparagraph
(A)) for applicable enrollees who receive services under the
opioid abuse treatment program is less than a historical
benchmark of total spending under such parts A, B, and D for
such enrollees or similar enrollees. Such benchmark shall be
adjusted at the Secretary's discretion for changes in law or
regulation, unforeseen circumstances, or advances in medical
practice.
``(6) Quality.--Under the model under this subsection, the
Secretary shall measure the quality of care furnished by
opioid abuse treatment programs, including elements related
to access to care, the unnecessary use of opioids, pain
management, and the delivery of behavioral health services.
``(7) Applicable enrollee.--In this subsection, the term
`applicable enrollee' means an individual who is, with
respect to a prescription drug plan--
``(A) enrolled with the plan; and
``(B) an at-risk beneficiary for prescription drug abuse
(as defined in section 1860D-4(c)(5)(C)).
``(8) Model not applicable to ma-pd plans.--The model under
this subsection shall not apply to MA-PD plans or enrollees
of such plans.
``(9) Clarification of application.--For purposes of the
preceding provisions of this section (including paragraphs
(3) and (4) of subsection (b) and subsections (d) and (f)),
the model under this subsection shall be deemed to be a model
under subsection (b).''.

Mr. WYDEN. Madam President, along with my colleague Senator Schumer,
I rise to offer what, in my view, are some needed changes to the
amendment Senator Toomey has now offered to the opioid bill. My bottom
line for the opioid legislation is that a real solution has to include
three priorities: more prevention, better treatment, and tougher
enforcement. To be successful, all three priorities must work in
tandem.
The Toomey amendment, which is often called the Part D lock-in, would
allow Part D plans to identify people in Medicare who may be abusing
opioids. These people would then be assigned to one prescriber and one
pharmacy to get their pills. This is an enforcement policy, and it
cracks down on those who game the system.
What is important, what is critical for the Senate to understand is
that the story does not stop there. If someone is addicted to opioids,
they need a path--a real path--to treatment. Without treatment, they
may get their pills on the street or they may turn to heroin. This
amendment ensures those who are at risk for opioid abuse are connected
to meaningful treatment choices so they can better manage their pain
and limit excessive prescriptions. Those struggling with addiction need
the health care system to be all hands on deck, working to ensure that
there is adequate treatment. That means your doctor, your health care
plan, and your pharmacy need to come together and develop a treatment
plan in order to ensure that Americans are on the road to real
recovery. Without access to treatment, the Toomey amendment alone would
simply lock persons suffering from addiction into a pharmacy, and they
would still be without a path out of addiction. Effective treatment has
to be more than handing a pamphlet to somebody struggling with a
condition as powerful as addiction.

My amendment also aims to end the tide of overprescribing in the
first place. It doubles the penalties for opioid manufacturers that
provide kickbacks to prescribers in order to boost their profits by
promoting the unapproved use of these drugs at the expense of a
patient's safety. The inappropriate practices of these companies have
been well documented in recent years, and it is high time for real
accountability when the opioid manufacturers go too far.
I will close by saying that at the Finance Committee hearing, which
was held last week, I asked the three panelists--one was a witness
chosen by the distinguished chairman, Senator Hatch, one was a witness
I chose, and one was an individual that both of us thought would make
an important contribution. The panel consisted of a pharmacist, a State
assistant attorney general, and a child welfare and substance abuse
expert. I asked all of them one simple question, and that question was:
Does treatment and enforcement have to work in tandem to solve the
opioid crisis? Each one of these witnesses--a witness chosen by
Chairman Hatch, a witness chosen by me, and an independent witness--
answered yes to my question. Prevention, treatment, and enforcement
must work in tandem, and to do that we have to adopt this amendment.
We ought to take action to improve policies in our government that
will actually solve the opioid crisis. I hope all of my colleagues will
support my perfecting amendment to the Toomey amendment.
With that, I yield the floor.
The PRESIDING OFFICER. The Senator from New York.
Mrs. GILLIBRAND. Madam President, I rise to speak in favor of
amendment No. 3354. I filed this amendment with my colleague from West
Virginia, Senator Capito, who has been a leader in our fight against
opioid addiction. The opioid addiction problem in our country is
severe. It is growing, and it is not going to end unless Congress comes
together to pass a law that targets the root causes of this epidemic.
The stakes are simply too high to ignore.
Last year alone, in communities all across our country, including
many in New York, 1.4 million more Americans started abusing opioids.
Every day, 44 more people are killed by an overdose. We have seen
enough data to know that our opioid addiction problem is spiraling out
of control. Opioid addiction is destroying too many lives in our
cities, too many families in our rural communities, and too many young
men and women in our suburbs.
I wish to tell the story of one of my constituents whose name is Sean
Murdick. Sean was a really special and gifted young man. He was
cocaptain of his high school football team and had that rare ability to
bring people together and connect with anyone. Sean didn't care if you
were on the football team or had a disability, he was always the first
one there to help you when you needed it.
After high school, Sean loved working with his hands, so he got a
good job as a construction worker. One day Sean broke his arm. Sean's
doctor gave him a prescription for oxycodone, a powerful opioid to mask
his pain. By the time his prescription ran out, Sean was already
addicted. He couldn't shake the addiction no matter how hard he tried.
He started using heroin and tried to quit many times, but the system
failed. The system failed him nearly every step of the way, and last
fall Sean overdosed and died.
I would like to tell you Sean's story from the perspective of his
parents. My hometown paper, the Times Union, did an incredible story
about his life. I can imagine the pain they suffer because I have two
young sons. The Murdicks

[[Page S1194]]

had many questions but very few answers, and they have been lost in a
fog of grief since their son's death 2 months ago.
The Times Union wrote:

They want to speak out in Sean's memory, to reclaim what
heroin stole from them in the hope that it might help other
parents struggling with a child's addiction.
``Sean did not die in vain,'' his father said, choking back
tears.
``We tried our best to save him. It wasn't enough,'' his
older brother said, his voice cracking. . . . His mother
walked over, embraced her son and spoke soothing words into
his ear. The father buried his head in his hands. It was a
tableau of sorrow.

We have seen this happen far too often. When their son spiraled down
into addiction--

His parents could see something was wrong with Sean. He
lost a lot of weight and seemed distant and fidgety. He
nodded off at the dinner table.
His father found a syringe in the bathroom and confronted
Sean.
``Dad, I'm sick. I need help,'' he said. ``This is not me.
I don't want to be like this.''

The parents told their story to our paper. The paper says:

It was a revolving door of failure: detox, intensive
outpatient care, relapse. He did not qualify for the most
intensive and costliest level of care, inpatient residential
treatment. They denied him because he was not homicidal or
suicidal and had a stable home environment. ``It was a never-
ending battle with the insurance companies,'' his mother
said. ``They treated him like the scum of the Earth.''

Now imagine being a parent and going through this with your son--
going from treatment center to treatment center.
When Sean finally died, he had the best care. He was in a treatment
center. When he called his mother, he said:

``Mom, I've gotta go. My steak's ready,'' he said. ``Love
you, mom.''

He went into the bathroom, and he overdosed.

Sean left his parents a final solace. Not long before he
died, he thanked them for their unconditional love and how
they supported him through a long road of misery.
``You did everything right,'' he told them.

I don't know how a parent can hear those words and think they did
everything right, but I can tell you as a Senator that the U.S.
Congress is not doing everything right.
Too many parents are telling these stories about their children who
have died and too many patients are being prescribed opioids, such as
Percocet, Vicodin, and OxyContin for acute pain. This medication is
prescribed to patients for a broken wrist or when they have a wisdom
tooth pulled--medication that they may need for only 2 or 3 days. Why
in Heaven's name are they sent home with a dose of 30 oxycodone pills?
What happens to those pills? Are they given to kids at a party? Are
they sold to addicts?
We know there is a huge issue with how prescriptions are being made,
how much medicine is being given to patients for this acute care, and
right now there are no guidelines--no guidelines--given to doctors.
I have a bill to create that guideline. We need a guideline for the
CDC. Our amendment is very simple. It would require the CDC to issue
clear guidelines to our medical community for when it is appropriate to
prescribe opioids instead of something nonaddictive, such as Extra
Strength Tylenol.
Our amendment simply requires the CDC to issue these clear guidelines
for how much opioid medication our medical professionals can prescribe
without putting a patient at high risk for addiction. These guidelines
are already being done for chronic pain, so they should also do them
for acute pain.
We need to do something. As Members of Congress, we need to respond
to the suffering of so many of our constituents. It is truly an
epidemic, and it needs a response.
I thank the Presiding Officer, and I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The senior assistant legislative clerk proceeded to call the roll.
Mr. McCONNELL. Madam President, I ask unanimous consent that the
order for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. McCONNELL. Madam President, I ask unanimous consent that at 2:30
p.m. today, the Senate vote in relation to the following amendments in
the order listed: 3362, Feinstein; 3395, Wyden; 3367, Toomey; 3345,
Shaheen; that there be no second-degree amendments in order to the
amendments and that, where applicable, Senator Enzi or his designee be
recognized to offer a budget point of order against the respective
amendment and that the sponsor or their designee be recognized to make
a motion to waive; further, that all the amendments be subject to a 60-
affirmative-vote threshold for adoption and that there be 2 minutes
equally divided in the usual form prior to each vote.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The PRESIDING OFFICER. The Senator from Nebraska.

Kari's Law

Mrs. FISCHER. Madam President, I rise today to discuss a bipartisan
bill that ensures all Americans can access 911 in emergencies.
In December of 2013, Kari Hunt was attacked in her Texas hotel room.
As this was unfolding, her 9-year-old daughter tried desperately to
call 911, but the call did not go through. Like millions of American
children, Kari's brave daughter was taught to dial 911 for emergency
assistance, but because they were in a hotel room, the phone required
her to dial 9 followed by 911.
In any emergency, a few precious seconds can mean the difference
between life and death. And although we cannot prevent tragic events
from taking place, we do have the ability to make it easier to get
help. That is why I have teamed up with Senators Amy Klobuchar, John
Cornyn, Ted Cruz, and Brian Schatz to put forward a new bill that could
save countless lives. Our legislation, named in honor of Kari Hunt,
would require that everyone has the ability to call 911 in an
emergency. This problem isn't isolated to one hotel room or a
particular incident.
As of March 2014, consumers could not directly dial 911 in 44.5
percent of hotel franchises and 32 percent of independent hotels. Over
the past 2 years, the hotel industry and phone manufacturers have
undertaken voluntary efforts to improve the problem, and I do commend
those efforts, but we need to do more. If one person cannot call 911 in
a life-or-death situation, that is one person too many.
The bill we have introduced, known as Kari's Law, would require
multiline telephone systems, such as those used in hotels and schools
and office buildings, to have a default setting that enables people to
directly call 911 without first dialing an access code such as 9 or 1.
The bill also requires that these phone systems be programmed to allow
a central location--such as the hotel front desk--to be notified if a
911 call is made. Through our legislation, first responders can more
easily locate people during an emergency. Then they face fewer barriers
while this is unfolding.
Kari's Law has already received generous support from across the
country. For example, in Nebraska, the bill is supported by the
firefighters associations in Omaha and Lincoln, the Buffalo County
Sheriff's Office, the city of Beatrice Fire and Rescue Department,
Cheyenne and Scotts Bluff County 911 representatives, and the chairman
of the Scotts Bluff County Board of Commissioners. The bill is also
supported by the hotel industry and the American Hotel and Lodging
Association.
I would also like to acknowledge the efforts of FCC Commissioner Pai,
who has devoted time and resources to bring attention to this very
important issue. Commissioner Pai traveled to Nebraska last June, and
he participated in a workshop on direct-dial 911 issues while at the
University of Nebraska in Lincoln. He has continued to encourage the
industry to work with him in an effort to find solutions to this
important issue. The Nebraska Public Service Commission, which led the
workshop, has also been at the forefront of the discussion.
And finally, we would not be here discussing this bill without the
tireless work of Kari's father, Hank Hunt. Hank has worked day in and
day out to advocate for this legislation at both the State and the
national level. Hank has made it his mission to ensure that no other
family will have to suffer through a similar tragedy. I paraphrase
Hank: It was the look on my granddaughter's face when we failed her. A
9-year-old did what she was instructed to do by her parents, teachers,
and adults. She was in a true, dire emergency, and she followed
instructions, but it didn't work.

[[Page S1195]]

I would call on all my colleagues to support this important
legislation. We owe it to Kari Hunt, her family, and the Americans who
rely on their ability to call 911 for emergency help.

Spoofing Prevention Act

Madam President, I also want to take a moment to speak about another
bipartisan bill that is currently before the Senate. This legislation
also seeks to protect Americans by updating our telecommunications
laws. It would fix loopholes in our laws that are allowing scammers to
take advantage of innocent Americans through a practice known as caller
ID spoofing.
Caller ID spoofing allows predators to deliberately falsify their
identification and telephone numbers relayed through caller ID. The
scammers frequently ask for personal information and for money. Often,
senior citizens and our veterans are the target of these predatory
practices. Caller ID spoofing has become a major problem for Nebraskans
and for law enforcement, which is why I am committed to eliminating
this practice.
In September 2013, USA Today highlighted the story of Marian Kerr
from Hastings, NE. Ms. Kerr is an 83-year-old retired hospital nursing
administrator who fell victim to a spoofing scam. She received a call
from individuals who claimed to work for the Federal Government, and
they asked for her bank account information. The scammers told her they
were Federal officials and already had her name, address, and her phone
number. They used this information to trick Marian into providing her
bank account number. Ms. Kerr had caller ID, but it displayed a number
in Nevada, not Washington, DC, or Hastings, NE. She attempted to call
back repeatedly, but she either received a busy signal or was sent to
voice mail. Ms. Kerr reported the incident to the police, but by then
it was too late. Her money was gone, and there was nothing that law
enforcement could do.
Last fall, the Omaha FBI issued a warning about the danger posed by
scammers using the Bureau's identification to target Nebraskans. The
callers claimed to be offering a grant from the Federal Government, and
they proceeded to solicit credit card and banking information. This
practice is happening across the country and it needs to stop. Whether
it is hardworking Nebraskans like Ms. Kerr or veterans who bravely
served our country, no one is immune to this form of fraud.
That is why I was very pleased to join with Senator Nelson last month
to introduce the bipartisan Spoofing Prevention Act. This bill would
amend the Truth in Caller ID Act. Currently, loopholes in this law are
allowing scammers to manipulate caller ID information and to harass
millions of Americans.
While the Truth in Caller ID Act has helped to curb spoofing, the
growth in new technologies has allowed scammers, especially those
operating overseas, to continue this fraudulent practice. The Spoofing
Prevention Act would crack down on spoofing by prohibiting caller ID
spoofing on all voice calls, including those originating outside the
United States, and all calls made using IP-enabled voice services. It
would also prohibit caller ID spoofing done via text messaging, which
is now becoming a really common practice. Additionally, the bill
directs the GAO to look at what the FCC and the FTC have done to combat
spoofing.
We must call for new solutions as technology continues to evolve, and
I urge all my colleagues to support this important legislation so we
can ensure that our citizens are protected from fraud and abuse.
Thank you.
I yield the floor.
The PRESIDING OFFICER (Mr. Tillis). The Senator from Indiana.
Mr. DONNELLY. Mr. President, I would like you to recognize the
assistant minority leader from Illinois, Senator Durbin.
The PRESIDING OFFICER. The Senator from Illinois.
Mr. DURBIN. I thank my colleague from Indiana.
Mr. President, the bill before us is the Comprehensive Addiction and
Recovery Act. It is one of the few bills on which we find so much
bipartisanship. It really is an issue that all of us understand back
home is a major problem, wherever home may be. In my State of Illinois,
there is no town too small and no suburb too wealthy to avoid the
challenge of this heroin crisis.
Here is what is happening. Over the last 10 years, we have seen the
pharmaceutical industry dramatically increase the number of painkiller
pills for sale. One classification of those opioids includes OxyContin,
hydrocodone, and other names that are pretty familiar to us. It turns
out that there have been so many of these pills produced that they have
now created an industry of their own--an illicit industry where people
are buying and selling them to get high. When they reached a point
where they can't find these pills or they are too expensive, they
switch, in the same category of narcotics, to heroin. Of course, heroin
can kill you if you have an overdose.
We now have more people dying from overdoses of heroin across the
United States than people who are dying in traffic accidents. To give
you an idea of the volume of this challenge, I have been all across my
State, from one end to the other, from Southern Illinois all the way up
to Chicago and the suburbs and towns in between. There is hardly a
single town that has been spared where some teenager wasn't found dead
because of a heroin overdose. There are things we are doing to try to
resolve this, but we are not doing enough and not doing it fast enough.
So the bill that is on the floor, the Comprehensive Addiction and
Recovery Act, is an attempt to find new ways for prevention, education,
and treatment of substance abuse. There is an amendment offered by
Senator Shaheen from New Hampshire. It is really a test. All of us can
agree on the goals. Senator Shaheen says that is not enough. That is an
empty promise unless you pay to achieve the goals. We have to put the
money into substance abuse treatment. We have to put the money into
efforts with law enforcement to reduce the likelihood of these drugs
coming into the United States. That is why I support her amendment.
I will offer another amendment too. What we are finding is that there
are not enough treatment facilities for this huge growth in people who
are addicted to heroin and other narcotics. There just aren't enough.
So my bill takes a look at Medicaid. That is the health insurance plan
for people in low-income categories. A few years ago, we changed this
law and said you can't treat people for substance abuse if you have any
more than 16 beds in your facility--16. Can you imagine in the city of
Chicago what that means?
Well, I went to Haymarket, which is a wonderful operation started by
Monsignor Ignatius McDermott decades ago, which treats people for
alcoholism and substance abuse. They have empty beds now that can treat
people who are addicted to heroin and help them to break away from this
habit. But if they are under Medicaid, they can't offer these beds to
these individuals. So I have an amendment with Senator Angus King of
Maine, and this increases the number of beds in each facility to 40.
This isn't a runaway number. It is a manageable number, and it is a
realistic number. If we are going to deal with heroin addiction, we
have to deal with it in an honest fashion.
Let me give an example of what I consider to be one of the more
effective approaches. In Gloucester, MA, the chief of police decided to
try something new. They were having too many heroin overdose deaths, so
he made the decision and announced that if you came to his police
department or sheriff's office and announced your addiction, they
wouldn't arrest you. They would put you into treatment. What happened
was a number of people came forward and went into treatment. It was a
good outcome for them and for the community.
I have a similar story from the town of Dixon in Illinois. They had
too many scary instances where people were either close to a heroin
overdose or actually passed away. They tried the same thing as
Gloucester, MA, and offered that if you came in and confessed your need
for help and treatment, they wouldn't arrest you. They would take you
into treatment. It worked. Over 20 local teenagers showed up because of
their addiction and they were put into treatment.
Of course, the problem is there aren't enough treatment facilities.
So this amendment I have would expand the

[[Page S1196]]

opportunities for treatment, and we have to do that.
The good news about this, if there is a good part of this, is that we
are finally dealing with addiction in reality. It is no longer viewed
just as a moral failing or characterized as some omission of
conscience. It is being viewed as a disease--a medical condition that
should and can be treated--and that is why we are making a step in the
right direction.
We also--I think it bears repeating--we also changed the law in this
Chamber not that many years ago, a law which was brought to the floor
originally by Senator Paul Wellstone of Minnesota and Senator Pete
Domenici of New Mexico, and that bill required that health insurance
policies in the United States, in the future, would cover mental health
counseling and substance abuse treatment. So, now, because that became
the law, the health insurance plans we buy cover our families for those
needs. Many families who never dreamed they would need substance abuse
treatment for their kids, thank goodness, can turn to their health
insurance plan for that kind of help. We have to protect that. Those
who talk about repealing the Affordable Care Act would be repealing
this very protection that families are using now for substance abuse
treatment. That isn't the answer. The answer is to have more treatment
facilities available so people can rid themselves of this addiction and
get on with their lives.
I have met so many of these people in my roundtables, including law
enforcement and doctors, but the ones I remember the most are the young
people addicted in high school who finally were able to break the
habit. They have a chance now for real life, but it is because there
was treatment there when they needed it.
I hope my colleagues will consider this amendment. It will not come
up today, but it will soon.
This is a good bill. I hope they will vote for the Shaheen amendment
because it pays for the services we are promising. I don't want to end
up making an empty promise to America as we face this heroin crisis.
I yield the floor.
The PRESIDING OFFICER. The Senator from Indiana.
Mr. DONNELLY. Mr. President, I thank the assistant minority leader
for those inspiring words, and I recognize the Senator from Virginia.
The PRESIDING OFFICER. The Senator from Virginia.
Mr. WARNER. Mr. President, I ask unanimous consent to speak for up to
6 minutes as in morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. WARNER. Mr. President, let me also join my colleague in agreeing
with the Senator from Illinois on his comments, and I, too, will join
him on voting in favor of the Shaheen amendment. It is important we not
only take on this question of opioid drug abuse but that we also make
sure we fund the program. I thank him for his leadership.

Filling the Supreme Court Vacancy

Mr. President, I wish to take a couple of moments and join with many
of my colleagues to talk about an issue of enormous importance on the
constitutional obligation to fulfill our duty in terms of reviewing
whomever the President of the United States nominates for the Supreme
Court. I wish to start, though, by saying a few words about Supreme
Court Justice Antonin Scalia and to offer my condolences to his family.
Whether you agreed or disagreed with Judge Scalia's decisions--and
mechanically I disagreed with many of them--he was a remarkable jurist
and he was a remarkable individual. Over the last 10-plus years, I got
to know him and his wife Maureen more in a social setting. He was warm,
witty, charming, brilliant, and he will be missed by all who agreed or
disagreed with him. My thoughts continue to be with Maureen and his
family.
I rise, I think, almost in the mode of what I believe Justice Scalia
would have said as someone who was a strict constructionist and someone
who believed so firmly in the words of the Constitution. The words of
the Constitution are quite clear in article II, section 2, where it
says the President shall nominate Justices to the Supreme Court, and it
is the responsibility of the Senate to advise and consent.
So my request to all colleagues in this body is simply let's do our
job. It is not if the President will nominate, it is when the President
will nominate--and I hope he nominates soon--we should give that
nominee their due consideration, a fair hearing, and then an up-or-down
vote. The President has repeatedly voiced his strong commitment to
nominating an eminently qualified replacement. That is his duty, and we
must do ours.
To those who suggest we should wait and let the American people
decide, the truth is, they already did. In 2012, the American people
voted to return President Obama to the White House for a second 4-year
term. That 4-year term doesn't end until January 20, 2017. I believe
there is ample time to vet a nominee and still wrap up this process
this spring.
Are we going to allow politics to totally overtake the work of this
body? Are we resigned to a complete and utter failure to govern until
next January?
I know the Presiding Officer and I both share a common background;
that is, a background in business. It is remarkable to me. No business
in America--no business in the world--would operate under the
presumption that because it is a Presidential year, that somehow we can
default on all of our duties and simply kick over every issue until
next year. If we operated a business that way, we would be out of
business.
I believe it is absolutely essential that when the President--and I
hope expeditiously--nominates an individual to the Supreme Court, that
this body do its job constitutionally: review that applicant, meet with
that applicant, hold hearings on that nominee, and then give that
nominee the up-or-down vote the Constitution requires.
The remarkable thing is in a year where there is a lot of commentary
about what the public wants, I can at least tell my colleagues what the
public wants in Virginia. They want us to do our job.
I have received an overwhelming response from Virginians from one end
of the Commonwealth to the other. They are expressing their opinion
clearly about how the nomination process should move forward. A lot of
Virginians are expressing their thoughts about what kind of nominee the
Senate should confirm or not confirm, but what they are not saying is
that the U.S. Senate should punt on this constitutional responsibility.
They want us to do our job.
Over the past week, what I have found most striking is the awkward
public position held by so many people who otherwise claim to be
advocates of a strict reading of the words of the U.S. Constitution,
who somehow are saying--imagining something that doesn't appear in the
Constitution, that a President or at least this President in his last
year--we are not going to follow the Constitution. We are going to kick
it over until next year. I believe that is irresponsible. I believe it
is inappropriate. I believe that does not follow the interpretation of
the Constitution and quite honestly I don't believe it would follow
what Justice Scalia, who was a strict constitutionalist, would want to
see this body do.
Yet we saw some on the other side of the aisle, literally within
hours of Justice Scalia's passing, saying: No vote. No proceeding. We
are not going to do our job. We saw certain members of the leadership
meet yesterday with the President, again reaffirming their
unwillingness to do their job.
This failure to act, this failure to do our constitutional duty,
could result--will result--in a vacancy on the Supreme Court stretching
close to a year, across two distinct terms of our highest Court. Over
that time, the Supreme Court could be deciding extremely important
cases, and in many ways they are not going to function as the
Constitution laid out.
Many of my friends on the other side of the aisle often quote
President Reagan. President Reagan himself said: ``Every day that
passes with a Supreme Court below full strength impairs the people's
business in that crucially important body.''
As a matter of fact, if we don't do our job, in effect, what we will
be doing is potentially shutting down another branch of government.
Regardless of where we fall on the political spectrum, if there is one
message we have

[[Page S1197]]

heard loud and clear over the last couple of years, the American people
do not abide shutting down various branches of government. The American
people deserve better than this.
I would again urge my colleagues on both sides of the aisle to step
up and do their job. Let's give the President's Supreme Court nominee
the appropriate respect, hear them out, have those hearings, and give
the Senate a chance to exercise its will in a straight up-or-down vote.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Indiana.
Mr. DONNELLY. Mr. President, I rise for all Hoosiers who have been
touched by addiction or suffered the loss of a loved one as a result of
opioid abuse, heroin use or other drug epidemics. I am here for every
Hoosier community that has been gripped by addiction.
I am here from Austin, IN, a small town of 4,200, much like many
small towns in the Presiding Officer's home State of North Carolina,
where more than 185 people tested positive for HIV, largely caused by
injection drug users who shared needles. I am here for Connersville,
which was devastated by a heroin epidemic that saw 41 overdoses and 8
deaths in a 3-month span. I am here for my hometown of Granger, which
was shaken last year when two teenage brothers, Nick and Jack Savage,
died in just one night from a prescription drug-related overdose. I am
here for Fort Wayne, Lafayette, and Terre Haute, and Indianapolis, and
every community across our State. No part of Indiana or our country is
immune from the pain of addiction and these drug epidemics.
By now many of us have heard the staggering statistics. One person in
America dies every 25 minutes from an opioid overdose, and overdose
deaths in the United States now outnumber fatal auto accidents.
Ultimately, this is about people. People like Mike Zoss of Tippecanoe
County. Mike was the youngest of three boys. Mike was creative, enjoyed
reading, and had a ton of friends. In high school he began
experimenting with prescription drugs. During his senior year, Mike's
mom Donna got a call no parent wants to receive. Mike had overdosed at
a friend's house from a combination of LYRICA and methadone. He landed
in intensive care and was in a coma for nearly 3 weeks. Miraculously,
Mike survived, but after struggling for nearly 3 more years with his
addiction, Mike died from another overdose.
This scourge is about families and the heartbreak they endure and all
the people whose lives are shattered by addiction or even cut short.
That is why I have been working on this issue for over 2 years,
listening to Hoosiers, introducing bipartisan legislation, partnering
with Federal, State, and local officials, and bringing stakeholders
together.
These families are why I support the Comprehensive Addiction and
Recovery Act. This bill provides States and local communities with the
tools to prevent and treat drug addiction and to support individuals in
recovery. CARA strengthens prevention efforts, increases access to
treatment and recovery services, develops best prescribing practices,
and expands access to naloxone, also known as Narcan, which can reverse
the effects of an opioid overdose. In addition, CARA expands disposal
sites for unwanted and unused prescription drugs to keep them out of
the hands of children and teens, and CARA strengthens prescription drug
monitoring programs. This bill provides States and local communities
with the tools to prevent and treat drug addiction and to support
individuals in recovery.
CARA strengthens prevention efforts, increases access to treatment,
develops best prescribing practices, and expands access to naloxone, as
I said. Naloxone can reverse the effects of an opioid overdose. These
are incredible steps that can make a huge change in what happens in the
future of our country.
While this bipartisan bill includes many important provisions that
help families in my home State of Indiana and across our entire
country, it will take all of us working together to prevent and treat
addiction. Prescribers and pharmacists, law enforcement and first
responders, parents and families, and officials at the Federal, State,
and local levels all have a role to play.
I want to talk today about how CARA can best help in these efforts.
First, I want to talk about prescribers. Our prescribers play a vital
role in addressing addiction because they are our partners in the fight
to reduce the risk of prescription drug abuse. They have the knowledge
and authority to help our patients, friends, neighbors, and family
members understand both the benefits of prescription opioids and the
potentially devastating dangers associated with opioid abuse.
Last year, we hosted a roundtable discussion in Indianapolis on
prescribing practices with my colleague, Congresswoman Susan Brooks. By
bringing together State officials, doctors, and pharmacists, all of
whom play key roles in curbing overprescribing, we can better engage
health professionals in the fight against the opioid epidemic. We want
to make sure doctors have the training, the tools, and the resources to
prevent overprescribing and also to help them make the best possible
decisions about how to treat their patients.
Right now there is not one set of currently nationally accepted best
practices that can help prescribers make the best informed decisions
about prescribing opioid drugs. Existing guidelines vary in the
recommendations that are made.
CARA would help. It includes a provision adopted from my bipartisan
legislation that I reintroduced last year with my friend and colleague,
Senator Kelly Ayotte from New Hampshire, which brings experts together
to review, modify, and update, where necessary, best practices for pain
management and prescribing pain medication.
Second, I want to talk about our first responders and our law
enforcement who are on the front line of this crisis. Frequently they
are called to scenes where an individual has overdosed, and they are
working to find ways to address these drug epidemics. In Northwest
Indiana, the Porter County sheriff's department is reaching out to
educate families about the heroin crisis there with a video that
includes first-person accounts about how the epidemic has impacted the
local community. In the northeast part of our State, over by the Ohio
border, the Fort Wayne Fire Department began using Narcan just last
August to try to help save people who had overdosed. In the first 4
days, they had to use it three different times--and many times since
then. In Central Indiana last year, Indianapolis EMS had administered
naloxone an astounding 1,227 times. We need to make the overdose
reversal drug naloxone more readily available to first responders and
law enforcement.
CARA includes a provision similar to one from my bill with Senator
Ayotte that provides grants to train law enforcement and other first
responders in the administration of naloxone to save lives. I have also
offered an amendment that encourages first responder units receiving
funding through this program to use outreach coordinators to ensure
that every individual who receives naloxone also receives in-person
followup. Indianapolis EMS recently began a similar outreach program
designed to connect overdose victims who receive naloxone with the help
they need.
CARA assists law enforcement by expanding resources to identify and
treat individuals facing addiction in criminal justice centers. I hear
frequently from my friends--the police officers, sheriffs, judges, and
court personnel throughout the Hoosier State--that more resources are
sorely needed.
Third, I want to talk about families. There are countless personal
stories across our State and almost every State about moms and dads,
brothers and sisters, wives and husbands, and grandparents who have
been impacted by addiction. I want to share a couple of these stories.
Our young friend Aaron--Justin Phillips remembers her son Aaron, a
talented athlete who had dreams of playing football in college and the
NFL. He was a starting quarterback on Lawrence North's varsity team. He
was smart and charming, with a generous heart.
It started for Aaron with a prescription pain medicine and then led
to heroin. At the age of 20 years old, in October 2013, Aaron died of a
heroin overdose. His mom said, ``We can't pretend it is not our kid
because it very well may be our kid who is next.''

[[Page S1198]]

There are people like Michelle Standeford of Lebanon, IN, who lost
her son and her nephew to addiction. Her nephew Greg died 3 years ago
from a heroin overdose at the age of 21. Her son Troy, 33, died
following a long battle with addiction. His struggle began when he was
prescribed opioids for the pain he was struggling with after a jet ski
accident. This past Christmas, Michelle visited Troy, who was in South
Florida seeking treatment. She said he was in great spirits and eager
to reunite with his family. A few weeks after Troy came back home to
Indiana, he passed away. Think of this. He left behind parents, a wife,
and two sons, 2 and 4 years old. These stories are way too common.
As Donna Zoss of Lafayette said, ``There are way too many kids dying,
and as a community we need to do something.'' She wants to make sure
other families learn from her experience before it is too late.
CARA would help families by raising awareness about opioid abuse and
heroin abuse and expanding access to treatment. It includes a provision
from our bipartisan bill with Senator Ayotte that establishes a
national drug awareness program. By helping families learn about the
serious effects of opioid abuse and its connection to heroin, it can
make a difference.
CARA also would strengthen additional prevention efforts and increase
access to treatment and recovery services with the goal of helping more
people overcome addiction, including specific initiatives for women,
youth, and vets.
We are not doing enough, and the burden of addressing the opioid and
heroin use epidemic has fallen heavily on our criminal justice system,
which is clearly not equipped to treat all those struggling with
addiction. That is why CARA is so important and why we need to pass
this critical legislation quickly.
We have an opportunity to work together--all of us--to pass a good
bipartisan bill that helps confront opioid abuse, heroin abuse, and
other drug epidemics. On the Federal level, it is our job to support
and strengthen partnerships on the State and local levels to make sure
every town in every State is accounted for and can heal. CARA will do
just that. It would be a significant step forward, although I think we
can all agree that it is just a first step.
Mr. President, I yield back.
The PRESIDING OFFICER. The Senator from Pennsylvania.

Amendment No. 3367

Mr. TOOMEY. Mr. President, I rise on the same topic that the Senator
from Indiana was addressing very eloquently through the absolutely
heart-wrenching stories he told of his constituents and their families.
These are stories we hear all across America. I hear them all across
Pennsylvania day in and day out.
Drug addiction is an enormous problem. It is devastating families and
communities in our States. I share the view of the Senator from Indiana
that this legislation is very important. It takes a number of steps
that are very constructive. I congratulate Senator Whitehouse and
Senator Portman for a very good piece of legislation that is going to
help save lives. It is going to help save families and communities.
I have an amendment that I am going to address that is going to take
another step to help save lives, and I hope my colleagues will
overwhelmingly support this because it is an epidemic the likes of
which I don't know we have seen in a very long time.
Last October, I convened a field hearing of the Senate Finance
Subcommittee on health care to learn more about this very epidemic of
opioid addiction and heroin addiction and the overdoses that are
resulting. We did it in Pittsburgh, and Senator Casey joined me. We
reserved a very large auditorium, and we invited some of the leading
local experts, doctors who were dealing with people who were suffering
from addiction, law enforcement folks, recovering addicts. We had a
standing-room-only crowd in that room. Such was the intensity of the
concern of this issue and the breadth of it because we all know people
who are affected by this terrible scourge.
A couple of things I learned in the hearing that are important is
that we have to figure out how we can reduce some of the
overprescribing of these narcotics--these prescription opioids--upon
which people then become addicted. We also have to find ways to address
the diversion from prescriptions that are obtained through the
conventional process, the black market, the streets, and the places
where it feeds the addiction.
I think one of the overlooked elements of this problem has been the
opioid epidemic that is affecting older folks, aging baby boomers, and
senior citizens who have become addicted to opioids for a variety of
reasons.
The headlines have screamed about this. USA Today's headline said:
``Many seniors Hooked On Prescription Drugs.'' The Wall Street Journal
had a headline recently: ``Aging Baby Boomers Bring Drug Habits Into
Middle Age.'' This came from a TV news channel: ``Senior citizens
getting hooked on painkillers.''
This is growing problem, and it doesn't know any demographic limits.
It affects senior citizens as well as young people. In fact, to give a
sense of one of the, perhaps, contributing elements to this, in 2013
there were 55 million opioid prescriptions written in America for
Americans over the age of 65. It is a stunning number. It is a 20-
percent increase in just 5 years. We have not had a comparable increase
in the number of senior citizens. It is a huge increase in the number
of prescriptions per person. This is probably related to the fact that
the number of opioid-addicted seniors has itself tripled in the last
decade.
One of the problems has been identified by the Government
Accountability Office. They estimate that in 1 year alone, 170,000
Medicare enrollees engaged in doctor shopping. That is the process by
which beneficiaries go to multiple doctors to get multiple
prescriptions for the same or similar powerful narcotics. They go to
multiple pharmacies to get them all filled, and they end up with these
commercial quantities of prescription drugs--vastly beyond anything
that any individual could need.
The GAO discovered that one beneficiary had visited 89 different
doctors in one year just to get prescription painkillers--89 doctors in
one year. That is almost 2 a week. Another beneficiary received
prescriptions for 1,289 hydrocodone pills. That is almost like a 2-year
supply. It makes no sense. I could go on and on with cases in which
fraud is being committed for the purpose of obtaining these
prescriptions, which are then sold in the black market.
There is also a subset of Medicare beneficiaries who are innocently
getting duplicate opioid prescriptions because they are being treated
by different doctors for different maladies. They have multiple
illnesses. They get multiple prescriptions because in many cases there
is nobody providing adequate oversight and coordination for their
care. So we have both, people who are intentionally and fraudulently
getting multiple prescriptions and then we have people who are
innocently getting it. So there is a way we can deal with this
inappropriate prescription and diversion into the black market, and the
administration has asked us to do this.

This administration--the Obama administration--has asked Congress to
give them, in Medicare, the power to limit certain beneficiaries who
are engaged in doctor shopping, exactly as people already can do so
within Medicaid and with private health care providers. So the simple
idea is to give Medicare the power when it identifies a beneficiary who
is engaged in doctor shopping--getting multiple, duplicative
prescriptions, either intentionally or unintentionally--to allow
Medicare to lock that patient into one prescriber and one pharmacy.
That way you don't have this problem. That is what the administration
has asked us to do.
So I have introduced a bill that does exactly that. It is called the
Stopping Medication Abuse and Protecting Seniors Act. Senator Brown of
Ohio is the lead Democrat on this bill. I thank Senators Portman and
McCain also for their work. This is the amendment we are offering to
this bill to give Medicare the very same tool that Medicaid has, the
tool that the administration is asking for, and the tool that all
experts say makes sense.
As I said, Medicaid and commercial users already do this, and we are
not inventing something new. What we are doing is simply applying a
proven technique that limits overprescribing and

[[Page S1199]]

diversion, applying that to Medicare, where it does not exist today. No
one who legitimately needs a prescription for opioids will be denied
that. That would be completely unreasonable and inappropriate.
In fact, we exempt seniors in nursing homes, where the nursing home
can provide the monitoring, and seniors who are in hospice, and cancer
patients who might need unusually large quantities are exempted. In
fact, this legislation would actually lock in a small fraction of 1
percent of Medicare enrollees, but that is the fraction that is
engaging in this very dangerous behavior.
First, I am grateful for the very broad bipartisan support that we
have. As a result, if we get this passed today--which I certainly hope
we will--we will help opioid-addicted seniors find treatment because
they will be notified when they come up on this list--when it is
discovered that they are going to multiple doctors and multiple
pharmacies. It will stop the diversion of these powerful narcotics.
It will save taxpayer money because taxpayers reimburse for all of
these prescriptions, even those that are fraudulent. Maybe, most
importantly, it will reduce the availability of these opioids. We have
25 Republican and Democratic cosponsors on the bill. We have the
support of the National Governors Association. Nearly identical
language was already passed in the House. It was embedded in the 21st
Century Cures Act, where it passed overwhelmingly.
The President's budget has asked for this very mechanism repeatedly.
The CMS Acting Administrator was before our committee, and
Administrator Slavitt said this legislation ``makes every bit of sense
in the world.'' The CDC Director is for it. The White House drug czar
is for it. The Pew Charitable Trusts testified on behalf of our
legislation, and the Physicians for Responsible Opioid Prescribing
support it--not to mention many law enforcement groups and senior
groups, such as the Medicare Rights Center.
This is a tool that is overdue. We have this tool in private health
care insurance coverage. We have this tool in Medicaid. We just need to
have this tool in Medicare.
I wish to single out for a special thanks my coauthor Sherrod Brown.
Senator Brown and his staff worked very hard and did a tremendous job.
They provided, in fact, very valuable feedback to make sure that all
the stakeholders were going to be treated fairly and specifically, that
beneficiary rights would be properly respected. That is a very
important and very constructive contribution that Senator Brown made to
this legislation. He also helped to secure many endorsements from
outside groups.
My fellow Pennsylvanian, Senator Casey, was very helpful and is
passionate about this issue. He has seen firsthand the damage that is
being done across Pennsylvania from opioid abuse. He is a cosponsor of
the legislation.
We had a very successful hearing in the Finance Committee. I thank
Senator Hatch for having this very topic of how we can limit the
diversion through Medicare of these very dangerous narcotics, and I
thought that was a very constructive hearing.
I also thank Senator Kaine, who, through his work on the Senate Aging
Committee, has been very active and extremely helpful on this issue.
Again, this is an amendment that has broad, bipartisan support. It
has been vetted by the stakeholders. It has been vetted by and
requested by the administration. It is endorsed by numerous health care
and law enforcement groups. The reason it has such broad support is
because it will save lives, it will protect seniors from opioid
overprescriptions, it will stop fraud, and it will dramatically reduce
pill diversion. So to vote no on this would be to allow the continued
flooding of very dangerous prescription opioids onto the black market,
and I can't think of any reason we would want to do that.
I urge my colleagues to support the bipartisan Toomey-Brown-Portman-
Kaine amendment. Let's get this adopted and then let's pass this
underlying bill, which is very, very constructive as well.
I yield the floor.
The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. WHITEHOUSE. Mr. President, as one of the authors of the bill
before us on the floor now, I wish to say that I appreciate and welcome
the Senator's amendment, and I appreciate the bipartisan way in which
it was achieved, with Sherrod Brown and Tim Kaine, as well as with the
other cosponsors of the bill.
With that, I yield the floor back so that we may hear from another
coauthor of this legislation who was with us through the long and
arduous process of preparing this bill, running the seminars, putting
together the advisory committee, and crafting the legislation.
I yield for the Senator from New Hampshire.
The PRESIDING OFFICER. The Senator from New Hampshire.
Ms. AYOTTE. Mr. President, I very much thank the Senator from Rhode
Island for the work that we were able to do together on this important
legislation, for his leadership, and, really, his passion for this
issue that is devastating my State--the heroin and opioid epidemic that
is facing all of us. I thank him for a very thoughtful approach and
bringing people together around this. I am so pleased we are debating
this on the Senate floor today.

Honoring Officer Ashley Guindon and Lieutenant James ``Jimmy'' Geraghty

Mr. President, I come to the Senate floor today with great sadness to
discuss and to honor the lives of two of our outstanding law
enforcement officers from New Hampshire who were taken from us far too
soon. One is New Hampshire State Police Lieutenant Jimmy Geraghty, a
U.S. Army veteran and outstanding public servant. Another is Prince
William County Officer Ashley Guindon of Merrimack, NH.
Ashley was a Merrimack, NH, native and a Marine Corps veteran who was
killed in the line of duty in Virginia 1 day after being sworn in as a
police officer to serve in the Prince William County Police Department.
These individuals represent the very best of law enforcement. It is
with such a heavy heart that I pause to remember Ashley Guindon, an
incredible young woman whose life was tragically cut short. Ashley was
killed in the line of duty last week, tragically, on her first day as a
police officer with the Prince William County Police Department in
Virginia.
Ashley could not have known her fate when she responded to an
emergency call, but she responded to the call with the same sense of
duty and resolve that all of our faithful law enforcement officers do
every single day because they don't know at that next stop, at that
next house that they respond to help someone in need, what they are
going to be confronted with.
Ashley's death is a terrible, unthinkable tragedy and serves as a
somber reminder of the tremendous sacrifices that our law enforcement
officers make every single day by putting their lives on the line to
keep us safe.
My heart breaks for Officer Guindon's mother Sharon, for her family,
for her friends, and for the public safety community, as they mourn the
loss of this tremendous young woman whose life ended far, far too soon.
I will keep them in my thoughts and prayers as I know everyone in this
Chamber will.
But Officer Guindon should not be remembered because of the
circumstances of her death. Rather, she should be remembered for her
tremendous life of service to her Nation, to the people whose community
she worked to keep safe, and for the sacrifices that she has made and
her family has made on behalf of all of us.
Officer Guindon demonstrated an incredible commitment to her country
in so many ways. Following her graduation from Merrimack High School in
2005, she joined the Marine Corps. In doing so, she was honoring the
life of her father and the service of her father, who deployed to Iraq
as a member of the New Hampshire Air National Guard. So she comes from
a family of service. Her father lost his life after returning home from
serving in Iraq, and Officer Guindon felt that she could honor his
memory by joining the armed services herself. So she joined and became
a marine.
In her high school yearbook she wrote:

As I take flight it only makes me closer to u daddy. Mom,
thanks for everything it'll be a long road but we can manage
and it will only make u stronger.

[[Page S1200]]

Underneath her picture in her high school yearbook, the caption read:
``live for something rather than die for nothing.''
Think about that: ``live for something rather than die for nothing.''
Well, absolutely, Officer Guindon did live for something. She lived
for our country in her service as a marine. She lived for members of
her community, giving of herself and making the ultimate sacrifice to
keep others in her community safe. She lived with such honor and
distinction, and she answered the call to duty.
Officer Guindon was taken from us far too soon. But by working to
ensure that we honor her service, her heroism, her commitment, and the
sacrifice she and all law enforcement officers make on our behalf every
single day, we can ensure that her inspiring legacy of dedication to
others, of service to her country and to her community will never be
forgotten. We will never forget her service or her sacrifice. We will
continue to honor her and her family for what they have done in service
to our Nation every single day.
I also wish to take a moment to honor another law enforcement
officer, someone with whom I had the privilege of working personally
when I served as attorney general of our State, someone whom I probably
called a friend, and who has also been taken from us far too soon.
I honor Lieutenant James ``Jimmy'' Geraghty, who passed away recently
following a courageous battle with cancer. I join his family, his
friends, and the law enforcement community in New Hampshire who mourn
his death. I am speaking about someone who touched so many people in
our State, who really lived a life of service, a life of heroism, a
life of integrity. I honor his service, his integrity, and his
dedication to excellence.
He was a member of the New Hampshire State Police for 24 years and
rose to the rank of commander of the New Hampshire State Police Major
Crimes Unit. The New Hampshire State Police Major Crimes Unit is the
unit that handles the most difficult cases in our State--murder cases,
very difficult cases. It is a unit where you are called upon at every
hour of the day in the most difficult of circumstances.
Lieutenant Geraghty handled some of the most troubling cases and the
most horrific cases you can imagine as a law enforcement officer. He
handled them with such incredible dedication, compassion, and
commitment, and he did his job so well.
In the most high-profile case of his career, Lieutenant Geraghty led
the investigation into the brutal 2009 Mount Vernon homicide--a
horrific, horrific case. It was a complex and extremely time-consuming
investigation that focused on multiple juvenile defendants.
Because of the thoroughness, professionalism, and dedication brought
to the case by Lieutenant Geraghty and the major crimes unit, the
prosecution was able to pursue the successful conviction of all the
defendants involved.
For their work on the 2009 Mount Vernon case, Lieutenant Geraghty and
the major crimes unit were presented with the New Hampshire
Congressional Law Enforcement Award for unit citations.
I had the privilege of being there when Lieutenant Geraghty received
that award, when he was there with his family. Really, the incredible
work that he did on that case made such a difference in bringing to
justice defendants who committed horrific, horrific crimes and in
keeping New Hampshire safe.
Lieutenant Geraghty will also be remembered for his entire
outstanding career of service to both New Hampshire and the Nation.
Lieutenant Geraghty also served very honorably in the U.S. Army for 5
years, holding posts at Fort Benning in Georgia, Fort Polk in
Louisiana, and at Fort Richardson in Arkansas.
He also served overseas by participating in the REFORGER exercise in
Germany. He achieved the rank of sergeant, E-5, during his career with
the U.S. Army and received an honorable discharge. But his service did
not end there. After serving in the armed services, he then returned
home and embarked on his career in law enforcement, first serving as a
police officer in the Hudson Police Department, after which he was
accepted as a trooper in the New Hampshire State police.
During his time with the New Hampshire State police, Lieutenant
Geraghty spent 8\1/2\ years with the Narcotics and Investigations Unit,
and he did a phenomenal job there investigating a variety of cases,
from street-level buys to multistate trafficking organizations.
While serving in the Narcotics and Investigations Unit, Lieutenant
Geraghty was assigned to the HIDTA--high-intensity drug trafficking
area--for 2\1/2\ years, so he understood and worked hard on the issues
we are trying to address on the Senate floor today regarding heroin and
opioid addiction and so many other illegal substances as he fought to
keep them off our streets. Lieutenant Geraghty's natural talent for
leadership and keen ability to work with others were critical in the
role he played in HIDTA. During his time with HIDTA, he received
several awards and recognitions for his dedication and commitment to
excellence.
He was promoted to the rank of sergeant in May of 2006, and from
there he was assigned to the Major Crime Unit as a detective sergeant
in February of 2008. In 2010 he was promoted to the rank of lieutenant
within his unit, assuming the commanding officer's position--a post in
which he served until he became ill last year. And he served with such
distinction.
I have many friends at the attorney general's office who worked with
the Major Crime Unit and with whom I have spoken--the chief of the
criminal bureau unit and with other prosecutors--and they speak of Jim
Geraghty's service with such glowing reviews, with such incredible
compassion, and they speak of the incredible hard work he put in. He
represented the very best of our law enforcement officers.
I wanted to talk about his career today because it was important for
me to mention his professional accolades, and there are many, because
he was such a humble man and he never liked to talk about all of his
accomplishments. He liked to focus on something I want to make sure we
remember about Jim Geraghty: He lived by the motto ``family first,''
which was incredibly apparent to anyone who knew him. He was married to
his wife Valerie for 30 years. Together they had four wonderful
children. They are an amazing family, son Jimmy and daughters Colleen,
Katie, and Erin.
I want to offer my thoughts and prayers to Valerie, to Jimmy, to
Colleen, and to Katie and Erin. You are an incredible family, and your
husband and father will never be forgotten. What an incredible person
he was. He impacted the lives of so many people with the service he
gave to his State.
It has been said that although Geraghty had an exceptional law
enforcement career, he considered his family his greatest adventure. In
a 2015 letter, his fellow local law enforcement officers described him
as a ``gallant public servant who has spent most of his life serving
others.'' Others said of him that ``he [was] truly a consummate team
player who demonstrated the true meaning of a quiet professional.''
Another individual said that ``he [was] humble, dedicated, and
resilient with any duties and/or responsibilities [he was] faced
with.'' And, lastly, ``His remarkable and unblemished career within law
enforcement is a true testament and shining example of what we all wish
to aspire to.'' This is how the officers who served with him, the
troopers who served with him, described Lieutenant Jim Geraghty. He
will be deeply missed.
I am honored to recognize Lieutenant Jim Geraghty and to honor his
tremendous contributions as the commander of the State Major Crime Unit
and to say what an amazing family man and great human being. He was
someone who lived his life with great integrity. He was truly someone
we would all want to emulate in living our lives.
Again, I offer my prayers to his family. They are an incredible
family as well, and I hope they know we will continue to stand with
them in their most difficult days ahead.
So today I wish to say about both Officer Ashley Guindon and
Lieutenant Jim Geraghty that they were incredible law enforcement
officers who gave so much to New Hampshire, to our country, and that
they really represented the very best in what it means to be an
American.
Mr. President, with that, I yield the floor.

[[Page S1201]]

The PRESIDING OFFICER (Mr. SCOTT). The Senator from Florida.

Return from Space of Commander Scott Kelly

Mr. NELSON. Mr. President, I rise to welcome a national hero back to
planet Earth--CDR Scott Kelley. After spending 340 days in space on his
most recent visit to the International Space Station, Commander Kelley
has smashed the previous U.S. record in space flight and for most of
the total time spent in space as well. But Commander Kelley's
accomplishment, while notable in its own right, is serving a greater
purpose. NASA is preparing to undertake one of the greatest
technological challenges in human history--a voyage to the planet Mars.
Depending on the alignment of the planets, Mars is anywhere from 35
million miles to an astounding 250 million miles from Earth. It is all
according to the alignment of the planets.
If you want to put that into perspective, Mr. President, the distance
from you and me reflecting the 238,000 miles from Earth to the Moon,
which is as far as we have gone and is a long way--that is the farthest
we have ever been--if that distance from the Earth to the Moon were
represented by the distance from you to me, then the distance to Mars
from right where this Senator is standing would be way out to the edge
of the District of Columbia and Maryland.
Commander Kelley's mission is a milestone on this journey to Mars.
The International Space Station--our football-sized laboratory orbiting
in space, as large as a football field from one goalpost to the other--
is our test bed for exploration. Indeed, Commander Kelley spent those
340 days at the International Space Station.
Now, as we venture out, traveling those vast distances between Earth
and Mars, it is going to mean that humans are going to spend more time
in space than ever before, so Commander Kelley's yearlong stay aboard
the station is an important validation of our ability to live and work
in space for the long periods of time someone would be in zero-g.
But there is another very interesting aspect to his mission. Scott
Kelley has an identical twin, his brother Mark. Retired Navy CAPT Mark
Kelley, also an astronaut, remained on Earth while his brother was in
space, and now he is a baseline to compare the changes in the body and
the psychological effects to his brother Scott. This comparison is
going to provide important insights into the effects of space flight on
the human body and perhaps even effects on the Human Genome itself. The
more we learn about how the human body changes in space, the better off
we are because we can prepare for the longer and longer voyages in
space. But we also gain insights into the fundamental working of the
human body that we may never have learned confined to Earth's gravity.
And who knows where these discoveries are going to lead--perhaps to new
cures and therapies for afflictions folks suffer here on the face of
the Earth.
The space station where Commander Kelley stayed for almost a year is
a powerful tool for science and for discovery and for exploration. That
is why at the end of last year we extended the authorization of the
space station all the way until at least through the year 2024. It is
also why I am so excited about the crewed flights from U.S. soil to the
space station resuming next year. Next year, Americans on American
rockets will go to and from low-Earth orbit. Once we have the Dragon on
the SpaceX or the Starliner on the Atlas V, those crewed capsules are
going to make regular trips to and from the space station. But we
should also then be able to expand the space station crew, because of
that regular visitation, from six to seven doing their research
projects on board the station. That means a lot more discoveries.
Some people may not appreciate how difficult it is to spend a year in
space, but I can tell you it is not only an amazing experience, but it
is tough on your body. The body experiences muscle atrophy in zero-g
and also bone loss. This is why astronauts have to be in peak physical
condition and also try to continue that as they are out in space for
long durations. And spending a year away from loved ones, of course, is
no easy task. This demonstrates the strength and the courage Scott
Kelley has shown.
So I want the Senate to recognize CDR Scott Kelley for this
accomplishment. It is going to take him some days to readapt to the
Earth's gravitational pull. I commend him for the contributions to
space exploration and thank him for the sacrifices he has made and the
sacrifices his family has made over the last year.
Welcome home, Commander, and thank you for offering to be a part of
this great adventure we call space exploration.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Arkansas.
Mr. BOOZMAN. Mr. President, prescription drug abuse is the fastest
growing problem in the country. It is a problem the Centers for Disease
Control and Prevention classifies as an epidemic.
The availability of prescription painkillers is a leading factor in
the increase of opioid abuse. Since 1999, opioid abuse overdose deaths
have quadrupled nationwide.
Unfortunately, my home State of Arkansas is not immune to the
problem. CDC data shows that it is one of 12 States with more
painkiller prescriptions than people--I repeat, one of 12 States with
more painkiller prescriptions than people.
Benton, AR, police chief Kirk Lane has seen the impact in his
community. During a recent visit to my office, he said: ``A lot of
people become addicted very innocently and can't find a way back.''
Placing prescription drugs in the medicine cabinet for safekeeping is
no longer the best option because 70 percent of Americans misusing
painkillers are getting them from friends and family.
Arkansas has implemented measures to combat this problem by
decreasing the availability of prescription drugs and properly
disposing expired and unneeded medication through the Arkansas Take
Back Program. This is an important step that has resulted in the
removal of more than 72 tons of unneeded medication from homes in the
State.
Congress has taken action to fight this epidemic. As a member of the
Senate Veterans' Affairs Committee, I have pushed the Department of
Veterans Affairs to reform its culture of prescription. Nationwide,
pharmacies have a system in place to prevent overfilling prescriptions.
It is time for VA to adopt a similar system.
I pressured the DEA--the Drug Enforcement Administration--to reform
its policy to allow clinics and pharmacies to serve as dropoff sites
for the collection of unused or unwanted prescription drugs.
Last year, we passed legislation to improve the prevention and
treatment of opioid abuse by pregnant women and care for newborns
affected by this abuse. That bill was signed into law.
Congress approved more than $400 million in funding to address the
opioid epidemic this fiscal year. That is an increase of more than $100
million from the previous year. Calls for additional funds for this
legislation are premature. We need to see the progress and results made
with the current finding.
We must continue our commitment to the fighting of this epidemic and
providing our communities with the tools they need to improve response
to addiction and promote treatment and recovery. That is why we need to
pass the Comprehensive Addiction and Recovery Act.
This bill can help give communities the ability to combat the growing
opioid epidemic in Arkansas and across the country by expanding
prevention efforts, supporting law enforcement, combating overdoses,
and expanding access to treatment.
I have heard from many Arkansans who support this bill. It has the
support of a wide range of organizations that represent law enforcement
officials, drug treatment providers, and health care professionals.
This speaks to the comprehensive approach we are taking to fight this
epidemic.
It also authorizes the Attorney General to award grants to veterans
treatment courts. These courts are critical in helping our veterans
break the cycle of addiction and turning their lives around.
Prescription drug abuse is a widespread problem that impacts all ages

[[Page S1202]]

and populations of Americans. I am committed to providing Arkansas
communities the resources they need to fight this epidemic.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from New Hampshire.

Amendment No. 3345

Mrs. SHAHEEN. Mr. President, I appreciate the comments from my
colleague from Arkansas about the challenges of the heroin and opioid
epidemic. I think it is really a pandemic that we are facing in too
many States across this country. Certainly it is a huge issue in New
Hampshire, my home State, where we have the highest percentage of
deaths from overdoses of any State in the country.
In a few minutes, we are going to be voting on the Comprehensive
Addiction and Recovery Act, which is an excellent piece of legislation,
sponsored by my colleagues Sheldon Whitehouse from Rhode Island and Amy
Klobuchar from Minnesota, as well as my colleague from New Hampshire,
Senator Ayotte, and Senator Portman.
We are also going to be voting on a number of amendments, including
an amendment that I have proposed, which is emergency supplemental
funding to make sure that the changes we are making as a result of the
CARA legislation actually get the resources that need to be provided in
order to make those changes work.
In 2014, more than 47,000 Americans died from lethal drug overdoses.
Each day, 120 Americans die from drug overdoses in New Hampshire. We
are losing more than a person a day from drug overdoses--three times as
many people as we lost last year in automobile accidents. These are
numbers we have been using a lot on the floor of the Senate in the last
couple of days, but I think they are numbers that we need to continue
repeating and repeating because losing 47,000 Americans from drug
overdoses is not acceptable.
Everywhere I go in New Hampshire, I am told one thing consistently by
drug treatment professionals and by law enforcement, and that is, they
need more resources and they need them now. Health workers are being
overwhelmed. Nationwide, nearly 9 out of 10 people with substance use
disorders don't receive treatment. They are being turned away. They are
being denied treatment because of a chronic lack of resources.
The amendment Senator Whitehouse and I have proposed addresses this
problem. It provides $300 million in emergency funding for the
Substance Abuse Prevention and Treatment Block Grant Program. This is
funding that will save lives in our States of New Hampshire, Rhode
Island, Arkansas, and in the Presiding Officer's home State of South
Carolina. This is funding that will save lives in each of our States.
Not only are health workers being overwhelmed, but law enforcement
officials are also being overwhelmed. We need an infusion of new
funding to mobilize additional efforts to stop opioid traffickers and
drug dealers.
This emergency supplemental amendment would allocate $230 million to
the Byrne JAG Program to directly combat the opioid crisis. These are
efforts that will keep drugs off the streets.
In total, the Shaheen-Whitehouse amendment appropriates $600 million
in emergency funding that will be immediately available to States and
those working on the frontlines to address this crisis. I think that is
why the National Governors Association, the Fraternal Order of Police,
the American Public Health Association, the American Society of
Addiction Medicine, the American Academy of Pain Management, the
American College of Physicians, the National Association of State
Alcohol and Drug Abuse Directors, and so many other groups support this
amendment. Again, the critical point here is that this amendment funds
key provisions of the CARA bill.
The Comprehensive Addiction and Recovery Act is a good bill. It is
excellent work that so many people have been involved in. The sponsors
did great work in writing the legislation. I support it. I am a
cosponsor. But it is an authorization bill that does not provide
funding. So if we support making the changes in law that are included
in the CARA bill, we should also support providing emergency funding to
those same programs.
To all my colleagues in this body, we know that doing the same thing
is not working. Every year more and more people are dying from drug
use. Congress needs to rise to this challenge, just as it has in so
many previous public health emergencies, because, make no mistake about
it, this is a public health emergency, and we have a history of
providing supplemental funding to address public health emergencies. In
2009, Congress appropriated $2 billion in emergency funding to fight
swine flu--a bill that passed the Senate 91 to 5. Many of us who voted
for that are still in this body. Just last year, Congress approved $5.4
billion to combat the Ebola outbreak--an outbreak that killed just one
person in the United States. Compare that to the 47,000 people we lost
in 2014 to drug overdoses. Surely--surely Congress can come together
now to fight this raging epidemic that is right here at home.
We can't avert our eyes from the 47,000 Americans who are killed by
lethal overdoses each year. We can't accept that 9 out of 10 Americans
with substance use disorders don't get treatment. We can't ignore the
fact that law enforcement officers in communities across this country
are overwhelmed by aggressive drug traffickers and a rising tide of
opioid-related crimes. The $600 million emergency funding in the
amendment I am proposing will help stem the tide. It will make a
powerful difference in communities all across America.
CARA is important legislation. I intend to vote for it. I hope this
body will pass it. But I urge my colleagues to also support the
amendment that makes sure we have the urgent emergency funding to ramp
up this fight in the months immediately ahead. Passing CARA without any
funding is like offering a life preserver to people who are drowning
and not putting air in that life preserver. This is a nationwide
crisis. It is way past time we mobilized a nationwide response that is
equal to the challenge.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Georgia.
Mr. PERDUE. Mr. President, I know we have a vote coming. I ask
unanimous consent to complete my remarks.
The PRESIDING OFFICER. Without objection, it is so ordered.

Filling the Supreme Court Vacancy

Mr. PERDUE. Mr. President, I rise today to discuss why I believe the
Senate should not hold hearings or schedule a vote on any Supreme Court
nominee offered by President Obama until the American people choose our
next President this November.
The American people are reacting to our global security and debt
crises when they go to the polls, and this upcoming election will not
only determine the direction of our country, but it also serves as a
referendum on the Presidency, Congress, and now the Supreme Court
balance.
The last 7 years have shown that this President has sought to exceed
the constitutional bounds of the Executive office by assuming powers
that were delegated to this body. For instance, in January of 2013 the
President attempted to recess-appoint nominees to the National Labor
Relations Board in direct violation of the Senate's will. Of course,
the Supreme Court later intervened and struck down those appointments.
As well, my colleagues across the aisle have repeatedly shown a
willingness to aid this administration in making unprecedented power
grabs, including employing the nuclear option for judicial nominees.
The American people were outraged at these events, as was I.
So while I acknowledge the President's position on insisting that the
Senate consider a nominee, it is vital that the people get their say on
this lifetime appointment. It is the role of the Senate to rise above
current political theater. It is about upholding principle and not
about the individual. The Senate simply should not consider a nominee
at this time and let the people have their say.
I should also point out that my position and the position of many of
my colleagues is not a novel idea. For instance, it was then-Senator
Obama who filibustered Justice Alito's nomination in 2006. It was then-
Senator Biden who in 1992 preemptively said that President George H.W.
Bush should avoid a Supreme Court nomination until after that year's
election. As chairman of

[[Page S1203]]

the Senate's Judiciary Committee, then-Senator Biden also made the same
point we are today when he came to the floor of the Senate and made
this quote: ``It is my view that if a Supreme Court justice resigns
tomorrow or within the next several weeks, or resigns at the end of the
summer, President Bush should consider following the practice of a
majority of his predecessors and not--and not--name a nominee until
after the November election is completed.''
The balance of the Supreme Court is in serious jeopardy. We must
ensure that balance remains as a check against efforts by government to
bypass the will of the people.
As a member of the Senate Judiciary Committee, I stand with Chairman
Grassley and other members in saying we will not consider a nominee to
the Supreme Court before the next President is sworn into office. We
are already in the midst of a political campaign season, so any nominee
will be seen through the lens of partisan politics. It is disingenuous
for the minority party to say otherwise. And this is to the point that
then-Senator Biden was speaking in 1992.
As we said in our letter last week, we intend to exercise the
constitutional power granted to the Senate under article II, section 2.
While the President shall nominate judges to the Supreme Court, the
power to grant or withhold consent of such nominees rests solely with
this body.
At a time when the stakes are so high, the American people deserve
the opportunity to engage in a full and robust debate over the type of
jurist they wish to decide some of the most critical issues of our time
and for the next generation. Not since 1932 has the Senate confirmed a
Supreme Court nominee in a Presidential election year to a vacancy
arising in that year--not since 1932.
It is necessary to go even further back, to 1888, to find an election
year nominee who was both nominated and confirmed under divided
government, as we have now. Today, the American people are presented
with an exceedingly rare opportunity to decide the direction the Court
will take over the next generation. The people should have this
opportunity.
Mr. President, I yield the floor.

Amendment No. 3362

The PRESIDING OFFICER. Under the previous order, there will be 2
minutes of debate equally divided prior to a vote in relation to
amendment No. 3362, offered by the Senator from Iowa, Mr. Grassley.
The PRESIDING OFFICER. Who yields time?
The Senator from California.
Mrs. FEINSTEIN. Mr. President, I ask unanimous consent to speak for 2
minutes.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
Mrs. FEINSTEIN. Mr. President, I wish to say a few words in support
of amendment No. 3362, which Judiciary Committee Chairman Grassley and
I, with Senators Cantwell and Ayotte, have cosponsored.
This bill has passed the Senate by unanimous consent three times. It
ensures that international drug traffickers can be prosecuted when
there is reasonable cause to believe that their illegal drugs will be
trafficked into our country. It also better enables the prosecution of
manufacturers and distributors of listed precursor chemicals who know
or intend that these chemicals will be used to manufacture illicit
drugs destined for the United States.
Finally, it makes a technical fix to the Counterfeit Drug Penalty
enhancement Act of 2012 at the request of the Justice Department.
I would like to thank Senators Grassley, Ayotte, and Cantwell for
cosponsoring this amendment. I hope my colleagues will pass it this
time with a vote, since it has been done by unanimous consent three
times in the past.
I yield the floor.
Mr. GRASSLEY. Mr. President, I wish to speak in strong support of
amendment No. 3362, offered by Senator Feinstein and me, the
Transnational Drug Trafficking Act. This is a bill that she and I have
worked on for many years.
One of the many reasons for the ongoing heroin epidemic in this
country is the increase in heroin supply on the streets of the United
States.
Mexican cartels are aggressively expanding into new territory here.
And they are flooding our communities with cheap, pure heroin. Indeed,
heroin seizures at the border have more than doubled since 2010. The
U.S. Government estimates that Mexican heroin production jumped an
incredible 62 percent from 2013 to 2014 alone.
And the reality is that it isn't just heroin coming over the border.
Between 2009 and 2014, U.S. Customs and Border Protection reported a
300 percent increase in methamphetamine seizures on the southwest
border as well.
This bill is a natural complement to CARA. We can't arrest our way
out of this heroin epidemic. We can try to reduce the heroin supply on
our streets by making it easier to target these cartels for
prosecution.
This is in part why Senator Feinstein and I introduced this
legislation. Our bill would make it easier for the Department of
Justice to prosecute cartels who harm our communities from abroad by
trafficking heroin, other drugs, and precursor chemicals for ultimate
delivery here.
If this amendment is adopted, prosecutors would need to prove only
that an international drug trafficker had reasonable cause to believe
that the illegal drugs or chemicals he manufactured or distributed
would be unlawfully imported into the United States, as opposed to
knowing or specifically intending that result.
This amendment passed the Senate by unanimous consent in October. It
also passed the Senate unanimously the past two Congresses.
But the House still hasn't taken it up. So I ask my colleagues to
vote for this amendment so we can send it to the House again, this time
along with CARA.
We need to attack the problem of opioid addiction from every angle,
and this amendment should be part of a comprehensive approach.
Mr. WHITEHOUSE. I yield back all time.
The PRESIDING OFFICER. Is there objection?
Without objection, all time is yielded back.
The question is on agreeing to the amendment.
Mr. GRASSLEY. I ask for the yeas and nays.
The PRESIDING OFFICER. Is there a sufficient second?
There appears to be a sufficient second.
The clerk will call the roll.
The senior assistant legislative clerk called the roll.
Mr. PAUL (when his name was called). Present.
Mr. CORNYN. The following Senators are necessarily absent: the
Senator from Texas (Mr. Cruz), the Senator from Florida (Mr. Rubio),
and the Senator from Alabama (Mr. Shelby).
Mr. DURBIN. I announce that the Senator from Missouri (Mrs.
McCaskill) and the Senator from Vermont (Mr. Sanders) are necessarily
absent.
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The result was announced--yeas 94, nays 0, as follows:

[Rollcall Vote No. 28 Leg.]

YEAS--94

Alexander
Ayotte
Baldwin
Barrasso
Bennet
Blumenthal
Blunt
Booker
Boozman
Boxer
Brown
Burr
Cantwell
Capito
Cardin
Carper
Casey
Cassidy
Coats
Cochran
Collins
Coons
Corker
Cornyn
Cotton
Crapo
Daines
Donnelly
Durbin
Enzi
Ernst
Feinstein
Fischer
Flake
Franken
Gardner
Gillibrand
Graham
Grassley
Hatch
Heinrich
Heitkamp
Heller
Hirono
Hoeven
Inhofe
Isakson
Johnson
Kaine
King
Kirk
Klobuchar
Lankford
Leahy
Lee
Manchin
Markey
McCain
McConnell
Menendez
Merkley
Mikulski
Moran
Murkowski
Murphy
Murray
Nelson
Perdue
Peters
Portman
Reed
Reid
Risch
Roberts
Rounds
Sasse
Schatz
Schumer
Scott
Sessions
Shaheen
Stabenow
Sullivan
Tester
Thune
Tillis
Toomey
Udall
Vitter
Warner
Warren
Whitehouse
Wicker
Wyden

ANSWERED ``PRESENT''--1

Paul

NOT VOTING--5

Cruz
McCaskill
Rubio
Sanders
Shelby
The PRESIDING OFFICER. Under the previous order requiring 60 votes

[[Page S1204]]

for the adoption of this amendment, the amendment is agreed to.
Mr. GRASSLEY. Mr. President, I ask unanimous consent that the votes
following this first vote in the series be 10 minutes in length.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.

Amendment No. 3395

Under the previous order, there will be 2 minutes of debate equally
divided prior to a vote in relation to amendment No. 3395, offered by
the Senator from Oregon Mr. Wyden.
The Senator from Oregon.
Mr. WYDEN. Mr. President, this amendment keeps the Toomey amendment
on enforcement completely intact and makes two critical improvements.
It adds prevention and treatment.
Colleagues, this is what the Republican witness in the Finance
Committee said is needed. It is what the Democratic witness in the
Finance Committee said is needed. We need more prevention, better
treatment, and tougher enforcement to work in tandem. The Toomey
amendment is about enforcement, but we also need prevention and
treatment. If somebody is addicted to opioids, they need a real path
out of addiction. This amendment ensures people who need help are
connected to meaningful treatment choices to better manage their pain
and limit excessive prescriptions.
My amendment also aims to end the tide of overprescribing in the
first place. It does that by doubling the penalties for manufacturers
that provide kickbacks to prescribers in order to boost their profits.
I offer this with my colleagues Senator Schumer and Senator Murray. I
very much hope we can get this amendment adopted. If we can have a
bipartisan effort in the Senate that ensures there is tougher
enforcement but also better treatment and better prevention to do that
we have to vote for this amendment.
I yield back.
The PRESIDING OFFICER. The Senator from Wyoming.
Mr. ENZI. Mr. President, the pending amendment, No. 3395, offered by
Senators Wyden and Schumer, would establish a new demonstration program
within Medicare Part D to coordinate the treatment of opioid addiction.
The proposal would also increase the penalties on drugmakers.
According to the Congressional Budget Office, the amendment would
increase direct spending over both the 2016 through 2020 and the 2016
through 2025 periods. If the amendment were adopted, then the Judiciary
Committee would exceed its spending allocation over both of these time
periods. As a consequence of the new spending proposed, the Wyden-
Schumer amendment is a violation of section 302(f) of the Congressional
Budget Act.
As I said before, we all agree that the heroin and opioid abuse
epidemic is real and has to be addressed, but I believe we ought to
address the problem living within the confines of the budget we
previously agreed to just last December. The underlying bipartisan bill
provides a good framework for tackling this problem. It provides a
comprehensive, specific, and evidence-based approach to help Americans
combat this epidemic.
In light of that, the pending amendment No. 3395, offered by the
Senator from Oregon, would cause the underlying legislation to exceed
the authorizing committee's section 302(a) allocation of new budget
authority or outlays. Therefore, I raise a point of order against the
measure pursuant to section 302(f) of the Congressional Budget Act of
1974.
The PRESIDING OFFICER. The Senator from Oregon.
Mr. WYDEN. Mr. President, pursuant to section 904 of the
Congressional Budget Act of 1974, I move to waive the applicable
sections of that act for purposes of the pending amendment, and I ask
for the yeas and nays.
The PRESIDING OFFICER (Mr. Toomey). Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The legislative clerk called the roll.
Mr. CORNYN. The following Senators are necessarily absent: the
Senator from Texas (Mr. Cruz) and the Senator from Florida (Mr. Rubio).
Mr. DURBIN. I announce that the Senator from Missouri (Mrs.
McCaskill) and the Senator from Vermont (Mr. Sanders) are necessarily
absent.
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?
The yeas and nays resulted--yeas 46, nays 50, as follows:

[Rollcall Vote No. 29 Leg.]

YEAS--46

Ayotte
Baldwin
Bennet
Blumenthal
Booker
Boxer
Brown
Cantwell
Cardin
Carper
Casey
Collins
Coons
Donnelly
Durbin
Feinstein
Franken
Gillibrand
Heinrich
Heitkamp
Hirono
Kaine
King
Klobuchar
Leahy
Manchin
Markey
Menendez
Merkley
Mikulski
Murphy
Murray
Nelson
Peters
Reed
Reid
Schatz
Schumer
Shaheen
Stabenow
Tester
Udall
Warner
Warren
Whitehouse
Wyden

NAYS--50

Alexander
Barrasso
Blunt
Boozman
Burr
Capito
Cassidy
Coats
Cochran
Corker
Cornyn
Cotton
Crapo
Daines
Enzi
Ernst
Fischer
Flake
Gardner
Graham
Grassley
Hatch
Heller
Hoeven
Inhofe
Isakson
Johnson
Kirk
Lankford
Lee
McCain
McConnell
Moran
Murkowski
Paul
Perdue
Portman
Risch
Roberts
Rounds
Sasse
Scott
Sessions
Shelby
Sullivan
Thune
Tillis
Toomey
Vitter
Wicker

NOT VOTING--4

Cruz
McCaskill
Rubio
Sanders
The PRESIDING OFFICER (Mr. Barrasso). On this vote, the yeas are 46,
the nays are 50.
Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected.
The point of order is sustained and the amendment falls.

Amendment No. 3367

Under the previous order, there will now be 2 minutes of debate
equally divided prior to a vote in relation to amendment No. 3367,
offered by the Senator from Pennsylvania, Mr. Toomey.
The Senator from Pennsylvania.
Mr. TOOMEY. Mr. President, this is a bipartisan, commonsense policy.
I wish to thank my coauthors, Senators Brown, Portman, and Kaine.
Lock-in is a tool by which beneficiaries who are abusing prescription
opioids are locked in to a single prescriber and a single pharmacy for
access to these powerful narcotics. It would make it difficult or
impossible for these excessive prescriptions to continue when a patient
is so locked in.
It is a tool that is already used by Medicaid and private insurers.
What our amendment would do is extend this important tool to Medicare.
It is a policy that has been requested by the administration. It is in
the President's budget. It has broad bipartisan support. It will help
stop fraud, help coordinate care for seniors, and save taxpayer money.
As Senator Wyden observed, his amendment, had it proceeded, would not
have actually extended this tool to Medicare. The only way we can do
that on this bill is to pass this amendment.
I would encourage everyone's support. I think we have an agreement
for a voice vote on this, but before we go to that, I wish to yield to
Senator Brown for his comments.
The PRESIDING OFFICER. The Senator from Ohio.
Mr. BROWN. Mr. President, I thank the Senator from Pennsylvania for
his leadership.
Various doctors may not realize they are prescribing duplicative
opioid painkillers. We have done the lock-in with Medicaid. In many
States, it has worked. This is a commonsense solution to help a
relatively small number of people but a growing number of seniors whom
a Medicare lock-in could assist.
I urge support for the Toomey-Brown amendment.
The PRESIDING OFFICER. The Senator from Pennsylvania.
Mr. TOOMEY. Mr. President, in light of the agreement for a voice
vote, I ask unanimous consent that the 60-vote affirmative threshold
with respect to amendment No. 3367 be vitiated.
The PRESIDING OFFICER. Is there objection?

[[Page S1205]]

Without objection, it is so ordered.
The question is on agreeing to the amendment.
The amendment (No. 3367) was agreed to.

Amendment No. 3345

The PRESIDING OFFICER. Under the previous order, there will be 2
minutes of debate prior to a vote in relation to amendment No. 3345,
offered by the Senator from New Hampshire, Mrs. Shaheen.
The Senator from New Hampshire.
Mrs. SHAHEEN. Mr. President, we are voting on very good legislation
with the Comprehensive Addiction and Recovery Act. This is a way to
expand programs that work to address what is a real pandemic of heroin
and opioid abuse in this country. But the reality is that unless we
provide the resources to make these programs work, it is like giving a
drowning person a life preserver that has no air in it. It doesn't make
a difference. We are losing 47,000 people a year--120 people a day--to
overdoses. Our law enforcement needs additional funding. The substance
abuse treatment folks need additional support.
What my emergency supplemental amendment would do is to support the
programs that are in the CARA legislation. It is about equally divided
between support for law enforcement and support for treatment. It helps
with prescription drug monitoring, with education, and with recovery.
It is the kind of support we need to provide if we are really going to
make a difference in this epidemic we are all facing.
I urge my colleagues to not just support the underlying legislation--
that is good and we should support it, but unless we provide the
funding, we will not have done what we need to to accomplish real
change to keep people from dying. I urge all of my colleagues to
support this amendment.
Mr. GRASSLEY. Mr. President, I wish to speak in opposition to the
Shaheen amendment No. 3345.
Of course, the opioid crisis demands resources, and significant
resources are being directed to it. But this amendment is political
gamesmanship by some of my Democratic colleagues for whom the Senate's
advancement of CARA doesn't fit their preferred political narrative.
CARA is a bipartisan bill that addresses the clear and present public
health crisis of heroin and prescription opioid abuse. Through the hard
work of many on both sides of the aisle, it passed the Judiciary
Committee unanimously. And just a few weeks later, we are considering
it on the Senate floor. This is the Senate working in a constructive,
bipartisan way on behalf of the American people, unlike the way it
worked under Democrat control.
But that is not a narrative some Democrats want the American people
to hear. So a controversy must be manufactured to create a distraction.
And the controversy that has been manufactured today is that CARA
doesn't appropriate any funds for this crisis.
CARA, of course, is an authorizing bill. It does many significant
things that I talked about here on the floor earlier in the week. But
it was never intended to appropriate funds.
That is what we have the Appropriations Committee for. That is why we
have an appropriations process. We should follow that process.
In fact, according to the Office of National Drug Control Policy, the
fiscal year 2016 appropriations act passed in December provides more
than $400 million in funding specifically to address the opioid
epidemic.
This is an increase of more than $100 million over the previous year.
None of that money has even been spent yet--it is available today. So
there is simply no reason to leap ahead of the fiscal year 2017
appropriations process.
The reality is that this public health crisis festered while the
Senate was in Democratic control for years. For example, heroin
overdose deaths more than tripled from 2010 to 2014.
And all the while, no emergency supplemental spending bill was
brought to the floor specifically to address it. In fact, no
authorization bill like CARA was brought to the floor either during
those years.
So I ask my colleagues to ignore this manufactured controversy. $400
million is available today to combat this crisis, an increase of $100
million. We should follow the appropriations process, which is just
around the corner, where competing priorities and tradeoffs can be
evaluated.
That is the best way to ensure both that adequate resources are
directed to this epidemic while at the same time maintaining fiscal
discipline.
I urge my colleagues to vote against the amendment.
The PRESIDING OFFICER. The Senator from Wyoming.
Mr. ENZI. Mr. President, the pending amendment offered by the Senator
from New Hampshire appropriates $600 million on top of the $571 million
provided in the bill as reported by the Judiciary Committee over the
2016-2020 period. Unlike the underlying bill, which requires
appropriators to provide the authorized funding within the
discretionary spending caps, the Shaheen amendment would designate new
spending as emergency not subject to budget enforcement.
I am also concerned that this amendment lacks specificity in how the
funds are allocated. For example, the bill provides $300 million to the
Substance Abuse and Mental Health Services Administration for substance
abuse treatment to address the heroin and opioid crisis and its
associated health effects. While we all agree that the heroin and
opioid abuse epidemic must be addressed, I believe the underlying
bipartisan bill provides a better framework to tackle this problem. It
provides a comprehensive, specific, and evidence-based approach to help
Americans combat this epidemic.
In the meantime, the Senate Appropriations Committee shepherds
resources to the opioid problem in the consolidated appropriations bill
signed into law late last year. Nearly $600 million was included to
start down the road to helping States and communities to address this
problem.
The appropriators, working with our authorizers inside the framework
of this bill, can evaluate the effectiveness of this year's spending as
they make decisions about how much to spend and how to spend most
effectively in upcoming years.
Finally, last year's budget resolution conference report contained a
deficit neutral reserve fund, spearheaded by Senator Ayotte and adopted
unanimously by the committee, to address the opioid challenge.
Together, Republicans and Democrats agreed that, if Congress were to
agree on policies and funds to tackle this urgent problem, we should
work to pay for it. The Shaheen amendment does not do that.
Also, the Obama administration did not request opioid funding in the
supplemental request sent just last week for emergency Zika funding.
The PRESIDING OFFICER. The time of the Senator has expired.
Mr. ENZI. In that case, let me say that the pending amendment, No.
3345, offered by the Senator from New Hampshire would cause the
aggregate level of budget authority and outlays for fiscal year 2016 as
established in the most recently agreed to concurrent resolution on the
budget, S. Con. Res. 11, to be exceeded; therefore, I raise a point of
order against the amendment under section 311(a)(2)(A) of the
Congressional Budget Act of 1974.
The PRESIDING OFFICER. The Senator from New Hampshire.
Mrs. SHAHEEN. Mr. President, do I have any time left to speak under
the previous 2 minutes?
The PRESIDING OFFICER. There is no time remaining.
Mrs. SHAHEEN. Then pursuant to section 904 of the Congressional
Budget Act of 1974 and the waiver provisions of applicable budget
resolutions, I move to waive all applicable sections of that act and
applicable budget resolutions for purposes of the pending amendment,
and I ask for the yeas and nays.
The PRESIDING OFFICER (Mr. Toomey). Is there a sufficient second?
There appears to be a sufficient second.
The question is on agreeing to the motion.
The clerk will call the roll.
The bill clerk called the roll.
Mr. CORNYN. The following Senators are necessarily absent: the
Senator from Texas (Mr. Cruz) and the Senator from Florida (Mr. Rubio).
Mr. DURBIN. I announce that the Senator from Missouri (Mrs.
McCaskill), the Senator from Nevada (Mr. Reid), and the Senator from
Vermont (Mr. Sanders) are necessarily absent.
The PRESIDING OFFICER. Are there any other Senators in the Chamber
desiring to vote?

[[Page S1206]]

The yeas and nays resulted--yeas 48, nays 47, as follows:

[Rollcall Vote No. 30 Leg.]

YEAS--48

Ayotte
Baldwin
Bennet
Blumenthal
Booker
Boxer
Brown
Cantwell
Cardin
Carper
Casey
Collins
Coons
Donnelly
Durbin
Feinstein
Franken
Gillibrand
Graham
Heinrich
Heitkamp
Hirono
Kaine
King
Kirk
Klobuchar
Leahy
Manchin
Markey
Menendez
Merkley
Mikulski
Murphy
Murray
Nelson
Peters
Portman
Reed
Schatz
Schumer
Shaheen
Stabenow
Tester
Udall
Warner
Warren
Whitehouse
Wyden

NAYS--47

Alexander
Barrasso
Blunt
Boozman
Burr
Capito
Cassidy
Coats
Cochran
Corker
Cornyn
Cotton
Crapo
Daines
Enzi
Ernst
Fischer
Flake
Gardner
Grassley
Hatch
Heller
Hoeven
Inhofe
Isakson
Johnson
Lankford
Lee
McCain
McConnell
Moran
Murkowski
Paul
Perdue
Risch
Roberts
Rounds
Sasse
Scott
Sessions
Shelby
Sullivan
Thune
Tillis
Toomey
Vitter
Wicker

NOT VOTING--5

Cruz
McCaskill
Reid
Rubio
Sanders
The PRESIDING OFFICER. On this vote, the yeas are 48, the nays are
47.
Three-fifths of the Senators duly chosen and sworn not having voted
in the affirmative, the motion is rejected.
The point of order is sustained, and the amendment falls.
The Senator from Iowa.

Amendment No. 3374, as Modified, to Amendment No. 3378

Mr. GRASSLEY. Mr. President, I call up Donnelly amendment No. 3374,
as modified.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

The Senator from Iowa [Mr. Grassley], for Mr. Donnelly,
proposes an amendment numbered 3374, as modified, to
amendment No. 3378.

Mr. GRASSLEY. Mr. President, I ask unanimous consent that the reading
of the amendment be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
The amendment, as modified, is as follows:

(Purpose: To provide follow-up services to individuals who have
received opioid overdose reversal drugs)

On page 33, line 9, strike the period and insert ``, which
may include an outreach coordinator or team to connect
individuals receiving opioid overdose reversal drugs to
follow-up services.''.

The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. WHITEHOUSE. Mr. President, I ask unanimous consent that I,
Senator Shaheen, and Senator King be recognized for a 15-minute
colloquy.
The PRESIDING OFFICER. Without objection, it is so ordered.

Amendment No. 3345

Mr. WHITEHOUSE. Mr. President, we rise to express our disappointment
with what just took place. I am one of the authors of the underlying
bill. I think it is a very good piece of legislation, but it would make
a very significant difference if it had some funding.
The simple fact that we have to face is this bill has no funding
right now. I know colleagues on the other side have come to the floor
to say there is funding--$80 million, $400 million--but in point of
fact I must disagree with them. Let me list the points that show, I
believe, why there is no funding to this bill at this point.
The first is that the funding they point to was passed out of the
Appropriations subcommittee 7 months before this bill even had its
markup. It would have been an astonishing feat of prediction to be
able--back then--to fund this bill now.
If that weren't clear enough, there was a change in the bill between
then and now. Then, if you wished to fund this bill, you would have put
the bulk of the money through the CJS Appropriations Subcommittee
because the bulk of this bill was written in the CJS Appropriations
Subcommittee. We only changed it this January in response to Republican
objections that nobody wanted to create new programs. So we rerouted
the new programs through existing programs. That is when it became a
Labor-HHS-dominated bill. So there is no way that last June, when this
money came through that Appropriations subcommittee, they knew it was
going to this.
Moreover, if you go to the agency that is responsible for
distributing this money, they are bidding the money out right now. They
have a use right now for every dollar of it. If we don't pass this
bill, they will put the money out and it will be spent. If we do pass
this bill, they will put the money out and it will be spent. If we
don't get the bill out soon enough, they will have to pass it out and
get it spent under existing law. So you simply can't say with a
straight face that this is a funded bill.
The only way this is funded is by robbing the accounts that SAMHSA is
now putting out now to bid to fund, in order to fund this bill. You can
say the money will be better spent under this legislation. I think that
is true. I support this bill. I am going to be for the bill all the way
through, even if it is not funded, but you can't say there is funding.
This is a very solvable problem. We have done it before. As Senator
Shaheen pointed out on the floor, when it was the swine flu, on an
emergency appropriations process, we appropriated $2 billion and when
it was Ebola, $5 billion. If you say: Well, no, now something has
changed, we can't do that, we have pay for it--Senator Manchin has a
pay-for. A penny per milligram of opioid raises over $1 billion. You
could do half a penny that could be contributed by the pharmaceutical
industry that is so culpable in this predicament, in this tragedy we
have, but, no, rather than allow this good program, this bipartisan
program to be expedited out there, to help the people who are dying--
47,000 in 2014, the last year--what we have done is protect the
pharmaceutical industry from having to pay any share of the solution.
I yield to my colleagues.
The PRESIDING OFFICER. The Senator from New Hampshire.
Mrs. SHAHEEN. Mr. President, I appreciate the comments from my
colleague from Rhode Island, who is the author of the Comprehensive
Addiction and Recovery Act. That is the underlying bill we were trying
to amend.
I would just point out that despite what the honorable chairman of
the Budget Committee said, the fact is that the emergency supplemental
funding amendment we introduced is very specific about where the
funding goes. It goes to programs that are addressed in CARA, expanded,
and improved; the substance abuse prevention and treatment block grants
that go to the States to be distributed, funding the law enforcement
through the Byrne-JAG and COPS grants that are very specific in how
they can be used to fight heroin and opioid abuse.
Like my colleague, I am disappointed--not surprised but disappointed.
I very much appreciate those people who voted for this amendment, who
were willing--particularly some of my colleagues from the other side of
the aisle--who were willing to step forward and say, if we are going to
address this problem, we have to provide the resources that
communities, that States need to fight this addiction.
The question I have for those people who didn't vote to support this
amendment is, How many more people have to die before we are willing to
provide the resources that are needed to fight this epidemic--47,000
people in 2014. In New Hampshire, we are losing more than a person a
day. In 2015, we lost over 400 people to overdose deaths from opioid
and heroin, three times as many people as we lost in traffic accidents.
So many communities will continue to be ravaged because we are not
willing to commit the resources to tackle this pandemic.
What do we tell the families of those people who have overdosed? What
do we tell the parents of young people such as Courtney Griffin, whose
father came and testified at a hearing Senator Ayotte and I had last
fall in New Hampshire. He talked about the difficulties of getting
Courtney treatment before she overdosed and died.
I met a man at a treatment center in Lebanon, NH, a man in recovery
who had been in and out of prison. I thought he put it very well when
he said: You know, it costs about $35,000 a year to keep somebody in
prison. Wouldn't it make more sense to put dollars into treatment
because it is a whole lot less expensive to provide the funding to

[[Page S1207]]

treat people who are using opioids and heroin, who are substance
abusers, than to put them in jail?
To all of my colleagues, I am disappointed, but I am not defeated.
The fact is, this is coming back. It will come back in the
appropriations process, and it will come back at every opportunity
because I am not going to quit on those families in New Hampshire who
need help. I am not going to quit on the treatment professionals who
are trying to provide treatment for the people who are in need. I am
not going to quit on the law enforcement, the police officers, the
sheriffs, and all of the people in law enforcement in New Hampshire who
are trying to put pushers behind bars and trying to get people off the
streets and into treatment.
I hope at some point the rest of the Members of this body are willing
to take up this cause and provide the resources people need because I
will tell you it is certainly worth it to address the 47,000 people we
lost. We were willing to put $5.4 billion into Ebola, and we lost one
person in America. We were willing to put $2 billion into fighting
swine flu, and we lost about 12,000 people in the swine flu epidemic.
We have not been willing to put funding in to address the thousands,
the tens of thousands of people we are losing each year in this
country.
So we are going to keep at it. We are going to keep fighting until we
get the resources that families and communities need to fight this
scourge.
I yield to my colleague from Maine, who has been--like my colleague
from Rhode Island--a real leader in trying to address this issue.
The PRESIDING OFFICER. The Senator from Maine.
Mr. KING. Mr. President, I rise in disappointment, surprise, and some
confusion that we have this bill. We spent a week--I went to the
Judiciary Committee. The bill came out of the committee unanimously.
There is tremendous interest in this subject. When I have talked about
it at home, I have said to my people in Maine, this is something we are
going to be able to do because every Member of this body is being
affected by this tragedy that is engulfing our country. This is
something we are going to be able to do together and indeed we have
done a lot together. We have a good bill. We have passed some good
amendments. One of the President's amendments was in the bill that we
passed this afternoon. This is important work, but it has to be
funded--the old saying in Maine, and I suspect everywhere else, put
your money where your mouth is.
I was on a teleconference with some folks in Maine just 2 hours ago
talking about this, and one of the chiefs of police said: It is time to
move from talking about being interested in this to investing in it. We
cannot solve this problem without money. It would be nice if we could.
There is a drastic and dramatic shortage of treatment facilities in
this country, and the only way we are going to be able to do it is to
pay for it.
We had a point of order on the budget. I have to tell you I am
confused because I stood here less than 3 months ago when we passed the
budget bill and $680 billion of tax extenders. Where was the point of
order then? It wasn't funded. A dime of it wasn't funded. Maybe there
was a point of order, but it was rejected and overwritten so fast that
none of us noticed it. It was the speed of light.
My mother used to say we strain at gnats and swallow camels. We
swallowed $680 billion of entirely unfunded tax extenders, and we
cannot solve it and bring it into our hearts to save lives for one one-
thousandth of that amount, $500 million--one one-thousandth of the
amount that we passed in a matter of minutes last December. I am
confused by this. I don't understand it.
By the way, 47,000 people, that sounds like a lot, but this is what
really sounds like a lot. Since this debate started at 2 o'clock this
afternoon, 10 people have died; 10 people have died in the last 2
hours; 47,000 people is 5 people every hour, 24 hours a day, 365 days
of the year. We are not talking about abstractions here, we are talking
about people's lives. We are talking about what I consider one of the
most serious problems I have ever seen in my State. We talk about
Ebola. We talk about ISIS. We talk about all of these challenges we
have. Yet this is something that is killing five people an hour, and we
are not willing to put the funds in to do it. It is a false promise.
I believe this bill is going to do a lot of good, but it is not going
to meet the promise we are making to the American people by all of this
drama this week about drug abuse and that we are going to do something
about it. We are not going to do enough about it because in order to
deal with this problem--and this is true everywhere--it is going to
take money to provide treatment for people who need it.
As I talked about this morning, the tragedy is when someone is ready
to change their life and ready to try to defeat this awful disease--and
they cannot find any place to give them treatment. I was at a detox
center in Portland just last week. They are turning away 100 people a
month from a detox center--not even a treatment center but a detox
center--because they do not have the beds.

I am delighted we are working on this bill. I am delighted we are
passing it. I think there is a lot of good in it, and it is, in fact, a
bipartisan bill. But to venture up to the edge of this problem and then
step away because we are not willing to pay for what, in my mind, is
one of the most serious emergencies we have faced since I have been in
public life is disappointing, surprising, and it is a great missed
opportunity for the country.
I join my colleagues in regretting the decision that was just made. I
think it was an opportunity where we could have spoken as one to
realistically attack this scourge that is devastating our people. We
are losing lives, we are squandering treasure, and we are breaking
hearts. The only way we are going to be able to solve this problem or
at least make a dent in it is to provide the wherewithal to the
programs throughout the country that are struggling manfully and
mightily to confront the problem and defeat it.
I yield the floor.
The PRESIDING OFFICER (Mr. Gardner). The Senator from Ohio.
Mr. PORTMAN. Mr. President, I thank my colleague from Nevada for
yielding to me to speak for a moment in response to the comments made
by my colleagues about the legislation before us, which is legislation
to address the horrible problem we have in all our States of the
addictions caused by heroin and prescription drugs. About 100 people
will die today from overdoses, and that is just the tip of the iceberg
because there are so many other people whose lives are being ruined,
families being torn apart, and communities being devastated.
Senator Whitehouse, other Members of this body, and I drafted this
legislation over the period of the last few years, including five
summits we had in this Congress to bring in experts from all over the
country on prevention, education, treatment, and recovery--dealing with
the law enforcement side and the importance of having Narcan available
and also helping to get prescription drugs off bathroom shelves and
ensure we had drug-monitoring programs. It is a comprehensive approach.
I will say I disagree a little with my coauthor, my colleague from
Rhode Island, in saying that if we could pass this bill, there would be
no funding for it somehow. There was a huge increase in funding, as
everyone knows, at the end of the year for opioids. Senator Whitehouse,
others, and I approached the appropriators and asked them to be sure
that funding was consistent with where we were on CARA at that time--in
the middle of the Judiciary Committee. When we had some jurisdictional
issues, we worked hard to draft the legislation so that if we could get
it enacted this fiscal year--that is between now and September 30--
there would be funding to help us accomplish what is in the
legislation.
However, as my colleagues know, this bill is an authorization bill.
What does that mean? It means it is a bill that directs how funding
will be spent. It is not a spending bill.
Having said all that, as Senator Shaheen knows, I supported her
efforts to add additional resources over and above what could be spent
this year on CARA because I believe this is such an urgent problem, and
I believe it does rise to the level of being an emergency. That is
saying a lot. I am a fiscal conservative. But that means it is not paid
for by offsetting other programs. It is

[[Page S1208]]

just additional funding because it is such an urgent need.
We have done this on other occasions with health care emergencies
when we have had something like the Ebola crisis. Well, I think this is
a crisis too, so I voted with Senator Shaheen today. I am a cosponsor
of her amendment. I support it, but I don't support the efforts of some
who say somehow there is no money in here. This is an authorization
bill. This is the first step toward getting the money, not just this
year but into the future. That is the point.
Back in the House, I was the author of the Drug-Free Communities Act.
Some 19 years later, $1.3 billion has been spent in support of the
Drug-Free Communities Act, helping to create over 2,000 community
coalitions, including in just about every State represented in this
body. Was that a spending bill? No. It was like this--an authorization
bill to direct the spending based on a lot of research and effort,
evidence-based practices we know would work. That is what this is. This
is taking it to the next level.
Specifically directed to the points my good friend from Maine just
mentioned about treatment centers being filled and detox centers not
having room for someone to go to get the detox and then get into
treatment, these are real problems in our communities now. That is what
this legislation is meant to address, not just by appropriations for 1
year but by changing the law for the future.
If we do this, and do it right, in another 19 years in this
legislation, we will spend even more than we spent on the Drug-Free
Communities Act. It will be well over $2 billion that will have been
spent that would otherwise not have gone out because of this
legislation. So just as Senator Whitehouse said that he strongly
supports this bill because it is evidence based, because we spent the
right time putting the effort into making sure it would be money well
spent, this bill is really important.
I appreciate the support of my colleagues--Senators Shaheen, King,
and Whitehouse. Senator Whitehouse and I have been at this for a few
years together. It is the right thing to do for our country at a time
when we do face a crisis.
Again, I will support the additional spending because I think this is
so critical. But let's not go forward with this sense that somehow this
doesn't matter. This does matter in a very big way. This is a necessary
first step. And in terms of this year, because we increased funding
dramatically at the end of the year for this fiscal year--not one penny
of that has been outlaid, by the way; it has been appropriated but
there has been no outlay yet--I believe anything we could get done this
year--getting it through the House, getting it through the Senate, and
the President signing it--would be funding we could use for these
important CARA programs just in the 7 months of this fiscal year.
Certainly we should right now--as I have done and I know Senator
Whitehouse is doing and others are doing--go to the Committee on
Appropriations and say: With regard to next fiscal year, let's be sure
that we have the entire bill funded. And again, I would support even
additional funding beyond that. But at a minimum, let's get this done.
This is an opportunity on a bipartisan basis to actually get something
done to help people who are crying out for our help. Communities need
our help. Families that are being broken apart need our help.
I appreciate the fact Senator Shaheen made her best effort today. She
was right, in my view, but let's also continue to work together to get
this legislation passed with whatever funding we can add to it. That is
great with me, but let's get this bill passed to ensure that going into
the future we are directing this funding effectively and increasing
this funding to help those who need it most.
Again, I appreciate my colleague from Nevada, and I am sorry to take
so much of his time.
I yield the floor.
Mr. WHITEHOUSE. Mr. President, if I can have 1 minute before the
Senator departs.
The PRESIDING OFFICER. The Senator from Rhode Island.
Mr. WHITEHOUSE. I thank the Chair.
I would like to end this conversation on a happy note, after what I
consider to be a very unhappy vote, and that is to express my
appreciation to Senator Portman for his collegiality and his work over
many years to get this bill to where it is now in the Senate. I express
my appreciation to him for voting for the amendment of Senator Shaheen.
I express my appreciation to him for publicly pledging to work as hard
as we can together to get funding for this bill into the appropriations
process that is underway right now.
I look forward to working with him on all those endeavors. I do
believe that we missed a big opportunity, because Senator Shaheen's
bill, had it passed, would have flooded a lot more money, a lot faster,
into the solution of this problem.
With that, I yield the floor.
The PRESIDING OFFICER. The Senator from Nevada.
Mr. HELLER. Mr. President, I want to thank my colleagues on both
sides of the aisle on this particular piece of legislation. I know
there is a lot of passion behind this, and there should be, and I do
believe at the end of the day there will be an appropriate
authorization and spending level so we can get this bill passed, which
is something I support.
I also want to thank Chairman Grassley, Ranking Member Leahy, and all
those who have been involved in this particular topic of bringing
opioid abuse to the forefront. Opioid abuse is an issue every Member of
the Senate hears about when they go home. For many Nevadans, substance
abuse is an issue that hits close. It is an issue I read about in
constituents' letters and hear in far too many calls that come in to my
office on this issue.
Like many of my colleagues, I have heard from those who are
struggling with addiction or who have lost a loved one to this
epidemic. In my home State of Nevada, there were 545 drug overdose
deaths in 2014 alone. I have heard countless stories from young
Nevadans who have experienced addiction themselves or seen their
friends slip into this scary spiral of abuse.
I recently met a young man from Reno who was advocating on behalf of
multiple friends whom he had lost to heroin overdose. He said it
started with experimenting with leftover painkillers in his friend's
parents' medicine cabinet. Eventually, the pills were gone, and the
group of friends started experimenting with harder and cheaper drugs.
Some of their friends fell into the juvenile court system after being
caught with illegal drugs.
Unfortunately, the court system wasn't equipped to adequately treat
their addiction. They slipped back into their old habits, and the young
man from Reno has now gone to multiple funerals.
I am glad he had the courage to tell his friends' stories. Opioid
abuse and addiction has stolen the lives of far too many Nevadans, and
it is time we do something about it.
I know my colleagues also hear the same stories in their offices on a
daily basis. In 2014, opioids were involved in almost 30,000 American
deaths. That means more Americans now die each year from drug overdoses
than they do from car crashes.
The unfortunate reality of opioid abuse has become a major public
health concern, and something needs to be done. We know this epidemic
hits all ages, all socioeconomic levels, all races, and all genders.
Opioid use often starts with treating legitimate pain needs. There
are two groups of Nevadans that are extremely important, and I have
focused my efforts today on these two very important populations: our
veterans and our seniors.
First, I have two amendments that improve access to treatment for our
Nation's veterans. My first amendment, Heller amendment No. 3346, would
include veterans service organizations in the Pain Management Best
Practices Interagency Task Force. Giving VSOs a seat at the table on
this task force will help us better understand the unique circumstances
our Nation's veterans face that drive them to use opioids in the first
place.
My second amendment, Heller amendment No. 3351, would allow veterans
nonprofit organizations to be eligible for grants from the Building
Communities of Recovery program. The Building Communities of Recovery
program is designed to pool community resources to help those affected
by

[[Page S1209]]

opioid abuse seek the proper treatment to recover from these highly
addictive pain medications and avoid slipping into a cycle of chronic
drug abuse.
Including veterans nonprofit organizations in this grant program will
allow places like Veterans Village in Las Vegas to access more
resources to treat the servicemen and -women in our State. As a member
of the Senate Veterans' Affairs Committee, I am concerned about how
opioid abuse impacts America's heroes. Some of these veterans are in
severe pain due to the injuries they sustained during service to our
Nation, and numerous veterans have reached out to my office for help
when the VA's policies are negatively impacting them.
As we debate the Comprehensive Addiction and Recovery Act, it is
critical for Congress to ensure VSOs have a voice. These organizations
understand the unique challenges veterans face with opioids and how to
resolve these issues. That is why I have filed two amendments to allow
this important stakeholder to come to the table and help reduce opioid
abuse.
I encourage my colleagues to accept these amendments, and I would
like to continue to work with the bill managers as we find a path
forward on them.
The senior population is another group of Nevadans that face unique
circumstances on how they become dependent on opioids. They are
prescribed opioids to cope with chronic pain and discomfort after
surgery and, obviously, rightfully so. In fact, about 40 percent of
Nevada's seniors are on some type of opioid, but opioids have qualities
that make them highly addictive and prone to abuse.
Pain is a highly complex issue, and there are many barriers to pain
management. Just recently I had a constituent reach out to my office
because they were being denied access to a lifesaving opioid pain
medication for a very rare and serious condition. Fortunately, we were
able to help resolve the situation, but it was disappointing that this
Nevadan had to go to such extremes to receive the treatment they
deserved.
No doubt Congress should play a role in addressing opioid addiction
and this epidemic, and I think there are ways to accomplish this goal
while ensuring that seniors in Nevada and throughout the United States
continue to receive the care they need. One of those ways is to
permanently repeal the Medicare caps on therapy services. Right now,
current law places an annual per-beneficiary payment limit of $1,880
for all outpatient therapy services.
I firmly believe that if patients had better access to physical
therapy, they would not be as dependent on highly addictive pain
medication. Seniors would also have a higher quality of life by
treating the sources of the pain and rebuilding their strength. With
proper access to care, seniors will be able to enjoy a happy and
healthy retirement rather than cope with the pain through highly
addictive medication that only masks their discomfort.
Senator Cardin and I have been working on a responsible alternative
to the Medicare's therapy cap. I believe more work needs to be done to
ensure that these proposals will solve the problem and ensure that
these seniors have access to the therapies and treatments they need.
Right now, the cap has been lifted until March of 2017. We have until
early next year to come up with a permanent solution to the therapy cap
issue, and I have no doubt that Senator Cardin and I will be able to
deliver results for seniors across this country.
The American people want us to put partisan politics aside and come
up with solutions to the problems we see every day. CARA is an example
that Congress can, and should, come together to solve these problems.
The epidemic of opioid abuse has reached a serious point in our debate.
I believe the Comprehensive Addiction and Recovery Act is a step in the
right direction.
I encourage my colleagues to pass this important legislation, and I
am hopeful that we can do it this week, showing Nevadans and all
Americans that we are serious about addressing this problem.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Minnesota.
Ms. KLOBUCHAR. Mr. President, I rise today to talk about the Supreme
Court vacancy for the second time on the floor, but I did want to thank
the cosponsors of our bill, Senator Portman, Senator Whitehouse, and
Senator Ayotte, and also Senator Shaheen for her strong amendment that
I think would have made such a difference if we could get some
immediate emergency funding.
As we know, there are other important provisions in this bill,
especially the work I am focused on with prescription drug monitoring,
the simple idea that when I talk to doctors, they are never sure if
this is someone who is actually abusing the system. They want to do
well. They have been trained to do well to get people out of pain. But
so often there is not a lot of monitoring about what is going on. And
this is going to help get the States to start doing their work. I again
thank Senators Whitehouse, Portman, Ayotte, and Shaheen for their work
on this bill.

filling the supreme court vacancy

Mr. President, I come today to talk about the Supreme Court.
Last Wednesday, I led a meeting of the steering and outreach
committee on the Supreme Court and the Senate's constitutional
responsibilities. We had the opportunity at that meeting to hear from
four distinguished law professors on the constitutional implications of
the current vacancy and to put some historical and constitutional
context about the choice before us. I would like to share some of the
insights with my colleagues.
First of all, Jamal Greene, a professor of law at Columbia Law
School, looked to the original intent of the Framers of the
Constitution, noting that ``the Framers did not contemplate the use of
the Senate's advice and consent power solely to run out the clock on a
presidential appointment. As [Alexander] Hamilton speculated in
Federalist 76, rejection of a nominee `could only be to make place for
another nomination by [the President].' ''
The critical point made by Professor Greene, which was echoed by the
rest of the panel, is that inaction is not an appropriate response when
the Constitution says that the President shall nominate and that the
Senate has a duty to advise and consent. In fact, Professor Gerhardt
from the University of North Carolina at Chapel Hill noted that the
only time Members truly abandoned their constitutional duties and left
this position open was during the Civil War. Think about that. Senators
before us in this great Chamber--even before we had this Chamber, when
they were meeting in other places. We have been through World War I, we
have been through World War II, we have been through the Vietnam war,
we have been through civil rights tumult, and always the position was
filled and not left vacant for that year time period. We have to go
back to the Civil War.
Another common theme we heard from all of the panelists is that the
proposed inaction by our colleagues on the other side of the aisle is
without precedent in our Nation's history. In the last 135 years, no
President has been refused a vote on a nominee for an open seat on the
Court. The Senate has confirmed more than a dozen Supreme Court
Justices in Presidential election years, including five in the last 100
years. So it is not as if we have to go way back in time; five of them
were in the last 100 years. Probably the most oft-cited example is the
example of President Reagan nominating Justice Kennedy in his last few
years in the White House. He nominated Justice Kennedy, and a
Democratic Senate confirmed--not just confirmed but confirmed
unanimously.
Another member of the panel was Professor Jeff Stone. He is a
professor at the University of Chicago Law School--actually, my
professor, my evidence professor. I always enjoy asking my professors
questions now that I am a Senator as opposed to when they used to ask
questions of me. He was, of course, a former colleague of Justice
Scalia's. In fact, when Justice Scalia left the University of Chicago
to be appointed to the bench, he actually gave his papers and all of
his notes to Professor Stone. While they had some different political
views, without a doubt, he had admiration for Professor Stone and
Professor Stone had admiration for Justice Scalia, as he has written
about since his death.

[[Page S1210]]

After reviewing the history of Supreme Court nominations, Professor
Stone concluded:

Despite all the fuss and fury over the Supreme Court
confirmation process, the plain and simple fact is that the
Senate always defers to the president as long as the
president puts forth nominees who are clearly qualified and
who are reasonably moderate in their views. And this is true
even when the Senate is controlled by the opposing party. In
short, nominees who are both qualified and moderate are
confirmed. Period.

I think he was using as an example--we know there have been nominees
who have been turned down by the Senate in past, including in the
recent past, but the point is, they got a hearing and they got an up-
or-down vote. There are cases where people withdrew their names. There
are cases where the up-or-down vote was not in their favor. But they
always were moved forward.
Although we have been accustomed to a certain level of partisanship
in Congress, Professor Stone pointed out that the nomination process
for Supreme Court Justices has remained in large part a bipartisan
process. Again, people may vote differently, but as a member of the
Judiciary Committee and a relatively new member in confirmation
processes for both Justice Kagan and Justice Sotomayor, those hearings
were very civil. At the time, Senator Sessions was the ranking member
and Senator Leahy was the chair. At those hearings, people asked the
questions they wanted to. They went on for a number of days. Then we
had a final vote, and then we came to the Senate and all was done. As
we know, among the Justices currently serving, the longest time from
the nomination to the confirmation was actually 99 days; that was
Justice Thomas.

So we have always had a process that has worked. And while the result
has, sadly, become more partisan--although there have been a number of
Republicans who voted for the recent nominees, it has been more
partisan over time. When we look at the unanimous vote Justice Kennedy
got, the process itself worked, and that is very important to the
functioning of the Senate.
The fact is, we may have a very difficult atmosphere around us
politically and sometimes right here in this Chamber, but we have tried
to keep our dignity and move forward with our processes, and we find
ways to work together and we treat each other with respect. For me,
that is a lot about what this is about, this process for a nominee.
Yes, it is about what the Constitution says. Yes, it is about
respecting history. Yes, it is about not leaving a vacancy on the third
pillar of our government when, in fact, our only job as Senators is not
to determine what happens in those cases or what the individual
decisions are, but it is to fund that Court and make sure that
vacancies are filled in our advice and consent function. But it often
goes beyond all of that for me. It is about how we function as a body,
that we keep to our processes, that we move legislation, that we move
nominees, and that we respect our traditions, we respect the Senate,
and we respect each other.
Looking beyond the constitutional duties of the Senate and the
historical precedent of the Senate considering Supreme Court nominees,
we have had the opportunity to hear from our panel, as I mentioned, as
well as from a number of others, about the importance of filling a
vacancy on the Supreme Court.
Professor Greene, whom I mentioned before, and others noted that this
inaction could leave the Court for two full terms without the ability
to resolve closely contested cases. They don't get the easy cases on
the Supreme Court. That is not why they are there. That is not why they
are called the Supreme Court. They get the tough cases. They get the
cases in the gray area. When the lower courts are in disagreement and
can't figure out what to do, they are the decisionmaker.
Professor Greene went on to say in our panel: ``The Supreme Court has
multiple responsibilities, but one of its main, core functions is to
resolve those disagreements [among the lower courts], and [this
vacancy] leaves the law in a state of uncertainty.''
The people of this country have enough uncertainty to deal with. Of
course, because of our democratic functions, we do not know who our
next President will be. There is a lot of blame and a lot of finger-
pointing going on throughout our political system right now. There is a
lot of uncertainty. There is uncertainty with the way our laws have
worked. But one of our jobs is to put some certainty in people's lives.
We did that with the budget at the end of last year. We did that with
the Transportation bill last year. We did that with a number of pieces
of legislation that were passed on a bipartisan basis. Now it is our
job to not leave the entire legal system in a state of uncertainty.
Former Justice Sandra Day O'Connor has also spoken out. When asked
about Republicans seeking to wait a year until considering a nominee,
she said: ``I don't agree. I think we need somebody there to do the job
now and let's get on with it.''
In fact, former President Ronald Reagan, who nominated Justice
O'Connor to the Supreme Court, said in 1987: ``Every day that passes
with a Supreme Court below full strength impairs the people's business
in that crucially important body.''
He made that statement around the same time he nominated Justice
Kennedy, who was confirmed, as I noted, unanimously by a Senate
controlled by the opposite party in the last year of a Presidency. That
is our closest and most recent example--confirmed in the last year of
the Reagan Presidency by a Democratic Senate, with a Republican
President.
We now have a Democratic President who is not running for President
again--he can't--who is in the last year of his Presidency, with a
Republican Senate.
The critical importance of filling this seat is clear, and it is not
something we can wait on for over a year. Not since the Civil War have
we had a vacancy for over a year. And, may I add, there is plenty of
time for the Senate to consider and confirm the nominee. Is it
convenient? No, it is not convenient. There is a lot going on. It is an
election year. Things happen. Unexpectedly, Justice Scalia died. And
many people who knew him well, such as my law professor in Chicago,
miss him. But he died, and that triggered a duty on the part of the
President and on our part.
The Senate has taken an average of only 67 days--about 2 months--from
the date of the nomination to the confirmation vote since 1975. This
means that if the President offers a nomination this month, that
nominee should receive a vote in the Senate by Memorial Day. If for
some reason that doesn't happen and the hearings take longer than we
think, I would put one other day forth: We could finish this by the
Fourth of July. For those who love the Constitution, that is certainly
a good holiday and end date.
Looking at the text of the Constitution, the precedent of the Senate,
and the importance of the circumstances, the matter is clear: It is the
duty of the Senate to thoughtfully consider the President's nominee to
the Supreme Court, and anything less than that disregards our oaths of
office.
Mr. President, I yield the floor.
The PRESIDING OFFICER. The Senator from Florida.
Mr. NELSON. Mr. President, I wish to associate my remarks with the
Senator from Minnesota and just say that what the Constitution says is
so clear. It says that the President shall--not may--it says shall
nominate and then the Senate will advise and consent. That is clear.
The President is going to nominate. So are we going to wait around for
a whole year without giving our advice and/or consent? In other words,
just do your job. So I thank the Senator for her comments.

Takata Airbags

Mr. President, I have a very touchy subject to talk about again--the
ongoing Takata airbag fiasco. It is now a recall fiasco. To this point,
some 26 million of these airbags that are in the center of the steering
column that we drive around with right in front of us or in front of
the passenger's seat or on the sides, side airbags--some 26 million of
them have already been recalled.
A little over a week ago, I spoke about this continuing customer
confusion over this recall fiasco. For the sake of the safety of our
American consumers who happen to be drivers in these vehicles with
these Takata airbags, we need to end this confusion. I think the
process has to begin with having the National Highway Traffic Safety
Administration, or NHTSA,

[[Page S1211]]

take a hard look at whether they need to start the process of recalling
all Takata airbags with ammonium nitrate-based inflaters.
Ammonium nitrate seems to be the problem. It is a chemical compound
that is ignited when you have a collision. Within less than a second,
it inflates with gases. This is the airbag that is supposed to save our
lives. But what is supposed to save lives has been killing lives
because the explosive force is so great that it starts to shred the
metal housing. That is sending pieces of shrapnel right into the driver
or into the passenger.
Last week, I showed the Senate one of these airbags, and then I
showed them a piece of metal that became, in effect, shrapnel, like a
grenade, only this piece was that big and it had killed a lady in
Orlando, FL. As a matter of fact, when the police got to the
intersection where she had a collision and the airbag deployed and they
got there and found her in the car, they thought it was a murder
because her neck had been slashed. But, in fact, it was this airbag,
exploding with such force that it shredded the metal. In this case, it
was a piece that big.
On February 10, I sent a letter to the NHTSA Administrator, Mark
Rosekind, asking him to do two things. First, I asked him to use his
authority to phase out the production of the new Takata ammonium
nitrate-based airbag inflaters as soon as possible. With all that we
know about these things, this ammonium nitrate should not be used as
replacement for the old Takata inflaters, and it certainly shouldn't be
used in the new cars that are produced and sold to consumers.
Second, in this letter, I asked him to seriously consider a total
recall of all Takata ammonium nitrate-based inflaters that are
currently in vehicles. My goodness, that is a big number. That is
potentially another 90 million units in this country alone. That could
be as much as 260 million worldwide. But with all the manipulation of
data and the serious safety lapses that our staff on the Senate
Commerce Committee has detailed in two separate reports, I think it is
something that we should seriously look at. Potentially, it is a big
number of recalls of this ammonium nitrate-based inflater that is
currently in vehicles.
I want to say that I supported Administrator Rosekind's nomination,
and I think he has done a number of things to try to improve NHTSA. But
I was not too pleased with his written response to my letter that I
received from him on February 26, just a few days ago. In my letter, I
asked him to provide me with the total number of inflaters that Takata
could supply under existing contracts with automakers. He didn't supply
that.
Will Takata continue to produce millions of these things? We don't
know. We don't know the answer.
Are consumers today basically getting a newer version of the old
version that has been so defective? No answer to that either. In other
words, are we going to replace an old live grenade with a new live
grenade?
In the letter, I also asked the Administrator to consider an
accelerated phaseout of the production of new Takata ammonium nitrate-
based inflaters. In his letter, he declined.
As to the request for NHTSA to look at a larger recall of Takata
ammonium nitrate-based airbags, Administrator Rosekind declined to call
for a larger recall. He based that statement on the fact that most of
the Takata airbags that have not been recalled contain something called
desiccant, which removes the moisture and is supposed to stabilize the
ammonium nitrate in the inflaters.
That desiccant is there because moisture is considered to be the
culprit that causes the ammonium nitrate to be defective in its
explosion. So desiccant is supposed to remove that moisture, and it is
supposed to stabilize the ammonium nitrate.
The exact quote in his letter is this: ``In fact, to date, NHTSA is
unaware of any inflator rupture, in testing or in the field, of a
Takata inflator using chemical desiccant to counteract the effects of
moisture.''
He says that NHTSA is unaware of any inflater rupture using the
chemical desiccant.
That statement is not true. On October 15 of last year, General
Motors recalled about 400 vehicles for Takata side airbags with the
chemical desiccant. Fortunately, in that testing, nobody was injured.
But that wasn't correct information given to the Commerce Committee,
and NHTSA finally admitted their error to our staff on Monday of this
week.
Why didn't NHTSA seem to know about it beforehand? This really raises
serious questions when a regulator doesn't even seem to know about its
own data. NHTSA had that data. As a result, it continues to raise
questions about who is really in control of this recall. Is it who
ought to be, NHTSA, or is it the manufacturer of the defective airbag,
Takata?
Deaths and serious injuries have occurred as a result of these
defective airbags. They have been in Florida, but they have been in
many other places. The last one was in the Carolinas in December, and a
Ford driver is dead as a result of it.
I can tell you that this Senator and many of the members of the
Senate Commerce Committee are not going to sit quietly and wait for
this to get sorted out in good time. Lives are at stake. We are going
to keep pushing until all consumers who have vehicles with Takata
airbags get answers and get help.
I wish I didn't have to bring this to the Senate floor, but in the
safety and sake of consumers we have to.
I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The senior assistant legislative clerk proceeded to call the roll.
Ms. HIRONO. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

Whole Woman's Health v. Hellerstedt

Ms. HIRONO. Mr. President, I rise to speak on the Texas case that was
heard by the U.S. Supreme Court, Whole Woman's Health. This morning, I
joined hundreds of pro-choice advocates on the steps of the Supreme
Court in advance of the oral arguments. They came from all parts of the
country with signs such as ``Don't mess with access'' and ``Respect my
fundamental human dignity.''
The lead-up to this case was a Texas law, HB2, which imposes
unnecessary medical requirements on the State's clinics that provide
abortion services.
According to the American Medical Association and the American
College of Obstetricians and Gynecologists, these requirements are not
necessary to protect the health of women seeking these services.
Rather, these onerous restrictions, known as targeted regulation of
abortion providers, or TRAP laws, have only one purpose--to deny
abortion services to women.
Three-quarters of clinics in Texas will close if this law is upheld,
leaving nearly a million women without adequate access to reproductive
services. By making the false claim that restrictions like those passed
in Texas will actually protect women's health, opponents of abortion
hope to conceal their true agenda, which is putting an end to abortion
and women's reproductive choices.
The Texas law is just one more example of a litany of legislation and
other attempts to limit a woman's constitutionally protected right to
choose. Attacks on reproductive rights, such as misleading undercover
videos, violence at clinics, and numerous attempts in Congress to roll
back progress on women's health care continued in 2015.
Since Roe v. Wade was decided, State legislatures have passed
hundreds of laws to chip away at a woman's right to choose. In the last
4 years alone, States have passed 231 anti-choice laws. Among the most
invasive are those requiring ultrasounds of women seeking abortion
care, and some of the most ill-conceived laws require providers to give
medically unsound information to scare women seeking abortion care.
Laws that are not based on medical science and opposed by medical
practitioners do not protect a woman's health. No matter how loudly or
how often these arguments--or these claims--are repeated, they are
lies. Lies repeated do not become truths.
While these restrictive laws impact all women, they impact minority
and lower income women most. For example, the Texas law will result in
the closure of more and more provider clinics. Women in Texas will have
to travel farther and farther to get to open clinics. Women who have
limited resources

[[Page S1212]]

to travel for needed services or cannot afford to take time from work
to travel these long distances are the most negatively impacted by TRAP
laws.
Why do women need to be protected from being able to access the
reproductive services they need and choose? Fundamentally, what is the
point of a constitutional right if one is unable to exercise that
right? I cannot think of any other constitutionally protected right
that has seen so many restrictions placed upon it, except perhaps the
right to vote, but that is a subject for another speech.
It is more than ironic that while many of our anti-choice colleagues
vehemently speak out in support of constitutional rights, when it comes
to women's bodies and reproductive choice, they are all too willing to
set aside their constitutional principles to invade those fundamental
rights. Neither Congress nor the States have a right to do that.
I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The senior assistant legislative clerk proceeded to call the roll.
Mr. ISAKSON. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. ISAKSON. Mr. President, I ask unanimous consent to address the
Senate as in morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.

Filling the Supreme Court Vacancy

Mr. ISAKSON. Mr. President, I am not a lawyer. I am a politician. I
was a businessman before I was elected to the Senate. I watched with
interest the debates since the death of Antonin Scalia about what the
Senate and country should do in terms of filling its vacancy, in terms
of its timing.
The Constitution tells us what to do. The Constitution tells us that
the President shall make an appointment, or a nomination, to fill that
vacancy and the Senate shall offer its advice and consent. There is no
deadline or trigger date. There are no other rules or guidelines.
There have been a lot of historic debates on both sides of the aisle
over whether or not a nomination for a Supreme Court justice should be
named in the last year of a Presidency. Interestingly enough, if you
read the history, sometimes it is the Republicans saying they shouldn't
do it and sometimes it is the Democrats. In fact, if you really go back
and look, we have all said the same thing. It would just depend on
whose ox was getting gored in the politics of a particular day.
I love Joe Biden. He is a personal friend of mine and a great Vice
President of the United States. I served with him in the Senate and on
the Foreign Relations Committee, which the Presiding Officer serves on
today.
I did a little research on what Joe had to say because I appreciate
his wisdom. In the last year of the Bush administration--H. W. Bush--in
1992 on June 25, then-Senator Biden made two statements, and I would
like to share those statements. The first is the following:

[I]t would be our pragmatic conclusion that once the
political season is under way, and it is, action on a Supreme
Court nomination must be put off until after the election
campaign is over. That is what is fair to the nominee and is
central to the process. Otherwise, it seems to me, we will be
in deep trouble as an institution.

Let's take that quote and apply it to the current contemporary time
we are in today. We are in a politically unknown territory. Yesterday
was Super Tuesday, and 15 States went to the polls. We had newcomers
getting the most votes, and we had old-timers getting the most in one
primary. We have women getting votes. We have men getting votes. We
have conservatives and we have liberals. We don't know who our
President is going to be or what party he or she will be from. But we
do know that when they are elected and sworn in January of next year,
they will be the President of the United States most contemporarily
appointed and elected by the people of the United States of America.
The Supreme Court is the ultimate arbitrator of what the executive
and legislative branches do. It is only appropriate that the Supreme
Court majority, as it is cast, be made up of nine people, five of whom
are in the majority, who were appointed freely and without political
influence, judged for their best political and legal acumen and in the
best interest of the country.
I don't think going to the current President, Mr. Obama, who is in
the last year of his term, and getting him to make an appointment that
will only last a few months of his last year in office is the right way
to go.
I think we need to say the following: The President of the United
States who is elected this November and sworn in next January will be
the President of all the people most contemporarily voted by the people
of America. That is the President who should make the nomination, and
that is the Senate that should make the confirmation.
I urge my colleagues who argued about going ahead and moving
forthrightly and quickly on filling Antonin Scalia's seat to think
about this. Next year the Senate will be a new Senate. It won't be this
Senate. Many of us are up for reelection. I may not be here. I don't
know who will be here. I am trying. I don't know who will be here. I
want to get here, but I don't know if I will be here.
We don't know who the President will be. Each of us, Republicans and
Democrats, have our pick. We hope it is our President. We hope it is
the man or woman we want, but we don't know that. But we do know that
on the first Tuesday in November, we will elect a new President. In
January, that President will be sworn in, and it will be his or her
opportunity, if we wait, to make the nomination for whomever will fill
Antonin Scalia's place. It will be the new Senate's place to confirm
that nomination. The Senators who are elected will be the ones most
recently elected to the Senate, and the President who is elected will
be the most recently elected President of the United States. That is
the person who should make that appointment, and that Senate should
make that confirmation.
Think about this. Ronald Reagan appointed Antonin Scalia in 1986.
Antonin Scalia served on the Court for 30 years until 2016. The next
person appointed to take his place may serve 30 years as well. That
takes us to 2046. That is a long time from now. Shouldn't we take the
most contemporarily elected President to make that appointment rather
than one who is going away and will be in the history books? I think it
is right to allow the President who has been most recently elected to
make that nomination and allow the newest Senate to make the
confirmation and do what is right for the American people.
This is not a Republican or Democratic thing. I respect my colleagues
on both sides of the aisle. We have all made the same statements. It
would just depend on whether it was our President or the other guy's
President, whether it was our Senate or the other guy's Senate.
In fact, I will close my remarks by again quoting my friend Joe Biden
from the same speech he made on June 25, 1992. He said: ``Others may
fret that this approach would leave the court with only eight members
for some time, but as I see it, the cost of such a result . . . [is]
quite minor compared to the cost that a nominee, the President, the
Senate, and the Nation would have to pay for what would assuredly be a
bitter fight, no matter how good a person is nominated by the
President.''
Vice President Biden made that statement when he was a Senator and
faced the same situation that we face today. He was smart and wise
beyond his years. He said: It is best to look to the future for the
appointment, the next President for the nomination, and the next Senate
for the confirmation and look to the future of the of the Court,
because it is the Supreme Court--many times on a vote of 5 to 4--that
will decide the fate of legislative and executive action. It is only
right that we have the best and most contemporarily appointed Court
that we could possibly have, and the only way to do that is to make
sure that the next President makes the appointment.
I underscore what I said at the beginning. It is not a Republican or
Democratic thing. It is a political thing. We are all politicians and
creatures to our politics. All of us have said the same thing. It would
just depend on who was in charge at the time as to whether we spoke
like Joe Biden as a Republican or spoke like Joe Biden as a Democrat.

[[Page S1213]]

I commend Antonin Scalia for being a great servant to the American
people. He was a great jurist, a great writer, and a great judge. He
will be missed.
Somewhere out there in America today, there is another Antonin Scalia
just waiting to be nominated and confirmed by the Senate. I don't know
who it is, but I know this: I want them to be found by the next
President of the United States elected this November and confirmed next
January by this Senate. That is the right person. That is the right
way, and I submit that is the way I recommend we do it.
I yield back the remainder of my time.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. BLUMENTHAL. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Lee). Without objection, it is so ordered.

Women's Health Protection Act

Mr. BLUMENTHAL. Mr. President, earlier today I joined a number of my
colleagues outside the Supreme Court to work with advocates who were
gathered there, thousands of people, including many young people.
Looking into their faces, I realized that for them Roe v. Wade is
history, but my mind went back to 1974, the year after Roe v. Wade,
when I was a law clerk to Justice Blackmun. I heard similar voices from
the serene, contemplative chambers of Justice Blackmun and thought
then--in fact all of us thought then--that Roe v. Wade would settle for
all time, at least for the next decades, the reproductive rights of
women in the United States of America, and we were wrong. We were wrong
that the law would be settled, that rights would be protected, that Roe
would be accepted, and that privacy would become enshrined as a matter
of constitutional law or at least accepted politically. We were wrong.
Today, in a historic case, the U.S. Supreme Court heard arguments on
a challenge to the basic fundamental right of privacy with practical
implications that will alter the lives of women in Texas, where the
case rose, and throughout the country.
I know firsthand from my experience as a law clerk, but even more so
in the decades since as an advocate for reproductive rights and women's
health care, as U.S. attorney, as a member of the Connecticut General
Assembly, first as a member of the House and then in the State Senate,
and as our State attorney general, working and fighting to enshrine in
State law the rights protected by Roe v. Wade and then protect them
from physical threat and intrusion at the clinics where those rights
were made real.
Those rights mean nothing if they are unprotected. If women need to
travel hundreds of miles, if women need to leave their jobs and their
children for days, if women have no access to those rights, they are
unreal for them. That is the net fact of the law that is
underchallenged in the case before the U.S. Supreme Court, Whole
Woman's Health v. Hellerstedt. That law, HB2, in effect, so restricts
the availability of reproductive rights in practical, real terms as to
place an insurmountable burden for many women on the exercise of those
rights. Those rights are prevented from being real for them, for
countless others, and they will be put out of reach for countless women
across the country if this law is not struck down.
That is what we are asking the Supreme Court to do: to strike down
this law that under the pretense of protecting women's health, imposes
restrictions that deny rights, rights to privacy that are basic to the
human condition. They are constitutional rights, but nothing is more
basic than the right to control your own body. Nothing is more
essential than protection of rights to decide when to have a child.
These issues of control over one's body involve control over one's
faith, rights of privacy, and power to make basic life decisions.
That is what it means to have a right to privacy. It is the right to
be left alone--as one of our Supreme Court Justices said, the right to
be left alone from unwarranted and unnecessary government intrusion.
The Supreme Court will have to make a judgment about whether the burden
placed on that right is justified by this supposed protection of
women's health.
Anybody familiar with this case knows that supposed reason for these
laws that require many privileges for doctors or particular widths of
hallways in clinics is a ruse, a pretense, in fact, a falsehood.
My view is the outcome should be clear in this deliberative battle
before the Court, but the ramifications, the practical impacts, are
severe for those women in Texas who would have no access to
reproductive health care, and for women around the country because the
simple stark fact is, since 2011, State legislatures have enacted 288
laws like the one in Texas, designed to restrict access to reproductive
rights. We are not talking about a situation limited to Texas. In State
after State, legislature after legislature, these rights would be
restricted by similar laws.

That is the reason I have introduced the Women's Health Protection
Act, to stop this invasion--it is truly an invasion--of women's
reproductive rights. The measure I have introduced would, in effect,
strike down such measures, prevent them, so as to reduce, and hopefully
even eliminate, the cost and the time required for litigation
challenging them in State after State, like what happened in Texas
where women have been denied the certain assurance, the basic security
of knowing that this care will be available to them, because of the
continuing litigation, the costs of lawsuits, and the time-consuming
contention and controversy that arises from it.
The arbitrary and arcane restrictions imposed by the Texas law
concerning admitting privilege requirements and building specifications
are unrelated to health and safety and clearly create an undue burden
on women's right to choose. That is the legal principle, the core
tenant that needs to be upheld by the U.S. Supreme Court.
I joined with a number of my colleagues, and in fact led the amicus
brief to the Supreme Court, which urges them to reach the right result
and strike down this law. My hope is that the outcome will not only be
right for Texas and the women of Texas--and the people of Texas because
the right of privacy is not guaranteed only to women, it is to men, and
the decisions that women make affect families and children as well as
their spouses. I hope the Supreme Court finally does what Roe v. Wade
was thought to do in clear, bright-line text that will prevent States
from intruding with these pretense, ruse laws, supposedly protecting
health when, in fact, all they do is restrict the right to privacy.
I am proud to join with my colleagues in fighting these attacks on
women's health care. But I hope that the clerks, as I once was, in the
Supreme Court will look from those windows today and think to
themselves that this case will, in fact, finally settle these issues,
finally give women the assurance and security they need.
There is no need to keep returning and relitigating these issues.
There is no need for this body to consume time and energy on defunding
Planned Parenthood. There is no need for these kinds of repeated
battles over rights that should be secure and unchallengeable in 21st
Century America. Rehashing this fight simply costs us in time and other
precious commodities that we should be spending on jobs, economic
progress, veterans, national security, investment in infrastructure,
investment in our human capital, and college affordability. All of the
present issues--those and others of this day--are what should occupy us
on this floor and occupy the country as we move forward, hopefully
guaranteeing that the rights in Roe will be real for every American
woman.
Thank you, Mr. President.
I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. MANCHIN. Mr. President, I ask unanimous consent that the order
for the quorum call be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. MANCHIN. Mr. President, I rise today to speak in support of the
Comprehensive Addiction and Recovery Act of 2015, which is bipartisan,
I might

[[Page S1214]]

add, and to discuss several amendments that I have submitted.
Mr. President, our country is facing a prescription drug epidemic,
and today is a good step toward addressing this crisis. This is a
crisis I have been dealing with since my days as Governor of the great
State of West Virginia. Opioid abuse is ravaging my State of West
Virginia and many other States. I know the Presiding Officer has the
same problem in Utah. Our State has been hit harder than any other
State in the country. Drug overdose deaths have soared more than 700
percent since 1999. We lost 627 West Virginians to opioids last year
alone. Mr. President, 61,000 West Virginians used prescription pain
medication for nonmedical purposes in 2014. This includes 6,000
teenagers. Our State is not unique. Every day in our country, 51
Americans die from opioid abuse. Since 1999 we have lost almost 200,000
Americans to prescription opioid abuse.
The fact that we have with the bill in front of us is simply this: It
is an important first step. It will authorize $77.9 million in grant
funding for prevention and recovery efforts, which we need, and expand
prevention and education efforts particularly aimed at teens, parents
and other caretakers, and aging populations. It will also prevent the
abuse of opioids and heroin and promote treatment and recovery. It will
expand the availability of naloxone to law enforcement agencies and
other first responders to help in the reversal of overdoses to save
lives. It will expand disposal sites for unwanted medication to keep
them out of the hands of our children and adolescents. It will also
launch an evidence-based opioid and heroin treatment and intervention
program to expand best practices throughout the country. It will
strengthen prescription drug monitoring programs to help States monitor
and track prescription drug diversion.
While the bill is a good start and addresses critical problems, there
is more that needs to be done. I have a few amendments I want to speak
about and explain that I think will improve the bill by changing the
FDA mission statement, providing grants for consumer education, and
requiring prescription prescriber training.
First of all, I firmly believe we need cultural change at the FDA.
That is why I submitted the Changing the Culture of the FDA Act as an
amendment to this bill. This amendment would strengthen the actions
that the FDA recently announced that they were committed to taking into
consideration the public health impact of approving opioid medications.
Mind you, what they said is that they were committed to taking it into
consideration. I don't think that is much of a change, and it is
definitely not a cultural change. It is a movement in the right
direction, which I acknowledge. By solidifying this commitment in the
agency's mission statement, we ensure that the agency oversees the
approval of these dangerous drugs and cannot waiver from their stated
goals.
The language in my amendment is similar to the language in the FDA's
current mission statement regarding tobacco, and we all know the
devastating effects of tobacco. The mission statement says simply this:
``FDA also has the responsibility for regulating the manufacturing,
marketing, and distribution of tobacco products to protect the public
health and to reduce tobacco use by minors.''
If we think it is that serious that we put this in the mission
statement for tobacco, why can't we do it for opiates? Tobacco kills
hundreds of thousands of Americans every year, and we have rightly
recognized this as a public health crisis. However, opiates killed more
than 18,000 people just by the end of 2014. That is 51 people every
day. This, too, is a public health crisis. It is absolutely ridiculous
that the FDA has treated opiates like any other drug up for approval.
To date, the agency has failed to consider the devastating public
health impact of their repeated decisions to approve dangerously
addictive opiates. We have seen that in their resistance to
rescheduling hydrocodone, their approval of Zohydro against the advice
of their own advisory committee, and their refusal to consult an
advisory committee on other dangerous opioid approvals, including their
decision to allow the use of OxyContin in children as young as 11 years
old. Opioids are simply different from many types of drugs the FDA
oversees. As I noted before, they have killed almost 200,000 people
since 1999 and have ruined the lives of countless others.
The FDA must be held accountable for their actions. Like our efforts
to protect the public--particularly children--from the dangers of
tobacco, the U.S. Congress must take action to ensure that the FDA
does, in fact, do what it has promised to do and take the devastating
public health impact of opiate addiction into account when approving
new drugs. It is putting it on par with tobacco, that is all. In a
mission statement, one has more responsibility than just passing it
through as a business plan.
My second amendment also relates to the critical role the FDA plays
in addressing the opiate epidemic. It would require the FDA to seek the
advice of its advisory committee before approving any new opiate
medication. These are experts, scientists, people who know the makeup
and composites of these chemicals and what they do to human beings. If
the FDA approves a drug against the advice of the advisory committee--
that means if they do not take the recommendation by their own experts
and they wish to put this drug on the market--the agency would be
required to submit a report to us, the people's representatives, the
Congress, justifying that decision. The approval will be delayed until
the report is submitted. Tell us why you won't take the advice of your
experts and why you even subvert and basically pay no attention.
The FDA plays a critical role in addressing the opiate epidemic as
the agency overseeing the approval of these drugs. Under the FDA's own
rules, they are supposed to convene a committee of scientific experts
when a matter is of significant public interest, highly controversial,
or in need of a specific type of expertise. With 51 people dying every
day in the country from an overdose of prescription opiates, it is
clear that the approval of opiates meets every one of these standards
and that the FDA should seek the counsel of its expert panel and adhere
to its recommendations with regard to approving dangerously addictive
opioids.

Unfortunately, this hasn't happened. It truly hasn't happened. Let me
give an example. It took us 3 years just to get rescheduled from a
schedule III to a Schedule II all opiates--Zohydro, Vicodin. These are
the most widely prescribed opiates. It took us 3 years, which what
should have been a 3-week turnaround.
The week after they even approved the taking down of these drugs from
a schedule III to a schedule II, which took over 1 billion pills off
the market, they came right back and they recommended a drug called
Zohydro. This is a drug that their expert panel had basically advised
11 to 2 not to put on the market. They failed to seek their council's
advice on the concerns with the safety of this drug.
Since that time, three new extended-release opioid medications--
Targiniq, Hysingla, and Morphabond--have been approved without any
advisory committee meeting at all. Let me give my reasoning on why I
think this happened. There was so much pushback on Zohydro from the
Governors, Senators, and Congress people for putting this high-powered
drug on the market against the advice of their own council that they
didn't want to go through that again, so basically they just skipped it
altogether and brought these drugs right to market. They also approved
OxyContin for use in children as young as 11, again without seeking the
advice of a pediatric advisory committee. This is a dangerous precedent
and must stop.
I am encouraged that in the FDA's recent announcement on opioid
approvals, the FDA has finally agreed that the approval of these
powerful drugs must be subject to an advisory committee. I am very
concerned, however, that the FDA will continue to exempt abuse-
deterrent opioids from this process and has not promised to abide by
the advice. They said they will take it under consideration. They are
not bound to take the advice of the advisory committee.
While abuse-deterrent formulations, which are harder to crush or
liquify, have a role to play in reducing the impact of this epidemic,
these drugs are

[[Page S1215]]

no less addictive than traditional opiates. In addition, in the real
world, we have seen these so-called abuse-deterrent properties easily
overcome. The tragic HIV outbreak we saw in Scott County, IN, last year
occurred after hundreds of people in that community shared needles to
shoot up Opana. They used the same needle to shoot up Opana--something
that should have not been possible if it were truly abuse-deterrent.
This amendment would solidify the FDA's commitment to seek the advice
of an advisory committee when approving opioid medications and would
strengthen it by extending that commitment to all opioids and by
holding the FDA accountable. The FDA does not listen to its own
experts. This is such a reasonable request and such a reasonable
amendment to protect all the people in all of our States. It is a
commonsense measure that would ensure that the FDA is fully considering
the public health impact and the many lives lost as a result of these
dangerous opioid medications.
Another amendment I have is on mandatory prescriber education. This
epidemic is one that needs to be fought on all fronts, but most
importantly, we need to fight it on the frontlines with prescribers,
which is precisely what my third amendment seeks to do. It requires
medical practitioners, our doctors--the people we trust--it basically
requires them to receive training. You would think they are getting
training on this now, but they are not. There is no specific training,
going through school or at any other time, on the safe prescribing of
opiates prior to receiving and renewing their DEA license to prescribe
a controlled substance. That is all we are saying. This training must
include information on safe opioid prescribing guidelines, the risks of
overprescribing opioid medication, pain management, early detection of
opiate addiction, and the treatment of opiate-dependent patients. This
is something only the doctors can do. These are the people writing on
their prescription pads, sending them to the pharmacists, and
fulfilling all of our prescriptions. We are asking for them to have
that type of required training when they get their DEA license and
renew their DEA license.
This must be fought on all fronts, but most importantly we need to
fight it on the frontlines with the prescribers. According to the
National Institutes of Health, more than 259 million prescriptions were
written in 2012. Think about that--259 million prescriptions were
written in 2012 just in the United States for opiate painkillers. That
equals one bottle of pain pills for every adult in the United States of
America. We are the most addicted country on planet Earth. With a
population of less than 5 percent of us living in this great country of
ours, we consume 80 percent of the opiates produced in the world. The
other 6.7 billion people don't use what we use. Why? That is a 400-
percent increase in the number of prescriptions since 1999. In a little
over a decade, there has been a 400-percent increase, and we are
pumping out more pills, thinking this is going to cure America. This is
without a corresponding increase in reported pain. They are not
complaining any more about pain; they are just getting more pills. But
it has come with a corresponding 400-percent increase in overdose
deaths. So if overdose deaths are related to the increase of pills on
the market, don't you think we ought to do something about it? It is
pretty simple.
I have too many stories from my constituents that they receive
significantly more pain medication than they need to treat their pain,
and those extra pills increase the risk of addiction for individuals
and are dangerous for society if diverted. Someone can get their teeth
worked on, get their teeth extracted, and they will get 30 days of pain
pills when they may only need them for 1 or 2 days. It is ridiculous.
I hear from physicians themselves that they do not receive enough
training. These are doctors telling us it is not in their basic
education as they go through medical school--prescribing these drugs--
or even after they leave medical school. There is no continuing
education demanded about this. Until we ensure that every prescriber
has a strong understanding of the state of opiate prescribing practices
and the very great risk of opiate addiction, abuse, and overdose
deaths, we will continue to see too many people prescribed these
dangerous drugs which can lead them down the tragic path of addiction.
Finally, we must improve our consumer education efforts. My fourth
amendment would establish consumer education grants through SAMHSA to
raise awareness about the risks of opiate addiction and overdose. There
are 2.1 million Americans addicted to opiates. Many of these
individuals began the road to addiction with a seemingly innocent
prescription and little or no warning about the danger from a
physician. They weren't told they could be addicted. They weren't told
they would be hooked and it would change their life forever. Or it
began when a friend offered a pill that they thought couldn't be that
dangerous because a doctor had given it to them: Here, I have got
something that will help you. Try this.

And they get started. There is simply too little understanding about
the dangers of these drugs, and too many get sucked into opioid
addiction because they don't understand the risk and because the people
close to them don't know how to recognize the signs of addiction or
know how to access the resources to help their loved ones.
It is the silent killer. It is the one we all keep quiet--every one
of us. Every one of us in America knows somebody--either in our
immediate family, extended family or a close friend--who has been
affected, but we say nothing. Use and abuse of prescription drugs cost
the country an estimated $53.4 billion a year in lost productivity.
These are people who can't function, who can't work, and are basically
drawing off of their unemployment or off of their insurance.
Medical costs and criminal justice costs--you name it. You talk to
any law enforcement anywhere in the United States of America and they
will all tell you a minimum of 80 percent of the crimes that are
reported that they have to go and serve are drug related--80 percent.
So the cost is probably even higher than that.
This amendment provides $15 million a year to help prevent these
costs in the first place. It makes sense. That is $15 million. OK, you
are going to say: Oh, that is a lot of money.
Let me just tell say that as a society we regularly invest in efforts
to prevent unnecessary deaths. We already have done that, and we
continue to do that. Thirty thousand people died in car accidents in
2013, and we invested $668 million in motor vehicle safety and accident
prevention. That is more than $22,000 per death that we have invested
trying to prevent people from getting killed in automobile accidents,
driving safely, DUI, everything. With 28,000 people dying of
prescription opioid or heroin overdose in 2014, this $15 million
funding represents an investment of $500 per person for a life that we
could save. We spend $22,000 trying to prevent accidents in
automobiles.
As to opiates, all we are asking for is a $500 investment to save
their lives. We have to put our priorities where our values are, and we
can do that. The grants that would be authorized under this amendment
would help those on the frontlines of this terrible epidemic to provide
their communities with the information they need to help stop the
spread of opioid addiction and to help people seek treatment. This
funding will better enable us to educate individuals about the dangers
of opioid abuse.
There are practices to prevent opioid abuse, including the safe
disposal of unused medication and how to detect the warnings of early
addiction. I would venture to say that most people do not know how to
look at their children and know that there is a chance that they may
get addicted or are getting addicted. It is sometimes too late.
It will help us save lives by raising awareness about the dangers of
prescription opioid medications to prevent opioid addiction in the
first place and ensuring that loved ones know how to help when a friend
or family member becomes addicted.
This amendment that we are asking for, this amendment that I am
asking for is one that really makes sense. If we can't educate the
public, then we have little chance of ever curing this epidemic.

[[Page S1216]]

We have had a lot of talk about the funds and how much money we are
spending. We just had a final amendment that I would like to address,
as there is a great need for funding to pay for substance abuse
treatment.
Well, I strongly agree with my colleagues who supported Senator
Shaheen's amendment to provide $600 million in funding, which we
desperately need to support Federal programs that work to prevent
opioid abuse and provide much needed treatment.
If you look at the amount of money it is costing now for
incarceration, all the lost time, all of the drug-related crimes that
have been committed, it would have been an investment well made, but I
know there are people who believe differently.
In 2014, 42,000 West Virginians, including 4,000 youths, sought
treatment for illegal drug use but failed to receive it. There was no
place to get it. In your State and my State people are looking.
Sometimes they are looking for this, and there is no place to put them.
If you have day courts or drug courts in your State, they will tell
you: We have no place to put them. There is no place to get the
treatment to cure a person who truly is looking for a cure. This is
just unacceptable. There are people who recognize that they need it,
and they beg for it. They have been turned away because there simply
weren't enough facilities, beds or health care providers in their
community.
But we spend money every year building new prisons all over the
country. We have a backlog, and we have an overcrowding prison
population. We know from long experience that when a person asks for
help, that is our opportunity. If we turn them away, they will never
come back. They just don't when they are turned away. That is why I
wish to introduce this amendment, and I would like a very vigorous
discussion on it.
We have tobacco, which we know is very dangerous and kills people. It
is harmful, and we spend a lot of money trying to prevent people from
using it and young people from starting to use it. We even tax it. We
tax it so that basically we can deter the use of it.
We have alcohol. We know alcohol can be very addictive and,
basically, it ruins people's lives. We know that and we tax that. We
have nothing on opioids--nothing.
What we are asking for is consideration of a 1-cent fee on every
milligram of opiates that are produced--one penny per milligram. This
fee would be levied on the pharmaceutical company, and the money raised
will be used to create a permanent funding stream to strengthen the
substance abuse prevention and treatment block grant.
I know so many people have taken a pledge: We are not going to pass
any new taxes.
I understand that. We are really at a crunch. We basically have cut
back, and our military is struggling. Every part of a program that we
think is near and dear to our States and to the people in our States is
having trouble. I am not asking to take away from another one. I am
asking that this one penny per milligram of opioids that are produced
in this country would give us permanent funding to start having the
treatment centers that we so desperately need. I don't know of any
other way to do it in a more compassionate way. We do it for
cigarettes; we do it for alcohol. We have opiates killing more than all
of that. I am just asking for that dialog, that consideration. It could
be something of a bipartisan movement, because this silent killer--
opiates--doesn't have a partisan home. It is not Democratic. It is not
Republican. It is not Independent. It is killing Americans--all of us.
The substance abuse prevention and treatment block grant goes to the
States to pay for critical substance abuse treatment programs. The new
funding raised, which is based on past opiate sales--I am basing it on
past opiate sales--could be anywhere between $1.5 billion to $2 billion
a year, and all the States will be able to participate. Every State
would participate in these moneys that would be available. They could
be used by States to establish new addiction treatment facilities, to
improve access to drug courts, to operate support programs for
recovering addicts, to care for babies born with neonatal abstinence
syndrome or to meet any other treatment need that your State or my
State might face. These treatments save lives and strengthened
communities. We are losing a generation, a whole generation.
Opioid producers have made billions of dollars selling their drugs
over the past several decades. I am not here railing against the
pharmaceuticals. They do a lot of good for our country and save a lot
of lives too. This is one that doesn't, and this one has been proven
that it is a killer.
This amendment asks them to contribute a small portion of their
profits to help pay for this treatment. Everyone says: They are going
to pass it on. Don't worry; you will be paying more. This is one time,
one penny--one penny a milligram. That is all we are asking.
For the 2.1 million Americans who are addicted to their products, my
amendment also provides exemptions. I am talking about the exemptions
now because I know people are going to say: What about our veterans?
What about those in severe chronic pain? What about those who are
terminally ill?
We have, basically, exemptions built into this amendment for those
people, so they are not put into hardship, and for the neediest in our
country. They are not going to be put in a hardship.
This is a cost that if we look at it, I don't know of any other way
to fix it. I really don't. I know people have taken pledges: We are not
going to do this, not going to do that, not going to consider it. Well,
you ought to consider the damage that is doing to America. I am not
asking for any other program to be sacrificed at all. So I think this
is responsible. This one penny. That is all I am asking for--one penny.
I am pleased the Senate is addressing this epidemic. It is in a
bipartisan way. We have the CARA package in front of us. I appreciate
that, and I know we all have a great passion for trying to cure this.
This is how we need to work to solve the major challenges in our
country that face us. I am pleased to see we are going through regular
order. We have amendments that we are able to put on and talk about. I
think it is worthy to have these discussions. We must provide the
critical resources needed, and I think we have a solution to that. I
hope we can have that discussion. I hope all of us can have an adult
discussion about how we save Americans, how we save our families, our
children, and the next generations to come.
I look forward to working with all of my colleagues and with you to
see if there is a better way we can strengthen and make a piece of
legislation better than what it is.
I yield the floor.
The PRESIDING OFFICER. The Senator from Ohio.
Mr. BROWN. Mr. President, I appreciate the comments from my friend
from West Virginia and his work on this issue that has hit West
Virginia and, particularly, southeast Ohio kind of first and hardest.
But it has spread to so many other places and caused so much heartache
and so much family disruption--not just for the young men or women, in
the case of young people who are addicted, but the whole family. As one
mother of a teenager said to me in Youngstown, OH, or in Warren, OH,
one day, this is really a family affair.
I am pleased to see bipartisan support for finally tackling the
opioid addiction epidemic. It has touched every State and almost every
community in our country. In 2014, more people died from drug overdoses
than any year on record, with 2,482 in Ohio. That is a record number of
prescription drug overdoses and a record 1,177 overdoses related to
heroin. People often start with pain medication, sometimes
overprescribed prescription medicine that will, in far too many cases,
lead to heroin addiction. Heroin is cheaper to buy on the street than
for people to get OxyContin or oxycodone or Percocet or any number of
legal morphine pain medications.
These numbers mean that in 1 year alone, 2,500 Ohioan families lost a
loved one to addiction. What those numbers don't account for are the
thousands of other families and hundreds of other communities that
continue to struggle with opioid abuse. It should not be easier for
Americans to get their hands on opioids than it is for them to get help
to treat their addiction. It should not be easier for Americans to get
their hands on opioids than it is to get help to treat their addiction.
Addiction is not an individual problem. It surely is not a character
flaw,

[[Page S1217]]

as many people half a generation ago liked to say when it was people
who didn't look like them. But the fact is it was not a character flaw
then and it is not a character flaw now. It is a chronic disease.
When left untreated, it places a massive burden on our health care
system and a terrible, terrible cost on families who have an addicted
family member. When we think about this epidemic, we have in our minds
a young worker who turned to painkillers after a back injury or a car
accident, someone who started with oxycodone--maybe as a party drug--
and then turned to heroin. This problem is bigger than that.
Our national conversation forgets the hundreds of thousands of
seniors who often are given unsafe and duplicative prescriptions for
opioids. It is not uncommon for seniors to be treated by multiple
specialists and physicians. Doctors may not know they are prescribing
duplicative painkillers, meaning this doctor prescribed a painkiller--
maybe oxycodone or OxyContin or Vicodin or another--and this other
doctor may have done the same thing. They weren't communicating, and
didn't know. Seniors find it difficult to manage all of their different
prescriptions far too often.
Take, for example, Ohioan Dennis Michelson. I met him at the Benjamin
Rose Institute on Aging in Cleveland last August. He is one of the
estimated 170,000 Medicare beneficiaries who recently battled an
addiction to pain medication.
He was prescribed pain medication by his doctor to manage chronic
migraines. When his primary care doctor sought to wean him off the
medication, he went to other doctors and pharmacists to obtain those
opioids. He was eventually arrested and charged with felonies for
tampering with prescriptions. He has since recovered. He is now an
advocate for reform to address the prescription drug epidemic.
After hearing his story, it strikes me that if a patient with
legitimate and sometimes complex medical needs winds up getting pain
medication from several different doctors--you could see how that would
happen; none of those doctors know about one another--the system has
failed the patient.
It is why I worked with Senator Toomey from Pennsylvania to introduce
the Stopping Medication Abuse and Protecting Seniors Act. I was proud
to see this body support it as an amendment today. We already have a
proven tool to address the problem of patients getting duplicative
opioids from multiple doctors and pharmacists. It is called Patient
Review & Restriction Programs. But despite their success in State
Medicaid programs and commercial plans, these programs aren't available
in Medicare prescriptions under current law. That is the purpose of the
Toomey-Brown amendment and what we are trying to fix.
The amendment will ensure that a small number of seniors who receive
high doses of addictive opioids from multiple doctors get those
painkillers from one doctor and one pharmacist. It is what we did on
so-called Medicaid lock-in--for people who were abusing the system on
purpose or more likely those who sort of fell into this trap and went
from doctor to doctor, pharmacist to pharmacist, in some sense doctor
shopping or pharmacy shopping--so that practice would end. We have done
the same sort of thing now with so-called Medicare lock-in. It would
save taxpayers $100 million over the next decade. It will reduce
overprescribing, and it will crack down on fraud.

I am pleased we have bipartisan support for this commonsense measure,
but this amendment and this bill are a step. We need a comprehensive
approach that addresses the entire spectrum of addiction from crisis to
recovery. I have introduced the Heroin and Prescription Drug Abuse
Prevention and Reduction Act. It will boost prevention efforts, it will
improve tools for crisis response, it will expand access to treatment,
and it will provide support for lifelong recovery.
Addiction is chronic. It doesn't mean that when somebody overcomes
their addiction and seems to defeat it, it won't come back later in
life. If we are serious about fighting this epidemic, we have to make
sure we provide a serious investment that will deliver results long
term.
My colleagues, Senator Shaheen of New Hampshire and Senator
Whitehouse of Rhode Island, introduced an amendment that would have
provided $600 million to fight this epidemic. It would have gone
directly to public health workers, directly to law enforcement
officials who are working on the frontlines of this battle every day.
It would have shown constituents we are serious about addressing this
crisis.
I was disappointed this body was unwilling and unable to find the
money necessary to address these problems. This legislation is a good
bill. Without the money, it is a good bill, but it is really only half
a good bill because my colleagues are simply unwilling--maybe it is the
tea party influence, maybe they are afraid of a Republican rightwing
primary, whatever it is--to ante up the dollars that would fully help
us deal with this epidemic. We can't do this without an investment.
I met with a number of tuberculosis experts in my office today. We
have been successful in this country with eliminating smallpox,
eliminating polio, and keeping Ebola from being contracted in the
United States and killing any Americans. We have done all of that
because we invested in a public health system. We can't address this
opioid epidemic without dollars. Yet my colleagues will simply always
back off and say: Well, we can't afford to do this. They can afford tax
cuts for wealthy people, and they can afford continuing to pump money
into expensive weapons systems, but they will not spend money to
address probably the most serious public health crisis we have seen in
this country in years.
Once again, I say that it should not be easier for Americans to get
their hands on opioids than it is to get help to treat their addiction.
This Senate should get serious about this. We should pass this bill, to
be sure, but there is so much else. I am distressed my colleagues chose
not to step up to the plate and do what deep down they know we should
do.

vote explanation

Mr. REID. Mr. President, earlier today, I missed the vote on the
Shaheen amendment No. 3345. If I had voted, I would have voted yea.
(At the request of Mr. Reid, the following statement was ordered to
be printed in the Record.)
Mrs. McCASKILL. Mr. President, I was necessarily absent for
today's amendment votes in relation to S. 524, the Comprehensive
Addiction and Recovery Act of 2015.
On amendment No. 3362 by Senator Feinstein, I would have voted yea.
On the motion to waive the Budget Act with respect to amendment No.
3395 by Senator Wyden, I would have voted yea.
On the motion to waive the Budget Act with respect to amendment No.
3345 by Senator Shaheen, I would have voted yea.
Mrs. FEINSTEIN. Mr. President, today I wish to join my colleagues in
supporting the Comprehensive Addiction and Recovery Act.
This bipartisan legislation takes a strong and balanced approach to
tackling the prescription drug and heroin epidemic our Nation faces,
and I am proud to be a cosponsor.
I would like to note the hard work by many of my colleagues and their
staffs--Senators Whitehouse, Ayotte, Coons, Kirk, Klobuchar, and
Portman. Their States have been especially hard hit by this epidemic,
and this bill would help alleviate some of the suffering.
We are all well aware of the sobering statistics. Drug overdoses kill
more than 120 Americans each day--more than motor vehicle crashes or
gunshot wounds. Opioid and heroin overdoses account for more than half
of these deaths. According to the Centers for Disease Control and
Prevention, in 2014, 25,760 people died from prescription drugs, and of
that, 18,893 deaths were caused by opioid painkillers. Heroin caused an
additional 10,574 deaths.
These numbers have continually increased over the past 15 years, and
today we are in the midst of an epidemic. That is why we need this
bill. We need a comprehensive response to a problem that has touched
every State of our country.

[[Page S1218]]

The Comprehensive Addiction and Recovery Act strengthens our
substance abuse prevention, treatment, recovery, and law enforcement
infrastructure. While it focuses on prescription opioid abuse and
heroin use, it also has the potential to help other drug problems that
we face. Specifically, it authorizes a number of programs to: ensure
access to appropriate, evidence-based medical treatment; address local
and emerging drug threats and trends; equip first responders with
lifesaving tools, such as Naloxone, an opioid overdose-reversal drug;
and strengthen prescription drug monitoring programs to reduce
overprescribing, doctor shopping, and ultimately overdose deaths. The
bill also establishes an interagency task force on pain management and
opioid painkiller prescribing. The overprescription and overuse of
these drugs are a major factor in this epidemic.
Lastly, to examine ways to improve access to drug treatment, the bill
requires a Government Accountability Office study on the 16-bed limit
for Medicaid reimbursement to drug treatment programs, also known as
the Institutions for Mental Disease exclusion.
The holistic nature of this bill is a clear step in the right
direction. It also supports the administration's efforts to confront
this epidemic and can help accomplish the goals laid out in the 2015
National Drug Control Strategy.
However, there are two things that I believe would have made this
comprehensive bill even more effective: 1, addressing the sheer volume
and availability of opioid painkillers; and 2, full funding.
First, on the widespread availability of prescription opioids, I
would like to outline a few often-cited facts from the Centers for
Disease Control and Prevention. Health care providers wrote 259 million
prescriptions for opioid painkillers in 2012. This was enough for every
American adult to have their own bottle of pills. Since 1999, the sale
of prescription opioid painkillers has increased by 300 percent. At the
same time, there has been no change in the amount of pain patients
reported. During this same time period, deaths from overdose of
prescription opioid painkillers quadrupled.
Additionally, according to the National Institute on Drug Abuse, 20
percent of people ages 12 and older have used prescription drugs
nonmedically at least once. The majority of those who abuse
prescription opioids get them for free from a friend or relative, often
from legitimate prescriptions written in excess.
And, over the past 5 years, the Drug Enforcement Administration has
collected more than 5.5 million pounds of unused or unwanted drugs,
including opioids.
Moreover, data from Express Scripts shows that while there are fewer
individuals filling prescriptions for opioids, the overall number of
prescriptions filled, as well as the number of days per prescription,
both increased.
All of this shows there are simply too many pills available for
diversion and abuse, and I believe better prescribing practices can
play an important role in reducing excess supply.
Our doctors and health care providers must improve the way they
prescribe these opioids, to ensure safe and effective pain relief, but
also to prevent misuse and overdose. At the same time, we must also
maintain appropriate access for legitimate medical needs.
Updated guidelines, such as those the Centers for Disease Control and
Prevention will soon release, will help improve prescribing practices.
Increased prescriber education can also help.
I am also looking into the possibility of responsibly regulating
initial opioid prescriptions to reduce risk for misuse, addiction, and
diversion. In my view, a patient who has a simple dental procedure does
not need a 30-day supply of Vicodin. This is the type of prescribing
that I believe we need to fix. Second, a bill like this can only have a
positive impact if its programs are actually funded.
My colleague from New Hampshire, Senator Shaheen, has introduced an
amendment that would provide emergency funding for the programs
authorized in this bill, and I urge its passage.
I do not need to tell you that opioid and heroin abuse are very
serious problems, but today we have an opportunity to address the issue
head-on and save lives. I encourage my colleagues to join me in voting
for this important bill.
Thank you.
Mrs. BOXER. Mr. President, the United States is in the midst of a
full-blown drug crisis. More people died from drug overdoses in 2014
than any previous year on record, claiming more lives than car
accidents across the country. Since 2000, there has been a 200 percent
increase in the rate of overdose deaths involving opioid pain relievers
and heroin, with 61 percent of all drug overdose deaths in 2014
involving some type of opioid.
These tragedies are proof of the fierce bonds of addiction, and it
seems no State has been spared from the opioid epidemic. In my State of
California, deaths involving prescription pain medications have
increased by 16.5 percent since 2006. In fact, there were more than
1,800 opioid-related deaths in 2012 alone, and 72 percent of those
involved prescription pain medications.
We cannot ignore the opioid crisis anymore. This is not a problem for
only the local communities or State officials. This is a nationwide
crisis and addressing it requires a multi-pronged response at all
levels of government. Last year, California was one of only 16 States
selected to receive funding from the Centers for Disease Control and
Prevention, CDC to help improve safe prescribing of opioid painkillers,
an important step forward in tackling the root cause of this
debilitating drug crisis.
The pain and sorrow of drug addiction knows no limits. This is a
tragedy that impacts families from all backgrounds, including our
servicemembers and veterans. There is substantial evidence that
prescription drug use and abuse is a major contributing factor to
military and veteran suicides. This has been a concern of mine for
several years, and I was proud to work with my colleagues in 2013 to
ensure that military and veterans hospitals were included in the Drug
Enforcement Administration's prescription drug takeback efforts so that
our military personnel, veterans, and their families could voluntarily
dispose of unwanted or unused prescription drugs.
However, much more must be done to combat this epidemic. To address
this emergency fully and effectively, we need to provide immediate
funding to the key grant programs included in the Comprehensive
Addiction and Recovery Act, CARA. I applaud Senator Shaheen and Senator
Whitehouse for introducing an amendment to give the Department of
Justice, DOJ, and the Department of Health and Human Services, HHS, the
tools they need to fund the essential prevention, treatment, and law
enforcement programs to help the families and communities torn apart by
drug abuse.
American lives are on the line, and we cannot wait to act. I urge my
colleagues to support this legislation.
Mr. BROWN. Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER (Mr. Tillis). The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. McCONNELL. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.

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