Efforts to combat the Opioid Epidemic. Public Health Officials from five states testified on prescription take backs, needle exchanges, and access to opioid overdose drugs. Subcommittee of oversight investigations is holding a hearing entitled a Public Health emergency, state efforts to curb the Opioid Crisis. The purpose of todays hearing is to examine state efforts and successes addressing the Opioid Epidemic as well as opportunities for future support. Just to let everyone know, the reason were getting a little late, the plane was delayed but now dr. Scott is on her way. So, we will swear in the witnesses when we get to that point. If we have to do that one later, we will. The chairman will now recognize herself for an Opening Statement. As i said, today, the committee continues this bipartisan efforts to combat the Opioid Crisis. As we know, the countrys in the midst of an epidemic unlike any in recent history. According to the centers for Disease Control and prevention, from 1999 to 2017, nearly 400,000 people died from opioid overdoses. In 2017, more than twothirds of Drug Overdose deaths involved opioids. The crisis has 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 with the overprescribing of pain medications. The second wave began in 2010 with increased deaths due to heroin overdoses. Like the first two waves, the third wave marked by the rise of synthetic opioids like fentanyl have shattered lives, traumatized families, and devastated communities. Now unfortunately, it looks like a fourth wave of the crisis may have already arrived. The Opioid Epidemic has fuelled a huge increase in method am fete mean use. In 2018, there were more than twice as many deaths involves meth than 2015. Meth is turning up in deaths and drug busts in the country. Given the complexity of the ep Dominican Republic and i epidemic, states must remain vigilant. To that end, this committee has taken numerous steps to develop the origins and drivers of the crisis. Through Committee Hearings we have heard from states, federal agencies and drug distributors about their roles and responses. The groundbreaking work by the committee uncovered some of the failures that led to where we are today and looking forward were focused on identifying ways to stem this crisis and bring relief to the millions of americans who are suffering. As part of that effort, our committee has worked across the aisle to pass Bipartisan Legislation designed to give states the tools and resources needed to help those impacted by Substance Abuse disorder. These legislative packages provided states billions of dollars in federal funding to assist in opioid response treatment and recovery efforts. And weve made some progress. Cdc provisional data indicates that Drug Overdose deaths have fallen for the first time in decades. While this downward shift is welcomed news, the crisis is far from over and we must continue to look for ways to bring relief to struggling cities and towns throughout the country. Todays hearing continues those bipartisan efforts. Day in and day out, states are on the front lines of this epidemic that kills more than 130 americans every day. As the epidemic now enters a new decade, states face the challenge of keeping pace with evolving crisis. In keeping with this committees bipartisan commitment to finding solutions for this National Emergency, last september the committee sent letters to 16 states requesting information about on the ground efforts to curb the epidemic. The committee has sought to understand whether federal funds actually reach the hardest hit communities, how states use the funds provided by congress, and what strategies have proven to be successful. Today we have five key states that have each received a letter from this committee. These states represent the first line of defense against the crisis, and they each play pivotal rolls in Treatment Recovery and prevention efforts. I want to thank all of you for coming today. The states compose a large swath of the country. While their demographics, geography, and challenges vary, each has felt the effect of the epidemic and they all rank among the states with the highest overdose death rates. As such, each have taken a number of steps to curve the epidemic. For example, pennsylvania was able to distribute nearly 13,000 naloxone kits in 2018 and again in 2019 thanks to a combination of state and federal funding. North carolina provided treatment to 12,000 uninsured persons thanks again to federal funding. And rhode island has been able to expand medication treatment in the prison system resulting in a 62 reduction in Overdose Deaths. These are just a few examples of how the states are fighting this ep demic and 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 combat the epidemic, what efforts are proving successful, and what we feed had to do for further improvement. I thank the witnesses for their service, for being here to testify on behalf of their states, and i look forward to hearing how we can all continue to Work Together to find the desperately needed solutions. With that, im pleased to yield for purposes of an Opening Statement, mr. Guthrie, five minutes. Thank you. Thank you chair degette for holding this important hearing on state responses to the Opioid Crisis. Our local communities are suffering. On average 130 americans die every day from an opioid overdose, and opioids were involved in 47,600 over dose deaths in 2017 which accounted for 67. 8 of all Drug Overdose deaths n. Kentucky, there were 1,160 reported opioid involved deaths in 2017. The energy and Commerce Committee has been steadfast in its efforts to help combat the Opioid Epidemic with both investigations and legislation. Whether it was the committees investigations into the Prescription Drug and heroin epidemic, opioid patient brokering, or manufacturers, we have continued to ask questions and get answers for the american public. When it comes to legislation, this Committee Led the way on the passage of the 21st century cures act, the comprehensive reduction communities act. I was proud to work on these comprehensive laws which are designed to combat the Opioid Crisis to prevention, advancing treatment, and recovering initiatives protecting communities and bolstering efforts to fight synthetic drugs line of scrimmage fentanyl. This hearing is a critical opportunity to check in with the states. Those that are on the front lines battling the nations Opioid Epidemic to see how the federal Money Congress provided has been allocated and spent. What successes they are having in combatting the epidemic, but also what challenges they are still facing and what additional authorities and resources could be helpful. The good news is that each state testifying before us today has seen a decrease in their overdose death rates. Federal assistance is making a difference. In addition, states are creating and implementing innovative approaches to combatting the epidemic. Examples include expanding efforts to connect people to treatment through ems in Emergency Departments e panding and increase the availability of na loca naloxone, increasing transportation to areas, expanding neonatal Treatment Programs, and efforts to address work force issues through a Loan Repayment Program and broadening the curriculum in training and medical schools. This hearing is a great platform for the state to share how the federal funding has made a difference in what programs they are working. Not only is it helpful for us in congress as we continue to conduct oversight and legislate but also to the states as they learn from each other about new ideas or innovative approaches that can be implemented. While progress is being made in some of the overdose death rates are declining, the director of National Institute of drug abuse declared this week that this country still has not controlled its addiction problems. Some states are continuing to see a high number of First ResponderEmergency Department encounters due to overdose. In addition, states are still facing many challenges including a lack of qualified work force in infrastructure, varying requirements in timelines, and different federal funding streams, and restrictions on funding including that some funds have been restricted to opioids impeding flexibility to address emerging challenges. In addition to the continuing threat of opioids, states are starting to see more instances of poliSubstance Abuse and polisubstance Overdose Deaths with states specifically citing meth methamphetamine and cocaine as a growing concern. Meth has been detected in more deaths than oxycodone and hyde coe done. Methamphetamine is involved in more deaths than fentanyl. The threats are evolving and the fight is not over. We want to continue partnering with state and local entities to combat the Opioid Epidemic as well as emerging threats which is why its important to not let our foot off the gas. Continue needs to continue supporting the states and this committee needs to continue conducting oversight of these issues. I want to thank all the witnesses for being here today. I look forward to hearing from you about all your successes we have had in combatting our nations Opioid Epidemic, also why the threat is changed, what we can do with our partners in this fight. I yield back. Thank the gentleman. The chairman recognizes the chairman of the full committee for five minutes. Thank you. Todays hearing continues the committees ongoing bipartisan efforts to combat the Opioid Epidemic fuelled by Prescription Drugs. This epidemic is a constantly evolving threat. This is not a crisis that we can solve over night and it requires ongoing federal and state attention. States are on the front lines of this National Emergency providing much of the support for those in need. Theyre our eyes and ears of whats occurring on the ground. Its the latest in a series of hearings weve held oon the Opioid Crisis. Weve heard from several states including rhode island about on the ground efforts to curve the epidemic. We heard from federal agencies about the urgent threat posed by fentanyl. The Committee Conducted legislation that gives our state and local departments tools and resources required to succeed in this fight including three pieces of legislation all bipartisan that were designed to give states funding and support n. 2016, the committee passed and president obama signed into law the comprehensive addiction and recovery act and the 21st century cures act. I have to mention that chairman degettes major role in that. These two laws authorized over a billion dollars in state specific grants and helped states bolster treatment, prevention, and recovery efforts. In 2018 the support act was passed and signed into law, authorizing opioid specific funding increasing opioid abuse and training, improving coordination and quality of care. In december, the house passed hr 3 which included 10 billion in additional opioid funding. This committee is committed to making sure communities are receiving the support they need to get relief from this crisis. Thats why we sent letters to 16 states last year requesting information on. We wanted to know how states are using federal opioid funds, whats being done to ensure the funds reach the hardest hit regions, and how funds have helped transform state treatment systems. Based on the responses, we heard that the federal money has allowed states to take important and innovative approaches to addressing opioid addiction. One of the most effective tools that is available to the states is medicaid. Several states elaborated on the Important Role of medicaid in stemming this crisis and the responses to the committee. A Study Released last week found that about 8,000 lives have been saved from an opioid overdose thanks to the expansion of medicaid under the Affordable Care act. We want to hear about any emerging trends in Substance Abuse theyre seeing. For example, several states informed the committee while they continue to fight the Opioid Epidemic, theyre also seeing increase of methamphetamine and poll li Substance Use. This of course is an alarming trend that threatens to become the next epidemic and i want to hear how congress can help states with this threat. Thank you to the witnesses, thank you madame chair for continuing your efforts on this. I dont know if anybody wants my time. If not, im going to yield back. Thank you. I thank the gentleman. Chair now recognizes the Ranking Member of the full committee, mr. Walden for five minutes. Good morning, thanks for holding this hearing. As i was preparing for this i noticed in my biggest county in my district they have a yellow alert up for opioids two, overdoses average per week in jackson county, oregon. Seven last week. No deaths. First responders tered naloxone five times last week. They believe its heroin with a heavy dose of fentanyl in it. For many years you heard the energy and Commerce Committee and this subcommittee in particular has been at the forefront to address the Opioid Crisis and Substance Abuse disorder issues weve done a lot of work on prevention. We know we have a lot more work to do. This hearing has held meetings from bringing in Purdue Pharma to our bipartisan investigations last congress about the rise in fentanyl, opioid manufacturing, opioid industry. These early hearings informed our legislative work including the comprehensive Addiction Recovery act, the 21st century care act, the Opioid Crisis grants, and billions more in federal appropriations to boost programs that fight, treat, and stop Substance Abuse and support access to Mental Health services. These efforts culminated in the sieping of the support act. Weve seen the results of 3. 1 reduction in opioid deaths based on recent statistics from the cdc. Im pleased weve continued to Work Together in this space. Its important. Including by continuing our work on fentanyl and with this important hearing today examining how the states are utilizing the funding and authorities provided by congress. But theres so much more we could do together. Earlier this year energy and commerce republicans published information about the Substance AbuseDisorder Treatment industry. The rfi built off the patient brokering 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 our rfi. With the billions of dollars were sending into the states for prevention and treatment, we need answers. Just yesterday, energy and commerce republicans sent a letter to the three opioid manufacturers. We began investigating together last Congress Asking them to complete production to our request. Its critical we fully understand the causes of the Opioid Epidemic in order to ensure that our solutions are the right ones and its important that they answer our questions. We should also hold a comprehensive series of hearings to conduct oversight in the implementation of the support act. For example, relevant to todays hearing, the support act included the info act which calls for the creation of a public and easily acceptable electronic dashboard linking to all the nationwide efforts and strategies to kocombat the cris. It was designed to meet a need of stakeholders telling us despite congress having to vote in record numbers, they had trouble finding what resources were available and where they were. Certainly an issue we heard a lot about from mr. Mckinley and others. This provisions absolutely critical in helping those on the front lines of the Opioid Crisis. Im really concerned about its slow implementation. In addition to oversight and support act we need to begin working on the next