Transcripts For CSPAN3 House Hearing On State Efforts To Com

Speemac. [background sounds] subcommittee on Oversight Committee will now here comes the order. It is hauling hearing in china and the public help emergencies, to curb the Opioid Crisis. The premise of todays hearing is to examine states efforts and successes and adjusting the Opioid Epidemics as well as opportunities for future federal support. And just to let everybody know, doctor alexander, the reason why we are Getting Started a little late. The plane was delayed. But now the dr. Is on our way. We will swear in the witnesses when we get to that. If we have to do that later we will. The. [cheering]. Will now recognize the suffering Opening Statement. As i said, today the committee contends his bipartisan efforts to combat the Opioid Crisis. As we know, the countries in the midst of an epidemic unlike any of recent history. According to the centers for Disease Control and prevention, from 1999, 2017, nearly 400,000 people died from opioid overdoses. In 2017, more than two thirds of Drug Overdose deaths involved opioids. The crisis, asked continued to evolve and the challenges that we face have continued to evolve along with it. The first wave of this crisis began in the 1990s, when they were prescribing him pain medication. The second way began in 2010 and it was increased as new to heroin overdoses. Unlike the first two waves, the third wave marked live the rise in synthetic opioids like fentanyl had shattered lives, traumatized families and devastated communities. Now, unfortunately it looks like a fourth wave of the crisis may have already arrived. It weighed epidemic asked fueled a huge increase in methamphetamines use and in 2018, no more than twice as many deaths involving deaths as many increasingly turning up the bus across the country. Given the complexity of the epidemic, and its ability to evolve, state federal and Government Agencies must remain vigilant. To that end, this committee asked taken numerous steps to escape the origins and drivers crisis. So we cant learn from it and try try to get ahead of the next wave. Through committee parents, we have are from state federal agencies and drug distributors about the roles and responses. In the groundbreaking work live the committee uncovered some of the failures led to where we are today. In looking forward we will focus on identifying ways to extend this crisis and bring relief to the millions of americans who are suffering. As part of that effort, our committee asked worked across the aisle to pass Bipartisan Legislation to finally give states the tools and resources needed to help those impacted live the disorder. These legislative packages provide the state millions of dollars in federal funding for response treatment and recovery efforts. And when we have made some progress. The provisional data indicates that the Drug Overdose deaths have fallen for the first time in decades. While the downward shift is welcomed, the crisis is far from over. We must continue to look for ways to bring relief to struggling cities and counties throughout the country. Jason continues on bipartisan efforts. David and day day out, since on the frontlines of this epidemic that kills more than hundred and 30 americans every day. As the epidemic now enters the new decade, they face the challenge of keeping pace of the evolving prices. In keeping with us, and his bipartisan commitment finding solutions for this National Emergency, last september the committee set letters to 16 states requesting information about on the ground efforts to the epidemic. Kemeny asked sought to understand the federal funds actually hit the hardest hit communities. How the use and what strategies have proven to be successful. Today we have five key states that each received a letter in this committee. He states represent the first line of defense against the prices and eat less pivotal roles in recovery efforts. I want to thank all of you for coming today. The states compose a large swath of the country. On the demographics and geography and challenges. , each asked felt the effect of this epidemic. And they all rank as among the highest overdose death rates. In fact each of them have taken a number of steps to curb the epidemic. For example, pennsylvania was able to distribute nearly 13000 get free of charge in 2018. And again in 2019. Thanks to a combination of state and federal funding. North carolina, provided treatment to 12000 uninsured persons things to again to federal funding and rhode island is unable to send medication in the present system resulting in a 62 percent reduction in Overdose Deaths. This is just a few examples of how the states are fighting this epidemic. In helping communities. As Congress Considers future action to address this crisis, all of our Witnesses Today provide important insights on how federal funds are being used to, the epidemic. When efforts are proving successful and what we need to do for further improvement. I think the witnesses for the service and for being here to testify and may have other states. I look forward to hearing how we cant all continue to Work Together to find the desperately needed solutions. With that i am pleased to yell purposes of an Opening Statement. Thank you for hauling this important hearing. Our local communities are suffering on average hundred and 30 americans die every day opioid overdose. There are involved in 47600 Overdose Deaths in 2017. Which accounted for 67. 8 percent of all Drug Overdose deaths. In kentucky, there were 1160 reported opioid involved deaths in 2017. The Commerce Committee asked been set out in its efforts to help combat the Opioid Epidemic. Mother was Committee News investigation for the Prescription Drug and heroin epidemic. The major opioid manufacturers, we have continued to ask questions and get the answers for the american public. When he comes to legislation, the Committee Led the way for the 21st century act. Comprehensive recovery act. , all of these laws which are designed to combat the Opioid Crisis to prevention, and is in treatment and recovery initiatives and protecting communities and bolstering our efforts to fight synthetic drugs what is known. This hearing is the critical opportunity for us to check in with states. Those of the our on the front lines, to see how the federal money on was asked been allocated and spent. While success is they are having, but that also what challenges they are still facing and what additional authorities and resources cant be helpful. Good news is that each state testifying before us today asked seen a decrease in their overdose death rates. Federal assistance is making a difference. In addition states are creating and implementing innovative approaches to combating the epidemic. Examples include expanding efforts to connect people to treatment through ambassador and Emergency Departments, expanding increasing availability of medication assisted treatment. Increasing nonemergency transportation treatment for those in rural areas. Expanding the neonatal Treatment Programs. In efforts to address workforce issues to the initiatives such as different programs running the curriculum. This hearing is the great platform. This is for the state to make a difference in what programs they are working. Not only is the helpful for us in congress as we continue to connect oversight and light display, but also to the state, they cant learn from each other. About new ideas and innovative approaches that cant be implemented. While progress is being made some of the overdose death rates are declining, the direction of National Institute of drug abu abuse, doctor and more, declared this week this country still asked not controlled this addiction problem. Some states, are continuing to see a high of First Responder Emergency Department encounter overdoses. In addition, states are still facing many challenges including a lack of qualified workforce and infrastructure printed and restrictions on funding including restricted to opioids and flexibility to address emerging challenges. In addition, our starting to see polySubstance Abuse and Overdose Deaths. This estate specifically stimulus such as an methamphetamine and cocaine. Thats a going concern printed is been detected in more deaths in opioids such as oxycodone and on cape cod on printed 14 of the 35 states, the report Overdose Deaths on with the bases, math is involved in more deaths than fentanyl. Can do with our partners n this fight. And i will yield back. The chair recognizes the chairman of the committee for five minutes. Todays hearing continues the ongoing bipartisan efforts to combat the Opioid Epidemic with a fuel by synthetic drugs putting people, families and communities at risk. It requires ongoing federal state attention. The states on the frontlines of the National Emergency providing much of the support for those in need. They are our eyes and ears the latest in a series of dreams held on the crisis and the occur from several states including rhode island on the ground efforts to the epidemic and we also hear from federal agencies about the urgent threat of fentanyl. The Committee Conducted bipartisan investigations of opioid distribution practices the energy and Commerce Committee has also been at the forefront passing the legislation that gives our federal state and local partners the tools and resources required to succeed in the fight including three pieces of legislation that would give the funding and support. In 2016 the committee passed the comprehensive addiction and recovery act and 21st century cures act which to mention its a major role in that. They authorize over a billion dollars of state specific grants and help the states bolster evidencebased treatment prevention and recovery efforts. In 2018 the support act was passed and signed into law reauthorizing of specific funding increasing the abusing overdose training and improving the coordination and quality of care. Then in december the house passed hr three that included 10 billion in additional opioid funding. The committee is committed to making sure the communities are receiving the support they need to get relief from the crisis and the states requesting information on how federal funds and put additional hope the congress can provide. Based on the responses theyve taken important innovative approaches to addressing opioid addiction and one of the most effective tools that is available to the states as medicaid. Several states elaborated on the Important Role demonstrating the crisis in response to the committee. The release last week found about 8,000 lives have been saved from an overdose thanks to the medicaid under the Affordable Care act. We want to hear about any emerging trends they are seeking for examples of all states informed the committee they also see an increase in methamphetamine and policy substance. This of course is an alarming trend for threats t of threats e next epidemic and i want to hear how congress can help the states come from this. Thanks to the witnesses in forward to hearing about their efforts. Thank you madam chair for continuing your efforts on this. I dont know if anybody wants my time, but im happy to yield back. The chair recognizes the Ranking Member of the full committee for five minutes. Thanks for holding this critically important hearing as i was preparing for this, i noticed in the county in my district they have a solo alert up for opioid. The two overdoses on average per week in jackson county. They had seven last week but fortunately no deaths. First responders administered in five times last week and they believe that its probably heroine with a pretty heavy dose of fentanyl. The deadly scourge continues. As he per the energy and Commerce Committee in this subcommittee in particular has been at the forefront of the efs to address the Opioid Crisis and Substance Use disorder issues, and weve done a lot of work on prevention and we know we have a lot more work to do. The committee has held hearings on the Opioid Epidemic for nearly two decades from reining in Perdue Pharma to testify in 2001 about the abuse of oxycontin to the bipartisan investigation into the rise of fentanyl, opioid manufacturing, distribution and Substance Use Disorder Treatment industry. They helped inform the legislative work including the comprehensive Addiction Recovery act 20 to authorize the state targeted response of the crisis grant and more in the federal appropriations to boost programs that fight, treat of use and access to Mental Health services. The signing into law in my home state of oregon we have seen the results of 3. 1 reduction in the opioid deaths based on the recent statistics from the cdc. Im pleased we worked together in this space including by continuing work on fentanyl and with this important hearing today examining how states are utilizing the funding and authority provided by congress. But theres so much more we can do together earlier this year energy and commerce published request for information about the Substance Use Disorder Treatment industry. The buildup for the patient investigation that we conduct it in the last congress, and this investigation brought us to the question of what is good treatment, and conversely what is bad treatment which is the central question posed by the rfi. With the billions of dollars we need answers. Yesterday energy and commerce sent a letter to the opioid manufacturers we began investigating together last year in Congress Asking them to complete the reduction to the request. Its critical we fully understand the causes of the epidemic in order to ensure that solutions are the right ones and its important that the answer the questions. We should also hold a comprehensive series of earrings to conduct oversight and implementation of the act for example relevant to todays hearings the act include the info act sponsored that calls for the creation of the public and acceptable electronic dashboard linking to all the nationwide efforts and strategies to combat the Opioid Crisis. The act was designed to meet the specifispecific need of local stakeholders who were telling us despite congress having to vote on record numbers into trouble finding the resources that were available and where they were. Certainly an issue we heard a lot about from mr. Mckinley and others. Its critical in helping those on the frontlines of the crisis and we are concerned about the implementation. In concern fo conference of thet we need to be working on the next wave of this nation to address not only Opioid Crisis but Substance Use disorders and we need to reauthorize the fentanyl band set to expire a matter of weeks in the prohibitions on various forms as broad bipartisan support we should do that expeditiously. Todays hearing is a step to understand the impact of the dollars on the states and i want to thank the witnesses for being here and being part of the equation and i look forward to hearing from you. With i will yield the balance of my time to mr. Burgess. Of course it was under your leadership to the committee that last year we worked on a bipartisan manner to produce legislation that ultimately signed into law by President Trump in october of 2018. And theandy began in the subcome with hearing from over 50 members it was to help the advancement initiatives for those affected by the opiate. You will be helpful in understanding the challenges that we faced continuing the fight against the addiction while ensuring they can manage their pain is important to congress to have hearings like this where we can ensure the effectiveness of the efforts to identify accounts where they exist. I will yield back with a notation that we have to subcommittee upstairs so we will be coming and going between hearings. Jennifer smith is the secretary of the department of drug about the whole programs. Doctor monica, the commissioner and Alexander Scott, i think they deemed you hear from the airport, so congratulations. Shes the director of the department of health and the state of rhode island. The commissioner bureau for Behavioral Health, department of health and Human Services state in West Virginia, welcome, and the deputy secretary Behavioral Health and intellectual development of disabilitys department of health and Oversight Committee<\/a> will now here comes the order. It is hauling hearing in china and the public help emergencies, to curb the Opioid Crisis<\/a>. The premise of todays hearing is to examine states efforts and successes and adjusting the Opioid Epidemic<\/a>s as well as opportunities for future federal support. And just to let everybody know, doctor alexander, the reason why we are Getting Started<\/a> a little late. The plane was delayed. But now the dr. Is on our way. We will swear in the witnesses when we get to that. If we have to do that later we will. The. [cheering]. Will now recognize the suffering Opening Statement<\/a>. As i said, today the committee contends his bipartisan efforts to combat the Opioid Crisis<\/a>. As we know, the countries in the midst of an epidemic unlike any of recent history. According to the centers for Disease Control<\/a> and prevention, from 1999, 2017, nearly 400,000 people died from opioid overdoses. In 2017, more than two thirds of Drug Overdose<\/a> deaths involved opioids. The crisis, asked continued to evolve and the challenges that we face have continued to evolve along with it. The first wave of this crisis began in the 1990s, when they were prescribing him pain medication. The second way began in 2010 and it was increased as new to heroin overdoses. Unlike the first two waves, the third wave marked live the rise in synthetic opioids like fentanyl had shattered lives, traumatized families and devastated communities. Now, unfortunately it looks like a fourth wave of the crisis may have already arrived. It weighed epidemic asked fueled a huge increase in methamphetamines use and in 2018, no more than twice as many deaths involving deaths as many increasingly turning up the bus across the country. Given the complexity of the epidemic, and its ability to evolve, state federal and Government Agencies<\/a> must remain vigilant. To that end, this committee asked taken numerous steps to escape the origins and drivers crisis. So we cant learn from it and try try to get ahead of the next wave. Through committee parents, we have are from state federal agencies and drug distributors about the roles and responses. In the groundbreaking work live the committee uncovered some of the failures led to where we are today. In looking forward we will focus on identifying ways to extend this crisis and bring relief to the millions of americans who are suffering. As part of that effort, our committee asked worked across the aisle to pass Bipartisan Legislation<\/a> to finally give states the tools and resources needed to help those impacted live the disorder. These legislative packages provide the state millions of dollars in federal funding for response treatment and recovery efforts. And when we have made some progress. The provisional data indicates that the Drug Overdose<\/a> deaths have fallen for the first time in decades. While the downward shift is welcomed, the crisis is far from over. We must continue to look for ways to bring relief to struggling cities and counties throughout the country. Jason continues on bipartisan efforts. David and day day out, since on the frontlines of this epidemic that kills more than hundred and 30 americans every day. As the epidemic now enters the new decade, they face the challenge of keeping pace of the evolving prices. In keeping with us, and his bipartisan commitment finding solutions for this National Emergency<\/a>, last september the committee set letters to 16 states requesting information about on the ground efforts to the epidemic. Kemeny asked sought to understand the federal funds actually hit the hardest hit communities. How the use and what strategies have proven to be successful. Today we have five key states that each received a letter in this committee. He states represent the first line of defense against the prices and eat less pivotal roles in recovery efforts. I want to thank all of you for coming today. The states compose a large swath of the country. On the demographics and geography and challenges. , each asked felt the effect of this epidemic. And they all rank as among the highest overdose death rates. In fact each of them have taken a number of steps to curb the epidemic. For example, pennsylvania was able to distribute nearly 13000 get free of charge in 2018. And again in 2019. Thanks to a combination of state and federal funding. North carolina, provided treatment to 12000 uninsured persons things to again to federal funding and rhode island is unable to send medication in the present system resulting in a 62 percent reduction in Overdose Deaths<\/a>. This is just a few examples of how the states are fighting this epidemic. In helping communities. As Congress Considers<\/a> future action to address this crisis, all of our Witnesses Today<\/a> provide important insights on how federal funds are being used to, the epidemic. When efforts are proving successful and what we need to do for further improvement. I think the witnesses for the service and for being here to testify and may have other states. I look forward to hearing how we cant all continue to Work Together<\/a> to find the desperately needed solutions. With that i am pleased to yell purposes of an Opening Statement<\/a>. Thank you for hauling this important hearing. Our local communities are suffering on average hundred and 30 americans die every day opioid overdose. There are involved in 47600 Overdose Deaths<\/a> in 2017. Which accounted for 67. 8 percent of all Drug Overdose<\/a> deaths. In kentucky, there were 1160 reported opioid involved deaths in 2017. The Commerce Committee<\/a> asked been set out in its efforts to help combat the Opioid Epidemic<\/a>. Mother was Committee News<\/a> investigation for the Prescription Drug<\/a> and heroin epidemic. The major opioid manufacturers, we have continued to ask questions and get the answers for the american public. When he comes to legislation, the Committee Led<\/a> the way for the 21st century act. Comprehensive recovery act. , all of these laws which are designed to combat the Opioid Crisis<\/a> to prevention, and is in treatment and recovery initiatives and protecting communities and bolstering our efforts to fight synthetic drugs what is known. This hearing is the critical opportunity for us to check in with states. Those of the our on the front lines, to see how the federal money on was asked been allocated and spent. While success is they are having, but that also what challenges they are still facing and what additional authorities and resources cant be helpful. Good news is that each state testifying before us today asked seen a decrease in their overdose death rates. Federal assistance is making a difference. In addition states are creating and implementing innovative approaches to combating the epidemic. Examples include expanding efforts to connect people to treatment through ambassador and Emergency Department<\/a>s, expanding increasing availability of medication assisted treatment. Increasing nonemergency transportation treatment for those in rural areas. Expanding the neonatal Treatment Program<\/a>s. In efforts to address workforce issues to the initiatives such as different programs running the curriculum. This hearing is the great platform. This is for the state to make a difference in what programs they are working. Not only is the helpful for us in congress as we continue to connect oversight and light display, but also to the state, they cant learn from each other. About new ideas and innovative approaches that cant be implemented. While progress is being made some of the overdose death rates are declining, the direction of National Institute<\/a> of drug abu abuse, doctor and more, declared this week this country still asked not controlled this addiction problem. Some states, are continuing to see a high of First Responder<\/a> Emergency Department<\/a> encounter overdoses. In addition, states are still facing many challenges including a lack of qualified workforce and infrastructure printed and restrictions on funding including restricted to opioids and flexibility to address emerging challenges. In addition, our starting to see polySubstance Abuse<\/a> and Overdose Deaths<\/a>. This estate specifically stimulus such as an methamphetamine and cocaine. Thats a going concern printed is been detected in more deaths in opioids such as oxycodone and on cape cod on printed 14 of the 35 states, the report Overdose Deaths<\/a> on with the bases, math is involved in more deaths than fentanyl. Can do with our partners n this fight. And i will yield back. The chair recognizes the chairman of the committee for five minutes. Todays hearing continues the ongoing bipartisan efforts to combat the Opioid Epidemic<\/a> with a fuel by synthetic drugs putting people, families and communities at risk. It requires ongoing federal state attention. The states on the frontlines of the National Emergency<\/a> providing much of the support for those in need. They are our eyes and ears the latest in a series of dreams held on the crisis and the occur from several states including rhode island on the ground efforts to the epidemic and we also hear from federal agencies about the urgent threat of fentanyl. The Committee Conducted<\/a> bipartisan investigations of opioid distribution practices the energy and Commerce Committee<\/a> has also been at the forefront passing the legislation that gives our federal state and local partners the tools and resources required to succeed in the fight including three pieces of legislation that would give the funding and support. In 2016 the committee passed the comprehensive addiction and recovery act and 21st century cures act which to mention its a major role in that. They authorize over a billion dollars of state specific grants and help the states bolster evidencebased treatment prevention and recovery efforts. In 2018 the support act was passed and signed into law reauthorizing of specific funding increasing the abusing overdose training and improving the coordination and quality of care. Then in december the house passed hr three that included 10 billion in additional opioid funding. The committee is committed to making sure the communities are receiving the support they need to get relief from the crisis and the states requesting information on how federal funds and put additional hope the congress can provide. Based on the responses theyve taken important innovative approaches to addressing opioid addiction and one of the most effective tools that is available to the states as medicaid. Several states elaborated on the Important Role<\/a> demonstrating the crisis in response to the committee. The release last week found about 8,000 lives have been saved from an overdose thanks to the medicaid under the Affordable Care<\/a> act. We want to hear about any emerging trends they are seeking for examples of all states informed the committee they also see an increase in methamphetamine and policy substance. This of course is an alarming trend for threats t of threats e next epidemic and i want to hear how congress can help the states come from this. Thanks to the witnesses in forward to hearing about their efforts. Thank you madam chair for continuing your efforts on this. I dont know if anybody wants my time, but im happy to yield back. The chair recognizes the Ranking Member<\/a> of the full committee for five minutes. Thanks for holding this critically important hearing as i was preparing for this, i noticed in the county in my district they have a solo alert up for opioid. The two overdoses on average per week in jackson county. They had seven last week but fortunately no deaths. First responders administered in five times last week and they believe that its probably heroine with a pretty heavy dose of fentanyl. The deadly scourge continues. As he per the energy and Commerce Committee<\/a> in this subcommittee in particular has been at the forefront of the efs to address the Opioid Crisis<\/a> and Substance Use<\/a> disorder issues, and weve done a lot of work on prevention and we know we have a lot more work to do. The committee has held hearings on the Opioid Epidemic<\/a> for nearly two decades from reining in Perdue Pharma<\/a> to testify in 2001 about the abuse of oxycontin to the bipartisan investigation into the rise of fentanyl, opioid manufacturing, distribution and Substance Use<\/a> Disorder Treatment<\/a> industry. They helped inform the legislative work including the comprehensive Addiction Recovery<\/a> act 20 to authorize the state targeted response of the crisis grant and more in the federal appropriations to boost programs that fight, treat of use and access to Mental Health<\/a> services. The signing into law in my home state of oregon we have seen the results of 3. 1 reduction in the opioid deaths based on the recent statistics from the cdc. Im pleased we worked together in this space including by continuing work on fentanyl and with this important hearing today examining how states are utilizing the funding and authority provided by congress. But theres so much more we can do together earlier this year energy and commerce published request for information about the Substance Use<\/a> Disorder Treatment<\/a> industry. The buildup for the patient investigation that we conduct it in the last congress, and this investigation brought us to the question of what is good treatment, and conversely what is bad treatment which is the central question posed by the rfi. With the billions of dollars we need answers. Yesterday energy and commerce sent a letter to the opioid manufacturers we began investigating together last year in Congress Asking<\/a> them to complete the reduction to the request. Its critical we fully understand the causes of the epidemic in order to ensure that solutions are the right ones and its important that the answer the questions. We should also hold a comprehensive series of earrings to conduct oversight and implementation of the act for example relevant to todays hearings the act include the info act sponsored that calls for the creation of the public and acceptable electronic dashboard linking to all the nationwide efforts and strategies to combat the Opioid Crisis<\/a>. The act was designed to meet the specifispecific need of local stakeholders who were telling us despite congress having to vote on record numbers into trouble finding the resources that were available and where they were. Certainly an issue we heard a lot about from mr. Mckinley and others. Its critical in helping those on the frontlines of the crisis and we are concerned about the implementation. In concern fo conference of thet we need to be working on the next wave of this nation to address not only Opioid Crisis<\/a> but Substance Use<\/a> disorders and we need to reauthorize the fentanyl band set to expire a matter of weeks in the prohibitions on various forms as broad bipartisan support we should do that expeditiously. Todays hearing is a step to understand the impact of the dollars on the states and i want to thank the witnesses for being here and being part of the equation and i look forward to hearing from you. With i will yield the balance of my time to mr. Burgess. Of course it was under your leadership to the committee that last year we worked on a bipartisan manner to produce legislation that ultimately signed into law by President Trump<\/a> in october of 2018. And theandy began in the subcome with hearing from over 50 members it was to help the advancement initiatives for those affected by the opiate. You will be helpful in understanding the challenges that we faced continuing the fight against the addiction while ensuring they can manage their pain is important to congress to have hearings like this where we can ensure the effectiveness of the efforts to identify accounts where they exist. I will yield back with a notation that we have to subcommittee upstairs so we will be coming and going between hearings. Jennifer smith is the secretary of the department of drug about the whole programs. Doctor monica, the commissioner and Alexander Scott<\/a>, i think they deemed you hear from the airport, so congratulations. Shes the director of the department of health and the state of rhode island. The commissioner bureau for Behavioral Health<\/a>, department of health and Human Services<\/a> state in West Virginia<\/a>, welcome, and the deputy secretary Behavioral Health<\/a> and intellectual development of disabilitys department of health and Human Services<\/a> in North Carolina<\/a>, welcome to you. Thanks all of you for appearing in front of the subcommittee today. As you are aware of the the come is holding an investigative hearing and when we do so we have the practice of taking over testimony under oath. Do any of you have objections to testifying under oath today . Let the record reflect the witnesses responded no. We advise you under the rules of the house and the committee you are entitled to be accompanied. Do any of you wish to be accompanied by council . The witnesses of responded no. Iq. What would you please rise and raise your right hand so that you may be sworn in. Do you swear that the testimony you give today will be the truth, the whole truth and nothing but the truth . You may be seated. What the record reflectlet the e witnesses responded affirmatively at all if you are now under oath and subject to the penalties set forth in title 18. In front of each of you there is a microphone and a timer and series of flights. The timer counts down and the red light turns on at the end when youre five minutes have come to an end. Members of the subcommittee my name is Jennifer Smith<\/a> and undersecretary for Pennsylvania Department<\/a> of drug and Alcohol Program<\/a> as well as a member of the National Association<\/a> of state alcohol drug abuse directors. Thanks for your interest we are using the state opioid response funding to promote prevention, treatment and recovery efforts. Acting as the Single Authority<\/a> for Substance Use<\/a> disorder services, my department coordinates efforts with federal, local entities as well as the cross state department. Our ability to orchestrate resources and direct policy during the Opioid Crisis<\/a> has been a crucial component in effecting longterm change maximizing Resources Available<\/a> to the communities. We are grateful for the federal grant opportunities afederalgrae of hopelessness and despair for families and communities. I can say with certainty that this has saved lives. With a population of 12. 8 million, pennsylvania is the fifth most popular state consisting of 67 counties that range from large urban centers to the rural counties. The number tragically doubled to more than 5400 lives lost or 13 deaths per day. They keep the pennsylvanians alike and that meant infusing the molds them into the the communities come implementing handled particles to transfer using overdose survivors from Emergency Department<\/a>s into treatment, expand access to medicaid practices for justification of assisted treatment and launching the 24 7 get help offline. What will it isnt clear it is clear the 230 million in federal funding that the state has received is making a tremendous impact. We have fused the resources and the momentum of the crisis to collaborate, modernizing innovate using dollars across the full continuum. In prevention week reduced opioid prescribing by 25 of developed prescribing guidelines unincorporated addiction content into medical School Curriculum<\/a> and established over 800 Prescription Drug<\/a> paperback boxes across the states. State. In treatment, we established a Standing Order<\/a> and distributed over 55,000 free kids, developed a handled model and expanded treatment capacity through 45 centers of excellence. They offer loan repayments and awarded 3 million to expand we awarded 2. 1 million to expand Community Recovery<\/a> services, developed a website to share recovery stories in desperate hope and awarded the grant funds to build Recovery Housing<\/a> support. In the coming months, pennsylvania will be focused on integrating quality into our four major goals of reducing the stigma, intensifying primary prevention, strengthening the treatment system and empowering sustained recovery. Without the sustained federal funding the collaboration necessary to accomplish these goals will be greatly diminished. Although weve made significant strides in our work i, our worke and we need your help. In terms it test funding vehicles and reporting mechanisms where possible such as utilizing a block grant and continued use of the Single State Authority<\/a> as the central coordinating entity. The continued relationship fostering stigma reduction and integration of services, the entire system of care is a monumental task. We are working diligently and we have made staggering progress. But please dont give up. The longterm success of the program and community depends on sustained funding and support. Two other quick considerations would be to address the stigma in a uniform way across the nation through language and action and seek ways to address the dire workforce challenges experienced by every state. Thank you again for allowing me to share with pennsylvania is having another suggestions for a moving the system forward. I look forward to answering any questions that you may have. Dont worry, we dont intend to give up. You are recognized now for five minutes. Ranking member and members of the subcommittee, thank you for the opportunity to speak with you today. In my role as the commissioner of Public Health<\/a> and as the states chief physician, im dedicated to addressing the epidemic in massachusetts. I commend the congress and federal agencies for funding those working tirelessly on the front lines every day. Our data indicates that in indin massachusetts, our Public Health<\/a> centric approach to the epidemic is working. Im heartened to let you know that from 2016 to 2018, our opiate Overdose Deaths<\/a> have declined by 4 . We continue to focus on prevention and education, the availability, medication treatment, Behavioral Health<\/a> counseling and assisting Recovery Support<\/a>. We have made progress, but its still unacceptable tha but neary 2,000 individuals in massachusetts died from this preventable disease each year. In my clinical practice i care for people with this disease and i never forget that behind these numbers which we will talk about today are real people, their communities and their families. Since 2016, weve been awarded approximately 159 million in federal funding specifically for the opiate use disorder prevention treatment and recovery entries allocated 111 million of those fun. With the expansion and enhancement of the treatment system for datadriven approach that targets high risk, i need a priority population in the spirit of use with the goal of reducing opiate overdoses and deaths. In 2015, governor baker appointed a group that developed an action plan emphasizing the data to identify hotspots and deploy appropriate resources. Additionally the wall referred to as the Public Health<\/a> Data Warehouse<\/a> enabled us to link 28 different data sets across the State Government<\/a> and establish a Publicprivate Partnership<\/a> to maximize the use of the data to study this major Public Health<\/a> crisis. This was unprecedented in massachusetts. So, the approach started with Data Analytics<\/a> and research allowing us to get a deep understanding of who was dying when, where and why so that new investments could be stripped check and impactful. The data lead us to quickly focus our efforts on five key populations of peaceful were still suffering from overdoses and Overdose Deaths<\/a>. Incarceration, communities of color, persons with Mental Health<\/a> and Substance Use<\/a> disorders, people with a history of homelessness and mothers with soviet use disorder. The data showed a rate of Overdose Deaths<\/a> of mothers with disorders was more than 300 times higher than those without. In response, one of the programs was moms didnt care which is currently an hundred federally funded. This innovative approach to a Seamless Integrated<\/a> continuum of care for women with Substance Use<\/a> disorders. It provides access to medication, prenatal and postnatal care, maternity and pediatric care, Behavioral Health<\/a> counseling and peertopeer Recovery Support<\/a> and so much more. We are supporting and expanding our Drug Monitoring Program<\/a> allowing all of massachusetts prescribers enhanced access to this vital system. Why do we have had many successes, we do see opportunities for the federal assistance so we can continue to make progress. This includes funding that is flexible. When funding requires addressing only opiate, the states are limited in the flexibility to address the changing landscape of Substance Use<\/a> disorder. It would enable others to this epidemic such as cocaine and methamphetamine. Additionally, there are currently several values to medication treatments such as methadone into these barriers should be removed. This would allow medication to be regulated or similarly to other chronic disease treatments and available in Traditional Health<\/a> care settings with increased access and reduce the stigma. In conclusion we are grateful to the congress for the commitment to address the Opioid Epidemic<\/a>. Much of the progress can be attributed to federal funding we have received and i encourage the congress to continue the federal funding efforts. This crisis do than to build overnight and it will take time to reverse. Addiction isnt a choice, it is a disease and with support of our federal partners we will build a solution to tackle this epidemic in massachusetts in this country. You are recognized now for five minutes. In the commissioner for the bureau of Behavioral Health<\/a> and the department of health and human resources. And i also serve as a member of the National Association<\/a> of state alcohol and drug abuse. I want to thank you for your commitment to address the crisis without the resources provided by the committee, West Virginia<\/a> would be in a considerably less position. I want to thank you for the opportunity to discuss the importance of the initiative to address the Opioid Crisis<\/a> and impact of the funding made available to promote treatment and recovery for Substance Use<\/a> disorder. It is no secret that West Virginia<\/a> had been ground zero of the crisis with the highest overdose rate. There are winning stories that describe what happened to the state and im sure these efforts have played a significant role draining the resources to West Virginia<\/a> but today i would like to tell you a different story. With your help West Virginia<\/a> has reduced the deficit for the first time in over ten years. With prescriptions and opioid doses have been reduced by 50 while the prescribing has increased by 208 . The capacity had been transformed into the number of people that can prescribe be the morphine have doubled from 243 to 584. Weve increased the number of treatment beds from 197 to 740 records indicate that they are about 85 full at all times. Additionally, nearly all facilities have access to integrated Substance Use<\/a> Disorder Treatment<\/a> in the communities. This extraordinary increase in infrastructure capacity is the result of this second Financial Investment<\/a> of the federal, state and drug federal funds. To distribute the lifesaving and two the rigorous education on the prescribing increased evidencebased pension programs and stood up quickly response to followup on individuals with experience nonfatal overdoses. In addition to these efforts, the state also increased its infrastructure for surveillance and data analysts and this drives all of the decisionmaking. The state complimented the work the federal projects by using the funds and revenue to undertake the development of the projects that expanded the availability of the digital treatment including facilities that specialize in pregnant and postpartum women. The scope of the problem required a Financial Investment<\/a> to respond to the crisis raiding the funds allowed them to balance the need for the interventions and services with the longterm needs to address the systemic issues that serve as an ongoing challenge to the states opiate response. While significant progress has been made, certain barriers and challenges remain. West virginia continues to experience substantial Workforce Shortage<\/a>s and the training related to the stimulants and Substance Use<\/a> the lack of capacity to serve children impacted by the crisis and in addition to concern when utilizing timelimited grandfathers and sustainability of effort and thinking about a bigger and longer Term Investment<\/a> of these are to have increasing availability and reducing Overdose Deaths<\/a>. The predictable and sustained provision of resources is the key to allow the stated providers to play and rely on the commitments and it can be to plan and operate programs that providers are not confident resources will be available beyond the oneyear commitment. It would be difficult to believe West Virginia<\/a> could have accomplished so much without the support of the committee. They have allowed them to have the resources needed to respond to this crisis that resulted in a decrease in Overdose Deaths<\/a> that are down at this point and the records say by 10 to be the financia. The financial resourcee crucial to the continuing success and maintaining momentum ongoing funding for state alcohol and drug agencies to coordinate prevention Treatment Recovery<\/a> services and continue progress while they remain West Virginia<\/a> is a place to address the future challenges and continue its progress. In summary we continue to say thank you to the committee, thank you for your support and for the resources and for allowing us to share what is happening and what is working in West Virginia<\/a>. I would like to recognize you for five minutes. Thank you Ranking Member<\/a> and members of the subcommittee for the opportunity to testify on North Carolina<\/a>s response to the epidemic. On behalf of the 10. 4 million approximately 26,000 have misused prescription orde or ilt opioids im allowed to express my deepest gratitude for your support of funding that has helped us turn the tide on the epidemic. It saved lives got transformed communities and has made the down payment on breaking the cycle of addiction and poverty in the state. Im also grateful to the committed staff of numerous federal agencies for the concerted strategy working across interconnected systems with healthcare, housing, employment and justice. North carolina was hit hard by the justice. In 2016, 1,407 died of an unintended overdose. We were one of the top eight states for deaths. Since the start of the epidemic nearly 100,000 workers have been kept out of the workforce because of opioid misuse alone. Today close to half of the children in North Carolina<\/a> sponsored care systems have parental Substance Use<\/a> as a factor in the out of home placement and of course the human cost for most of the communities and families is immeasurable. The scale of the problem underpins the magnitude for the accomplishment. The response is organized into three pillars. Prevention, Harm Reduction<\/a> and connection to care. These encompass numerous strategies all made possible in the federal funding. Cutting the supply of the prescriptions making access to lifesaving, supporting exchange programs, making addiction medicine the core of the education, partnered with county and local communities, launching intervention at the start of the treatment the time of the reversal coming and blending together the broad efforts to support the housing employment and address the causes of the Substance Abuse<\/a> disorder. With the separate North Carolina<\/a> for the first decline of deaths in five years decreasing 9 between 2017 to 2018. Weve also seen the 24 decline in the prescribing and 20 increase in the number of uninsured individuals receiving treatment. 1 million north carolinians do not have Health Insurance<\/a> and health of the visits to the emergency room are uninsured therefore the highest priority has been expanding evidencebased treatment for those without insurance. We focused on medication assisted treatment providing to an additional 12,000 people. The success is clear but with your help, theres much more wee can do. We can stretch further if its no longer required to obtain a waiver for addiction. Theres no additional waiver required to prescribe the exact same medication being prescribed for other conditions. We should strengthen the focus on just the population to study found exiting North Carolina<\/a> prisons were leaving North Carolina<\/a> prisons were 40 times likely to buy it in opioid overdose in the general population. We are grateful to have recently received the 6. 5 million grant from the department of justice to create these programs and expand the jail based treatments. But we have a long way to go. Most significant would be giving us more time. The same funding over longer windows of time or permanently would allow them to the next wave of the epidemic. That is already pressing as we start to see the rise of Overdose Deaths<\/a> from methamphetamine. Before major federal funding in this epidemic became available, 12,000 people in North Carolina<\/a> have already died. Meanwhile, North Carolina<\/a> shared the Substance Abuse<\/a> prevention treatment block grant hadnt changed in recent years when North Carolina<\/a> was one of the Fastest Growing<\/a> populations growing 9 between 2010 and 2018. Growing the block grant with inflationary cost updated allocation formula would allow the states to make better use of shortterm funding to prevent the next epidemic and save lives. Most of all, safeguarding the Affordable Care<\/a> act is critical to the longterm success of the fightinoffighting the opioid ep. States with higher rates of coverage of more sustainable ways of providing treatment and are able to prioritize their precious federal block grant dollars on the system investments. This is why we are working hard everydaevery day to expand medin North Carolina<\/a>. In closing, i want to applaud the flexibility of much of the federal funding we have received which has allowed each state to respond to its own pressing need. Our strategies are working with our eyes are on the horizon. We appreciate your leadership and i welcome your questions. Doctor Alexander Scott<\/a> you are recognized for five minutes for your Opening Statement<\/a>. Chairwoman, Ranking Member<\/a> guthrie and distinguished members of the committee, thank you for inviting me to join you today to discuss Rhode Islands<\/a> efforts to address the opioid overdose of epidemic. Collaboration between states, federal agencies and federal leaders such as yourselves is critical to our shared goal of preventing overdoses and saving lives. The fish you has taken a staggering toll on my state. Since i became the director of the Rhode Island Department<\/a> of f health in 2015 and Overdose Deaths<\/a> have occurred during this time, more rhode island have lost their lives to Drug Overdose<\/a>s than two car crashes, firearms and fires combined. Almost immediately after coming into office in 2015, governor gina warren Overdose Prevention<\/a> Intervention Task<\/a> force to develop a centralized, strategic data driven comprehensive plan to prevent overdoses. The task force include stakeholders and experts in various fields including Public Health<\/a>, law enforcement, Behavioral Health<\/a>, communitybased support services, education, Veterans Affairs<\/a> and recovery. As a cochair of the task force, ive helped steer the efforts into the four focus areas, prevention, treatment, recovery and rescue or reversal. Weve changed the culture of prescribing and have dramatically reduced our dramatically reduced our prescribing captions Copyright National<\/a> cable satellite corp. 2008 we have a vast, statewide Treatment Network<\/a> in place. We have cultivated a group of certified, peer recovery specialists, who walk side by side with people in recovery. We have put thousands of na locks own kits on the streets and started to give people hope and focusing at the Community Level<\/a>. We have learned that regardless of your race or ethnicity, regardless of your zip code, income, or insurance status, every door for every person should make treatment and Recovery Services<\/a> available. We believe that addiction is a disease and recovery is possible. One prime example is the story of jonathan from east providence, rhode island. Jonathan became dependent on opioids at 16 years of age. At 25, after more than 30 tries, and after reaching depths many of us could not fathom, he was finally able to find, sustain, and maintain a life in longterm recovery. He is now thriving as an expert adviser to the Governors Task<\/a> force and he leads our states recoveryfriendly workplace program. When you talk to jonathan about his journey, he says the opposite of addiction is not sobriety. The opposite of addiction is connection. This is true for every community. Were trying to make the connection and sense of community that brought jonathan and so many others back from the brink a part of every Overdose Prevention<\/a> we put in place in rhode island. We have had some success. After the number of Drug Overdose<\/a> deaths increased each year in rhode island for the better part of a decade, that number decreased by 6. 5 between 2016 and 2018. However, significant challenges remain. Fentanyl related Overdose Deaths<\/a> continue to increase and the opioid conversation must be considered within the larger context of an addiction epidemic that has alcoholism, tobacco use, cocaine use, and other substances involved. We can broaden the scope even further to talk about the Health Implications<\/a> of social and emotional isolation and the need to address the root causes of these challenges in our communities. All of this requires us to look beyond what many believe to be our traditional focus areas in Public Health<\/a>. We need to look at the social, economic and environmental determinants of health which is what makes you healthy and me healthy, factors like access to quality education, fresh fruits and vegetables and reliable transportation. We need to ensure that all children grow up in homes and go to schools where they feel safe, supported and loved, to ensure that people have the houses that are healthy, safe and affordable and to ensure that people have jobs that offer fair pay. This is a part of our response. The efforts and the progress that ive outlined today would not have been possible without the tremendous contributions of congress and the federal agencies you fund. I thank you for that sincerely and i look forward to part neneg to address what lies ahead on behalf of rhode island and on behalf of the state and Territorial Health<\/a> officials where i serve as immediate past president. Thank you. Thank you so much, doctor. Its now time for members to ask questions and the chair will recognize herself for five minutes. As i mentioned in my Opening Statement<\/a> and as many of you mentioned, and thank you, the committee has really been focussing on the Opioid Epidemic<\/a> for a number of years and this committee in the last few congresses i was the ranking democrat, now im the chair, but its been a real bipartisan effort over the years, to help address this crisis and ultimately under, of course, a number of pieces of legislation and the 21st century act which congressman upton and i sponsored we provided the states with a considerable amount of funds to address Substance Abuse<\/a> and were happy to see some of those funds have been used as part of your efforts. Several of you mentioned that we need to give more flexibility to the states to address, i believe, miss smith, you said to address the system, not the substance. Im wondering if some of you can talk about what we need to do to give that flexibility as some of the substances shift . Miss smith, do you want to expand on that a little bit . I would be happy to. Thanks for asking that question. This goes to, in many of your opening remarks, you mentioned about the poly Substance Use<\/a> and the increase in particularly methamphetamine and cocaine that many states across the nation are seeing. I think one of the challenges has been for us with the funding being so focused on opioids, its been challenging depending on the types of programs we want to establish in making sure we were appropriately tying it to opioids, while recognizing some folks who benefit from the program may not identify opioids as their primary substance or identify them at all. Do you think that thats getting more noticeable, that people are moving from opioids . Absolutely. Mr. Kinsley, youre shaking your head yes. Are you seeing that . Absolutely. Were seeing that in North Carolina<\/a>. I think in North Carolina<\/a> the Substance Abuse<\/a> prevention treatment block grant is the only sustainable tool we have to build the workforce and treatment sources for those individuals to go to get ahead of the problem. Dr. Alexanderscott, you talked a lot about what rhode island is trying to do. What about this crisis are you dealing with now that you werent able to see a couple years ago . Are there new things youre seeing now . Certainly the increase in the percent of fentanyl with Overdose Deaths<\/a> is occurring. We are seeing an increase in poly substances, multiple substances involved with Overdose Deaths<\/a> and weve recognized the importance of going upstream more to get at the root causes of what is driving many of the challenges associated with both Mental Health<\/a> and Substance Use<\/a>. Do you think that the language with some of the federal funds youre getting is too restrictive for trying to address some of those issues . There is opportunity to be more deliberate allowing for the flexibility so we can look more upstream and engage more at the Community Level<\/a>. Miss mullins, what would you say the key challenge your state is facing right now with addiction . Right now my key challenge is workforce. I do not have enough people to deliver the treatment that is needed for the statement. We could open more days for prescribers, but we do not have the therapists to be able to support that prescribing. And dr. Bharel, in your written testimony you said that massachusetts utilized federal funding to support expansion and enhancement of our treatment system. Can you tell me specifically about how the federal funds enabled you to do that and what could be done more if you had more flex snblts. Absolutely. Thank you for your leadership in this area. What weve been doing in our Public Health<\/a> approach to this Opioid Epidemic<\/a> is focusing on prevention and intervention but enhancing our treatment system and as has been said before, what were dealing with now, many of us, is trying to build a system in a place that, where for Behavioral Health<\/a> issues in general, for many, many decades have been under funded. Were trying to build up systems is of care so that individuals can get the treatment that they need. We have used some of our federal funds to enhance treatment opportunities, including increasing our treatment beds within our system to over 1200, including increasing training and availability of office based opioid treatments and enhancing availability of methadone. Thank you. I just want to, again, i want to thank all of you for your efforts and let you know this committee and the full energy and Commerce Committee<\/a> is committed to helping make the maximum flexibility. I will remind you in the recent federal 2020 government funding bill, Congress Continues<\/a> to invest 1. 5 billion in state opioid response grants and so in response to the changing drug abuse landscape we allowed them to use this funding for stimulant use but if theres more we can do let us know because we want you to consider ourselves to be your partners with that. I will recognize mr. Guthrie for five minutes for questioning. Thank you very much. Appreciate you all being here and telling your stories and bipartisan you asked a lot of the questions i was going to ask and youve answered them well. One thing i want to get at, flexibility. I remember when we did the markup, our colleague on the committee, bobby rush, i dont know if he had an amendment or just made a point, different communities have different issues and all opioids are in every community, speaking specifically on his, i remember the discussion being on theres x amount of resources, were focusing on here, and as you bring more workers using the money you can you cant always use the opioid money for somebody on another substance but helps you build the infrastructure moving forward and we need to open up and look at that. Thats something we need to look at. Something that was interesting to me is that as we were having a hearing or roundtable, we had a couple that had a son that had passed away, we had some families that experienced that, and they talked about the patient brokering and it just walked away with just appalling there seemed to be not any states that you represent, but he was in a state and was just being sent from one brokerage to another. A couple of you, a couple of straights looked at that and i think dr. Alexanderscott, rhode island has looked at patient brokering. Its my interesting that rhode island certifies Recovery Housing<\/a> and started this certification two years ago. Can you talk about the certification process, why rhode island started it and about how many recovery homes you have certified . Thank you. I will be happy to provide Additional Information<\/a> to support this. Our Sister Agency<\/a>, the department and hospitals, recognized the importance of having social derm neterminants addressed such as housing. Recovery housing is a critical tool for supporting those living the lives of recovery like jonathan that i mentioned earlier. We wanted to make sure that there is a level of quality and standards across all of the recovery houses that were available and this Sister Agency<\/a> in rhode island oversees the certifications to help establish those standards. I can get back to you on the official number that we have of recovery houses that are available, but this has been a quality and datadriven program that we have felt to be critical to supporting this Opioid Epidemic<\/a>. Thank you. Also i think pennsylvania. My understanding in the last year pennsylvania passed legislation that enables the department of drug and Alcohol Program<\/a>s to regulate and license Recovery Housing<\/a> that receives federal funding. Can you talk about why you needed to do this and the effect of it and when it goes into effect . Yeah. Absolutely. I mean i think it was passed by the legislature and our governor for the same reasons that it was in other states like rhode island. We were definitely identifying issues both through parents, through advocacy groups, through individuals who were attending Recovery Housing<\/a> events noticing there seemed to be some inconsistencies with practices and we felt it was really critical to pass some legislation that allowed us to have oversight of these entities. In pennsylvania we dont really know the exact number of current recovery houses operating, we know its in the thousands, and what this legislation will enable us to do is create regulations so any house that receives referrals or funding from state or federal entities will have to be licensed by our department. It wont require that every recovery house in pennsylvania be licensed, but the hope is that folks are utilizing the website that contains the Licensing Information<\/a> to utilize those licensed entities that they know have some level of Quality Services<\/a> and maybe it will reduce business at some of the more scrupulous entities. Thank you. I have a cussen who is a neonatologist and talks about the issue in general when we talk about this and i know that in the for the opioid mother, neonatal absence syndrome, i only have a few seconds, maybe one of you, have any of you used federal dollars for the neonatal absence syndrome and has it reduced in your state . Probably only one of you gets time to answer. Anybody working with that specifically . West virginia is working very specifically to provide treatment to women affected by Substance Use<\/a> disorder. It doesnt the treatment itself sometimes can increase neonatal syndrome with the use of medication assisted treatment but our babies are being born healthier and their birth outcomes are better and were optimistic with continued effort there we can make more progress. Thank you. I yield back. The chair recognizes mr. Pallone for five minutes. Thank you, madam chair. As congress and the committee consider further action on the Opioid Crisis<\/a> i would like to hear more about how federal funds have been used to make a difference and based on the state submissions to the committee which i mentioned in my opening it appears several states have successfully used federal funds to respond to the crisis. Let me see how many i get can through here. Mr. Kinsley, in your testimony you noted federal funding has enabled North Carolina<\/a> to provide treatment for 12,000 uninsured people. In the same testimony you mentioned and i quote, since 2016 when the first of the major federal opioid grants was received North Carolina<\/a> saw its first decline in Overdose Deaths<\/a> in five years, decreasing 9 from 2017 to 18. What factors to you attribute to reducing Overdose Deaths<\/a> and proi providing treatment to people who need it . Thank you. Our focus has been 100 on medication assisted treatment and distribution in communities. I believe the naloxone distribution has been tied to the halt in death and reduction in deaths we have seen and after that important programs that have linked individuals into care have been able to sustain that treatment and move individuals in recovery. Programs like peer support specialists, individuals in recovery themselves, weve placed them in Emergency Department<\/a>s. Weve worked with our local ems providers to actually induct people into treatment so if an individual who has an opioid reversal through an ems visit does not want to go to the hospital, they can actually begin their treatment then and theres a followup group of folks that come out and see those individuals after the fact. Its been a lot of very scaled, very strategic focused interventions like that have moved people into recovery and into the treatment pipeline that have been really important for us in North Carolina<\/a>. Thanks. Let me go to miss smith. I was encouraged here from your testimony that pennsylvanias has witnessed an 18 decrease in Overdose Deaths<\/a> from 2017 to 18. What factors do you attribute the reduction and what are the few key areas that pennsylvania should focus on to continue that trend if possible . I think the keys for us is not all that different, actually. Big focus on getting naloxone into communities, overdose survivors from the hospital into treatment. We had a major issue in our hospitals and Health Systems<\/a> with individuals overdosing and being quickly released back out on to the streets to overdose again, repeated times. I think those two things have been key for us. I think moving forward what we would like to do is spend more time and energy in the prevention space, trying to prevent before we get to worrying about needing naloxone and activating the warm handoff process. Our focus was keeping people alive. Now weve started to get a handle on that, now i think we can spend time and energy really thinking about looking upstream and how do we improve our prevention efforts. Thank you. Let me go to dr. Alexanderscott with regard to Rhode Islands<\/a> response to the committee. You noted that federal funds have enableds the state to improve data and surveillance, expand treatment capacity and support innovations in delivery and treatment. Can you give us some specific examples of how federal funds have helped rhode island in those areas . There are multiple examples similar to what has been mentioned. Since you asked about data specifically, we use data in as realtime as possible. We obtain 48hour reporting from our Emergency Department<\/a>s for any suspected or actual overdose that has occurred. On a weekly basis, we have a crossagency team that assesses where overdoses are, gis mapped across the state and we release advisories to municipalities, Key Stakeholders<\/a> and providers, to focus their areas when the overdoses have increased beyond a certain threshold that allows us to drive out the resources we have based on data in realtime at the local level which is one example. We continue to expand treatment and Recovery Services<\/a> with the intention of meeting people where they are. Going out to reach folks through a mobile recovery treatment vehicle is another example. Thank you. I dont know if i can get West Virginia<\/a> in. Miss mullins noted the states treatment system has been overhauled and much of the positive work to date has occurred and been made possible as a direct result of the federal funds awarded since 2016. Do you want to give us briefly some examples of how federal funds have let West Virginia<\/a> provide treatment and Recovery Services<\/a> particularly in rural and financial disadvantaged parts of the state . Specifically really it has given us the ability to expand our clinical providers who could provide. We now have people in all of our 55 counties able to receive m. A. T. And then we have prescribers in most counties. Thats been the number one success weve really experienced with the federal funds. Thank you. Thank you, madam chair. The chair recognizes the gentleman from oregon for five minutes. Thanks again for the hearing and to our witnesses for your participation as well. I want to start with a question about transportation issues. Its a big problem in districts like mine, just to put it in my perspective mine would stretch from the atlantic to ohio, almost bigger than any state east of the mississippi. At my round tables i heard from a woman, she had to travel five hours in to another state, washington state, just to find a provider to help her with treatment to get her off her addiction. For each of the witnesses whats your state doing to address access to treatment faced by rural patients where theres no local help . If you could be brief on that because i have another one on 42 cfr part 2 i want to get to as well. If anybody wants to weigh in on how to help in the rural areas . Yeah. Thank you for the question. North carolina has 100 counties. We have we are dosing about 20,000 people a day in our epidemic Treatment Program<\/a>s. I think our largest two strategies to address rural access has been first and foremost moving as much care into officebase the outpatient Treatment Program<\/a>s as possible. Thats why we would love to see the data x waiver requirement removed to make that easier. Weve doubled the number of physicians in North Carolina<\/a>. We have a long way to go. Were not going to get largescale otp providers there. Weve been investing in project echo which has leveraged our ability to train providers to give them the support they need to take on these patients. As you know, the act expanded who could administer treatment. Anybody else want to weigh in on this . I would be happy to quickly. So pennsylvania is really fortunate in that we have a large number of opioid treatment providers already in the state. So thats an advantage for us. Beyond that, to assist rural communities, we have a particular ramp grant we call it, rural access to medication, where we are expanding access to medication assisted treatment in rural areas thanks to a grant from the federal government and offered a Loan Repayment Program<\/a> for practitioners in areas that are hard hit by the Opioid Epidemic<\/a> but have Workforce Shortage<\/a>s which you can imagine is mostly rural areas. The commitment for that Loan Repayment Program<\/a> is that you have to have two years of experience treating s. U. D. Patients and commit to an additional two years treating in that area. Okay. I want to move on to this 42 cfr part 2 issue. The confidentiality of alcohol and drug abuse patient records. I heard a lot from providers about how this impacts negatively the Effective Exchange<\/a> of information regarding individual Substance Use<\/a> and Disorder Treatment<\/a> and their other health issues. We passed legislation in the house overwhelmingly to try to address this, protect patient privacy, but allow the right flow of information to medical providers. Tragically it went on the rocks in the senate and i would like to see us renew our efforts here. Can you all tell me briefly, are you seeing patients impabtsds by this . I heard it from providers in my district. Yes, doctor . In massachusetts we provided comments related to 42 cfr and some of the obstacles that produces as we have started to think about what is the next step of what needs to happen to fight this Opioid Epidemic<\/a> one of the issues is around integration with Mental Health<\/a> issues and Substance Use<\/a> issues as well as how to connect that to the medical care that an individual needs and there are many aspects of 42 cfr that are an obstacle there. Others run into this . Doctor . You have a place to be aware of where it may be considered is within the school system, making sure that School Nurses<\/a> and psychologists are able to exchange the information needed to care for children who have Mental Health<\/a> or Substance Use<\/a> challenges. Others want to comment on this . North carolina is fully supportive of modernizing 42 cfr in an attempt to both maintain privacy but also move us to integrated care. I think weight important is that we have to also systemically address stigma to help reduce the systemic exclusion of individuals from employment, housing and Everything Else<\/a> they experience as well. Exactly. Miss smith . He said exactly what i was going to say, that really addressing he was looking at your notes. It has to be the primary concern here. I think its important to protect those individuals who suffer from this disease, but at the same time i dont know how we move to a truly integrated system of care when we treat their records differently. We keep talking about treat them the same as everyone else, as someone who has Heart Disease<\/a> or diabetes, but accept their medical records. Right. I think we need to change that conversation. Which has led to deaths. We need to fix this. I hope we can, madam chair, renew this effort to pass a reform here. I know the administration has done some things, they could within the existing law, but i dont think that goes far enough. This is an issue weve been working on for a long time in this committee and we these to find a resolution. Thank you, madam chair. The chair recognizing the lady, miss schakowskey. Thank you. The opioid Overdose Deaths<\/a> in illinois fell for the first time in five years. The tee crease was likely impacted by the efforts of this committee and congress to combat the Opioid Epidemic<\/a>. But this trend was primarily driven by the decline in deaths among white residents. Today, in illinois, opioid Overdose Deaths<\/a> among black and latinos continue to rise. In fact, my hometown of chicago experienced more opioid Overdose Deaths<\/a> than homicides in 2017. Of the 796 people who died from opioid deaths that year, 400 were africanamericans. As a and a recent study from the american journal of Public Health<\/a>, found that black and hispanic residents of cook county, illinois, were more likely to experience a fentanyl involved overdose than whites. That doesnt square with the sort of Public Perception<\/a> of the Opioid Crisis<\/a> as a white suburban and rural issue. So i wanted to ask you, dr. Alexanderscott, i know you have experience not only in your state, but as the president and former president of the association of state and Territorial Health<\/a> officials, can you tell us how the congress, how we can help states to address the overlooked Racial Disparities<\/a> in the Opioid Epidemic<\/a> . Thank you so much for this question. Its such a critical issue for us. We in rhode island are also starting to take a more deliberate approach at addressing this by really making sure that we have Health Equity<\/a> lens in terms of how we are implementing our Overdose Prevention<\/a> and intervention efforts. We have to make sure that every community that is impacted by this has the opportunity to have access to the Treatment Services<\/a> as well as continue to look upstream to address the root causes that exist. We cannot overlook the social, economic and environmental determinants occurring in various communities. And i appreciate that. Congressman guthrie raised this question to some extent as well. Go ahead. To be able to tackle this. The start is with what you have done which is exposes the fact that different races and ethnicities are impacted by this epidemic in different ways and we have to make sure that we are taking into account the cultural and socioeconomic and environmental influences that are contributing to why we have these different outcomes and focus on addressing the root causes and making sure that funding that you appropriate is able to take place at the Community Level<\/a> and be driven by what the Community Needs<\/a> to make the difference. Thank you very much. Dr. Bharel, your testimony mentioned in your testimony you mentioned that you are focusing on communities of color in your state responses. What does that look like . Yes, thanks for bringing up this important issue. One of our five areas where we found we have seen an increase in overdoses and Overdose Deaths<\/a> is in our community of color. We have been using funds to assist us in those examples. As our Overdose Deaths<\/a> have begun to decline from 2016 to 2017 when we broke down our death data by race and ethnicity, we found that the only groups still with an increasing rate of opioid Overdose Deaths<\/a> was black men. We have rerouted some of our efforts to focus on communities of color. To give you a few examples, we redid some of our prevention campaigns to address different communities and provide them in different languages. Additionally, another example is we have a licensed addiction Counselor Program<\/a> that we have now focused on latino and africanamerican members of our community so that more individuals can be trained and then go back to their communities to provide services. Thank you. I think the statistics are just completely unacceptable in chicago and a lot of metropolitan areas and especially among communities of color and it would be a terrible mistake to go with just this overall data and not look at the particular communities. Thank you for responding to this question. I yield back. Thank you. The chair now recognizes the oh. I wonder if i could offer something for the record as well. I forget . What is . If i could put in the study i mentioned, the geographic distribution of fentanyl involved Overdose Deaths<\/a> in cook county, illinois, and u. S. News world report article titled separate, unequal and overlooked. Without objection both items will be entered into the record. The chair recognizes the gentleman from texas. I thank the chair for the recognition and dr. Bharel, briefly, mr. Guthrie had talked a little bit about patient brokering. I will share with you some of the most troubling testimony we have had in this subcommittee on this issue was from your assistant attorney general i think his name was eric gold, who came and testified to one of our oversight investigation subcommittees about sober homes that were located in other states, so his massachusetts residents would be lured to other locations to have their treatment and, of course, all covered by shusinsurance with n reidentifiable metrics as to whether or not anyone was Getting Better<\/a> and, in fact, i think he shared with us data not only did they not get better but he had a number of deaths of massachusetts residents that happened as a result of being farmed out to a sober home. As kind of followup to his testimony, is there anything that youre the states sort of chief medical officer, is there anything else you can share with us about what he told us that day . Absolutely. So the quality of care that our patients receive in this system is absolutely critical that we all make sure it reaches the highest standards for the vulnerable population. Theres several things we do at the state level. We take seriously our responsibility to license and contract with all of the Substance Addiction Services<\/a> we provide through the department of Public Health<\/a> and through that licensing and contracting authority, which has recently been enhanced through massachusetts law, we are able to set the criteria and have a feedback loop. We also respond to complaints, we do relicensing every two years and can at any time to inspect a site. I will add in terms of sober homes we in massachusetts have a voluntary sober Home Certification Program<\/a> which must meet certain criteria and standards and weve seen improvement and have over 2,000 beds in that system as well. Very good about that. Just to be clear, when mr. Gold came and testified to us, he wasnt talking about sober homes within state or within the commonwealth of massachusetts. He was talking about sober homes that might be in a more agreeable southern climate, not that theres any more agreeable climate than massachusetts in january, im sure, but i never experienced that. But that was the deal, that people would be, again, lured, you can come spend your winter in a sunny location and you all sort of lose control of the situation when that happens. I guess what im asking, are we doing any better as far as being able to communicate between states about when this type of activity happens, when you lose a resident to addiction in another state is there some type of followup thats done on that . I dont have any specific example of a patient brokering to give you. I can have the Attorney Generals Office<\/a> to follow up to see what they can provide. I will say one of the things we need to do in our state if people are leaving is make sure we have the facilities and the appropriate access to care in the state and weve been working hard in that. One really important success that many of us have in terms of crossstate communication is the proipg monitoring programs and ours in massachusetts which providers are required to use before prescribing opioids is connected to 37 other states and washington, d. C. , and that really helps understand care that individuals may have received in other states as well. Of course the whole program was a product of this committee many, many years ago. I remember us working on it. As did we work on project echo when orrin hatch was in the Senate Finance<\/a> committee. Thank you for mentioning project echo. Mr. Kinsley, let me ask you, if i could, addressed the 42 cfr part 2 issue, but do you feel that within your state that your programs are able to share the appropriate addiction medical records so they can coordinate care with people undergoing treatment for Substance Use<\/a> disorder . The simple answer is no. We have invested a lot of resources through peer support and other tools to try to support that coordination of care, care management, et cetera, but theres still a huge limitation and even doctors within the same systems cant easily talk to one another to coordinate care around their patients. I think we should redouble our efforts. We got 42 cfr part 2 reform done on the house floor in 2018. We were not able to survive the senate. When President Trump<\/a> signed the big bill into law, that part was removed. We need to continue to work on that because its critically important. Thank you. I yield back. The chair recognizes the gentleman from massachusetts for five minutes. Thank you, madam chair. I want to thank the witnesses for being here today. Your testimony, i want to thank our colleagues as well on this committee for its attention youre welcome to boston any time in winter. Might not be the warmest, but super bowl rings tend to warm you up. Weve had our share of those. Hopefully might be something you guys can experience some time soon. Well move right along. You said on the Massachusetts Commission<\/a> which in march 2019 recommended exploring the use of evidencebased safe injection facilities or safe consumption sites. These are shown to reduce the risk of infection, improve Public Health<\/a> outcomes and increase outreach to Treatment Services<\/a>. Safe injection facilities are supported by the Massachusetts Medical Society<\/a> and the implementation of these sites is being explored by the massachusetts state legislature. Can you elaborate how the Harm Reduction<\/a> commission came to recommend piloting evidencebased safe injection facilities and as addressed in the report explain why the state facilities do not violate federal law . So thank you, congressman, and thank you for your support of the work happening in massachusetts and around the country. Talking broadly about the Harm Reduction<\/a> Commission First<\/a> to address the safe injection facilities, these were reviewed and the evidence was reviewed and a recommendation was to look at this further through our legislative process and i understand there to be legal barriers both at the state and federal level. Talking about Harm Reduction<\/a> broadly and what we currently have the capacity to do in Public Health<\/a>, weve really been focusing our effort on the high risk populations ive mentioned and one of the important Harm Reduction<\/a> pieces including Syringe Service<\/a> programs, weve expanded those in massachusetts from several years ago to less than ten to over 30 now and ive had markedly good Response Rates<\/a> of not only collecting syringes but also providing Harm Reduction<\/a> services, decreasing infections and connecting people to care. One statistic thats been helpful for individuals is that for every hundred syringes that are handed out, 120 are returned. Really also cleaning out neighborhoods and communities as well. Weve had a focused effort in that as well as outreach to communities at highest risk. Other evidence based treatment strategies such as fda approved drugs are considered the Gold Standard<\/a> for treating those who suffer from opioid use disorder. Doctor, our commonwealths response to the committee indicated that the state has increased access to medication assisted treatment to those who have been incarcerated and reentering the community. Can you describe the types of treatments massachusetts is providing to the incarcerated population and the state and if theres any disconnect, seeing as individuals who are incarcerated lose medicaid once they are incarcerated road blocks that come from that disconnect . Absolutely. Im proud to say one of the areas where weve had a lot of improvement is in treating individuals with incarceration. As i mentioned in my testimony one of our five high risk groups, in fact, we see from our data that when individuals are leased from incarceration, their risk of opioid overdose death is 120 times higher than other individuals, especially in the two to four weeks after release. That data and information really helped us open up dialog in new ways with our criminal justice colleagues and now the department of correction is offering fda approved medication for opioid use disorder as well as a pilot happening in seven of our jail systems. We also are expanding our program both postrelease assistance because as has been mentioned earlier, individuals not only need to be connected to medications when they leave, but also employment and housing opportunities. Thank you, doctor. Mr. Kinsley, a study published this week found that states that expanded medicaid had a 6 overall lower rate of opioid use or opioid Overdose Deaths<\/a> than states that did not choose to expand medicaid. For specific opioids, this rate was as high as 11 more unlike the other four states represented here today, obviously North Carolina<\/a> decided not to expand medicaid. Has that diminished the states ability to provide longterm evidence based options to uninsured citizens . Absolutely. Thank you for the question. We estimate 426,000 people have an opoid or prescription misuse. We have been able to provide treatment to 12,000 uninsured folks. Half of everybody coming into an e. D. Room with an opioid overdose are uninsured. We are digging out of this hole with a teaspoon. We are proud of our progress. Based off the recent report, we estimate 415 north carolinians would be alive today had we expanded medicaid in 2014. Thank you. I yield back. Gentleman from West Virginia<\/a> is recognized for five minutes. Thank you, madam chairman. I would like to enter into the record this letter from the voices from choices. Its a deals with the nonopioid options to treat acute pain. With unanimous consent we enter that. Without objection. Thank you. I guess maybe to focus back on miss mullins on your some of your testimony and first, i want to congratulate for West Virginia<\/a>, the work youve done because like you said, weve been the epicenter of this problem. Weve grown from 52 to 57 deaths per hundred thousand. Its incredible to see. My concern has been from the day one on this, that weve never really understood the contributing factors that have led to abuse. Weve had people in here from nih and cdc, theyll talk about the socioeconomic issues and weve been able to quibble back and forth about theres states like New Hampshire<\/a> that has an opposite socioeconomic contributing factors as compared to West Virginia<\/a> and for years, they were the number two in the country. I would like to i would like to understand more about what were doing about prevention rather than the treatment . From an engineering perspective, when we have a Building Collapse<\/a> or failure, we go back and find out what caused it and then we can fix it. Lets do it so it doesnt happen again. My question back to you, what do you think the contributing factors are . Because i look at, for example and i agree with dr. Scott who said its about connectivity. Im not i want to see how that goes together. Texas has a rate of only 10. 5 to our 57. What are they doing right in texas that we in West Virginia<\/a> or maybe around the country can learn about what are they doing there . Because we know that drugs are coming across. Its not like we dont have access to these illegal drugs. We know where theyre coming from. What can we learn to prevent people from abusing drugs . So i think in terms of contributing factors, West Virginia<\/a> experienced a perfect storm. We had prescribers trying to treat pain. We have individuals in high injury occupations, coal mining and some of the other industries we have in West Virginia<\/a> are prone to accidents. When we had influxes of pills coming into the state. We had easy availability. Those things were how the perfect storm, if you will, got started with lowincomes and people the recession and the Different Things<\/a> that were happening, people becoming frustrated. In my opinion, we have to go further back stream. We have to start with our kids. We have kids in absolute crisis. They are not living with their parents. Theyre living many are living in foster care. Let me interrupt. I would like to have more of a dialog with you about this. Rather than take all the time, there are a couple more things. Im concerned if we dont stops the preveng, dont get into the prevention, were going to see even more neonatal problems with our children. Were going to see the impact its going to have on foster families and foster children and our foster homes as a result of this. So im really curious about how we stop it in the first place or how we mitigate the problem into the future. So let me go to the last comment i would like to hear from any of you on the panel, is that we know one of the Tobacco Settlement<\/a>s that occurred years ago, 9 7 , 97 of the money that came in for Tobacco Settlement<\/a> payments went for nontobacco use. They were used for fixing potholes. They were fixing balancing state budgets. Should we do the same thing . Because i would imagine that were going to see quite a bit of litigation over this opioid and there are going to be federal settlements on this. Is there a role for us for the federal government to try to step in to make sure that that money doesnt go for using potholes and balancing budgets . Is there some way that we can assure it will go for things like prevention or foster care or neonatal, to ensure longterm funding for people that are making investments in treatment . How would you react to a federal involvement in the settlements . Any of you . Thank you for the question. We would welcome the opportunity to have sustainable funding that allows us to really focus on this epidemic cpre hencively and over the long term. Many of us have referenced the importance of stability with the funding, particularly when you look at making sure that the funding can be implemented at the Community Level<\/a>. The Community Entities<\/a> that we are engaged with need to know that the funding thats available to them to address determinants of health and address the comprehensive system will with be in place for a long enough time for there to be an impact. And the improvement that we want to see. So the assistance that is welcomed to help us do that across the board, is certainly to be well received. The gentleman from california is recognized for five minutes. Thank you very much and thank you all for being here and fort incredible work that youre doing in your states. This committee has worked in a bipartisan manner over the last several years to pass legislation to help state implement programs to help curb the Opioid Crisis<\/a> sweeping our nation, but more can and more must be done. While members on both sides of the aisle are committed to addressing this issue, at the same time there are continued efforts not to expand medicaid in some states and even to make access to medicaid more difficult overall. Despite the fact that increased access to care means increased access to lifesaving treatment. In fact, just last week, a new study was published in the journal of the association of the American Medical Association<\/a> found expanding medicaid under the Affordable Care<\/a> act may have saved as many as 8,000 people from fatal opioid overdose. I would like to ask unanimous consent to insert this into the record. Without objection. According to the Kaiser Family<\/a> foundation, another study in 2017, medicaid covered 54 of people who received treatment for opioid use disorders. Despite the words about wanting to increase access to Mental Health<\/a> and Addiction Treatment<\/a>, there are also efforts to roll back the Affordable Care<\/a> act which would eliminate coverage of the essential Health Benefits<\/a> like Mental Health<\/a> services and Addiction Treatment<\/a> and repeal the Medicaid Expansion<\/a>. If we truly want to address this crisis in a meaningful way we need to work to increase coverage, expand medicaid, not take it away. Time after time ive cared for a patient who was overdosing in the Emergency Department<\/a>. They usually come unresponsive and blue. And in the Emergency Department<\/a>, we treat everybody with a lifethreatening illness, regardless of their ability to pay. But once they are stabilized and leave the Emergency Department<\/a>, leave the hospital, they need to find treatment to help them beat their addiction. They need to go to the facilities that offer the programs that receive the grant money and those facilities often benefit if they have the medicaid and if they dont have medicaid they wont go because the Opioid Epidemic<\/a> is an unprecedented crisis states have needed to make fundamental changes to their Treatment Systems<\/a> to compact opioid addiction and Substance Abuse<\/a> disorders. I would like to hear how federal funding has played a role in these systems. Miss mullins, the response to the Committee Notes<\/a> the infrastructure was initially not capable of meeting rising demand for opioid Treatment Services<\/a>. How have the federal funds helped West Virginia<\/a> treatment infrastructure system, including the role that medicaid has played. Medicaid has been a key component. We have used medicaid. With respect approved for an waiver. So we have used that as part of our backbone to pay for Treatment Services<\/a>. But the waiver doesnt enable us to train providers. It doesnt enable to build infrastructure. We use the grant funds to wrap around that waiver and build infrastructure as well as cover people with no insurance or who are underinsured. That has been our strategy to braid those funds together. I dont think we could have done one without the other. According to a recent study, its more wide ily access in states that expanded medicaid. Rhode island and West Virginia<\/a>, two medicaid expanded states both noted in their responses to the committee the importance of federal medicaid dollars and their ability to address the Opioid Crisis<\/a>. You raised in your written statement that medicaid, is, quote, the most important tool in a sustainable response to the Opioid Epidemic<\/a> and would bring 4 billion for health care. How would it help it state. The interconnection that individuals get through employment cannot be overlooked. I remind my team every day they are potentially one drug test away from losing their Health Insurance<\/a> andeneding up in a place they cant pay. North carolina we estimate that 500,000 additional people would have insurance with Medicaid Expansion<\/a>. Those would be our ability to shift to get treatment through medicaid through the 1115 waiver and use resources to build our results. We have done some good work here that we took a step forward. But if we make it harder for people to enroll in medicaid such as repeal iing the medicai expansion from the Affordable Care<\/a> act, repealing the essential Health Benefits<\/a>, by making it difficult for people to enroll like work requirements and actually block granting medicaid, were going to take five steps back. So its very important to keep that big picture perspective in our efforts. I yield back. Thank you. The chair recognizes the gentleman from West Virginia<\/a> for five minutes. Thank you, madame chair. Let me answer a question that mr. Mckinney asked of you all and that was how do we trooet this money. We had the Tobacco Settlement<\/a> and many states. They cated a separate commission. Whatever purpose your individual states might want, i recommend that model to take that lump sum and stretch out to assist in this case it would be with whatever issues you all had with Substance Abuse<\/a>. But that West Virginia<\/a> model has worked well for economic two development in the commonwealth. My district is the area stretched between West Virginia<\/a> and North Carolina<\/a>. And while virginias numbers look better, my destruct does not. I have the side that is heavily impacted and all the areas in coal country and virginia that look like West Virginia<\/a> when it comes to the Opioid Crisis<\/a>. So im concerned about a lot of these issues and were all moved by testimony from time to time in earlier you all had a discussion related it privacy versus medical care. The testimony i remember is the man who came dh to testify it for his brother. Who could not testify buzz he had died. He had licked the opioid problem ask then was in a major car accident. Because the doctors had no idea he had an opioid problem and he was unconscious and could not tell anybody, dont give me the opioids, they gave him the opioid ps he survived the injuries from the accident. He did not survive the reintroduction of opioids to his system. We so we have to work on that problem. I appreciate your testimony. Foster care. You said half of the children in foster care their parent hs some form and it was one of the factors of drug addiction. But you didnt see in the written testimony how many young people that was. Us can get you the exact numbers. We have 12,000 individuals in North Carolina<\/a> than the foster care system. So roughly 6,000. And i thought it was interesting that dr. Alexander r scott and your answer to another question mentioned the School Systems<\/a> and making sure there was money this. I know several families that have first gone through foster care and then adopted children who came out of households that the parents were addicted to various drug, but particularly opioids. And they have significant behavior problems and its taken a lot of efforts. What can can we do to hp our School Systems<\/a> deal with the next generation. They may not have drug problems themselves, but theres lots of behavior problems. In rhode island we have introduced a studenten assistant Services Program<\/a> that allows for counselling, peer recovery and support of both the students and their families. And the ability to have that be be integrated with what the physical Health Services<\/a> are for students in school really will allow for a kpre hecomprehensiv approach to addressing the needs of our youth. Including behavior problems that are a result of being around folks who were using drugs at the time the first couple years. That also be included. That does address the Mental Health<\/a> and behavioral challenges that youth often face. I want to learn about what pennsylvania is doing with its doctor Loan Repayment Program<\/a>. We need more Health Care Providers<\/a> out in our most affected areas. The rule areas, the coal counties that have been affected by this. Tell me about that program some more. Sure, so this was an innov e Innovative Program<\/a> we decided to use our federal funding for. We are a Medicaid Expansion<\/a> state. For treatment dollar purposes, a hot of our patients are medicaid patients. Which means the federal grant dollars, we can use to be innovative and think of creative ideas. So we have done some housing things. We decided how do we address the workforce issue. Its an issue all aloss the cross the nation. We decided that you had to be practicing in an area with high opioid use. You had to have at least two years of experience treating patients with Substance Use<\/a> disorder. And you had to commit to an additional two years in order to make good on that loan repayment. Have you had the program long enough to know if the doctors or Health Care Providers<\/a> stay after their additional two years . Two years has not lapsed. I look forward to getting that information in the future. My time is up. Ill be happy to share Additional Information<\/a> a about how many we have granted. I yield back. I thank the gentleman. The chair recognizes the gentle lady from New Hampshire<\/a>. I just want to say thank you to you for your leadership in my seven years in congress this is one of the best and most productive hearings i have been at. Its an honor to be on this committee. Im the founder and cochair of the Bipartisan Opioid Task<\/a> force that has close to 100 members. Just to give you a sense of the scope, New Hampshire<\/a> was hit very hard along with West Virginia<\/a>. Perfect storm situation. But what im proud of is that New Hampshire<\/a> has innovative models coming out of the Opioid Epidemic<\/a> and, yes, indeed we need to include methamphetamine, cocaine and the rest. And i want to focus in on a particularly vulnerable population and a marly, pensive population. For the taxpayers, for the communities, and for individuals personal lives. And that is the incarcerated population. Where we know that at least 65 in some of our counties as high as 85 of our incarcerated population have cooccurring Mental Health<\/a> and Substance Abuse<\/a> issues. One of my big ahha moments in the last seven years was to discover that something that passed Congress Many<\/a> years ago at the inception of medicaid called the medicaid inmate exclusion caused people to lose coverage and lose the funding for health care, namely Mental Health<\/a> treatment, during that poord of incarceration. New hampshire is a Medicaid Expansion<\/a> state, thank god, given the discussion today. But literally, the day you fwo in, you lose your coverage. And to me, if we were to design a system that would fail american taxpayers, families and communities, it would be this system. Because what happens is people live with very, very high recidivism rates. We are the taxpayers. And we have people in incarceration get nothing treatment for martheir Mental Health<\/a> disorder. When they come out, we all act shocked they go back to their addiction. Were not shocked that they go back to their diabetes. We shouldnt be shocked they go back to their addiction. So i have trood legislation that we call the Humane Correctional Health Care<\/a> act. What this could do is continue medicaid coverage during incarceration so we can ensure treatment for Substance Use<\/a> disorder and mental healillness what happens that we have already demonstrated in New Hampshire<\/a> is a kramatic drop in the resit is Virgin Islands<\/a> rate. From 50 to 60 down to 18 . And left, right or center, thats saving lyes and saving taxpayer dollars. Im pleased that you agreed to join today. Quickly moving on to questions, dr. Scott, 2016, i know rhode island implemented a statewide Treatment Program<\/a> for opioid addiction within your department of corrections. Id lo to share with my colleagues. But can you just explain the overall decrease in Overdose Deaths<\/a> and what the outcome so far of that program has been. Thank you for that question. The key to the program has been making sure that we have all three fda approved medications. We also allow for screening of of all incarcerated inmates. That was made vanl to them. The final key is making sure that prior to release from incarceration, they are connected to one of our communitybased Behavioral Health<\/a> agencies. They become a client in advance and make sure that once they are released, they are able to have a warm handoff directly to continuing to receive recovery and Treatment Services<\/a> at the Community Level<\/a>. Thats one of the key components for our programs as well. So as i continue to build bipartisan support for this legislation, id love to work with you and others. Its the barriers to rofr ri, so people can be successful in their lives, get back to raising their children, get back to work, get back to paying taxes. So thank you. I yield back. I appreciate this hearing. Gentle lady from indiana is recognized for five minutes. Thank you so much to you and the Ranking Member<\/a> for holding this really important hearing. Im really pleased that we are focusing once again on opioids. Some of the most important work that i have done in my time here in congress, and i want to thank each of you and particularly all the states that responded to the committees questions. It really is wonderful to see all of the progress and all of the efforts that each of your states are making. I think while its not getting much Media Attention<\/a> anymore, there was a period of time the last few years where opioid issues were on the front pages and on tv all the time. And its not anymore. Its fallen off the radar. Of the american people. Except for those families and those professionals and the people who were dealing with this day in and day out. So i really want to thank you for your work. You want to focus, go become to the workforce issues. Because all of this whether its prevention, whether its treatment, whether its the work that you all are doing, if we dont have the workforce, and i say workforce even beyond physicians and addictions, we need to stay focused. My friend across the aisle from illinois and i introduced the workforce act. And its meant to raise the cap on graduate medical residency slots by a thousand more residencies across the country. To an addiction medicine. I know i have spoken to Iu Med School<\/a> in indiana. I represent indiana and i u with the challenge tried to put more emphasis on addiction medicine at all levels. Whether its in nurse iing you t to back to start the Loan Repayment Program<\/a> and learn if any other states are doing that. The Smith Building<\/a> on what my colleagues said, you wanted to say a little more about loan repayment and i want to do lightning rounds to find out if your states are doing it. If not, why not. Yes, so quickly to add, i was able to find the data here in my notes. We made 91 awards to individuals from 23 different counties that totalled 4. 7 million for that program. And it was a combination of both practitioners. More of the clinician level and then 1. 8 million for actual medical professionals, which uncollude physicians assistants and physicians. We tried to capture the full range of professionals as parking lot of that program. The second round of awards is currently out. So applications are being submit ed to us for a second round of awe warding for that program. Do you plooef if we inb creased the number of resident den b sit the slots in addiction medicine, would that will helpful . I do. Your state . Thank you for this important attention to the professional training. In massachusetts, we were the first state to develop voluntarily all four medical schools core competency ises that were standardize d for all medical students that was quickly taken up by all of the three dental schools and our nursing programs. Training over 8,000 individuals in a standardized way to balance the needs of Pain Management<\/a> with the potential for opioid misuse. So its enhancing the capacity for individuals to treat this medical illness. One of the challenges with med schools is in the past they have given little time to addiction medicine and pain issues. Are they starting at the first year now in r your med schools . The trick with our Core Competencies<\/a> is we allowed each medical school to create the curriculum the way they needed to based on what the curriculum is. So they imposed it in multiple ways. But that allowed to do many a matter of weeks because the Core Competencies<\/a> were broad enough. We know from graduating medical students that they are seeing the difference and feel more prepared. Thank you. Were very excited. We just did a Loan Repayment Program<\/a> this year. We had over 100 applicants, i think 102. We funded 22 of those applications. With a twoyear requirement to practice within the state. That was focused on therapists because so much of West Virginia<\/a>s existing Loan Repayment Program<\/a>s focus on the medical, the physician, so we reallyed something to focus on the therapy level. But in addition to that, we also provided about 154 scholarships, which with the same types of requirement that eliminated the front End Investment<\/a> and some of the Student Loan Debt<\/a> as well. Very briefly. Swl we have a Loan Repayment Program<\/a> for doctors and midlevels. We have worked to train 900 residents and 4 of the 5 medical schools built the training into the core curriculum. Thank you. And with the chairs indulgence if we can get rhode island to answer. Our program has also expanded to include Behavioral Health<\/a> providers and our medical school does now incorporate the data waiver training into our medical School Curriculum<\/a>. So as students graduate, they automatically have the data waiver to be able to prescribe. Thank you all for working so hard with your institutions. Critically important. It will make a difference. The gentle lady from florida is recognized. Thank you for calling this hearing on the Public Health<\/a> epidemic. And thanks to all of our expert witnesses for everything that youre doing to help families deal with the dire consequences. In florida, we have lost well over 5,000 of our neighbors per year. And while im really proud of the work of this committee passing of 21st century and the addiction and recovery act and support act, there is one glaring problem that has been highlighted by a few of my colleagues here today. Thats the lack of continuity of care and resources in the minority of state this is have not expanded medicaid. North carolina has not expanded medicaid. I believe the other states have. Your written testimony you noted that for every sing is the person who is brought to the Emergency Department<\/a>, nearly half has no Health Insurance<\/a> at all. Further you stated that, panding medicaid would bring an additional 4 billion into North Carolina<\/a> for health care. All of the democrat you can members of the florida congressional delegation yesterday sent a letter back home. Its the opening day of the florida legislature. And our message to the governor and to members back in florida was that youre not doing right by our citizens. One recent study said if florida expanded medicaid, we would draw down almost 14 billion for our state over the next five years alone. It would improve peoples health, it would improve access to health care and do so much for families who suffer the consequences of the Substance Use<\/a> disorder. Talk to us again about how expanding medicaid in North Carolina<\/a> would allow the state to target federal grant dollars to address the Opioid Epidemic<\/a>. Thank you for the question. At present, more than twothirds of the federal state opioid response grants that receives are just going for treatment. And thats a laudable and notable purpose for those dollars. But we do not have those dollars available to building the workforce. To increasing the way that our system works together and coordinates care. Instead we are expanding treatment because we dont have Medicaid Expansion<\/a>. The state legislature reopened and reon conveniented today around a budget thats not been able to be passed. Primarily in the debate of Medicaid Expansion<\/a>. I hope were able to increase access in North Carolina<\/a>. Other recent studies have shown that now 37 states plus the district of columbia have expanded the other states that havent, were sending dollars to and subsidizing the budgets and health care of other states. How many lives have you saved in pennsylvania because pennsylvania expanded medicaid . In pennsylvania as a result of Medicaid Expansion<\/a>, we have been able to trooet about 125,000 additional patients. So for us, thats huge. I can tell you with the large amount of funding over 230 million coming to the state, if we did not have medicaid expand, youd not be hearing me talking about a Loan Repayment Program<\/a> about housing, about expanding and corrections. About any of those things. Because the reality is we would be spending all of those dollars just on a plain old treatment. So as a result, we have been able to repurpose those dollars in ways that allow us to modernize the system, to integrate with physical health, Mental Health<\/a>, Behavioral Health<\/a>, altogether in one system moving forward. So i really cant stress enough the importance of having participated in Medicaid Expansion<\/a> and certainly hope it continues. How about you in massachusetts . Pz. Its evidence based. We have been able to tackle the very charging and complex issues related to that care. Preventing disease in the first place. Making sure at highest risk. How important to Substance Use<\/a> treatment. You talked about the predictability of care and the predictability of those. Its very important in terms of sustaining. I talked about the infrastructure we have been building without medicaid paying for residential treatment. Theres no way to sustain those valuable services. And according to my note, we have over 21,000 West Virginia<\/a>ns receiving medicaid assisted treatment in our state. Thank you so much. Gentleman from maryland is recognized for five minutes. Thank you, madame chair. Thank you to the panel of witnesses. Very compelling testimony today. I thank you all for coming. We have learned, of course, that its unappropriate prescribing practices and number of you have spoken to that today. We know that many states such as virginia, maine and rhode island have set limits for opioids. Dr. Alexander scott, as part of the response to the addiction crisis, r your state enacted regulations in 2017 that limited the initial prescription of an opioid to no more than 30 morphine milligram equivalents per day. Pz do you think the policies have been successful in steering providers to make better prescribing decisions . Thank you, congressman. We had data that the higher the morphine equivalents for the longer period of time, the higher the risk of becoming addicted to opioids over time. And thus their risk of an overdose. We wanted to make sure theres flexibility for the provider in determining what was needed for the patient and we also thought it critical to distinguish between acute pain and chronic pain in limiting the opioids prescribe prescribed. So by cut cutting off the mme at 30 for acute reason for pain, we have seen a substantial decrease in the number of opioids prescribed for an initial use of pain. Marly r for scenarios. We have chose ton handle chronic pain needs separately because often times people already have an addiction or tolerance to opioids that require a multidispciplinary approach to addressing that. Let me drill down on that a little bit more. Us know the cdc in their recommendati recommendations has indicate d they should avoid prescribing over 90 a day. And many states have put that kind of recommendation into code. I think nevada and South Carolina<\/a> have limited prosecutions. Theres a lot of products on the market etc. Peshlsly long acting products that do exceed that. So us understand that the products are spended for patients who have become opioid resistant, as you mentioned to these lower dose products. But do these high dosage opioids pose enough of an overdose risk that we should at least begin to explore methods to limit their market availability in your judgment . We have considered that in our regulations approach for acute Pain Management<\/a>. In addition to the 30 morphine milligram equivalents limitation, we have also required that long acting opioids are not used for acute pain in those scenarios as well. Because of the challenge that can occur. And again, distinguishing from those patients that already are dealing with chronic pain and would need to be handled separately. Thank you. The fda has taken previous action to limit the use of these high dose products and um posed a risk evaluation in medication Strategy Program<\/a> on providers who prescribe these products. Us also know there was a recently released study on this topic that failed to find any evidence that the rems program was actually successful at achieving those goals of reducing and prescribing. Given the recommendations, precedent on prescribing limits, the lack of existing action, it may be time for fda or congress or both of us to explore options for limiting the market availability of high dose opioid products that are currently on the product and limiting the products. So thats something i look forward to exploring a wide array of solutions. Gentleman from new york is recognized. Thank you to our panel for interesting and helpful conversation. If your testimony, many of you hit on a topic thats near and dear to my heart. Thats eliminating bureaucratic and unnecessary barriers to Substance Abuse<\/a> treatment. Research has shown that individuals being actively treated lower their risk of overdose by up to 50 . Even when provided without responding psychosocial supports or services. With any other medication that lowered mortality by 50 , we would be hailing this as a miracle drug and doing everything in our power to get out to anyone who could need it. Unfortunately, here in the united states, we continue to make it harder to obtain these medications than the powerful opioids that got us into the problem in the first place. So secretary smith, i was pleased to see that in your testimony, you called for the elimination of the requirement for providers to obtain a waiver from the dea to prescribe depend. I have trood the mainstreaming addiction act with over 100 cosponsors to do exactly that. Can you describe why this is such an important step to take in expanding access to Addiction Treatment<\/a>. Absolutely. Thank you so much for correspondesponsoring that legislation that we are fully supportive. So i mentioned earlier in my opening that we have expanded our dea exwaivered physicians to over 4,000. And we are near the top of the list when you lock at states in terms of number of physicians. But looks can be deceiving. So when you actually take a look at those 4,000 waivered doctors and you lock at what are their pribing capacities, and thn whether or not they are actually prescribing up to their capacity or not, its pretty staggering. So we have a very large percentage who are still at that 30 patient capacity level. And most of them are not even prescribing 30 patients. So we have worked with an Organization Called<\/a> vital strategies to design a survey thats going to go out to all 4,000 physicians in the state to ask specific questions about why they arent treating more patients. Would they be willing to treat more patients. Is it an education issue. Is it a barrier because of additional oversight. So anecdotally, we have definitely heard that efforts to overregulate is what they often say. Doctors who were trained to administer any and all kinds of medication, but to specifically call out this kind of medication and say you need a special waiver to administer this. They dont want to be bothered with that. So pennsylvania believes that anysteps we can take to eliminate the barriers to change the conversation that treating addiction is a clinical necessity and we rely on trained physicians to be able to provide that treatment. If us could have the rest of the panel respond yes or no, do you agree with the assessment made by secretary smith . The access and decreasing the barriers is critical. We spoke about it in our testimony. Do you agree with the waiver . Yes. I want to use my time here. Yes, but we dont have the therapists to really support those physicians once they are the Workforce Shortage<\/a> is way more impacted on the therapies and the counselling side. Yes, were supportive. Yes, we support and look to expand the Services Available<\/a> as well. Many of you also mentioned individuals released from incarceration as a population particularly vulnerable to opioid overdose. Noting that the justice population has a death rate of 120 times higher than a general population. I heard your exchange with my colleague from New Hampshire<\/a>. So while federal grant opportunities such as the Medication Assisted Treatment Initiative<\/a> are helping to fill in some of the gaps, a more comprehensive and sustainable strategy is required. Therefore, i have championed the reentry act to allow states to restart benefits for incarcerated individuals 30 days prior to release providing a funding stream for medication assisted treatment, Case Management<\/a> and Recovery Support<\/a> services and creating a seamless transition back to community care. Commissioner, would allowing the states for eligible individuals 30 days prior to release help to reduce Overdose Deaths<\/a> for that population . Making sure theres a continuity of care is critical. Pz. Thank you. I have exhausted my time. With that, i yield. I thank the gentleman. Thank you very much. I thank our Ranking Member<\/a>. We have heard a lot of encouraging stories from the states today about how they would be able to put federal funds to use and make progress. But its also clear theres still unmet needs and unresolved challenges that states face as they work to address the ongoing crisis. Id like to explore some of the remaining challenges as we consider further support. In your testimony, you noted unresolved challenges around building a robust Addiction Treatment<\/a> workforce including attracting and retaining people to work in rural areas throughout the state. Can can you describe the steps the state has undertake skpn what additional hurdles remain. Theres multiple challenges for this. Its a per vvasive Workforce Shortage<\/a> in all areas of employment in West Virginia<\/a>. We do not have enough people to fill our vacancies. But it also is about a parody in terms of what we pay our workforce thats not the same. When students graduate with debt, they are graduating with levels of debt that cannot expect to earn salaries that are commensurate with their levels of education. So to me, thats a fundamental thing we must address. And the Student Loan Debt<\/a> to go with it. So we really have been focusing on those Loan Repayment Program<\/a>s, scholarship programs, anything that we can to really increase our pipeline. But also to provide the ongoing education that we can. Were finding that our individuals that are entering recovery have a strong interest in providing services. So were paying particular attention in our Loan Repayment Program<\/a>, even to persons who might be in recovery and wishing to take those next steps to enter the workforce. Is there sml at the federal level that can be helpful in sort of underguarding and helping to unearth individuals who would move into that line of work. Secretary smith n your written testimony, you also referenced the lack of additional treatment workforce and noted that demands on Addiction Treatment<\/a> workforce will increase as more people move towards treatment and recovery. So can you describe how the lack of workforce has inhibited pennsylvanias ability to provide services to vulnerable populations and what steps have your state take ton address the problem given that more people are moving toward treatment and recovery. Our workforce challenges particularly in urban centers like philadelphia and pittsburgh have really inhibited the ability for vulnerable populations to access treatment. To give you an example, we have an Advisory Council<\/a> that advises my department. One of the members is a practicing addiction medicine physician who happens to also treat adolescent ises. But hes part of the la ttino community. His practice is so overwhelmed with patients that hes working well into the night beyond his Office Closure<\/a> offihours becaus those individuals have nowhere else to go. And so part of the challenges that we hear in building a workforce where you dont have kmooun indication barriers, where you have doctors who are treating patients that really understand them and communicate with them, a lot of the challenges come down to the education and training requirements. Some of those language barriers that exists in being able to meet those requirements. Very well. In North Carolina<\/a>s response letter to the committee, the state notes that, quote, in many of North Carolina<\/a>s communities hard e hardest hit by the Opioid Epidemic<\/a>, its difficult to implement programs and recovery access because the community lacks basic infrastructure including broadband and cell phone service. So can you describe how broadband and Cell Phone Services<\/a> are important to helping North Carolina<\/a> address the Opioid Epidemic<\/a> in these communities and what more could congress do to overcome this challenge. Thank you for the question. Its a key strategy for our efforts to expand access to treatment. Yet many parts cant sustain a signal digitally. And so without those, were not able to sustain those services. That is built on the fact that its a sustainable approach for education, for all these providers, for parody, i agree with what my colleagues have said. I have run out of time. Dr. Scott, i have a question for you but i will submit it if your response at a later time. Id like to ask for this letter from new york state. Cob added to the record. Without objection. I yield back. The chair recognizes the very patient mr. Willeder for five minutes. Thank you, madame chair. Thank you for letting me today. This is a really important and relevant topic. One of the major newspapers in the state of ohio yet had an article that just came out. But we know in 2009 we had 1,423 people die of overdoses in the state of ohio. That number went up in 2017 to 4,854. And the trend right now is going down. But these are all deaths we dont want to see. Pz when i have gone around my district, when im talking to my providers, one of the things they were telling me for several years is we cant find help. And its everything from finding the tlars to finding where think that can get services. So in the last congress, i introduced the act that established a dashboard through hhs so they could go out there and find help. And what id like to ask you all today is questions tooz whats going on in your states f i may. And if i could ask everyone, i dont have a the lot of time. Maybe be brief on your answer. Some of your states have developed public dashboards. When were these create d and wht information do you have in them. We just go right down the line. I will be as brief as possible. Pennsylvania has an interactive dash board. Youre able to act seas zest that. It contains information like overtoes deaths, distributions, ems leave of behinds, treatment statistics ask the number goes on and on. So happy happy for you to check that out. What information do you have contained in them . It was established about two years ago. Youre welcome. Thank you for the question. Massachusetts put out a dashboard that contains the same information using a predictive model as well as town by city. So all 351 towns and cities get a report on the number of deaths in their communities so they can do local based planning as well as ems and health care data. We also since 2015 have put together for the first time data across State Government<\/a>. So were looking for the First Time Health<\/a> data as it relates to Public Health<\/a> but also criminal justice schools. Thank you. So for West Virginia<\/a> over the last couple years, we have been use i using reports uploaded quarterly that highlight Overdose Deaths<\/a>, prescription monitoring and things we have been focusing on. We do that quarterly. We we expect to upload and make public a dashboard that tracks nonfatal deaths and overdoses. And stay tuned. Were really looking forward to releasing that this week. Thank you. North carolina launched its opioid action plan dashboard in 2017. Its around the Opioid Epidemic<\/a>, but it broadens into other Substance Abuse<\/a> disorder. It allows to drill down in their community, which we have seen as being incredibly powerful at aligning us to the same strategies and getting foundations andntties, private Public Partnerships<\/a> on board with focusing dollars in the same way we need to focus. The other thing is all of these caters relate back to strategies. Similar to whats been heard in rhode island when the governor activated the prevention and intersengs task force, we understood that having a dashboard would be critical to that. That was activate d in the 2015 timeframe. Our dashboard does serve as metric for each of our Strategic Initiatives<\/a> on prevention, recovery, reversal. And treatment. And also allows for the public to be able to access where Treatment Services<\/a> are, as well as access to other service ises that are needed. My last 15 seconds, if i can ask real quick. Have your communities had a problem finding those federal tlrs out there to get that help. Yes and no. Mostly no because of the way the procurement system has worked and the capacity to put data in the community to know what problems they are seeing and can ask for the appropriate funding. Its targeted. I would go with secretary smiths answer. Many people have no trouble, but there are still some folks out there troubling to find that information. We have been able to deploy funds r for 50 local communities. Our issue is primarily bewet dont have enough funds because they are going to augment treatment. We use a datadriven process to target which communities need it most and are looking given its rhode island to make sure that every town is and city has access to the services needed. Thank you very much. I want to thank you for allowing me to be here today. I want to thank all of our witnesses. One of the members said this was one of the best hearings we have had this session. And i agree. Its really excellent and very good information as we move forward to see what our next steps are. In response to the committee, the Committee Received<\/a> responses from 16 states regarding how the states addressed the Opioid Crisis<\/a> for federal funding. I move to enter all of those responses into the record and in addition, were going to enter them all from florida, indiana, kentucky, massachusetts, new mexico, new york, North Carolina<\/a>, ohio, pennsylvania, rhode island, tennessee, West Virginia<\/a>, wisconsin. Without objection, those will be ordered. In addition, in continuation of our bipartisan work looking at addiction and treatment issues today, the committee is sending a bipartisan letter signed by the Ranking Member<\/a>, myself ask others, letters to the dea, dhs and hhs about the merit r jens of what this panel was talking about. Methamphetamine and Substance Use<\/a> and what the administration is doing about this. And i would ask unanimous consent to enter those three letters into the record. Without objection, that will be ordered as well. And the chair would like to remind members that pursuant to the committee rules, they have ten Business Days<\/a> to submit additional questions for the record to be answered by the witnesses. Several of the members did ask the witnesses to answer additional questions. I would ask all of you to respond promptly if you seth any of those questions. With that, this subcommittee is adjourned. Today house managers will walk the articles of impeachment into the Senate Chamber<\/a> followed by a reading of the articles. John roberts will be sworn in to preside over the trial. And all 100 senators will take oaths as jurors. Senate historian Donald Richie<\/a> spoke about the oath taken by senators during the 1999 clinton impeachment trial. At this time, i will administer the oath to all senators in the chamber with article 1, section 3, clause 6 of the constitution in the Senate Impeachment<\/a> rules. Will all senators now stand and raise your right hand. To you swear in all things pertaining to the trial of the impeachment of William Jefferson<\/a> clinton, president of the united states, now pending, you will do impartial justice according to the constitution and laws so help you god . The clerk will call the names and record the responses. So a question. Every sing is the member of the senate takes an oath what they take office . Why is there a special oath for this . The constitution requires a special oath. It requires that it be different from the oath they take. The constitution only spells out the oath that the president takes. The oath that the Congress Takes<\/a> is a note that congress itself has written. And other officials do. But theres a sense that this is something different. Its not a legislative day. Youre presiding over it. Its the chief justice of the united states. This is to remind everyone that this is not a daily political business of the senate. It is a trial. And they are, in a sense, senator r jurors. They are not completely jurors. But they are not completely senators. They are both. They have to keep that in mind. This is one way of trying to impress it on them. The impeachment of President Trump<\/a>, watch unfulterred coverage of the senate trial on cspan 2 live as it happens and same day reairs. Follow the process on demand at cspan. Org impeachment. And listen on the go use iing t free cspan radio app. Skrrcspan 3 is life now at nan pelosis weekly news conference. Just a day of after she is announced the house managers for the trial against President Trump<\/a>. This is live news coverage. Here at our table, a republican of nebraska, congressman, lets begin with the story in the Washington Post<\/a> this week. The president plans to divert additional 7. 2 billion in pentagon funds for the border wall. Congress controls the Purse Strings<\/a> and youre on the commit that decides where money should go. Are you concerned about this . Are you okay with the president deciding to divert this money . Well, first of all, good morning, greta. Good to see you again. Thanks for having me on the program. This was a topic of discussion as we worked through the appropriation process. Theres 12 bills and it takes the bulk of the bill, sometimes it doesnt get done and theres a threat of government shutdown. That didnt happen this year. There was an aggressive effort by democrats and republicans to try to find common ground. A part of the earlier discussion was that there was going to be limitations on how the president could potentially use wall funding from other sources. Those were lifted. They were not part of the deliberations and we moved forward. So theres a court case about this. The court has stopped another court has stopped the injunction. Its going to move forward. Listen, Border Security<\/a> is important to americans. There are really four components to trying to have a just and vibrant immigration system and the first part of that is Border Security<\/a>. You cannot have chaos and disorder at your border and then allow for a just and compassionate system to develop. There are other components of this that involve interior enforcement and a reworking of our immigration laws so that they are modernized and updated. But when people can come here illegally and we dont have the resources to be able to handle that, it is unfair to people who are waiting in line and who have used the legal system to try to come here. So as difficult as the situation is on the border, its actually gotten better. And some type of barrier security has to be an important component of that. So the president then has not promised that mexico would pay for it . Well, look, im here to talk to you about immigration policy or anything else that you want. The reality is that we have a new agreement with mexico and this is actually helping reduce the number of border crossings. I was just there last summer during the tsunami when our Border Patrol<\/a> was basically overrun by so many people needing help. And i went to see what the realities were and people were treated humanely. The issue of children being separated from families, children are kept in another place when they are not with a parent basically. I was there when a 2 month old baby had to be taken into custody because it may have been smuggled across the border. So this is a difficult situation and there are problems that are going to occur when you have that many people trying to come over the border. But our Customs Officials<\/a> and Border Patrol<\/a>s are doing the best they can. Go morning, everyone. How are you","publisher":{"@type":"Organization","name":"archive.org","logo":{"@type":"ImageObject","width":"800","height":"600","url":"\/\/ia802800.us.archive.org\/11\/items\/CSPAN3_20200116_131500_House_Hearing_on_State_Efforts_to_Combat_the_Opioid_Epidemic\/CSPAN3_20200116_131500_House_Hearing_on_State_Efforts_to_Combat_the_Opioid_Epidemic.thumbs\/CSPAN3_20200116_131500_House_Hearing_on_State_Efforts_to_Combat_the_Opioid_Epidemic_000001.jpg"}},"autauthor":{"@type":"Organization"},"author":{"sameAs":"archive.org","name":"archive.org"}}],"coverageEndTime":"20240716T12:35:10+00:00"}