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Senate Vote: 221     Vote Date: Oct 3rd, 2018

Issue:  H.R. 6 (SUPPORT for Patients and Communities Act ), A bill to provide for opioid use disorder prevention, recovery, and treatment, and for other purposes. Question:  On the Motion to Concur in the House Amendment to the Senate Amendment to H.R. 6.

Result:  Agreed to in Senate, 98 to 1, 1 not voting.  Agreed to earlier in House (House Roll Call 415, 9-28-18).  (Became Public Law 115-271 (signed by the President, 10-24-18). GOP and Democrats scored.

Freedom First Society: H.R. 6 is a package of more than 50 bills addressing the nation’s “opioid crisis.” (See House Roll Call 288, 6-28-18).  Unfortunately, almost all of these bills comfortably ignore the source of the nation’s deadly epidemic — drug cartels taking advantage of a porous southern border and an increasingly responsive culture. Instead, of forcing the federal government to exercise its constitutional responsibility to enforce our borders, H.R. 6 would throw more money at the resulting addiction problem with more unconstitutional intervention in the medical marketplace.

We have assigned (good vote) to the Nays and (bad vote) to the Yeas. (P = voted present; ? = not voting; blank = not listed on roll call.)

Bill Summary:
Although at the time of this posting, H.R. 6 has become public law, the Congressional Research Service has not updated its summary from the version passed by the House in Roll Call 288 (6-28-18).

Since then, the Senate took up the measure and passed an amended version (Senate Vote 210, 9-17-18).  Next, the House considered the Senate amendment with Roll Call 415 (H. Res. 1099) and added its amendment.  The Senate then accepted the House amendment with this Senate Vote 221 (10-3-18).  Both of these actions added new programs and provisions to the original House passed bill.   For example during the Senate “debate” leading up to its initial September 17th vote, Senator Lamar Alexander (R-Tenn.) stated:

“We have a sense of bipartisan urgency about  finishing our work in the Senate and combining our efforts with the House. Their bill is a good bill. I think combining it with ours will  help make it stronger, and we will get our bill to the President.”

In an October 24, 2018 news release following the President’s signing of the amended H.R. 6 into law, Senator Alexander listed the following ten key provisions of the legislation:

  1. STOP Act—to stop illegal drugs, including fentanyl, at the border [FFS: i.e., shipments via the U.S. Mail]
  2. New non-addictive painkillers, research and fast-track
  3. Blister packs for opioids, such as a 3 or 7 day supply
  4. Extends support for Medicaid patients seeking treatment from 15 to 30 days, covering all substance use disorders
  5. TREAT Act—permanently allows more medical professionals to treat people in recovery to prevent relapse and overdoses
  6. Prevent “doctor-shopping” by improving state prescription drug monitoring programs
  7. More behavioral and mental health providers
  8. Support for comprehensive opioid recovery centers
  9. Help for babies born in opioid withdrawal and for mothers with opioid use disorders
  10. More early intervention with vulnerable children who have experienced trauma

Freedom First Society Analysis: In our earlier analysis of the House action (Roll Call 288, 6-22-2018), we accused Congress of ignoring the root causes of the deadly epidemic while proposing to treat its symptoms with an unconstitutional expansion of government.  As for the root causes, we place the blame on Establishment elites and a complicit Congress marching to their tune.

The Establishment has an open borders agenda which explains why Congress has refused to enforce our borders thus allowing the easy inflow of illegal drugs.  Even more fundamentally, the Establishment has attacked the underpinnings of a free society — traditional morality and religion.  No wonder that many, finding little purpose in life, choose the escape of the opium den.  As we see below, America is also suffering from a “Meth” crisis, so the subversion of America’s cultural underpinnings must not be ignored.

Unfortunately, the Congressional floor debates over H.R. 6 are glaring in their refusal to address the fundamental question:  Why is America afflicted with these crises?

The following remarks are from the Senate debates on 9-17-18 [Emphasis added]:

Senator John Boozman (R-Arkansas): “This comprehensive package covers a wide range of avenues to attack this problem and get individuals the help and support they need to recover. This includes prevention, treatment, additional law enforcement tools, and expanding research into non-addictive pain treatments.   I appreciate the leadership of my colleagues on the HELP, Finance,  Judiciary, and Commerce Committees to advance this important  legislation that is necessary to address the ever-growing opioid crisis.   The legislation expands a grant program to train our first responders administering naloxone, the drug that can be used to block the effects of opioids and prevent deaths from an overdose….

“Not only does this legislation help those already impacted by the  crisis, it also aims to stop even more dangerous drugs, like fentanyl,  from getting into the country in the first place by improving detection  of prohibited drugs being illegally imported through the mail.   These provisions are just a small piece of the puzzle. Together, with other measures in this bill, we can make a real difference and change the conversations we have around opioid abuse and addiction to focus not on the lives taken but on the lives which are being saved. The comprehensive response to the crisis shows how committed we are as a nation to combating opioid addiction.

Senator Edward Markey (D-Mass.): “This bill contains a number of proposals that will help families and  communities struggling day in and day out to respond to the opioid  overdose crisis. One of those proposals is my bipartisan Opioids Milestones Act, a bill I authored with Senator Lisa Murkowski and Senator Maggie Hassan to create a scorecard for our Nation’s response to the opioid crisis.   The Milestones Act will require the Federal Government to both set  tangible benchmarks for how we are addressing the opioid crisis in our country and measure progress on key objectives every single year. When  people are sick, they get a treatment plan. The United States of America needs a nationwide treatment plan for fighting the opioid crisis, and that is what this provision will create for our country.  Those objectives include reducing overdose deaths, expanding treatment availability, increasing the number of individuals in sustained  recovery, and decreasing emergency room visits for overdoses….

“With more than 220 counties across the United States at risk of a  hepatitis C or HIV outbreak related to the opioid crisis, we cannot  afford to wait any longer to arm our States with the tools needed to tackle the public health consequences of this epidemic….

“If we are going to reduce the supply of heroin, fentanyl, and illicit prescription opioids, then we have to reduce the demand through treatment. That must include increasing access to effective medication-assisted treatment, or MAT….

[Freedom First Society: Is treatment really how you reduce the demand?  Senator Markey’s treatment solution merely targets the demand that has been already created and tries to divert it.]

Senator Markey continues:  “The bill we vote on today cannot be the end of our efforts to help solve the opioid overdose crisis. The opioid crisis knows no  boundaries, and neither should our efforts to combat it.”

[Freedom First Society:  What a prescription for unlimited government!  Collectivism run amok!]

Senator Angus King (Ind.-Maine): “Mr. President, the discussion today is about the opioid  crisis, one of the most serious public health crisesI have seen in my  adult life, certainly in the State of Maine. It is an enormous problem  across the country, particularly in rural areas. In my State, we are losing more than one person a day to an overdose death. That is an epidemic by anybody’s definition.”

Senator Margaret Wood Hassan (D-New Hampshire): “I rise as the Senate considers bipartisan legislation that marks a  critical step forward in the fight against the fentanyl, heroin, and  opioid crisis.  In New Hampshire, and all across our Nation, entire communities are being ravaged by this epidemic. In order to turn the tide, we need to combat the challenges communities are experiencing from all angles; we need to collaborate across traditional boundaries; we need to take a truly all-hands-on-deck approach because the magnitude of this crisis demands it….

“This is a good start, but it is and must be only a start.”

Senator Steve Daines (R-Montana): “While we must focus on combating the opioid crisis, we must also continue to address a related but separate epidemic that is wreaking  havoc in Montana and in many other States; that is, the methamphetamine epidemic.   In Montana, meth is destroying families and communities and disproportionately impacting our Tribes. In fact, we have seen a 415-percent increase in meth cases from 2011 to 2017, and a 375-percent increase in meth-related deaths in that same timeframe.”

The following remarks are from the Senate debates on 10-3-18 [Emphasis added]:

Senator Lamar Alexander (R-Tennessee):  “We  are in the midst of contentious disagreement about the Supreme Court,  but at the same time we have an urgent, bipartisan consensus, of  virtually unanimous agreement, to deal with the most urgent public  health epidemic facing our country today in virtually every community;  that is, the opioids crisis….

“People often say, when I describe our bill — which we called the Opioid Crisis Response Act but is now called by, I think, a better name, the SUPPORT for  Patients and Communities Act  — when I describe the bill, people ask:  Where is the money? Well, the money is not in this bill. This is an  authorization bill. We do money in other bills. We call them  appropriations bills. The Congress and President Trump have both been attentive to the money.   Since just March, including the appropriations bill passed in March  and the appropriations bills approved by the Senate last week, we will  have directed in the Congress $8.5 billion toward the opioid crisis — everything from hundreds of millions for non-addictive pain medicines to  $1 billion for grants to States for more treatment — so $8.5 billion just this year. That is the money….

“The opioids epidemic is going to have to be solved in Ames, IA,  and Nashville, TN, and Sacramento, CA, and communities all across this  country by Governors who work with medical faculty to change the  curriculum on how doctors learn about pain medicine; by States that,  like Tennessee, have begun to limit the opioid prescriptions to 3 days  at a time to try to avoid the 60-day, 60-pill bottle that someone might  take home and use 15 pills and then have the rest taken by a teenager  to a party, with a terrible result at the end; by the judges who deal  with opioids and their criminal cases; and by the nurses and the  treatment officials who try to help people with medication. All of this has to be solved community by community by community. We know that. We  are not pretending that a single act here can fix the problem.

“We have had urgent bipartisan consensus on this. There have been contributions from 5 Senate committees, and 72 different Senators are reflected in  this bill. That is why we have urgent bipartisan consensus, because we want to do everything we can do to provide tools to parents and  patients and doctors and nurses and communities and Governors — anyone  we can find — to deal with this crisis.”

[Freedom First Society:  This points to another looming crisis. Congress has helped the States to become dependent on and addicted to federal handouts for their resources.  The federal government now has deep pockets with the income tax and the ability of the Federal Reserve to inflate the money supply to finance the federal government’s deficits. A revolution to restore federalism would solve a myriad of problems.]

Senator Alexander continues:  “In our State, as in most  States, more people are killed by opioid overdoses than by car  crashes — in Tennessee, 1,776 last year. That is why the House passed  this bill by 393 to 8 last Friday. That is why, after we vote on this  bill today at 3:15, it will go directly to the President, and I am confident he will sign it quickly.”

Senator Shelley Moore Capito (R-West Virginia):  “The SUPPORT Act successfully builds on the work Congress began with  the passage of the Comprehensive Addiction and Recovery Act back in  July of 2016, and it is a critical next step in our fight against an  epidemic that continues to devastate families and communities across  this country, especially in my home State of West Virginia.  This legislation reflects what we have learned in the past few years  since we passed CARA….

“When thinking about next steps for fighting the opioid epidemic, one of the first things I realized was that the formula for State funding was not providing adequate resources to the hardest hit States — States like West Virginia. I joined with my colleague Senator Shaheen from New  Hampshire — her State also has been devastated by this epidemic — to help change that formula….

“Something else we quickly realized in West Virginia was that we didn’t have the treatment facilities or the trained workforce to adequately support individuals seeking treatment. To address these  needs, I worked with my colleague Senator Hassan from New Hampshire to create a grant program establishing comprehensive opioid recovery  centers, or CORKs, in the most affected areas, and I worked on  provisions that will help increase and better prepare our healthcare  workers….

“We also have the need for recovering addicts to be able to find that pathway back to employment. To address both of these needs, this legislation authorizes grants that will align job training and  treatment services, including several provisions from the CARA Act that I sponsored with Senator Brown from Ohio.   As to the causes of the crisis, there are many, but there are two areas that come up again and again.   First is the need to reduce the number of prescriptions for opioids.  To get at the root of the problem, Senator Feinstein and I introduced  the Using Data to Prevent Opioid Diversion Act. Our bill, which is now a part of the SUPPORT Act, provides drug manufacturers and distributors with data to identify pharmacies that are suspiciously ordering  prescription opioids, and it grants law enforcement the authority to hold them accountable, as they should be, if they fail to use this data to identify, report, and stop suspicious orders….

The second issue that comes up often is the need to reduce the amount  of synthetic opioids like fentanyl, which is killing — killing — people.  It is 100 times more potent than heroin.   The STOP Act will help prevent the shipment of synthetic opioids into  the United States through the international mail system, where the vast amount of these originate….

“Something we have seen in West Virginia are the ripple effects of the opioid epidemic. These are the children, the families. An unbelievably increasing number of children are being raised by their grandparents,  raised by their great-grandparents, or are in foster care. It is  putting a major strain on our social services but also on the individual child who, through no fault of their own, has ping-ponged  from house to house in very emotional kinds of ways.

[Freedom First Society: Are these not largely due to the successful Leftist attack on the family? Too many Republicans legislators accept the inroads targeting the traditional family, while eagerly joining with the perpetrators to throw federal money at the symptoms.]

Senator Capito continues:  “There are more babies receiving neonatal care, and I have worked with  my colleagues to make sure the CRIB Act, which I worked on with Senator  Brown as well — this measure clarifies a State’s ability, under Medicaid, to provide care for infants with neonatal abstinence syndrome in residential pediatric recovery centers like Lily’s Place, which we have in Huntington, WV….

Methamphetamine is something that is way on the rise and taking over, unfortunately, from heroin, which is just a terrific tragedy.   There is no one silver bullet when it comes to the opioid epidemic,  but one thing is certain: I and we will keep fighting against those who are bringing deadly drugs into our communities. We will fight for those struggling with addiction and seeking treatment. We will fight for the children who are caught in the middle, and we will fight for every other person who is affected by this crisis.”

[Freedom First Society:  Perhaps Senator Capito should also be fighting those in Congress who are helping to create despair by destroying America’s heritage of economic opportunity and those legislators who are undermining a culture of strong families with religious values, where there is greater resistance to the temptation of drugs.]

Senator Amy Klobuchar (D-Minnesota): “In the end, the way I look at this is that our first goal is to stop people from getting addicted in the first place.That means doing all we can to stop this fentanyl, carfentanil, and all the illegal drugs from coming in. That means providing education in our schools so kids understand what is happening and how dangerous these drugs are. That means working with our doctors and healthcare providers so they are not overprescribing opioids. We now know that four out of five heroin users got their start on legal prescription drugs….

[Freedom First Society:  Certainly, something is missing here. Surely, the crisis can’t stem from “overprescribing doctors and health care providers.” And educating our kids in school to see the danger must be an uphill battle, particularly now that they see states legitimizing the “recreational pot” culture.   And particularly when our government schools have told them there is no God or higher purpose in life.”

Senator Klobuchar continues:  “The last point is to go after the bad guys, the people who are trying  to get people hooked on these drugs.”

[Freedom First Society:  And many of these “bad guys” came into the U.S. through the federal government’s refusal to enforce our borders, even after 9-11.]

Senator Rob Portman (R-Ohio): “This legislation is important because although Congress acted a  couple years ago, unfortunately, the problem has gotten worse, not  better, and we have learned more. The last major legislation we passed  on opioid legislation was about 2 years ago. By the way, during those 2  years, I am told I have been on this floor 56 times talking about this issue.”

Senator Ron Wyden (D-Oregon):  “Mr. President, when it comes to Medicaid, there is no  question the program is front and center in the fight against the opioid epidemic. Medicaid is the single largest payer of substance use  disorder services in the Nation, paying for a third of all medication-assisted treatment across the country and covering millions of Americans currently suffering; yet gaps in the system still exist.   The SUPPORT for Patients and Communities Act includes a number of  policies that will help fill some of these gaps both within Medicaid and across the healthcare system.

Senator Patty Murray (D-Washington):  “Mr. President, earlier this year, I heard from an elementary school principal in Washington State about how the opioid  crisis was hurting the kids in his school. Students at his school were  having trouble focusing in class as they dealt with the trauma of a family member’s substance use at home. Some of his teachers were having trouble understanding how best to help those students with their trauma.”

[Freedom First Society:  Is this really a federal issue?  Most in Congress ignore the fact that the Constitution authorizes the federal government to perform relatively few functions. Instead, they realize they can get reelected simply by championing popular causes.  It works, since the public is regularly given the image that we have a national government responsible for anything that needs doing.  Yet with its excesses, Congress creates the poison and the power-grabbing antidote in the same laboratory.]

Senator Murray continues: “The bill we all crafted together is a meaningful, bipartisan  compromise…. It includes provisions to develop a task force and grants to help support trauma-informed care programs and increase access to mental health care for children and families in their communities, including at schools like the one the principal told me about, and provisions to build on critical public health activities to prevent opioid misuse from occurring in the first place.   It includes provisions to address the economic and workforce impacts of the opioid crisis, such as support for training to help the nearly 1 million people out of work due to opioid use disorder to gain and  retain employment, as well as provisions to strengthen our behavioral workforce so patients and families can access the treatment they need.   It continues meaningful grants that help States address the most pressing problems associated with substance use disorders in their communities and makes those grants more flexible and available to our Tribal communities who are suffering deeply with the impact of  substance use disorders.   It expands access to treatment services by making more providers eligible to prescribe medication-assisted treatment.   It includes provisions to help the Food and Drug Administration address the crisis as well, such as giving it new authority over packaging and disposal of opioids, as well as many other steps to help those on the frontlines of this epidemic.”

Rebuilding a Congress accountable to an informed electorate, a Congress that respects the limits of the Constitution, will require organized action from responsible, concerned citizens.  Please consider the program of Freedom First Society.