Transcripts For CSPAN3 House Members On Opioid Crisis 20171028

Those are only two of my good things. I dont want to tell you about the bad things. But he really helped me. I had had had somebody that guided me and he had a very, very tough life because of alcohol, believe me. Members of the u. S. House met recently about combatting the Opioid Epidemic. They also shared their own stories in dealing with opioids and other drugs. Subcommittee will come to order and for an opening statement. In the midst of a fierce battle against an epidemic by opioids. This crisis has touched every corner of american society. Whielt new england and the regions represent states hardest hit by the epidemic. Health officials from the south and reaching across the Mountain West all reported growing over dose deaths in those counties. The latest deaths is astounding. 91 americans died every day from an over dose. Now more than ever we must come together and strengthen our commitment to fight this malady. I expect todays member state will bring to the forefront key insights and solutions on this critical issue. The energy in Congress Committee led several bipartisan initiatives. And the comprehensive Addiction Recovery alct and the 21st century act are now law at the state and local levels. Much needed policy changes are being implemented. The inflicted passage of kara and cures. As a result, patients now have greater access to evidencebased treatment, adiksz Treatment Services and over dose reversal therapies. Cures on the other hand provided 1 billion in grants for states to support an array of prevention treatment and Recovery Services. I believe these initiatives are making a significant difference. And other issues have emerged from this fight. Earlier this year they responded to reports of people over dosing on heroin laced with fentanyl. The ready availability of these synthetic opioids have become a Public Health threat and illegal Online Pharmacies operating in Foreign Countries are exacerbating this every day for our state and federal officials. Todays hearing will allow us to gain member perspective on existing ways to combat the Opioid Epidemic. Representatives on and off the energy and Congress Committee will testify, share their stories and propose legislative solutions for our consideration. In advance i want to thank house members for participating in this discussion and we look forward to hearing from everyone whos going to be before us today. Let me yield what little time i have left to the vice chairman of the subcommittee, mr mr. Guthrie. Obviously im going to be brief. So many families have been devastated by this. Had all these different scenarios but when you see it in reality, i was in owens burrow one evening and met a mom the mom of an athlete and honor student who had had her acl torn playing soccer, was prescribed pain killers. After her recovery she was addicted and turned to heroin and passed away due to an over dose. This is a sad story repeated through all groups, all areas and something im looking forward to hearing all the testimony today to look for ideas to further do what congress has done for kara and moving forward as well. Chair now recognizes the Ranking Member of the subcommittee, mr. Green. Thank you, mr. Chairman. The sentrs for Disease Control and prevention has called for Prescription Drug over dose and an epidemic has found drug over dose to be the leading cause of injury death between 1999 and 2010 the death rate from prescription pain killers only continued to rise. In 2015 more than 52,000 people died of drug over doses in america. About 2 3 were linked to opioids. The New York Times found that 59,000 to 65,000. Today more than 2 million have use disorders and the rate of heroin over doses has increased dramatically and the rise is directly linked to the Opioid Epidemic. In 2010 approximately 3,000 drug poisoning dects were connected to heroin. And only continues to rise. Theres no community that hasnt been touched by this crisis and some have been ravaged by it. So much is needed to combat it when communities across the country are being torn apart. And the state targeted response of the Grant Program. It provided money to states to address the Opioid Epidemic. Extending this money is a crucial part of any continued response to the epidemic. We need an approach that employs Proven Health strategies and spans the entire spectrum from prevention and recovery and Crisis Response and expanded access to treatment and life long recovery tools. The Affordable Care act is part of our efforts to fight the epidemic. Those with 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 Medicare Programs like texas are left out in the cold. For those in the individual markets, all plans must include services for Substance Use disorders and consumer kzinate be denied coverage because of a history of Substance Abuse. This is not a small feet, roughly 1 3 of all individual market policies didnt cover mental substance treatment. It covers provision and remove 5. 5 billion annually for the treatment of people with mental and Substance Use disorders. And scrap the Medicaid Expansion states would be absolutely devastating to our fight against Prescription Drugs and heroin addiction crisis. The largest cries in our country has known and this is not time for Health Care Safety nets. Im excited to hear from my colleagues and to combat the Prescription Drug epidemic. We need a solution that targ thts entire spectrum of addiction. Prevention, Crisis Response for those who fall through the cracks and expanding acstees treatment and providing support for recovery. We must be guided by science and avoid stigmas and not fall into the traps, misconceptions about proven treatment strategies. I look forward to advancing new strategies and funding to turn the side of this growing crisis and really help families and communities that desperately need it and i yield back my time. Gentleman yields back. I make an organizational note. We are going to be hearing from energy and commerce members. Theyre welcome to give their testimony from the witness tale, which ever they prefer. Were going to move to our first panel, chairman upton, and chairman lada and agon youre welcome to testify from the table or so chair recognizes chairman of the full committee, mr. Walden. I i come here today on behalf of my constituents like i do every day but especially today with our opportunity for all members to make their case to the energy and commerce committee. We want to welcome them and i think as our colleagues on both sides we have already said all of us in all of our communities face these challenges related to drug over doses. I held a round table day before yesterday in bend, oregon where we learned a lot about the problems were facing and some of the successes. And the importance of the work were doing here. Its a heart breaking epidemic thats been featured on the frupt pages of our local newspapers, on National Television as part of the story from orfriends and Family Members. Reasonable estimates forecast more than 90 americans die from opioid over doses each day while more than a thousand are treated each day for abusing oopioids. More than 64,000 died and in oregon alone more people died lash year from drug over doses than from Car Accidents. I recently held round tables in Southern Oregon to see how we could better combat this crisis and what more can be done is crucial to our efforts to end the scourge. Theyve led a number of bipartisan initiatives to help address the epidemic, initiatives that are now law like the comprehensive addiction and recovery act and resources are becoming avail nl and important policy changes are being implemented to stem the tide of opioids. They improved evidencebased treatment for those with Substance Abuse disorders and it it made sniignificant changes i over dose reversal medications. The new law also included criminal justice and Law Enforcement related provisions. The cures act provided a billion dollars in grants for states, the first of which was to be administered by the Substance Abuse and Mental Health Services Administration. My state of oregon received a 6 1 2 million in grants. However, so much more work needs to be done. Since that act, other issues have emerged. Such as the proliferation of fentanyl and its an logs. And then their are allegations of pill dumping. Ive heard the all too familiar tale of the mother whose oldest son was preskiebed opioids after injuring a knee in basketball and became addicted. And after years of bouncing between addictions, he spoke about how better tracking and treatment could have helped catch his sisters problem earlier, 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 beevor state. Theyre why were here today. Addressing the Opioid Epidemic provides an allhandson deck effort. Im looking forward to hearing feedback and input to hear about whats working and whats not and find ways to compliment our existing law and address emerging issues. So i appreciate everyone here today. With us taking time to participa participate, together we must continue to fight this Opioid Crisis in amare cu. And i yield back. Gentleman yields back. And to reiterate the format for today, members are invited to either give testimony for the witness table or the diish, which ever they prefer. So ill recognize frank from new jersey for five minutes. Thank you. Todays member day provides us the opportunity to hear from our colleagues about how the epidemic is uniquely effecting their districts as well as additional efforts to help those effected by this crisis. Like all communities across the its having consequences in my home state. Drug over doses are the leading cause of accidental death. According to the centers for Disease Control, there was a 16 increase in drug over dose, deaths in new jersey between 2014 and 2015. And last year drug over dose 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 for cara, we also worked together for the state targeted Response Grant Program as part of the 21st sernry cures act and this Program Provides a billion dollars to states to address the Opioid Epidemic. These were positive and bipartisan laws 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 the year trying to repeal the Affordable Care act which would have prevented millions of americans from getting the help they need to treat Opioid Health disorders and allow insurers to discriminate against those with opioid disorders and would have allowed states to wave the Health Benefits. But thankfully those repeal efforts have famed to date. So whats clear is individuals with Substance Use disorder need us to Work Together to do more. Despite progress in washington, the epidemic has shown no signs of relenting and thats why we must continue to support and increase funding for Proven Health approaches spanning the entire spectrum from crisis to recovery, including expanding access. Those efforts should include more funding and we should extend the Opioid Crisis Grant Program so we can expand even further access to treatment and Recovery Services. I look forward to working together in a bipartisan fashion to help our country respond to this crisis. Gentleman yields back. Chair recognizes the chairman of the energy subcommittee, for upton. This is very important as were able share our personal experiences in the crisis, opioid addiction and abuse. This silent epidemic has for sure torn through families, and communities in my home state of michigan but we know across the country as well. In 2015 there were nearly 2,000 opioid deaths in michigan alone. 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 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 and yes, individuals suffering. All of these folks have said tragically the death toll continues to rise. Thats why weve been taking concrete steps here in this committee to combat the widespread epidemic. Last year the president signed into his sweeping package as part of 21st century cures a bill that everyone of our Committee Members supported. An additional one billion dollars was allocated to the states. And like michigan to address opioid treatment and we received 16 million and that will make a real difference. To those suffering, i just say help is on the way. And as a result of this administrative action, hes helping to lead the charge. They started meeting with experts in academia to talk about ways they can Work Together to address the crisis. I look forward to seeing the results of the research that nih is doing with its industry partners. There are also things we in congress can help nih with in these endeavors. Fist, we need the nih to develop more options. Second, we need the evidence if nih can develop an effective therapy and finally we must acsesellerate nonaddictive pain measures. The sooner we can supply powerful new tools for every community. These efforts cant happen fast enough. And these are some of the many reasons 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 for meaningful, Bipartisan Legislation that will make a difference. Together well bring it out of the shadows. Gentleman yields back. Chair recognizes gentleman from new jersey. Three minutes please. Thank you, mr. Chairman and this is the first time ive been on this side and what a fun looking group. Much more fun over here. If it makes the gentleman more comfrtdable we could swear you in. That means id be under oath. The Opioid Crisis is devastating families and communities across new jersey, the state i represent. In 2015 the garden states death rate was 2 1 2 times the sky rocketing u. S. Rate. Were making progress with the implementation of the recovery act of 2016 but more work needs to be done. I acknowledge the efforts of one of my constituents. Claudet has made a positive difference in the lives of those suffering from drug addiction. Her community in crisis helps equip the luved 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 claudet and organizations Like Community and crisis. Their efrlts are efforts we should make sure congress understands and applauds. Ib2012 Health Care Providers wrote 259 million prescriptions for opioids. They addressed that issue by inreforming and improving the drug approval and label process at the fda. And the first time the congress has rekiered the agency to work with advisory committees before labelling decisions and to make recommendations regarding Educational Programs for prescribers of extended release and long alktingope yids. And encourages the development of opioid abruce properties. And we have to make sure resources such as the grants administered by the substnls abuse and Mental Health Services Continue to give states what they need experiment and test. New jersey recently secured a grant from the Substance Abuse and Mental Health Services Administration to focus on this crisis. Also recently awarded community in crisis and to other able organizations, 100 in prevention resource and empower summerset with a 125,000 grant to assist addressing the problem of opioid abuse. And partners in conecing people to the resources and susport 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. Chair wants to thank this panel. Well move to our second panel. Mr. Butter field from North Carolina, and from california and florida. Again members are advised they may speak from the witness table, which ever is their preference. So the chair recognizes ms ms. Masumi of california. Thank you mr. Chairman for inviting us today to testify about proposals to address our nations Opioid Epidemic. We all have heart breaking stories. In my home district of sacramento we experienced a particularly deadly over dose crisis last year which is as much as 50 times stronger than heroin. Addiction is a devastating disease that knows no pounds and we must come together in a comprehensive manner. We took a step forward by passing the addiction and recovery act into law last year. Understanding addiction and its cons kwenequences are multipron. I look at this problem as i do any other health care problem, which means i examine it holistically, from prevention to Early Intervention to treatment. Theres lot we can do at each of these stages. All of which rest on truly building our nations Mental Health system and integrating Mental Health with physical health care. Historically theyve been treated as character flaws and not addressed with evidencebased medical treatment. We can reverse that by making it more available, and reducing stigma. In 2012 erepresentative lance and blunt and i passed the excellence in Mental Health project into law. This is allowing stalts to demonstrate that building up community had Health Clinics improves access to care. We extepd tnd the year to more states. We should strongly consider this as one way to help address the Opioid Crisis. We need make sure Health Insurers are offering Mental Health benefits. However this is irrelevant if Mental Health benefits are not offered in the first place. There have been proposals which allow states to wave the essential Health Benefits meaning to once again not be required to curb mentdal health and addiction centers. And would mean loss of coverage from millions suffering from substance buse disorder. I am encouraged by steps being taken to address the crisis including the limiting of opioid prescription for subscribers and insurers. We need to build on these efr efforts. And bolstering our Mental Health work force, addressing the vureta of in patient to Residential Care and more. And i look forward to working on these policy proposals to address this pressing issue. Thank you and yield back. Chair recognizes gentleman from florida. Thank you, mr. Chairman. How about now . Very good. Thank you, mr. Chairman. The United States is in the midst of an opioid over dose epidemic. Sadly 91 americans die every day due to opioid over doses. Nearly half of all opioid over dose deaths involve a prescription opioid. In 2010 in response to the Opioid Crisis in floridas problem, floridas legislature enacted state wide tracking of pain killer prescriptions, coupled with Law Enforcement using Drug Trafficking laws to prosecute providers caught over prescribing. Within three years florida saw a decrease of more than 20 in over dose deaths. Despite this positive trend, opioid abuse continues to plague my district. In fact my district had the second highest prescription death rate in florida in 2014. In response i worked last congress to insure pacifico county was included as a high intensity Drug Trafficking area. Inhablinging law inforcesment to receive Additional Resources to combat the spread of drug related crime. I want to applaud the committee. And a prevention act and the promise act which passed last congress. The medicare Patient Safety and drug abuse prevention act created a pharmacy and blocking Program Giving cms the tools to crack down on this abuse and 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. And increased safety by requiring the va and d o, d to update their Clinical Practice Guidelines for managing of opioid therapy for chronic pain. Requiring the va, opioid prescribers to have the enhanced Pain Management and safe opioid prescribing education and training and encourage the va to increase information sharing with state licensing boards. I think thats critical. As far of the 21st century act, florida has received over 27 million in grants by increasing access to treatment and Recovery Services strengthening Public Health surveillance and improving Pain Management practices. These are supporting floridas all hands on deck approach across the state to curve opioid abuse and save lives. Iumier pleased theed administration are leading the charge on this critical issue. I yield back. Thank you. Mr. Butter field for three minutes, please. Thank you very much. For 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 by crediting my friend and our former colleague, mary bono, who was also from florida, it was very dear to her and she knew the impact it was having on her state. She brought this to the f forefront of our subcommittee years ago. At first, mr. Chairman i thought mary was over reacting to the Opioid Crisis in florida because it had had touched her family personally. But after we had had hearings and i looked into it, i came the conclusion she was not over reacting and it was indeed an epidemic, not just in florida but across the country. Just last year i worked with many of my colleagues on the comprehensive addiction and recovery act passed into law. That bill included roughly 20 different legislative proposals to help slow the epidemic. This Committee Approved 500 million. American people need know that. We approve 500 million to address opioid abuse. Despite attention from congress were 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. 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 of that with me today medics administered the appropriate drug in response to Opioid Crisis 28 times by midaugust. When they usually administered the treatment 30 times per quarter. According to chris parker with the Wilson County Emergency Medical Services theres 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. There were more than 500 diagnoses for Emergency Department. Regrettably in my humble opinion the administration is not taking this situation seriously. The budget offered by the Current Administration cuts funding by 16 . The cdc by 17 . The national instult stuts of health by 19 . Im also very concerned about the proposals to gut the medicaid program. The senate for Budget Priorities estimates nearly 100,000 people with an opioid use disorder have gained coverage through Medicaid Expansion. Congress must do all that it can to stop this epidemic from d devastating more lives, fam aelgs and communities. Congress should provide certainty to combat this epidemic which is why im the original co sponsor. The opiate and heroin abuse crisis act of 2017 introduced by mr. Lieu hawn. We must also protect existing fundings for research, provide tools to communities to address this epidemic and reduce the stigma for those needing a treatment. I want to thank you for convening this hearing. And all of you for your time, your attention and your energy to this issue because it is an emergency in our country. Thank you. I yield back. Thanks to gentleman. Chair recognizes gentleman from indiana for three minutes, please. Thank you for holding isthis poimert pont hearing today. While it is important to look forward and address what elsz needs to be done, we need insure legislation we have already passed is being properly implemented and working as congress intended. In july 2016 the comprehensive addiction and recovery act, landmark legislation was passed into law. I spent months convening stake holder round tables and working on bipartisan language which became section 303 of kara. Section 303 updates the controlled substances act and opioid Addiction Treatment lays while insuring patients are offered and approved on all fda treatments. Prior to cara, millions had their treatment determined based obtheir setting of care. With a passage of cara, patients must be offered a full range of Treatment Options based on their individual clinical needs and plan. Unfortunately 15 months after the legislation was signed into law, seksz 303 still has not been implemented. I urge the committee to insure theyll be properly implementing the law. Every day is one more day that our Family Members, friends and colleagues are battling a disease with fragmented and incomplete Treatment Options. Specifically they should send a Dear Colleague letter to let them know to offer on a patients needs. Additionally curriculum for doctors, pas and Nurse Practitioners should be updated to include opioid addiction medications. Moreover, all of the public facing material should be modernized to reflect this patientcentered aproach. 55 people in vand burg county have died of a drug over dose in the first nine months of this year, which is more than all of 2016. Thuve the availability of all medicaid assistance treatments will help to stem the tide of unnecessary deaths. It is vital that as the Committee Moves forward in the fight against opioid abuse disorder that we insure cara is properly implemented and helping people combat this disease. Again, thank you. And recognize gentleman from ohio. Well, thank you mr. Chairman. Opioid abusz and addiction has caused devastation in every Community Across our nation. In ohio in 2015, 3,050 people lost their lives. In 2016 that increased. Thats an increase from the Previous Year and that means 11 death as day. For comparison in 2016 there were 1,133 traffic fatalities in ohio. That meentz drug over doses caused more deaths than traffic accidents. These figures are heart breaking and its sad to know this isnt getting better. 2017s over dose fatalities are out pacing 2016. This problem knows no limits and has effected husbands, brothers, sisters, fathers and mothers, destroyed marriages, ruined careers and cut too many lives short. When i read through my obituaries, ive noticed more younger individuals without a cause being listed. Unfortunately in too many instances because of drug over dose. Ive heard how opioid addiction impacts our communities. Ive met with kmuncommunities a spoken with families to learn how its directly effected their lives. Its because of these stories that would direct to create a Public Health data base for nation wide efforts to combat the Opioid Crisis. It would serve as a Central Location for public and others to track federal funding allocation made available for opioid abuse. Find research relating to opioid abuse from all federal agencies at state, local, and tribal governments as well as Law Enforcement, medical experts and research institutes. Further more, the legislation would charge hhs to evaluate a myriad of issues relating to Pain Management, prescription guidelines and Effective Solutions and problems used across the country. These findings be available on the data base as well and nhs would be instructed to offer recommendations for targeted areas of improvement. I believe this data base will allow for easier access of information 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 nation wide every day, we have run out of time to find a solution to the crisis. We need action now. I appreciate the community for holding the forum for Creative Ideas and solutions and hope it leads to more lives being saved. I appreciate the opportunity to be here and yield back the b balance of my time. The chair wants to thank all the members on this panel for your testimony. You are now excused and we will seek the next panel. Inquiry. Gentleman will state his parliamentary inquiry. Im not sure thats the right terminology but i wanted to include thin record have i lost my right to do that . Without objection, so ordered. Thank you. And the chair would ask that the next panel, which is mr. Johnson, mr. Welch, leader pulohsy and ms. Brooks and members of the committee are welcome to provide their information from the witness table, which ever is your preference. And mr. Johnson, ill recognize you for three minutes. Thank you, mr. Had chairman. I appreciate this discussion about an issue that is so vitally important. It is no secret that americas in the midst of an Opioid Crisis. Last year in my home state of ohio alone about 86 of over dose 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 light on some of the good work being done by people in my district to help combat the Opioid Epidemic and let everyone know about some of the pause trv things taking place. Recently i had the honor of visiting field of hope. A faith based 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 any surgery from a High School Athletic injury. Her prescriptions ran out before her pain was panaged but unfortunately by that point she was addicted. She ended up in prison several times for theft. And checked into numerous rehab facilities. 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 campice and witnessed the good work theyre doing first hand. We in congress and especially in this committee have an Important Role to play in work being done by organization like field of hope. We need prevention policies that steer people like kevins daughter away from opioids in the first place. Nonaddictive treatments exist today and more on the way but these innovative treatments are not always covered by federal programs like medicare and medica medicaid. We should closely examine the Reimbursement Policies and insure patients have access to e effective alternatives without pain addiction. And ive been encouraged by priechbt payers, pharmacists and patient groups to address it through new Treatment Options and prescribing guidelines. I think congress can play a role 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 act and with that, i yield back the balance of my time. Gentleman yields back. The chair is then pleased to recognize the entire vermont delegation. Mr. Welch. We dont have the numbers of texas but i appreciate the recognition. First of all, thank you. Youre taking time to focus attention and demonstrate the urgency of this challenge. Second this so effects us all. I mean its heart breaking and doesnt matter whether its a red district or blue district. It doesnt matter what your view is on the size and scope of government. This is hurting people in your district 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 peter, isnt this going to do bad things for the reputation of vermont . And then acknowledged what he was saying was true in their own states, so you focusing attention on it, thank you. Thats step number one. I can give you some statistics in vermont. Theyd be similar to mr. Johnson. Her Prescription Drug problems with individuals increased from 24. 77 in 2012 by 80 . Heroin went from 913 in 2012 and increased to 4,488. Everyone 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 about him being homeless, him goic from being a fulltime working person to being out on the street, her having to call her daughters saying their brother may soon be dead. All of that is real and all too viv vivid. So this is an enormous challenge. Our job is to come up with policies that are going to help people help themselves and id like to make a few suggestions. Number one, we have to have full funding for the comprehensive addiction and recovery act and weve got to find the money to allow our communities to do that work. 2, we have to have more resunch into alternative treatment. Im working to get the comprehensive addiction and recovery act to find better alternatives to treat pain. Three, lets allow for partial filling ensure and then to help them with the addiction. Indiana is tackling our problems headon. Just yesterday, Indiana University announced a new initiative, called responding to the addiction crisis. Its being led by the dean of nursing, robin newhouse. Iu is committing 50 million over the next five years to collaborate with state to fight this crisis and every iu campus in this state is going to be involved. Focusing on education, Addiction Sciences and community and workforce development. 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. 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 Prescription Drugs so people can get those drugs out of their medicine cabinets and out of our kids reach. Not just kids, adults. There will be locations all across the country. I really encourage everyone because everyone has a role to play. October 28th is National Takeback day and i hope we get that word out. Thank you, mr. Chairman. I yield back. Very well. I thank the gentle lady for providing the date. This hearing is being streamed on facebook live. Your information has been distributed to everyone tuning in this morning. 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, mr. Luhan, from oklahoma and energy and commerce members are advised they may present from the dias or witness table which ever is your preference, if youre seated at the table, we will provide a nametag for you. So when ever youre ready, mr. Lujan, you are recognized for three minutes, please. Thank you. I thank the chairs and Ranking Members for the opportunity to discuss how new mexico has been impacted by the Opioid Crisis. 501 new mexicans died of Drug Overdose deaths in 2015. Across this country there were 52,444 deaths and 560,000 deaths between 1999 and 2015. Half a Million People missed thanksgiving dinner on their daughters softball game, who werent able to help their son with math home work or kiss their spouse good night. Brothers and sisters, parents and friends and children we 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 recovery act and 21st century cures act. These were steps in the right direction. These efforts alone were not enough. I heard from my community the funding pass is helpful but hard to use in part because of the short funding period that impacts communitys ability to plan for long term and expanded capacity. We know in too many areas like new 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 stopped using heroin on mtks own and felt he was going into relapse 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 give the treatment and Wraparound Services patients need we need stability and give organizations ability to plan and not fear losing vital support from congress. Most of all, we need to give constituents like jay a place to go after hes fought a tough fight on his own. Thats why i introduced the opioid and heroin abuse crisis investment act to continue funding to combat the opioid ep dem ec we passed. I welcome my colleagues a support because we must extend this funding an additional 5 years and beyond. However, this still isnt enough and why we must look at new efforts for vital investments for appropriate and quality accessible treatment treatment. These barriers are rudeMental Health and treatment and Substance Abuse treatment and administrative barriers against the most effective form of opioid treatment and shortage of rural physicians to provide assistive treatment. Committees must realize hoping for the best is not valid public policy. Theres a quick fix to solve the Opioid Crisis. Thats not true. We need to advance legislation takes into account long term planning for state and communities. We need bring to it the floor of the house, send to it the senate and get it passed to the president s desk. I fear until we recognize that we will lose brothers and sisters, parents and friends and children. Mr. Chairman, i thank you for holding this important hearing and finding a way to work in a bipartisan fashion to address this important issue. I yield back. The chair thanks the gentleman. Mr. Mullin ger will be recognized for three minutes. After that we will allow the minority leader to be seated at the table and hear her testimony. Go ahead for three minutes, please. Mr. Chairman, i have no problem with letting miss pelosi go next if she would like to. If the minority leader is ready, yes, well recognize you for youre recognized. Thank you, mr. Chairman. Thank you for your courtesy. I really came to listen as well as to convey some thoughts. This is only the second time ive ever testified as leader or as speaker in that capacity, because this issue rises to the level, as you know, life and death. So with gratitude to you and 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. The Opioid Epidemic is taking a savage daily toll on the American People and regardless where they live theyre in every district in this country. It is tearing parents apart, an impact on the wellbeing of our children, its claimed the lives of tens of thousands of americans every year. On average, robbing 90 people of their lives each day, again, just to testify to that. I know its matter of your record here. Opioid addiction is a Public Health catastrophic and is growing more dire and deadly everyday. I believe it is really important for us to respond to this National Emergency with the seriousness and urgency it requires. Fortunately, we have had bipartisanship in passing legislation, comprehensive addiction and recovery act. We all came together during the Bipartisan Legislation that was passed the 21st centurys cure act people were so happy that the addiction language was in there. That day we heard the stories of families so upset it would break your heart. Families that lost a child, a young teenager, 21yearold whatever within a matter of days or weeks before that particular signing, president obama signed that legislation. It had the language, just hasnt had the money to an adequate extent. That, mr. Chairman is my appeal for 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, built on the progress of acas Medicaid Expansion provided a vital lifeline for tens of thousands of americans struggling with addiction. As governor of ohio, our former colleague, john kasich noted thank god we expanded medicaid because that money is helping to rehab people. Yet 19 states have not taken that step. We stand ready to work with you mr. Chairman in good faith to improve the aca but remain vigilant with efforts to gut the aca because it will create even more of a problem in terms of opioid just to name one thing. The Opioid Epidemic is a challenge to the conscience of the entire country. We urge boldly to get the Recovery Services they need. We must work with providers in the pharmaceutical industry to push effective prevention measures so we can reduce unnecessary prescriptions and stop this epidemic at the source. Knowing your busy schedule i will submit my entire statement for the record. Again, thank you for the courtesy of being able to testify for the committee and thank you for your leadership on this important issue and thank you, mr. Green as well. The chair thanks the 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. If you need to leave, that is certainly understandable as well. In the meantime ill recognize mr. Mullen for three minutes. Thank you for your hospitality. I will listen. From texas. Thank you, leader, for being here. Before mr. Mullen testifies, mr. Chairman, id like to thank him for his work. Literally when the water was going down in houston you called me and said, i have some churches in tulsa who want to partner with your churches, so we did that. Instead of having one weeks work from folks for the Cherokee Nation i think they stayed a month helping my seniors and disabled clean out their 3 or 4 foot of water in their house. I didnt realize they had the drywall skills. Thank you. As one with a daughter in houston and grandchildren, i thank you as well. Mr. Green, thank you. The Cherokee Nation called us off the bat and said, how can we help and we had churches reach out to us. Weve been very fortunate to Work Together on multiple issues here in congress and a friendship carried past that. 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 Opioid 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. Ive never been one to use pain medicine. My wife says im different, i think most people would probably agree with that. I do understand pain. 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 it was something that can be treated like a cold or the flu. All we do is mask it. We have seen stronger and stronger drugs coming out. We have seen them become controlled substance, narcotics that we send home simply in a bottle with prescription and say thats controlled. Now, weve seen an epidemic spread from the middle class to the low class to the wealthy and to our mothers and fathers and brothers and sisters and coworkers. When do we put the genie back in the bottle . How do we continue to allow drugs, addictive drugs, continue to be sent home with our loved ones . The highest percentage of death of accidental opioid deaths are mothers, middleaged women. Most of them got addicted to them after birth or elective surgery. How is that possible . How do we let it continue to move down that path and not say that we have to do something bold about this . When its 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 weve got to go back to where it started. It started when we started treatment. I am very proud to be on this sub committee, im very very proud the chairman is taking a very heavy interest in this and proud chairman murphy took an interest in this, too, were proud to be able to pick up one of his bills. Hr 3545, that will at least allow doctors, after surgery, to build an access records to know if that person has an addictive behavior so were not sending those types of drugs home with them. I look forward to continue to work with the committee. I look forward to finally being able to put some type of remedy in bringing this to closure and quit hurting our families back home. I hope we can approach this in a bipartisan approach and put politics aside and families first. Thank you, i look forward to working with you. I yield back. Thanks. The gentleman yields back, recognizes mr. Tonkco. Thank you, chairman burgess and Ranking Member green and members of the subcommittee. We are a nation in crisis. The Opioid Epidemic is wreaking havoc at an unprecedented scale with cdc estimating 64,000 dead from Drug Overdoses in 2016, astonishing 21 increase from the Previous Year. This Public Health disaster is costing us more lives annually, at the peak of the aids epidemic than gun and traffic accidents combined. If this congress doesnt find the solutions to turn the tables we will be complicit in this american tragedy. Im here today to offer two legislative solutions, i introduce the addictive improvement act hr 3692 with my good friend, ben. And provide access to assisted treatment by allowing certified midwives and other registers nurses to prescribe and in addition it would codify the 2116 rule that allows physicians to treat up to 275 patients with the medicine and allow nonphysician providers to prescribe mat. The Addiction Treatment act would allow postpartum women struggling with addiction and improve outcomes for over 13,000 infants born each year with neonatal abstinence syndrome. Despite the treatment and comprehensive recovery act 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 patients who need opioid disorder are receiving it. Let me repeat it. Only 20 of patients who need opioid use disorder are receiving it. This would address the treatment gap and save lives. This committee should act on this Bipartisan Legislation without delay. The second bill id discuss is medicaid reentry act, hr 4005. Thisceze legislation is a targe attempt to address the problem of Overdose Deaths that occur post incarceration. Studies have shown individuals who are released back into the Community Post incarceration are roughly eight times more likely to die of an overdose in the first two weeks post release compared to other times. The risk of overdose is elevated during this period due to reduced physiological intolerance among the incarcerated population, a lack of effective addicted Treatment Options of incarcerated and transports back into the community. The medicaid reentry act would grant states flexibility to restart medicaid coverage for medicaid individuals 30 days post prerelease. By allowing the medicaid benefits to start prior to release states could provide more effective Addiction Treatment prerelease and allow smoother transitions to Community Care releasing overall deaths post release and scarce medicaid dollars. Met me be clear, this would not expand Medicaid Eligibility in any way, simply grant states new flexibility to start an individuals medicaid benefits 30 days earlier than allows under current law. This would dovetail with innovative reentry programs already championed by republicans and democrats in states across our country and give individuals reentering society a fighting chance to live a healthier drugfree life. Let me end with an urgent plea for action and bipartisanship. I know many of the testimony would in normal times be met with typical bipartisan objections and stuck in a procedural morass. These are not normal times. When your house is on fire you dont look to see whether the firefighter is wearing a red or blue uniform 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 open mind. I thank my colleagues for their time and consideration of this legislation i have presented and again to the chair Ranking Member and members of the subcommittee, thank you for offering such, you know, attention to a crisis that has gripped this country in severe measure. Thank you. I yield back. Gentleman yields back. The chair recognizes the gentleman from new york, mr. Hudson for three minutes. Thank you, chairman burgess and Ranking Member green. Thank you for giving me the opportunity to speak on behalf of my constituents. As noted the Opioid Epidemic is a nationwide issue and deserves our attention. It is noted to be killing more people now than the hiv epidemic did in its peek in the 90s. It is not based on race, social class or age and destroys lives and marriages and careers. In my home state of new york it has hit hard. New york is home to four cities in the top 25 of worst cities affected by the crisis, one of which is in my district, favoritevill fayetteville, North Carolina, a police captain, son of a police chief in the same town injured his back on the job and was prescribed and opioid following his surgery. He told me he vividly remembers the moment he became addicted the first time he took one of these medications. Within a year he was a fullblown heroin addict and since recovered and now mentors treatment. This is a story with a happy ending. Fayetteville has become home of soldiers and veterans who have become addicted after being prescribed opioids for injuries in combat or training. The tragedy is the v. A. Does not have enough inpatient beds to treat every veteran and oftentimes they go without help and forced to selfmedicate using opioids found on the black market. This is outrageous and unacceptable. We need to find Real Solutions to put an ends to this heartbreak. Im pleased to Work Congress that passes the addiction and recovery act and 21 century cures act. It has made huge steps in opioid addiction. Its clear we have work left to do. One idea im working on is expanding access to expose addiction drugs, opioids, expose rx, manufacturer of powder mixes with water inside the pill bottle and renders any unused opioids not only inaccessible but also biodegradable. We need to explore this and work with my colleagues on the committee to help treat and prevent this opioid addiction. Thank you, mr. Chairman. I yield back. The chairman yields back, thanks the gentleman. The chair recognizes the gentleman from massachusetts, mr. Kennedy for three minutes. Thank you as well for bringing us all together an colleagues from across the country. I want to thank my colleagues that testified already. Their comments are right on. They jo the depth of this epidemic across the country and affected so many districts around our nation and myriad of ways our federal government can help respond to it. There is no Silver Bullet to this but ideas out there genuine that have widespread support and i hope will deserve this committees attention going forward. Addiction, as many know, is not a disease that knows Congressional Districts or state borders or Electoral College results, doesnt care how much money is in your bank account or asks how many children you have. For patients on the front lines of this epidemic today, its personal and painful and petrifying. The question before all of us is there an epidemic, you heard from everybody today saying that there is, the question is, how do we go forward . My colleagues have outlined some of their solutions, i wanted to touch on a couple of broad themes as well. First and foremost is medicaid. Medicaid, as of now covers about 30 of all nonelderly adults with opioid addiction in this country. 30 . The 20 of opioid addicts that do not have Health Insurance largely extends from individuals in states that did not take a Medicaid Expansion. This is not enough. We need to expand our Medicaid Programs to ensure everybody gets help when need it not just insuring access and capability but flushing out networks that provide stories you have heard from so many folks around the country, even if they are enrolled in medicaid, there are not providers that will take it. If providers do take it, they would have to wait months in order to get a slot to get into treatment. Theres complex reasons for that. In my own opinion, a big portion comes to low medicaid reimbursement rates that end up butting the burden of treatment on the backs of providers making sure patients get the care they need. Second is Law Enforcement. Folks, we lock people up in this country, theyre sick. We need to be doing an awful lot more, not only to make sure that safety net for Mental Health system is not criminal Justice System but supporting the officers on the front line of the epidemic across the country and put in an impossible place of forcing to have to arrest people and put themselves in danger because our Mental Health system is not robust enough. I was a state prosecutor. We threw people in jail that were sick. They were breaking into homes and cars to try to satiate an Opioid Epidemic and addiction because they didnt have anywhere else to go. Finally, ill be brief, mr. Chairmany the medical community, you heard miss brooks talk about education and prediction of drug Monitoring Programs and folks talk about prescription guidelines, all of those are on the table. I got in an argument with a surgery technician on my hospital bed who was trying to prescribe me painkillers i wouldnt take because im deathly afraid of these things. That part needs to change. Im working with my colleagues to make sure of this. I yield back. The chair thanks everyone on this panel, will allow you to depart. We have a panel that will be mr. Costello of pennsylvania, mr. Wahlberg of michigan, mr. Carter of georgia and chairman goodlap of virginia. Mr. Wahlberg, we are doing energy and commerce members first but with your permission ill go to the chairman of the increasing committee. Chairman, youre recognized for three minutes. Mr. Chairman, Ranking Member green and members of the committee, thank you very much for the opportunity to testify about the Opioid Crisis in america. This crisis affects americans across all socioeconomic levels and all regions of the country including my home district in virginia and rightfully gained attention of congress. According to the Northern Shenandoah Valley Substance Abuse coalition they have seen opioid overdoses resulting since september 30th making 33 deaths in that portion of my district so far this year. Just recently i met with the mother in roanoke whose darting is an addict living on the streets. Her concern was heartbreaking to hear. I know each congressman in this room have heard Bright Futures wasted away and lives taken too early and why we must help addicts rebuild and reclaim their lives, stop drug traffickers and make our community safer. We at the Judiciary Committee have been pleased to work with the Energy Commission on commerce in this fight to combat this epidemic. Just last year, since last year, the Judiciary Committee passed seven legislative measures that addressed the Opioid Epidemic. Notably the committees worked collaboratively to see that the opioid addiction abuse act signed into law last year. It come bats the Opioid Epidemic by establishing a streamlined catastrophic opioid abuse Grant Program including vital training and abuses by First Responders and Law Enforcement and unlawful distribution of opioids, drug alternative treatment courts and residential Substance Abuse treatment. Weve also targeted those who traffic in opioids. The transnational Drug Trafficking act now law includes Law Enforcements pursuit to include International Drug manufacturers and distributorers in source nations. Federal prosecutors can use that to pursue on for drug traffickers poisoning american citizens. Additionally in july of this year, they reported favorably the stop the importation and trafficking of synthetic analogs act. It is an unfortunate reality the synthetic drug use and Opioid Epidemic are linked. Opioid is regularly laced with drugs such as fentanyl and its to keep pace with chemically altered drugs and Law Enforcement to keep drugs off our streets. That legislation is before the energy and commerce committee. I hope you will take a very close look at it. 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 is unwavering. I look forward to our continued Work Together to that end. Thank you. The chair thanks the gentleman and thanks for the time to be on our panel today. We appreciate you being here and know we have work to do and we will Work Together on this. Thanks for the opportunity. Mr. Wahlberg, youre recognized for three minutes, please. Im always delight to go behind the chairman of the Judiciary Committee, especially since theres some of my bills in his committee. Let me say, chairmanburg guess and Ranking Member green, i want to thank you for holding todays hearing. You will see input from members who represent different corners of our country yet the very same problem. Since the heroin Opioid Crisis came to the forefront ive heard so many devastating stories about families losing loved ones, ive toured recovery centers, talked with survivors who continue to battle addiction and ridden along with Law Enforcement to understand the challenges they face in keeping our neighborhood safe. Ive also met a number of amazing compassionate individuals, fellow citizens who have stepped up and are leading the fight in their communities. A few weeks ago,as . Opportunity to meet with a constituent who established ryans hope foundation. A Nonprofit Organization named in honor of his son who died from a heroin overdose in 2012. He was only 25. Ryans hope fund structured long term residential treatment for addicts. So far, they have helped and nearly helped 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 and 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 recoverybased program in downtown adrian is a result of a Community Partnership between local police and county Sheriffs Office and rotary clubs and 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 communitybased initiatives like these to get resources to those in need. Congress also has more to do. One example is jessies law, a bipartisan bill ive introduced with congresswoman debbie dingle. It i to ensure medical professionals are equipped to treat patients and prevent overdose tragedies, named ajesse grubb, who died last year of an opioid overdose. He battled heroin addiction nearly seven years but clean for six months. She made a new life for herself in michigan and training for a marathon when an infection related to a running injury required her to have surgery. Jessies parents told doctors she was a recovering addict and shouldnt be prescribed opioids. Unfortunately jessies discharging physician didnt know her addiction history and sent jessie home with a prescription for 50 oxycodone pills. Jessie became a sad death by overdose statistic. Jessies law will insure physicians and nurses have access to a consenting patients complete Health Information when making treatment decisions. Such information is crucial to provide a patient centered care, prevent relapses and ultimately save lives. As we Work Together to address this crisis, its my hope the stories and ideas shared today will inform our efforts and ensure we pursue Meaningful Solutions to insure obstacles and have local communities help the Opioid Crisis headon. Thanks for listening to my story. Thanks. I believe this concludes all the energy and commerce members seeking to give testimony. If any arrived we will allow them to testimony as they come in. 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 that would be good as well. Chairman rogers, thank you for being here and being part of this discussion this morning. Youre recognized, sir. Thank you, mr. Chairman and colleagues, thank you for hosting us, on this very very important topic. Over the past 15 years, many of you have heard me advocate for a holistic approach to the calamity that we face, including enforcement, prevention and treatment measures, like those successfully implemented by operation unite in kentucky. We need to further encourage regional collaboration on this issue that ignores lines on a map. I hope to work with the committee on this issue in the future. Today, however, mr. Chairman, id like to focus on treatment. Despite the life weve 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 turnover 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, katherine 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. 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. Will the gentleman from georgia and commerce member join us at the table. Mr. Carter, if youre ready, i will recognize you for three minutes. Thank you, mr. Chairman and Ranking Member green. I warrant to start with my testimony for how to continue to combat this growing epidemic. As a pharmacist i always made it a priority to advise and assist my patients with medications they prescribe. As a Community Pharmacist i had a bond with neighbors and that bond pushes pharmacists to act proactively helping their patients. One of the largest is increase in opioids for pain relief. We need to look at other options and outlets for the treatment of pain and find a good medium. I believe we can work with the fda to prioritize nine treatments for patients and provide a channel for those therapies. In addition as it currently stands prescribers are able to writeup to three 30 day prescriptions for drugs for patients. I believe it would be pertinent to look at the prescribing and look at the effectiveness of allowing fewer initiate prescriptions and limited refills rather than three months of prescriptions. Similar to that notion, allowing pharmacists to have a greater say in limiting the number of pills filled in a prescription could help address the transition to addiction. For instance, limiting the field for acute pain needs such as a dental procedure could help prevent an individual from getting hooked on opioids. Now theyre only able to partially fill a prescription in the instance it doesnt have enough stock to fully fill a prescription. A simple 7day pill could cover their pain needs and keep more out of circulation. Prescription drug Monitoring Programs are a great resource combatting Prescription Drug abuse. They can be lengthened to better curb this epidemic. One way to do so is better align the data so states can collaborate to create a more comprehensive picture of peoples drug use further linking state dmps and allowing more accuracy how states respond to potential abuses. Truck takeback programs continue to expand across the country. Currently, 19 states have some form of take back programs and 23 states have take back programs allowing pharmacists to accept unused drugs and they access the Drug Cabinets of parents and grandparents. Too often these unused pills act as a gateway to further abuse by young adults. Expanding these programs through pharmacies or paid through mail programs can take some Prescription Drugs off the street. The creation of middle ground therapies are those missing in todays market. By research and development we can help drive expensive time consuming efforts to make those treatments a reality. Currently few options left between trauma doll and opioids and that is driving prescriptions across the country. Thank you, mr. Chairman and committee for the opportunity to provide testimony here today. I look forward to working with everyone to tackle this issue. The chair thanks the gentleman. The gentleman yields back and recognizes the gentle lady from illinois. Thank you, mr. Chairman and Ranking Member green. Id like to start off by telling you a story from a young man from my Congressional District in rockford, illinois. I had the good fortune of meeting his mother who told me this story. Chris passed away in the summer of 2014 only 32 years old. He had injured his back. As a result, his physician prescribed and opioid to relieve his pain. Soon after that he became dependent on that prescription opioid, found out the 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 enrolled in a college called Rock Valley College where he was studying construction management. A year after being clean he relapsed again and ended up passing away. We know stories very similar to this are happening all over our country. I was so proud when we came together, democrats and republicans, and actually passed some meaningful legislation to help address this Opioid Crisis. One of those bills that was included in that was to care for infants born with an opioid dependency due to their parents addiction. We received the Government Accountability report that my bill called for very recently. It reviews and makes recommendations to care for these infants. What it really ended up showing 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 yet put this into practice. Theres not even a protocol to screen and treat these newborn babies who are born addicted because of their parents addiction. It further reinforces that this is not the time to cut medicaid. Medicaid pays for 4 out of every 5 babies that are suffering from Opioid Withdrawal upon their birth. Its helped 1. 6 Million People with Substance Abuse disorders and access to treatment. So i just really more than anything want to make the point medicaid has to be protected and not cut. I want to stress one other point because of the Congressional District i represent. That is that the Opioid Crisis is worse in Rural Communities, where the drug related deaths are 45 higher. Rural states have higher rates of overdose, especially prescription opioids, 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 with 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 piece of legislation to help Rural Communities better leverage the u. S. Department of agricultural to combat heroin and opioid use. We need continue to look at solutions that work in rural areas like telemedicine, which will help us overcome the transportation access issues that i mentioned earlier. With that, mr. Chairman, i yield back the rest of my time. The chair thanks the gentle nd the chair thanks the gentle recognizes the gentleman from dayton, ohio. Thank you, mr. Burgess and mr. Green and Ranking Members of the committee. I came from dayton, ohio. My counties in ohio are montgomery, green and fayette. Despite our communitys efforts to battle the Opioid Epidemic for years, it continues to destroy my community and my opportunities on a daily basis. This year, current estimates suggest 800 people could die in my primary county, Montgomery County due to opioid overdose. Sadly that would more than double the number in 2016, the highest number to date. Imagine 800 families receiving notice someone in their family died as a result of opioid overdose. Hard numbers like this in abuse and addiction. Recently working with the county sheriff i called for the appointment of a dayton drug czar to coordinate the regions response to the epidemic. I worked on a local basis. I would like to highlight my bill, hr 982 responding treatment act, the treat act as the title suggests would increase access to abuse treatment by unhamstringing the resources. Medicaid exclusions states with facilities more than 16 beds like jails are not eligible for reimbursement for individuals incarcerated compounding the problem of Substance Abuse and Mental Health policy dating to 1995 limits use of grants for its center for Substance Abuse treatment to only communitybased Treatment Facilities excluding those incarcerated. Mine offers a common sense solution to eliminate barriers for those incarcerated by allowing medicaid to reimburse Substance Abuse treatment for someone incarcerated. No reason why someone medicaid eligible should lose their benefits when incarcerated. Limiting sam ta for providing Substance Abuse treatment of individuals would also assist. Since i first introduced the treat act in november of 2015 and reintroduced it in this congress it has broad support from medical providers to local jurisdictions. The president s commission combatting Opioid Crisis was just issued july 21st, 2017 strongly endorse this concept in the treat act. The single fastest way to have treatment and numerous treatment providers parents and Nonprofit Organizations have urged this course of action. Chairman burgess and Ranking Member green and members of the subcommittee, this would be an important step to help those individuals at a time we have the ability to intervene in their lives. Thank you. Thank you and the gentleman yields back. Recognizing the gentleman from kansas. Thank you very much. Thank you for the opportunity to come and talk and share some of my 30 years of experience as an obgyn in rural kansas. As most of the Committee Members know, 92 people die in this country everyday from opioid addiction. I want to describe a couple of seminal events, why do we end up in this situation . I look back in the last 10 years, the number of pills i sent home for a postop patient doubled. The average csection and average hysterectomy. All of a sudden each week the number of pills they need literally doubled. I went back to figure out why and how come . The first thing i think of patient bill of rights came about 1993 or so. Over the next 10 years there was a great document, patients suddenly expected they should have no painy no pain after surgery and come into the er with a sprained ankle and expect to have no pain and the demand for narcotics went up and up. Somewhere in the early 2000, something was introduced called a pain scale. They called it the fifth vital sign. Its probably the worst thing ive seen introduced in my medical career and described the amount of pain they had which was very subjective. Beyond that it became a measure of how good medicine you were practicing even tied to your reimbursement. Suddenly, the patients were getting double and triple the medications, on the postoptive floor, residents were getting percocets every 6 hours and every 4 hours and pca pumps increased doses. What im trying to say we almost doubled the amount of narcotics people are getting in the hospital and then they wanted twice the amount go home with as well. Physicians were faced with a struggle saying i dont think you need this much, patients becoming more and more in control of their own healthcare. I think those are a couple reasons why we ended up here and needs to be reeducation done. I want to point towards valley point at norton, kansas. They treated over 300,000 patients over the past 50 years and kept incredible statistics and have incredible treatment plans. What they taught me about a month after release, a month after they started their path to recovery they had a second physiological reaction and when these people od and die. People need to recognize for a month they need to have very close treatment and probably for two months and even a year. Its during that second episode before they had treatment they were taking a certain amount of heroin and a handful of pills and a pint of whiskey when they retreated from that for a month and they went back to that same dose they overdosed and stopped dying. What kills people, if i give anybody enough morphine, you would stop breathing. Theyre unable to metabolize it, we need to recognize thats a critical moment. Treatment plans cannot last a week and will last months and years probably and need to make sure were adequately funding outpatient treatment and make sure theres good followup at home and reward facilities like valley hope with great outcomes. Mr. Chairman thank you so much for taking on this task and look forward to working with you. Chair recognizes the gentleman, mr. Stivers, im sorry, chairman stivers. Thank you very much, mr. Chairman. Appreciate you holding this hearing and appreciate Ranking Member green and all of you looking at solutions for this Opioid Crisis plaguing all the communities across this country. Congressman turner alluded to it in ohio, opioid overdoses exceed Car Accidents as the leading cause of death for most ohioans. There have been a lot of great ideas presented here today and i have appreciated learning from many of our colleagues. I for the last five years have held opioid round tables, drug round tables in my district to talk about solutions and weve come up with some of ideas from the field of folks that know what is driving this crisis. Ill talk about some medical things in a second. The first thing i know we have to do is bring back hope and Economic Opportunity to people. I think what youre doing, mr. Chairman, with Regulatory Reform and what were doing with tax reform will help with that. There are a lot of other things we can do first. The idea that came out of our roundtable this year is on evidencebased treatment. If youve been to one Treatment Facility youve been to one Treatment Facility. They all do things differently. Too many theres nothing tying you to the treatment any more when they walk out that door. Thats a problem. I think we should have evidencebased 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 about the second issue i want to bring up, pain as a vital sign. Every other vital sign you can think of, your temperature, blood pressure, pulse, can be measured by a machine. Pain cant be measured by a machine. Its a subjective number and should not be the fifth vital sign. We have to try to fix it. I appreciate what cms has done to remove the reimbursement based on surveys of Pain Management. I think we need to remove pain as a vital sign. The third idea is encouraging alternatives. Theres lots of ways to manage pain including acupuncture, fire roprac tick services and other things that Chiropractic Services and things that dont involve a pill. The third is prescription change an i know, buddy, the pharmacist testified on this. And i supported what became law, i believe pharmacists should be empowered to authorize partial fill of opioid prescriptions on their own. Buddy already said it, but 70 of the folks who misuse prescriptions get it at some point, bridge that addiction through friends and families medicine cabinets. We have to fix that. The final issue i dont hear talked about enough is tapering doses. When somebody is on an opioid about 30 days, they have a physical addiction to it. You talk to most pharmacists theyll talk about a tapering dose instead of going off cold turkey. Thats something we need to bring culture around of having folks understand that. A lot of primary care physicians, mr. Chairman, feel very uncomfortable doing issuing more 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. Those are just five ideas of some proposed solutions. Many of my colleagues also have great ideas. I really appreciate mr. Chairman and Ranking Member you holding this hearing. We are committed to working with you to driving the scourge of drug addiction out of this country. I really appreciate what youre doing. I yield back. The chair thanks the gentleman, the gentleman yields 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. Schneider from illinois, miss clark from massachusetts, mr. Jeffries from new york, and mr. Jenkins from West Virginia. Representative snyder, youre recognized for three minutes. Thank you. Thank you, chairman burgess. Ranking member green, for inviting me here today to discuss the epidemic of opioid addiction, abuse, and overdose that is ravaging our communities. I represent the people of illinois tenth district, including parts of cook and lake counties. And the Opioid Crisis has hit our neighborhoods extremely hard. In cook county, which includes the city of chicago, opioid overdoses increased by 87. 4 . I repeat that, 87. 4 between 2013 and 2016. Over the same period, we witnessed a troubling increase in fentanyl. Synthetic opioid which is even more deadly than heroin and whose overdoses are often fatal. In the face of these challenges, i would like to recognize the Lake County Opioid Initiative and chicago area Opioid Task Force along with other area organizations for their work to prevent opioid abuse, addiction, overdose, and death. In this epidemic, our adversary is constantly shifting so we must insure our doctors are up to date with the most recent best practices and research for preventing and treating this disease. Earlier this year, i noted a bill called preventing opioid abuse through continuing education or opioid pace act. This bill would require providers who treat patients with prescription opioid for Pain Management to complete 12 hours of continuing education every three years. This would be linked to renewal of the providers Drug Enforcement agency license. In an effort to cut down on overprescribing, they would focus on Pain Management guidelines and best practices. Earlier detection of pain disorder and the treatment of patients with opioid use disorder. Im proud a modified version of this bill at the department of defense was included as an amendment to the nda authorization. Our men and women in uniform are not immune from the damages of opioid addiction. In fact, the National Institute of Health Reports that rates of misuse are higher among Service Members than civilians due to the use of these drugs to treat symptoms of ptsd and chronic pain. As we seek new solutions, i urge my colleagues to support these programs we have in place to fight back. In particular, the Affordable Care act greatly increased our ability to counter Opioid Epidemic by expanding medicaid and requiring individual market policies. They would Cover Services related to treating Substance Abuse disorders. The states with the highest rates of substance overdose dets would suffer from the expansion. It would add to the fire. I urge my colleagues to consider new solutions to address this crisis, including the opioid pace act and preserve the programs we have in place to address this epidemic. With that, i yield back. Chair thanks the gentleman. Chair recognizes representative jeffries from new york for three minutes, please. Thank you, chairman burgess and Ranking Member green, for holding this hearing as well as for your leadership on this very important issue. Appreciate the opportunity to testify today on the synthetic drug awareness act of 2017, hr449. The Opioid Crisis ravaged families across the country without regard to zip code, income, race, religion, or gender. Like a malignant tumor, the Opioid Crisis is eating away at young people in urban america, Rural America, as well as suburban america. One reason the opioid abuse has become so prevalent and so deadly is the emergence of the synthetic drug called fentanyl, a substance that can be 50 to 100 times stronger than morphine. In order to address the Health Crisis we confront, its important to consider both the cause and effect. Hr449 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 Health effects of synthetic drug abuse by 12 to 18yearolds in america. With the information the study will provide, congress can work to prevent Substance Abuse by younger americans through an enhanced and enlightened lens. Nationwide, the 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 in availability of potent and dangerous substances like illicit fentanyl and other synthetic drugs. Teenage fentanyl use is a vicious cycle. Adolescents have a still developing prefrontal cortex which can facilitate drug seeking behavior. The drug then altered the development of the area of the young brain, making that behavior permanent. In fact, more than 90 of adults who develop a Substance Abuse disorder begin using prior to the age of 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 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. Chair thanks the gentleman. Chair recognizes the gentleman from West Virginia, mr. Jenkins, for three minutes, please. Thank you so much, mr. Thank you so mump, chairman burgess, Ranking Member green, and members of the subcommittee for giving me the opportunity to discuss this most challenging Public Health and safety issue of our time. My home state of West Virginia is ground zero for the Opioid Epidemic. West virginia has the nations highest overdose rate and the highest rate of newborns exposed to opioids and other drugs known as neonatal abstinence syndrome or nas. 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 unfortunately became adistricted as a teenager. 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. 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. We dont talk much about this. On the floor of the house repeatedly over 3 years. Congress has been moving in this direction. And voted last congress to have the better vans adds mrgs be able to work with veterans. Instates where medical marijuana is legal. But i focus on just one simple item. Not the facts when i hope the committee would look at. Tl one piece of legislation that i have introduced with doctor andy harris. Somebody who doesnt agree with me about the medical marijuana. But he strongly agrees with me theres 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 by partisan legislation. And be able to have Robust Research to resolve these questions. So theres no doubt. This is the cheapest most effective way to be able to stop the crisis. Where people have access to medical marijuana. There are fewer over doses, and people opt for it. Dealing with chronic pain. I would appreciate the subcommittee looking at this issue. As your time permits. The crisis has hit the atlanta counties of full ton, cob and has hard as anywhere in td country. From prescription painkillers to heroin. 72. 3 of drug related fatalities were caused in opioid. An increase from 16. 8 the year before. In 2015 the cob county Narcotic Team seized more than more heroin than in the previous 20 years. Combined. Compared to four such deaths in 2010. Behind the statistics are hurting devastated families. That are torn part by addiction. Facing financial return in the desperate effort to try anything to make things right or worse losing a lof loved one to a drug over dose 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. Gentlemen yields whack back. Chair thanks the chair. Chair recognizes mr. Faso for three minutes. 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 tragedy. Thats the face of whats going on. Thats what im trying to address with regard 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 was going to talk longer. I realize my time is up. Looking through the prizm of a prosecuter, theres three days to address this. One is Law Enforcement. Two is prevention, and 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 consider 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 overdoses this 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. I 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 there tamper resistance, abuse resistant. 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 this in 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 this. 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 thats 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. The crisis affects minnesotans of all backgrounds in Rural Communities, big cities, and in our suburbs. 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 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 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 residence 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 provide 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. It 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 leaders, 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 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 someone, 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 neighbor 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. On saturday the amazon ceo and Hillary Clinton will attend an annual dinner. Live coverage starts at 7 00 p. M. Eastern on cspan, online, or on the free cspan radio app. This weekend on book tv on cspan2. A book publisher Anniversary Party in washington d. C. Im telling you. Did all the fun things. Reporter sunday at 8 00 p. M. Eastern, nbc news correspondent katier t katie tur reflects on the campaign in her book unbelievable. Its no secret politicians dont like reporters generally. Nixon had a fraught relationship with his press corps. Getting into it with reporters. What was unusual about this was the very public nature of it. The way that he would go after reporters, myself included, from the stage of rallies. And have the crowd, encourage the crowd to essentially turn on us and boo us. And at 9 00 p. M. Eastern on afterwards, journalist and the former host of face the nation on the impact of changing technology on journalism in his book overload. Hes interviewed by susan glasser. The first thing we have to keep doing is doing what were doing. Thats trying to sort out the true from the false. And thats an overwhelming job now. Its a bigger responsibility than weve ever had, because were dealing with so much more information. We, now, have accessed more information than any people in the history of the world. But we are running a little short on curators right now. Were getting so much information that we really cant process it. For more of this weekends schedule, go to book tv. Org. Now that the house has passed the budget resolution, work can begin on tax reform in the house and senate. We get a preview from the wall street journals tax policy reporter. Richard reuben, how does the reason Budget Proposal specifically set up the next steps for tax reform in congress . It does two things. One is it sets up whats known as reconciliation. Thats a fast track procedure that lets a bill move through the senate in particular without any democratic votes. It can get on the floor with a straight up or down vote and republicans have the majority, and it can also get off the floor passed with a straight up or down vote. Thats unlike most legislation with the 60 vote threshold where republicans would need democratic help. A path is cleared for it to happen. The second thing is it sets the parameter for the tax bill. It can increase deficits by as much as 1. 5 trillion over the next decade. Thats the outer limit the tax writing committees are going to try to hit. Part of your line says the move starts a sixday count down to release of the closely guarded details of the tax plan. Tell us about the time line and what it looks like for the tax bill in the house. This is youre going to want to have cspan on 24 7 in november. Its going to be busy and furious. The ways and Means Committee in the house is going to release the text of their bill and start their committee, amendments and votesau november 6th. The Senate Finance committee will weigh in at some point maybe that week or early the following week. It will be on the house floor probably the week of november 14th, and the Senate Finance committee and senate floor shortly after that. Leaders in both says the goal is to get the house and senate to pass something by thanksgiving. And then theyll go away, eat turkey, come back, and try and reconcile the differences between whatever the house passes and the senate passes. Ae and we expect the bills to be different. It was a close shave getting the budget resolution through the house. 20 republicans voting against the measure. A number from new york and new jersey with concerns about state and local Tax Deductions. What dont they like about the possibility of that being included in the tax reform package . They dont like anything about repeal being included in the tax bill. Heres why. If youre have a high tax state, california none of the members voted against the budget. You are able now to deduct your state and local taxes, your income taxes or sales taxes and your property taxes from your federal tax bill. Thats a real benefit for residents in those states and even the other things that are likely to be in the bill with bigger standard deduction, lower rates, are not going to offset that loss for a lot of people, particularly in those states and those districts. So republicans from new york and new jersey were trying to make a point. They did it. They werent able to take down the budget, but they made a clear point that Republican Leaders if they want to solve a problem, a vote counting problem theyll have before this bill reaches the floor, theyre going to try to reach a deal that may not get all 11 members that voted no today on the budget from those states, but theyre going to have at least maybe a way to get a few of them. And the way is to focus somehow on property taxes and acknowledge that people pr from high income areas where income Tax Deductions are a bigger concern may just never be able to vote for the house tax bill. And certainly thats been an argument for democrats in the house as well. The Democratic Leader Nancy Pelosi after the vote issuing a letter to all the members saying our caucus has to be fully mobilized. Whats their number one argument against the tax reform package . The number one argument is theres a real benefit to billionaires and millionaires. Weve heard this from democrats repeatedly. They say this plan, even though we havent seen the details in full is tilted to the people at the top of the income scale. It cuts tax rates at the top, cuts the Corporate Tax rate and the tax rate on other businesses. For the democrats thats not acceptable. The second argument is the deficit argument. Saying this is going to increase budget zdeficits and put pressue on spending programs. Even if theyre not specifically on the table as part of a tax bill, that they create a desire on republicans and in argument, to cut the programs later down the line. Lets look at the senate. You tweeted about john cornyn saying that the goal is to get the tax bill through the senate before thanksgiving, reconcile with the house after that as you mention. You also write about there are obstacles in every direction. Are there more obstacles in the senate than in the house . I think thats what well find out in november. The senate math is tougher. They have 52 votes, and they need to hold 50. They can only let two members ago, and you can imagine the usual set of members that might have difficulties. Senator corker, senator paul wants to make sure theres large tax cuts. Senator flake is generally with republicans on policies but has his differences with his party right now. Senator mccain, collins. You can imagine at some level, they can only lose two of those members, so thats going to be the challenge for republicans in putting this package together that can on the senate side. Has the white house been taking an active role, ma munuc and gary cohn . That was happening more over the summer and into september. And for the last fewngaged by l the committees and the Senate Finance committee do a lot of the detail work to get the bill where it needs to be in order to pass to get through the committee and on to the floor. We did have a situation where the president weighed in on potential changes to a 401 k plan. Thats something that members are sensitive to hearing from the president and having him get involved which hes got political clout among the republican base. But also jumping in and declaring red lines and what cant change and what has to change. Its something that can up end a multidimensional dplex process. That dynamic between the administration, particularly the president and his twitter account and the republicans on the hill is something that bears watching as november rolls forward. Lots of tax debate ahead. Richard reuben is a tax reporter on twitter at Richard Reuben dc. Thank you for joining us. Thank you. You can read the budget resolution and the associated tax reform language at cspan. Org. Just click the congress tab where youll find our congressional chronicle. Cspans washington journal live every day with news and policy issues that impact you. Coming up saturday morning, jacob zen a fellow at the Jamestown Foundation discusses americas military presence in africa in the wake of the ambush in niger where four Service Members were killed. Then well feature editor and chief eddie alderman. Well talk about selfdriving cars and how theyll change the roadways. And raphael koronza looks at the status of the proposed boarder wall between the United States and mexico. Join the discussion. Next on cspan3, a zugsz about nafta negotiations. With current and former government officials from mexico and canada. This runs about an