But that sounds right. Ms. Degette its really raised going up in crisis, right . Thats correct. Ms. Degette and arrests for counterfeit pills have increased as well . Mr. Chester id have to get back to you if its an increase. We have been investigating these networks. Ms. Degette i think youd agree the amount of fentanyl recovered has been growing exponentially it has . It has. Ms. Degette dr. Compton, i want to ask you, because other opioids often lead to fentanyl use, some have suggested to stem the need for fentanyl we also need to treat opioid addiction because addiction drives the users to seek those other drugs that contains that, would you agree . Dr. Compton i think the fentanyl issue is most closely related to heroin addiction. Those that use heroin have trouble with fentanyl. Ms. Degette and treatment as we learned in many hearings in this subcommittee isn important component in the addiction fight, is that right . Dr. Compton absolutely. We think expanding Treatment Access is a key component of our attempts to address this. Ms. Degette now based on i assume you had experience with opioids and with heroin. You just cant stop this by arresting people, would that be fair to say . You got to also have treatment. Dr. Compton i think its to point out its the combined Health Public and Public Safety approach that looks most promising. We look at models that include criminal justice systems as well as Public Health showing reduction in crime as well as Important Health outcomes. Ms. Degette but Health Outcomes are a key part of that . Dr. Compton of course. Ms. Degette so this is what im concerned about. When youre trying to treat opioid addiction, as weve also learned in our many hearings in this subcommittee, its a comprehensive treatment that is very extensive. Wouldnt you agree with that . Dr. Compton we. We certainly learned that the treatment needs to last quite a long time. It takes people a long time to turn their lives around and recovery is not an instantaneous process. Ms. Degette and they sometimes change the chemistry of the brain so you have to have medication and treatment and other types of tools to be able to treat this, is that right . Dr. Compton yes. Research has demonstrated that. Ms. Degette so in some of these states that have been hit hard with the opioid and fentanyl epidemic, the Medicaid Expansion that theyve been able to get has been able to help them really target populations for Addiction Treatment and prevention, would that be fair to say . Dr. Compton certainly treatment expansion is a shared goal for all of us and making sure the research embedded within the Health Care System is important. Ms. Degette after the passage of the Affordable Care act, medicaid was now able to pay up to 50 of medication treatment in some of these hardestit statesis that right . Dr. Compton well, id reay nt to refer the spefic case state officials that implement those programs or to c. M. S. Ms. Degette so you are not familiar how some states have been able to increase their treatment . Dr. Compton im certainly familiar with the states efforts to expand treatment. Ms. Degette well, lets talk about ohio, for example. In ohio, republican Governor John Kasich recently said, quote, thank god we expanded medicaid because that medicaid money is helping to rehab people. And in fact, a february 6, 2017, pew report noted that ohio added 700,000 new medicaid recipients under its expanded program, and roughly a third were diagnosed with a Substance Abuse disorder. According to the c. B. O. , the republican a. C. A. Repeal proposal would cut 880 billion in federal outlays for medicaid over the next 10 years. Would you disagree with any of those figures . Dr. Compton well, certainly we are interested in research that can look at changes in the Health Care System. Were partnering with famsa to study ms. Degette would you disagree, for example, that ohio added 700 new medicaid recipients under its expanded program and a third were diagnosed with Substance Abuse disorders . Dr. Compton those figures sound reasonable. Ms. Degette ok. What im worried about is probably pretty clear. If you reduce the Medicaid Expansion that in states like ohio, kentucky, West Virginia, other states that have been hard hit by fentanyl and opioid and heroin, that thats also going to reduce the treatment programs youre able to give them. Thank you, mr. Chairman. Mr. Murphy youre right. You cant arrest our way out of this. We have to treat our way out of this. Just a followup. Do we even have enough providers, does anyone know . We know that half the counties have psychiatrists, psychologists, social workers. Do we have enough trained drug treatment providers in america . We do not havenough to fully meet the needs and they are not evenly spread across the country. Thatshy were engaging in the Rural Initiative to address the particularly severe shortages in rural areas. Mr. Murphy thank you very much. I would add treatment is important. Preventing people to needing Addiction Services in the first place will also save the Health Care System a lot of money so were making sure were using safe prescribing practices is a component. Mr. Murphy thank you. We have seen the epidemic ravage. Even affluent areas of my home of Orange County, california, are struggling with over 200 deaths per year. Now we are witnessing a far deadlier fentanyl lace drugs. Mrs. Walters reserved for the most severe and acute pain are being yeaded to heroin, cocaine and counterfeit drugs. As a mother of four young adults, it breaks my heart every time i see or hear of another life lost. Just last year, a 19yearold from Orange County overdosed after taking fentanyllaced cocaine. This epidemic, again, hit home with a d. E. A. Investigation resulted in four arrests for an alleged fentanyl importation and distribution conspiracy in long beach. The d. E. A. Reported the men had tablets 0 fentanyl d 13 kilo grams of the nar kotyks. Mr. Milione, i want to commend your agency for keeping the drug off the streets of Orange County. Mr. Milione, the making and distributing of pills containing fentanyl have been disguised by molding the pills in a wide variety of counterfeit brands and colors. What are the most prevalent pip types being discould have had pill types being discovered . Mr. Milione oxy could he doan, depending on the market. So if there is a market, they will replicate them. If they want a powder substance in a capsule, that market will influence how they package it. Mrs. Walters what types of pill making machinery are most commonly associated with these counterfeit drug operations . Mr. Milione there is a broad range. Anything from an inexpensive pill machine to ones that cost 10,000, 15,000, 20,000 that can produce 250,000 pills an hour. One is hand held that can be easily used so its a Broad Spectrum there. Mrs. Walters are the most likely sources of these counterfeit drugs . Mr. Milione china is the primary source for fentanyl. Going into mexico and the networks are shipping the merchandise up into the United States. And what were seeing more and more actually the pills, the counterfeit pills are being made in the United States at different domestic transportation cells around the country. Mrs. Walters ok. Thank you. Dr. Houry, we understand the typical victim of a fentanyl overdose can be extremely hard to define since it does not follow economic structure or community locales. What can you tell us about Current Trends andendencies . Dr. Ury so youre right. Were eing this epidemic really increased in all demographics. Its the most hardest hit in those 2544 and were seeing it moore in men. What i think is important, though, people, like in rhode island, we saw that a third of the those had a prescription within the past 90 days for an opioid and a third of those had a high dosevale prescription. What we said in the guideline to be cautious is people getting exposed to opioids and then going on to fuel their addiction through heroin and fentanyl. Mrs. Walters thank you. And mr. Chester, in recent months, fentanyl was first identified as a major problem in the northeast, parts of the midwest and certain states like florida and maryland. What do you see as trends or directions of its spread . Mr. Chester we have begun to see some indications its moved west. Sacramento, california, was the first one. That was about a year ago, that weve begun to see it move a little farther west. I think fentanyl found its way in the northeast simply because it was easier to mix into the powder white heroin that was popular in the northern United States so in the western part of the United States i think were beginning to see more of the pill form that mr. Milione was discussing as well. But fentanyl, even though it began being geographically being concentrated in the northeast, weve seen indicators in areas throughout the United States. Mrs. Walters thank you. I yield back the balanc my ime. Mr. Murphy ms. Castor, you are recognized for five minutes. Ms. Castor thank you for all our expert witnesses for shining a light on this. It does feel like we are in the twilight zone, though, because as were talking about the seriousness of the Opioid Epidemic, were faced in two days with a vote on a health bill that will recede in this countrys responsibility in Health Services to families who are adicked, who need Substance Abuse addicted, who need Substance Abuse treatment, Mental Health treatment. Mr. Chester, you said one in nine are receiving treatment who need it. Mr. Milione, you say we have to reduce demand as part of a balanced strategy. And yet this g. O. P. Health care bill thats coming to the floor will take a hatchette to coverage for millions hatchet to coverage for millions of americans. Plus, it will end medicaid Health Services as we know it that provide in florida, in most states, the most important Mental Health and Substance AbuseHealth Services. This is very important but, boy, this bill thats coming up for a vote would really takes us backwards when we are talking about opioids. In fact, one of my local sheriffs in Pinellas County which is st. Petersburg and clearwater says we cannot and never will solve this problem at the Law Enforcement level. It needs to be treated as an addiction problem, a Mental Health problem. We may have had Great Success in beating back the pill mills but all that meant is we are going to see a switch to different drugs and different dealers. And i wanted to highlight whats happening in West Virginia because it is startling and there is a good Investigative Reporter thats shining a light on it. Mr. Milione, according to a december, 2016, article in the charleston gazette mail, opioid wholesalers ship mass quantity its of opioid medicines that apeern to be far in excess what certain communities in West Virginia should receive based on sound medical needs. The article says, quote, in six years drug wholesalers showered the state with 780 million hydrocould he doan and oxy ,728 pills while 1 overdosed. Nfettered shipment was this reporting strongly suggests that West Virginia appears to have been receiving uantity its of hydrocodo and oxycodone pills more than necessary. Are you familiar with the reporting that suggests that West Virginia may have been grossly oversupplied with angerous prescription opioids . Mr. Milione i am. Ms. Castor it is shocking that addiction to pain pills, according actual of the reporting and what you have testified here that once you ave oxy and hydrocodone that takes over someones life that will quickly lead to the users seeking more powerful opioids such as heroin or counterfeit pills both of which may be adulterated with fentanyl. Dr. Houry, in your testimony you say reversing epidemic requires changing the way opioids are prescribed. Is it therefore reasonable to assume that addiction to prescription pain medicines have a connection ultimately to the fentanyl problem and the larger Opioid Epidemic . Dr. Houry yes. Many of the people who have overdosed on fentanyl have had an opioid prescription at the time of their death. So i believe all of these fentanyl, heroin and prescription opioid Overdose Deaths have linked. Ms. Castor and mr. Milione, another ran a story about the influx of opioids into West Virginia, reported on a small town called kermit, which i understand have 392 people. Kermit received over nine million hydrocodone pills in two years. If this reporting is true, its hard to believe we have sufficient systems in place to spot dangerous trends. Is the d. E. A. Familiar with the reports regarding what happened in this small town with the oversupply of addictive pills, and what can you tell us about it . Mr. Milione i am familiar with the report but were familiar thats happened in many locations across the country so we have an obligation, obviously, across the whole supply chain. Ms. Castor whats happening with the wholesalers . Mr. Milione they have to uphold their regulatory obligations and weve taken action recently against two of he big three, mckesson and cardinal. We were hoping their programs will work to prevent diversion and they uphold those obligations. But its not just the wholesalers. We have to go all the way down the supply chain in order to kind of try to maintain this distribution. Its certainly complex and its a challenge but we are well aware of the issues all across the country. Ms. Castor thank you. My time has run out. Mr. Murphy dr. Burgess, youre recognized for five minutes. Mr. Burgess i dont know if we can get this map of the opioid deaths in 2015 up on the screen. The map is almost counterintuitive to me. We talk about thats not the one. Its the total opioid death in 2015 for purposes of illustration. Thank you. Almost counterintuitive. Six of the states with the lowest numbers go back one slide, please. Six of the states with the lowest numbers, of those six, four are border states, texas, california, north dakota and montana, which would be counterintuitive when we talk about things that are coming in across the border. But also if you look at the map, boy, it seems like theres a bullseye on the midwest. And what are you doing to sort of interrupt those supply chains that have targeted a portion of the country . Its a great question. Its coming in and not staying at the border where it coss crosses. Its going to locations. The midwest is unfortunately getting hit. Mr. Milione now the west is also getting hit. What we are doing . Were applying with Law Enforcement techniques. Infiltrating the supply chain but looking at the distributors and trying to disrupt them with the judicial process. Mr. Burgess ambassador, let me ask a question. Thank you for being here today. And just for the record you are career at the state department, is that correct . I am. Mr. Burgess theecretary has been in china recently. The testimony you provided in your written and verbal testimony kind of indicated that perhaps things were looking up, there were positive developments and i guess im just not feeling that there are positive developments. And in fact, mr. Milione, please dont arrest me but i went online and looked at how to order fentanyl online just while were sitting here and there are a lot of opportunities. And i suspect those opportunities, many of them come from asia or come from china. Mr. Brownfield ambassador brownfield, do you think were doing enough to interrupt those . Mr. Brownfield we are starting close to point zero in terms of our cooperation with china. We have moved in a positive direction. We are dealing with a country that has somewhere between 170,000 and 400,000 companies that produce pharmaceuticals somewhere in the peoples republic of china. As recently as two or three years ago, there was largely no control over their production whatsoever. Ince then, 116 synthetic drugs are now controlled by the chinese government, and within the last month and a half, literally within the last month, four new ones, including important fentanyl analogues are now controlled by the chinese government. We have a dialogue. We are talking to one another. Three years ago their answer, which by the way is not unusual around the world was, we do not have a fentanyl problem and therefore we are not particularly interested in cooperating with you because it is not being abused in china. Weve gotten beyond that. Are where we want to be . No, of course not. What you have just proven is we have not yet solved the problem. But are we in fact ahead of where we were two, three years ago, on that i say yes mr. Burgess i thank you for that effort. I agree with you thats a positive development. But given the distributional aspects on our United States map, is it possible and really its for anyone on the panel is it possible to identify from which laboratories or manufacturing houses overseas, which are causing us the greatest problems in these areas that were seeing only our United States map . Does anyone have an answer for that . Congressman, its a great question, and to build on what ambassador brownfield had, in our beijing office tremendous success getting leads from the chinese of u. S. Based recipients of their fentanyl. Mr. Milione thats a huge step forward and allows us now to uncover that network in the United States. Yes, we had successes uncovering what those labs are in china and weve been working cooperatively with our Law Enforcement counterparts over there and were very pleased with the direction its going. Mr. Burgess well, just in the limited time i have remaining, dr. Houry and dr. Compton, you talked about fentanyl use patterns. I am a big believer in monitoring programs. I was a physician. Its important to have drugs like fentanyl available. Were grateful for their utility in clinical settings. Clearly they have to be used appropriately. But do you have a sense of what i was talking to the d. E. A. And the state department about, do you have a sense of where the use patterns are occurring . Are you able to target limited resources so that perhaps an e. R. Can have one of these Early Intervention programs . If you are in a hot spot i think thats a good idea. If you are in luck on, texas, that might not be as important. Dr. Houry in ohio we were able to do that. We found eight counties that haghhighest rates and were then able help guide ohio where to focus their efforts and then in maacsetts we also saw there was a high rate of Overdose Deaths in those that were recently incarcerated about 50 times what we saw in other populations so we were able to use the data for that. With the Prescription Drug monitoring programs, you can very much see people at risk for opioid use disorder and help further that link. Mr. Burgess are you . Dr. Houry what were doing right now, the program has been in place for two years and we are in 44 states and getting data and quicker and able to be used by states. Mr. Burgess im way overtime. We authorized a bill back in 2005. It shouldnt be just recently. This should have been an ongoing exercise over the last decade. In my opinion. Thanks, mr. Chairman. Mr. Murphy before i recognize the next one, i want to put together a couple of pieces. The gentlelady from florida and dr. Burgess from texas talked about these cases. Kermit, West Virginia, you mentioned this tremendous prescription rate. Massive amount. I pull up another chart here of disability rates in the United States. And dont you know, mingo county in West Virginia are among the highest in the nation. What dr. Burgess pointed out, the deaths are occurring there. It makes me wonder as youre talking about collecting more data, how much more data do you need . You see the targeted areas where the amount of prescriptions is way, way out of control you see on the map. Its way out of control. And yet in and these deaths are occurring. Are there any kind of teams going into these places and identifying whos writing these prescriptions and the deaths that come from this . Dr. Houry absolutely. Weve been sending teams into ohio, massachusetts, to rhode island giving specific information to the states. Mr. Murphy West Virginia . Dr. Houry i did a site visit myself in West Virginia. Weve been working with eight states to look at the prescription monitoring prrams. 18 states have adopted or implemented aspects of the guidelines to help with safer prescribing in their states. And we are starting to see significant improvements. You see things like kentucky through our c. D. C. Funding. They have an alert for high morphine equivalent to make sure people are getting safer prescriptions. Mr. Murphy thank you. Mr. Cassidy, you are recognized you are recognized for five minutes. Thank you. Its an important issue because its an important fight for our communities. Obviously the Law Enforcement piece and figuring out how we can stop the enter into our country of the components of fentanyl is very important. Ms. Schakowsky i want to say, again, and its been said many times before, this is also a very Serious Health issue. And to my republican colleagues, as we face this vote thats coming up on thursday, we have to recognize the importance of the medicaid program. Its the second biggest payer for drug abuse treatment in the United States. Its funded roughly 25 of public and private spending on drug abuse treatments in 2014. We talk about West Virginia, were talking about a lot of lowincome people. And medicaid is really the source of help for them. For my home state of illinois, medicaid has been absolutely vital to address Substance Abuse and providing access to treatment. Medicaid expansion has provided coverage to 650,000 lowincome adults in illinois. Nearly one third of whom have Mental Health or Substance Abuse disorders. Thats just the typical percentage all over the country. Without medicaid, these individuals would be more likely to end up in Emergency Rooms or jails, which would drive up costs for state and local budgets. Its also clear that illinois in illinois we need to be further expanding access to Substance Abuse treatment, and im sure thats the case in many other states around the country. Rom 2014 to 2015, illinois saw 120 increase in the number of deaths from drug overdoses. And so, you know, the republican trumpcare proposal would decimate the Medicare Program that serves one in four people in illinois. One in four people in illinois. The republican bill would end Medicaid Expansion, impose a drastic per capita cap on funding. I want to go more on more about that because its been certainly addressed. Dr. Compton, wouldnt you agree that solving the fentanyl and opioid addiction problems requires that we also ensure people have access to appropriate Substance Abuse treatment . Dr. Compton certainly given that the underlying issue is in pioid use disorder, its important. Ms. Schakowsky you stated the rise ifentanyl, heroin and Prescription Drug involve overseas are not unrelated. Im sorry, overdoses, not overseas. I am going to say that again. The rise in fentanyl, heroin and Prescription Druginvolved overdoses are not unrelated. Would you agree that in order to solve the fentanyl crisis we must also add address the larger opioid Prescription Drug epidemic . Dr. Houry yes. I think a very comprehensive approach is needed and i think prevention is a key aspect to that. Ms. Schakowsky i wanted to ask dr. Compton, how harmful would it be for a patient with an opioid disorder to have to discontinue his or her Substance Abuse treatment . Dr. Compton one of the keyest predictors of relapse and of recidivism is stopping treatment. So when people stop treatment particularly abruptly they are extraordinarily high risk to relapse to their ongoing addiction problems as well as criminal behavior and other serious problems. Ms. Schakowsky im very concerned. Im also on the budget committee. We know theres been proposed an 18 cut in h. H. S. 5. 8 billion in the National Institutes of health. My understanding is that youre actually doing some research on i dont know if the right word is vaccine but some sort of prevention something that would against opioid addiction, is that true . Dr. Compton we even have research specifically targeting fentanyl where the development of a vaccine might lead to an approach that can keep the fentanyl from getting into the brain. The goal is to keep it in the circulatory system so you get antibodies attached and keep it out of the brain where it excerpts exerts its dangerous effects. Ms. Schakowsky i want to thank all the people here today testifying how youre trying to stop it before it starts and understand all the sources. I also am interested in the Health Services. Thank you. I yield back. Mr. Murphy now recognize the chairman of the committee, mr. Walden, for five minutes. Mr. Walden i want to thank the witnesses, again, for your learned testimony. The fentanyl threat, mr. Chester described to us, is the third wave of the Opioid Epidemic. It seems in individual states i looked at some maps are seeing different effects, different aspects of the overall epidemic. Some are facing fentanyl headon right now looks like in other areas it hasnt hit or at least not as with a deadly effect. Others are seeing Prescription Drug or heroin overdoses. So i guess my question is, are we better off to look at this as sort of a statebystate basis . I realize there are National Implications but it seems like there are some hot spots in the states. So when we think about a strategy here to combat it, should it be multiheaded and look at this Opioid Epidemic in this way and look at kind of all of the above or sort of a one size fits all . What is best . We look at it a national security, Law Enforcement and Public Health issue at the National Level and then at the state level there are unique environmental factors that cause different manifestations of the opioid problem and as you correctly pointed out, there is fentanyl in some states more than it is others. Mr. Chester there are prescription opioid in others. In others theres heroin. In fact weve seen evidence in some places that the heroin deaths are prepond rant and other cases fentanyl surpassed heroin as being part of the most deaths. Number one, we try and respond to unique aspects of that states environment but also develop a framework to share Lessons Learned from one state to another. So things certain states have found to be successful in dealing with their particular aspect of the problem can be shared with other states who may not be facing that particular problem but may see it in the future. Mr. Walden all right. Thank you. Ambassador brownfield, first of all, i want to commend the state department and the good work that you all have done and commend the d. E. A. For your work in helping get the recommendation to the march 16 effort by the u. N. Commission on narcotic drugs in favor of controlling two primary fentanyl precursors. And i want to thath chinese, too. I met with the ambassador. We sent them a letter thanking them for their work shutting down some of the facilities. What do you hope will be the impact from the u. N. Recommendation on the fentanyl problem in the u. S. . What can we expect out of that . Mr. Brownfield first, out of the risk of shamelessly pandering to you, let me thank you to your letter to the ambassador. It makes my job enormously easier when they hear directly from you. What do we respect expect from the c. N. D. Decision to control the two precursors . First, we have to wait another roughly 168 days before it is fully implemented. This is a period of time during which the 100 of roughly 85 Member States of the u. N. Who are part of the c. N. D. Are have ratified the treaties have the right to seek an exception. I do not expect anyone to seek an exception to the ruling because the vote was unanimous. It was 510. When it comes in to effect, the countries that produce these two precursors, the two most prevalent precursors in the production of fentanyl in the entire world will be required to control, register, license these fy production of precursors there . Mr. Walden which two countries are there . Mr. Brownfield the most important country is china which in fact did support not only support but did assist us in some extent in lobbying for the passage. So what will happen at that point in time, whenever a company, any company in the world is going to export either these two precursors, the government of the country where it is produced will be required to notify the National Authorities of the country to whicit is being exported. And it will have to provide the basic data and information. How much, which, who is the receiving party, route by which will be shipped. That shipped. That then allows the authority to determine what is coming in and doing the Due Diligence to verify this is a legitimate and legal shipment. This is why i said in my oral statement, this is a way to shut own the diversion of legal and legal produced. The state of oregon tried this in oregon. It made a big difference when you put pseudofed run behind the the eudoephedrine behind countier. The counter. Id meat a big difference. I commend you and the governments involved in taking this step. We look forward to being partners with you going forward. I yield back the balance of my time. Mr. Tonko, you are recognized or five minutes. Mr. Tonko sorry about that. Problem with the mike. Thank you, mr. Chairman. I am quite satisfied were holding this hearing today because it is literally a life or death issue for my constituents. In my hometown of amsterdam new york a Small Community of about 18,000 people, we had four Overdose Deaths and another dozen treated overdoses in the month of december alone. If that rate of carnage were maintained for an entire year, one in every 375 individuals in my hometown would perish. These overdoses were all attributed to fentanyl. One in 375. When you drive down the interstate in my district, you see instead of billboards for mcdonalds or taco bell you see billboards advising you to call 911 for opioid overdose. I visited a clinic where i witnessed people taking the first steps toward recovery. It raised the limit on the number of patients doctors can treat for opioid use disorder. This fuel misdrive to push for policies that will expand the recovery opportunity for everyone. Thats why i found it astounding that in all of the witnesses testimony today, the word medicaid was mentioned just twice and both times in the context of Prescription Drug monitoring programs. We can talk supply reduction all we want but you simply cannot talk about a federal response to the Opioid Epidemic without talking about medicaid. Which is the largest payer for Behavioral HealthCare Services in our country. In new york, medicaid pays for 38 of all med case assisted dream for opioid use disorder. In new jersey, its 22 . Pennsylvania, 29 . Indiana, 17 . I could go down the list but you get the point. As my colleague sls pointed out, theres a huge elephant in the room here. The Trumpcare Bill this house is being asked to vote on late they are week would be the single most devastating piece of legislation to individuals struggling with addiction in our nations history. Trumpcare would eviscerate treatment for individuals who are struggling with opioid addiction by ending the Medicaid Expansion, repealing fwarnetees of Mental Health and substance garen teefs Mental Health and sub guarantees of Mental Health and Substance Abuse treatment and gutting the program. The American Society of addiction medicine, a professional society representing over 4,300 professionals in the field of addiction medicine wrote to congress say, we are concerned that rolling back the Medicaid Expansion, sunsetting the e. H. B. Requirements and capping federal support for medicaid beneficiaries will reduce coverage for and access to Addiction Treatment services. Changes that will be particularly painful in the midst of the ongoing Opioid Epidemic. Rolling back the medicaid expansioand fundentally changing medicaids finance bing structure to cap spending on Health Care Services will reduce access to evidencebased Addiction Treatment and reverse much or all progress made on the Opioid Crisis last year. The Mental Health lee ayon group, an Umbrella Organization for grups groups involved in Mental Health and substance service, wrote that repealing the a. C. A. Would leave one million nonpregnant adults with serious Mental Illness who were able for the first time to gain coverage under Medicaid Expansion, it would also leave uncovered the two million childless, nonpregnant people with Substance Abuse disorders who had coverage for the first time. Governor casey, thank god we expanded medicaid, thats able to help people. Governor jan brewer, no ones idea of a bleeding heart liberal wrote, and i quote, it affects our most vulnerable, our chronically mental ill, our drug addicted. It will devastate their lives and the lives that surround them because theyre dealing with an issue which is very expensive to take care of as a family with no money. I could go on but you get the point. I would, mr. Chairman, like to order into the record, place into the record, this letter from 415 addiction groups nationwide opposing trumpcare for the devastating impact that trumpcare would have on treatment for the Opioid Epidemic. Without objection. Mr. Tonko thank you, mr. Chairman. From my Vantage Point there is no one outside of a threeblock radius of this Capitol Building that thinks that trumpcare is anything better than a raging dumpster fire. Certainly no one think this is backroom bill will improve the lives of those struggling with the disease of addiction. With that, mr. Chairman, i yield back. The speaker pro tempore the gentleman yields back. I want to know from the gentleman note for the gentleman, the article referenced before from the Washington Post says the important takeaway is that theres not one Opioid Epidemic. Well leave this here, you can continue to watch the House Energy Subcommittee hearing on our website. Go to c