Transcripts For CSPAN3 White House Director On Drug Policy Testifies On Overdoses 20220719

As chair of this committee, ive worked to ensure that every person dealing with addiction can access comprehensive treatment and care and when it comes to the bad actors that fuel this crisis, i have use this gavel to hold them accountable for their actions. This feeling comes at a very difficult moment for our nation. Overdose deaths in america have been rising for more than two decades and during the coronavirus pandemic, fatal overdoses skyrocketed to historic levels. Tragically, Overdose Deaths increased by more than 36 2020 and another 15 in 2021 with more than 100,000 lives lost. Biden Harris Administration and democrats in congress have taken aggressive action to address the supply and demand factors contributing to this races. President biden to office we have stopped more fentanyl at the border than ever before. This administration hasnt reached drug intervention seizing 800 pounds of pencil each month. This represents a or full increase in fentanyl interdiction over the previous administrations efforts in 2019. To build on this progress from a present biden three budget all for more than 10 in additional funding for interdiction efforts, a request i hope all my colleagues will support. At the same time, the administration and congress have made significant progress in treating addition addiction as the disease it is by expanding access to treatment and rare and wraparound treatment. The law. The First Federal fund for Harm Reduction services. The administrations evidence has invested tens of millions of dollars in initiatives to reach underserved communities, combat stigma and expand access to lifesaving treatment. These programs save lives and this administration has prioritize them also today we will hear from dr. Rahul gupta. He will testify about the Biden Administrations 2022 drug control strategy. This National Strategy focuses on what works, it uses evidencebased strategies to will them the progress already made by the Biden Administration and outlines a plan to invest in communities, present substance misuse and increase access to treatment and recovery services. The National Strategy takes bold steps to ensure that medication to reverse overdoses is available to anyone at a moment of crisis. A strong bipartisan priority that will save lives. A strategy for most access to Fentanyl Test strips which are a vital tool for overdose death preventions among young adults. The National Strategy also builds on the administrations progress to disrupt the supply of dangerous substances into the u. S. By targeting Transnational Criminal Organizations that are manufacturing and trafficking fentanyl. This years National Strategy also goes further than any prior drug control strategy to address inequities that lead people in some communities with insufficient access to health care and makes them more likely to be pulled into the middle Justice System as a result of drug misuse. The overdose crisis affects every community, represented by our Committee Members today. Both democrats and republicans, we owe it to our constituents to do everything we and to build on the administrations progress and Work Together to advanced solutions to this Public Health races. That includes sending a strong Bipartisan Mental Health bill to the present desk and a Substance Abuse disorder package that the house approved last week. It also means passing hr 63 11, the care act, a bill i authored and introduced with senator Elizabeth Warren and others that advances the objectives of the National Drug control strategy by providing crucial resources to the local communities on the front lines of this Public Health crisis. I thank the director for appearing before the committee today and for the biden Harris Administration continued commit and to ending our nations overdose crisis. I now yield to my good friend, Ranking Member, for his opening statement. Thank you, chairwoman maloney for calling this hearing today. Our committees mission is government efficiency and effective us. Our committees mission is to protect taxpayer dollars from rod waste and abuse. Our mission is to haul hold government officials accountable. Republicans on the committee have been pushing to hold hearings on the efforts by the Biden Administration finally have a toplevel biden official testifying today. This is long past due. I urge the chairwoman to old more hearings when we can examine the many crises impacting america today. I thank you for testifying. There was an investigation into americas fentanyl crisis. We sent letters to the office of drug control policy, customs and border production protection and the dea to address the southern border and overdose epidemic. We appreciate the response from your agency but many important questions remain unanswered. One of these outstanding questions is how President Bidens border crisis and this administration opening border policies have aiding and abetting trafficking of drugs like fentanyl in our country. Fentanyl is being smuggled across the southwest border at unprecedented rates. U. S. Customs and Border Protection seized over 11,000 pounds in fentanyl in fiscal year 2021. Thats more fentanyl season one fiscal year than fiscal years 2020 and 2019 combined. The standard fatal overdose of fentanyl is two milligrams. 11,000 pounds of fentanyl is more than 5 billion milligrams. That means we seized about 2. 5 billion lethal doses of fentanyl and one fiscal year. That does not include all the fentanyl we know has been smuggled across our borders undetected. Cartels are overwhelming Border Patrol agents to provide a steady supply for dealers and users alike. The primary question is, what is President Biden going to do to secure the border and cut off the free flow of illicit drugs into our country . Also wrote an open letter to lawenforcement seeking information about how the fentanyl rices is impacting local communities. We received distressing responses from communities across the country. They tell us the devastating effect fentanyl has had young lives lost and families destroyed. I ask unanimous consent to submit these response letters into the record. No objection. Without objection. On top of the crises at the southern order, democrat locked lockdowns in School Closures because Mental Health issues for students leading to historic overages rates. According to preliminary data from the cdc, more than 107,000 people died from a Drug Overdose in the u. S. In 2021. Thats a nearly 15 increase over 2020 which is already 831 increase over 2019. Our nations Mental Health crisis continues to worsen due to the economic our chip and supply chain crises caused by President Bidens disastrous policies. Its shown that stress over money can make people 20 times more likely to attempt suicide. Inflation remains at a four a 40 year highend gas prices are the highest in American History and many families are stressed, wondering how they will make ends meet. Tragically, fentanyl overdoses are becoming the leading cause of death for americans 1835. More than covid, car accidents, gun violence or suicide. Teenagers and young adults are turning to social media apps to find xanax and other pills, many of which are counterfeit and laced with fentanyl. Fentanyl has often been founded counterfeit marijuana. We must act now to secure our southern borders and stem the flow of illicit fentanyl. Its heartbreaking to see how desperately people are trying to escape the impact of President Bidens policies. This administration has flooded the market with illicit drugs so they can do just that. Thank you, madam chair and i yield back. The gentleman yields back i would note in response to your statement that we have already held more than 25 hearings this congress with Biden Administration officials and others. Today is the 25th that i have a list of these hearings and without objection i will enter it into the record and now i will introduce our witness. We hear from dr. Rahul gupta, the director of National Drug control strategy. Please raise your right hand. I dont see him up there. Is he on . Dr. Gupta i am on. Please raise your right hand, do you swear that the testimony were about to be giving is the truth, the whole truth and nothing but the truth so help you god . Dr. Gupta i do. The witness answered in the affirmative. Thank you and without objection, your written statement will be made of the record. You are now recognized for your testimony. Dr. Gupta members of the committee, thank you for inviting me to testify about resident bidens National Drug control strategy. It was released at a time of unprecedented challenges. For far too many years, the Opioid Crisis has ripped of the social fabric of our nation and destroyed lives and livelihoods. The center for Disease Control and prevention estimates that overdoses have claimed over one million lives to date. In 2022 alone, in 2021 alone, we lost a life every five minutes. These are family members, coworkers and neighbors. Overdose deaths in america had more than doubled in 2019 and the covid19 pandemic amplify the difficult oldies in accessing treatment. As a practicing physician for the last 25 years, i have treated many patients with addictions who have gone on to lead successful lives. I have also seen too many patients succumbed to their disease. I have attended far too many funerals. Working in the emergency room, i have experience weeks and months where i was working and overdose every shift. Behind these overdoses, there are millions of individuals experiencing nonfatal overdoses that are taxing Fire Fighters and the health system. These are tens of millions of americans. There are other estimates as well. The Economic Cost of the epidemic is 1 trillion per year. Up to 26 of the loss in u. S. Labor force participation can be attributed to the disease of addiction. Addiction in the overdose epidemic is a nonpartisan issue which is evidenced by the fact that it touches everyone, regardless of where you live or how you vote. This is what ending the Opioid Epidemic is part of resident bidens agenda and why it has strong support across the country and across Political Parties for finding comprehensive and meaningful solutions. As the National Drug enforcement policy develop this, we realize this epidemic is being driven largely by untreated diction and Drug Trafficking. The seven goals focused on reducing Substance Abuse, Overdose Deaths and the supply of illicit system a substance increasing prevention, treatment and recovery efforts. And finally improving the way the criminal Justice System addresses Substance Abuse disorder so people can get the help they need before its too late. There are also four key issues. Its critical we are making sure everyone in act. We are also working to ensure everyone gets the treatment. We are disrupting Drug Trafficking operations in the United States had a fundamental responsibility to protect and this is precisely what the Biden Administration is doing. We are improving data points particularly with nonfatal overdoses as they are good indicator that someone may experience a fatal one in the future. This ushers in a new era of drug policy is comprehensive, holistic and targeted to saving lives first. At this moment in history, our nation is at an inflection point. Our actions must rise to the occasion by being full of innovation but also compassionate and consequential. the biden Harris Administration and drug control strategies unprecedented, evidence blueprint designed to save lives immediately, Building Infrastructure for treating drug addiction and disrupting Drug Trafficking. All the while ensuring the federal government is accountable and serves as a good steward of taxpayer dollars. Saving lives is our northstar. I believe every life is precious. If this strategy is implemented as intended, we could be saving 164,000 lives over the next three years and help tens of millions of people get into treatment. The president and i are committed to seeing this through because american lives depend on it. Thank you for your continued efforts to make our country safer and as President Biden said, lets come together to beat this. I look forward to your questions. Guest the gentlemans yields back and i recognize myself or five and three question. Thank you very much. For coming for the committee today and your leadership and thank you for your tireless commitment to ending the overdose prices which has devastated so many families in our country. I know this is been a top priority of the biden Harris Administration since day one. In addition to issuing this Years National drug control strategy what progress has the Administration Made so far in expanding access to services and care to prevent overdoses and treat addiction . Dr. Gupta thank you. We have had significant progress made. There are now telehealth provisions that allow providers to treat addiction across the country especially in rural areas and behind the walls. Telehealth is a crucial aspect of expanding treatment stop we know that less than one out of 10 people today are getting the treatment they need. We have also allowed the dea to have a mobile methadone as well as take it takehome methadone. Helps us expand treatment when people are dying without treatment. We are also making efforts to make sure everyone can get naloxone which three out of four, almost 80,000 people are dying because of the lack of it. At the same time, we are allowing more and more physicians and providers to be able to write prescriptions and practice guideline changes so they are able to get more treatment. Our goal of treating untreated addiction, creating the infrastructure and the American Rescue plan has invested for alien dollars which is unprecedented and the president has now called for an increase of 2. 3 billion. . 75 of the dollar increase goes towards making sure we are expanding treatment and expanding prevention and expanding recovery services. Guest the coronavirus pandemic strain every aspect of the American Health care system with a disproportionate burden calling on people with addiction and the providers who treat them. One with the federal government responded to this crisis was by promoting the use of telehealth to increase american access to addiction treatment. Does the Administration Support the continued use of health flexibilities for treatment beyond the coronavirus. Can you expand how was made available to people and they are made this t . Dr. Gupta thank you, chairwoman. It is extremely important for President Biden, for this administration to ensure that Telehealth Services are available and are made available beyond the Public Health emergency. The reason for that is, especially people in rural areas, like my home state of West Virginia, are often unable to drive, not able to take the effort to get where it is needed because of the variety. These telehealth efforts allow more efforts to be provided to more people. It is a time where we need to meet people where they are and telehealth, including phone consultations, allows us to do that. And especially in communities of color who already have a difficult, delayed time accessing services, this is another service that will help us expand treatment. Sen. Maloney i led nearly 100 of my colleagues on the democratic side in reintroducing the care act, landmark legislation that would provide 125 billion in new federal funding directly to communities that care providers, 10 years to overcome the overdosed crisis. We need to provide sustained, comprehensive investment and treatment and care to communities at the frontline of this crisis as our care act with due, why or why not care act would do, why or why not . Dr. Gupta it is one of the critical aspects of this particular crisis that we provide this service to folks, not just treatment but beyond treatment to provide support, comprehensive support. It is important that we think about the ability to get people help when they need it, where they need it, and efforts like this help us get there quicker and ultimately save lives. Sen. Maloney thank you. I commend the administration for its work to overcome this crisis and reduce the harm it inflicts on our society, and i am a proud partner with you in this work, and you bring invaluable experience to the country from your work in West Virginia. I now call on representative norman. Re rep. Norman thank you, chairwoman maloney. Dr. , thank you for taking the time to come. You said the Biden Administration had a top priority for protecting americans, protecting the border. Did you say that . Am i right . He has done a great job of protecting the border . Dr. Gupta thank you, congressman, for that question. We believe strongly it is an important part of every nation to secure and protect its border. There are number things going on in this area that i think are important to note. As i visit i speak to the women and men on the border sen. Norman i dont mean to interrupt. I have a limited amount of time. Is he taking the steps to protect, to close the border . Is that what i understand you to mean . Dr. Gupta congressman, thank you again. The president has taken steps to make sure our border remains secured. Sen. Norman this is two different universes. You are seeing the numbers i assume you agree with the numbers of the illegals coming across, we will average 585,000 per month. We are up to 1. 6 apprehensions. Donald trump with the wall had this solved. We had 50 during the three prior years. Those on the terror watch list were basically zil. This past year it is 50 on the terror watch list. How can you sit there and say this administration has a goal of protecting americans . I am construction business. We had a leak on one of our projects. We stopped to fix the leak. Really, this is a mischaracterization at best for you to say this administration either the numbers are completely false, we are getting an unprecedented number of people coming across. We have 3 million to 5 million illegals in this country. We dont want words and we dont want hearings. We want action. All he has to do is build a wall and have a designated point of entry. How many times has the Vice President into to the border that you know of . She was supposed to be those the czar heading this up. Dr. Gupta i will leave that to the Vice President to answer. What i will tell you sen. Norman zero. She is giggling, she is laughing. How many times have your staff been to the border . Dr. Gupta thank you for that question. The first week in office i went to the southwest border and i went to mexico. Recently last month i went to the border in san diego. I was able to spend a considerable amount of time. I will say, as the Ranking Member mentioned, since last year at the beginning we have apprehended 600,000 pounds of illicit drugs, including 11,000 pounds of internal. I will tell you of fentanyl. I will tell you why that is important. Sen. Norman they are coming across. That is why the cartels are winning. They are making 1 billion a month. They are unfettered coming into this country. The blood is on the hands of this administration, what he is doing. Police officers are sick and tired of the dangers they face on the streets in South Carolina because of his inaction. This is one of the tragedies that will be hard to walk back that this administration will not take ownership to start counting things he has done start touting things he has done. Our sovereignty is at stake and we are losing. It astounds me. I know you are part of the administration, but it astounds me you are making these statements because it is not true with the open borders he is allowing to happen and endanger everyone in america. Dr. Gupta if i can complete my response, what i was saying is that that amount of drugs is not in our communities killing americans right now. The proceeds, up to 16 billion, that has been denied and we are denying those to the criminal organizations and the host countries that are often destabilized fragile democracies that become the cause for emigration in the first place. This problem does not start or end at the border. It starts with shipments in china and ins up in overdoses and fatal overdoses in our communities. Sen. Norman how many countries sen. Maloney time has expired. We can have our second round, but we have to keep moving. Congresswoman, you are now recognized. Thank you, chair maloney. I am extremely disappointed that the Biden Administration budgets have proposed prohibiting the districts from spending its local funds on commercializing recreational marijuana. I will be submitting a question for the record on this matter. With that said, since assuming office, the Biden Administration has shown a robust commitment to advancing equity and censoring recovery over punishment in our federal response to the overdose crisis. In 2022 the strategy clarified further this crucial commitment. Dr. Gupta, could you explain the Racial Disparities that currently exist in incarceration and arrests for drugrelated offenses, and how have these equities in the ways that communities experience overdose crises . Dr. Gupta thank you. It is no doubt that the disparities in incarceration that exist and continue to exist have perpetuated a lot of challenges. I would say that the question is with congress, and i will leave it with that. Having said that, the president has been very clear that he supports decisions regarding legalization of marijuana to individual states, but at the federal level he has supported decriminalization of marijuana use and automatic disparagement of records because of the disparities in incarceration. One thing we are doing in this strategy is looking at all of the metrics available to us and where the data makes sense. We were able to put forward a state model on deflection of the idea that for nonviolent crime, if someone has a Mental Health disorder or addiction, get the person help, treatment, figure out housing, lets get them other things instead of incarcerating them. It is not only a good thing to do that prevents recidivism, but it is costeffective for the community. It is these kinds of things that the strategy looks a and is figuring out how to solve problems with the lens of equity additive. Sen. Norman to address the inequities in our criminal justice strategy urging the department of justice to identify opportunities to amend federal statutes requiring mandatory minimums for drug related offenses and it calls for greater over governmental collaboration to address the root causes. How have these steps how will these steps advance Racial Equity in our federal response to the overdose crisis . Dr. Gupta thank you, congresswoman. As a physician who has practiced for 25 years ive seen the effect of not only for individuals, but their families, and communities. It is important for the administration to make sure we are looking at every option and every possible way to have both Judicial Independence and figure out what the best way forward in ensuring we are addressing equity at the same time we are addressing the drug crisis that is happening. It is important for us, as i mentioned, to look up the alternatives that includes drug courts, making sure people have the help while incarcerated. We know that two out of three people behind the wall have a Substance Abuse disorder or addiction. It is important for us to make sure people are getting the treatment both behind the walls but also upon reentry. The reason is, is that is a commonsense smart way to save lives, but also have money and have more productive communities. Up to 25 , 20 6 of the Labor Force Participation loss has been because of addiction and we need to change that. Looking at it through the lens of equity is an important piece of doing that. Sen. Holmes norton proposing steps for the federal government to better understand these recreational inequities across our criminal Justice System. It calls for universal Substance Use disorder screening for people who are arrested. How will these steps help to ensure that people in incarcerated settings have access they need to treat addiction, and why is this such an important sen. Maloney the gentleladys s time has expired. Dr. Gupta the federal government is working on that for federal prisons, because we want to walk the talk. We want to make sure we are leading. We are working with the department of justice, dea, hhs to provide treatment behind the walls to have productive communities at reentry. Sen. Maloney representative cloud, you are recognized. Rep. Foxx this is virginia foxx, i believe i was next. Rep. Cloud she can go next. Sen. Maloney thank you, michael. Rep. Foxx it is interesting to me that you say behind the walls. It is impossible for you to say people in prison, i guess. What percentage of drugs coming across the southern border are fentanyl were laced with fentanyl . Or laced with fentanyl . Dr. Gupta i can speak on seizures. Repl foxx what percentage are fentanyl or are laced with fentanyl . Dr. Gupta i can get you that data. Sen. Foxx i think it is most of them. What policies has this administration implemented to stop it . I would like you to say 1, 2, 3, 4 policies. Do not go into extraneous information, please. Dr. Gupta yes, congressman. First of all, there is the United Statesmexico framework that is looking at particular policies that fueled the trafficking, that fuels the transfer across the border, and works with mexico as a partner to make sure we are working on that. Second, the president signed an executive order that expands the prosecution and sanctions to not just individual traffickers but the enablers and financiers. I can provide details later on to you. Sen. Foxx the first thing that you gave, nothing. There is nothing in what you said. It is working on an agreement. So, nothing there. You are saying one thing and i will look for the details. During the Trump Administration we saw the first annual decrease in Overdose Deaths and 30 years with the trump dhs setting an alltime high for the amount of drugs seized at the border and the Trump Administration rewarded an record amount of federal grants in support of drug intervention in Public Health programs. What can we do to replicate this kind of success moving forward, and why hasnt the Biden Administration already checked those programs in place . Dr. Gupta as the West Virginia Health Commissioner at the time during 2018 the deaths from fentanyl went up by 10 . The decrease was not, unfortunately, in fentanyl in that time. Two weeks ago the cdc provided the first 12 month numbers that have shown a few hundred decline in the deaths over a 12 month period from monthtomonth. Sen. Foxx let us have that information. We would like to be able to compare what happened during the Trump Administration with what is happening, because that is not what we understand. The Trump Administrations stamps on security at the southern border helped make america safer, stop the flow of opioids into the nation, and reduce Overdose Deaths, but the biting administrations but the bidens an illustration stance is allowing Overdose Deaths to continue increasing, despite what you are saying. Without addressing our southern Border Security we cannot stop the flow of fentanyl into the country. According to the cdc in 2021 more than 107 thousand people died from Drug Overdose, up from 91,799 in 2020. Why has the Biden Administration failed to bring down Overdose Deaths . Dr. Gupta thank you, congresswoman. I believe we are seeing now a blunting of the curve of those deaths. We know there are multiple factors and we know it is important to secure our border and continue to secure our border. That is why President Biden proposed a budget increase of 300 million for Customs Border protection or the drug budget. It is important we provide the men and women on the border in uniform the resources and technology and infrastructure that they need to do the job they are supposed to do. Sen. Foxx come on, mr. Gupta. You cant believe that. As a physician who has served in Rural Communities, can you describe what should be done to protect Rural Communities from fentanyl and dangerous opioids . Dr. Gupta first we have to get naloxone out there. We can prevent 80,000 deaths, a majority, if we can get naloxone out there and connect with the treatment. We need a robust lawenforcement enforcement Drug Trafficking program. They are bringing in local, state, federal partners to work collectively and doing a great job. It is a combination of Public Health and Public Safety, especially in Rural Communities. Sen. Foxx you seem to know what to do but you are not doing it. Thank you, madam chair. Sen. Maloney representative lynch . Rep. Lynch thank you for joining us, and thank you for your good work. I have been at this for a while and we have had a difficult time in addressing the drug problem in this country. We seem to have gone from a policy where we tried to get people clean and sober toy policy where we now try to get them off one drugged and put them on another drug, and im speaking specifically about suboxone and how we have taken the lid off and allowed doctors to have hundreds of patients and just give them suboxone and not really deliver any Behavioral Health services that would get at the underlying addictive activity. Those individuals that im seeing in my district where we have a couple of clinics that handout suboxone, the patients go out the door the patients go out the door and they trade that or they buy fentanyl or methamphetamines, which is even a worse problem. They cannot get high with the suboxone, so they are going to harder drugs and we are seeing much more violent activity. An individual on methamphetamines might be up for days and we are seeing a lot of stabbings and violence. I am questioning the whole policy where we seem to be moving away from getting people straight, getting them clean, getting them sober, getting them back into their lives, and instead getting them on different drugs. I just dont see a good result as a result of that policy. Do you have any thoughts on that . Dr. Gupta thank you, congressman. One thing ive realized in the last two decades is this is a brain disease, just like a lot of other diseases. The way that we need to treat that is as a disease of the brain. That includes making sure that we understand the disease better. We provide the fdaapproved medications to help the person. People may have different ways of getting at the treatment, congressman. Some people may do ok cold turkey. Others may need the medicatio n for various amounts of time. We have to figure out how to give the help to people when and where they need it, because they may not be coming back. The next time they come back may be as a fatal overdose in my emergency room. That is why we have taken actions here to save lives first. Part of that means getting people the help they need, figure out what works for them while not giving up on our research agenda. Sen. Lynch i appreciate that, i do, but im telling you and trying to give you feedback. It is not working where i am, in the eighth Congressional District of massachusetts. I have 10 cities and hundreds and hundreds of people altogether right next to the suboxone clinic, right next to the methadone clinic that are shooting up. They are shooting up five or six times a day. You know, it is just a bad situation. Ive had to go down there and look for young people who have left their families and are now totally off the grid and addicted to fentanyl and methamphetamines. It is a sad state. You know, the general of medicine came out with an article last week the journal of medicine came out with an article last week, two weeks ago, that between 2019 to 2020 the adolescent death rate has gone up 100 . It doubled in one year. I just think we are pushing more of this stuff out. It is not helping. I think we have to reassess. One last question. I am also on the Transportation Committee and i had an unclassified briefing with the department of Homeland Security and the faa. They tell me, and this is on Judicial Watch as well, we had 9000 unauthorized drone incursions over the southwest border last year. 9000. Im just wondering, these drones have a payload of anywhere from 3, 5, 8 pounds. Im sure a lot of fentanyl is coming over the border by drone and not by individuals, but they are shipping it in. I am wondering, i know the number of interventions has increased, but i worry about volume. Is there more volume coming over . Do you have more thoughts on that . Sen. Maloney expired, but the doctor may answer your question. Dr. Gupta it is tragic, congressman, and we are willing to work with you and congress in any way possible to help americans. On the second part, that is exactly the challenge of the 21st century. The tools and technology we need to be deterrence to these air drones, marine drones, some of these subterranean tunnels that ive been inside of, we need to work collectively to have deterrent technologies of the future because our adversaries are not waiting for us to develop them to fight this. I look forward to working with congress on some of those aspects, which the bad guys figure out one way or another to bring drugs in. Sen. Lynch i look forward to working with you as well. I yelled back. Sen. Maloney representative cloud, you are now recognized. Rep. Cloud i have a few quick questions that should be easy. How many fentanyl have there been in the last year . Dr. Gupta about 80,000. Sen. Cloud we know the majority of that is coming over the southern border. Where is the cartel sourcing it from, the fentanyl or components to make it . Dr. Gupta predominantly china. Sen. Cloud if china were to send over some bomb or Chemical Warfare that killed 70,001 hundred thousand people in our country, with that be an act of war 70,000 to 100,000 people in our country, would that being an act of war . Dr. Gupta we are trying to understand the importance of cooperation in this area. Sen. Cloud if they sent that many people over with guns that killed 70,000 to 80,000 people, would that be considered an invasion . Dr. Gupta dearly people are dying already from fentanyl clearly people are dying already from fentanyl. Sen. Cloud we have gone from the coyotes on the second side of the border who would hide until Border Patrol would move their post and then they would try to sneak people and drugs across. Now the coyotes are armed sometimes better than our Border Patrol agents and our Border Patrol agents are told to stand down. No they bring their loads to the cartel and get them to station for processing. This is a backwards approach to Border Security. The chair at the beginning of the hearing tried to make some benefit to make it sound good that we are catching more fentanyl at the border. Thats a ridiculous notion and a spin on bad news. We are catching more because theres more coming across, not that we are catching more of a percentage. Almost half a million got away not to mention the ones we know we are not catching. The cartels are wreaking havoc on our nation while this nation stands down. Youre wanting more money from us to fix this issue, but my question is we have sent you money to secure the border, the Biden Administration. How do we know that if we send you money for anything you are going to use it for what you are legally obligated to use it for . Why should congress trust the Biden Administration at this point . Dr. Gupta when i talk to individual agents and leaders at customs and Border Protection and federal agencies and look at the technologies that are enhanced, the infrastructure and people that could be enhanced, all of the deterrent and Detection Technology that could be enhanced, that is the rationale. Sen. Cloud we have already paid, in congress, we have authorized and paid for much more border infrastructure and technologies to be put into place and the Biden Administration refuses to pay more than what it would take to put the wall up than what it would take to take it down resting in a stockpile. We are turning mexico into a narco state because of our inaction on the border and theyre having a foothold and taking over communities in the United States of america. I dont understand how the Biden Administration makes any sort of positive news out of this. Dr. Gupta i went to the wall in san pedro, and i walked 10 meters to the United States and i went down several feet into a drug smuggling tunnel coming from across the border. There were hundreds of those. They are constantly bringing men and women off the Border Patrol to seize and provide medication to those tunnels. We need cooperation from the mexicans to do that on their end. Sen. Cloud they are coming in drones. The wall that we have already paid for that the administration is breaking the law not to build, we have paid for and given the direction to do it, their job is to execute the laws of the land and they are not executing. There is no way around that. They need to execute the laws of the land as sworn to do, as you have sworn to do, as biden has sworn to do, and harris has sworn to do. A lot of this is being bought by young people over tiktok. Cartels are recruiting over tiktok to make transports and that sort of thing. Social media as well. The big tech and social Media Companies then are pretty effective at clamping down on ideologies they dont believed be effective. What is getting them to disallow Cartel Activity on their platforms . Dr. Gupta several conversations with big tech companies. We are working at the office. The cdc is working to make sure big tech is taking its own accountability and place. The dea is providing the one token killed campaign through a variety of mechanisms, including social media. Clearly there is more that we need to do. Why . We still have kids often times, but others as well, who dont often understand the importance of counterfeit pills these days. But the conversation and work is ongoing. I have been personally engaged and involved in some of those conversations and actions. Sen. Cloud i yield back. Sen. Maloney representative raskin, you are recognized. Sen. Raskin dr. Gupta, addiction is a terrible brain disease, as you have described it. I believe the administration has adopted an approach called Harm Reduction of trying to help people recover from addiction and trying to reduce the other legal harms lethal harms. Can you explain, what is the overall theory behind Harm Reduction . What are the components of it . How is it working now . Dr. Gupta thank you, congressman. Over my 25 years what i have seen often is the only time i would see someone is when they are dead in my emergency room. I would often see them reversing and they go away. Where people are using drugs, we are not there. Where we are in the doctors offices and hospitals, they are not there because there is a lack of trust and understanding. The idea of Harm Reduction is to meet people where they are, engage them, and build trust. What studies have shown is that these strategies allow more people to enter into treatment and allows more people to be saved, in terms of saving their life, and it is costeffective. The administration is embracing proven strategies like naloxone, the antidote, making sure people get the antidote for opioid overdose. Because we talk about counterfeit drugs that are in the community now, we are looking at how do you get people to help to check their own drugs to make sure that they are not playing russian roulette each time they use those drugs. Lastly, the Student Service program that helps us prevent the spread of dangerous, fatal, and lifelong diseases like hiv and hepatitis. We have gone through an epidemic and we know what an outbreak of hepatitis and hiv looks like and a proven strategy to prevent that from happening. The goal is making sure we are saving lives first and foremost, and then obviously engaging individuals. Sen. Raskin you have a policy that most of the states and local governments are participating in along with the federal government . Dr. Gupta yes, it has bipartisan support and it is one that has been adopted by many states and local governments and has, as a result, saved lives. Sen. Raskin well, how do you envision the role of the National Government Going Forward in expanding access to Harm Reduction services . Obviously we are in the thick of this terrible crisis. Our people are suffering, and more and more people are getting addicted. How can the federal government become an instrument of actually getting assistance to our people who need it . Dr. Gupta Harm Reduction policies, we as a provider at a local Health Division i can tell you is about Building Community trust and bringing partners together, including Law Enforcement, to build that trust. The federal government and congress can provide the resources needed for communities to be able to, on a voluntary basis, and the ability to heal the community through Building Trust through connecting people back with treatment and offering resources that they need to move forward. We have too many broken communities across the nation because of this crisis, and this is another opportunity to do that with resources of course with congress. Sen. Raskin i will yield back, madam chair. Sen. Maloney mr. Grossman, you are recognized. Sen. Grothman can you hear me . In 2020 6000 people crossed the border. Most recently 103,000. 6000 in april to 182,000. Do you feel that is a complete and total embarrassment . How would you describe that performance and what we are discussing today . 6000 to 180,000 . Dr. Gupta im having difficulty hearing you. I believe you were comparing numbers . Sen. Grothman 6000 people crossed the border into the United States in april of 2020. That number was 183,000. Do you consider that a complete embarrassment and you think we need to do something dr. Gupta thank you, congressman. I believe obviously we are concerned about the amount of fentanyl and other drugs that are trafficked across the nation globally. One of the things that i think its really important for us and for us to not lose sight of is where the drugs are coming from, how they are being manufactured, and obviously what is happening to the American People falling victim. Sen. Grothman 6000 to 183,000, does that bother you . Dr. Gupta congressman, clearly it is important that we have a robust border, and i do believe to the extent that our men and women are doing their job, they are doing their job and we need to provide them the resources. Sen. Grothman the system to which under the rules they operated under two years ago 6000 people were busted instead of 183,000 . Dr. Gupta frankly, congressman, i would prefer to go to a place where we did not have literally any Overdose Deaths. We have too many Overdose Deaths, over one million americans have died. Sen. Grothman you dont want to answer that. Given the huge number of deaths, 110,000 from Illegal Drugs and 12 months, do you feel more people now should be put in prison for selling or trafficking these drugs, fentanyl in particular . Dr. Gupta i believe that people who are trafficking, manufacturing, and routing these drugs for the sole for the sole purpose of profit need to be held accountable. Sen. Grothman you think more people should be going to prison for trafficking or selling fentanyl . Dr. Gupta i feel that people should be accountable for their actions. Of course, we have the most lethal drug supply we have had in this nations history. Sen. Grothman if we had to do last year over, do you feel more people should be going to prison than now for 110,000 deaths . Dr. Gupta congressman, i think the responsible pupil should be sen. Grothman next question. Do you know the total number of professionals dealing with addiction and that sort of thing has can you give an estimate to the number of people making their living as addiction professionals . Dr. Gupta i can tell you that we have significant shortages of professionals for addiction medicine. Sen. Grothman can you answer one of my questions . The total number of people working in this field today compared to 10 years ago . Dr. Gupta i can get the figures for you, congressman. I do know that we have significant shortages, but i can get you exact numbers. We had significant turnover during the pandemic as well. Sen. Grothman next question. [indiscernible] people who die or are convicted for selling these drugs family dr. Gupta family background . Sen. Grothman family structure. Family structure. No father at home. No mom and dad at home. No parents at home . Sen. Maloney the gentlemans time has expired. Representative kelly, you are recognized. Sen. Kelly thank you, madam chair. The Biden Administration is committed to a Health Equity approach to addressing Substance Abuse disorders and recognizes people have been unable to obtain treatment simply because they experience low income or live in a community lacking adequate recovery resources. President bidens National Drug control strategy aims to address the Systemic Health disparities that previous administrations have ignored. Director gupta i understand there is a link between unemployment and experiencing Substance Abuse disorders. How has the administration been addressing this and other root causes . Dr. Gupta thank you, congresswoman. I believe this administration looks at the underlying factors. It is important to understand childhood experiences matter, we call them adverse childhood events and experiences. It is important that we know from this data that someone who has these types of events, five or more, has almost tenfold increase of using illicit drugs. Also, overall, lack of education, less likely to have or hold a job. These things are connected. When we look at the underlying factors, things like housing, jobs, economic security, food security, all of those aspects are important to a persons not only survival but thriving. It is important for us as we work with other agencies like hud, transportation, or others to make sure that we are looking at the entirety of the picture of communities and addressing it from that perspective as well. Sen. Kelly i was going to ask how the administration plans to utilize preventive methods to specifically address the social determinants of health . Dr. Gupta thank you. One of the things that we want to be able to do as the president has announced and taken leadership on is to make sure that people have the housing they need, especially in the area of Substance Abuse disorders. Its critical. The same thing goes for food security. It goes for economics. It goes for deflection, to get people help instead of incarcerating them. Those aspects are part of the strategy and allow us to build a more resilient population while making sure we are focusing on primary prevention for schoolaged children as well to have a more robust future america, which is a really important part of this strategy. Sen. Kelly can you cite any improve i know youve only been around not quite to years but any improvements, any consequences of your work already in ensuring equity when addressing treatments for opioid use disorder . Have you seen any pattern changes by using your strategy . Dr. Gupta we clearly are seeing, as i mentioned two weeks ago, the cdc for the first time demonstrated a 12 month pattern with fewer deaths than the past report a month ago. It is a very small amount of change. We are hoping and expecting that as we continue this effort it will help more. We are working with the department of education have information disseminated to School Districts around prevention messages. It is the president s committed to ensuring that equity is something we are looking at carefully, because we are seeing for the first time some of the highest rises in Overdose Deaths in africanamerican populations, especially black males. The worst problem is we know some populations have the most difficulty entering treatment. We are trying to narrow those gaps to make sure that we are at the end of the day saving lives. Sen. Kelly further research and methodologies surrounding the social determinants of health is something the administration is prioritizing . Dr. Gupta yes, congresswoman. It is something we are making sure that we are looking into. The research, not just what is, but what are those differences. How can we make it better . We are also looking at prevention and treatment aspects that can help us get to a place where fewer americans are using drugs and fewer americans are ultimately dying. Sen. Kelly i want to say that we cannot fully address Substance Abuse disorder without first addressing the true causes and ensuring that marginalized communities receive the support that they need. Thank you. I yield back. Sen. Maloney you are recognized. Thank you for being here. Last month during a Traffic Stop Police in pennell county, not a border county but in my state, stopped two women for speeding. They found 500,000 fentanyl pills last month. 500,000. Synthetic opioid deaths including fentanyl up 23 from last year. Cocaine deaths of 23 from last year. Myth and other stimulants up from last year. Arizona, in two months from the end of last year, seized more than 3 million fentanyl pills. Madam chair, i asked that this article be put into the record. Sen. Maloney without objection. Thank you. Dr. Gupta two weeks ago they found 55 pounds of fentanyl stuck in a gas tank coming across the border. Hallelujah, they are stopping some. 2018, pennell county, zero fentanyl pills. 2019, 700. 2020, 200,000 plus fentanyl pills. 2021, more than 1. 1 million fentanyl pills in that county alone. In your written testimony you say the United States has a fundamental responsibility to protect its borders and this is what the Biden Administration has been doing. Two months ago secretary mallorca testified they had operational control over the border. Are you familiar with the secure fence act of 2006 . Dr. Gupta i am aware of it. Sen. Biggs heres how they define operational control. The prevention of all unlawful u. S. Entries including entries by terrorists, other unlawful aliens, and instruments of terrorism, narcotics, and other contraband. You wouldnt say that our borders operationally secure knowing the amount of narcotics coming across . Dr. Gupta what i would say is that our border is secure but there is more we can do. Sen. Biggs you are saying the border is secure . That undermines the credibility. You say approximately 92 of the heroin seized in the u. S. Is from mexico, 92 of the drugs coming from over the southern border. That is not operational control. According to the dea, 42 of pills tested for fentanyl contained a lethal dose. In the texas ports of entry they saw a 1000 increase in seized fentanyl. You say thats a great sign and its good we are stopping some of it, but the president of the national Border Patrol council testified under oath this year that cdp is likely if they seize 5 of what is coming over the border lucky if they seize 5 of what is coming over the border will stop you understand what im saying . The ratio indicates we are failing. Yet you tell us that the border is secure. You say that you have visited the border into places. In two places. I would love for you to come with me, you and me incognito. We will tell them that you are the executive director of the National Drug policy, we wont tell them that. Come down to the border and i will take you places where you can watch what is happening. You can watch our men and women overrun. There are literally hundreds of miles unprotected, which is where drugs are coming in. We will find a place, we will watch people come across in camo with backpacks on carrying drugs. I will do that with you. When you say we want interdiction materials, hightech, all of that, fantastic, but when you talk to Border Patrol agents and we will talk to real Border Patrol agents and managers who will tell you if they dont know who you are and they can trust you what is going on. They will say we may need more resources, but what we really need is the policy so that we can enforce the law to secure our borders. As long as we fail to do it we will continue this rather inhumane approach to the border. You have Drug Trafficking, human smuggling, Human Trafficking coming across. You have people like the lady who was wandering around in the desert found by some sheriffs deputies about two months ago. Why are you carrying those pills . They are morningafter pills because i knew that i would be raped repeatedly coming across. It is incumbent on you before you can solve the problem youre trying to solve, and i appreciate your trying to take a multifaceted approach and it is a huge task. I dont envy you the task, but as long as you are in denial of what is happening on the border you will not solve the biggest part of this, the smuggling. I do extend to you an invitation to come with me to the border. I often. I go to a lot of places and i would love to have you with me. Sen. Maloney representative wasserman schultz, you are recognized. Sen. Wasserman schultz thank you for your testimony and efforts to combat this. I would say for the record that your efforts are from not understanding what the crisis is. My experience with you and the conversations ive had with you, it is clear to me that you understand the depth of the crisis. It is also clear to me that immigration policy and border policy is not in your job description. Our colleagues on the others of the aisle talk a good game about focusing on what we are actually responsible for. That policy is not what we are responsible for in the oversight committee. I want to talk about an issue that affects my home state of florida and states that have not expanded medicaid, how inadequate coverage contributes to the overdose crisis. Overdose deaths are lower where medicaid has been expanded under the Affordable Care act. They experience at least 10 fewer overdoses of synthetic opioids like fentanyl and 11 fewer involving heroin compared to states who have not expanded medicaid. How does Medicaid Expansion combat Opioid Epidemic and expand treatment for individuals experiencing Substance Abuse disorder . Dr. Gupta thank you. I appreciate the efforts and of the fact that we were able to see some offloads once again of the interdiction. It is important. The treatment part is so critical, because as we try to get people to help, one of the reasons people dont get the help is because they dont have the coverage and they cannot afford it. Very few people we are trying to help cannot afford to see a physician or provider, and that is tragic and unfortunate. We know there is a direct link between increasing access to care and getting actually the care. It is critical. That is probably one of the most important pieces of the backbone that we would need to solve this crisis and save the 170,000 lives. Access to care is a critical component. Obviously people who get it are able to have one more issue they dont have to worry about while seeking care. Sen. Wasserman schultz absolutely. We are all painfully aware of the addiction and overdose crisis and how it has impacted our nations young people. The final two years of the Trump Administration the overdose mortality rate against adolescence went up 94 . This crisis affects young adults who may struggle to find Adequate Health insurance. Let me tell you, you and i together saw firsthand the efforts being made with an entire deck full of interdicted drugs in south florida that were brought in among one of the largest interdictions of drugs in our history that the coast guard was able to recover. You and i were there to witness it. Any suggestion that there is not every effort being made to interdict the smuggling of illicit drugs is erroneous. I want to focus on Medicaid Expansion and how it would help young adults acquire Health Insurance. How would increased access to Health Insurance lead to access to effective treatment and recovery and improved outcomes for young adults and society generally . We have 12 states in the country, mine included, that have not expanded medicaid. As a result the rates of Drug Overdose are higher and no states then and is in those states that have expanded medicaid. Dr. Gupta thank you, congresswoman. First of all, it is important to note that half of the people with Substance Abuse disorder have Mental Health and vice versa. This overlap in Mental Health is also part of the importance of access to care. It is true and tragic that young people are perishing at a higher rate than ever before because of the overlap of the two. It is also true that the majority of the people of the 170,000 deaths are between 25 and 54 years of age, the working age population across the country. We are losing 100,000 people at a time every year. If you think about it from economics, common sense, the ability to get people, the ability for them to feel they can get help, and overlap, it is critical. Sen. Wasserman schultz it is basic math. If you have Health Insurance and can afford to pay for your health care youre much more likely to be able to get access to that care and prevent ever being a victim of drugs in the first place and able to overcome Substance Abuse disorder in the second place. I appreciate your explanation on how expanding medicaid is vital in our fight against this terrible crisis. The Affordable Care act provides a powerful tool to fight addiction and overdoses that republican governors like ron desantis refuse despite the misery and death this disease brings on. Because Governor Desantis is immune to facts, science, and the shame of the overwhelming grief that families must endure because of his actions he has not been moved to act, but that doesnt mean we dont call out his and other governorscruel indifference that adds to the pain that millions of americans suffer. I yield back the balance of my time. Thanks so much for your service. Sen. Maloney representative fallon, you are recognized. Sen. Fallon according to the dea come the illegal smuggling has increased dramatically over the past two years. You agree with the das assessment that the smuggling of cocaine and methamphetamines is on the rise . Dr. Gupta congressman, we are seeing an unprecedented drug supply environment that this country has never seen before. Sen. Fallon the dea said the only major drug that is actually on the decline as far smuggling is heroin. It is only because fentanyl has replaced it because it is cheaper and easier to smuggle and there is greater profit and is a lot deadlier. Is it accurate to say that fentanyl is 50 times more powerful than heroin and 100 times more powerful than morphine . Dr. Gupta we are seeing a trans position transition and a pandoras box has been opened with the Lab Production of synthetic fentanyl. The live share of the drugs being smuggled into our country from which country again . Dr. Gupta where they are being produced is mexico but there are other nations, like china. Most of the methamphetamine as part of the countries is produced in mexico and most of the fentanyl is produced in china. I also heard from the dea agents that production is on the rise in mexico. Is that right . Dr. Gupta the precursors are shipped about the predominant for china and mexico. You know, you can understand my concern. Sen. Fallon when you have won 70,000 american deaths 170,000 american deaths. Here we have the worst on record for daily encounters for april with 284,000 but then that record was broken in may. During the Biden Administration 200 million border encounters. Only 1 of those folks who have crossed the border are smuggling narcotics, even small amounts, that is 36,000 times. That is remarkable. Here are some stats. During the Biden Administration come over one Million Pounds of illegal arc how to ask narcotics have been seized across the border. The secretary last year testified and i was a little surprised of my colleagues did an outstanding job and his questioning. Again, your testimony for the Biden Administration, that border is secure . That is correct . Dr. Gupta we believe certainly that the border secure to make sure we are seizing both the drugs but also the narcotics aspects with our partners closely with mexico to ensure that because of the problems do not begin or end at the border and other Illegal Drugs, we want to make sure we are addressing the causes of production, because of mass transportation, the route as well as from shipment from china. Sen. Fallon i apologize. Im just shocked. I think that is a shockingly inaccurate. The fact of the matter, the border is not on federal government. This administration is putting americans at risk. President biden imposing sanctions on transnational cartel and drug traffickers. The administration expedited criminals from mexico to the u. S. , including double top cartel operatives. The administration is also sanction another 26 operatives and 10 trafficking organization. By the administration has been aggressively going after the cartel. I will like in the record. Without objection, congressman you are now recognized. Thank you madam chair, thank you for your leadership. Alongside with other former companies are responsible for massive crimes and the harm from the Opioid Epidemic. They should be held accountable. They should not be able to hide behind bankruptcy or shield their assets from the cr imes they have committed. I want to focus on the Current Research to show that cannabis is the key when it comes to relieving pain. Opioid reduced related hospitalizations. Reduced opioidrelated facilities. 64 of opioid abuse in patients. I appreciate your leadership. I imagine you and the administration are aware of these . Dr. Gupta thank you. We are closely monitoring these, being someone who has implemented a medical Cannabis Program in the state of virginia. I understand how this works and we are monitoring those studies as well. Would you say in your experience, it is true that cannabis use is a effective alternative for chronic pain patients . Dr. Gupta there is evidence that suggests that in cases of certain chronic pain, cannabis can be. When it comes to acute pain, what category does opioid restrictions fall under . Do you know . I can let you know if you do not. Most opioid prescriptions are class two. Dr. Gupta cannabis is still categorized as a schedule one drug, which is a heavily restricted category. Just be clear, this means that cannabis is more restrictive has more restrictive policies than opioids have, even though opioids have killed americans. It is a contradiction that needs to be resolved. Dr. Gupta thank you. Clearly the bash had been clear about this in regards to the decree will is a, but also it is important for us to keep continuing to look at this from a research perspective, medical perspective. Clearly the policies that we have had in this country in regards to marijuana have not worked in the president has said so. I admire your Public Service i know you have two careful not to get ahead of the president s and you are being appropriate and diplomatic in your responses. The president has the executive authority the dea, hhs to consider administratively rescheduling marijuana which will facilitate research. I am part of legalizing him at the very least decriminalize and, at the very least make sure it is rescheduled so it is not more restrictive than opioids. You do not have to make public comments, but can you ensure the committee today that privately at the very least you will urge the president and the administration to follow the best judgment of science here and medical research because that can help in solving this problem. Dr. Gupta it is the foundation for so many ways to proceed forward, including our current strategy is to follow data and science. I commit that we will continue to do that. Sen. Ro khanna thank you. I hope you and the administration will consider rescheduling and can look at and resolve this discrepancy. I appreciate your Public Service, appreciate your work. Thank you for appearing before this committee. Sen. Maloney gentleman yields back. Representative donald. You are now called upon. The president of donald . Rep. Donald thanks for joining us. You are talking about transportation of fentanyl and other routes. You mentioned there is a precursor that comes from china. Would you say that most of the pills are manufactured in mexico . Dr. Gupta yes. They are manufactured in mexico as a production. Where do they go from there . Dr. Gupta they are often traffic. We know that they end up in the hands of unsuspecting americans often times. How are they trafficked into the United States. We understand that they are trafficked across all routes, from land border, speed border from a force of entry, air, as we have been discussing. Rep. Donald i have another question. What would you say would be better for Border Control agents to be fully focused on the trafficking of narcotics, as opposed to processing people coming across the border at a illegal point of entry . Dr. Gupta i think youre trying to get to the point of resources i guess. The fact of the matter is, we have to be able to do both. When it comes to narcotics bash. Rep. Donald resources are finite, you can only put so many resources at your disposal. We know there are so many men and women of a Border Patrol at the disposal of the United States. Then processing people with asylum applications that are coming to a illegal point of entry . Dr. Gupta what i would say to you, it is a of resources. The president has asked for a budget to match that. Its also look at the profits that are driving the transnational terminals they should. I say this, these are crime organizations that are involved in smuggling people, smuggling guns and cash. Rep. Donald i agree with what you just said. They are smuggling people and drugs, cash and weapons. If we know these things that you have just alluded, isnt the best policy from the white house , and this is definitely respect to your in the administration to make sure Border Agents are focused on all of these things, as opposed to just processing people at the border. When a border agent, i have been there all times. When a border agent is at the southern border, and a group of people come out of the rush forcing the border illegally, the border agent either him by themselves or their selves, they have to stop watering and they have to go to the process. I witnessed this first hand. That agent. At that time, one that agent had to defend people coming there the border illegally come on that radio there were people coming from the mcallen section that did not want to give the name of. Im going to go back to the original point of questioning. Is it better off in the United States for Border Agents to be focusing on trafficking as opposed to actually going to the process of processing people coming into our country at a illegal point of entry . Dr. Gupta i hope we can do both. I hope we can do both because it is what drives. Rep. Donald hope is not a strategy. Hope is wishful thinking. The reality is, you already said there are finite resources, there are only so many border agencies. If you had to choose, which one do dr. Gupta you choose . Dr. Gupta if we follow the strategy that laid out, the president strategy, i think you will find a number of technological aspects for both detection and deterrence to allow us to actually save money by using technology for that. We must go after the process of these transactional criminal organizations. Rep. Donald i agree with you. I reclaim my time. We actually stop processing people at a illegal point of entry because then they will not pay the drug cartels or the prophets to traffic them into the United States. The drug cartels are using Human Trafficking into our country as a way to actually increase in Drug Trafficking into our country. Sen. Maloney the gentlemans time is expired. Rep. Donald thank you, madam chair. Sen. Maloney you are now recognized. Thank you, madam chair. Thank you for being here. Thank you for your lifetime work in this field. I want to talk to you a little bit and very much appreciate the evidencebased approach. We have had success the bipartisan way on criminal justice reform. We had people agree that eminent based resource can endure and effective. They clearly work when it comes to Substance Abuse. 30 million americans you have Substance Abuse problems, 70 say they are in recovery or have recovered. For those of us who are familiar with recovery, there is certainly a argument to be made, you are always in recovery once you have become addicted. Your institution. I was involved in a sober living nonprofits. The reciting judge, who is a republican nominee, we were talking about the last comments about hope, hope of having programs like that where users and families, users and services, addicted people can see them work and come to a evidencebased research. The frustration is getting the federal government to be involved. From our perspective, identifying those programs and incentivizing investment cement programs at those programs at a Community Level. We speak to that the both frustration and successes . There is a exponential understanding of addiction and neuroscience is so wonderful. Thank you. I think it is an important piece to understand, at least two thirds of people that are incarcerated have a diagnosis with Substance Abuse disorders or addiction. It is important to think about all of the programs of diversion , like deflection programs. We just put out a law for Public Safety and Public Health for community to Work Together for people to get the need. The second is commonsense. Third, drug courts. We want to make sure we have a diversion in drug courts. We have robust training and to ensure people have the opportunity for nonviolent crimes to have to move on to make sure that happens. Treatment for people incarcerated is critical and we are doing that because people become more productive. The death rate become significantly decreased when we can treat people. And then reentry compilers important to make sure that when people are ready to reenter a society, we get them the tools that they need to be successful. That is what we have been continuing. Understanding that recovery is not about treatment only, but also the support the individuals need what their help, with their home, the community and their approach to life to make sure that they have all of the surrounding services and support to make them successful. Having had multiple discussions with secretary wash, to ensure the committee how do we coordinate those services question the Community Level years ago, i had a conversation with a legislature and we are dealing with and i have the organ in city telling me, why are you surprised that we arent releasing back into your district and they are back here within a month, one we only gave them 200. How are we incarnating those services at the federal level and the state level . Dr. Gupta the federal level, it is important for us to be working together. It allows us to work with house and Human Services with neighbor to make sure we have recovery ready workforce, but also recovery ready employers and employment places. Allow that to happen. As a matter of coronation with exactly what we are doing. But bringing all of the agencies together and work on this collectively. The state level, i am proud when i talk to leaders who are leaving the copyrighted workforce. To see how far we are moving when we decide it is the right thing to do. There are governors across the country that are actually moving to understand there are 23 million americans that the president called out in a state of union speech that are on the path of recovery. We need to support them and do every thing we can to provide resources. Rep. Desaulner thank you. I yelled back. Sen. Maloney you are now recognized. Thank you. Is fentanyl the deadliest drug coming across the border . Dr. Gupta there are some others, but predominately it is. Is it being manufactured in labs only makes inside of the border . Dr. Gupta yes. When they are manufacturing these synthetic opioids, why are they obtaining the precursor chemicals from . Dr. Gupta mostly from china. What is this administration doing to hold china accountable for helping the cartels create and distribute . Dr. Gupta i agree with the words of secretary blinken, who spoke recently about china policy which is, we have to work with the p. R. C. To make sure that these terminal elements within the p. R. C. Are held account and china demonstrate the leadership that it must actually hold accountable. One of the things we are doing, we are working closely with our ambassador in beijing to see how we Work Together. We have a specific ask of the people and we provided them the app in meetings and in writings. We want you to make sure that there is and you are following the uniform. We want to make sure your Companies Know the customer on the way to the end at making sure that what is keeping track. Let me reclaim my time. We obviously do not feel that that is a firm stance with china. We all know from history, china is not the most truthful country we deal with. They steal our electoral property. For the crisis we have in america. They smuggled those people and drugs in their operations, correct . Are they using their human smuggling operations to silicate their drug smuggling operations . Dr. Gupta we believe sometimes they are and sometimes they are not. It depends on the reasons for both. The reasons you had so many questions is, the republicans have been to the border numerous times. The drug cartels tells us, in fact, drug cartels use human smugglers to get there drugs across the border. My question, why is the southern border only mentioned twice in the National Drug control strategy for 2022 . Dr. Gupta i might point to you, there is a entire response that needs to provide strategy. It focuses just on the border strategy, the caribbean and northern. You have been asked this question about many republicans on the committee. Im going to give you one more opportunity to ask you a question. Since im the last questionnaire, im going to remind you are under old. You believe the Biden Administration is doing everything it can to control the illicit flow of fentanyl across the southern border . Dr. Gupta i believe we can do more. I think we need to do more. I think part of that requires making sure that we are Holding Mexico and the Mexican Government accountable so that the sustained level of enthusiasm that we are working on, then check again trafficking as well as cash trafficking, we want them to act accordingly and robust as we arent. We put a lot of resources in new mexico. Making sure that folks have the technology, resources. We can do more to stop the shipment of precourses from china and make sure the next country does not for that. I will close with this. My time is about up. There arent many areas unfortunately where there is bipartisan agreement in congress. There is one agreement, that fentanyl is coming across the southern border. This Administration Needs to do more. When you ask from a funding, when we talk to the Border Control, they say that this administration continues to do things to tie their hands. The recent announcement was title 42, that is only making the illegal Border Crossings to significantly increased. Sen. Maloney time is expired. This administration is going to have to get serious. You cant have that she cant have a Community Hearing on the National Drug control strategy and the federal response without addressing these crises at the southern border. This administrations response is substandard and only making a bad situation worse. Sen. Maloney you are now recognized. Thank you for being here with us today. I know addiction is a could go issue, even as my colleagues focused so much on some of the immigration policies, i know within our country we just have not done enough to push back and understand or push back on this rhetoric that we do not have a Substance Abuse issue in our country. Especially with even some legal pharmaceutical Companies Pushing the opioids contributed to the crisis here at home and merely of my colleagues continue to benefit from this political contribution from some of the same folks that continue to push those drugs onto our families. One of the things i want to talk about, is that exciting aspects of opioid reversal medications, will help achieve so much and saving lives. We seen in places like Narcan Distribution Program reduced opioids overdoses by 11 without increasing use. I would like to submit for the record, a study to show some of the impact of that program. Sen. Maloney without objection. Rep. Tlaib it is imperative to that over overdose medication is affordable everywhere around the United States. So it can be readily available for people who needed the most, including those in neglected communities. You should know, seeing some of the information coming out over the past decade, 2000 of my fellow detroiters lost their lives. You know, addiction on them. Through under 64 were overdosed in 2019. 86 of those were opioids. What can you tell me that you are doing to improve that . Dr. Gupta this is about making sure it is affordable and effective. Where making sure that states have a satisfied amount to be able to as well as have a distribution plan, especially the most vulnerable communities in the state to be able to distribute. We are very intentional about making sure we are removing the affordable aspect and in the hands of people who needed. We know that if we cannot, we are on track to have deaths. We are talking about hundred and thousands of americans lives that could be saved. For every dollar, there is a 2700 return investment. Theres a bigger bang for buck in terms of saving life. It is cyclical aspect of the strategy. Were going to make sure we are working with hhs, with our other federal agencies and state partners as well as local nurse. Rep. Tlaib thank you. How we have it accessible in some of our high schools and university. You know, i have been hearing an increase in addiction among our college aged i would say and used. Anything that we are doing in that regard . Rep. Tlaib thank you. We see children die. It is important we work on the supply side and make sure kids are aware. It is going to be very important for us to make sure we are removing the stigma and getting people to understand, this is about saving a life and not making judgments. We believe life is precious and worth saving. Rep. Tlaib absolutely. As i look at our country, if it is not this crisis of addiction, there are others. We really need to try to work on this holistically as well. Thank you also much. I yield. Sen. Maloney before we close to my want to offer the Ranking Member and opportunity to offer any Closing Remarks you may have. You are now recognized. Thank you so much for coming before this committee. We appreciate your willingness to give us an update on what this administration is focused on with perspective drug control. I think you heard loud and clear that republicans are concerned with the lack of Border Security among the southern border. We get this from many conversations with Border Control and with local Law Enforcement. Even in kentucky, my Task Force Agents tell me, all of fentanyl and crystal meth, which is the two main drugs of choice right now in the street in rural kentucky, Rural America are coming across the southern border. I do not think it makes a lot of sense for this administration to say they are focused on drug control, when we have a border that is wide open. This administration continues to do things to tie the hands of our Border Agents, announcing they are going to do things like suspend title 42. We need to get serious about the border and we need to hold mexico and china accountable for the drugs that they are working together to manufacture in mexico, which inputs from china that they are sending across the border. I think we can do that. This administration is going to have to take it seriously and greatly reversed course with respect to Border Security. What that madam chair, i yield back. Thank you for holding this hearing. Sen. Maloney before i get to my closing, it is clear we need a comprehensive approach to this crisis. I would like to enter into the record a customs and Border Protection study showing that in 2019, 90 of heroin and 80 of coming into the country arrived as a legal Border Crossing points. Trumps border wall would not have stopped any of these opioids in the greater resources from proving a two ever build a wall with the poor use of taxpayers money. I ask consent to put the u. S. Border customs report into the record. Without objection, the Opioid Epidemic has been ravaging this country for years. It has affected all of our communities in red states and blue states, often it can fill hopeless. The biden Harris Administration is committed to combating the Opioid Crisis and has already made meaningful progress and has a Clear Strategy from stop it from devastating our communities and families. This clear plan is what gives me hope. I am grateful because the administration is adopted Public Health and reduction approach that will help ensure people with addiction receive a life changing treatments regardless of who they are and where they live. That includes the directors announcements today, he supports extending the use of Telehealth Services to provide medication for opioid abuse disorder. The administration has also laid out a plan to success seizing drugs at our southern border by encouraging federal state Law Enforcement agencies to Work Together and by investing the right technology to keep our southern border secure. Todays hearing made clear we cannot reduce the prevalence of drugs in our community through intervention of Law Enforcement alone, nor is it possible for Public Health measures along. We need to address both supply and demand that requires a whole governmental approach with Public Health of Law Enforcement agency is working together to get the job done. Every life lost to a overdose is a tragedy. The 2022 National Drug strategy provides a roadmap to prevent these tragedies and to finally address this crisis. Now democrats and republicans have worked together through legislation and appropriation to make this plan a reality. We should start by passing my care act, which would further expand access to treatment, overdose reversal medication, and test strips by providing the comprehensive sustained funding needed to overcome overdose hikes. With that, in closing, i want to thank all of our panelists for the remarks. I want to commend my colleagues for participating in this event. With that, without objection, all numbers have five legislative days to submit materials and to submit additional written questions for the witnesses to the chair which is reported to the witnesses for a response. I ask our witness to please resp labor secretary marty walsh says the economy would cover Severe Damage if the childcare shortage is not addressed. The secretary testified on President Bidens 2023 budget request before House Appropriations subcommittee. This is just short of two hours