Transcripts For CSPAN Issue Spotlight Opioid Epidemic 20170821

Last year for people under the age of 50 is Drug Overdose. That is according to data by Public Health agencies compile over time. That is more than the highest car crash was 54,000 and 1872. More than a 50,000 who died from agerelated publications in 1995 and more than 39,000 who died from gun violence including homicides, suicides and accidents in 1993. Two hours here on cspan, we want to take an in problem, k at the hearing from state officials on the front lines of the opioid medical professionals who treat addiction, lawmakers from hard hit areas, we want to in just a little bit. Well open our phone lines and you how the Opioid Epidemic is affecting you personally, first, part of our conversation from the author of he book dream land, the true tale of americas opiate epidemic. I want to ask you about something you wrote on your blog. Days g about heroin these is another way of writing about america. Who we are and what weve become. That. Ou explain sure. I began, it began to occur to me as i began to write. In the middle of this project, and i began to wonder this problem was affecting appalachian, but why it was affecting charlotte and salt lake and places that did very well in the last 20 to 30 years, not rustbelt areas at all. Common denominator . I began to understand that the denominator was our own isolation and that you were really writing about much bigger than simply Drug Trafficking. My background is as a crime thought i was writing a book about Drug Trafficking from mexico and marketing, pharmaceutical marketing, all of that is certainly part of the story, but beyond that it gets into who weve become. Weve become so isolated, weve done enormous amounts to destroy community in this country. The dream land title comes from a Swimming Pool in portsmouth, ohio, in on the ohio , river. Once were the thing the held the town together, thats where you grew up, it was a place where everyone came together and really. Ommunity obviously, it was sustained by jobs, sustained by good downtown, a main street. But once that went away, once away, it was ent ike salvaging of the societal immune system. Left places very vulnerable that ook place in a rustbelt areas, destruction of community, but in wealthier areas, and in suburban was so isolated, uburban community, architecture, almost designed for that. Technology, while it connects us really does a lot to separate us, so these were ome of the reasons why writing about heroin is writing about who weve become as a country, as a people. Dream land in d ohio. Mouth, what should viewers know about mexico . Yes. Part of my book deals with the uys who first figured out the heroin traffickers, who first igured out that this very aggressive push to promote pain pill prescribing among doctors doctors buying into that idea, would eventually lead to a heroin a vast new heroin and the guys that i write about in my book were the ones who figured that out and saw in columbus,erging ohio, in the areas around there. He various cities around cincinnati. Wheeling, West Virginia, places like that. Hese guys had developed a system by then, they developed coast, where all the markets that they broke into static number a of addicts, and they are all from the same town. T was all this one town in particular, i think it played a very Important Role in this. Name of the town these guys figured out a retail selling heroin by the 10 of a gram. Ery much similar to pizza delivery. So you call, you order, they to deliver driver hits of heroin to near where you lived. With their model initially developed it on the western side of the united tates, where the number of addicts were static. They became master marketers. They couldnt kill each other all from the ere same town. They knew where each others mother lived. When they competed they couldnt eliminate the competition the way people in the underworld traditionally have dating back capone. So they had to become master marketers and thats what they became. Way of discounting, giving dope away free in front of who done clinics, to guys just got out of jail. You bring five new customers, 50 balloons of heroin, that kind of thing. The key moment comes when they river for ssissippi the first time. One guy in particular, i talked jumped the ok, mississippi river, landed in olumbus, just as a massive new push is under way by pharmaceutical companies and pain specialists, particularly area of southern ohio, est virginia, kentucky, to promote narcotic painkillers by oxycontin, as t, new solution to pain. This creates a whole new number of huge new addicts and they are there to then service those addicts once hey can no longer afford those pills and are looking for something cheaper. So youve got a story of ohio, ike portsmouth, youve got the drug traffickers mentioned, what should viewers know about Purdue Pharma . Forming crucial in what we have today. Primarily i would say oxycontin was crucial. The drug that Purdue Pharma makes, was crucial. For two reasons. One was that Purdue Pharma used aggressive form of marketing to doctors, giveaways, similar to the marketing techniques that the boys used to pharmaeir heroin, purdue used to convince doctors that these pills were no longer particularly, oxycontin was no longer addictive and they would be fine prescribing it to their patients. And they gave away stuff. Dont do this any more but for seven years, for the drugs life they gave away trips. They gave away a c. D. Called swing in the right direction oxycontin, where we got some swing band tunes. T was a very aggressive, constant kind of marketing to doctors to convince them that to do. S fine and also, oxycontin was a crucial part of this because not contain any abuse deterrent for the first 14 years of its life so it took addicts, people would get addicted and it would take their tolerance up to very high would be d then they looking for a cheap potent heroin proved to be that, particularly the heroin from mexico, proved to be the crucial alternative in that. Showed viewers this chart of Drug Overdose disabilities 2016 rising somewhere to 65,000 people in United States, in 2016. Where is your story taking years . What i would say the mid1990s, i in in 2014. Ook those years, i would say, where then, of ing, and course, its interesting, when i was writing the book, im a long reporter and i kind of knew the most innovative and changing part of our economy is the underworld. Its always morphing into something new. I kind of knew that part of the story would just continue to morph as the book and the book came out thats also whats happened with the emergence of fentanyl as an people are drugs using. The book is dream land, true opiate americas epidemic. According to the centers for disease control, West Virginia highest opioid death rate in the country. 41 people died of opioid overdoses for every hundred thousand residents of state. The second and third hardest hit and s were New Hampshire kentucky. Public safety secretary john on ally of kentucky was capitol hill earlier this year testifying about the opioid state. Ic in his we loss hit 1,404 kentuckians congressman said. Fentanyl is now the driving force behind these overdoses. 13,000 e. R. Visits. 13,000 e. R. Visits in a state of 4. 5 million people. Country, youve heard the numbers, nearly a commercial airplane per day. If this were a disease we would wearing hazmat suits to combat it but overdoses and those visits only tell half the story. Devastates communities. As soon as we got our arms around heroin, we began to see fentanyl. State police tells us in the last six years alone, weve seen 6,000 percent increase in fentanyls in our labs. 6,000 percent increase. I think all of us know the devastation it had on our justice community, our jails and prisons are at capacity. Inn. Ave no more room at the the Public Health crisis is on full display in c. I. A. Hepatitis c rate, a form of Viral Hepatitis at seven times the national average. In t across the river indiana they had an outbreak of. I. V. That rivaled that of subsaharan africa. So we passed, one of the first pass a states, to comprehensive Syringe Exchange program and now in kentucky we have 30 programs passed by local option in our state. We know that that increases the treatment capacity by five times. Someone just walks over the doorstep of one of those programs and it battles back diseases. Sadly kentucky, as the cdc 54 of 220 counties, most susceptible to a rapid outbreak of h. I. V. So what is our response in kentucky been . Bold step on the exchange program, passing comprehensive legislation in consecutive years on and pill on bills mills. Second state in the country to attle back synthetics, dealing with heroin directly and fentanyl. Being the first state in the usage of whatdate we call our Prescription Drug monitoring program. Weve become the first state in the country now to equire physicians when prescribing, to limit for acute ain to limit prescriptions to three days. Some have done seven or 10. E limited it to three days and i can promise our governor spent some capital on that thats how him. Tant it is to weve dubbed things on worker rograms and help for those who are addicted through various forms of treatment. Gain, looking at things like neonatal abstinence syndrome, weve increased funding many and to helpbat that the suffering of those addicted there. Weve put it in our jails and in our prison. Again, i think i mentioned rocket dockets with prosecutors put y to make these cases, them on a separate plane to deal with them in the most appropriate way possible. Weve increased treatment at the department of corrections by nearly 1100 percent since 2004. We validate that treatment every year. The return on investment now is almost 5. Some of the innovative programs have heard about is just recently chronicled in the new is the way we use trexone on the front lines. We give an injection prior to release and injection upon we try to link that returning individual to the services in the community, to if they are medicaid eligible, to see what resources they have to continue that a question d i know will be do we link those folks up to counseling. We do our best. Its not mandated. Best. Our in kentucky ill tell you both validated and anecdotally were tremendous results from sing m. A. T. And counseling together but in the form of cognitive behavioral therapy, seeing that used in jails and prisons. Emulate whats been going on in rhode island with the anchor e. D. Program. We visited with the director ago through an nga project and were doing peer recovery and bridge clinic soon. Well use a to the line to get folks linked up o treatment and educating our medical and dental schools. Ide close out and conclude, i we have the ink most comprehensive effort that ive seen in 25 years in criminal justice with something core, the response effort, and so with that i look forward to questioning. Chairman. , maryland is another state struggling with the opioid of this year, y the states governor larry hogan signed legislation that would doctors to prescribe the lowest effective dose of painkillers. And another bill to allow prosecutors to seek an drug onal 10 years for dealers who sell the open owed fentanyl. Fentanyl more about later tonight. Well hear from the maryland governor. We havent heard a lot about heroin and fentanyl, its mostly prescription opioids which is a big part of the problem. Overdoses in roin maryland. Started as an overprescribed drug problem but it evolved. And this problem is constantly evolving. We went from heroin to fentanyl one is a fentanil and hundred times more powerful than the other and its killing people the first time they are using it. Issue that ive been, as governor baker has since i irst started running for governor i traveled around our state and i was shocked to hear from one end of our state to the people talking about, whats the number one problem in your region and they would say heroin. And it was in small towns and in rural communities. Problem. T just an urban none of the government leaders at that time were talking at it. It was something we were sort of being quiet about. Governor in became 2015, the first thing i did was reate an emergency opioid and Heroin Task Force and i had our Lieutenant Governor chair it. Around our arings state in various regions, to give input, and hundreds of show up. Uld and out of those hearings, we with 33 recommendations, from education and prevention to intervention, and we enacted all 33 of them. Down the hing to slow problem so we went further. We passed tougher laws on Law Enforcement. We doubled the number of treatment beds. Did nothing. The crisis kept evolving. Hair win in the last 12 months in our smallpeople state of maryland, which is far gun shootings, and traffic accidents and a number added r diseases, all together. So we, all of these governors at this table have done incredible work. Everythingone almost that they have done in every other state and it hasnt slowed this problem down. To grow out of control. We ball game the first state in declare state of emergency. Some people may remember the riots in baltimore. Declared a state of emergency, sent in the national guard, extra police officers. This emergency is far bigger. Have a single death in the riots in baltimore. 12 ave 2,000 in the past months with heroin. Nd opioids and fentanyl and carfentanil. Its tearing apart families and communities from one end of our other, and ill just say, in spite of all of our we arent making much progress. Weve got to find a way to get the federal, state, local working in the same direction together with Community Organizations and faithbased organizations right and weve families, got to hit it from every direction with everything that weve got. This is one of the biggest ever affect our country. Not just from a drug crisis, number ng to become a one killer if we distant slow this thing down. Earlier this year, President Trump appointed new Jersey Governor Chris Christie to lead the president s commission on drug addiction and the Opioid Crisis. The president and Governor Cabinet roomin the of the white house to hear from addicts. Ng as you know, youve been the governor of indiana for four ears, this issue causes enormous pain and destruction to everyday families in every state in this country and thats why i felt it was so important to bring pam and a. J. Here today to you meet them and hear directly from them their stories. Honored that the president would ask me to take on this task with the group that weve put together, and im to work with the on they general as well, issues of prevention and so we dont drugs get people hooked in the first place. Addiction is a disease. A disease that can be treated. And we need to make sure we let the president talked about how folks dont talk about it. We talk about cancer, we talk about heart disease, we talk diabetes and were not afraid to talk about it but people are afraid and ashamed to about drug addiction and while they dont talk about it lives. E lives of good people. N the end the president ended by saying talk about life. Were both prolife the difference between the were nt and i is prolife for the whole life, not just for the nine months in the the whole life. Every life is an individual gift rom god and no life is irredeemable and people make mistakes. We all have. Drug make a mistake with use and it is a mistake. We cant throw away their life. Thatresident and i believe every life of an individual is a gift from god and is precious, an thats why it was such important issue for him in the campaign, and why im so honored to work with the president who the value of life. And the value of Second Chances. Commission,what this i hope, is going to be about. To be able to give he and the the best dent suggestions we possibly can, about having a national fight epidemic. Is mr. President , thank you for your conference and thank you for your support. You. President trump thank you very much. Tell a nessa, you could little bit of your story. So beautifully. So first of all i would like you so much to bringing a national m to level. There are people dying ever day and its heart breaking. Governor christie, i need you to know that i draw so much from you. Nd courage standing up for people who had given up completely. In me from a small town south jersey. My aunt is a teacher, and she the importance of education. My uncle is a firefighter. He taught me the importance of law and order. I went to a private high school, was a cheerleader. I went to college, where i sorority. Fter i left college, i had an njury and was prescribed painkillers and it took off from there. I knew nothing about heroin. Warned. Ver not that its anybody elses fault. It began with an injury . Prescription, a painkiller. What was the drug they gave . Percocet. And then from percocet and then from oxy, it went to heroin, because it is efinitely, like you said, more acceptable and so much cheaper. Everything. , i lost i was homeless. I chose to be homeless. Streets of on the and out city, i was in of jail. And i was lucky enough to see kind of light where i was became a pimp a system that we have in new jersey, which saved my life. They sent me to a long term reatment facility, integrity house in new jersey, and they life. My how long did it take you to get off this horrible stuff, how hard was it for you . Basically, it was so hard. And i felt that was the hardest part. Couple of months later, the psychological aspect think that you need it. Youre re still still not as sad. You have no feelings. Like youre a shell, and it takes over your whole life. To choose to be homeless instead of live with your parents. Choose not to speak to your family. What did your parents say during this whole process im looking at you, american, all perfect. [laughter] im saying its hard to believe that youre living on streets. Hard for my shed for my family. Streets uld drive the of Atlantic City to find me. She couldnt find me. Aspect at lost in every of the word. And in jail, like i said, i was sent to integrity house and they my life. They gave me a Second Chance at life. And from there, i went to a house. I got a job. Out. I quickly moved got an apartment. Im graduating from drug court year, and its amazing the opportunities that have been me, sitting across from you right now. Years ago, i didnt have a clue to live and today im here to represent the light that can born out of the defeat of this darkness. And there is a tomorrow. And there is a day after that. And ave to fight for it people have to know that there are people fighting for them, too. Because you give up. There comes a point where you you have nothing. You have already ruined everything so there is no point here to ber but im show you there is hope. You can get better. Thereis a better way, and is a better life. Wish i could tell you the feel with the i people that are overdosing every day and dying and the families to go through that suffering. Need. Is no we can help somebody. We can change it. Amazing s the most thing i have ever been a part of in my whole life and i would and every to each one of you, thank you for giving me this opportunity. Me. Eans the world to it is my life. I used to think being an addict downfall. But look at me. Im here today, its obviously a stronger and better person. [applause] thank you very much. A. J. , i know how successful your what a great man he on you in a ure different way. Really mean, vanessa spelled it out. But i grew up in a little town its a jersey, picturesque town, really good my dad is a supreme justice. [laughter] my mom also serves in big government. I grew up, a good student. Athlete. I found alcohol probably well on my way to having an issue but then i found oxycontin. Accident, t into an and i decided that it would be a thats a to try it, and where my story started. President trump were you immediately hooked . I remember thinking this is how im going to live the rest my life. I was always searching for something outside of myself that better. Ke me feel people think this drug is the problem. O some extent it is but addiction is a disease that i always had and it just had to be unlocked. Feel like thats what oxycontin did for me and when that happened, now im a brother a business owner. Im at a treatment center. And i love it. Happy i went back i was on track. [inaudible] it. Idnt love but i really enjoy what i do elping other alcoholics and addicts. President trump you still have an alcohol problem . I dont drink, i dont do drugs. President trump but you could see you were going to have that problem but you found this oxycontin . Yes. Nd, you know, i was a i ended up homeless. My parents did not want me at home. I was living out of my car. Then i ended up going to a long term treatment center, and what i was. That i was an addict and i would rather die than live with that. Myself, i wasnt able to get home so i surrendered. Believe people dont this part of the story, they have a conception of god and a on my knees i got said god please just let me die. Let me die. I swear to affection, [inaudible] my goal now in life is helping other alcoholics and addicts, think, you know, back then, i would have rather died than had this disease. Now, a normal person can be miserable and they can be angry and resentful, and thats just they will live their life. Me, if i get angry, resentful, miserable, ill drink and heroin and then i will die. President trump not anymore . Im not allowed to be miserable. I have to get the most out of life. Normal people dont have that. Hey will die if they dont do that so im grateful that i am what i am. Yet amazing trump an story. How did you get off of it how id you get did you go to a center or something . What happened . I did. Went to the mountains in arizona to a place. It was he said, said, what are you coming off of . Opioids. He said you you wont die and hey put me in the center and i detoxed cold turkey. What was that like . Times worst than the flu but the anxiety is the worst part. Ideations crawling on your skin. President trump you got through it how long did that take . Two weeks. Resident trump two weeks they used to call it cold turkey, right . Do they still do that . Ofyou went through two weeks that, and that was hell . Yeah. President trump but then you knew you were going to get better . No. The mental obsession came and i wanted to use it so badly but i what i was and i knew i couldnt, so i wanted the to stop. I wanted my brain to stop yelling at me. Person want to be that anymore so i figured i would and it would stop. My dad i can he canceled my personal credit cards. I dont know how he did it. Got on my knees an prayed and that was really the beginning. President trump he did you a Great Service when he did it . He did it. Resident trump youve done an amazing job. Celebrate. Not easy, not easy, a. J. . No, its not. That my son was 10 months. Ean, mike, hes 65 to the left. He walked me down the aisle on one of the ay, life. T days of my he was healthy, happy, thriving, to go back to school. Ad a job, girlfriend, had everything together, so having a previously vigil having been at our wedding on december 3 and three weeks later december 23, two police our door show up at unfortunately, my son odd after being clean for 10 andahalf months. Smoking cocaine and crystal meth he was a senior in high school with months to graduate, he had a crystal meth overdose, and by the time i got to the hospital, because his friends drove him there. Didnt even know he was doing this to this extent but by the time i got to the hospital, the you need toand said call your family now. We dont think theres anything we can do for your son. We managed to transfer him to another hospital. He got the care he needed. Coma for three days and suffered some minor memory loss from that. As an se, at this time, 18yearold, said oh, im never again, touch anything staying clean. Less than a couple of months later, hes back on the streets taking drugs but caught in ing pot and ended up jail. I told him early on, i will put every penny and dime i have into recovery and get you clean 100 , but if you end up in law, theres the nothing i am doing for you, because you have to figure out your way. So he was in jail a couple of times. E went cold turkey in jail getting clean. When he was clean for almost a year andahalf during that to , he was going back school. Years old. 21 he was volunteering at a recovery house working with work trying to help them through their programs. He spoke at a conference in West Virginia. They selected him and figured he good spokesperson maybe. You know, would be able peoples hearts. Did pass. Said, he nothing as parents prepares you to deal with the fact that mike outlive our son, that sisters who idolized him will never see him anymore. Bet christmas presents wont able to give. Smile, ss his laugh, his ill miss him, his hug, ill miss his dry sense of humor. If he would him walk me down the aisle on my wedding to mike, he asked me, entail, what does that mean . I explained to him. He said, oh, but im pretty sure. Ive watched it on tv to know that i have to take him on a he ing trip to make sure measures up. [laughter] he was just that kind of guy. Coming up to us at the celebration saying your son is amazing, you dont know, your son saved me. Your son was one of the people ao came and dragged me out of house i was living in, and took me to his place and gave me that he really didnt ave, just brought me to meetings. This is why im here. Seen nationally with governor christie, managed to have happen in new jersey to there to egislators ake the program for recovery accessible and affordable to all. Fortunate to have an Insurance Plan but at this point of the program, it wasnt by insurance. Four days in a Recovery Program thats uys know, nothing. m here so that parents, no parent should have to bury their child. Should have to, you know, wonder, as vanessa said, i id try, this is entirely something that can be dealt with and i appreciate what you are do. G to President Trump in this program, would he have been in better shape . It have possibly helped . He was in a couple programs. President trump im just saying she said think 35 e was in the program days. That was his most successful program. Mentioned, carlos had an underlying problem with forgetting about himself. E had a scholarship to a prestigious university. As a freshman going in, he was accepted into an engineering normally that didnt happen. He had a lot of different outs. See it. Dnt he was always looking for, how can i escape . Thought also he several times about suicide, so treating the whole person. Its not just the disease of its what is causing you to go after the drug, to seek it out, to stay with it. Hooked, youre hooked. How can you work within yourself to feel good about yourself, worthy. Re everybody is loved. Loved, dy should feel everyone is precious, and you worthyr said everyone is of being reclaimed. Unfortunately, carlos couldnt reclaim his life and behind everybody suffering or in recovery, theres parents and family just like me. President trump thank you. Carlos sounds like he was a great guy. It, ny people go through being appreciate you here. In july, the president s commission chaired by governor urged the president to declare the Opioid Crisis a national emergency. Week, while on his working vacation at his golf course in president the stressed Law Enforcement efforts. President trump thank you very much, secretary price, for your the crisis of s opioid opioid heroin, cocaine. It is a tremendous problem in. Country nobody is safe from this that threatens the young and old, rich and poor, communities. Everybody is threatened. Drug overdose is now the leading cause of accidental death in the United States and opioid deaths have nearly 1999. Ed since t is a problem the likes of which we have not seen. Federal drug prosecution have down in recent years. Were going to be bringing them up and bringing them up rapidly. Of 2016, there were 20 fewer than in 2011. Looked at this scourge and let it go by. Average drug offender decreased from 2009 to 2016. Uring my campaign, i promised to fight this battle because as United States, my greatest responsibility is to people and american ensure their safety. Especially in some parts of our ountry, it is horrible whats going on with opioids and other drugs, but the opioid is omething that nobody has seen anything like that. Today, we are giving a briefing come back fromns this terrible epidemic and keep youth from going down this deadly path. Best way to prevent drug is to on and overdose prevent people from abusing drugs in the first place. Start, they wont have a problem. If they do start, its awfully tough to get off. Keep them from going talking to you elling them its no good for you in any way, but if they dont start, it will never be a problem. Working with Law Enforcement officers to protect innocent citizens from drug ealers that poison our communities. Strong Law Enforcement is absolutely vital to having a drugfree society. I have had the opportunity to hear from many on the front Opioid Epidemic. Im confident that by working with our healthcare and law we will nt experts, fight this deadly epidemic and will win. Tates were also very, very tough on where much of this comes in. N china, certain forms of manmade drugs comes in, and it bad. Were speaking with other and getting cooperation, but were being very strong on this southern this to the likes that country certainly has never seen that kind of strength. Were going to do our job, get done, and we have a tremendous team of experts that want to beat this horrible happened to our country, and we will. We will win. We have no alternatives. Win for our youth. We have to win for our young people and, frankly, we have to for a lot of other people, necessarily people that are totally addicted and have serious problems. Here, andou for being were going to get on with our meeting. Thank you very much. Thank you all. Later, the president told reporters outside his e state in new jersey that he was opioid ly declaring the epidemic a national emergency. The Opioid Crisis is an emergency, a national emergency. Ere going to spend a lot of time, effort and a lot of money to the Opioid Crisis. Do that . E you going to President Trump were going to draw it out and make it a national emergency. Problems, the likes of which we have never had. When i was growing up, they had lsd and they had certain generations of drugs. Never been anything like whats happened to this country over the last four or five years. Nd in all fairness, this is a worldwide problem, not just a United States problem. This is happening worldwide but this is a national emergency. Also partovernors are of the effort and at the annual meeting of the national earlier S Association this summer, charlie baker, the massachusetts, and roy cooper, the governor of North Carolina talked about the situation in their states. But the first thing ive called for is treatment, and the irst thing we have to realize s we cannot have millions of americans lose their Health Overage and still effectively attack this crisis. E cant significantly reduce medicaid funding as will be opioid ul in fighting addiction. Of opioid Addiction Treatment and Substance Abuse medicaid comes from coverage. So were kidding ourselves if we dont think whats happening ith healthcare in congress ight now isnt affecting this issue. But at the same time, there are other things we can do to attack the problem. Weve heard about the issue of making sure ng and Prescription Drugs are less available to people. Comprehensive strategy on that in North Carolina. Were seeing reductions in prescriptions to people and squeezing a ike balloon. Weve seen now an increase in heroin use. Sometimes thats even cheaper is whens really deadly its laced with synthetic fentanyl and other drugs that immediately. Need help with from the federal government is helping us to fight the king ers and in traffic china where a lot of this synthetic fentanyl is being with that. Help but one thing we know at the addiction level and law this, ement will tell you we cannot arrest our way out of this problem. Of neverending cycle people going to Emergency Rooms then put arrested and in jail and getting back out and going to , thats not work. And what we have to do as part is widespread use of nalaxone. Make sure we have emergency intervention with overdose. E who time in the next 2448 hours that we have to get to them and convince them they to have treatment. Weve got to have that treatment available. Aw enforcement stands ready to divert these people who are addicted to substances and to treatment. Lready, we have comprehensive programs throughout North Carolina where Law Enforcement is making sure that theyre treatment, we are a fan of medication assistant treatment. Each individual is different and you have to have healthcare righters deciding what is for them. We even have some law nforcement agencies who are inviting people with problems to promising theyre not to arrest them and assist them in getting help. O these strategies are positive, that were implementing. They are comprehensive. Heyre probably 36 or 37 of them. We need to make sure we share when we particularly have our studies to tell us whats working. We know this Law Enforcement is and theres ignificantly less of a chance that people get rearrested once theyre diverted into treatment. So i look forward to hearing ideas, both at this conference. Make sure that you let us know happening in your state. And i and rnor baker governor christie have had a number of calls with you to let us know whats happening. Attack ortant that you it in a comprehensive way, and that we o make sure ight this problem on every level from Law Enforcement to treatment to prevention, to education. And ive had enough of it and i know you have too. Thank you so much, Governor Cooper. Baker, can we turn to you . You led the hhs committee here nga. An you talk about that experience and where we want to go from there . Gov. Baker im looking at the row of governs in front of us and i know almost everybody here participated in those phone calls that Governor Cooper was is dealing in and one way or another with this issue in their own right and their own state. I cant emphasize enough how important it is that we handle this, which is f overprescribing of pa medication in the United States. We consume 80 of the worlds opioids. There are places all over the globe where people would never give someone an opioid deal with their particular problem. If they did, theyd give them 60. Or two instead of 50 or part of the reason why we made training in this mandatory for graduating from nursing, medical, dental and pharmacy schools and says if youre a prescriber, you cant get relicensed unless you take and pass a course in this, so many people have writing those prescriptions for when you confront them about it basically say you this isnt something that was part of the curriculum. Of 2014, when youre writing 240 million opioid prescriptions Substance Abuse and Mental Health association saying addicted to come heroin started on prescription pain meds, its pretty clear problem came up. If you look at the data associated with the last 15 years and the growth of the epidemic, prescribing the top line, overdose is the second and deaths to opioid and heroin are the third line and its hat period of time, pretty clear where this came from and one of the things i certainly hope we get out of National Commission that were participating in is a much a e aggressive stance as country to the way we handle and deal with prescription pain meds. I agree completely with all of ginniss in dr. Mc commentary how important it is focus on the start and to separate prescriptions from larger me stuff from prescriptions to people dealing with chronic illnesses and terminal disease. Than really different what actually goes on the ground every single day in most places around this country. The second part i would say is and recovery piece has tremendous potential but at the same time its a significant things o and one of the we eard quite a bit of when held the public hearings in ashington and this is another place where the National Government can play a big role. Not treated the study addiction earch on with quite the same focus and we treat cardiovascular disease or certain kinds of ancers or other mechanisms and illnesses and cures and therapies that come out a lot of the nih work, and one of the going to be k is critically important to the assistant al Treatment Movement is much etter data and what works and why. One of the things thats always this is when out you talk to the folks in the toatment on this, they refer them as saboxoni providers or or vivat rolviders 12step folks. In most forms of medicine, the box, works, the tool based on bestpractice standards, tons of experience bodies of evidence, this person is best suited with dealing with to their addiction. Thats not the way we do this in country. In the another place i think our states and another place where the Research Community can play a big role is all get a lot us smarter about which treatments are most likely to be successful with certain kinds of folks who dealing with certain kinds of circumstances, situations, symptoms, and the final is one of the things i appreciated about the nga conversation about this is to chasing s open this. Here wasnt anybody who felt this was something that they could sit back and do nothing about. Data in ok at our own massachusetts, i see modest progress on prescriptions, okay. And deaths, it is modest. Ive never seen anything with the kind of negative trajectory has, and its really going to take persistence nd determination over a long period of time of working the front end, associated with how eople become addicted in the first place, the whole area associated with intervention and treatment and recovery, and what capabilities and approaches to treatment will work best with certain People Incorporated into Ongoing Development and best practices for people Going Forward and an on the part of both and federal ents governments to see our way through. The big thing is we didnt get here overnight. Of really bad s behavior by a whole bunch of people, in my opinion, in the Clinical Community and i say as a healthcare guy, that got us into this mess and the likelihood we get out of this small. T will be its going to be pretty important that everybody stay with it for a long period of an issue ot make it that we all focus and Pay Attention to for a few years and else. To something this one is going to require ontinued vigilance, continued inquiry, continued investment, in the way we e handle this stuff. 80 of the worlds opioids of the worlds5 population. If you walk away with nothing else today, i hope you walk away with that. Has to change. We heard North Carolinas people talking about losing their medicaid coverage. He was talking about republican affordablerepeal the care act. And that law, 31 states the people of District Of Columbia expanded medicaid and expansion is providing insurance to 14 million people. Many argue that without medicaid, thousands of opioid addicts wont be able to seek treatment. P next, well hear comments rom colorado congresswoman and bernie sanders. I would assume this is an ongoing challenge facing your state. Would that be a fair statement . True egette it would be but weve helped people since expansion. And it helped but we know theres a lot more work that needs to be done. N fact, in your statement, you said medicaid has laid the foundation for treatment coverage. Is that correct . Rep. Degette that is correct. Tell i wonder if you can me briefly how medicaid funds fight ping rhode island this epidemic. Rep. Degette medicaid funds treatment, all three forms of fda approved medications. Morphine, and the injectable. Opts, to integrate receiving into those methadone treatment and other forms of treatment. Well have a full treatment from detoxification inpatient and medication and assisted treatment as well. You. Nk bills u looked at these that House Republicans have passed and the senate at whichns are looking severely reduce the medicaid aid to the states . Would those impact your state of rhode island . Ep. Degette any bill that would reduce access to medicaid reduce aid expansion or Affordable Health insurance would have a negative impact on rhode island as 77,000 lives are covered approximately by medicaid. Thats 77,000 in rhode island covered by the Medicaid Expansion . Degette correct. The Medicaid Expansion counted for more than 60 of the medicaid spending on Substance Abuse treatment in kentucky. Between 2012 and 2014, theres been more than a 700 increase treatment e abuse provided to kentucky residents expansion. Aids so i guess i want to ask you, it like medicaid has been particularly helpful in kentuckys fight against the Opioid Crisis. With that . Ee let me say this. Unequivocally u, of our governors equipment and, 1115 , exampled by the waiver and i refer to it at this very moment to expand our treatment option under that. Me ask you my question. Ould you agree that medicaid has been particularly helpful in kentuckys fight against the opioid. Tilley i would agree. Im sorry, let me finish. I would agree through under the of funding we have increased treatment back to by 1100 . Let me ask you this if the Medicaid Expansion went away, efforts. Impair your tilley im the secretary of justice. Youre not going to ask my to ask so i want secretary moran a question. Ecretary moran, governor gh attempted to expand it twice. But the legislature rejected it twice. I know virginia is making the out of the tools it has, you had had Medicaid Expansion, more money in virginia, would this have helped help out to more people on this opioid issue . An emphatic yes. Is that . More people would have access to treatment. Now, i will give credit to our department of health. A very innovative arts program, Addiction Recovery carve out ervices to a medicaid waiver to address the individuals addiction needs, expansion, icaid 400,000 virginians would be covered and the governor has to do that every opportunity. Thank you. Thank you very much, mr. Chairman. Yield back. America just cannot go backwards on this. Very costly severe problem for families and all of to watch what is happening with proposals from on healthcare, really backwards, whether away ripping the bridge beneficial or an assault on medicaid, the biggest 50year n it in its history, would be disastrous for our ability to support families this crisis. Ask ct, id like to unanimous consent to submit for the record a consensus statement from the National Association of directors october Senate Version of the g. O. P. Health bill. It states, in part, medicaid is essential effective cost partnership, it has a record of innovation and improvement of outcomes for the nations most including systems, individuals struggling with opioid dependency. O amount of administrative or regulatory flexibility can compensate for the federal spending reductions that would bill. S a result of the medicaid or other forms of and ehensive accessible Affordable Health coverage, in coordination with Public Health and Law Enforcement entities is comprehensive and effective way to address the this country. C in ear marking grants for exclusive purpose, treating addiction under medical and Behavioral Health coverage is likely to be neffective in solving the problem. Ill ask unanimous consent that be admitted for the record, mr. Chairman. Give it review it and back to you before youre done. Important. Ery spear headed it the funds to our state and ive back home in florida held a number of round table, Law Enforcement, professionals, docs, and ogists, er they say the key is longterm overage to treat this as the chronic disease it is. And thats why when you rip away coverage and instead say in its were going to have opioid fund, an where you provide a few dollars er, thats not going to provide that long term coverage that you need to treat this chronic disease. I wanted to get that off my chest here right off the bat. Boss, you havetor a lot of experience with this. Be able to well this crisis ddress if the medicaid and ripping it of americans ions were to succeed . I believe that Rhode Islands address this crisis would not be able to be sustained if we were not able to to medicaid ce expansion to the number of Rhode Islanders that depend on it and i thank you for your pointing the fact that providing treatment alone is not enough. If we dedicate that towards thats wonderful. Owever, there are oftentimes comorbid conditions related to the treatment. F they dont have Affordable Healthcare for the rest of the body, were not going to be able to treat the person well enough sustain any kind of recovery. Are you able to provide right now the type of longterm treatment that is addiction . N opioid yes, we are. In fact, youve instituted a anchored, that links them up with recovery coaches in their recovery process. Successful has this been in helping individuals recover . Of the individuals that meet coaches in the emergency department, about 82 are receiving referrals to in tment and engage treatment and recovery services, which is pretty phenomenal, actually, and the actual anchor ed program itself is not the rted by medicaid, but fact that we are not required to prevention e abuse treatment block grant funds to access, itself to block it frees up that opportunity to mayblock Grant Funding that not be supported by medicaid or other insurance. Although, the program is so that many insurances, including thirdparty commercial insurances are paying for the coaching program. The president comes from a state and i come from a state opioid have a major crisis. It is devastating the entire country. What will this bill do to opioid and treat the crisis which is decimating this ountry from one end of america to the other . What happens if you cut 800 billion in medicaid. The ill people get treatment they need . In my state, its inadequate. State inhink theres a the country providing the necessary treatment and deal tion capabilities to with this opioid and heroin crisis which is ravaging america. Will 800 billion cut on that i understand additional money going into opioid treatment here, but that without th context. It he commission had recommend recommended. As part of that, the president last week saying that national clare a Opioid Epidemic emergency. What does that mean . Were not quite sure yet what the emergency will entail but the mably, it should allow cabinet agencies and states who spend federal dollars to free it up to use it in more flexible ays, you know, to address the Opioid Epidemic, in ways that the money hadnt previously been for. Ized but i think the commissions main goal in pushing for a national n of a emergency was a symbolic one, so that the white house could its taking this seriously. It considers it an emergency, acting that theyre with some urgency and urging others to do the same. Lastly, let me ask you about the food and Drug Administration fda, he new head of the scott gotlieb. What has he said and done about crisis . Dr. Gotlieb made opioids a major focus of his since he was nominated and confirmed. Makera requested that the of one opioid painkiller pull it from the market because of its abuse. L for this particular drug was an hiv outbreak in indiana a few years ago. T was being used intra venously, and the drug maker complied and pulled it from the market. Fda is also trying to push ahead with getting more training and education for the people who prescribe in general, the new commissioner seems to be really pushing the bounds of his authorities when it comes to opioids. You can follow his reporting issues at care rolecall. Com and on twitter. Joining us. Thank you for having me. Our look at the Opioid Epidemic in the United States continues on cspan, inviting our phone calls for your input on our program and how, in particular, what the Government Role in the Opioid Epidemic is, 2027488921 is the number to use for those of you in the central time zones. The mountain pacific use 2027488920. If you have been impacted personally or your community by crisis, use that 2027488922 line, and well take your tweets at atcspan and look at some of those. Look at how the crisis has sparked an article this week in the Washington Post. At the top 40. Got responses from the top 24 populous counties in the United States. Ake a look at the rise in opioid deaths in these counties, just over the last couple of years. Looking at middlesex, washington. C. , fairfax, virginia, minnesota, as the death rates rise. Miami dade county, florida. The top, baltimore in ohio. Nd spiking over 600 deaths in new york city. Lets go to new york state and hear from keith. Evening. Caller good evening. How are you. Father of a daughter, our oungest daughter, my daughters death was this year from this Opioid Crisis. She passed away. Shes only 24 years old and has fighting this for quite a while. Help her torying to ehab and everything, and its just once youre hooked to this heroin, its got you and it wont release you. I dont know what there is to what there is you can get to help people with, unless you can get them into some programs and theres got to be a way we can get people in so that theyre not dying. Many young people like from this stuff everybody is saying. Myself, im a volunteer fireman here for the county. Through this with a lot of people ive seen over the years. Save my own en daughter because i was narcan and it really hurts. Its heart wrenching. Really sorry to hear about that, keith. Tell us if you can. How did this all start for your daughter. Where did it begin . Caller funny you should say that, i just cleaned out her room recently, and i guess once in rehab, they make you start with a book and write down your birth to present day ages you start using and whatever, i mean, she started at age 5 smoking. He started working up to drinking. Host at age 5 . You said she started at age 5 . In er thats what it said the book. You. Dnt lie to i have my x here also. I couldnt believe it. And 12, she was stealing beer out of the refrigerator from me, cigarettes from my ex. She started smoking pot. It got stronger at 16 with opiate oxycodone. 18. S selling at it just kept going and going. In amsterdam. Shes been in and out of jail. The hardest thing in my life by having her arrested car. Nauthorized use of my we got her into rehab. Out, shet once she got was fine. Host keith, our condolences on that. Go e going to let you because we have a limited time and have other people. Sorry to hear about your daughter. Lad you shared her story this evening. Millboro, virginia. Jeff, how are you. Caller hi. You tonight . Y no means am i playing down our crisis on opiates, epidemic. The heroin but i have a point to make. I worked for the government during Ronald Reagan times with project wars development, with several big roducts and programs that are no longer classified. Severelyat time, i was injured and now at age 60, i am constantly. Ive had many back surgeries, other things. And somewhere, we speak out that of e are a certain amount do need help with opioid medications. And please, dont think im downplaying our crisis. I know were in a mess. For the an speak out people that do need this medication . That, jeff. Ate lets go to our line for those affected by the crisis as both have, and we hear from rachel in san antonio. Evening. Caller hi. And i was in ld the hospital recently for a week and my roken shoulder, mother at the same time was in with a broken pelvic bone, hich is more painful than a broken hip, she says. Wow. Both. Se shes had and she would call me crying in in pain, use she was and she was in her 80s, you 80s. She was in her middle and there i was in the hospital. So on my story, no one ever told me and i know im going to frightfully ignorant. Im a well educated middle class told me ut no one ever how fast your body becomes to addicted to it, but used it. More and more. I assumed that because the doctors were giving it to me, it would take two or three weeks adjusted to o get it and start requiring more. No one said it takes days. Its just a matter of days, and no one ever told me that. Us the d rachel, tell using. Er that you were it w. Rco or maybe s na ydrocodone, if thats the same thing. Mine was better, so mom gave me she was ers that discharged with. Fortunately, neither one of us addicted. That i me trauma done had had for dental work or something, and it was pretty old and i just never used it because it. Nt need host how are you feeling now . Now, well, im better but none of us became addicted, angry that no one ever told me what to expect. Host appreciate your input. Lets hear from carol in frederiktown, ohio. Caller hi. Host go ahead with your comments. Romyal gia ave fib and bad kidneys, so i cant take anything overthecounter. I cant get anything with opioids to help with any of the roblems i have because of the epidemic. Host are they saying they cant certain amount. Caller ive had several, yeah. Host we showed you this chart earlier in the program about the with the highest opioid death. There are top three states in the category, West Virginia, per 100,000, West Virginia with 41. 5 100,000, New Hampshire. 4. 3 per 100,000, and kentucky, 29. 9 per 100,000. Auburn, new om york. A couple of more minutes from your calls. York. Cindy in new hi, cindy, go ahead. Caller hi. 2015, i found my 27yearold son dead from a heroin overdose. Had just left rehab probably maybe six weeks before. Our community, there was absolutely no help, no meetings, no support. When you called, you get a bed rehab. You had to wait for days, call in on a daily basis. And in our community, we all pulled together and we had formed a group. We are now a nonprofit. E are called heel, heroin epidemic action league, and we lives. Ng 20 015, we had close to heroin overdose deaths. There was one every week, if not to , and something needs change. They need to realize this is not a quick fix. Program is not enough time. Then ed to heal the body, heal the mind and then heal the soul. Program. Estep putting a 28day slap on it is not saving lives. Mentioned this earlier in the program, the white house, he president naming the Opioid Epidemic a national emergency, a national crisis, health line writing here, the white house is to release specific details on its plan, but if the administration moves forward, it Significant Impact on the Opioid Epidemic in the United States, in particular, say, emergency money to address the crisis, one of the major benefits of an emergency enabling the federal government to dip into its coffers. Well get one more call here note that we will open up our phone lines a bit later on with thespan, so stay program here, and we go to tacoma, washington and sandra. Hello. My grandson is 23, and hes opiates. Es been shooting up, tried it a few times, a couple of times. He people have had so many addicts here that and so many people dealing that they dont even know where theyre at and to bustt have the time them. There are so many people here. My grandson got addicted. Had friends in high school that were dealing it. Too. Also prescribed it need and my thing is we the doctors to stop prescribing for those drugs to stop coming into our country, i mean, you know, its just children and its horrible. Host whats the answer for coming into heroin the u. S. , do you think . Caller put more regulations and it. N its killing our kids. You know, its insanity, that its coming n, and in all the time and we ont were not stopping it enough, you know, i mean, they need to bust those people and if people because its not the little person thats big people s the making money off of it that are doing it. Host well open up our phones later on so stay with us. About the re overprescription of pharmaceuticals in particular, opioids. That state, they have filed a lawsuit in the state of ohio against drug ompanies saying they have misled doctors and patients about opioid painkillers. State is suing purdue farm, oxycon tin, behind johnson johnson, teva pharmaceutical, and endopharmaceuticals and allergan. Overstated the benefits of painkillers. Vulnerable d populations such as the elderly and veteran. And violated antifraud Consumer Protection laws. The man behind the lawsuit washington june in d. C. On capitol hill. This drug problem is absolutely pervasive. Everywhere. Its in our smallest communities cities. Suburbs. I think if you go back historically, ublyou could trac to southern ohio in regard to the pain med problem. Addiction, t of the although some may start on heroin, most people become ddicted to the pain meds and move to heroin, because at some point, they cant get the pain is soymore because heroin cheap. Biggest problem is southern ohio with the pain med problem. Sociologist, i could guess and i dont have a great deal of expertise in this area and it starts with that. Ands absolutely everywhere, part of the challenge i think always, if you look at this problem, and i know that some are at a different stage than we are. Path. Ll down the would, you know, suggest is the biggest challenge you have is getting people to this is a problem in their community. Community. And for the five years, every interview ive done, ive looked into the tv camera and said, if youre watching this, you have an opioid problem. Problem in your community. So one followup. The demand problem as talking to kids as early kindergarten. How about the supply problem. Is there any way to deal with that . You said you see it everywhere state, Law Enforcement seeing it everywhere. Any thoughts on the supply issue . Mr. Dewine of course, youre talking to someone whos a and y prosecuting attorney what we do in the Attorney Generals Office is assist Law Enforcement. Always look first to the Law Enforcement problem and what we did five years ago is created called Law Enforcement heroin group, unit, out of dci. Talk in public about exactly what we do, but we help the local sheriff or local prosecutor or the local police, once theyve their drug ted investigation, well help them take it to a higher level and bigger fish and the bigger drug deals. That remains an essential part of what we do. The attorney general of the United States about cooperation with information border, and that is a work in progress, so that e get realtime information coming off the border, back into ohio. Do work with our federal partners, and the fbi, Drug Administration, and we have a very close and good working relationship with them. So Law Enforcement is a key part. T but were not going to arrest our way out of this problem. With it o deal wholistically, which is do a better job in regard to treatment and getting people treatment and keeping them in treatment, and we have to do better job , a much with prevention, which i think is the most opportunity. At this in the long run, where are we going to be in 10 years, 15 years or 20 years . Kindergarten and very few schools are doing this. Thank you. Deaton, you talked conditions onomic and disparity that cause it. Are those Economic Conditions getting worse . Trending better . Way it geographically different . I think theyve gotten short term but i dont think this is a shortterm problem. I think this is a deep problem do with, you know, what people who dont have a University Degree are going to with their lives, and the world that they used to inhabit a world thats broken, and i things e meaning the that give meaning to their lives, the steady jobs are anymore, and i e am not particularly optimistic. Its a good idea for everyone to go to college. Think maybe things like apprenticeships, maybe a new way of thinking about that world of help. Lly would i should say, though, that i opioids because that was my schtick here but i about the something opioids in some sense is the easy part of this, though, god enough, and we really have to do that. We really have to change this doctors that believes that pain should be treated with essentially, which is something we never used to do. Thank you, professor. Appreciate that. Has expired. Mr. Dewine, synthetic opioid 100 times more potent than morphine and clerk the have insight into the reasons for this development in ohio in particular or are there parallels or lessons that can be drawn for other states . Congressman paulson, thank you for the question. Car fentanyl is so dangerous. Their officers, many women of these departments do not field test drugs anymore. We had an experience in ohio with the last month of where the officer overdosed literally because he was in the presence of this and it somehow got into his system. Dangerous, we believe that a couple of things are happening. The believe that the fentanyl is coming in primarily from china or certainly some could be made in ohio, but we think it is mostly coming in from china. I know that senator portman has been directly involved in that concern and members of the house and senate as well. I think you see the drug dealers , they are great marketers. It is amazing. System, is all about customer service. It is all about delivery. I tell people that if you look at heroin, mexican drug cartels have perfected a business model. They develop it in mexico, ship it across the border into ohio they can drink it to this the stick it to the street level and sell it to drug dealers. You pick up the phone you call, and they will even deliver it, they get you started, and i am told im not a next for them told that the racial between earlystage heroin addict and it late stage her and alex, the amount taken could be as high as 100 to one so a 10 a day habit can become a 100 a day habit. They are all chasing a high. For dealers to get, it is cheaper for them, and they make more money on it. Also it is a way to broadcast the this is Something Different and something hot. The irony is that when we get into a situation for five or six people dying in one weekend, in the city in ohio, obviously because we are on fentanyl or carfentanil, a different approaches see or something there, the demand appears to go off. We worry, we put the bulletin out and local Law Enforcement says, look, be very, very careful. What we were you are encouraging people to take a higher high. Nothing makes sense about this. It is clear that peoples brains are being altered. Is person who is buying it not looking the way rationally the way you and i would be looking at it today, not being added. Thank you mr. Chairman, thank you. I thank you mr. Chairman would like to thank you for holding this hearing it is obviously a very important issue. Said, this is in every community in the country. Great group of witnesses and particularly elected think mr. Dewine for what he is doing, holding the from a single industry accountable. We could make them pay, like others will, and it will send a message that we will start thinking about these differently. We believe in a capitalistic system in this country, and i certainly do, but we wanted to be just at some level and i think what youre doing will make that happen. It is really obvious what we need to do, the witnesses have eloquently covered that today. Is steps that mr. Dewine taking are extremely important, making sure we manage ourselves in this situation by having the Health Care System in place so that we can support the people affected by this, and i associate myself with the senator from New Hampshire with his comments about the importance of medicaid. Verycomments were encouraging when you talked about the investment, how it is seen as a Large Business opportunity, and theyre putting and putting a lot of money against it. So, the same reasons for capitalism that cause the problem hopefully will be redirected to alleviating the problem. Deaton, your comments are the most sobering in many ways, these deaths will spare something a manifestation going on in our community which is very vexing and how we deal with it. Globalizationd and Technical Innovation to a excitedh have been narrowly positive for the state of humankind but very negative for certain communities in particular. And it has been negative for pockets in every community. And how we confront that, the isolation, the lack of security to human beings, you touched on that they are not getting married. This opiate situation has been the perfect storm of events, almost like a match to fire based on that. There is no ability, these people are frozen. They lack security, they are not engaging in society the way that americans historically have. The cost of doing nothing against this is obviously not nothing. So, as an economist, how do you think about how we should approach this . It seems to me a transformative investment is required in these communities if we will jumpstart them and the citizens of them out of the condition that they are in right now. Which will obviously be very expensive, but how do you think about that in terms of not doing something . Representative, i wish any the answer to that question. I think globalization has been an issue, i think automation in some ways is more of a threat, too many of those jobs, and there has not been much of a decline, in fact, in most industries there has been a substantial increase in American Manufacturing output. But the jazz are not there anymore because we do not need the labor to do that. Know, you saw the slide that i showed, this isnt happening in europe and europe is facing the same challenges. Globalization is happening there, the pressure on jobs is the same in europe and one of our research topics, is i do not know the answer. My friends on the left tend to say that europe has a much better social safety net than we do, and one of the policies that ,eople talk about is mothers children getting state allowances on a regular basis stuffs mothers from trying to shop around for man all the e what is the cost to us if we do not solve this problem . Well i think the opiate problem will be solved. Putting aside of though. Problem what is the structural progress problem that you identified . I think, do you actually think we can actually do something about it, is there something we can do . I certainly think that we need thehink through all of possibilities and look at some of the things that are happening in europe. The german apprenticeship system seems to really hold people together in a way that does not happen in this country. I know a lot of employers who are upset about the labor force not trade of college for what they want, and some sort of apprenticeship system may help that. But i really, i do not have any Surefire Solutions to solve this. Thank you sir. We heard from minnesota congressman erik paulsen asking about fentanyl, that is a pharmaceutical that was first manufactured as a painkiller in 1960. Stronger than heroin, and sometimes it is added to heroine to make it more potent. According to the cdc, deaths from synthetic drugs like fentanyl increase by 72 from 2014 to 2015. Among those who died from fentanyl overdoses were the musician, prince and 2016. The House Oversight Committee Really recently held a hearing looking at the dangers of fentanyl. Thank you for inviting me to provide an overview of the rise in fentanyl and overdose deaths. My name is dr. Wilson compton and i am a physician and researcher. I have seen firsthand the devastating impact of the oh. Crisis on families and communities and conducted numerous studies to better see trends and appeared abuse and ways to respond. What is fentanyl and its relationship to the Opioid Crisis . Breezyhigh potency and solubility which allows it to enter the brain faster leading to faster onset effects which increased the risks of overdose and addiction. The emergence of fentanyl and other high potency synthetic opioids create in our createng jew enormous challenges for Law Enforcement and First Responders who may come into contact with the drug. It is one part of the ongoing overdose epidemic. Well resent efforts have begun to curb overprescribing of the prescription of the prescription opiates, overdoses continue to rise maybe due to the rise of her own and fentanylrelated deaths. Efforts in this area are bar part of the Broader Initiative of the office of National Drug control policy and the department of health and human services. Of people using. Fentanyl largely overlaps with those using heroine so there are strategies being implemented to address the crisis and they are expected to address fentanyl overdoses. The fda cochairs and opioid sbcommittee in the dhs Behavioral Health coordinating council and in this world we help to coordinate interagency efforts. How is research helping to address the opiate crisis . We have supported the development of three medications who which are fda approved to address the addiction. They have strong evidence of effectiveness. Despite this effectiveness, only a fraction of people with opioid addiction are being treated with these medications due to limited treatment capacities, stigma, lack of training and cost. Therefore, we are helping to develop strategies to promote wider adoption of these medications. For example initiating deep in bupenophrine in other areas. Other studies have found that providing methadone and other medications reduces opioid use and increases the likelihood of engaging in treatment. How can research specifically inform our research into fentanyl . We are supporting research to better understand fentanyl use patterns and trends in hotspots such as ohio and New Hampshire. In the first stage of the New Hampshire study for example, researchers reported that about one third of fictional users knowingly use the drug and may seek out a certain dealer or product when the hear about overdoses because it might think that it is highly potent. What about overdose treatment, xone can reverse overdoses, the current it is not enough. In response we are supporting research to develop new and longerlasting naloxone formations and new administration protocols. And in support research a partnership with the cdc and the appalachian regional commission, we are testing interventions to address opioid use in rural america. In addition we are planning a Research Initiative to study treatment models resulting from the different resources provided to the state of our 21st century care act. Research is also underway to develop a vaccine for fentanyl to keep fentanyl from entering the brain thereby protecting against addiction and overdose. 33,000 deathser from. Overdoses occurred in 2015, with nearly 10,000 involving synthetic opioids like fentanyl. Sciencebased solutions are available and the challenges often in their implementation. Neither will continue to work our organization will continue to work closely with federal agencies, those here today, and others, Community Organizations to address this challenges. Thank you and i look forward to your questions. Do we have enough providers . That half of the counties in america do not have enough social workers. Do we have enough trained drug treatment providers in america . We do not have enough to fully meet the needs and theyre not evenly spread across the country which is where we are engaging with roush the Rural Initiative to address this particular severe shortage. Thank you very much. And i would add that treatment is part of the it will save the Health Care System a lot of money to make sure we it. Doing thank you mr. Chairman. We have seen opioid and heroine epidemic ravaged every part of our country. Even affluent areas like my home of Orange County, california are struggling with over 200 deaths per year. Now we are witnessing a for a deadlier iteration, the fentanyllaced drug, a killer reserved for the most severe and acute pain which is now being added to heroin and cocaine. As a mother of four young adults, it breaks my heart every time i see or hear of another lost. Just last year, and 19yearold from Orange County overdosed after taking fentanyl laced cocaine. This epidemic again hit home when a dea investigation resulted in four arrests for an alleged fentanyl importation distribution conspiracy in long beach. The dea reported that the men fentanyl tablets and 13 kilograms of the narcotic. Would like to commend your agency for this investigation in keeping this deadly drug off the streets of Orange County. Maloney, the making and disturbing of pills containing fentanyl has been discussed by molding the pills in a wide variety of counterfeit brands and colors. What are the most prevalent pill types being discovered . Thank you for the question. It is a pretty broad range, oxycodone, they will mimic whatever is popular on the street, depending on the market. So if theres a market for oxycodone for example, they replicate those. If it is a powdered substance that they like in a capsule, because it would rather snorted, that will influence how the package it. What kind of film making machinery you must range,e is a broad anywhere from an inexpensive machine for pills to one that costs up to 20,000 which can produce 250,000 pills per hour. Some of them are handheld and can be easily used and it is a broad spectrum. What are the most likely sources of these counterfeit drugs . China is a primary source for the fentanyl but if youre going into mexico, the networks are shipping the merchandise up to the United States. What we are seeing more and more arehe counterfeit pills being made in the United States in different domestic transportation cells around the country. Thank you. Edit dr. , we understand that a fentanylictim of a overdose can be extremely hard to define as it does not follow economic structure or community locales. What can you tell us about Current Trends in tendencies and tendencies . You are right, we are seeing this epidemic increase in all demographics. 44 hardest hit are the 20 to or 25 to 44 and we are seeing it more in man. Likei think is important in rhode island, we saw that a third of that deceased had a prescription in the past 90 days for an opioid and a third of those have had a high dose of prescription. So we ask that people be cautious people are getting exposed to opioids and going on to fuel their addictions with her when an fentanyl. Thank you. Mr. Chester, in recent months, fentanyl was identified as a Major Program in parts of the northeast and present the midwest and states like florida and maryland, where do you see it having . We have begun to see it some indications that it is moving to west, much of california was the first area about a year ago where we began to get moving love it further west. I think fentanyl, found its way into the northeast simply because it was easier to ms. Into the carter heroine mix into the powder heroin that is more popular there. But fentanyl, even though it victim being geographically concentrated in the northeast, weve seen indications of areas of it everywhere in the United States. Thank you. I yield the rest of my time. On the other side of the capital, a Senate Community a Senate Committee also took up the issue of fentanyl. The u. S. Postal service and Border Control testified about their efforts to deal with international and domestic fentanyl shipments. I want to focus just a minute, because in my last briefing with the dea at home, they recounted to me in very graphic and vivid details how dangerous fentanyl and carfentanil is for our Law Enforcement and First Responder personnel. That obviously extends to people who may be handling these substances through the postal system. So, we know that you can overdose by touching this stuff with a their finger or breathing it in, and carfentanil in particular has changed the way our lawenforcement is dealing with everything about the way they enter a suspects home to a crime scene afterwards. Wantso know that we do not to put parties like the usps personnel at risk. So, let me start with you, what has the Postal Service done to help address these risks to usps employees and how can we protect our workers but make sure that Law Enforcement has with will they need to investigate and crackdown on the supply of these emphatic . Yes, senator. The usps has over 600,000 employees. From processing to delivering the mail, transporting the mail, all of our employees are involved in the supply chain. Whether itr basis, is International Service centers or other Processing Centers around the country, delivery operations, we do a lot of training with our folks around hazardous conditions. Pastve seen tragedy in the in our organization so we are very well aware of the effect that back and do. On consistently training employees and we do the same with our Inspection Service which does a lot with the processing facilities as well, for oversight and investigating and addressing issues that we find in the mail. Thank you. I will ask mr. Perez to comment. Has takensed how cbp to it protect its personnel has taken to take his the p has takenat the cb to protect its personnel. A worker who took off her gloves to touch a suspect cell phone and odd. Beginning in 2015 would began a very copperheads of training and instruction a very comprehensive training and instruction for people who would potentially come in contact with these substances. The depth, the proper handling, aware,ngs they need to if and when they encounter a parcel are a person who may be caring or even a vehicle as well, who may be transferring these opioids. So in addition to that, we began a Naloxone Program as well, so we have the countermeasures deployed in over 30 locations now, over the past two years. Those locations include all of the busiest express consignment facilities, all of the Busiest International may facilities, along the southwest border where we see the most trafficking in these types of opioids. Weaddition to all of that, have also deployed over 600 sources of narcan in addition to the naloxone throughout the country. Note, the officers and agents that are typically trained in actually utilizing these are ems certified, cpb officers and their agents. That is pretty much what we are doing and we continue to make sure that the training and awareness is ongoing and we absolutely do everything we can, particularly with the uptake and our encounters with these drugs . I will ask you to answer the same thing. Obviously, the concern here is for instance Law Enforcement, things that they are putting third parties that risks, with these undercover operations and they will stop doing it. We obviously need to be able to continue investigations, so i would be helpful to hear that training is ongoing, but how does ubs address this issue . I will be honest with you i really do not know the answer but i will get back to you on that. Just, there used to be certain kinds of undercover i think Law Enforcement has taken a look at, because of the risks of people handling a package that they may not know and may carry a deadly substance, so it would be great if you looked at it. Askother thing i wanted to mr. Tommie, you discussed in your testimony that fentanyl and others synthetics are bought online, both on the open web and the dark web. What efforts are being made internationally to crackdown on illegal purchases of these synthetic drugs and the precursor chemicals that are used in them, what is happening internationally . The state department is engaged in extensive negotiations with countries that we feel are sources for these kinds of things. I can give you a conference of answer across the board, but i did talk with our bureau of narcotics enforcement and they give me some information on what is happening with china which is off great concern and has been brought up. I can share that with you. In response the reputed u. S. Requests made through the bilateral joint group that we have with china, the enforcement china has in fact mystically controlled now more than 134 synthetic drugs including carfentanil. That is an advance that we have made in getting them to see this. Chinas decision to domestically control for example, carfentanil which is caused the deaths in the United States that you mentioned, is a welcome measure and we hope to continue we hope to continue working with the chinese. In many cases they argue to us that this is not causing problems in their country but we have succeeded in convincing claiming they maybe that but it is causing problems in our country and we want them to take measures. We continue the process, theres a lot of work left to do but weve had that access. Thank you very much and thank you mr. Chair. Thank you. For you mr. Shank, if the packages dropped off at the ups facility, you are able to track it with a code, electronically, to share information with the customs and border protection. That is premature system, correct . That is correct. Ok. In the Postal Service, tell me what you cannot do the same thing . When an inbound package is coming in, for foreign shippers, they ship through a foreign Postal Service and they render it to the usps, we do not have that direct connection. So that state department, why can we not require that from the ,hippers in Foreign Countries or their equivalent of their post office . Well, as my colleagues in the Postal Service said, unlike the express shippers that control both ends of the transaction, we do not control both ends. But why can we not tell them that they cannot utilize our post office unless they have an electronic tracking number on it that we can track and share with cbp to cut down on this . Our treaty obligations, and organization based on rep to prosody and exchange reciprocity and exchange of electronic mail if they request it . We would like to be able to share data with them, we have offered here is the problem. The Ranking Member as chairman talked about the fact that we have a problem in this country and we do. It, they do not want to do it, i do not want to do a lot of things that i am told to is, it hasnin the truth an Economic Impact in our country. But not doing it is also having an Economic Impact. Way, peopleany could roll up their sleeves and say, hey, look, we have people dying every day in every state in the union from this stuff and it is time to say enough . Mr. Senator, i would argue that we are doing our very best to hold their feet to the fire and demonstrate to them has the threat been made that we will not be able to ship through the Postal Service if they do not do this . We have not made that exquisite threat, that would be outside of our treaty obligation. It is actually not a threat, it is a reallife situation. We can pack people on the back and say please, but that has not worked. Imt in it in a coney not in the negotiation, so i do not know what you are facing but i do know that there is a constant pal of money theyre are making and it has ruined a lot of lives. I would just encourage that the next them you meet, buckle down and do it. Otherwise, we might have to do some pretty draconian things at this and and im not sure we want to go in that direction, ok . I assure you senator, we are working very hard to demonstrate urgency on this. Ofs is just a general think i appreciate you all being here, by the way. The inspector general, came up and a report on inbound outgoing mail. This is a question for you mr. There were 11 recommendations, five of those have been closed. If im am correct, six of them are still open. One of the recommendations was that the Postal Office establish a way to better clarify the requirements of packages. Why are we not doing this . Earlier today, we did speak. My colleague indicated we will have the mo you setting up right now it Customs Border protection. Hammeredhen get that out and get it in place as soon as possible. Just to reiterate for the record, we have not waited for the mo you. A lot of these things, we work collectively with some folks locally to get these in place. Good. Pretty sure you agree with that assessment . In fact, yes. I mentioned earlier the timeline getting that delivered, and that is codifying many of the best practices and procedures that are already in place. If i might, mr. Chairman, when you get that mo you, could you rifle coffee off to this commission so we can know that it is done . We can provide it. Thank you. One more thing, and this goes to whoever would like to respond. If not, all of you. Is there legislation required in order for you to take swifter, stricter action to prevent these poisons from coming into this country, or do you think you have the ability to do it with what is on the books now . Anybody can go. Could you repeat one more time . The question is do you require further legislation to be able to take swifter and stricter action to prevent these poisons from coming into the country, or do you have enough latitude with the rules that are on the books now . There legislation needed for you to be able to stop these drugs from coming in is the question, or do you have the latitude to do it today . I defer to the state department or customs to maybe answer. Senator, we are comfortable with our authority. Nevertheless, again, just would continue to emphasize the unquestionable need to further good,forts to get advanced information. To you have anything you would like to add. Let me just piggyback on what mr. Peres said. The timing of rolling out this pilot i think is critical. I would just ask that if you have any recommendations that need to be changed within the code, dont be afraid to tell us. That would be helpful. All right, thank you all for being here today. Very much appreciate it. The house subcommittee on investigations also heard testimony on how fentanyl enters the United States. United states Law Enforcement has identified to the primary sources of the u. S. Illicit fentanyl threat china and mexico. An illicit supplier and laboratories openly sell fentanyl. Chemist work around their government control efforts by modifying chemical structures to create substances not recognized as illicit in china but having the same deadly effects. Although there is ongoing collaboration with china, the lack of current chinese laws that prohibit manufacturing or export is one of the challenges we face in stemming the flow of illicit fentanyl in china. Mexican drug cartels also obtain and primarilyyl use it as an adult rent in heroin that is produced in mexico. The cartels have discovered that manufacturing fentanyl is much more costeffective and draws less Law Enforcement attention than cultivating opium properties opium poppies to put his heroine. Seized across the u. S. Border is typically 5 to 10 in. ,any people who use drugs heroin or prescription pain pills, are unaware of the presence of more talking fentanyl in the narcotic. Fentanyl use in suspected heroin or counterfeit use is more potent than the drugs they visible, and it readily leads to overdosing, and this is often how Law Enforcement first learned that fentanyl or an analog has been introduced into the local drug market. The addictive nature and demand led tcos toas compete for a portion of the illicit u. S. Drug market. Illicit fentanyl is not only dangerous for people who abuse drugs but also for Law Enforcement, Public Health workers, and First Responders who could unknowingly come into contact with it. Accidental skin contact or inhalation of the substance during Law Enforcement activity is one of the biggest dangers and challenges we face in Law Enforcement. In response to the dramatic increase in availability of opioids in close coordination with other federal department and agencies developed availability and Reduction Plan to reduce the supply of heroin and illicit fentanyl in the United States. We are targeting supply chain networks, coordinating with domestic and International Partners and providing Field Training to highlight officer safety and collaboration efforts. Ice is also fully engaged with the dea special Operations Division and the National Targeting Center drug in a five shipment routes, parcels that may contain heroin, illicit fentanyl, and fentanylrelated substances and manufacturing materials that go into making pills in the United States, fully exploding financial and other investigative analyses along the way. The crisis demands urgent and immediate action across Law Enforcement, interagency lines in conjunction with experts and scientific, medical, and Public Health communities. Thank you for the opportunity to appear before you today, and i look forward to your questions. Leadsed on the data that Law Enforcement to International Mail facilities at nine different airports in 2017, i find it amazing that not one package of fentanyl was detected. Is there more difficulty in coming up with a targeting profile for fentanyl shipments that we know about, and what can be done to prove this . Detection of fentanyl at the land border and consignment packages and mail is a challenge that we continue to deal with. Successwe have better in certain channels than we do in others. Their ability to target packages inbound in the United States is much better than our ability to target mail coming to the United States because the universal postal union we operate under does not mandate that international shippers, including china and others, provide advanced information about packages. Requiring that would help . Yes, it would. Over theis it coming border in mexico . Specifically . The two areas where we have seen it most prevalently is in Southern California and southern arizona. The vast majority has been detected how do they bring across the border . And personally owned vehicles or bodies, people coming as pedestrians across the border at ports of entry. People come legally through ports of entry, and either way, they are both coming through . Legal. Where we are not detecting it is between the ports of entry. Were seeing it come in at designated ports of entry and seized. But other parts were not seeing . They are not picked up their . On the land border, were not seeing it come between the ports of entry. Other method of it coming through the United States is consignment packages and mail, which generally is detected in the interior at express consignment hubs, where all consignment packages are cleared by cbp or at International Mail facilities designated around the United States. Thank you. Before we wrap up our program focusing on the u. S. Opioid epidemic, we want to open up phone lines and get your thoughts on in particular the governments role in the crisis. Heres how to join the conversation. For those of you in the eastern 2027tral time zone, use 488920. 2027 pacific mountain, 488 921. If you have been particularly impacted, the number is 2027488922. We welcome your tweets as well. Perhaps an angle we really did not touch on is much, according to a couple of our viewers this evening, here is sandy. She tweets similar view from lee. An article earlier this week in the Washington Post looked at the city of philadelphia, the headline sent in a link to thousands of urban overdose deaths. They write that the spike in fatal until overdoses in greater philadelphia has been among the steepest. In 2012, it was linked to nine fatal overdoses. Putting to the health apartment, by 2014, the number had grown to 100. Lets get to calls. Roseville, ohio, and ernest. Yes, im a cancer patient myself and i have been. N opioids for 15 years now since the emergency came out or theyre calling it, i understand because these people out here that its it, the doctors are doing it by over medicating so many people, and then they cut them off, you know . Just cold turkey. I mean, my doctor shut me down a month ago because i missed an appointment. What does that do to you physically . Caller he completely quit seeing me, and did not warn me you know, what was going to happen or anything. Within five days, i was in the emergency room almost dead. Anybody that thinks that you can go cold turkey off of these opioids after longterm use, thats not true. You will die of respiratory failure. At least half the people will. We appreciate you calling in. We will hear from don next in spokane, washington. Caller hello. Im 58 old, and i recently had surgery. To function every day, i get hydrocodone number 10. To get those, i have to go , which Pain Management regulates and watches you. They have you do a urine test, any sure you are not doing other drugs. The problem is these other people are getting them on the street, and they are making combination drug cocktails. My concern is im not going to get any better. Neck isons told me my going to be the way it is, and im going to need Pain Management. Wayke the pain meds the they are. They are reducing my intake slowly so i do not have that withdrawal, and at one point, i will get a lower dose, and then keep on that lower dose to suffice my pain, so that is what i have to say on that, and i hope doctors out there do a regimen where they do Pain Management where it is overlooked, make sure the patient is not combining these drugs like heroin and stuff and whatnot. Or anyt have no alcohol illicit drug in my system to get my pain medicine, so that is my impact on tonight. [indiscernible] appreciate that. Here is a cdc chart looking at the spike in heroin deaths over the last few years. Lets here next in florida. Kevin, hello there. Hey, guys. I did not think i would get picked tonight, but im glad i did. Host glad you got on. Caller thank you. From south florida, and the epidemic is pretty bad. I want to know that i am 24 and i am an addict in recovery, and i do have an elderly father, so i do understand the impact it makes on people that actually need it, but my point for the think thatis that i basically, like the lady was saying earlier how practices were different back then, and people really do not need these opiates. The truth is Big Pharmaceutical Companies make tons of money off their doing the thing in ohio state, and it is bad, man. They are bad. It needs to stop. You say you are 24. How did you get started . How did your habits start . If you look back in early florida, five or 10 years ago when the pill mills started, it was very lenient here. Everybody came to south florida to, like, the pill mills. Thats how everyone started in south florida. You could get them so easily. You were, like, in your late teens or early 20s when this all started for you . I was caller i was actually a lot younger. What happened is that the pharmaceutical companies that got everyone hooked onto the oxycodone then came out with the that train, the withdrawals are even worse than the original oxycodone. Its like they are just adding more and more things to make more and more money, and its just bad, man. Thanks for calling this evening. Lets hear from diane next. Yes, i have three daughters. One of them is highly successful. The other two are basically. Ecovering from heroin i am raising my grandson. He is six now. He had the opiates in his stool, and it was either foster care or raising him, and there are thousands of Grandparents Raising Grandchildren because of this addiction that is killing and ruining families and people. And how old are your daughters . You talked about a couple of them in recovery. And 22. 30 drug,ce they pick up the their brain, and i believe that donald trump should be able to build the wall to stop the heroin from coming in through our southern borders. Thing E Post Office that should have been set of a very long time ago. I dont know what the hesitance of that is. Will ever getf i my daughters back. I talked to them, but sometimes i have had things stolen from me so they could buy these drugs. You are pretty sure they are using heroine . Caller oh, yeah, definitely. Host lets hear from randolph. Caller im an addiction at a Treatment Facility at a Municipal Hospital here in new york city. E detox people from opiates some of the things we are finding is that people are coming in with severe withdrawals as a result of the combination of heroin and fentanyl, and theres definitely a need to adjust sometimes some of the detox protocols. 30start everybody off on milligrams of methadone and tapered down, but for those coming in on fentanyl, we may need to a just that because the withdrawal from fentanyl is more severe and more prolonged than regular heroine. Where do your patience or the people you are treating say they are getting this fentanyl . Anywhere on the street. Anybody selling heroin on the street nowadays, and a lot of it is laced with fentanyl. Also, we are finding that i listened to the governor from new jersey, but one of the things we found over the last year or so was that there are many people coming over from new jersey seeking treatment here in new york as new yorkers seeking treatment. The same thing, like Treatment Access in new jersey is not everything they say it is. Can you treat them . They are new jersey residents. Are you allowed to treat them . Because we are a readers hospital, we are allowed to accept people without the ability to pay. Host thanks for sharing your expertise. Lets take another call. Where are you calling from . Caller im calling from virginia. With the pharmaceuticals, they are only making money. They get these products, they do not know what they are putting in it. I suggest that if you all would do more research on cannabis, thatthat would stop because right now, im on it, and its not really doing me any good. Host right now, youre on cannabis . [captioning performed by the national captioning institute, no, if they were to do more research on it. They had me on three different medications. Its not really helping. And everyize alcohol thing else which cause liver damage and kidney damage and all that, but you never heard of that anyone overdosing on cannabis. All our colors, we appreciate you calling in this evening. A reminder, too, that all the programs we show you this evening, hearings, comments from governor christie and the president from earlier this