Transcripts For CSPAN3 Drug Control Policy Acting Director Testifies On Opioid Epidemic 20170728

Before mr. Connolly and i give Opening Statements, i want to thank everyone. Our guests, panelists, those in the audience, members and staff and everyone for how accommodating you were this morning. We had an unforeseen contingency that arose in our normal hearing room. Thank you for being so understanding. Over the past two decades, illicit drug use emerged as a Public Health and safety crisis with overdoses becoming the leading kauj of injury or death in the United States. Opioids specifically heroin and prescription pain relievers are the cause of most Overdose Deaths in the United States with a death rate more than doubling since the year 2000. In south carolina, which is where im from, at least 95 people die from heroin in 2015 which is almost twice as many as the Previous Year and more than 5660 died from the abuse of prescription opioids over the same period of time. 0 died from prescription opioids over the same period of time. The epidemic is growing and lives are at stake, literally. It is imperative our nation continue a strong effort across for distribution and c consumption. In 1988 the policy for the antidrug abuse act to inform drug advisories across the government to advise on drug policies and create and oversee the drug control budget. Ondcp is uniquely equipped to eye dress wh address what role the federal government can play in terms of the current economic and Socio Economic role it plays in our country. The operation lapsed in 2010 but the office continued to receive appropriations each year. And in december 2015, this Committee Held a hearing to discuss various proposals for reauthorization. We heard from the then director who talked about combatting the use of Prescription Drugs was top priority for the age enspip however, since then, ondcp failed to produce a drug strategy and National Drug control budget which is supposed to be refleesd later than february 1st each year. In the mean tile, deaths due to opioid overdose has increased in the u. S. In 2016. No office is perfect. God Knows Congress certainly is not. But it is our responsibility, nonetheless, to see that deadlines are met. Particularly statutory deadlines, resources are well spent and leadership that can be provide nationally is being provided. Here is a prevention as spepect education aspect, enforce the aspect, punishment aspect and oversight aspect. The federal government long occupied a space as it relates it both the illicit use of Illegal Drugs and illicit use of legal drugs. We will learn about how this agency can work toward the goal of reducing and ultimately eliminating our nations Opioid Crisis. We will also examine how ondcp can help mitigate the harm in commune its Cross America have felt as a result of our nations Opioid Crisis. There are many areas worthy of exploration today and we thank all of our witnesses for appearing before the committee. We look forward to your testimony as we consider next steps for reauthorization. With that, i recognize my friend from virginia. I thank the chair. Thank four having this meeting and thank you for accommodating our witnesses and to hear the case for why we felt especially adding the dimension of a personal story that mr. Flannery has courageously been willing to share. Thank my friend from south carolina. This is an area where we can find Common Ground where bipartisan cooperation must occur and i note chairman is committed to doing it, as am i. We are in the middle of National Epidemic emergency. Opioids have taken lives aCross America and unfortunately shows no signs of ending. Everyday, everyday, 91 americans die from an opioid overdose. This epidemic doesnt care where you live or what Political Party you belong to. The crisis has touched every corner of our nation. Where i come from, northern virginia, is no exception. Fairfax county, which i chaired for five years, reported more than 100 drugrelated deaths last year. Prince william county, other county i represent reported 52. These are after tstronomical nu. Mr. Flanlys son, their son, kevin, tragically lost his life to opioid overdose two years ago. Three years ago. Kevin was a graduate of the university of virginia. He aspired to a career in filling maki filling film making. But became addicted to oxycontin because of a prescription and medical condition and died at the age of 26. Mr. Flattery has been an outspoken advocate for the need to address this crisis and we all welcome his testimony here today p. M. Everyday people across the country people die from drug addiction. Families are torn apart. Americans are suffering. The crisis cannot wait. As members of congress, weve got to do everything we can to assist and reverse this crisis. Unfortunately were not sensing that same sense of emergency from the administration. On the campaign trail, President Trump said, and i quote, we will help the people seriously addicted, we will help those people, unquote. But were six months into the administration and the president has still not appointed a drug czar. To lead the office of National Drug control policy. Nor mass the nation produced a National Drug control strategy. Instead what president has done is proposed cutting the program that are already working. His proposed budget would cut 370 million to the Substance Abuse and Mental Health Services Administration which provides grants for opioid overdose drugs, Mental Health and prevention programs, in the midst of a national emergency. We cannot accept that. The president s efforts to repeal the Affordable Care act also would have devastating affects on americans suffering from drug addiction. The latest effort to repeal the ai ca would take Health Insurance away from 2. 8 Million People with Substance Abuse disorders. Let me repeat that. 2. 8 million. Congress must not let that happen. Additionally, repeal of the Affordable Care act could also make it difficult for individuals with Substance Abuse disorders to find the help they need. Legislation repealing the bill would allow states to weigh the aca requirement that Mental Health and Substance Abuse treatment are part of the essential Health Services. This would lead many of those seeking help without the treatment they desperately need. We are here to discuss the National Drug control policy. This office plays a Critical Role in coordinating the federal response to our nations drug epidemic. The office manages a budget of more than 370 million and coordinates 316 different departments and agencies. Ondcp also administers two federal grant kpro grams. Communities in my district for example have been fortunate to receive assistance for what is called the high intense drug Traffic Program which provides groonts local its and states and tribal areas to county Drug Trafficking activities. Its and tribal areas to county Drug Trafficking activities. In 2010 we saw a shift to emphasize Public Health base Services Within the National Drug control strategy. I look forward to hearing more about the importance of a comprehensive approach to this challenge. Prevention and treatment are important tools working together as the chairman suggested in how we approach this. What is also important is ensuring that any drug control strategy has results over ra radiology. Evidence should guide Public Policy particularly what matters with Public Health and safety. We have witnessed the perils failing to follow that restrire in marijuana policies. Each time i noted we have no empirical evidence that justifies marijuana as classified as schedule 1 drug. In fact, the u. S. National institute and drug abuse for years was the sole federal entities that controlled access to the federal governments loan lone Research Supply of marijuana unwilling to fund for koun duct any research into the possibility as to whether marijuana might have positive benefits. Any research into the possibility as to whether marijuana might have positive benefits. This has led us down a dark path t where the drug policy provided cover, arresting nonviolent offenders and eight times those of whie of white americans, filling prisons, scarring families often for life. We have to rethink that approach. And it has to be empirical based. I want to thank our panelists today mr. Chairman for contributions to the office of National Drug control policy. And their personal contributions to this dialogue. And i want to reiterate my commitment to cooperate with you, mr. Chairman. And our mutual staff to make sure that we are aggressively addressing this critical issue that is now afflicting our country. Thank you so much. I yield back. Gentleman from virginia yields back. Well hold a record open for five legislative days for anyone who would like to submit a written statement. I will recognize our witnesses. I will recognize you, from my right to left, then introduce you that way and recognize you for your Opening Statements. I would tell all of the witnesses your Opening Statement is part of the record. Im sure that my colleagues have read it. So to the extent you can, keep your Opening Statement within five minutes so the members can have an active dialogue with you. You are first witness is richard balm from the office of National Drug control policy. Next, we have miss diana mauer, director of justice and Law Enforcement issues at the Government Accountability office. We have dr. Keith humphreys, professor of psychiatry and Behavioral Sciences at stanford university. And mr. Don flattery, who is an addiction policy advocate and parent who has been impacted by todays subject matter. We want to welcome all of you and thank four being here. Pursuant to rules all witnesses should be sworn in before they testify. I advise you to all rise and lift your right hand. You solemnly swear the testimony you are about to give is the truth, the cheel truwhole truth nothing but the truth so help you god . All answered affirmative. You may sit down. With that, rerecognize director balm. Members of the committee, thank you for inviting me to pair before you today to discuss the activities of the office of National Drug control. Is your mike on . How is that . Is that better . Just might be old age on our behalf. Do i need to get real close . Yes. I will start over. Can you restart the clock for me . Thank you for inviting me to appear before you to discuss the activities of the office of National Drug control policy. It is a tremendous honor for me to be here. We have a dedicated team of policy experts working to address the Opioid Crisis and full range of drug threats our country faces. Having strong support of the president , his administration and congress and particularly this committee means a great deal us to. Given the state of this crisis, we authorize the office charged with responding to it is more important than ever. Thank you for taking this on. Were grateful. As you are all aware, we are in the midst of the worst drug epidemic in u. S. History. We lost more than 52,000 people to Drug Overdose incluesing 3 p,000 overdoses including opioids. The epidemic began with overprescribing of Prescription Drugs and involved into hero anyone and fentanyl. I have met with parent who have lost children, visited communities hit hard by this epidemic. When i was in johnstown, pennsylvania, students at university of pennsylvania johnstown just found out a star on the wrestling team died of an overdose from fentanyl. We know these are stories you have heard in your districts and all over the country. Most lethal drugs are not made in the u. S. Ondcp work with partners to improve with drug control dismantle organizations that traffic the deadly drug niece our communities. Beyond opioids we also face a rapidly growing threat from cocaine, as well as serious threats from methamphetamine, synthetic drugs and marijuana. Look forward to discussing these specific drug threats in more detail in the q a. Ondcp is the lead Drug Control Agency and adviser to the president on drug issues. Issues include policy development, drug budget oversight as well as targeted grant funding. Our position within the white house provides a platform to build support for proven strategies to address quickly moving drug threats. Reducing the drug supply is critical to all of our efforts. Domestic Law Enforcement plays a Critical Role in reducing drug availability and building cases against trafficking groups. Also playing a Critical Role in the science, addiction and evidencebased treatment and breaking the stigma surrounding Substance Abuse so people are more likely to seek treatment and obtain lifetime recovery. Prevention is a vital component of addressing drug abuse in this country. I have made it a priority to reinvigorate National Prevention effort to engage youth in schools and online. This is a critical component for permitting drug use in the first place. Ondcp also focused on supporting ways for the criminal Justice System to better address addiction within the populations. For many People Engagement with the law is the first opportunity to access treatment services. Whether through pretrial or prearrest aversion. It is bet are for all r for all that need treatment receive it. The strategy is from ekmercomme and other stake holders. One of our greatest strength is to coordinate drug control activities across the federal government and work directly with state, local, tribal and International Partners to further the administrations drug policy goals. We use our budget Oversight Authority to prevent duplication and make sure federal dollars are well spent. We have worked to lift up innovative programs at state and local level such as Police Assisted Addiction and redufrco where people are helped with treatment for drug addiction. We coordinate the response to specific drug threats. Our National Heroin core nation group and National Group are more nimble across development. Such as safe handling directions for fentanyl so First Responders dont experience overdose and efforts to take down dark web marketplaces on the internet for drugs like fentanyl. Department of justice took down a primary source of fentanyl. As you are well aware, there are two Grant Programs that work to address the problem. The dnc provides grants to hundreds of coalitions across the country prp before i close i would like to acknowledge and thank the accounting office. Weve been through numerous talks and they are extremely helpful to us in our work. We look forward to working with a measure that ealigns prioritis and to best address the cries thas the country faces on drugs. Thank you. Thank you, director baum. Ms. Mauer . Good morning, chairman gowdy, Ranking Member connolly, other ranking mers and staff. Im here to discuss gaos work on illicit drug use. It is a truly multifaceted effort with very Different Missions in Public Health, law ep forcement, intelligence, education, corrections and diplomacy. And it needs to be. The problems from illicit drug use in the United States are complex, widespread, and deepseeded. If there is one thing we have learned over the past several decades, there are no quick or easy fixes. But more significant than the cost and complexity of federal efforts is the very human, very tragic and increasingly deadly toll of illicit drugs. According to the cdc there are over 52,000 deaths from Drug Overdoses in 2015. Up more than 40 in 2009. It is difficult to grasp numbers like that. 52,000 deaths in year means 144 americans died everyday. Thats more every two days than in all of the terrorist attacks in this country since 9 11. Here is another way to think about it. The Vietnam Veterans memorial here in washington, d. C. Has over 58,000 names on it. So one way to visualize the current human impact of illicit drugs is to picture building a memorial of similar size every single year. Given these bleak facts, its vital that taxpayer dollars to address this problem are well spent, making progress, and that various agencies are well coordinateed. Those are goals to keep in mind as you consider reauthorization. Its important for ondcp and various agencies to have a Clear Strategy to guide them. Goals and measures to know whether they are making progress and seamless coordination and collaboration. And over the years ondcp, to its credit, focused a great deal of time and attention developing strategies, and using Performance Measures to assess the progress of federal drug control efforts. The administration is currently updating the National Drug control strategy. Since that remains a work in progress, my comments today are based on goals and measures from previous strategies. In 2010 ondcp issued a series of goals with specific outcomes the federal government hoped to achieve by the end of 2015. As we have previously reported and testified, ondcp goals to provide a dashboard with meaningful indicators of progress and clear goals. Federal government achieved none of the seven overall goals established in 2010. Now in some key areas, they move in opposite direction and things got worse. For example, number of drugrelated deaths increase over 41 rather than decreasing 15 as planned. The prevalence of drug use by young adults increased rather than decreased. Largely due to increased marijuana use. But there is also important progress in some key areas. There have been substantial reductions in the use of alcohol and tobacco by eighth graders and prevalence of drug use by teenagers also dropped. Not to meet goals in 2010 but certainly an encouraging sign. And preventing drug use is a key part of the overall federal effort. Last year the comptroller general convened a Diverse Group of health care, Law Enforcement and education experts to discuss, among other things, high Priority Areas for future prevention ef porpts they identified several options including increasing the use of prevention programs that research has shown to be effective. Working to change perception of drug use. Emphasizing the Substance Abuse disorder is a disease that can be treated. Reducing the number of prescriptions issued for opioids supporting Community Coalitions that include the Health Care Education and Law Enforcement sectors. And improving federal data on drug use. Mr. Chairman, as Congress Considers these and other options while debating reauthorization, it is worth reflecting on the deeply engrained nature of illicit drug use in this country. It is an extremely complex problem that involves millions of people, billions of dollars, and thousands of communities. Gao stands ready to help congress assess how well ondcp and other federal agencies are doing to reduce the impact of illicit drug use. Thank you for the opportunity to testify this morning and i look forward to your questions. Thank you, ms. Maurer. Dr. Humphreys . Chairman gowdy, Ranking Member connolly and members of the committee, thank you for your leadership and thank you for inviting me to speak to you today. My comments are from being 30 years in research and addiction. And i was honored to serve in the obama and bush administrations. Mr. Humphries, sorry. If we can interrupt. It is very hard to hear you. You need to oh, okay. Speak right into it. Is this better . Much better, thank you. I hope you said thank you for having me here today. Thank you for your leadership. As has been said, we are losing over 50,000 americans a year. Thats more than we lost to aides and the epidemic. Ondcp was responding to the crack cocaine epidemic but i think a modernized adcp could be a powerful force against this new and quite different epidemic. Ondc, if there is no one Riding National strategy, some of them lose interest not because they dont care but because they have a lot to care about at the federal level. Competitive programs, duplicative programs or those without effectiveness, the most important job is to herd the cats in washington and get strategy unified and effective. You can help them do that job better by giving out more carrots and sticks. So on the carrot side providing some money for demonstration projects could help them entice agencies to try new drug policies or programs. On the carrot side, ondcps power to review and decertify budgets could be strengthened so director of ondcp was the final word on that rather than usually having to yield to omb. Related to that there is a notification requirement in the 2006 notification that says congress has to be notified when there is dessert if ication. That makes people not want to use that. I with urge to you drop that. Last, i would urge to you put the ondcp director position back in the cabinet. That gives the message we are taking drug policy seriously. Another Critical Role is to serve as resource to the white house and to congress on the role of the addiction issues in Mainstream Health care. Just to give you an example on that, a very current example, many people arent aware that medicaid is now the lead funder of opioid Addiction Treatment in this country. So its important for ondcp to be a voice to say if we curtail that program we by definition curtail treatment for this problem. Being helpful for medicaid and other programs own voice of procedures and policies to reduce the likely hod that opioid prescriptions are inappropriate. Ondcp has been less influence shl on Health Care Policy than it could have been because it was created as a domestic policy. Law enforcement is important in drug policy. It may be more important for the Opioid Epidemic which was started not by criminal gangs but started by the health care system. Congress could have a broader role for Health Care Policy by better balancing the focus of the agencys authorization sust as one crude indicator of what the last asked ondcp to do, mentioning introduction 40 times, enforcement 98 times and health care only once. Congress could also mandate a bigger role in the drug policy Development Process for Major Health Care agencies like the cdc, fda and cms. Congressional guidance regarding staffing to be sure they have good inhouse Health Policy expertise could also help. Finally with congresss help, ondcp could guide drug policy through efforts to take an example of why this matters, we really dont know how many people are addicted to heroin in this country. The numbers just arent that good. Conducting reresearch are important questions like that would reap huge rewards for the development of policy and also its evaluation. In closing, we are in the midst of one of the worst drug addictions in our nation. The drug policy can lead the government and policy in a coordinating effective an lifesaving response to this horrifying epidemic. Thank you for your time, leadership and i look fofrd rwao your questions. Thank you. Mr. Flattery and all of the members would like to recognize and welcome your wife with you today as well. Youre recognized. I join others in thanking you, mr. Chairman, and Ranking Member connolly, least for today, and other members of the committee. Conducting reauthorization of National Drug control policy. It is a muchneeded discussion to ensure federal government is prepared it fight to end the epidemic of Prescription Drug and heroin addiction the country is facing and while i strongly support as an advocate, the activities of ondcp, my purpose in this discussion today is not to drill down and discuss individual activities in any detail. My names don flattery. Until recently i lived in fairfax county, virginia. Im a former federal manager. Recent member of the task force on Prescription Drug and heroin abuse. Policy adviser to the National Addiction fighting nonprofit the fed up coalition. And active participant in my newly adopted county of Brunswick North carolina addiction it is aing force. But im not here today in any of those roles. Im addressing the Committee Solely as a grieving parent. Someone who lost list 26yearold and only son to opioid overdose less than three years ago. In Prior Committee hearings, you have heard the appalling statistics about the explosion of addiction rates and Overdose Deaths. Im intimately aware and familiar with them. Ill not repeat them here. But those discussions are often far too clinical. As you federal official webs elected officials, state officials, deliberate and consider collusions, it is far too easy to become detached. As you proceed, imimplore you to recall the personal impacts. We are not just speaking about shocki shocking be a tuesd shocki shocking abtuse sta it tthat ti. We are talking about my son, your daughters and facing things that must stop. Let me talk about my son. On memorial day 2015, our family lost my son. Kevin had the typical suburban upbringing. Private schools, sports and high skooj athletic. He came from a loving twoparent home and led the quintessential middle class life, enjoying all of life and gods blessings. He was a good student, graduate of the local allmale prep school gonzaga here in washington, d. C. Later the university of virginia where he actively participated in student and fraternity life. Kevin came to his addiction as a working adult while pursuing his talent and passion working in the Film Industry in hollywood in new york city. He was exposed to opioids as a teen after an injury and told me himself that he thought nothing of them. Like so many, he underestimated them. While working, he began selfmedicating issues with anxiety and depression with the widely available opioid Prescription Drug oxycontin. Which is a common story, as many struggling with coincident Mental Health issues develop addiction problems. He quickly became dependent and addicted. He returned home to virginia in fall of 2013 to his family seeking treatment and support. Like many struggling in search of treatment he tried a wide variety of pathways including detoxification. Medicated assisted programs. And outrageously expensive 28day beabstinence only residential program. Some of these covered by insurance. But others covered out of pocket. Like others in recovery he experienced the painful and very common progress of seeming progress followed by relapse. Following medically assisted drug, he used again and did not recover. The short biodescription i just gave you is an example of how the scourge of the opioid addiction before us today has no stereo typical victim. It is affecting people of all walks of life, all income levels and all backgrounds. This epidemic, and make no mistake, this is an epidemic, and my sons addiction do not respect income, social status or intelligence. Thats what epidemics do. That point bears repeating in every hearing this committee and others conduct which touch upon this health crisis. Since my sons loss, ive learned a great deal about the disease of addiction that current epidemic and underlying causes and painfully for me and my wife some evidencebased treatment opportunities that offer hope but now only for others. From the perspective of an impacted parent, as a sit zeb and as an advocate, i would like to at my voice to thousands traveling the same journey about some imperatives needed to stem the tide of the epidemic. First is the primary topic of this very hearing. The need for a strong well resourced and effective ondcp has never been more important. A policy office directly tied to the office of the president not only sends a message to the public about the importance of effective drug policy but it also ensures more Effective Development of integrated cross federal Government Programs and policies. Ondcp plays an essential role in being an integrator and coordinator for the widely disparaged addiction fighting, cdc, fda, programs in the v. A. , dod, Indian Health service and wide variety of Law Enforcement agencies. Interagency dikugses and collaborations will be ineffective without this singular collaboration entity empowered to work across stove piped efforts and programs. The second imperative is continuous coverage of Addiction Treatment. Access to medication assisted treatment already remains illusive for far too many patients. Changes to the Nations Health care system that removed mend al he health and Substance Abuse as an essential benefit is a disaster for many including those like my son seeking such help. We must find ways to expand, not limit, access to addiction fighting medications and insure Insurance Companies and providers do so at a reasonable cost. Einsure Insurance Companies and providers do so at a reasonable cost. Nsure Insurance Companies and providers do so at a reasonable cost. Thank you again for addressing the need. We need to ensure federal entities do their part to appropriately protect our loved ones and Public Health p. Americans suffering from this scourge deserve no less. Thank you. Americans suffering from this scourge deserve no less. Thank you. Thank you, mr. Flattery. Now recognize the gentlemen from oklahoma, mr. Russell, for his questions. Thank one mr. Chairman. And thank you, panel, for being here today. I agree with all of the statements made. Mr. Flattery, you certainly bring you and your wife bring this issue, put a personal face on it. It affects so many. I have also seen the devastating effects of treating veterans. And seeing a number of folks as they try to come home, it seems to be the simple thing is just to give warriors a bag of cocktail type of medications and then now they are on addiction answers s and we wonder why the returning veteran came home and quote committed suicide when it may have been the direct effectses of overmedication and addiction. It seems to me, mr. Chairman, that we all have responsible for this. It was congress who made the decision to relax the laws to have moreover the counter access to what i consider to be legalized heroin. My first question and whoever would like to comment, we will start with you mr. Baum, thank you for your service and dealing with difficult issues, what legislatively can we do . We let the genie out would the bottle by relaxing the access. Even in the great state of oklahoma you see pain and Injuries Center everywhere. Can you go in and come out with a bag of pills. What legislatively would you like to see done with the decades of retrospect in how we get here . Congressman, thank you for your question. There is a lot of things that we can do. I guess i would start by saying when were in a crisis and so many people are dying, we need to do more of everything. So i would love to see tighter restrictions on use of the narcotic analgesics. I dont think the evidence is there to have these substances used as a default for chronic prescriptions. One someone is using these substances for more than five days their addiction rates go up dramatically. So tighter controls on that. Certainly on resources. For treatment. And medically assisted treatment. We have evidence that some do well. If you look at data, only a third of the people diagnosed with opioid use disorder have access to treatment. So and let me say, one last thing, main turn it over to my colleagues, is that 80 of people with a Substance Abuse disorder dont come forward for treatment. So we dont just need to get better high quality treatment to those who are on waiting lists. We need to go out and find the people out there and bring them in and control them and encourage them to get the help that they need. Thank you, sir. Anyone else who would care to comment . Congressman, i want it give you an important piece of information about how much prescription opioids americans consume. On per capita basis we are the world leader by an enormous margin, six times what European Countries prescribe. We could cut prescribing by 40 and we would still be the world leader in opioid prescribing. That is the biggest wheel. There are many good policies, treatment, prescription monitoring and so forth but thats the fundamental thing is we are just prescribing way too much. Ms. Maurer . Yeah. When the comptroller general convened the panel of experts last year, that was one of the topics of discussion, precisely what you just asked about. And there are common themes that came across from that body of experts. One was exactly what dr. Humphreys just talked about. First and for most is prescribe fewer opiate medications. But hand in hand with that is also a theme of providing additional education to providers. The cdc has guidelines, recently updated guidelines that apparently the word has not gotten out fally on those things. Prescription drug monitoring programs are an important part of this as well as on the Law Enforcement side continuing aggressive investigation and prosecution of pill mills. Thank you. If i may, just to add to that recent activities have been somewhat successful in reducing the number of prescriptions that the u. S. With 5 of the worlds population consumes and 80 of the worlds opioids, voluntarily prescribing guidelines and systems that have an impact. Last year prescription in this country declined to over 220 million prescriptions. Thats still enough for every american to have their own prescription bottle for 30 days. These drugs are flooding our medical cabinets making them available for overuse and abuse. You asked the question, what can you do legislatively . We need our state partners because they are responsible for managing the practice of medicine and we need them and they are, we are beginning to see some progress in state capitals, addressing the overprescription of opioid drugs. Thank you. And thank you, mr. Chairman, for your indulgence. I yield back. Gentleman yields back. Gentleman from virginia is recognized. I thank the chair and panel for their testimony. Mr. Baum, this is hearing on your office has your office submitted a draft reauthorization bill to congress . Mr. Connolly, we have not. But we do have some considered thoughts and would be happy to discuss some of those. We need a reauthorization bill from somebody even if we decide to go a different direction. Any idea when it might be submitted . Chairman pointed aught i think the last reauthorization was 2006. It has grown stale. We heard dr. Humphreys point out you started out as originally crack cocaine focus. Things have changed. Reauthorization has to take og any zans to that. We want to be supportive. But we have to have some kind of timeframe in which youre going to not you personally, your office and administration will interact with congress that ultimately has to do the reauthorization. Any idea when we might see a draft . I dont want to give you a time line. But can i tell you i have stud id the time line closely. We know what we need to do. We can put together a reauthorization bill and get something to Congress Rather rapidly. I dont presume to speak are for the committee but i think as you hear on bipartisan basis, we are seized with this urgency and i hope you will take it back. We want to see a reauthorization. We are happy to help. We are eager to move out on it. Like wise we need a strategy. Any idea when a strategy will be submitted to congress. I have a very precise idea. I know mr. Gowdy raised it as well. Were developing strategy now. I do want to say that i take the deadlines that, statutory stead lines, extremely seriously. I know the deadlines are february 1st. In the Trump Administration we are developing a strategy. We have a draft. We are consulting both formally in terms of letters to members of congress. Ive been traveling holding meetings. Im holding inner agency meetings. We are corkiworking a conferenc strategy. I will stipulate it all this. I only have five minutes. When can we see it. In the deadline is february 1st of next year. There is an issue with we are required to wait until the president s budget comes out which sometimes is a few weeks after. But early next year you will have a comprehensive drug strategy from the administration covering the entire scope of the issues p. Let me invite you even in draft form, if you can, because we want to be partners and the murj en urgency demands and i hope this will show what members are experiencing in their deck strikt districts. I would be glad to work with you. Istricts. I would be glad to work with you. I think you are perfect. Youre my constituent. How can we do any better than you . But its been six months and youre not alone, there are a lot of vacancies in the executive branch, but this one is pretty critical. Any idea when we might hear name floated, as well as someone nominated . Thank you for the strong endorsement. Thank you. I wont help you with donald trump. I can bad mouth you, if yit will help. This guy is a loser. Yeah, yeah. Can i take back my time now . Yeah. Its my name, but yeah. As soon as we have something to report you will be the first to know. So comforting. Thank you. Mr. Flattery, i want to go back to your testimony and thank you so much for being willing to share. Thank you to your wife for coming up here. If the chair would allow me to draw more of the story of kevin. Your son wasnt hanging around with the wrong crowd that was into drugs and thats how he ran into trouble. Thats not how his problem began. Is it . No, it is not. My son did not as many unfortunate young people do, he did not surrender his youth. Did not turn his back on his activities and friends and school work. He became addicted as a working adult. Pursuing what he was passionate about. But he became addicted what triggered the need or his perceived need for the use of opioid . In my sons case, my wife and i believe that he began medicating issues with self medicating issues with a widely available drug. But why . Because, like many people who develop addiction problems, they often have coincident psycho social issues that have to be dealt with. Thats why pairing of Mental Health services and Addiction Treatment service says so critical. In his case he was in new york trying to an aspiring filmmaker. That time in hollywood. In hollywood, all right. He was exposed to widely available oxycontin and very inexpensive. He came home. Dehe did. From your point of view made a really good faith effort to try to lick this. Correct . Yeah. Adding to our own tragedy, our son was into treatment. He realized he had fallen into the rabbit hole and was in over his head. He was seeking our support. He tried a number of pathways. They are common pathways. Detox. Intensive outpatient support from fairfax hospital. On a regimen of saboxon. And he still struggled with it. He attended peer support through aa and na. But at one point, he came to us and said, you know, i just he began to manipulate his own saboxon because it is selfadministered medication. He said i think i would like to try a residential treatment program. And i do have issues with my sons experience in residential treatment. Many, not all, residential treatment programs often use a detoxification and then couple either cognitive behavioral talk they therapy during the 30day stay, with what i consider to be reformulated dogma which is available for free all over Church Basements around the country. Those which my son encountered are very expensive. 28,000 to 30,000 a year. Those types of programs, i think, are em plem attic of why our treatment system is broken. Many families will do anything in their power to get help for their loved one. As we would. And many families are bankrupting themselves sending them to such facilities that then after the 30day stay, release them to the wild. And they often are treating the people who attend, not as patients, but as customers. And the disease of addiction is a chronic recurring issue that has to be dealt with over a long period of time. In my sons case, he was not ready to be released to the wild after 30 days. It is not a magic fix. And our traekst system heatment be reengineered to provide longterm care for a chronic condition. And thats, in my my estimation, where my sons journey broke down. Thank you. Youve been gracious, thank you. Gentleman from tennessee, dr. D de . Thank you. Mr. Flattery, you and your wife probably are more well known to this system than you care to. You talk about the ease of access than opioids and specifically oxycontin. Can you explain a little further what your understanding is of why these are so easy to get and why they are so inexpensive . Well, i will first start with the basic essence of the anatomy of this epidemic. As mr. Humphrey indicated, it wasnt started by drug dealers who built a Business Model around providing illicit drugs. It has its origins in the medical community. I believe you are a medical p k practitioner yourself and understand that. In an attempt to be compassionate in treating pain, americans, physicians, use their prescription pad. American physicians also have a deficiency and prior training on proper Pain Management and addition management. There isnt even a whole discipline yet built around addiction management in medical school. In an attempt to provide kpa compassionate care, physicians are providing drugs for all manner of pain conditions for which they are never intended. They started out as a drug to address terminal cancer pain and recovery from acute injuries. And it drifted into the use of opioid drugs for migraines, arthritis, indiscriminate lower back pain. In the dental community for wisdom tooth extraction. And they not only were overprescribed, they were being prescribed in kbauquantities th were completely unnecessary for the treatment of an acute condition. As mr. Baum indicated, longterm use of opioid drugs lead it addiction. Now you ask the question about ubiquitous, i guess, and the answer is in 2013 we hit the peak year in the u. S. With over 259 million prescriptions. Thats a number of billions in the individual of individual doses. And those drugs are flooding communities and work places. And theyre just widely available, and theyre available for potential misuse. And so theyre available at low cost on the street. Okay. Mr. Baum, is there currently any legal requirement for prescribers, physicians, Nurse Practitioners to fully educate their patients on not only the harms Addictive Properties of these medications, but also to educate them on the dangers and illegality of sharing these medications with other people . Thank you for the question. There is no requirement from mandatory prescriber education. And frankly, im very concerned about that. I know in the Previous Administration there was discussion about increasing voluntary prescriber education, but in looking at the progress, i dont think its been nearly enough. And i think its something that we ought to talk about, making it mandatory, to make sure at least those prescribers that are putting these very, very powerful drugs in the hands of our citizens spend a few hours learning about the risks and about addiction. I think it would be important. Its something that we should talk about. I think its, yeah, probably more than something we should talk about. As a former physician and current holder of a dea license, i know that i would make it a point to educate my patients on the power of these drugs. But also, i think theres responsibility among the patients to know that it should be illegal to share these drugs. I have a license, went to medical school to prescribe them, but patients often will just share it with family and friends thinking thats okay. That should be a crime. And it probably is, but its not enforced. And if one of the problems is over prescribing, that needs to be stopped. And physicians and million medical students and all prescribers should be educated in medical school on this issue because of the scope of this problem, the time is ripe to do that. But also, i think that it is a patients responsibility to properly handle these medications and there should be laws and documents that a patient should sign when they pick up this prescription either from the pharmacy or when physicians prescribe it. Would you be willing to look at that as an option . Yeah. Absolutely look at it. But i really think the major responsibility is with the prescribers. When you have an injured kid that youre taking to the doctor and the doctor gives you your prescription to take pills for 30 days or 60 days and you get your bottle of pills with the directions, the tendency is to follow the directions. And now were putting it on parents to ask the doctor, hey, should does my kid really need to take this for 30 days for a wisdom tooth extraction. And i think it should be the other way. The doctors are the experts. Theyre the one in the white coats, the responsibility to think about the powerful medications theyre putting in the hands of our citizens. And ill promise you that the vast majority of all doctors feel the same way. They dont want to harm patients with these medications. They dont want to prescribe irresponsibleel. There are always back actors, and thats who we need to focus on. I think that that door swings both ways. Physicians definitely should take the brunt of the responsibility. Also think that Law Enforcement should focus on people who share or sell these medications, because as a physician, that was always a concern of mine. If i was treating someone with chronic pain or even cancer, you just assume that those people are taking the prescriptions properly. Thats not always the case. And i have all kinds of stories whereic tell i found out people were being put in very vulnerable situations by family members to get these prescriptions so they could go out and sell them and so they were forced to lie to me. I didnt know i was doing the wrong thing and i know other physicians are in the same situation where they get tricked or duped into thinking people have critical problems or illnesses. And so i do think the enforcement side of that needs to be ramped up as well. But theres a dual responsibility and the bottom line is we have a huge number of people dying every year, and its not time to think about what we should do. We should be doing it and im happy to work with you further on this issue. And thanks to the chairman for giving me the additional time. I yield back. Gentleman from tennessee yields back. District of columbia is roitzed. Thank you very much, mr. Chairman. And i want to first thank you for this hearing. Its very timely hearing and i appreciate the bipartisan way in which this hearing is being held. This is an across the board problem. Already ive heard ideas including from my colleague on the other side as to the kinds of things we need to be thinking about and for reauthorization. I thought the president had begun in a bipartisan way himself when early on he said he thought that we should and here im quoting him show great compassion about the Opioid Epidemic. And then the office of management and budget virtually abolished your agency with a 95 cut. And here is where bipartisan ship mattered. There was an outcry on both sides of the aisle, and i think in the only or one of the few circumstances where ive seen the omb take back its mark, it did, and now i understand only a 5 cut. And mr. Chairman, could i ask that the letter from the Ranking Member Elijah Cummings and from representative johnson, republican from ohio was signed by 75 members asking that this cut be reversed. It worked and id ask that that be made a part of the record. Mr. Chairman, is that a part of the record . Without objection. Thank you, sir. First, let me mention the statement by mr. Connelly. It was a very telling critique of current marijuana policy. We all know, i dont care what side of the aisle thaw sit on that marijuana is per se legal in the United States. Certainly by people younger than anyone on these panels other than younger than 40, let me say, to be gracious. Yet congress has prohibited the District Of Columbia from using its local funds to tax and regulate marijuana. Tried to keep the district from indeed making possession of only 2 ounces legal, but congress didnt know how to write an appropriation rider that would do that effectively. So here is what we have, the unintended consequences of no regulation, no taxation as eight states do, but you can possess marijuana. So what weve done in the District Of Columbia is we have expanded the underground market for marijuana. Indeed, its nicknamed in the district the drug dealer protection act. And the Washington Post actually identified a marijuana dealer, and he said it was a license for me top print money. Now, there are members of this committee who are from some of the eight states that have legalized marijuana, they are alaska, california, colorado, maine, mast, over, Washington State and washington, d. C. My question for mr. Baum is if d. C. If the District Of Columbia could tax and regulate marijuana, would that have the effect of at least partially undermining the illegal marketplace for marijuana in this city . Well, i thank you congresswoman for the question. I have to say, im a federal official. Marijuana is a schedule one illegal substance in the country i understand that and i have very limited time. Im trying to find cause and effect. Youve seen whats happened in the other eight states, and im simply asking if you make it legal, if everybody is using it anyway as is surely the case for younger people, would that make it less likely thaw go to an underground pedal her. Maam, respectfully, i dont believe that. Its a harmful substance. Just because its not killing people the way fentanyl dooish. Im talking about how you buy it, sir. Yeah. Everyone isnt using it. And we have our im concerned about young people in this country, and let me ask you this. If youre concerned about young people, would you be concerned that the District Of Columbia cant regulate marijuana so as to keep it out of the hands of people under 18, for example . Would that be a concern of yours if, in fact, youre going to possess if a jurisdiction is going to possess marijuana, should it not at least have the opportunity to keep marijuana out of the hands of children . I worry that making a substance widely available and legal increases acceptance of it and increases use among youth. And i think we need to look very closely at whats happening in colorado and the other states to see if marijuana use, especially can i ask if you are doing that . We would very much like you to do that. What are you doing as to the states that have already legalized marijuana . Are you giving us any feedback so that well know what to do when the time comes for reauthorization . We absolutely the gentle ladys time as expired, but you may answer her question. We did have a federal team go out to colorado and talk to officials across the spectrum and were trying to learn about whats happening. And i have to say, im concerned about this commercial iced model of immediate spread viability of marijuana in very limited controls of marijuana being grown on public lands, of the involvement of car tell us in colorado and some of the marijuana production. I think there are a lot of challenges. And i think its something we need to really think about, whether we want to make a substance that is harmful more available to our citizens. Thank you, mr. Chairman. Gentle lady yields back. The gentleman from montana is recognized. Thank you, mr. Chairman. And thank you for the panel for your testimony. This is critically important issue. And mr. And mrs. Flattery, thank you for putting a personal face on this epidemic we have here. As i travel, you know, i hear repeatedly the impact of drug addiction on skyrocketing kids in foster care, crime, domestic violence. As i talk to Law Enforcement, in addition to the personal tragedies that weve heard today, so this is very appropriate we have this conversation. And i also am looking for solutions and seek your advice. I would be curious. We have 50 states where we look at solutions. Im curious to hear from the panel of any particular examples where states have taken action that have had positive impact on this issue and just so that we can learn to look at whether or not some of those things make sense at a national level. Thank you, congressman. Ill give you two state policies that show evidence of good effect. One is which has been done in oklahoma is called reimbursement lock in. What this is is that if you are covered by an Insurance Program and suf three, four, five, six, serve providers writing you prescription, the insurer, say medicaid will tell you, look, you can get this prescription, but you have only one doctor. And if that person is doctor shopping or dealing on the side, then theyre constrained, but if theyre a legitimate patient. Second Prescription Drug monitoring programs. These vary in quality around the country. Some are easy to use. Some are hard to use, but the best ones allow the physician to know before they write that prescription is this person getting lots of prescriptions other places. It also can be used by the state to see is there a particular provider who has really suspicious prescribing. When those programs are well resourced, they reduce Overdose Deaths. Those should both be used everywhere in my opinion. So in that particular case in oklahoma, how is that actually accomplished . Its zon through medicaid. So the medicaid set up a rule which they have the power to do as a payor and said if you get multiple opioid prescriptions from different providers on medicaid, you have to pick one of those doctors is going to be your doctor, period, and theyre all going to have to come there. And its an administrative decision that a ned kad director can make. Okay. And open it up to the rest of the panel. Are there other examples that youve seen in states that have been effective . Thank you, congressman. And i hope to be coming out to montana. Senator daines invited us out there. Youre welcome. We have room for you. So i did want to just mention, you know, police and Law Enforcement around this country, they really understand this problem very well. And theyve been innovating across this country especially in the states that have been hard hit. And i think that sometimes we over simplify, but there are drug traffickers, drug dealers and major violent criminals and those people need to go to prison for their crimes, but there are also people that their only offense is using and purchasing drugs, and many of those people can be diverted to treatment. And theres a lot of innovation in know i mentioned in my testimony the Police Assisted Addiction program where police are actually taking people in, opening up their Police Station 24 hours of the if you want to come in for treatment and you dont have any serious trafficking or criminal offense, they will do an interview with them and consult with a Health Worker and theyll put them in the car and drive them right to treatment. And i think, you know, police are very smart and flexible and getting the people into treatment that need treatment is something that they are facilitating across the country. Fire departments are doing it as well. You look at the people in our communities that operate 24 hours a day, police, fire, crisis intervention, they are really stepping up and are a critical part of the solution all aacross the country. And mr. Baum, where is that particular program being run . It started in woouser mast. But nau its in 250 places all across the country. Tremendous leadership by Police Chiefs and cher i was who are stepping up to deal with this problem. Just real quickly to echo what mr. Baum was just discussing. That was one of the main themes last year was that the real pornls of having these Community Networks at the local level that bring together Law Enforcement, bring together Public Health, bring together the education sector, our work last year was focused on prevention but can have real benefits across the board with all different aspects of illicit drug problems. Okay. If i may, to sort of add on to the notion that we need to continue to support diversion to treatment in lieu of incarceration, one of the barriers to being effective in doing that is we need a nations reengineered treatment system. You cannot divert someone to treatment if in rural areas of many states there is no effective treatment to divert them to. Its an unnecessary and excessive burden to play on Law Enforcement and there are a nbl of noteworthy programs around the country to pursue that. But until and unless we reengineer our treatment system, were only going to have minimal effect. And then another follow on, you had asked mr. Humphrey pointed out a number of places where were having some impact on less prescribing, the original development of voluntary opioid prescribing guidelines for chronic pain that cdc developed are being mimicked and adopted it the in the states. The regulation of medicine occurs at the state, not here in this panel. And we are seeing a number of states try and expand the use much prescribing guidelines throughout the practice of medicine in their states and not only in just er settings, and thats where they first start. We need them to be applied in general practice settings where 60 of opioid drugs are being priebld. Thank you. Thank you, mr. Flattery. I jeeld back. Gentlemen yields back. Gentleman from missouri is recognized. Thank you, mr. Chairman. And i thank the witnesses also for participating in this hearing today. On may the 10th, 2017 s attorney general Jeff Sessions issued a memorandum instructing federal prosecutors to, quote, charge and pursue the most serious, readily prooufbl offense including mandatory minimum sentences for drug crimes. Sessions sentencing memo marked a reversal from attorney general eric holders smart on Crime Initiative which sought to move away from mandatory minimum drug sentences and instead focus federal resources on the most dangerous criminals in complex cases. Ag sessions appears to be trying to reinstate the harsh and inzrimt use of mandatory mince from the failed war on drugs. Doctor humphreys t do you think that a district mandatory minimum policy will help us make progress in curbing the destruction caused by the Opioid Crisis . Thank you for that question, congressman. I do not think thats the case. I work a lot with states. I travel a lot, and what i see all around the country, south carolina, texas, south dakota, california, oout, is Bipartisan Coalition to move away from mass incarceration and the way we handle drug problems basically in the 80s and 90s. And the one place that hasnt sunk in is actually in washington. I think the states are out front on that. Theres strong bipartisan agreement. Its better to treat people than lock them up. You know, there are some horrible actors out there who are doing terrible things, but they are a small part of who gets swemt up generally in Drug Enforcement. And we should actually be trying to restore everyone we can. Many of these people are just lowlevel people who are addicted. And theyre much better handled in the health system, not by giving them a tenyear stint in the prison. In response to mr. Session memorandum, republican senator rand paul wrote, and i quote, the ags new guidelines, a reversal of a policy that was working, will accent wait the injustice in our criminal justice snl. We should be treating our nations drug epidemic for what it is, a Public Health crisis, not an excuse to send people to prison and turn a mistake into a tragedy. Doctor humphreys, do you agree with senator paul . I do agree with the senator that this is a public addiction is a Public Health crisis, and it is as has been said by mr. Flattery a it is a chronic medical illness. We should be taking care of it in the treatment system. And again, i understand that there are terrible drug traffickers who are violent and terror eyes communities and i have no sympathy for them at all. But a huge number of people at the low end of drug trade are people who themselves have drug problems, and we should be looking at them as people we can try to restore through the treatment system or through collaboration. Drug korlgts being an excellent model. There are other models of probation. What the criminal system is trying to do is not punish people forever, try to restore them to health by working with the treatment system. Mr. Baum, is your philosophy in line with what we just heard from mr. Humphreys . Well, the way i would put it, congressman, is that every case is different. And in the federal system we see primarily significant drug traffickers and violent criminals. And if youre a significant drug trafficker or a violent criminal, you run a network thats bringing illicit narcotics into our country, breaking our laws and putting the health of our citizens at risk, i think you do deserve a significant sentence. But i also agree that we need to sort carefully the people that come into the system. And there are many people whose only offense is buying and using drugs, and those people that are drug dependent and not involved in running a significant trafficking organization, those people absolutely should be diverted into treatment, into drug courts and alternative sentences. So i think that sometimes folks lose track that the federal system is really charged with the trafficking oirnds, the major criminal groups. Its really state and local governments that are responsible for dealing with local drug dealing and drug users that may commit mild minor offenses. So we really have to learn to tell the difference and treat differently those with different criminal records and criminal backgrounds. I thank you for your response. I yield back, mr. Chairman. Gentleman yields back. The gentleman from wisconsin. Thank you. Its been a while since i traveled outside of the country. I think about 14 years. But last time i went outside the country i went to taiwan. And they dont seem to have this huge drug problem that we do in this country. And at least in my state,ible, i might be wrong, butible more people die of opiate abuse every year than murders and Car Accidents combined. Certainly in most counties thats true, which is just horrible. Are any of you familiar with the type of sentencing that we have in countries which dont have these like taiwan that dont have these huge numbers of people dying from opiate abuse . Mr. Baum, do you know what they do in other countries . Yeah. I think, you know, because of the incredible over prescribing weve had in this country for two decades, our problem is like no other. Canada is experiencing some of the similar problems that we have, but theres no other country that hands out these dangerous, addictive narcotic an algees iks the way we do. Theres no question. For years theyll write books about the horrible things our medical professionals did the last 15 years. Im told its getting better. But does anybody know if you are caught with enough heroin caught with heroin in other countries that dont have these problems what type of prison sentences are handed out . The nations in asia tend to have very strict penalties and also very strong messaging about drug use. The u. S. Problem is different, and i would simply say in the u. S. We need to get back theres a lot we need to do on the Prescription Drug problem, but also on prevention, because we need to get a very strong and consistent message out to our youth about the incredible risks they face from using drugs, especially with fent anl contaminating our drug supply. Drug use is a very risky behavior and we really need to prevent and delay delay and prevent if we can initiation of drug use, especially for people that are our young people where theyre still growing, their bodies are still growing. Its very risky behavior for young people. Okay. We had four people here. Does anybody know what type of drug sentences are handed out in countries like taiwan that dont have an opiate, big opiate problem . Nobody knows . Nobody has checked into in . I have certainly been to taiwan and other countries like that. They have very, very tough criminal justice sentencing. Well, both you and mr. Baum said its very, very tough. What does very, very tough mean . The Death Penalty for dealers. Even for low level dealers, theres places where even with possession you can a small amount of possession you can end up doing a really long time in prison. Oh, my. Of course, we have put an awful lot of people in prison in this country. Its not as if we havent tried that route. And i think we are different than those more cohesive societies, a more freedom Loving Society captain listic society and also a health care. Im against capital punishment. Across the board. But its just interesting how other countries deal with it. The mr. Humphreys, are all people who use opiates or maybe wind up dying of open yalgts, are they all addicts . No, sir, they are not. These are valuable medications when used properly and safely. The people that use them benefit from them and then do not get addicted. It is not everybody. What percentage of people who die of opiate abuse do you think are addicts. Of the people who die of abuse, i would say most of them are. Theres occasional people who have consider like an accidental exposure, like a kid goes to a party and gets an objectiony theyve never had before gets it with a lot of alcohol but most people have been using for a while and are addicted. Ill tell you what goes on in my area and id like you to comment on it. In my area, we are told that the opiates are frequently purchased from a dealer in Milwaukee County and then the opiates are brought back to fond lack county or more rural points north. And the thing that frustrates local Law Enforcement is they feel, because Milwaukee County is kind of a liberal county that, well, if people are caught selling drugs in these more Northern Counties where theyre, you know, a little stricter judges, they are strongly deterred from selling drugs again, but in Milwaukee County, a more liberal county they get a slap on the wrist. And i was under the impression that maybe if we forced liberal counties to put mandatory minimums on that maybe it would deter some of these counties. Would you comment on that. Low level dealers not necessarily low level, but go ahead. Dwrau. Id be happy to talk to you at length more than we have time here for, congressman, but i dont believe that the really long sentences motivate that population because they dont think that way. Theyre not thinking about what theyre going to do in 11 years. Theyre thinking pretty close. When you threaten from ten to 20 that that motivates them. Thats what ive seen. I think thats an insulting thing to say, but ive gone over my time. The gentleman yields back. The gentleman from massachusetts. I want to thank the members of the panel for helping the committee with its work. Director baum, back in 1993 till about 2009 your position as director, even though you were acting director, director of the office of National Drug control policy was a cabinet level position. I have joined with mr. Roth fuss and a large group of democrats and republicans writing to President Trump asking him to reestablish the director of the office of National Drug control policy as a cabinet level position. Could you tell the committee what that might mean if we were to reelevate that position . Thank you, congressman for the question. In my officers at ondcp, both under the bill Clinton Administration and under the george w. Bush administration, i watched bar barry mick calf fray. And i see being at the cabinet meetings and being able to engage as an equal with the other secretaries was something thats valuable. I have to say in the Trump Administration ive had strong support from the cabinet. Ive met with the cabinet secretaries and engaged with them frequently. So that Political Support is very strong in the Trump Administration. But i do understand your point that it can be an asset to be formally included in the president s cabinet. All right. I want to go back to the marijuana question. So in my state by rerch endid you mean the citizens of massachusetts just voted to approve Recreational Marijuana in my state. Now, my personal experience has been well, i opposed that, but we lost decisively on the ballot question. I just cannot see how flooding the streets with another drug is going to help. And part of my work as a member of congress has been to establish a residential Treatment Facility for young people because the age at which these young people have been lured into oxycontin and then heroin and fentanyl is just its a horrific situation. And ive got probably 500 kids that have died of Drug Overdose. And mr. Flattery, im totally sorry for your loss, and i certainly kba thighs with your position. And im thankful for your courage to come forward, you and your wife, with your sons situation. But i could find no really decisive studies on the effects of marijuana on the developing brain. You know, and obviously when you put something out when you legalize Recreational Marijuana, society is putting this in acceptance and implied suit ability so that people are going to look like, hey, this is something thats not harmful and i can engage in that. You talk a little bit about what that might mean for the general population. Thank you, congressman. Let me say a few words and then maybe dr. Humphreys has a few words as well. States have a lot of options in how they manage Something Like marijuana. And i think sometimes were looking at this sort of all in or all out kind of policy. And if states want to alter and have a less severe sentencing and i totally support that. Believe me, i dont think people should be thrown in jail for smoking marijuana. Thats not that doesnt happen. And thats my point. The states have options, but the idea that its going to be so legal and so accessible to young people really does put themgs at risk. And, you know, theres a lot of research already on the harmful effects of physical and cognitive caused by marijuana. And this research was done on earlier marijuana before we had these incredible high levels of thc which we have now, the new forms of marijuana shatter and wax and the liquids that are being vamd. These are very, very powerful substances. These super poured marijuana has not been tested. So i just, you know, as a parpt, i just dont want my kids and other kids in this country at a young age being exposed to these substances. And i think weve really got to think about when we make these policy decisions whats best for our youth. Mr. Dr. Humphreys, do you want to add . Yes, sir, i would. Marijuana is way more potent than its been in previouser ras and people are using it every single day much more. Im quite worried about the public impact. I think its being under estimated how destructive this drug can be can be. And im also worried about the fact had that we have a commercial industry its kind of like Tobacco Industries fantasy of what theyve always want the Marijuana Industry is getting. I think the Regulatory Framework in these states needs to be much, much stronger. Otherwise were going to reget it deeply. Thank you. I yield back, mr. Chairman. Ja from massachusetts yields back. The gentle lady from florida is recognized. Thank you so much, mr. Chairman. Thank you for this very important hearing today. And thank you as well to our witnesses, particularly mr. And mrs. Flattery. We thank you for introducing us to kevin today. As a former police chief, we in florida are all too familiar with the devastation drug addiction inflicts on families and on every community it touches. First, we battled pill mills, but now we see ourselves last year we lost 14 persons a day, higher than even during the height of the pill mill crisis. In Orange County the Sheriff Office responded to more than 160 overdoses in the first three months of this year. Is this an epidemic . I would say yes, it is. Too often the criminal Justice System as weve heard many times today serves as the initial stop for individuals suffering from addiction disease. The Orange County jail has become the de facto and is called the largest Drug Treatment Center and Mental Health provider in the region. In the Obama Administration we saw a shift to a Public Health model of response to the Opioid Epidemic and an increased focus on prevention, treatment and Recovery Efforts. Dr. Humphreys, can you just give us some examples of plea vengs treatment and Recovery Efforts that were expanded under the Obama Administration and why these efforts are so important in fighting the drug addiction crisis. Thank you for that question. Id be very happy to do so. We saw addiction as a Health Problem, and therefore, we tried to build Health Services directly into the Mainstream Healthcare system. Historically Addiction Treatment has been funded by a separate block grant away from all of medicine. That makes the services uncoordinated. It makes them hard to access. So that is why wanting to break away from that is why the Affordable Care act says that taking care of Substance Use disorders is an essential health care benefit. You go to the same healthcare system. Its reimbursed the same way. It makes it easier for people to access. They dont feel stigma teased. They can talk to a regular doctor and the doctor can get paid for intervening with it. Same thing in the medicaid expansion. Covering Substance Use disorder as a core service, not an add on, not a block grant, but a special set aside but a core service because this is a problem that is very prevalent among medicaid enrollees. Its a Health Problem that needs to be addressed. And so we tried to build everything in. And if we do that in washington, our belief and my belief was that that makes it much more likely on the ground in your communities and everyone elses community that the locals will Work Together too. Theyll know who each other are and theyll Work Together to bring people back to health. Thank you so much. And mr. Flattery, earlier we were talking about some of the creativity from local jurisdictions, and you mentioned one of the barriers to that is just the need to reengineer,ible you said, treatment programs. I think we ran out of time. Id love to hear a little bit more of your thoughts on that. Well,ible that the treatment, the world of treatment especially for opioid stangs use disorder is entirely broken. In many rural areas of the country there is no treatment at all. In those counties, particularly in my newly adopted state that have some treatment, there are limits. There are cost issues. There are Insurance Coverage issues. Theres actual stigma from those in recovery who are judging others who are choosing medication assisted treatment. There are prescribers who are charging cash on the barrel head only, and sometimes 500 to treatment someone with bu pin or fin. There are manufacturers of alternative medication assisted treatment who are in every state capital lobbying and making statements about competitor medication assistant treatment. All of those are creating barriers to people getting evidencebased treatment. And i previously had discussed some 30day residential treatment programs whoible are often treating people as customers and not patients and theyre detoxing and releasing people to the wild and a short burst attempt, a 30day attempt is woefully inadequate when were dealing with a chronic, longterm condition. So thats kind of what there are a be this of issues surrounding why our treatment system just does not work. And we need to reengineer it with some of the enthusiasm that were using today to discuss changing our Nations Healthcare system. All right. Thank you so very much, mr. Chairman, i yield back. Gentle lady yields back. The gentle lady from the Virgin Islands is recognized. Thank you, mr. Chairman. And thank you for holding this hearing. The high intensity Drug Trafficking area program or high da was created to provide assistance to federal, state, local and triable Law Enforcement agencies operating in areas determined to be critical Drug Trafficking regions in the United States. There are currently 28 h id a regions which include almost 66 of the u. S. Population in 49 states, the District Of Columbia, puerto rico and the u. S. Virgin islands. To date these regional have steadfastly worked with local Law Enforcement to coordinate efforts and share intelligence. Mr. Baum, do you consider the work of high da integral to the advancement of the mission of the office of National Drug control policy . Thai, congresswoman for the question. We are extremely proud of the h id a program. They are working every day in a partnership, federal, state, local collaborating on looking at and studying the problem they face in each of these regions and deciding together on the priorities. And i think its important to make the point that ondcp, we provide grants for the programs, but we dont tell them what to focus on. Right. Its a regionalel focused program and its designed to bring people together and coordinate federal, state and local laumts and theyre producing very dramatic result. Actually, if you look at the amount of cash and assets they are seizing, they more than pay for themselves three times over, three 1 2 times over. So i think the congress for their great support of the h id a program. Its really getting a great return on the dollar. They are really making a difference in our communities. As you talked about the success, high da initiatives identified over 8,800 Drug Trafficking organizations disrupting or dismantling over 2,700 of them and seizing over 895 million in cash and none cash assets from drug traffickers in 2015. And as you said, these are organizations working with local Law Enforcement who identify the threats specific to those areas, identify how to go after them, how to disrupt and to dismantle those activities in the areas in which they are, woing chlgt ive seen the work that theyre doing in the virj sin islands and as a former narcotics prosecutor, im just completely, very howeveric be supportive of the work that theyre doing in those areas is really important. But in the area in which i represent, the u. S. Virgin islands and puerto rico where high da works together, they cover that area is recognized by ondcp in 2013 for its outstanding work in disrupting Drug Trafficking networks through the caribbean destined for the mainland usa. Mr. Baum, would you agree that the region is integral to combatting transit routes for drugs from south america into the u. S. Mainland . Yes, absolutely, congresswoman. Its a very important area and it is sort of in a neighborhood of the world that faces a lot of drug challenges and so were very pleased to have the high da there and we know uts a significant threat that you nace in the Virgin Islands. Yes. You know, we are right now, the u. S. Virgin islands according to the fbi in 2016 has the highest murder rate per cap at that in the country, higher than any other state, commonwealth or territory. And we know that most of it is due to drug traffic lg. Most of the drugs are not used by virgin islanders. The Virgin Islands was purchased because of our geographic importance and drug dealers with smart people. Theyve recognized that there is an important route there as well. And are using the islands for that. Nonetheless, the house today will likely appropriate over a billion and a half dollars to begin building a wall on our southern border and meanwhile, the Virgin Islands and places like me are facing enormous murder rates, enormous disruption to our communities because of this Drug Trafficking, because of the whats happening there. And i believe that a lot of that money, those billions of dollars that are being spent on that wall and appropriate ate there could be better used to wall our self from the Drug Trafficking that is coming through this country. Mr. Baum, is there any additional monies that you think that high da would need to be effective in its war against drugs . Congresswoman, the president in his fy 2018 budget request asked for 246 million for the high za program. Thats the largest request ever from an administration, and so were hoping to get kongs support for that and on the Border Security issue, Border Security is really important. We face a lot of challenges ask so there is a need for infrastructure and officials. And were really pleased at the incredible leadership of secretary kelly in getting cvp and dhs folks back engaged in combatting drugs. Certainly we think high da is an important part of the Drug Enforcement solution. Thank you. I just wish mexico would pay for it instead. I yield back. Gentle lady from the Virgin Islands. Ill recognize myself for five minutes of questioning. Dr. Fum fridays, it is currently against the law to prescribe controlled substances outside the course of a professional medical practice. Its a pretty ar contain statute. Its not used all that often, but it strike me that until you control that group that is uniquely empowered to prescribe controlled substances, and i appreciate the fact that director baum thinks its an education issue. I dont know that many did you mean doctors. I dont know that many i dont think its an education issue as much as it is a money issue. So how do we capture the attention of those uniquely situated people in our culture who have the authority to write controlled substance prescriptions . Thank you for that question, mr. Chairman. I divide doctors up as follows, the Biggest Group of doctors are good people who do the right thing. And they need to be left alone. Second Biggest Group are good doctors who do the wrong thing and they need education and training. There is a third group. It is a small group. Its probably less than 1 of physicians who are not good people and they do the wrong thing knowingly. And we saw this, my time at ondcp in florida, a massive concentration of people giving out huge quantities of oxycontin. And i think at that point theyre no different than any other drug trafficker. The fact that theyre an md is irrelevant. They know what theyre doing. Theyre being harmful and thats why we have Law Enforcement to go after them and im all for them doing that. Well, i know we and we certainly used to. It was fern mean and for amean back when i was at the da office, but da diversion is not as active, unless you know something i dont know, theyre not as active as they once were. So i get that its hard to go after doctors and just so the record is clear, my dad is a physician. I actually like doctors. But they are uniquely empowered in our culture. Jaer connelly cant write a prescription for an antibiotic or a controlled substance. Doctors can. And you can be in this specialty but write an an algeesic prescription. So im with you. I appreciate the deference you show to physicians that its an education and i do think the overwhelming majority want to do the right thing for the right reasons. But theres a lot of money in this particular realm. And until there are prosecutions for physicians who prescribe outside the course of a professional medical and what i mean by that, just so nobody thinks im getting to complicated. Writing a prescription on a cocktail napkin at a bar for someone youve just met that youve never done any diagnostic test on, you just happen to take his or her word, i like my chances in front of a jury of that being out side the course of professional medical practice. So, mr. Baum, as you write your plan, it would be great if you could address da diversion and whether or not theyre being plusd up. I know its tough to go after doctors. Jurys are sympathetic with them, but theyre uniquely positioned in our culture and somehow or another weve got to address it. Dr. Humphreys, let me ask you this. You mentioned drug court a couple of times. Do you have a position or is there research that indicates whether preadjudication or post adjudication drug courts work better . Im not aware of research that proves that point because those populations are really different kinds of people typically. Given the option early versus later. I do know that both drug courts as well as other models that have been promulgated, hope probation is one that now the federal government supports. 24 7 sobriety on the alcohol side where you use the court as a mechanism to enforce abstinence with regular checks and treatment back up as needed all show, you know, very good outcomes. We should be doing those much more. By good outcomes i mean you get the trifecta. The public is safety Substance Use goes down and then incarceration goes down. Well, i want you to help me with something if you can, and i ask this respectful. As you travel if youre ever invited to address a group of public defenders or criminal defense attorneys, oftentimes they will refuse the offer of drug court because probation is easier. It is not better for their client. But its easier. So weve got to kind of reconfigure what is in the best interest of the client, remaining addicted but just having a shorter period of probation is not in the best interest of the client skpchlt theyll believe you and they wont believe an old prosecutor. So in my remaining time, director baum, in case my mom is watching, i want to be really clear. Im not advocating for the legalization of marijuana. I want to be very, very clear about that. However, i dont understand why its a schedule one. Its certainly not treated as an inherently dangerous substance for which there is no medicinal value. It takes a tractortrailer full of marijuana to even trigger a mandatory minimum under our drug laws. So is there any appetite for researching whether or not it should remain a schedule one drug . Congressman, the administration doesnt have a position on that. Im happy to dialogue with your office. Let me just briefly say that we strongly support research on medical use of marijuana, and if there are obstacles that we see that prevent good research, we want to address those obstacles. Because if there are component elements of marijuana that could be put through the fda process and turn into medicines that can help people in this country, we want to do that. So we do think theres some potential and we support research on the subject. Well, just so everyone is clear, methamphetamine is scheduled what . Ible its schedule two. Two. Cocaine is scheduled what . Also two. Cocaine base is scheduled what . Two. So it is scheduled lower than marijuana. And again, you can schedule something and still not have it scheduled as a one. And i would encourage the powers that be, whoever you need to consult with in the administration, to at least explore whether or not its scheduled correctly, without being perceived as advocating for legalization. Understood. With that, mr. Connelly, im going to give you a chance to im reluctant to say whether or not you want, but im going to give you a chance to conclude. I thank my friend. I want to followup on what you just asked. So the point being made here in some ways, mr. Baum, is if you not you personally, if the government, federal government on this subject, marijuana, and how dangerous it is, has no credibility because of the lack of serious empirical work, it threatens our whole drug policys credibility. And youre seeing this happen on marijuana in the states. Theyre making decisions misnor ton talked about eight states, but there are over 25 states that have in some fashion, including my home state of virginia, liberal iegsd their laws from medical reasons all the way to recreational reasons. I think youd have to confess to the chairmans point, there was no empirical evidence to justify putting marijuana 50 years ago as a schedule one drug. Who did that empirical evidence . Im sorry. Could you repeat that. Who did what . Whoo who made it schedule one . I am asserting and you can feel free to try to contradict. There was in fact no empirical evidence to justify putting marijuana ahead of the drugs the chairman just listed as a schedule um one drug 50 years ago. And i would you brought up the need to have Empirical Research before we start rushing pell mel to approve it for medical purposes. And i agree with you. Here is the problem as i said my Opening Statement, only one federal entity controls marijuana for legal purposes for experiment taking, testing and the like. Research. And its mission is all about proving the harms of something. They have prior determined the outcomeful research. Nobody thinks nie da is an objective neutral place to go to look at the good, the bad, the indifferent about marijuana. It doesnt have that credibility. So if were going to do what you suggest we need to have a different entity with credibility where were looking at objective evidence and science and then we can determine, well, where does marijuana work. Mr. Humphreys made the point that theres a more lethal or stronger, more fortified versions of marijuana coming out that concern us. But we put a lot of people in jail and weve treated this like its more dangerous than cocaine and the other substances the chairman and has had huge consequences. Based on vegts scientific ed. Im not arguing for the legalization either. I agree with my friend from south carolina. Im not going there. But neither can i justify the current policy of treating it as the worlds most dapgous drug with its class fk. You can feel free to respond and im done. Congressman, i understand the point that youre making. I would love to go with you in your district to talk to Police Chiefs and sheriffs. I think in reality on the street police, sheriffs, they dont treat marijuana the way they treat heroin and fent anl. So i think in practice there is a priorityization of the most deadly drug threats. I actually think thats his point is Law Enforcement doesnt, our sentencing scream does not, methamphetamine and marijuana are not treated the same from a sentencing standpoint, but yet marijuana is considered to be inherently dangerous with no medicinal value, therefore a schedule one, and it would just be helpful, dpen, to mr. Connellys point for us to have some consistency or at least be able to explain why certain drugs are scheduled one and others are not. And, you know, we can save that for another day. And again, thats coming from two people that are not advocating for the legalization. Just for some common sense in how its scheduled. On behalf of all the members, i want to thank all of our witnesses for your expertise mr. And mrs. Flattery in your case, your very tragically earned expertise in this area. And i cannot imagine how painful it is. Any and every parent, and you dont have to be a parent to appreciate how difficult what youve done today is. And i absolute you for your advocacy so other parents do not have to live through what you and your wife have lived through. I want to thank all the witnesses for your cleaning although with one another and your comity with one another and with the committee. And with that if theres no further business, thank you, mr. Connelly. Without objection, the committee stands cspan, where history unfolds daily. In 1979, cspan was created as a Public Service by americas Cable Television companies. It is brought to you today by your cable or satellite provider. The Senate Banking committee this morning held a confirmation hearing for the president s nominee to be the next comptroller of the currency and also the nominee for Federal Reserve vice chairman for bank supervision. Idaho senator mike crapo is chair of the banking committee