the subcommittee on oversight investigation will now come to order. today, the subcommittee on oversight and investigations is holding a hearing in titled, public health emergency, state efforts to curb the opioid crisis. the purpose of today's hearing is to examine states efforts and successes and addressing the opioid epidemic, as well as opportunities for future federal support, and just to let everyone know, doctor alexander scott the, reason why we are getting started a little bit late, the plane was delayed, but now the doctor is on her way. so, we will swear in the witnesses when we get to that point, and if we have to do that one later, we will. the chairman recognizes herself an open i using statement. as i, said the committee continues its bipartisan efforts to combat the opioid crisis. the country is in the midst of an opioid epidemic unlike any in history. according to the cdc, from 1999 to 2017, nearly 400,000 people died from opioid overdoses. in 2017, more than two thirds of drug overdose deaths and voiced evolved opioids. the crisis has continued to evolve, and the challenges we have faced have continued to evolve along. with it the first wave began in the 1990s with the overprescribed of pain medication, the second wave began in 2010 with increased death 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 fueled a huge increase in math and that i mean use, in 2018, there were more than twice as many deaths involving meth as 2015, and that is increasingly turning up an overdose death and drug busts across the country. given the complexity of the epidemic, and its ability to evolve, states in congress must remain vigilant. to that end, this committee has taken numerous steps to investigate the origins of drivers of the crisis, so we can learn from it, as we try to get ahead of the next wave. 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, we are 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, the past bipartisan efforts to help those impacted by substance use disorder. these legislative packages provided states billions of dollars in federal funding to assist in recovery efforts, and we have made some progress. cdc provisional data indicates that drug overdose deaths has fallen for the first time in decades, while the downward shift is welcome news, it is far from over. and we must continue to look for ways to bring relief to struggling cities and towns throughout the country. today's hearing continues those bipartisan efforts. day in and day out, states are on the front lines of this epidemic that killed more than 130 americans every single day. as the epidemic enters a new decade, and keeping with this commitment to finding solution to this nassau urgency, letters were sent 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 roles in treatment recovery and prevention efforts. we want to thank all of you for coming today. the states composed a large swath of the country, wilder demographics, they have all felt and they had the highest overdose deaths rates. the two them have taken a number of steps to carve the epidemic. pennsylvania could distribute 13,000 of naloxone kits in 2013, and again in 2019. thanks to a combination of state and federal funds. north carolina provided treatment 12,000 uninsured persons thanks to federal funding, and rhode island has been able to expand medication assisted treatment in the prison system, resulting in a 62% reduction an overdose path. this is how these states help communities. as congress considers action to address the crisis, all of our witnesses provide insights on how federal funds are used to come that the epidemic, what efforts are successful, and what we need to do further. and thank the witnesses for their service, for being here to testify on behalf of the state, and i look forward to hearing how we can all continue to work together to find the desperately needed solutions. with that, i am pleased to yield for purposes of an opening statement. there guess free, five minutes. >> thank you for holding this on state responses to the appellate epidemic. our local communities are suffering. on average, 130 americans die every day from an opioid overdose. and opioids were involved and 47,600 overdose deaths in 2017, which accounted for 67.1% of all deaths. there were -- reported deaths in 2017. energy and commerce committee have been steadfast in its efforts to combat the epidemic, with both investigations and legislation. whether there were investigations into the prescription drug and heroin epidemic, opioid distributors or the manger manufactures, 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 addiction recovery act. the support for patients and communities act, i was proud work on all three of these comprehensive laws, which were designed to combat the opioid crisis through prevention, advancing treatment and recovering initiatives, protecting communities and bolstering our efforts to find a synthetic drugs like fentanyl. this hearing is a critical opportunity for us 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 success they are having and 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 has seen a decrease in the overdose deaths. faiths sense 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, emergency departments, expanding and increasing the availability of naloxone and medicaid assisted treatment, increasing non emergency transportation options for those in rural areas. expanding neonatal abstinence syndrome treatment program for mothers, and workforce initiatives like a loan repayment program, and broadening the curriculum in medical schools. this hearing is a great platform for the states to share how the federal funding has made a difference in the programs. not only is it helpful for us and congress as we continue to conduct oversight and legislate, but also to the states as they learn from each other about new ideas or innovation approaches that could be implemented. well progress is being made, the director of national institute of drug abuse, doctor norah, declared this week that this country still has not controlled its addiction problems. some states are continuing to see a high number of -- overdose. states are facing many challenges, including a lack of qualified infrastructure, varying requirements and timelines and different federal funding streams, and restrictions on funding, including that some funds have been restricted to opioids, in pleading flexibility to address emerging challenges. in addition to the continuing threat of opioids, states are starting to see more instances of poly substance abuse, poly substance overdose deaths, with state specifically citing methods that i mean and cocaine as a growing concern. nationally, since last, year matt impediment has been detected in more deaths than oxygen. and 14 of the 35 states that report overdose deaths to the federal government, matt impediment is involved and more deaths than fentanyl. the threats are involving and the threat is not over. we will partner with state and local entities to combat the epidemic, as well as emerging threats, which is why it's important to not let our foot off the gas. congress needs to continue to support the states, and this committee needs to continue to conduct 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 and combatting the epidemic, but also have the threats have changed, what challenges remain, and what more we in congress can do with our partners, you, in this fight. and i yield back. >> i thank the gentleman, the chair recognizes the chairman of the full committee, mr. frank pallone jr. for five minutes. >> thank you. today's hearing continues the committees ongoing bipartisan efforts to combat the opioid epidemic, whether field by prescription drugs or illicit, synthetic opioids, this epidemic is a constantly evolving threat, putting families at grave risk. this is not a crisis that we can solve overnight it requires ongoing's detention. the states around the front lines of the national mercy regarding much of the support for those in need, they are eyes and ears on what's occurring on the ground, that's why this hearing is so, important it's the latest in a series of hearings it is held on the opioid crisis, and several states including rhode island about the epidemic, history the federal agencies about the urgent threat posed by fentanyl, and also directed to your bipartisan investigation into opioid distribution practices, then urgent commerce committee is also been on the four pointer passing critical legislation that gives our federal state and low will pop nerves the tools and resistance succeed including three pieces legislation all bipartisan. designed to give states funding and support 2016 the committee signed into law the comprehensive addiction ever covering acts and the 21st century cures act if you mention the chairwoman gets a major role in. that these two laws authorized over a billion dollars there in space state to suffolk grandson prevention recovery efforts. in 2018 the support act was passed and signed into law, realizing appeared specific funding opioid abuse and overdose production training and improving coordination and quality of care and then in -- there is ten billion dollars in additional opioid funding, this committee is committed to making sure communities receive funding the need to receive elites. we have requested information on how federal funds have this is to the states in this fight. and additional help and how it will affect future actions. much no sees or using federal opioid funds and find out how funds have helped transform systems. the federal money has allowed states to take important and innovative approaches to addressing opioid addiction or the most effective tools that is available is medicaid several states elaborated on that, a study released last week found it about 8000 lives have been saved from an opioid overdose thanks to the expansion of medicaid under the affordable care, act we want to hear about emerging trends and subjects abuse that are being seen, for example several states continue to fight the opioid epidemic, were also seeing an increase in methane feta mean and poly substance use, this of course is an alarming trend that threatens to be the next epidemic and i want to, thank the witnesses, we look forward to hearing about their, efforts thank you madam chair for continuing, your efforts on this i don't know if anyone wants my, time if not i'm going to yield back. >> thank you gentlemen we now recognize the ranking committee of the committee mr. walden. >> thank you for holding this green the important meeting, us as i was preparing for this i know is the biggest county in my district they have a two overdoses per average for week, and seven last week and fortunately no deaths. . they believe that it's probably heroin with a pretty heavy dose of fentanyl in it, the deadly scourge continues, for many years that urgent commerce committee this subcommittee has been at the forefront of the efforts to address the opioid crisis, and substance use disorder issues, we've done a lot of work on prevention, we know we have a lot more work to do this committees held hearings we've conducted investigations on opioids an opioid epidemic for nearly two decades bringing in new pharma to testify about the abuse of oxycontin to our bipartisan vacillation into the rise of fentanyl opioid manufacturing, opioid distribution, substance use disorder treatment industry, these early hearings help informed or legislative work, including the comprehensive addiction recovery act, kara, 21st country cures, act which authorizes see tarred decked -- billions more in federal appropriations, to fight treat and stop substance abuse and support access to mental health these efforts, culminated to signing the support act. the most recent statistics to the cdc. i'm pleased we have contained who are together on the space. it's important including by continuing our work on fentanyl. and with this important hearing today examining how the states are utilizing the funding. and the authorities provided by congress. there are so much more we can do together earlier this year. and harvey and commerce and republicans publishing request for information, about the substance use disorder, treatment industry, the builds off the patient brokering investigation that we conduct in the last conference, in this investigation brought us to the question, what is good treatment, and conversely, what is a bad treatment, which is a question posed by rfi the billions of dollars we are sending into the states for prevention treatment we need answers yesterday and urging commerce, sent a letter to three operated manufactures we began investigating last congress, asking tingly production, is critical we fully understand the causes of the opioid epidemic in order to ensure our solution to the right ones in support that they answer a questions. we also hold a comprehensive series of hearings to, relevant today's hearings, to support act included the nfl acts, sponsored by mr. latta, which called for the creation of a public electronic dashboard, linking to all the nationwide effort and strategies to combat the opioid crisis. the infill act was described to meet the local meet of state holders that were telling us, despite congress voting to combat the opioid crisis, they had trouble finding the resources, and where they were. this was certainly an issue we heard a lot about from mr. mckinley and others. these provisions are critical in helping those on the front lines of the opioid crisis, and i'm really concerned about it slow implementation. in addition to oversight, we need to begin to work on not only opioid crisis, but also substance use disorder's more broadly, was urgently we need to reauthorize the fentanyl ban, which is set to expire in a matter of weeks. we authorize the prohibitions on various forms of fentanyl by prohibitions support, should do that expeditiously. and i want to thank all our witnesses for being here and being part of this equation. and i look forward to hearing from you. with that, i yield a balance of my time to the ranking member on the subcommittee on health, mister bridges. >> thank you for yielding. it was under your leadership that we worked on a bipartisan manner to produce legislation. and ultimately decided to law by president trump in october of 2018. and it really began in the subcommittee with the members we heard from, and we heard from over 50 members, not just the committee, but throughout the congress, the probably had in their districts in the ideas that they were bringing to the tables that we could work on. the support act was written to help the initiatives for those affected by opioid habituation. i still want to thank our witnesses for being here today it will be helpful understanding the challenges that we face continuing this fight against opioid addiction and death, while ensuring that patients can't manage their pain. it is important to congress to have hearings like this where we can ensure the effectiveness a legislative efforts and identify gaps where they exist. i want to thank the chairman. >> madam chair, i yield back with the notation that other members will be coming and going. >> i ask unanimous consent that the members running opening statements be made part of the record. without objection, so ordered. i now want to introduce the witnesses for today's hearings. miss jennifer smith, the secretary of the department of drug and alcohol programs, commonwealth of pennsylvania. welcome. doctor monica bharel, the commissioner of the commonwealth of michigan. doctor nicole alexander-scott, i think they banned you hear from the airport, so congratulations. he's the director of the department of health for rhode island. miss christina mullins, commissioner bureau for behavior health, health of human services, state of virginia. welcome. and mister kody kinsley, director of intellectual disabilities, department of health and human services. state of north carolina. welcome to you. thanks to all of you for appearing before in front of the subcommittee today. as you are, aware the committee is holding an investigative hearing, and when we do so we have the practice of taking all of our testimony under oath. do any of you have objection to taking testimony under oath today? >> let the records reflect that the witnesses responded. no under the rules of the house and committee, you are entitled to be accompanied by counsel. it doesn't if you wish that? let the record reflect the witnesses have responded. no so if you would, would you please rise and raise your right hand that you may be sworn in. you swear the testimony you give today will be the truth, the whole, truth and nothing but the truth? you may be seated. let the record reflect the witnesses responded affirmatively, and all of you are now under oath, and subject the penalties set forth in title 18, section 1001 of the u.s. code. we now recognize the witnesses for five minutes summaries of the written statements. in front of you, there's a microphone, a timer, and a series of lights. the timer counts down your time, and the red light turns on when your five minutes have come to an end. and, so, miss smith, i'm pleased to recommend recognized for five minutes. >> thank you. chairman, ranking member, and members of the subcommittee. my name is jennifer smith, and i am a secretary for pennsylvania drug and alcohol programs, as well as a member of the national association of state alcohol and drug abuse directors. thank you for your interest and how pennsylvania is using the state opioid response funding to promote food prevention, treatment, and recovery efforts. acting as the states single authority for substance use disorder services, my department coordinates efforts with federal and local entities, as well as across state departments. our ability to orchestrate resources and direct policy during the opioid crisis has been a crucial component in effecting long term change, and maximizing resources available to our communities. we are grateful for these federal grant opportunities at a time of hopelessness and despair for families and communities. i can say with certainty that this funding