Transcripts For CSPAN2 Senate Panel Looks At Stopping Flow Of Synthetic Drugs To U.S. 20170526

We have a great group of members who are here and i know everybodys got a lot of different commitments this morning. We are also eager to hear from our witnesses and talk about a critical issue facing our country. Its really a crisis in our communities and its getting worse, not better and the crisis is this Opioid Epidemic. The country is being gripped by it. My state is in many states are. Its in every corner of my state. Earlier this month in ohio, there was a near fatal but now overdose following a routine traffic stop. He p he noticed there was white powder spread around the car. He did the right thing. He put on his mask and gloves, arrested some individuals,s, went back to the Police Station and noticed it on his shirt there was some powder so he reached up like this and brush the powder off his shirt. This guy is 6foot three, 225 pounds. A big man. He fell to the floorimmedi unconscious in overdose. They administered narcan immediately but it wasnt enough. Wapi they had to rush him to the hospital were two more narcan doses were ministered and likely his life was saved. The police chief said he wouldve died if he had been alone and he also said what if he had gone home with that powder on his shirt and hugged his kid. Thats just an example of what we are facing. Its devastating our communities and families andan creating a danger for lawenforcement and other First Responders. Fentanyl is 30 50 times more powerful than heroin. A lethal dose can be as little as 2 milligrams. We had some speeches about it this week and we were able to show how just a tiny amount of fentanyl can be deadly. We also know about other synthetic drugs coming into our country. This issue is getting worse, as i said. The number of overdoses and deaths have increased dramatically. Our former colleague included opioids in his worldwide threat assessment. He noticed that deaths have increased 73 so sadly they death toll continues to climb. We will continue to hear about that this morning pretty one county in ohio, fentanyl was responsible for 394 Overdose Deaths in 2016. Thats one county. Youll hear from tom later, the medical examiner, he will tell you he is projecting 581 fentanyl related deaths out of 850 total Drug Overdoses. Fentanyl is life far, our biggest killer. A lot of these are deaths due to mixing with other drugs, leaving the user with no idea what theyre taking. An example of this is a new cocktail called gray death. It includes a mixture of heroin, fentanyl, car fentanyl, seven oh. Heroin is the weakest drug in that mix. Think about that. This is available on the street for as little as 10 20. Even though these drugs are selling inexpensive, fentanyl has a high profit margin making it very appealing to the drug dealer. The Drug Enforcement agency estimates that a kilogram can be purchased from a chinese supplier for a few thousand dollars. Th a kilogram can be used to make hundreds of thousands of pills with profits in the millions. Bottom line, we need to stop this flow of illegal, illicit fentanyl. Unbelievably, it comes for the u. S. Mail system. Of this is a shock to many constituents and others were learning about this. While some of the fentanyl is smuggled into the United States from mexico and canada, primarily it comes directly into the United States. Were h including some Law Enforcement who is here it primarily comes from one place which is china. It is produced in laboratories there and our understanding is that most of the fentanyl produced in china is intended for export to one place and that the United States. The number of chinese websites ready to ship, do a Google Search for fentanyl for sale,th it produces a number of websites for the drug and many others appear to be readily available. You can purchase a gram for 250 but it says the more you buy, the less you pay, offering discounts for larger volumes. To ease concern about whether the purchaser will receive the order, the guaranty discrete shipment with undetectable and careful packaging. While shipment was available at a number of countries, they knew their audience and offered express delivery to the United States. Many of these websites are so sure that seizure will not be stopped by Law Enforcement that they guarantee it. If the original gets lost theyey will send you another one for free. Several website we reviewed made it clear they exclusively used express mail service or ems as their courier. That is the International Postal service by the upu. S look, our shared goal today is to try to stop these drugs from exploiting our own streams of mail into our country. Every member has been involved on this issue on prevention and education and treatment and recovery. Weve actually passed to initiatives in the congress focused on the issue. We understand its muchr broader than justjo interdicting, but we have to do a better job of interdicting. Following 911, congress that ad identified weaknesses in International Shipping standards as a significant problem and made clear that requiring advanced data would make our country safer. That was 15 years ago. When Congress First legislated, it did so and left a gaping loophole. The trade act of 2002 mandated that commercial carriersrs provide advanced electronic data that could be used to identify certain packages being shipped into the United States. In that legislation, Congress Asked the postmaster general to the side of the post office can be subject to the same requirements they were putting in place for all private carriers. Today, no determination has been made. Lt our country is less safe as a result. As such, the difference between the information between what their required to provide is very different than the Postal Service. The Postal Service handles a much higher volume ofa International Packages in the commercial carriers combined. Prior to any shipment arriving in the United States, they are required to electronically provide data to Law Enforcement including customs and Border Protection withe basic information including what the shipper name and addresses. The name and address of the person receiving the package. A description, piece count and wait. This information is transmitted to customs and Border Protection and other agencies. Based on this information they then target suspects needed for additional scrutiny and selects the packages they want to inspect when they arrive in the United States. Commercial carriers are charged 1 dollar. Package which most commercial carriers pass on to the shipper. Now this applies to Postal Service. The Postal Service handles hundreds of thousands of packages every day. Packages shipped are routed through International Service center with jfk airport receiving the overwhelming majority of the packages. How these packages are processed is different at each center. Cpb is tasked with identifying packages for shipment it wants to inspect. It isnt that easy. Due to the hundreds of thousands of packages, the Postal Service is left to manually sort through large shipments trying to identify what theyre looking for. All internationally shipped packages are required by the universal postal union to have certain information attached to them including the sender, description but the problem is information is not electronic. Its not transmitted in advance so its not useful to Law Enforcement. Essentially its useless. Theyve indicated it will require member countries to place a barcode on every package starting in 2018. Thats fine, however the shipper is not required to load electronic information until 2020. Meanwhile, we have a crisis. Realistically the target date is closer to 2022 but theres no guarantee it will even happen by then. For 15 years the Postal Service has been on notice of the need to collect advanced electronic data about its packaging. We cant wait any longer. As americans are dying every day from these poisonous drugs flowing into our country, we must act and weve got to stop this fentanyl and other synthetics from coming in. Jf the Postal Service is trying to use electronic information at jfk to help cpb identify the packages. P they are providing electronic data for packages that weigh less than 4. 4 pounds or e packages. Once the Postal Service shares the information they use it toio identify the package it wants to inspect. Postal service locates and prevent present some for inspection. This is a step in the right direction. After 15 years of not doing this, the results today are lacking. 2 in 2016, late last year the Inspector General found the Postal Service failed to present all the packages selected for inspection and a substantial number back any electronic data associated with it. I understand theyre trying to take steps to remedy this issue and i look forward to hearing the details of that today. Without advanced electronic data we will continue to miss a significant portion. Further the Pilot Program is only happening at one location. At the other four centers there sifting through packages h , like trying to find a needle in a haystack. We cant continue like this but we need electronic data and we need it now. We been working on a bipartisan way to solve this problem. Thats why we introduce legislation called the stop act. My coauthor is here today and p she will speak in a moment. At aimed at providing information. We have 16 cosponsors in the senate. Their separate legislationrtisac that has 128 bipartisan cosponsors. Our focus today is getting input from the panel so wes. Have a clear understanding as we move forward. Thank you all very much for being here. I think my colleagues are being here. I would like to turn tor Ranking Member senator carper. Today we talk about special moments, we call them all hands on deck. This is an all hands on deck moment for not just those of us in this room this is an all hands on deck moment for our country. I want to thank our chairman and amy global chart for the work they have done and others on this committee have done to get us ready for this day. Hearg they focus the focus on todays hearing is more about at least one of the ways these drugs are getting into communities and what we could do to stop them. I look forward to hearing from our witnesses to better understand the processes used by the Postal Service, by private shippers to Screen International mail shipments and to identify and stop potentially illicit packages. I look forward to learning more about the coordination between federal agencieses working well and identify areas we need to push for improvements. Training in todays discussion is the Postal Service in partnership which is our first line of defense in preventing the flow of Illegal Drugs and contraband into our country. As some of you recall, protecting and improving the system in this country has been one of our biggest priorities on this committee for a number of years. The Postal Service is vital to our. [inaudible] agency is facing insolvency if congress does not act. In acting that legislation will free up billions of dollars that the Postal Service can use not only to invest for the future and improve customer service, but also shore up mail security. It is worth noting that despite the uncertainty at the Postal Service, the inbound package volume has grown significantly in the past three years. From 150 in fact, its nearly doubled going from 150 million pieces in 2013 to more than 275 million pieces in 2016. Theres no question, we welcome that but its putting a strain on an already deretched resource. Unlike private carriers, the Postal Service is required too deliver all mail that receives from foreign post in a timely manner. This is due to membership in the postal union which sets international standards. It also ensures we can send mail to ourselves and friends and family and Business Partners overseas. The state department represents United States with something called the universal postal union and they will be here with us today to discuss their involvement in this key organization. We look forward to hearingg from our Postal Service and witnesses about our commitment to promoting the exchange of electronic data as a means of combating the shipment of drugs and other illegal goods. While our packages are all screened before being presented to the post, they can and often do target packages for additional screening. They can target packages based on the country of origin or scans done by the Postal Service. Recently the Postal Service have been working closely together on a Pilot Program that allows cbp to useto advanced electronic data on small packages from china arriving at jfk airport. While the Postal Service provides other countries with advanced electronic data about male originating in the United States, we dont always get the same information from other countries. C this makes it harder for cbp to do its job as packages arrive here. The Pilot Program at jfk is a rare exception. I hope we can learn today whether there are any recommendations to improve and expand this program. As my colleagues have heard me say many times, find out what works, do more of that. Private carriers like ups are also joining us here todayiers v providing us with advanced electronic data on packages tested for our country. Unlike the Postal Service, private carriers have integrated systems in locations around the world and can refuse to accept a package at origin that does notst contain any shipping manifest data. Learning how this process can hopefully help us cover the gaps splitted by smugglers. Elsa look forward to identifying ways in congress to ensure federal agencies in our state and local partners have the resources they needfroo to combat the open engine Opioid Crisis on the ground. Specifically im eager to hear from our witnesses on the second panel, each of whom serve on the front line of the nations Opioid Epidemic in various capacities from Law Enforcement to doctors and addiction experts. These witnesses will give us perspectives on the challenges we face in fighting opioid addiction and the strategies proven effective. Particularly in delaware and ohio and nationwide. To while i look forward to a discussion of ways to reduce americans access to and use of synthetic opioids, this is just part of the equation. No we must not lose sight of the need to focus on the root causes of the considerable demand for drugs. Not just on the symptoms but on the root causes of those considerabl considerable demand for drugs. Until we do that the crisis will only continue to worsen and smugglers will continue to find ways to block the supply of dangerous drugs. Todays we Opioid Crisis is arguably the worst in history. Over 33000 americans suffered an opioid related death in 2015. That disrupted the population of our capital in delaware. D our home state has not been immune and none of our states have been immune. According to delawares division of forensic science, there are 200 Overdose Deaths in 2015, 228 last year 308. These numbers are for a little state and they are staggering. Unfortunately their worst in ohio and elsewhere. Substance abuse is a complex problem with consequences for everyone. We cannot Pay Attention only to the symptoms of the problems without trying to address the underlying cause. We know Overdose Deaths are preventable as the crisis worsens we need to Work Together to provide robust funding to help save lives. In closing, i believe its critical to note that access to healthcare plays a pivotal role in combating addiction. Unfortunately proposals to repeal the Affordable Care act threaten to undermine the progress in addressing the Opioid Epidemic. As we all know, medicaid is the single largest pair of. Substance Abuse Services in our nation, paying for one third of all medication assistance treatment. Current plans to repeal the Medicaid Expansion program, they threaten to make the program were says millions will be at risk of losing coverage for Substance Abuse prevention, treatment and Recovery Services just at the time we need those services the most. O Going Forward, i look forwardth to working with our colleagues on both sides of the aisle to address the underlying causes and to learn what we can douch. And how we can bring about substantial, lasting change. Thank you so much. Thank you. As the senator noted, we have a colleague with us that is not on the committee and that is a makeover chart. She is coauthor of the stop act. We appreciate your interest and we welcome your participation and i would like to ask unanimous consent that even though shes not a member of the committee that she be allowed to participate in the hearing. You chose to spend your birthday with us. I would like to recognize senator coble chart. We talked about this in advance and other members would like to make a brief Opening Statement if thats all right. I know she has another markupsh she is supposed to be at. Senator coble chart if you would make if you remarks would appreciate it. Its a very celebratory moment to be here with the subcommittee for my birthday. Thank you. It was an amazing moment to meet some of the witnesses out there and i think you will learn a lo lot. Ive never heard the corne speech on this but the medical examiner hits home how dangerous this is. We take this personally. The investigation is still going on it wasnt just prints. T its also a mom in rochester minnesota. A student in duluth and like every state, we see opioid death on the rise now exceeding homicides in our state. I would this in three ways, when we pass this framework that i think started us thinking that way, and i want to thank senator portman for his leadership on that bill, and we work in a bipartisan way. Three things, trying to reduce the number of people getting hooked on legal opioids and that means everything from our Prescription Drug monitoring bill to the work that we are trying to get changes in how prescriptions are given out and how many drugs are given out for simple things like wisdom teeth. The second is treatment and we did some good work with the cures act and we will have to continue to work with the budget and i appreciate your leadership on the republican side in objecting to these cuts that we heard from the house. I think that will be really important. K the third is that we all know as people are migrating over to the Illegal Drugs because they are either cheaper or easier to get, we will see more of these kinds of overdoses from things like fentanyl. Just in the past few months of my state we have had 11 people die from heart fentanyl which is an even more powerful form of fentanyl. It is 100 times more potent than fentanyl. The dose is the size of 2 grams of salt. It can be fatal. On our Judiciary Committee we heard from customs just last week and the numbers we heard is that in 2013, fentanyl seizures were at 2 pounds and now last year, 440 pounds, to give you a sense of this tremendous increase. s thats why i am proud to be the lead democrat on our bill. We have the stop act which he has described well, i thinknk its really important that we start using modern technology so we are as sophisticated in tracking down these perpetrators as the ones that are getting our kids hooked and killing people in our country. i know other senators were here who haves people worked as prosecutors. They see that as a real issue is well. Arehave drug dealers who changing the components in these drugs and they are doing it with fentanyl and then they make it harder for us to prosecute them especially in a rural areas e where its not easy to call a medical expert up as we have it today in washington. And so we are feeling good about this bill because senator grassley, senator feinstein, the two leads on the Judiciary Committee our audit and others to look at the bill. It simply makes it easier to prove up analogues when the change the composition ofomposi synthetics. Its another thing i would suggest what i most want to thank senator portman for his leadership and his willingnessfo to work across the aisle in thia really important issue and thank you as always senator carper. Thanks. Thank you, senator klobuchar. Any of the members would like to make a brief Opening Statement . James. All right. Well go to first panel of witnesses and weve got a very distinguished panel. Some of you were here for a roundtable industry location last year where frankly the stop act first originated because we were able to identify this problem. I like to call the witnesses individual first. Gregory thome, thank you for being here, director at the ticket for that which works to advance u. S. National interest of u. S. National engagement. Prior to joining, he held Senior Foreign Service positions and morocco, rye, finland, brazil and other countries. Robert cintron is here, the Vice President of Network Operations at the Postal Service. He began he began his Postal Service career 31 years ago as a clerk in rochester new york. He oversees the Postal Servicese Distribution Network including Overall Network design come policies and programs of processing sites, which is such a Card Movement and make policies programs that support the postal network. Third we have robert perez, thee acting assistant commissioner at the u. S. Customs and Border Protection. Privacy he served as director of Field Operations for cbp new York Field Office last year he oversaw the arrival of more than 21 Million International travelers and 249 in imported goods. Over the course of his distinguished career he represented cbp as of course he could expert all over the world in many Different International business conferences on assignment and as a guesttu lecture as he boards could expert. We have Tammy Whitcomb who is acting Inspector General for the u. S. Postal service. She came to the Postal Service as an Audit Director in 2005 served five served as deputy Inspector General starting in 2011. Post prior at the post office she also worked at both International Revenue service spectra serviced and u. S. Department of treasury Inspector General for tax invitation. Finally we have Norman Schenk with us. The Vice President of global customs policy and Public Affairs for the united Postal Service. With gps he is spent the last 30 years working drug withitwi government leaders run the world on reducing trade barriers, sampling processes and mostnd recent was supply chain to good issues. He testified to congress and Drug Enforcement issues and he currently serves on advisory committees to the World Customs Organization of the Us Department of commerce. He currently chairsce International Chamber of commerce commissions on customs and trade. Again i appreciate everyone of her witnesses being here this morning and we look forward tond hearing your testimony. Its the custom of the subcommittee to swing the witnesses, but this time would ask you to please dan and racial righthand. Please stand and raise your right hand. Th, th [witnesses were sworn in] thank you. Please be seated. I would note that all of the witnesses indicated that they were prepared to testify under oath and the record reflect that they all answered in the informative. Your written testimony will all be made part of the record and i would ask you to try to keep your all, to fiveminute speech so that we can get to the questions. And mr. Thome, id like to start with you. Thank you, chairman, portman, ranking membe,Ranking Member cas of the subcommittee. Good morning and thanks again for the opportunity to appear today to discuss the issue of illicit drugs including synthetic opioids in International Mail. The supply side of the synthetic oh. Crisis presents complicated picture with multiple pathways for these drugs into the country. In addition to shipments that by the way into the United States from across our land borders and through express deliveryll services illicit fentanyl and other illicit drugs also into the country through International Mail. Typically a small shipments purchased online by individual customers. The department of state is aware that the small shipments propose unique challenges to u. S. Customs and Border Protection, challenges that exchange of dance electronic data can help mitigate. Consequently the department of state works closely with cbp and the u. S. Postal service to take steps at the global level to increase the availability for International Mail. International mail. Before discussing these efforts, i should explain that the postal accountability and enhancement act of two thousand six identifies the department as the lead agency for International Postal policy. The main forum for our work is the universal postal union, upu. It is an intergovernmental he organization of 92 countries that have committed to delivering one anothers mail on the basis of reciprocity. The upu congress and its 40 member Postal Operations Council or poc, write and adopt the x of the union, which are the rules of the road for International Mail exchange. 2012, the congress of u. S. Was successful in submitting amendments that required each number state to adopt Security Strategy which included requirements for providing aed. In 2016, the United States was reelected to the poc and sellers to a selected to cochair the supply chain. Workcommittee oversees all on customs, security and transportation standards. The United States also chairs the Committee Standing group on postal security. These leadership roles position is extremely well to ensure that highprotein Security Issues move forward as quickly as possible. Ss have made and weve made significant progress toward that goal. Ation with active participation and technical input from the United States, the upu cooperated with the World Customs Organization to develop Electronic Data Systems allow for the capture, transmission and receipt of aed. In february of last year the poc adopted a new Regulatory Framework for the exchange of aed called the roadmap for aed implementation. The United States now leads the Steering Committee correlating the work required to reach the roadmaps milestones which include final adoption of the technical messaging standard for item level data adoption of thaf standard should take place at this falls poc meeting. As significant as these achievements are there only part of the picture and there are obstacles to overcome. The main impediment to widespread aed is the limited ability of most Postal Service is to collect and transmit it. The upu Business Plan adopted in 2016 calls for all Postal Service is to have thele capability to Exchange Item level data by the end of 2020. However, the technical ability to exchange this data does not translate directly into the ability to collect or enter it. Many post offices in the developing world to not have Internet Connectivity or even reliable sources of electricitye which makes collection of data and transmission of data externally difficult. Even in developed countries some Postal Services have been slow to invest in the needed infrastructure for item level Electronic Exchange of data. Es currently few if any countries have the ability to provide it10 for one of of their mail requiring customs declarations. Our approach is been to support the upu to provide capacity butt that enables the ed. The upu is devoting half of its cooperation budget over the nexa four years to a project designed to position Postal Services in developing countries to obtain this capacity. The major focus of this program is the ed. Will continued support and encourage these efforts but recognize the rapid acceleration and investment and use of electronic data for customs and security will also be driven by the Business Needs a postal operators themselves. Postal operators now understand that delays caused by necessary customs processing are a major impediment to their own ability to grow their Business Model and adapt to the rapid growth of ecommerce transactions. Ly exchange of eed is the only real solution to this problem. Consequently while the unitedbl states was once a voice in thehs wilderness almost alone in calling for eed exchange wheree now leading a course of countries developing and developed that demand eed. Another Significant Development with implications for eed is a upu decision to launch the integrated product plan which aims to modernize the upu Product Offerings with an eye toward ecommerce. This farreaching effort has clear benefits for the customs processing of mail. Phase one which begins in january 2018 will introduce segregation of mail and items containing documents and those containing goods. This split will facilitate compliance with customs requirements including aed. Phase one requires mail items containing goods to have a upu standard articled label which ia critical to enabling aed. Furthermore, upu regulations, upu approved regulations in february 2016 which will allow members to impose aed requirements on items containing goods provided they take into account whether the requirements of their imposing can be met by those to whom they apply. The thinking behind this relation was inventing something that is impossible immediately has a condition for living and other countries mail is the same as refusing to receive it at all. Such requirement undermined the reciprocity that is at the heart of the upu. In conclusion i would like to assure the subcommittee that the state department is fully committed to accelerating all coaches go to provide aed. To that end we will spare no effort to ensure swift implementation of the upuns roadmap and the integrated product plan. As these programs move forward we are confident the number of countries able to provide aed and the portion of their mail stream that it covers willam continue to grow. Thank you, mr. Chairman. I look forward to answer your questions. Good morning, chairman portman, Ranking Member carper, and members of the subcommittee. Thank you, chairman portman, for calling this hearing. My name is robert cintron, i am Vice President of Network Operations for the United States Postal Service. I would see the Postal Services national Distribution Network including its international operations. Congress has given u. S. Customs and Border Protection the responsibility and authority to discrete items at the first entry into the United States. Att an entry customs has the authority to open and inspect all inbound items without a word to identify prohibited items. Inbound International Mail from foreign postal operators arrived by plane at one of her International Service centers known as isc. Typically arrives a large bags packed in containers. After an initial box screening by customs, inbound shipments received an initial receipt scam by the Postal Service. At this point items requested by customs are presented for further inspection. For those items which advanced electronic data, known as aed, is furnished, customs has been his ability to target items for inspection. Today the Postal Service collects aed for more than 90 of its outbound International Packages, and receives 4050 oh this information or inbound packages. Nd to put this in perspective, comparing data from fiscal year 2015 to the present, aed forou inbound International Packages has increased from approximately 1 , to present range between 4050 . In other words, the Postal Service currently receives data on a substantial amount of inbound shipments, including those originating in china. The percentage of inbound items with aed is expected to continui to grow, especially as more countries develop their capacities. In an effort to further expand the provision of aed for International Inbound volume, the Postal Service is prioritizing updating aed from the largest volume foreign postal operators, which collectively account for over 90 of all inbound volumes. For example, we have entered into Bilateral Agreements that require aed with foreign postal operators of china, korea, hong kong, and australia. We have entered into voluntary data sharing agreements with more than 34 in the polls to facilitate exchange of aed. Additionally the Postal Service has the Pilot Program in our new york isc. That allows customs use inbound aed for more advanced targeting. With the Lessons Learned fromm this pilot we are working with customs to expand this approach to her other iscs. Unlike private companies the Postal Service must accept ans. Deliver mail from nearly every country in the world pick the Postal Service is not controlled induction of foreign mail destined for United States we cannot control the collection of aed abroad. However, the Postal Service in collaboration with the state department and customs plays a leadership role in advocating for the Global Collection and exchange of aed. Through negotiation and advocacy and by targeting nations with greater capacity like china, inbound aed has grown enormously in the past few years. In conclusion, we shared concerns about americas Opioid Epidemic and we continue to work with customs to enhance the interdiction of Illegal Drugs and contraband. Mm the Postal Service is committed to taking all practicable measures to ensure our nations mail security and provide themo American Public the best and most Efficient Service possible. Again, thank you for this chance to testify and i look forward td your questions. Rning, good morning, chairman portman, Ranking Member carper, distinguished members of the subcommittee. Pp data for the opportunity to appear today to discuss thee report u. S. Customs and Border Protection and combating the flow of dangerous synthetic opioids, particularly fentanyls into the United States. The majority of fentanyl smuggled into the u. S. Is done so through International Mail facilities, express consignment terry facilities, or through our ports of entry along the Southern Land border. In fiscal year 2016 cbp officeri and agents seized or disrupted more than 3. 3 Million Pounds of narcotics. Cpb remain proud to be hasta significantly increased over the past few years. From two pounds seized in 2013,p to over 400 pounds seized in 2016. Fentanyl is the most frequently seized illicit synthetic opioid. Along the southern border heroin is often spiked with fentanyl. Fentanyl is also sometimes spiked with other substances and sold as synthetic heroin. Drug trafficking organizations continually adapt to evadection detection and interdiction by Law Enforcement. Cbp uses the same drug interdiction methods to seize se fentanyl as it uses to detect of the drugs coming across the border. However, they detection of fit no remains challenging due to the limited field testinges capabilities and the bride of fentanyl analogs on the market. In the express consent of private cbp can place electronic old and notify carriers that a a parcel needs to be presented for cbp or to cbp for inspection. Cbp is working to limit the same system in the International Mail environment. Together with the United Statest Postal Service weve been conducting an advanced data pilot on express mail and eat packages from some countries. Thanks for the sport of congress, cbs made significantor investments and improvements in our drug Detection Technology and targeting capabilities. For example, the national targeting center, cbp leverages advanced information alongside Law Enforcement intelligence records to identify smuggling trends and target shipments that may contain illicit substances or related equipment being diverted for illicit use such as hill presses, tablet machines. In addition to their experienceg training and intuition, cbp i officers and agents use various forms of technology and equipment to detect synthetic drugs hidden on people come in Cargo Containers and other conveyances. Data from substances believed to be or to contain fentanyl and found in the mail or an express carrier packages is transmitted to cbp is laboratories andviceso Scientific Services fora interpretation. At land ports of entry,nd ports instruments provide a readout record officers and agents. And the low purity of fentanyl found along the southern border usually only about 7 of controlled substance current our content, make the detection of fentanyl particularly difficult. K9 operations are another invaluable component of cbp is counter narcotic efforts. Cbp is going to working tos al safely and effectively add fentanyl as a trained order to deploy narcotic detention, detection k9 teams. Cbp cbp is also a program to provide training and equipment to keep our frontline employees safe from accidental opioid exposure. There were ongoing Pilot Program cbp officers are trained to recognize the signs and symptoms of an opioid overdose and administer the locks on, a potential lifesaving drug for the treatment of opioid overdoses. Cbp will continue d to do all we can to refine and enhance effectiveness in our detection and interdiction of fentanyl. And other dangers syntheticc opioids to the mail and across t our nations borders. Chairman, Ranking Member carper and its enrichment of the subcommittee thank you for the opportunity to testify today and afforded to your question. Good morning, chairman portman, Ranking Member carper and members of the subcommittee. Thank you for inviting me to discuss our work on inboundterno International Builder first look at five some context. We started examining this area two years ago after we received complaints that the Postal Service was not presenting mail to customs and Border Protection for screening as required. After looking into it we determined audit work was needed. Given our role as the office of Inspector General for the Postal Service we focus on the Postal Service is procedures and its coronation with cbp. We did not review cbps operations although we did talk to the staff together to get information are also both cbp and the Postal Service provided information used in our reports. They consider some details sensitive and requested read actions in the public versions that we posted on our website. Inbound International Mail when you enter the postal system at five International Service centers around the country. Ters generally all inbound International Mail is subject to inspection by cbp, and the Postal Service must present for inspection all the mail that cbp requests. The Postal Service reseed 621 million pieces of inbound International Mail in fiscal year 2016. Lm almost half were packages. The growth of ecommerce has caused inbound package volume to nearly double in the last three years, causing challenges foric managing this flow of traffic. More than half of the package volume is from the packets which a small track packages under 4. Given the growth of International Package close to the Postal Service there is a need to find more effective ways to manage inbound traffic. Some foreign post in the Postal Service has electronic customs that which includes information on the center, addressee and contents of the mail piece. This that helps both with the processing and inspecting inbound mail. International poster relations are beginning to change in recognition of the importance of pose providing advanced electronic customs data. The Postal Service could require this data through Bilateral Agreements it makes with foreign postal operators. However, our audit work that instances of Bilateral Agreements with the Postal Service had not requested this advance customs data. Since november 2015 the Postal Service has been piloting a joint initiative with cbp in new york. Cbp is integrating its data systems with the Postal Service systems to use advanced data to target packages for inspection. The Postal Service and cbp intend to expand this pilot to new locations before the end of the fiscal year. We h we have issued five reports on inbound International Mail operation since september 2015 and found several problems with the presentation of inbound packages to cbp. First, Postal Service employees sometimes began processing packages before arrival scans have been input into the system. This could result in pieces missing customs screening or in the acceptance of inappropriate or unknown shipments. Ng second, problems with scanning during processing into and out of customs meant that the Postal Service cannot always determine whether a package was in cbps custody or its own. Third, and no significant, at times the Postal Service just did not present packages to cbp for inspection when requested. Instead, the packaging processse directly into the ministry. These failures that occur several reasons including human error and Electronic System problems. An additional factor is that the Postal Service and cbp do not have a formal written Agreement Regarding the appropriate procedures. To address our findings we have made 11 recommendations in areas such as enhancing systems, providing employee training and oversight, improving scanning data, i ensuring items are presented to cbp, requesting advance electronic customs of data from foreign posts, and Court Meeting with cbp to establish a formal Agreement Regarding presentation requirements. The Postal Service agreed with these recommendations and has taken sufficient action to close five of them. Six recommendations are still outstanding, including establishing a formal agreement with cbp. Urity ensuring the safety and security of inbound International Mail is a critical challenge for the Postal Service and cbp. More effort is needed to quickly fix problems in the current process and to make sure cbpbp receives as much electronic customs data as possible. My office will continue to monitor this issue and we will work with our colleagues at the department of Homeland Security office of Inspector General onia any related work that theyyo conduct. Thank you. Thank you, chairman, portman, Ranking Member carper, and distinguished members of the committee. I appreciate the opportunity to appear before you today to discuss how providing the necessary data to customs and Border Protection and other Government Agencies can help target contraband and weed out bad actors seeking to import Dangerous Goods and counterfeit items into the u. S. Mr. Chairman, my presence here today, the thursday before memorial day weekend is quite literally deja vu. I provide a similar testimony on this very same day 17 years ago in the year 2000, to the house jubcommittee on criminal justice, drug policy, and human resources. Figuring then was titled drugs in the mail, how can it be stopped . For that i was asked to do the same thing, walked to the processes that ups follows to support advanced data to cbp that will enable them to screen for high risk packages being imported into the u. S. Unfortunately since 2000 the problem of importing illicit goods into the u. S. Is only grown worse. Enabled by the internet, bad actors are getting smarter and smarter, using every avenue available to send illicit goods into theil u. S. Back in 2000 the issue of illicit drugs in the mail was centered on amphetamines and ecstasy. Today the threat has expan expa fentanyl and hightech opioids. The bottom of parcels can into the u. S. Has increasedreased substantially, particularly from foreign posts which doesnt almost 90 90 of all packages ih this country. Ups delivers more than 19 million packages and documents every day in over 220 countries and territories around the world. We work hard to be united problem solves. Our business processes are complex under technology advanced. We also were closer with cbp at her own expense to comply with and even exceed existing legal requirements. The key to making this work is advanced electronic data we provide which enable cbp and 47 other Government Agencies toto target highrisk inbound shipments and screened and out of the network and sometimes thats as much as 36 hours in advance. This data can also be used to screen for counterfeit products and contraband, another growing problem. We also applied technology, l technologically advanced networking with those that enable us to locate any suspect package in our system any given time so it can be retrieved and tender to legal authorities for additional screening. In 2000 when i testified before the House Government Oversight Committee that were about 21 million package shipments entering the u. S. Annually, about 10 million to the private sector which were accompanied by advanced electronic data, and d 11 million for the internationaa mail system which did not have any electronic data. Even 17 years ago it was clear cbp and other federal agencies could not manually screen packages, purely because of volume, and that the most e effective way of interdicting that shipments was through the use of advanced electronic data. The bond of packages entering u. S. Has increased many times over here in 2016 foreign posts likely sent over 400 over 400 million packages to thee u. S. , and the volume is rapidly growing. Weve been using advanced data for years, even before it was required by the trade act. Bob and i worked together for probably over 20 years on some of these things to provide cbp with item level detail about each and every shipment entering the country. This helps us reduce the potential for Dangerous Goods entering the u. S. Its also important to note ups and other express carriers update Incident Data for all, Foreign Countries both developed and developing, and i could take out my smartphone because even in the most remote places just take a picture of it and transfer it on. In conclusion, if i could take off my ups hat for 30 seconds. I do a lot of International Travel and work with customs agencies around the world on this very same issue. When i board a flight back to u. S. , i dont look around the passengers looking for suspected terrorists. I think about the bags and bags of four post packages that are loaded in the belly of the aircraft. No one has any idea whats in those packages. None whatsoever. The government doesnt allow d passengers on a plane without personal information or back into our country without a passport or screening. Why do we allow over 1 million and potentially more dangerous packages a day into this country with no requirements for information that will allow cbp to do their job more effectively . I urge you to take action on this important issue. Thank you. Thank thank you, mr. Schenk and thank all the witness. Senator carper has agreed to delay his questions for members or his asked a question. Of the memset of the committee to go to. I would like to start with senator lankford. Thank you, mr. Chairman, a Ranking Member, appreciate that very much. Tell me about where we are as far as moving on advanced w electronic data and why for developing countries this has taken so long when there are some straightforward solutions. If they can get the mail to the spot skill to get out, like advocate the data . Why cant they get the data . Thank you for the question took we been working very closely with the upu to try to move this process among very quickly but the issues we face in developing countries, i woula say previously the was a lack of will and a lack of understanding that for them to catch up with their Business Models and take part in the ecommerce boom that is occurring worldwide. There wasnt an understand that aed was a key to that. I think the major advance weed s have made, and its not a statistic but it is a change of mindset within the upu that countries now understand regardless of their level of development, they have a lot ton learn and a lot to gain and they can even enhance their economy by taking part in this. The encouragement from the congress would be at some point to say packages dont come in without it. Obviously that isolates a lot of countries and a lot of people who may not be able to get materials in. But the most straightforward way we can do with it is just to put a deadline out there and say we dont allow packages to come into our country in less there are some electronic Data Collection in advance. Thank you. As i described in my testimony, the global postal system simply isnt able to exchange aed conference of the at this time. Requirement to do so immediately as a precondition to our accepting its mail, it would severely restrict the inflows of mail into our country, and probably preclude the acceptance of mail covered by a Bilateral Agreement. If we stopped accepting other countries mail on short notice, we have to anticipate that many would stop accepting our spirit i would be surprised if anything that congress could do on short notice. But i would assume that we would set a Firm Deadline to say, by the state certain, this is not being negotiated in the days ahead, this seems to slip your after year. My concern is how do we get a date certain that is sitting on the horizon that we know it will be resolved, at least for this, because this is just one element of trying to be able to stop the Alyssa Milano of drugs in. Clearly, most to stop the illicit movement of drugs in. This is only one element to be able to help deal with this. It should be a straightforward element. I agree that it should be straightforward. I think the challenge we face is that of the country just working on other timetables. I think weve made good progress. And again i think the questionth we their own needs, they now understand. Again, the upu is putting forward half of its cooperation budget to helping these countries install the capabilities they need, but electricity and internet are not available everywhere. Biting countries where they are, were still did with germany and france last i hearda to have electricity. Le the uk does so we can go on and on and on to places that this should be pretty, ht straightforward. 04 us we had to be able to get this resolved. A let me ask a separate question. Cbp and usps have worked on m. O. U. Relationship for quite a while to try to establish consistent methods of how theyre going to exchange data. How is it working right now and where are we in the process of getting a clear m. O. U. Of exchanging information . The m. O. U. Regarding just the general operation, senator, and out of functions at her International Mail facilities and how that mail is delivered, with cbp we expect to get that back with our comments to the u. S. Postal Service Within the next two to three weeks. I checked on that just before i got it. Its been about a year or so. Indeed, syndicate. The m. O. U. Really puts into place best practices that have already been in place and a lot of the locations quoting jfk back in new york by now the mail is handled, that is, the ones that are coming from countries of interest for cbp. Im not aware of specific it into the detail of the electronic data. Data from mars under the confines of the pilot that ist being run. At . Any comment . I did want to add on to exactly what was said. Its been a year and certainly we been working and we do at each one of our iscs work very closely with Customs Border protection to make sure the processes, procedures post be in place we had working through those. T so like weve been waiting for the m. O. U. To get that finalized. Certainly working and glad your web back a few weeks and get a finalized. Assume that gets finalized fairly rapidly at the comes back in. Yes. You can assume that to beaccu accurate. Again thats just basic operation to be able to help increase efficiency in then the process. On the Inspector General site thinks tell me where we are store as the things that we can provide the greatest oversight on to make sure they get checked off from yes psp i know you gave us a very good list, top items are congressional oversight, what would you left . I think the m. O. U. Is critical, and i also think the encouragement for the Postal Service to work the Bilateral Agreements with these countries to receive the data, i think theyre making some really good progress. When we first started our work in 2015, and mr. Cintron, mentioned it. Theres not much of that at all available. Significant progress is being made and has been made in the last two or three years. But its one of the sync the check to continue work on and sure every Bilateral Agreement has a requirement in it. So those are two things that ihi would encourage. I would only say to this group, appreciate the diligence and the focus on this as it is been seen and noted already for commercial entities. This has been something they have been very first visit on for a while. Obviously they have seamless network. They are not receiving every single package that comes in every single country. They can monitor down to theirbu system but it is a system that is achievable and a process. I would also know for cbp we appreciate very much the work that you wer you are doing. This is an currently dangerous work. As sort of been noted by the chairman in his Opening Statement, even the smallest amount that gets in, if theyre doing an inspection is life or death issue. And so from our committee to all of your team we express our gratitude for what youre protecting the american citizens from. Thank you. Yield back. Thank you. Senator carper. Thanks. Thanks so much. Sometimes we have a Diverse Panel like this, people that are knowledgeable, highly knowledgeable about a particular issue where trying to address i asked them to help us solve the problem. I ask you, and i will ask you today to help us solve the problem. Each of you to say, anything else, delete this. Congress, this committee with one thing we ought to do like right away. Tony becausewant to call you of jim tommy, the great is the player. Great baseball player. Tommy, for god sakes do this. I said earlier, this is all hands on deck, it is all hands on deck. We trying to convey a sense of urgency. When we go home, the folks we represent convey a sense of urgency. Thank you very much. As we have talked about, this is a difficult problem that needs a lot of solutions, but in terms of the remit of the state department in our interactions with the upu, as i said before, were turned the corner with the countries that want 80, i think well all have to Work Together to give a realistic timeframe. We have an epidemic here that cannot wait years and years. With the momentum we have or i i would say since the 2012 upu congress, its really accelerated. Countries want this. If they find themselves in ath situation with have a with a date certain which is why hesitate to put one on in response to the question previously, we run the risk of losing that momentum and that if their mail shipment or stop or threaten to stop in the United States, that could have devastating effects on the economy. I was asking give me one take away, one thing we ought to be doing to expedite this, move it. Give me one. If we put her efforts behind with the upu is doing and keep it moving along with the effort bilateral happening we can make this happen. Do you want to give us some advice . Give us some advice. What can we do to get this moving . I think in my personal opinion the fact that you put forward is on the right track and it will certainly contribute to this. We just need to craft it in a way thats realistic to get it done with countries that weie cant order to do things that we need to negotiate and help them see the benefit doing get. All right, mr. Cintron . I guess for us they must be some way we can incentivizing these folks. Some of the nations that still are not doing their share. They are not third world thir nations. They are not third world nations. There must be someone we can incentivizing them. Go ahead. One thing we would ask support about our strategy to target, focus in on targeted countries. Gycu so we understand, that part when you look at the whole picture for us, our strategy is been to really stay focused on where we see the largest volume coming in and i think thats where we looking for that cooperation and certainly, to take that step as was noted here, one of the concerns is some of the conditions we might find in somi of these other developing countries. But for us our strategy will is going to be to stay focused and prioritize. We believe through that after our efforts and what were doing with aed and the pilot at jfk we can really pushes along in order to help custom you havent answered my question. I asked both of you the sameme question. What does cox need to do to help move this along, expedite this . What do we need to do . One other thing i might ask is certainly around the passage of comprehensive pulse reform for us, and theres a lot of things tied up in that anythingi you can do to help us with that regard, so helps our overall initiative with everything were doing. A number of us have been working on this as you know, we want to have additional postal revenues in order that they cant among other things modernize their Mail Processing centers. Again, new equipment, new vehicles for delivery, modernize the post offices. Sounds like there might be another use for additional revenues of the Postal Service and that might be helpful as well. Good, thank you. Thats a good take away. Mr. Perez . Good advice for us. First, let me say thank you, senator come for the ongoing support not just of this committee for the entirety of the congress for everything that cbp does and the entirety of the everything we put forth to combat illegal narcotic trafficking. Thats her up with the civil to ask ever so respectfully that support continue for all things narcotic trafficking. Because cbp, we are not waiting and dont wait for the evolution of the different types of threats and enhancements that we everlutely need to lean forwardd and do everything we possibly can to interdict, to detect, to deter and to dismantle those who would do us harm in thison fashion. The weather were talking about that or whether were talking about tools and technology that were trying to deploy, and even the personnel. L. That ongoing support that this body continue to provide cbp onn the overall drug nation is actually critical we appreciate that. Same question. I think focusing oversight on ensuring the m. O. U. Moves forward quickly, and also i just heard a minute ago that the m. O. U. Does not necessary to cover the Pilot Program. I think that pilot, theres lots of Lessons Learned through that pilot, but expanding that pilot quickly across the country to the other International Service centers so that the data that is being received from these countries can be used to target specific and dangerous packages. The oversight in that area speeded when we come back, when we have a cigarette i want to talk about the pilot and thosed Lessons Learned. Please, last witness, please. Norm, 17 years ago today. Past the stop act. The reason i say that is we discussed was here 17 jusco and nothing tangible has changed ang it just, moving at a snails pace than we think the right way is to pass legislation. We appreciate all the fine work that is been done on that. We work with cbp for years before the trade act and i dont know how they do the job that tm they do on the mail. Ave ou because we have our own challenges with all the data, but were talking about the minimum so pass the stop act. Answered much. Thank you, mr. Chairman spirit senator mccaskill. So i understand efforts of all thank all of you. We are all hands on deck as senator carper said on this. And this committee is doing an investigation into another piece of this, which is the sales and marketing technique that a been employed by the opioid manufacturers. Were also going to be look ato the distributors in terms of that issue entrant in our country. But i want to focus in a my time here on the fact that we are having some of the fentanyl produced in china sent to the United States where then it is sent to mexico. Are you all aware that this is commonly occurring . We have a large amount of opioids are moving to our country in that regard . Is anybody disagree with that analysis . Senator, if i can comment, i would share that myth understanding is that much of the fentanyl that is coming out of china, when in its actual form, will come directly into the u. S. Ct what weve seen, that moves from china typically into mexico, diluting, creating analog and then lacing heroin shipments with the fentanyl as well, is precursors and moving directly from china into mexico. Om chi not aware, alleys this current current time of the movement southbound from the u. S. Into xico, but gladly take that back. My staff has looked into this and believes that there is a significant amount of this that is moving from china to the United States, the precursors, then going from the United States to mexico for them to process in their labs. If we are getting one information, i can live with that. If you dont have information, its accurate, im worried. Because i think its really important that we understand where this is flowing. Mr. Cintron, would you agree that you will believe that some of this is coming to the United States and then being shipped to mexico as a precursor to be used in the labs to cut hair with . Yes sensitive. I can specifically responded that but certainly the Inspection Service part of the organization we can provide you activesync i can provide you information on that. So i understand that mail from not covering the cost to the United States Postal Service to handle this meal, is that correct . Again, send to do, i apologize but i was soon as your permission to provide any ofaft that information post hearing . Again my staff tells me that we are underwriting, the United States Postal Service is underwriting the costs of mail coming to hear from china. That just seems crazy to me. How when world is that happening . While again, unfortunately im not able to answer that specific question but i certainly can provide information after the hearing, senator. Ou we are struggling to keep the is Postal Service out of bankruptcy. Its one thing to be giving fedex and ups ideal on the last mile of Package Delivery which ive been raving about in this committee for many, many years. But if your we are actually man cheaper for china to use thee United States Postal Service because we are underwriting our costs here, that it wasi outrageous and im anxious to get to the bottom of the. If you would follow up as quick as possible we would appreciate it. Absolutely. Okay. For the trade act, it is my understanding in terms of the private deliveries that they are not actually, theyre supposed to be having the information on the packages they sent, the name and the address of the recipient come into this country from other countries. But i understand many times all cbp gets is the address of the processing facility where it is coming to and not the address of the actual recipient is. Is that accurate, mr. Perez . In the context of u. S. Postal service, the general mail, that is true. That is the type of data that we pursued to the pilot to begin to get more of that. On talking a phase two of the trade act requiring the name and address of the recipient from the private carriers, is, is that come hasnt been fully automated . Are we getting the address and recipient from, not some Postal Service but from fedex and as a private carrier. To my knowledge yes, but i take that back to make sure we can confirm that for you. From the other commercial entities and carriers we typically do get a pretty coppers of list of information in advance with respect to those particular shipments. Well, once again my information, based on staff preparation for this and the preparation ive done for the sharing is that, in fact, they are not providing the name andvi address of the recipient, and that many times all you get is the address of ups or fedex processing facility where theac package is coming. I would really like to know why we are, why my information is different than yours. In and the other information that e have is that we are not even imposing the finds the need to be imposed on the carriers for not following allotted by way this is the trade act that was imposed after 9 11 when were trying to get after the securith of our ports and the security of the into point in terms of our country, in terms of goods, people and services. So i will be anxious to hear your follow up about that. Re phase three of trade and limitation was supposed be penalties for the bad description. Ha its my understanding that phase three has not been implemented. Does anybody know the answer to that question . I dont have the details on phase three of the trade act at this time. T gladly take that back and get i back to you and your staff. Okay. If we are not getting the address where the packages going and were not finding the carriers ahead of time so we can actually look to see if this was an address that has popped up before, i become Law Enforcement needs to be all hands on deck here, were not getting to and not even knowledgeable about whether not with intimated the part of the lower penalties are enacted, our Research Indicates that sometimes penalties have been imposed but they been negotiated down to the carriers lawyers from thousands of dollars to 50 bucks. If thats occurring thats a huge problem. Im a little worried that folks dont have the answers to these questions at this hearing can, understand the subject matter of the sharing and i look for to getting the attitude as quick as possible. Yes, mr. Schenk . Senator, if i may respond to that. Certainly from a ups perspective, weve been providing that information, full information, of the shipper, the description, value, country oftr origin since we started Bring International imports into the u. S. In 1985, and the programpr was developed with cbp. I would also say that weve gonr well beyond the trade act working with cbp with the air cargo advance screening process which is a voluntary program that was implemented after the attempted yemen bomb attempt onn that were we not only transmit a the shipper, we go the extra mile and transmit the multiple when it is ecommerce shipments. Speaking for ups, we do not only the required but we go beyond the required. In your opinion has phase three been implemented . He believed there are penaltiess that would apply to you if some out a package came to the United States through your company that didnt have the address of the recipient on it . The answer to that when is i dont know how we could because our process and systems are developed that a system, a package can enter our system and less that information has been r entered in their and then he cant go through because ourro systems interconnect between ups and cbp. Practically speaking, it couldnt happen. We well, we will followup on information we have and get information for all you and go forward from there. Thank you very much. Thank you senator mccaskill. Im going to ask my questions and we will have another route as well. I know senator hassan has egregious stick around. We have another colic is registered for the ball i think we need to back up and talk about what this hearing is all about, and that is is it helpful, and mr. Perez, i expect her and to others, but all of you, is it helped of advanced electronic didnt be able to identify these packages thatth have this poison in them, which is what were focused on today, which is synthetic opiates that are coming into our country, killing more and more of our citizens every day . D wanted that it has electronic data and is at helpful for you to be able to stop some of this poison from coming in our communities . Yes or no . Unquestionably, mr. Chairman, having advanced electronic data as we do receive for all of the types of cargoes is a key tool in our ability to manage and assess risk, to focus and target those threats that may warrant a great inspection, potential if its a male cargo, people, conveyances all types. And so unquestionably. Having t having that dad and working towards giving that advanced data make sure it is high quality and reliable for us toto do that work is a high priority. The reason why were working so closely turquoise to get the point. Of light is like the needle in a stack talking earlier. I meet with your folks back home and they use the exact word you just use. This is a tool we desperately need. Otherwise which is not effective at stopping the stuff. It of the contraband as well but were focused here on a crisis. I appreciate the state Department Perspective on diplomacy try and work withn other countries and i really appreciate you, mr. Thome, saying to use the stop act is on the right track but this notion of the country work on ontime tables and some countries dont have electricity, china has electricity and we know where the stuff is coming from. Tyf some of it is coming from indeed. They have electricity, too. This notion i will say, and mr. U cintron, i understand yourut hav concern about having to apply this to all countries and you know it in your comments, you prefer it to be targeted to countries that are known to be sending us this poison. Let me just follow up on that a little bit. Senator carper and i talked about this yesterday, countries that circumvent our trade laws because have a terrorist attach them because of a dumping order lets and they simply ship thee product to another country. Why wouldnt that happen here . Etc we will only target a couple countries what we know there are countries of interest, whyhy wouldnt they just ship it to c another country, say vietnam or malaysia or indonesia and still have these poisons come into our country . Can you answer that question . Yeah, the best i was say this. Our focus, our strategy is to prioritize the list pics of big look at it, make a riskose assessment and target those particular countries. Certainly i think as we were, certainly the inspection Service Working in collaboration with other Law Enforcement agencies, i think is probably the other key. As you collaborate, we share information, if those events occur i think we refocus and do that. I guess our point is a starting point. Our peace was around raise the highest risk, would we see the haiphong and how to go to your point on capacity, those particular countries that have it, we should really be focus on those and get that information. Unfortunately what we see is theres shipment of the stuff and it was some to be shipped of the countries, from evidence that we have. It we dont have this broadly applying and you noted earlier that its voluntary now. And i guess i would ask you, doa you have enough data pressure and is going to be no because you like more advancedwo electronic data from these other foreign posts. So again what our legislation says is its time to follow up on what congress past 15 years ago, which was asking that then cabinet secretary in charge, now Homeland Security, and Postal Service and the commission to come up with a plan. Norm said he testified 20 years ago, even before that, i. C. E. And those in the context of preparing for the 2002 trade act. D so i would just make a point broadly that we do have a crisis. We all acknowledged that and this is not business as usual. Above the country over to the own timetable, that doesnt work. That dog dont hunt because its an epidemic. And you noted, mr. Thome, advanced electronic data is in their interest, too, and there a consensus now you said among countries around the world that they need to provide it. Lets get moving on it. Another question i would have is for mr. Perez, you talked about canines. S. I just have to ask this question because as th of this informatin away to college at around tables discussion but you go and i was told sniffing dogs dont work y because the dogs could die from sniffing a package or a letter with that no end. Whats the situation with regard to monitoring generally and screening . Many of us, im on legislation to provide more funding for legislation a specific with regard to canines, doesnt work or is it too dangerous . Thank you, mr. Chairman. On the k9 front we are currently in a test phase to train the canines for the specific odor. As you probably know they are trained for a variety of narcotic odors. re trained for a number of ors. Otic od they may detect or be able to ,lert to some of the opioids but we are specifically training them in a very safe way with the types of odors generally admitted from fentanyl and such. Not with actual fentanyl that our laboratory folks make sure we are doing in a safeway but enabling that tool but along with the other alleged tronic tools at our disposal, where we are actually your taking readings and sending the spectra back to determine whether or not. I like to think it could be done safely. I would suspect it still a huge danger to them. Its much better to have targeted packages where you have reason to suspect a package by having electronic data. You would agree with you . Absolutely. Can you talk about the Pilot Program and the lack of coordination between the Postal Service and the cpb and a memo for understanding. You said you had 11 recommendation, six of which are still outstanding. You said we ought to expand the pilot quickly have you looked at our legislation . Do you think our legislation would help to expand the pilot quickly . We did look at the legislation, we didnt do a Detailed Analysis of the impact of the legislation on the Postal Service, we are supportive of the general idea in the legislation about increasing the amount of advance electronic data,we however the impact of that on the Postal Service is something we havent done a Detailed Analysis of pride we s do believe, as we said in our statement that Additional Data would be helpful and i think a pilot is moving in that direction as well. T is a thats what the stop act is about, making that mandatory and moving away from just making it a pilot but making it a requirement. Just quickly for you, youu talked about having testified in 2000 on this several years ago and the fact that you get your data to the cpb, sometimes 36 hours in advance which gives them time to respond to it. Tell us how you do that. How do you do what the post office has not been able to do over the past 15 years since the trade act . Thank you chairman. It really starts with the collection of the data and it depends on the size of thehe customer, but the bottom line is for the large multinational we have software and directac interfaces with them but even in the individuals that walk into our ups stores, it can be input so we get the input into the system immediately. As soon as the package is picked up, thats what is i the indicator, and every 15 minutes our system automatically transmits to cbp so we can get the information to them as early as possible. That was part of the collaborative effort from the business side we have a shared responsibility to do that. Then depending on whats going on with the shipments, they communicate back with us but the principle and foundation of what we do is lets get the data and get it to you as soon as possible. There are a couple transmissions that get a little technical, bu but. So when a packages picked up, the data goes. German, can i clarify. I want to get to senator hassan. Hes been very patient. If you dont mind will do a second round. Thank you for allowing me to participate in the subcommittee and for your leadership on the stop act. I do want to take a minute to echo senator carpers reminder that while we are focused on the supply of illicit drugs and especially the precursors to the synthetic drugs that we have to continue to also focus on the demand side at home which is why Medicaid Expansion and continuing work to make sure people can get treatment and were working on prevention as well and its so important. As you probably know, New Hampshire is one of the states that has been hit hardest by the Opioid Epidemic. 70 of our Overdose Deaths involved fentanyl. 80 so far this year involved fentanyl. We are seeing an analog of fentanyl, and just in the past six weeks weve seen success from car fentanyl. So to echo what my colleagues are saying, everywhere we go we are talking a from people from all walks of lives whose lives have been taken or ruined or impacted, and its drain on not only our lives but our economy as well. I wanted to focus, on my last briefing with the dea, they recounted to me in very graphic and vivid details how dangerous this is for our Law Enforcement and First Responder personnel. That obviously extends to people who may be handling the substances through the postal system. We know you can overdose by touching this stuff with the bare finger or breathing it in. Car fentanyl in particular has changed the way our Law Enforcement is dealing with everything from how they enter a suspects home to the crime scene after words. We also know we dont want to put third parties at risk so let me start with you, what has the Postal Service done to help address these risks to employee employees, and how can we protect our workers to make sure that Law Enforcement has the tools they need toto investigate and crackdown on the supply. The usps has over 600,000 employees so from processingli to delivering the mail,ng transporting the mail, all of our employees are involved. On a regular basis, whether its International Service centers or other centers around the countr country, delivery operations, we do a lot of training with our folks around hazardous conditions. We seen tragedy in the past in this organization and we are well aware of affects of what that can do. Our focus is to constantly and consistently train our employees. Thank you. I will ask mr. Perez to comment, youve discussed cbp as protecting personnel and i would love it if you can expand and talk about the balance. Hamp i know of an agent in New Hampshire who is doing everything right. She was massed and gloved and she took off her glove to handle the cell phone and she deed, drop back by multiple doses of narcan. Thank you. Beginning in 2015, we began a very comprehensive training and instruction that was deployed to all of our frontline officers and agents and to people who would typically come in contact with the substances. A parce we need to have training on any parcel where they believe the presence of these dangerous opioids may be. In addition to that, we began our marks on program, we have those countermeasures deployed in over 34 locations for the past two years. Those locations include all the busiest facilities and thehe locations along the southwest border where we see the most trafficking in these types of opioids. The last point i will make in addition to all that is that weve also deployed over 600 doses of narcan in addition to the locks him across the country. A side note, the officers and agents that are typically trained in utilizing these are ems certified officers and or a agents. That is pretty much what were doing and we continue to make sure that training and awareness is ongoing and we do absolutely everything we can, particularly with the uptick d in our encounters with these drugs. And i will ask you to answer the same thing,u obviously the concern is if for instance, Law Enforcement thanks they are putting thirdug parties at risk through undercover operations and they will stop doing it. We obviously need to continue investigations so its helpfulss to hear that training is ongoing. On how does ups address this issue. Ill be honest with you, i. Dont know the answer but i will get back to. Be ceki there used to be certain kinds of undercover operations that i think lawenforcement is taking a look at because of the risk to people handling a package they may not know has an illicit and deadly substance. It. It would be great if you would look at it. The one other thing i wanted to ask mr. Tommy, you discussed in your testimony that fentanyl and others synthetics are bought online, we on both the open web and the dark web. What efforts are being made internationally to crackdown on illegal purchases of these drugs and the precursor chemicals that are used. Whats happening internationally. The state department is engaged in extensive negotiations with countries that we feel are sources for these kind of things. I cant give you a a comprehensive answer across the board, but i did talk with our bureau of narcotics and they did give me some information on whatsic happening with china which is of great concern and i can share that with you. In response to repeated u. S. Request made through the Bilateral Group that we have with china, china has domestically controlled more than 134 synthetic drugs. This is an advance weve madec in getting them to see this. Chinas decision to domestically control car fentanyl which has caused the deaths in the United States that you mentioned is a welcome measure, and we hope we can continue working with the chinese. In many cases they argue to us that they are causing problemsir in their country and we have succeeded in convincing them that even if that may be something they claim, they are causing problems in our country and we want them to take measures. We continue that process, there is a lot of work to do but we have had that success. Thank you very much. Thank you, mr. Chairman. So for you, the packages are dropped off at ups facility whether its here or some other foreign country, you are able to track those electronically and share w information with the customs and Border Protection and thats pretty much your system, correct. Thats correct the Postal Service, tell me why you can do the same thing. Inbound packages coming in, foreign shippers who ship to a forum post and then they turn into the usps. We do not have that direct connection. State department, why cant we require that from thefo shippers in Foreign Countries, their equivalent of their post office. Is my colleague from the Postal Service said, unlike the express shippers that control both ends of the transaction, we dont control both ends. But why cant we tell them they cant utilize our post office unless they have an electronic tracking number that we can track and share with cbp to cut down on this baloney. Our treaty obligations is based on represent prosody. Do we do that for them . Will we give them an electronic tracking if they requested. We have offered him we would like to be able to share data with them if they have the capacity. Heres the problem. The Ranking Member and thehe chairman talked about the fact that we have a problem in this country and we have a problem t in this country. On i get it, they dont want to do it, i dont want to do a lot of things im told to do. So why dont we hold the feet to the fire. The truth is it would have some impact on our country, but im here to tell you, not having it done is having an economic impact. Is there anyway people can u roll up their sleeves and say look we have people dying every day in every state in the union from this crab and its time to say enough. Mr. Senator, i would argue we are doing our best to hold their feet to the fire and to demonstrate to them. Has the threat been made that they will be able to ship it to the Postal Service. We have not made that explicit threat. That again would be outside our treaty obligation. Its actually not a threat,l its a reallife situation. Look, we can pat people on the back and say please, but that hasnt worked so im not in the negotiations and i dont know what youre faced with but i do not what what were n faced with in this country and its costing a pile of money and ruining a lot of lives. I would encourage you the next time the upu meets to buckle down and do it. Otherwise we might have to do something on this end and im not sure we want to go that direction. I take your message and i want to assure you we are working very hard to demonstrate the urgency. Thank you. I appreciate that. Its not you, its just a general overall thing. I appreciate you being here. The Inspector General came up with some audit reports on inbound International Mail to the Postal Services for this question is to you, there were 11 recommendations. Five of those have been closed. If my math is correct, six are still open. One of the recommendations was that the Postal Service establish to better clarify inspection of requirements. Why are we doing this . Earlier today we spoke and my colleague indicated within the next three weeks we will have the mou that sitting up right now at Customs Border protection and will be back to the Postal Service. We will then get that hammered out and get it in place as soon as possible. Just to reiterate for the record, we havent waited for the mou but a lot of theseso things we work collaboratively with them locally to get these things in place. I appreciate with tha that. Ou do you agree with that . Yes that is in effect codifying many of the best practices and procedures already in place around the country. Nt so mr. Chairman, when you get that mou signed could you send a copy off the leadership of this committee. Absolutely. One more thing. This goes to whoever would like to respond. Is there legislation requiredifg for you to take swifter or stricter action to prevent these poisons from coming into the country or do you think you have the ability to do it with whats on the books now could you repeat one more time the question. The question is you require further legislation to be able to take swifter and stricter action to prevent these poisons from coming into thery country or do you have enough latitude with the rules that are on the books now. Is 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 would defer to the state department were customs to maybe answer. Or, we a we are very comfortable with our authorities, nevertheless we continue to emphasize the unquestionable need to further the efforts to get advance information. Do you have anything you would like to add . I would just piggyback onny what mr. Perez said that the timing of rolling up this pilot is critical. I would ask if you have anyit recommendations that need to be changed within the code, dont be afraid to tell us. That would be helpful. Thank you all for being here. I appreciate it. Senator daines. Thank you, mr. Chairman. I want to thank you for your personal leadership on this issue. The people of ohio and the people of this country have been very proud of what i saw six weeks ago with the chairman in beijing. We had meetings with the chairman in china, numbera. Three in charge of all of china followed by a meeting with the premier and mr. Chairman, you are very direct in asking for the help from the Chinese Government at the very highest level that deal with these issues at the source. Thank you. I saw that behind closed doors and thank you for yourad leadership that extends and influences be on this country and around the world to stop this scourge. Thank you thank you for testifying today before committee. Ar in recent years in my home state of montana we have been facing an epidemic. I realize its something that started with the opioid in the northeast working its way across the country, it is in big sky country as we speak. Largely the import of math is coming from mexico. It has gripped my state and is showing the somber and sad sign of the drugs widespread presence. In fact, in december 2016 the Montana Department of justice issued a report that there were 14 children that died in our foster care system. Eleven of the 14 children died as a result of Household Drug use. Four of those wereh. Specifically linked to math. That is not the way yourere supposed to grow up as a child in our great state. In addition the Montana Department of justice criminal investigation has seen, since 2010 to 2015 a tripling of the number of cases they are addressing that relates to math. It has left its mark on montana through increased incarcerations, increased death, heartbreak and in straining our Community Resources to keep up. To to stop the importation of math at its source would go far to begin the healing process in states like montana. In your written testimony you mentioned from fy 15 to present the use of advanced electronic data for inbound International Mail increased from approximately 1 to somewhere in the 40 50 range. I know in montana mexico has specifically been identified as an overwhelming source of math. The question is, what countries and which countries have been collaborative or unresponsive in sharing advanced electronic dat data. The second part of that, has mexico been helpful in providing the necessary data. Yes, i could provide that information, we have many countries that we have Bilateral Agreements with and others that we are receiving advanced electronic data from that make up 40 50 , but i can provide you some betterfo information after the hearing, specific to mexico. Any zeroing in on a couple specific countries, mexico and china that are the largest sources of illicit drugs. Have they been responsive and working toward the 2020 implementation date for universally providing advanced customs data or are we justra grasping at the air. As it relates to china, i can provide better data, absolutely we are seeing substantial data that comes back from them. I can provide you that information after the hearing. Thank you. They mentioned in testimony that the ups delivers more than 19 million packages and documents each day while providing the advance customs data. Could you share how many packages containing illicit drugs are removed from delivery by cbp due to the use of advanced customs data. Rc number two what percentage might those packages represent . Thank you senator. The reality is not perfect. We would like to say no bad people are going to use our network, but they certainly attempt to do that. Fortunately with the relationship that we have with customs and Border Protection and sharing information we do find ways to interdict it and we do get some occasional shipments. We have had several shipments of fentanyl over the past year that were seized by cbp and weve also had a little bitf more in terms of numbers of shipments of math that was mentioned earlier. We also work with cbp in terms of percentage, its minuscule. One of the reasons we would hope that the bad people dont try to user network is because of all of the programs we do w and actually what were talking about is oneonone border level stuff with that and our ability to track and trace and work with the local authorities which we do on investigations. Could you share, do you have an idea the estimate or percentage of packages under current practices that areil flagged because of illicit drugs . O for i would have to defer to mr. Perez. I can provide you the data after the session. At the very small amount but i can provide it. Small is less than 1 . Less than 5 . I dont have that but i will provide it. Thank you. Id like to close by saying i do believe the most effective way to end this crisis in a state like montana and allow this healing process to begin will be by cutting it off at the source. Yes we have to work on our demand issues, but we can Work Together on source and we will need the collaboration between the usps, cbp and are formed post take holders, and of our foreign post stakeholders decide not to cooperate, i do think we need to take stronger action and put america firstst in this equation. Thank you. Thank you so much for taking on this issue. Its critically important. I remember our conversation from last congress. Dea was in the room and when i suggested they may want to use drug dogs to detect fentanyl packages, the dea told me that would not be wise given that if they could smell it they would die. Mov were dealing with an incredibly dangerous material and this is moving through the Postal Service and every postal worker who touches a package is at risk. I think this isnt just about, its not just about processing and getting things through, but it really is an issue of care for your employees and so i just wanted to raise that. We ms. Whitcomb, we noted in your testimony that the Postal Service report, your audit work found that the Postal Service had the ability to request advanced custom data under several bilateralai agreements but opted not to do that certain circumstances. Why did the Postal Service make that determination, and what would you recommend in response . I think most of the bilaterals did not have thesera requirements are older Bilateral Agreements. More recently the negotiations on bilaterals have includedlu this requirement so i believe its more of a timing issue and a recognizing of the importance of this overtime. I think it has improved over time, but some of the ones we had reviewed that did not have the requirement were older Bilateral Agreements. He may know a little bit more about the direction the Postal Service is taking to include this more consistently in the Bilateral Agreements than i do at this time. All new Bilateral Agreements require advance electronic data. This is for anyone on the panel. It seems like the argument t is the cost issue. I understand the other issues also complicate equalizing the shipping requirements, but costs, processes and technology seem to be a factor in the Postal Service claims which are inhibiting their efforts. Is this an accurate statement . Cof if so, how do we bring down the cost of compliance and technology if possible to look at prioritizing electronic data, upgrades to a tiered system with foreign shippers and under the current method you are using to address the situation, how long do you think it would take to get Foreign Countries utilizing aed at higher rates . Do you have any plans to have that discussion . Mr maybe we can start with you. Through the Pilot Program that we have, with the u. S. Postal service we are currently getting advanced electronic data from several different countries, specifically the pilot and jfk has to do with china and france so we will continue to focus on that a work alongside our partners to see what else we can do to make sure we are being able to utilize and get that advanced electronic data and also focus our efforts to expand not only the volume that were able to apply but the quality itself so we can make better and more informed decisions on where to focus our efforts. To clar i certainly want to clarify more on the point earlier that with the aed in the pilot at jfk, certainly one of the things we will look to do is expand that part of it to the other areas that we have and get better with the amount that we are generating that its going to and i can speak more about that later. In regard to the cost, the costs are really going to be incurred at the foreign post where they really have the technological upgrades and challenges that will need, andto certainly the Technology Part of what we can do on our side is a little bit different in regard to aed once we get the data itself. I dont want to prolong this, but i will tell you if we were happy with the speed to which the u. S. Postal service were dealing with this issue, you wouldnt be here. This is not moving fast enough , we see these drugs coming in we have had numerous deaths in my state because of fentanyl abuse and we know the delivery point is the United States Postal Service, either. In this country or recent investigation and prosecutionilo regarding fenton all moving in the mail from portland oregon, but it originally came in from canada. This is serious stuff. It needs to be addressed and we need to have a plan with detailed timelines. If resources are problem, we need to know that. If you, if theres a legal problem with the bilaterals or with the agreement, we need to weow that. If theres a resource that problem we need to know that but we have to stop jeopardizing the lives of people who move this stuff whether its at the post office or people who come in contact with the package unwittingly. Weve got to have a plan. It is frustrating because we address this in a roundtable last year or the year before and im hearing the same things over and over again. Pilots are good, but they dont give us a plan. I applaud the chairman and the Ranking Member for bringing this issue to the committee. This is something we are going to be serious about in terms of oversight and moving forward. With that i yield back the rest of my time. Thank you. We will now do a quick second round, lightning round and lety me say i agree with what my colleagues are saying that were not moving fast of fast enough. Let me give you a specific example. There was a letter sent in april 2016, more than a year ago to this committee. In the letter it said, the t plan to expand the jfk Pilot Program with china to Los Angeles International airport is currently scheduled for the summer 2016. We are now in the summer of 2017. Has it expanded . It has not yet. Okay, it has not. The upu, we heard today aboutrd what will happen with regard to the universal postal union and with all due respect to our International Partners in the upu, will get done by 2018, 2020 or even 2022. They keep pushing it back with respect to advance electronic data. If we didnt have a crisis in this country we could go along with the normal routine which is other countries are working on their own timetables. We cant afford to have them work on their own timetables because our people are dying. The question i ask is how many more americans have to die before our government gets its act together to make sure the pilot is working, make sure it is expanding as promised and has not occurred and make sure were actually doing everything we can keep this poison out of ourth communities. There is not one silver bullet. I will still align from my Ranking Member who said theres a lot of silver bbs,b but this is one of them. Everyone of you have acknowledged that today. My hope is because of this hearing we will move more quickly on this issue and get the legislation passed give you the Additional Authority if you do need to have the tools to be able to identify the right packages to go after them, stop some of the poison and increase the cost on the street because right now this stuff is so cheap and so deadly that its killing more people. We will hear from the next panel about whats happening in our communities and whats likely to happen this year compared to last year. The summary is, more peopleyo dying. Its getting worse and worse. Thank you for being here. I now turn to my Ranking Member, mr. Carper. Thank you. Senator heitkamp was speaking just a moment ago. Im reminded of the work that weve done in one of the things we focused on is how do we increase the revenue flow to the Postal Service so they can replace vehicles and modernized mail process that are designed to handle large packages or parcels and how do we modernize the post office to provide better service, how do we provide those revenue streams. Another reason they need revenue is to be able to do their job, better job withgo respect to moving these highly toxic chemicals. We will use that in reminding our colleagues why its important to move on postal legislation sooner rather than later. This is one of the reasons we need to do that. The other thing i want to come back to is the pilot. J that jfk and why is there a delay in extending it to the other four destinations . Let me explain the pilot itself, when they started in 2015, in the recent two months weve made some pretty significant improvements. Part of what we try toe eliminate is the manuall handling of the product itself so we get the advance electronic data and we provided to Border Protection, they provide us a list of what they want us to extract. We renew that in a fashion of identifying the facts and identifying what we need to do to extract those pieces. In todays environment, when there hasnt been anyy expansion theres been improvement significantly to take that and put it on the processing equipment. We work very closely with the Inspection Service and or engineering systems to be ablele to do this on our processing equipment. One of the key things that will happen with this is it will be on equipment at jfk, weve also connected theyre down flow facilities connected to jfk where we are actually able to track those pieces now much the same way you heard from ups testimony, pretty much everything we do this very well on the domestic side of the network. We are very good at this part, tracking barcodes. We have the ability to do that, the expansion and arep full commitment is to get those other sites up and r running now that we have flashed through this. As quickly as we can get it upr. We need to do it in collaboration with Border Protection and mr. Perez may want to chime in we are very focused to move forward and get expanded to the other four sites. Thank you. Lets have a final 30 seconds. Gi i want to make sure youre not here 17 years from now. We probably wont be either. Give us a great take away for your to do list. I think the key thing is passage of the stop act and not only will it help with the problem as a whole, we think it will help the postal operators and their negotiators so that they have legislative language that says we have a mandate, we have to do it. The other thing is if there was a way to increase the amount of information shared, we have a great working relationship but there are limitations in terms of if we knew more about who some of the bad people were, we could build that into our systems and shrink the haystack from both sides. Thank you. A i will be asking for the record if theres any amendments or change changes that should be made to the stop act. What changes should we consider. F mr. Chairman, so far we are halfway home and this has been a great first half. Thank you. Let me conclude by thanking our witnesses again and thank you to everyone of you for what you are doing in your own way to try to push back on this epidemic because each of you in your capacities are working on this issue. Weve got to figure out how too do it more effectively and faster. I will end with the story. Yesterday we had our weekly buckeye coffee and we haveve ohioans come in, as was the case yesterday and for rural letter carriers were there. He they were there from the union to talk to me about postal issues. They talked about the stop act and the need for more resources. Senator carpers efforts, and hes been a leader in this over the years. Two of the four took me aside privately. This is 50 of your role letter carries who came to see me and said i have a family member, one was a nephew, one was a son who were addicts, recovering addicts now. In both cases they had the opioid addiction and are now in recovery, in and out, which is not unusual, and they both said to me youve got to move forward with this. You have to continue your efforts. Ng i would just tell you this is affecting everybody includingg our families and our friends and neighbors in every zip code and including the role letter carriers who came to talk to me about another topic but ended up focusing on a personal topic which is their deep concern about this issue. Thank you for being here and i appreciate continuing to work with you on this legislative agenda and stopping this poison from coming into our communities. Thank you. [inaudible conversations] [inaudible conversations] the second panel has joined us and we will move quickly through the introductions. Each of you deserve a 20 minute introduction but i will give you a shorter one today with the hope that we can get to questions more quickly. The first is the executive director at boston medical center. As some of you know he has been at this a long time and he is a expert. He was the drugs are until just a few months ago and we are delighted to have you here. Second we have thomas sign in, police chief and county ohio. He is chair of the lawenforcement sector of the task force and everywhere in southwest ohio people look to him for his advice and he willl talk to us about whats happening on the street. We have Thomas Gilson who is a medical examiner. Previously he was state medical examiner for the state of rose rhode island. He gives us data on whats happening broken down by area of the county rules suburban innercit innercity and its very helpful. It affects everybody. It knows no zip code. Hes also here with us and he is the chief for the division of medicine and delaware. Previously he served as medical director of the Phoenix House foundation in new york. He also founded a project engage and has been very involved in delaware as the chair of the Drug Overdose fatality. I appreciate all four of you being here today of experts and we ask you to stand so we can swear you in quickly. We ask you to raise your right hand and repeat after me. Use where the testimony you will give will be the whole truth, the truth and nothing but the truth so help you god. Yes or. Please be seated. Mr. Chairman can i make a quick, we are representing. [inaudible] she has gone on to be a health wonderful leader in our state on a wide range of healthcare issues but i think theres a young guy back there. He is 15 years old. We welcome him as well. We will be watching carefully to see if his lips are moving with his father speaks. Thank you. Im sure you attribute all of your success in life to senator carper. She has succeeded in spite of my mentoring. But the record reflect they answered in the affirmative to the oath. Your written testimony will be printed in the record in its whole. We ask you to keep the oral comments to five minutes. We want to have time for questions and dialogue. Lets start with doctor gilson. Go thank you. Good morning. I am the medical examiner as well as the Crime Laboratory director. Thank you for allowing me to be here to speak on this subject. If i were to tell you a major catastrophe would kill tens of thousands of people in the United States this year, how will the team respond . , to money, people, resources would be put into action. If this was allowed to happen again, how many more hearingsin would be called to determine what went wrong in the response . The crisis should be thought of as a slow moving mass fatality event that occurred last year, again this year end next year. Re each year its getting worse than the previous period in myat home we will see approximately 800 drugrelated deaths in 2017 which is an increase from our most devastating year last year, 2016 when we saw approximately 660 people died from drugrelated deaths. Nearly 90 will be due to opioids or opioids of some kind. Prescribed pills, heroin, fentanyl. Its a nationwide Public Health emergency which is simply out of control. Ohio is one of the hardest hit states. O other states are particularly hard hit as well. In the fall 2011 my office alerted our connie executive to an alarming trend in the rise of heroin associated deaths. In subsequent years weve partnered with the police department, u. S. Attorney is office, the board of health and Mental Health to launch a Community Initiative which hasmb attempted to combat this Public Health crisis. Partners were quickly added including the cleveland clinic. The healthcare survivor an important response, we have drop off boxes to take back over prescribe prescription pain medication and over 50 Police Departments. We have a Distribution Program at the county hospital and the board of health. We also issue warning letters to those at greater risk while in carson incarcerated and those leaving Treatment Centers. These folks are at risk because of decreased tolerance. On also our heroine committee allowed us to look at data from the overdose fatalities in an attempt to plan intervention strategies. We also hosted a heroines summit in november 2013. Lawenforcement has also created Specialized Task forces to work with our medical investigators to begin investigations earlier in our regional forensic laboratory, provide highly scientific testing, prosecutors of theg county and federal level are now leveling charges against targeting dealers. All of this work continues to implement communitywide. When a heroin overdose occurs, individuals typically fall asleep and read slowly and shallowly until they stop altogether. The dying sequence can be relieved by the heroin antidote block some with whic which was made readily available in ohio and is a first step in saving lives and should be applauded. They partnered to distribute it by prescription and we have documented over 1000 reversals with block some. A Pilot Program started in 2014 and ramps up last year end documented another 300 reversals. These individuals do not have to make a final trip to my office for the introduction of fentanyl and more potent like car fentanyl which is seen in our jurisdiction is a tranquilizer that diminishedce the effect of mock sound. Several effects may be administered in the time window is shortened. , this is the fundamental reason for the catastrophic mortality rise. Research conducted at the medical Examiners Office in my county, in collaborationla with medical lawenforcement and partners indicates that nearly 600 people died of heroin overdose between 2012 and 2014. Some promising intervention point should be considered. Several of these overdoses had been prescribed within two years of their death. Several of these people were dr. Shopping and with the mandatory infant mentation of a drug monitoring program, we are now moving in a positive direction to reduce this as an entryway for people to go into the illicit drug market. A final example of how the information can be gleaned from death certificate andfi death review data is that many of the individuals who came to my office had been in contact with the legal system and or drug and alcohol treatment programs. There is a tremendous need for education in these opportunities are needed to maximize those for messaging but its naive to think that education and messaging would be affected if we dont adequately address the need for Treatment Options once the message has been delivered. People can recover from drug addiction with adequate support. While data and information are b critical in helping to determine a helpful strategy, its been inspiring to see the community that has broughtex treatment and prevention, lawenforcement, prosecution of medical examiners likeso myself together for a single purpose which is to save lives. Igation at the same time, however, our local resources have been stretched to the point of exhaustion. The Death Investigation are facing doubledigit caseloads annually. Equipment problems and complex processes to support the fight with the analogs entering our country. While weve interacted successfully, its clear that the delivery of drugs to our country continues to invade Treatment Options that are severely limited. Our community has added millions of dollars in the past several years. Our estimates are there are enough people in my county to fill our football stadium every year end that approximately a sufficient number of people to fill our basketball arena transition over from heroine to fentanyl. That used to be largely caucasian majority of upwards of 5 8 of victims. Od its changing now and it seems almost with purposeful intent. Cocaine is being mixed into the fentanyl distribution inaf an effort to introduce these drugs into the africanamerican community. Cocaine had been the only drug that victims in our community were for predominately africanamerican. That has changed since the introduction of cocaine into the supply distribution and it is also of note that we have a High Percentage of africanamerican deaths in our overdose crisis. The strategies to combat this crisis are not a matter of innovative creation but of sheer will, cooperation and adequate resources. Tment the resources that are local level are depleted and overwhelmed. Treatment needs to be open and adequately funded. Our county executive, in cooperation with our drug board has created additionalth funding for treatment. The imd exclusion which limits the number of treatment beds to 16 for Substance Abuse Treatment Facility needs to be lifted and i sai salute the bill offered by you and your ohio colleague that will more than double the number of available beds. Agreements with china, mexico and canada need to be strengthened and delivery of these substances to the u. S. Postal service and other Services Needs to be squeezed off. I appreciate your cosponsorship to this purpose. Further there is a National Crisis in my field in Death Investigation. My field especially, forensic pathology is in dire need. There are less than 500 boardcertified fulltime pathologist practicing in the United States. Currently, on my professional organizations website, 28 offices are seeking to hire additional forensic pathologist. I have the privilege of having the oldest Training Program in the country. O there are only five saidal programs in existence and they are not funded by medicare, unlike any other medicalgrdo training specialty. Tholog our Program Graduates one or two doctors a year end a system that can only produce a few dozen pathologist annually. We rely on accurate data around mentality to define this crisis so will serve a significant measure. Its essential Additional Support be given to these Training Programs as well as the doctors already practicing in the field. All these actions are beyond the ability and authority ofun the local county like mine. We need your continued and renewed assistance and resources to all phases. Im sorry to go over time, its a very important topic. I thank you for your time and consideration. I would be happy to answer any questions we also provided a packet of information which summarizes even more. I couldve talked longer. Thank you very much. Thank you. Just because i have to leave, and i wish i could stay for all of you, but i alsoso wanted to thank doctor gilson who was deputy chief medical examiner for quite some time. Thank you so much for your work and thank you for your continued work, and thank you to all of the panelists. Im sorry i will miss you, but weve talked before and we will talk again. Thank you so much. Thank you remember, your full statement will be part of the record. Thank you. Thank you for theur opportunity and the invitation to be here today, and for your ongoing leadership in this epidemic. N think we all know this epidemic is the pressing Public Health issue of our time and in many respects a Public Safety issue of our time. N the National Survey on drug use and health approximate that of 2. 1 Million People in the u. S. Have an opioid use disorder. In 2015, last year we had complete national statistics, 91 people. Day died from an overdose including prescription pain medication, heroine, and or fentanyl resulting in over 33000 deaths in 2015 alone. In massachusetts, 1900 people died of an overdose in 2016 and that is up from 742 just from 2012. In addition to a addiction and a death we know drug use associated with this has been linked to dramatic increases a in Viral Hepatitis across the country along with local outbreak of hiv. A recent analysis done by the cdc showed there are at least 220 counties, mostly in appalachia that are at risk for another outbreak like the one we saw in scott county indiana two years ago. Over the past two years weve seen synthetic opioids. The cdc estimates that Overdose Deaths attributed to synthroids increased by over 72 from 2014 until 2015. Reports from the dea as well as state lawenforcement indicate that these deaths have been testing positive for fun all. Y illi this is largely manufactured. Domestic Law Enforcement seizures have increased by 426 from 2013 until 2014. Analysis is limited to those states, like ohio that have excellent or very good reporting which means Overdose Deaths are reported with the specific drug involved. Others reported increases from 2014 until 2015 with states in the northeast and midwest experiencing the highest increases. A recent analysis of Overdose Deaths in massachusetts show that deaths involving fentanyl rose from 32 in 2013 2013 to 72 in the first half of 2016. Fentanyl is also mixed with heroin or cocaine with or without the users knowledge. As we have seen in some high profile depths it can also be disguised as pain medication overdose. It is generally openly shipped to the United States or shipped to mexico where it gets mixed in with the u. S. Before transporting it to the United States. I will go into detail due to lack of time, but i thank you all know the administrative, the administrations responses to these efforts. In all of those efforts we need to ensure people that need treatment finally have access to highquality care including medication. The Affordable Care act contributed to perhaps the greatest expansion of treatment by ensuringat Substance Use Disorder Treatment was one of the ten. Ssential benefits that Medicaid Expansion plans and marketplace plans had to cover. It also ensured that those benefits be offered on par passage of the comprehensive Addiction Recovery act that work rescinding the ban. We accomplished a lot in our time here in washington. But we still have a long way to go. I will focus the remainder of my remarks on what i think the recommendations as i look on how we deal with fentanyl. Continuing to enhance our intelligence and information gathering on the manufacturing and distribution of fentanyl is critical. I was very appreciative of the calls for better information. There are still many unanswered questions. C cs call i was happy to hear that dni looked at synthetic opioids as a major threat. Quite honestly i was frustrated during my time at a wind dcp c that i didnt know we had fit know at things like carpet notes until we saw local outbreaks in the United States. Our Intelligence Community iss too good for us to be caught unaware in terms of whats coming at us. Since that know as harder to detect and can present a hazard to state and federal and local Law Enforcement we need to promote better ways to expand current drug testing technology. In case need to develop detection capabilities. We need to continue to provide n factbased handling instructions to Law Enforcement orbital and others who may come in contact with fentanyl. We need to continue our engagement with china andle present for additional actions to schedule fentanyl analogs and to take down a list of manufacturers and shippers. G theres also a significant amount of variability of standard testing a fentanyl with Law Enforcement, colonel Justice System, medical examiners and treatment programs. The need to incorporate fentanyl into their direct testing panels. With Public Health experts we need to develop Industry Information material on how users can minimize their overdose risk in areas where fentanyl might be present. We need to expand the use of naloxone by anyone is in position to witness or confers an overdose. Cy because of the potency of fentanyl and what appears be pattern of drug users injecting a loan, that period of time we have to reverse and overdose should be shortened. We also need the federal government to deploy Rapid Response teams to our communities like we do with other diseases so that communities have the investigatory tools that they cant to examine some of these outbreaks and the causes behind it. We need to expand programs that engage active drug users to promote safer injecting, distribute naloxone and minimize overdose risks. More importantly, most important to reserve the coverage gates made to the Affordable Care act, particularly Medicaid Expansion and other federal grant programs. Even with these provisions time access to quality care remains an issue for many, particularly in rural communities. Thank you for your time and look forward to your questions. Thank you. Thank you, chairman and senator carper. First id like to tell you i think this issue of addressing fentanyl is important. Excessively to any issue i have to attend to in the hospital. Trying to help individuals get into care, creates a rapid spiral of addiction, much more so than we would say otherwise. In delaware currently, 25 of individuals actually die sorry, 25 , only 25 only 25 of our individuals have that know in their blood at time of death. So we look at the potential for damage in our state when reached the levels of massachusetts. I think it would be a real catastrophic increase in the coming year. Having said that i want to share briefly as someone who sits in a hospital, works in inpatient setting emergency room at clinics, doing that for 25 years, just some of the Lessons Learned. This is a horrific epidemic. It strikes across the board. I take care to not only Young Mothers who have given birth and High School Kids who are paul bolding champion and wrestling champions but also grandparents and couples. All races, all ages. What they share is horrific addiction. N. Their brains have changed. Their motivational circuits have been distorted. As well that this new one set of withdrawal, and withdrawal which is like primal misery. And withdrawal that prevents them from moving through that wall to go on to care. They will say outside of that care and avoided at all costs because thats also are reachable moment, also will be can leverage. We done that in the hospitalss and weve done that in jails. When someone is put in a hospital and they can no longer be an outside and they are avoiw desperate to avoid withdrawal, and we can address withdrawal. We can treat aggressive. We been able to leverage the an give them into treatment. Twothirds of the people that ice in the hospital i very agreeable to go into longtermon care. They dont come into the hospital looking for that. They have an affected leg or hard but they use that opportunity to get into drug treatment. Its really remarkable. Twothirds of individuals i see are actively looking to go into drug treatment when it offer and address their withdrawal. Of those individuals, remarkably nearly 80 80 show up to the Community Care provider when i contacted them onto methadone and hospital. The hospital at the reachable moment. Of those individuals 70 other a month later. What im telling you is individuals who are addicted to opioids can have come into our hospital system, its a reachable among to address withdrawal that we can use that to leverage into getting the two treatment and they stated. If youre on drug treatment come on medicines like suboxone whict block hope youre scum if you use opiates overdose. Truly its about safety directly to my patients every day when i see them in the clinic, yesterday i clinic and this is why said, take your suboxone today and tomorrow, and those days would onto way about you overdosing. Pretty simple straightforward safety message. It is critical to what im trying to do and help individuals into care and stay in the care so they dont overdose and dont die is really having access to the character where pretty fortunate are in delaware weve been able to expand outpatient slots foror primary Substance Abuse care really by the thousands. So for me its like no difficulty when identify an individual in the hospitalin hitting the medicare the next day in the committee setting, has to be that contiguous or i lose them and they relapse. Its remarkable unable to do that im able to do that because that care is available. That care is completely and weve been on medicaid. Without medicaid that kerry would collapse. And so i can say that what im really fearful of is an fearful that i know how to address this goal. Epidemic. T ts i know i to treat patients that have who are addicted to heroin and other drugs. I know how to get them into a t safe, but an fearful i will lose the tools and a medicines i need to keep them safe here i really fearful that some of the cuts that it can propose will completely get the system that i rely on to treat my patients, keep them, help them get to a better place. So basically im saying, please, its critical. Dont take away my ability to treat my patients and keep them safe. They depend on me and i am depending on you to really preserve the system of care that i can able to work with and make improvements. Without it i think this war isis lost. Thank you, dr. Horton. Chief synan . Think a chairman portman and Ranking Member carper along with the subcommittee for giving me the us opportunity to discuss is very important topic about synthetic drugs are destroyingre the lives of loved ones in our community. In my 24 years of Law Enforcement ive never seen a a substance cause such damage and devastation with the death rates at a prisonlevels than Car Accidents and homicidesve combined. I have witnessed that are of drugs in my Small Community watching an entire family from a mother to her three sons wiped out. Three brothers, an entiretion ge generation gone because of drugs. The last two brothers due to heroin. Event such as a slightest to form the coalition at a time when we were calling this epidemic with an average of 2025 overdoses and one to two deaths a two deaths a week and epidemic. In july 2016 i received a call from a fusion center, a part of Homeland Security, originally designed after the 9 11 attacks to share intelligence on potential terrorist situations, which can analyze or share local and federal Law Enforcement along with the public. Recognizing the centers ability to analyze data quickly, we use it to track trends on that street. At that 00 p. M. I got a call saying there was a new drug on the street called carfentanil. They said we are not sure, it is used to knock out large animals. I replied, like a pig . He said no, elephants. We try to obtain as much information as we could to figure out what the introduction of carfentanil on our streets would mean. What we learned about the drug is frightening. It is potentially using chemical weapons and is not intended or for humans it had the potential to kill human. It is now on our streets issuing a public warning, concerned not only worried about user but also the public. Anyone to be unknowingly exposed to a externally data synthetic. Youre so concerned that we recommended stop field testing of heroin. The officers safety is a priority over enforcement. This is reached other states like georgia and florida to ensure the safety of the officers. With all the dangers facing Law Enforcement, this danger, which could be undetected until its too late, is a concern that could we knew the drug was struggling controlled and monitored in the u. S. , and with the dea, we determined it was not coming within the u. S. We could never havent dissipated that our epidemic would reach levels along the line of pandemic. It could be the new normal. In august 19 through the 27th of 2016, an event occur that would forever change the heroin epidemic when the hardest hit in cincinnati experienced 200 overdoses and three deaths in one week. Theres nothing on the streets like this, we experienced a literal shift from the organic opioid of heroin to this and that it opiate of fentanyl, always derivatives, a carfentanil. This is testing the limits of users, First Responders, the system of government, hospitals, and the spirit of each person drawn in to the point of breaking. I not only witnessed the devastation, but the determination of the same people who try to keep up with the new normal. The new average of 50 up to 70 averages of overdose. 11 people died in one weekend in multiple overdoses at the same time and same location. At times, they reached 40 in stretching resources and even large police and Fire Departments such as cincinnati who in one district with 20 officers at 16 overdoses and four shootings causing an officer to be unable to respond other calls. In 2012 are average at seven deaths that were fit all related. In just three years that never exploded the 238 in 2015. Heroic efforts made by many who initiated an intimate program such as quick Response Teams have tried to connect users to treatment, collation using narcan to every First Responder and 19 months had used over 7500 kits of narcan. That sheer volume of numbers and letters to follow the mantra of the starfish parable where our young boy was walking down the beach with thousands of starfish had washed up. The envoy would pick up a starfish, threw it in the sea and go for the next one. And all financing to stop the boy said young man, this treatment to make a difference. You cant save them all. The young boy picked up a starfish, throwing it back in the blood, i saved that one. This description we followed beautiful and heartbreaking in its rally. Describing what we are right now on this epidemic. But no matter how great our efforts initiative our determination, the tremendous influx of such powerful synthetic such as fentanyl which will be glad seven alter the molecular structure the more powerful derivatives which are Court Offices identified at least ten variations of fentanyl. In the current ultimate on opioid scale carfentanil have rendered each initiative less effective forcing us to change our police are to keep up with its power. The original two mg narcan we issued over 1000 Police Officers now obsolete. We had to replace it with a higher concentration which, due to the strength of the synthetic, require multiple doses. It is more common to hear users unconscious being placed on a constant narcan drip to keep them alive. The synthetic is so now ingrained in our area thats when we think the situation cant get more difficult, cost even mor these in other drugs like cocaine. This will cause more overdoses and deaths due to the cocaine user bodys not being accustomed to it. It is expanding. For people in cincinnati who bought they thought was ok, overdose. Two died on the scene. Since i submitted this report last week, another person in that incident died. Three have died, one is hospitalized at my last check. The same week, in my community, a mother drove her baby into a driveway where she got out and collapsed. The mother believed she had only purchased heroin, and found out she had given a mixture of cocaine, fentanyl, and carfentanil. I commend this committee for taking the time to hear, investigate, and look into the ways of reducing these powerful synthetics fermenting our country, drug supply and our communities. I plead with this panel to help to stop this poison from getting in to the country. Although this will not stop addiction or stop every supply, each intervention that prevents them from reaching the streets means First Responders can get relief from the overwhelming numbers that has cost such pressure on them and we have coined the term called First Responder fatigue. Take this deadly ingredient from those on the street so they become less powerful. Take this tool away from them so that our tools we are using can be given a chance to work. Reduction from these powerfully devastating synthetics would mean less people would overdose, the numbers of deaths would go down, and, for us, each one of those numbers is a person. A person who is a mother, father, brother, sister, son, or daughter that will forever grieve the loss of their loved one. Thank you for allowing me to speak on the subject and i commend you for the compassion on helping all of us. Thank you. Thank you to all four of you thank you, chief. And thanks to all for your person very powerful testimony. I was struck by her testimony, chief, the Law Enforcement. As you sit try to keep up with the changing drug mix and specifically the move to synthetic opioids, fentanyl carfentanil in particular. Im thinking about how Law Enforcement approaches this. It now you have a situation where, through the u. S. Mail system, someone can, at the po box designated, pickup fentanyl from china, use it as an individual and theres no drug dealer for you to go after. Some of these individuals also become a drug dealers as you said, and yet its a different situation than being able to go after the source because the source is coming into the u. S. Mail. You talk about tools. Earlier we were talking to Law Enforcement folks who said cbp said they want the tool being able to get advanced electronic data so they can identify these packages. Ka you also said you want to take this tool away from the traffickers, the tool of being able to ship this stuff in ourou committees to the mail system. I guess i would ask you, given your experience and given your background in this and seeing what is going on, what could be helpful at a critical chokepoit like these International Service centers we talked about here today to be able to stop this poison in particular keep the volume down to avoid the First Responders fatigue but in part to raise the cost, the risk to the trafficker of being caught but also the cost of this by reducing the supply . Yes. Du it would definitely help cutting off that supply. There is very little risk for the dealers what never theres quite a bit of reward. The problem with that, through the mail is that its not like in the 80s with the crack we had major gains that were mostly pushing the crack cocaine. Went to identify digging you cut the head off the snake and the rest of it collapsed. Rs here it is adware with hundreds of jews and officer in the network or source in 18. It makes makes it very difficult for enforcement. I do want to say that i want to caution we dont repeat history. And i we did a great job of shutting down hill mills and doctor shopping. Integrally that great part of this epidemic when we had a segment of society that was left out their opiate dependent. I want to be careful that we not just shut officesupply which is encode important part of this piggy would get First Responders a chance to breathe. I also want to make sure that while we are doing it we so the resources on the backend. As part of the publication with this epidemic is if you can get someone whos opiate addictedan into treatment, often theres not the Space Available plus theres discussion of medically assisted treatment and the sideshow thats affected but we need doctors and nurses along with that we need the facility to go along with it. Not only is that chokepoint important but we need to work on the issue of having these people who are addicted get long term b care order to reduce that the band which my belief is once will reduce demand then we will reduce supply. Thats a great point. I was impressed with dr. Hortond healthcarhealth care system thas the ability to take somebody who is in need of treatment andd within 24 hours dipping intoto treatment, which fragment frankt the case in many places in ohio. Particularly and our world area. We have a real issue with the availability of treatment and longerterm recovery which as you know ive been focus on because i think that leads to better results and i think Law Enforcement system can lead to better results by supporting our drug courts more as we do, i know youre involved in that as well. Dr. Gilson, you talked about what youre facing specifically talked about the forensic pathologist being overwhelmed. We talked a little about this prior to the hearing as well. One thing you said to me was that at a death scene where someone had overdosed from fentanyl, your people sometimes find a package literally a package from china at the death scene. Again, i think this is just an extraordinary change from what you are used to with cocaine or, for that matter, with heroin coming overland and axle at the Street Corner in cleveland, ohio. I was struck by that. Can you talk to us for a second about what you see happening but i think is a told you earlier yet the best database in ohio and for 2016, forcefully you were. I could that the be increased, the number of deaths from fentanyl was 399 as i recall, almost 400. Sent you to keep his accurate data on overdoses and fit nobody to deaths, what trends are you predicting for 2017 as compared to the 399 . What you project for 2017 . For 20 senator, i think we are already far enough into play 17 that we can make some predictions. One is that the crisis is going to get worse here we are projecting an increase from 660 total deaths up to close to 800. I think most of that again is going to be driven by fentanyl, and i think the other thing thah everybody in the room should be an incredibly concerned about is what is going to be the impact of the analogs of fentanyl . We had 54 deaths in 2016 related to carfentanil just in myiction. Jurisdiction. Since the beginning of 2016 weve identified at least 1617 different analogs of fentanyl, and many of these like carfentanil are far more potent fentanyl is already a bad drug. What concerns me is at some point if these drugs start to replace that know in our community, these numbers will take off again. To echo can what the chief said, we started with the diverted Prescription Drug medication and about 2011, what my office i was a transition away from transition from Prescription Drugs oxycodone which appear to plateau and heroin it took off dramatically. And that was he a trend up until 2016. When heroin store to look like they were going to go down, Education Programs comfortably caught a title with a fentanyl, another more important potent drug in 2016 was a uniform disaster and cuyahoga county. We newly lost twice as many people. These are hundreds of people dying of Drug Overdoses. If carfentanil becomes the new fentanyl in 2017, i shudder to b think how much worse that can be. Dr. Gilson, is the carfentanil also coming through the mail system . I think this is again partly what i can say from death scenes and partly what i can glean from the collaborations we have with particularly Drug Enforcement agency. Yes, the answer to that. My investigators by happenstance or sometimes identify computer records, packaging that clooney show that these drugs are coming from overseas. The concept that a lot of these drugs are coming from china is something that our dea liaisons completely, you know, support. The idea that, whatever senators mentioned it earlier, maybe they come to this country and then get routed into mexico i think its also true. Because in the heroin epidemic, a mexican production went up dramatically to the point where they became the second largest heroin producer in the world. That Distribution System is deathly inplace editing fentanyl to follow the same Distribution System. So i do think that these are drugs that are coming fromld in overseas, primarily from china and being sold in our country, probably almost on the basis that could be considered an act of terrorism. Thats interesting. Given what weve said earlier about, and what mr. Botticelli said with regard to the dni, the director of National Intelligence last year for the first time, the ship for the first time last month and isst rolled assessment. He put synthetic opioids into a National Security context. Sen. T senator peters . For thank you, mr. Chairman. Thank you for calling this very important hearing of the opioid abuse in michigan is going at an alarming rate as it is around the country and its important for us to get to the bottom of this and understand how we can do with it and appreciate your leadership on this issue over the months and years even working on this and certainly thanks each of the panelists for your compelling testimony as well in dealing with this. Dealsi my first question really deals with how we deal with the underlying Substance Abuse and the medical treatment necessary to treat this as a medical issue is a Law Enforcement issue but your testimony, chief, thi thisa Public Health issue for some for both that we have to deal with. Whenever we think about Public Health, i think about our Health Care Policies and in particulara the Affordable Care act with its expansion of medicaid which certainly has been significant in my state. Medicaid expansion has led to over 600,00 600,000 individualsw having Health Care Coverage where they didnt have ithere t before. Part of the Affordable Care act is coverage for Mental Health as well as Substance Abuse, which gets to the heart of the issue of this problem. Since the aca Medicaid Expansion into effect i think more than 1. 6 million americans have now gained access to Substance Abuse treatment. So mr. Botticelli and dr. Horton, could you speak of individuals enrolled in medicai are using the program and whether or not we are seeing an actual impact on folks who are suffering from Substance Abuse problems . [inaudibl [inaudible] thank you. You think i would know how to do this by now. That we saw for a long time, is that when National Surveys look at why people not able to access treatment, not having adequate access to Insurance Coverage and being underinsured are one of the biggest reasons. Youre right, when the part of think did a number of things as related to increasing access to care. Disorder it may Substance Abuse Disorder Treatment and Mental Health treatment one of the essential Health Benefits that required by Medicaid Expansion and by ensuring that those benefits were on par with other medical benefits. Weve seen some remarkable results as religion increase access to care. Under the Affordable Care act. I think your point about particularly the Medicaid Expansion population which are not higher prevalence the source in general population. T we have seen i think remarkable results. Quite honestly remarkable results in those states that have been dramatically impacted by this epidemic like west virginia, like kentucky. New hampshire, massachusetts. So weve seen an incredible increase in peoples ability to access care to do that. The other piece i just want to make two quick points before. The other important point is that people Substance Abuse disorders often have comorbid Mental Health and quite honestly other health conditions. Its not just accessing care for the Substance Use disorder. They need care for the hepatitis, and Mental Health coverage. Thth and the last thing i will say is i really worry about not just people losing coverage but the stability of our treatment infrastructure. Some of these folks can say that these programs operate on very thin margins. And i worry that were even going to have a treatment infrastructure for those remaining people who can access care if theyre not able to bill insurance. Thank you. Anybody else . Yes, thank you. As i mentioned in our system we have developed some very unique partnerships with community providers. So we are able, we now screen 30,000 admissions to our medical hospitals, the largest in delaware. Identify those are opioid dependent quickly run withdrawal and treat that and they are agreeable to go into care. That care is predominately medicaid pixel our Largest Community Provider Program called connection is largest footprint in the state, develop developed the footprint because had a reliable funding stream. Its not only a funding stream that cares for military patient it covers all patient. Really a quality provider. But the bulk of the revenues is what allows them to exist so that reliable revenue stream. And because of that i able literally, my record is 12 hours so i can find some and get into treatment the committee on medicine and i can do that because the individual is covered for the most part that coverage is medicaid. If medicaid goes away, that i collapses and, frankly, the Substance Abuse infrastructure in delaware collapses. So i will i didnt for individual in the hospital. I wont have anywhere to send them. They will leave the hospital. They will relapse within hours to days and it will be back in the hospital. Actually return to the good old days of the revolving door and that cost, astronomical cost of caring for these individuals to place like my Hospital Health system and we will never attain to the root cause issue. The big difference these days is the volume of heroin that used to be once upon a time individual use one, two, five bags a day. Now its 50 back today. I think of it as russian roulette, instead of bullets its bags of heroines. In any of those bags has been a leader, its amazing. So we are in the middle of all this and because ive access, read access to Substance Abuse treatment on demand, unable to make a difference. Erence im clear that those individuals are taking medicine are overdosing i know because a coming week after week. Thank you. Chief, you are on the i im sorry, can i add a different perspective . Please do. We dont track it specifically but we go after respondent guessing and one of the most heartbreaking things we see is an individual who has been seen in an Emergency Department within weeks, sometimes the days for drug a dg overdose and now instead of a Drug Overdose. These are the people dr. Horton doesnt see. En they dont make it back to treatment. They die and we do have the capacity in my county to send these people when we have their captive attention, theyve just nearly died, to treatment. We send them back on the street like dr. Horton said to try and ife if they can work somethingng out. Anything like Medicaid Expansion being eliminated the limits peoples access to health care, i cant see any good coming from that in this crisis, special with its mortality. A i appreciate those comments and just have chief, youre in the front lines. Thank you for your service on the front lines. I would assume you would concur . Absolutely. Of Law Enforcement are very proud of my colleagues have taken the lead on this but the problem is were taking a leader in something that really is a Public Health issue. You are taking Law Enforcement has taken programs like quick Response Teams to get addiction specialist out there. Narcan, we have become the paramedics picked it is not in, for officers to use it to treatment. It is well outside of our room to be doing this issue but for us would now become somewhat addiction specialists. For Law Enforcement to talk about the we should not be decreasing medicaid, to jump or desist is to us. In order to reduce that the man which would internally reduce us the supply went to get people into treatment. One of the programs that are teams are doing out there and the area is signing people up for medicare to try to get them into that treatment. These are individuals are walking with a user to try to get them into treatment and if medicaid is gone, then that would have a significant impact. It is not uncommon for us to find a user, call Treatment Facilities, be told there is a bed open, drive up and find that it is gone. It is difficult enough, taking away medicaid would make it even more difficult. Were already like a mouse on a wheel trap spinning as it is. Taking away more tools will keep it difficult and we will continue to dig ourselves into a hole. I am going to turn the gavel over to my colleague. Big mistake. Ask him to conduct his final questioning and close us out. I want to think the four of you for being here and for your work every day. All four of you are in the trenches, on the front lines. Thank you for helping reverse this tide which unfortunately is moving in the wrong direction. Before you walk out, i will say this to your face, not behind your back, thank you for your sustained, continued leadership. Maybe we can use the effort that you have led, along with Amy Klobuchar and others. If we can work that well across the aisle on important issues, maybe we can make sure the folks show up the hospital, that they actually have access to treatment. We have to focus our attention on that. Thank you. I want to come back to dr. Horton. Explain to the folks who might be following this, how is it in delaware when somebody shows up at the hospital and they have had an overdose. For brief moments or hours, theyre ready to go. Theyre ready to start treatment. Within 24 hours we often have the ability to place them in treatment. How are we able to do that in delaware and not in other states . Does it have anything to do with the Medicaid Expansion . In order to put someone into treatment i have to have a treatment to put them into. That treatment is primarily the expansionmedicaid and problems like connections developing those outpatient slots because they had revenue that could be relied upon. Without the revenue, the Treatment Center wouldnt exist. We are able to leverage reachable moments. There are many more than just the hospital. How do we find the other reachable moments cannot lock up, for example that they are so ready to go into that injury that they agree to go into treatment. In the emergency room when someone is being admitted to the hospital, they are there. It is about having the institution accept that this was an issue and implement pathways. We are good at creating Electronic Health records, mechanisms to screen and algorithms to treat. We had the wherewithal. It was a natural place to do those experiments and they worked and can be replicated. By that i mean identify the issues around withdrawal, use that as the lever to move them into care. Most patients are very interested in it and as i said, two thirds of my patients are willing to go and most of them show up at the backend. But what about the lockup . We have the same result where someone had been arrested, breaking into a garage. Im told by my colleagues at New Castle County where the Police Departments are trying to struggle with this, they have come up with their own programs. Thank you for that. Let me this is i would think it is what he describes as a best practice. Folks are ready for treatment and we get them into treatment. Maybe each of you can give them one example of best practice and that the rest of us can learn from and implement. This is an area that we focused on at the white house. I will give you an example at boston medical center. We opened what i believe is the first opioid Urgent Care Center in the country. So that folks who came into the Emergency Department were identified coming into the community could walk in or were brought in to an Emergency Department. We have dedicated staff, some peers, recovery coaches. They are about to work with them. Getting access to a bed and care is not easy. They work to make sure that people have the care that they need. But i have to say because this is important massachusetts still has the lowest uninsured rate in the country. It is not an issue for staff in boston medical center, or the emergency staff department, or any other facility. We have a generous medicaid benefit. Opioid and Urgent Care Center is something worth looking at. Great, thank you. I have to go along that track also. In Hanover County we are trying to get the hospitals work with us. As patients, we are looking at this from a Law Enforcement aspect, which is not going to solve isnt going to be the answer, but part of the problem we are also facing is those people who dont want to get into treatment, which is a significant amount of people. There is a hurdle not just going from jail or to the hospital. But how do we get them into Treatment Facilities. Its one of the challenges we are trying to overcome. If we can ticket to the medical system where they can go to the hospital and received treatment. If we started treating this like a brain injury or illness, that it is defined as, then i think we would have a better solution. Thank you, chief. Thank you senator. You know, a lot of ideas come to my mind. Just give me a really good one. I think one of the things we have to do is use the information that can be gleaned from people who die from overdoses to design intervention strategies. We saw people 40 of people who can to my office that had been incarcerated within two years or had been in treatment within two years. I send each of the people leaving jail or Treatment Facilities a letter spelling out Risk Reduction strategies. Dont use by yourself, dont go back to the same folks. If we can take the burden off the epidemic crushing these systems, it could be used to define very effective intervention strategies. Thank you for each of you. Before i close i add another thought. Then i will turn it over to senator peters. I want to thank you again we want to thank you again for being here for those with whom you work and represent. Every now and then, we have hearings that are illuminating. It is rare we have a hearing that is illuminating and terrifying. It really is an all hands on deck, as we wrap this up. My deputy Legal Counsel my last was governor come what i think has asked to do is be the founding chairman sumner called the American Legacy Foundation. The American Legacy Foundation was created out of the 50 state Tobacco Settlement what the Tobacco Industry provided a lot of money to each of the states for. Of 25 years. Provide we also something called the American Legacy Foundation which developed a campaign which is probably the most Effective Campaign we have seen in these countries history in terms of convincing and people if theyre using tobacco to stop and if you hadnt started not to start. I realize its not entirely comparable parallel but we havea not talked a lot about messaging. Messaging. Not talked at all that messaging. I think in the back of the night i think thats got to be with all those, i talked earlier no silver bullet, a lot of silver bbs. That might be one, given what weve accomplished with the American Legacy Foundation and the truth campaign. Its what i would not dismiss. Finally i would mention the first panel two yes will will be asking the question for the record, i will be asking for again short list, things we ought to be doing, and asking you to come back to those ideas so i can repeat something she said that will be fine. I think you can feel a realth sense of urgency on the side of the dais and im sure we feel it from your side as well. Thank you all for what you are doing. Were in this together. Lets go forward together. God bless you. Thank you. Senator peters. Just come first want to concur with all your comments. Thank you, senator carper for asking one last final question. Going back to the root causes and appreciate your response on how we have to make sure we have Health Insurance available, medicaid available for Substance Abuse, counseling and treatment. Theres also a compelling evidence that prescription opioids are really one of the key drivers for what were seeing here with prescriptions. Dr. Gilson, i know you mention in your county that individuals who had been prescribed controlled substance within twop years other death, over half of. Them had prescription opioids that led to this. And so just the final question. Are we aware of other source of treatment so that we should be prescribing so that we can stop what appears to be perhaps of a prescription opioids to patients within become addicted to this, that we need a different types of treatments . And think about how we practice medicines and other impediments to preventing that . What she would be think about Going Forward in trying to basically stop the pipeline that start with some Prescription Drugs . Thank you, senator, for the question. I think you really hit the genesis of the problem, nail on the head exactly, the culture in medicine tended towards overprescribing of opiate painin medications for chronic pain. The scientific support for that was minimal and that unfortunately became a standard of practice that if they castrated and large opioid addicted population. It we gave prescription pain medication to everyone in this room, they would become addicted to prescription pain medication. They would become addicted to opioids. We have credited a substantial, large, addicted population through the use and abuse of prescription pain medication. That is absolutely in comfortably true. And how we get back from that i think is that we have to start the reeducation of our medical community. We have to put much stricter use and guidelines on people prescribing pain medication. I am sympathetic to people have chronic pain, but if its an infected treatment that crates and unnecessary and reallym symp detrimental consequence, the sciatica treatment. We shouldnt, we should hold accountable the people who promoted that idea. It was a very well documented and im really ashamed to sayme. That, that impart the medical committee played in this crisis isnt stopping. I still have lots of anecdotal information of people getting a months worth of vicodin at the get teeth pulled with refills. We have to stop that, turn the flow off. Ne but i think dr. Horton of the folks here said we have a population of people who already are suffering from that over liberal prescription. We cant turn our backs on them. They will be with us for a whiln and treatment does work and i think the ways that we improve treatment will be more effective for that. During my time here we worked at the cdc accompanies of guidelines and i think some of issues that we heard in terms of not opioid therapies, the challenges i think for one, changing the culture of just giving a prescription, but i think the other issues where it is insurance reimbursement forwc things like physical therapy and acupuncture and often even about therapy that can really help fix that was i think an issue that weve really got to take a look at in terms of those challenges. I will say that weve had some good evidence in state set of really robust Prescription Drug monitoring programs. I i think weve seen some good data on reduction of Prescription Drug Overdose Deaths for physicians had to register and they had to check each and every tactics i know many states have moved to mandatory registration and mandatory checks. Because it seems like that works. You often get pushback from physicians. I understand that sometimes they are busy but my response was we are 15 years into this epidemic and i dont think its unreasonable for a position to take modicum of education and to check the Prescription Drug monitoring program. We are losing too many people. Thank you. Appreciate your testimony. Im sorry, were you going to sai something . Ng only that in our set think we to intimate some of those measures around really ratcheting up for prescribed. Thats a small states they can make the changeover to see that cultural change. And so there is hope about being able to attend to it. The levels. First treatments for Prescription Drugs, anyways the genie is out of a bottle and so we are set, yes, most of the patient into her exposed to Prescription Drugs but now most of them are abusing heroin. They were having, surrogacy to epidemics. The Prescription Drug epidemic hasnt gone away so those measurenationto continue, reduct now we have a heroin epidemic as well. If i could just add one more thing because i think its important. Because congress supported this, if you talk to the folks at the lash is a felt, they will say that actually need to do a better job of researching not opioid pain medications. And i think one of the barriers is looking at what the Administration Proposed in terms of nih reductions, that he think it puts a significant damper on nih Research Capabilities and to come up with not opioid, nonaddictive prescriptions for pain medication. I think it undercuts what Congress Passed as part of the 21st century cures act. Thank you so much. Appreciate it. Thats a good note to end on. Weve got a lot of i think that ideas. Some of them weve heard before but preacher amateurs like to say, he says even quires need tt be preached to pick so we appreciate you introducing us, and never of good practice, as practice new ideas but also someone, especially the last one, that makes a lot of sense. Again thanks to all of you are coming for the work your colleagues are doing. The hearing record remained open for 15 days for any additional comments for questions by any of our subcommittee members. With that this hearing is adjourned. Thank you so much. [inaudible conversations] [inaudible conversations] this Holiday Weekend on American History tv on cspan3, saturday at 10 p. M. Eastern on real america, the 1977 documentary meant of bronze about the allblack 369 u. S. Infantry regiment known as the Harlem Health fighters during world war i. Approximately 24 were attacked. He got slug almost immediately, and johnson fought them off. He shot and he swung his rifle around and he defeated the 24. Cut out picky 21 wounds to his body but he refused to die. Sunday at 9 10 p. M. Historian and author Elizabeth Cobbs on the women telephone operators of the u. S. Army signal corps. Before they got this entire line up that meant the local operator had to speak to a french operator. They had to parlay view. Most of them did not parlay view. They had to get bilingual and recommend who could handle this job. In other words, they begin recruiting women because they were as good as men can otherwise you just use men, but because at least at this job they were better than them. And monday at 9 a. M. Eastern will visit the National World war i museum and memorial in Kansas City Missouri and talk with the museums senior curator, authors and the museums president and ceo. What we do is tell the story through the lives of people, ordinary people, men and women, folgers as well as those who serve in the armed forces from all sides. For a complete American History tv schedule go to cspan. Org. Sunday night on after words, msnbc host chris hayes examines how the criminal Justice System is dividing the country in his book a colony and the nation. Hes interviewed by author elizabeth hinton. It seems like bergson is really kind of an anchor and in many ways, im wondering how your experience reporting that a limited what youre talking about growing up in the bronx in the 80s. The thing about ferguson the blue mind was like if you grew up in the city and you grew up in the bronx, you are this conception of cities, in cities there are these racial frictions, in cities you have bad neighborhoods in good neighborhoods, all kinds of loaded ways in which Police Police committees diwali, all kinds of loaded ways in which the borders a different neighborhood sits atop each other, overlap and create this sandpaper friction. All that to me was tied for deeply to either the bronx, new york for cities. I moved to chicago and atlanta d. C. And all these things come to think blue mind about ferguson was like viciousness valley 20,000 people. Its totally, its between Northern Edge of st. Louis and like the suburbs. You just try through it. It looks like anywhere. Its just strip malls and parking lots and houses and the idea that what i express there was like the level of exploitation and the level of racial oppression and friction, the level of the invasiveness of policing, the intensity of the humiliation. All of that in this place that was heretofore anonymous. Something about that blew my mind. Watch sunday night at 9 p. M. Eastern on cspan2s booktv