Transcripts For CSPAN2 Opioid Epidemic 20180110

The committee will please come to order. We turn our attention to the opiate crisis. The nations number one Public Health challenge. Our witnesses sam, the author dream and, true to of americas opiate epidemic. Senator moran i will have an opening statement. Though will hear from our witness. Ive suggested if he wants to take more than five minutes to say what he has to say we would welcome that. Theres plenty of conversation back and forth it is unusual to have a single witness utter hearing. This is an unusual topic. One you quote gary franken is the worst madman epidemic in history. The challenge it presents has captured the attention of every member. This is what we call the bipartisan hearing. Most wars are. Democrats and republicans have agreed on the topic, on its importance in the witness. Its my hope that will restrain from lecturing one another and Health Insurance and focus on the topic. This kills more americans every day than car accidents. In each state were reminded of that almost every day. Yesterday a job i am meeting in nashville, the head of all of our state institutions with training doctors the governor told me in our state of 6. 6 Million People there are 7. 6 million opiate prescriptions written. Even though the state has reduced amounts of opiates prescribed, the number of Overdose Deaths was up because of the sentinel. Rather than spending more time on the crisis i wanna learn from you. When 100 million americans live with pain 25 million with chronic or severe pain why is it not a good idea to find the holy grail of medicine, nonaddictive Pain Medicine . Stronger communities are the ultimate solution work in a Central Government washing can washington do that helps . Do you have a chapter entitled searching for the holy grail. I read your book. I think theyre a number of others weve about it with them. The search began 75 years ago and 28 with the committee on problems with drug dependence. Couldnt the best scientists find a way to extract painkilling elements from morphing while discarding his miserable addictiveness . This effort to find a better way to treat pain to revolution toward pain treatment. First the pain of dying patients then chronic pain and pain clinics, and enterprising drug company spiraling into the addiction and consequences we find today. At least twice doctor Francis Collins had predicted the holy grail that was for so is now within reach. Last month he said perhaps within five years. His organize nih researchers with private companies to speed up the process. Doctor Scott Gottlieb is on track to fasttrack it. I read at least some of your book to say that some of this may never be found. Some scientists it should not be found. I hope you will tell us what you think. Should we not continue to find nonaddictive Pain Medicine ten suffering . The secondary i want to learn is what we can do from washington, d. C. Weve tried to address the ravages of this. Congress passed the comprehensive Addiction Recovery act of the 21st century cares hacked to give states and communities the tools and resources they need to combat the crisis. Theres a provision by senators warning capital that made it clear pharmacies could only fill part of certain prescriptions that way a mob filling the pain prescription could ask only for three days worth of pills instead of 30 days he was prescribed. In addition it included for the 1 billion in state grants. Were considering additional funding for treatment and to discover alternative Pain Medicines. Weve held hearings on Lifestyle Changes such as exercising and eating healthier. You and i apparently have one thing in common. Im a skeptic of washin you s is a problem of society. What a loser sense of community we become easy prey for external solutions to complex problems like opiates. In your words quote i believe more strongly the antidote is community. Make sure people do things together. Break down barriers to keep people isolated and Strong Families where everyone is interested in the wellbeing of everybody else. Whenever ive tried to solve a problem in the end its boil down to creating an environment in which create communities to create problems. For example after spending years in state reform in education i traveled the state to create 143rd better schools taskforces. I have the same views as a fixed child left behind so, what does congress do from kin washington, d. C. About this opiate crisis . We have jurisdiction over a significant amount of what youve written about a dreamland but not the spending of money. Were eager to hear your testimony in your solutions. I am glad to be continuing our discussion on this important issue. Our witness today has been following the crisis and growth and thank you for joining us. I also welcome your wife and daughter who i assume are sitting behind you there. I look forward to hearing your perspective on how to better help support this crisis. I appreciate the investigator work that you have done to shed light on this challenge. The rising this is broader in scope than any book can tell. This people from every background and corner of the country that has stories about the harm this is done. These are veterans think chronic pain struggling with addiction, doctors cheatin treating babiesd and more. Ive heard the stories firsthand the meeting with doctors and families fighting this disease. Visiting a local hospital the staff told me almost one out of every two babies born have mothers who struggle with Substance Abuse. Thats astonishing and heartbreaking. Its not the only evidence of this epidemic. This is much is happening in longview, local hospitals across the nation. Were losing 91 people a day to opiate overdose. I dont just mean the individuals facing theres other victims as well. Children struggling to cope with the impact of their parents addiction. Many of foster homes. Parents were shattered with the heartbreak of their childs illness and many struggling with the financial cost and it hurts our communities as a whole. It takes up resources, it takes workers out of our local economy. We are behind the curve of fighting the sect but. One was a state employee a woman named jamie mae. A pharmacist charged with overseeing the cases who are receiving Prescription Drug from injuries. She noticed summertime from the same painkillers that been prescribed. The paper she published in 2005 was one of the first papers in the country. She published her paper over a decade ago which shows we have been fighting this battle far too long. Im glad weve taken the necessary steps. In 2016 it passed the cares hacked which included a billion dollars in states the comprehensive addiction and recovery act which supports specific outreach for veterans and postpartum women. There is more to do. Along with many my colleagues i hope we can move more funding in the budget or appropriations agreement. First responders and Treatment Professionals have made it clear that continued federal funding is key. Fortunately weve heard talk but weve yet to see the president take the action that this emergency to mans and that he promised families. The own council of economic advisers estimated the expert Economic Cost to be over 500 billion just for 2015. Addressing the problem the spec will take an enormous investment of time and energy focus im eager to see this committee continue the bipartisan approach to take action to address this epidemic. I look forward to working with you in heaven are members bring their ideas forward. We have to do more to fund the prevention efforts and treatment programs. It means providing supplemental states needs to implement tools to help turn the epidemic around. We need to learn i know the people on the ground have the resources they need to respond. It means going beyond treatment and recovery. We need to support the individuals in the families and communities suffering. Im interested to hear your perspective. Im grateful for you being here today. Before going to beat this, we have to find and interact solutions. I look forward to working with you and the members. Thank you for having an important hearing. Thank you for taking the time to be here. If 30 Years Experience as a journalist and author. Written extensively on truck trafficking. The other three claim books, the most recent book one a National Book critics circle award. Early in the career he was the recipient of the maria moores cabinet price. The oldest International Word in journalism covering latin america. The recipient of a patterson fellowship awarded to print journalists. Welcome. Clearly im a rookie here. When a thank you for having us hearing allowing me the opportunity to address it. Im happy to be here with my wife and daughter were part of producing dreamland and without whom the book not have been finished. This is the deadliest drug that we have known hitting areas that have never seen this drug problem. The first in modern america to be spread not by mafias or street dealers but by doctors over prescribing pain pills convince theyre doing right. Urged on by the pharmaceutical industry the medical establishment and urged on by us, the American Health consumers who want an easy end to pain. Isis could not have changed of inciting the kind of torment and death we have upon ourselves. These drugs are symbol for our era. Formals for decades weve exulted the private sector while we ridiculed government as inefficient, incompetent and wasteful. We admire wealthy Business People regardless of the way they made their money produce value to our country and communities. We have a second gilded age. This epidemic that tries on a the costs have been borne by the Public Sector all the has been private. I believe its about issues far deeper. The effect of the cultural shift about the hollowing out of smalltown america and the middle class and that buying stuff that they could be attacks with one magical Silver Bullet. In so doing we put ourselves of doing things so essential that they have no price. We have been invaded by cheap junk as a result. We dug up dreamland pool replaced it with the stripmall. Heroin is what you get when you destroy dreamland. Isolationists parents natural habitat. The epidemic is calling on us to come together. I believe more strongly than ever the antidote to hear what is not in it is community. People coming together to work in small and local ways for solution. No one saving the world alone. The good news is there is no solution. Theres Many Solutions, each small and must be tinkered with. Some discarded and each must be funded fully in for a long time. None of them is sexy. None will do the trick alone. Across america communities are finding the solutions. The more they leverage the talent and energy bringing in ptas, pastors, recovering addicts and librarians in the chamber of commerce, the more cops and Public Health nurses who bridge the cultural kata schism between them. We did not have this demand into terry had a large supply of narcotics in the last two decades. I believe doctors reassess how, to whom and in what quantity they prescribe the drugs. That does not mean cutting people off who are on high doses of the trunk and leaving them to fight for themselves. Means allowing Insurance Companies that do not involve narcotics. Allowing a wider away ray of pain strategies. Young docs need more education that school and Pain Management and addiction treatment. Its delusionals to spend time and money on yet another wall along the border hoping this will stanch the supply of heroin and fentanyl. Drugs are coming in with areas already. The only thing that will truly help stop these trucks into our country is a deep respectful and forthright and honest relationship with mexico that will lead to becoming a neighboring partner we can work with effectively. Another wall is just like carolyn. It feels good for the moment but will leave us in the worst place in the long run. Another Silver Bullet for complicated adult problem. Sometimes its about the monday mechanics of governing. We should find new ways to expand our National Forest of pathologist which is dangerously dwindling. We must expand Treatment Options in the country. One place to do it is jail. Consider how the country will be help by transforming jail into a place of nurturing recovery instead of tedium. It becomes an asset instead of the liability. I would also add that all across America Family suffering due to the addiction of a loved one or the loss of a loved one. They are the raw material to be marshaled and harnessed in this fight. Many need to be involved to help solve the wounds that will last a lifetime. Senators can help this by recognizing and giving platforms to which to tell their story. Maybe because im a reporter, i believe the stories of addiction can be reduced. Im happy to elaborate on any of this. Want to urge you to view this as an opportunity to revive the regions him or by globalization and free trade. The roots of our narcotic addiction stands in the way of revival. Many regions cannot revive until people can pass a drug test of fill new jobs. This is not only a story of drug addiction but of economic affliction. Has politicians who natural response is to look for things you can do quickly to show constituents are taking action. Thats understandable i would caution against believing in shortterm actions. Carol makes up a great start but its only a start. Everything ever learned has taught me the importance of longterm Community Responses and commitment. American history offers two templates for action first is the Marshall Plan to rebuild europe after world war ii. The second is our Space Program. Each of of government and the private sector bring in money, brains, energy and longterm focus. Each achieved a good for country. You were doing things are be on her own shortterm selfinterest. The Marshall Plan was about building up ravaged regions while containing the viral spread of soviet communism. It allowed report countries to prosper and contribute to the world again. A Marshall Plan for american recovery might focus on rebuilding the regions caught and ravaged by economic devastation to contain the viral spread of addiction. To our Space Program we are inspired to spend years of dollars to achieve something no previous generation ever thought possible. We ended up far beyond the moon. To spill over benefit, and simple human that is beyond calculation. Seems to me we might profitably apply these examples. To regions of forgot americans for the problem began. Listed not because its easy but because it is hard. Because thats what americans do and has always done. Like our Space Program i believe an effort will need to last for years to be a folk effective. Focus on the profound problems of destruction in the hollowing out of the country. But also as a gift that it can be. Its an opportunity to bridge the polarization that not that the country. One of the few issues that can do that. Do not miss the opportunity. It doesnt come around often. This calling is the very reason you got here in the first place. Youll be remembered for acting when acting was not easy to do. I believe your hometowns will thank you. Your county will thank you. And we, your countrymen and women will thank you long after youre gone. Im happy to talk about anything you want. We will have a fiveminute round of questions. Ill try to stick to five minutes because we have senators who want test questions. The book was great not sure i can see copies around the desk. Its a hundred yards long you can see how the community was surrounding the pool and activities. The idea that big pharma lighting committed fraud is a part of the book and part of the problem. Theyre punished but we need to make sure people cannot. Some of it could be state law. I continue to become more more alarmed that our profession is part of the problem. Weve tried to fix it. We monitor and see if theyre seeking different doctors we have gotten rid of bad doctors, the pill mills are no longer in kentucky. Yet, we have a county in the mountains of 21000 people. Last year 2. 8 million dose of hydrocodone. Everybody knows its a problem. And it was worse last year. They prescribe more. Its an 11 increase. When we look at what we do we have to think about how we spend it and what we do. We want people to have healthcare so weeks been medicaid. You can have an overlay of the hair when an opiate problem is related to poverty and healthcare expansion. Pay 3 a month and you can get it trade it. We have to figure out more rules. The hard part is the chronic. If im your physician and you been coming to me for low back pain that i get you off of it . We all know the knowledge. People have read your book and yet we still have this enormous prescription opiate problem i agree how do we fix the medical aspect of it. Thats a massive question i think one of the reasons you find a correlation between heroin overdose the Medicaid Expansion is because more access to medical care means more access to pills. We havent change the basic culture. One of the reasons for doctors to prescribe pills for if we get back to the 1970s Insurance Companies were reimbursing a wide array of strategies for pain. Cut back significantly in many areas. It gets back to the dr. Has available to him or her to me that feels like a crucial step. I run into doctors who tell me that say they dont have other options. I live in a county with 4 unemployment. Players, say we cant find enough workers that are drugfree. Then 30 of the people at work 30 are disabled. We all have big hearts that we give them stuff that perhaps when you become a permanent non worker we could chant the cycle thats more difficult. We to figure out how to do it with a hardener brain we have work requirements and only temporarily disabled till youre back in the workforce. We d need to be careful of how we do it. You can see the time clock we have on the senators, because everyone will want to have long conversations with you. Well try to wrap each one up in five minutes and then well keep going as long as we can. Thank you. The talk about the federal government. A Critical Role in preventing the tracking in solving the epidemic. In some areas it has capacity and reach one example is the center for Disease Control and prevention they provide funding for washington d. C. I invested in running a Public Awareness campaign and manage a Critical National surveillance program. Silly program to capture nonfatal overdoses as well as fatal overdoses. It uses innovative ways to get timelier data. That started under the Obama Administration to raise awareness of their be a crisis and can actually personalize and disseminate this message in. This administration has requested cuts for cdc budget. You mentioned we need quality data collection. Can sherry thoughts on the need for robust funding . Think we need to expand research for addiction and Pain Management. All of this is part of these Many Solutions i want to talk about the federal governments role it is no way to suggest it has a dominant role or the important stuff is going on at the local level. The role of the federal government might be to facilitate make easier their lives. Cdc has some programs that are fairly effective. One is during the book i found nobody who wanted to talk about this except for government workers. The first line of defense on this one. When i thought id bitten off an enormous contract to write a book the people who really didnt care for working on this from the beginning, prosecutors Public Health nurses many of whom were on the local level. Im a Crime Reporter theyve done amazing work in the face of almost youve written about the importance of Medicaid Expansion to make sure they get medic care assistant treatment Medicaid Expansion allowed 1. 6 million uninsured people with substance use. Can you talk about the importance of medicaid making sure Medicaid Expansion provided drug treatment for people who do not have it. I know people in different communities have been anonymously helped by those. I dont want to downplay with senator paul is talking about. Think one reason for that into many communities pills are still the only trunk medical treatment. In the important part is the Mental Health support and everything else. When he get more access to healthcare there other things that come along. One thing that comes along is a reliance to this day on the pills. We have dropped the prescribing sums triple what it was in the late 1990s. That means we probably read by too much on it. I dont understand the impulse to strip away Medicaid Expansion, particularly in areas where this assault. To me its regions that desperately need the services they provide for Medicaid Expansion. Thank you. First of all, let me thank you for writing such an important book. The possibilities what has been discouraging to me is despite much greater Public Awareness and much more money and much greater intentions, the problem does not seem to be getting much better. One possible communitybased approach was described in the morning sentinel and waterville me. It struck a chord with me because lawenforcement officials in my state tell me their jail intake rooms resemble hospital emergency rooms. With some Police Departments in maine and other areas are doing, they are telling at x that if they command with their drug center in the van, they will place them in treatment facilities. This is a different approach for Law Enforcement to take. Rather than locking people up, helping them to get the help they need. Its also very communitybased. In your experience, have you seen that type of program work better than the traditional approach . In reference to your first point i think we need to keep in mind that they have been suffering for 20 plus years. Its been going on for 20 years. Weve been at it for your half or two years. As a culture we need to learn patience and to not believe in Silver Bullet answers to mysterious problems. There is a complicated thing. If we have that solve this in the last year and half or two years i would say of course not. We need to keep working at it. These exists because it took a long time. For Law Enforcement i would say in general some of the most innovative folks and things ive seen come from Law Enforcement. You would think they would hold onto the old ways, but i have been amazed to see the innovative ideas coming out of lawenforcement. I read about the transformation of jail. If you come out of this with a new kind of way that jail is run as a c in the state of kentucky, that would be an enormous advance. It would be an asset not a liability. A place where you take people once a detox want to see clearly the wreckage of their lives and change and then we put them in a place that is tedious, ganged up, sexual stuff going on. What i have seen in certain jails and in kentucky, ive seen a remarkable change. One of nurturing and coming together. Youre working on your recovery from the moment you get up at eight in the morning until 11 0o up. That change in jail would be enormous. I tried to highlight things that were not just be beneficial to this problem, but for the next drug problem as well. So were not plan whack a mole with this stuff. I believe jail is a great place of effervescence when it comes to this epidemic in the way new ideas are being tried. Its in jail. Sounds like what youre highlighting this one of those. Lways have used it, then we will not really have advanced. And that is the problem that we will hit and we will wonder why we are not making greater advances. My feeling is changing jail is the way it is happening. Not just the revolutionary idea. You can find this in various examples around the country. It is very invigorating to see. Thank you. Thank you, senator collins. Senator casey. Thank you, mr. Chairman. Mr. Sam quinones, thank you for your i wanted to start with some ofh the reality is that i see y states like pennsylvania we had last year 4,624 Overdose Deaths. Obviously a lot of that being driven by the Opioid Crisis epidemic. Whaty. At i see is if i missed se of your testimony going back and forth between the hearings if i seemin pennsylvania is a where there was an ad hoc group of people coming together of the mayor of the small town and police chief and the Treatment Professionals needing overtime to. But i keep hearingng is we need more resources. We are getting our arms around this. Theyve made some strides as you know. What is your sense of the way the federal government can provide more resources. To watch the task force committees sprout up and county after county. Yes, these folks are coming together and theres a bunch of people on the committee recovering addicts, a lot of different folks. Lo we cant find the money for the nuts and bolts that make it work like office space, that kind of stuff that is essential. Thank you but do not think that they are overprescribing and creating addiction for 20 years. One year, 1 billion but encompassing to what the country needs, it is an unprecedented problem because it is in every state of america coast to coast to sew the evidence shows there is a need for sustained a to me that is a crucial part of this as well. This needs to go for some time. The repeal they were setting up a separate fund so i took what i thought was a good idea and made it into a different bill but we appreciate your testimony on these issues. Thank you for being here today and for being in gainesville last week. For thousands of children across my state and around the country are having their lives turned upsidetu down. Youve identified the need for more services. Can you elaborate onse specifically what programmatic needs there o are for families d resources in your experience that might help mitigate the crisis. Honestly as a reporter i would likene to say best off talking to people that work in that field. I do think one of the areas that is devastating is that there is so much need now. Its a workar for grandparents d today and its just mind boggling to think what the need would be a because their mom and dad are gone or in prison or what have you. So my feeling is that is a basic macro level that we need to look at on how to fund more foster care and how to do foster care better. I feel like the larger point about the solution if you will to this broad epidemic that individual solutions and collectively. If we can persuade individuals than a low human being hello hud or childs hardluck is their own plight then we could entice more people to be foster parents didnt care for these children tor lobby on their behalf and o forth, so i think that is a good overall message that i am taking away from your book. Weve already discussed jails and in your book, you highlight some that offer rehabilitation services, and peculiarly in those areas you have people putting themselves into the criminal Justice System just so they can get assistance or are their relatives and friends doing so. And i s was like to sort of discussed a good source of settings. I used to represent austin indiana on account of the issuen of an opioid and many local sheriffs and communities like that around indiana had a strong suspicion because i have spoken with them that their inmates have either hiv or hepatitis c or Something Else that they might typically test for. They are legally on the hook to provide medical services to them and in a place like scott county indiana that would remove the budget for many years if theyye tested positive. Number one have you encountered this dilemma and if yes, do you have any thoughts about it . I dont doubt it. Nothing surprises me more about this topic i have to say. Foster care that another that you just mentioned to think about this deep social problems but i dont think they have an answer for. I get to that poin the point thm overwhelmed by the ways the problem manifests itself. You do have a eight role in facilitating the resources. The people in the counties ive been to are working hard and imaginatively, so going to them and finding out what they mean seems to me as the evidence would show the way that we proceed on this. I do believe absolutely in the e federal government has a profound role in helping the solutions in facilitating them thank you for appreciate the hearing. There is a story about you tell about something we havent talked about features the heroine epidemic that rode on the back of Prescription Drug you tell it brilliantly and my reaction reading it is this was all happening inhi plain sight t somehow we missed it. The white house estimated so a billion dollars is a lot of money but i at this. 2 of what its costing and the Rural Counties in my state. 92 of the people they are admitting to our testing positive for heroin or the jailer that opens up the trail, opens up the window and says look what are you shoving me that there are women and beer spending. 2 on targeted treatment so as a former local person i am all about people in the Global Committee that they cannot do it without resources and the counties i go too if anything, they have lesses acces today to the treatment than they did ten years ago, so it is striking that we are moving in the wrong direction and i wonder whether you would want to comment on that. Wth there is a lot to comment on. One of the problems is with our overprescribing of these pills, we created legions of addicts and that the weekend the best logistics potential of the Drug Trafficking culture that i know fairly well and it is viewed as a pretty disgusting drug and people are far more enamored with meth and coke and stuff so they didnt really traffic heroine or didnt want to get involved with it too much until now of course the profit motivation and its exploded the numbers of people who are trafficking from mexico and elsewhere, so thats one thing. As i said before, i believe that Community Solution is one ive seen where people are working hard and coming up with solutions appropriate to the counties and regions. As i sai said there is a longtm focus and i believe a lot of folks arein looking to the fedel government. Republican and democrat in this fight for sustained help and not oneoff kind of ideas. You mentioned briefly earlier the Health Insurance reimbursement creating challenges were you writing about the inability to get lowcost social work for examp example. Initially in Pain Management for many years it was to take one individual and design over time the close connection of the patient and the doctor together to design a menu of strategies that would help this one individual, so one individuals and many strategies. Marital counseling, diet, acupuncture, physical vigor p. Etc. As we begin to believe that one kind of pill or drug would be the solution to all pain, Insurance Companies dropped a lot of that and you couldnt really decide the full panoply of strategies. Because you are no longer getting reimbursed for the loven of god. To me i think that its fundamental in this whole problem. When doctors are educated they need the tools and they are told theres a pain epidemic in the country andic increasingly they were left with one tool and its a good reason we got into this so i believe strongly this comes with talking about their dilemma that they need more solutions in thathe moment. If they were a leader into all of this and i think you can get acupuncture etc. Its a fundamental part of this. Thank you, senator bennett. Senator murkowski. There is no Silver Bullet thursday complicated no Silver Bullet for a complicated adult problem and yet we all know as it has been mentioned its not just an adult problem. Our children are dying of overdoses and suffering because the parents are checked out. I went to a Senior Center sitting with a group of primarily senior ladies and said if im having lunch with you today, what would you be talking about and they looked around and said where we would find services for our grandkids. Because all of us are taking care of our grandkids. We need to look at this from a Broad Perspective and strived heidi on the Marshall Plan. The problem i see with that is we are still suffocated and strangled by the stigma is attached. We see there is an acknowledgment that this person or that individual died of an overdose. Those are failures and losers, which is a horrible thing to s say. How do we get people galvanized to help and to be inspired to do something as big as i agree with you this needs to be in order to make the difference. Are we making w headway or reducing the stigma . We are going to write this book and put it out but the truth is its going to die when it comes out because nobody in this country cares about this problem. I couldnt find anybody except the Public Health nurse and pubd vocational narcotics officer in charge. But everybody else had a reason why is end parents or families e mortified, embarrassed that this was a different kind of problem than existed in the past. People were mortified at what had happened. And you never saw an obituary that told the truth. In this case it was he died at home of a heart attack at age 25. Now i believe what is helping to change that its similar to say its a radical transformation in the Public Attitude in the last ten years. Its getting to know people who affected them and i know youve heard a lot more about how you need to provide funding that there is a public profile role to ask senators if you go to communities and to find those parents and talk to them and point out the programs and groups that are sprouting up all over the country. Its amazing to see this. Meet withit parents and say thak you. Tell us your story and help recruitt them. Theres a lot of folks that would go along and do that if they were asked. We have as human beings from the prehistoric times to today always needed stories to help us understand. And the only reason this wasnt well publicized was years ago the people who could bestpl tell the story and now increasingly they want to talk and its so important to embrace them and bring them out of the shadows. Some of them not yet maybe someday soon and with that, my feeling is theres a horrible stigma and one of them in ways s we defeat this to read stories and i believe as Public Officials you all could have a magnificent role. Have them talk a little bit about we would look for yo loveo tell your story. The. A great reminder that we can have that role. We have several senators remaining who want to ask questions so we will try to stick to that five minutes so we have time for everybody to be involved. Senator murphy is next. Thanks very much mr. Chairman. If one of us were to go down to the senate floor and give a speech on loneliness we would worry that they would come off feeling wererr looking silly. If you read the grea this greatk about the Mental Health crisis he comes to the conclusion that in the end the only effective treatment programs are the ones that build connectivity between people and you didnt title your book the Great American heroine epidemic you titled it dreamland. You made the case in your opening comment about connectedness. Its a private lowcost Community Pool was closed in part because the factors outside of the governments control. People have a lot more going on in their house, they had their g own pool, they have more tv channels had a lot of reasons to stay inside. And yet, you hinted at being critical about the decision. It probably would have been criticized in a money losing effort for the results might have beeresult might havebeen ae open. Where you left off in your testimony, you focus your book on the question of building communities. They should be thinking about these things so share with us can thoughts on how were change may be the way we spend money into public policy. We have a lot of people working on this in a variety of ways. My feeling as a reporter is always to go there and ask them it has a convening role by providing the infrastructure that does bring people together. I think it is not a conversation that we had enough in this country and you might be the ones to perhaps leave it. We would be inspired, my feelings re whidbey. So how do you do that . Im a reporter and im not sure i know all the ways but my impulse is a journalist is to go to those areas and talk to as many people as you can and highlight them. I was going to say to the senator, just find the people who are working har hard, find e community coalitions, the task a forces and your presence at one of the meetings would be huge. Try doing that. Its a great idea. Try to be with those folks and understand and see what ea pr event . Probably, who cares. You want to highlight these are the folks working and from that, thats how innovation works. Youve got the factory floor, the supervisor of the accounta accountant, they are all putting their brains together finding incremental ways to make the product better and i think cities and towns work the same way. No s magic bullet or magic wand, just slow incremental work. We are going a to spend an awful lot of money on this epidemic and its worth challenging us to think about it. I do believe in the overall. I dont have a clue. Im just trying to understand this enormous country that we have and sometimes it is hard. Thathat is a pretty good description of how we feel. You dont pretend a medical expert but why is it no boy is d idea to try to find nonaddictive Pain Medicine . Its a strange thing. My friends from college when they hear me say this as i got into the story for the first time in my life i began reading philosophy about how we create happiness as human beings how we achieve, what is happiness because it seems like all these people all across the country are looking toth this substancen one form or another to the happy at least for a b f few hours. Andd it seems to me in a few was that philosophers ive read talked about working hard to word something that you are fulfilled by an excited by that you love to do and along the way comes a fulfillment. In your book first it was to help people that were dying of horrible pain and then it appeared erroneously they might not be addictive and so this whole revolutionary way of making became a vital sign comes up and then they turn out to be addictive but because they turned out to be addictive is that a reason not to try to find other medicines that are nonaddictive . I would never stand in the way of science, but i feel that in the long run humans have never done well when they have it all, when they get all the pain treatment and none of the consequences, to me ita is a hunch and if ten years from now i have to come up with a bill i would be thrilled and happy for those people who benefit. It sounds like with your general approach you would suggest that could be possible buthat it might only be one strategy. They believmaybe these others given the fact that we need friction in our lives to be productive and to be happy in fact i believe that there are other things that need to happen in american culture. I believe as individuals and writininwriting this book i stod drinking soda. I wanted to be the change that i would want to see in the country so i stopped eating food i saw advertised on. I felt that it was important to do things that would reduce the chances. I have no problem with research trying to find it and painkilling without any addiction. I just have a skepticism that in the long run we would be able to handle it, that we behave very poorly when they have no other friction in their lives. He had a meeting of all thef people in the state who were p charged with the goal of changing their attitudes towards prescribing opiates. One of the Health Official said to me when i told him i would be hearing to about you today so and 50 seconds can you tell us about that . Its transformed the heroin market completely. Its democratized. It used to be when it was another country it came from four or five mexican states and now it can come from nebraska, canada. It has made throwing dealers are more m willing to kill people. I used to be for many years to become people overdosing your clients and there wasnt a warning, it was an advertisement on the street a lot of people ran to find who will be the person or told them that i was expensive to do and what you want to do is reduce because it gets the more volume and therefore create a buzz around your product. Its a diabolical thing to describe, but that is the nature it seemsge to me a and also its about many more people to get involvedpe in this end by the dk where thats coming from mexico but its also being soldex on te dark web very profitably and that has a lot of people now involved in selling it but probably never would have before. Thank you mr. Chair and Ranking Member for in this hearing and mr. Quinoes for being here and for your work. Just at the outset i would say some of the themes you touched on today about Community Also seems that the author has touched on a and i think that your book and his together are really important. I want to just start by buying a little bit of groundwork. I was governor of the nature starting in january of 2013 and i am also a governor that worked with my Republican Legislature to implement Medicaid Expansion. In 2013 we had 192 deaths in new hampshire. In 2014, 32 326 were on an upwad trajectory even before the Medicaid Expansion and in fact one of the reasons we all came together to implement a is because we had a crisis in a drug Overdose Deaths in our state and we do the Medicaid Expansion would get more treatment to people and my own anecdotal sense that it didnt cause an increase to the opioids thats is reinforced by an article in Health Affairs so i want folks to have a sense of that. I b think there may be a correlation here but to suggest there is a causation is troublingou to me and i also thk it speaks to some of the stigma issues that you talked about. I do also want to thank you for your insistence that this is a problem that was decades in the making. Its going to be decades in the fixing and it requires subtle approaches and approaches that can evolve in the way the epidemic is evolving to the transplant. In our state it has changed a lot in the way Law Enforcement and the Community Addresses this casa thank you for your advocacy on that. I want to spend a little bit of time on one of the issues i dont think we touched on as much right now as it deserves. In your book you chronicled the socalled letter to the new england journal of medicine that was completely misinterpreted and used to claim that their products are virtually nonaddictive. Doctors also wrongfully relied on the letter of Scientific Evidence addiction is rare when using the opioids. It is astounding that one paragraph jotted down in 1980 the horrible epidemic that we are seeing today. Your book outlines how Drug Companies played a bigger role in house off of them have misled patients, providers and Public Officials about the nature of their products. Can you give a brief overview of the role of the pharmaceutical industry in creating the misconceptions got a minut one e and 45 seconds. I think it was pivotal. It starts with paying specialists believing we were poorlyg treating pain. This is the story of a lot of people doing what they thought was the right thingngy but doig too much of it maybe. I dont believe that they would have had a megaphone that they came to have for it not for a lothelove of the moneyey and fug into the selective use of their information by pharmaceutical companies. Its what changeits what changd then of course they were joined by certainhe institutions but i think they saw early on that they had tried the time released and it was a magnificent drug. Had they stuck right there we would be applauding them. Instead what the school is the market was pretty small and there is a much larger one called chronic pain which is normal pain of america basically and they got on board and this was also by the way an important part of this is that these years were with the industry went through as a sales force arms ss race where every company was having oriented or in more sales reps and these were not the older sales reps that were rooted in facts. Fact. Its my impression talking with doctors that they knew what they were doing and they were not such a hard sell, they were more informational and then you hire a bunch of goodlooking young folks to inundate so the pharmaceutical representatives went from like 35,000 but i do have to say i dont want to blink at thek complications. I believe also we as americans play a huge role in all of this. Our desire to have a quick end to pain cant be accountable for our own wellness. Thank you for this i just wont have time for a second round of statements that in my state of the need for funding to support the grassrootss efforts like the safety that could save station programs are critical and i would look forward to talking with you more about that. Thank you mr. Cherry and mr. Quinoes. I think dreamland and factor the man are the most important in the last 25 years, its a tremendous work. I want to ask two questions if i can. The first one is weve had witnesses here and theyve asked the questions could we set a goal of being Addiction Free by 2030 and i am mindful of your point that there is no Silver Bullet and we will rebuild these economies and enable them to protectan themselves. If you dont set. The target thn you dont marshal your resources around getting the target soap if you would advise us on what the target would be again i posed the question to the folks can reset the target by 2030 and Francis Collins said yes, that is doable if you defined a defie right way it is doable in the current scientific knowledge and technological likelihoo likelihs nearterm future but if you were to give us a target, what would you tell us . We would all be in trouble. I would say that a target is good and it is something to strive towards. Its always good too have a deadline or a goal. What that should be and whether or not humans can never be Addiction Free is debatable in my opinion and i am not sure that is possible. However, as i said iny some of the testimony, to me this is a scifi story. I lived in mexico for ten years and i just adopted the idea that the problem was demand driven. When you arrest a Street Corner dealer another one a a ps up but the demand is going to keep producing streetcorner. I agree about the primary in all of that stuff starts at i believe its supply and i came to believe that after living in mexico where i believe the demand because mexicans like to play but because it absorbs them of responsibility and its not really our drug problem, it is binational and needs to be addressed as such. But when i start doing this but i begin to realize that is what happened is we had no real problem with this before the overprescribing. The difference in this story is that the supply didnt come from colombian dealers and it came from doctors buying into sincere, wellmeaning, good, welltrained doctors buying into the idea that they could help their patients just by massively prescribing these pills. So, the goal is to target and all that but my way of thinking, supply is the issue and therefore, to get their requires that there is a reason all the guys from vietnam came back addicted. They were in rural tennessee, there was no supply survey found the more you separate an addict from the supply the better chance the addict has of success and thats what theyre finding in some parts of portsmouth ohio. I have a brother in law. I know him well and u. S. Attorney in portland who decided he would be the ceo of a Substance Abuse and he says this. If there was a social movement for the recovery it would become the most powerful political move in theth United States and grappling with this issue of how toch get over the stigma and the democrats republicans, blue state, red state it would be massive and help us meet whatever targets we set so i am curious what you think about that. The more of those stories come out the more we know how many people around us have this issue in their lives and the more it becomes natural. You mentioned that a lot. It makes us understand this is something going on all around us and it is an amazing thing to have written a book like this and then go on the road. Im over my time but i appreciate you being here today. Thank you for being here and for your research on the rising and i want to followu follow ue point about supply. You write about a hospital in columbus where a doctor in the adolescent department helping heroine addicts get detoxed talks about the kids he was seeing who started with prescription painkillers and he says it was all of them. A story that is true people are four times 40 times more likely to be addicted and many people that misuse pictures that were legally prescribed whether to them or a friend with a relative. Do you mind saying a bit more about that experience. I have an ex rupture when i was at the la times and i didnt realize it and went to the hospital later and i spent two days it was a perfect example of what to do and what not to do. They gave me two vicodin, a very good idea. I had just been cut open, so a very good idea and then when i left, they gave me a bottle of 60 vicodin and said take as needed. I have never written about health care. I didnt know. They told me as i left, take as needed. I felt okay that sounds like aspirin. I dont like taking pills, so i took two of the pills. I knew now what it wasit and sue enough found and disposed of it. That is a perfect example. Theres actually some data on this but found between two thirds to 92 of patients that went to go a there werent reported that they wind up with these opioids afterwards and just like you a lot of them sit around in the medicine cabinet and can fall into the wrong hands. As noted earlier in the last congress, senator capito and i passed a bill to try p to tackla problem if they are in pain a few days later they can get a few more pills if that is what they want tols do. I just want to talk about that one little part. That is exactly the kind of thing im talking about, these small solutions. They prescribed 60 or 90 of the pills. Like i did, you say okay. Or in your case, 30 times more. Plumore. Plus the beatles and so on. I get back to the basic dichotomy here. The story in a magic bullet solution. I think theres lots and lots of Little Things and what you are outlining sounds to me like one of those Little Things. We got a law passed here but that doesnt make it a reality, so we have sent letters to every governor in the country to the different medical organizations asking them to back us on the implementation of the partial fill in here we are more than a year after its changed and the Drug Enforcement Administration Still has a definition of partial fill that is out of date not in compliance so just a couple weeks ago along with senator grassley and senator feinstein sent a letter to ask them to update these regulations so as you say weve done our part and now weve got to get the bureaucracy to get in line with this. I really appreciate you being here today. What an opportunity to have a conversation. You chronicle this epidemic as having its roots two decades ago at least and yet we find ourselves still scrambling and in some cases not gaining ground with losing ground. I represent wisconsin and the new front of this battle. In a Community Like Milwaukee County, specifically this was the cause of 170 deaths in 2017 combined with other opioids overdoses, theres about 420 in that county last year and its just one example in the state of wisconsin. And at this point, there is no sense that 2018 is going to be a turnaround. Despite the fact that Milwaukee County has a dedicated heroine task force and leaders from the local Law Enforcement and Health Providers have been collaborating toeaea address th. I wanted to sort of dovetail on your conversation with the chairman and about synthetics sort of changing this epidemic in some ways. We need to be prepared for even are next generation of synthetic opioids and what is the federal role in assisting communities . That is a huge question and im not sure i have all the answers to the. Its been remarkable and transformative. Itss like the third stage. I do believe that having lived inun mexico is calling on us to understand the only way we are going to stop any kind of an effect this by working with mexico, not at odds. There is no way you can stop the smuggling into the United States because it is so small. My feeling is one thing that seems to be extra really counterproductive in my opinion having lived in the country a long time is the rhetoric that im not saying as a way of rose colored glasses with regards to mexico i know the issues and the corruption and the depth of the problems but nevertheless in a person to person connection that we have never really achieved that is how you advance. It was a very interesting case in july they shut down the naturmajordark web marketplacesf last year and it was a classic example of how you make a huge dent in supply by working with theseme governments into me thoe are the ways you help local Law Enforcement. To it feels to me like you are standing in the ocean. Maybe we can follow up. I have held a love of roundtables with stakeholders from recovering addicts, family members whove lost loved ones, Law Enforcement health etc. You talk so much about solving this through ending isolation and having stronger communities. I do find some significant variation between what i hear in the urban centers in wisconsin and in rural areas everything from the availability of resources to help people who want to get treatment even to what drugs are being taken to and i would love to hear your thoughts. Im not going to be able to stay for the second round but perhaps in a followup about how we strengthen communities. Been devastated by ease closures for example. You said heroine is what you get when you destroy dreamland and use that isolation is the natural habitat. In the state of maine, the Opioid Crisis appears to have started decades ago in Washington County that borders canada and it is an economically disadvantaged counties very high rates of unemployment and a lot of isolated communities. It then spreads everywhere in name including our most prosperous towns and cities. The Portland Press herald last summer ran a ten part series on the Opioid Epidemic and it focused one story on the lobster industry highlighting the high entry rate in that industry and also the logistical challenges of securing treatment in the rural communities. Its a great story. Ive read it. They will be interested to know that. In your investigation, did you find that drug dealers tend to target communities that are economically devastated, are they more Fertile Ground for addiction fax i did notice that. I dont think drug dealers are deep sociologists. I think they are following the money coming into the first place this begins his economically devastated because teepain treatment and resortingo doctors was part of how you navigate economic disaster. You get disabilities as we were talking about earlier. You have people who are trying to navigate and to get that, you need a doctor and again, this seemed as time went on the it became something to result to a substance. You get pills and you can solve them and people figure that out. Some of the first dealers were seniors, they were not young people at all, they were seniors that figured out that kids will buy this stuff and so the rest. I do believe as you said that this is it starts in areas with deep economic affliction and in the areas that are viewed as kind of the losers and the great freetrade we had over the last 30 or 40 years perhaps. Now of course that made me change my view of the story Charlotte North Carolina, banking center, very wealthy country clubs and mansions, they have the problem a that problemi think that it is into some larger questions of the as americans how we view pane and what we want to deal with. I want to followup on your comment about the horrific role that is played by grandparents. I held a hearing in the committee to look at this issue and grandparents raising their grandkids due to the Opioid Crisis. Just as an important statistic i will tell you that in my state, between 2010 to 2015, the number of grandparents taking care of their grandchildren and being solely responsible for their care soared by 24 and its because of the Opioid Epidemic. I think that is what is happening. I think that story is repeated in many states in the country. Thank you for your good work. Senator murray, do you have additional questions . I just want to thank the witness for being here today. Your name has been pronounced a lot of different ways. [laughter] can you pronounce it. Quinoes. [laughter] [laughter] its been pronounced to me in numerous different ways through my life. Thank you for your excellent work and i look forward to working with you and all of the committee members. Thank you senator murkowski has questions and then we will wrap up the hearing. So many statistics you have cited in your book but one that floored me was the reference to the volume goes in the United States consume when it comes to narcotics and you state that the United States consumes and they are writing 83 of the votes oxycodone and 99 of the worlds hydrocodone. Gram for gram a group of specialists wrote in 2012 people in the United States consume more narcotic medication than any other nation worldwide. Okay, so people can become addicted whether you are a u. S. Citizen or some place in south america, what is it about this country that has us at only 99 of the worlds hydrocodone and vicodin . What is it that has happened here . That is a terrific question and one that began to hit me as i got into this book and realized it wasnt just a story about a drug addiction but who weve become as americans. Two generations ago or so, about a Million People joined the army and the whole country participated in defeating the nazis and now we cant get our wisdom teeth out without getting massive doses of opioids. I mean, i sought the answer to that. What is the common denominator between words of ohio, a town battered by almost every Economic Force the last 30 years in Charlotte North Carolina which is a very wealthy town, Salt Lake City and these towns have done very well. What is the overriding common denominator . It isnt economics obviously. You have two very different economic situations. By way of feeling is that it is a combination of isolation and also frankly maybe this was an essay on the dangers of prosperity that too much stuff given to freely people are not expecting. Everybody fearing that its scanning thei their anemia due o keeping them outside for keeping them indoors and all across the country. But is it interesting to you that those that were doing the deliveries didnt use the stuff. They were addicted to Something Else. They were addicted to the resources that came back. But you look at that and say what is it about americans that has pushed us in this direction in such an extreme direction . You have other countries that have the same issues that we have. They have economic decline, isolationism, the same things that we have come and get me have turned to opioids to done numb it all. We focused on the individual and great ideals of american kind of experiments that have become twisted and the pursuit of convenience and be entertained us with selfreliance ifor selfreliancs isolation. Accountability becomes tantrums whenever any political official oor cough call for doctor doesnt exactly what we say it seems these are things behind of whatf this but maybe we have had too much. Weve become pampered in some sense. I dont pretend to know at all. These are questions that im fascinated by and i would love to talk about them but i make no claim to know all the answers to these questions you are posing. So, this statement was made back in 2012 in the journal of pain physicians. What do you assumwould you assue numbers have continued to increase . Part of it bears noting part of that is because a lot of the countries dont use enough of these drugs. People die in horrible agony from cancer when they shouldnt be. There is a proper role for these drugs and inhuman medicine and distrust the debate over what that role is is a very, very important one and up to now in the last 20, 25 years in the country, the proper role would appear to be a bottle in every medicine cabinet and that is where he got into trouble. Thank you. Thank you mr. Chairman. Mr. Quinoes, if i need to make a couple of quick observations about her testimony had been one of your space shot Marshall Plans ideas. Listening to this, one thought i had is with your family here especially as i mentioned before, you should be glad you were not nominated for some think were some senator would have kissed you under the table and confused using the process. We thoroughly benefited from your testimony. It strikes me that with your book and with her testimony you may be helping to lead a revolution in a different direction than the one you describe in your book. One of the leading states for this problem. Working together with the governor is change the way they teach doctors on what to do about opioids. You have many prescriptions of three days worth instead of 60. There are some steps that we can take and i congratulate you for that. On your testimony, he wanted to demonstrate humility and you dont claim to know everything. We find around here thats a very useful attribute because we dont know everything either. Helps hear from you and second you are wonderful storyteller. He reminds me of my friend alex haley who wrote roots and he told me after he made his speech he said men make a suggestion when you begin you would say may i tell you a story instead of making a speech . Someone might ask and listen to what you have to say so because of your storytelling we listen to what you have to say. Finally on the Marshall Plan and the space shot i think senator murray and murkowski worked together fixed no child left behind a couple of years ago. One of the things no child left behind in education is have as a goal 100 of children would be proficient in reading and math by the year 2014 and i remember when that was set i was not in the senate and i thought i guess thats all right. We say all people are created equal and Samuel Huntington a professor at harvard said most of our politics is about setting high goals for ourselves so we never reach in dealing with the consequences so not having reach them a sort is sort of what we do as a country. Then i was thinking about a created a lot of problems for us and the consequences that were attached to that. On the Marshall Plan and this they shot i think it might be more like the Marshall Plan. As they shot was a high goal and inspired everybody but it was done from washington. He was essentially organized single shot efforts and the Marshall Plan actually was a request of European Countries to come up with their own plan. It wasnt marshalls plan or president trumans plan. Those countries came up with a plan and we funded it but then they implemented it and some succeeded more than others. Its probably what will happen here. Some sort of hide whole but i think the better example may be the Marshall Plan. And you are right to cause each of the states are different and i like the fact that you talk about parts of the country that are ravaged by a globalization and on line purchasing and leaving main streets empty and people without things to do but then we have charlotte and nashville. The complex problem and youve helped us understand it. Thank you for your leadership and we appreciate your family coming as well all the way from los angeles. Senator murray anything else . The hearing record will remain open for 10 days. Members may submit Additional Information to the record within that time if they would like. The Committee Meeting on thursday january 11 for the executive session on nominations, thank you for being here. 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