Transcripts For CSPAN Washington This Week 20160612

The world to take this time and pray and ask god to continue to look over our chief and commander and those family members and keep those family members strong and love their loved ones. Host that is a good way to stop this time around. Thank you for all of the calls. ,omorrow on washington journal instead of our usual lineup of to devoteare going the entire three hours to opening our phone lines, opening up twitter for your tweets and spend the full Washington Journal Program tomorrow talking about your reaction to the events in florida. Lets take you back to the white house a little less than one hour ago with president obama. President obama today as americans, we grieve the brutal murder, the horrific massacre of dozens of his dozens of innocent people. We pray for their families who are grasping for answers with broken hearts. We stand with the people of orlando who havent doored a terrible attack on their city. Although it is still early in the investigation, we know enough to say this was an act of terror and an act of hate and, as americans, we are united in grief, and outrage, and been resolved to defend our people. I just finished a meeting with fbi director komi and my National Security advisers. Andfbi is on the scene leading the investigation with local Law Enforcement. I have directed the full resources of the federal government be made available for this investigation. We are still learning all the facts. This is an open investigation. Definitiveched no judgment on the precise motivations of the killer. The fbi is appropriately investigating this as an act of terrorism and i have directed we spare no effort to determine what if any inspiration or association this killer may have had with terrorist groups. Person clear is he was a filled with hatred. Over the coming days, we will uncover how and why this happened and we will go where the facts lead us. This morning, i spoke with my good friend, orlando mayor buddy the and i conveyed to him best condolences of the american people. This could have in any one of our communities and i told the mayor that whatever help he and the people of orlando need, they are going to get it. As a country, we will be there for the people of orlando today, tomorrow, and all the days to come. We also express our profound gratitude to all police and First Responders who rushed to harms way. Their courage and professionalism saved lives and kept the carnage from being even worse. It is the kind of sacrifice our Law Enforcement professionals make every single day for all of us and we can never thank them enough. This was an especially heartbreaking day for our friends and fellow americans who are lesbian, gay, bisexual or transgender. Targeted a nightclub where people came together to be with friends to dance, to sing and to live. The place they attacked is more than a nightclub, its a place of solidarity and empowerment where people come together to raise awareness, to speak their minds come and advocate for their civil rights. This is a sobering reminder that attacks on any americans, regardless of race, ethnicity, religion or Sexual Orientation is an attack on all of us and the fundamental values of equality and dignity that define us as a country. Terror willte or ever change who we are or the values that make us americans. Today marks the most deadly shooting in american history. The shooter was apparently armed with a handgun and powerful assault rifle. Ais massacre is therefore further reminder of how easy it is for someone to get their hands on a weapon that lets them shoot people in the school or in a house of worship or in a Movie Theater or in a nightclub. We have to decide if thats the kind of country we want to be. To actively do nothing is a decision as well. In the coming hours and days, we will learn about the use of this tragedy, their names, their faces, who they were, the joy that they brought to families and two friends. And the difference that they made in this world. Say a prayer for them and say a prayer for their families. God give them the strength to bear the unbearable and that he give us all the strength to be there for them and the strength and courage to change. Need to demonstrate we are to find more as a country by the way they live their lives than either hate of a man who took them from us. Draw go together, we will inspiration from heroic and selfless acts, friends that helped friends, to care of each. Ther and saved lives in the face of hate and violence, we will love one another. We will not give in to fear or turn against each other. Instead, we will stand united as americans to protect our people and defend our nation and take who wouldinst those hurt us. May god bless the families of and may god continue to watch over the people that we love. This is an amazing family story if you think about it where terrible cool trees terrible cool trees are perpetrated, but its a family where fathers killed her sons, or wives had their husbands overthrown and murdered, where some colluded in murder. Its a family unlike any other. The romanovs a book about the dynasty that ruled russia for over 300 years. All the girls and all the children were wearing their own bulletproof vest. Not bulletproof vest, but vests sewn with romanoff diamonds, hundreds and hundreds of diamonds so they can have money orcase they needed to escape by their way out. They spent months sewing the diamonds in. When the bullets came, tragically, these made their agony much longer because the diamonds,unced off the hardest substance known to man than they did not die. Tonight on cspans q a. Panel on thete increasing use of synthetic drugs, those created from manmade chemicals rather than natural ingredients. Judicial panelists heard about the challenges and controlling the sale and distribution. This runs two hours and 15 minutes. Wherever they are in the testimony, we will let them give their Opening Statement right away. In many areas, we hear time and again that technology is outpacing the law. But in no other area is the result of this gap as deadly and tragic as it is with the recent rise in the production, marketing, and sale of synthetic drugs to young people. Traffickers created these drugs in laboratories so that they produce the same or greater effects on a user as controlled substances. But when the government acts to ban the new drug, traffickers simply tweak the chemical formula ever so slightly to evade the law. Dealers give these substances exciting names like spice and crazy clown. Legitimateem at Convenience Stores to market them to young people as legal and therefore, presumably safe, a safe way to yet high. But of course, this is all a lie. These drugs are anything but safe. Almost six years ago to the day, iowa became one of the first young people to die from the effects of smoking synthetic marijuana. Davids parents have become advocates for education, awareness, and action against the menace of synthetic drugs. I am honored to have them and davids brother here today. Davids father will share his familys story. Synthetic marijuana, or cannabinoid, is a substance that has little to do with the marijuana plant. The substance is typically composed of plant matter sprayed with chemicals designed to mimic the effect of the thc, the active marijuana ingredient, with far more potency. Synthetic cathinones, often marketed as bath salts or glass cleaner, are another type of synthetic drug. They are stimulants that imitate the effects of cocaine and methamphetamines. More recently, a third category of synthetic drugs has emerged. Synthetic opioids in the form of fentanyl. They are 50 to 100 times more powerful than morphine. They are deadly convergence of the synthetic drug threat and the current Opioid Epidemic. Last week it was reported that the over choice of fentanyl was responsible for the death of the musician, prince. According to the dea, synthetic drugs are largely developed outside the United States, in china, and smuggled into the country through the mail or across the border with mexico. Reports indicate the profits are often traceable back to the middle east. We need to take a long look if Law Enforcement has the tools needed to protect the public from the synthetics. This committee acted to cleared the traffickers since then it is clear they are outpacing us. Testifying before the Senate Caucus on narcotics cantrol, this committee acted by passing my bill, the David Mitchell rogza act. The bill placed a series of synthetic can have annoyance and other analogs on schedule one. It also extend the time for which a substance can be temporarily scheduled by the da to protect the public. The bill became law as part of the synthetic drug abuse prevention act. This is an important step to protect young people. Calls the Poison Control Centers began to level off or decline for a time. In march 2011, the da has used temporary Scheduling Authority to place 35 synthetic drugs on schedule one. Clearly, the threat posed by these drugs has not abated. Calls the Poison Centers for synthetic marijuana have once again begun despite rising from 2600 in 2013 to 3600 and 2014, almost 8000 in 2015. News stories continue to depict the awful effects of ingesting these substances on our youth t he effects on our health care and criminal Justice Systems. Law enforcement continues to encounter these substances in record numbers. I thank all of our witnesses for being here today to help us learn more about this crisis. Many of us on the committee have supported legislation that we think we can help. Given the complex way that traffickers can invade the law, this is a difficult problem that doesnt have an easy answer. I will turn to senator feinstein. I shortened my statement, i want my printed statement put into the record without objection. Sen. Feinstein thank you. I want to welcome our witnesses. As i look out at the audience, it appears a knowing and intelligent audience. Im pleased to see this. I have a humorous comment. I would not deliver it well. I will cease and desist. We are here to discuss synthetic drugs and the challenges in bringing the manufacturers and traffickers of these substances to justice. I think the audience knows that unregulated substances mimic the effects of controlled substances such as marijuana, pcp, and lsd. That is bad news. In 2015, there were 7789 Poison Center exposures nationwide to Synthetic Cannabinoids, known as synthetic marijuana. This was the most since the drug appeared in the United States. There were 3960 exposures in the states represented by this committee, mr. Chairman. That is almost half of the exposures nationwide. The challenge for Law Enforcement is that manufacturers, mostly in china and india, change one molecule or two molecules in the composition of a drug and produce a controlled substance analog. The new drug, although it has a similar effect on the body to a controlled substance may no longer be illegal under federal law. Enforcement efforts become difficult. These drugs are shipped to our country where they are marketed as legal alternatives to illegal drugs. They appeal to used because they are easily accessible; often sold at gas stations, Convenience Stores, or online. We beginning to see a decrease in synthetic cannabinoid exposures. Other synthetic drugs, such as synthetic opioids, continue to bring havoc. For example, fentanyl and its analogs are deadly and highly addictive synthetic opioids. In sacramento, there were 52 fentanylrelated overdoses in one month, resulting in at least 12 deaths. Nationally, from 2014 to 2013 there was an 80 increase in overdoses involving synthetic opioids, including fentanyl. I have never seen that before. An 80 increase in one year. While alarmingly high, these statistics may be inaccurate. Fentanylcaused deaths are often misclassified as prescription opioid or heroin related. Like other illicit drugs, illicit fentanyl and its analogs are clandestinely produced and primarily enter the United States in one of three ways. One, chinese chemists reduce and ship it to the United States Via International mail. Two, mexican drug traffickers produce it with precursor chemicals from china and smuggle it across the southwest border. Three, chinese chemists reduce it and ship it to canada, where it is smuggled across the northern border. The point is, regardless of the type, synthetic drugs pose a deadly and quickly evolving Public Health threat. Mr. Chairman, you and i have held 2 drug caucus hearings on this topic dating back to 2011. Since then, congress has only scheduled 26 substances, and another 35 have been administratively controlled through temporary scheduling only 11 of which have been permanently controlled. Simply put, our current legislative and administrative framework prevents the swift action that is needed to address this constantly evolving problem. That is why, with others, in 2015 i reintroduced the protecting our youth from dangerous synthetic drugs act. This is a bipartisan bill cosponsored by many members of this committee. This bill would prevent manufacturers from skirting federal law by establishing an Interagency Committee that would convene on an as needed basis to quickly designate and prohibit new synthetic drugs encountered by Law Enforcement. Importantly, since controlled substance analogues are not subject to schedule one research restrictions, legitimate scientific and medical research would be safeguarded. Controlling new synthetic drugs more quickly will better enable us to protect our nations youth and ensures successful persecutions against those who manufacture and traffic these drugs. If people here have comments on this bill, i would very much like to hear them. One thing is clear, mr. Chairman. We have to move, we have to do something to stop this. I have never seen this in my lifetime before in this country. I am hopeful that under your leadership we will be able to come forward with important legislation. I thank you, very much. Sen. Grassley i associate myself with her remarks about acting quickly. Michael botticelli is the director of the National Drug control policy. He leads the administrations drug policy efforts, and is responsible were creating an annual National Drug control strategy. Previously, he served as the director of Substance Abuse substances at the Massachusetts Department of Public Health. An undergraduate degree at siena college, and a masters of education at st. Lawrence university. We are glad you are back. Richard hartunian, the u. S. Attorney, Northern District new york. Prior to his confirmation,n he served as assistant u. S. Attorney for 12 years. He is a graduate of georgetown university, Albany Law School of union university. Chuck rosenberg has served as acting administrator of the dea since may of 2015. He began his Career Service his career in Public Service as an assistant of public attorney in virginia from 1994 to 2000. After a few years in the private sector he served in a series of senior positions in Law Enforcement, including console to then fbi director mueller of the fbi, and to then attorney general, and then Deputy Attorney general. He holds law degree from the university of virginia and a masters degree from harvard. The final witness is dr. Douglas throckmorton Deputy Director from the center of drug evaluation and research at the u. S. Fda. He joined the fda in 1997 after working as a basic science researcher and academic position at the Medical College of georgia and Veterans Administration hospital in augusta, georgia. He earned his m. D. From the university of Nebraska Medical School and completed his residency in western reserve and his fellowship at yale university. Would you start . Mr. Botticelli thank you for inviting me back to discuss issues related to synthetic drugs. Although all synthetic drugs, methamphetamine, fentanyl, and cannabinoids, are a concern of the administration i will focus on new psychoactive substances. There known as designer drugs or legal highs. They are designed to mimic these effects of controlled substances and circumvent controls. In 2015, the United Nations estimated there were over 600 identified nps on the mobile market. The vast majority are not controlled under Un Drug Treaties or authorities. Nps are often mixed with material to form a dangerous final package in alluring packaging. The composition could vary from batch to batch. They have no known medical use, and many pose a serious threat to Public Health, including addiction and lifethreatening medical consequences. I appreciate that they are here from iowa talk about davids Death Associated with the use of a synthetic cannabinoid. There are many young people who are testament to the deadly impact nps are having on our communities. Although the un, the federal government, and all 50 states, and the District Of Columbia have developed responses to controlled substances, that use with which they can be manufactured extent controls challenging. According to the dea, all nps are manufactured in china and marketed to the u. S. By being shipped. Given the fatal and nonfatal effects of these substances this needs to change. The u. S. Is leading discussion with how Global Response to nps can be improved. A special session of the Human Assembly rejoined other countries to encourage the World Health Organization to engage more proactively in the review for substances for International Control. While International Control of drugs and precursors are important, the existing International Framework is underutilized and unable to expeditiously control the overwhelming number of nps that exist or could be developed in the future. As a result, the u. S. In partner countries are pushing other countries, like china, to take control of nps within their borders. In october, china announced actions to gain control over nps to include placing 116 substances under national control. Most importantly, china streamlined their scheduling process for nps and determined the impact of a substance domestically and internationally should factor into the review for substances for control. Our federal agencies will work directly with china to reduce the manufacture of nps. Federal agencies are working with Law Enforcement to support investigations domestically and abroad, with the science and Research Community to better understand the pharmacology of nps and perform treatment strategies, and with prevention partners to inform communities about the dangers of synthetic drugs. Despite these efforts we are concerned about the availability of traditional responses to reduce use and availability of nps domestically. Scheduling provided by congress helps Law Enforcement and the Justice System address nps, but the Data Collection needed to support scheduling actions for the existing and potential nps is a huge task. Under the along statute, prosecutors must start each case a new, even if the same substance is involved, an unnecessarily timeconsuming and resource intensive process. For the past year, technical experts at dea, fda, and the National Institute of drug abuse have been reading and working together with the Data Collection required to place new drugs under control and how that plays into the permanent scheduling processes. We believe a coordinated response to scheduling, which aims to protect Public Health and safety, and takes into and safety, and takes into account Research Interests is needed to stay ahead of the supply of nps. Shortterm, congress can help by legislatively controlling a significant number of nps structurally related to scheduled compounds. Scheduling these compounds does not prohibit researcher access, but prevents further harms to the public. In the longterm, more significant reforms to the scheduling framework are needed to stay ahead of the new realities of the illicit drug market. The United States is not alone with grappling with how to modify their regulative processes. In recent months, the United Kingdom and australia have taken bold steps in getting ahead of the drug threat. Ondcp is committed to making progress and will continue to work with international partners, federal government agencies, and partners at the state, local, and tribal levels to prevent threats to our communities that these dangerous substances pose. Senator grassley thank you. Go ahead. Richard thank you, chairman grassley, senator feinstein, members of the committee. On behalf of attorney general lynch and my colleagues at the department of justice, i thank you for the opportunity to testify about synthetic drugs. Despite our significant efforts, synthetic drugs flourish with horrible human cost, including hallucinations, violence, hospitalization, and worse. Many are produced in china by chemists who vary the formulas to stay ahead of the scheduling process. There are no quality concerns. The variations of potency and unknown mixes of chemicals pose a danger to users. Police officers and counter users who are delusional Police Officers and counter users who are delusional. It garnered worldwide attention in 2012 involving a 50 fouryearold utica man under the influence who is seen naked in the street waving a tree branch. A 54yearold utica man under the influence who is seen naked in the street waving a tree branch. When the man told the police that they would have to kill him to stop him, the officers deployed a taser gun. The man pulled the probes out of his chest and continued walking until 2 officers subdued him. In march of 2016, Syracuse Police took a 25yearold man to the hospital after his mother reported he set his mattress on fire after ingesting Synthetic Cannabinoids. Syracuse has seen so many overdoses of cannabinoids known as spike it has been called spike nation. Under the analog acts, criminal reliability depends on a finding that the substance is an analog intended for human consumption and if the defendant knew the substance was regulated under federal law or the identity of the substance. Even if a substance is widely regarded as a controlled substance analog under the statute, each criminal prosecution must establish that fact anew, requiring extensive use of expert witnesses to prove the analog is substantially similar to a controlled substance in structure and effect. Proving it was intended for human consumption is another challenge in light of the practice of marketing and selling cannabinoids with names like bath salts and not for human consumption labels designed to set up a lack of knowledge defense makes it difficult to convict highlevel suppliers. Neither the challenges or evasive actions of the drug manufacturers and distributors, however, have deterred our efforts to protect the american public. In new york, we first used the analog act in a case that began in 2009 to convict 20 defendants in a ring importing molly from china and distributing it in the syracuse area. Multikilo quantities were shipped, some falsely labeled as metal corrosion inhibitors. In 2012, we successfully prosecuted the owner of 9 head shops in Central New York which sold synthetic drugs. We seized nearly 12 kilograms of spice and k2, and thousands of packages of amped and legal funk. He went to jail for 87months. From coast to coast and in the heartland, attornies have achieved similar successes. In north dakota, after 2 teenagers died from overdoses in the grand forksarea in 2012, charles carltons Online Business was revealed to be importing analogues from several countries and distributing them. Carlton and 14 other defendants were sentenced up to 246months. In california, victor pleaded guilty to causing 24 tons of misbranded drugs to be introduced into interstate commerce marketed with names like bazaaro, orgasmao, and nutronium. In florida, a Chinese National was sentenced to 15 months in federal prison and forfeiture of 1. 5 Million Dollars for his involvement of supplying kilograms of cannabinoids to the u. S. , russia, europe, in multikilo partials. Multikilo parcels. Zhang was a chemical engineer and monitored the scheduling. In the Northern District of iowa, in 2015, there was conviction of conspiracy to distribute analogues and launder drug money. Syed and anwar were distributors of Synthetic Cannabinoids with names like mr. Nice guy and mr. Happy. While our prosecutions punish some and a tour others, and raise Public Awareness of the dangers of synthetic drugs, we understand that education, prevention, and rehabilitation are essential. We understand education and rehabilitation are essential. We partner with educators and Health Care Providers in town Hall Meetings and event like the east Side Community forms sponsored by 3 syracusearea high schools. We invest in Leadership Programs like our program reaching fifthgrade students. Reentry court helps high risk supervisees find the help they need to reach a great into society. The tools congress has given us has allowed us to take aggressive action against drug manufacturers and dealers. We face challenges, but our resolve to hold poison peddlers accountable remains unwavering. I look forward to answering any questions. Admin. Rosenberg thank you. It is a pleasure to be here. I appreciate you holding a hearing on this topic. In our lexicon we use words perhaps without thinking unprecedented, historic, and unique. I think what were seeing is unprecedented, historic, we have an epidemic. Another word that is sometimes overused, but is apt here. This is an epidemic. I want to talk about this little the magically. I will be brief. And then, of course, i am happy to answer questions. Three words that help me think about the problem, vile, volatile, and lethal. Let me explain. The reason that this is so vile, and you touched on it mr. You touched on it, mr. Chairman is because a lot of these poison peddlers are marketing to children. They take substances, put them in shiny foil packages, put cartoon characters on them, give them an innocentsounding name, stick it in a convenience store. Stuff tosell this kids. By any definition, i think that is vile. Volatile, let me explain that as well. As you touched on this, mr. Chairman, and senator feinstein mentioned, as my other witnesses will talk about we are trying to , keep up with a picture that changes almost every day. We have identified Something Like 400 new nps psychoactive substances over the last 4 or 5 years. We were seeing one a week at one point. Now, two to three a month. I feel almost every time i sign and administrative control regulation that i am telling the bad guys, not this one anymore. Move over here. That is what they do. It is volatile. For everyone substance we control legislatively or administratively, there are 11 that are uncontrolled. It is changing all the time. Vile and volatile. Let me address lethal. Folks will talk about this today, eloquently, perhaps on this panel and on the next one, the effect it has had on our kids and those we have lost. I want to talk about it from a different perspective. A Law Enforcement perspective. Fentanyl is so dangerous we have had to instruct agents that if they touch it or inhale it accidentally, they can die. If they are a k9 officer and the dog sniffs it, perhaps because it is laced with heroin, that dog can die. We have trained our agents, not because they are First Responders, they are typically not, but because they could encounter fentanyl, to administer narcan to each other. If they come upon a first responder, they could do it. We have to educate our people because it is so lethal. Its really a remarkable substance. We are putting out a roll call video through the International Association of police to warn one million Police Officers across the country that you cannot field test this stuff or transport it the way you normally transport other drugs. You have to be so careful. Only being exposed, not even purposefully ingesting or smoking it, just being exposed to kill you. Those are the three words that help me think about the problem. Vile, volatile, and lethal. We have a lot of work to do. We are playing catchup, and we need your help. Thank you for the opportunity. Sen. Grassley thank you. Youre very plainspoken. Dr. Throckmorton im with the i am douglas throckmorton, the Deputy Director for programs at the fda, part of the department of health and human services. Thank you for the opportunity to discuss the Important Role the fda has in assessment of new drugs, illicit or nonillicit, to protect the Public Health and new drug development. Let me begin by saying that i agree with the comments that the three panelists have made as far as the seriousness of the issue. New synthetic drugs are flooding the u. S. Market. They pose Significant Health risks. We appreciate the effort the committee is doing. The fda is committed to doing our part. The fda is the lead federal Agency Responsible for regulating controlled substances and enforcing the controlled substances act. Many responsibilities are performed by the fda in this area. I will focus on the role in the drug scheduling process, including emergency control of new and dangerous street drugs. We conduct a medical evaluation, sometimes referred to as agefactor analysis, which forms the basis of the recommendation to the dea about the appropriate level of control for a substance that has the potential to be abused. They are spelled out in my written testimony. That of evaluation involves careful analysis on many kinds of data, chemical synthesis, structure, absorption, receptor binding, and clinical studies to understand the drugs abuse potential. Once complete, our analysis is shared with the National Institute of drug abuse for concurrence and sent to an hhs , which transmits the recommendation for final decisionmaking. Under the csa, there are five schedules depending on abuse potential. Schedule one is the highest level of control reserved for drugs with a high potential for abuse, no currently accepted medical use, and lack of accepted safety for use under medical supervision. In addition, the fda has a role in the nontemporary scheduling of illicit drugs where the dea contemporarily place a subject in to one more quickly. The fda provides information about whether a given substance is an ingredient in an approved drug product or the subject of a study. We participate in the final scheduling action following the emergency action. The scientific evaluation process to determine the appropriate level of control balances the important need to protect the public from dangers posed by drugs and substances of abuse, while seeking to provide access to these drugs for researchers for potential drug development. In addition to its role in scheduling drugs, the fda works with the department of justice, including the dea, to support criminal investigations involving the criminal cell, criminal sale and use of illegal substances. I want to turn to the novel psychoactive substances. Fda has been actively engaged with dea to assess the use potential of these substances and doing what needs to be done. We completed a memorandum of understanding with the dea about our ability to Share Confidential Information efficiently to facilitate work together. Between 2011 and 2016 we were able to respond to all dea requests for recommendation regarding permanent scheduling of illicit substances. Both of them most of them were emergency scheduled. We are working with the dea to do even better. By improving the process of drug scheduling, with the enactment of the Drug Prevention act of 2012, as a part of the fda innovations act, scheduling illicit drugs can be done on reduced amount of information using binding studies and functional essays. Using this approach, we have evaluated 16 substances to make recommendations for permanent scheduling by dea. Extending this approach, we have been able to apply a similar way to look at the socalled bath salts. These are highly dangerous stimulants and hallucinogenic substances that can cause severe toxic effects, including convulsions and death. We recognize the challenges of controlling these substances in light of the harm of Public Health observed and that chemists can rapidly alter the chemical structures to stay ahead of regulators. Placing these substances in schedule one can protect Public Health, but the same chemical structures and pharmacologic up overlap legitimate therapeutic use. Disincentive to research for those therapies. Their fees. To echo michael botticelli, we believe in scientific review to balance the Public Health risks posed by illicit use of these compounds while preserving the need to develop new there these under appropriate and scientific understanding. The fda is committed to working with federal partners to understand and enhance the timely appropriate scheduling of these substances. We hope the committee addresses this problem and will give relevant federal agencies opportunity to share responses, including sciencebased solutions that would address the threat to Public Health and safety posed by these dangerous compounds. Thank you for the opportunity to appear before you. I am happy to answer any questions. Senator grassley i will ask my colleagues, who have five minutes, and we have will not we will my have a second round because we have five witnesses on the second panel. I want to make sure they have their opportunity to testify before the committee. I will start with mr. Hartunian. It appears from your written testimony that you and some of your colleagues have had success prosecuting cases similar to the controlled substance analog enforcement act, despite the challenges opposed by proceeding under that statute. You are to be commended for that. With that in mind, despite complaints about the scheduling process being too slow and cumbersome, do you have an opinion on continuing to schedule dangerous synthetic substances, or should we just rely on prosecuting these substances as analogs . Richard thank you for that question. The more Chemical Substances that we schedule, the easier it is for us to do our jobs. The act in 2012 is helpful, adding chemicals and substances to the list under the controlled substances act, making it easier for prosecutors, in a more straightforward way, to prevent cases in court. Establishing the chemical compound is on schedule and proceed with questions about its chemical composition and effect. When we run across synthetics on schedule, we have to deal with the challenges of the controlled substance analog act. They are well familiar to, i know you, senator grassley and chairman feinstein with your work with the drug caucus come you have heard about this. We have to prove these elements beyond a reasonable doubt. It can be challenging. Their suspect to expert testimony battles. Frequently the defendant will call in about the testimony of a substance, when in fact, there is testing that is being done. There is a possibly of testing being done. A lot of the times the chemists have to rely on Research Documents or animal testing. That can make it difficult to prove. To answer your question, sir, the faster we can get these drugs scheduled, the better. Senator grassley we keep hearing our current scheduling approach for synthetics is not enough to deal with it. We also hear concerns that if we moved to schedule substances to quickly come it could hurt legitimate research. As we look to find a better approach to address this threat, what can you tell us, and the congress, about how other countries are addressing it. Are they potential models for the United States . What has been the impact of research in those countries . Dir. Botticelli i agree with senator feinstein that there is a legitimate pathway for legitimate medical research as it relates to schedule one substances. The challenge has been on the Public Health side. I think there is a tremendous amount of conversation with interagency partners to look at opportunities to streamline the research process. We are always open to those kind of issues to deal with. I think we have to err on the side of how we dedicate the Public Health harm and stay ahead of these substances. That should be our first priority. I think we continue to monitor what other countries have done around this. The United Kingdom took an interesting approach. Rather than looking at it chemical by chemical, or molecule by molecule, they are looking at these drugs based on their psychoactive effect on the brain and brain receptors so we can look at staying ahead of some of these as part of the psychoactive effect. Conversations that we have had with the fda and dea looking at how we can streamline the process given the information we have on the individual chemicals and can we look at, based on the ea information and other information, really put forward a greater number of the substances to be scheduled . Sen. Grassley i will ask mr. Rosenberg my last question. Something mr. Botticelli mentioned, can you tell what the dea and other components are doing to confront china about their role in delivering this poison to our country . Are the steps that china has taken enough . If not, what else would you like to see done . Dir. Botticelli in october, china took an important and helpful step when it regulated 116 chemicals. I have met personally with senior members of their antinarcotic enforcement bureaus. They tell us they will do more. I hope that is right. Even after they regulate, the guys shift a little right or left and keep going. So far i have been heartened i what they have done in october, and what they will do to help us regulate additionally. We have to do more here, as well. Sen. Grassley senator feinstein . Sen. Feinstein ive listened carefully. It seems like we have a battle of the experts, which slows down the movement on these drugs and lets them get ahead of Law Enforcement. For me to look at one month in sacramento, which is not a big city in california, and somebody dies every single day of this drug to me, it is like zika. There is a lot of effort going on to speed up research. Here, we have to speed up the ability to enforce. The question comes to eliminate this battle of the experts, that is in the courtroom, would a committee made up of an Interagency Group of scientists that would convene on an as needed basis, to legally determine whether a new synthetic drug is a controlled substance analog would eliminate the need for lengthy and repeated congressional scheduling actions for small chemical alterations to already schedule substances. What im going with this, and senator grassley and i have held many hearings, there is no drug activity that is more important to get at, to be tactile, to be able to move, deal with mutations and changes. If you depend on a change of the law every time this changes slightly, we are way behind. It seems we need some mechanism of experts, like those at this table, to sit down, look at a drug, make a decision, and move on. Could anyone comment on what i have just said question mark you dont have to agree, but i would like to listen. Why dont we start with you . Dr. Throckmorton i agree with the importance of identifying a way to speed decisionmaking in terms of the sheer number of products. The specific action that you are suggesting, the analog, changes to the analogues, this is something the fda has a large role in. I dont know that i would be able to comment about our particular agencys view other than we are interested in doing whatever we can. Our role is on the scheduling actions. My day job is to make sure nothing we are doing around scheduling is impeding the actions the dea needs to take with regard to these important, dangerous drugs. Sen. Feinstein mr. Rosenberg . I will ask each one of you. Admin. Rosenberg our process is cumbersome. Im not exactly sure how we fix it. One of the things that i like is what dr. Throckmorton referred to. Speaking holistically about how these substances bind to receptors rather than molecule by molecule. We have done some of that. So far, it has worked, but we need to do more. I am open to just about anything that makes our process less clunky and cumbersome. The devil is in the details, of course. Im very happy to work with you and your staff on that. Sen. Feinstein we will take you up on it. Mr. Hartunian the prosecutors have to deal with the evidence as we find it. We develop evidence and we have to deal with whether the substance is a scheduled drug or not. As i explained, the more we have on the schedule, the more straight forward our prosecutors can be. There is benefit to our dhs partners have other work at the border in seizing substances that come into the country. If we have a substance that is not scheduled, we fall to the analog act or other tools. We have to establish the case using our experience and the developmentment with our agents. Admin. Rosenberg it is important to look at the committee. Is it duplicitous . We probably have shared concern over are we creating another layer bureaucratic process . I know you dont want to do that. Youre having more discussions sen. Feinstein what would you recommend . We need to move on this and do it quickly. Admin. Rosenberg part of this is looking at and we have been heartened by the conversation we have had amongst federal agencies to look at how we streamline the process and make sure we have evidence. We have to look at, what is the criteria to determine if drugs are scheduled. It is a cumbersome analysis to determine if each drug as the health and Harms Associated with it. We need to look at it and work with you on the criteria with which we schedule these, and see if we can do a better job of streamlining them. That we can work with congress on to look at some level of scheduling for those substances. Sen. Feinstein thank you. Mr. Chairman, i dont know if theres anything we can do within the drug caucus on this. I view this as a real emergency. The value out there on drugs i was talking to someone today who had a teenager who feels very badly because she wont get involved in drugs or drinking. She is being set upon by the youngsters she goes to school with, works with. Youre not like us. Youre not one of us. You have to do all of this. Somebody has to get to the heart of this and point out the death rates and incapacitate incapacity that is developing among young people from this kind of use. And the fatality of this is so inordinate. E if anyone can make a suggestion first of all, we should come up with something that enables the government to move rapidly. Sen. Grassley obviously, i dont disagree and i hope that our staffs have been talking to some degree. I got that impression. If that is it right, you tell me. Senator tellis . I think he goes first, then you. Senator tellis. Sen. Tellis mr. Rosenberg, i have a question about your written statement. You made comments about coordinating with various agencies, Homeland Security, dea, i. C. E. , can you talk about what is working, what we need to do differently, and the involvement with state and local agencies . Admin. Rosenberg i presume you want me to talk about enforcementrelated matters . We have a real challenge. This is only one of a whole bunch of things that we are trying to combat in this country. I have asked all of my special agents around the country to tell me and to work on the most significant threats in their jurisdiction. By and large, controlled Prescription Drugs heroin, synthetics, meth, cocaine, those are the top. We are spread thin. We are down to 800 personnel overall. We have a bunch of challenges. We are working really well, i think i am biased, but i think it is true with our task force officers. 35 of our Law Enforcement within the dea our state and local task force officers. That is remarkable. We are relying on them, and folks with local knowledge, to tell us where the hot spots are and trying to hit that. It shifts and changes all the time. We are outmanned. Senator tellis i want to thank you for your work in North Carolina. Our local Law Enforcement has a lot of positive things to say about you. Im glad we worked on equitable sharing and other things to come out of that. That is important to keep them engaged. We appreciate it. In the state house and 2011, we took action on the synthetic marijuana and bath salts. What more i states do well we try to sort out that her policy . Can you cite any states that are particularly good . Others that are behind that we should work with to get a handle on at the state level . Admin. Rosenberg in terms of establishing controls . Sen. Tellis what we are to do is not go too far. In North Carolina, we had synthetic marijuana, bath salts we put action on the precursor to methamphetamine. What im trying to do is to figure out what could be positive action that they could take, and what could be potentially problematic that needs federal consistency . Admin. Rosenberg i do not have in my head a statebystate state practices list, but i will get that to you. Sen. Tellis that would be helpful. From the extent that we could learn from other states that are doing it well, we can take action when it is not disruptive to what we are trying to do nationally. Admin. Rosenberg great question, i will get back to you. Sen. Tellis again, i do not think people understand what we are talking about. The cannabinoids and synthetics that exist. If you look at marijuana that is legal, it is several times more powerful than it was 2 decades ago. I worry about this problem increasing. Now you have marijuana tourism. People going from states where it is illegal, two states where it is not, and going back. If they had a good experience, they will try to create more potential demand. We have to get ahead of the problem, and other problems that could be created if they go to other, more powerful drugs. Is it true that china is one of the largest manufacturers of these substances . Synthetics . Admin. Rosenberg yes, sir. Sen. Tellis what are we doing to interdict them, and what more do we need to do . I want to talk about education, to decrease the demand. What are we doing to thwart the supply . Admin. Rosenberg i think mr. Hartunian made an important point. Even if the bad guys are tweaking molecules to invade to evade our regulation, at least for a time, it gives our brothers and sisters at the dhs the ability to seize without a clouded legal landscape. There is a value in scheduling, s just not a permanent value. Sen. Tellis because they keep moving the goalposts . Admin. Rosenberg it is still important. Sen. Tellis any comment . Mr. Hartunian we try to do what we do and all drug cases, to work up the supply chain when we establish our investigation. That is always the goal. I doing that, we find overseas targets and we have to do our best to identify them and follow the money when we can. To establish evidence that would allow us to reach beyond our borders. Sen. Tellis just to be clear on the china example, are these illicit operations in china producing the supply, or Legal Enterprises under the Chinese Government . Sen. Grassley after you answer that, we will have to move on. Mr. Hartunian to my knowledge, they are engaged in the cases that we have seen, they are conducting themselves in violation of our laws. Admin. Rosenberg i think that the answer is both. This year volume of chemical manufacturing in china presents a problem in looking at this, but they have part of their business looking at some of the illicit substances as well. We have been working with a joint Interagency Task force west with a special group focused on nps interdiction and precursors around methamphetamine. Admiral smith has taken this on looking at interdiction. Some of the challenges, particularly around fentanyl, is that we do not have good detection and monitoring. Sometimes hazardous monitoring around street fentanyl. Sen. Franken thank you for your testimony and work. I want to wrap my brain around a couple of things. One of which, we are talking about synthetic drugs. Stuff that is on the street or sold in head shops, that kind of thing. I want to ask, obviously we have had an Opioid Epidemic. Opioids are prescribed. I want to get understanding of this right. Rosenberg, you say the 2014 National Survey on drug use and health, 4. 3 million americans aged 12 or older report taking a prescription painkiller for nonmedical purposes within the past month. Yes, sir. Franken how much of that were legal opioids prescribed, and how many were street opioids . Specifically because you dont know how much is in it . Which is which . May i get started by coming at it from a slightly different direction . Sen. Franken no. Yes. May i start by not admitting that im going to come at it from a slightly different direction . Franken sure, do that. Those are stunning figures. As to your question, initially, most of that stuff was legally prescribed and sitting in peoples medicine cabinets. What happens next, the street value lets say that you are hooked on oxycodone or hydrocodone. You run out of the stuff. The street price is pretty high. You may pay one dollar for milligram or 30 per code. Per pill. The substitute is heroin. It is much cheaper. The substitute for that is fentanyl, which is cheaper yet. Sen. Franken you say that they took prescription painkiller we know the vast majority get them from friends and family. They are not buying them on the street. But as they get addicted, they turn to a street purchase all pharmaceuticals. We see sentinel prepped into fentanyl prepped and opoid,s like an at th an which has a potential impact for death which is far greater. Franken another thing we have been trying to get into and this is about scheduling. My question is and this is a basic question. Not have as much experience as the chairman and Ranking Member in terms of could there be some type of conditional scheduling where we does basically what has happened is someone create a chemical, they sell it in bath salts, people die, it takes a while to adjudicate that ok, this should be illegal. And then in the meantime, they change a molecule, and veteran barrier . He constitutional barriers, legislative barriers . Order the barriers to saying we have observed something has killed somebody what are the barriers to saying weve observed something is killed somebody. Of right now we are going to schedule this conditionally and no one can make this now. It is illegal to make it now. It is illegal to sell it now. What are the barriers to that . The processswer youre talking about is what we would call emergency scheduling. At the intent of the emergency scheduling provision is to make it possible to do exactly that. With limited information less information than when the fda does it analysis and Animal Studies less information, the dea says, we ever were we have reports of people being harmed. We think this drug is a substance we want to emergency schedule. Theres an expedited mechanism for us to say, we agree, please make that happen. That can happen reasonably quickly. In a matter we turn our review around within a week, for instance. It has been followed by permanent scheduling, and two years ago, three years ago, the time that rings were allowed to emergencies go told scheduled so you could put something into that schedule make it illegal to manufacture, possess, distribute while we datad on developing the necessary to permanently schedule it. I believe that is now 18 months or two years. Tohave a long time it takes control. I think the question the panel asking canly we do it even more efficiently . Can we make a final decision without going through that to process and reduce the amount of information to come to that decision more weekly . That is what we are talking about . What are the bare bones in order to make that recommendation, that final decision. Grassley senator klobuchar. Senator klobuchar thank you, mr. Chairman. We passed our bills. Mine was the combating designer drugs act, and that helped with specific cases to get some of these substances list did. Listed. We had a number of kids dying in our state. We had duluth it was going to make duluth the last place on earth because there were so many people hanging out on the streets around it and there was a major, major prosecution and they were able to use the bill that we passed, senator grassley, just to show what we do matters. I am a supporter of senator feinsteins bill, but i have also introduced the bipartisan bill with senator grassley and senator graham, as well feinstein, that looks into what is stopping us from prosecuting some of these cases. I think what is going on is these drugs get listed as not intended for human consumption they that label on even though we all know they are intending them for human consumption. They use that as a defense in court or if they say, well, it humanot intended for construction. You cant prosecute us for that. Itomes out of many proves that these drugs are used andan human consumption it allows that evidence to be introduced in court. So, could you talk may be director and by the way, thank you for coming to and couldrecently, you talk about this and maybe mr. Rosenberg, these challenges, it can as well how help if we close this loophole . I support senator feinsteins bill. I would like to specifically close this loophole as a former prosecutor. I know how the loopholes become not little loopholes. They become a hole that you can run a truck through full of synthetic drugs. Chef by sure. We are very supportive of legislation looking at sure. Were very supported of legislation looking at this. We are very supportive the way these drugs are marketed, the way they are sold, the way they act on the brain are proven indicators that the substances are clearly intended for human consumption. I am not a prosecutor, but i would imagine any enhanced tools we could give prosecutors to go after this would be an important vehicle to get them out of our communities. Senator klobuchar i totally get that side. Our state is the land of many treatment centers. We use that more than drug courts. It really bugs me when we cannot go after the bad guys. That is why i want to close this loophole. Thank you, senator. You know, as a former prosecutor, that prong intended for human consumption makes it particularly challenging to work up the supply change. These suppliers become more insulated and it becomes challenging. I think our department has been working with your staff and was to continue to keep working with your staff to find ways to prove, how we are going to prove that element. Its interesting that prosecutions in this area are relatively new. I would say in the last five or 2010, 2000 11 i have been a drug prosecutors from his 20 years, we had not seen these senator klobuchar the testing of these things and this whole analog problem they were happening everywhere and people were dying. It was such a hassle to rufus sometime two prove it sometimes. As we do more cases, i think we are learning more, gaining more areas, seeing how the court are interpreting evidence. I think this will be an ongoing process. Mr. Martini and mr. Stole my last point. I am happy to look at anything that helps us do that. Senator klobuchar thank you very much. When senator feinstein was to go, i will help takeover with the next row. Thank you, senator grassley. Senator grassley senator blumenthal. Senator blumenthal thank you, mr. Chairman and the Ranking Member for having this important hearing. I had your job in connecticut for four and a half years, and it is the best job in the world yes, it is. Maybe onlymenthal second to being attorney general in the state, but one of the things i did was to actually try drug cases as a United States lessons froming my the then u. S. Attorney from the Southern District of new york bob fiske a number of the cases we did with the da. I was grateful and amaze but and amazed the wife the extreme eric urgent heroism of the dea agents. Granted thate for walk into situations where gunfire is as likely as somebody opening the door area they often operate in hostile environments where they are held accountable, but no one else is. I just want to thank all of the Law Enforcement agents federal, state, local, who do this work, because it is challenging and demanding and they are on the lines. But of course, we are not going arrest or jail our way out of this crisis. , you have been a very articulate and eloquent folks men on behalf of the measures necessary to change our culture and our prescribing practices, which are often away the demand for those substances are created, as you know, because you have visited connecticut. I thank you for coming to visit. Ofave done a series roundtables, 13 around the state, and produced a word that makes recommendations 22 recommendations for changes in them,d practice, among changes in the prescribing practices of doctors more training, education so powerful substances that lead to addiction, are reduce. Is what canto you be done to change the culture and the training that we give to our training physicians so they unintendedf the consequences and they are surely unintended. These prescriptions are often done with the best intentions, but as the father of four children, i know percocet, vicodin, oxycontin are made available freely. Thank you, senator. It was a pleasure to be with you in connecticut and i think your leadership and innovation that is happening in connecticut is very important. I think you articulated that we a fewhe root cause of our it academic lies in the vast overprescribing of our Opioid Epidemic was in the best over prescribing of medication. We have been supportive of mandatory prescriber education. I have often said i do not think it is unreasonable in the middle of an epidemic to ask physicians to take a limited amount of education and many states have moved to implement mandatory education. One of our greatest deficits has been the black of access to Treatment Services the lack of access to Treatment Services. I hear that everywhere we go. Not being able to give people into treatment. The president has proposed a pretty robust proposal to expand treatment for every state. While we need to focus on prescribing and dealing with the root causes we have so many people who need treatment but are not able to get it. I think it is important that we tok at expanding treatment reduce these steps. That is one of the recommendations and our work and that is what we have learned and i am sure it is familiar to be very expert members of this panel that the criminal Justice System can play a part in compelling people to seek and if it is areatment condition, a probation. I cant tell you the number of , thets we have said to us fact i had to report to a probation officer kept me in treatment. Intersect between Law Enforcement and Treatment Services where the two go together . My time has expired, mr. Chairman. I think you for the opportunity. I want to thank the panel. This is an extra ordinary group and making a real contribution. Thank you. Senator grassley you have you havecus to brought a focus to this problem as senator feinstein and others on the committee are trying to work on. We are hoping to get a resolution to move very quickly. I ask you i would say you were dismissed and now. Thank you very much. We will not have a second round of restaurants because we have a long can panel a second round of questions because weve along second panel. I will start introducing the second panel what youre coming. Mike from iowa he and his wife jan and son daniel have become leading advocates for education to combat the spread of synthetic drugs after their son david fatally shot himself in 2010 after taking k2, a synthetic marijuana substance that caused him to have severe hallucinations or they were honored as advocates for action by the office of National Drug control policy injury 13. Our next witness is chief cathy lanier, of the d. C. Metropolitan police department. She has served as chief here in 2007. Strict since she served most of her time in the Fourth District rising to the level of commander. She subsequently became the commander for the major narcotics branch, vehicle or homicide unit, and special operations division, where she established the agency for first Homeland Security counterterrorism branch. She holds a bachelors, a masters degree from Johns Hopkins university, and a masters degree in National Security studies from the naval postgraduate school, monterey, california. Our third witness is mr. Joseph coronato. Es served since 2013 as the ocean county prosecutor in ocean county, new jersey. Prior to his appointment, he had served as prosecutor in the new jersey state attorney generals office, in the atlantic countys prosecutor office, and in private practice. He is a graduate of North Carolina Central University law school or it on it witness, her sullivans myth. Dr. Smith serves multiple roles as an Emergency Room Physician and in the Tennessee Regional Medical Center emergency room department. He is also a lieutenant in the Cookeville Police department and a fellow of the American College of Emergency Physicians. Residency, the university of tennessee. Final witness, dr. Jim Hall Services epidemiologist with the center for applied research on Substance Abuse and health at Nova Southeastern university. He also serves on the National Institutes of health National Drug Early Warning system and s drug safety and Risk Management advisory committee. For the past 30 years, he has tracked patterns and trends of Substance Abuse in florida as a states representative on the of drug abusetute Community Epidemiology workgroup. Of long introductions, but they are all important people. Would you please start . The button is on green button, im sorry. Rozga on behalf of of my family, i want to thank you for inviting me here today. Yesterday was the sixth anniversary of my sons death. As you might understand my testimony today is difficult. We started to learn what happened to years earlier. Days earlier. David went to a friends home and smoke appeared after smoking became veryid agitated. He told the boys he felt like he was in hell. I want to stress the significance of that statement because as a Christian Young man, hell represented the worst place david could imagine. This is far and away the worst, scariest, evil thing he experienced. We later learned rapid heart rate, increased Blood Pressure, feeling like you were being chased by demons or satan himself is not an uncommon experience. After a bit, david seemed to be calming down and wanted to go home and take a nap. Prior to leaving his friends, they agreed to get together and go to graduation parties that evening. Tragically, after coming home, david continued to be tormented by the drug and instead of taking a nap, he came home and shot himself. We saw nothing in david to indicate he was depressed, much less suicidal. He just graduated high school and was on cloud nine, looking forward to his summer and attending the university of Northern Iowa that fall. The Police Investigation into his death also concluded david wasnt suicidal and had a severe reaction to the drug. We learned these drugs can totally take over your mind and body and you are powerless to do anything. I ended my testimony in front of the drug caucus in 2011 by telling them where simply not doing enough work moving quickly enough. Sadly, i have the same message for you today. We are not moving quick enough and giving Law Enforcement and prosecutors the tools they need. The New York Times ran the story on june 10, 2010, the day after davids funeral on the problem with k2. In response to synthetic drugs becoming illegal, a shop owner responded, once it goes illegal, i already have something to replace it with. There are hundreds of synthetics and we just go about them a couple at a time. I remember thinking how ridiculous that seemed, but that is exactly what happens. We started with Synthetic Cannabinoids, then mdma, and now synthetic heroin and who knows what is next. It is quicker, easier, and most importantly, cheaper to bring these synthetic drugs to market. Senators, the landscape has forever changed. K2 is not the secondhighest mountain in the world. Purple haze is not a jimi hendrix song. Hide behind false advertising and it successfully used our laws against us. Quite simply, these people are murderers who knowingly sell poison for their own financial gain. To our knowledge, david was the second death in the u. S. Tied to k2. Early on there were struggles because we were seen as the poor family whose son committed suicide and we were trying to blame this fake pot. Imagine talking to legislatures in 2010 or 2011 saying you want to ban bath salts and other things being sold under false pretenses. Not an easy task. Fortunately, no credible person doubts the tragic consequences of the drugs today or that we have a real issue. As we visit communities and schools around iowa, i continue to be amazed that after six years there are so many who have not heard of these drugs. As a parent how do you talk to kids about things you dont know about . We need to educate parents about the dangers of these synthetic drugs. I know the war on drugs is not a poplar phrase to use but for those fighting in the trenches i dont know what else to call it. We are in a battle for our children, grandchildren, schools and communities. Senators, i pray you move quickly to take action. Far too many families have suffered as a result of these drugs and the criminals manufacturing and distributing them. On behalf of my family, i ask you to proactively provide tools to strengthen the education. Thank you for your time. Maybe i pronounced your name wrong . Would you tell me how you pronounce it . Please proceed. I have prepared testimony for the record. In order to avoid duplication, i aboutlike to talk to you what the Synthetic Cannabinoids and other synthetics are doing in washington, d. C. And the challenges we face. I think it would serve better to hear that. Please proceed as you like. We have been dealing with synthetic drugs since 2009. When they first arrived, they were very much marketed told children. Skooby snacks were being sold in Variety Stores, gas stations. We would get calls for children who were on the way to school, would stop in these Little Stores and purchase this skooby snack, and at school they would be calling for an ambulance with rapid heart rate, vomiting, possibly passing out, but nothing more serious than that, as if that is not serious enough for 10 and 11yearold children. But then as the chemicals started to change and became more prevalent any names of the packaging started to change, the marketing to individuals began to change. We started to see proliferation various different types of synthetics as marketed in the Small Business and Variety Stores around the city. It was such a huge impact across the entire city, Public Health in particular, what we saw when we had kind of a peak last year in 2015 was literally as many as 20 calls a day for emergency transports by an ambulance to take a person who was under the influence of synthetics and out of control, or unconscious, to the hospital. If you think about 20 ambulance trips a day, each time it would require multiple officers to take a person into custody. Many of these individuals, when they used the Synthetic Cannabinoids their heart rate is high, very agitated, violent, their core body temperature goes up and we are trying to get them out of the middle of the street or where they are putting other people in danger. Then we are in a position where we and fire personnel have to wrestle a person in that state into an ambulance to get them to a hospital. Officers were getting injured, fire personnel getting injured, and the potential for these individuals who were in this excited delirium state to die from that struggle. Just to take them into custody and sometimes get them out of the middle of the highway. The potential for incustody death when trying to help someone in crisis. It was so significant last year, i would stop on my way home almost every day and have to call an ambulance for someone i saw who was either in a catatonic state that was under the influence, sometimes standing in the middle of a busy road in the city, or completely unconscious and people flagging me done to call an ambulance, that in one particular neighborhood, i had a person welcome to me while we were onting on an annual ands and he said i am a returning citizen, i spent a lot of years in jail for selling drugs and i would never sell a drug like this in my community. To me, that was the beginning of understanding of just how significant this was in our community. I learned from talking to some of those individuals who were standing around and waiting on emergency transports. Of a lot of individuals using the Synthetic Cannabinoids were under probation or provision in the community, and the Standard Drug test didnt test them for the use of these synthetics, you had people who had been heroin addicts or using our call or using marijuana were now to synthetics because there were no Standard Drug screening picking it up when they went to see their probation officer. So you had people who would not normally using this drug switching to the drug so they could stay out on the street. I had several individuals tell me that personally. Because of that and many other reasons we were doing everything we can to enforce it. You have heard the challenges. We had businesses that were selling it, but it was just the cost of doing business with them. We would seize large quantities and submit for testing, we would get it back and move on to another drug. Drugs,ng the seizing of but no ability to prosecute, we worked to pass another law last year that allows us to seize based on packaging, quantity and price so it goes around the scheduling but allows us to fine the business up to 10,000 for selling it. I can shut a business down that is still selling. I give a 96hour emergency closure. That is a little more than seizing your product. Now it is more cost of doing business and you can get a 10,000 fine. When we take that seized the product and get it tested to see if we can go forward with prosecution. This is an epidemic. It is not going to go away. It is continuing to change. Most continuing to be recently it targets largely the poor, homeless and those living on the street and most vulnerable to this. Weve had successes with the Pretrial Service agency. People arrested for felonies were tested, 20 were coming back positive for synthetics. That is higher than the drug of choice in the district for many years cocaine. A significant portion. We now have gotten the Pretrial Service agency to do the screening for those out under supervision and it has made a big difference. We have a lot of challenges and a way to go. This is a dangerous drug and the stories you heard a minute ago about the impact is having a i see that first and every day so anything you can do would be appreciated. Thank you. Opportunity for the for me to speak to you today. Ocean county is the second largest county landwise in new jersey and our population is slightly over 600,000 people. Fifth largest in new jersey. As prosecutor i am the chief Law Enforcement officer for the county. My office consists of approximately 200 employees, 95 detectives and agents and my support staff. I am here to discuss the emerging problem of synthetic drugs. This is not an isolated issue or unique to my jurisdiction the one that affects people across the country. Traditionally it was k2, spice, and bath salts and those are a problem but we have synthetic marijuana, opioids and other new emerging variations. This is where i think the biggest emerging problem exists. Synthetic opioids and marijuana. One young girl, 18 years of age, died in a motel room. They were doing 50 heroin packs a day. As a father of two children, i know it is my responsibility to use every effort to address the epidemic. In new jersey, we have the highest potency and purity of heroin in the country and the least expensive. The synthetic opioid is so powerful that a micro gram can kill. Is easily transported and it is lethal and devastating. In 2012, there were 53 Overdose Deaths in ocean county. In 2013, there were 102 Overdose Deaths. As a result, the alarming numbers developed a plan to combat the epidemic. My plan to address this epidemic is broken down into three areas. Prevention, education, strict Law Enforcement and treatment and breaking the cycle of addiction. All of all initiatives implemented, narcan is a huge part of that plan. I researched what other states were doing and came across narcan. I established a protocol and ocean county was the first state in new jersey to implement a Law Enforcements narcan problem. Allrogram which included Law Enforcement agencies adopt in the program. From drug dealers to fund the program. We focused on the street and people were dosed with narcan. The first time used to save a life was april 6, 2014. Are as follows. In 2015, 272 narcan deployments and 118 deaths. And this year, 173 narcan deployments and 61 drugrelated deaths. You can see in 2015, the overdose total has risen to 118. The statistics for 2016 are not promising so far. We continue to utilize narcan by dissipate the range of over a 150. We need to do more to develop a strategy to combat the cycle of opioid addiction. Ive broken it down into three parts. Hospital, Treatment Options and detox. Patients are transported for additional treatment and monitoring. After treatment, but prior to release, a recovery coach meets with the patient, and the recovery coach operates 24 hours a day, seven days a week, it is a Pilot Program we instituted. There after, they are transported to a detox facility. At the detox facility, the patient stays 4872 hours and assess the Treatment Options are discussed and agreed to. Availableent options working with the new Jersey State Police and the police lab announced that more often than not the taxes consumed by ocean county taxes dont contain heroin but other drugs. Many of these packets are cocktails containing drugs such as cocaine, heroin, fentanyl, methamphetamine, and the deadly component is now synthetic opioids. Fentanyl itself is a hundred times more powerful than morphine. We had a 14yearold die already using fentanyl patches. There is a fentanyl that is more powerful and there is the tablet form and another form of fentanyl out there. Now there is w18 which is another synthetic opioid allegedly ten times stronger than morphine. This drug is on the horizon. So far it hasnt made its way to the jersey shore but has been seen in philadelphia. Here is the issue. Law enforcement has a distinct problem with synthetic marijuana when synthetic marijuana constantly changes a small component of the product and lab testing cant identify the drug. Drug makers have been as constantly change one small component to elude Law Enforcement. Designers change one small component to allude the testing from the schedule of the narcotic. The form is changed into some instances into a pill like form and because of the changing nature of the drug the National District attorney associations recently signed for senator fiensteins bill and the district supports the assault act mentioned here today. Concern is if narcan will reject opioid. I will see if we need to adapt and reflect the changes to reflect synthetics as they develop. Overdose deaths relate to new cocktails and the individual and body cannot handle the additives that the synthetic opioids contain. I would look to congress to take the lead and assist Law Enforcement and help the Community Address the issue. It is my belief this is an addiction issue that needs to be addressed with the Health Care Community and Law Enforcement collaborating. I would like to thank you for the opportunity to address the committee. Thank you, very much. Now, dr. Smith. Thank you very much, sir. It is an honor to be here. You know, i was asked to speak in terms of medical aspects of these dangerous drugs, these synthetics. I would like to lump them into a couple groups. First are the cannabinoids. You ever about them today and previously in other testimonies and statements. They bind to the same receptors that marijuana does. The thc receptors in your brain. The second group bind to a Different Group of receptors, serotonin and dopamine. All of these receptors are responsible for pleasurable feelings that your brain experiences and that you experience. They are different receptors but they affect people now in much the same way. I have a hard time clinically telling them apart as an emergency physician. Everything you ever today here is true. Phenomenal Blood Pressures, immediately dangerous, critical levels. Heart rates, same way. Very critical heart rates. Blood pressure is 250 over 140, heart rates in the 170s, body temperature is 106, 107, seizers, kidney failure, paranoia, agitation, violence. Violence beyond anything you have every seen. It is all very common with these drugs. The other group are the opioids, the synthetics there. They cause euphoria, respiratory pressure, andlood death from those is generally from respiratory ilya. Opiates, and let me touch on this, you have heard how potent they are but let me put it in perspective. If you think about most medicines we use today, they are used in milligram quantities. Think about the volume of a milligram. It is something akin to a grain of salt. These things are dosed in microgram quantities which is a thousandth of a milligram. Doses that are tiny fraction of a grain of salt being lethal. How little variation and how small that has to be to cause a fatal result. There are a lot of here. You have heard there are no test. A lot came from the discussion into this. There are no test for this medically, either. It is much bigger than we know and it is growing. It is growing by leaps and bounds. There are costs associated with these things. In middle,tal tennessee, a 228 bed keep care hospital. Over the last three years, we have admitted when hundred 98 of those two hour intensive care unit. And we look at the hospital bill. Sometimes they stay in the hospitals for two weeks and tie up beds that are needed for patients are acute medical problems. It averaged about 29,000 a patient. That is pure, fixed cost. Not charges, cost. If you do the math, and i believe i got this right, i did it twice, that is over 5. 7 million in care to my hospital alone. Of those 198 people, only three any insurance whatsoever. This is a true cost to our medical system. We dont know longterm effects. We dont. We know short term effects. We have seen behavioral disorders and we have seen people with kidney failure and we have seen way too many deaths. Way too many deaths. My college, back in january of this year conducted a survey of its membership. In that survey, over 1500 Emergency Physicians across the United States in every state in the union responded and there was very interesting results there. The first was, 95 of the physicians who saw an increase in the number of these drugs and other presentations in the Emergency Department. Most importantly, 87 of the staff saw violent acts committed by these patients and 42 of the staff had seen actual injuries to Staff Members in the Emergency Department as a result of the violence to these of these patients. I will tell you a couple stories i have personally seen and dealt with to maybe put a human perspective, although i dont think i can touch anything mr. Rozga said. We had a 14yearold child come in weighing 140 pounds. This young man had consumed a cannabinoid. He was restless and agitated. In order to control his behavior ofe gave him 140 milligrams versed, a cousin of valium. Versed, a typical dose for a young man like that to not be aware of a painful procedure is somewhere between one and three milligrams. This young man in the first hour that he was in our department 140 milligrams of this versed. That is, depending on the dosage range, 4488 times the typical dose to control his behavior. Any other child would have required life support, a ventilator, Blood Pressure support to stay alive after that much medicine. That only kept him on the bed. He kept talking to me. And in the next hour that he was transferred to pediatric intensive care service, he consumed another hundred milligrams of the versed. There was a call to a hotel room where a man had consumed drugs became very paranoid and felt like he was being attacked. Keith, thank goodness, did not own a firearm. Instead he pulled out his pepper spray and sprayed those he thought were attacking him. Friend, seeing the violence and the paranoia, called the police. As my first Police Officer went through the door he was retrieving his ax. He was about to spray those attackers. The oldest of which was two. This is dangerous stuff. My solution im not a legal expert but you have to become very nimble, you have to deal to make these things go away. Anything that you can do to prevent the manufacture, importation, the trafficking, the use and possession of these drugs, given your power under the constitution, is imperative. I appreciate the chance to talk to you and i am honored i am in your service. Thank you. Thank you, dr. Smith. Now, dr. Hall. Chairman grassley, and Ranking Member klobuchar, what are known internationally as novel psychoactive substances have become a major drug problem in the 21st century. Along with the nonmedical misuse of pharmaceuticals and, of course, heroin. You have already heard the nature and extent of the problems caused by these toxic and addictive substances. Therefore i will use my time to provide examples of the impact in the state of florida as well ofto address the vital role surveillance epidemiology in the early identification and spread of these substances in the United States and around the globe. In the autumn of 2014, Fort Lauderdale area of florida was hit with an epidemic of medical emergencies and deaths from the flacca. C known as it resulted in 63 deaths in Broward County alone and produced thousands of medical emergencies. Purchased online by mid level dealers from chemical suppliers in china and shipped by world wide delivery services. A single kilogram produced 10,000 doses. The frenzy of flacca united the community under the Drug Prevention and coalition of the united way. The rapid and extensive response brought World Wide Media attention and pressure on the government of china to ban the prohibition or the production and the sales of alpha pvp along with 1500 synthetic drugs effective october 1, 2015. Within two months, flacca was gone from the streets of Fort Lauderdale. Demonstrating how a Community Working together across multiple organizations can impact a global problem. Over the past two years, nonpharmaceutical fentanyl produced in clandestine im labs labs in china and probably mexico have been linked to the majority of more than 1300fentanyl related deaths just in florida. The nonmedical pharmaceutical fentanyl has been sold as street heroin, and more recently been this guys as counterfeit medications including fake xanax and other pills. Counterfeit medications containing nonmazuma goal that nonme a vital Surveillance System for involve psychoactive substanceicize the twoyear old national instustute National Drug Early Warning system or ndews. Its website provides special reports on synthetic drugs, webinars from leading scientists, a list linking 1200 scientists and criminal justice professionals from 12 nations in realtime. Other key surveillances conducted by the ondcp network of Investigative Support Centers as well as the European Monitoring Center for drugs and drug addiction, which is currently tracking more than 560 novel psychoactive substances including 98 new synthetics identifiedyied for the first time in 2015. Finally, the radar system which studies Prescription Drug abuse, has recently identified counterfeit pills