Transcripts For CSPAN3 House Members On Opioid Crisis 20171012

Classic moments of life and in 2011, it was selected in the issue, one of the best photos in life magazine for the past 75 years. American history tv, all weekend, every weekend, only on cspan3. The house energy and commerce subcommittee on health met yesterday to hear testimony from members of congress about how the nations Opioid Epidemic has affected their districts and their constituents. Texas congressman, michael burgess, chaired this hearing. Its three hours and fifteen minutes. The subcommittee will come to order and ill recognize myself for an opening statement. The United States of america is in the midst of a fierce battle against an epidemic brought to us by opioids. It does not matter where you live, this crisis has touched every corner of american society. While new england and the ohio valley regions represent states hardest hit by the epidemic, Health Officials from the south and reaching across the Mountain West all report a growing number of Overdose Deaths in those counties. The latest figures from the centers for Disease Control and prevention as astounding. 91 americans die every day from an overdose. Now more than ever, we must come together and strengthen our commitment to fight this malady. I expect today will bring to the forefront key insights and potential solutions on this critical issue. In the previous congress, the energy and Commerce Committee led several bipartisan initiatives to help address the Opioid Epidemic. The comprehensive Addiction Recovery act and the 21st century cures act are now law, and providing resources at the state and local levels. Muchneeded policy changes are being implemented. The passage of both with the passage of both kara and cures. In fact, as a result of kara, patients suffering from Substance Abuse now have greater access to evidencebased treatment, Addiction Treatment services, and overdose reversal therapies. Cure is, on the other hand, provided 1 billion for grants for states to support treatment and Recovery Services. I believe these initiatives are making a significant difference. At the same time, other issues have emerged in this fight. Earlier this year, our committee responded to reports of people overdosing on heroin laced with synthetic opioids, fentanyl, which are 100 to 1,000 times more potent than morphine. They have become a Public Health threat and illegal Online Pharmacies primarily operating in Foreign Countries are exacerbating this epidemic every day for our state and federal officials. Todays hearing will allow us to gain membership perspective on potential ways to complement existing policies and federal regulations to combat the Opioid Epidemic. Representatives both on and off the energy and Commerce Committee will testify about the Opioid Epidemic, share their stories and propose legislative solutions for our consideration. In advance, i want to thank house members for participating in this important discussion, and we look forward to hearing from everyone who is going to be before us today. Let me yield what little time i have left to the vice chairman of the health subcommittee, mr. Guthrie. Thank you very much. Obviously, im going to be brief. So many families have been devastated by this. And dreamland, which is a book i read about the Opioid Crisis, an important book i read about the Opioid Crisis, had all these different scenarios, and but when you see it in reality, i was in owens borough one evening and met a mom. The mom was a mother of an athletic student, an athlete and honor student who had her acl torn playing soccer. Was prescribed pain killers. After her recovery, she was addicted to pain killers since she couldnt have access to them, turned to heroin and passed away due to an overdose. This is a sad story thats repeated through all groups and all areas, and its something that im looking forward to hearing all the testimony today to look for ideas to further do what congress has done and moving forward, as well. I thank you, mr. Chairman, for yielding, and i yield back the balance of my time. The chair recognizes the Ranking Member of the subcommittee, mr. Green, three minutes for an opening statement, please. Thank you, mr. Chairman. The theres for Disease Control and prevention has called for Prescription Drug overdose and has found Drug Overdose to be the leading cause of injury and death in the United States. Between 1999 and 2010, the death rate from prescription pain killers more than quadrupled and only continues to rise. In 2015, more than 5 2,000 people died of Drug Overdoses in america, and about twothirds of those were linked to opioids. The total is only rising. The New York Times analysis of preliminary data found that 59,000 to 65,000 likely died from overdoses in 2016. Today its estimated more than 2 million have use disorder and too few people are in treatment. The rate of heroin overdoses has increased dramatically. This rise is directly linked to the Opioid Epidemic. In 2010, approximately 3,000 drug poisoning deaths were connected to heroin. In 2013, the number jumped to a total of 8,000 Overdose Deaths and only continues to rise. Theres no community that has not been touched by this crisis and some have been ravaged by it. This committee has taken steps to address the crisis. But so much is needed to combat it when families and communities across the country are being torn apart. Included in the 21st century cures of the state targeted response to the Opioid Crisis Grant Program, it provided 1 billion over 2017 and 2018 to states to address the Opioid Epidemic. Extending this money is a crucial part of any continued federal leverage to respond to the epidemic. We need an approach that deploys proven strategies and spans the entire spectrum from prevention to treatment and recovery. These include robust funding to support prevention, Crisis Response and expanded access to treatment and lifelong recovery tools. The Affordable Care act is a vital part of our efforts to fight against the Opioid Epidemic. More than 1. 5 million americans with Substance Use disorders have access to treatment through medicaid. That didnt before the aca, thanks to the Medicaid Expansion. Unfortunately, americans fighting addiction live in states that refuse to expand their Medicaid Programs like texas are left out in the cold. For those in the individual market, all plans must include services for Substance Use disorders and Mental Health and consumers cannot be denied coverage because of a history of Substance Abuse, all thanks to the aca. This is not a small feat. Prior to the aca, roughly a third of all individual market policies didnt cover Substance Use treatment. Repealing the mental Substance Use disorder coverage provision of the aca will remove at least 5. 5 billion annually from the treatment of lowincome people with mental and Substance Use disorders. Going even further, scrapping the Medicaid Expansion in states that took the money would be absolutely devastating to our fight against Prescription Drug and heroin addiction crisis. Were in the midst of the largest Public Health crisis in our country, and this is not time to cut Health Care Safety nets that serve those in recovery. Im pleased that we have the opportunity to hear from our colleagues about their proposals and to combat the Prescription Drug epidemic. We need a comprehensive solution to the crisis that includes real dollars and targets the entire spectrum of addiction. Prevention, Crisis Response, for those who fall through the cracks and expanding access to treatment and providing support for recovery. We must be guided by science and avoid stigmas and not fall into traps, misconceptions about proven treatment strategies. I thank the chairman for having this conversation and look forward to advancing new strategies and funding to turn the side of this growing crisis really help families and communities that desperately need it. And i yield back my time. The gentleman yields back. The chair thanks the gentleman. Well actually ill make an organizational note before we move to our first panel. We are going to be hearing from energy and commerce members at the outset. Energy and commerce members are welcome to give their testimony from the witness table or from the dais, whichever they prefer. We move to our first panel with chairman walden, pallone, upton, issue and lada. Youre welcome to testify from the table or the dais. So the chair recognizes the chairman of the full committee, mr. Walden. I thank the chairman. I come here today on behalf of my constituents like i do every day. But i think especially today with our opportunity for all members to make their case to the energy and Commerce Committee, first we want to welcome them. And i think as our colleagues on both sides of the aisle have already said, all of us and all of our communities face these challenges related to Drug Overdoses. I held a round table the day before yesterday in bend, oregon, where i learned a lot about the problems theyre facing and some of the successes theyre having. And the importance of the work that were doing here. Its a heart breaking epidemic thats been featured on the front pages of our local newspapers, on national television, as part of the stories from our friends and Family Members. And with good reason. Conservative estimates forecast that more than 90 americans die from opioid abuses overdoses each day. 90 a day, mr. Chairman. While more than 1,000 are treated each day for abusing opioids. In 2016 alone, more than 64,000 americans died from Drug Overdoses. And in oregon alone, more people died last year from Drug Overdoses than from Car Accidents. I recently held round tables in southern and Central Oregon to discuss how we can combat this crisis. Meeting with people on the front lines in our communities to find out whats working, what more can be done, is crucial to our efforts to end this scourge. Energy and Commerce Committee has led a number of bipartisan initiatives to help address the Opioid Epidemic from groundbreaking initiatives that are now law, like the comprehensive addiction and recovery act, cara, and the 21st century cures act. Resources are becoming available and important policy changes are being implemented to stem the tide of opioids. Cara established a comprehensive strategy for improving evidencebased treatment for patients with Substance Abuse disorders and it made significant changes to expand access to Addiction Treatment and services and overdose reversal medications. The new law also included criminal justice, Law Enforcementrelated provisions. 21st century cures act provided 1 billion for grants for states the first half made available in april of 2017 to be administered by the Substance Abuse and Mental Health Services Administration, or samsa. My state of oregon received a 6. 5 million in grants to help combat the epidemic that plagued our great state. However, so much more work needs to be done. Since the passage of cara, other issues have emerged in the fight against opioids, such as the proliferation of fentanyl and its analogs. And then there are allegations of pilldumping and the practice of patient brokering. My own district, ive heard the all too familiar tale of the mother whose son was prescribed opioids and he became addicted. Another, a sister died of overdose after years of suffering from addiction and bouncing between pharmacies. He spoke about how better tracking and treatment could have helped catch his sisters problem earlier and perhaps made counseling more effective. As it was, she was only caught because two pharmacies in a small town happened to check with each other. You see, by then it was too late, though. These two stories may have come from oregon but theyre not exclusive to the beaver state. Theyre why were here today. Addressing the Opioid Epidemic requires an all hands on deck effort. Today well be hearing testimony and stories from our colleagues, both on and off the energy and Commerce Committee about what more can be done. And im looking forward to hearing feedback and input from both sides of the aisle to hear about whats working and whats not and find ways to complement our existing law and to address emerging issues. So with that, mr. Chairman, i appreciate everyone here today. With us taking time to participate. I look forward to hearing from all of my colleagues and together we must continue to fight this Opioid Crisis in america. And i yield back. The gentleman yields back. The chair thanks the gentleman. And, again, just to reiterate the format for today. Members on the energy and Commerce Committee are invited to either give testimony from the witness table or from the dais, whichever they prefer. So at this time, ill recognize the Ranking Member of the full committee, frank pallone, from new jersey for five minutes, please. Thank you, chairman burgess. Todays member day provides us the opportunity to hear from our colleagues about how the epidemic is uniquely affected their districts, as well as to hear their ideas of additional efforts and funding that is needed to help individuals, families and communities affected by this crisis. Like all communities across the country, the Opioid Epidemic is having devastating consequences in my home state. Drug overdoses are the leading causes of accidental death in new jersey. According to the centers for Disease Control and prevention, there was a 16 increase in drug Overdose Deaths in new jersey between 2014 and 2015, and last year drug Overdose Deaths topped more than 2,000. And unfortunately, were continuing to see increased deaths from this tragic epidemic. Im proud of the steps this committee has taken to respond to this tragic epidemic that is taking the lives of 91 americans every day. Im pleased that we Work Together in a bipartisan fashion to pay us the comprehensive addiction and recovery act or cara. We also Work Together to create the state targeted response to the Opioid Crisis Grant Program, as part of the 21st century cures act. And this Grant Program provides a billion dollars to states to address the Opioid Epidemic. There were positive and well, these were positive and bipartisan laws that we produced in 2016 during the last year of the obama administration. That was 2016. 2017 has been much different. Congressional republicans have spent much of this year trying to repeal the Affordable Care act, which would have prevented millions of americans from getting the help that they need to treat opioid use disorders. And the repeal legislation passed here in the house would have allowed insurers to once again discriminate against people with preexisting conditions, such as opioid use disorders. The republicanpassed bill would also have allowed states to waive essential health benefits, including Mental Health and Substance Use treatment. Thankfully, those repeal efforts have failed to date. So as we move forward, whats clear is that individuals with Substance Use disorder, their families and their communities need us to Work Together to do more. Despite some progress here in washington, the epidemic has shown no signs of relenting, and thats why we must continue to support and increase funding for Proven Health Public Health approaches spanning the entire spectrum from crisis to recovery, including expanding access to medicationassisted treatment. Those efforts should include more funding and we should extend the Grant Program so that we can expand even further peoples access to opioid abuse treatment, prevention and Recovery Support services. So i look forward to hearing from my house colleagues and continuing to Work Together in a bipartisan fashion to help our country respond to this crisis. I yield back, mr. Chairman. The gentleman yields back. Chair thanks the gentleman. The chair recognizes the chairman of the subcommittee, mr. Upton, for three minutes. Thank you, mr. Chairman. This is very important, this member day, as were able to all share our personal experiences on a crisis that has been plaguing our nation over the last couple of years. Opioid addiction and abuse. This silent epidemic has for sure torn through families, neighborhoods and communities both certainly in my home state of michigan. But we know across the country, as well. In fact, in 2015, there were nearly 2,000 opioid abuserelated deaths in michigan alone. Even more tragically, more than 22,000 babies are born every year across the country with neonatal Opioid Withdrawal syndrome. This terrible epidemic has hit home both in my community and yes, even in my extended family. So this is very personal to me. As it is with so many throughout our communities. The last couple years ive been meeting with First Responders, Crisis Center employees, advocacy groups, and, yes, individuals suffering. All of these folks have said that tragically, the death toll continues to rise. Thats why we have been taking concrete steps here in this committee to combat the widespread epidemic. Just last year, the president signed into his sweeping package aimed at attacking the Opioid Epidemic from all sides. Its part of 21st century cures, a bill that every one of our Committee Members supported. An additional 1 billion was allocated to the states. And like michigan, to address opioid Addiction Treatment and prevention, this year the first round of funding was delivered, we received 16 million, and that Grant Funding will make a real difference. It will. To those suffering, i just say, help is on the way. And as a result of this legislation, as well as administrative action, nih director, francis collins, is helping to lead the charge. This summer the nih started meeting with experts in academia and bio pharmaceutical industry to talk about innovative ways in which government and industry can Work Together to address the crisis. I strongly support that work and look forward to seeing the results of the research that nih is doing with its industry partners. There are also things that we in congress can help nih with in these endeavors. First, we need the nih to develop more options for overdose reversal. Second, we need the evidence of nih can develop an effective therapy for addiction. And finally, we must accelerate the development of nonaddictive pain medicines. The sooner that we in congress supply the resources necessary to conduct that work, the sooner that we can supply powerful new tools for every community. These efforts cant happen fast enough. And these are some of the many reasons that i continue to support robust nih funding. Theres more work to be done, and here in congress well continue to take steps to address that epidemic. And in this committee, were on the front lines to advance meaningful, Bipartisan Legislation that indeed will make a difference. Together well bring it out of the shadows. I yield back. The gentleman yields back. The chair recognizes the gentleman from new jersey, mr. Lance. Three minutes, please. Thank you, mr. Chairman. And i must say, this is the first time ive been on this side of the dais, and what a finelooking group. Much more fun being over here, as you know. If it makes the gentleman more comfortable, we can swear you in. That means i would be under oath. Yeah. Thank you, chairman burgess, for organizing this conversation today. The Opioid Crisis is devastating families and communities across new jersey, the state i represent. In 2015, the garden states death rate was twoandahalf times the skyrocketing u. S. Rate. We are making progress with the implementation of the comprehensive Addiction Recovery act of 2016. But more work needs to be done. I acknowledge the efforts of one of my constituents, bass kin ridge resident, claudette saabtell. She has made a difference. Her advocacy group, community in crisis, helps equip the loved ones of those in pain. None of the progress we have made so far in this fight against drug addiction and opioid abuse would have been possible without the work of people like claudette and organizations Like Community in crisis. Their efforts are efforts that we should make sure congress understands and applauds. I work closely with claudette on the issue of overprescription. In 2012, Health Care Providers wrote 259 million prescriptions for opiates. They reformed and improved the medical drug approval and label process at the food and drug administration. For the First Time Congress has required the agency to work closely with expert advisory committees before making critical product approval, and labelling decisions and to make recommendations regarding Educational Programs for prescribers of extended release and longacting opiates. Cara also encourages the development and approval of opiates with abusedeterrent properties. We also have to make sure resources such as the statetargeted response to the opiate crisis grants administered by the Substance Abuse and Mental Health Services Administration continue to give states the tools they need to experiment and test best practices. New jersey recently secured a 13 million federal grant from the Substance Abuse and Mental Health Services Administration to focus on this crisis. The drugfree Community Support program and the White House Office of National Drug control policy also recently awarded community in crisis and two other able organizations. Hunter and prevention resource and empower somerset, with a 125,000 grant to assist in addressing the problem of opiate and heroin abuse. Provide education and implement prevention measures. Community in crisis and they are great partners with the resources and support they need. These investments are not only the right thing to do, but help lessen the significant strain on Law Enforcement resources. I commend each group on its important work. Mr. Chairman, i stand ready to work with you and colleagues on both sides of the aisle to continue this work. Thank you for calling this hearing today. The chair thanks the gentleman. The chair wants to thank this panel. We will move to our second panel. Members identified wishing to speak in the second panel, mr. Butterfield of North Carolina, miss matsui and mr. Bilirakis. Members may speak from the table or from the dais, whichever is their preference. So the chair recognizes miss matsui of california for three minutes. Thank you, mr. Chairman, for inviting us today to testify about proposals to address our nations Opioid Epidemic. We all have heartbreaking stories of constituents whose lives were lost too soon to an opioid overdose. In my home district of sacramento, we experienced a particularly deadly overdose crisis last year due to pills contaminated with fentanyl which is as much as 50 times stronger than heroin. Addiction is a devastating disease that knows no bounds, and we must come together to provide solutions in a comprehensive mann. In this committee we took a step forward by passing the comprehensive recovery act into law last year. We need to build on these efforts, understanding addiction and its consequences are multipronged and we need a multipronged solution. I look at this problem as i do any other health care problem, which means i examine it holistically across the spectrum from prevention to Early Intervention to treatment. In the case of the Opioid Epidemic, there is a lot we can do at each of these stages. All of which rest on truly building up our nations Mental Health system, and integrating Behavior Health care with physical health care. Historically, Mental Health and addiction have been treated as character flaws, and therefore not addressed with evidencebased medical treatment. We can reverse that course by making treatment more available, bolstering our Mental Health work force and reducing stigma. In 2012, representative lance and senator stabenow, blount and i passed a Mental Health demonstration project into law. This project is allowing states to demonstrate that building up communitybased Behavior Health clinics improves access to care. Last week we induced legislation to extend the years of and expand it to more states. This is one way to help address the Opioid Crisis. We also need to enforce Mental Health laws to ensure Health Insurers are offering Mental Health benefits equal to physical health benefits. It is irrelevant if Mental Health benefits are not offered in the first place. There have been proposals which included provisions that allow states to waive benefits, meaning insurance would not be required to cover Mental Health and Addiction Treatments. Thats not good. Cutting billions from Medicaid Program would also mean loss of coverage for millions suffering from Substance Use disorder. We cannot take these steps backward. I am encouraged by steps being taken across the Health Care Sector to address the crisis, including the limiting of opioid prescription for prescribers and insurers. We need to build on these efforts. That includes considering proposals in congress to provide resources and training for state and local enforcement, and bolstering our Mental Health work force, educating the public, addressing availability of a range of Treatment Options from outpatient to inpatient to Residential Care and more. And i do look forward to continuing to work the committee on these policy proposals to address this pressing issue. Thank you, and i yield back. The chair thanks the gentle lady. The chair recognizes the gentleman from florida, mr. Bilirakis, for three minutes, please. Thank you, mr. Chairman. [ inaudible ] how about now. Okay, very good. Thank you. Thank you. Thank you, mr. Chairman. The United States is in the midst of an opioid overdose epidemic. Sadly, 91 americans die every daydou to opioid overdoses. Nearly half of all opioid Overdose Deaths involve a prescription opioid. In 2010, in response to the Opioid Crisis in floridas pill mill problem, floridas legislature enacted statewide tracking of pain killer prescriptions, coupled with Law Enforcement using Drug Trafficking laws to prosecute providers caught overprescribing. Within three years, florida saw a decrease of more than 20 in Overdose Deaths. Despite this positive trend, opioid abuse continues to plague my district. In fact, my district had the second highest Prescription Drug death rate in florida in 2014. In response, i worked last congress to ensure that pascoe county was included as a high intensity Drug Trafficking area. Enabling Law Enforcement to receive Additional Resources to combat the spread of drugrelated crime. I want to applaud the committee for including my bills, the medicare Patient Safety and drug abuse prevention act, and the promise act in cara, which passed last congress. The medicare safety and drug abuse prevention act created a farms and physician lockin program with medicare advance and Medicare Part d giving cms the tools to crack down on this abuse in the medicare program. And its important for us to maintain oversight, of course, as you know, on this program as cms is developing the rules. The promise act will increase safety for opioid therapy and Pain Management by requiring the v. A. And dod to update their Clinical Practice Guidelines for managing of opioid therapy for chronic pain. Requiring the v. A. Opioid prescribers to have the enhanced Pain Management and safe opioid prescribing education and training and encourage the v. A. To increase informationsharing with state licensing boards. So i think thats critical. As part of the 21st century cures act, florida has received over 27 million in grants to help fight the Opioid Epidemic by increasing access to treatment and Recovery Services, strengthening Public Health surveillance, and improving Pain Management practices. These critical funds are supporting floridas all hands on deck approach across the state to curb opioid abuse and save lives. Im pleased the administration and this committee are leading the charge on this critical issue, and i look forward to working together to help save lives and prevent addiction. I yield back, mr. Chairman. Thank you. The gentleman yields back. The chair thanks the gentleman. The chair recognizes the gentleman from North Carolina, mr. Butterfield, for three minutes, please. Thank you, very much, chairman burgess, and to my fellow colleagues. Thank you for the opportunity to address the committee today about the state of the Opioid Epidemic in my home state of North Carolina. And let me just begin, mr. Chairman, by crediting my friend and our former colleague, mary bono, who is also from florida. Mr. Bilirakis. Who talked so incessantly about this issue, because it was very dear to her, and she knew the impact that it was having on her state. Miss mack brought this important topic to the forefront of our subcommittee some years ago. She was chairman of the subcommittee, and i was the Ranking Member. At first, mr. Chairman, i thought mary was a little bit overreacting to the Opioid Crisis in florida, because it had touched her family personally. But after we had hearings and after i looked into it, i came to the conclusion that she was not overreacting. That it was indeed an epidemic, not just in florida, but all across the country. Just last year, i worked with many of my colleagues in this room on the comprehensive addiction and recovery act that was passed into law. That bill included roughly 20 different legislative proposals to help slow the epidemic. As part of the 21st century cures act, this Committee Approved 500 million. The American People need to know that, mr. Chairman. We approve 500 million in supplemental funding to address opioid abuse. Despite the investments and attention from congress, we are still feeling the Opioid Crisis very close to home. During the august work period, i saw the effects of the epidemic on my Small Community in wilson, North Carolina. Just in august alone, there were two deaths because of the opioid abuse in the community. According to reports in the wilson times, and i have a copy today, medics administered the appropriate drug in response to Opioid Crisis 28 times by mid august. When they usually administer the treatment 30 times per quarter. According to chris parker with the Wilson County emergency medical services, there is a definite increase in opioid use and abuse in our county. North carolina has a real problem on its hands. America has a real problem on its hands. By july of this year, there were more than 500 diagnoses for Emergency Department visits up from 410 at the same point last year. Regrettably, mr. Chairman, in my humble opinion, the administration is not taking this situation seriously. The budget offered by the Current Administration cuts hhs funding by 16 . The cdc by 17 . The National Institutes of health by 19 . Im also very concerned about the proposals to gut the Medicaid Program that we have considered in this committee. The center for budget and policy estimates nearly 100,000 people with an opioid use disorder have gained coverage through Medicaid Expansion under aca. Congress must do all that it can to help stop this epidemic from devastating more lives, more families and communities. Congress should provide certainty certainty and funding to combat this epidemic, which i which is why im the original co sponsor of hr3495, the opiate and heroin abuse crisis investment act of 2017 that was introduced by mr. Lieu han. We must also protect existing funding for research and opioid use disorder coverage, provide tools to communities to address this epidemic and reduce the stigma for those needing a treatment. So i want to thank you for convening this hearing. I want to thank mr. Lata, mr. Bilirakis, for your time and attention and energy to this issue. Because it is an emergency in our country. Thank you. I yield back. The chair thanks the gentleman. The gentleman yields back. The chair recognizes the gentleman from indiana, mr. Bouchon, for three minutes. Thank you for holding this important hearing today. Opioid abuse disorder has ravaged our communities and while it is important to look forward and address what else needs to be done to combat this terrible disease, we need to ensure the legislation we have already passed is being properly implemented and is working as congress intended. In july 2016, the comprehensive addiction and recovery act, cara, land marked legislation addressing the opioid abuse crisis was passed into law. I spent months convening stakeholder round tables and working on bipartisan language which became section 303 of cara. Section 303 updates the controlled substances act and officebased opioid Addiction Treatment laws by ensuring that patients are offered and physicians are trained on all fdaapproved treatments. Under previous law prior to cara, millions of opioidaddicted patients had their treatment determined based on their setting of care. With the passage of cara, patients in these settings must now be offered a full range of Treatment Options based on their individual clinical needs and individualized treatment plan. Unfortunately, 15 months after the legislation was signed into law, section 303 still has not been implemented. I urge the committee to conduct strong oversight to ensure samsa will be properly implementing the law. Every day that this law goes unimplemented is one more day that our Family Members, friends and colleagues are battling a disease with fragmented and incomplete Treatment Options. Specifically, samsa should send a Dear Colleague letter to notify physicians they must offer all an die addiction medicines based on a patients clinical needs. Additionally, curriculum for doctors, p. A. S and Nurse Practitioners should be updated to include training on all fdaapproved opioid addiction medications. Moreover, all of samsas publicfacing material, including their website, should be modernized. According to the Evansville Courier and press, 55 people in vanderburg county, indiana, have died of a Drug Overdose in the first nine months of this year, which is more than all of 2016. The availability of all medicationassisted treatments, regardless of where a patient chooses to seek them, will help to stem the tide of these unnecessary deaths. It is vital that as the Committee Moves forward in the fight against opioid abuse disorder that we ensure cara is properly implemented and helping people combat this terrible disease. Mr. Chairman, again, thank you for this hearing and i yield back my time. The gentleman yields back. The chair thanks the gentleman and recognizes the gentleman from ohio, mr. Lata, for three minutes, please. Thank you, mr. Chairman. And, again, thank you for holding this hearing today. Opioid abuse and addiction has caused devastation in every Community Across our nation and in ohio it has been especially hardhit. In ohio in 2015, 3,050 people lost their lives from unintentional Drug Overdose. In 2016, that number increased to 4,050. Thats a 32 increase from the previous year, and that means 11 deaths a day. For comparison, in 2016, there were 1,1 33 traffic fatalities. That means that Drug Overdoses caused nearly four times as many deaths compared to traffic accidents. These figures are heartbreaking and sad to know that this problem isnt getting any better. Many county coroners in ohio say that 2017s overdose fatalities are outpacing 2016s. This problem knows no limits and has affected husbands, wives, children, brothers, sisters, fathers and mothers. It has destroyed marriages, ruined careers and cut too many lives short. When i read through the obituaries in my local newspaper over the past year or two, i have noticed more younger individuals without a cause of death being listed. Unfortunately, in too many of these instances, its because of Drug Overdoses. Across my district in northwest and west central ohio, ive heard how opioid addiction impacts our communities. Ive toured businesses and met with Community Leaders and spoke with families to hear how Substance Use disorders have directly affected their lives. It is because of these stories that i plan to introduce legislation that would direct the department of health and Human Services to create a public electronic database of information relating to nationwide efforts to combat the Opioid Crisis. The database would serve as a Central Location of information for the public and others to track federal funding allocations made available for research and treatment of opioid abuse, find research relating to opioid abuse from all federal agencies, state, local and tribal governments, as well as nonprofits, Law Enforcement, medical experts, Public Health educators and research institutes. Furthermore, the legislation would charge hhs to evaluate a myriad of issues relating to Pain Management addiction, prescription guidelines, treatments, trends and patterns and Effective Solutions and problems used across the country. These findings would be available on the database, as well, and hhs would be instructed to offer recommendations for targeted areas of improvement. I believe that with the help of hhs, and other relevant agencies, this database will allow for easier access of information, funding streams and relevant data that can help to combat the opioid abuse epidemic across our nation. With 11 people dying every day in ohio and over 91 americans dying nationwide every day, we have run out of time to find a solution to this crisis. We need action now. I appreciate the committee for holding this forum to express Creative Ideas and solutions and hope it leads to more lives being saved. Mr. Chairman, i appreciate the opportunity to be here and i yield back the balance of my time. The chair thanks the gentleman. The gentleman yields back. The chair wants to thank all of the members on this panel for your testimony. You are now excused and we will seat the next panel. Mr. Chairman, parliamentary inquiry. The gentleman will state his parliamentary inquiry. Im not sure thats the right terminology, but i wanted to include into the record two newspaper articles that i referenced. Have i lost my right to do that . Is the gentleman asking unanimous consent . I am, yes, sir. Without objection, so ordered. Thank you. And the chair now would ask that the next panel which is mr. Johnson, mr. Welch, leader pelosi and ms. Brooks. And, again, members of the committee are welcome to provide their testimony from their seated position on the dais, or from the witness table, whichever is your preference. And mr. Johnson, ill recognize you for three minutes. Thank you, mr. Chairman. I appreciate this discussion about an issue that is so vitally important. It is no secret that america is in the midst of an Opioid Crisis. Last year in my home state of ohio alone, about 86 of Overdose Deaths involved an opioid. This epidemic can be felt in virtually every Community Across the country. And today i want to share a story that will shed some light on some of the good work being done by people in my district to help combat the Opioid Epidemic, and to perhaps let everyone know about some of the positive things that are taking place. Recently i had the honor of visiting field of hope, a faithbased nonprofit Treatment Facility in Southeastern Ohio that assists area families ravaged by poverty and drug abuse. Field of hope recovery house was founded by a man named kevin dennis. After he witnessed his own daughter become addicted to opioids after she had knee surgery from a High School Athletic injury. Her prescriptions ran out before her pain was managed, but unfortunately by that point she was addicted. She ended up in prison several times for theft. And checked into numerous rehab facilities before she fully recovered from addiction. She is now a recovery counselor at field of hope and is happily married with a child. I heard some incredibly powerful and touching stories during my visit to the field of hope campus, and i witnessed the good work they are doing firsthand. We in congress and especially this committee have an Important Role to play in supplementing and enabling the work being done by organizations like field of hope. On the front end, we need to develop prevention policies that steer people like kevins daughter away from opioids in the first place. Innovative nonopioid, nonaddictive treatments exist today, and more are on the way. But these innovative treatments are not always covered by federal programs like medicare and medicaid. We should closely examine the Reimbursement Policies in place to ensure that patients have access to effective alternatives for Pain Management without the risk of addiction. Ive also been encouraged by recent efforts by providers, pharmacists and patient groups to address the addiction crisis through increased awareness, prescribing guidelines and new Treatment Options. I believe congress can play a role in ensuring that all prescribers are equipped with education and Pain Management, so they can provide effective pain treatments for patients and timely intervention for those who are addicted. I look forward to continuing to work with my colleagues on the committee, and in the house to find Effective Solutions to this scourge. Mr. Chairman, its a national crisis. We need to act, and with that i yield back the balance of my time. The gentleman yields back. The chair thanks the gentleman. The chair is pleased to recognize the entire vermont delegation. Mr. Welch, youre recognized for three minutes. We dont have the numbers of texas. But i appreciate the recognition. First of all, dr. Burgess, thank you. Mr. Green, thank you. Youre taking time to focus attention and demonstrate the urgency of this challenge. Second, this so affects us all. I mean, its heartbreaking. And it doesnt matter whether its a red district or a blue district. It doesnt matter what your view is on the size and scope of government. This is hurting people in your district, dr. Burgess, and mr. Green, and in my district and my colleagues here. In vermont, our governor dedicated his entire state of the state address to this epidemic in 2014. And i remember at that time many of my colleagues asked the question, peter, isnt this going to do bad things for the reputation of vermont . But then acknowledged that what he was saying was true in their own state, in their own districts. So you focusing attention on it, mr. Chairman, thank you. Thats step number one. I can give you some statistics in vermont, but they would be very similar to mr. Johnson. I mean, our Prescription Drug problems with individuals increased from 2,477 in 2012 by 80 . Heroin went from 913 in 2012 and increased to 3,488, a 380 increase. Every one of those stories is a story of family heart ache. I got a letter from a mom whose 27yearold son became addicted to heroin and just the story of him being homeless, him going from being a full time working person to being out on the street, him her having to call her daughters, saying their brother may soon be dead. All of that is real and all too vivid. So this is an enormous challenge. Our job in congress is to come up with some policies that are going to help people help themselves. And i like to make a few suggestions of things we need to do. Number one, we do have to have funding. We have to have full funding for the comprehensive addiction and recovery act. And weve got to find the money in order to allow our communities to do that work. Two, we have to have more research into alternative treatment. Im working with mr. Mckenley to try to get the comprehensive addiction and recovery act to find better alternatives to treat pain. Three, lets allow for partial filling of opioid subscriptions. Many of us have signed letters that would allow that to happen. Four, lets support the recent action by commissioner gottlieb. Hes done some good things. Immediate release hes trying to get Immediate Release opioid manufacturers to follow a more stringent set of rems requirements, which includes training doctors to safely prescribe these drugs. So this hearing is tremendous. Focusing attention. The next step is to put this into legislative action. Thank you, mr. Chairman. The chair thanks the gentleman. The gentleman yields back. The chair recognizes miss brooks for three minutes, please. Thank you, mr. Chairman, and thank you, Ranking Member green for hosting this incredibly important hearing. Too Many Americans are struggling with the crippling effects of drug abuse and addiction and the statistics, as we know, are devastating. According to the Indiana State Department of health, every twoandahalf hours a hoosier is sent to the hospital for an opioid overdose. There are enough bottles of pain killers in circulation for nearly every hoosier to have their own. And the number of infants born addicted to opioids is increasing at an alarming rate with Health Care Costs for these babies costing indiana more than 64 million in 2014 alone. And as we know, like so many other states, hoosiers are now more likely to die from a Drug Overdose than a car accident. When i came to congress in 2013, ive been very focused on our communities and families that this epidemic has swept up. And like so many of my colleagues, weve held round tables, weve held meetings, weve met with addicted individuals, families. Weve been on the front line with subscribers, health care workers. We all agree, this is a federal problem and a local problem. Last queer we passed cara, which included my bill to establish an Interagency Task force to review, modify and update the best practices for Pain Management and prescribe pain medicine. Hhs has already taken steps, informing this task force, but more needs to be done. In my view, its critical to ensure that the medical professionals have continuing medical education for the prescribing of deacontrolled substances that have such a high risk of abuse. Im exploring options to ensure that physicians and other medical professionals who prescribe these scheduled drugs have more and better education linked to the application and renewal of their dea licenses. Professionals who prescribe and dispense opioid medications must have better training so that they fully understand those patients who sadly have gotten the onset of addiction due to what they have been prescribed and now they need even better education to help prevent that onset and then help them with the addiction. Indiana is tackling our problems headon. And, in fact, just yesterday Indiana University announced a new initiative called responding to the addictions crisis. Its being led by ius dean of nursing, robin newhouse. Iu is committing 50 million over the next five years to collaborate with state and Community Partners to tackle this crisis. It is going to be one of the most comprehensive statebased responses and every iu campus in the state is going to be involved. Its going to focus on training and education, Data Collection and analysis, policy analysis and development, addiction sciences, community and workforce development. So major steps are being taken across our state, because everyone has a role to play, from our prescribers to our medical, to our higher ed institutions. And i want to remind folks that dea has a national Prescription Drug takeback day. Its approaching on october 28th. It provides that safe convenient responsible way to dispose of excess Prescription Drugs so that people can get those drugs out of their medicine cabinets and out of our kids reach. And not just kids. To adults. So there are going to be locations all across the country, and i really encourage everyone, because everyone has a role to play, and so october 28th is National Takeback day. And i hope that we get that word out. Thank you, mr. Chairman. I yield back. Very well. And of course, i thank the gentle lady for the providing the date. This hearing is being streamed on facebook live, so your information now has been distributed to everyone who has been tuning in this morning. So thats a good thing. And perhaps we can each individually try to make that date part of our discussions as we go through the rest of the month. I want to thank this panel for being here. You all are excused. I have a panel identified of mr. Lieu han, mr. Tom ko, hudson. Members are advised they may present from the dais or from the witness table, whichever is your preference. If youre seated at the table, we will provide a name tag for you. Is so whenever you are ready. Thank you, mr. Chairman. I thank the chairs and Ranking Members for the opportunity how new mexico has been impact the by the Opioid Crisis. 591 mexicans died of drug Overdose Deaths in 2015. Across this country, there were 52,404 deaths in 2015 and 560,000 deaths between 1999 and 2015. A half a Million People who missed thanksgiving dinner on their daughters softball game, who werent able to help their son with math homework or kiss their spouse good night. Thats brothers and sisters, parents and friends and children we have lost too soon because, in part, congress has not responded forcefully enough to the crisis. Last congress we did important work by passing the comprehensive Addiction Recovery act, c. A. R. A. , a 21st century cures act. These were steps in the right direction, but these efforts alone are not enough. Ive heard from my community that the funding passed and cures is helpful, but hard to use. In part, this is because of the short funding period, which impacts communities ability to plan for the longterm, and expand capacity. We know that in too many areas like mexico, there are simply not enough people and resources. Many want help and cant get it. Im reminded of a story relayed to me by one of my constituents, jay, who had stopped using heroin on his own. But felt as if he was going into relapse and sought help at a local Treatment Facility. Said realized he was in trouble and sought help at a local Treatment Facility. Jay was told, come back when youre using. He was turned away and told to come back only if he started using again because they lacked the capacity to treat patients who were not active drug users. Thats simply not right. To really expand the treatment, prevention and wrap around services that our constituents need, we need to have regular funding, we need to be able to plan without losing vital support from congress. And we need to give constituents like jay a place to go after hes fought a tough fight on his own. Thats why i introduce the opiod crisis investment act, for an additional five years. I would welcome my colleagues support because we absolutely must expand this funding for five years and beyond. We need to help vital investments to address the barriers to quality and accessible treatment. These barriers occur in the r l rural health resources, providing Substance Abuse treatment, administrative barriers against the most effective form of opiod abuse treatment and a shortage of rushl rural locations that provide assistance and treatment. Theres a quick fix to solve the opiod crisis, thats simply not true. We need to advance legislation that takes into longterm planning for states and communities, we need the kbbrin it to the floor to get out passed and to the president s desk. If we do not investigative in thin invest in this crisis, we will lose more brothers, dsistes and children. Thank you to the gentleman, mr. Mullen, youre going to be recognized for three minutes, after that, we will allow the minority leader to be seated at the table and hear her testimony. But mr. Mullen, go ahead for three minutes, please. Mr. Chairman, i have no problem with letting ms. Pelosi go next if she would like to. If the minority leader is ready, then yes, well recognize you. Youre recognized. Thank you, mr. Chairman. Thank you, representative mullen for your courtesy, i really came to listen as well as to convey some thoughts. This is only the second time i have ever testified as leader or as speaker in that capacity because this issue rises to the level of, as you know, life and death, so with gratitude to you and to the Ranking Member, mr. Green, for bringing us together in a bipartisan way on this issue, that is a matter of life and death. Thank you, mr. Burgess. The opiod epidemic is taking a savage daily poll on the American People. Theyre in every district in the country, the soucourge is teari families apart, its having an impact on the wellbeing on children and its claiming the lives of tens of thousands of people every year, robbing 90 people of their lives each day. Opiod adick someo diddiction is Health Catastrophe and is growing more dire and deadly every day, i believe its really important for us to respond to this National Emergency with the seriousness and urgency it requires, we have had bipartisanship that passes legislation, that addiction and recovery act, we all came together during the Bipartisan Legislation that was passed, the 21st century cure act, that people were so happy that the addiction language was in there, that day we heard the stories of the families, so affected, break your heart, families who had lost a child, a young teenager or 21yearold or whatever within a matter of days or weeks before that particular signing, that president obama signed that legislation. But it had language just hasnt had the money to the adequate eb extent. And that mr. Chairman is my appeal to you, democrats and republicans to Work Together to have the funding to fund the key initiatives authorized in the bill. I do want to make a pitch for medicaid, build on to the progress of Medicaid Expansion, provided a vital lifeline for tens of thousands struggling with addiction. John kasich said, thank god we expanded medicaid, because medicaid is helping to rehab people. Yet nine states have not taken that step. We stand ready do work with you in good faith with republicans to improve the aca, but remain vigilant in efforts to gut medicaid, because it will create even more of a problem in terms of opiods just to name one thing. The opiod epidemic is a challenge to the conscience of the entire company, we invest again urgently and boldly to get families the Recovery Resources they need. And we must works with providers in the pharmaceutical industry to Fund Prevention problems, so we can so much this epidemic. I will submit my entire statement for the record, again, thank you for the courtesy of being able to testify before your committee, and thank you for your leadership on this issue, and thank you mr. Green, as well. Thanks, minority leader, for being here today, youre welcome to stay and listen to the testimony of the other members, but we also respect your schedule and if you need to leave, that is certainly understandable as well. But in the meantime, ill recognize mr. Mullen for three minutes. Thank you for your hospitality. I will listen. I recognize the gentleman from texas. Thank you for being here, but before mr. Mullen testifies, mr. Chairman, i would like to thank him for his work, literally when the water was going down in houston, you said i have some churches in houston that want to partner with your church, and we did that, so instead of having one weeks work from the people at Cherokee Nation, they stayed for a month and helped people clearwater from their houses. As one with a daughter in houston and grandchildren, i thank you as well. Mr. Green, thank you. The Cherokee Nation called us right off the bat and said how can we help, and we had churches each out to us and we have had the opportunity to work on multiple things in congress. And it was an honor to be able to help your constituents. Thank you mr. Chairman and mr. Green for allowing us to talk about such an important epidemic that is going across our nation, we talk often about the opiod epidemic, but, what are we talking about as far as how did we get here and how do we go back . We never want to talk about taking medicine backwards. But i sit in front of you from a gentleman whos had surgery since i was a little boy, i was born with my hips out, and my feet and club feet position, and i started having surgeries very young. I also built up a very large pain tolerance. And i have never been one to use pain medicine. My wife says im different than most, i think most people in this room would probably agree with that. But i do understand pain. And i understand the need for medicine. But in 96 when pain became a sense, and in my opinion, we let the genie out of the bottle. We started treating it like we treat the cold or the flu and all we do is mask it. We have seen stronger and stronger drugs coming out, we have controlled substances, narcotics that we send home in a bottle with a prescription and say thats controlled. Now we have seen it spread to the middle class, to our brothers and our sisters and our coworkers. When do we put the genie back in the bottle. How can we allow addictive drugs continue to be sent home with our loved ones . The highest percentage of deaths, opiod deaths, are mothers, middle aged women. Most of them got addicted to them after birth or an elective surgery. How is that possible . How do we let it continue to move down that path and not say that weav to do something bold about this . When its a controlled substance, why do we allow it to go home . Wouldnt that be better treated in the hospital. We talk about a lot of remedies, but we have got to go back to where it started and it started when we started treating it like a sense. Im very, very proud, that chairman burgess youre taking an interest in this and chairman murphy took an interest in this too. And thats why were proud to pick up one of his bills, its h. R. 2545 that will at least allow doctors to know if that person has an adi diddictive ber so were not sending those kinds of drugs home with them. I hope that we can approach this in a bipartisan approach, put politics aside and put families first. I look forward to working with you, i yield back. The chair recognizes the gentleman from new york for three minutes. Ranking member green and members of the subcommittee, we are a nation in crisis, we have opiod addiction at an unprecedented scale. And astonishing 21 increase from the previous year. This Public Health disaster is costing us more lives annually than at the peak of the aids epidemic, as many as guns and traffic accidents combined. If this committee doesnt figure out a way to turn the tide in this epidemic, we will be part of the access improvement act, h. R. 3692, with my good friend, this legislation would expand access to medication treatment by mid to prescribe in addition this legislation would codify the 2016 rule that allowed physicians to treat up to 275 patients and eliminate nonphysician providers to provide m. A. T. The Addiction Treatment access improvement act, would particularly benefit postpartum women who are struggling with addiction and would neonatal abstinence syndrome. There is still a significant shortage in treatment capacity, resulting in individuals waiting months if not years to receive effective Addiction Treatment. Only 20 of treatments who need treatment for opiod use disorder are currently receiving it. Let me repeat that, only 20 of patients who need treatment for opiod use disorder are currently receiving it. The access improvement act will save lives. This committee should act on this Bipartisan Legislation without delay. The second bill i would like to discuss, is the medicaid reentry act. H. R. 4005. This legislation is a targeted attempt to address the problem of Overdose Deaths that occur post incarceration, studies have shown that individuals who are released back into the Community Post incarceration are roughly eight times more likely to die in an overdose for the first few weeks post release as other times. Due to reduced physiological tolerance for opiod amongst the incarcerated population, a lack of Addiction Treatment options while incarcerated and poor Care Transitions back into the community. The medicaid reentry act would grant states flexibility to restart medicaid coverage for individuals 30 days prior to release, by letting the benefits start prior to release, medicaid would provide treatment prerelease, reducing the risk of Overdose Deaths post release, striking an overall wiser use of scarce medicaid dollars, let me be clear, this legislation i have introduced would not expand m medicaid eligible in any way, it would just start an individuals would dove tail with reentry programs that are already been championed by republicans and democrats in states across our country and would give individuals a chance to live a healthier, drug free life. I know that many of the ideas that this committee will hear today would in normal times be met with the typical partisan objections and end up stuck in a procedural morass. These are not normal times. When your house is on fire, you dont look to see whether the firefighters are wearing red or blue uniforms before they turn their hoses on. If were truly going to make a difference in this crisis and save lives, we have to have a big heart and an open mind. I thanni inthank my colleagues time and for the chairman of the subcommittee, thank you for offering such attention to a crisis that has gripped this country in severe measure. Thank you, i yield back. The chair recognizes the gentleman from North Carolina, congressman hudson. As has been noted, the opiod epidemic is not a opiod epidemic is killing more people per year right now than the hiv epidemic did at it peak in the 90s. These drugs do not discriminate based on race, social class or age and they destroy lives, families, marriages and careers. In my home state of North Carolina, the opiod epidemic has hit very hard. One of which is in my district, fayetteville, North Carolina. One particularly devastating story that i heard from a c constituent i met while touring my district. He was a police captain, son of a police chief in my time. He went baas injured on the job was prescribed a opiod after surgery. Within a year he was a full blown heroin addict. Hes since recovered and now mentors people in treatment. Fayetteville has become the home of soldiers and veterans who have become addicted after being prescribed opiods for injuries sustained in combat or in training, the tragedy is that the va doesnt have beds to treat veterans so oftentimes veterans go without help and are forbesed to self medicate, we need to find Real Solutions so we can put an end to this heart break, im proud to comprehensive addiction and recovery act and the 21st century cares act. These laws have made huge steps in the treatment of opiod addiction, but its clear we have work left to do. I am working on legislation to dispose of opiods, dispose rx manufactures a powder that renders any unused opiods, not only inaccessible, but also biodegradable. Its innovation ideas like this that we need to exproper and i look forward to working with my colleagues on the committee. The chair recognizes the chairman from massachusetts mr. Kennedy. Thank you for convening this hearing and bringing all of us together. I also want to thank my colleagues that have testified already, their comments i think are right on, i think they show the depth of this epidemic across the country, how its affected so many from our districts and around our nation and the myriad ways in which our federal government can help respond to it. There is no Silver Bullet to this. But there are ideas out there that are, i think, genuine that have widespread support and i hope will deserve this committees attention going forward. Addiction, as many know, is no it a disease that knows Congressional Districts or state borders or college results. For patients and families on the front lines of this epidemic today, this is personal, it is painful and it is petrifying. The question i think before all of us is that is there an epidem epidemic, you have heard from my colleagues today that there is. I want to touch upon a couple of broad themes as well. First and foremost is medicaid, medicaid, as of now, covers about 30 of all nonelderly adults with opiod an opiod addiction in this country, 30 . And the 20 of opiod adoidicts that do not have health insurance, largely stems from individuals in states that did not take a Medicaid Expansion. This is not enough. We need to strengthen our Medicaid Programs to make sure that everyone gets the care that they need when they need it. That means not just expanding medicare eligible but flushing out the networks that medicare provides that you dont have 2 stories that so many of us have heard from folks around the country, even if they are enro l enrolled in medicaid, there are providers that dont take it. And if providers do take it, they have to wait months to get into treatment. Theres complex reasons for that, but a lot of that is low medicaid reimbursement rates that puts the onus on the provider rather than medicaid. Folks we lock people up in this country that are sick, and we need to be doing an awful lot more not only to make sure that the safety net for our menl health systems. Our Police Officers who end up being on the front lines of this epidemic in this country and are put in an impossible place to have to arrest people and put themselves in danger because our me Mental Health care is not good enough. They were breaking into homes and cars to try to satiate an opiod addiction, because they didnt have anywhere else to go. Finally, and ill be brief, mr. Chairman. The medical community, we heard folks talk about prescription guidelines, and others, all of those need to be on the table. I had surgery before, i got in an argument with a surgery technician on my hospital bed who was trying to prescribe me painkillers that i wouldnt take because im so deathly afraid of those things. I look forward to working with my colleagues to make sure that this committ this will allow you to depart and we have a panel that will be mr. Ko costello, mr. Carter and congressman goodlat of virginia. And mr. Wahlberg, we are doing energy and commerce members first, but with your permission, ill go to the chairman of the Judiciary Committee since hes made time to be with us this morning and chairman goodlat, youre recognizes for three minutes. Members of the committee, thank you very much for the opportunity to testify about the opiod crisis in america. This crisis crosses individuals at all socioeconomic levels. According to the Northern Shenandoah Valley Substance Abuse coalition, they have seen 11 opiod overdoses since september 20, making over 43 deaths in my district so far this year. Just recently i met with a mother in roanoke whose daughter is an opiod addict whos living on the streets. Everybody in this room has heard these stories of futures taken away and lives taken too early. Stop drug traffickers and make our community safer. We at the Judiciary Committee have been pleased to work with the committee on energy and commerce in this fight to combat this epidemic. Just last year, since last year, the Judiciary Committee has passed seven legislative measures that address the multifaceted nature of the opiod epidemic, the energy and Commerce Committees worked collaboratively to make sure that the 21st century care act signed into law last year. This Bipartisan Legislation combats the opiod heepidemic. Including vital training and resources for First Responders and Law Enforcement, criminal investigations for the unlawful distribution of opiods, drug and other alternative treatment courts and residential Substance Abuse treatment. We have also targeted those who traffic in opiods, the transNational Drug trafficking act which is now law, improves Law Enforcements ability to pursue interNational Drug manufacturers, brokers and distributors in source nations. Federal prosecutors can now use the important tools in that bill to pursue foreign drug traffickers who are poisoning american citizens. Additionally in july of this year the Judiciary Committee reported favorably to stop the importation and traffic, of synthetic drugs. Heroin is regularly laced with synthetic drugs such as fentanyl. This bill ensures that our laws keep pace with the sbintroducti of chemically altered drugs to keep these off our streets. I hope youll take a very close look at it and if we can pass it out of the committee, im sure it will pass the house with a very strong vote. Mr. Chairman and members of the committee, i appreciate the opportunity to testify, my dedication to curtailing the opiod crisis is unwavering, i continue to look forward to that end. Thank you. The chair thanks the gentleman. We appreciate you being here, and we know we have work to do and we will Work Together on this. And im always delighted to go behind the chairman of the Judiciary Committee, especially since theres some of my bills in his committee. But let me say, chairman burgess, Ranking Member green, i want to thank you for holding todays hearing to receive input from members who represent different corners of our country and yet the very same problem. Since the heroinopiod crisis came to the forefront, i have heard so many devastating stories about families losing loved ones, i have toured Recovery Centers and talked with survivors continuing to battle a addiction and rode along with plau Police Officers who are tasked with keeps us safe. Fellow citizens who have stepped up and are leading the fight in their communities. A few weeks ago i had the opportunity to meet with a con scor stit constituent name george, a Nonprofit Organization named in honor of his son who died in 2012, he was only 25. Ry ryans hope fund they have helped and nearly 40 addicts by sending them to rehab. To help cover these costs, he has also teamed up with local First Responders to organize a Charity Hockey game called hockey against heroin. In my own home county, the Pathways Recovery Engagement Center just opened its doors last week. I got a chance to see the center in august, when it was in the final stages of construction, this recovery based program in downtown adrian is the result of a partnership with local clubs and the local Hospital System and Mental Health authority. Ryans hope and the Pathways Resource Center are just two shining examples of constituents in my district making a difference. We need more Community Based initiatives like these to get resources to those in need. But Congress Also has more to do. One example is jesses law, a bipartisan bill i have introduced with congresswoman debbie dingell. It seeks to thensure that medic professionals safely treat their patients. Its named after jesse grubs who died of an opiod addiction. He had battled addiction but had been clean for six months and she was training for a marathon when an infection related to a running injury required her to have surgery. Jesses parents told doctors that she was a recovering addict and shouldnt be prescribed opiods, unfortunately, jesses discharge physician didnt know her addiction history and sent jesse home with a prescription for 60 oxycodone pills, jesse became a statistic. Jesses law will make sure that doctors and nurses will have access to a patients complete Health Information when making treatment decisions, such information is crucial to provide patient centered care, prevent relapses and ultimately save lives. As we Work Together to address this crisis, its my hope that the stories and ideas shared today will inform our efforts and ensure we pursue meaningful me measures to ensure that we give local communities the funds to meet this crisis head on. I believe this concludes all the the energy and commerce members seeking to give testimony, if any arrive, we will allow them to testify as they come in. But i think our panel now will be chairman rogers, mr. Marshall of kansas, mr. Turner, mayor of dayton, ohio. If you wish to join us now, that would be good as well. And chairman rogers, thank you for being here, and being part of this discussion this morning, youre recognized sir. Well, thank you mr. Chairman and colleagues, thank you for hosting us on this very, very important topic. Over the last 15 years, many of you have heard me advocate for a hole listic holistic approach to the calamity we face, including prevention and treatment measures like those successfully implemented by unite in kentucky. We need to ensure regional collaboration on this issue that ignores lines on a map and i hope to work with the committee on this issue in the future. Today, however, mr. Chairman, i would like to focus on treatment. Despite the light we have shown on addiction, only 10 of those needing treatment for alcohol or drug related addiction actually receive it. 10 . Underlying challenges in the treatment workforce, further compound this lack of access. There are simply not enough incentives for Health Professionals in training to specialize in addiction medicine. Treatment professionals work in stressful environments, receive relatively low pay, and turn over at rates much higher than other Health Professionals. Nih continually pioneers research on addiction science, and new ways to treat this chronic disease, yet america has only half the number of practicing Addiction Specialists needed to put their findings in practice. This is a Patient Safety and Public Health calamity. Patients in need of Addiction Treatment ought to have access to specialized care, in every corner of the country. Thats why i will soon be introducing legislation with my colleague catherine clark, to create a Student Loan Repayment program for qualified Substance Use Disorder Treatment professionals. This program will not only encourage Health Professionals to pursue careers in addiction medicine, but steer them towards areas most in need of their services. Though its not a Silver Bullet, this bill would be another substantial step in the right direction. And i hope to work with each of you, mr. Chairman, and members, to this end, and i thank you for allowing us here today. I yield. The chair thanks the gentleman, the gentleman yields back. Would the gentleman from georgia wish to join us at the table . And mr. Carter, if youre ready, i will recognize you for three minutes. Thank you mr. Chairman and Ranking Member green, i want to start my testimony by thanking you for holding todays hearing on how to epidemic. I as a pharmacist i have always as a community pharmacist, i develop close bonds to people who are often my friends and neighbors, that bond pushes pharmacists to always act proactively in helping their patients. One of the largest concern i have heard is opiods for pain relief. We need to look for other outlets for treatment of pain and find a good immediate yumt. I believe we can work with the fda to provide nine create a channel for those therapies. In addition, as it currently stands, prescribers are able to write up to 300 prescriptions for patients. I think its pertinent to preexamine those allowing fewer initial prescriptions and limiting the number of refills rather than three months of prescriptions, similar to that notion, allowing pharmacists to have a greater say in limiting the number of pills in a prescription could help limit the transition to addiction. Limiting the pain for a dental proveed your on der cara a pharmacist is only allowed to fill a partial prescription. A simple seven day fill could cover their pain needs and keep more pills out of potential use or circulation. Prescription Monitoring Programs are a great resource in combatting Prescription Drug one way to do so is to better align the data included so that states can collaborate to create a more comprehensive picture of peoples drug use, further limiting state pmts and can monitor more actively potential abuses. Drug take Contact Programs continue to expand across the country, currently at least 19 states have some form of drug take back programs and 23 states have programs allowing pharmacists to accept unused and unwanted drugs. One of the most common ways teenagers access Prescription Drugs is through the medicine cabinets of their parents and grand parents. Expanding paid for mail programs can take some of those Prescription Drugs off the street. The creeks of middle ground for therapies will pro facilitating research and development, we can help drive the expensive and time consuming efforts needed to make those treatments a reality. Currently there are a few options left between tylenol, tr tramodol and openoids and thats driving prescriptions across the country. So thank you mr. Chairman and the committee, i look forward to working with everyone to tackle this issue. The chair recognizes the gentle lady from illinois for three minutes. Thank you mr. Chairman, and also Ranking Member green, i would like to start out by telling you a story about a young man from my Congressional District, named chris boozman, i had the good fortune of meeting his mother who told me this story. He had injured his back and as a result of that, his physician prescribed an opiod to relieve his pain, soon after that, he became dependent upon that prescription opiod, and found out that he could go to the street and find something very cheap called heroin, 10. So he continued this cycle of overdose, rehab, relapse, and he was on the right path, he had enrolled in a college called Rock Valley College where he was studying construction management. But a year after being clean, he relapsed again and ended up passing away. And we know stories very similar to this are happening all over our country. And i was so proud when we came together, democrats and republicans, and actually passed some meaningful legislation to help address this opiod crisis. One of the bills that was included in that was to care for infants born with an opiod addiction due to their parents addiction. In fact we received the Government Accountability report that my bill called for very recently and it reviews and makes recommendations to care for these infants. But what it really ended up showing is that we have a very long way to go. The department of health and Human Services has a strategy for improving infant care but they havent put this into practice, theres not even a protocol to treat these new infant babies who are born addicted because of their parents addiction. Medicaid pays for four out of every five babies that are suffering from opiod withdrawal upon their birth, its helped 1. 6 Million People with Substance Abuse disorders and access to treatment. I really want to make the point that medicaid has to be prote protected and not cut. I want to stress one other point because of the Congressional District i represent. And that is that the opiod crisis is actually worse in Rural Communities, where the drug related deaths are actually 45 higher. Rural states have higher rates of overdose, especially prescription opiods like the kind chris had been prescribed for his back injury. We dont have the resources to fight back at the level that we need to, we dont have enough physicians in Rural America, we dont have enough hospitals that have up to date technology to help with this crisis, we dont even have the needed transportation to reach these Treatment Centers. Thats why earlier this year i introduced a Bipartisan Legislation to better the department of Agriculture Programs on opiod use and abuse. We need to which will help us overcome the transportation and access issues that i mentioned earlier. With that, mr. Chairman, i yield back the rest of my time. Chair recognizes the gentleman from dayton, ohio mr. Turner for three minutes. Thank you, mr. Green and members of the subcommittee, i thank you for the opportunity to appear today on this important issue, i come from dayton ohio, my counties in ohio are montgomery, green and fayette. And despite our battle against the opiod epidemic for years, this year, current estimates suggest that 800 people could die in my primary county, Montgomery County due do opiod overdose, sadly that would more than double the 370 drug Overdose Deaths from 2016, the highest number recorded to date. Imagine 800 families receiving notice that a member of their family has died from an opiod overdose. Recentably in working in conjunction with the county sheriff, i have appointed a Regional Drug czar to respond to this heepidemic. Today i would like to highlight my bill h. R. 1482. The treat act would increase access to Substance Abuse treatment, by lift medicaids institutionses f es mental dise exclusions say that 16 beds are not eligible for reimbursement for Substance Abuse for individuals who are incarcerated compounding the Substance Abuse and limits the use of grants from its center for Substance Abuse treatment, to only Community Based Treatment Facilities, excluding those who are incarcerated. My bill by allowing medicaid to reimburse for Substance Abuse Treatment Services furnished to individuals who are incarcerated theres no reason why someone whos medicaid eligible should lose their benefits upon incarceration. I first introduced the treat act in 2015, and reintroduced it this year, to medical providers to local jurisdictions the president s commission on combatting drug addictions was strongly endorsed this concept that is in the treat act. The White House Commission called lifting the restrictions is the fastest way to improve treatment availability across the nation noting that every governor, numerous treatment advisors and nonprofit abuse centers have urged this action. Lives are at stake, this would be an important step to bring treatment to those individuals who are at a time when we have an ability to intervene in their lives. Chair recognizes the gentleman from kansas, dr. Marshall for three minutes. Thank you, mr. Chairman, very, very much, thank you for the opportunity to come and talk about i experience as an ob gyn in kansas. 92 people die in this country every day from opiod addiction. What i wajtd ewanted to do is d a couple of sentinel events, why do we have this much addiction . What i would send home for a post surgery patient doubled. For the average postop patient, the amount of pills they would need literally doubled. And i went back to figure out why and how come. The patient bill of rights came about in 1993 or to. And over the next ten years, there was a great document, patients suddenly started to expect that they would have no pain after surgery, they would come to the er after a sprained ankle and expect to have no pain, and the demand for narcotics went up and up. We introduced a pain scale and we called it the fifth vital sign. Where they suddenly described the oomt of pain they had, which is very subjective. And beyond that and it started become a major factor in how good a were getting the double and triple the medications and on the postoperative fleer, rather than getting meds every six hours they were getting them every four hours, what im trying to say we almost doubled the amount of narcotics people were getting in the hospital and they wanted twice the amount to go home with as well. So physicians were faced with this struggle, saying i dont think you need this much, but patients being more in control of their own health care. So i think thats a couple of reasons why we ended up here, and i think there needs to be some reeducation done. I would like to point to valley hope of kansas. They have treated over they have incredible treatment plans. What they taught me is about a month after they started their path to recovery, that they had a second fiphysiological reacti, and thats when people od and die. People recognize that for a month they a need to have very close treatment. So its during that second episode, when before they had treatment, they were taking a certain amount of heroin and a handful of pills and a pint of whisky, when they retreated from that for a month, and they went back to that same dose, they overdosed and ended up dying, if i gave anybody enough morphine, you would stop breathing, so theyre unable to metabolize it. We viennese need to recognize t treatment plans dont last a week, we need to make sure were adequately funding outpatient treatment and making sure theres good followup at home and we need to reward places Like Valley Health for having great outcomes. Thank you for taking on this task and we look forward to working with you as always. The chair recognizes the gentleman from ohio. Chairman stivers for three minutes. Mr. Chairman, i appreciate you holding this hearing, i appreciate Ranking Member green and all of you looking for solutions to this opiod crisis thats plaguing all the communities across this country, congressman turner and alluded to it. But in ohio, opiod overdoses now exceed Car Accidents as the leading cause of death for most ohioans. And theres been a lot of great ideas presented here today, and i really have appreciated learning from many of our colleagues. I for the last five years have held opiod round tables, drug round tables in my district to talk about solutions and we have come up with some ideas from the field, folks that know what is driving this crisis and ill talk about some medical things in a second. But the first thing i know we have to do is bring back hope and Economic Opportunity to people. And i think what youre doing mr. Chairman with Regulatory Reform and what were doing with tax reform is going to help with that. But there are a lot of other things we can do. First, the idea that came out of our round table this year was on evidence based treatment. If youve been to one Treatment Facility, youve been to one Treatment Facility. Because they all do things differently. Some Treatment Facilities, once you walk out that door, theres nothing tying you to the treatment anymore. And thats a problem. And i think we should have evidence based treatment, it should be based on the science of the day and how Recovery Works and i think we need to build that into our reimbursement standards, i think thats so important. Dr. Marshall already talked be it the second issue, and thats pain as a vital sign. Every other vital sign you can think of. Your temperature, your pulse, your Blood Pressure can be measured by a machine. And pain cant be measured by a wh machine its subjective. I appreciate what cms has done to remove the reimbursement on the surveys of Pain Management, but i think we need to remove pain oozeas a vital sign. Theres lots of ways to manage pain, including acupuncture, cairo Practice Services and other things that dont involve a pill. And we need to change the culture on that. And the fourth idea is some prescription changes. I believe that pharmacists should be empowered to authorize partial fill of opiod prescriptions on their own, and buddy already said it, but 70 of the folks who misuse prescriptions, bridge that addiction through their friends and families medicine cabinets and we have go to fix that. And one thing we dont talk about enough, is typering doses, after someone has been on opiods for 30 days, they have a physical addiction to, and when you talk to pharmacists they talk about a tapering dose. And we need have a culture around people understanding that, because a lot of primary care physicians, mr. Chairman, feel very uncomfortable with issuing for prescriptions, but a tapering dose actually will reduce the physical addiction and actually will result in less people wanting to feed that addiction in other ways. So those are just five ideas of some proposed solutions. Many of my colleagues also have great ideas, i appreciately appreciate mr. Chairman and Ranking Member you holding this hearing and were committed to working with you to driving the scourge of drug addiction out of this country and i really appreciate what youre doing. I yield back. I want to thank all of you for providing your testimony today. This panel is excused and our next panel will be dr. Winstrop from ohio, mr. Snipyder from illinois, ms. Clark from massachuset massachusetts, mr. Jeffries from new york and mr. Jenkins from West Virginia. Representative snyder, youre recognized for three minutes. Thank you, thank you mr. Chairman burgess and Ranking Member green for inviting us here to discuss the open it a dadick opiod addiction and abboous. I represent parts of cook and lake counties and the opiod crisis has hit our neighborhoods very hard. In cook county, which includes the city of chicago, opiod overdoses increased by 87. 4 . I repeat that, 87. 4 between 2013 and 2016. Over the same period, we have witnessed a troubling increase in fentanyl, a synthetic opiod, which is even more deadly than heroin and whose overdoses are often fatal. In the face of these challenges, i would like to introduce the lake county opiod initiative along with other area organizations for their work in trying to prevent abuse and overdose. We must ensure our doctors are up to date with the most recent best practices and research for preventing and treating this disease. Earlier this year i introduced a bill called preventing opiod abuse or opiod pace act. This bill would require providers to complete 12 hours of continuing education every three years. In an effort to cut down on overprescribing, cne would focus on best treatment. Early detection of opiod use disorder, and the treatment and management of individuals with opiod use disorder. At the department of defense was included as an amendment to the nda authorize days. Our men and women in uniform are not immune from the damages of opiod addiction, in fact opiod misuse is higher among Service Members than among civilians due to the use of these drugs to treat ptsd and chronic pain. As we seek new legislative solutions solutionsby expanding medicaid and requiring individual market the states with the highest rates of drug Overdose Deaths are also the states that would suffer from a roll back of Medicaid Expansion. Simply put, repealing the aca would add file to the fire of the opiod heepidemic. Preserve the programs we have in place to fight the help 2keepid. The chair recognizes representative jeff reise for three minutes please. Thank you chairman burgess and Ranking Member green for holding this hearing on this very important issue. Appreciate the opportunity to testify today on the synthetic drug awareness act of 2017, h. R. 449. The opiod crisis has ravaged families across the country without regard to religion, race, or gender. Like a malignant tumor, the opiod crisis is eating at way at young people in Rural America, urban america as well as suburban america. A synthetic drug call eed fental that can be 50 to 60 times stronger than morphine. H. R. 449 addresses a critical and sometimes overlooked threat, the use of synthetic drugs by teenagers. It requires the Surgeon General to prepare a comprehensive report on the public effects of synthetic drug abuse by 12 to 18yearolds in america. With the information this study will provide, congress can work to prevent Substance Abuse by younger americans through an enhanced and enlightened lens, nation wide Drug Overdose death rate has more than doubled during the past decade among younger americans. Many experts believe this troubling phenomenon results from the rise and ability of potent and dangerous substances, like elicit fentanyl and other synthetic drugs. Teenage fentanyl use is a vicious cycle as they are still developing frontal cortex. The drug then alters the development of this area of the young brain, making that behavior permanent. In fact more than 90 of americans who develop a Substance Abuse disorder began using prior to the age after 18. In new york city, overdoses now kill more people each year than murders, suicide and car crashes combined. This phenomenon we have seen repeated over and over again all across america. This bill has significant support amongst republicans and democrats and has been incorporated into the legislative agenda for the Bipartisan Heroin Task force. It also has support from a number of health and Patient Advocacy groups, including the American Academy of pediatrics, American Association of nurse practi practitioners, as well as the National Association of police organizations. Thank you again for this opportunity to testify and i respectfully request Committee Consideration at your earliest convenience. It. The gentleman yields back, the chairman recognizes the gentleman from virginia for three minutes. Thank you very much chairman burgess, Ranking Member green and members of the subcommittee for giving me the tumpbt opporto discuss this most challenging unapproximate lick health issue of our time. My home state of West Virginia is ground zero for the opiod epidem epidemic, West Virginia has the highest rate of opiod heepidemi and the highest rate of newborn from this tragic epidemic, however, has come an exceptional response from communities across my state, coming together to find solutions. One shining example is lilys place. A unique facility that specializes in treating newborns suffering from n. A. S. I was proud to work with two nicu nurses and a Passionate Community leader to start lilys place after they saw, we saw the dramatic rise in newborns with n. A. S. Lilys place has been operating for three years and has cared for more than 190 precious newborns. Lilys place has brought National Attention to West Virginia solutions. Just yesterday, the first lady, melania trump, visited lilys place in my hometown of huntington, to talk with the caregivers about helping the most vulnerable in our society. Lilys place provides a great environment with care given by doctors and nurses in a nurturing setting conducive to recovery. Mothers and families are included in the healing process. Lilys place and others advocating for this model of care have struggles dealing with cms. Making it harder to replicate this model. That led to my introduction of the nurturing and supporting healthy babies act. Last year, through this committees work, my legislation was incorporated in care which of course became law and was passed. Thank you for your work. My legislation requiring gao to closely look at the different care models for n. A. S. In medicaid coverage and the gao report was just released last week. It found that nonhospital settings like lilys place, are a proven model of care to treat n. A. S. Newborns. It identified this model of care as a proven effective treatment approach and can actually reduce the cost of care. Here is my ask. I would encourage this committee to advance two measures critical to the care of these precious newborns. First, i have sponsored the crib act pending before this committee with congressman mike turner, which makes sure these models of care are included in nonhospital Treatment Facilities or recognized by medicaid to remove the barriers. Second, based on the gao report, i ask you working with me, this committee, to memorialize in legislation the recommendation in this report and have these become law so these precious newborns can receive the very best possible care. Thank you, mr. Chairman, for your interest in this issue. And i yield back. Chair thanks the gentleman. Dr. Winstrip, youre recognized for three minutes. Thank you, chairman burgess and Ranking Member green, for hosting us today. I mean that sincerely. Were hearing a lot of good ideas and it gives us a lot of food for thought. The Opioid Crisis is affecting each and every one of our districts across the country. Thats very obvious. And i appreciate the chance to come and speak today and share with you some stories from ohios second district. My office recently sent a survey to the constituents of our district, and we asked them to share their stories and experiences with the Opioid Epidemic. And the results are heartbreaking, as you might imagine. We received hundreds of responses, up to seven pages of responses. I want to share a couple of those with you. One said my brother uchl unfortunately became addicted as a teenage. Hes very lucky because at 33 years old, hes still here, but hes still fighting every day to stay sober. These drugs have no place in our country. Theyre ruining our youth, our future. Another one, a woman said i have four boys, and three of them are struggling with this addiction. The cost of going to a methadone clinic is very difficult. The cost of Treatment Facilities is too expensive. Im going broke trying to get my children sober. Clearly, this epidemic is devastating for southern ohio as it is across the country. In one county alone, the overdose death rate was 37. 5 per 100,000 residents, and in another county, 318 residents died of an unintentional Drug Overdose in 2016. This spring, the Columbus Dispatch reported at least 4,149 ohioans died from an unintentional Drug Overdose in 2016. And one local newspaper called the overdoses the new normal in that county. I appreciate what dr. Marshall had to say earlier, as a doctor, i can agree with him on many of the factors that have driven so many people into addiction. And i would really like for us to talk some time about prevention, which i think is the longterm vision for our country. I can tell you as a doctor, i had someone come up to me just last year and say, my friend wanted me to thank you if i met you. I said why is that . Because she was addicted to prescription pain meds, and when she came to you, you gave her alternatives, and you didnt give her any. We search for answers. Were all searching for answers. One of the sheriffs in my district, hes working hard on this solution, and hes using prevention, because he said i cant incarcerate our way out of this. But he did show me what one patient received on medicaid in a year, what one patient in one year received from medicaid as far as narcotics, and i promise you it was more than i prescribed in my entire surgical practice in a year. Then he showed me what medicaid paid for it. So while i understand that medicaid is providing help and care for a lot of people, it may be driving the problem as well. Because as some are getting treatment, many are getting fed. And the problem is being exacerbated. We need to look at that, and there needs to be a better oversight of how were handling this. This sheriff directs an essay contest asking local students to write an essay about the dangers of opioids and how they hope to become the generation to stop the epidemic. As i said before, he said he cant incarcerate his way out of this. We cant always treat our way out of this. But i hope that we take some time in this process for a longterm vision of how we can prevent people from ever getting in this situation to begin with. With that, i yield back. I thank you your time and attention today. Thank you. The chair in absence is recognizing Congress Woman clark. Thank you to you and chairman burgess for holding this member day today. Were all here because we lose 91 americans a day to the Opioid Epidemic. And every one of those 91 deaths affects not only the victim but also their loved ones, their work place, and their community. Now is the time for us to come together and find solutions to end this National Health emergency. And with that in mind, i would like to speak in favor for commonsense proposals im leading, each with a great republican partner, aimed at addressing a different aspect of the Opioid Epidemic. The first is the youth act, which i introduced with my colleague from indiana, dr. Bucshon. The Opioid Epidemic has had a tragic impact on our young people. From harmful changes in brain and social development to long gaps in education and job training, the effects can be profound. The youth act would expand access to evidencebased medication assisted treatment for adolescents and young adults. Giving them the best possible chance at recovery. The second proposal is the prescribing support act, which i introduced with my colleague, congressman evan jenkins. Tragically, opioid addiction often begins in the Doctors Office where patients are often prescribed more medication than they need or without being informed about the risks of addiction. The prescriber support act would establish statebased resources for prescribers to consult when making decisions about prescribing opioids. Third, a recently introduced ever prescription conveyed securely act with my colleague from oklahoma, congressman mullin. This proposal would insure that all prescriptions for controlled substances filled through Medicare Part d would be transmitted electronically. Electronic transmission would help doctors and pharmacists spot patients attempting to doctor shop and it would make it more difficult to forge a prescription. All the while saving taxpayer dollars. Finally, i will soon be introducing a bill with my colleague from kentucky, congressman hal rogers, that will create a Student Loan Forgiveness Program for professionals who enter and stay in the Substance Use treatment field. In my district, i have heard time and time again from families and providers that there simply arent enough treatment specialists available to help the growing number of americans struggling with Substance Use disorder. Our bill will help build this critical workforce. There is no single solution to the Opioid Crisis. However, these four Bipartisan Solutions can help put us on a path to beating this epidemic. I thank the chairman and the Ranking Member for giving us this opportunity to have this conversation, and i look forward to working together. I yield back. The chair thanks the gentle lady. The gentle lady from connecticut is recognized for three minutes, please. Thank you, mr. Chairman. Chairman burgess and Ranking Member green, thank you so much for holding this important hearing on the growing Opioid Epidemic. Everywhere i go in connecticut, i meet people whose families have lost loved ones to drug addiction. Moms and dads, sons and daughters, brothers and sisters. Its an epidemic that affects families and communities across the country, regardless of age, race, gender, socioeconomic status. During one of my visits recently to an Addiction Treatment center in waterbury, i met a young woman who has been struggling on the streets with addiction. She has a new child, and shes so grateful to be in a program that is allowing her to stay clean and helping her keep her child. I met a 45yearold man in the fail Treatment Center in new britain, who for 20 years has been battling his addiction and is coming to terms with it and is able to hold a steady job. These are real people, real families and real lives affected by this crisis, and the stakes are high. If these vital Treatment Centers are forced to close their doors or if we limit access to them, people will die. In my hometown of cheshire, a neighbor whose daughter was a class mate of one of my children contacted the office that they had lost track of their daughter. She had bn on the streets addicted to drugs. We were able to help them find her. She wouldnt accept the treatment, and a week later, she was dead. Thats what its like now in america. The situation is so dire in connecticut that our chief medical examiner lost its accreditation. They cannot keep up with the autopsies. Were expecting more than 1,000 deaths this year. Thats the third highest rate in the country. They literally cannot keep up with the autopsies. We need to do something. And this Congress Needs to act. Im pleased at our good bipartisan work last year. My bill of the prevention drug addiction act of 2016 was included as part of the Conference Committee and our good bipartisan work to insure that were addressing the issues of prevention that many of my colleagues have addressed here today, bolt provider education on how to prescribe as well as for parents, coaches, and others who need to be aware of the risks of Prescription Drugs. But theres important work at stake. I do want to Say Something about the Affordable Care act. We need to protect the funding, which is providing vital access for people across america. And were at real risk now as we consider that funding and whether the medicaid access will be cut off, which is funding so many more programs in my state. Again, i want to thank this committee for the good work and encourage all of our members come together and help address this vital need, this growing epidemic that is affecting all americans. Thank you, and i yield back. Chair thanks the gentle lady. Chair recognizes the gentle lady from utah for three minutes, please. Thank you, mr. Chairman, for such talking about such an issue. I would like the thank the Ranking Member green, also, for giving us the opportunity to speak about the Opioid Epidemic and crisis. Nationwide, the rate of deaths has exploded to over the last ten years to now more than 60,000 deaths every year. In utah, the department of health says that more people are dying from opioid and heroin overdose than ever before. Six people die from opioid overdose per year. Alarming increases from 2013 to 2015. Utahs seventh highest for those deaths per capita in the United States. Heres what hits me the hardest. The innocent children that are being affected by the Opioid Epidemic. In too many cases, parents are no longer parents. Their children are parenting themselves, and the parents are now slaves to their addiction. This is actually happening in elk ridge, utah, a place where, which is just a few minutes away from my home. Theres a boy who is in third grade who talks about his life with his mom, who is addicted, and his stepfather, who is addicted. He talked about waking up by himself and getting himself ready for school. And also getting his brother ready for school and his newborn sister. He makes breakfast for them and prepares a bottle for his newborn baby. Who is his sister. He talks about the fact that many times, he misses the bus when hes going to school because hes taking care of his brother and sister. And theres no one to take him to school. His brother cries, asking for his mom and dad, and he as a third grader, has to try to explain to his brother why mom and dad arent around. Thats not the end of the story. His newborn sister is actually addicted to opioids because his mother took the drugs while she was pregnant. And while in the hospital, for fear of getting caught, she actually took opioids and would rub it on the gums of her baby so that the baby wouldnt show signs of withdrawal. This is what is happening in america. This story is not unique to utah. Its happening everywhere. The parents are now in jail. They were arrested for trying to return stolen merchandise at the local walmart and neglect of their children. But i have to say that the childrens lives arent better now without mom and dad. Their nightmare is just beginning. So i feel very strongly about this. At a time where theres so much partisan politics, this is an issue where so many of us are standing together. I believe american democracy is at its best when two people are talking about what we are for. Here woo are in a room talking about what were for. Im so proud were coming together, but coming together is not enough. We actually have to apply some of the solutions were talking about when it comes to the crisis and i think the opportunity to im thankful for opportunity to work on this. Thank you. And i yield back. Chair thanks the gentle lady. Let me take the new jersey delegation in seniority, and mr. Pascrell, ill go to you first for three minutes. Thank you, chairman burgess. Ranking member green. I dont have to tell you or anyone here that opiate abuse and misuse is one of our countrys Fastest Growing problems. It is also one of the most vexing problems we face. And there are no simple solutions. Prescription drugs serve a valid medical purpose. But many of them carry a high risk of addiction and abuse. Many of my colleagues have good ideas about steps we can take to address opiate abuse and misuse, so i commend you for giving us the opportunity to share them. Today, i would like to share some information about a program that was developed and is in use at my hometown hospital, st. Josephs Regional Medical center in paterson, new jersey. As the busiest Emergency Department in the state of new jersey, st. Joes commitment to reducing abuse can serve, i believe, as a model for Emergency Departments across the state and across the country. We need to recognize that Emergency Departments are in a unique position with respect to Prescription Drug abuse. On one hand, a component of pain that legitimately many other health settings. To prevent addiction where it often starts with a valid prescription in the emergency room, st. Joes initiated a first of its kind alternatives to opioids, or alto. Alto program. The alternatives to opiates. This new approach utilized protocols primarily targeting five common conditions. The alternative therapies offered through st. Joes alto program include targeted nonopiate medications. Trigger point injections. Nitrous oxide. Ultra sound guided nerve blocks to tell a patients Pain Management needs, and avoid opiates whenever possible. In the first year of operations, this program decreased Emergency Department opiate prescriptions by more than 50 . The goal is not to eliminate opiates all together, because these drugs remain an important part of Pain Management. However, the alto program reserves their use for severe pain, end of life pain, surgical conditions. Thats it. This decreased prescriptions by more than 50 . The goal is not to eliminate all together, because these drugs remain an important part of Pain Management. However, the program deserves their use for severe pain, end of life pain, surgical conditions. As a result, only about 25 of the acute pain patients treated with nonopiate protocols since the programs launch eventually needed opiates. I believe that the initial successes of this program make it very important that we have a broader implementation and study. I leave this to your discretion. That is why senator booker and i plan to introduce legislation to establish a National Demonstration program to test Pain Management protocols that limit the use of opiates in hospitalbased Emergency Departments. Its my hope that strategies that provide alternatives to opiates can become a larger part of the discussion of how to combat this opiate epidemic. And that this committee will review and consider my legislation upon its introduction. With that, mr. Chairman, mr. Ranking member, i yield back to you. Chair thanks the gentleman. Mr. Mccarthy, youre recognized for three minutes, please. I thank the chairman burgess and Ranking Member green for hosting this opportunity today for those of us not on this committee to share our thoughts. We have all seen the numbers. Last year, over 60,000 deaths from overdose, opioids involved in the vast majority of those. In ocean county, new jersey, my home county, were losing somebody every 43 hours. And a couple weeks ago, my county was designated a high intensity Drug Trafficking area, desperately needed, but also disturbing sign of where we are. It may be unusual for a member to sit here and promote other peoples bills, even bills written by the other party, but as the republican cochairman of the Bipartisan Heroin Task force, representing over 90 members of boat parties, thats exactly what im here to do today. As your Committee Considers legislative next steps to pursue, i want to recommend the Bipartisan Heroin Task forces legislative agenda for your consideration. We are committed to being rigorously bipartisan. We did not include any bills in our agenda unless it had bipartisan cosponsors and both the republican and democratic chairs, cochairs, agreed to it. Five of the bills that were recommended fall within your jurisdiction. Representative tim walbergs jesses law, will insure that doctors have access to a consenting patients prior history of addiction. So they can make informed decisions. Representative david joyces stop o. D. Act, will increase First Responders access to narcan and synthetic opioid testing. Representative Hakeem Jeffries synthetic drug awareness act requires we investigate how the synthetic Opioid Crisis is affecting young people specifically. Representative evan jenkins crib act will insure treatment for babies with neonatal syndrome, and representative Brian Fitzpatricks road to recovery act addresses the imb excluz, which is one of the barriers preventing access to Substance Abuse treatment. Were proud of our members work. I would also note many of our ideas coincide with the white houses Opioid Commission recommendations and i note the good work done by the republican main street on the same issue. On behalf of my democratic cochair, annie kuster, our fice chairs, Brian Norcross and brian fitzpatrick, i urge you to consider these bills. Well continue to expand and update our legislative agenda as we tackle this critical issue facing our country. Thank you and i yield back. Gentleman yields back. The chair recognizes the gentleman from arizona for three minutes, please. Chairman burgess, Ranking Member green, members of the committee, thank you for allowing me to come before you today to testify on an issue that has had a devastating impact on my district. I want to first of all echo the sentiments of representative mcarthur. Im also on the task force. At least two arizonians die every day from opioid overdoses. Last year, deaths due to opioids rose 16 from the year before. As a former Law Enforcement officer, some of what i see today is familiar from my time serving communities. The harrowing stories of addiction, the pain Family Members face, including child abuse, domestic abuse, and the loss of a loved one. And also the relationship to organized crime. But i must tell you that what we are seeing today, the devastation that opioids have wrought on our communities is far more impactful than the drugs i fought to keep off the streets when i was a cop. Over the summer, i held a roundtable in my district on opioids. I heard from families, First Responders, local Law Enforcement, and Health Care Providers. Im here today to bring their voices to you as we commit to tackling this issue in a bipartisan and comprehensive way. As you work to develop policies to combat this epidemic, i implore you to consider the impacts to Rural Communities and to tribal communities, which face unique obstacles and barriers to treatment, care, and Recovery Resources. According to the cdc, American Indian and alaska natives have the highest death rates from opioids than any other community. American indians and alaskan natives have long faced disparities when it comes to resources for Mental Health care and Substance Abuse. Thats why funding created by the 21st century cures act in addition to expanded medicaid coverage in arizona have been crucial in helping families get the care they need. As many of you know, access to Crucial Health Care Services in Rural Communities and across Indian Country can be scarce. And often requires families to travel long distances. Providers in Rural America have benefitted from expanded medicaid coverage and are now seeing lower rates of uninsured patients than ever before. In states that expanded medicaid, the share of uninsured Substance Use or Mental Health disorder hospitalizations fell from 20 in 2013 to 5 in 2015. The increase in coverage has allowed rural providers to operate on the thinnest of margins. To help keep their lights on and their doors open. If Congress Repeals that coverage, rural providers will close their doors and patients who need the help will face fewer choices. We need to give states local Law Enforcement and tribes more resources and more flexibility to assess what works, but we must approach this problem comprehensively, and with a robust commitment to those we represent. I urge your committee to thoughtfully consider these issues and how they affect communities across rural and tribal communities. Those voices must be heard when it comes to this crisis. I thank you, and i yield. The gentleman yields back. The chair thanks the gentleman. If you wish to be excused, you may do so. But were all anxious to hear what the gentleman from maine has to share with us. So youre recognized three minutes. Thank you, mr. Chairman, very much. Thank you, Ranking Member, for the opportunity to be in front of you today. In our great state of maine, mr. Chairman, we have on average one person dies every day from a Drug Overdose. There is a recent study that said that six out of ten families in our great state, six out of ten, mr. Chairman, are impacted directly or indirectly by this epidemic, including, i might add, my own family. Rural maine has been hard hit. Rural america has been hard hit with this epidemic. Thats why i join the Bipartisan Task force to combat the heroin epidemic, and that led in part to a very comprehensive bill that we all passed in a bipartisan way last year, the comprehensive Addiction Recovery act that sent about a billion dollars back to our states so they had better resources and more flexibility to address this scourge on our kids and our Family Members directly on the ground in our respective districts. Now, the model, mr. Chairman, of the great state of maine is i lead. For are a bunch of things we have been doing in maine to help fight this epidemic that i think the rest of the country can learn as we learn from others. We have put in place a Prescription Monitoring Program that is very tough and very effective. In particular, it sets very strict limits on what opioids are prescribed. It mandates the use of this system by prescribers, and if you are prescribing opioids in the state of maine, you must check this program, this database on a regular basis to make sure those that are being prescribed should be in fact those that are receiving the pain killers. If folks are coming from out of state or theyre paying with cash, it also triggers a review of the program to make sure that these drugs are falling in the hands of the right people. Now, i also serve, mr. Chairman, i might add, on the House Veterans Affairs committee. And along with mr. Dunn, mrs. Tenney, Jody Harrington from texas, and mr. Tonko, we have introduced a bill that asks the Veterans Administration facilities in the state of maine and hopefully around the country, to use their local state Prescription Monitoring Programs or to interface with those because theyre more comprehensive in many cases, theyre tougher. I would also encourage you, mr. Chairman, and mr. Ranking member, as youre going down this path to make sure we do everything humanly possible to hold those that are manufacturing synthetic opioids like fentanyl, hold them accountable. These drugs are horrible. Theyre not expensive to manufacture. And theyre anywhere from 50 to 100 times more potent than heroin and methadone. So with that, sir, i appreciate the opportunity to participate here. I know that my associates on either side of me have a lot to say, but we have done a lot in maine, but we have a lot more work to do. Thank you, sir. The chair thanks the gentleman. Would the gentleman entertain one question on your pripg drug Monitoring Program . Yes, sir. Do you provide feedback to the prescribing doctor, this is a list of patients we have for you that you have prescribed . Is there a twoway street . It is, but the system is quite accurate, mr. Chairman. Such that the prescriber can see that data online. Very well. Representative, youre recognized for three minutes, please. Thank you, mr. Chairman. And the other members of this distinguished committee, for your work to bring awareness to this Opioid Epidemic. As well as your work to bring Forward Solutions to help address it. Im particularly grateful for your willingness to allow members who do not serve on this committee the opportunity to share how our districts have been impacted by this scourge. Opioid addiction has become a growing problem throughout North Carolina and particularly in the southeastern part of the state, home of the seventh Congressional District which i have the privilege to represent. Its a growing and significant challenge for our communities, parents, Law Enforcement, local health departments, Treatment Facilities and schools, to name just a few. This epidemic is so ramp nlt, in fact, it would not be a stretch to say that if a family doesnt have a relative suffering from this addiction, they know a friend or family who does. Perhaps the most alarming to me are the reports out of my district about narcan parties. Thats right. Narcan parties. These are parties where teens and others go intending to get as high as possible with the expectation that they will be brought back to life by an injection of narcan if needed. I also hear from members of the Law Enforcement community that they are administering narcan to the very same individuals on a regular, even weekly, basis. Now, if this isnt a sobering fact of how this addiction is destroying lives, i dont know what is. In 2015, there were more than 1100 opioidrelated deaths across the state of North Carolina. The three counties most impacted by the Opioid Epidemic in the seventh Congressional District are brunswick, newhanover, and pender counties. In 2015, there were 24 deaths in brunswick death. 45 in newhan over, and 14 deaths in pender county. Now, i have met with and heard from parents who have lost a child to an overdose, Law Enforcement officers who were struggling daily to prevent this epidemic from further penetrating into our communities, and individuals working at Treatment Facilities who do not have enough resources or beds to keep up with the demand. As with every complex problem, there is no Silver Bullet answer to this epidemic, unfortunately. However, its my belief that congress can play a significant role by facilitating collaboration among the very best and brightest to Bring Solutions forward that will enable the country to turn the tables on this scourge. In the seventh Congressional District, were fortunate to have many bright and committed individuals who have been working diligently on this issue for some time. Many of whom serve on my Law Enforcement and Health Care Advisory committees, and each of them, mr. Chairman, stand ready to assist this committee and congress as we work to address this problem in a comprehensive and effective way. Thank you again, mr. Chairman, for the opportunity to testify today. I yield back. Chair thanks the gentleman. Chair recognizes the gentleman from iowa, mr. Young, three minutes, please. Thank you, mr. Chairman, Ranking Member. I would like to thank the committee for holding this hearing and i really wants to tell a story. I want to highlight the actions the community of bridgewater, iowa, has undertaken in the last year to take back their town. Its a small town of 200 people in southwest iowa, facing a problem with opioids and a range of other drugs. As drug use there slowly started to rise in the community, which relies on the county Sheriffs Office to keep them safe, the residents were unable but not unwilling to stop the influx of drugs into their town. Residents of bridgewater started to see cars coming into their town with out of state license plates, and from counties across the state, as the cars came, so did the crime. Residents and Law Enforcement noticed an uptick of crimes, theft, and vandalism which traced back to drug users and dealers coming to town. Empty houses came into drug houses. Powers by gas and generators which led to more than four houses burning to the ground. Last spring, residents were fed up as they saw the town they were raised in slipping away. They decided to take action. Concerned residents met in the basement of a church to find a way to save their town. This is when they decided to take back bridgewater. Residents formed a Nonprofit Group to fight the drug crisis together. As word spread, Media Outlets across the state came to the small town to shed a light on one of many communities suffering in this third district. I visited bridgewater in april to meet with the residents in that same church basement. As they began their mission to make sure that their town was safe again. I studied their faces. Listened intently, and their mission is my mission. They started to hold forums with drug counsellors, Law Enforcement, state and local legislators and other individuals offering help, as residents start to clean up their town, theyre met with hostility and retaliation from drug dealers and users. Leaders of the take back bridgewater movement were run off the roads, swerved at by those who want to protect the status quo, and a number of other incidents occurred, but the residents pressed on. The citizens of bridgewater will not surrender. As neighboring communities saw what the residents of bridgewater were doing, they wanted to do something in their communities. Leaders in towns in southwest iowa often discuss strategies together to protect their neighbors. Thats what iowa is all about, neighbors helpingnerics. Communities helping communities. Just last night, residents of bridgewater gathered in the basement of that very same church to kick off a fund raiseer for their nonprofit. Theyll be going throughout southwest iowa to sell christmas wreaths to adorn the home doors of homes throughout the region. Residents will use the funds to take back the community. Bridgewater will not turn a blind eye to opioids and drugs in their community. And we must not forget the human tragedy of addiction and desperation. This epidemic is enslaving and killing our sons and daughter, our mothers and fathers. As the federal government addresses this issue, its my hope we use bridgewater as an example that local communities can have the largest impact if we partner with them in having the tools they need to be successful. A one size fits all program will not save as many slievs as a solution tailored to one community. Take back bridgewater is not just a slogan. Its an action plan. Its a reality. And its happening. And its not just happening in bridgewater. Its happening all around the country. Thank you for holding this hearing. Chair thanks the gentleman. The gentleman from oregon recognized for three minutes. Thank you, mr. Chairman. I appreciate the focus on the Opioid Crisis that grips every community to some degree and affects every state. Especially critical for our veterans who are twice as likely to die from accidental overdoses. As were slowly acknowledging the depths of the Opioid Crisis, which is good, we seldom acknowledge one of the simplest, most Effective Solutions. Medical marijuana. Cannabis. Now available in 28 states, largely driven by the voters. Not the politicians. Most recently in florida, where their voters approved it by over 70 . I have distributed some information here entitled the physician guide to cannabis assisted opioid reduction. On the back are the citations for each of the points that are on this chart. References cannabis reducing opioid overdose mortality. How cannabis reduces opioid consumption. How cannabis can prevent dose escalation and the development of opioid tolerance. Cannabis alone or in combination with opioids could be a viable first line. Mr. Chairman, we dont talk much about this although on the floor of the house repeatedly over the last years, congress has been move ng this direction and voted last congress to have the Veterans Administration to be able to work with with veterans in states where medical marijuana is legal. But i focus on one simple item, not the fact, which i hope this committee would look at. But there is one piece of legislation that i have introduced with dr. Andy harris, somebody who doesnt agree with me about the efficacy of medical marijuana, but he strongly agrees with me that there is no longer any reason for the federal government to interfere with research to be able to prove it. The federal government has a strangle hold on this research. We have Bipartisan Legislation, 3391, which would break that strangle hold and be able to have Robust Research to resolve these questions so there would no longer be any doubt. This is cheapest most effective way to be able to stop the crisis where people have access to medical marijuana, there are fewer overdoses, and people opt for it dealing with chronic pain. I would appreciate the subcommittee looking at this issue as your time permits. Thank you mr. Chairman, Ranking Member. Chair thanks the gentleman, gentleman yields back. Chair recognizes the gentle lady from georgia for three minutes. Thank you mr. Chairman and thank you for holding this hearing. The Opioid Crisis has hit the counties of fulton, dekabul as hard as in any part of the country. In 2016, 72. 3 of all drugrelated fatales in cobb county were caused by opioids, that was an increase of 16. 8 over the year before, in 2015 the Narcotics Team seized more heroin than in the previous 20 years combined. In future ton county the medical Recorders Office recorded 77 heroin deaths in 2014 compared to just four in 2010. Behind the statistics are hurting devastated families, family that are being torn apart by addiction, facing financial ruin in their desperate effort to try anything to make things right, or worse, losing a loved one to a Drug Overdose or suicide. The Opioid Crisis as weve heard is indeed a complex one. Its an incredibly sensitive issue, particular ecally for communities that have long felt immune to fatal Substance Abuse problems. Still community threw churches and nonprofits with the support local state and federal government are coming together to take action. This year in the city of alpharetta they created a new Program Designed to key crease painkiller abuse across the down. With the help of the roadary club in that city the city purchased special boxes that were used to collect unused or unwanted medications and located them at police and fair stations across the county. While the boxes cost 1,000 each they are designed and constructed specifically to prevent anyone from stealing the drugs inside. This may seem a small measure but it is making an impact by providing a safe secure disposal point. In the city of johns creek the Hub Community Resource Center is acting as a life line for those seeking drug abuse and Mental Health attention. Ultimately, we have to continue to look for root causes. As the District Attorney in cobb county said we are not going to be to arrest our way out of this epidemic. The road to recovery must be lined with Treatment Options. Further, nonopioid and nonpharmacological treatments do exist. The university recognized pain Awareness Month in september by educating our community about those alternatives. We also need to do a better job of data sharing. Important information that exists at the local, state and federal level. I stand ready to help you in any way. Thank you mr. Chairman for this opportunity. Chair thanks the gentle lady, who yields back. Chair recognizes the gentleman from florida. Three minutes. I would like to thank the chair and Ranking Member for providing us this opportunity for members to sew share how the Opioid Crisis is affecting their constituents including my neighbors in Pinellas County, florida. Our societys use of opioids has truly become an epidemic. Last year, 11. 8 million americans aged 12 or older misused opioids, including nearly 900,000 children aged 12 to 17. Over 50 of the people with both Substance Abuse and a Mental Health disorder do not receive treatment for either issue. Tragically, my home state of florida was a Prescription Drug abuse capital of the United States in last decade. They were known as pill mills and described massive amounts of otherwise legal narcotics which were then distributed into our neighborhoods, schools, communities, and throughout the country. When i was governor we went after pill mills and put them out of business. While florida wave won the battle against these pill mills our country is losing the war against opioid addiction. We are underfunding Addiction Treatment side stepping what the science tells success the best way to fight the addiction. Now the scope of the crisis has broadened beyond Prescription Drugs into heroin and tent till. My home of Pinellas County was no exception. Last year we saw a string of deaths from xanax mixed with fentanyl. In 2015 heroin fentanyl and oxycodone were responsible for over 3800 deaths in florida alone. It is a tragedy, an epidemic and the need for action is immediate. I saw the devastation firsthand recently when i visited the nonprofit operation par in my district just a few months ago. I heard directly from those in recovery being helped by their innovative more holistic approach. If we are going to combat this problem we cant concentrate on Law Enforcement alone. Florida should serve as an example to the rest of the country that only going after suppliers is inset. Lets be clear. The people who misuse opioids arent the worst of the worst. They are our neighbors our friends our parents and children who are desperately in need of help. They offer suffer in silence and isolation because of the stigma and shame surrounding drug abuse. Unfortunately, america learned this lesson the hard way treating the crack epidemic as simply a Law Enforcement exercise. We cant combat our Opioid Crisis without investing in new Treatment Options long term Mental Health and Substance Abuse Recovery Resources, and the men and women on the ground working in nonprofits in government, collaborating with First Responders and Law Enforcement to help those in need in all of our communities. This includes funding for the Substance Abuse Mental Health service and the National Institutes of health, which provides the research and innovative treatments not often permitted using traditional funding. This Funding Provides grants, including in pinellas down for innovative local solution force treating Mental Health and Substance Abuse disorders like what is happening at operation par and bed not broken organization. This includes funding overdose reversal. We will lose this fight without naloxone, americans will die unnecessarily, and because florida did not expand medicaid funding for these organizations is even more vital and something i hope your committee continues to prioritize in this ongoing battle. Thank you again for this opportunity to share how my home of Pinellas County is combatting this epidemic. Thank you mr. Chairman and this committee. Thank you chairman, Ranking Member, and members of the committee for holding this important hearing and hosting all of us today. I appreciate and understand many of the testimonies we have heard from our colleagues. Its important to note that we represent district that are often extremely different from each other, democrat, republican, rural, and urban. It is rare when an issue can unite not only an conference but an entire congress. At the risk of speaking for my colleagues, i would like to express that we all stand together against the Opioid Epidemic. Now, in my district in the 19th district in upstate new york, i can tell you a couple of stories. Green county Emergency Responders recently reported to me they came upon a scene where they had two individuals who had overdosed. One individual required eight doses of naloxone in order to be revived. Another required six. This is not an uncommon phenomena. County sheriffs have reported to me going back to the same household, the same apartments, on the same evening to administer narcan to revive people who overdosed. Other county sheriffs have told me that every single drug dealer they arrest has Public Benefit and food stamp cards in their possession. Its ironic that we the public are often sustaining economically those that prey upon our citizens. In my district, the board of supervise in Columbia County recently passed an Opioid Epidemic response plan. This plan is an enormous step forward to combatting the Opioid Crisis in our region. Allster county has also substantially increased local funding to fight the crisis. Twin county Recovery Services in columbia and green counties is also serving those with addiction through clinical, residential, and Educational Programs. I think the bottom line, mr. Chairman, my colleagues, we have got to have Educational Programs that help us staunch the demand for these substances and not just try to staunch the supply. Congress must continue to help our local communities by ensuring they have the support and the 21st century cure examines kara, supporting samsa legislation and passing legislation such as the stomp act by making it more difficult for the Postal Service to ship fentanyl and carfentanil through the mail. I recommend more research into how opioids affect the brain and learn maw on how to defeat this chemical dependency. Our work is far if finished. We must stay engaged with each other, with our communities and stay engaged with victims and families to truly effect your way and facilitate an authentic reversal. This dangerous and upward tend of opioid addiction in our communities. I thank the committee for their service and for eye louing to us bring this testimony forth today. Chair thank the gentleman. Gentleman yields back. Chair recognize mrs. Katco for three minutes. Thank you mr. Chairman and Ranking Member green. I appreciate being given the opportunity to testify about this topic and giving me the opportunity to not only discuss what has been being discussed but a partial possible solution, hr 2851 to stop the importation, trafficking of sin ed athletic analogued act of 2017 which i will refer to as sitsa. Im driven in my testimony today and for my support for this bill by two things. One is my 20 years as a federal organized crime prosecutor, prosecuting every manner of drug known to unanimous and knowing that based on that experience i have never seen anything that remotely resembles the tragic consequences of the current synthetic drug problem and the heroin issue in this country. And they are intertwined. I can talk chapter and verse about whats going on in my community but i want to introduce you to people we have lost since i have been in congress. John and tina sochi lost their daughter who was murdered in front of her 18 month old child by her boyfriend who was addicted to opioids. Two years later, still grieving the loss of their daughter, their lost their son to a heroin overdose. Their son was a drug counsellor. Joe camp nola lost his son, and his son was a drug counsellor at the time. And john and tina lost their son as well. Kevin jones lost his stepdaughter. Theresa wilson lost her son after he ingested synthetic marijuana that was purchased over the counter at a local head shot. He had convulsions and drowned. Deanna x. All these stories are tragic. This one perhaps the worst. Deanna was a High School Athlete a great individual. She got involved in hair wane after abusing opiates. Thee became pregnant, went cold turkey and quit. She was five months pregnant, had not had relapses. I drug dealer who i can describe as one of the worst individuals on earth cajoled her into trying a new mixture. She tried it that one time, died, and lost her unborn child as well. Thats the face of this trajectory de, the face of whats going on here. Thats what im trying to address with respect to the sitsa act. Toxic and synthetic drugs are designed to mimic straight drugs like marijuana. What this drug is trying to do is to recodify the problem. The problem i encountered when i was a prosecutor doing synthetic drug prosecutions is that the statutes dont keep up. The drug that killed theresa wilsons son took four and a half years after they identified the chemical compound before it was listed in a drug analogue statute. This bill that i have that already passed the judiciary and is simply waiting to get out of b and c before it can get on the floor turbo charges that process, reduces it to about 30 days. It also in a nutshell will give individuals in coming who disagree with the classification of one of these drugs 180 days to have it removed from the act. I can tell you looking through the prism of a prosecutor there are three ways to address this. Number one is Law Enforcement, two is prevention, and number three is treatment. As mr. Fossa noted we have done a lot to address prevention and treatment this. Sitsa act is something Law Enforcement needs it is and a game changer. I hope anc will examiner it in a swift manner so we can get it on the floor and put it in the arsenal for Law Enforcement to be able to attack this problem in meaningful manner. I yield back. The chair recognizes gentleman from massachusetts mr. Keating for three minutes. Thank you, mr. Chairman. Let me go off my notes and try speak from the heart. Before i was a member of congress i was a d. A. For 12 years. Started a task force. Now its over a decade and a half on at the time a heroin task force. But it was as a result of my work as a d. A. Wed go to unattended deaths. We would find out that the person there had no criminal record, they started their addiction with Prescription Drugs, went to heroin, custom is cheaper and more available, believe it or not, and then they die. I consoled parents who lost a child. I worked with grandparents who were raising their children. In my own family, i lost a cousin to an overdose right after he was coming out of detox. Most dangerous time. On a brighter note, i have another Family Member who is a decade and a half in recovery. I have seen this firsthand. In my district since we are sharing that, one of my communities, fall river, they are on pace for over 1,000 overdose this is year, just this one city. And over 100 deaths. In my district i have four of the five leading counties in terms of the opioid deaths. I want to thank this committee for the work they have done with the kara act w21st century cures that you are working. I think that workss at risk if we backtrack on the availability of treatment through the aca or another source because, as you know, 34 of the people before them did not have the guarantee of that treatment, which is important. 18 didnt have the coverage for Mental Health treatment thats necessary as well. And the Medicaid Expansion those states that did it there is no 11 million low income americans covered by this. I also want to thank you on the efforts that weve worked on a bipartisan basis. Its worked on efforts of the stop act, which is in front of this committee. I hope it moves forward. Some of that is being done administratively where we look at making our drugs that are there ever at thatter resistance, abuse resistan. Cosponsoring a saves act character allows coprescription of naloxone thats there. It solves a problem for the medical community and work with the veterans in terms of making sure they are educated. I just heard my colleague talk about the fact we deal with in this three ways. Interdiction is limited. I had a private meeting in my office with the leaders in terms of customs and Border Patrol and whats going on. Its limited because so much of it has increased through the mail, through fedex, through ups, very hard to deal with in that respect although we should do what we can to prevent it. Prevention is important, obviously when dealing with medical treatment and the middle school population. Let me conclude with think. I was up last night thinking about what i was going to say to you today. When i got to congress we sat down with the fda and people to air out concerns. Only myself and representative hall rogers is still here from that group. At the end of listening to us, these experts came and said, congressman, you dont understand about medicine. You dont understand about medical treatment. We are there to deal with some pain. And tha part of our and i slammed the table. I said, you dont understand about pain, the pain of losing a son or a daughter a grandchild, the pain of families, the pain of what it does to your income and work when this happens. That kind of pain doesnt go away. And we havent progressed enough from that, frankly. Its great for this committee. Its great i think for myself to take whatever expert advice week. But on this issue, people are depending on us. Weve got to create the urgency and deal with it ourselves. We cant rely on other people to do it n. Many cases, we are the court of last resort. We can do this. Week Work Together and we can make sure it can be done. But lets do it ourselves and lets take that leadership. I want to thank you for the leadership you have shown in this. And i plan to work with you any way i can. Chair thanks the gentleman. Gentlemen yields back. Chair recognizes the gentleman from minnesota mr. Paulson for three minutes. Thank you mr. Chairman for this opportunity to speak about the opioid addiction in minnesota. Minnesota is like the rest of the country. It is struggling with the crisis thats tearing families apart through addiction and death. And the numbers are only getting worse. Minnesota saw a 12 rise in opioid deaths from 2016 over 2015. Opioid deaths from in 2016 over 2015. The crisis affects minnesotans of all backgrounds, Rural Communities, big cities, and in our suburbs. Just in year and a half ago in my home town we saw the passing of music legend prince due to an opioid overdose. In minnesota there are 50 opioid prescriptions written for every 100 patients that visit our doctors. Clearly, we need to change the culture and our delivery of care to stop the flow of opioids when there are proven alternative types of treatments that may not require those prescriptions. When someone requires surgery for back pain they can choose between minimally Invasive Surgery or the standard surgery that requires a long postsurgery stay in the hospital and powerful painkillers. One way to reduce the use of opioids is to use the more minimally invasive procedures. An example is minimally invasive and do not require Long Hospital stays and opioids to dull the pain from other invasive procedures. An example is minimally invasive si infusion, which has been shown to reduce the pain for dangerous painkillers. Unfortunately, some private insurers dont cover this procedure, forcing people to choose the standard surgery that requires addictive opioids for Pain Management. Instead of simply prescribing a drug for the pain, providers should look for other therapies and insurers so people are given more choices to manage their pain. We must encourage insurers to cover more types of procedure. The Opioid Crisis also affects local businesses, including our pharmacies. According to the d. E. A. In 2014 there were 16 armed robberies involving stolen opioids at minnesota pharmacies. Last year that number doubled. People get hurt and die during these crimes. Dangerous drugs are put on the street. Businesses have to close their doors because of safety concerns and communities lose vital resources and neighbors because of addiction and the crime that goes with it. Earlier this year i spoke to a mom, a mom from maple grove, minnesota, whose son bought f t fentanyl online, consumed it, and died. We need increased funding for safety resources, for trained Law Enforcement officers to spot and stop opioidrelated crime. Our communities depend on access to health care and we need to do more to reduce the crime and Death Associated with opioid addiction if we are going to help people get the care that they need. I want to thank you, mr. Chairman, i look forward to working with you and the rest of the members on your committee for Bipartisan Solutions on opioid addiction. Chair recognizes the gentle lady from rochester for three minutes. Thank you, mr. Chairman. I want to start off by saying as a former deputy secretary of health and social services in delaware, former secretary of labor, and Community Member and Family Member, Substance Abuse has touched my life and so many others. Everything from our economy, to our prison system, to our families. From crack, to heroin, to all forms of opioids. And in many ways, delaware reflects our nation. Geography, were urban and rural. We mirror the country in terms of demographics. Unfortunately, like the rest of the nation, we are facing a growing Opioid Crisis. Just yesterday, our death toll from this horrible disease rose to 171 delawareans for the year. That might not seem like a lot to some, but to put that into perspective, that many deaths in the state the size of delaware made us number 13 per capita in the country last year for opioid Overdose Deaths according to the Kaiser Family foundation. This Public Health crisis is prevalent in districts across the country. And congress has the opportunity to impact it in a meaningful way and take action. This is why its so important to tackle this issue on a bipartisan basis. The opioid addiction has taken a stronghold across the nation, and we must Work Together to combat the flow of drugs throughout our country. This is a problem for all states but particularly on the east coast where compact states means that none of us can act alone. Drug trafficking doesnt stop at delawares borders with maryland or pennsylvania or new jersey, and neither does this Public Health crisis. Delaware and our neighbors have made great progress through collaborative programs like hida and Prescription Drug Monitoring Programs. But that should just be the beginning. We arent doing enough. But it is also important to remember that there are people in delaware and in all of our communities making a difference. Every day on the ground, for people, for families, and in neighborhoods, they are combatting this crisis on the ground. I want to thank all those people who are fighting, whether they are in Public Health. Whether they are doctors, First Responders, the faith community, community groups, families, all those who are doing their part to make sure that we tackle this issue. We in Congress Need to join them. I hope that we in congress will also continue the Work Together and address this epidemic by providing resources for prevention, support for recovery, and access to care. Thank you so much. I yield back my time. Chair thanks the gentlelady. Gentle lady yields back. We are going to have a series of votes and its my hope we will adjourn when the votes occur. Im going to ask the members here, and i appreciate you staying with us for so long. Lets continue to yield three minutes, but try to do it in two so everyone gets a chance to testify before the vote, so all the members who remain, if youll join us at the table and youre recognized for three minutes. Mr. Chair, i want to start by thanking you for allowing members to testify on this issue. Today i would like to draw the subcommittees attention to the significant needs of those who have sought help for addiction completed treatment and are just beginning to lover in recovery. These individuals often choose to live in sober living facilities after completing treatment in order to ease into the routines of daily life. However, there are far too many sober homes that are commonly unequipped to handle patients at risk of overdose or do not employ staff with specialty training for individuals in recovery. Worst of all, some of these facilities do not encourage recovery but exploit Vulnerable People recently released from treatment in order to collect insurance payments. This can mean life or death for people like tyler from my district of pasadena california who died from an overdose after his sober home didnt recognize the symptoms of his overdose and didnt have naloxone. The medication that can reverse an overdose. Tyler was only 23 years old. Unfortunately, this is not an isolated issue. I have heard from advocates in arizona, pennsylvania, missouri, ohio, and countless others who are concerned for their friends and neighbors living in unregulated sober living facilities. I would like to submit for the record a New York Times article from 2015, and a may 2017 report from the department of justice outlining abuse and fraud at sober homes in new york and florida. Without objection. So ordered. These reports describe sober living facilities that lacked access to naloxone ordered unnecessary tests on respects to exhaust their Insurance Benefits and required respects to relapse and reenter treatment so resident directors could claim some of the medicate benefits. Licensing for recovery residence or sober living facilities varies substantially from state to state and there are facilities in every state operating without licenses at all. Further, oversight of these facilities is minimal. So patients with loved ones in recovery struggle to distinguish good actors from bad ones. For some individuals they may not discover their facility is negligent until it is too late. That is why this week this week i plan to introduce the ensuring quality sober living act. My legislation would require the Substance Abuse and Mental Health Services Administration to develop a set of best practices for residential Recovery Facilities so patients families and states can distinguish quality sober living facilities from sites that are fraudulent or you unequipped to offer appropriate assistant. The bill would require samsa to disseminate these to each state and require them to pry Technical Assistance and support. My bill would require states to help samsa to set up criteria to distinguish quality sober living facilities. These best practices would allow the guidelines for common sense measures like requiring that all fees and charges be explained to residents before entering a binding agreement and that naloxone is available and accessible and that staff and residents are trained to use it in emergencies. Thank you very much. Gentle ladys time is expired. Chair recognizes the gentle lady from indiana for three minutes, please. Thank you mr. Chairman. Indiana is no different from any other state that we have heard from sitting here. Pain is the number one reason why americans seek health care, the number one cause of disability that costs the u. S. Economy more than 600 billion in direct Health Care Cost and lost productivity. The veteran population is particularly impacted by the chronic pain crisis with more than 50 of the va patients responding and reporting chronic pain. We can reduce demand by effectively treating chronic pain and providing better access to fda approved nonopioid pharmaceuticals, medical devices, and alternative therapies. As we develop policy, we should number one recognize importance of a multidisciplinary approach. Chronic pain is pervasive and largely unaddressed by the health care system, number two, promote Cutting Edge Research to high quality evidence is urgently needed for physicians and patients to make informed decisions to understand the causes and mechanisms of chronic pain. Advanced best practices in Pain Management in medicare. In 2016, one in three Medicare Part b beneficiaries received a prescription opioid. They should offer evidence based Pain Management as an alternative to opioid prescriptions. Also, there should be a review of the graduate medical Education Programs training and education of providers on Pain Management and opioid prescriptions. I hope these ideas will be helpful to reduce the abuse of opioids in our communities. Thank you, mr. Chairman, i yield back my time. Chair thanks the gentle lady. Mr. Donovan, you are recognized for three minutes. Thank you mr. Chairman. Chairman burgess, Ranking Member green and member of the subcommittee thank you for the opportunity to testify before you today to share my thoughts on the Opioid Crisis. This year alone there have been more than 100 reported Overdose Deaths in my district. That number would be much higher if it werent for the 574 naloxone saves reported. Before i came to congress i served as District Attorney of Richmond County which comprises of Staten Island, new york. Based on that experience my time in congress and input from local experts like the Staten Island partnership for Community Wellness i support a three tiered approach to this problem that addresses education, treatment and enforcement. Targeted education campaigns can teach the next generation of potential users about the dangers of Substance Abuse, particularly of sinister compounds like fentanyl. Treatment is crucial. We have learned that recovery is cycle and relapses will happen. Our policy should reflect that reality. Our society understand addiction is a medical illness not a criminal act. Lets help the addicted, not punish them. Grants for local treatment programs is the most effective way to help end the cycle of addiction from the federal level. Lastly, we cannot ignore the importance of enforcement, particularly against traffickers. My comprehensive fentanyl control act would update sentencing guidelines to reflect the fact that a few grains of rice worth of fentanyl can kill an individual. I firmly believe that the experts on the ground are best equipped to taylor their approaches to meet their communities needs. Its our job as legislators to provide them with the resources necessary to accomplish their mission. Legislation like the cures act and the comprehensive addiction and recovery act, which i championed to constituents back in my district are exactly the right approach. Thank you again for the opportunity to share my thoughts. I look forward to working with the subcommittee and continuing to address this national crisis. Thank you, sir. Chair thanks the gentleman. Representative hartzel, you are recognized for three minutes. Only use two. Thank you, mr. Chairman. Thank you for this opportunity. In missouri the scourge of drug abuse is a growing problem. It will take all of us to help solve it. I have heard stories of families torn apart. Livelihoods in tatters. To this end, i ask the committee to explore ways to make it easier for faithbased organizations to offer Addiction Treatment programs. Ive seen firsthand the power of faithbased recovery programs in treating addiction. In my district i have visited multiple christian organizations that have high rates of success in treating addiction. By centering on a community of faith these organizations provide support structures that stay with recovering addicts their entire lives. In some cases they also provide services that arent available in other Addiction Recovery programs in the area. For instance, one religious organization in my district provides housing for both mothers and their children while the mothers seek treatment for their addiction. No doubt, their recovery is greatly facilitated by the Additional Support of their children. I firmly believe faith based programs are part of holistic programs that treat the body and spirit during the darkest times. And i ask the committee to seriously consider making available and expanding any and all funding opportunities to faithbased organizations providing Addiction Treatment and programs. In addition, on a second topic, the imd exclusion caps the number of beds Mental Health facilities receiving medicaid can have at 16. Multiple Health Care Groups have come into my office saying this blocks critical access to treatment for people who need inpatient treatment for addiction including some of the societys most vulnerable, veterans, pregnant addicted women, women with dependent children and youth. I encourage the committee to explore ways to provide some relief to this outdated rule. Thank you very much, i yield back. Chair thanks the gentle lady. Gentleman from pennsylvania is recognized for three minutes but only use two, please. Thank you mr. Chairman. As this committee aware Drug Overdoses involving prescription opioids and heroin quadrupled since 1999 and are the leading cause of accidental death in this nation. Substance abuse cost our country over 600 billion annually. In my home state of pennsylvania, drugrelated deaths and addiction rates were amongst the highest in the nation. In one year pennsylvanias rose 20 , while my districts increased by 50 . Mr. Chairman, this epidemic is costing both resources and precious lives, like my constituent carlos castelanos. He loved sharing his talent and love of music playing the drums at school and a local church group. However he got involved with drugs during his time in school and spent some time in jail, but with the strength and support of his family, he began receiving treatment and his life improved. He helped others by volunteering at a recovery home and brought people suffering in similar situations to treatment programs. Last December Carlos walked his mother pamela down the aisle for her wedding. He was getting ready to get back to school. He had a steady job and a girlfriend. Would seem many of his battles with addiction were headed in the right direction. A point of hope in the war that caused so much in devastation. Then, mr. Chairman, on december 23rd, just days before christmas, two Police Detectives showed up at pamelas door to tell her the devastating news that no mother can ever prepare for. Carlos overdosed on a drug laced with fentanyl and was unable to be saved. Carloss life and his death cast a bright light on the fact that addiction is nothing short of a chronic disease. I would also like to bring to attention what my colleague did, socalled institute for mental disease, or imd exclusion, is a longstanding policy that limits the federal matching funds to states for Services Rendered to medicaid enrollees who suffer from Substance Abuse disorder or Mental Health treatment. Some states like my state of pennsylvania have used the in lieu services provision, but with limitations on population size, facility size, and length of stay. This blocks access to treatment for people who need treatment for addiction including some of societys most vulnerable. I encourage my colleagues to adopt the road to recovery act, a bill i introduced, which addresses real world concerns expressed by local lawmakers, Community Leadersers, and health care professionals. I yield back. Chair recognizes the gentleman from pennsylvania for three minutes. Thank you mr. Chairman. Speaking with constituents about the Opioid Epidemic i learned firsthand the impact this epidemic is having on our communities in pennsylvania. It is affecting families and individuals of all ages, races, and socioeconomic backgrounds. Throughout my Congressional District and throughout this nation there are parents, teachers, athletes, doctors, teenagers struggling with addiction, a disease that has no boundaries when it comes to who it affects. These families and these individuals are why we must continue our work to pass legislation like the come comprehensive addiction and recovery act and the 21st century cures act, two bills i supported that are now low. These bipartisan bills are helping our communities through increasing access to treatment and expanding prevention, education, and intervention efforts. In the communities i represent, a recurring sentiment i heard was, you would not believe how much treatment costs. The cost of treatment and recovery is indeed crippling for so many families, even for individuals who have insurance. 35,000 for a 30day at a Treatment Center. 10,000 for a tenday detox. Hundreds of dollars spent on flights to recovery programs across the country. Families are being forced to refinance their homes, parents are taking on second jobs, and retirees are reentering the work force to help pay for treatment for a Family Member struggling with addiction. Those seeking help should not be faced with insurmountable cost. To help individuals provide Financial Assistance to Family Members struggling with addiction, ive added my name to the Addiction Recovery through Family Health accounts act. Under current law individuals can only use funds in their Health Savings account, flexible spending account or Health Reimbursement arrangement to pay for Addiction Treatment for their spouse or dependents. This bill will give people the option to help Family Members be it a niece, grandfather, cousin, inlaw, et cetera. This legislation is a step in the right direction in alleviating the financial burden of Substance Abuse treatment. Im proud of the work the committee has done to face this epidemic and i am continuing this work. Chair thanks the gentleman. The chair recognizes a final gentleman from pennsylvania for three minutes. But only use two. Thank you, mr. Chairman, for holding this important hearing today about this epidemic. I think its interesting that youve had three pennsylvanians right in a row. It represents the geography of pennsylvania, eastern, middle, and western. Certainly communities in western pennsylvania are among the hardest hit in the Opioid Epidemic. There has been a Staggering Amount of Overdose Deaths specifically in my district. 648 individuals lose their lives from heroin or opioidrelated overdoses. Last year that number was 4,342 in pennsylvania alone. According to a recent article in the Pittsburgh Post Gazette in 2016 the number of Overdose Deaths in pennsylvania was four times the number of deaths cause by Car Accidents. In other recent reports three people in my district were revived by narcan after each overdosed at a convenience store. Thankfully, the First Responders were able to save their lives. While it is encouraging to see both congress and the administration have taken action to address this issue we have a long way to go. From my perspective we should be taking a three prong approach to combatting the epidemic, we must implement measures to prevent addiction, we must treat addiction once it has taken hold of swurngs and finally we must vigorously enforce laws on the books to stop drug traffickers from spreading their poison into our communities. To help combat this, i led an effort to include language that will help ensure our veterans who are at significant risk to get the program they need to overcome opioid addiction. This is one positive step in the right direction. Another area where congress should focus, one of specific interest to me, is strengthen and increase our partnership with mexico, especially with the state departments merita initiative. Our nation to the south has suffered a significant level of murder by drug cartels. By increasing our partnership with mexico we can defeat the cartels that cause so much pain there and here in the u. S. Overlooked is that many of the narcotics that mexican cartels traffic end up in the hands of americans. Increasing security at ports of entry through technology, cameras, and manpower is necessary to interdicting drugs. Border security for america act will do just that. Another bipartisan bill that i hope will end the crisis was introduced with congressman collin peterson. Hr3526. I look forward to that moving forward. Again i thank you for the opportunity to testify before the committee this morning on an issue that greatly affects the constituents in my district. Chair thanks the gentlemen. Gentlemen yields back. All members having had a chance to speak, with votes on the floor, the committee stands adjourned. Heres a look at our primetime schedule on the cspan networks. Starting at 7 00 p. M. Eastern on cspan, a live debate between Newt Gingrich and Washington Post columnist e. J. Deon on the Trump Presidency and american democracy. At 8 00 eastern on cspan 2, book tv with authors that have written books adapted into movies, and cspan 3 at 8 00 p. M. , its American History tv with programs on the 60th anniversary of the integration of little rock central high school. Cspans washington journal live every day with news and policy issues that impact you. Coming up friday morning, author floyd abrams discusses the First Amendment and press freedom. Then President Trumps relationship with the republican party, William Cristol will join us for that. Also the Health Care Executive order signed by President Trump, reporter Katelyn Owens will be on to talk about the future of health care. Be sure to watch cspans washington journal live at 7 00 eastern friday morning. Join the discussion. Tomorrow remarks from President Trump in washington, d. C. The Family Research council and other conservative organizations have been meeting the last 12 years to hear from key