russia. i thought that, i mean yes, there are lots of reasons to be suspicious, lots of reasons to be wary, lots of reasons to be very, very cautious, but i thought it was possible, i made the classic classic mistake of thinking it was possible to have a reset with russia and i wanted to engage with feldman pruden and see if we can start talking about syria, areas where we had, where we needed to engage. then it just became clearer and clearer to me that was fools errand. : : :

. the president pro tempore: please join me in reciting the pledge of allegiance to our flag. i pledge allegiance to the flag of the united states of america, and to the republic for which it stands, one nation under god, indivisible, with liberty and justice for all.

the presiding officer: under the previous order, the leadership time is reserved. under the previous order, morning business to closed. under the previous order, the senate will proceed to the consideration of h.r. 6, which the clerk will report. the clerk: calendar number, 485, h.r. 6, an act to provide for disorder prevention and treatment and for other purposes. the presiding officer: under the previous order, the time until 5:30 p.m. will be equally divided in the usual form. the senator from utah.

mr. hatch: i rise today to speak on three very important topics. first, today is the celebration of constitution days and second is the signing of the miscellaneous tariff bill and finally, the opioid epidemic across -- opioid crisis response act. tonight marks 231 years since the founding fathers signed a charter that would alter the course of history, the u.s. constitution. this document serves as the foundation of our government and rerightly celebrate its anniversary -- rightly celebrate its an verse with constitution days. it has fieding principles that has served the american people very well, the separation of powers, rule of law, and system of federalism work together to

the goal of preserving liberty. the framers of the constitution recognized that the government derives its power from the people themselves. the government overturned the prevailing wisdom, or should i say the constitution overturned the prevailing wisdom that men are made for governments declaring instead that governments are made for men. these principles and our nation's dedication to them are core to our american ethics. today they set our country apart as a symbol of freedom and prosperity across the globe. the constitution is the culmination of centuries of human progress. we have a charge to fulfill its promises, we have a duty to uphold its principles. may we commit ourselves today,

and every day, to defending the truths so eloquently and essentially articulated in the constitution of our united states. mr. president, before i yield the floor, i have two more topics i'd like to address. first, the passage of the miscellaneous tariff bill act of 2018, an important piece of legislation that was signed late last week by the president. senator wyden and i introduced the bill on a bipartisan and bicameral basis, and it passed unanimously, a great example of how both parties feel about relieving americans from the burdens of job-killing tariffs. the miscellaneous tariffs bill was designed to help both supporters and producers by suspending or reducing burdensome tariffs that unnecessarily increase manufacturing and operating costs for american companies.

a miscellaneous tariff bill has not been enacted since 2010, and our businesses and manufacturers have been forced to wait too long for congress to act. i am pleased that we were finally able to end that wait. i am also pleased to report that this is the first n.t.b. -- or miscellaneous tariff bill, to have been enacted under the new process set out in the american manufacturing competitiveness act of 2016. this new process was crafted to provide a robust consultation with both house and senate rules that would be transparent and open to all. the international trade commission and the department of commerce vetted each petition to determine eligibility based on this new criteria. each of these agencies made

great efforts to evaluate each one of the thousands of petitions against the high standards set out in the amca. i would like to thank all of the staff who worked diligently do so. senator wyden and i also worked closely with our colleagues throughout this entire process to resolve any concerns that they may have with any of the included products. in the end i think we crafted a bill that we all can be proud of because it will help american businesses and it will help them compete around the world. the passage of the miscellaneous tariff bill, in conjunction with the successful implementation of tax reform, will continue to expand the american workforce, improve the american economy, and keep america competitive. and, finally, mr. president, i'm

also here today to talk about the passage of an incredibly important bill to individuals and families and communities confronting an epidemic that is overwhelming our country. this isn't the first time that i've been talking about the opioid epidemic, and, unfortunately, it likely won't be my last, but i am happy to say that today's remarks will highlight some very good news. as part of a coordinated effort with four other committees, the senate finance committee's package will be voted on tonight as part of the opioid crisis response act. but before i get to what is in that bill, i want to give some details of the unfortunate reality our country is facing. last year more than 72,000 americans died from a drug overdose. the majority of these overdoses involved prescription opioids,

or illicit opioids like heroin or fentanyl. i have spoken to many families who have experienced the devastating effects of these addictions firsthand, and i have an sadly impressed by the invasiveness of this rampant epidemic. truly, i promise you have more friends, family, and coworkers who have been affected by this epidemic than you probably realize. my home state of utah continues to be hard hit by this crisis. an alarming number of utahans have undergone hospital stays and emergency room visits due to opioid overdoses. in 2017 alone over 450 utahans died from an opioid overdose. as you may notice,

mr. president, congress has recognized this problem for some time, and while this package is a significant step forward, it isn't the first thing we've done, nor will it be the last thing we do. take, for example, the bipartisan family first prevention services act, which was enacted earlier this year in february. our committee also worked together to realize a ten-year extension of the children's health insurance program which, as a part of its mission, helps moms, babies, children, and teenagers struggling with addiction or its impacts on families across the country. our work did not stop there. we proceeded to work on ways that our committee, with its jurisdiction over medicaid, medicare family services and customs could work to improve the lives of the millions of americans who have been devastated by this devastating

epidemic. mr. president, there are simply too many pieces of this bill to cover them all in one speech, but i'd like to give some highlights. the bill will make a real difference in medicare, a program in which one in three beneficiaries is prescribed an opioid. it will empower patients through information on paying treatment alternatives, it will expand treatment options for patients suffering from addiction, including through increased access to care via telehealth in a pilot program that will allow medicare to cover methadone and wrap around services to treat addiction for the first time. the bill also increases the ability to track opioid prescriptions to prevent misuse an diversion while making sure

that patients get the medication they need. we know many children are in foster care as a result of the opioid epidemic, and this bill supports programs that will help parents complete treatment for opioid addictions and reunite with their children more quickly. it will also increase the availability of family residential treatment programs, allowing more patients to receive -- more parents to receive help while still caring for their children in a supervised setting. for the first time since medicaid became law in 1965, pregnant women can receive medicaid coverage for prenatal and post natal care while seeking treatment at institutions for mental disease. new and improved prescription drug monitoring programs allow states to better understand the full scope of an individual's prescription use across payments

and insurers. this bill brings that data into the hands of providers and insurance plans to help them develop care plans for those with substance abuse disorders. of course, let me just say that additionally this package is not limited to fixes in the health care space. we also worked with senator portman to craft the bipartisan stop act which has also been incorporated into this package. that bill sets new requirements for the united states postal service to obtain advanced electronic data that allows for u.s. customs and border protection to effectively target and stop fentanyl and other illegal substances from entering

the country through our postal system. getting our law enforcement -- giving our law enforcement -- getting our law enforcement this additional data will bolster efforts to stop dangerous opioids at the border and keep them away from american families. in short, the finance committee's portion of this larger effort is an important step forward, but it is made that much more meaningful given the wide ranging provisions included from the judiciary committee. from the judiciary, commerce, banking, and help committees. together, this bill will provide the resources, capacities, and direction to state, local, and federal governments to better assist those who are in such great need right now. additionally, i want to thank the leader, the chairman, the ranking members, and all other members of the four other committees that have been

involved in this great undertaking. there has been no shortage of effort or genuine concern from both sides of the aisle to address this painful issue that has hurt so many american families. i appreciate this bipartisan push to create a successful place for a piece of legislation, and i think this bill represents congress at its best. i encourage all of my friends on both sides of the aisle to vote for this important piece of legislation tonight, and i look forward to working with my colleagues in the house to advance a bill that addresses the opioid epidemic to the president's desk. and with that, mr. president, i yield the floor. and suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

a senator: mr. president. the presiding officer: the senator for arkansas. mr. boozman: i ask unanimous consent the order for the quorum call be rescinded. the presiding officer: without objection. mr. boozman: thank you, mr. president. mr. president, the opioid epidemic is a national crisis. it has destroyed lives, torn apart families, and strained community resources. since the year 2000, more than 300,000 people in the united states, 300,000 people have died from opioid overdoses. congress has aggressively -- is aggressively working to combat this problem by expanding prevention efforts, empowering law enforcement, and increasing access to treatment. we passed the comprehensive addiction recovery act, the 21st century cures act, and the bipartisan budget act to improve the tools and resources available to fight this epidemic, and we have another opportunity to continue turning the tide with passage of the

opioid crisis response act of 2018. last week, i met with arkansans who are on the front lines of this battle. they have seen the destruction caused by opioids in our schools, our hospitals, and the judicial system. the individuals i spoke with agree that more resources are needed in this fight. that is what the opioid crisis response act will deliver. this comprehensive package covers a wide range of avenues to attack this problem and get individuals the health and support they need to recover. this includes prevention, treatment, additional law enforcement tools, and expanding research into nonaddictive 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 the grant program to join first responders administering the drug that can be used to block the effects of opioids and prevent deaths from an overdose. in arkansas, this is having a very positive impact. since 2017, the arkansas naloxone project is training more than 3,300 first responders to administer the drug. this evident has saved at least 142 lives. the program continues to grow. it's working. other states can replicate the success we have seen in arkansas by using grant funds to train first responders. not only does this legislation help those already impacted by the crisis, it also aims to stop even more dangerous drugs, 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 that are being saved. the comprehensive response to this crisis shows -- the comprehensive response to the crisis shows how committed we are as a nation to combating opioid addiction. i applaud the u.s. department of agriculture with this week's announcement of its partnership with communities across the country to fight the opioid epidemic in rural america, including newport, arkansas. newport usda is investing more

than $150,000 to convert the former jackson county jail into the white river women's shelter. this facility will help individuals recovering from opioid misuse and provide prevention, recovery, and treatment services to combat the opioid epidemic in the region. we all have a stake in this fight. if individuals are living healthier lives, they will be able to be more productive citizens and help the community thrive. the opioid crisis response act of 2018 will aid us in this effort. i look forward to the senate passage of this bill and president trump signing it into law so we can reverse opioid abuse statistics. and with that, mr. president, i note the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

quorum call:

nor senator mr. president? the presiding officer: the senator for michigan. mr. peters: mr. president, i ask the quorum call be vitiated. the presiding officer: without objection. mr. peters: mr. president, our nation is the suffering through a public health crisis. our nation, our neighbors, our families -- in fact, very few among us -- can say that we have not been personally impacted by the opioid crisis. the scope is simply staggering. 116 lives are lost every day to opioid overdose.

116 sons and daughters. 116 husbands and wives, siblings and parents who will never come home again. 116 lives that ended decades too soon, lost every day. substance abuse disorders do not discriminate. we feel this pain in every region in our country, urban and rural areas in red and blue states. we know there's no silver bullet that will end this crisis overnight, but we do know how to fight it together, and that is what we are doing today. tonight the senate will pass the bipartisan opioid crisis response act, and this body will show a unity of purpose that, frankly, i wish we could show more often. as this important bipartisan legislation came together, i worked closely with my colleague, senator shelley moore capito, of west virginia, to make sure that our nation's

youth were not left behind. we know young adults are more than twice as likely to misuse prescription opioid pain relievers as compared to adults. one in five high school seniors knows where they can easily get heroin. and the problem continues to escalate. in michigan, the rate of opioid overdose deaths among youth under 25 has doubled since 2012. these are empty seats at the dinner table, in classrooms, and in workplaces. when tackling a problem this large, we need to follow the data and invest in what works, especially for adolescents and young adults. health experts, including the american academy of pediatrics, recommends medication-assisted treatments, or m.a.t., as the gold standard for opioid addiction treatment. while we need to continue

investing in research, completed studies have shown that youth treated with m.a.t. are more likely to reduce opioid misuse and injection drug use, continue their medical care, and achieve long-term so bright. -- long-term sob bright. the research we have on using medicate h. says l. sissed treatment shows that to be safe and effective, especially in comparison to the life-threatening risk faced by patients who go untreated. research shows that medicaid-assisted treatment has the power to cut the mortality rate of opioid- addicted patients in half if not more. france instituted a strong m.a.t. strategy in response to a heroin epidemic in the 1990's. the death rate due to overdoses were decreased by nearly 80% over the course of just four years.

substance use disorders are not a personal or a moral failure. they are a public health crisis brought on by chemical dependency. we are fortunate that our doctors and researchers have developed medication that can help end dependency and save lives, and we must get to to measurements who need it the most. it is troubling that many americans whose lives could be saved do not have enough access and it is devastating that american youth have hardly any access at all. currently only one in 12 youth who need free trade agreement for an opioid addiction actually receives it. a 2017 study found that one in four adults in treatment for heroin received medicaid-assisted treatments. while this sounds low, for adolescents, the rate is less than one in 40. and even for those fortunate enough to achieve or get the

active treatment, m.a.t. is not being used widely. similarly, only one in eight adults for treatment for prescription opioids receives medicaid-assisted treatments. for adele he isents, this is one out of out of 250. that is why the peters-capito provisions of the opioid crisis response act are absolutely crucial. they will support the identification and development of best practices for treatment and treating opioid addiction among youth and point to an m.a.t. as a specific strategy. in addition, senator capito and i successfully added a related amendment to the appropriations bill that funds the u.s. department of health and human services and recently passed the senate. the amendment will require the substance abuse and mental health services administration to submit a report to congress on what steps it takes to support m.a.t. the agency specifically will

also identify barriers they must overcome to get medicaid-assisted treatment to eligible youth. young americans copying with substance use disorders deserve every opportunity to recover. hold on to their future aspirations and lead stable and fulfilling lives. we must continue working together at every level of government as we combat this opioid crisis with scientifically proven strategies, including, for some of our youngest lives. an important step in this response is getting these provisions across the finish line, and i urge my completion to act quickly to get this legislation to the president's desk to be signed into law. i recognize these provisions are just a start, but we are losing 116 lives every day. we need to save as many as we

can and as soon as we can. thank you, mr. president. i yield the floor. i suggest the absence of a quorum. the presiding officer: the clerk will call the roll. quorum call:

quorum call:

a senator: mr. president. the presiding officer: the senator from massachusetts. mr. markey: thank you, mr. president. mr. president, i ask for vitiation of the quorum call. the presiding officer: without objection. mr. markey: thank you mr. president, very much. i rise today to speak about the pending legislation to address the opioid epidemic, a crisis the likes of which we have never seen in america. all of us know that this crisis is a nightmare. it is a scourge. the prescription drug heroine heroine -- heroin and fentanyl epidemic is a human tragedy happening in nearly every city and town of our country. preliminary estimates indicate that opioid overdoses claimed an estimated 49,000 lives just last year, including nearly 2,000 people in massachusetts.

that's more than gun violence. that's more than car accidents. the opioid epidemic is the deadliest drug overdose crisis in american history. a crisis of this proportion demands action at all levels, and i am pleased that the senate is taking a step in that direction today. i'd like to thank senators lamar alexander and patty murray and their staffs as well as the leadership and staffs of the other committees who worked to create and refine the legislative package that we'll be voting on later this evening. 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 opioid milestones act, a bill i authored with

senators lisa murkowski and maggie hassan to create a score card to the 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's what this provision will create for our country. those objectives including reducing overdose deaths, expanding treatment availability, increasing the number of individuals in sustained recovery, and decreasing emergency room visits for overdoses because if we

don't have a dash board, a score card to clearly and quantifyably show our progress on this epidemic, we will continue to fight the same battle over and over again. we urgently need to know whether our policies and resources are being used in ways that have a measurable impact on the public's health. the milestones act provision in this bill will provide a national road map for ensuring that our federal and state resources pay lifesaving dividends. that's my goal. that's senator murkowski's goal. that's senator has san's goal, and in the bill. this type of strategy was put in place to fight the hiv-aids epidemic in america, another disease that was surrounded by stigma, inaction and a lack of

research until advocates, scientists, health care providers and policymakers joined forces to chart a path forward and to make measurable progress. and while that are war is not yet won, new h.i.v. diagnoses and deaths have declined dramatically over the past two decades in the united states. when america has a plan, america wins. and that is why i am pleased that this legislative package includes important bipartisan legislation that i introduced with senators todd young and tammy baldwin to help address increasing rates of infectious diseases like h.i.v. caused by injection drug use. with more than 220 counties across the united states at risk of a hepatitis c or hiemb --

h.i.v. 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. massachusetts had more reported cases of hepatitis c in 2016 than any other state, the same year we peaked in overdose deaths caused by illicit opioids. the public health consequences of the epidemic are life and death. one recent study published in the american journal of public health roughly estimates that 510,000 people could die over the next decade due to opioid-related causes, which include overdoses as well as other causes of death tied to opioids such as h.i.v. infections from sharing syringes. that's what senator young and i

are trying to deal with, deal with this issue so we can create the tools to help us deal with this growing medical problem in our country. the provision will help ensure the federal government works with states to improve education, surveillance and treatment of opioid use related infectious diseases like h.i.v. and viral hepatitis. but we have more work to do to combat this crisis if we are going to reduce the supply of heroin, fentanyl and i will list -- and illicit opioids. that includes m.a.t., only about one in ten individuals with a substance use disorder will be able to access treatment. that is unconscionable and demands immediate action. and that's why as part of the

comprehensive diction and recovery act -- addiction and recovery act, our cara bill of 2016, senator rand paul and i worked together to include provisions that would for the first time allow physician assistance and nurse practitioners to prescribe lifesaving medication assisted treatment like suboxone for individuals with substance use disorders. since these provisions went into effect, more than 8,000 physician assistants and nurse practitioners have registered to provide medically assisted treatment. and that has resulted in more americans accessing this lifesaving care, especially in community health centers and rural communities across this country. for doctors and medical promotion -- professions m.a.t. stands for medical assisted therapies.

exangd -- expanding m.a.t. means more access to treatment. nurse practitioners want to respond to the demand side of the opioid crisis, and they are stepping up in a major way to connect individuals to the treatment which they need. unfortunately, the authority, nurse practitioners and physician assistants have to prescribe this lifesaving treatment expires in a few short years. if we don't intervene now, a substantial amount of our prescriber population will no longer be able to treat individuals with substance use disorder using this effective treatment. that will further strain our already woefully inadequate treatment workforce. that's why senators paul and senators hassan and senator collins and i introduced new bipartisan legislation to provide permanent m.a.t.

prescriber authority for nurse practitioners and physician assistants. our bill also extends this authority to other nursing professions already playing an important role in our fight against the opioid crisis. certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists, these dedicated nursing professionals are irreplaceable members of our health care community and we need to make sure they can provide treatment that saves families from the suffering of diction. the legislative package we are voting on in the senate unfortunately does not contain this bipartisan legislation on medication assisted treatment. this is a missed opportunity to build upon our commitment to treatment. but the house-passed opioid legislation does contain a version of our provision to make the prescriber authority for nurse practitioners and

physician assistants permanent, and to expand that authority to the other nursing professions. i will continue working with my colleagues to ensure that the lifesaving provision makes it into the final opioid package negotiated between the house and senate leaders. 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. not only must we expand access to treatment, we must also think about how we can help to prevent addiction from taking hold in the first place. last week i introduced bipartisan legislation with senator orrin hatch to help ensure patients and their loved ones understand the risk of prescription opioids. i've heard too many stories

about substance use disorders that began from an opioid prescribed to an individual injured on the job who needed to feel well enough to return to work the next day, or to help heal a sports injury. that is the story of corey polazi from taunton, massachusetts. in hool corey -- in high school, corey had a love for the game of baseball. but the basic diamond for him him -- baseball diamond for him was the happiest place on earth. in his junior year corey had a shoulder injury that required surgery. he became addicted to his medication. his painkiller addiction eventually became heroin addiction. and in 2013, corey suffered a heroin overdose which has left him permanently disabled. but corey and his family,

laurie and dave, turned this tragedy into triumph. today they share their stories at schools and other organizations to warn the public about the danger of drugs and offer a message of hope for those who are faced with addiction. we thanked them for their courage, for their strength and for their commitment to ending this crisis. the pollazi family knows firsthand that prescription opioids are dangerous, but because of the confusing names and ingredients, many families may not know that they have just left the pharmacy with a bottle full of danger. the path from one bottle of pills for patients who have had their wisdom teeth removed or suffered a sports injury to addiction needs as many roadblocks put in place as is humanly possible. the legislation that senator hatch and i have introduced, the lessening addiction by enhancing labeling, or label

opioids act, would require that all prescription opioid bottles dispensed to a patient contain a clear, concise warning that opioids may cause dependence, addiction or overdose. in the absence of legislation to ensure that providers across the country receive uniform mandatory education on safe opioid prescribing, we need to give patients information on how to safely use, store, and dispose of these dangerous medications. in the same way we put warning labels directly on cigarettes for being addictive and causing potential death, we need labels to caution patients about the daiks -- dangers of prescribing opioids. it is important that everyone who receives an opioid prescription understand the potential risk, and a sticker on an opioid pill bottle is a

powerful, consistent reminder of that danger. we must do all we can to put a stop to this dangerous opioid crisis that has ravaged families and communities across the country for too long. we are moving in the right direction. but today's vote should not be the end of our work on this issue. i thank my colleagues in this chamber for their commitment, and i look forward to working with them in the conference and beyond to make sure that we put everything in law nationally that helps to ensure thahahaha children have to look to the history books to find that there ever was such an epidemic as this opioid crisis. on once again i thank senators heakser -- senators alexander and murray for their great work. i yield back.

the presiding officer: the senator for maine. mr. king: mr. president, the discussion today is about the opioid crisis, one of the most serious public health crisis i have seen in my adult, certainly in the state of maine. it's 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. there are few rays of hope in

this rather bleak picture. the numbers continue to get worse. more and more families are being devastated by this crisis, and there aren't many answers being provided. there is, however, one ray of hope that this bill that we're going to be discussing and voting on this afternoon does provide, and that is treatment works. recovery is possible. i was at a rally in portland, maine, just a week ago with people of all ages from all over the state who were there to publicly say i'm in recovery, it works, treatment saved my life. and i think that's what's so important about continuing the work that we've done in this body. now, the problem is that treatment, particularly in rural areas, is short on infrastructure. it's short on people who can

deliver the treatment. and we can fund programs and traumatic about them here, -- and talk about them here, but if you are talking about a place in maine, you're not talking about a tremendous amount of infrastructure. but there is available an army of people who can contribute to the solution of this problem. the people i'm talking about are nurse practitioners. nurse practitioners are, in many ways, the unsung heroes in the health care discussion, particularly, again, in rural areas where there aren't a lot of physicians. but nurse practitioners were enabled in the cara bill to provide medical assisted treatment -- medicine assisted treatment, but the problem is that authority expires in 2021, and therefore we need to fix that.

it's working. it's an important part of our ability to deliver these low profile saving service -- lifesaving services. and we've got people in maine, nurse practitioners who are willing, ready and more than able, and they've proven that, more than able, to continue their lifesaving services, 1,700 in the state of maine. the bill we're going to be voting on this afternoon unfortunately does not have this extension in it, but i'm here this afternoon to urge those who are going to be supporting the bill and then working on it in conference with the other body to see that this small change, maying the authority for -- making the authority for nurse practitioners to deliver medically assisted treatment to people suffering and trapped in the throes of addiction, allowing those nurse practitioners to have that authority to not have it expire

in 2021 and create the anxiety both in the patient community and in the medical community that termination will do. let's, for once, do something before it's a deadline. let's do it now. and i believe we can do it as part of this discussion, as part of the final resolution of the bill that's going to be before us this afternoon, which i entirely support. but i think this is an important addition that will strengthen it and that will particularly strengthen the ability to deliver this care, this treatment that so important to so many people and families and communities, particularly in the smaller towns and rural areas of america and in my state of maine. so, mr. president, i rise to support the bill but also to suggest this small change that i think will dramatically increase the effectiveness of the treatment that the bill enables and will allow it to be delivered in an equitable and

direct and important way to people all across the count no matter -- across the country no matter where they live or the status of their health infrastructure because nurse practitioners, as i say, are an army of people who are ready, willing, and able to deliver this service, and i hope we can make this one modification to this bill that will allow it to allow that service to be provided, not only between now and 2021, but on into the indefinite future when hopefully we can rid the country of the scourge of this terrible opioid and drug addiction. thank you, mr. president. i believe this is something that we can and should do, and i look forward to working with my colleagues to make this happen. mr. president, i yield the floor. a senator: mr. president. the presiding officer: the senator for new hampshire.

ms. hassan: thank you, mr. president. i also want to thank my colleagues senator king and senator markey for their remarks and their work as we all come together to battle this terrible opioid epidemic. mr. president, i rise today as the senate considers bipartisan legislation that marks a critical step forward in the fight against the fentanyl, heroin, and opioid crisis. mr. president, 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 that communities are experiencing from all angles. we need to collaborate across traditional boundaries. we need to take ta truly -- a truly all-hands-on-deck approach because the magnitude of this crisis demands it. mr. president, this crisis does not discriminate.

i've spoken to so many individuals and families from all walks of life who are heart broken and reeling. their loved ones were professionals, students, athletes, parents, and then they fell victim to this illness and their lives and the lives of those who loved them were never the same. just this morning i met with a number of grandparents who are now the primary caregivers for their grandchildren, a situation that many of us at first considered a phenomenon and now realize has become commonplace because the children's parents have died or they are in prison or they are simply absent or unable to be a caregiver due to their substance use disorder. i spoke this morning with this group of grandparents, two of

whom have been raising their grandson for nearly nine years now, one of whom has seen her grandchild returned -- two grandchildren returned to their parents after their parents recovered from their addiction but in one case the grandparent who's grandchildren have gone back to his parents at age 57 starting life completely anew. she had given up her job, gone through her entire retirement savings to keep her children safe while their parents battled their addiction. another set of grandparents who, again, have given up everything to keep their grandson safe are scared of going to court to get permanent custody and adopt their grandchild because they

are concerned that the child's father will reappear and contest the custody and the cost of that custody battle will mean that they have no money left to care for their grandchild. most heartbreakingly, both sets of grandparents said to me that they were worried about what would happen to their grand children should -- grandchildren should they die since the children's parents might not be able to be there for them. i was also reminded today that at one of our largest treatment centers in new hampshire the providers estimate that 40% of those in treatment have children which means there will be more and more children in our communities who need their grandparents or other caregivers to step forward.

mr. president, this crisis is also taking a particular toll on first responders who respond to overdose after overdose sometimes reviving the same people on the same day. and this crisis impacts our workforce and our economy. i met with a number of ploars who can't -- employers who can't fill jobs because they can't find workers who can pass a drug test. and there are people now in recovery, some with convictions on their record, who wonder if anyone will ever give them a second chance. there is a lot of collateral damage from this crisis. now, the good news is that just as the ripple effect of this epidemic touches all parts of our communities, people from all corners of new hampshire and our country are responding as communities, as friends and neighbors, and as first

responders and health care providers in a collaborative manner. this is a multifaceted problem and it requires a multifaceted approach. but for too long we haven't seen a federal response that matches the urgency on the ground. i'm hopeful that by passing this bipartisan legislation we can move forward with giving communities and families some of the support that they need and that they have been waiting for, aching for. mr. president, this comprehensive legislation we are considering today includes many priorities that the people of new hampshire, particularly those on the front lines, have been urging us to fight for. this bill reauthorizes and improves state-targeted response grants to ensure that states hit hardest by this crisis, states like new hampshire, continue to get the resources that they need. this legislation also includes

the bipartisan comprehensive opioid recovery centers act, which i partnered on with senator capito, to offer grants to expand existing centers of care to provide comprehensive coordinated care and support services like housing and employment reintegration for those in recovery. we have also heard loudly and clearly from our health care providers that we need a more integrated approach in order to combat this complex disease on all fronts. so this bill includes legislation that senator portman and i worked on together aimed at the next generation of doctors, encouraging medical schools and residency programs to integrate addiction medicine and treatment into their curriculum as well as ensuring that doctors who get this training can get medicated assisted treatment as soon as they are licensed and have a d.e.a. number. and members of lawmpletd have

made clear that they need additional tools to crack down on bad actors in the pharmaceutical industry whose behavior has greatly contributed to this crisis. so senator grassley, senator cruz, and i worked on a provision to make those tools available and to hold industry-bad actors accountable. this legislation also curbs the importation of deadly fentanyl and other synthetic drugs being shipped through the borders to drug traffickers here in the united states. these are just a number of the key provisions included in this bill, and as the senate moves forward and moas into -- moves into negotiations with the house of representatives, i will work with members of both parties to make important improvements. for example, we should keep working in a bipartisan way to include a provision making permanent prescribing authority for nurse practitioners and

physician assist unanimous at some of the -- assistance at some of the centers that senators markey and king were just talking about. nurses and practitioners are an important part of this. and they are prescribing authority should be made permanent. and we should allow additional practice nurses to prescribe. mr. president, i am pleased that we are taking this step forward today. i am grateful for the senate's bipartisan work that has brought us to this point, the consideration of the bill on the senate floor. i'm particularly grateful for the work of senator alexander and senator murray. this legislation is a vital next step in our efforts to combat this crisis, but the biggest mistake that anyone could make is thinking that our efforts are anywhere close to being done.

as the families i met with this morning made clear, we have a lot more work to do. i'm encouraged by the progress of this bill, and i believe its implementation will help us mount a much more informed and comprehensive response to this devastateing epidemic. i also remain encouraged that we have secured a significant increase in federal funding to combat this crisis through our budget negotiations. but let there be no mistake, we will need to continue to work together, in particular to learn about which treatment and recovery practices will be successful in the long run, and we will need further research to establish best practices for supporting a newly at-risk -- the children with this disorder. we have been responding to and learning about this disease as the epidemic unfolded, and there

is much we do not know and much we still need to tackle. i'm encouraged that members of both parties have come together, demonstrating that we can put partisanship aside and work together to address some of the most dire challenges our communities face. we owe it to all of the many stake holders in this fight to keep listening to them, to keep collaborating together, and to keep working on solutions so that we can truly make progress and get better. this is a good start, but it is and must be only a start. thank you, mr. president. i yield the floor.

mr. mcconnell: mr. president. the presiding officer: the majority leader. mr. mcconnell: are we in a quorum call? the presiding officer: the senate is not in a quorum call. mr. mcconnell: since the senate last convened, hurricane florence made landfall on our nation's eastern seaboard. according to the latest estimates, this terrible storm has already claimed more than 20 lives in north carolina, south carolina, and florida. with more than a million americans subjected to mandatory evacuations, many families have been displaced, and the storm

surge and historic rainfall have brought communities to their knees with crippling flooding. the senate stands with all those affected. we stand ready to ensure that communities in the storm's path have the resources they need to recover and rebuild. once that time comes. for now, we stand in solidarity with the americans who are battling this storm and with first responders who bravely risk their own safety to care for their communities. on another matter, today the senate will take two important actions to help vulnerable americans. first we will pass the patient right to know drug prices act spearheaded by senator collins. this legislation would ban so-called pharmacy gag clauses which prohibit pharmacists from sharing drug-pricing information that would save consumers money. in circumstances when the out-of-pocket retail costs of a medication is actually cheaper than the price through

insurance, it will allow customers access to information they need to choose the more affordable route. after that, we will vote on major landmark legislation to address the opioid crisis that continues to weigh on our country. my fellow kentuckians and i are all too aware of how drug abuse and addiction attack families and communities. overdoses killed 1,500 kentuckians last year alone. that's more than four fatalities per day. nationwide, it's more than 115 fatalities per day. the effects of this emergency compound themselves. the crisis can eat away at family ties, at community institutions, at economic opportunities, precisely the things that are necessary to lift americans out of addiction and into recovery. on one hand, research suggests that opioid use rose the most in

the very communities where employment fell the most. on the other hand, experts blame the opioids themselves for a major share of falling workforce participation to the tune of roughly one million missing workers. a comprehensive crisis demands a comprehensive solution. that's exactly what this landmark legislation is. it combines work from five committees and input from more than 70 senators. first, this legislation will help cut off the opioid crisis at its roots. it will stop more drugs at the border, improve interstate monitoring, and encourage reform of prescription dosing. it will encourage recovery through more resources for state and local responders, better access to care for patients, and more support for the families and caregivers of those affected, and this legislation looks to the future by surrounding long-term medical research and economic solutions to get our country past this

vicious cycle. i'm pleased that two of my provisions are included, the career act which expands grants and targets funded for transitional housing and job opportunities to help recovering individuals find their footing and stay sober, and my protecting moms and infants act which will refine our federal efforts to combat the effects of opioids on expectant mothers and their unborn children. the situation facing americans and communities is urgent. with this landmark legislation, the senate has risen to the moment. it's no wonder that experts and advocates representing more than 200 organizations on the front lines of the opioid crisis have publicly called on the senate to act. well, that's just what we will do when we pass this landmark legislation later today. now, on a final matter, mr. president, it's been 70 days, 70 days since the

president nominated judge brett kavanaugh to fill the current vacancy on the supreme court. for more than two months, the senate has poured over judge kavanaugh's professional record. we have reviewed the 300-plus opinions he has authored while serving on the d.c. circuit. more pages of documents than have ever been produced for a supreme court nomination, more than for the five past nominations combined. and testimony from prominent legal scholars and top litigators who praised the nominee's intellect and his exemplary performance on the federal bench. we have also considered a wealth of evidence that pertains to judge kavanaugh's character and his personal integrity. we have heard testimony or received open letters from literally hundreds of men and women who know judge brett kavanaugh, who have worked

alongside him or clerked for him as a judge or who have known him and his family personally over the years. this is what the senate has considered for the past 70 days. in the senate, and around the country, almost everyone who went into this process with an open mind who was prepared to give judge kavanaugh a fair hearing has come away impressed, but now, now an accusation of 36-year-old misconduct dating back to high school has been brought forward at the last minute in an irregular manner. it is an accusation which judge kavanaugh has completely and unequivocally denied. this is what he said. this is a completely false allegation. i have never done anything like

what the accuser describes to her or to anyone. it is an accusation which the ranking member of the committee of jurisdiction has known about for at least six weeks. known about for six weeks, yet chose to keep secret until the 11th hour. neither she nor any of her democratic colleagues chose to raise this allegation during the committee staff's bipartisan background calls with the nominee. they did not raise it even when the name -- even with the name redacted in the 65 meetings, 65 meetings judge kavanaugh held with senators before his confirmation hearing, including his private meeting with the ranking member. they did not raise it even with the name redacted in four days

of exhaustive public hearings while judge kavanaugh testified under oath. even though they chose to raise myriad other matters at the hearing, including sometimes bizarre innuendo. they did not raise it in the closed session, the proper forum where such an allegation could have been addressed with discretion and sensitivity. they did not raise it in the 1,000-plus follow-up questions that senators sent to judge kavanaugh in writing. but now, now at the 11th hour, with committee votes on schedule, after democrats have spent weeks and weeks searching for any possible reason that the nomination should be delayed, now, now they choose to introduce this allegation. not through the standard

bipartisan process, not by advising the judiciary committee colleagues and committee staff through proper channels, oh, but by leaking it to the press because the chain of custody of this letter runs through the democratic side of the judiciary committee. that's the chain of custody. i can't explain the situation any better than the senior senator from maine put it yesterday evening when she said if they believed judge kavanaugh's accuser, why didn't they serve us this information earlier so that he could be questioned about it? and if they didn't believe her and chose to withhold the information, why did they decide at the 11th hour to release it? it's really not fair to either of them the way it was handled. well, if as the senior senator m texas said yesterday -- or earlier today, the democrats have so egregiously mishandled

this up until now, it's no excuse for us to do the same. just because the democrats have egregiously mishandled this, said senator cornyn, there is no excuse for us to do the same thing. i'm glad that chairman grassley is following standard practice and regular order, and he stated he plans to pursue this matter by the book, with bipartisan interviews of both judge kavanaugh and dr. ford. i have great confidence in chairman grassley and his ability to proceed through this process. a senator: mr. president. the presiding officer: the senator for montana.

mr. daines: mr. president, i want to thank my colleagues, this body for their hard work and true bipartisan effort to address the opioid and drug crisis in the united states. the legislation before us will help combat an epidemic that touches the lives of almost every person in our country. in montana, opioid overdoses have claimed the lives of 700 people since 2000. and from 2013 to 2014, 42% of all drug-related deaths were caused by opioids, with easier access and a larger supply on the street, we are finding opioids in the hands of more and more people. it's tearing families apart. it's devastating our communities. 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 many other states, and that is the methamphetamine epidemic.

in montana, meth is destroying families and communities in disproportionately -- and disproportionately impacting our tribes. in fact, we have seen a 415% increase in meth cases from 2011 to 2017, and a 375% increase in meth-related deaths in that same time frame. put this in perspective, in 2013, law enforcement seized 40 powfnedzs of -- pounds of meth. in 2017, that number more than quadrupled to 188 pounds, almost all meth in montana is smuggled across the southern border. and we're seeing a dramatic increase of that drug flowing from mexico into our communities and meth is linked to more violent crimes and robberies than any other drug.

meth is highly addictive. it's destructive. it destroys the body both inside and out. and we're seeing sad story after story on the effects and impacts of meth and drug use in among -- in montana making headlines. in fact, just last week, a man was charged with leaving a baby in the woods near lolo hot springs who admitted he was high on meth and bath salts. according to reports, he left a 5 months old in the woods because, quote, he grew tired of carrying it. this is a despicable and horrible story. this is just one of many we're seeing across montana. i'm thankful for those on the ground in machine machine for diligently working to com-- montana for diligently working to combat this crisis including jim fox as well as our local law

enforcement. at the federal level, our goal must be to partner with states and communities to overcome this devastating reality. oongdz that's -- and that's why i fought for specific provisions to be included in this opioids bill we're going to pass this week. my bipartisan legislation, the mitigating meth act, which expands the state targeted response to the opioid crisis grants to include indian tribes as eligible recipients and that's included in this broader legislation we have before us. this initiative is extremely important to curbing substance abuse on indian reservations. the stop act, another bipartisan bill that i've cosponsored is included in this package before this body. this bill helps stop illegal drugs from crossing the border or being shipped through the postal service. in addition, programs like the high intensity drug trafficking area, drug courts, and the cops

antimeth program are all reauthorized in this package, and i can tell you something. these are vital resources in combating meth use in montana. without these tools we'll continue down a dark path. but i believe with these programs and by passing this bipartisan bill in the u.s. senate, we can begin to finally curb this problem. i truly want to thank my colleagues and i look forward to passing this legislation and sending this to the president's desk.

a senator: mr. president? the presiding officer: the senator for maryland. a senator: i ask consent that the quorum call be dispensed with. the presiding officer: it is not. mr. cardin: mr. president, shortly we're going to have an opportunity to vote on the opioid crisis response act of 2018 which i strongly support, but i want to share with my colleagues a roundtable discussion i held in baltimore just a few hours ago. i met in the area of cherry hill, i met with leading experts in regards to the opioid crisis. we had the leadership from baltimore city, baltimore

county, anne arundel county, representatives from the state, and a lot of different other organizations. it started with dr. jason lotter who is president of bay mark giving us a tour of the new facility that he opened up in cherry hill. this is a wonderful new facility for opioid addiction. it uses the use of medicines in order to control a person's addiction, and it is the state of the art facility. it was just opened last month or two months ago. so it's a brand new facility. and i -- i asked dr. clutter exactly how he was able to do this. the first thing he mentioned to me was the importance of the affordable care act. because of the expansion of medicaid and the coverage for addiction and the coverage of essential health benefits within the affordable care act, the

clinic can get a lot more reimbursement for the people who use the facilities giving them the wherewithal to be able to construct a new facility in the community, giving access to care for those who have addiction. we then heard from jose rodriguez who's the baltimore city health department's director of opioid overdose prevention, and he told us about a lot of the innovative programs that we are looking at in baltimore in order to provide treatment to opioid adiblghted individual -- opioid addicted individuals. one of the innovations that the mayor of baltimore wants to do is known as the stabilization center. the stabilization center would be 24/7 which is critically important. people that are stressed normally are not during normal business hours. and it's important to have availability in the inscon veents -- inconvenient hours of

the early morning. and an emergency room provides that access, but the problem is that emergency rooms, many are not capable of handling people with o.d. that individual can become very disruptive within the emergency room setting making it difficult for the hospital to provide adequate care for the other patients. so the mayor of baltimore wants to establish a stabilization center which would be 24/7 and available to handle people who have drug problems when they need it and provide the necessary services to not only save their life but to put them on a track to deal with their addiction needs. we're very proud of the leadership in baltimore city to move forward on this. i wanted to share that with my colleagues some of the innovative programs that are being suggested. linda brian is the baltimore county program manager for recovery oriented system of

care. she was telling us about a program in baltimore county where they use peer coaches. these are -- peer support system, people who have gone through the addiction recovery process. they train them under this program, help them to go out and coach those who are suffering from addiction so they not only get in treatment but they stay in treatment and they have a road to recovery. it's an innovative program that is working well in baltimore county. we then heard from jen corbin who is the program director for the anne arundel county crisis response team. here, mr. president, we have an innovative program known as safe stations. let me explain this. this is 24/7 also. i already told you the need for 24/7 programs. what the leadership in anne arundel county -- and this is a county that borders baltimore and borders annapolis. annapolis is part of anne

arundel county. so it's an urban area but it has some rural aspects to it. they allow every one of their fire stations, every single one in their county, to be accessible 24/7 for an individual who is stressed and needs help in regards to their drug problems. now, when they set this program up, which is less than a year ago, they're expecting to get about five visits a week. they're getting five to ten visits a day, a day. people are coming in to get rid of their drug paraphernalia, no questions asked. they'll take it there. they're getting in there to access the system as to how they can deal with their drug addiction problems. they're seeking care. they're coming in there when they're stressed. and they are getting care. the first responders will provide immediate help and they have the availability of county services to get people into treatment 24/7.

it is working. it's working so well that we have people from other counties that are referring their people to go to anne arundel county to go to the fire station house. and just this past week, one of the private insurers told one of their insured, why don't you go to the anne arundel county fire station in order to get your help. we need to expand these types of programs of the fire chief told me one other thing which was very interesting. theft crime in anne arundel county since they started this program is down 13%. theft crime, of course, as we all know feeds -- a lot of it feeds habits and it's showing it's paying off to the community in reducing crime. i mentioned today's roundtable. i've had about a dozen in maryland throughout the state, eastern maryland, western suburbs, baltimore suburbs, southern maryland, the northern counties.

and there's a common theme here. the common theme is there's no simple answer to the opioid crisis, that it involves not only a health issue and we need to have services under our health but we also need to recognize it deals with transportation, it's a social problem, deals with how the courts handle these issues. it's multiple disopinions that are -- disciplines that are involved in dealing with the opioid epidemic. and that's why i'm so pleased that we're going to have a chance to vote on the opioid crisis response act of 2018. we all know that despite our great efforts here and we've provided billions of dollars of additional federal support for these programs, that the opioid crisis is still on the rise. the number of o.d. deaths ever still increasing in many parts of the country. every community is experiencing challenges with the opioid crisis. so it is appropriate that we are taking comprehensive action to deal with this problem.

the opioid crisis response act of 2018 reauthorizes and improves the 21st century cures act. governor hogan, the governor of maryland, has strongly urged us to pass this section. f.y. 17 maryland received $20 million under the cures act it will help states like maryland even do more. it's a true federal partnership of our state and local governments to deal with this crisis by providing greater base support for opioid problems. secondly, this bill provides comprehensive opioid recovery centers under samhsa. why is this important? this allows for locals to apply for federal grants for innovative new programs. i mentioned the stabilization program in baltimore city. it's also one on the upper shore. stabilization -- there's no direct funding for stabilization centers because it's not a

hospital. it's -- it doesn't fit into the normal reimbursements. this program that's included in the opioid crisis response act will allow grants to move forward on these innovative programs such as the one in baltimore city. the legislation provides for us dealing with peer support, an area that i have championed in the -- on the finance committee and have talked frequently on this floor about the importance of peer support programs. this legislation will help provide technical assistance in order to provide peer support, but also asks the g.a.o. to take a look at the medicaid reimbursements to see if we can't have a more comprehensive way to deal with peer support reimbursement. it expands telehealth, an area i've been directly involved with. i'm happy to hear that. it's an important part in dealing with the opioid crisis. it deals with a new area that we haven't really dealt with

before, and that's housing. as i said, the problem of opioid addiction is not just health. it's also housing. and this legislation will provide a way in which we can help the homeless and deal with the housing issues in order to make people less vulnerable to being left out of the opioid recovery. it does deal with the underlying causes with research and development and nonaddictive painkillers to get c.d.c. grants and to look at mechanisms that control prescription drugs. and it does deal with the killer effect of -- that we have in fentanyl. fentanyl, as you all know is a synthetic drug primarily produced in china but there are other sources that come into this country that are mixed with heroin causing in -- causing in many cases instant death. this will provide a way which customs will have greater enforcement to keep fentanyl out of the united states andro