Transcripts For CSPAN2 Senate Judiciary Hearing On Opioid Ep

Opioids have exacerbated americas staggering overdose death rates. In 2017 moreor than 70,000 peope died from Drug Overdoses making it the leading cause of injury related deaths in the United States. Se, 60 involve prescription opioids and illicit opioid such as fentanyl. Americans fared no better against Opioid Epidemic in 2018 when more than 10 Million People aged 12 or older of abused opioid in 2 Million People suffered from an opioid use disorder and on average 130 americans died each day from an opioid openers. We did not know that some cost and disrupted lives or untimely deaths from widespread misuse of prescription and nonprescription opioids but we know from our family, our neighbors and our friend who bear the enduring lost loved ones that the opio crisis is not over. We must continue contending with this crisis. That being said, we made Great Strides over the past three years to help combat the epidemic, congress has passed landmark Bipartisan Legislation directed to combating the opio crisis and most notably, the comprehensive addiction and recovery act in the 21st century care act both of which i proudly supported were signed into law in 2016. Combine these two bills provided over 1 billion to combat the opio crisis. With an emphasis on increasing Prescription Drug abuse prevention and treatment programs, two years later Congress Passed the bipartisan support for communities act which is the most comprehensive antidrug addiction and trafficking legislation in modern history. We cracked the support act to address every element of the Opioid Epidemic for manufacturers and distributors to prescribers and it users to First Responders and recovery professionals. To date congress has dedicated 11 billion to tackle the opio crisis. With the largest portion of that funding granted to the department of health and Human Services. Today we will hear from the ministration and the executive Branch Members that shape and execute the Government Strategy for combating the opiate epidemic. The office of National Drug control policy, the department of justice, the Drug Enforcement administration and the department of health and Human Services. This hearing is important we think about the oversight where we have in congress to ensure the executive Branch Partners are properly stewarding the funding we have provided to them to clearly tackle the opio crisis. That said the federal government is just one aspect to combating the epidemic and we do not stand alone. Curving opio crisis relies on widescale integrated solutions from all impacted impactors. So today during the hearing we have an opportunity to hear from key components of the private sector including the healthcare distribution alliance, National Community Pharmacists Association community anticoalition of america and drug policy expert from the corporation. Together we anticipate a close and comprehensive review of our collective efforts to curb the supply of opioids and unnecessary prescription of opioid for evidencebased prevention, treatment and Recovery Services for opioid use disorder to identify future needs as state and local level and developed sophisticated and tailored solutions to the destructive and deadly crisis. Before i turned to the Ranking Member and witnesses i like to take a moment to remind us all that americas drug abuse problem did not begin with opioid misuse, and will not and with the Opioid Crisis. In my home state of iowa, methamphetamine abuse has remained a persistent and problem. Nationwide in 2017 almost 1 Million People had a methamphetamine use disorder and reportedly clinically significant impairment including health problems, disability and failure to meet responsibilities at work, school or home as a result to drug use. This number is significantly higher than the 684,000 people who reported having methamphetamine use disorder in 2016. In 2016 alone my home state of iowa reported over 1500 child abuse reports relating to methamphetamine. Not just in the home but being found in the childs body. Ultimately americans are suffering from drug dependency. Our loved ones are dying from drug abuse at alarming and distinct rates. Opioids are priority today but methamphetamine and other dangerous substances impacting urban and Rural Community should and will be addressed going forward. Thank you and now i will turn to Ranking Member feinstein for her Opening Statement. Thank you very much. I think your Opening Statement up tale each other and i suspect the up to what i remember of the committee thinks. The question is, what to do about it. Just last year, overdoses were 48000 deaths. To me that number is stunning. In 2016 Life Expectancy in the United States has fallen for the third year, largely due to opioid related Overdose Deaths. In the Economic Cost are just unbelievable, 700 billion a year. One of the reasons it grew is because a lack of education among medical professionals which has led to overprescribing. So we saw in many cases pharmacies were pill mills with turning out millions of pills to smaller communities regardless of medical necessity. Opioid manufacturers and distributors, i believe, had a responsibility to identify and report the suspicious orders. But they did not. This problem was compounded by an adequate responses from the federal, state and local governments. The Trip Administration declared the Opioid Epidemic of Public Health emergency in 2017 but has only used three of the 17 authorities triggered by the declaration, limiting its effect. The office of National Drug control policy omd cp, failed to issue National Drug strategies in 2017 and in 2018. The 2019 strategy did not include concrete goal for a fiveyear projection for a program and Budget Priority both of which are required by law. And according to the october 2019, department of justice id report, the Justice Department and dea did not initially use all of their existing authorities and resources. Reduced quotas for opioids are whole registrants adequately accountable. The result was an Opioid Epidemic that evolved from Prescription Drugs to heroin and ultimately to fentanyl. There is little question in my mind that the initial response to the opioid situation was ineffective. How do we get back on track . I very much believe that any solution must include a whole government approach and we have got to use all available resources. The comprehensive addiction and recovery act enacted in 2016 laid the foundation for this approach. In another bill, the support a act, was signed into law last year. It built on the 2016 legislation is by authorizing critical agencies as well as prevention Treatment Recovery and enforcement programs and expanding research. This act also included a provision called the using data to prevent opioid diversion, this part of the law is designed to ensure that opioid manufacturers industry routers are held criminally and civilly liable for identifying and reporting suspicious orders of opioids. I happen to be the one offer that and im very much concerned that its never been really enforced. So today, i am introducing new legislation to strengthen this law. And this legislation will require data on all controlled substances to be reported. Not just opioids. In order to better identify suspicious orders, it will also require pharmacies to report all transfers of controlled substances to the dea each month. There is so much to do, the federal government has begun to do this, omdcp has established a number of interagency working groups including the National Opioid synthetic Coronation Group. To monitor emerging trends and data. The Justice Department created the opioid enforcement and prevention effort to division and thats the opioid fraud and abuse detection unit under a new initiative known as j code focused on disrupting the online sale of illicit drugs. For its part, dea has increased its tactical diversion squad enforcement and administered of actions against negligent distributors and manufacturers. As a result of these efforts for the First Time Since 1990 Prescription Drug related Overdose Deaths decreased. That is really good news. So there are things that we can do to save life and reduce addiction. The center of Disease Control and prevention has warned us of wave Drug Overdose epidemics is upon us. Most of those suffering from addiction they tell us use more than just opioids, and 2018, cocaine, methamphetamine and benzodiazepines were present in nearly 60 of all opioid related Overdose Deaths. That is a stunning figure to me. So we have to take a good look at it and see what we need to do and i would encourage our Witnesses Today to comment on this and if you have a solution or a thought, i think wed be very interested in hearing them. Our country has been ravaged by an addiction epidemic and it cost tens of thousands of lives every year. So failure should not be an option. This is an important hearing and i so look forward to hearing from our witnesses and hopefully with new ideas and constructive thought. Thank you very much. Thinking Ranking Member and i would recognize senator durbin for opening comments. Thank you, madam chair for this hearing. I called seven a graham several weeks ago to consider this and i think him and you for making a possible today, i will not state again whats been stated, we can accept it, or in the worst drug epidemic in the history of the United States and losing an average of 2017 of 130 people each day. There is no time to smaller suburb to wealthy to escape this drug epidemic in my state across the nation. But its not the first drug epidemic in our history. The crack cocaine epidemic showed, i hope we learned that we cannot incarcerate our way out of this addiction crisis, weenie prevention, intervention and treatment on the front and not just prosecution on the back end. There is a growing bipartisan consensus that harsh prison sentences have not only failed to stop drug addiction but created unjust and disastrous outcomes. Im proud this committee spearheaded the First Step Act to right these wrongs. Now we need to make sure as we combat current drugs on the market and the spread of synthetic fentanyl analogs that we do not impeach Scientific Research that can say people who overdose on these drugs and we do not criminalize any harmless substances in the process. Let me ask you to consider this fact. A recent study of faunal overdoses in massachusetts from 2014 2016 found 83 of patients required more than two doses. More than two, why, because more lax on is no longer Strong Enough to stop and overdose. Researchers have not yet identified an antidote that is. In a research and a more powerful antidote may include the drug fentanyl or some analog. Thats what im proposing legislation that will allow the truly harmful analog to be added to schedule one but not at the expense of facilitating vinyl research to discover lifesaving antidote. Unfortunately theres been an effort to bypass this conversation about the research aspect but i hope we can return to it. The second point is this, we can learn an important lesson from the 1990 tobacco master settlement agreement. The msa was landmarked 246 billion settlement to hold big tobacco responsible for hooking americans on nicotine. And get your bidding to millions of death, i might add there at it again with vaping. But only 8 of the dollars paid under that settlement were devoted to Public Health forms of nicotine addiction. 8 . Most of the money was spent on unrelated items like roads, stadiums, many states, cities and counties sued the opioid industry in a massive lawsuit underway in cleveland today. That could produce a large settlement. I think its critical that a substantial portion of the settlement be dedicated to fighting opioid addiction. Third point is this, it was in june of 2016 in this hearing room at this very table that i learned food for the first time when the acting director of the Drug Enforcement administration revealed on the record it was actually the dea that approve the annual quota of opioids to be produced in the United States. Opioid addiction starts with prescription keep painkillers made by pharmaceutical companies regulated by the Drug Enforcement administration. However, the Inspector General and department of justice found, dea was slow to respond to the dramatic increase in opioid abuse and needs more fully utilized this regulatory resource. For years, dea permitted format to produce enormous evergrowing amount of opioid pills each year even though dea had the ability to set quotas limiting the production. For example, in 2017 the Drug Enforcement administration of the government of the United States of america allowed pharma to produce 13 billion opioid doses to be put on market, how much would that be . That would be a three week prescription for every adult in america approved by the Drug Enforcement administration. For years ive been calling on them to set lower quotas, last year senator kennedy in louisiana on the other side and i joined in a bipartisan effort to reform the law and required the Drug Enforcement administration to adjust opioid quotas to reflect the reality of whats happening in america. Madam chair, im sure youre well aware of the county in your state, lee county on the border of iowa and illinois, lee county iowa averaged 45 opioid pills per person for nearly a decade dispensed by one pharmacy in that county. 45 opioid pills per person for every person living in that county for ten years. In Hardin County illinois one of the least populated counties in my state about 4300 people, between 2006 and 2012, 2. 7 million opioids were shipped to a fingal pharmacy in Hardin County enough to provide every resident with 90 painkillers pills a year. The Drug Enforcement ministration is supposed to monitor this so that approve a massive production on the front end and no monitoring on the bakken, as we see these areas and counties being swamped with opioids. For years weve been calling on them to lower quotas now they have legislative authority and no excuses, unconcerned the dea is not taking this seriously as it should and will ask questions when we reached the point. Dea has lowered and the quarters of years, dea proposed 2020 coders do not take into account drug addiction, overdoses and deaths in other words, the former production quotas dont look at the reality of the worst drug epidemic going on in america today. I look forward to working with my colleagues to continuing on a bipartisan basis to do with this. Thank you. We will start with our panel one and we will introduce our witnesses and we will start with witness statements. With us today on panel one we have mr. Chester, assistant director of National Opioid and synthetic Coronation Group of the office of National Drug control policy. In this capacity he leaves enter Agency Efforts to reduce the availability of fentanyl and synthetic drugs in the United States by distracting the Global Supply chain and we also have ms. Amanda, she is director of opioid enforcement and prevention efforts for the United States department of justice. She is responsible for correlating the strategic responses to the Opioid Crisis including all investigative and prosecutorial efforts. We also have tim mcdermott, he was appointed as an assistant administrator of the Drug Overdose<\/a>s making it the leading cause of injury related deaths in the United States<\/a>. Se, 60 involve prescription opioids and illicit opioid such as fentanyl. Americans fared no better against Opioid Epidemic<\/a> in 2018 when more than 10 Million People<\/a> aged 12 or older of abused opioid in 2 Million People<\/a> suffered from an opioid use disorder and on average 130 americans died each day from an opioid openers. We did not know that some cost and disrupted lives or untimely deaths from widespread misuse of prescription and nonprescription opioids but we know from our family, our neighbors and our friend who bear the enduring lost loved ones that the opio crisis is not over. We must continue contending with this crisis. That being said, we made Great Strides<\/a> over the past three years to help combat the epidemic, congress has passed landmark Bipartisan Legislation<\/a> directed to combating the opio crisis and most notably, the comprehensive addiction and recovery act in the 21st century care act both of which i proudly supported were signed into law in 2016. Combine these two bills provided over 1 billion to combat the opio crisis. With an emphasis on increasing Prescription Drug<\/a> abuse prevention and treatment programs, two years later Congress Passed<\/a> the bipartisan support for communities act which is the most comprehensive antidrug addiction and trafficking legislation in modern history. We cracked the support act to address every element of the Opioid Epidemic<\/a> for manufacturers and distributors to prescribers and it users to First Responders<\/a> and recovery professionals. To date congress has dedicated 11 billion to tackle the opio crisis. With the largest portion of that funding granted to the department of health and Human Services<\/a>. Today we will hear from the ministration and the executive Branch Members<\/a> that shape and execute the Government Strategy<\/a> for combating the opiate epidemic. The office of National Drug<\/a> control policy, the department of justice, the Drug Enforcement<\/a> administration and the department of health and Human Services<\/a>. This hearing is important we think about the oversight where we have in congress to ensure the executive Branch Partners<\/a> are properly stewarding the funding we have provided to them to clearly tackle the opio crisis. That said the federal government is just one aspect to combating the epidemic and we do not stand alone. Curving opio crisis relies on widescale integrated solutions from all impacted impactors. So today during the hearing we have an opportunity to hear from key components of the private sector including the healthcare distribution alliance, National Community<\/a> Pharmacists Association<\/a> community anticoalition of america and drug policy expert from the corporation. Together we anticipate a close and comprehensive review of our collective efforts to curb the supply of opioids and unnecessary prescription of opioid for evidencebased prevention, treatment and Recovery Services<\/a> for opioid use disorder to identify future needs as state and local level and developed sophisticated and tailored solutions to the destructive and deadly crisis. Before i turned to the Ranking Member<\/a> and witnesses i like to take a moment to remind us all that americas drug abuse problem did not begin with opioid misuse, and will not and with the Opioid Crisis<\/a>. In my home state of iowa, methamphetamine abuse has remained a persistent and problem. Nationwide in 2017 almost 1 Million People<\/a> had a methamphetamine use disorder and reportedly clinically significant impairment including health problems, disability and failure to meet responsibilities at work, school or home as a result to drug use. This number is significantly higher than the 684,000 people who reported having methamphetamine use disorder in 2016. In 2016 alone my home state of iowa reported over 1500 child abuse reports relating to methamphetamine. Not just in the home but being found in the childs body. Ultimately americans are suffering from drug dependency. Our loved ones are dying from drug abuse at alarming and distinct rates. Opioids are priority today but methamphetamine and other dangerous substances impacting urban and Rural Community<\/a> should and will be addressed going forward. Thank you and now i will turn to Ranking Member<\/a> feinstein for her Opening Statement<\/a>. Thank you very much. I think your Opening Statement<\/a> up tale each other and i suspect the up to what i remember of the committee thinks. The question is, what to do about it. Just last year, overdoses were 48000 deaths. To me that number is stunning. In 2016 Life Expectancy<\/a> in the United States<\/a> has fallen for the third year, largely due to opioid related Overdose Deaths<\/a>. In the Economic Cost<\/a> are just unbelievable, 700 billion a year. One of the reasons it grew is because a lack of education among medical professionals which has led to overprescribing. So we saw in many cases pharmacies were pill mills with turning out millions of pills to smaller communities regardless of medical necessity. Opioid manufacturers and distributors, i believe, had a responsibility to identify and report the suspicious orders. But they did not. This problem was compounded by an adequate responses from the federal, state and local governments. The Trip Administration<\/a> declared the Opioid Epidemic<\/a> of Public Health<\/a> emergency in 2017 but has only used three of the 17 authorities triggered by the declaration, limiting its effect. The office of National Drug<\/a> control policy omd cp, failed to issue National Drug<\/a> strategies in 2017 and in 2018. The 2019 strategy did not include concrete goal for a fiveyear projection for a program and Budget Priority<\/a> both of which are required by law. And according to the october 2019, department of justice id report, the Justice Department<\/a> and dea did not initially use all of their existing authorities and resources. Reduced quotas for opioids are whole registrants adequately accountable. The result was an Opioid Epidemic<\/a> that evolved from Prescription Drug<\/a>s to heroin and ultimately to fentanyl. There is little question in my mind that the initial response to the opioid situation was ineffective. How do we get back on track . I very much believe that any solution must include a whole government approach and we have got to use all available resources. The comprehensive addiction and recovery act enacted in 2016 laid the foundation for this approach. In another bill, the support a act, was signed into law last year. It built on the 2016 legislation is by authorizing critical agencies as well as prevention Treatment Recovery<\/a> and enforcement programs and expanding research. This act also included a provision called the using data to prevent opioid diversion, this part of the law is designed to ensure that opioid manufacturers industry routers are held criminally and civilly liable for identifying and reporting suspicious orders of opioids. I happen to be the one offer that and im very much concerned that its never been really enforced. So today, i am introducing new legislation to strengthen this law. And this legislation will require data on all controlled substances to be reported. Not just opioids. In order to better identify suspicious orders, it will also require pharmacies to report all transfers of controlled substances to the dea each month. There is so much to do, the federal government has begun to do this, omdcp has established a number of interagency working groups including the National Opioid<\/a> synthetic Coronation Group<\/a>. To monitor emerging trends and data. The Justice Department<\/a> created the opioid enforcement and prevention effort to division and thats the opioid fraud and abuse detection unit under a new initiative known as j code focused on disrupting the online sale of illicit drugs. For its part, dea has increased its tactical diversion squad enforcement and administered of actions against negligent distributors and manufacturers. As a result of these efforts for the First Time Since<\/a> 1990 Prescription Drug<\/a> related Overdose Deaths<\/a> decreased. That is really good news. So there are things that we can do to save life and reduce addiction. The center of Disease Control<\/a> and prevention has warned us of wave Drug Overdose<\/a> epidemics is upon us. Most of those suffering from addiction they tell us use more than just opioids, and 2018, cocaine, methamphetamine and benzodiazepines were present in nearly 60 of all opioid related Overdose Deaths<\/a>. That is a stunning figure to me. So we have to take a good look at it and see what we need to do and i would encourage our Witnesses Today<\/a> to comment on this and if you have a solution or a thought, i think wed be very interested in hearing them. Our country has been ravaged by an addiction epidemic and it cost tens of thousands of lives every year. So failure should not be an option. This is an important hearing and i so look forward to hearing from our witnesses and hopefully with new ideas and constructive thought. Thank you very much. Thinking Ranking Member<\/a> and i would recognize senator durbin for opening comments. Thank you, madam chair for this hearing. I called seven a graham several weeks ago to consider this and i think him and you for making a possible today, i will not state again whats been stated, we can accept it, or in the worst drug epidemic in the history of the United States<\/a> and losing an average of 2017 of 130 people each day. There is no time to smaller suburb to wealthy to escape this drug epidemic in my state across the nation. But its not the first drug epidemic in our history. The crack cocaine epidemic showed, i hope we learned that we cannot incarcerate our way out of this addiction crisis, weenie prevention, intervention and treatment on the front and not just prosecution on the back end. There is a growing bipartisan consensus that harsh prison sentences have not only failed to stop drug addiction but created unjust and disastrous outcomes. Im proud this committee spearheaded the First Step Act<\/a> to right these wrongs. Now we need to make sure as we combat current drugs on the market and the spread of synthetic fentanyl analogs that we do not impeach Scientific Research<\/a> that can say people who overdose on these drugs and we do not criminalize any harmless substances in the process. Let me ask you to consider this fact. A recent study of faunal overdoses in massachusetts from 2014 2016 found 83 of patients required more than two doses. More than two, why, because more lax on is no longer Strong Enough<\/a> to stop and overdose. Researchers have not yet identified an antidote that is. In a research and a more powerful antidote may include the drug fentanyl or some analog. Thats what im proposing legislation that will allow the truly harmful analog to be added to schedule one but not at the expense of facilitating vinyl research to discover lifesaving antidote. Unfortunately theres been an effort to bypass this conversation about the research aspect but i hope we can return to it. The second point is this, we can learn an important lesson from the 1990 tobacco master settlement agreement. The msa was landmarked 246 billion settlement to hold big tobacco responsible for hooking americans on nicotine. And get your bidding to millions of death, i might add there at it again with vaping. But only 8 of the dollars paid under that settlement were devoted to Public Health<\/a> forms of nicotine addiction. 8 . Most of the money was spent on unrelated items like roads, stadiums, many states, cities and counties sued the opioid industry in a massive lawsuit underway in cleveland today. That could produce a large settlement. I think its critical that a substantial portion of the settlement be dedicated to fighting opioid addiction. Third point is this, it was in june of 2016 in this hearing room at this very table that i learned food for the first time when the acting director of the Drug Enforcement<\/a> administration revealed on the record it was actually the dea that approve the annual quota of opioids to be produced in the United States<\/a>. Opioid addiction starts with prescription keep painkillers made by pharmaceutical companies regulated by the Drug Enforcement<\/a> administration. However, the Inspector General<\/a> and department of justice found, dea was slow to respond to the dramatic increase in opioid abuse and needs more fully utilized this regulatory resource. For years, dea permitted format to produce enormous evergrowing amount of opioid pills each year even though dea had the ability to set quotas limiting the production. For example, in 2017 the Drug Enforcement<\/a> administration of the government of the United States<\/a> of america allowed pharma to produce 13 billion opioid doses to be put on market, how much would that be . That would be a three week prescription for every adult in america approved by the Drug Enforcement<\/a> administration. For years ive been calling on them to set lower quotas, last year senator kennedy in louisiana on the other side and i joined in a bipartisan effort to reform the law and required the Drug Enforcement<\/a> administration to adjust opioid quotas to reflect the reality of whats happening in america. Madam chair, im sure youre well aware of the county in your state, lee county on the border of iowa and illinois, lee county iowa averaged 45 opioid pills per person for nearly a decade dispensed by one pharmacy in that county. 45 opioid pills per person for every person living in that county for ten years. In Hardin County<\/a> illinois one of the least populated counties in my state about 4300 people, between 2006 and 2012, 2. 7 million opioids were shipped to a fingal pharmacy in Hardin County<\/a> enough to provide every resident with 90 painkillers pills a year. The Drug Enforcement<\/a> ministration is supposed to monitor this so that approve a massive production on the front end and no monitoring on the bakken, as we see these areas and counties being swamped with opioids. For years weve been calling on them to lower quotas now they have legislative authority and no excuses, unconcerned the dea is not taking this seriously as it should and will ask questions when we reached the point. Dea has lowered and the quarters of years, dea proposed 2020 coders do not take into account drug addiction, overdoses and deaths in other words, the former production quotas dont look at the reality of the worst drug epidemic going on in america today. I look forward to working with my colleagues to continuing on a bipartisan basis to do with this. Thank you. We will start with our panel one and we will introduce our witnesses and we will start with witness statements. With us today on panel one we have mr. Chester, assistant director of National Opioid<\/a> and synthetic Coronation Group<\/a> of the office of National Drug<\/a> control policy. In this capacity he leaves enter Agency Efforts<\/a> to reduce the availability of fentanyl and synthetic drugs in the United States<\/a> by distracting the Global Supply<\/a> chain and we also have ms. Amanda, she is director of opioid enforcement and prevention efforts for the United States<\/a> department of justice. She is responsible for correlating the strategic responses to the Opioid Crisis<\/a> including all investigative and prosecutorial efforts. We also have tim mcdermott, he was appointed as an assistant administrator of the Diversion Control Division<\/a> on july 24, 2019. He served as the principal advisor to the ministry or on all matters pertaining to the regulation and coronation of programs with the diversion of produce controlled substances. And please help me with your name, doctor period he serves as the chief medical officer as a Mental Health<\/a> services administration. Hes familiar with the development and utilization of medical services and nuance of regulation and across various state and provider perspective as he delivers direct patient care. Thank you very much. We will go ahead and start with her witness statements and we will start with you mr. Chester. Chairwoman urns, Ranking Member<\/a> feinstein and members of the committee, thank you for inviting me too testify on the dynamic and challenging opioid environment we continue to face in the United States<\/a>. In the whole government approach to addressing it. The office of National Drug<\/a> control policy under the leadership of director jim carroll is uniquely positioned within the executive office of the president to courtney they ministration apprehensive approach to drug policy development and implementation. It began in the opioid issue the dominant threat was heroin. A relatively low crisis which allowed for not intervening use and heroin enabled an easy transition from prescription opioids to listen opioids. Fentanyl emerged as a major overdose driver in 2015 initially as an adulterer to heroin but by mid 2070 many states have experienced or crossover were mo people were overdosing and dying from fentanyl then heroin exclusively. Today we see more diversification across the opioid environment with a variety of fentanyl and nonfentanyl synthetic opioids readily available. Some highly sophisticated counterfeit pills sold on the darknet and delivered direct to consumers. This is further complicated by user transfer among different drug types and across both synthetic opioids and nonopioid drugs like methamphetamine. Combating illicit availability demands president ial leadership, strong bipartisan support from the congress and the synchronization of international state, local and tribal partners across the public Law Enforcement<\/a> National Security<\/a> and intelligence communities. This allows us to deeply understand the environment in its complexity and identify and rapidly close gaps and capabilities as they emerge. Over the last four years the government made lifesaving gains the synchronized approach first laid out in 2016 heroin availability Reduction Plan<\/a> and the final report on the commissioning drug addiction in 2017. President trumps initiative to stop opioid abuse in 2018 and the 2019 National Drug<\/a> control strategy. We have the answer policy objectives along three clear lines of effort. Prevent drug use before it starts, improve access to treatment for longterm recovery and reduce the availability of illicit drugs in the United States<\/a>. Most important, the strategy guides and synchronizes government actions on the entirety of the drug problem to achieve the singular goal of saving american lives. This is the only criteria that truly matters by which the American People<\/a> will measure the success of our efforts. These foundational documents and the efforts they articulate have enabled significant a commish meant over the last few years. The creation of the apartment of justice joint criminal opioid our teams within the fbi to target the internet trafficking synthetic opioids. The training and deployment of k9 teams throughout custom and Border Protection<\/a> and office of Field Operation<\/a> specifically trained to protect fentanyl. The establishment of the 24 hour, seven day capability for cpp under the act for new synthetic opioids as they emerge in the marketplace and the passage of the historic support act which recently authorized new Medicare Part<\/a> b benefits the law opioid treatment programs to build further Services Including<\/a> counseling and medication next month. However, the illicit opioid environment continues to present a daunting challenge. Synthetic opioids shipped in small quantity make detecting and seizing the drugs monumentally difficult as they move through the mail, express across the borders. The increasing prevalence of drug users, counterfeit pills and the rapid emergence of highly addictive deadly and readily available opioids for prevent efforts. As chinas efforts to elicit classwide fentanyl scheduling take hold new production sources and distribution are emerging. These challenges are not insurmountable. Now more than ever our efforts must remain synchronized across antigovernment with estate partners, our partners in the private sector and others to produce the complementary effects to in the crisis. I would like to think this committee for your foresight and leadership in addressing this conical National Security<\/a> Law Enforcement<\/a> and Public Health<\/a> challenge. On behalf of the ministration we look forward to continue to work with you to confront the extreme complex issue. Thank you for the opportunity to testify today and i look forward to your questions. Thank you mr. Chester. Chairwoman urns, Ranking Member<\/a> feinstein and members of the committee, thank you for the opportunity to discuss the department of justice to combat the Opioid Epidemic<\/a>. Im the director of prevention efforts. My position in the Deputy Attorney<\/a> General Office<\/a> was created for the sole purpose of ensuring the department is properly formulating and nipple Mining Resources<\/a> to the full six deck with the express goal of combating up your crisis. I also have 13 years of experience as a drug prosecutor working as an assisting United States<\/a> attorney and a deputy section chief and the department criminal division. I know firsthand that the department is not simply paying lip service when the leadership expresses commitment to stem the tide of the epidemic. It is responding aggressively and intentionally with every tool at his disposal. One such tool is focused on the department effort of darknet websites. These websites allow prolific drug suppliers to sell fentanyl on the market places. Dismantling them is a priority for the department which is why in 2018 the fbi established the joint criminal opioid darknet enforcement team. Since the launch there have been too successful largescale takedowns that have taken dozens of accounts off the web and hundreds of kilograms of drugs off the street. The department has also been diligently working to prosecute Mexican Cartel<\/a> to traffic fentanyl and fentanyl analogs into the United States<\/a>. The Mexican Cartel<\/a> are not only producing their own fentanyl but mixing it with other drugs such as methamphetamine, heroin and cocaine which is contributing to the staggering numbers of voters death throughout the country. The department is using all the tools at his disposal to combat the cartels winning the conviction of Cartel Leader<\/a> El Chapo Guzman<\/a> who is certain to life of 30 years in july of this year. Another noteworthy initiative is operation synthetic opioid search or sos that focuses on illicit opioids that have obtained the highest overdose death rate in the country. The prosecutors in the district worked towards prosecuting cases involving synthetic opioid. The first to the program alone over 300 cases were charged in the ten districts. Additionally the department has created the regional prescription opioid strikeforce. Also known as our poet, a joint Law Enforcement<\/a> effort the holds resources and expertise of multiple agencies to identify, investigate and prosecute Healthcare Fraud<\/a> scheme in the region one of the most hardhit by the epidemic. Since october 2018 establishment the strikeforce has charge more than 70 defendants were collectively responsible for disturbing over 40 million pills. These medical professionals were charged with drug offenses was to penalties for the diversion of opioid. It has also worked handinhand with hhs to ensure when there is a takedown of the medical professionals patients are not left out in the cold. Rather they are met by a team of Public Health<\/a> officials who can refer them to legitimate medical providers or Addiction Recovery<\/a> services. The department recognizes we cannot put it out of its crisis and using resources to help prevent opioid abuse before it takes place. This occurs through school and community outreach, partnership with american tribes, Public Service<\/a> announcements and training for medical professionals. Additionally the department has a robust Grant Network<\/a> established for opioid abuse and Overdose Prevention<\/a>. This includes plans to facilitate treatment, prevention and Victim Services<\/a> and state and local Law Enforcement<\/a> better investigate heroin and prescription opioid distribution. Finally, i want to remind you of what i spoke in june. Importance of legislative solution for classwide scheduling of fentanyl like substances. The nation has seen the uses of prescription opioid decreased the deaths in the United States<\/a> has reached record levels. One of the causes of the proof relation of fentanyl in the analogs. As you know invertebrate 2018, the dea responded to the proof elation of fentanyl analog by scheduling the fentanyl like substance on a temporary emergency basis. In response to the scheduling order we saw a significant decrease encounters a fentanyl like substance and reduced production of the substance by traffickers. Classwide scheduling is working. But the temporary emergency scheduling order expires in 51 days. As a prosecutor i can tell you that legislation to permanently schedule fentanyl substances is important and necessary step to continue countering this epidemic. We are running out of time and if the solution is not found prosecutors will be hindered and traffickers will be helped. We cannot afford to move in the wrong direction while fighting this crisis pretty thinking for the opportunity to testify and we look forward to continue to work with congress to find solutions necessary to address the epidemic. Thank you. Mr. Mcdermott. Chairwoman urns, rank them over feinstein and distinguished members of the committee on behalf of the 9000 men and women, thank you for the opportunity to discuss a response of your crisis. Over the past several years our nation has been devastated by an epidemic that was fueled by the overprescribing potent Prescription Drug<\/a>s and the increase in prescribing for the first decade of 2000 was fueled by a belief that pain was undertreated in the United States<\/a>. Prescribing during this time created a generation of opioid users presently of more than 3 million americans. Unfortunately, as prescription rates have declined over the last four years we have seen a dramatic and disturbing shift, the mexican drug cartels are filling the void with cheap highly potent white powder heroin they continue to mix it with fentanyl and selling in the traditional and in many cases counterfeit pills made to resemble pharmaceuticals. The dea is seen chinese, mexican nationals working together to move massive amounts of heroin, fentanyl, fentanyl related substances across the southwest border. The prophet that these are collecting are sounded. A kilogram of fentanyl is produced for less than 5000 and can have a yield in excess of 1. 5 million. Dea believes the sale of the cartel will continue to be the primary Mexican Cartel<\/a>s controlling the illegal Drug Distribution<\/a> throughout the United States<\/a>. To these cartels do not have boundaries or laws of mexico, the United States<\/a> or any other country. Dea will focus its attention and effort on the command and control component of these major Drug Trafficking<\/a> organizations to protect our citizens from the devastation that they bring a violence and drugs. With respect to addressing the diverse of control substances and Prescription Drug<\/a>s, i oversee the activities of dea converging control program roughly eight 80 of her workforce. Less than 1 , less than a fraction of 1 have disproportionately impacted the epidemic. In fact, for 5 new heroin users state they started the cycle of addiction on prescription opioids. Within the Diversion Program<\/a> we have realigned criminal investigators and embedded them alongside the diversion investigators in an effort enforcement groups we call tactical diversion squad groups currently we have 86 of the groups nationwide who are dedicated to investigating, disrupting and dismantling individuals and organizations involved in teams. These groups along with the additional 87 groups are using all tools administrative, civil and criminal to pursue the registrants who violate the law. We also remain focused on the limits dea establishes for manufacturing of scheduled one into controlled substances appeared with the publication of the 2020 quarters on december 2 the dea has decreased quarters for the six most frequently misused opioid by 55 on the level established at the end of 2016. We been able to break down the quarters because doctors nationwide are writing less prescription to opioid, a 30 decline since january 2017. Despite the decline, let me show the committee that we recognize the opioids are essential medicines especially with those of pain in dea will continue to work with fda, the center for medicare and medicaid services, cdc and the state office to ensure their adequate supply for those in need. The division continue the robust Outreach Program<\/a> aimed at improving communication and cooperation. In closing, i want to thinking for the opportunity to be here today and i look forward to your question. Thank you. Doctor please. Chairwoman ernst, Ranking Member<\/a> feinstein and distinguished members of the committee, thank you for inviting me too discuss the approach to the pure crisis. I am chief medical officer, im an addiction psychiatrist with expertise in multistate operations provider supervision and the treatment of Mental Illness<\/a> and Substance Use<\/a> disorders in vulnerable and underserved population. The omission is to reduce the impact of substance misuse and Mental Illness<\/a> in communities across the country. We are the Agency Within<\/a> hhs that leads Public Health<\/a> efforts to improve the lives of individuals living with Mental Illness<\/a> and Substance Use<\/a> disorders as well as their families. The number one priority in combating the open your crisis is expansion of prevention, treatment and Recovery Support<\/a> services, we do this by providing a range of grants targeting a pure crisis. The state opioid response gramps and the rest of the crisis including prescription opioids, heroin to fentanyl and fentanyl analogs by increasing access to medication treatment or mat using the three fda approved medication for the treatment of opioid use disorder producing opioid Overdose Deaths<\/a> to the provision of prevention, treatment and recovery activities for opioid use disorder. We partner with Many Community<\/a> providers another stakeholder organizations for appropriate evidencebased opioid prevention strategies. These include drug takeback and disposal programs and overdose education as well as distribution activities and Marketing Media<\/a> campaigns and strategies to reduce stigma. In order to ensure individuals receive a comprehensive array of services they also provide Recovery Support<\/a> services one of the most common approach to implement Recovery Support<\/a> services by grantees is utilization of support, individuals who are then in recovery. Another common Activity Development<\/a> enhancement and expansion of Recovery Community<\/a> organizations as well as the use of recovery residency. Peers are engaged in a number of settings for individuals with opioid use in the border initiate and maintain recovery. They strongly believe that the expansion of comprehensive a systematic care and continued partnership between federal government, state communities we will continue progress in combating the Opioid Crisis<\/a>. American indians and alaska natives have been especially hardhit by increasing rates of prescription and illicit opioid use. Addiction and overdose as well. These populations have the secondhighest overdose death rates from heroin and the third from synthetic opioids. An effort to address the Opioid Epidemic<\/a> in indian countries, they have established the tribal opioid response or tour program the resource. It aims to address the crisis and tribal communities by increasing access to culturally appropriate and evidencebased treatment. It is also been a leader to reduce overdose by increasing availability and use to reduce overdose to funding and technical assistance. Its Overdose Prevention<\/a> toolkit released in 2013 is one of the most resources. The toolkit provides information on recognizing the risk of ope overdose, the signs of overdose and how to provide Emergency Care<\/a> and an overdose situation is intended for community members, First Responders<\/a>, prescribers, people who have recovered from an open unit overdose, family members as well as communities and local government. The opioid prevention targeting scripture drug misuse have shown positive outcome in the strategic prevention framework Prescription Drug<\/a> program to target the priority issue a Prescription Drug<\/a> misuse. The Program Works<\/a> and pharmaceutical communities on the risks of overprescribing too young adult and brings Prescription Drug<\/a> abuse prevention activity, education to schools, communities, parents, prescribers and patients. All grantees are required to have an operational state run Prescription Drug<\/a> Monitoring Program<\/a> called pdm p. And our supporters in developing capacity and expertise in the use of data from these pdm ps. The National Survey<\/a> on drug use and health also known is providing key national and state level data on a variety of Substance Use<\/a> and Mental Health<\/a> topics including opioid misuse. Its a vital part of surveillance efforts related opioids. It is also building existing partnership with nih a partner in implementation of healing communities project. To improve Research Practice<\/a> pipeline and committed to promoting evidencebased practices in Service Delivery<\/a> models. Thank you for the opportunity to testify on the issue, i look forward to answering any questions you may have. Thank you to our witnesses and we will start with five minute rounds within the members. Doctor, id like to start with you please. According to the u. S. Census bureau rural areas cover approximately 97 of the nations land area and approximately 56 of iowans live in the Rural Communities<\/a> and we heard from senator durbin outlining his Rural Communities<\/a>. And your written testimony you highlighted the Substance Abuse<\/a> and Mental Health<\/a> administration worked in those Rural Communities<\/a> and thank you for doing that. Can you describe a key challenge to reducing the impact of Substance Abuse<\/a> use and Mental Illness<\/a> in Rural Communities<\/a> especially when it comes to opioid and if you can also talk about methamphetamine as well. Thank you for the insightful question. I believe the focus is treatment capacity. We do have a great number of providers that need to be in the right places. Treatment capacity is addressed by a variety of different techniques. Telehealth is one of the areas we are exploring to increase capacity to the rural areas. As well as provider expansion, and collaboration the dea has certified a large number of wavered physicians at providers including expansion for Nurse Practitioners<\/a> to mid levels increasing provider limits so they would be able to treat a greater number of patients. Unde have to attack this problem from different angles as well as including primary care colleagues as well. Certainly have a lot of resources we are devoting towards that and we think the congress for the appropriation with a substanceabuse block Grant Funding<\/a> in particular. The block Grant Funding<\/a> can be block Grant Funding<\/a> can be utilized for the treatment of many Substance Use<\/a> disorder. In addition to the grants which also can be used to treat opiate use disorder and any cooccurring Mental Illness<\/a> or substances disorder a great o number of do have cooccurring Substance Abuse<\/a> and Mental Illness<\/a> and funds can be appropriated, are appropriated for that as well. Very good. Mr. Mcdermott, dea is our nations from my defense julissa controlled substances. F Bipartisan Legislation<\/a> support act which combats the Opioid Epidemic<\/a>, and i worked in that measure to strengthen drug takeback programs and their efforts and an increasing disposal of drugs and how can dea work to increase participation in those drug takeback programs . Twice a year they do a takeback and its been very productive. The most important thing i can say is typically when an adolescent is involved with the abuse of opioids could typically starts in the medicine cabinet and thats the most important thing to get out of your house. If we can get the message out and we ar are doing a much bettr job i can tell you now with the participation of tribal areas as well and the addiction rates are tremendous. I was back in the denver area and we covered montana and had serious concerns for the takeback has been very productive and we have more participation from state and local symbols of participation from the coalitions and participation from hospitals, you name it. So we are out there and its been a bit very productive and at the end of the day there is sometimes criticism to say we only get x. Amount of opioids that any amount you take out of your house or off the streets is beneficial. Ranking member feinstein. Thanks very much, madam chair. I believe that the chairman of the committee and i very much believe that fentanyl should be made a schedule one drug and should proceed to do that. I cant believe that in 48,000 Overdose Deaths<\/a> can you in any way, shape or form gives the constituency for those 48,000 deaths . In other words, who is dying, d, what is their age, race. One of the defining features of the crisis is the fact that it cuts completely across racial, economic, geographic and gender lines. A lot of the Drug Overdose<\/a> patterns that we saw in the years past are defined by this crisis because it is introduced into the marketplace into that users in much different ways. Sometimes as it is fixed up a jet lands in the existing drug use population and is sold on the internet perhaps to an unknowing user who thinks that they are just getting opioids from another country. Its a person that doesnt understand or know they are being part of the illicit environment but they are getting a pill can being presented as a counterfeit drug. So it cuts across all racial geographic and demographic lines and thats one of defining features of this. With anyone on the panel not support fentanyl being made a schedule one drug . I assume the answer is yes and armchair, i believe very strongly coming into the chair and i have discussed the fentanyl should be made a schedule one drug as soon as we possibly can. I think 48,000 people dying from it. Can anyone give us a description of the deaths and the majority of usage involved in those deaths . Senator, i can start and then others can fill in if they would like to. One of the things we have seen in the evolution and i think i touched on this in my Opening Statement<\/a> is that in 2006 there was a small outbreak in illinois and was tracked back to mexico. Mexico. It was neutralized an and defend the ball didnt completely go away but it did decrease and it wasnt until 2015 we started to see it as a regular feature in postmortem toxicology testing and drug seizures. By that time, drug traffickers principally from chin china entd the scene and were bringing into the country order for the dark mac through mail. The reason that i say that is because rather than having individuals have to go drug traffickers and make a facetoface cash transaction, it was now able to be diffused across the country and anyone with access to a laptop or the dark lab and crypto currency could have it delivered directly to their house and this speaks to the proliferation of illicit opioids and fentanyl across the country. What was originally started in the northeast as it involved intravenous dru drug use in populations expanded across the country to where we are today. So any newly discovered the fentanyl substance should be added to the controlled substances act i name; but everybody support that . Anybody disagree . Madam chair, i think we have our work laid out for us and i know senator durbin has thoughts on this, but we work to make fentanyl a schedule one drug and try to reverse these deaths. Is there any common denominator of people in the 48,000 racially, economically, age wi wise . Not too many common denominator is. I think some of our state partners that we deal with providproviders a lot of informn and have spoken to perhaps an increase in the Africanamerican Community<\/a> about what he saw and other opioids. The only other common denominator for anyone that has doubted the availability of the drug and availability we know leads to increased first use and first use leads to chronic use with opioids perhaps more so with any other drug. To use for picking a schedule one drug . Yesmen can absolutely. Does everyone on the Panel Support<\/a> taking it a schedule one drug . Would like to comment . Senator, id have to take that back to the department and have i dont want you to get in trouble. [laughter] i would agree. I also would like to take that question back. If you would, i certainly would appreciate an answer because that is where i am going and that is what i deeply believe. Thank you madam chair. Senator grassley. The office of the office of Inspector General<\/a> recently reviewed the deas efforts to control the diversion of opioids. The report did this conclusion, the dea was slow to respond to a significant rise in the use and diversion of opioids since the early 2000s. So, mr. Mcdermott, the Inspector General<\/a>s report states that the department and dea agreed with all the recommendations. How is dea prioritizing and meeting these recommendations . Senator, as we speak today we are working on those. One of them is, there was criticism of dea pertaining to our work plan for diversion investigators. We have changed the works plant and worked with oig and weve implemented their recommendations as we speak today. And thenio i think the next question to you is easy to answer. Would you commit to update congress on the progress of meeting these recommendations . Yes, sir. Okay, thankda you. Last year Congress Passed<\/a> landmark legislation addressing the Opioid Crisis<\/a>. We call that the support act, and proud to have cosponsored and move through the Judiciary Committee<\/a> as chairman at the time. A number of bills that are part of the law. So ms. Liskamm, the oig report states that because the support act is relatively new, the Justice Department<\/a> is quote unable to measure or even predict its effect on the Opioid Crisis<\/a> or deas opioid enforcement efforts. Question, while that may be the case, and maybema legitimately e case, the director of opioid enforcement prevention efforts of the Justice Department<\/a>, thats your position, can you provide anecdotal evidence of success of the federal governments efforts to end the crisis . With respect to the support act or in general . Know, with respect to the sport act. So the dea is implement a number of the acts from the support act come specifically suspicious order database that was implemented october 23 of this year and a note they are still working through through r of other components within the support act to include their work with the database which is been invaluable to the department with respect to her opioid investigations. I can tell you i have seen firsthand how these types of databases have been used to successfully prosecute diversion of opioids, both with dirty doctors to nationwide opioid manufacturers and distributors. We arere working with dea to ensure that we are able to hit those benchmarks with the support act. Since im going to ask this question of the entire panel, and it deals with fentanyl, and i hope it doesnt cross over what senator feinstein asked. Its well known, fentanyl and its dangerous analogues come to the United States<\/a> from china. In april china issued a classwide control of fentanyl analogues, also earlier this year witnesses from dea, the Justice Department<\/a>, ondcp, commented at the Judiciary Committee<\/a> hearing that they aree monitoringey chinas actions and ensuring followthrough. To all of you, what Significant Developments<\/a> at each of your agency show the americanen peope that were winning the fight against chinese fentanyl entering our country . All start with you, mr. Chester. Yes, senator, a a couple ths have come together to bring some tangible outcomes from chinas efforts to schedule fentanyl class. The first one is the president direct appeal to president xi asking them to Class Schedule<\/a> was an absolute game changer. Ambassador branstad leadership and scored nation with the administration and the interagency has been incredibly important. And that resulted in china not only following through completely on f its one make commitment but also taking some tangible steps such as two months ago inviting use officials to the conviction of nine individual, four for trafficking fentanyl from china. Directorgeneral traveled to china in september come spoke with the Chinese Government<\/a> about some tangible steps they cans take moving for to include greater lawenforcement cooperation, greater policy policy coordination and we believe the steps in china are positive i will take us in a path where they will begin to reduce the full fentanyl coming into the United States<\/a>. For the rest of you, if you have an answer, make it short because my time has run out and i dont want to infringe upon the other people. Ms. Liskamm. Just briefly. Its my understanding we see a significant drop off in the amount of fentanyl and analogues come from china through the mail which shows the positive steps that have been taken from chinas classwide scheduling and i would just remind the committee that since the temper scheduling order went into effect we have in the traits in as significant drop off of analogues in this country. I believe theres more than two analogues that event encountered in this calendar year which shows both chinas actions and actions here in the United States<\/a> are working with respect to fentanyl analogues. China right now, one in beijing and the working relationship has been excellent. Do you have anything else to add to be 56 to add . Certainly over a quarter million of the kids have distributed across the country with reversible over 14,000 overdoses. Thank you. Madam chair. Thank you, senator durbin. I want to make sure that the record is clear in 2016 when we had a hearing before this committee we established the Drug Enforcement<\/a> administration and approved the production of 14 billion doses. 14 billion. That meant that every adult in america could take a one month prescription of opioids based on the approved production quota from the Drug Enforcement<\/a> administration. We were in the midst of the worst drugs in the country and opioids driving to fentanyl and heroin. And approving 14 billion of these doses, requested by the pharmaceutical industry. A number of us started asking questions, what is going on here . Why are we producing all of these opioid pills, dramatically more than is necessary for the health of america, as a consequence, mr. Mcdermotts testimony today is that the quota productions have gone down some 55 . I dont know what the exact number is. Im estimating around 8 billion at this point. 8 billion opioid doses a year. What is that equivalent to . Its equivalent to a twoweek dosage for every adult in america. Thats what were Still Producing<\/a> in opioids as we talk about all the consequences of the opioid drug epidemic. And so, mr. Mcdermott, senator kennedy and i said whats going on here . Is the dea paying attention to whats happening with the opioid pills once theyre produced . And the response to me was, senator, if you want us to pay attention, put it in the law and we did and we said from this point forward, when they set the quotas at dea, take into account the deaths in America Related<\/a> to opioids. The diversion of these opioid pills, from the ordinary medical course of commerce and the following. And so we waited to see, mr. Mcdermott what happened and you know the response from the dea, we just cant find that information, we cant take that into consideration. In fact, the dea basically told us, that due to the grouping of drug classes and all sources provided, the data could not be used to estimate diversion for setting the production quotas. What does it take. Host how do we get the dea to acknowledge that 8 billion do doses is more than could be legally used for medical purposes . Senator, thank you for your question. As we feel discussed by the former acting administrator, d. E. A. Realizes that we could have done things differently. Were doing things differently for the last three months. I read your letter and senator kennedys letter and we went over quota again. I assure you its a priority for me and to the administrator to ensure that we have a balanced approach and we are looking at those. If you look at the numbers, i think were doing exactly what you asked us to do. Weve reduced 8 billion, enough for every adult in america to have an opioid dose for two weeks, every adult in america, you think thats a good response in the midst of a drug epidemic . Sir, we work with hhs. We work with fda, we work with c. D. C. And the Attorney Generals Office<\/a> to assure theres adequate medical supply and research to ensure that. And well continue to work with your office to limit those numbers and to ensure at that we have the proper medical supply out there. Lets start with this. If our government doesnt start by a reasonable regulation of the production, fapharma will continue to ask for more and more and more and more far beyond whats medically necessary and far beyond chronic pain and ordinary uses. If the d. E. A. , the Drug Enforcement<\/a> administration is not in on the program, were going nowhere with this conversation and i hope that that changes and soon. Senator kennedy and i put it in the bill and so far, we havent had a chance from the d. E. A. That i think is appropriate. May i ask, the doctor a question. Is there an antidote to fentanyl . In your initial statement, you had mentioned that you had heard anecdotal reports where people had required more than one dose of naloxone as a reversal for opioids. At this time that is our that is our fda approved option. Naloxone has been reused to reverse opioid overdoses and long acting like fentanyl may require more than one dose. Thats why when naloxone has been administered and resuscitated they require adequate medical supervision. And this is what we have now. The scheduling of fentanyl analogs and weve discussed this in a separate meeting. I am not opposed of putting fentanyl analogs schedule, and what im concerned about we dont have an effective antidote to fentanyl and im worried that what were putting on to a schedule one process, which prohibits production in the United States<\/a>, is going to close out the possibility of research into an antidote for fentanyl, which i think should be underway. It would be, i think, ludicrous for us to believe that fentanyl is going to disappear even if the import numbers are coming down. What im asking you to do, all im asking you to do is in putting the fentanyl analogs on schedule one, give us some process so that researchers can look for that fentanyl antidote which could literally save lives today. Naloxone is, i guess, has some value, but really doesnt have the effective application that could make a difference. Mr. Chester, miss liscomb if youd like to respond . Im proud to say omcb, department of justice and health and Human Services<\/a> have been working throughout the sister on the balance youre talking about, controlling substances that are dangerous as they come into the United States<\/a> and allowing adequate researcher access. And we believe we struck that balance and enjoyed working with the committee on this to ensure that as substances are gathered up, that are more than reasonably dangerous and potentially dangerous, that we provide an unprecedented level of researcher access to be able to pull them out of the schedule for Research Purposes<\/a> to do two things, to determine their medical merit as you discussed, maybe the next generation of naloxone or to determine if they have any active effect on the body or theyre not dangerous and they should be descheduled. We believe the work that weve done between both of those departments, actually strikes that balance very, very well, with an unprecedented level of researcher access, but at the same time, an unprecedented level of control for the substances that are dangerous to americans. Lets continue that conversation and thats the balance im looking for, too. Yes, sir, absolutely. Senator blackburn. Thank you, madam chairman, and thank you to each of you for being here. I think you can hear the bipartisan frustration in our voices. We have an issue that continues to get worse not better. In tennessee we have seen an increase in our drug related deaths. Were lets see i, 1837 last year, up to 1776. We know from our nashville Law Enforcement<\/a> community that fentanylrelated deaths are increasing, our tbi director roush has said he is seeing a continued increase, so, it is something that were facing statewide. We seem to have a problem with fentanyl on the streets and in upper east tennessee and we engage regularly, constantly with Law Enforcement<\/a> and the Health Care Professionals<\/a> and this is why we need you all to really collaborate with us in a timely manner, to find answers to this. Senator feinstein and i sat down and talked a little bit yesterday about how drugs and Mental Illness<\/a> and how that affects the homeless issues, which theyre struggling with in california, many of our cities are. So we need to move past these discussions. Weve been at this for a while. Especially with the opioids. And look at what is going to be a coordinated, longterm strategy. Look at how were going to get resources to Law Enforcement<\/a> in some of these hardest hit areas around our country. And weve got a knoxville task force and doj commended them and we commend them for the good work that they are that they are doing, and when it comes to hhs, what are we going to do to promote treatment for the thousands of addicts, people that are caught up in a revolving door situation with Law Enforcement<\/a> . Theyre incarcerated and they are not receiving the treatment that they need. So, mr. Chester, and ms. Liscomb, i want to come to you first. Talk about what youre doing to get resources to Law Enforcement<\/a> and doctor, id like for you to talk a little about treatment and what you all are changing to make treatment and recovery available for physicians. What are you doing to train doctors . What are you doing to educate pharmacists when it comes to this . As senator durbin just said, the number of pills that are in the system and then being able to achieve that balanced approach. People that need it to get it, but then to get the rest of it out of the system. So, mr. Chester, to you first. Miss liscomb to follow and then doctor, and please be mindful of the clock. Ill be very quick, senator. When you talk about resources for Law Enforcement<\/a> from the office of National Drug<\/a> control policy, principally its a high intense Drug Trafficking<\/a> area or high program that find Law Enforcement<\/a> and task forces at the local, state and federal. In a combined effort. In a combined effort, absolutely. The thing about the task forces theyre unique to the particular area and focused on particular drug threat in that area, rather than a one over the country solution. And gives them the flexibility. Yes, absolutely. Miss liscomb . Likewise at doj, we have a number of Strike Forces<\/a> where we utilize the same methodology in combining resources and state and Law Enforcement<\/a>. Like the appalachian strike force. Theyre focused on efforts in the ambulation region and while they have d. E. A. , hhs, oig involved, they also rely on their local and state partners in order to combat the diversion of opioids in those areas. Thank you. This is anchored in evidencebased practices and promoting evidencebased practices through provider. We have two main initiatives, the provider support system which implements data materials into medical School Curriculum<\/a>s, as well as for Substance Use<\/a> disorder, education as a whole and education, we believe that Health Care Settings<\/a> is certainly the place where we can improve our scope for educating the next level and education of providers. And how widely utilized are those programs . 50 i believe over 157,000 individuals have been trained through both programs. Thank you. Yield back. Yeah, senator white house. Thank you very much. Let me start with a question about the Purdue Pharma<\/a> case. I dont know if either of you guys were involved in that from doj, but more than a year ago in august of 2018, senator hassan and i sent a letter to the department of justice asking about why the case against Purdue Pharma<\/a> that was being proposed as a federal criminal indictment out of the Western District<\/a> of virginia, once it got to the political side of the department of justice, suddenly got turned into a misdemeanor prosecution for a fine that in the context of this litigation is not very significant and that operated not against purdue, but against the Holding Company<\/a> so that purdue could continue to do goodness with medicaid and other federal programs. The fact that mr. Giuliani was involved at the same time he was involved with the department of justice on other matters adds an extra odor to the disappearance of this prosecution at the political level. And first of all, id like to try to get an answer to my darn letter of august of to 18. I dont think thats asking too much. Second id like to know what you know about why that prosecution was made to disappear and turn into a misdemeanor settlement. And i can look into that letter, senator. Im not aware of what the status is, but ill be sure to take that back to my colleagues. I was not involved in that litigation so i dont have a lot of specifics to share with you, but i can tell you the department is very actively looking into nationwide manufacture and distributors of opioids. We recognize the role that many of those companies played, including the executives in those companies, and in contributing to the Opioid Crisis<\/a>, and so youre in the multidistrict litigation, right . Youre at least a participant in it if not a litigant. Weve filed a friend of the court letter in that litigation, thats correct. And what assurance can we have that in your role as a friend of the court in the multidistrict litigation, the department of justice will actually take a serious position in favor of the plaintiff when the record so far is that youre calling the right lawyer, you go to the political appointees at doj and your case disappears into a misdemeanor against the Holding Company<\/a> . So as a friend of the court were not a party of the multidistrict litigation, were simply there to provide guidance whether its to the court or the plaintiffs in that case. Which way is the guidance going to go . I think it depends what the issue is and what help they need. I know right now weve been helping with depositions of d. E. A. , either current or former employees. Weve been assisting in pulling together the arcos data a part of that litigation. So supporting the discovery phase and the information gathering phase of the effort . Thats correct, senator. And when you take a position, will the same people who scotched the Western District<\/a> of virginia prosecution be making the decision as to what position the department should take substantively . Im not sure what position the department is going to take, i dont know what the issue is going to be, but i can tell you that and again, reiterate, the department does have open investigations which i obviously cant comment on, but is very actively looking into the space and trying to find our to hold people accountable for their involvement in creating this. I hope you do a better job than you did the last time. The last question i have has to do and this could go to which ever one this is more after technical question. As you heard today. Theres broad bipartisan support for scheduling fentanyl as a an unlawful drug. And all of you seem to agree with that. However, as we go to hhs, this administration says, no, we shouldnt do that because the chemistry in in question is very complicated, and if you ban fentanyl analogs, you will likely get into potentially banning drugs that could actually help with addiction or wi with, you know, response to an overdose. So, it seems to me that the most important thing that you all could do is get the administration aligned behind a program for how we schedule fentanyl without banging into the objections from hhs. Perhaps mr. Chester, you can lead with that because i think youre probably trying to coordinate this effort. Yeah, senator. And we have been. We have been coordinating between hhs and its departments, nida, fda, c. D. C. Is there a common position yet . Excuse me . Is there a common position yet . Yes, there is, the common position was transferred to the committee in department which, as i discussed earlier, is the balance between gathering and when we talk about fentanyl i do want to be clear, i do want to be clear, what were talking about is fentanyl analogs, additions or substitutions for the fentanyl skeleton, reasonably to be in the body, as the substances come in variations of fentanyl and theyre captured. And there would be an unprecedented level of access to be able to access those substances and to be able to do research on them and determine their actual activity and determine if theres medical merit and thats what weve been able to do between the department of health and Human Services<\/a> and the department of justice bringing them together to get an agreement that we have struck the right balance between control and access, and thats what weve presented to the committee. Okay. Well, my time has expired. More to follow. Senator cornyn. Doctor, the we talk about opioids, that includes, thats an umbrella term, correct . It includes Prescription Drug<\/a>s, heroin, fentanyl, its at the universe of what we consider to be opioids . Certainly would include all of those synthetic and natural, opium, heroin, all the way through to Prescription Drug<\/a>s as well. In your experience as an addiction specialist, when people cant get Prescription Drug<\/a>s, do they opt in for a cheaper alternative like heroin, frequently . A subset, subset would. And there are 15,000 heroin related deaths although the numbers are murky, because frequently as several of you have mentioned, you have a cocktail of a variety of drugs, sometimes mixed together, which is which is deadly, obviously. You mentioned naloxone, which is something administered by First Responders<\/a> and others when somebody is suffering a Drug Overdose<\/a>. I think you mentioned there were 14,000 roughly applications of that drug last year successfully, but that just saves the persons life from the overdose at that moment. That does not cure the addiction, correct . Correct. We believe at samsa and most prediction officials believe that treatment would have to continue for an extended period of time. Simply one intervention wont be effective, whether it would be reversing the overdose. And i would highlight that its evidencebased practice and certainly something wed promote as a wonderful option for reversing opioid overdoses. And certainly been a life saver, but my point is, and you just made it as well, that the person remains addicted and needs additional treatment and help, correct. Correct. The treatment should extend on the full spectrum from if the person requires detox, residential, outpatient and treatment has to continue. We know when treatment continues, we have better outcomes. Do they get moved to other drugs like methadone or similar . So, thank you for bringing na up. Medication is the treatment and the cold standard for opioid use disorder. Whether it be methadone, naltrexone, all three are approved medicaids for treatment that have been found to decrease overdose, improve social capital in particular, employment, criminal justice involvement, homelessness. And engage in other treatment seeking behaviors. Reducing hiv spread. So certainly getting patients in treatment is our goal. Youve mentioned chairman ernst and you discussed Mental Health<\/a> issues. Do you see Substance Abuse<\/a>rs who are people suffering from a Mental Health<\/a> crisis who seek to selfmedicate . Is that a phenomenon that you see . That again would be one subset of individuals. Certainly the Substance Use<\/a> disorder and Mental Illness<\/a> are interactive, reinforcing typically when one gets worse, adherence to the other treatment is worse as well. When one gets better and effectively treated it can provide a conduit for the other. Certainly theres a subset of individuals who have cooccurring and Substance Use<\/a> disorders and others that dont as well. Mr. Mcdcdermomcdermott, the source of opioids we havent talked about that much so far is the mexican drug cartels. And the wore border, something that your agency is combatting. I know theres a lot of justified outrage at pharmaceutical manufacturers that overmanufacture and doctors who overprescribe prescription opioids, but a substantial amount of opioids comes across our southern border from the mexican drug cartels, correct . Correct. And the fentanyl transits through mexico from china. Maybe not all, but a substantial amount. Correct. If we want to get serious about combatting the Opioid Crisis<\/a> in america, we have to get serious about Border Security<\/a> and intervening or implant di implant interdicting those before theyre smuggled into the United States<\/a>, would you agree. Yes. And theyre used to subsidize illicit activities like Human Trafficking<\/a>. Is that an accurate statement . Accurate. My time has run out. Thank you to the witnesses before us today. One of the things i wished the. An american had the time to hear is the broader bipartisan trying to 48,000 have died in every state, every level, every senator has gone to funerals, engaged to Public Health<\/a> community and tried to tackle this and broadly shared frustration how slow some processes moving like scheduling fentanyl and how much we have failed is failed to grasp the depth of this. You youre with the d. E. A. . Correct. Im grateful for what d. E. A. Has done across the country, but we lost 400 to overdoses last year, 15 increase over the year before that, an increase before the year before that, an increase the year before that. In a bipartisan effort to do mo more, ive worked with cory gardner from colorado knowing where the drugs are going. As youve heard from several of my colleagues, senator durbin forcefully pointed out that weve had a system that now for years sends literally millions of opioids to towns that have tiny little populations or pharmacies in interdicting that dwrgs would strike me as a pressing goal. You can order a pizza or a package from amazon and know in realtime by text or calls or emails if you want them, exactly where your package is and when its going to arrive. And weve worked with d. E. A. Now for months and months to try and get concensus on whether or not the d. E. A. Wants realtime knowledge of where massive deliveries of opioids that are likely to be diverted are happening. All of us are familiar with the story of a small town in West Virginia<\/a> that ended up with millions and millions of doses for a town that just had a few thousand residents. So if i could, mr. Mcdermott, does the d. E. A. Have the ability now to track shipments of opioids as they move from the manufacturer to the distributor, do you have the ability to monitor that in realtime now . Senator, we do. We enhanced our data so weve done that and we also, as part of the support act, we had the source. Weve been in october of 23rd of this year, we have that coming in. But to answer your question about realtime data, we monthly would be better at this point now. So its not realtime now to answer my question. Its not monthly now. When do you get data about how large a shipment has made to a particular town or pharmacy . By statute, we receive 30 of the manufacturing distributors, 30 on a monthly basis, 70 on a quarterly basis and thats by statute. By statute, the vast majority of data if i were in your shoes as Law Enforcement<\/a> id want and youd get months after the deliveries. Thats correct. So senator gardner and i have introduced a bill, a suspicious data act, to help collect that data and analyze in realtime that youve got knowledge that you can act on, that Law Enforcement<\/a> can act on pharmacies can act on when we see distributors honing in on one town and delivering millions and millions of doses. Last year enough opioids were shipped to my little state of delaware and i bet the vast majority werent on. But 400 took enough to die. One of the issues this has been focused on is three quarters of them died because of a mixture with fentanyl and i commend both our efforts to try and accelerate the scheduling of fentanyl and the steps that china has taken, but theres so much more we have to do. Doctor, let me ask you about the way in which we can and should be innovative around developing new methodologies for treating pain and addiction. Ive also introduced with senator gardner of colorado the effort act which would support Critical Research<\/a> into the signs of opioid addiction. Its passed out of the house and unanimously voted out of the Senate Confirmation<\/a> committee and hope we will see a full vote on it soon. Can you look at which aspects would benefit most from Additional Research<\/a> . Before you answer, weve learned on a bipartisan basis there will be be more funding for the nih and this coming year, where do you think we could make the most impact on opioid addiction with more research . Certainly anchored in evidence, the Research Supports<\/a> all aspects, prevention, prevention efforts certainly have yielded fruit. Treatment with the evidence based practices that we already have, expanding mat is probably one of biggest ones we would promote, as well as Recovery Services<\/a>, because treatment isnt just in the setting and the clinic, but recovery committees. Thats where evidence lies and thats where i would expect the greatest fruit to be yielded. Im also pleased that the outcome, it seems now, that the outcome of our appropriations process will be that omdcp will receive, office of National Drug<\/a> control policy will have a deserved increase in funding and folks, this, as Genuine National<\/a> crisis that demands all hands on deck and all of us engaged in finding the best ways we can to deliver resources for research, for Law Enforcement<\/a> and coordination at the federal and state level. Thank you, madam chair. Senator. Thank you, for the state of missouri, this is a crisis thats been truly devastating. Missouris Life Expectancy<\/a> as a whole has been declining for years on end because of the surge in Drug Overdose<\/a>s, in the surge of death and despair often linked to opioid addiction and other addiction, its taking an enormous toll around the country, but missouri is unfortunately, in many ways, ground zero for epidemic. Thank you for being here and let me start with you. I brought suit against opioid manufacturers, we were the second or third state to do so, its very early on, this has been two and a half years ago, close to three years ago. I understand the Eastern District<\/a> of new york started a criminal probe of opioid makers and distributors. Im wondering if you can give us the scope of that investigation, anything about what you might know where it stands . Unfortunately, i cant comment on open investigations, but i can point you to public indictments of manufacture and distributor executives. As of late, one was the executives of miami luken and the other was a Rochester Drug<\/a> corporation. Where we have made a point of holding the executives in charge of these companies, who have helped contribute to the crisis responsible. I think its important to do. Speaking of executives. Is it hypothetically, is it that some of these companies, some of the major distributors and makers may be investigated and charged. Is that the potential . We will obviously go where the evidence takes us, thats always a possibility. Good, well, im glad to hear that. Im hoping that federal prosecutors will look closely at that. If we are going to be charging opioid and heroin dealers and putting them in prison and we should. We absolutely should. That accountability has to go up the supply chain. I know from our own investigation from the state of missouri the outright deception of some of these pharmaceutical companies, they knew opioids were addictive and knew the data did not support the prescription in the mass numbers that they were being prescribed and yet they deliberately misled the public, sometimes for particular doctors and veterans and other as risk communities, deliberately did so over a number of years and made literally billions of dollars and theres got to be accountability in the law for this. I want to come back to the question of drug smuggling, mr. Mcdermott maybe ill address this to you. In the state of missouri now, the supply of prescription opioids and the black market supply, i should say, is being ratcheted down, which is generally a positive thing. Its a very positive thing. However, what were seeing is drug addiction continues to surge in the state and in the wake of prescription opioids were seeing black market fentanyl as weve been talking about and also methamphetamines. Those products are not produced in the state of missouri and methamphetamines, produced in mexico and comes across the southern border and its no exaggeration to say in the state of missouri every single one of our counties, 114, every single one is awash in Illegal Drugs<\/a> and i mean awash in them. You cannot go into a school in my state and not find these Illegal Drugs<\/a> with a snap of the finger. So tell me about what our latest efforts are on the border and how were doing to interdict the drugs and what we need from congress and its truly, its a crisis for my state. Senator, i was in missouri before i went to headquarters and left and came back and so forth. So i totally agree with you 100 . Were working with cvp. We have some of the highest seizures in the United States<\/a> on methamphetamines and i can tell you the men and women are the Division Work<\/a> for the health and welfare of the state. And you have great professionals there and one of the best supervisors i had went down to your area. So were adding additional bodies as well as when i was the asack there we were able to get Additional Special<\/a> agents assigned to the st. Louis division so i believe that were doing Everything Possible<\/a> to work with our state and local counterparts as well as the department of justice and you have some excellent you have an excellent u. S. Attorney in your state. What more do we need to do specifically on the border, however, and ms. Liskamm, feel free, what happens with the flow of the drugs . We prefer not to have to deal with it in the state and prefer the drugs not to come to the state to begin with and theyre pouring into the state. In springfield, for instance, weve had Record Number<\/a> of overdoses, more in a twomonth period from what looks to be fentanyl and potentially met am m am methamphetamine. What do we need to do to stop the flow across the border. Youre correct the drugs from the Mexican Cartel<\/a>s, methamphetamines, analogs are coming into the country. Right now we have 51 days left and we very much need congress to act on this one point. And so, i think thats the number one request at this point. Thank you very much. Thank you, madam chair. Senator hirono. Thank you. I know that we are here talking about opioid issues, but as mentioned by senator hawley and senator ernst that other states have other problems. And hawaii is mainly still meth so id like to ask you well, let me give you a little bit of data on hawaii. The hawaii high intensity Drug Trafficking<\/a> threat assessment identified meth not opioids as posing the greatest drug threat to the hawaii region. 20122018 the number who died by meth overdoses increased 250 . And the meth problem is it not isolated to hawaii. Data from disease of control and prevention, Overdose Deaths<\/a> nationwide increased fourfold between 2012 and 2016. What resources are your organizations this is for the whole panel, are your organizations committing to address the increased use of meth in states like hawaii and obviously, its in missouri, its in iowa. What Additional Resources<\/a> do you need . Senator, i can start and we can work our way down. At the beginning of this year, director carroll had spent so much time travelling around the country and heard members of congress and realized that we had put so much effort into the Opioid Crisis<\/a> and rightly so, but that wed learned a lot of developed a lot of architecture and put that in methamphetamine and weve worked to get together the interagency and come up with solutions. I had a good conversation with the attorney from hawaii, where its coming from and what the patterns are. Its not only the drug itself, its associated criminality thats deeply affecting hawaii so were working to find tangible solutions, whether that is using grant money that is specifically been for opioids and expanding that to methamphetamine as well. And the Prevention Program<\/a> and the programs are a way that we can understand this is a clear problem across the country and its not geographically located and we can take a lot that we had and apply it as well. Any of the other panelists . Thank you, senator. I echo what mr. Chester said with respect to the grants. There are many grants out there that are focused on the Opioid Crisis<\/a> as they should be, but we have been hearing increasingly that theres a need to get money to help address methamphetamine. Ive also spoken with the u. S. Attorney there and recognized what a huge issue it is in your district. And i just cannot point enough to what is happening with the Mexican Cartel<\/a>s and they have been for several years and continue to produce met amphetamine and the purity rates are through the roof and close to 100 purity. Its an epidemic, something were continuing to work with and i think that the d. E. A. Can speak to some of the programs, but i know that were looking at domestic trafficking routes and how we can best attack the cartels that are bringing this into the country. Do you know how most of the meth coming into hawaii are coming in, through the mail, through our ports, do you know . What i have heard from speaking with the u. S. Attorney there, its coming in through both routes and theyre doing what they can to address it. My understanding is that theres very little opioids in hawaii and that its primarily relatively speaking . Yes, compared to some of the other districts. So were working on ways to help with that office in terms of stopping the flow of methamphetamines into that state. Have any of you come up with anything specific with regard to the stopping the meth coming into hawaii and also what kind of Treatment Options<\/a> or prevention options there are for a state like hawaii . Anything specific . That you can offer . They can speak to the great works theyre doing with the government of mexico to identify some of the labs down there. So currently on two things to answer one of your previous questions, we have these cartels are poly drugs, they provided d. E. A. With funding for over 400 Task Force Officers<\/a> from state and locals that know the air and know whats happening on the street level. So we have pea been able to implement that. It was for the Opioid Crisis<\/a>, however, due to the fact that its poly drugs, theyre working cases that are methamphetamine as well. Weve seen it surge in the task force positions, as well as we have 11 offices in mexico right now. Our primary office is in mexico city and were working with the Mexican Government<\/a> on a daytoday basis to take out methamphetamine labs and were worki working with them on record seizures and target values that are brought back to the United States<\/a> and face justice here. My time is up, but id like to submit a question, its one thing to prevent them and once they get here and especially among young people. Senator kennedy. Mr. Mcdermotmcdermott, it se me that weve got three problems here, people in china are addicting our people in ameri america. People in america are rather, people in mexico are addicting the American People<\/a>. And the United States<\/a> government is addicting the American People<\/a>. Senator durbin talked to you about the current quota being eight billion doses of opioids a year, is that right . By his math, sir, yes. Thats 25 vicodin tablets for every man, woman and child in america. Now, if i take 25 vicodin over two weeks, im going to get addicted, arent i . Probably, sir. Yeah. So we can agree then that the eight billion is too high, right . Sir, i would not agree on that. What i can say is why not . Because it depends on the medical use, sir. I understand. And we know what the medical use is. Its 25 vicodin tablets for every man, woman and child in america. You dont think thats too high . Sir, our quota is based on what we think is necessary for the medical use as well as research as well as exportation. And you think we need every one of those vicodin tablets . Sir, were trying to do a balanced approach. What i can tell you i assure you ill work with your office and mr. Durbins to i want mr. Mcdermott im not trying to be rude. You reach to Point Patience<\/a> ceases to be a virtue. You tell me we need eight billion, thats like nine zeros, doses of opioids per year for the American People<\/a>, 25 vicodin tablets, lets say for every man, woman and child. Thats your testimony, we need every single one of them. Sir, i said the quota is appropriate for what we believe for the United States<\/a>. So you think thats what we need . The quota we believe is appropriate balance for what ive discussed. Okay, i think youre saying yes, is that right . Sir, what i i dont speak bs okay . Youre saying yes, right . Sir, we believe the quota is it appropriate. Okay, let me ask you this. You get information about what pharmacists are prescribing, right . Quarterly and monthly in some cases . No, we get information on a quarterly and monthly basis with the manufacturer and distributors are distributing to the pharmacies. I think we just said the same thing. So if you see that a pharmacy in buck snort, usa, population 1500, just subscribed or prescribed 7,000 vicodin tablets last month, that kind of tells you something, doesnt it . Thats too many, right . And we agree i mean, we can agree thats too many, right . Sir, if we had that data, which is what youre describing is the pdmp data. We have the data that goes to the pharmacy. We do not have the data that goes out. Why dont you get it . We dont have that, we have to get that from the state and if we could ask for your assistance, that would be a game changer. That doesnt seem to me thats complicated. If a pharmacist is writing scripts for 5,000 vicodin tablets in buck snort when there are only 1500 people, weve got a problem, duh. I agree with you. So you send somebody in and you say, mr. Pharmacist, who in gods name is prescribing all this . And then you stop it. If the you dont stop it you punish them the rest of their natural lives. I would agree with you why dont you do that . Because we dont have that data. You dont have the data. You dont have the data. Doc, let me ask you something, now the record up, youre a smart man, yale, howard, youre telling me youve got to go out and educate doctors and pharmacists that if you take too many vicodin tablets youll get addicted . You talked about evidencebased practices. Youre telling me that the average doctor in america doesnt understand that if you give somebody a six month supply of vicodin, they are going to get addicted . Weve got to get educated for that . What were talking about is enhancing medical School Curriculum<\/a>, provider curriculum. Doc, doc. I barely got through the part where you cut up the frog in biology and i know that if you give somebody a sixmonth supply of vicodin, theyre going to get addicted. Why dont we do something to the doctors that are doing this . They dont need evidencebased training, theyve been to medical school. Im over. Senator blumenthal. Thank you, madam chair. I think as you have sensed, there is impatience and anger and even fury about this Opioid Crisis<\/a> and with all due respect, i know that you all are the messengers, youre not the policy makers and you have to take back our message to you and i think you can sense that its one of frustration, to say the least. And as my colleagues have expressed, i dont think its good enough to say, as you have, mr. Mcdermott, well work with you because thats what agencies have been saying to us, and maybe partly the fault is the United Nations<\/a> congress, if so, you should tell us. But this crisis has existed for some time. Its not suddenly reared its head, going back to years ago, connecticuts rate of addiction was rising and so was its rates of death due to overdose in 2018, it was 1,017 Overdose Deaths<\/a> and that number is expected to rise this year between 2012 and 2018, there was a 221 increase in opioid related deaths. Thats in connecticut alone. So i think that there has to be an effort to hold accountable not only the mexicans and the chinese, but the manufacturers and distributors in this country. And senator kennedy raises a valid point and ive raised it numerous times since my four children all had athletic injuries and they were prescribed 30 days worth of opioids and the first thing my wife and i did was tell them they werent getting any of it. And i recently had shoulder cuff, rotator cuff surgery and i was prescribed, i think about the same length of opioids and i didnt even bother filling the prescription. And yet, there are now medical courses, courses in medical schools on Pain Management<\/a>. So the medical profession is recognizing its responsibility and i think that the manufacturers and distributors have to be held accountable, too. And in terms of the conscio consciousness about this issue, i know ms. Liskamm you have prosecuted mexican politicians from cartels, from major cartel heads. In your view has the level of corruption diminished over recent years . I think depending on the country that youre looking at, there are Different Levels<\/a> of corruption and one of the reasons that i spent a great deal of time working on those types of cases is obviously when theres corruption, it allows the cartel to operate in that country sort of carte blanche. But youve seen no diminishment of the levels of corruption in those countries . I personally have not seen a diminishment, but i have not been as actively involved in those investigations in my current role. How do most of these cartels ship their drugs into this country . I can speak from my experience. I have had the opportunity to sit down with numerous members of or i should say former members of the Sinaloa Cartel<\/a> who are now cooperating witnesses, describing routes such as tunnels that they spend a billion dollars to build under the border, and whether using a passenger vehicle or a truck, that has hidden compartments in it to bring drugs in through lawful ports of entry and personally prosecuted cases in could california and which is called a ponga boat, which is a fishing boat, through a maritime method through the coastline. That the cartels are doing everything they can to get drugs into the country and get as much profit as possible. A wall is not likely to stop it is that correct . I dont know. I think they utilize every method possible for them to get into the country. So far youve mentioned tunnels, entry, water routes, none of those would be prevented by building a wall and im not going to press you on this point because i recognize the limits of your appearance here, but i appreciate your testimony and all of those who have been here today. Thank you so much. Senator tillis. Thank you, madam chair. Thank you all for being here. I didnt plan on asking this question, but i think i will start with you, miss liskamm, when we think of this wall on monolithic fence, its my understanding were trying to work on tunnel detection, capabilities and technology, particularly over in california and other parts of the southwest. I believe were talking about updating the legal ports of entry to scanning of vehicles, and structures, and funding coast guard more so they can better beef up their interdiction efforts and secure the border. Do you believe if we were focusing on the identifying tunnels for Illicit Trade<\/a> and Human Trafficking<\/a> and Drug Trafficking<\/a>, having 100 scanning that that would have an impact on drug interdiction . I think the did ept could use every possible tool available to combat the drugs coming into this country and so i think all of the tools that you mentioned, would be beneficial in helping to stem the flow. Yeah, me, too, thank you. Mr. Mcdermott, happy holidays. I actually want to Say Something<\/a> that i think positive coming out of the d. E. A. And it has to do with so many of the scheduling 3 opioids over schedule 2 because they appear to be less addictive. And i appreciate you all on that behalf. Im curious with the data 0 out of your agency. Im not saying it necessarily the same focus, at least at this point with the c. D. C. And other agencies within government. Do we have any idea when they will actually catch up and with some of the policies that you guys have already been moving and trying to provide data, the other describers share senator kennedys concerns. And they emphasize, potentially theyre opioids and theyll provide a gateway. Thank you for that work. What about the rest of government. Whats the progress there to emphasize the less addictive drugs . What i can say, were working on a daily basis with hhs and fda and c. D. C. And doj and omcp as a whole of body government. What we do is ensure what is best for the u. S. Citizen and were working on that and i hear senator kennedy and durbin and assure them well continue to work on what theyve asked us to do. I think we need the agencies to catch up and we need to do work and be commended for it. I dont know who to ask the question and maybe the doctor in the house, but i have a what is its my understanding at least back when i was speaker of the house and North Carolina<\/a> is one of the states that implemented policy to reduce the prescription or prescribing opioids or minimizing the amount that they are prescribed with some sort of oversight and check back. But its my understanding years ago that one of the leading causes of suicide in this country are people who are experiencing chronic pain conditions. Is that still accurate . It is a mange major cause, i wouldnt say its the leading cause. One of the things were trying to balance, if its the only medication that has efficacy around these things, chronic pain, its one of the reasons we prescribe it, would you agree with that. Id say its a thoughtful perspective that individuals with chronic pain in particular, they may develop opioid dependence, but not the other behaviors of substance disorder. The c. D. C. Issued guidelines in 2016 and i believe they will be in process of revising the prescribing guidelines and when it comes to provider education, id like to provide just a little bit of clarity of both the goal it to provide with those with Substance Abuse<\/a> disorder and Mental Illness<\/a>. We try evidencebased practices when it comes to our medical School Curriculum<\/a> for treating Substance Use<\/a> disorder and not just limiting prescribing practices. Thank you, mr. Mcdermott in response to one of senator kennedys questions, you said youd love to get the data from the state you dont have today. Its not like you can just call up the state Health Department<\/a> and say you need this information. You need statutory to do that. What would you would you mandate the state to have the information. Host and that would provide the insight for senator kennedy would like you to have absent congressional action you dont have that . We do know the. We have to go on a state to state basis. As i said i was in colorado and we had to sue the state to get that information. Thank you. Senator leahy. New, and i. Treatment and recovery programs Enforcement Actions<\/a> and as vice chairman of the Senate Appropriations<\/a> committee the bill filed late last night the budget package we have 1. 3 billion as of last night in the fight against the Opioid Epidemic<\/a>. 110 million for Rural Communities<\/a> for opioids respond program. 500 million for targeted research and opioid addiction Pain Management<\/a>. So 31. 9 million for pregnant and postpartum women opioid abuse disorders, 89 million for medicationassisted treatment for Prescription Drug<\/a>s in opioid addiction. So i think that money is going to be a help. If any of you disagree with having that money and that please say so because i think the house members, senators of both parties who worked with me on that. We have a lot of progress for my state of vermont we still have problems the university of vermont that is also in the burlington area and in the rural areas two hours each week for a treatment if the Healthcare Professionals<\/a> prescribed for addiction just like they do medication. Certainly has the treating opioid use disorder we would support any further expansion for all treatments and for vermont one of the first to implement where individuals would initially get treatment at a specialty site then continue had a spoke center so certainly we would want to not only do that but also Telehealth Options<\/a> as well. We appreciate that because that brought our numbers down considerably. Lets Work Together<\/a> on this we can talk and agree on this we have to make sure that it happens the Chinese Government<\/a> took steps to prohibit sentinel coming up on fentanyl targeted sacs sanctions make a difference to fenton now being shipped to north america. Senator we have seed decreased direct from china shipments into the United States<\/a> at the positive step in the right direction but what we do have to watch is if its coming from another country like canada or a european country and an increase in the production of fentanyl in mexico and the southwest border with other plant based drugs we are putting emphasis on that so all chinas actions have had an effect we have to make sure they contribute to solve the problem. You mentioned the importance of written testimony the administration on the task force of all funding including 5 million for the state Drug Task Force<\/a> if these are important and why are they considered critical efforts for the epidemic . Senator im not familiar with those figures but i can tell you that ive mentioned a couple of them the task force and initiative that have come out over the past couple years to stem the tide on this epidemic so im not familiar with that specific grant budget but we are trying to put our resources where we see results. I have some followup questions on that to keep that money in the appropriations bill. Thats where the money has to come it started in the president s budget but its more difficult. Senator kennedy asked for an additional 30 seconds. I know you are new but explained to me in english why every man woman and child in America Needs<\/a> 25 doses of opioids every year. I know you work hard at what you do doctor. I have two brothers who are physicians but doctors need to police themselves. You will not convince me that someone is smart enough to go to medical school doesnt understand that if they give someone a six month supply of vicodin they will get addicted and the doctors need to police themselves. At this time we are ready for our first panel as we set up for the second panel will be the bios of the second panel thank you to our witnesses for being here today thank you very much. With the second panel we have doctor bradley doctor hauser doctor stein is a senior policy researcher for Rand Corporation<\/a> practicing adolescent psychiatry policy researcher at the Rand Corporation<\/a> and as a professor of psychiatry at the university of pittsburgh executive Vice President<\/a> miss kelly oversees all state and federal regulatory and Political Activities<\/a> doctor hauser is the Vice President<\/a> of policy and Government Affairs<\/a> for the National Pharmacist<\/a> association and over 25 years a private consultant in policy issues related to Substance Abuse<\/a> to treatment into the witnesses on the second panel i will ask you to hold your statements to one minute and then we will make sure your entire statement is submitted for the record then we will proceed with questioning after that we do have votes that have been called so quickly go to your statements that would be helpful. Good morning and Ranking Member<\/a> feinstein with the practic seeing child psychologist in pennsylvania many are children of crisis as parents, siblings and aunts and uncles my clinical work is how the Opioid Crisis<\/a> involves analgesics and treatment and touching multiple systems involving Child Welfare<\/a> and Public Housing<\/a> and the systems track very complicated ways to understand these interactions of the unintended consequences if we were to confront this successfully. We have made Great Strides<\/a> with the pain pills for example some chronic pain patients and others have finding trouble finding a new doctor if theres retires that to make sure that these individuals have access to better Pain Management<\/a> as well as treatment. Thank you doctor stein. Good morning for the opportunity to discuss and address the Opioid Crisis<\/a> for the record our industrys primary mention that this effort working with our supply chain partners to regulate our industry and fda and all state regulatory agencies every legitimate entity in the supply chain must be properly licensed and have a valid dea registration look forward to working with committees to address the Opioid Epidemic<\/a> and we look forward to your questions. Good afternoon chairwoman and members of the committee representing the Community Pharmacist<\/a> 22000 independents participating in numerous initiatives it includes evaluating prescriptions adopting electronic prescribing taking part dispose my meds utilizing the pharmacist toolkit advocating for greater access i will summarize my recommendations i think continue dialogue and continued Health Care Provider<\/a> Resources Data<\/a> sharing including prescriber systems the dea pharmacy may not that been updated since 2010 i would encourage them to do so advancing the role of medication assisted treatment and a medicaid provider to expand the disposal offices. Thank you. Thank you chairman and Ranking Member<\/a> and the distinguished members of the committee more of this needs to be focused on prevention this is the most Cost Effective<\/a> way to deal with the epidemic the program meets the reduction of misuse through the implementation that includes those sectors actively involved supply and demand. We train people to implement strategies to reinforce one another including awareness from changing policy and the procedures to change the physical design of the communit community. For those that have undertaken these types of approaches with those Substance Use<\/a> and other metrics that can be transferred from the program to build and maintain that capacity and then to break down silos. I will yield my time to senator feinstein if you want to ask some questions for the second panel. I actually have no questions. Thank you for coming. I just want to ask a question of the distribution chain i used an example at the outset of 4300 people that received two. 7 million opioids. One pharmacy. One pharmacy. We are very pleased wie new functionality that was put forward. Didnt mr. Mcdermott say that its a matter of months before they get the information . It is. Its either monthly, he said 30 there are some d your Distribution Company<\/a> sends mass amounts of opioids to a tiny pharmacy in the middle of nowhere in illinois. By contact . I hope that would mea mean you d contact Law Enforcement<\/a> and save time out, this isnt right, something just happened here we want to report it. Do you feel the responsibility to do that . Theres got to be some people that look and say they delivered what. Our responsibility is to report to the Prescription Drug<\/a> Monitoring Program<\/a>s overseen at the state level so the turnaround time varies, some or every 24 hours but that is the members responsibility to report a. I think we are on a roll call on the floor. I will just wrap up. Youve talked about alternative for the perception of opioids and the barriers that are there for the effective treatment of the misuse. What immediate policy changes to your recommended increase alternatives to prescription opioid medications . I think we need to make sure we are developing, disseminating anit really financially supportg and paying for alternatives both in the shortterm and longterm. In the shortterm we know certain types of procedures such as wisdom teeth being removed, we dont need this. We need to make sure youre using those. For more chronic pain we have things like physical therapy. We need to develop a picture insurance is covering a whole variety of treatments that are effective. Pain isnt going away. It affects 20 of u. S. Adults and in pairs so much they can do their daily activities and we need to be able to manage that. Your testimony if you go through the written testimony that youve provided, there are some powerful prevention success stories. How can Congress Must<\/a> support this type of programs . Thank you so much. Just by exerting leadership and i think its also important that we have more communities that are trained and have the capacity to get those types of outcomes, tiny bits of federal money, 125,000 a year with a dollar for dollar match is basically all that they get. So it is an amazingly great federal resource and as senator coons said, we have a tiny bump up yesterday, but literally for every million dollars, we end up with another eight to ten rounds. I do apologize we are going to cut you short on your panel today. I think other members have all fled to the floor so we will also flee to the floor, but i do want to thank you for your input and input. We do have your records and those are submitted for the record. We will make sure of that and i appreciate the time and attention is given to us. Thank you so much. And we will keep the record open for one week for any members wanting to submit items for the record. [inaudible [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] this holiday week booktv is on cspan2 every day with primetime features each night. Watch tonight beginning at eight eastern on cspan2 and enjoy booktv this week and every weekend on cspan2. This weekend booktv features three new nonfiction books. Stop and think about for a minute. The russians have elected him against all odds to be president of the United States<\/a> and he is a russian spy. Think about that for a minute. Thats like landing a man on the moon, thats like the assassination of julius caesar, like christopher columbus. Thats one of greatest events of World History<\/a> if they were able to actually achieve that. Philosophers have been thinking about fairness for time immemorial. Lots of you thought about things like privacy and the like. They have never had to think about these things in such a precise way that you can actually write them into a a Computer Program<\/a> or into an algorithm. And i realized it was more diverse the night ever known in my Little Corner<\/a> of new jersey, and getting into jazz and starting to read all these other writers more seriously like art, i began to wonder why my friends and night such a narrow perception of the sugar rich cultural tradition and what i thought that my father was some outside of his cultural tradition when in many ways he was just exemplifying it. Watch booktv this weekend and every weekend on cspan2. Next, i discussion on the current political situation in afghanistan. And the role the taliban and other powerbrokers like the u. S. China russia and Pakistan Play<\/a> in future peace arrangements. The Brookings Institution<\/a> hosted this event. Welcome too","publisher":{"@type":"Organization","name":"archive.org","logo":{"@type":"ImageObject","width":"800","height":"600","url":"\/\/ia902804.us.archive.org\/5\/items\/CSPAN2_20191227_130100_Senate_Judiciary_Hearing_on_Opioid_Epidemic\/CSPAN2_20191227_130100_Senate_Judiciary_Hearing_on_Opioid_Epidemic.thumbs\/CSPAN2_20191227_130100_Senate_Judiciary_Hearing_on_Opioid_Epidemic_000001.jpg"}},"autauthor":{"@type":"Organization"},"author":{"sameAs":"archive.org","name":"archive.org"}}],"coverageEndTime":"20240716T12:35:10+00:00"}