As drug overdoses climb — rising 12 percent between October 2016 and October 2017 — Congress has floated dozens of proposals to combat opioid abuse.
Some lawmakers have deeply personal connections to the epidemic of addiction in America. These are their stories.
This story first appeared in the June 4, 2018, issue of CQ magazine.
Sen. Johnny Isakson
The future finally appeared promising after years of struggle for Isakson’s 25-year-old grandson.
Charley Joyner was poised to graduate summa cum laude with a mathematics degree from Georgia Southern University after getting treatment for drug addiction and remaining in recovery for several years.
But two nights before graduation, Isakson received a 3 a.m. phone call from his son, John, saying the police had found Charley’s body. He died of an opioid overdose.
Isakson said he had noticed personality changes. For years, Charley sought treatment — sometimes doing well, other times backsliding. The family knew there was a problem if Charley didn’t come home or his parents didn’t know where he was.
After Charley’s death, Isakson and his wife started a college scholarship fund in his name.
The family tragedy also helped fuel the Georgia Republican’s legislative efforts to combat the opioid crisis, focusing on prevention to help people avoid addiction in the first place.
“You want to try and help other people to avoid it if possible and help everyone be aware that it can happen in any household, at any time, at any place and to anybody,” Isakson said.
Charley was one of more than 900 Georgians who died of an opioid-related overdose in 2016.
Over the course of one year, the number of prescribed opioid doses surpassed 541 million, the equivalent of roughly 54 doses for every man, woman and child in the state, according to Isakson.
Last year, he supported a bill aimed at allowing the Department of Veterans Affairs to securely share data with state prescription drug monitoring programs for patients prescribed opioids by VA providers. It was signed into law in November.
Last month, he introduced a bipartisan measure, along with Sens. Dean Heller, a Nevada Republican, and Robert Menendez, a New Jersey Democrat, that would require the Department of Health and Human Services and the Centers for Medicare and Medicaid Services to develop a plan to prevent opioid addiction and increase access to medication-assisted treatment.
Charley was doing well in school and working before his death; his family was excited about his prospects, Isakson recalled during a recent Senate Health, Education, Labor and Pensions Committee hearing.
“Addiction is the big problem,” he said. “Charlie was a great kid, as smart as he could be, but he was hooked. And no matter how long you stay out in recovery and free of drugs, it only takes one.”
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Rep. Debbie Dingell
Dingell has experienced first-hand the complicated challenges addiction presents for families.
Her father was addicted to opioids, among other drugs, and her little sister died of an overdose at age 44.
But the Michigan Democrat said she believes efforts to limit access to prescription opioids shouldn’t go so far that they prevent patients with legitimate needs from getting the medications to help them.
Dingell’s husband, 91-year-old former Rep. John Dingell, suffers from chronic pain, a result of joint deterioration and numerous surgeries. He is cautious and doesn’t want to take the pills if he doesn’t have to, but he needs relief, she said.
“When I go to the pharmacy to pick up his pills, people say to me, you need to do something. We are demonizing people who are taking pain pills,” she said. “People with legitimate needs need to be able to get their medicine and not feel like a villain.”
Dingell has called on her fellow lawmakers to help spur research into alternative treatments for pain.
In February, she introduced a bill that would give the National Institutes of Health new authorities to better partner with innovative companies exploring new ways to address the opioid crisis and other public health threats. Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander, a Tennessee Republican, and ranking member Patty Murray, a Washington Democrat, have introduced companion legislation in the Senate.
Removing the stigma around mental health is also a priority for Dingell.
People self-medicate with drugs and other substances to deal with conditions like depression and anxiety, yet the country’s mental health system has been systematically destroyed over the years, she said.
She co-sponsored a bill, known as Jessie’s Law, which would allow doctors to better access a consenting patient’s addiction history to inform their treatment. The measure was approved by the House Energy and Commerce Committee in May.
Talking about her personal ties to the overdose crisis is still hard for Dingell, but she sees the need to put real faces on how drugs devastate families across the country.
“I would never have had the courage to talk about this 10 years ago. You just didn’t. It was an embarrassment. It was a stigma,” she said, adding that the world has changed. “I talk about it honestly because we need to help each other.”
Carter’s unique perspective in Congress as its only pharmacist informs his views as he and fellow legislators work to address opioids.
Before entering Congress in 2015, the Georgia Republican spent 30 years filling prescriptions and running a pharmacy business that grew into three locations around Savannah. As a state senator in 2011, he successfully sponsored a bill to launch a prescription drug monitoring program in Georgia. In the 115th Congress, Carter joined the Energy and Commerce Committee, which oversees health care policy.
During his time behind the pharmacy counter, Carter said he observed a shift in opioid prescribing practices. It became obvious when a patient had been to a doctor running “pill mills” — clinics in which physicians write prescriptions in exchange for cash without delivering any true medical care. Such clinics often flood a community with drugs.
“They’re infamous for dispensing the holy trinity of drug abuse,” he said: oxycodone, the opioid painkiller; Xanax, an anxiety treatment that, when mixed with opioids, can increase the risk of overdose and other harms; and Soma, the muscle relaxant.
Patients would come in with prescriptions for 180 doses of each of those drugs, Carter said.
“You know right then it’s a pill mill,” he said. “You’re not getting any medical benefit from those three prescriptions in that combination in that quantity.”
While those kinds of prescriptions could be a red flag, especially if they came from out of state, Carter said it was not always easy to tell if a prescription was legitimate.
“When you’ve got a prescription just for oxycodone, who am I to say that the long-haired, body-pierced, tattooed guy is not in pain? I can’t profile like that. I don’t know that he’s not in pain. That’s unfair to expect for us to be law enforcement officers,” he said.
That’s why Carter is backing a bill to help train pharmacists on when and how they can reject suspicious prescriptions. It would require the administration to develop training materials on circumstances when pharmacists can decline to fill a prescription for a controlled substance if they suspect it’s fraudulent or is meant to be abused or diverted.
The bill was marked up by the Energy and Commerce Committee in early May and is likely to be in the package of bills the House is aiming to pass this month.
“The only thing worse for me, as a pharmacist, than filling a prescription that’s going to be diverted or abused, is not filling a prescription for a patient who truly needs it,” Carter said. “Now that keeps me up at night.”
Rep. Ann McLane Kuster
When she founded the Bipartisan Heroin Task Force in 2015, Kuster didn’t realize she would eventually join the many families trying to help loved ones struggling with addiction.
At first she thought the painkillers her brother was taking after receiving two hip replacements were fine because doctors prescribed them. But the New Hampshire Democrat became increasingly concerned about the length of time and doses he was taking.
“I had known that the opioid crisis cuts across all demographics, but there is a real feeling of helplessness when it happens to your family,” she said.
The biggest challenge in getting her brother help was finding a treatment program that would take him, Kuster said. Many facilities wouldn’t accept him because he was medically compromised, but the surgeon couldn’t finish the surgeries he needed because he was dealing with a substance use disorder, she said.“It was a Catch-22.”
Eventually, the family connected with a care coordinator and her brother entered a 28-day residential treatment program. But many families aren’t successful in finding effective treatment or long-term recovery for their loved ones, she said.
New Hampshire had the second-highest rate of opioid-related overdose deaths in the nation with 35.8 deaths per 100,000 people in 2016, driven largely by the use of fentanyl and other deadly synthetic opioids, according to the National Institute on Drug Abuse. That’s nearly three times higher than the national rate of 13.3 overdose deaths per 100,000.
On May 8, Kuster and Rep. Carlos Curbelo, a Florida Republican, introduced legislation that would require the Department of Health and Human Services to develop an evidence-based practices toolkit for hospitals that receive payment under Medicare Part A in an effort to help reduce opioid misuse.
The high rate of prescribing has been a factor driving the opioid epidemic, Kuster said.
“This legislation will give prescribers and hospitals access to more information about best practices and alternative pain management techniques that can help prevent people from suffering from substance misuse in the first place,” she said.
Sen. Ron Johnson and Rep. Jim Sensenbrenner
Johnson and Sensenbrenner both found themselves moved by the story of a Wisconsin mother whose 19-year-old son died of a heroin overdose in 2014.
Laurie Badura’s son, Archie, started experimenting with marijuana in high school, but turned to opiates, and ultimately heroin, after he graduated. He overdosed in January 2014 and stayed clean for 77 days, Badura recounted earlier this year on a podcast that Johnson’s office runs.
“He swore he would never do it again, and I believed him. He believed himself,” she said. “This thing just came inside and caught him, and it took us all off guard that terrible morning.”
Badura eventually set out to help other families and their loved ones dealing with addiction by starting a nonprofit called Saving Others for Archie, or SOFA.
Sensenbrenner and Johnson, both Wisconsin Republicans, paid homage to Archie with their companion bills named the Stopping Overdoses of Fentanyl Analogues, or SOFA, Act.
The measures would give the Drug Enforcement Administration authority to deem certain fentanyl analogues as Schedule 1, a classification for drugs such as heroin that have no medical use and a high potential for abuse.
They would also allow the DEA to immediately schedule new fentanyl variations as they pop up, instead of having to first issue a temporary scheduling order, which can sometimes make criminal prosecution difficult.
“It is a big, big deal,” Sensenbrenner said. “Currently, it’s a hole in the law enforcement response to opioids … big enough to drive an 18-wheeler truck through.”
Fentanyl and fentanyl analogues accounted for more than 20,000 deaths in 2016, representing roughly 30 percent of all drug overdose deaths in the U.S. that year, according to the National Institute on Drug Abuse.
Johnson himself lost a nephew to a fentanyl overdose in 2016.
“It’s affecting every community, potentially any family,” he said. “Nobody’s safe.”
Sen. Tammy Baldwin
For years, Baldwin traveled throughout her home state of Wisconsin talking with families devastated by the opioid crisis and thinking how close to home for her those stories hit.
But it wasn’t until 2017 that she began sharing her own story about growing up with a mother who also suffered from drug addiction and mental illness.
“I know how hard this fight is,” she said recently. “And yet, I have been reticent to share my own story because I know that my mother felt the stigma.”
Baldwin shares her story now, in part, to help fight against the shame people feel about drug addiction.
As early as she can remember, the Democratic senator knew her mother struggled. Baldwin’s grandparents raised her in Madison and would take her on Saturdays to visit her mom.
Sometimes she was great; sometimes she would sleep almost the entire time, Baldwin recalled.
“I remember what it was like to come home from school and not be able to get into the house,” she tells viewers in a new TV ad. “I’d pound on the door but my mother wouldn’t answer. She’d be passed out inside.”
Baldwin said her personal experience drove her to focus on helping improve access to substance abuse treatment and promoting prevention in schools.
She also sees the need to give states more flexibility in how to use opioid grant funds appropriated by Congress because the overdose epidemic is larger than just one type of drug.
Methamphetamine and heroin are big problems in Wisconsin, Baldwin said.
“People who overdose have in their system all sort of drugs,” she said.
Baldwin doesn’t believe that a 2016 opioids-related law that Congress cleared did enough to help states and local communities fight broader drug abuse issues, not just those related to opioids.
The treatment for people with an opioid addiction is pretty specific in terms of blocking certain receptors to prevent highs, but those don’t work for meth addicts, she said.
“This can’t be just for opioid addiction,” she said.