Therefore, presumably safe, a. Afe way to get a high of course, this is all a lie. These drugs are anything but safe. Almost six years ago to the day, a young man from ohio became one of the first young people to die from the effects of smoking. Ynthetic marijuana or k2 his parents have become advocates for education, awareness, and action against the menace of synthetic drugs. I am honored to have them and davids brother here today. Davids father will share davids story. Is aetic marijuana substance that has little to do with the marijuana plant. Substance is typically composed of plant matter sprayed with chemicals designed to mimic , theffect of the ths active marijuana ingredient, with far more potency. Asthetics often marketed the salts or glass cleaner are another type of synthetic drug. They are stimulants that imitate the effects of cocaine and methamphetamines. More recently, a third category of synthetic drugs has emerged. Form ofc opioids in the in theow form of fentanyl. They are 50 to 100 times 50 to 100 times more powerful than morphine. They are deadly convergence of andsynthetic drug threat the current Opioid Epidemic. Last year it was reported that fentynal wasce of responsible for the death of the musician, prince. Synthetic drugs are largely developed outside the United States, in china, and smuggled into the country through the mail or across the border with mexico. They are often traceable back to the middle east. A long look if Law Enforcement has the tools needed to protect the public from the synthetics. Committee has cleared the traffickers, it is clear they are outpacing us. Testifying before the senate bycus, this committee acted passing my bill, the David Mitchell roster act. The bill placed a series of synthetic can have annoyance and other analogs on schedule one. It also extend the the time for which a substance can be temporarily scheduled by the da to protect the public. Part oflaws the synthetic drug abuse prevention act. This was to protect young people. Calls the Poison Control Centers began to level off or decline for time. In march 2011, the da has used Scheduling Authority to place 35 synthetic drugs on schedule one. Clearly, the threat posed by these drugs has not abated. Calls the Poison Centers for synthetic marijuana have once rising fromdespite 2014,nd 2013 to 3600 and almost 8000 in 2015. News stories continued affecting the awful effects of an jesting these substances on our youth. The effects on our health care and criminal Justice Systems. Law enforcement continues to encounter these substances in record numbers. I thank all of our witnesses for being here today to help us learn more about this crisis. Many of us on the committee have supported legislation that we think we can help. Given the complex way that traffickers can invade the law, this doesnt have an easy answer. I will turn to senator feinstein. I shortened my statement, so i want my printed statement put into the record without objection. The ledger feinstein thank you. I want to welcome our witnesses. Out at the audience, it appears a knowing and intelligent audience. Im pleased to see this. I have a humorous comment. I would not deliberate well. I will cease and assist. Synthetice to discuss drugs and the challenges in bringing the manufacturers and traffickers of these to justice. I think the audience knows that unregulated substances mimic the effects of controlled substances such as marijuana, pcp, and lsd. That is bad news. In 2015, there were 7789 Poison Center exposures nationwide to , known ascannabinoids synthetic marijuana. This was the most since the drug appeared in the United States. There were 3960 exposures in the s represented by this committee, mr. Chairman. Almost half of the exposures nationwide. The challenge for Law Enforcement is that manufacturers, mostly in china and india, change one molecule or two molecules in the composition of a drug and produce a controlled substance analog. Although it has a similar effect on the body to a controlled substance may no longer be illegal under federal law. Enforcement efforts become difficult. Oure drugs are ship to country where they are marketed as legal alternatives to illegal drugs. They appealed to used because they are easily accessible, often sold at gas stations, convenience stores, or online. We beginning to see a decrease in sin that it cannabinoid exposures. Other synthetic drugs, such as synthetic opioids continue to bring havoc. Yl and itse, fentan analogs are deadly and highly. Ddictive synthetic opioids in sacramento, there were 52 related overdoses in one month, resulting in at least 12 deaths. There was an2013 80 increase in overdoses involving synthetic opioids, including fentanyl. I have never seen that before. Increase in one year. While alarmingly high, these statistics may be inaccurate. Fentanylcaused deaths are often misclassified as prescription related. Heroin like other illicit drugs, its analogs are clandestinely produced and primarily enter the u. S. In one of three ways. 1, chinese chemists reduce and ship it to the United States Via International mail. Traffickersrug reduce it with precursor chemicals from china and smuggle it across the southwest border. 3, chinese chemists reduce it canada, where it is smuggled across the northern border. The point is, regardless of the pose aynthetic drugs deadly and quickly evolving Public Health threat. Mr. Chairman, you and i have held 2 drug caucus hearings on this topic dating back to 2011. Since then, congress has only scheduled 26 substances, and another 35 have been administratively controlled through temporary scheduling only 11 of which have been permanently controlled. Simply put, our current legislative and administrative framework prevents the swift action that is needed to address this constantly evolving problem. That is why, with others, in 2015 i reintroduced the protecting our youth from dangerous synthetic drugs act. This is a bipartisan bill cosponsored by many members of this committee. This bill would prevent manufacturers from skirting federal law by establishing an Interagency Committee that would convene on an as needed basis to quickly designate and prohibit new synthetic drugs encountered by Law Enforcement. Importantly, since controlled substance analogues are not subject to schedule one research restrictions, legitimate scientific and medical research would be safeguarded. Controlling new synthetic drugs more quickly will better enable us to protect our nations youth and ensures successful persecutions against those who manufacture and traffic these drugs. If people here have comments on this bill, i would very much like to hear them. One thing is clear, mr. Chairman. , we have to do something to stop this. I have never seen this in my lifetime before in this country. I am hopeful that under your todership we will be able come forward with important legislation. I thank you, very much. I associate myself with her remarks about axing quickly. Is the botticelli director of the National Drug control policy. He leads the administrations drug policy efforts and is responsible were creating an annual drug control strategy. Previously, he served as the director of abuse substances at the Massachusetts Department of Public Health. An undergraduate degree at Siena College and a masters of education at st. Lawrence university. We are glad you are back. , the u. S. Rtunian attorney, Northern District new confirmation his he served as assistant u. S. Ttorney for 12 years he is a graduate of georgetown university, Albany Law School of union university. Chuck rosenberg has served as acting administrator of the dea sine may of 2015. Began his Career Service his Career Public Service as an assistant of public attorney in 2000. Ia from 1994 to after a few years in the private sector he served in a series of senior positions in Law Enforcement, including console to director mueller of the fbi. And to attorney general and Deputy Attorney general. Was confirmed as the hilda law degree from the university of virginia and a masters degree from harvard. Dr. Douglastness is throckmorton from the center of drug evaluation and research at the u. S. Fda. He joined the fda in 1997 after working as a basic science researcher and academic position at the Medical College of georgia and Veterans Administration hospital in augusta, georgia. He earned his m. D. From the university of Nebraska Medical School and completed his residency in the case of western reserve and his fellowship at yale university. Would you start . Thank you foron inviting me back to discuss issues related to synthetic drugs. Although all synthetic drugs, methamphetamine, fentanyl, and cannabinoids, are a concern of the administration i will focus on new psychoactive services. There known as designer drugs or legal highs. They are designed to mimic these effects of controlled substances and circumvent controls. In 2015 the United Nations estimated there were 600 identified on the mobile market. The vast majority are not controlled under Un Drug Treaties or authorities. They are often mixed with material to form a dangerous final package in alluring packaging. The composition could vary from batch to batch. Medical use,known and many pose a serious threat to Public Health, including addiction and lifethreatening medical consequences. I appreciate that they are here from iowa talk about davids Death Associated with the use of a Synthetic Cannabinoids. Whoe are many young people are testament to the deadly impact they are having on our communities. Although the un and all 50 states and the District Of Columbia have developed responses to controlled substances, that use with which they can be manufactured extent controls challenging. According to the dea, all nps are manufactured in china and marketed to the u. S. By being shipped. Given the fatal and nonfatal effects of these substances they need to change. Leaving with how Global Response to nps can be improved. A special session of the Human Assembly rejoined other countries to encourage the World Health Organization to engage more proactively in the review for substances for control. While International Control of drugs and precursors are important, the existing International Framework is underutilized and unable to expeditiously control the overwhelming number of in ps that exist or could be developed in the future. As a result, the u. S. In partner countries are pursing other countries, like china, to take control of nps within their borders. In october, china announced actions to gain control over nps to include placing 116 substances under national control. Importantly, china streamlined their scheduling process for nps and determined the impact of a substance domestically and internationally should factor into the review for substances for control. Our agencies will work directly with china to reduce the manufacture of nps. Working withs are Law Enforcement to support investigations domestically and abroad. With the science and Research Community to understand the pharmacology of nps and perform treatment strategies, and with preventer partners to inform communities about the dangers of synthetic drugs. Despite these efforts we are concerned about the availability of traditional responses to reduce use and availability of nps domestically. Scheduling divided by congress helps Law Enforcement and the Justice System address nps, but the Data Collection needed to schedule actions for the existing and potential nps is a huge task. Under the and along statute, prosecutors must start each case a new, even if the same substance is involved, and unnecessarily timeconsuming and resource intensive process. For the past year, technical experts at fda and the National Institute of drug abuse have been reading and working together with the Data Collection required to place new drugs under control and how that plays into the permanent scheduling processes. We believe a coordinated response to scheduling, which aims to protect Public Health and safety, and takes into account Research Interests is needed to stay ahead of the supply of nps. Shortterm can help by legislatively controlling a of npscant number directionally related to scheduled compounds. Scheduling these compounds does not prohibit researcher access, but prevents further harm to the public. , more longterm significant reforms to the scheduling framework are needed to stay ahead of the new realities of the illicit drug market. The United States is not alone with grappling with how to modify their regulative processes. In recent months, the United Kingdom mental stress you have taken bold steps in getting ahead of the drug threat. Committed to making progress and will continue to work with international partners, federal government agencies, and partners at the state, local, and tribal levels to prevent threats to our communities that these dangerous substances those. Senator grassley thank you. Go ahead. Thank you, chairman grassley, senator feinstein, members of the committee. On behalf of attorney general lynch and my colleagues at the department of justice i thank you for the opportunity to testify about synthetic drugs. Despite our significant efforts, synthetic drugs flourish with horrible human cost, including hallucinations, violence, hospitalization, and worse. Many are produced in china by chemists who bury the formulas to stay ahead of the scheduling ross s. There are no quality concerns. The potency of unknown mixes of danger topose a users. Police officers and counter users who are delusional Police Officers and counter users who are delusional. It garnered worldwide attention a 5012 involving fouryearold utica man under a influence who is seen naked in the street waving a tree branch. When the man told the police that they would have to kill him to stop him, the officers deployed a taser gun. The man pulled the probes out of his chest and continued walking until 2 officer subdued him. In march of 2016, syracuse believes took a 25yearold man to the hospital after his mother reported he set his mattress on fire after ingesting Synthetic Cannabinoids. Syracuse has seen so many overdoses of spike it has been called spike nation. The analog acts, criminal reliability depends on a finding that the substance is an analog intended for human consumption and if the defendant knew the substance was regulated under federal law or the identity of the substance. Even if a substance is widely regarded as a controlled substance analog under the statute, each criminal prosecution must establish that fact a new, requiring extensive use of expert witnesses to prove the analog is substantially similar to a controlled substance in structure and effect. Proving it was intended for human consumption is another challenge. Marketing and selling cannabinoids with names like bath salts and not for human consumption labels designed to set up a lack of knowledge defense makes it difficult to convict highlevel suppliers. Neither the challenges or evasive actions of the drug manufacturers and distributors, however, have deterred our efforts to protect the american public. In new york, we first used the analog act in a case that began in 2009 to convict 20 defendants in a ring importing mali from china and distributing it in the syracuse area. Werekilo quantities shipped, some falsely labeled as metal corrosive inhibitors. In 2012, we successfully headcuted the owner of 9 shops in Central New York which sold synthetic drugs. We see nearly 12 kilograms of spike and k2, and thousands of packages of amped and legal funk. He went to jail for 87months. From coast to coast and in the heartland, we have achieved similar successes. In north dakota, after 2 teenagers died from overdoses in the grand forksarea in 2012, charles carltons Online Business was revealed to be importing analogues from several countries and distributing them. Carlton and 14 other defendants wereentenced up to 46months. In california, victor pleaded guilty to causing 24 tons of misbranded drugs to be introduced into interstate commerce marketed with names like neutron young, orgasmao, nutronium. In florida, a Chinese National was sentenced to 15 months in federal prison and forfeiture of millions of dollars for his involvement of supplying kilograms of cannabinoids to the u. S. , russia, europe, and multikilo partials. Zhan was a chemical engineer and therch and monitored scheduling. 2015, there was conviction of conspiracy to distribute analogues and launder drug money. War were distributors of Synthetic Cannabinoids with names like mr. Nice guy and mr. Happy. Punishur prosecutions some and a tour others, and raise Public Awareness of the dangers of synthetic drugs, we understand that education, prevention, and rehabilitation are essential. We partner with educators and Health Care Providers in town Hall Meetings and event like the east Side Community forms sponsored by 3 syracusearea high schools. We invest in Leadership Program like our reaching fifthgrade students which helps high risk supervisees find the help they need to reach a great into society. The tools congress has given us has allowed us to take aggressive action against drug manufacturers and dealers. We faced challenges, but our resolve to hold those accountable remains unwavering. I look forward to answering any questions. Dmin. Rosenberg thank you it is a pleasure to be here. I appreciate you holding a hearing on this topic. In our lexicon we use words ,erhaps without thinking unprecedented, historic, and unique. I think what were seeing is unprecedented, historic, we have an epidemic. A word that is sometimes overused, but is apt here. This is an epidemic. I will be brief him and then i am happy to answer questions. Me thinkds that help about the problem, vile, volatile, and lethal. The reason that this is so vile, and you touched on it mr. Chairman, a lot of these poison paddlers are marketing to children. Take substances, put them in shiny foil packages, cartoon anracters on them, give them innocentsounding name, and put it in a convenience store. They sell this to kids. By any definition, i think that is vile. Asatile, let me explain that well. As you touched on this, mr. Chairman, and senator feinstein mentioned, we are trying to keep up with a picture that changes almost every day. We have identified something nps psychoactive 5ubstances over the last 4 or years. We were saying one a week at one point. Now, two to three month. I feel almost every time i sign and administrative control regulation that i am telling the this one anymore. Move over here. That is what they do. It is volatile. For everyone substance we control legislatively or administratively, there are 11 that are uncontrolled. It is changing all the time. Bile and volatile. Let me address lethal. Eloquently, perhaps on this panel and on the next one, the effect it has had on our kids and lost. I want to talk about it from a different perspective. A Law Enforcement perspective. We have is so dangerous had to instruct agents that if they touch it or inhale it accidentally, they can die. If they are a k9 officer and it, perhapsfs because it is laced with heroin, that dog can die. We have trained our agents, not because they are first responders, they are typically not, but because they could , tounter fentanyl administer narcan to each other. If they come upon a first responder, they could do it. We have to educate our people because it is so lethal. We are putting out a roll call video through the International Association of police to war in one million Police Officers across the country that you ornot field test this stuff transport it the way you normally transport other drugs. You have to be so careful. Only being exposed, not even purposefully ingesting or smoking it, just being exposed to kill you. Those are the three words that help me think about the problem. Vile, volatile, and lethal. We have a lot of work to do. We are playing catchup, and we need your help. Thank you for the opportunity. You. Or grassley thank im with theton fda,buted director for the part of the department of health and human services. Thank you for the opportunity to discuss the Important Role the fda has in assessment of new drugs, illicit or nonillicit, to protect the Public Health and new drug development. Let me begin by saying that i agree with the comments that the three panelists have made as far as the seriousness of the issue. New synthetic drugs are flooding the u. S. Market. They pose Significant Health risks. We appreciate the effort the committee is doing. The fda is committed to doing our part. The fda is the lead federal Agency Responsible for regulating controlled substances and enforcing the controlled substances act. Responsibilities are performed by the fda in this area. I will focus on the role in the drug scheduling process, including emergency control of new and dangerous street drugs. Evaluation, medical sometimes referred to as agefactor analysis, which forms the basis of the recommendation to the dea about the appropriate level of control for a substance that has the potential to be abused. They are spelled out in my written testimony. There is an analysis on many kinds of data, chemical synthesis, structure, absorption, receptor binding, and clinical studies to understand the drugs abuse potential. Our analysis is shared with the National Institute of drug abuse for concurrence and sent to an hhs which transmits the recommendation for final decisionmaking. Are five csa, there schedules depending on abuse potential. Schedule one is the highest level of control reserved for drugs with a high potential for currently accepted medical use, and lack of accepted safety for use under medical supervision. A roletion, the fda has in the nontemporary scheduling of illicit drugs where the dea contemporarily place a subject in to one more quickly. The fda provides information about whether a given substance is an ingredient in an approved of aproduct or the subject study. We participate in the final scheduling action following the emergency action. The scientific evaluation process to determine the appropriate level of control balances the important need to protect the public from dangers posed by drugs and substances of abuse, while seeking to provide access to these drugs for researchers for potential drug development. Inaddition to its role scheduling drugs, the fda works with the department of justice, to supporthe dea, criminal investigations involving the criminal cell, criminal sale and use of illegal substances. I want to turn to the novel psychoactive substances. Assessing the use potential of these substances and doing what needs to be done. We completed a memorandum of understanding with the dea about our ability to Share Confidential Information efficiently to facilitate work together. 2016 we2011 and responded to all dea requests for recommendation regarding permanent scheduling of illicit substances. Both of them most of them were emergency scheduled. Toare working with the dea do even better. By improving the process of drug scheduling, with the enactment of the Drug Prevention act of 2012, as a part of the fda innovations act, scheduling illicit drugs can be done on reduced amount of information using binding studies and functional studies. Using this approach, we have substances to make recommendations for permanent scheduling by dea. Approach, we have been able to apply a similar way to look at the socalled bath salts. These are highly dangerous stimulants and hallucinogenic substances that can cause severe toxic effects, including convulsions and death. Ofrecognize the challenges controlling these substances in light of the harm of Public Health observed and that chemists can rapidly alter the chemical structures to stay ahead of regulators. Placing these substances in schedule one can protect Public Health, but the same chemical structures and for muscle logic at in from zoological in formal logical use may act as a disincentive for use for those their fees. To echo michael botticelli, we toieve in scientific review balance the Public Health risks posed by illicit use of these compounds while preserving the need to develop new there these under appropriate and scientific understanding. The fda is committed to working with federal partners to understand and enhance the timely appropriate scheduling of these substances. We hope the committee addresses this problem and will give relevant federal agencies opportunity to share responses. Including sciencebased solutions that would address the threat to Public Health and safety posed by these dangerous compounds. Thank you for the opportunity to appear before you. I am happy to answer any questions. Senator grassley i will ask my colleagues, who have five minutes, and we have eyewitnesses on the second panel. I want to make sure they have their opportunity to testify before the committee. Will start with mr. Hartunian it appears from your written testimony that you and some of your colleagues have had success prosecuting cases similar to the controlled substance analog enforcement act, despite the challenges opposed by proceeding under that statute. You are to be commended for that. With that in mind, despite complaints about the scheduling process being too slow and cumbersome, do you have an opinion on continuing to schedule dangerous synthetic justances, or should we rely on prosecuting these substances as analogs . Thank you for that question. Substancesemical that we schedule, the easier it is for us to do our jobs. Act in 2012 is helpful, adding chemicals and substances to the list under the controlled substances act, making it easier for prosecutors, in a more straightforward way, to prevent cases in court. Establishing the chemical compound is on schedule and proceed with questions about its chemical composition and effect. When we run across synthetics on withule, we have to deal the challenges of the controlled substance analog at. Iey are well familiar to, know you, senator grassley and chairman feinstein with your work with the drug caucus come you have heard about this. We have to prove these elements beyond a reasonable doubt. It can be challenging. Expertuspect to testimony battles. Frequently the defendant will call in about the testimony of a substance, when in fact, there there is city testing that is being done. A lot of the times the chemist have to rely on Research Documents or animal testing. That can make it difficult to prove. To answer your question, sir, the faster we can get these drugs scheduled, the better. Senator grassley we keep hearing our current scheduling approach for synthetics is not enough to deal with it. That if wer concerns moved to schedule substances to quickly come it could hurt legitimate research. As we look to find a better approach to address this threat, what can you tell us, and the congress, about how other countries are addressing it. Are they potential models for the United States . What has been the impact of research in those countries . Dir. Botticelli i agree with senator feinstein that there is a legitimate pathway for legitimate medical research as it relates to schedule one substances. The challenge has been on the Public Health side. Is a tremendous amount of conversation with interagency partners to look at opportunities to streamline the research process. We are always open to those kind of issues to deal with. I think we have to air on the side of how we dedicate the Public Health harm and stay ahead of these substances. That should be our first priority. We continue to monitor what other countries have done around this. The United Kingdom took an interesting approach. Rather than looking at it chemical by chemical, or molecule by molecule, they are looking at these drugs based on their psychoactive effect on the brain and brain receptors so we can look at staying ahead of some of these as part of the psychoactive effect. Conversations that we have had with the fda and dea looking at how we can streamline the process given the information we chemicalse individual and can we look at, based on the ea information and other information, really put forward a greater number of the substances to be scheduled . Sen. Grassley i will ask mr. Rosenberg my last question. Otticelli mr. B mentioned, can you tell what the dea and other components are doing to confront china about their role in delivering this poison to our country. Are the steps that china has taken enough . What else would you like to c done . Dir. Botticelli in october, china took an important and helpful step when it regulated 116 chemicals. I have met personally with senior members of their antinarcotic enforcement bureaus. They tell us they will do more. I hope that is right. Even after they regulate, the guys shift a little right or left and keep going. So far i have been heartened i what they have done in october, and what they will do to help us regulate additionally. We have to do more here, as well. Sen. Grassley senator feinstein . Feinstein ive listened carefully. It seems like we have a battle of the experts, which slows down the movement on these drugs and lets them get ahead of Law Enforcement. Month in look at one sacramento, which is not a big somebodyalifornia, and dies every single day of this drug to me, it is like zika. There is a lot of effort going on to speed up research. Here, we have to speed up the ability to enforce. Eliminateon comes to this battle of the experts, that is in the courtroom, would a committee made up of an Interagency Group of scientists that would convene on an as needed basis, to legally determine whether a new synthetic drug is a controlled would eliminate the need for lengthy and repeated congressional scheduling actions for small to alreadyterations schedule substances. What im going with this, and senator grassley and i have held many hearings, there is no drug activity that is more important to get at, to be tactile, to be able to move, deal with mutations and changes. If you depend on a change of the law every time this changes slightly, we are way behind. It seems we need some mechanism of experts, like those at this table, to sit down, look at a drug, make a decision, and move on. Could anyone comment on what i have just said question mark you dont have to agree, but i would like to listen. Why dont we start with you . Dr. Throckmorton i agree with the importance of identifying a way to speed decisionmaking in terms of the sheer number of products. The specific action that you are suggesting, the analog, changes to the analogues, this is something the fda has a large role in. I dont know that i would be able to comment about our particular agencys view other than we are interested in doing whatever we can. Our role is on the scheduling actions. Make sure is to nothing we are doing around scheduling is impeding the actions the dea needs to take with regard to these important, dangerous drugs. . En. Feinstein mr. Rosenberg i will ask each one of you. Admin. Rosenberg our process is cumbersome. Im not exactly sure how we fix it. One of the things that i like is orton referredkm to. Speaking holistically about how these substances bind to receptors rather than molecule by molecule. E have done some of that so far, it has worked, but we need to do more. I am open to just about anything that makes our process less clunky and cumbersome. The devil is in the details, of course. Im very happy to work with you and your staff on that. Sen. Feinstein we will take you up on it. Mr. Hartunian the prosecutors have to deal with the evidence as we find it. We develop evidence and we have to deal with whether the substance is a scheduled drug or not. As i explained, the more we have on the schedule, the more straight forward our prosecutors can be. There is benefit to our dhs partners have other work at the border in seizing substances that come into the country. If we have a substance that is not scheduled, we fall to the analog act or other tools. We have to establish the case using our experience and the developmentment with our agents. It is rosenberg important to look at the committee. Is it duplicitous . We probably have shared concern over are we creating another layer bureaucratic process . I know you dont want to do that. Youre having more discussions sen. Feinstein what would you recommend . We need to move on this and do it quickly. Admin. Rosenberg part of this is looking at and we have been heartened by the conversation we have had amongst federal agencies to look at how we streamline the process and make sure we have evidence. Whatve to look at, is the criteria to determine if. Rugs are scheduled it is a cumbersome analysis to determine if each drug as the health and Harms Associated with it. We need to look at it and work with you on the criteria with which we schedule these, and see if we can do a better job of streamlining them. There is a host of chemicals now that we can work with congress on to look at some level of scheduling for those substances. You. Feinstein thank mr. Chairman, i dont know if theres anything we can do within the drug caucus on this. I view this as a real emergency. The value out there on drugs i was talking to someone today who had a teenager who feels very badly because she wont get involved in drugs or drinking. She is being set upon by the youngsters she goes to school with, works with. Youre not like us. Youre not one of us. You have to do all of this. Somebody has to get to the heart of this and point out the death and incapacitate developing among young people from this kind of use. The tablet he of this is so in order the fatality of this is so in order and it. Anyone that i can make a suggestion. First of all, we should come up with something that enables the government to move rapidly. Sen. Grassley obviously, i dont disagree and i hope that our staffs have been talking to some degree. I got that impression. If that is it right, you tell me. . Enator tellis i think he goes first, then you. Senator tellis. Rosenberg, imr. Have a question about your written statement. You made comments about coordinating with various agencies, Homeland Security, e. , can you talk about what is working, what we need to do differently, and the involvement with state and local agencies . Admin. Rosenberg i presume you want me to talk about enforcementrelated matters . We have a real challenge. This is only one of a whole bunch of things that we are trying to combat in this country. I have asked all of my special agents around the country to tell me and to work on the most significant threats in their jurisdiction. By and large, controlled Prescription Drugs heroin, thoseics, meth, cocaine are the top. We are spread thin. We are down to 800 personnel overall. We have a bunch of challenges. We are working really well, i but i i am biased, think it is true with our task force officers. Our Law Enforcement within the dea our state and local task force officers. That is remarkable. We are relying on them, and folks with local knowledge, to tell us where the hot spots are and trying to hit that. Changes all the time. We are outmanned. Tellis i want to thank you for your work in north carolina. Enforcement has a to saypositive things about you. Im glad we worked on equitable sharing and other things to come out of that. That is important to keep them engaged. We appreciate it. State house and 2011, we took action on the synthetic. Arijuana and bath salts what more i states do well we try to sort out that her policy . Can you cite any states that are particularly good . Others that are behind that we should work with to get a handle on at the state level . Admin. Rosenberg in terms of establishing controls . Sen. Tellis what we are to do is not go too far. In north carolina, we had synthetic marijuana, bath salts we put action on the precursor to methamphetamine. What im trying to do is to figure out what could be positive action that they could take, and what could be potentially problematic that needs federal consistency . Admin. Rosenberg i do not have in my head a statebystate state practices list, but i will get that to you. Be. Tellis that would helpful. From the extent that we could learn from other states that are doing it well, we can take action when it is not disruptive to what we are trying to do nationally. Admin. Rosenberg great question, i will get back to you. Sen. Tellis again, i do not think people understand what we are talking about. And syntheticss that exist. If you look at marijuana that is legal, it is several times more powerful than it was 2 decades ago. I worry about this problem increasing. Ow you have marijuana tourism people going from states where it is illegal, two states where it is not, and going back. Experience,a good they will try to create more potential demand. We have to get ahead of the problem, and other problems that could be created if they go to other, more powerful drugs. Is it true that china is one of the largest manufacturers of this substance . Of synthetics . Admin. Rosenberg yes, sir. Sen. Tellis what are we doing what morect them, and do we need to do . I want to talk about education, to decrease the demand. What are we doing to thwart the supply . Admin. Rosenberg i think mr. Made an important point. Even if the bad guys are tweaking molecules to invade operation, it gives our brothers and sisters at the dhs the ability to seize without a clouded legal landscape. There is a value in scheduling, just not a permanent value. Sen. Tellis because they keep moving the goalposts . Admin. Rosenberg it is still important. Sen. Tellis any comment . Mr. Hartunian we try to do what we do and all drug cases, to work up the supply chain when we establish our investigation. That is always the goal. Overseashat, we find targets and we have to do our best to identify them and follow the money when we can. To establish evidence that would allow us to reach beyond our borders. Sen. Tellis just to be clear on the china example, are these illicit operations in china producing the supply, or Legal Enterprises under the Chinese Government . Sen. Grassley after you answer that, we will have to move on. To my knowledge, they are engaged ,n the cases that we have seen they are conducting themselves in violation of our laws. Admin. Rosenberg i think that the answer is both. This year volume of chemical manufacturing in china presents a problem in looking at this, but they have part of their business looking at some of the illicit substances as well. We have been working with a joint Interagency Task force west with a special group focused on nps interdiction and precursors around methamphetamine. Admiral smith has taken this on looking at interdiction. Some of the challenges, particularly around fentanyl, is that we do not have good detection and monitoring. Sometimes hazardous monitoring around street fentanyl. Thank you for your testimony and work. I want to wrap my brain around a couple of things. One of which, we are talking about synthetic drugs. Orff that is on the street sold in head shops, that kind of thing. I want to ask, obviously we have had an Opioid Epidemic. Opioids are prescribed. I want to get understanding of this right. Say therosenberg, you 2014 National Survey on drug use 4. 3 million americans aged 12 or older report taking a prescription painkiller for nonmedical purposes within the past month. Were legal that opioids prescribed, and how many were street opioids . Of fentanyl because , you dont know how much is in it . Which is which . Leah started by coming at it from a slightly different direction . Sen. Franken no. Not admitting that im going to come at it from a slightly different direction . Oxycodone, those are stunning figures. Ask your question, initially, most of that stuff was legally prescribed and sitting in peoples medicine cabinets. What happens next, the street value lets say that you e hooked on oxo codon or hydrocodone tax oxycodone or hydrocodone. Stuff. Out of the the street price is pretty high. You may pay one dollar for milligram or 30 per code. The substitute is heroin. It is much cheaper. The substitute for that is fentanyl sen. Franken you were saying that they took prescription painkiller as a start for nonmedical purposes, 4. 3 million. Part of the testimony i read was that there is street pills that have fentanyl in them. Admin. Rosenberg yes, sir. Sen. Franken we know the vast majority of people who abuse reception drugs get them from friends and family. As they become more addicted, they often turn to street purchase of these pharmaceuticals. See fentanyl we pressed into pills that look like Prescription Drugs. Buying thinks they are an opioid when they are buying a fentanyl pill, which is much more powerful and has potential impact for death. Another thing i want to try to get into this is about scheduling. In terms of could there be some kind of conditional can e where we basically what is happening is somebody creates a chemical, they sell it as a bath salt, people die, it takes a while to adjudicate that, ok, this should be illegal. In the meantime, they change the molecule. ,hat is the barrier constitutional barrier, legal barriers, legislative barriers what are the barriers to saying weve observed that something has killed somebody or a couple people, we are going to put a conditional we are going to schedule this conditionally and no one can make this now. It is illegal to sell it now. What are the barriers to that . Mr. Hartunian the process youre talking about is emergency scheduling. Part of that provision is to make it possible to do exactly that. With limited information, less information than we have when the fda does the eight factor analysis. Sayshrockmorton the dea weve got reports of people being harmed, we think this drug is a substance we want to emergency schedule, the is next but i did mechanism for us to is an expedited mechanism for us to say we need to make this happen. A turnaround within a week, for instance. It has been followed by permanent scheduling. Two years ago, three years ago, the time that things were allowed to be emergency schedule was made longer. Something into that emergency schedule, make it illegal to manufacture while we it on the data maintains the control for a longer time. The question the panel is is can weely asking do it even more efficiently. Can we make a final decision about scheduling without having to go through that twostep process. Amount ofuce the information we need in order to come to that final decision more quickly . That is when we are talking about the fda, looking to see what is the barebones we need to have in order to make that recommendation . You, mr. Chairman. We passed the combating designer drugs act. We had a number of kids die in our state. We had a head shop in duluth that got closed down because there were so many people hanging out on the streets around it. A major federal prosecution, they were able to use the bill. E passed now, we have to do more. I am a supporter of senator feinsteins jill. Bill. I also support the bipartisan intothat actually looks what is happening right now and what is stopping us from prosecuting some of these cases. What is going on is that these as not intended for human consumption. We know they are intending them for human consumption. They put that label on. Then use that defense in court. It says not intended for human consumption, so you cannot prosecute us for that. Does is makes it easier to prove that these synthetic drugs are in fact intended for human consumption areooking at factors like they marketing them that way, what are the advertising and allows that evidence to be to take onin court this false claim. Thank you for coming to minnesota recently. Could you talk about this and these challenges and how this could help us close this loophole . I would like to specifically close this loophole. Mr. Botticelli we are supportive of looking at legislation to broaden prosecutorss authority. The way these drugs are marketed , the way they are sold, how they react, how their brain reacts, proven indicators of how these substances are intended for human consumption. Any enhanced tools we could give prosecutors to go after this would become an incredibly important vehicle. Carrying the Drug Court Funding for treatment. Our state has landed many treatment centers. It really bugs me when we cannot even go after the bad guys getting people on this drug. That is why we want to close the loophole. As you know,erg makes it challenging for us to work our way up the supply chain. The suppliers become more insulated from the folks who are actually doing the dealing, it becomes challenging to obtain evidence. The department has been working with your staff and wants to keep working with your staff to find ways to improve how we are going to prove that element. Mr. Hartunian our prosecutions in this area are relatively new. The have come on in the last five or six years. We did our first case in new york in 20102011. Ive been a drug prosecutor for almost 20 years. Part of it is the cost in the rural areas. The cost of testing and this analog problem it was such a hassle to prove it sometimes. Learningnian we are more coming getting more experience, seeing how courts are interpreting the evidence we are offering. Admin. Rosenberg i think we are Getting Better at it. We are learning more as we do it. Im happy to look at anything that helps us do that. Thank you so much. I willor feinstein help takeover the next panel. , forank you, mr. Chairman having this very important hearing. I had your job in connecticut for 4. 5 years, mr. Hart unian. World, seconde only to being attorney general in the state. Cases ase to try drug unite states attorney, taking that United States attorney,aking lessons from bob fiske number of cases i tried we did with the dea. Grateful and amazed by the extraordinary courage and her wisdom of the dea agents. Heroism of the dea agents. That deake for granted agents walk into situations where gunfire is likely as somebody opening the door. They operate in hostile environments where they are held accountable but no one elses. No one else is. I want to think the Law Enforcement agents, federal, state, local, who do this work, because it is challenging and demanding and they are on the front lines. Going to arrest or jail our way out of this crisis. Mr. Botticelli, youve been a very articulate and eloquent on behalf of the measures necessary to change our culture and our prescribing practices which are often the way the demand for those substances is created. You visited connecticut my thank you for coming to visit. Ive done a series of roundtables, producing a report that makes 23 recommendations and practice. Law among them, changes in the prescribing practices of doctors the powerfuling so painkillers are reduced. Is, what cano you change the culture and training we give to our prescribing physicians so they are aware of the unintended consequences and they are surely unintended, they are done with the best of motives and intentions, but i know percocet, vicodin, oxycontin are made available freely what can be done to change this culture . This issue is one that deserves our attention. Your leadership and some innovation happening in connecticut is really important. We know the root cause of our Opioid Epidemic starts from overprescribing of prescription pain medications. Physicians get little to no training on addiction issues in general. The cdc just came out with prescribing guidelines. We have been supportive of mandatory prescriber education. I dont think it is unreasonable in the middle of an epidemic to ask physicians to take an amount of education. One of our greatest deficits in this epidemic thats why weve been talking about scheduling, has been lack of Treatment Services in the United States. I hear the impact of not being able to get people into treatment in every state. The president has proposed a pretty robust proposal to expand treatment in the United States for every state. While we need to focus on we have somebody people in the u. S. Who need treatment who are not going to be able to get it. We need to look at expanding to reduce thess deaths. That is one of the recommendations in our report. The expertrned note thef our panel kernel Justice System can play a part in compelling people to seek and stay with treatment if it is a condition of probation. The expert members of our know that the criminal Justice System can play a part. Between an intersection investing resources and more a Law Enforcement and Treatment Services. The two go together. I want to thank this panel for being here. Youre making a real contribution. Thank you. Youve brought focus to this problem as senator feinstein and i and others on this committee are looking to work on quickly. Thank you very much. We will not have a second round of questions because we have a long second panel. I will start introducing the second panel while you are coming. Iowa. Rom and son, daniel, have become leading advocates to combat the threat of synthetic son, after his other david, fatally shot himself in 2 to masonsaking k attic marijuana substance, that caused him to have severe k2, ainations ,ynthetic marijuana substance that caused him to have severe hallucinations. Kathy from the d. C. Metropolitan Police Department has served as chief here in the district since 2007. She began her career as a uniformed officer in 1990 and served most of the time in the Fourth District rising to level of commander and became the Commanding Officer for the Narcotics Branch of a homicide unit and special operations she established the agencys first Homeland Security counterterrorism branch. She holds a bachelors and masters from Johns Hopkins university and National Security studies from the Naval Postgraduate School in monterey, california. Our third witness is Joseph Coronado who has served since 2013 as the ocean county prosecutor, chief Law Enforcement officer in ocean county, new jersey. He served as prosecutor in the new jersey state Attorney Generals Office in the Atlantic County Prosecutors Office and a private practice. He is a graduate of uppsala university. Serveslivan smith multiple roles as an Emergency Room Physician and as medical director for tennessee regional rescue squadr ems and his lieutenant in the cooksville Police Department and a fellow of the American College of emergency physicians, m. D. University of tennessee and residency university of tennessee memorial. Hall fromess, dr. Jim the center for applied research on Health Disparity at Nova Southeastern university. He serves on Scientific Advisory panel on the National Institute of healths National Drug Early Warning system and the u. S. Fda drug safety and Risk Management advisory committee. For the past 30 years, he has tracked patterns and trends of Substance Abuse in florida as the states representative on the workgroup for the state. Would you please start . Is the red button on . Or green button. Im sorry. Members of the judiciary committee, on behalf of my family and the thousands of families who have suffered as a result of the synthetic drugs and i want to thank you for inviting me here today. Im here with a heavy heart. Yesterday was the sixth anniversary of davids death. My testimony today is difficult. Our introduction to synthetic drugs occurred two days after our sons death. Friends purchased something called k2 at a local mall and david went to a friends home and smoked it. David started to become agitated, so we took them outside to walk him around and get some pressure. He told the boys he felt like he was in hell. Man in theian young hell represented the very worst place david could ever imagine. This is the scariest, evil thing he had experienced. We later learned that rapid heart rate, increased Blood Pressure, it is not an uncommon experience. David said he wanted to go home and take a nap. To get together later that evening and go to some graduation parties. Tragically come after coming home, david continued to be tormented by the drug. Instead of taking a nap, he came home and shot himself. We saw nothing and david to indicate he was depressed, much less suicidal. On cloud nine looking forward to his summer and university of Northern Iowa that fall. Investigation into his death concluded that he was not suicidal and that he had had a severe reaction to the drug. They can to go over your mind and body and you are powerless to do anything. Take over your mind and body. We are simply not doing enough, not moving quickly enough. Sadly, i have the same message for you here today. We are not giving Law Enforcement and prosecutors the tools they need. The New York Times ran a story 2010 regarding the problem with k2. Ithop owner responded once goes illegal, i already have something to replace it with. There are hundreds of these synthetics and we just go with a few at a time. That is exactly what happened. We started with Synthetic Cannabinoids, now, synthetic heroin. Who knows what his next. It is cheaper to bring these to market than their traditional counterparts. The landscape of drugs in Society Today has forever changed. We are living at a time when bath salts are not put in your bathwater. K2 is not the second highest mountain in the world, purple haze is not a jimi hendrix song and ivory snow is not soap. Marketers. Rrific they have used our own laws against us. Whoe people are murderers knowingly sell poison for their own financial gain. Davids death was the second in the u. S. From k2. Imagine talking to legislators in 2010 and telling them you wanted to ban bath salts or computer screen cleaner because they were drugs being sold under false pretenses. Not an easy task. Theredible person doubts tragic consequences of these drugs today or that we have a real issue. As we visit communities and schools throughout iowa, i continue to be amazed that after six years, there are still so many who have never heard of these drugs. How do you talk to your kids about things you dont even know about . We have to start educating parents and communities on the dangers of the synthetic drugs. We are in a battle for our children, grandchildren, schools and our communities. I pray you move quickly to take action. For to many families have suffered as a result of these drugs. Far too many families have suffered as a result these drugs. I ask you to provide resources and lawation enforcement with the tools they need. Please proceed. In order to avoid duplication of some of the other testimony, i would like to just talk about what synthetic drugs are doing in washington, d. C. And the challenges we face. I think it would serve you better to hear that. We have been dealing with the synthetic drugs now since around 20092010. They were marketed towards children. We saw scooby snacks. That was being sold in brady stores, gas stations. We would get calls for children on their way to school. In these Little Stores and andhased this scooby snack when they got to school, would be calling for an ambulance. Rapid heart rate, vomiting, possibly passing out. Nothing more serious than that. The chemical started to change and it started to become more prevalent and the names of the packaging started to change, the marketing to individuals began to change. We started to see proliferation of different types of synthetics in businesses around the city. Acrosssuch a huge impact the entire city. Public health and particular. What we saw when we had a peak last year in 2015 was literally as many as 20 calls a day for emergency transport by ambulance to take a person under the influence of synthetics and out of control or unconscious to the hospital. Think about 20 ambulance trips a requireh time, it would officers to take the person into custody many of these individuals, their heart rate is very high, their very agitated, very violent. The temperature goes up and we are trying to get them out of of the street or where they are putting other people in danger and we are in a position where we have to wrestle a person in that state into an endless and get them to a hospital. Officers were getting injured. The potential for these individuals in this excited delirium state to die from that struggle to just take them into custody and get them out of the middle of the highway, the ,otential for in custody death it was so significant last year, i would stop on my way home almost every day and have to nebulous for someone i saw who statether in a catatonic call an ambulance for someone i saw who was either in a he saidtate im a returning citizen. I spent a lot of years in jail for selling drugs and i would never sell a drug like this in my community. To me, that was the beginning of the understanding of just how significant this was. I also learned from talking to some of those individuals standing around while we are waiting for emergency transport, because of the individuals using the Synthetic Cannabinoids were under some supervision or probation in the community and the Standard Drug test did not test them for the use of Synthetic Cannabinoids, you have people who had been using alcohol and marijuana were switching to Synthetic Cannabinoids because there was no Standard Drug screening picking it up when they went to their probation officer. You have people switching to that drugs that they could stay on probation versus getting caught in that drug screening. I had several individuals tell me that personally. Because of that and many other reasons, we were doing everything we can in terms of enforcement we would seize large quantities, submit it for testing. By the time we would get it back, they had moved on to another drug. Seizing drugs with no ability to prosecute in many cases, we did work with our supervisory Affairs District to pass another to last year that allows us seize based on packaging, quantity, price. Fine the us to business up to 10,000 for selling that. Down, givea business them a 96 hour emergency closure. More a cost to doing business. , wecan get a 10,000 fine take the product and get it tested to determine if we can go forward with prosecution. This is an epidemic. It is not going to go away. It is continuing to change. Most recently, it targets the poor, the homeless and those that are living out on the street and most horrible to this. Vulnerable to this. About 20 of the people under supervision or that were arrested for felonies were tested, 20 were coming back positive for synthetics. That is higher than the drug of choice in the district for many years, cocaine. Pretrialotten the agency to do the screening for those under supervision and it has made a big difference for us. We still have a long way to go. This is a dangerous drug. The stories you heard about the impact it is having on people, i see that firsthand every day. Anything that can be done, we appreciate it. Thank you, chief. thank you for the opportunity to appear before you today. Im the prosecutor in ocean county, new jersey. Ocean county is the second largest county land wise in new with a population slightly over 600,000 people. On the people enforcement officer in the county. My office consists of approximately 200 employees. The emergingiscuss problem of synthetic drugs. This is not an isolated issue unique to my jurisdiction. Traditionally, they took the form of k2, spice and bath salts. Bute are still a problem, there are emerging variations. I witness firsthand eight Overdose Deaths in my county in my first week in office. As a father of two children come i knew it was my response ability to address this epidemic. Our opiates come from philadelphia and new york city. Acrogram can kill microgram can kill. In 2012 and there were 53 Overdose Deaths in ocean county. In 2013, there were 102 Overdose Deaths. The plan to combat this epidemic has broken down into three areas. Prevention and education, strict Law Enforcement and breaking the cycle of a diction. Of all the initiatives implemented, narcan has led to stunning revelations. I researched what other states were doing and came across narcan. Ocean county became the first county in the state of new jersey to implement a Law Enforcement narcan program. Which included all Police Departments. Kits, seizedarcan dollars from drug dealers to pay for the program. The first police use of narcan was on april 6, 2014 in seaside heights. Narcan int of ed in 2015,y 217 deployments. Hurt 73 deployments 173 deployments. Overdose toll had risen to 118. The statistics of 2016 are not promising so far. We expect the range to be in 150. D hospital, detox and Treatment Options emt and paramedic deployment from a patient is transported to the hospital emergency room for additional treatment and monitoring. Treatment but prior to release,ecovery a recovery coach meets with the patient. A Pilot Program we instituted and enter a detox facility. The patient will stay 4872 hours. Assessment of the Treatment Options are discussed with the patient. They may be transferred outside. Working with the state police these packets are cocktails containing many other drugs such as cocaine, caffeine, morphine and methamphetamine. Appears regularly now in ocean county. Is 100 timesnyl morphine. Ful than there is fentanyl and tablet w18, 10 times stronger than morphine. Here is the issue. Law enforcement has a distinct problem with synthetic marijuana. Chemist constantly changes a small component. They use this to elude Law Enforcement. Designers change one small component to elude testing. The synthetic opiates are produced in pill like form. We recently signed on to support bill andfeinsteins f the salt act mentioned here today. Im exploring to see if we need to adapt and modified the use of to address synthetic overdose. I will look to congress to assist Law Enforcement communities and health care committees to address this issue. This is an addiction issue that needs to be addressed with Law Enforcement and health care collaborating. Thank you very much. Dr. Smith . Dr. Smith thank you very much, sir. It is an honor to be here. Ofas asked to speak in terms the medical aspects of these dangerous drugs. I want to lump them into a couple of groups. First is cannabinoids. Youve heard about them in previous testimonies and statements. Same receptorse marijuana does, the thc receptors in your brain. The second, serotonin and dopamine come all of which are responsible for pleasurable feelings. There are different receptors, but they affect people in much the same way. I have a hard time telling them apart as an emergency position. Everything youve heard today his true. Is true. What pressure at critical levels, heart rates, same way. Blood pressure at critical rates. Heart rates, same way. , 106, 107. Ature seizures, kidney failure, paranoia. Agitation. Violence. Violence beyond anything youve ever seen. Its all very common with these drugs. The other group, the opioids. The synthetics their cause euphoria and sedation and respiratory failure. They cause low Blood Pressure and death, generally from the respiratory failure. Youve heard how potent the opioids are. If you think about most medicines we use today, these things are used in milligram quantities. A volume of a milligram, youre talking about something that is akin to a grain of salt. These things are diagnosed in micrograms, tiny fractions of a grain of salt. Imagine a little variation in how small that has to be to cause a fatal result. There are a lot of problems here. A lot of that came from the Law Enforcement and of this discussion. There are no tests for these things. Because of that, this epidemic that is here now is much better than we know thats bigger than we know. And it is growing. Is here now is much bigger than we know. Odalys three years, weve admitted 198 to our intensive care unit. Over the last three years. These people stay in the hospital sometimes two weeks. Those kinds of beds needed for other patients, it averaged 29,000 a patient. That is just pure fixed cost to our system. Not charges, just cost. Million in care to my hospital alone. Only three of those people had any insurance whatsoever. We dont know the longterm effects. We know the shortterm effects. We team behavioral disorders, people with kidney failure we have seen behavioral disorders. People with kidney failure. And way too many deaths. In a survey, over 1500 people, physicians, emergency positions across the u. S. Responded with interesting results. There were 95 of physicians who of an increase in the number these drugs and their presentations in the emergency department. Staff had seen violent act committed by these patients and 42 of the staff had seen actual injuries. I will tell you two stories i personally dealt with to put this into a human perspective, although i dont think i can touch anything mr. Roscoe said. We had a 14yearold child who weighed 114 pounds. This young man had consumed a cannabinoid. We could not keep him on the bed. He was restless and agitated. In order to control his behavior ofgave him 140 milligrams theum in his first hour typical dose is somewhere between one and three milligrams for someone his size. Given one ofn was 40 milligrams 140 milligrams. Dose tomes the typical control his behavior. Any other child would have required lifesupport. In order to stay alive. That only kept him on the bed. We kept talking to him. In the next hour, he was transferred to a pediatric intensive care service, he consumed another 100 milligrams of heversad. A man who had been consuming cannabinoids that like he was being attacked. Felt like he was being attacked. He took out his pepper spray and sprayed those attacking him. His girlfriend called the police. The first Police Officer went through the door and was he was about to spray those attackers. This is dangerous stuff. I am not a legal expert, but you , youto become very nimble have to be able to make these things go away. Anything you can do to prevent the manufacture, the importation, the trafficking, the use, the possession of these given your power under the constitution is imperative. I appreciate the chance to talk to you provide honored and in your service. Thank you. Grassley and ranking what are known retroactively as psychoactive substances have become a major problem in the 21st century. Along with the nonmedically misuse of pharmaceuticals and heroine. Youve already heard the nature and extent of the problems caused by these toxic and addictive substances. I will use my time to provide examples of their impact in the state of florida as well as to ofress vital roles surveillance epidemiology in the early identification and spread of these substances in the United States and around the globe. In automotive 2014, Fort Lauderdale was hit with an epidemic, medical emergencies and deaths from the synthetic alpha pvp sold on the streets as flocka. It resulted in 63 deaths in Broward County alone and excitingthousands of medical emergencies. Purchased online by midlevel dealers from chemical suppliers kilogramcome a single sold for 1500 and produced 10,000 doses. United theof flocka community under the leadership of the county government in the local Drug Prevention coalition of the united way. Their rapid and extensive response brought worldwide Media Attention and pressure on the government of china to ban the production and sales of alpha pvp along with 115 other synthetic drugs effective october 1, 2015. Wasin two months, flocka gone from the streets of Fort Lauderdale. Community,ng how a working together across multiple agencies and organizations can impact a global problem. Over the past two years, nonpharmaceutical fentanyl produced in clandestine labs in china and probably mexico have been linked to the majority of related deaths just in florida. It has been sold as street her win or used as an adult rent heroin,nt mixed with figs and next fake xanax and oxycodone pills. Have beenentanyl identified tragically after people have died. The twoyearold National Institute on drug abuses National Drug Early Warning system based at the university a providests website special reports on synthetic drugs, webinars from leading , list serves linking 1200 scientists and criminal justice professionals from 12 nations in realtime. Surveillances conducted by the network of Investigative Support Centers and the European Monitoring Center for drugs and drug addiction, which is currently tracking more than 560 novel psychoactive substances, synthetics8 new identified for the first time in 2015. The radar system which studies Prescription Drug abuse has recently identified benefit pills containing counterfeit pills containing pharmaceutical fentanyl the current federal controlled substance analog act needs updating to streamline the classification of new substances and facilitate prosecution of criminal activity associated with them. For china to ban their production and online sales and exportation. The most important strategy is to reduce the demand for drugs of abuse, including the Opioid Epidemic. Prevention, particularly at the Committee Level that Community Level and a massive expansion of Addiction Treatment nationally. Thank you. Now, i have questions. Before i ask my questions come i l ask that i have to leave you and your family have become tireless advocates for education and awareness. You were honored as an advocate for action by the office of National Drug control policy in 2013. May be too easy of a question for you, but one we have to have your feeling on. Can you tell us more about what you and your family have been doing in this area . You been working with families of other victims. Do you think there are additional steps the federal government needs to take to educate young people about the dangers of synthetic drugs . Hasur family specifically worked with the Governors Office of drug control policy in the state of iowa and been invited into schools, community groups, churches and so on and so forth. Just to speak to the people there were students of these synthetic drugs. Predominately amongst the parents, a lot of our kids, grandkids are sometimes all too well aware of the substances but it has not registered on the adultss radar. We need to have better tools for Law Enforcement, prosecutors. There needs to be an educational element to this that gets out to our communities. We have worked with other families and keep in contact thatother families have experienced loss and bad situations. What we do is not meant for everybody. It is not easy to go and share and talk. When i do these things come i put on my game face. Feel called to do this. Sons legacy our as well could we do not want to see his death be in vain. I would hope and prayer would be that no one has to suffer what we have come a sadly, that has been the case. Statistics synthetics compared to crack cocaine in their ability to bring violence per last summer, there was a spike of reported cases of synthetics here in the district. A number of Violent Crimes that appeared to have connections to these drugs, including the murder of a young man on a metro. Could you describe specific cases or types of cases where synthetic drugs led to violence in the district . I know you cannot talk about ongoing investigations, but can you confirm the synthetic drugs young a role in that congressional staffers murder last year staffers murder last year . Lanier sometimes we were told by family members. Yes, the case you are referring to is one of those cases. , anad a recent case innocent victim was viciously murdered. I happened to arrive on the scene just minutes after the suspect was taken into custody and as soon as i look at the the way he was behaving, the officers trying to maintain him in custody, i knew immediately he was under the influence. Thats how dramatic the behavior is. I would liken it more to pcp than crack cocaine. My experience here in the district is in the early 1990s, we had an issue with pcp. To pcp withty violence is striking. The impact on our policing it is so difficult to go after what initially started as something that targeted children and then targeted the general public and then targeted the people that were the most horrible, homeless vulnerable, homeless and poor. Strategy has to change daily. I have narcotics officers that are very good and effective. 232 pounds of the stuff last summer. It is becoming established as a streetlevel drug. When it was sold in packages and ready stores ready stores, that was troubling variety stores, that was troubling, but now, it is being sold on the streets and the consequences are drastic in terms of violence. Thank you all for your testimony. Thank you very much, mr. Chairman. Thank you to all of you for your good work. Seen theprobably prince autopsy is out. Today is prince day in minnesota soh his birthday, he is loved in our state and a musical genius. We have seen synthetic drugs and opioid Addiction Treatment of people who are not nearly as famous in our state. I wonder if you can comment on fentanyl and what you are seeing in terms of the increases and how that is playing out in overall synthetic drug abuse issues. Mr. Coronado when you are finding is there is fentanyl included in the pack. The bodies cannot handle it. It becomes a marketing tool. Because it is so inexpensive and because it is so prevalent right now, more and more people when they become addicted to an opiate are going towards her win but they do not know what they are getting. Theyre getting fentanyl in a combination. It is a death sentence. One, they get prescribed or two, they are getting illegally. Coronado fentanyl is usually used for cancer patients. That is how it is prescribed. E dont see it abused there it is being synthetically produced and used. When we had a hair when lab test her win lab in our county lab, theyt a heroine did not even know how to package it. They had googled it. We were able to determine that this is where they were putting it together. We are leaving this hearing now. You can see the rest on www. Cspan. Org. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] [captions Copyright National cable satellite corp. 2016] 7, 2016. I hereby appoint the honorable steve womack to act as speaker pro tempore on this day. Signed, paul d. Ryan, speaker of the house of representatives. It the speaker pro tempore pursuant to the order of the house of january 5, 2016, the chair will now recognize members from lists submitted by the majority and minority leaders for morning hour debate. The chair will alternate recognition between the parties with each party limited to one hour, and each member other than the majority and minority leaders, and minority whip limited to five minutes, but in no event shall debate continue beyond 1 50 p. M. The chair recognizes the gentleman from West Virginia, mr. Jenkins, for five minutes. Mr. Jenkins thank you, mr. Speaker. The house will vote this week on a resolution of disapproval on a carbon tax, a new tax that would greatly hurt my state of West Virginia. West virginias the second largest producer of coal in the United States. The coal mine in West Virginia made this country what it is today. It made the steel that built skyscrapers and the ships that won world wars. If a carbon tax would be imposed, all of this would change. According to the nonpartisan congressional budget office, a carbon tax would hurt our economy. Raise prices and diminish peoples purchasing power. It would reduce the number of hours people worked, resulting in lost wages. It would also disproportionately hurt lowincome families and raise Energy Prices for seniors and for families. West virginia already has one of the highest unemployment rates in the nation. What we need are policies that create more jobs, encourage companies to expand and hire, diversify our economy, and reinvest in our people. Our coal miners and our coal fields have suffered enough. They cant afford a tax on the very energy West Virginia produces. The message is clear, West Virginia needs more jobs and reinvestment not a carbon tax. Mr. Speaker, the e. P. A. Is at it again. Its writing yet another rule that will hurt our economy and could make it harder for us to build new roads and create jobs. In this economy, when West Virginia has one of the highest unemployment rates in the nation, the last thing we need is more red tape. We dont need more bureaucrats getting in the way of our state s ability to develop our resources. The new ozone standards the e. P. A. Wants to impose on states would hurt manufacturing, drilling, mining, and agricultural operations. Hurting the families who depend on these jobs. The e. P. A. Is ratcheting up its ozone standards on states. Most states and counties havent even met the 2008 ozone standard, and now the bar is being raised again. This is unrealistic. Counties not in compliance with the new standard could find it even harder to attract and build new developments. In southern West Virginia, that means we might not be able to redevelop our former mine sites to full productivity and potential. It could even hold the much needed hobet mine redevelopment. Nonclient counties also might not be able to build even new highways. For southern West Virginia, that could mean long planned highway projects are put on the back burner again. This week well vote in the house on a bill to put the brakes on the e. P. A. s latest actions. Well give the states time to catch up before the e. P. A. Tries to impose yet another standard. We will protect Public Health while ensuring implementation of new ozone standards that dont cripple our economy. This is a commonsense bill that deserves bipartisan support. Mr. Speaker, i yield back. The speaker pro tempore the chair now recognizes the gentlelady from new york, mrs. Lowey, for five minutes. Mr. Speaker, i rise to honor an extraordinary public servant, anita datar, who was tragically killed late last year during the despicable terrorist attack at the Radison Blue Hotel in mali. Anita, only 41 years old, was senior director for field programs for the International Development firm palladium. She went to mali on a usaid supported Research Project focused on womens reproductive health. Raised in new jersey, anita devoted her entire career to international Public Health and development. She started as a peace corps volunteer in senegal and then continued to travel throughout subsaharan africa, latin america, and the caribbean helping vulnerable communities escape poverty and disease. Anita founded a Nonprofit Organization that connects lowincome women in developing countries to Quality Health services. She was especially committed to expanding access to Family Planning services and treating and preventing h. I. V. Anitas son is in the gallery today with his father david. They will join anitas friends and colleagues at a reception this evening at the u. S. Institute of peace to remember anita and celebrate the mark er work left on so many. Rohan recently moved to my home district in new york. Were proud and honored to have you in our community. Your mom made the world a better place through her passion, her spirit, and dedication to helping others. Herselfless commitment to service is one of the many indelible legacies anita bestowed on rohan and all those who have the honor of knowing her. Mr. Speaker, i ask unanimous consent to place into the house record the text of the s. Res. 347, a Bipartisan Senate resolution honoring the memory nd legacy of anita datar and condemning the terrorist attack in bamako, mali on november 20, 2015. We will continue to be inspired by anitas dedication to helping others. Thank you. I yield back. The speaker pro tempore without objection. The material requested by the gentlelady from new york is entered into the record. Pursuant to clause 12a of rule 1, the chair declares the house in r on thursday, the house will consider legislation to help puerto rico with its financial crisis and a bill setting congressional spending for 2017. For more on the congressional schedule, here is an interview from this mornings washington journal. The senate is mostly focused on the Defense Authorization bill. Theyve been trained to get policy set for the pentagon next year. The house will be coming back to vote tonight. Congresstions for itself. They decide how much money to spend on their own offices and their own staff. Host what is going on off of the floor . Theres lots of focus on the president ial primary, but also some interesting congressional primaries today. California, iowa and north carolina. Some competitive races that will key points decided today. Talk a bit more about those races because we will beginning our viewers primary results tonight. Be giving our viewers primary results tonight. Caller the most interesting state if you had to pick one is north carolina. Newurt ordered a redistricting round. A lot of members of Congress Today are running in new districts. To have one district where incumbent republicans two incumbent republicans have to face each other. Tonight, one incumbent will lose for sure. Donald trump came in pretty late this week and endorsed rene elmers this w race. Either way, we will have an incumbent lose tonight. Theres some open seat races in a lot of places. In california, theres multiple real fights there in multiple districts. The top two finishers in the primary make it to november, regardless of party. In some races, you have democrat versus democrat. Paul ryan also unveiling part of the republican agenda. What will he be talking about and why begin with this topic of poverty . Caller hes talking about a new approach to poverty for republicans. This has been a passionate issue for him. He got his start working for , a famous figure in republican politics who spent years and sing the party needed a new approach to dealing with poverty. That is something paul ryan has cared about four years. It is no coincidence that if paul ryan is the speaker, this is the issue he will lead off with. They are also prepared to roll out policies on health care, energy, Foreign Policy come everything. Poverty comes first because it is close to paul ryans heart. Host what are your repeal reporters telling you about how lawmakers are reacting to Donald Trumps comments . Caller paul ryan has commented on this once. Comes comments on the judge came out of left field. Mitch mcconnell has criticized it. Susan collins did, Lindsey Graham has strong comments. He suggested republican lawmakers who have endorsed trump should rescind there were theirtions rescind endorsements. Drawn strongs have rebukes from republicans. Is it bad enough that paul ryan and others will withdraw their endorsements . Paul ryans likely gets that question at his event today. Go to www. Cspan. Org for details of our coverage. Four housecspan2 and floor proceedings as they get underway this morning. House and floor proceedings. I want to show you todays of National Journal daily. Who was the format and the audience back in 1991. It was a fax newsletter that when out in the afternoon. It was touted as this revolutionary concept. We will give you news the same day it happens. It sounds almost quaint, but back in 1991 when there was no internet, it was unusual. This would go out to fax machines on capitol hill and the idea was watch your fax machine late in the afternoon and you will get news of things that happened today. Now, that is old hat. At the time, it was a unique product. Host how closely were reporters tasked to following a certain issue and a certain beat . How often did reporters report on an issue . Caller sort of granular coverage. The editor blasted that readers would not be interested in this stuff. Committee markups and floor proceedings and amendments and really intricate stuff that tv networks were not interested in. People in washington wanted to know in great detail what was happening on the floor. That is one of the driving things behind National Journal. Host what has changed in 25 years . Caller we launched a morning product. Daily. L journal to tell more stories people what is going to happen in the future and not just what happened yesterday. We think there is real value in telling people what we think is going to happen tomorrow and next week and next month. We try to see around corners and see big picture analysis. Host congratulations , british ed kingdom Prime Minister David Cameron and the Independence Party leader will debate it this afternoon. Cspan3 will have live coverage at 4 00 eastern. Our live coverage of the president ial race continues tonight with primaries in six states california, montana, new jersey, new mexico and north and south dakota. Hillary clintonon more different vision for our country, our side of democrats for progress, for prosperity, for fairness and opportunity than the presumptive nominee on the republican side. Donald trump so were going to win for our vets. Were going to win on education. No more common core. Bring it down. Bring it down. We want it local. Were going to win with health care. Were going to win at the border. Were going to win at trade. Bern senator sanders we have to redefine what politics means in america. We need people from coast to coast standing up, fighting back and demanding a government that represents all of us, not just the 1 . Join us live at 9 00 p. M. Eastern for election results, candidate speeches and your reaction, and well look ahead at the fall battleground states. Taking you on the road to the white house on cspan, cspan adio and cspan. Org. We are going public. Well be watched by our friends and by people across the country, and i would hope, as i id before, that the senate may change. Not as an institution, but may become a more efficient body because of televised proceedings. The proceedings of the United States senate are being broadcast to the nation on television for the first time, not that we have operated in secret million now. Millions of americans have sat in the galleries and observed Senate Debates during their visits to washington. But today, they can witness the proceedings in their own homes. And the senate floor has been the kind of stage the senators have been acting on that stage. The audience is in the galleries and by our action today, we havent really fundamentally altered that situation. We simply enlarged the galleries. We have pushed out the walls to include all of the American People who wish to watch. Commemorating 30 years of coverage of the u. S. Senate on cspan2. House Speaker Paul Ryan reacted today donald trump statements regarding a judge overseeing a lawsuit against a trump business. Speaker ryan was asked about it during an event unveiling a republican antipoverty plan house of help, city of hope. Its an alcohol and Drug Treatment Program in a lowincome neighborhood of washington. The proposal would make changes lfare, food and howing housing aid, make the aid more efficient and allow states to make more decision about how its distributed. Good afternoon, everyone. Thank you for coming. Im so very glad to have you. My name is bishop sherly hallowway and youre standing at grace view, which is house of help, city of hope at grace vufmente i am so very glad that you are here. I have the awesome privilege and pleasure to introduce our speaker, our guest speaker here to announce his plans. Let me tell you a little bit about paul. Paul entered into congress in 1999. And he was 2012 chairman of the ways and means committee. And i found a man that really loved his country and he loves his people. Hes been here three times. He met the people. Hes taken time to listen to the stories. Hes taken an opportunity to hear the lives and i believe that he listens. He says to me all the time that his mom taught him this, and i also have come to cherish her advice that god gave us two ears and a mouth and we need to use it in that proportion because oftentimes were busy talking but were not listening. So id like to introduce to you who i consider the listener of america, i introduce to you the speaker of the house [laughter] theres no room. Id like to introduce to you the speaker of the house, paul ryan. Put your hands together. [applause] the speaker i think we need a new podium here. If i can do some reorganizing, if you dont mind. Oh, my gosh. I saw that coming. Grab that. Ok. This is the biggest one here. That thing is too big. Ok. Deidre, do you want to hand it to me again . You guys. Sorry. Were really sorry. The speaker theres always a first in this job and heres another one. Im going to put this thing sideways and if it works it works. If it doesnt it doesnt. I dont think its going to work. Ladies and gentlemen, budget chairman and engineer tom price. First of all, i want to thank pastor shirley. I want to thank pastor shirley. Bravo. We are so grateful for her hospitality. This is my third time here at grace View Apartments at the house of help, city of hope. The house of hope, city of help. I always get that wrong. When i came here a few years ago, i met a guy named james woods. James is recovering right now. He just had some health issues, some heart surgery. Jails told me a story about four years ago. In this neighborhood he lived, he sold drugs, he was violent, he was involved in gangs. He went homeless. He got addicted. Then he went to jail. After he got out he wanted to turn his life around. So what did he do . He came here. He went clean. He got a job. He got married. He turned his life around 180 degrees. So i remember asking james, how did you do this . How did you come from a life of deprigs, homeless, crime drugs, homeless, crime, turn it around and he said two words pastor shirley. What she did was she held him accountable. She created an environment where right was right and wrong was wrong and she held james to those standards. She got him through this tough time because she got through to him. She didnt parachute in some social worker. She was part of this community. She had credibility. He knew when she said something she meant something. And what she taught him was that selfrestraint is the essence of selfrespect. You know, if you are struggling in poverty, sometimes people around you have to recognize your inner worth before you can see it yourself. Now, i think we need to take this lesson and we need to apply this lesson to our entire economy. These are the people who are fighting poverty on the front lines and these are the people who are fighting poverty on the front lines and theyre winning. If theres anyone we should listen to it is them, the people here in our communities who are actually successfully fighting and winning and beating back poverty. Thats what theyre saying, and what theyre doing is theyre not isolating the poor. Theyre elevating the poor. If we want people to contribute to our society, then we need to reward those contributions and thats what the plan that we are unveiling today that if i pull out i might knock all these things off you got a plan in your hand . Otherwise im knocking all your microphones off. This is what the plan were unveiling today does. It rests on five principles. Number one, reward work. To r two, tailer benefits peoples specific needs. Number three, demand results. Hold each other accountable. Number four, improve skills and schools. Number five, help people save and plan for their future so that people have their own horizon that theyre shooting for. This is how you fight poverty. This is how you create opportunity. This is how you help people move onward and upward and this is just one, the first installment of our sixpart agenda. We are calling this agenda a better way. We are calling this a better way and we will be rolling it out over the next three weeks. Can go to better dop better. Gop. We think this sums up our case. We want to build a confident america where no one is stuck, where no one settles and where everyone can rise. That is why we are here today. I want to thank our members for their hard work on this plan. What you have here assembled are members of congress from all parts of the country who work so tirelessly on our task force to deal with issues of poverty, to deal how you restore upward mobility, how you make sure we have a confident america and i want to thank Bishop Shirley holloway and everyone here for inspiring us to do better. Thank you very much. [applause] well, mr. Speaker. I can see what your challenge was here. Listen, thank you very much, everybody, for being here. Mr. Kline bishop, thank you for being here. Not for just hosting us here today but showing us there is a way. There is a way for every american to have hope and to achieve their dreams and to come out of dire circumstances and move forward into a very successful life. But thats been our challenge, and thats why this group has come together. Weve been fighting a war on poverty for over 50 years, and weve been losing the war on poverty for over 50 years. We have some examples of success and by golly, theres one right here. We need to find a way to give people hope and to come out of poverty, not be held in poverty all of their lives. So were doing a lot of things. Im the chairman of the education and Work Force Committee and it is clear i think to all of us that you cannot achieve your dreams, you cant come out of poverty without an education, without the job training you need to get the job that you need so that you can have meaningful work and pull yourself out of poverty. So were going to do several things. Were working on them already. We need to make sure that our Early Childhood learning is quality learning, that its doing what it is supposed to do. We need to reform Higher Education so that more people have an opportunity to get the skills that they need, to get the job that they need to come forward. Ive been very proud and pleased to be part of this group working with my colleagues. This is a better way. I almost did it again. You shouldnt touch anything up here. This is a better way. Were proud to be bringing it forward. We need to give people hope and an opportunity. And i think now jackie walorski. Mrs. Walorski well, good morning. I consider it an honor to be standing here with bishop to see hands on the difference that people make in this country. And the one thing i took away from her this morning was that words matter. And the bishop as well as everybody in this place could tell you weve heard a lot about breaking the cycle of poverty in this country. Theres been a lot of words spoken. Theres been a lot of words exchanged, but im also grateful to be a member of congress and have an opportunity to fix one little piece of this and to bring attention to one little piece which is this issue of snap. I lead a subcommittee on nutrition and we looked at the past, present and future of snap. And the one thing that is a motivating factor here is the same kind of motivation we view on this subcommittee. We heard in our hearings firsthand from people that are really trapped in whats called the fiscal cliff. Instead of celebrating and being happy about a promotion or the next job or the next run out of poverty, theyre full of anxiety because there is a ceiling that keeps them down. And im just im so happy to be part of a group today with speaker ryan and this better way that has taken all the words over the decades and put them into a plan that we can move through the u. S. House of representatives and this congress and lead the way for thousands of people who are trapped and to actually do what we said with those words, build a bridge out of poverty so every child in this nation can still reach their american dream. And i couldnt be more proud today than to stand here with e bishop and all the folks and her team here and for the speaker for allowing me to do my little part. Thanks so much. Mr. Conaway thank you. Im mike conaway. Ive been workingh
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