Transcripts For CSPAN3 House Members On Opioid Crisis 20171121

Against an epidemic brought to us by opioids. It does not matter where you live. This crisis has touched every corner of american society. While new england and the ohio valley regions represent states hardest hit by the epidemic, Health Officials from the south and reaching across the Mountain West all report a dwroeg number of Overdose Deaths in those counties. The latest figures from the cdc is astounding, 91 americans die every day from an overdose. Now more than ever we must come together and strengthen our commitment to fight this malady. I expected tos members will bring to the forefront key incites on this critical issue. In the Previous Congress the energy and Commerce Committee led several bipartisan initiatives to help address the epidemic. Theyre now law in providing resources at the state and local levels. Much needed policy changes are being implemented. The passage of both kara and cures. In fact, as a result of kara patients suffering from Substance Abuse now have greater access to evidence based treatment, Addiction Treatment services and overdose reversal therapies. Cures on the other hand provided 1 billion in grants for states to support and array of prevention, treatment and Recovery Services. I believe these initiatives are making a significant difference. At the same time other issues have emerged in this fight. Earlier this year, our committee responded to reports of people overdosing on heroin laced with synthetic opioids, fentanyl, which are 100 to 10,000 times more potent than morphine. The availability of this opioid have become a Public Health threat and partsies primarily operating in other countries are exacerbating this epidemic every day. Todays hearing will allow us to gain member perspective on potential ways to complement existing policies and federal regulations to combat the Opioid Epidemic. Representatives both on and off the energy and Commerce Committee will testify about the Opioid Epidemic, share their stories and proposed legislative solutions for our consideration. In advance i want to thank house members for participating in this important discussion and we look forward to hearing from everyone whos going to be before us today. Let me yield what little time i have left to the vice chairman of the Health Subcommittee mr. Guthrie. Thank you very much. Ill be brief. So many families have been devastated by this and dreamland which is a book i read about the Opioid Crisis had all these different scenarios and but when you see it in reality i was in owensboro and met a mom, the mom was a mother of an athletic student who had her acl torn playing soccer, was prescribed painkillers. After her recovery she was addicted to painkillers since she couldnt have access to them turned to heroin and passed away due to an overseas dose. This is a sad story. This is repeated through all groups and areas and its something that im looking forward to hearing all the testimony today to look for to further do what congress is done to kara in moving forward as well. I thank you for mr. Chairman for yielding and i yield back the balance of my time. Mr. Green, three minutes for an Opening Statement please. Thank you, mr. Chairman. The centers for Disease Control and prevention has called for Prescription Drug overdose or abuse in the United States is an epidemic has found Drug Overdose to be the leading cause of injury death in the United States. Between 1999 and 2010, the death rate from prescription painkillers more than quadruple and only continues to rise. In 2015, more than 52,000 people died of Drug Overdoses in america and about twothirds of those were linked to opioids. The toll is only rising. The the New York Times analysis of preliminary data found that 59,000 to 65,000 likely died from overdoses in 2016. Todays its estimated more than 2 million have use disorder and too few of these people are in treatment. The rate of heroin overdoses is increased dramatically in recent years. This rise is directly linked to the Opioid Epidemic. In 2010 approximately 3,000 drug poisoning deaths were connected to heroin. In 2013, the number skbrump jumped to a total 8,000 Overdose Deaths and only continues to rise. Theres no community thats not been touched by this crisis and some have been ravaged by it. This committee has taken steps to address the crisis but so much is needed to combat it, when families and communities across the country are being torn apart. Included in the 21st century cures of the state targeted response Grant Program, it provided a billion dollars over 2017 and 2018 to states to address the Opioid Epidemic. Extending this money is a crucial part of any continued leverage to respond to the epidemic. We need an approach that employees proven Public Health strategies and spans the entire spectrum from prevention to treatment and recovery. These include robust funding to support prevention, Crisis Response and expanded access to treatment and lifelong recovery tools. The Affordable Care act is say vital part of our effort to fight against the Opioid Epidemic. Through medicaid that doesnt that didnt before the aca thanks to the Medicaid Expansion. Unfortunately, americans fighting addiction like live in states that refuse to expand their Medicaid Programs like texas are left out in the cold. For those in the individual markets all plans must include services for Substance Abuse disorders and Mental Health and consumers cannot be denied coverage because of a history of Substance Abuse all thanks to the aca. This is not a small feat. Prior to the aca, roughly a third of all individual market policies didnt cover Substance Abuse treatment. Repealing the Substance Use disorder coverage will remove at least 5. 5 billion annually from the treatment of low income with abuse disorders. Going even further is the gut the Medicaid Expansion in states that took the money would be absolutely devastating to our fight against Prescription Drug and heroin addiction crisis. Were in the midst of the largest Public Health crisis in our country has known and this is not time to cut Health Care Safety nets that serve those in recovery. Im pleased that we have the opportunity to hear from our colleagues about their proposals and to combat the prescription, drug epidemic. We need a comprehensive solution to the crisis that includes real dollars and targets the entire spectrum of addiction, prevention, Crisis Response for those that fall through the cracks and expanding access to treatment and providing support for recovery. We must be guided forward to advancing new strategies and funding to turn the side of this growing crisis really help families and communities that desperately need it. And i yield back my time. The gentleman yields back. The chair thanks the gentleman. Well actually ill make an organizational note before we move to our first panel. We are going to be hearing from energy and commerce members at the outset. Energy and commerce members are welcome to give their testimony from the witness table or from the dais, whichever they prefer. We move to our first panel with chairman walden, pallone, upton, ms. Eschoo, and chairman latta. Youre welcome to testify from the table or the dais. So the chair recognizes the chairman of the full committee, mr. Walden. I thank the chairman. I come here today on behalf of my constituents like i do every day. But i think especially today with our opportunity for all members to make their case to the energy and Commerce Committee, first we want to welcome them. And i think as our colleagues on both sides of the aisle have already said, all of us and all of our communities face these challenges related to Drug Overdoses. I held a round table the day before yesterday in bend, oregon, where i learned a lot about the problems theyre facing and some of the successes theyre having. And the importance of the work that were doing here. Its a heartbreaking epidemic thats been featured on the front pages of our local newspapers, on national television, as part of the stories from our friends and Family Members. And with good reason. Conservative estimates forecast that more than 90 americans die from opioid abuses overdoses each day. 90 a day, mr. Chairman. While more than 1,000 are treated each day for abusing opioids. In 2016 alone, more than 64,000 americans died from Drug Overdoses. And in oregon alone, more people died last year from Drug Overdoses than from Car Accidents. I recently held roundtables in southern and Central Oregon to discuss how we can combat this crisis. Meeting with people on the front lines of the fight in our communities to find out whats working, what more can be done, is crucial to our efforts to end this scourge. Energy and Commerce Committee has led a number of bipartisan initiatives to help address the Opioid Epidemic from groundbreaking initiatives that are now law, like the comprehensive addiction and recovery act, c. A. R. A. , and the 21st century cures act. Resources are becoming available and important policy changes are being implemented to stem the tide of opioids. C. A. R. A. Established a comprehensive strategy for improving evidencebased treatment for patients with Substance Abuse disorders and it made significant changes to expand access to Addiction Treatment and services and overdose reversal medications. The new law also included criminal justice, Law Enforcementrelated provisions. 21st century cures act provided 1 billion for grants for states the first half made available in april of 2017 to be administered by the Substance Abuse and Mental Health Services Administration, or samhsa. My state of oregon received a 6. 5 million in grants to help combat the epidemic that plagued our great state. However, so much more work needs to be done. Since the passage of c. A. R. A. , and the 21st centuries cure act, other issues have emerged in the fight againsto opioids such as the proliferation of fentanyl and its analogs. And then there are allegations of pilldumping and the practice of patient brokering. My own district, ive heard the all too familiar tale of the mother whose son was prescribed opioids and he became addicted. About parent shared with me the sist story of his sister, a nurse, who died of overdose after years of suffering from addiction, bouncing between pharmacies. He spoke about how better tracking and treatment could have helped catch his sisters problem earlier and perhaps made counseling more effective. As it was, she was only caught because two pharmacies in a small town happened to check with each other. You see, by then it was too late, though. These two stories may have come from oregon but theyre not exclusive to the beaver state. Theyre why were here today. Addressing the Opioid Epidemic requires an all hands on deck effort. Today well be hearing testimony and stories from our colleagues, both on and off the energy and Commerce Committee about what more can be done. And im looking forward to hearing feedback and input from both sides of the aisle to hear about whats working and whats not and find ways to complement our existing law and to address emerging issues. So with that, mr. Chairman, i appreciate everyone here today. With us taking time to participate. I look forward to hearing from all of my colleagues and together we must continue to fight this Opioid Crisis in america. And i yield back. The gentleman yields back. The chair thanks the gentleman. And, again, just to reiterate the format for today. Members on the energy and Commerce Committee are invited to either give testimony from the witness table or from the dais, whichever they prefer. So at this time, ill recognize the Ranking Member of the full committee, frank pallone, from new jersey for five minutes, please. Thank you, chairman burgess. Todays member day provides us the opportunity to hear from our colleagues about how the epidemic is uneekly affecting their districts, as well as to hear their ideas of additional efforts and funding that is needed to help individuals, families and communities affected by this crisis. Like all communities across the country, the Opioid Epidemic is having devastating consequences in my home state. Drug overdoses are the leading causes of accidental death in new jersey. According to the centers for Disease Control and prevention, there was a 16 increase in drug Overdose Deaths in new jersey between 2014 and 2015, and last year drug Overdose Deaths topped more than 2,000. And unfortunately, were continuing to see increased deaths from this tragic epidemic. Im proud of the steps this committee has taken to respond to this tragic epidemic that is taking the lives of 91 americans every day. Im pleased that we Work Together in a bipartisan fashion to pay us the comprehensive addiction and recovery act or c. A. R. A. We also Work Together to create the state targeted response to the Opioid Crisis Grant Program, as part of the 21st century cures act. And this Grant Program provides a billion dollars to states to address the Opioid Epidemic. There were positive and well, these were positive and bipartisan laws that we produced in 2016 during the last year of the obama administration. That was 2016. 2017 has been much different. Congressional republicans have spent much of this year trying to repeal the Affordable Care act, which would have prevented millions of americans from getting the help that they need to treat opioid use disorders. And the repeal legislation passed here in the house would have allowed insurers to once again discriminate against people with preexisting conditions, such as opioid use disorders. The republicanpassed bill would also have allowed states to waive essential health benefits, including Mental Health and Substance Use treatment. Thankfully, those repeal efforts have failed to date. So as we move forward, whats clear is that individuals with Substance Use disorder, their families and their communities need us to Work Together to do more. Despite some progress here in washington, the epidemic has shown no signs of relenting, and thats why we must continue to support and increase funding for Proven Health Public Health approaches spanning the entire spectrum from crisis to recovery, including expanding access to medicationassisted treatment. Those efforts should include more funding and we should extend the Grant Program so that we can expand even further peoples access to opioid abuse treatment, prevention and Recovery Support services. So i look forward to hearing from my house colleagues and continuing to Work Together in a bipartisan fashion to help our country respond to this crisis. I yield back, mr. Chairman. The gentleman yields back. Chair thanks the gentleman. The chair recognizes the chairman of the subcommittee, mr. Upton, for three minutes. Thank you, mr. Chairman. This is very important, this member day, as were able to all share our personal experiences on a crisis that has been plaguing our nation over the last couple of years. Opioid addiction and abuse. This silent epidemic has for sure torn through families, neighborhoods and communities both certainly in my home state of michigan. But we know across the country, as well. In fact, in 2015, there were nearly 2,000 opioid abuserelated deaths in michigan alone. Even more tragically, more than 22,000 babies are born every year across the country with neonatal Opioid Withdrawal syndrome. This terrible epidemic has hit home both in my community and yes, even in my extended family. So this is very personal to me. As it is with so many throughout our communities. The last couple years ive been meeting with First Responders, Crisis Center employees, Advocacy Groups, and, yes, individuals suffering. All of these folks have said that tragically, the death toll continues to rise. Thats why we have been taking concrete steps here in this committee to combat the widespread epidemic. Just last year, the president signed into his sweeping package aimed at attacking the Opioid Epidemic from all sides. Its part of 21st century cures, a bill that every one of our Committee Members supported. An additional 1 billion was allocated to the states. And like michigan, to address opioid Addiction Treatment and prevention, this year the first round of funding was delivered, we received 16 million, and that Grant Funding will make a real difference. It will. To those suffering, i just say, help is on the way. And as a result of this legislation, as well as administrative action, nih director, francis collins, is helping to lead the charge. This summer the nih started meeting with experts in academia and bio pharmaceutical industry to talk about innovative ways in which government and industry can Work Together to address the crisis. I strongly support that work and look forward to seeing the results of the research that nih is doing with its industry partners. There are also things that we in congress can help nih with in these endeavors. First, we need the nih to develop more options for overdose reversal. Second, we need the evidence of nih can develop an effective therapy for addiction. And finally, we must accelerate the development of nonaddictive pain medicines. The sooner that we in congress supply the resources necessary to conduct that work, the sooner that we can supply powerful new tools for every community. These efforts cant happen fast enough. And these are some of the many reasons that i continue to support robust nih funding. Theres more work to be done, and here in congress well continue to take steps to address that epidemic. And in this committee, were on the front lines to advance meaningful, Bipartisan Legislation that indeed will make a difference. Together well bring it out of the shadows. I yield back. The gentleman yields back. The chair recognizes the gentleman from new jersey, mr. Lance. Three minutes, please. Thank you, mr. Chairman. And i must say, this is the first time ive been on this side of the dais, and what a finelooking group. Much more fun being over here, as you know. If it makes the gentleman more comfortable, we can swear you in. That means i would be under oath. Yeah. Thank you, chairman burgess, for organizing this conversation today. The Opioid Crisis is devastating families and communities across new jersey, the state i represent. In 2015, the garden states death rate was twoandahalf times the skyrocketing u. S. Rate. We are making progress with the implementation of the comprehensive Addiction Recovery act of 2016. But more work needs to be done. I acknowledge the efforts of one of my constituents, bass kin ridge resident, claudette saabtell. She has done critical work and make a difference in the lives of those suffering from addiction. Her Advocacy Group, community in crisis, helps equip the loved ones of those in pain. None of the progress we have made so far in this fight against drug addiction and opioid abuse would have been possible without the work of people like claudette and organizations Like Community in crisis. Their efforts are efforts that we should make sure congress understands and applauds. I work closely with claudette on the issue of overprescription. In 2012, Health Care Providers wrote 259 million prescriptions for opiates. The c. A. R. A. Provisions i authored reform that by improving the drug approval and label process at the food and drug administration. For the First Time Congress has required the agency to work closely with expert advisory committees before making critical product approval, and labelling decisions and to make recommendations regarding Educational Programs for prescribers of extended release and longacting opiates. C. A. R. A. Also encourages the development and approval of opiates with abusedeterrent properties. We also have to make sure resources such as the statetargeted response to the opiate crisis grants administered by the Substance Abuse and Mental Health Services Administration continue to give states the tools they need to experiment and test best practices. New jersey recently secured a 13 million federal grant from the Substance Abuse and Mental Health Services Administration to focus on this crisis. The drugfree Community Support program and the White House Office of National Drug control policy also recently awarded community in crisis and two other able organizations. Hunter and prevention resource and empower somerset, with a 125,000 grant to assist in addressing the problem of opiate and heroin abuse. Provide education and implement prevention measures. Community in crisis and they are great partners with the resources and support they need. These investments are not only the right thing to do, but help lessen the significant strain on Law Enforcement resources. I commend each group on its important work. Mr. Chairman, i stand ready to work with you and colleagues on both sides of the aisle to continue this work. Thank you for calling this hearing today. The chair thanks the gentleman. The gentleman yields back. The chair wants to thank this panel. We will move to our second panel. Members identified wishing to speak in the second panel, mr. Butterfield of North Carolina, miss matsui of california, and mr. Bilirakis of florida. Members may speak from the table or from the dais, whichever is their preference. So the chair recognizes ms. Matsui of california for three minutes. Thank you, mr. Chairman, for inviting us today to testify about proposals to address our nations Opioid Epidemic. We all have heartbreaking stories of constituents whose lives were lost too soon to an opioid overdose. In my home district of sacramento, we experienced a particularly deadly overdose crisis last year due to pills contaminated with fentanyl which is as much as 50 times stronger than heroin. Addiction is a devastating disease that knows no bounds, and we must come together to provide solutions in a comprehensive manner. In this committee we took a step forward by passing the comprehensive addiction and recovery act into law last year. We need to build on these efforts, understanding addiction and its consequences are multipronged and we need a multipronged solution. I look at this problem as i do any other health care problem, which means i examine it holistically across the spectrum from prevention to Early Intervention to treatment. In the case of the Opioid Epidemic, there is a lot we can do at each of these stages. All of which rest on truly building up our nations Mental Health system, and integrating Behavior Health care with physical health care. Historically, Mental Health and addiction have been treated as character flaws, and therefore not addressed with evidencebased medical treatment. We can reverse that course by making treatment more available, bolstering our Mental Health work force and reducing stigma. In 2012, representative lance and senator stabenow, blount and i passed a Mental Health demonstration project into law. This project is allowing states to demonstrate that building up communitybased Behavior Health clinics improves access to care. Last week we induced legislation to extend the years of and expand it to more states. We should strongly consider this as one way to help address the Opioid Crisis. We also need to enforce Mental Health laws to ensure Health Insurers are offering Mental Health benefits equal to physical health benefits. It is irrelevant if Mental Health benefits are not offered in the first place. There have been proposals which included provisions that allow states to waive benefits, meaning insurance would not be required to cover Mental Health and Addiction Treatments. Thats not good. Cutting billions from Medicaid Program would also mean loss of coverage for millions suffering from Substance Use disorder. We cannot take these steps backward. I am encouraged by steps being taken across the Health Care Sector to address the crisis, including the limiting of opioid prescription for prescribers and insurers. We need to build on these efforts. That includes considering proposals in congress to provide resources and training for state and local enforcement, and bolstering our Mental Health work force, educating the public, addressing availability of a range of Treatment Options from outpatient to inpatient to Residential Care and more. And i do look forward to continuing to work the committee on these policy proposals to address this pressing issue. Thank you, and i yield back. The chair thanks the gentle lady. The chair recognizes the gentleman from florida, mr. Bilirakis, for three minutes, please. Thank you, mr. Chairman. How about now . Okay, very good. Thank you. Thank you. Thank you, mr. Chairman. The United States is in the midst of an opioid overdose epidemic. Sadly, 91 americans die every day due to opioid overdoses. Nearly half of all opioid Overdose Deaths involve a prescription opioid. In 2010, in response to the Opioid Crisis in floridas pill mill problem, floridas legislature enacted statewide tracking of pain killer prescriptions, coupled with Law Enforcement using Drug Trafficking laws to prosecute providers caught overprescribing. Within three years, florida saw a decrease of more than 20 in Overdose Deaths. Despite this positive trend, opioid abuse continues to plague my district. In fact, my district had the second highest Prescription Drug death rate in florida in 2014. In response, i worked last congress to ensure that pascoe county was included as a high intensity Drug Trafficking area. Enabling Law Enforcement to receive Additional Resources to combat the spread of drugrelated crime. I want to applaud the committee for including my bills, the medicare Patient Safety and drug abuse prevention act, and the promise act in c. A. R. A. , which passed last congress. The medicare safety and drug abuse prevention act created a pharmacy and physician lockin Program Within the Medicare Advantage and Medicare Part d, giving cms the tools to crack down on this abuse in the medicare program. And its important for us to maintain oversight, of course, as you know, on this program as cms is developing the rules. The promise act will increase safety for opioid therapy and Pain Management by requiring the v. A. And dod to update their Clinical Practice Guidelines for managing of opioid therapy for chronic pain. Requiring the v. A. Opioid prescribers to have the enhanced Pain Management and safe opioid prescribing education and training and encourage the v. A. To increase informationsharing with state licensing boards. So i think thats critical. As part of the 21st century cures act, florida has received over 27 million in grants to help fight the Opioid Epidemic by increasing access to treatment and Recovery Services, strengthening Public Health surveillance, and improving Pain Management practices. These critical funds are supporting floridas all hands on deck approach across the state to curb opioid abuse and save lives. Im pleased the administration and this committee are leading the charge on this critical issue, and i look forward to working together to help save lives and prevent addiction. I yield back, mr. Chairman. Thank you. The gentleman yields back. The chair thanks the gentleman. The chair recognizes the gentleman from North Carolina, mr. Butterfield, for three minutes, please. Thank you, very much, chairman burgess, and to my fellow colleagues. Thank you for the opportunity to address the committee today about the state of the Opioid Epidemic in my home state of North Carolina. And let me just begin, mr. Chairman, by crediting my friend and our former colleague, mary bono, who is also from florida. Mr. Bilirakis. Who talked so incessantly about this issue, because it was very dear to her, and she knew the impact that it was having on her state. Ms. Mack brought this important topic to the forefront of our subcommittee some years ago. She was chairman of the subcommittee, and i was the Ranking Member. At first, mr. Chairman, i thought mary was a little bit overreacting to the Opioid Crisis in florida, because it had touched her family personally. But after we had hearings and after i looked into it, i came to the conclusion that she was not overreacting. That it was indeed an epidemic, not just in florida, but all across the country. Just last year, i worked with many of my colleagues in this room on the comprehensive addiction and recovery act that was passed into law. That bill included roughly 20 different legislative proposals to help slow the epidemic. As part of the 21st century cures act, this Committee Approved 500 million. The American People need to know that, mr. Chairman. We approve 500 million in supplemental funding to address opioid abuse. Despite the investments and attention from congress, we are still feeling the Opioid Crisis very close to home. During the august work period, i saw the effects of the epidemic on my Small Community in wilson, North Carolina. Just in august alone, there were two deaths because of the opioid abuse in the community. According to reports in the wilson times, and i have a copy today, medics administered the appropriate drug in response to Opioid Crisis 28 times by mid august. When they usually administer the treatment 30 times per quarter. According to chris parker with the Wilson County emergency medical services, there is a definite increase in opioid use and abuse in our county. North carolina has a real problem on its hands. America has a real problem on its hands. By july of this year, there were more than 500 diagnoses for Emergency Department visits up from 410 at the same point last year. Regrettably, mr. Chairman, in my humble opinion, the administration is not taking this situation seriously. The budget offered by the Current Administration cuts hhs funding by 16 . The cdc by 17 . The National Institutes of health by 19 . Im also very concerned about the proposals to gut the Medicaid Program that we have considered in this committee. The center for budget and policy estimates nearly 100,000 people with an opioid use disorder have gained coverage through Medicaid Expansion under aca. Congress must do all that it can to help stop this epidemic from devastating more lives, more families and communities. Congress should provide certainty certainty and funding to combat this epidemic, which i which is why im the original co sponsor of hr3495, the opiate and heroin abuse crisis investment act of 2017 that was introduced by mr. Lujan. We must also protect existing funding for research and opioid use disorder coverage, provide tools to communities to address this epidemic and reduce the stigma for those needing a treatment. So i want to thank you for convening this hearing. I want to thank mr. Latta, mr. Bucshon, mr. Bilirakis 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. The chair thanks the gentleman. The gentleman yields back. The chair recognizes the gentleman from indiana, mr. Bucshon, for three minutes. Chairman burgess, Ranking Member green, thank you for holding this important hearing today. Opioid abuse disorder has ravaged our communities and while it is important to look forward and address what else needs to be done to combat this terrible disease, we need to ensure the legislation we have already passed is being properly implemented and is working as congress intended. In july 2016, the comprehensive addiction and recovery act, c. A. R. A. , landmarked legislation addressing the opioid abuse crisis was passed into law. I spent months convening stakeholder roundtables and working on bipartisan language which became section 303 of c. A. R. A. Section 303 updates the controlled substances act and officebased opioid Addiction Treatment laws by ensuring that patients are offered and physicians are trained on all fdaapproved treatments. Under previous law prior to c. A. R. A. , millions of opioidaddicted patients had their treatment determined based on their setting of care. With the passage of c. A. R. A. , patients in these settings must now be offered a full range of Treatment Options based on their individual clinical needs and individualized treatment plan. Unfortunately, 15 months after the legislation was signed into law, section 303 still has not been implemented. I urge the committee to conduct strong oversight to ensure samhsa will be properly implementing the law. Every day that this law goes unimplemented is one more day that our Family Members, friends and colleagues are battling a disease with fragmented and incomplete Treatment Options. Specifically, samhsa should send a Dear Colleague letter to notify physicians they must offer all anti addiction medicines based on a patients clinical needs. Additionally, curriculum for doctors, p. A. S and Nurse Practitioners should be updated to include training on all fdaapproved opioid addiction medications. Moreover, all of samhsas publicfacing material, including their website, should be modernized to show this patient centered approach. According to the Evansville Courier and press, 55 people in vanderburg county, indiana, have died of a Drug Overdose in the first nine months of this year, which is more than all of 2016. The availability of all medicationassisted treatments, regardless of where a patient chooses to seek them, will help to stem the tide of these unnecessary deaths. It is vital that as the Committee Moves forward in the fight against opioid abuse disorder that we ensure c. A. R. A. Is properly implemented and helping people combat this terrible disease. Mr. Chairman, again, thank you for this hearing and i yield back my time. The gentleman yields back. The chair thanks the gentleman and recognizes the gentleman from ohio, mr. Latta, for three minutes, please. Thank you, mr. Chairman. And, again, thank you for holding this hearing today. Opioid abuse and addiction has caused devastation in every Community Across our nation and in ohio it has been especially hardhit. In ohio in 2015, 3,050 people lost their lives from unintentional Drug Overdose. In 2016, that number increased to 4,050. Thats a 32 increase from the previous year, and that means 11 deaths a day. For comparison, in 2016, there were 1,133 traffic fatalities. That means that Drug Overdoses caused nearly four times as many deaths compared to traffic accidents. These figures are heartbreaking and sad to know that this problem isnt getting any better. Many county coroners in ohio say that 2017s overdose fatalities are outpacing 2016s. This problem knows no limits and has affected husbands, wives, children, brothers, sisters, fathers and mothers. It has destroyed marriages, ruined careers and cut too many lives short. When i read through the obituaries in my local newspaper over the past year or two, i have noticed more younger individuals without a cause of death being listed. Unfortunately, in too many of these instances, its because of Drug Overdoses. Across my district in northwest and west central ohio, ive heard how opioid addiction impacts our communities. Ive toured businesses and met with Community Leaders and spoke with families to hear how Substance Use disorders have directly affected their lives. It is because of these stories that i plan to introduce legislation that would direct the department of health and Human Services to create a public electronic database of information relating to nationwide efforts to combat the Opioid Crisis. The database would serve as a Central Location of information for the public and others to track federal funding allocations made available for research and treatment of opioid abuse, find research relating to opioid abuse from all federal agencies, state, local and tribal governments, as well as nonprofits, Law Enforcement, medical experts, Public Health educators and research institutes. Furthermore, the legislation would charge hhs to evaluate a myriad of issues relating to Pain Management addiction, prescription guidelines, treatments, trends and patterns and Effective Solutions and problems used across the country. These findings would be available on the database, as well, and hhs would be instructed to offer recommendations for targeted areas of improvement. I believe that with the help of hhs, and other relevant agencies, this database will allow for easier access of information, funding streams and relevant data that can help to combat the opioid abuse epidemic across our nation. With 11 people dying every day in ohio and over 91 americans dying nationwide every day, we have run out of time to find a solution to this crisis. We need action now. I appreciate the committee for holding this forum to express Creative Ideas and solutions and hope it leads to more lives being saved. Mr. Chairman, i appreciate the opportunity to be here and i yield back the balance of my time. The chair thanks the gentleman. The gentleman yields back. The chair wants to thank all of the members on this panel for your testimony. You are now excused and we will seat the next panel. Mr. Chairman, parliamentary inquiry. The gentleman will state his parliamentary inquiry. Im not sure thats the right terminology, but i wanted to include into the record two newspaper articles that i referenced. Have i lost my right to do that . Is the gentleman asking unanimous consent . I am, yes, sir. Without objection, so ordered. Thank you. And the chair now would ask that the next panel, which is mr. Johnson, mr. Welch, leader pelosi, and ms. Brooks. And, again, members of the committee are welcome to provide their testimony from their seated position on the dais, or from the witness table, whichever is your preference. And mr. Johnson, ill recognize you for three minutes. Thank you, mr. Chairman. I appreciate this discussion about an issue that is so vitally important. It is no secret that america is in the midst of an Opioid Crisis. Last year in my home state of ohio alone, about 86 of Overdose Deaths involved an opioid. This epidemic can be felt in virtually every Community Across the country. And today i want to share a story that will shed some light on some of the good work being done by people in my district to help combat the Opioid Epidemic, and to perhaps let everyone know about some of the positive things that are taking place. Recently i had the honor of visiting field of hope, a faithbased nonprofit Treatment Facility in Southeastern Ohio that assists area families ravaged by poverty and drug abuse. Field of hope recovery house was founded by a man named kevin dennis. After he witnessed his own daughter become addicted to opioids after she had knee surgery from a High School Athletic injury. Her prescriptions ran out before her pain was managed, but unfortunately by that point she was addicted. She ended up in prison several times for theft. And checked into numerous rehab facilities before she fully recovered from addiction. She is now a recovery counselor at field of hope and is happily married with a child. I heard some incredibly powerful and touching stories during my visit to the field of hope campus, and i witnessed the good work they are doing firsthand. We in congress and especially this committee have an Important Role to play in supplementing and enabling the work being done by organizations like field of hope. On the front end, we need to develop prevention policies that steer people like kevins daughter away from opioids in the first place. Innovative nonopioid, nonaddictive treatments exist today, and more are on the way. But these innovative treatments are not always covered by federal programs like medicare and medicaid. We should closely examine the Reimbursement Policies in place to ensure that patients have access to effective alternatives for Pain Management without the risk of addiction. Ive also been encouraged by recent efforts by providers, pharmacists and patient groups to address the addiction crisis through increased awareness, prescribing guidelines and new Treatment Options. I believe congress can play a role in ensuring that all prescribers are equipped with education and Pain Management, so they can provide effective pain treatments for patients and timely intervention for those who are addicted. I look forward to continuing to work with my colleagues on the committee, and in the house to find Effective Solutions to this scourge. Mr. Chairman, its a national crisis. We need to act, and with that i yield back the balance of my time. The gentleman yields back. The chair thanks the gentleman. The chair is pleased to recognize the entire vermont delegation. Mr. Welch, youre recognized for three minutes. We dont have the numbers of texas, but i appreciate the recognition. First of all, dr. Burgess, thank you. Mr. Green, thank you. Youre taking time to focus attention and demonstrate the urgency of this challenge. Second, this so affects us all. I mean, its heartbreaking. And it doesnt matter whether its a red district or a blue district. It doesnt matter what your view is on the size and scope of government. This is hurting people in your district, dr. Burgess, and mr. Green, and in my district and my colleagues here. In vermont, our governor dedicated his entire state of the state address to this epidemic in 2014. And i remember at that time many of my colleagues asked the question, peter, isnt this going to do bad things for the reputation of vermont . But then acknowledged that what he was saying was true in their own state, in their own districts. So you focusing attention on it, mr. Chairman, thank you. Thats step number one. I can give you some statistics in vermont, but they would be very similar to mr. Johnson. I mean, our Prescription Drug problems with individuals increased from 2,477 in 2012 by 80 . Heroin went from 913 in 2012 and increased to 3,488, a 380 increase. Every one of those stories is a story of family heartache. I got a letter from a mom whose 27yearold son became addicted to heroin and just the story of him being homeless, him going from being a full time working person to being out on the street, him her having to call her daughters, saying their brother may soon be dead. All of that is real and all too vivid. So this is an enormous challenge. Our job in congress is to come up with some policies that are going to help people help themselves. And i like to make a few suggestions of things we need to do. Number one, we do have to have funding. We have to have full funding for the comprehensive addiction and recovery act. And weve got to find the money in order to allow our communities to do that work. Two, we have to have more research into alternative treatment. Im working with mr. Mckenley to try to get the comprehensive addiction and recovery act to find better alternatives to treat pain. Three, lets allow for partial filling of opioid subscriptions. Many of us have signed letters that would allow that to happen. Four, lets support the recent action by commissioner gottlieb. Hes done some good things. Immediate release hes trying to get Immediate Release opioid manufacturers to follow a more stringent set of rems requirements, which includes training doctors to safely prescribe these drugs. So this hearing is tremendous. Focusing attention. The next step is to put this into legislative action. Thank you, mr. Chairman. The chair thanks the gentleman. The gentleman yields back. The chair recognizes the gentle lady from indiana, ms. Brooks, for three minutes, please. Thank you, mr. Chairman, and thank you, Ranking Member green for hosting this incredibly important hearing. Too Many Americans are struggling with the crippling effects of drug abuse and addiction and the statistics, as we know, are devastating. According to the Indiana State Department of health, every 2 1 2 hours, a hoosier is sent to the hospital for an opioid overdose. Across our state, there are enough bottles of pain killers in circulation for nearly every hoosier to have their own. And the number of infants born addicted to opioids is increasing at an alarming rate with Health Care Costs for these babies costing indiana more than 64 million in 2014 alone. And as we know, like so many other states, hoosiers are now more likely to die from a Drug Overdose than a car accident. When i came to congress in 2013, ive been very focused on our communities and families that this epidemic has swept up. And like so many of my colleagues, weve held roundtables, weve held meetings, we met with addicted individuals families. Weve been on the front line with subscribers, health care workers. We all agree, this is a federal problem and a local problem. Last year, we passed cara, which included my bill to establish an Interagency Task force to review, modify, and update the best practices for Pain Management and prescribe pain medicine. Hhs has already taken steps, informing this task force, but more needs to be done. In my view, its critical to ensure that the medical professionals have continuing medical education for the prescribing of deacontrolled substances that have such a high risk of abuse. Im exploring options to ensure that physicians and other medical professionals who prescribe these scheduled drugs have more and better education linked to the application and renewal of their dea licenses. Professionals who prescribe and dispense opioid medications must have better training so that they fully understand those patients who sadly have gotten the onset of addiction due to what they have been prescribed and now they need even better education to help prevent that onset and then help them with the addiction. Indiana is tackling our problems headon. And, in fact, just yesterday Indiana University announced a new initiative called responding to the addictions crisis. Its being led by ius dean of nursing, robin newhouse. Iu is committing 50 million over the next five years to collaborate with state and Community Partners to tackle this crisis. It is going to be one of the most comprehensive statebased responses and every iu campus in the state is going to be involved. Its going to focus on training and education, Data Collection and analysis, policy analysis and development, addiction sciences, community and workforce development. So major steps are being taken across our state, because everyone has a role to play, from our prescribers to our medical, to our higher ed institutions. And i want to remind folks that dea has a national Prescription Drug takeback day. Its approaching on october 28th. It provides that safe convenient responsible way to dispose of excess Prescription Drugs so that people can get those drugs out of their medicine cabinets and out of our kids reach. And not just kids. To adults. So there are going to be locations all across the country, and i really encourage everyone, because everyone has a role to play, and so october 28th is National Takeback day. And i hope that we get that word out. Thank you, mr. Chairman. I yield back. Very well. And of course, i thank the gentle lady for the providing the date. This hearing is being streamed on facebook live, so your information now has been distributed to everyone who has been tuning in this morning. So thats a good thing. And perhaps we can each individually try to make that date part of our discussions as we go through the rest of the month. I want to thank this panel for being here. You all are excused. I have a panel identified of mr. Lujan, Markwayne Mullin of oklahoma, mr. Tomko, mr. Hudson, and bl kennedy. Members are advised they may present from the dais or from the witness table, whichever is your preference. If youre seated at the table, we will provide a name tag for you. So whenever you are ready. Mr. Lujan, youre recognized for three minutes. Thank you, mr. Chairman. I thank the chairs and Ranking Members for the opportunity how new mexico has been impact the by the Opioid Crisis. 501 mexicans died of drug Overdose Deaths in 2015. Across this country, there were 52,404 deaths in 2015 and 560,000 deaths between 1999 and 2015. A half a Million People who missed thanksgiving dinner on their daughters softball game, who werent able to help their son with math homework or kiss their spouse good night. Thats brothers and sisters, parents and friends and children we have lost too soon because, in part, congress has not responded forcefully enough to the crisis. Last congress we did important work by passing the comprehensive Addiction Recovery act, c. A. R. A. , a 21st century cures act. These were steps in the right direction, but these efforts alone are not enough. Ive heard from my community that the funding passed and cures is helpful, but hard to use. In part, this is because of the short funding period, which impacts communities ability to plan for the longterm, and expand capacity. We know that in too many areas like 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 had stopped using heroin on his own. But felt as if 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 really expand the treatment, prevention and wrap around services that our constituents need, we must increase funding and create stability. We need to get local governments and organizations the 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 introduce the opiod crisis investment act, for an we passed in 21st century cures for an additional five years. I would welcome my colleagues support because we absolutely must expand this funding for five years and beyond. However, this still isnt enough, which is why we must look at new efforts to drive vital investments to help those in need and address the barriers to appropriate quality and accessible treatment. These barriers occur in the rural health resources, providing Substance Abuse lack of regional coordination of treatment resources, lack of support for rural physicians providing Substance Abuse treatment, administrative barriers against the most effective form of opioid abuse treatment and a shortage of rural physicians who provide medication assisted treatment. We must recognize that hoping for the best is not valid public policy. Theres a quick fix to solve the Opioid Crisis, thats simply not true. We need to advance serious legislation that takes into account longterm planning for the federal government and communities. We need to bring to the floor of the house, send it to the senate, get it passed, and to the president s facts. I fear well continue to lose brothers and sisters, parents and friends and children. Mr. Chairman, i thank you for holding this important hearing and finding a way for us to work in a bipartisan fashion to address this important issue. Thank you, mr. Chairman. I yield back. The gentleman yields back. The chair thanks the gentleman. Mr. Mullin, youre 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. Okay. Mr. Chairman y have no problem with letting mrs. Pelosi go next, if she would like to. If the minority leader is ready, 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 i have ever testified as a leader or in that capacity because this issue rises to the level, as you know, of life and death. So with gratitude to you and to the Ranking Member, mr. Green, for bringing us together in a bipartisan way on this issue that is a matter of life and death. Thank you, mr. Burgess. The Opioid Epidemic again is taking a savage daily toll on the American People. We know that. And regardless of who they are or where they live, theyre in every district of the country. The surge is tearing families apart, having an impact on the wellbeing of our children. Hollowing out communities. 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 a matter of your record here. Opioid addiction is a Public Health catastrophe and is growing more dire and deadly every day. And i believe that 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, the comprehensive addiction and recovery act. We all came together during the Bipartisan Legislation that was passed, the 21st centuries cure act that people were so happy that the addiction language was in there. That day, we heard the stories of families, so sad it would break your heart. Families who had lost a child, a young teenager or 21yearold or whatever, within a matter of days or weeks before that particular signing. President obama signed that legislation. But it had the language. It just hasnt had the money to the adequate extent. That, mr. Chairman, is my appeal to you for democrats and republicans to Work Together to have this 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, which 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 expended medicaid because that medicaid 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 with republicans to update and improve the aca, but we remain vigilant against efforts to gut aca because it will create even more of a problem in terms of opioids, just to name one thing. The opiate epidemic is a challenge to the conscience of the entire country. We must act urgently and boldly to get americas families the prevention treatment and Recovery Resources they need, in and that regard, we must work with providers and the pharmaceutical industry to push effective prevention measures so we can reduce unnecessary prescriptions and stop this epidemic at the source. Knowing of your busy schedule, ill submit my entire statement for the record. Again, thank you for the courtesy of being able to testify before your committee, and thank you for your leadership on this 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, and if you need to leave, that is certainly understandable as well. But in the meantime, ill recognize mr. Mullin for three minutes. Thank you for your hospitality. I will listen. Well recognize the gentleman from texas. Thank you, leader, for being here. Before mr. Mullin testifies, mr. Chairman, i would like to thank you 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. And instead of having one weeks worth of your folks from your Cherokee Nation, i think they stayed a month helping my seniors and disabled clean out their three or four foot of water in their house, and i didnt realize they had that drywall skills. So thank you. I have a daughter in houston and grandchildren, i thank you as well. Mr. Green, thank you. The Cherokee Nation called us and said how can we help . We had churches reach out to us. We have been very fortunate to work on multiple issues here in congress and its been a friendship that carried past it. It was an honor to be able to help your constituent. 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 as a gentleman who had surgery as a little boy. I was born with my hips out and my feet in the club feet position. And i started having surgeries very young. I also built up a very large pain tolerance. And i have never been one to use pain medicines. Now, my wife says that im different than most. I think most people in this room would probably agree with that. But 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. And all we do is mask it. And 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, we have seen an epidemic spread from the middle class to the low class to the wealthy and to our murths and fathers, to our brothers and sisters and our coworkers. When 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 deaths, of accidental opioid deaths, are mothers. Middleaged women. Most of them got addicted to them after birth or an elective surgery. How is that possible . How do we let it continue to move down that path and not say that 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. And it started when we started treating it like a sense. Im very proud to be on this subcommittee. Im very, very proud that chairman burgess, youre taking this very heavy interest in this, and im proud that chairman murphy has took an interest in this too. Thats why were proud to be able to pick up one of his bills. Its hr3545. That will allow doctors after surgery to access records to know if that person has an addictive behavior so were not sending those type of drugs home with them. I look forward to continuing to work with the committee. I look forward to finally being able to put some type of remedy and bringing this to a closure. And quit hurting our families back home. And i hope that we can approach this in a bipartisan approach, put politics aside, and put families first. Thank you. I look forward to working with you. I yield back. The chair thanks to gentleman. The chair recognizes the gentleman from new york, mr. Taurngmr. Mr. Tonko, for five minutes. We are a nation in crisis. The Opioid Epidemic is wreaking havoc in our communities at an unprecedented scale. With cdc estimated 64,000 dead from Drug Overdoses in 2016, and an astonishing 21 increase from the previous year. This Public Health disaster is costing us more lives annually than at the peak of the aids epidemic. As many lives as gun violence, traffic accidents combined. If this congress doesnt find Additional Solutions to turn the tide on the Opioid Epidemic, we will be complicit in this american tragedy. First, i introduce the Addiction Treatment access and improvement act with my good friend congressman ben ray lujan. This legislation would expand access to treatment by allows certified nurse midwives and other registered nurses to prescribe bubp afornorphene, an would allow them to treat patients and eliminate the sunset of the provision that allowed nonphysician prescribers to preskriet m. A. T. It would particularly benefit pregnant and post partum women who are struggling with addiction and improve outcomes for the over 13,000 infnlts that are born each year with neonatal abstinence syndrome. Despite the expansion of treatment and the comprehensive treatment and recovery act, theres 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 treatment are currently receiving it. Let me repeat that. Only 20 of patients who need treatment for opioid use disorder are currently receiving it. The Addiction Treatment access improvement act would address this treatment gap and save lives. This committee should act on this Bipartisan Legislation without delay. The second bill i would like to discuss is the medicaid reentry act. Hr4005. This legislation is a targeted attempt to address the problem of Overdose Deaths that occur post incarceration. Studies have shown that individuals who are released back into the community postincarceration are roughly eight times more likely to die of an overdose in the first two weeks postrelease compared to other times. The risk of overdose is elevated during this period due to reduced physiological tolerance for opioids among period due to reduced physiological tolerance for opioids amongst the incarcerated population, a lack of additional Treatment Options while incarcerated and poor care tr transitions back into the community. The medicare reentry act would start medicare 30 days prerelease. By allowing the benefits to restart prior to release states would be able to more ready provide Addiction Treatment pre release and allow smooth transition to community case, reducing the number of Overdose Deaths post incarceration. Let me be clear, this legislation would not expand Medicaid Eligibility in any way. It would simply grant states new flexibility to restart an individuals medicaid benefits 30 days earlier than allowed under current law. This increased flexibility would dovetail with innovative reentry programs already being championed by republicans and democrats in states across our country and would give individuals reentering society a fighting chance to live a healthier drug free life. Let me just end with an urgent plea for action and bipartisan. Ship typical partisan objections, and end up stuck in a procedural morass. These are not normal times. When your house is on fire, you dont look to see whether the firefighter is wearing red or blue uniforms before they turn the fire hoses on. We have to have a big open heart and open mind. I thank my colleagues for their time and consideration of this legislation that i have presented. Again to the chair Ranking Member of the 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, chair thanks the gentleman. Chair recognizes the gentleman from North Carolina. Thank you for allowing many eto speak. As has been noted the Opioid Epidemic is not an isolated issue, its a nationwide issue. Its killing more people per year right now than the hiv epidemic did at its peak in the 90s. These drugs do not discriminate based on race, gender, social class or age, they destroy lives, families, marriages and careers. In my home state of North Carolina the Opioid Epidemic has hit a heart. Top 25 of worst cities asked, one of which is in my district, fayetteville, North Carolina. One story that stuck with me, he was a police captain, the son of the police chief in the same town and he injured his back on the job and was prescribed an 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 full blown heroin add diks. Hes since recovered and mentors addicts through treatment. This is a story with a happy ending, unlike many stories. Fayetteville is the home of veterans who have been addicted after being prescribed open yoi opioids. Often times veterans go without help and are forced to selfmedicate by using opioids found on the black market. This is outrageous and unacceptable. We need to find Real Solutions so we can put an end to this heartbreak. Im proud to have worked with congress which resulted in the passage of comprehensive Addiction Recovery act. These laws have made huge steps forward in the treatment of opioid addiction. Its clear we have work left to do. One idea im working on is expanding access to safe ways to dispose of Prescription Drugs, particularly opioids. Dispose rx is a company my district manufactures a powder that mixes with water inside the pill bottle and renders any unused opioids, not only inaccessible, and inextricable, but also biodegradable. Its innovation ideas like this we need to explore. Im working with colleagues on my committee to treat and prevent opioid addiction. Chair recognizes the gentleman from massachusetts, mr. Kennedy, for three minutes, please. Thanks, mr. Chairperson, and many thanks for convening this hearing and our colleagues from across the country. I want to thank my colleagues that have testified already. Their comments are right on. They show the depth of this thats affected our country and our crickets around the nation and the myriad ways our federal government can help respond to it. Theres no Silver Bullet to this, but there are ideas out there that are, i think, genuine that have widespread support and that i hope will deserve this committees attention going forward. Addiction is not a disease that knows Congressional Districts or state borders or Electoral College results. Its not one that cares how much money is in your bank account or asks how many children you have. For patients on the front lines, it is personal and painful and petry fieing. The question before all of us isnt is there an epidemic . Youve heard from everybody today saying 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 nonelderly adults with opioid addiction in this country, 30 . And the 20 of opioid addicts that do not have Health Insurance largely stems from individuals in states that did not take a Medicaid Expansion. This is not enough. We need to strengthen our Medicaid Programs to ensure that everybody gets the care they need when they need it. That means not just insuring access to medicaid and eligibility, but it means flushing out the networks that medicaid provides that you dont have the stories so many have heard from folks around the country, even if they are enrolled in medicaid, there are not providers that will take it and if providers do take it that they would have to wait months in order to get a slot to get into treatment. Theres complex reasons for that, but in my own opinion a big portion of that comes to low medicaid rebim ursment rates that ends up putting the burden of treatment on the backs of providers rather than making sure that patients get the care that they need. Second is Law Enforcement. Folks, we lock people up in this country that are sick. And we need to be doing an awful lot more, not only to make sure that that safety net for our mejt Health System is not our criminal justice system, but supporting Police Officers who end up being on the front lines of this epidemic and addiction epidemic across the country and put in an impossible place of forcing to have to arrest people, forcing to 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, that were breaking the homes and cars to try to satiate an Opioid Epidemic addiction. They didnt have anywhere else to go. Finally, and ill be brief, mr. Chairman, the medical community, you heard ms. Brooks talk about education. Weve heard folks talk about drug Monitoring Programs, prescription guidelines, i like mr. Mullen had surgery before. I got in an argument with my surgery technician on my hospital bed who was trying to prescribe me painkillers that i would not take because i am deathly afraid of these things. Im looking forward to working with my colleagues. Chair thanks the gentleman, and thanks everyone on this panel. Will allow you to depart, and we have a panel that will be mr. Costello of pennsylvania, mr. Walberg of michigan, mr. Carter of georgia, and chairman goodlatte of virginia. And mr. Walberg, we are doing energy and commerce members first, with your permission, ill go to the chairman of the Judiciary Committee since hes made time to be with us this morning. And chairman goodlatte, youre recognized for three minutes. Mr. Chairman, Ranking Member green, 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 soes yo economic levels in all regions of the country and including my home and district of virginia. Has rightfully gained the attention of congress. They have seen 11 opioid overdoses resulting in four deaths since september 20th. Making 33 deaths in that portion of my district so far this year. Just recently i met with a mother in roanoke whose daughter is an opioid addict living on the streets. Her concern for her daughter was heartbreaking to hear. Sadly i know that every member of congress in this room has heard these stories of Bright Futures wasted away and lives taken too early. That is why we must act to provide more tools to help addicts reclaim and rebuild their lives, stop drug traffickers and make our community safer. We at the Judiciary Committee have been pleased to work with the committee on energy and commerce in this fight to combat this epidemic. Just last year, since last year the Judiciary Committee has passed seven legislative measures that address the multifaceted nature of the Opioid Epidemic. Notably the judiciary and Commerce Committees worked collaboratively to see the comprehensive opioid abuse, cara signed into law last year. This bipartisan streamlined comprehensive opioid abuse Grant Program, including vital training and resources for First Responders and Law Enforcement. Criminal investigations for the unlawful distribution of opioids, drug and other alternative treatment courts and residential and other Substance Abuse treatment. We also target those who traffic in opioids. The trafficking act which is now law improves Law Enforcement ability to pursue interNational Drug manufacturers, brokers and distributors in source nations. Federal prosecutors can now use the important tools in that bill to pursue foreign drug traffickers who are poisoning american citizens. Additionally in july of this year the Judiciary Committee reported favorably to stop the importation and trafficking of synthetic analogs act. It is an unfortunate reality that synthetic drug use and Opioid Epidemic are inextricably linked. Heroin is regularly laced with synthetic drugs such as fentanyl. This provides Law Enforcement with the tools needed to keep these drugs off of our streets. That legislation, i believe, is currently before the energy and Commerce Committee. I hope youll 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. Chair thanks the gentleman, thanks for making time to be with us on our panel today. We sincerely appreciate you being here and we know weve got work to do and we will Work Together on this. Thanks for the opportunity. Mr. Walberg, youre recognized for three minutes, please. And im always delighted to go behind the chairman of the Judiciary Committee, especially since theres some of my bills in this committee. But let me say, chairman burgess, Ranking Member green, i want to thank you for holding todays hearing to receive input from members who represent different corners of our country and yet the very same problem. Since the 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 neighborhoods 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 i had the opportunity to meet with a constituent named george bareth from monroe county. He established a Nonprofit Organization named in honor of his son who died from an heroin overdose in 2012. He was only 25. Ryans hope funds structured longterm residential treatment for addicts, and so far they have helped and nearly helped nearly 40 addicts by sending them to rehab. To help cover these costs mr. Bareth has also teamed up with local First Responders to organize a Charity Hockey game called hockey against heroin. In lenoway county, my own home county, the Pathway Center 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 the result of a Community Partnership between local police and the county Sheriffs Office, rotary clubs and the local Hospital System and Mental Health authority. Ryans hope and the Pathways Resource Center are just two shining examples of constituents in my district making a difference. We need more communitybased initiatives like these to get resources to those in need. Congress also has more to do. One example is jesses law. A bipartisan bill ive introduced with congresswoman debbie dingle. It seeks to ensure that medical professionals are equipped to safely treat their patients and prevent overdose tragedies. Its named after jesse grub who died last year of an opioid overdose. Jesse had battled a heroin addiction for nearly seven years, but had been clean for six months. She had made a new life for herself in michigan and was training for a marathon when an infection related to a running injury required her to have surgery. Jesses parents told doctors that she was recovering addict and shouldnt be prescribed opioids. Unfortunately jesses discharging physician didnt know her addiction history, and sent jesse home with a prescription for 50 oxycodone pills. Jesse became a sad death by overdose statistic. Jesses law will ensure that physicians and nurses have access to a consenting patients complete Health Information when making treatment decisions. Such information is crucial to provide a patientcentered 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 remove obstacles to care and empower local communities to tackle the Opioid Crisis head on. And i thank you for listening to my story. Gentleman yields back. The chair thanks the gentleman. And i believe this concludes all of the energy and commerce members seeking to give testimony. If any arrive we will allow them to testify as they come in. But i think our panel now will be chairman rogers, mr. Marshall of kansas, mr. Turner, mayor of dayton, ohio, and ms. Bustos, if you wish to join us now, that would be good as well. And chairman rogers, thank you for being here and being part of this discussion this morning. Youre recognized, sir. Well, thank you, mr. Chairman, and colleagues. Thank you for hosting us. On this very, very important topic. Over the past 15 years, many of you have heard me advocate for a holistic approach to the clamity 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. And 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 light weve shown on addiction, only 10 of those needing treatment for alcohol or drugrelated addiction actually receive it. 10 . Underlying challenges in the treatment workforce further compound this lack of access. There are simply not enough incentives for Health Professionals in training to specialize in addiction medicine. Treatment professionals work in stressful environments, receive relatively low pay and turn over at rates much higher than other Health Professionals. Nih continually pioneers research on addiction science, and new ways to treat this chronic disease. Yet america has only half the number of practicing Addiction Specialists needed to put their findings in practice. This is a Patient Safety and Public Health ca lamity. 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. And i hope to work with each of you, mr. Chairman and members, to this end. And i thank you for allowing us here today. I yield. Chair thanks the gentleman, gentleman yields back. Will the gentleman from georgia and energy and commerce member wish to 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 want to start by my testimony by thanking you for holding todays hearing, for soliciting members on how to continue as a pharmacist ive made a priority to advise and assist my patients. I develop close bonds with people who are my pretends and neighbors. That bond pushes pharmacists to act proactively in helping their patients. One of the largest concern ive seen is increased prescribing of opioids for pain relief. We need to look at other options and other outlets and find a good medium. We can prioritize and create a channel for approval of other thi therapies. Prescribers are able to write up to three 30day prescriptions for look at the effectiveness of allowing fewer initial prescriptions and a limited number of refills rather than three months of prescriptions. Similar to that notion allowing pharmacists to have a greater say in limiting the number of pills filled in a prescription could help to address the transition to addiction. For instance, limiting the fill for acute pain needs such as a dental procedure could help prevent an individual from getting hooked on opioids. Under cara a pharmacist is only able to partially fill a prescription. With the consent of the patient or prescriber or in the instance it doesnt have enough stock to fill a prescription. A simple sevenday fill could keep their pain needs and Prescription Drug Monitoring Programs, bdmps are a great resource in battling Prescription Drug use. They can be strengthened to better curb this epidemic. One way to do so is get better data so states can collaborate to createsh further linking state pdmps and improving data and access could improve. Drug takeback programs 19 states have some sorm of drug takeback programs and 23 states have programs allowing pharmacists to accept unused and unwanted drugs. One of the most common ways in which adolescents access Prescription Drugs is through the Drug Cabinets of their parents and grandparents. Too often these unused pills can act as gateway to further abuse by young adults. Expanding these programs through Law Enforcement pharmacies or paid programs can take some of these Prescription Drugs off the street. The creation of middle ground therapy, by facilitating research and development we can help drive the expepsive and time consumer efforts to make those treatments a reality. There are few options left between tylenol, tramadol and opioids. That void is driving decisions 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 changs the gentleman. The gentleman yields back. The chair recognizes the gentlewoman from illinois. Thank you, mr. Chairman and Ranking Member green. Id like to start out by telling you a story about 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 when he was only 32 years old. He had injured his back and as a result of that, his physician prescribed an opioid to relieve his pain. Soon after that he became dependent upon those that prescription opioid. And found out that he could go to the street and find something very cheap called heroin, 10. So he continued this cycle of overdose, rehab, relapse, and he was on the right path. He 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. And 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 including included in that was to care for infants born with an opioid dependency due to their parents addiction. In fact, we received the Government Accountability report that my bill called for very recently. It reviews and makes recommendations to care for these infants. But what it really ended up showing is that we have a very long way to go. The department of health and Human Services has a strategy for improving infant care, but they havent 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. So it further reenforces that this is not the time to cut medicaid. Medicaid pays for four out of every five babies that are suffering from Opioid Withdrawal upon their birth. Its helped 1. 6 Million People with Substance Abuse disorders and access to treatment. And so i just really more than anything want to make the point that medicaid has to be protected and not cut. I want to stress one other point because of the Congressional District that i represent, and that is at the Opioid Crisis is actually worse in Rural Communities where the drugrelated deaths are actually 45 higher. Rural states have higher rates of overdose, especially prescription opioids like the kind chris had been prescribed for his back injury. So 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. So thats why earlier this year i introduced a bipartisan piece of legislation to help Rural Communities better leverage the u. S. Department of Agriculture Programs to combat heroin and opioid use. So we need to continue to look at solutions that work in rural areas like telemedicine which will help us overcome the transportation and access issues that i mentioned earlier. With that, mr. Chairman, i yield back the rest of my time, thank you. The chair thanks the gentle lady. Thank you, i want to thank you for the opportunity to appear before you today on this important issue. As the chairman said i come from dayton, ohio. My counties are montgomery, green and fayette. Despite our communitys efforts to battle the Opioid Epidemic for years, the epidemic continues to destroy my community and my constituents on a daily basis. This year current estimates suggest that 800 people could die at my primary county, Montgomery County due to opioid overdose. Sadly that would more than double the 371 drug Overdose Deaths in 2016, the highest number recorded to date, imagine 800 families receiving notice someone in their family has died as a result of opioid overdose. Heartbreaking numbers like this have made Montgomery County, ohio ground zero. Recently in working in conjunction with the county sheriff i have called for the appointment of a Dayton Area Drug czar to stream line. Ive worked on a local basis to help stem this tie, today i would like to highlight my bill, accessing the treat act. It would increase back soesz to Substance Abuse treatment by lifting two restrictions that hamstring full deployment of federal resources. Medicaids institutions for mental disease exclusion states that facilities with more than 16 beds, like jails, are not eligible for reimbursement for Substance Abuse Treatment Services furnished to individuals who are incarcerated. Compounding the problem a Substance Abuse and Mental Health Administration Policy dating to 1995 limits the use for Substance Abuse treatment, c sat, to only communitybased Treatment Facilities excluding those who are incarcerated. My treatment act officer a common sense solution that would eliminate these barriers to treatment for individuals who are incarcerated by allowing medicaid to reimburse for sbubs Treatment Services furnished. Theres no reason why medicaid eligible should lose benefits by becoming incarcerated. Limiting the would also assist. Since i first introduced the treat act in november of 2015 and reintroduced it in this congress as garden abroad, the president s commission on combatting drug addiction and the Opioid Crisis interim report just issued july 21, 2017 strongly endorsed this concept in the treatment act. Quote, the single fastest way to increase treatment availability across the nation, noting every governor, numerous treatment providers, parents and nonprofit Advocacy Group operations have Ranking Member green and members of the subcommittee, lives are at stake. This would be an important step to bring treatment to those individuals who are at a time when we have an ability to intervene in their lives. Thank you. Their thanks the gentleman, gentleman yields back. Chair recognizes the gentleman from kansas dr. Marshall. Thank you very much for allowing me to come and talk and share my experience as an ob gyn in rural kansas. 92 people die in this country every day from opioid addiction. What i wanted to do was describe a couple sentinel events, why did we end up in this situation . As i look back in these last ten years the number of pills that i would send home for a postop patient doubled. For the average c section, the average his recollect my, all the sudden each week to get the people that postop visit the number of pills they would need literally doubled. I went back to figure out why and how come. First thing i think of, patient bill of rights came about in 1993 or so. Over the next ten years there was a great document, patients suddenly began to expect that they should have no pain, no pain after surgery. They would come into the e. R. With a sprained ankle and expect to have no pain the demand for narcotics went up and up. Somewhere in the early 2000s, the worst thing ive ever seen introduced. They suddenly described the amount of pain they had, which was very subjective. And beyond that eventually became part of a measure of how good of medicine you were practicing, tied to your reimbursement. Suddenly patients in the postop area were getting double and triple the medications. On the postoperative floor, rather than get percocets every six hours, they were getting them every four haurs and the pca pumps increased doses. What im trying to say is we almost doubled the amount of narcotics people were getting in the hospital and then they wanted twice the amount to go home with as well. So efficient physicians were faced with this struggle of i dont think you need this much, but patients becoming more and more in control of how many of their own health care. So i think those are a couple reasons why we ended up here. I think there needs to be some reeducation done. Id like to point towards valley hope at norton, kansas. Theyve treated over 300,000 patients over the past five years, kept incredible statistics, have incredible treatment plans. What they taught me is about a month after release, a month after they started their path to recovery, that they had a second physiological reaction, and thats when they these people o. D. And die. People need to recognize that for a month that they need to have very close treatment, and probably for two months and even a year. So its during that second episode when they when before they had treatment they were taking a certain amount of heroin and a handful of pills and a pint of whiskey. When they were treated from that for a month, and they went back to that same dose they overdosed and stopped dying. We need to understand what kills people is that if i give anybody enough morphine you would stop breathing. So theyre unable to metabolize it. We need to recognize thats a very critical moment. Treatment plans cannot last a week. Theyre going to last months and years probably. We need to make sure were adequately funding outpatient treatment. We need to reward facilities like valley hope who have great longterm outcomes. Mr. Chairman thank you for taking on this task. I look forward to working with you as always. Chair thanks the gentleman, gentleman yields back. Chair recognizes the gentleman from ohio, chairman stiveres. Thank you, and all of you for looking at solutions for h open poid crisis plaguing all communities across the country. In ohio opioid overdoses now exceed Car Accidents as the leading cause of death for most ohioans. And there have been a lot of great ideas presented here today and i really have appreciated learning from many of our colleagues. I, for the last five years, have held opioid round tables, drug round tables, in my district to talk about solutions and weve come up with some ideas from the field of folks that know what is driving this crisis. And ill talk about some medical things in a second. But the first thing i know we have to do is bring back hope and Economic Opportunity to people. And i think what youre doing, mr. Chairman, with Regulatory Reform and with a were doing with tax reform is going to help with that. But there are a lot of other things we can do. First, you know, the idea that came out of our round table this year was on evidencebased treatment. If youve been to one Treatment Facility youve been to one Treatment Facility. Because they all do things differently, too many of them do things that when you walk out that door theres nothing tieing you to the treatment anymore. And thats a problem. And they need to i think we should have evidencebased treatment. It should be based on the science of the day and how recovery works. 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, which is pain as a vital sign. Every other vital sign you can think of, you know, your tp, your blood pressure, your pulse can be measured by a machine. Pain cant be measured by a machine. Its a subjective number and it should not be the fifth vital sign. Its led to ore overprescribing culture in this country and we have to try to fix it. I appreciate what cms has done to remove the reimbursement based on the surveys of Pain Management, but 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 Chiropractic Services and other things that dont involve a pill. I think we need to change the culture on that. The fourth idea is some prescription changes. I know that buddy carter whos a pharmacist talked about a couple of these. I sponsored the partial fill legislation that was rolled into care and became law. But i believe pharmacists should be empowered to authorize partial fill of opioid prescriptions on their own and buddy already said it, but 70 of the folks who misuse prescriptions get it at some point, bridge that addiction through friends and familys medicine cabinets. Weve got to fix that. The final issue i dont hear talked about enough is tapering doses. When somebodys on an opioid for about 30 days, they have a physical addiction to it. If you talk to 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 because a lot of primary care physicians, mr. Chairman, feel very uncomfortable with 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. So 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. Their changs the gentleman. I want to thank all of you for providing your testimony here today. This panel is excused. And our next panel will be dr. Windstrop from ohio. Mr. Snyder from illinois, ms. Clark from massachusetts, mr. Jeffries from new york and mr. Jenkins from West Virginia. Representative snyder youre recognized for three memberships. Thank you, chairman burgess, Ranking Member green for inviting me here today discuss the epidemic of opioid addiction, abuse and overdose that is ravaging our communities. I represent the people of illinoiss tenth district. The Opioid Crisis has hit our neighborhoods extremely hard. In cook county which includes the city of chicago opioid overdoses increased by 87. 4 . Ill repeat that, 87. 4 between 2013 and 2016. Over the same period weve witnessed a troubling increase in fentanyl, sin thetic opioid, which is more deadly than heroin and whose overdoses are often fatal. In the face of these challenges id like to recognize the Lake County Opioid Initiative and chicago area Opioid Task Force for their work to prevent opioid abuse addiction, overdose and health and death, rather. In this epidemic our adversary is constantly shifting. We must ensure doctors are up to date with the most recent best practices and research for preventing and treating this disease. Earlier this year i introtused a bill called the preventing opioid abuse through continuing education, or opioid pace act. This bill would require providers who treat patients with prescription opioids 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, the cme would focus on best practices. Early detection of opioid disorder, and treatment and management of opioid use disorder. Im proud that the department of defense was included as an amendment to the nda authorization. Our men and women in uniform are not immune to the opioid misuse. Its higher among Service Members than among civilians due to the use of drugs to treatment ptsd and chronic pain. As we seek new legislative 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 by expanding medicaid and requiring market policies that would Cover Services relating to treating Substance Abuse disorders. The states would suffer from a rollback of Medicaid Expansion. Simply put repealing the aca would add fuel to the fire of the Opioid Epidemic. I urge my colleagues to consider solutions, including the opioid pace act and preserve the programs we have in place. Chair thanks the gentleman. Their recognizes representative jeffries from new york. Thank you, chairman burgess and Ranking Member kbreen for holding this hearing as well as 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 has 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 multifaceted Public Health crisis we confront its important to consider 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 of synthetic drug abuse by 12 to 18 year olds in america. With the information this study will provide congress can work to prevent Substance Abuse by younger americans through an enhappensed and inlightened 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 and availability of potent and dangerous substances like elicit fentanyl and other synthetic drugs. Teenage fentanyl use is a vicious cycle. Adolescents have a still developing cortex which can facilitate drug seeking behavior. It alters the development of this 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, suicides and car crashes combined. This phenomenon weve 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, the 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 mr. Jenkins from West Virginia. Thank you so much, 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 grounds 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 n. A. S. , 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 had 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. And 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 oreck recognized by medicaid to remove the barriers. Second, based on the gao report i ask you, working with me, this committee, to memorialize 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. Their thanks the gentleman. Dr. Winstrop, youre recognized. Thank you for host thinking today. I mean that sincerely. Were hearing a lot of 2k3w50d ideas and 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. I appreciate the chance to come and speak today and share with you some stories from ohios second district. My office sent a sure vie to our district and asked them to share stories and experiences with the Opioid Epidemic. The ultraares are heartbreaking, as you might imagine, and we received hundreds of responses up to seven pages of responses. I just want to share a couple of those with you. One said my brother unfortunately became addicted as a teenager. Hes very luck by 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. They are ruining our youth, our future. Another one, a woman said i have four boys and three of them are struggling with this addiction, can cost of going to a methadone clinic is too expensive. Im going broke trying to get my children sober. In one county alone the overdose death rate buzz 37. 5 per 100,000 residents and in another county 318 residents died of an unintentional Drug Overdose in 2016. The 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. Id 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 . She was addicted to prescription pain meds. When she came to you, you gave her alternatives and you didnt give her any. We searched 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 encars rate 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. And then he showed me what medicaid paid for it. And 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 other 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 and thank you for your time and attention today. Thank you. The chair recognizes congresswoman clark. Thank you, Ranking Member green and 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 workplace 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 id like to speak in favor of four common sense proposals that i am 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. Bushaun. 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 prescriber 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 prescribers support act would establish statebased resources for prescribers to consult men making decisions about prescribing opioids. Third, recently introduced the every prescription conveyed security act with my colleague from oklahoma, congressman mullen. This proposal would ensure 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 more 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 Howell 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. Chair thanks the gentle lady. The gentle lady from connecticut is recognized for three minutes, please. Thank you, mr. Chairman. Chairman burgess and rainging member green, thank you so much for holding this important hearing on the growing Opioid Epidemic. Everywhere i go in connecticut, i meet people whos families have lost loved ones to drug addiction. Its an epidemic that affects families and communities across the country regardless of age, race, gender, socioeconomic status. One of my visits to a Treatment Center in water bury, i met a young woman on the streets due to addiction. She has a young child. Shes so grateful for a program allowing her to stay clean and keep her child. A met a man who for 20 years has been battling his addiction and is finally coming to terms with it and able to hold a steady job. These are real people, real families and real lives that e affected by this crisis. 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, they lost track of their daughter, 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 so dire in connecticut that our chief medical examiner lost its accreditation. They cannot keep up with the autopsies. Were expecting more than a thousand deaths this year. Thats the third highest rate in the country. They literally cannot keep up with the autopsies. We these to do something and this Congress Needs to act. Im pleased at our good bipartisan work last year. My bill of the prevent drug addiction act of 2016 was included as part of the Conference Committee and our good bipartisan work to ensure that were addressing the issues of prevention with many of my colleagues have addressed here today, both 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 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. Were at real risk now as we consider that funding and whether the medicaid access will be cut off, which is funding so many important programs in my states. Again, i want to thank this committee for the good work and encourage all of our members to come together and help address this vital need, this growing ep chemmic that is affecting all americans. Thank you and i yield back. Chair thanks the gentle lady, recognizes gentle lady from utah, ms. Love, for three minutes. Thank you, mr. Chairman, for talking about such an issue. Id like to 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 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. Is 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. Ultrasound 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 both 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 exclusion, 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 vice 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 Prescription 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 rampant, 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 newhanover, 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 lives as a solution tailored to one community, which hoos the which has the buyin of its residents. 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. Theres one piece of legislation that ive introduced with dr. Andy harris. Somebody who doesnt agree with me about the efficacy of 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 stranglehold on this research. We have by partisan legislation. And that would break that stranglehold. 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. Recognizing the gentle lady from florida for three minutes. Thank you, mr. Chairman, and thank you for hold thing hearing. The Opioid Crisis has hit the atlanta counties of full ton, cob and has hard as anywhere in the country. From prescription painkillers to synthetic drugs to heroin. In 2016, 27. 3 of all drug related fatalities in cobb county were caused by opioids, an increase from 16. 8 the year before. In 2015 the cobb county Narcotic Team seized more than more heroin than in the previous 20 years. In fulton county, there were 77 heroin deaths in 2014, compared to four such deaths in 2010. Behind the statistics are hurting devastated families. Families torn apart by addiction facing financial return in the desperate effort to try anything to make things right or worse losing a loved one to a Drug Overdose or suicide. The Opioid Crisis as weve heard is indeed a complex one. Its an incredibly sensitive issue, particularly for communities that have long felt immune to fatal Substance Abuse problems. Still, communities through churches, nonprofits, with the support of 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 decrease painkiller abuse across the down. With the help of the rotary club in that city the city purchased special boxes that were used to collect unused or unwanted medications and located them at the police and firestations 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, the incarceration of addicts should not be seen as a solution. 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 share how the Opioid Crisis is affecting their constituents including my neighbors in Pinellas County, florida. The statistics are shocking. 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 abuse and 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 often 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 County 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 gentleman. Chair recognizes mr. Faso for three minutes. Thank you chairman, Ranking Member green 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 more 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 facile kate an authentic reversal of this dangerous and upward trend of opioid addiction in our communities. I thank the committee for their service and for allowing us to 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 synthetic analogs act of 2017. 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 man, 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 campanola 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 shop. 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 with heroin after abusing opiates. She became pregnant, went cold turkey and quit. She was five months pregnant, had not had relapses. A drug dealer, who i can only 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 prosecutor, theres three ways 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 treat. 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 now 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 hal 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 we can. 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. In many cases, we are the court of last resort. We can do this. We can 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. And do not require Long Hospital stays and opioids to dull the pain from other invasive procedures. An example is minimally invasive s. I. Indugs, which some private insurers dont cover this procedure. 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 procedures. 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 delaware 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 work 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 a holistic approach 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 providing Addiction Treatment and programs. On a second topic the imd exclusion caps the number of bids Mental Health facilities receiving medicaid can have at 16. Multiple Health Care Groups have come into my office saying this blocks critical access for treatment for people who need inpatient treatment. Including pregnant, idicted women. I encourage the committee to explore ways to provoid some relief to this out dated rule. Gentleman from papais recognized for three minutes but only two two, please. Drug addictions invauvlg prescription opioids and are the leading cause of accidental death in this nation. Substance abuse costs our country annually. Drug related deaths were amung the highest in the nation. Within one year of the opioid related deaths rose 20 while my districts increased by 50 . This is costing resources and precious lives like my constituent. He always loves sharing his talents and love of music playing for it local church group, however, like so many he got if volved with drugs during his time in school and spend some time in jail. But he began receiving treatment. He help hadded others by involving in a recovery home and he brought people suffering to treatment programs. Last december he lost his mother pamela down the aisle for her wedding. He had a steady job and a girlfriend. It would seem many of his had battles were headed in the right direction in a war thats caused so much devastation. Then just days before christmas, two Police Detectives showed up to tell her the devastating news no mother can ever prepare for. Carlos over dosed on a drug laced with fentanyl and was unable to be saved. His life and death cast a bright light on the fact that drug addiction is nothing less than a disease. Its a long standing policy that prohib hadts the matching funds for states for services rend frrd medicaid enrollees who suffer from Mental Health treatment. Some states like my state allowing for inpatient treatment but with limitations on population, size and length of stay, these limitations blocking access to treatment for people who need inpatient treatment for addiction, including some of societys most vulnerable. I urge my colleagues to adopt the road to recovery act and olmo expres concerns by health care professionals. I yield back. Chair recognize the gentleman from pennsylvania for flthree minutes. I have learned first hand the impact this epidemic is having on our communities in pennsylvania. Its effecting families and individuals of all ages, races and Socio Economic backgrounds. Throughout this nation there are parents, teachers, athletes, doctors, teenagers and seniors struggling with addiction, a disease that has no boundaries when it comes to who it effects. 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, both that are now law. These bills are helping our communities through if creasing access to treatment and expanding prevention, education and intervention efforts. In the communitys i represent a rekerring 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 those who have no insurance. 35,000 for a 30 day at a Treatment Center. Hundred hads of dollars spent on flight to recovery programs akrusz the country. Parents are taking on second jobs and retirees are reterring the work force to help pay for treatment for am faally member suffering from addiction. Those should not be face would insurmountable costs. To help provide afinancial assistance, ive added my name as a co sponsor to the Addiction Recovery through Family Health akournts act. Under current law they can only use funds in their flexible spending account to pay for Addiction Treatment for their pous or dependents. This will give them the option to help had Family Members receiving drug treatment be it a niece, grandmother, cousin, in law, etc. This is the right direction. Im proud of the work the committee has done to help those in the epidemic. I yield back. Gentleman yields back. The chair recognizes the final gentleman from pennsylvania. But only use two. Thank you for holding this important hearing today to testify about this epidemic. I think its interesting youve had three pennsylvanias in a row. It represents the geography of pennsylvania. Particularly among the hardest hit had in our national Opioid Epidemic. Theres been a Staggering Amount of opioid deaths in my district. They lost their lives from heroin or opioid related over doses. Last year 3, it was four times the number of deaths caused by Car Accidents. Another recent report, three people were revived by narcan. Thankfully the First Responders were able to save their lives. We still have a long way to go. We should be taking a fleaprong approach. We must implement pesh hadders to prevent addiction, treat it once it has taken hold over someone and finally vigorously if force the laws from spreading their poison to our kmucommunit. It will help insure our veteran whose are significant risk to overcome opioid adiction. This is one positive step in the right direction. Another area where congress should focus, one of which is of specific interest to me is to strengthen our partnership with mexico. Our neighborer to the south has suffered a horrific level of murder at the hands of drug car tells. We can help them defeat the car tells that cause so much pain both there and here in the u. S. Often over looked is the fact that many of the narcotics they traffic and in the hands of americans. Further more increasing through increased use of technology is absolutely necessary to interdicting drugs like the border security. American security act will do just that. Another bipartisan bill i hope will end the crisis was introduced to hr 3526. I look forward to that moving forward. I thank you for the opportunity to testify before the committee on an issue that greatly effects the constituents. Gentleman yields back. Are had members having had a chance to speak with votes, the committee stands adjourned