Speeches & Floor Statements

Opening Statement: Alexander: Washington, D.C. Can Help, But Solution to Opioid Crisis is Strong Community

Posted on January 9, 2018

Today we turn our attention again to the opioid crisis—the nation’s number one public health challenge.   

Our witness is Sam Quinones, the author of “Dreamland, The True Tale of America’s Opiate Epidemic.”           

Senator Murray and I will each have an opening statement, then I will introduce the witness. Then we will hear from Mr. Quinones and then senators will each have 5 minutes of questions.

Mr. Quinones, it is unusual to have a single witness at our hearings. But this is an unusual topic, one you quote Washington State research professor Gary Franklin as calling the “worst man-made epidemic in history.”

The challenge this crisis presents has captured the attention of every member of this committee. Your research and writing have been acclaimed for their depth and breadth. 

So this is what we call a bipartisan hearing, one in which Democrats and Republicans have agreed on the topic, on its importance and on the witness—and it is my hope that we senators will restrain our habit of lecturing one another about health insurance and focus today on the opioid crisis. 

This epidemic kills more Americans every day than car accidents.  

In each of our states we are reminded almost every day of the crisis.

Yesterday I dropped by a meeting at the Tennessee Governor’s Residence in Nashville. The heads of all our state’s institutions involved in training doctors were planning how to discourage the over prescription of opioids.  

The governor told me that in our state of 6.6 million people, there were 7.6 million opioid prescriptions written in 2016.

And that even though the state has reduced the amount of opioids prescribed, that the number of overdose deaths is up because of abuse of fentanyl, a synthetic opioid.

Rather than spend more time establishing the crisis, I want to focus today on what we do about it.

Here are two things I am hoping to learn from you:

First, when 100 million Americans live with pain, 25 million of them with chronic or severe pain, why is it NOT a good idea to continue to find the so-called holy grail of medicine, a non-addictive pain medicine?

And, second, if stronger communities are the ultimate solution to this crisis, as you suggest often in your book, what can a central government in Washington do that actually helps?

Now, on my first question: you have a chapter in your book entitled, “Searching for the Holy Grail:  finding a non-addictive pain medicine.”   

This search began 75 years ago, in 1928, with the Committee on Problems with Drug Dependence.   This was the goal, as you describe it: “couldn’t the best scientists find a way of extracting the painkilling attributes from the [morphine] molecule while discarding its miserable addictiveness?” 

This effort to find a better way to treat pain, you say,   led to a revolution in attitudes toward pain treatment, first using opiates to relieve pain for dying patients, then for patients with chronic pain and then—abetted by a multitude of helpers from Mexican gangs, to pain clinics, overprescribing doctors and enterprising drug companies—spiraling into the addiction and its consequences we face today.

At least twice before this Congress, Dr. Francis Collins, the head of the National Institutes of Health, has predicted that the Holy Grail that was first sought 75 years ago is now within reach.

Last month he said perhaps within five years.

With our encouragement, Dr. Collins has organized NIH researchers in partnership with private companies to speed up the process and the Food and Drug Administration Commissioner, Dr. Scott Gottlieb, is on board to fast track the effort within the bounds of safety and efficacy. 

But I read at least some of your book to say that this Holy Grail may never be found. You even quote some scientists who say it should not be found.  

So I hope you will tell us, what you think about this:  should we not continue to try to find non-addictive pain medicine to relieve suffering without addiction? Is that not the obvious antidote to the opioid epidemic?

The second area I hope to learn from you about is what we can do from Washington, D.C. 

We have tried in important ways to address the ravages of this crisis, which we have experienced in almost all of our states.

In 2016, Congress passed the Comprehensive Addiction and Recovery Act – CARA – and the 21st Century Cures Act to give states and communities – those on the front lines – the tools and resources they need to combat this crisis. 

For example, in CARA, a provision by Senators Warren and Capito was included that made it clear pharmacies could only fill part of certain prescriptions – like oxycodone, an opioid. That way, a mom filling her son’s pain medicine prescription after his wisdom teeth surgery could ask for only three days’ worth of pills, instead of the 30 days he was prescribed.

In addition to encouraging the development of a non-addictive pain medicine, Cures included more than $1 billion in state grants.

We are considering additional funding for treatment and to discover alternative pain medicines. 

We have held hearings on wellness — lifestyle changes such as exercising and eating healthier that help people lead healthier lives, and what incentives would help people make those lifestyle changes.   

But you and I apparently have at least one thing in common: I am a skeptic of Washington’s capacity to solve problems that are essentially problems of communities, families and lifestyles.

You say that the opioid crisis is a problem of society. That when we lose our sense of community, we become easy prey for quick, external solutions for complex problems, such as opioid painkillers.

In your words, “I believe more strongly than ever that the antidote to heroin is community...make sure people in your neighborhood do things together...break down those barriers that keep people isolated.”  

In my experience in public life, including time as governor of my state, I have become increasingly convinced of the problem-solving abilities of communities with good jobs and schools and strong families where everyone seems to be interested in the wellbeing of everyone else.

Whenever I have tried, as governor or senator, to solve a problem, in the end, it has boiled down to creating an environment in which communities could themselves fix problems—not sending in single-shot solutions from a distance.   

For example, after spending years on state reforms in education as governor, I ended up traveling the state to create 143 Better Schools community task forces, because I believed that communities who wanted good schools could have them and those that did not would not.  

I held the same views as we fixed No Child Left Behind in 2015, when we restored more decisions to classroom teachers, school boards and states.

So exactly what does Congress do from Washington, D.C. about this opioid crisis?

This committee has jurisdiction over a significant amount of what you have written about in “Dreamland,” but not the spending of money. That belongs in the Appropriations Committee.

We are eager to hear your testimony and your solutions.