Frank Pallone

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, proponents of this legislation argue that taking away patients' privacy rights related to substance use disorder treatment records is okay because we would be applying the HIPAA standard that applies to other sensitive health conditions like HIV, but I strongly disagree. Individuals with substance use disorder face risk because of their medical conditions that those with other medical conditions do not. According to SAMHSA, those negative consequences include loss of employment, loss of housing, loss of child custody, discrimination by medical professionals and insurers, arrests, prosecution, and incarceration. Unlike other medical conditions, including HIV, you can be incarcerated, legally fired, and denied visitation with your children due to your substance use disorder. So let me paint this picture with a few examples. A 20-year-old pregnant woman in Wisconsin voluntarily went to a hospital to seek treatment for addiction to the opiate OxyContin. Rather than providing treatment, the hospital called State authorities to report this woman. She was taken into custody and held for several weeks before a judge ordered her released. Another example provided to the committee from a provider in Maryland explained: Some time ago, we had a young lady in our methadone maintenance program who committed suicide. She had turned her life around. She was in college, working full time, owned her own car, was purchasing a house, and was no longer using illicit substances. She had to complete probation for her crimes that she had committed while she was actively using these drugs. Her mother did not know she was in methadone treatment. She did not want her mother to know because her mother did not agree with methadone, and the judge found out she was in the methadone maintenance program and disclosed it in a court hearing with her mother present. The judge and her mother insisted that she ``get off that stuff,'' and she complied only because of the pressure from both to do so. She began abusing illicit substances and participating in illegal activity to obtain those substances. The guilt and shame of returning to what she described as a life of hell led her to write a suicide note and end her life. Experiences like this, in addition to stories of individuals with substance use disorder who have lost jobs, housing, and child custody because of their substance use disorder, are reasons that some individuals with substance use disorder fear coming forward to enter treatment due to the negative consequences that result. It is why more than 100 groups, including AIDS United, joined the campaign to protect patient privacy rights. They have joined together to fight to protect the heightened privacy protections that exist under existing law. Further, unlike the proponents of this legislation contend, the existing law is not an anomaly. States like Florida have laws requiring written patient consent for the sharing of a patient's substance use disorder and mental health treatment records, while others like New York, Kentucky, and Texas have such requirements for the sharing of HIV records. Other States have such requirements for reproductive health treatment records. Further, the existing law is consistent with the confidentiality protections applied to substance use disorder treatment records. In fact, the law governing the confidentiality of VA medical records, 38 U.S.C. 7332, is consistent with and broader than part 2. Unlike that law, the VA cannot share a patient's substance use disorder, HIV, or sickle cell anemia treatment records with another provider without written patient consent. So, Mr. Speaker, I want to stress that I do believe that we can learn an important lesson from our response to HIV, particularly during the height of the AIDS epidemic. A critical part of this Nation's response to the AIDS epidemic was increasing the privacy protections applied to HIV medical records. Such action was taken because people were afraid to enter treatment for HIV/AIDS because of the negative consequences that could result. In the midst of the opioid epidemic, this bill would result in doing just the opposite: lowering the privacy protections applied to substance use disorder medical records despite the fact that, like during the AIDS epidemic, some individuals with substance use disorder remain afraid to enter treatment because of the negative consequences that result. And in many cases, they only do so out of the part 2 assurances that they can control to whom and for what purposes their treatment record is shared. The increased stigma, discrimination, and criminalization faced by people with substance use disorder support the maintenance of the heightened privacy protections under existing law, in my opinion. And for some individuals, it is these privacy protections that make them feel safe to enter and remain in treatment for their substance use disorder. I am afraid that by passing this bill we could be creating a barrier that will keep people from getting the treatment they need, and that is a risk I am simply not willing to take. Mr. Speaker, I reserve the balance of my time.

Mr. PALLONE

Mr. PALLONE. Mr. Chair, I yield myself such time as I may consume. Mr. Chair, I want to speak briefly on a point that I think is being lost here. This bill presumes that expanding access to residential treatment is the answer, and it is not necessarily. Without any requirement that States address gaps in Medicaid community-based services, I think there is a possibility that we risk more harm than good. The former director of national drug control policy has reminded us that most of these IMD facilities provide detoxification services. But detoxification is only the first stage of addiction treatment. Indeed, it may increase the potential for overdose if patients do not remain or have any support when released, since, with detoxification, their tolerance for opioids is significantly reduced. The proposal before the House will likely create an overreliance on institutional treatment and may exacerbate the dearth of community-based health services. People with substance use disorder often find themselves unable to access intensive community-based behavioral health services when they need it. Likewise, many cannot access services in the community when they are discharged following a crisis. Incentivizing inpatient care may actually increase opioid overdose, the very harm that Congress is seeking to prevent. Experts have raised serious concerns with this bill's institutional focus because recent data suggests that inpatient detoxification is an important predictor of overdose, largely because many who receive inpatient care aren't then connected to community-based treatment programs or put on medication, leaving them extremely vulnerable. Again, I am concerned that we may be contributing to this crisis with this legislation. Mr. Chair, I reserve the balance of my time.

Mr. PALLONE. Mr. Chairman, I thank the gentlewoman for yielding. Mr. Chairman, I support my colleague's, Representative Kildee's, amendment to this legislation. It is certainly important to require States to report information on individuals with co-occurring disorders and what disorders are suffered, and it is equally important to have information on access to community care for individuals suffering from a behavioral health issue other than a substance use disorder. Mr. Chairman, I want to stress that this information is important, but the underlying problem with the IMD CARE Act continues. I believe this bill is, at best, an ineffective use of scarce Medicaid dollars. More importantly, it may undermine ongoing efforts to improve the full continuum of care for people with substance use disorders.

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I want to thank my colleague from Texas for yielding. Mr. Chairman, I rise in opposition to H.R. 2851, legislation that would give Attorney General Jeff Sessions through the Drug Enforcement Administration sweeping new authority to combat the synthetic drug crisis facing our country. In 2016, nearly 64,000 Americans died because of a drug overdose, and the overdose rate from the synthetic opioids, such as fentanyl and fentanyl analogues, nearly doubled. We know that illicit fentanyl and fentanyl analogues are extremely deadly and increasingly are being shipped into our country through China. I know all Members would agree that synthetic drugs are a very real threat that we have to combat. However, it is unclear to me that the appropriate response to this crisis is the creation of a new schedule-- schedule A--that would impose new burdens on researchers and manufacturers. It would also dramatically limit the scientific and medical role HHS and the FDA play in our scheduling process today. In fact, the DEA already has the authority today to temporarily add these synthetic substances to the Controlled Substances Act if they determine that they pose an imminent hazard to public safety. The agency has used this authority over 80 times, including most recently to put all fentanyl-related substances into schedule I. DEA also has authority under the Analogue Act to treat synthetics that are substantially similar to a controlled substance the same way they treat the controlled substance, and this is authority the DEA has and continues to use to combat this crisis. Instead of proposing to improve the DEA's existing statutory authority, this bill creates a new schedule for synthetic substances, and it gives almost sole discretion as to when a substance can be temporarily scheduled in the new schedule A and expands temporary scheduling for up to 5 years. Another reason I oppose this bill is because it also eliminates the critical scientific and medical analysis by HHS and FDA. It only requires the DEA to consider recommendations from HHS, eliminating the binding nature of such analysis under the permanent scheduling process today. A letter in opposition from a coalition including the ACLU, Drug Policy Alliance, Human Rights Watch, and the NAACP, among others, has also raised concerns about SITSA circumventing the role of HHS in the scheduling process. The letter notes: ``SITSA would enable the Attorney General, an unelected individual, to single-handedly determine which substances are acceptable for private citizens to consume.'' As a public health agency, HHS, acting through FDA, is best positioned to be making decisions regarding scheduling drugs or substances based on their scientific and medical analysis. We should not hand this authority over to a law enforcement agency, and that is yet another reason why I oppose this bill. I also continue to be concerned about the potential for H.R. 2851 to undermine or stifle research and development of synthetic substances. We know that many synthetic drugs have the same chemical properties as drugs with known therapeutic uses. By subjecting schedule A substances to the same requirements as schedule I, we may be unintentionally creating hurdles for the research community to evaluate whether these substances may be possible alternatives for treatment of pain and addiction. These are all discussions I wish I could have raised during consideration of the legislation in the Energy and Commerce Committee. Despite receiving primary referral, the chairman chose to cede to the Judiciary Committee, denying our members the opportunity to have a full debate on this legislation. For all these reasons, I join my colleague, Congressman Nadler, the ranking member of the Judiciary Committee, in opposing this flawed legislation, and I urge all of my colleagues to do the same.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, House Republicans have taken their appalling assault on New Jersey to new lows: The Natural Resources Committee is considering legislation that would penalize States like New Jersey, where Governor Murphy and our people have had the courage and foresight to block drilling in State waters. What House Republicans don't realize is that New Jerseyans will never be blackmailed into accepting drilling miles away from our $38 billion- a-year tourism industry. We know the damage that the BP oil spill did to communities on the Gulf Coast, and we will stop at nothing to prevent it off New Jersey's waters. The Trump administration offered the largest offshore drilling plan we have ever seen last year, but even the President understands the true dangers of drilling. We know this because he excluded drilling off Florida waters at the request of his political allies there. Republicans understand the risk of offshore drilling, yet they are all too happy to subject coastal communities throughout our country to the risk. So much, Mr. Speaker, for State rights. Mr. Speaker, New Jerseyans have a long memory, and we will never forget this assault on our economy and our way of life.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, this bill would require the Department of Health and Human Services to conduct a study and submit to Congress a report on the adequacy of access to abuse-deterrent opioid formulations for individuals with chronic pain enrolled in Medicare Advantage or part D. While I am hesitant about the true impact abuse-deterrent formulations can have in addressing this crisis, especially given that these formulations can still lead to opioid dependance and misuse, I also recognize that we must be utilizing every tool available to combat this epidemic. I am especially glad that this bill includes language to address the price of abuse-deterrent formulations as well. It is critical, when evaluating the adequacy of access, to also study the price of such drug formulations, as cost is a critical component of access. Mr. Speaker, I support the bill, and I urge my colleagues to support the bill. I yield back the balance of my time.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise to express my support for H.R. 4275, legislation that would help pharmacists detect fraudulent prescriptions by requiring the Department of Health and Human Services to develop training materials to provide pharmacists, providers, and patients with a greater understanding of the ability and responsibility of pharmacists to refuse to fill potentially fraudulent or forged prescriptions. Pharmacists serve on the front lines of the fight against the opioid epidemic. H.R. 4275 would provide pharmacists the tools they need when faced with patients suffering from addiction or with other individuals interested in abusing or misusing controlled substances. Combatting fraudulent or forged prescriptions is one step in helping to prevent diversion and reducing the number of opioids available in the supply chain. Once enacted, HHS would work with the Drug Enforcement Administration, the Substance Abuse and Mental Health Services Administration, and other relevant stakeholders including pharmacists, medical societies, licensing boards, health care providers, and patients to draft and disseminate materials to inform about the circumstances under which a pharmacist may decline to fill a prescription and the federal requirements surrounding such a decision. In addition, HHS will offer guidance on how to decline to fill a prescription and actions to take after doing so. This will ensure that all parties understand when and why a controlled substance prescription may be declined. H.R. 4275 will empower pharmacists to fight back against forged or altered prescriptions and help prevent opioids from entering the hands of people suffering from addiction or who are at risk of becoming addicted. I want to thank Representatives DeSaulnier and Carter for their leadership on this legislation, which is also supported by the National Community Pharmacists Association. Addressing our national opioid crisis requires an all-hands-on-deck approach, and I am pleased that this legislation recognizes the important role pharmacists can play. I urge my colleagues to vote in support of H.R. 4275. Madam Speaker, I yield such time as he may consume to the gentleman from California (Mr. DeSaulnier), the sponsor of the bill, and thank him for his work on this important legislation.

Mr. PALLONE. Mr. Speaker, I urge my colleagues to support the bill, and I yield back the balance of my time.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise in support of H.R. 5197, the Alternatives to Opioids in the Emergency Department Act, introduced by my colleague from New Jersey, Representative Pascrell. This legislation would create a demonstration program to support emergency departments in developing, implementing, enhancing, or studying alternative pain management protocols and treatments that limit the use of prescription opioids in emergency departments. Supporting the development of additional protocols for alternatives to opioid medications as proposed by this bill can help reduce the number of those put at risk of addiction and lead to fewer fatal and nonfatal overdoses. Mr. Speaker, I encourage my colleagues to support this legislation. Mr. Speaker, I yield such time as he may consume to the gentleman from New Jersey (Mr. Pascrell), the sponsor of this bill.

Mr. PALLONE. Mr. Speaker, I urge support, urge my colleagues to support this bill, and I yield back the balance of my time.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise in support of H.R. 5587, the Peer Support Communities of Recovery Act. I want to thank Mr. Lujan for sponsoring this bill, but also for being the major sponsor of many of the pieces of legislation that we have discussed today and we are passing today as part of this opioid package. This bill would amend the existing Communities of Recovery grant program to allow SAMHSA to provide funding for regional technical assistance centers. These centers would provide technical assistance for the implementation of regionally driven, peer-delivered addiction recovery support services, establishment of recovery community organizations, and establishment of recovery community centers. Mr. Speaker, I urge my colleagues to support this legislation. Mr. Speaker, I yield such time as he may consume to the gentleman from New Mexico (Mr. Ben Ray Lujan).

Mr. PALLONE. Mr. Speaker, I urge my colleagues to support this bill, and I yield back the balance of my time.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise in support of H.R. 5685, sponsored by Representatives John Faso and Peter Welch. I commend my colleagues for their work on this important bill. We know that opioid abuse and misuse is a significant and growing problem in the Medicare population. We know that we need to do more, not only to bring down opioid prescribing, but to make seniors aware of the dangers of opioid addiction and the existence of alternatives. H.R. 5685 would add educational resources regarding opioid use and nonopioid pain management alternatives to the ``Medicare & You'' handbook, which is mailed to all Medicare households each fall. While this is an important bill, I want to underscore that it is incremental and it is limited. I want to reiterate my continuing concern that while Democrats support working on a legislative package to address the opioid crisis, we must first assure that we do no harm. The Trump administration and Congressional Republicans' efforts to dismantle the Affordable Care Act would do serious harm to our healthcare system, and to individuals suffering from opioid use disorders specifically. For instance, the Trump administration continues to undermine the individual market by promoting junk insurance plans, such as short-term limited duration health plans. These plans, which would be medically underwritten and would exclude individuals with preexisting conditions, would make coverage in the Affordable Care Act compliant market much more expensive. This would make coverage for individuals who need comprehensive coverage, such as individuals with opioid use disorders, less affordable and accessible. The opioids package cannot be considered in a vacuum. Make no mistake, ongoing Republican efforts to sabotage the Affordable Care Act could not only reverse any gains we may make from these efforts today, but will inflict broad, lasting harm to our healthcare system and to our ability to fight the opioid crisis. Mr. Speaker, I have no additional speakers. I ask my colleagues to support this bill, and I yield back the balance of my time.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I urge my colleagues to support the bill, and I yield back the balance of my time.

Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise in support of H.R. 5583, which would require all Medicaid programs to report on behavioral health quality measures in Medicaid, and I thank the sponsor, Ms. Clarke. The Medicaid behavioral health core set of measures contains 16 key measures used by CMS to measure and evaluate the quality of behavioral healthcare that is being provided by State Medicaid and CHIP agencies. Recently, CMS added two additional measures related to opioids. The core set is designed to help ensure that those with behavioral healthcare needs are receiving appropriate screening management and follow-up for their mental health conditions, such as substance abuse disorder, including opioid use disorders, ADHD, depression, or schizophrenia. Currently, the behavioral health core set is a quality measure. However, given the expanse of the opioid epidemic and need to improve mental healthcare quality and coordination for those with substance abuse disorders and all patients, mandatory reporting will ensure we have a standard nationwide dataset on the quality of behavioral health treatment that our beneficiaries receive under Medicaid. Quality treatment is vital to assist in bolstering our Nation's mental health and substance abuse care and in improving our healthcare system's ability to fight the opioid epidemic. I urge my colleagues to support this legislation. Mr. Speaker, I yield as much time as she may consume to the gentlewoman from New York (Ms. Clarke).

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I also urge my colleagues to support the bill, and I yield back the balance of my time.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise in support of H.R. 5473, legislation offered by my colleagues, Representatives Lujan and Comstock. H.R. 5473 would provide greater clarity to drug and device manufacturers regarding the studies that should be conducted for purposes of making claims on the labeling of medical products that they may replace, delay, or reduce the use of opioids. This is practical legislation, Mr. Speaker, that I believe will help to encourage manufacturers to do the necessary work to determine how we can identify for providers and patients medical products that can serve as alternatives to the use of opioids for purposes of pain treatment. Mr. Speaker, I urge my colleagues to vote in support of H.R. 5473, and I reserve the balance of my time.

Mr. PALLONE. Mr. Speaker, I yield such time as he may consume to the gentleman from New Mexico (Mr. Ben Ray Lujan), who is one of the sponsors of this bill.

Mr. PALLONE. Mr. Speaker, I also ask that my colleagues support this bipartisan legislation, and I yield back the balance of my time.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise in support of H.R. 3331, sponsored by Representative Lynn Jenkins and Representative Doris Matsui, and I commend my colleagues for their work on the bill. One of the reasons why the opioid crisis is so intractable is the lack of access to behavioral health services in all of our communities, and the continued segregation of behavioral health from physical health. For decades, we have neglected our behavioral health infrastructure, and siloed behavioral health from our broader healthcare system. The lack of integration between behavioral and physical health has had serious consequences for patients, including poor to non-existent coordination of care, severe provider shortages, and poor health outcomes. One barrier in addressing true integration has been that behavioral health providers in large part don't have access to electronic health records, and were left out of the push to update electronic health records systems. That is an unfortunate legacy that we are still dealing with today. H.R. 3331 takes an important step in addressing this problem. It is a bipartisan bill that would incentivize behavioral health providers to adopt electronic health record technology, through the Centers for Medicare & Medicaid Innovation. While this is an important bill, I want to underscore that it is incremental and it is limited. I want to reiterate my continuing concern that while Democrats support working on a legislative package to address the opioid crisis, we must first assure that we do no harm. And I must remind everyone that Republican efforts to dismantle and sabotage the ACA would do serious harm to our healthcare system, and to folks with substance use disorders specifically. Just last week, the Trump Administration requested that a federal court eliminate the protections in the ACA for people with preexisting conditions. That includes people with opioid use disorders, whose access to health insurance and vital treatment for opioid use disorders would be taken away if the Trump Administration is successful. The opioids package cannot be considered in a vacuum. Mark my words-- Republican efforts to tear down the ACA and the Medicaid program will not only reverse any gains we may make from these efforts today, but will to inflict broad, lasting harm to our healthcare system, and to our ability to fight the opioid crisis. Mr. Speaker, I yield such time as she may consume to the gentlewoman from California (Ms. Matsui).

Mr. PALLONE. Mr. Speaker, I have no other speakers. I urge support of the legislation, and I yield back the balance of my time.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise in support of H.R. 4284, the Indexing Narcotics, Fentanyl, and Opioids Act, or INFO Act. The opioid crisis is a complex issue that requires an all-hands-on- deck approach. Communities across the Nation are being ravaged by this crisis, and many are working hard to find ways to stop it. With 115 people dying every day from opioid overdoses, communities could benefit from sharing effective interventions to decrease opioid use disorder and overdose deaths and having one-stop access to Federal resources, including grant funding announcements, available to support their efforts. The INFO Act would create a central repository for information on programs within HHS related to the reduction of opioid abuse and other substance use disorders, as well as how communities nationwide are tackling the opioid epidemic. In this way, folks across the country can work together and learn from one another. This easily accessible, electronic public dashboard would allow for strategies to combat this crisis to be shared and served as a resource to patients, loved ones of those with opioid use disorder, and local communities. The INFO Act also would establish an interagency substance use disorder coordinating committee to help coordinate response efforts to the opioid epidemic within HHS. Mr. Speaker, I urge my colleagues to support this legislation, and I yield back the balance of my time.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I also urge my colleagues to support this legislation, and I yield back the balance of my time.

Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise in support of H.R. 5009. Mr. Speaker, I support H.R. 5009. As we know, opioid use a disorder is a medical condition that requires lifelong management. Even if someone has completed treatment successfully and is in long-term recovery, the risk of relapse remains. A patient recovering from opioid use disorder may visit a healthcare provider or require medical interventions that typically result in the need to treat pain. However, for those affected with opioid use disorder, a prescription of an opioid medication could cause individuals to relapse into misuse and lead to an overdose or even death. H.R. 5009, Jessie's Law, is bipartisan legislation introduced by Rep. Walberg (R-MI) and Rep. Dingell (D-MI) that would require the Department of Health and Human Services (HHS) to convene appropriate stakeholders and develop best practices for displaying opioid use disorder history prominently on a patient's medical records, whenever requested by a patient. This legislation would enable patients suffering from opioid use disorder to choose to share their history with opioids with healthcare providers and have that information prominently displayed in their medical record--allowing for better informed, safer pain management care. This legislation would also require HHS to annually develop and disseminate written materials to health care providers regarding permitted disclosures of certain information to families, caregivers, and health care providers under Federal health care privacy laws during emergencies. This will improve the awareness of providers of instances in which they may share information about a patient's overdose with their family. I urge my colleagues to support this legislation. Mr. Speaker, I yield such time as she may consume to the gentlewoman from Michigan (Mrs. Dingell), one of the sponsors, Mrs. Dingell.

Mr. PALLONE

Mr. PALLONE. Mr. Speaker, I would also urge my colleagues to support the bill, and I yield back the balance of my time.