Statements on Introduced Bills and Joint Resolutions

Floor Speech

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Mr. KAINE. Mr. President, I rise to discuss a bill I am introducing called the Co-prescribing Saves Lives Act.

All across the Nation, and certainly all across my Commonwealth, we are seeing the scourge of prescription drug abuse and a heroin epidemic. These opioids are having major impact in communities everywhere in Virginia, from the coal mines of Appalachia to rural communities in the Shenandoah Valley, to right here in suburban Fairfax County.

I have heard, as have my colleagues, stories from parents who have buried children, from companies that can't find employees who can pass drug tests, and certainly from law enforcement officials, including judges, prosecutors, police officials, and sheriffs, who talk about the dramatic expansion of opioid addiction in this country. The numbers are kind of shocking. When I came to the Senate and started doing tours around the State in the spring of 2013, I really wasn't schooled about this, and I started to hear stories.

Heroin and opioids now account for 25,000 American deaths a year. In Virginia, and in much of the United States, the deaths from opioid overdoses are now exceeding deaths from motor vehicle accidents. According to the Centers for Disease Control, in the United States fatal opioid-related drug overdose rates have quadrupled since 1990 and have never been higher than they are right now.

The question is, How do we address this crisis? Obviously, the answer is there is no single answer. There are a lot of things that have to be done. The Federal Government, State and local communities, faith communities, nonprofit organizations, families, individuals educating themselves--there are a lot of answers, but we have to move forward with steps that we know can reduce overdose deaths.

There is some good news. There are advances that can help us do this, and one of the advances has been the development of a drug called naloxone, which is a medicine that is safe and effective as an antidote to all opioid-related overdoses, including heroin, prescription opioids, and fentanyl. It is a critical tool--it has been proven to be a critical tool since its development in preventing fatal opioid overdoses.

One of the neat things about naloxone is if you come across somebody who is in respiratory failure from an overdose or for some other reason, you can administer naloxone to that individual, and if it is not an overdose, it doesn't have any side effects. It can bring somebody back from the overdose-caused respiratory failure, but it doesn't have any negative side effects if it turns out the person is suffering from something else.

In Virginia there is an organization called Project REVIVE! that trains people to administer naloxone. In one of our communities in Russell County in Southwest Virginia, about a year ago I took the training with a lot of family members and others--just 2 hours of training--to learn how to do this.

Since naloxone has been developed and come into more common usage beginning in the late 1990s, it has saved more than 26,000 people who have been in the throes of an overdose. Naloxone has brought them back to life. I think a lot of professionals--public safety professionals and health care professionals around the country--have seen how effective it is.

One answer to our overdose problem is to co-prescribe naloxone when someone is getting a prescription for an opioid. Opioids have legitimate uses, to manage pain. So when somebody is getting a prescription for that, co-prescribe naloxone so they have the antidote right there in case of an overdose.

There are overdoses from people who are using drugs inappropriately and grabbing somebody else's prescriptions and using opioids, but there are also quite a few overdoses where people who are legitimately prescribed the drug--and they are usually prescribed it for pain--they develop a tolerance to the drug. The package may say to take one pill every 6 hours, but the pain is strong, and after 3 hours they start to feel it again and somebody thinks, OK, the drug has worn off now so I can take another one. So a person can start to take too many because of pain symptoms, and they get into an overdose situation for that reason too. If a person has a naloxone co-prescribed, they can have the antidote right there that they can administer themselves, or someone else can, if they get into an overdose situation.

Many communities, States, national organizations, and medical organizations have supported co-prescribing naloxone to patients who are taking opioids as a critical part of this overdose problem, and we have guidelines. Not everybody who gets an opioid prescription needs naloxone. My wife broke and dislocated her shoulder two Good Fridays ago, and she was prescribed a powerful opioid pain killer. She used about a day and a half's worth of it. It made her sick to her stomach so she quit using it. Not everybody who gets prescribed a prescription opioid needs naloxone, but there are certain warning signs--the medical profession has developed the warning signs--and if you have the warning signs, you should get the co-prescription. Developing these guidelines helps physicians, pharmacists, and other providers determine who is at risk and whom we should be proactive with regarding a co-prescription.

What this bill does is the following: It improves access to naloxone by encouraging physicians to co-prescribe in a couple of circumstances, to co-prescribe this lifesaving drug alongside opioid prescriptions and make it more widely available in Federal health settings.

The Co-prescribing Saves Lives Act would require that the Secretaries of Health and Human Services, Defense, and Veterans Affairs would establish physician education co-prescribing guidelines for all Federal health centers, including VA hospitals, DOD hospitals, the Indian Health Service, and federally qualified health centers. So within Federal health care facilities, if there is going to be an opioid prescription to somebody in a high-risk situation, there would be a mandate that naloxone would be prescribed as well.

This bill is based upon work that has already been done in the Federal Government. The VA especially has been a real leader in setting up these co-prescription guidelines. In addition, the bill would provide a program of grants through State departments of health that are interested in doing the co-prescribing guidelines for private physicians not in Federal settings in their States. The funding would allow States to purchase naloxone, to provide copay assistance for uninsured patients, and to fund training for health professionals and patients. Grant funding could also support State innovation and provide for community outreach. The kind of program where I trained last summer, Project REVIVE!, is just a community program trying to battle opioid overdose deaths in the coalfields of Appalachia. That would be the kind of program that if other States wanted to do that, could be eligible for grant funding.

In closing, this is just one solution. Obviously, the real solutions, the important ones, are still around prevention. Why do Americans get prescribed so many more opioids than folks in other nations? What do we do about prescriptions when the quantities that are given are too big and then we end up with a lot of unused opioids that can be taken by young people or stolen and sold? There are a lot of issues we have to solve, but there is this bit of good news; that naloxone saves lives and it is easy to administer. It doesn't have a negative effect. If we can broaden access to naloxone for those who have been prescribed opioids--we have saved lives in the past and we are going to save a lot more.

I will conclude by saying there is a dad in Northern Virginia--a guy by the name of Don Flattery--who has been very public about the loss of his son, Kevin, who was a 26-year-old graduate of UVA in 2014. He talked about his son, the family, the advantages they had, and his educational track record of success at UVA, but then he fell into the just bottomless pit of opioid prescription, opioid addiction, and he perished in 2014. What Don said is that ``I feel we need to keep personalizing what is happening. We are not addressing shocking, obtuse statistics--we are speaking about my son, your daughter, our neighbors ..... they are real people with real lives, and their losses are the face of the epidemic we must stop.''

That is what this bill intends to play a part in.

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