Transcripts For CSPAN Oversight Hearing On Drug Control Policy 20151206

Record as secretary of state. What does she want to run on . What is the platform . She is going to be the first woman president. Ask for your support because i am a woman, though i am proud to be one. But i will force Hillary Clinton to fight on ground where she will have to talk about the reality that every one of her policies are bad for women as well as men. Fight on the to ground of her track record and if she faces me, we will win. [applause] i think that is a perfect conclusion to our day. Happy hanukkah ladies and gentlemen. Happy 30th anniversary. On the roadkes you to the white house and into the classroom. Our student cam documentary contest asks to tell us the issues they want to hear from president ial candidates. Our camthe details on contest at cspan. Org. I am here to voice my support for the courageous people of afghanistan. Women and man who has suffered for years under the taliban regime. Each of us has the responsibility to stop the suffering caused by malaria. Every life in every land matters. All of it and do something to help. After studying first ladies and knowing some of them very , or, like my motherinlaw lady bird johnson, is that our country benefits from whatever our first ladies interests are. She is the second woman to be the wife of one president and the daughterinlaw of another. She became first lady after a controversial election brought george w. Bush to the white house. She helped comfort the nation while continuing to pursue interests long important to her including education, literacy, and womens health. Examining the public and private lives of the women who filled the position of first lady. Et ont at 8 00 p. M. American history tv on cspan3. Hearing on u. S. Drug policy. Then a hearing on russias violations of a 1987 nuclear treaty. Then your calls and comments on washington journal. Directorl botticelli, of the office of National Drug control policy, discusses efforts to reduce illegal drug use, prescription medicine, alcohol, tobacco, and marijuana. This is two hours 15 minutes. Subcommittee on Government Operations will come to order, and without objection the chair is authorized to declare a recess at any time. The office of National Drug control policy is charged with guiding the big picture strategy for addressing illicit drug problems in this country and the consequences thereof. We can all agree this is a problem that merits meaningful solution. Over the years we have tried a variety of approaches. From the launch in 1988 to the and reauthorization in 2006 today, the ondcp has been intimately involved in the spectrum of drug control efforts. A look hearing will take at the ondcp particularly since the last reauthorization which expired at the end of fiscal year 2010. To mask theolved evolution in the nations drug control strategies. What is the value of this organization and is it appropriately placed . Earlier this year, we sent a congressman and senators and the letter includes proposed language for the reauthorization of the ondcp. Todays hearing will discuss that proposal. We will hear testimony from the director of National Drug control policy mr. Botticelli, who will speak knowledgeably to the work being done there, as well as the proposed authorization language. As we look at these proposed changes to the highintensity referredficking areas, to as the hidta program. It has been a leader and bringing together local, state, national, tribal Law Enforcement entities together by targeting and disrupting Drug Trafficking organizations. We are very familiar with that in Western North carolina has we have one of those areas that has that cooperation. In response to this proposal, the national hidta Directors Association wrote to the members suggesting a compromise that would allow for the use of funding for prevention and treatment, but with the cap. Willgine that the director be able to provide further excavation on that letter and the proposed language. We look forward to hearing from you and all of the witnesses today. I would now recognize mr. Conley for his Opening Statement. Meadows. You mr. The office of National Drug control policy plays a Critical Role in coordinating the drug epidemic in which the annual deaths from drug overdoses now outnumber those caused by gunshots or car accidents. Manages a budget of 375 million with two National Credit programs at coordinates the related equities of the departments agencies and programs totaling more than 26 billion. Its more than a little concerning that they allow the former Office Organization to expire five years ago. It has been nearly a decade since Congress Seriously considered National Drug control policies and activities and is well hear from the panel a great deal has changed in that interim period. Not for the better. Aptly notes that in his prepared remarks that the scourge of drug abuse has no boundaries does not recognize your graffiti social economic status, race gender or age. The efforts of the when tcp are vital to a visible and so mr. Chairman i appreciate the bipartisan support with which we approach this hearing and the proposal toward reauthorization. I know that many of us are very troubled by the spike in heroin use in our communities. Heroine used to be a very static amanda drug. In my home state of virginia the number of people who died using heroine or other opiates is on track to decline for the Third Straight year. Heroine related deaths doubled in my own county between 2013 and 2014 and that follows a troubling trend across the National Capital region. District hasn my been fortunate to receive assistance from the Trafficking Area Program which provides grants to local state, travel and Law Enforcement agencies and the drugfree Communities Program which provides grants to create Community Partnerships aimed at reducing Substance Abuse among young people. Theinia has 20 counties of 95 that have been designated to Drug Trafficking areas. Four are part of the Appalachian Region and 16 are part of the washington baltimore area. Program has historically been more enforcementfocused, we are beginning to see an emphasis on treatment reflected in the proposal. Halve at 5 the amount of funds to be used for activities. 20 of the areas support for vegan activities. Four preventative activities. As their efforts predate the prohibition in the previous authorization. My district benefits from that particular exception. Providing residential day treatment and medical detoxification services. I think that 5 limit does not make sense, especially in light of a lot of the changes in demand for opiates and other drugs. I look forward to hearing more from dr. Botticelli about the drug control strategy. The proposed preauthorization language would allow the areas, uponfficking request, to spend funding on treatment efforts and above the cap on prevention efforts. That wouldve allowed a similar strategy on diversion that have proven successful in the capital region. With yourte mr. Kelly Law Enforcement background, acknowledging that we cannot rest our way out of the problem and that we are moving more toward a partnership between Public Safety and Public Health to take a more holistic approach to the Substance Abuse challenges facing so many communities across america. And the compelling personal story speaks to the power of treatment and recovery. Mr. Chairman, i hope our subcommittee can play a constructive role in helping to advance this effort and a very much appreciate the bipartisan spirit to which our colleagues have approached it. The chair will now recognize the gentleman from maryland. Thank you mr. Chairman. Connollyened to mr. Could not help be reminded that in this day and age, we are fully realizing that drug addiction has no boundaries. Rich,ects blacks, whites, poor from one coast to the other and theUnited States statements with regard to treatment, ladies and gentlemen some of the most profound words that will be spoken here is we had better wake up and begin to address this more and more as a Health Problem because what we are seeing now with heroine, ive known about heroine for many years in baltimore but now its spreading everywhere and people are beginning to understand that prevention is so crucial. The office of National Drug control policy has a difficult that crucial mission, tasked with leading efforts across the federal agencies to reduce drug use and mitigate consequences. Ondcp is also responsible for developing and intimating strategies and budgets annually while furthering longterm goals while none of these responsibilities are simple, i have been expressed with how diligently they have handled these tasks will being efficient with the resources provided. To discuss theay reauthorization of this vital work which includes the drugfree program which im very familiar with the Grant Program that helps prevent drug use and includes highintensity Drug Trafficking which operates the state local and lawenforcement agencies to demand dismantle and disrupt Drug Trafficking areas. The overall goals are substantial. Whichakes are high include reducing drug use among our youth, reducing the chronic abuse of a wide range of substances and lowering drugrelated deaths and illnesses. Despite what sometimes seems to be insurmountable obstacles, ondcp is engaging many of these fronts. Ondcp took a crucial step in recognizing that addressing drug addiction is not merely a Public Safety issue. Its a Public Health issue. We must tackle the demand as well as the supply. We must recognize that prevention and treatment are crucial tools that complement lawenforcement efforts. Ive seen up close and arsenal the way that drug abuse can be destructive. If you wantaid that to destroy a community you can do it through drugs. In my own city of baltimore ive seen entire communities fractured and broken by drug use. Ive seen landmarks like the lexington market become synonymous with Drug Trafficking. I have seen people in so much pain they dont even know they are in pain. People who used to be staggeringg citizens to the streets slumped over from the effective heroine addiction. Right now, if you went to baltimore in certain areas you would see hundreds of them, people who have lost their way. This is not the baltimore where i grew up and it is not the baltimore i know is possible. Over the years they have demonstrated exactly how prevention and treatment can come from it lawenforcement efforts. I am also encouraged that this is one of five organizations that will receive 2. 5 billion to addressed our heroine epidemic situation through the heroine Response Strategy using a wraparound approach that encompasses lawenforcement Community Involvement treatment and prevention strategies, they dismantled 92 Drug Trafficking organizations seized almost 12,000 kilograms of marijuana and 3000 kilograms of cocaine and 410 kilograms of heroin since 2013. Its because of these demonstrated successes that i was pleased to learn that the ondcp is asking congress to equip all of them with crucial prevent meant and treatment tools as well. Today i look forward to learning more about the changes they are proposing and what it has been doing to address recommendations provided by the accountability office. This is and if you issue that affects all of us. If it has not affected you yet, i promise you that it will. Whether you live in west baltimore or the mountains of new hampshire, drug abuse affects every community in america. I look for to working all of my colleagues to ensure a full and swift reauthorization, a program that is absolutely crucial to the future success, safety and health of our great nation. With that mr. Chairman i thank you i think the gentleman for personalhtful and words as it brings it home up close and personal. I think the Ranking Member for that. I would hold the record open for five legislative days for a member who would like to submit a written statement. The chair has noted the presence of the gentleman from ohio. Particulart in this topic is important. He has stepped out for an Armed Services hearing that will be back joining us, so without objection we welcome mr. Turner to participate fully in the hearing. We will not recognize our panel of witnesses and im pleased to honorablee botticelli. I will try to get that better. He is more famous for painting. The director of the National Drug control policy at the office of National Drug control policy. Mr. David kelly the Congressional Liaison at the national highintensity Drug Trafficking director association and mr. David mauer, the director of justice and Law Enforcement issues at the gao, welcome to you all and pursuant to committee rules, we ask a witnesses would be sworn in before you testify. Please stand and raise your right hand. Please limit your oral testimony to five minutes but your entire written statement will be made part of the record. Mr. Botticelli, we recognize you. Committee,of the thank you for the opportunity to appear before you today to discuss the proposed legislation to reauthorize the office of National Drug control policy. It is an honor to be at this hearing today. Ondcp was established by congress under the antidrug abuse act under 1988 and was recently authorized by the National Drug control policy reauthorization act. As a component of the executive office of the president. Use blished policies and objectives of the program. We help evaluate, coordinate and oversee the International Efforts of the executive branch and ensure that the efforts complement state and local policy activities. Ondcp is responsible for administering the National Drug control strategy which is our primary blueprint. Abusereat the substance programs as Public Health challenges and have approaches to address drug control policy since they released the inaugural strategy in 2010. In that strategy they set ambitious and aspirational goals for the production of illegal drug use and consequences. These goals with amateur can progress has been made in many areas that we know that we have far to go. Mood ance we have moved toward achieving our goals and we have met our goals related to the lifetime prevalence of tobacco and alcohol use among looking at our goals related to the thick drug use by young adults with find so him andana use and himhim and him him away winter shall ensure funding appropriated for the program are extended for the establishment of treatment rogue rams. The proposed asian wilted aboard 5 combating drug use in dealing with its effects is an expensive proposition. The administration requested more than 27 billion in 2016, ensuring this money is well spent, that we are making progress and that the various agencies are well coordinated and is vitally important. It took congress and the American Public assess how well the programs are working. To tell because agencies do not have good enough Performance Measures will stop ondcp has focused a great deal of time, attention and resources on developing and using Performance Measures. Five years ago they established a series of goals with specific outcomes hoped to achieve by 2015. We reported that a related set of measures were generally consistent with effective Performance Management and useful for decisionmaking. That is important to remember when the conversation turns to what those measures tell us. According to a report issued two weeks ago, none of the seven goals have been achieved and at some of the key areas the trendlines are moving in the opposite direction. For example come of the percentage of eight graders who have used illicit drugs has decreased rather than increased. Substantially more americans now die every year of drug overdoses than traffic crashes. Its important to recognize progress in key areas. The 30 day prevalence of drug use by teenagers has also dropped. There has been recent progress in federal drug invention and Treatment Programs. Two years ago we found the coordination across these programs at 15 federal agencies were too often lacking. Recommended that they take action to reduce the risk of duplication and improve coordination. Since a report, ondcp has done just that. Weve updated the budgeting process and monitoring effort to enhance coordination. A report highlighted the overlap among various entities. The fund and support multiagency centers. These were one of five information sharing entities we reviewed including the joint Terrorism Task force and urban area fusion centers. We found that while the entities have distinct missions, roles and sponsor abilities, they can overlap. 37 the 34 fieldbased entities we reviewed conducted overwhelming investigative and support activities. Themd not held hold responsible for coordination or assessed opportunities for coordination. Since a report they taken action to address recommendations but they have not sufficiently enhanced coordination mechanisms or enhanced coronations such as serving on one anothers governance boards or how collating can be applied to reduce overlap. In conclusion, as Congress Considers the options for reauthorizing it is worth reflecting on the nature of the list drug uses in this country. It is an extremely complex problem that involves millions of people, billions of dollars and thousands of communities. Costs to very real lives. Mr. Chairman, thank you for the opportunity to testify and i look forward to your questions. I appreciate the fact that you acknowledge deficiencies and areas where performance was good. Thank you for that balanced testimony. The chair is going to recognize the vice chair of the subcommittee, mr. Wahlberg, for his five minutes of questioning. I appreciate that and enjoyed my time in your district. You of that since you do not have a chance to call the sheriff. Country, inross the the communities and across my district, we have experienced some significant struggles in fighting against the growing tide of heroine use and abuse, and the misuse of medication, prescription am a pain medicines as well. Im aware that ondcp has increased his efforts in response to the heroine Response Strategy but unfortunately it is limited to certain regional areas. Mr. Botticelli, what efforts undertaken to address description drug abuse and heroin use. I think there is no more pressing issue that faces ondcp right now than the r. Kelly associated with Prescription Drugs and heroine. Part of the work thats continuing to monitor these drug trends and make sure we are putting these efforts against those. In 2011 the released a Prescription Drug abuse plan acknowledging the role that these drugs were playing at the time that happened to relate to these issues. They included broad efforts to reduce the prescribing of these Prescription Medications and call for statebased Prescription Drug Monitoring Programs. Theing with our partners at dea to reduce the supply of drugs coming from these communities and to coordinate Law Enforcement actions. We also simultaneously called for an increase in treatment resources to deal with the demand that we see. We have made some progress. We have seen reductions in Prescription Drug misuse and a leveling off of Prescription Drug overdoses. Unfortunately, that has been replaced by significant increases in heroine related overdose deaths. X is it simply where they are going because of reduced cost to data, ithen we look at appears that only a small portion of people who misused Prescription Drugs progress to heroine. About 5 . But new users to heroine 80 started misusing pain medication so misusing the heroine crisis compels us to deal with the Prescription Drug issue. From the copper hence of perspective we know that some of this is related to the vast supply of cheap your heroine, in parts of the country where we havent seen it before as congressman cummings talked about we know that it has been in many of our communities for a long time but we have to diminish the supply that we have. We also have to treat it and make sure that people have access to good, evidencebased care and we have been working with our partners in Law Enforcement to diminish overdoses in the locks on. I have to say i have been heartened by how Law Enforcement across this country has taken on not only reversing drug overdoses but to the point of not arresting people are shepherding people into treatment. Not only have we seen Law Enforcement entities respond but we are really accelerating and coming up with what i think are really Innovative Programs to get people into treatment. Efforts asy, what that program undertaken to prevent Prescription Drug use and heroine use . Thank you for that question. The program has historically identified the most prevalent threat. There is a greater threat certainly in the northeast and other areas of the country than the abusive heroine and controlled Prescription Drugs. It is probably the overriding issue taking the lives of so many. For that reason it is put that on the radar. The program through its enforcement efforts at the ground level comprised of federal agencies state and local working together to identify the source of the heroine coming into the country and dealing with the organizations that have invaded our communities through a variety of investigative methods. But the program also embraces a very ballistic and multidisciplinary approach. We recognize in Law Enforcement across this country each and everyday day that we cannot arrest our way out of this problem and for that we have reached out to the Public Health have madeand we partnerships where partnerships never were before, international as well through ondcp and the dea which is the background. Theyve worked to identify where it is coming internationally. When we do that we try to interrupt the supply line. It goes to distribution areas throughout United States. Groups thata aa focus on the major trafficking, not the youth on the street or the person inflicted medically but by the organizations making money at the anguish of so many. We look at it as a multidisciplinary approach from enforcement invention and partnerships established throughout the Public Safety and Public Health community. The chair recognizes the Ranking Member of the subcommittee, mr. Connolly. I would be pleased to defer to the distinct Ranking Member mr. Cummings if he prefers to go. In trying to tackle drug use from all angles i understand that the users demand reduction efforts as well as supply reduction efforts. That we wouldand like to clarify in the it istion section that demand reduction work that can include prevention, treatment and Recovery Efforts. Give some examples of what you mean by prevention, treatment and Recovery Efforts . You noted, one of the overriding efforts is to restore balance to drug policy, that for too long we have used Public Safety as our prime response to issues of drug use and under this administration we have tried to focus on a balanced portfolio of increasing demand reduction efforts and treating. T as a Public Health issue our understanding of addiction has changed dramatically from understanding it is a criminal justice issue and an acute condition and a chronic disease. We have seen some dramatic butction in underaged use we also know that many times we let the degrees progress to its most acute condition which is why we call for language to allow us to do a better job of screening people and intervening early before they reach the condition and before they intersect with the criminal justice system, but we know that to treat this issue requires more than acute treatment, that this is a chronic disease that requires longterm recovery and we know people need Additional Support beyond treatment, things like housing, employment and peer recovery. It allows us to focus on that continuum of demand reduction strategy that we know to be effective. I understand that ondcp would like to allow everyone at the request of their boards to expand their abilities to use prevention efforts that i support this because 27 of them already understand the importance of using prevention activities and i support this because ive seen the treatments work so well in baltimore and washington which is one of the two that allow treatment. The washington baltimore haida has allowed Drug Prevention treatment to 2000 individuals of criminal records today and over half of these have successfully completed the Treatment Program. Rate afterism arrest one year has been 28 while comparable recidivism rates is over 40 . As i mentioned in my Opening Statement the washington baltimore haida has captured over 4000 fugitives from drug charges and removed over 2000 firearms from the streets in the last three years alone. In your written testimony you noted that the Law Enforcement community recognizes that we cannot arrest our way out of this problem. Would you agree that treatment and prevention efforts have augmented the washington baltimore ability to carry out the mission and how so . That the program has traditionally been an enforcementbased program. Thats where our greatest success has been over the years but we also recognize that the multidisciplinary and multifaceted approach is so very important as the landscape of drug abuse has changed that treatment and prevention play crucial roles in the overall strategy. Washington baltimore have had Treatment Programs well before the Treatment Program was in place but we also recognize that its a very expensive proposition and prevention has been throughout the program for a number of years. Programibility of that and the beauty is our ability to bring people together to make the best possible use of resources to tap into other prevention resources together with some limited funding to make a great impact. I really believe that could continue under the current reauthorization language and i alieve treatment does have place at the table and most across the land would agree with that and the executive board would have that ability to bring that aspect of the strategy in to play should they decide to do that. Mr. Botticelli others are using prevention tools like encouraging Law Enforcement and,ials to use the locks one of the things that has concerned me is that they jacked manufacturer, the knowing this is a drug that could save peoples lives, they jacked up the prices and i have been all over them and im wondering, what efforts i know that you know this, but what, if anything have you done to encourage the manufacturer of this lifesaving drug to be reasonable . Disturbed thatry the manufacturer decided at this great demand to more than triple the price of the locks on niloxon. Pursuing a number of goals. I am pleased to say that just a few weeks ago they improved the new Nasal Administration developed by another manufacturer and so we hope that will continue to bring some competition to the marketplace. We will establish part of our work over the past several years about dedicated grant or grams to help support the additional purchase of the drug because of this lifesaving drug. It is particularly disconcerting to me that people took advantage of some of the incredible dire need we have to significantly raise the price. Thank you mr. Connolly. The chair recognizes the gentleman from South Carolina for five minutes. Gentlemen, thank you for being here today. I just want to go over a couple of things that mr. Botticelli said in his opening testimony. Thatrd mr. Botticelli said he made substantial or significant progress in the areas of 2010 i heard him Say Something different. Lets drill down into these seven goals. Could you briefly tell us what they were . He mentioned one which was eighth grade marijuana use. The seven goals were set out in the 2010 strategy to look at 30 date used by teenagers broken down by illicit drugs, 30 day use by young adults, the amount of chronic users of illicit drugs, drugrelated deaths, morbidity, and drugged driving. If i read the gao summary correctly stop me if im gaog, in march of 2013, the said that on the seven goals 2010, that you folks at make progress on one, no progress on four and there appeared to be a lack of data on the other two. Fastforward to a couple weeks ago and you folks said you had made progress on one, no progress on three and what someone described as mixed progress on three others. Here is my question. Five years. None of them have been achieved. In the progress on one, white are we still spending money on this if you had five years and we are actually getting worse and not better. Let me go over it in detail. We know that youth are particularly vulnerable. We have made considerable progress toward those goals. The Young Adult Group . Correct. And we know that Substance Abuse by young adults can really set as long term trajectory pattern. Use we look at illicit drug that is where we have not made progress. If you take marijuana out from other illicit drugs than we have made progress. Goal as it ise related to alcohol and tobacco. Do you agree . If we take marijuana out have we made substantial progress . We did not have access to the root data that it seems to be consistent with the broad analysis. One of the other things we look at his chronic usage. They are often involved in criminal behavior. A number ofk at those markers in terms of cocaine use and methamphetamine use we see significant reductions and were moving toward our goal. We are moving away and we have seen a dramatic increase in the chronic use of marijuana among young adults in this country. If you look at our marker that looks at reducing drug use among young adults, we have seen no change. If you take it out of the young adult use we have seen significant and would have met our target were it not for marijuana and increases in marijuana use. If you had access to the root data and had the ability to separate separated out its different now than 2010, would it give Congress Better data . A better look into what they are a couple she if we can separate accomplishing if we can separate out that drug . Access to better data is better information to inform congressional decisionmaking. Mr. Botticelli, are you able to do that . Yes. The chair recognizes the Ranking Member mr. Connolly for five minutes. He was just asking about metrics and mr. Morriss testimony left the impression that rather than progress we are experiencing retrogression. Are we making progress in heroin use . Clearly we are not. Progress in cocaine use . Yes, we are. And marijuana is now in legal limbo. Not at the federal level but states are moving away. And he is quite right, you need to desegregate that to have adequate accurate data. One of the things about metrics is even the seven metrics cited, they are a little bit broad and we kind of want to dig down because what we want to do is and the drug search. Whatevers most efficacious way to do that is what we want, too. One of the concerns of got are you from boston . Where are you from . We were commenting the accent is closer. Where are you from . Melrose, massachusetts. Brighton and alton. I can tawk that way if i hafta. [laughter] i try not to. Since i represent virginia. A 5 ntly, we have in law, cap on the prevention and treatment for your program. Is that correct . That is correct. The new legislation would double that to 10 . The current language would allow for an amount greater than 5 and they are recommending that it be cap at 10 . Effectively, but not statutorily . Effectively. I have a problem with a cap, because any cap is arbitrary. Then you and your college might determine that in this case the prevention and treatment rate is the way to go so the mix be different in South Carolina or North Carolina or virginia. I want to make sure you have flexibility. Is that the goal that you are seeking . That is exactly right. Strike thatto balance and maintain the integrity of the program as we know it and the success of the program as we know it which is primarily been enforcement based. We also recognize the prevention so treatment of the approach in trying to avoid diluting the program and Mission Creep and being lawenforcement professionals, knowing there is in the 5 which no hitta country has approached in recent memory have approached 5 of the spending on the program and yet they have that ability. We feel that allowing openended spending or funding for those has the possibility of changing the structure and integrity of the program or a particular haida as we know it. Is it unity unity or strategy . If we had one or more that really bent a particular way it would change the landscape as we know it. Your test my also says we cannot arrest our way out of the program, why not . Why not just arrest them, call it a day. Isnt that more effective . Unfortunately, that is not the case. For everyone on cspan, that was a devils advocate question. There are not enough jails, there are not enough Police Officers or Law Enforcement officers to do that. Isnt it also true that when people do and up in the jail they get treatment because we cannot or the problem in jail. We would hope, but not always and sometimes they come out worse than they went in. Law enforcement across the land has had a paradigm shift in the understand that we cannot arrest our way out of the program. They also recognize that addiction is a disease and needs to be treated. But those that benefit and capitalize are the ones we are after. You talked about Budget Reductions, can you expand on that . The haida program has historically been very valuable funding. The we have in the past provided a very substantial return on investment. Certainly the language have we reduced . We have not. But you talked about a Budget Reduction from fy 15. Did i miss that . While he is checking the dollar amount reflected in the reauthorization language was taken from the president s fy 16 Budget Proposal and not representative of level funding of the program. My testimony was that what they were recommending instead of going back congress awarded us 245 million and we have done tremendous things with that money. 193 the language of reauthorization in print, should someone decide to latch on would be a 22 reduction and would severely handicap the program. The chair recognizes the gentleman from ohio for five minutes. I want to follow on to the issues with my good friend mr. Connolly. What to thank you for your leadership on the issue of the heroin epidemic and your mission is visiting with the members of the ohio delegation and the impact on our communities. We discussed that judges and prosecutors in my district have the that upwards of 75 of individuals they arrest or prosecute our substantive are subject of addiction. And you said there are barriers in place that inhibit the ability for those that are incarcerated to receive treatment and i want to get your thoughts. From 1995, the Substance Abuse and Mental Health Services Administration has a policy in place that prohibits the use of grants for treating individuals who are incarcerated. In this instance we are not talking about Additional Resources just resources being applied will stop and the second exclusions medicaid expressly prohibit the reimbursement for Services Provided to individuals incarcerated. They are entitled to receive medicaid and qualify for medicaid and the Treatment Services they would receive are not permitted during the period of incarceration. And one thing we know is that it feed leads to theft, to the addiction or other types of criminal activity that results in their incarceration. Introduced the treat act which would allow the amount of money to be used for incarceration in treatment and for those individuals who are toicaideligible to be able reimburse for those expenses for treatment because as you indicated, people are not saving treatment once they are incarcerated. Director but a chilly i wonder if you would speak for a moment about those federal dollars and whether or not you believe lifting those barriers would help others get treatment. It was a pleasure meeting with the ohio delegation. First and foremost we want to divert people away from incarceration in the first place. I saw a really Innovative Program in dayton ohio where the police chief is holding programs to get people into care. Toyour point, we do want ensure they have access to highquality treatment. As mr. Kelly talked about, unfortunately it takes a tremendous amount of resources and because of the prohibition on medicaid, it often goes to the corrections or state Public Health agency to help support treatment, but unfortunately too few people have access. Any opportunity we have to work ensurengress for how we people get good care behind the wall becomes really important. That untreated edition when they come back will perpetuate the cycle of chronic addiction. The policy and grants being made available to communities are excluded to be used for those incarcerated . We would be happy to work with you. Any opportunity we have to increase the capacity of our jails and prisons to expand treatment you on behind the walls is a priority. I appreciate your interest in this and mr. Kelly you are bringing this issue and to focus that there are the resources for that treatment there. Congressman, or bring this comment because i am well aware in our area in new england we deal with institutes on a fairly frequent basis on a number of issues. I can tell you from my past Law Enforcement experience that most, if not all issues had some relation to drug abuse and the were a number of people i know personally that went into a correctional institute, came back out and without treatment were back to meeting crimes and back on the addiction so it is important from a personal standpoint. We have done some work looking at the federal prison system at gao and the Bureau Prison has expanded and the amount of resources specifically on drug Treatment Programs and inmates eligible for those programs. One of the big incentives to take advantage is they can have a reduction in the amount of their sentence if they successfully complete those programs. I think the gentleman for his insightful and well informed questions and so the chair now recognizes the gentlewoman from the District Of Columbia, my friend. Appreciate this hearing, mr. Chairman. Heard we have heard to blame increase that on the drug administration, nor does he. In fact, staying ahead of the such a challenge that i think we ought to concede that it will always be a challenge. Looking into what we can really do i have a question on the drug du jour, and the District Of Columbia, and another question on marijuana. Remember when the was that the entire nation focused on was crack cocaine and is of course, everybody focused on opiates and heroine, and it will change tomorrow. I was very interested in mr. Treatingquestion about people when they are behind bars. , had a roundtable last night there are people all around the country because of the reduction sentence for mandatory that alms mandatory minimums. This is one of the Great American and Law Enforcement tragedies. We treated crack cocaine differently from crack cocaine from cocaine, 100 to one and by the way democrats and republicans. This was certainly bipartisan. We destroyed the in theirmerican family mid30s. The prime of life. Andy you hear about opiates heroine, you might and about the Law Enforcement approach which you have been authorized to pursue. Botticelli,ou, mr. In light of prevention, i dont see how you can prevent the next drug did you are drug du jour. We have not even brought up the words synthetic drugs yet, but i am a sponsor with several members on the other side, of a bill to deal with that new phenomena. You cannot expect Law Enforcement to prevent new drugs from changing. Im not sure why they change. At the very least, it seems to me that once you have somebody, thesell often find witnesses that had just been released from mandatory minimums and had them reduced by an these are two years linked with drug traffickers by using drugs. Believenot help but that if somehow treatment had been earlier available that we might have prevented one of the worst tragedies in Law Enforcement. 10 thatt be 5 , has the ring of a number pulled flatf the air, because you funded and do not think you can get anymore. Is that essentially the long and short of it . Where did you get 10 from . Especially as a cap . That was ahe 10 figure derived in two different ways, using the prevention history from the hidta program even though 5 of funding has been available for a period of time, many hidta have never approached that. How about treatment . Except in this region because we were grandfathered in has the experience that the Ranking Members spoken about educated you at all about treatment . Is that directed to me . Certainly it has. In fact i speak for all hidta directors. 10 . At was the basis of are not suggesting another percentage of just suggesting it may not be evidencebased. It was more based on the budget and the fact of the in theis historically prevention realm would never exceeded more than 5 . I also spoke about the partnership we have and the fact that we as a enforcement professionals value that and the fact that by elevating it to increase almost doubling it would give the executive boards fairly wide discretion and an effective baseline. The baseline of a hidta differs across the nation. The new england hidtas baseline is 3. 1 million per year which would allow the executive board up ron upon approval of the director qs upwards of 300,000 is a maximum. Thats also very important to realize that set the only source of funding for treatment that would be available. The beauty of the hidta program is across the spectrum of health care and correlating with other people we can really maximize that impact. I think it goes back to allowing ,or treatment and prevention enforcement. The multidisciplinary approach is very important, and we recognize the fact that we are flat funded. Discretionary funding sometimes is buried and discretionary funding more discretionary funding would certainly allow hidtas across the land to use more money for these programs. Thank you mr. Kelly for your response. We recognize the chairman from wisconsin for five minutes. I will start with director ticelli i dont think of wisconsin as being the heroine center of the world. If i multiply it out, it would be higher than that by a factor of three times or something. Only 8000 . Let me just say this is 2013 data. We expect in the next few weeks to have 2014 data available. Based on what i have heard, i would anticipate that the number of heroine associated deaths are higher than that it thousand. That bothers me of the top. How are you getting that data . Is every county reporting . Is that comprehensive or two different counties have different ways of reporting . Works way the reporting is that county and medical examiners report that to the federal level. There is probably wide variability in the reliability of that reporting. We have been working on enhancing the quality. Maybe i can help you with that. Why dont you get me the data for wisconsin and i can tell you if that is accurate. Where is this heroine coming from. We know that the vast majority is coming from mexico. This compels us to not only work domestically with domestic and supply reduction strategies but with our colleagues in mexico. I was just there to months ago and one of the main agenda items of our Security Dialogue was the additional actions at the Mexican Government can take in terms of ratification eradication going after heroin labs, we are seeing it in defense and will labs and this morphinelike drug. Overall strategy has to be looking at working with our mexican colleagues, reducing the supply coming from mexico and working to intercept more heroine. I was under the impression a lot of these pockets are growing in afghanistan. You are saying the whole thing is mexican. Probably another reason we should be doing a lot better job than we currently are locking down the border. On the how much prison iso you expect to get a federal crime possession of heroin or state crime . I believe it is a state crime. Are you sure . I am looking at might legal counsel. If i am caught with enough heroine that you know i am selling, what kind of written sentence can i expect in a federal court. Works i dont know the exact answer to that, what we do promote is that we know that many people who sell small amounts of a drug to feed their own addiction these are folks praying not the folks praying on our community. We want to make sure the people doing that largely because of get the bestiction care and treatment. To me, in wisconsin we have but afor treatment frustrating thing is that the cost of heroine is so low and the reason is that the people selling the heroine are not paying enough of a price. Heroine was around in the 1970s but wasnt so abuse like today. One of the reasons why the cost is going down is i am learning today that i dont think you guys consider enforcement enough of a priority. People are killing people. In wisconsin more people are dying of heroine than automobiles and accidents combined. Something that the federal government can do is begin to make the cost of heroine go up. Im concerned that you guys are not we cannot prosecute our. Ay out you have to try or the heroine cost will not go up. Honestly when we look at Public Health strategies, decreasing the availability and increasing price has been a primary strategy and that is part of the goal because of the cheap availability of heroine we know that has prompted part of the dramatic increase which is why we are focusing on domestically working on Law Enforcement to dismantle these organizations why we continue to work with x ago reducing supply. We know that there is this system to a the supply and demand. I would be the first to admit that while we need to continue to ramp up demand reduction strategies it meets the comp lament supply reduction work. I would absolutely agree that we need to look at how would mesh the supply of heroine and the trafficking organizations. I hope that you do that sincerely because im afraid at this point youre just throwing up your hands and saying we will just do education. The chair recognizes the gentleman from misery. Thank you and think the witnesses for being here. Let me ask director botticelli we are in an epidemic, it is afflicting americans in every part of this country in every background so the reauthorization is timely and urgent. Ive heard you speak eloquently and powerfully about how treatment is one of the ways that we can reduce the 17,000 deaths annually from prescription painkillers and 8000 deaths annually from heroine. Ive seen firsthand the value of lifesaving and life renewing Services Offered by communitybased nonprofits that provide residential treatment for substance disorder abuse. They provide the full continuum fromre for addiction residential treatment out care and support. One upon completion of the programs that is essential to them staying clean and being a productive member of society so it shouldnt be all about throw them in jail and locke imola. And think that this is a disease that needs to be treated. I agree with mr. Turner. If you are poor and you rely on medicaid for health care which we know that a lot of states have not expended under the aca, there is an outmoded policy known as the institution of mental diseases exclusions better known as the imd exclusion which bar medicaid from paying for residential treatment at the facility of more than 16 beds and the new york time cover this extensively last year about how the exclusion prevents people from accessing intensive care that they need as heroine addiction is surging. This yields a twotiered Healthcare System where only people on medicaid lose access to the kind of treatment. It may be clinically indicated and medically necessary but i believe this is wrong and it must be changed. I want to join with my friend from ohio mr. Turner in trying to change that. Mr. Director, do you agree that people on medicaid should have access to the same kind of treatment . The people who dont rely on medicaid . Congressman, thank you for that. One of things that we know to be effective dealing with Substance Abuse disorders is that people need to be contacted to a continuum and that Residential Rehabilitation removing people from their environment giving them new skills and jobs are particularly important for longterm success we want to e sure people have access that everybody has access to that continuum of care. I would agree that the administration has taken a look at the imd exclusion and secretary burwell just sent out a letter number of months ago to the state medicaid directors saying there are a number of levers that medicaid can use to help support a continuum of care but also waiver from the current exclusion. I know i used to administer statefunded Treatment Programs that many of them are under significant demand right now and that imd exclusions can seriously limit the ability of our Treatment Programs to serve more people. So we would want to look at how do we expand treatment capacity and how do we ensure people who are on medicaid and have access the last thing i will mention is in spite of the Affordable Care act and Medicaid Expansion in many states there are many people who remain uninsured and i what to make sure they have access to all of that care as well. Is to ensurer goal that our safety net funding remains in tact so that everybody has access to the full continuum of care. States happens in the that do not see waivers . Should this be a National Policy . Not only through the Affordable Care act, but through the implementation of Mental Health, equity and addiction parity act we have to look at making sure that we treat addiction like any other chronic disease and that we reimburse for those Services Like we do with any other chronic disease. We need to use other every tool in our toolbox whether it is parity enforcement a block grant to make sure people have access when they need it, not just because they can afford it. Im sure you realize that people who realize they need care often have to wait before they get care and often get a limited duration when they need longterm care and rehabilitation. I think the gentleman. The chair recognizes the gentleman from georgia for five minutes. Thank you and thank you for being here. As you can imagine, Prescription Drug abuse is very important to me. As a pharmacist, i have dealt with this experience this lived it and i have seen it and ruin lives and families. Its obviously very important to me. As a measure of the Georgia State senate i sponsor built 36, something i am proud of. Mr. Botticelli, i want to ask you, can you tell me what is your direct cup role in combating Prescription Drug abuse . We play a primary role first the meat express my appreciation for you and your leadership and to focus on scripture and drug Monitoring Programs because that has been one of our prime goals to ensure every state has a robust Prescription Drug Monitoring Program. That was one of our main goals when we released the plan. Today we have 49. Part of our role is to make sure they are adequately resourced. We know that having good Realtime Data availability and sharing information becomes important. How do you find those . Through grants . Those are through grants through the bureau of justice. When we set up our program, we were eligible for certain krantz because we did not have theain programs within Prescription Drug Monitoring Program that we needed, for instance sharing information across state lines. We could not get the bill passed at the time with that in it, which made us noneligible for those kind of grants. I would be happy to work with you, if there are additional eligibility requirements, if you feel like they become a burden in terms of states not having access, we would be happy to work with you. That is an important element in my hope is we can get that changed to the point where we can share information. I practiced right on the georgia South Carolina line, i would get prescriptions quite often from the states that need that information. Youto switch quickly mentioned a while ago and i took an interest, the decriminalization of marijuana, i suspect that has had an impact is wondering if you have done any studies. Opposed to the decriminalization or legalization. I was a practicing pharmacist for 33 years and i spent my career using medication to improve health and its a pet peeve of mine. When i want to know is in the states that have legalized or decriminalized it, i viewed it as a gateway drug. Ore we seen a decrease increase or any impact at all in other drug use in those states . We have a report going through final processing looking at part of that issue. Specifically looking at what the department of justice is doing or not doing in the states involving their use of marijuana. That report may address some of your questions. But i dont have any specific information. It is right on point and i think it is an important issue that needs to be addressed. Another point brought up during this conversation that i wevery interesting have done quite a bit of approval with Justice Reform and we talked about it in congress and having programs in our risen systems because they are full of people were in there for drug abuse problems. Illegal drug use and we need to have programs in our prison system that will treat them. It is a disease i can tell you as a professional and it needs treatment, what are we doing to help in the prison system with those types of programs . System inmatesal are eligible for residential drug Treatment Programs. If theyve come in with an addiction they can get that treatment and they can get reductions in their sentences if they successfully complete the program. So it is voluntary . White arent they required . If you go into prison for drug dependency, why are you not required to go through therapy . In the legislation the ability for inmates to have sentence reduced creates a pretty strong incentive and i know that for a number of years that beale p did not have adequate resources to meet the demands they since made a lot of progress in addressing that particular issue. I cannot speak to whether every single inmate actually gets treatment. I do know that many of them want to get that treatment. Many inmates may want that Treatment Program but i suspect that all citizens want them to get it. Recognizes the gentleman from massachusetts for five minutes. I want to thank the witnesses for your excellent testimony. Full disclosure, mike botticelli is a friend of mine. District is a high intensity Drug Trafficking area and mr. Kelly has been a frequent flyer to my district trying to address the problems there. Most pointedly weve had a critical situation in massachusetts in my district as well as other parts of the state and maybe just explaining that will offer some value to what the office of National Drug control policy actually does. Weve had a pernicious problem with heroine coming into my district from mexico. It was through his help that we figured all of this out, but its coming out of mexico and colombia, the earlier Drug Trafficking network was to the dominican republic, we had a lot of dominican gangs providing that as mr. Kelly informed us but between the office of the National Drug control policy and hidta, we were able to bring in resources. We are dealing with the system with local towns and cities and counties, the state one of their hot areas was Providence Rhode then we arell and dealing with the Mexican Border and the Mexican Government. Ondcp. Together so we get all of these resources. I had a number of homicides in my district that had the population and brutal murders directly tied to the drug trade. Ondcp did a remarkable job so from member to member how you deal with this in your district, ondcp is an important part of that and that is how we bring these resources together which are scarce. But it express support for mr. Turnerss idea about accessing samsung, but they are short funded on that end as well, but maybe we can do something on a Pilot Program where state prisons might identify certain programs like dayton ohio or massachusetts where we are trying some innovative stuff to deal with the potential inmate population. I appreciate the work you have been doing and thank you for your testimony as well. Seeof the problems that i on a daytoday basis and im up ofmy neck in it is the power oxycodone. Some horror you stories about young people that we have been dealing with one young woman had a tooth extraction got a prescription of oxycontin and then she tells me now she falsely claimed persistent tooth pain and got another prescription and to later she is fully addicted and then she started complaining about other teeth and having other extractions. So she was having teeth pulled out of her had to get the oxycontin. When people are doing that, it tells you this is a powerful drug. Because of the tolerance that it does to the vein brain and the tolerance and resistance it develops, greater dosages are needed. Thats one example and i could give you a bunch more. Drugs it we are allowing companies to produce these which they areby building a Customer Base for life by getting people on this oxycontin. Its overloading their brains and its grabbing them. Advantage commercial to producing customers for life. Now, the fda got god bless them, but the expanded the use to children. It seems like we are not all rowing in the same direction here. I actually filed a bill to ban oxycontin and there were more lawyers and lobbyists all over me on that i didnt have a prayer. Do tos it that we could look again and the substances we are allowing people to sell. Am not against Pain Management but this is ridiculous. Its off the charts in terms of the opioids we are putting out on the street. How do we address that . We are prescribing enough Prescription Medication to give every adult american their own bottle of pain pills. We all want to make sure people have access to these lifesaving medications for those who need it. One of the areas where we havent made enough progress and we would love to work with congress is ensuring that every prescriber as the minimum amount opiate on or unsafe thats where we are thrilled with the new england hidta because that is often the place where it starts. Im sure that the dentist thought he was very well intended in treating someones pain. I would imagine he got little to no training on pain prescribing and identifying addictive behavior. We have to work on all fronts not only that we make them as an abuse deterrent but that we are stopping this over prescribing that we see throughout the country will stop its critical thruster rain in the prescriptions and that critical point is often with dr. Patient relationship. Chair recognizes himself for a series of questions. Let me be real brief in terms of the introduction. We have a bipartisan agreement that this is something that we need to address. The question for me becomes with the authorization and the suggestions made in that, is for the appropriate place money funding. I can tell you that i started a nonprofit with a good friend of mine who lost his grandson and there is a cycle within that family of drug abuse. In on a nonprofit to work on the prevention side of things. I want to go closer because i think this is all about coordination. Mr. Kelly was talking about increasing the amount. S, ias we look at these cap want to make sure were not talking about the Law Enforcement component and spending the money on prevention and treatment, when it would be better allocated in a Different Agency that already does that. I think you are following that. My tougher question to you first, director, in the reauthorization language there is talk about getting rid of the performance system, wife . Why . One of the things we have looked at is how do we achieve our main goals and mission. We are fully cognizant of our role both to ourselves as an agency, and congress and the American People that we monitor performance. Came up with this new development, performance system why get rid of it . Had cut to the chase just cut ase, how do you do that getting rid of a program . You have existing mechanisms within our current the administration that monitors the performance. Who made the mistake . You created a new one, and then you are doing away with it, i dont understand. I want to be clear end of front, there were elements of the Performance Review summary that helped in our ability to continue to monitor performance. Let me be clear and upfront, i want you to work to keep the system of Performance Review in place. Make it meaningful and measured. I just got finished saying i am willing to look at increasing the authorization and renewing it. Appearances that you did not meet your performance standards and got rid of the program. That is not satisfactory. Do i have your commitment today to make that meaningful and put it back in . I would be happy to i want to assure you that we satisfy you your request. Is where spending billions and not getting what what we need, then we need to reallocate those funds if you could put up the chart. This gets back to how i opened up a little bit. This actually i believe this chart is one that comes from the 2014 or 2016 and performance summary produced by your group. We can see there that prevention and treatment across agencies is substantially higher already. I guess thats 11 billion is where it would be read would be. That i those programs have taken advantage of in use with grants are actually working in treatment and prevention. You drop down to the next group that is domestic Law Enforcement. Let me be specific in knowing you have a willing participant here to help you with reauthorization. Ida concerned we are taking when we are army already spending money and other agencies to do that when you actually would address that. What i would like us to do is relook at that, if we can. And if we are not meeting the 5 cap, the gentlewoman from d. C. And the gentleman from maryland both talked about that treatment component is effective, but we are not meeting the 5 cap. What i want to do is to make sure these we are allocating the money with the proper agency , andrform those functions not making a Law Enforcement officer do treatment prevention. , want to give them the tools but they are not in the treatment and prevention business. Fire in the Law Enforcement versus business. Do agree . Do you agree . I would agree. Despite the fact that we have significant funding for prevention and treatment, we know that we have gaps in many parts of the country. I would agree, but is either the bestplace ida place. We work with the program on making sure if they are investing money, it goes towards evidencebased programs. Let me to you i have ida programs in three counties in my district, the only Common Thread here is transportation. We are looking at main corridor is coming from the south. To do away with money from the program there, is not addressing the treatment or prevention aspect. It is all about transportation and that goes from the democrat and republican chair that are working in those counties. They work better together, and to reduce funds concerns me. Do you follow my logic . I appreciate that, let me reiterate. We were not trying to dilute the main mission of the program. Reactm saying, will you address address we with that bias. I need to go on to my other colleagues. You can try to fail me so ell me. Will my sheriffs agree that we need to increase the amount of money going to treatment and prevention in haida and go away from them, with a agree . I would say they probably would object. If they do, we would have an issue. The woman from the virgin islands. Thank you very much. Good morning gentlemen, thank you for the work you do. I am so incredibly appreciative of everything you all are putting forward, your testimony, thoughtfulness. My first job out of law school with a narcotics prosecutor in the bronx. I understand this completely and the importance of the work that you do. As a member of congress representing the United States virgin islands, i very much strongly support the bipartisan effort of reauthorizing the office of National Drug control policy. I see how important it is, not only for our nation, in terms of treatment, but preventative things as well in terms of stopping the flow of drugs in and out of the country and its transportation throughout. For years, the otherwise peaceful communities of the u. S. Virgin islands have been experiencing elevated levels of crime and violence. Much of it is related to the economy. Turn movedy has in tremendously to an illegal drug trade. We are very grateful for the the virginsence in islands, and would be in favor of increased presence. We are aware that much of the traffic of drugs that is coming into the mainland is coming through the caribbean corridor. Many people are not aware of how much drugs are coming into this country through such a small area of the United States. You can imagine, it is coming through such a small, important order of this small community, the effect is having it is having on the people that live there. Individuals completely afraid to go out not only at night, but now during the day. We are having drug wars and occurring not even blocks away from schools in the middle of the day. Although a significant effort has been made in recent years to secure Additional Resources to address Drug Trafficking, in our opinion, much remains to be done to help stem the flow of drugs and related crime. Diminish the negative impact of drug abuse in the communities across the u. S. Virgin islands and puerto rico. In response to the congressional directive earlier this year, ondcp took a major step in helping to promote a well coordinated federal response issue by publishing the first order counter narcotics strategy. You, as to whether or not you believe that exclusively including the u. S. Virgin islands and puerto rico Statutory Mission would help include the border and aspects of the work in aspects of the work. Because we are so small in numbers in terms of population, almostare unaware that 40 of the drugs are come into the country come through those areas. Thank you. We share your concern. We have seen an increased flow in the caribbean. To produce to comply the 2015 caribbean counter narcotics strategy. We are actually going to be relevant all of a stakeholders in early twice 16 to review the progress against our goals and ambitions for this. We have every intention Going Forward to include specific action items in the strategy Going Forward to that address the caribbean and u. S. Virgin islands. It will continue to be a priority. I will look work with you as closely as possible. Our families, elders, and children really need your support. Mr. Kelly, do you have any thoughts . Haida in puerto rico about a month ago. I was impressed with the work theyre doing. I have been speaking with the coast guard who is doing that work as well, and would like your thoughts on that. Thank you congresswoman, you have struck a number of points. Has been program intimately involved with the caribbean. Haidaly through our program presently there, but we on a monthly basis, we have a Conference Call. Sometimes as many as 90 people on the Conference Call. It is the caribbean intelligence Conference Call where members of but all thecp, federal agencies here in the u. S. Talk about the transportation of drugs and the sharing of intelligence. We have made great progress. So much so that it has been a repetitive Conference Call. We will continue that. To your point on including in the reauthorization of the type of border savagery strategy, i think it is important as we look at this country, that we look inlet edward, but we also have to insulate ourselves from the back outside. That is the transportation corridors where these drugs are invading the community. It makes perfect sense to me that the caribbean is a very important partner in this issue of reducing the supply that comes from elsewhere in the world. We know that we have to take greater strides in protecting, not only the people of the caribbean and those nations and territories, but to prevent a transportation of drugs and make that a no go zone. Thank you very much. I am so impressed working with you all. I will be watching. Think thank the gentleman, mr. Director, why are you requesting 22 less . For the haida program . Part of the challenge you punish them by reducing their budget . Selective ofis not what our value of the haida program is. My wages my wife is a waitress, she says appreciation of screen. Is green. What is a reflection it a reflection of . Where did the money go . Can you get that to the committee. Im concerned. I will recognize the gentleman from new york. Maloney mrs. Maloney you should not be a limiting review processes, but strengthening them. Certainly knowing the problem we have, we should not be reducing what we are ending, but maintaining, and hopefully growing on it. I would figure back to the conversation we have been having an opiates, that they have been prescribed strongly in the increase and the increase. Are you tracking if the restrictions are coming from doctors or is there illegal if they are illegal . Vast majority of prescription pain medications are coming from legitimate prescriptions. We only see a small percentage sales orom internet streetlevel purchases. 70 of people who start using prescription pain medication get them free from friends and family, who often got those from just one dr. As people progress, they move from doctor to doctor. That comprises a little proportion of overall prescription pain medication in the supply. We know if we will deal with this issue, that we have to diminish the prescription pain medication. Mrs. Maloney also reports that people on opiates become addicted to heroin. Apparently heroin is cheaper. Is that in your database . One of the questions you asked . Often heroin goes to crime. That 80 of know people on heroin started by using or misusing a prescription pain medication. We do know that when you look at heroin use, it is lower as a percentage of use of Prescription Drugs. Thatow that it appears only a small percentage of people are progressing from Prescription Drugs is to heroin misuse to heroin. The magnitude of the drug issue has led to an increase in the number of people using heroine. Mrs. Maloney is there a punishment for the doctors who misuse the opiates. I thought it was astonishing that woman had teeth pulled out of her head to get pain medicine. Obviously her doctor was not petent if you was pulling he was pulling teeth that didnt not deserve to be extracted. What is the punishment for a doctor that is prescribing painkillers inappropriately. Director i think we have to distinguish between those physicians who are well intended , versus dealing with those physicians who are just doing it is a huge cash business. We have seen that in many parts the country. Mrs. Maloney how is it a big cash business . Director and one county in ,lorida, because of lax laws and because they do not have a Prescription Drug Monitoring Program, 50 of the top 100 prescribers were in one county. Working with the dea and the police, and the Prescription Drug Monitoring Program we were able to enact laws and reduce these huge pill mills. Law enforcement in reducing those pill mills become the prime strategy. We have been working with the federation of state medical board. Have oversight and disciplinary action as it relates to physician who are clearly out to the range of appropriate prescribing. Taking disciplinary action against those physicians, and other prescribers who are clearly outside the bounds of what normal prescribing behavior would be needs to be part of the strategy. My time is almost up, but i do want to asked mr. Mauro about the gao release report about the coordination efforts of drug abuse prevention , reported by an overlap of 59 of the programs. What is the possible impact of this overlap . Why did you raise that in the report . We found overlap in 2015. What we meant is there were programs that could potentially be providing grant money to the same recipient. The right hand would not necessarily know what the left hand is doing. The good news is we issued findings, we made recommendations to take a look across the programs. I have done that. They have identified the need for greater coordination and put mechanisms in place. We have since closed it is incremented. As it is implemented. Thank the gentleman, we will do a limited secondround. By very limited, i will recognize the gentleman wisconsin for four minutes. A strict four minutes. Then we will recognize mrs. Norton for a strict four minutes. The gentleman from wisconsin is recognized for four minutes. Because itome back was a rhetorical question as to whether possession of heroin is a federal crime. What is the expected prison term you get if you have enough heroin with you that you are probably some sort of dealer . You ask for . V federal prosecutors ask for . I dont know. A lot of factors go into it. Minimum mandatory there a mandatory minimum . It is a function of prosecute it is a function of the prosecution. I dont know what those are. Do you know how many people are in federal prison . I dont know, i do know that well over half of the population is serving a system sentence based on Drug Trafficking. To me there is a big difference between heroin and other drugs. Marijuana being illegal, but there is no one dying from a marijuana overdose. This heroin thing is a whole new thing. Much worse than cocaine, and anything. That is why i dont like it blended with the other things. Know how many prosecutions for heroine . Either possession or selling . I do not know. I want you to give me those things. For youit is important three, who are supposed to be the federal people fighting heroine to familiarize yourself little bit about what is going on in the criminal and federal courts dealing with heroin. Asking these questions because i thought you would give me questions, and you dont know them. We would be happy to work with her colleagues. You have important jobs, you should know the answers. I will ask you more questions later when you have time to get the answers. Unrelated,estion, one of the problems we have this there are physicians who are clearly selling prescriptions for opiates that they should not be selling. Another problem, to me, is we have physicians prescribing more opiate than traditionally needed. Someone goes in for a root canal, instead of giving a prescription for three days, you give a month. Why the practice has taken hold . We completely agree that not only are we overprescribing, but in many instances people that need limited pain medication are getting up to 30, 60 day doses. Services isnd human developing guidelines as it relates to prescribing a medication for these exact not only appropriate prescribing, but also not overprescribing the amount given out. Business, buteral so many of the prescriptions that are paid for by medicare, do you think it would be appropriate for federal guidelines for the appropriate amount of opiate prescriptions . One of the issues we are particularly looking at with medicaid is not only the of these clinical standards, but also continuing to focus on what we call log and programs to ensure that people who might be going in to multiple physicians or pharmacies are locked into one. We are looking at a wide variety of medicine systems mechanisms to see how we could diminish the cost of Prescription Drug use. Thank you. The gentlewoman from the District Of Columbia is recognized. Chairmansiate the indulgence. I had a question on synthetic drugs. Agree my police chief would not want it either. Plusook down 19,000 packets of synthetic drugs only recently here in d. C. It was the Law Enforcement that did it. These synthetic drugs present a new challenge. I want to know how you handle it. In october alone, we have had Emergency Services called 580 more for the 18 times than 18 times a day to respond to synthetic drug emergencies. Here we have Bipartisan Legislation that has introduced i am not sure any of it can be found constitutional. Unlike heroin, which is what it is, they change the composition. Are you pursuing synthetic drugs . In light of the fact that a criminal statute cannot be overly broad or it violates due process, do you have the tools to do your Law Enforcement work with what is now going across the u. S. My republican members who have this problem when the bills come from texas and pennsylvania. Thank you. I am glad i have the opportunity to talk about synthetics. One of our concerns is the increase of new psychoactive substances. We have been working with our counterparts in china because we know that the vast majority of these precursor chemicals are coming in from china. Were happy to say that china just used moved to schedule over 100 of these substances. To your point, about how to we stay ahead of these new compositions has been to challenge a challenge to us at federal and state levels. We are happy to work with congress in terms of legislation that has been rent introduced. Governmentgive the scheduling authority. China is doing new legislation, you do need new legislation to effectively do Law Enforcement. I believe we have not been able to stay ahead of these new compositions. I have one more question before my time is up. I know that for states in d. C. Have legalized small amounts of marijuana. And therefore have legalized possession of the sale. In d. C. They are sending our people to the illegal market because we cannot yet. Goes forof your work marijuana. In light of the fact that this 20s increasingly states have decriminalized, are on really spending resources marijuana, particularly in light of the fact that in terms of white, black, and getting into mandatory minimum the arrest records are almost entirely black or latino because the white kids are not in the Law Enforcement areas. In light of that racial disparity, how much of your funds for Law Enforcement goes for marijuana being legalized before your eyes . Get you an exact breakdown in terms of Law Enforcement effort. Can you send the brick the chairman breakdown. A breakdown. I was going to issue. Answer. I get an the vast majority of the resources that the government looks that are for enhanced prevention programs. The department of justice has issued saying we will not be using limited federal resources to focus on low level folks who are using this for largely personal use. I think we have heard today that people want to use every