Transcripts For CSPAN3 House Members On Opioid Crisis 201710

the subcommittee will come to order. i will recognize myself for an opening statement. the united states of america is in the midst of a fierce battle against an epidemic brought to us by opioids. it does not matter where you live. this crisis has touched every corner of american society. while new england and the ohio valley regions represent states hardest hit by. the epidemic, health officials from the south and reaching across the mountain west report deaths of those counties. the latest figures from the centers for disease control and prevention is astounding. 91 americans die every day from an overdose. now more than ever we must come together and strengthen our commitment to fight this. i expect today's members will bring to the forefront key insights and potential solutions on this critical issue. in the previous congress, the energy and commerce committee led several initiatives to help address the the opioid epidemic. the comprehensive recovery act and the 21st century cures act are now law and providing resources at the state and local levels. policy changes are being impacted. in fact, as a result of kara, patients suffering from substance abuse now have greater access to evidence-based treatment, addiction treatment services and overdose reversal therapies. it provided $1 billion in grants for states to support ab array of prevention, treatment and recovery services i believe these are making a significant difference. other issues have emerged in this fight. earlier this year our committee responded to reports of people overdosing on heroin lace d wit synthetic opioids, which are 100 to 10,000 times more potent than morphine. the readily availability of these opioids have become a public health threat and illegal operating in foreign countries are exacerbating this epidemic every day for our state and federal officials. today's hearing will allow us to gain member perspective on potential ways to compliment existing policies at federal regulations to combat the epidemic. representatives both on and off the commerce committee will testify about the epidemic and share their stories and propose solutions for our considering. i want to thank house members for participating in this important discussion and we look forward to hearing from everyone who is going to be before us today. >> i'm going to be brief. so many families have been devastated by this. in dream lapd, which is a book about i read about the ep yoid crisis, had all these scenarios. when you see it in reality, there was an honor student playing soccer. it was prescribed painkillers after her recovery. and passed away due to ab overdose. these are the sad story that's repeated through all groups and all areas. it's something i'm looking forward to hearing all the testimony to look for ideas to further do what congress has done with kara and moving forward as well. i thaupg for yielding back. >> ab opening statement please. >> thank you, mr. chairman. the cdc and prevention has called for drug overdose and abuse in the united states and epidemic has found drug overdose to be the leading cause of death in the the united states. between 1999 and 2010 the death rate from prescription painkillers quadrupled and only continues to rise. in 2015 more than 52,000 people died in america and two-thirds of those were linked to opioids. the total is only rising. . the "new york times" analysis of preliminary data found that likely died from overdoses in 2016. today it's estimated more than 2 million have an abuse disorder and too few are in treatment. the rate has increased dramatically in recent years. this rise is directly linked to the opioid epidemic. in 2010 guests were connected to heroin. in 2013, the number jumped to a total of 8,000 overdose deaths and only continues to rise. there's no community that has not within touched by this crisis and some have been ravaged by. so much is needed to come at it when families are being torn apart. included in the cures are the state targeted response to the crisis grant program. it provided a billion dollars over 2017 to 2018 to stage to address the epidemic. extending this money is a crucial part of federal leverage to respond to the epidemic. we need an approach that has proven public health strategies and spans the entire spectrum from prevention to treatment and recovery. these include robust funding to support prevention, crisis response and expanded access to treatment and lifelong recovery tools. the affordable care act is a vital part to fight against the epidemic. more than 1.5 million americans have access to treatment through medicaid that it didn't before the aca thanks to the medicaid expansion. unfortunately, americans fighting addiction like states that refuse to expand their programs like texas are left out in the cold. all plans must include services for substance abuse disorders and mental health and consumers cannot be denied coverage because of a history of substance abuse horchlg. this is not a small feat. a third of all individual market policies didn't cover substance abuse treatment. from the treatment of low income people. going even further is medicaid is scrap ped for expansion in states that took the money would be absolutely definite stating to our fight against prescription drug crisis. we're in the midst of the largest public health crisis our kaun kohn try has known and this is not time to cut safety nets that serve those in recovery. we need a comprehensive solution to the crisis that includes real targets and targets the spectrum of addiction, prevention, crisis response for those who fall through the cracks and expanding access to treatment and providing support for recovery. we must be guided by science and not fall into traps and misconceptions proven treatment strategies. i thank the chairman and look forward to advancing new strategies and funding to turn this growing crisis and really help families and communities in desperate need. >> we are going to be hearing from energy and commerce. with that. the chair recognizes the chairman of the full committee, mr. walden. >> thank you, chairman. i come here today on behalf of my constituents like i do every day, but i think especially today with our opportunity for all members to make their case to the energy and commerce committee. we want to welcome them and as our colleagues on both sides of the aisle have already said, all of us in our communities face these challenges related to drug overdoses. i held a roundtable the day before yesterday in bend, oregon, where learned a lot about the problems that they are face iing and some of the succes they are having. and the importance of the work we are doing here. it's a heartbreaking epidemic that had been featured on the local pages of part of the stories out of our family members. in 2016 alone more than 64,000 americans died from drug overdoses and in oregon alone more people died last year from drug overdoses than from car accidents. i recently held roundtables in southern gob to discuss how we can better combat this crisis. meeting with the people in our communities to find out what's working, what more can be done is crucial o our efforts to end this. initialives are now law like the recovery act and the 21st century cures act. resources are becoming available and important policy changes are being implemented to stem the tide of opioids. it made changes to expand access to addiction treatment in services and medications. 21st century cures act provided a billion dollars in grants for states. the first half of which was made available in april of 2017 to be administered by the substance abuse and mental health services administration. my state of oregon received grants to come pbat the epidemi. since the passage of kara, other issues have emerged in the fight against open yoids. there are allegations of pill dumping. my own district i have heard the all too familiar tale of the mother of the oldest son was prescribed opioids after injuring his ankle and didn't take long for him to become addi addicted. another parent shared the story of his sister and nurse who died in overdose after years of suffering from addiction and bouncing between pharmacy ises. perhaps made counselling more effective. she was only caught because two pharmacies happen to check with each other. you see by then it was too late. these two stories may have come from oregon, but they are not exclusive to the beaver state. they are why we are here today. addressing the epidemic requires an effort. today we'll. hearing testimony and stories from our colleagues with on and off the energy and commerce committee about what more can be done. i'm looking forward to hearing input from both sides of the aisle to hear about what's working and what's not and find ways to compliment our existing law and address emerging issues. so with that, i appreciate everyone here today with us taking time to participate. i look forward to hearing from all my colleagues and we must continue to fight this opioid crisis in america. i yield back. >> whichever they prefer. >> thank you, chairman. today's member day provides us the opportunity to hear from our colleagues about how the epidemic is uniquely affecting their districts as well as to hear their ideas of additional efforts and funding that is needed to help individuals, families and communities affected by this crisis. like all communities across the country, the epidemic is having devastating consequences in my home state. drug overdoses are the leading causes of accidental death in new jersey. according to the centers for disease control, there was a 16% increase in drug overdose deaths in new jersey between 2014 and 2015. last year drug overdose deaths topped more than 2,000. unfortunately, we're continuing to see increased deaths from this tragic epidemic. i'm proud of the steps this committee has taken to respond to this tragic epidemic that has taken the lives of 91 americans every day. i'm pleased we worked together in a bipartisan fashion to pass the addiction and recovery act. we also work together to create the response to the opioid crisis grant program as part of the 21st century cures act. this grant program provides a billion dollars to states to address the epidemic. there were positive and bipartisan laws that we produced in 2016 during the last year of the obama administration. that was 2016. 2017 has been much different. congressional republicans have spent much of this it year trying to repeal the affordable care act, which would have prevented americans from getting the help they need to treat dwords. the repeal legislation passed in the house would have allowed insurers to discriminate against people with disorders. the republican-passed bill would allow states to wave the health benefits including mental health and substance treatment. thankfully those repeal efforts have failed to date. so as we move forward, what's clear is that individuals with substance use disorder, their families and communities need us to work together to do more. despite some progress here in washington, the epidemic has shown no signs of relenting and that's why we must continue to support and increase funding for proven public health approaches spanning the entire spectrum from crisis to recovery, including expanding access to medication and treatment. those efforts should include more funding. we should extend the state target and response to the opioid crisis grant program so we can expand even further people's access to abuse treatment, prevention and recovery support services. i look forward to hearing from colleagues and continuing to work together in a bipartisan fashion to help our country respond to this crisis. i yield back. >> gentleman yields back. the chair recognizes the chairman of the subcommittee for three minutes. >> thank you, mr. chairman. this is very important as we're able to all share our personal experiences on a crisis that has been playing our nation over the last couple years. opioid addiction and abuse. this silent epidemic has for sure torn through families, neighborhoods and communities both certainly in my home state of michigan, but we know across the country as well. in fact, in 2015, there were nearly 2,000 opioid abuse-related deaths in michigan alone. even more tragically, more than 22,000 babies are born every year across the country with neonatal withdrawal syndrome. this terrible epidemic hit home in my community and even in my extended family. so this is very personal to me. the last couple years i have been meeting with first responders, employees, advocacy groups and individuals suffering. all of these folks said that tragically the death toll continues to rise. that's why we have been taking con e crete steps here in this committee to combat the widespread epidemic. just last year the president signed into a sweeping package aimed at attacking the opioid epidemic from all sides. as part of 21st century, a bill that every one of our committee members supported. an additional $1 billion was allocated to the states. like michigan to address opioid addiction treatment and prevention, this year the first round was delivered. we received $16 million and that grant funding will make a real difference. as a result of this legislation, as well as administrative action, the director is helping to lead the charge. they started meet iing with experts to talk about innovative ways in which government and industry can work together to address the crisis. i support that work and look forward to seeing the results of the result that nih is is doing with its industry partners. there are also things we in congress can help nih with in these endeavors. first, we need the nih to develop more options for reversal. second, we need the evidence to develop a therapy for addiction and accelerate the development of nonaddictive pain medicines. the sooner that we in congress apply the resources necessary to conduct that work, the sooner that we can supply powerful new tools for every community. we are on the front lines to advance meaningful bipartisan legislation that indeed will make a difference together will bring it out of the shadows. i yield back. the gentleman yields back. the chair recognizes the gentleman from new jersey for three minutes. >> this is the first time i have been on the this side and what a fine-looking group. >> it's devastating families in new jersey, the state ai-represent. in 2015 the garden state's death rate was two and a halftimes the u.s. rate. claudette has done critical work and made a positive influence. her advocacy group helps equip the loved ones of those in pain. none of the progress we have made so far in this fight against drug addiction and opiate abuse would have been possible with the work of claudette and organizations like community in crisis. their efforts are efforts that we should make sure congress understands and applauds. i work closely with claude et on the issue of overprescription. health care providers wrote 259 million prescriptions for opi e opiates. it addressed the issue by improving the medical drug approval and label process at the food and drug administration. the first time congress required the agency to work closely with expert advisory committees before making critical product approval and labeling decisions and make recommendations regarding educational programs for providers of extended release and long-acting opiates. they encourage the approval of opiates with abuse deterrent properties. we also have to make sure resources such as the state targeted response to the opiate crisis grants administered by the substance abuse services administration continued to give states the tools they need to experiment and test best practices. new jersey recently secured a $13 million federal grant from the substance abuse services administration to focus on this crisis. the drug free community support program and the white house office of drug control policy awarded community in crisis and to other able organizations and empower summer set with a $125,000 grant to assist in address iing the problem of abu. provide education and implement prevention measures. community in crisis, resource and empower are great partners in connecting people with the resources and support they need. these investments are not only the right thing to do, but help lessen the cig is cant strain on law enforcement resources. i commend each group on its important work. i stand ready to work with you and colleagues on both sides of the aisle to continue this work. thank you for calling this hearing today. >> we will move to our second panel. members identified wishing to speak in the second panel, mr. butterfield. whichever is their preference. the chair recognizes california for three minutes. >> thank you for inviting us today to testify about proposals to address the opioid epidemic. we all have heartbreaking stories of constituents whose lives were lost too soon to an overdose. in my home district of sacramento, we experienced a crisis last year due to pills contaminated with fentanyl. addiction is a devastating disease that knows no bounds. we must come together to provide solutions and comprehensive manner. in this committee, we took a step forward bypassing the comprehensive addiction and recovery act into law last year. we need to build on these efforts understanding addiction and consequences are multipronged. we need a multipronged solution. i look at this it problem as i do any other health care problem. which means i examine it wholistically across the spectrum to early intervention to treatment. in the case of the ep yoid epidemic, there's a lot we can do at these stages. all rest on building up the mental health system and integrating behavioral health care with physical health care. historically, mental health and addiction have been treated as character flaws and therefore, not addressed with medical treatment. we can reverse that course by making treatment more available, bolstering our workforce and reducing stigma. in 2012 the representative and sthart and i passed an demonstration project into law. this project is allowing states to demonstrate that building up health clinics improves access to care. last week we introduced legislation to extend the years of more states. we should strongly consider this as one way to help address the opioid crisis. we also need to enforce mental health laws to ensure it's offering men tall health benefits actual to physical health benefits. how this is relevant if benefit. s are not offered in the first place. there have been proposals that included provisions that allow states to waive health benefits meaning not be required to cover mental health and addiction treatments. that's not good. it would also mean loss of coverage for millions suffering from substance abuse disorder. we can't take these steps back ward. i'm being encouraged to address the crisis including the limiting of prescription prescribers and insurers . we need to build on these efforts. that means to provide resources and training for state and local enforcement and bolstering mental health workforce, educating the public, addressing availability through outpatient to inpatient to residential care and more. i look forward to continuing to work with the committee ob these policy proposals to address this pressing issue. thank you and i yield back. >> the chair thanks the jept l lady. the chair recognizes the gentleman from florida for three minutes. >> thank you, mr. chairman. how about now? thank you. thank you, mr. chairman. the united states is in the midst of an opioid overdose epidemic. sadly, 91 americans die every day due to opioid overdoses. nearly half of all overdose deaths involved in prescription opioid. the opioid crisis in florida's pill mill problem. the legislature enacted statewide tracking of painkiller prescriptions coupled with law enforcement using drug trafficking laws to prosecute providers caught over prescribing. within three years, florida saw a decrease in more than 20% in overdose deaths. despite this positive trend, opioid abuse continues to plague my district. my district had the second highest prescription drug death rate in florida in 2014. i worked to ensure that there's a high drug trafficking area. enabling law enforcement to receive additional resources to combat the spread of drug-related crime. i want to applaud the committee for including my bills for safety and drug abuse prevention act and the promise act, which passed last congress. the medicare safety and drug abuse prevention act produced a pharmacy and physician program within the medicare part d giving cms the tools to crack down on this abuse in the medicare program. it's important for us to maintain oversight. as you know on this program, that they are developing the ru rules. for opioid therapies. for managing therapy for chronic pain. requiring them to have the enhanced pain management and safe opioid prescribing education and training and encouraged the va to increase information sharing with state licensing boards. i think that's critical. as part of the 21st century cures act, florida has received over $27 million in grants to help fight the opioid ep e demic by increasing access to recovery services, strengthening public health surveillance and improving pain management practices. these critical funds are supporting florida's all hands on deck approach across the state to curve opioid abuse and save lives. i'm pleased the administration and this committee are leading the charge on this critical issue and i look forward to work ing together to help save lives and prevent addiction. i yield back, mr. chairman. >> the gentleman yields back. the chair recognizes the gentleman from north carolina for three minutes. >> thank you very much, chairman. and to my colleagues, thank you for the opportunity to address the committee today about the state of the opioid epidemic in my home state of north carolina. let e me just begin by crediting my friend and our former colleague who was also from florida. who talked about this issue because it was dear to her and she knew the impact on her state. brought this important topic to the forefront of our subcommittee some years ago. she was the chairman of the subcommittee and i was the ranking member. at first, i thought she was a little overreacting to the opioid crisis in florida because it had touched her family personally. after we had hearings, i came to the conclusion that she was not over reacting that it was indeed an epidemic not just in florida but across the country. i worked with many colleagues in in room on the comprehensive addiction and recovery act that was passed into law. that bill including 20 proposals to slow the epidemic. as part of the act, this committee approved $500 million. the american people need to know that. we approved $500 million in supplemental fund iing to addre opioid abuse. despite attention from congress, we are still feeling the opioid crisis very close to home. during the august work period, i saw the effects of the epidemic on my small community in north carolina just in august alone there were two deaths because of the opioid abuse in the community. according to reports in the times, medics in wilson county administered the appropriate drug in response to opioid crisis 28 times by mid-august. when they usually administer the treatment 30 times per quarter. according to chris parker with the wilson county emergency medical services there, there's a definite increase in opioid use and abuse. there's a real problem on our hands. by july of this year, there were more than 500 diagnoses for emergency department visits up from communities. congress should provide certainty, certainty and funding to combat this epidemic which is why i'm the original cosponsor of hr 3495, the opiate and heroin act of 2017. we must also protect existing fundings for research and opioid use disorder coverage, provide tools to communities to address this epidemic and reduce the stigma for those needing treatment. i want to thank you for convening this hearing. >> chair recognizes gentleman from indiana for three minutes, please. >> thank you for holding this important hearing. opioid abuse disorder has ravaged our communities. we need to ensure the legislation passed is properly implemented and working as congress intended. the comprehensive recovery act was passed into law. i spent months convening stake holder round tables and working on bypartis -- bi with the pass cara, patients must now be offered a full range of treatment optioned based on their individual clinical needs. 15 months after the legislation was signed into law, section 303 still has not been implemented. i urge strong oversight to ensure samsa will be properly implementing the law. every day is one more that our family members, friends and colleagues are battling a disease with fragmented and incomplete treatment options. curriculum should be updated to include training on all fda approved opioid addiction medications. moreover, all of samsa's material should be modernized to reflect this patient centered approach. 55 people in one county in indiana have died of a drug overdose in the first ninths of this year, which is more than all of 2016. the availability of all treatments regardless of where a patient chooses to treat them will help to stem the tide of these unnecessary deaths. it is vital as the committee moved forward in the fight against opioid abuse, that we ensure cara is properly implemented. >> thank you, mr. chairman. again, thank you for holding this hearing today. opioid abuse and addiction has caused devastation in every community across our nation. ohio has been especially hard hit. in 2015, 3,050 people lost their lives from a drug overdose. in 2016 that number increased to 4,050. that means 11 deaths a day. in 2016, there were 1,133 traffic fatalities in ohio. drug overdoses causes four times more deaths compared to traffic accidents. many county kcoroners in ohio sy that 2017's overdose fatalities are outpacing 2016's. this problem knows no limits. when i read through the obituaries in my local newspapers, over the past year or two i've noticed more younger individuals without a cause of death being listed. in too many of these instances it's because of drug overdoses. across my district, i've heard how opioid addiction impacts communities. i've spoke with families to hear how substance use disorders have directly affected their lives. it's paubecause of these storie that i plan to introduce legislation to direct the department of health and human services to create a database that would serve as a central location of information for the public and others to track federal funding allocations made available for research and treatment of opioid abuse, find research relating to opioid abuse from all federal agencies, state local and tribal governmen governments. furthermore, the legislation would charge hhs to evaluate a myriad of issues relating to pain management, addiction, prescription guidelines, treatments and effective solutions and problems used across the country. these findings would be available on the database as well and hhs would be instructed to offer recommendations for areas of improvement. i believe that with the help of hhs this database will allow for easier access of information, funding treatments and relevant data to help to combat opioid abuse across our nation. with over 91 americans dying nationwide every day, we have run out of time to find a solution to this crisis. we need action now. >> chair wants to thank all of the members on this panel for your testimony. you are now excused and we will seek the next panel. >> mr. chairman, parliamentary inquiry. >> gentleman will state his parliamentary inquiry. >> i'm not sure that's the right terminology but i wanted to include into the record two newspaper articles that i referenced. >> without objection, so ordered. >> thank you. >> and the chair now would ask that the next panel which is mr. johnson, mr. welch, leader pelosi and ms. brooks. again, members of the committee are welcome to provide their testimony from their seated position on the dais. >> thank you, mr. chairman. i appreciate this discussion about an issue that is so vitally important. it is no secret that america's in the midst of an opioid crisis. last year in my home state of ohio, about 86% of overdose deaths involved an opioid. this epidemic can be felt in virtually every community across the country. today i want to share a story that would shed some light on some of the good work being done by people in my district to help combat the opioid epidemic and perhaps let everyone know about some of the positive things that are taking place. i had the honor of visiting field of hope, a faith based nonprofit treatment facility that assists area families ravaged by poverty and drug abuse. it was founded by a man named kevin dennis after he witnessed his own daughter become addicted to opioids after she had knee surgery from a high school athletic injury. her prescriptions ran out before her pain was managed but unfortunately by that point she was addicted. she ended up in prison several times for theft and checked into numerous rehab facilities before she fully recovered from addiction. she is now a recovery counselor at field of hope and is happy married with a child. i heard some incredibly powerful and touching stories during my visit to the field of hope campus and i witnessed the good work they are doing firsthand. we in congress and especially in this committee have an important role to play in supplementing and enabling the work being done by organizations like field of hope. we need to develop prevention policies that steer people like kevin's daughter away from opioids in the first place. treatments exist today and more are on the way. but these innovative treatments are not always covered by federal programs like medicare and medicaid. we should closely examine the reimbursement policies in place to ensure that patients have access to effective alternatives for pain management without the risk of addiction. i've also been encouraged by recent efforts by private payers, providers, pharmacists and patient groups to address the crisis. i believe congress can play a role in ensuring that all prescribers are equipped with education and pain management so they can provide effective pain treatments for patients and timely intervention for those who are addicted. i look forward to continuing to work with my cheolleagues on th committee and in the house to find effective solutions to this scourge. it's a national crisis. we need to act. with that, i yield back. >> the chair is pleased to recognize the entire vermont delegation. mr. welch, you are recognized for three minutes. >> we don't have the numbers of texas, but i appreciate the recognition. first of all, dr. burgess thank you and mr. green, thank you. you're taking time to focus attention and demonstrate the urgency of this challenge. second, this so affects us all. i mean, it's heartbreaking. it doesn't matter whether it's a red district or a blue district. it doesn't matter what your view is on the size and scope of government. this is hurting people in your district, dr. burgess and mr. green and in my district and my colleagues here. in vermont, our governor dedicated his entire state of the state address to this epidemic in 2014. and i remember at that time many of my colleagues asked the question, peter, isn't this going to do bad things for the reputation of vermont? but then acknowledged that what he was saying was true in their own state, in their own districts. so you focusing attention on it, mr. chairman, thank you. that's step number one. i can give you some statistics in vermont. our prescription drug problems with individuals increased from 24 in 2012 by 80%. heroin went from 913 in 2012 and increased to 3,488. everyone of those stories is a story of heartache. i got a letter from a mom whose 27-year-old son became addicted to heroin. he went from being a full-time working person to being out of the street, her having to call her daughters saying their brother may soon be dead. all of that is real and all too vivid. this is an enormous challenge. our job in congress is to come up with some policies that are going to help people help themselves. i'd like to make a few suggestions of things we need to do. number one, we have to have full funding for the comprehensive addiction and recovery act. we've got to find the money in order to allow our communities to do that work. two, we have to have more research into alternative treatment. i'm working with mr. mckinly to try to get the comprehensive addiction and recovery act, to find better alternatives to treat pain. three, let's allow for partial filling of opioid subscriptions. four, let's support the recent action by commissioner gottlieb. he's done some good things. he's trying to get mediate release opioid manufacturers to follow a more stringent set of rems requirements. this hearing is tremendous, focusing attention. the next step is to put this into legislative action. >> the chair recognizes mr. brooks for thr -- ms. brooks for three minutes. >> too many americans are struggling with the crippling effects of drug abuse and addiction. the statics are devastating. according to the indiana state department of health, every 2.5 hours a hoosier is sent to the hospital for an opioid overdose. across our state there are enough bottles of pain medicines in circulation for nearly every hoosier to have their own. health care costs for these babies costs indiana more than $64 million in 2014 alone. like so many other states, hoosiers are now more likely to die from a drug overdose than a car accident. i've been very focused on our communities and families that this epidemic has swept up. like so many of my colleagues we've held meetings, we've met with addicted individuals, families. we've been in the front lines with prescribers, health care workers. this is a federal problem and a local problem. last year we pass eed cara. hhs has already taken steps informing this task force but more needs to be done. in my view, it's critical to ensure that the medical professionals have continuing medical education for the prescribing of controls sled substances. i'm exploring options to ensure that physicians who prescribe these scheduled drugs have more and better education linked to the application and renewal of their d.e.a. licenses. professionals must have better training so they fully understand those patients who sadly have gotten the onset of addiction due to what they've been prescribed. now they need better education to help prevent that onset and help them with the addiction. indiana is tackling our problems head on. just yesterday indiana university announced a new initiative called responding to the addictions crisis. i.u. is committing $50 million over the next five years to collaborate with state and community partners to tackle this crisis. it is going to be one of the most comprehensive state based responses. and every i.u. campus in the state is going to be involved. it's going to focus on training and education, data collection and analysis, policy analysis and development, addiction sciences, community and work force development. so major steps are being taken across our state because everyone has a role to play from our prescribers to our medical to our higher ed institutions. and i want to remind focuses that d.e.a. has a national prescription drug take back day. it's approaching on october 28th. it provides a way to dispose of excess prescription drugs so people can get those drugs out of their medical cabinet and out of their kids' reach. there are locations all across the country. i encourage everyone, because r everyone has a role to play. >> of course, thank the gentle lady for providing the date. this hearing is being streamed on facebook live. so your information now has been distributed to everyone who's been tuning in this morning. so that's a good thing. perhaps we can each individually try to make that date part of our discussions as we go through the rest of the month. i want to thank this panel for being here. you all are excused. i have a panel identified. energy and commerce members are advised they may present from the dais or the witness table. sho spouse good night. congress has not responded forcefully enough to the crisis. like new mexico there are simply not enough people and resources. many want help and can't get it. i'm reminded of a story relayed to my by one of my constituents who stopped using heroin on his own but felt he was going to relapse and sought help at a local treatment facility. jay was told, come back when you're using. he was turned away and told to come back only if he started using again, because they lacked the capacity to treat patients who were not active drug users. that's simply not right. to really expand the treatment, prevention and wrap around services, we must increase funding and create stability. we need to give local governments and organizations the ability to plan and not fear losing vital support from congress. most of all, we need to give constituents like jay a place to go after he's fought a tough fight on his own. contin i'd welcome my colleagues' support because we absolutely must extend this funding for an additional five years and beyond. however, this still isn't enough which is why we must look at new efforts to address the barriers to appropriate quality and accessible treatment. these barriers include rural mental health and substance abuse infrastructure, lack of support for rural physicians providing substance abuse treatment, administrative barriers against the most effective form of opioid abuse treatment and a shortage of rural physicians who provide medication assisted treatment. we must recognize that hoping for the best is not valid public policy. there's a quick fix to solve the opioid crisis. that's simply not true. we need to advance serious legislation that takes into account long-term planning for the federal government and for states and communities. we need to bring it to the floor of the house, send it to the senate, get it passed and to the president's desk. i fear we'll continue to lose brothers and sisters, parents and friends and children. mr. chairman, i thank you for holding this important hearing. i yield back. >> mr. mullen, you're going to be recognized for three minutes. after that we will allow the minority leader to be seated at the table and hear her testimony. >> i have to problem with l letting ms. pelosi go next if she would like to. >> if the minority leader is ready, yes, we'll recognize you. you're recognized. >> thank you, mr. chairman. thank you, representative mullen for your courtesy. this is only the second time i've ever testified as leader or as in that capacity because this issue rises to the level, as you know of life and death. so with gratitude to you and to the ranking member mr. green for bringing us together in a bipartisan way on this issue that is a matter of life and death. the opioid epidemic again is taking a savage daily toll on the american people. regardless of who they are, where they live, they're in every district in the country. the scourge is tearing families apart, having impact on the well-being of our children, hollowing out communities. it's claimed the lives of tens of thousands of americans every year, on average robbing 90 people of their lives each day. again, just to testify to that. opioid addiction is a public health catastrophe and is growing more dire and deadly every day. i believe that it is really important for us to respond to this national emergency with the seriousness and urgency it requires. fortunately we have had bipartisanship in passing legislation, the comprehensive addiction and recovery act. we all came together during the bipartisan legislation that was passed, the 21st centuries cure act that people were so happy that the addiction language was in there. that day we heard the stories of families so affected, break your heart. families who had lost a child, a young teenager or 21-year-old or whatever within a matter of days or weeks before that particular signing that president obama signed that legislation. but it had the language. it just hasn't had the money to the adequate extend. that, mr. chairman, is my appeal to you for democrats and republicans to work together to have the funding to fund the key initiatives authorized in the bill. i do want to make a pitch for medicaid. we built on the progress of medicaid's aca expansion has provided a vital life life for tens of thousands of meramerica struggling with addiction. as john kasich noted thank god we expanded medicaid because that medicaid money is helping to rehab people. yet 19 states have not taken that step. we stand ready to work with you in good faith with republicans to update and approve the aca but we remain individremain vig of -- the opioid epidemic is a challenge to the conscious of the entire country. we must act urgently and boldly to get america's families the prevention, treatment and recovery resources they need. we must work with providers and the pharmaceutical industry to push effective prevention measures to we can reduce unnecessary prescriptions and is to be this at the source. i will submit my entire statement for the record. again, thank you for the courtesy offing able to testify before your committee and thank you for your leadership on this important issue. and thank you, mr. green, as well. >> as chair thanks the minority leader for being here today. you're welcome to stay and listen to the testimony of the other members, but we also respect your schedule and if you need to leave,that is certainly understandable as well. in the meantime, i'll recognize mr. mullen. >> thank you for your hospital ta ity. ly listen. >> thank you for being here. mr. chairman i'd like to thank him for his work. literally when the water was going down in houston, you called me and said i have some churches in tulsa who want to partner with your churches. we did that. instead of having one week's work of folks from your cherokee nation, i think they stayed a month helping seniors and disabled from cleaning out three or four feet of water from their house. >> as one with a daughter in houston and grandchildren, i thank you as well. >> thank you. mr. green, thank you. cherokee nation called us right off the bat and said how can we help. and we had churches reach out to us. it was an honor to be able to help your constituents. thank you, mr. chairman and mr. green, for allowing us to talk about such an important epidemic that is going across our nation. we talk often about the opioid epidemic. but what are we talking about as far as how did we get here and how do we go back? we never want to talk about taking medicine backwards. but i sit in front of you from a gentleman who's had surgery since i was a little boy. i was born with my hips out and my feet in the club feet position. and i started having surgeries very young. i also built up a very large pain tolerance. i've never been one to use pain medicine. my wife says i'm different than most. i think most people in this room would probably agree with that. but i do understand pain and i understand the need for medicine. but in '96 when pain became a sense and in my opinion we let the genie out of the bottle, we started treating it like it can be treated like a cold or the flu. all we do is mask it. we see stronger and stronger drugs coming out. we see them becoming controlled substance, narcotics. now we've seen an epidemic spread from the middle class, the low class to the wealthy and to our mothers and fathers and brothers and sisters and coworkers. when we put the genie back in the bottle, how we continue to allow addictive drugs continue to be sent home with our loved ones, the highest percentage of accidental opioid deaths are mothers, middle age women. most of them got addicted to them after birth or an elective surgery. how is that possible? how do we let it continue to move down that path and not say that we have to do something bold about this? when it's a controlled substance, why do we allow it to go home? wouldn't that be better treated in the hospital? we talk about a lot of remedies but we've got to go back to where it started. and it started when we started treating it like a sense. i'm very proud to be on this subcommittee. i'm very proud that you're taking a very heavy interest in this and i'm proud that chairman murphy had took an interest in this too. that's why we're proud to be able to pick up one of his bills. it's hr 3545 that will at least allow doctors after surgery to be able to access records to know if that person has an a addictive behavior. i look forward to being finally able to put some type of remedy in bringing this to closure and quit hurting our families back home. i hope we can approach this on a bipartisan approach, put politics aside and put families first. thank you. >> chair recognizes the gentleman from new york for three minutes. >> thank you. we are a nation in crisis. the opioid epidemic is wreaking havoc in our communities at an unprecedented scale with cdc estimating 64,000 dead from drug overdoses in 2016, an astonishing 21% increase from last year. this public health disaster is costing us more lives annually than at the peak of the aids epidemic. as many as gun violence and traffic accidents combined. if we don't find solutions, we will be complicit in this american tragedy. i'm here today to offer two legislative solutions. first i introduce the addiction treatment access improvement t act. this legislation would expand access to medication assisted treatment by allowing certified nurse mid wives and other advanced practice registered nurses bto treat patients and i litt eliminate the provision that allows providers to prescribe m.a.t. act would particularly benefit pregnant and postpartum women to improve outcomes for the over 13,000 infants born each year wi. individuals wait months if not years to receive treatment. only 20% of patients who need treatment for opioid use disorder are currently receiving it. only 20% of patients who need treatment for opioid use disorder are currently receiving it. the addiction treatment access improvement act would address this and save lives. the second bill i'd like to discuss is the medicaid reentry act hr 4005. this legislation is a targeted attempt to address the problem of overdose deaths that occur post incarceration. studies have shown that individuals who are released back into the community post incarceration are roughly eight times more likely to die of an overdose in the first two weeks post release compared to other times. the risk of overdose is elevated during this period due to reduced physiological tolerance for opioids amongst the incarcerated population, a lack of effective treatment addiction options while incarcerated and poor care transitions back to the community. the medicaid reentry act would grant states flexibility to restart medicaid coverage for medicaid eligible individuals 30 days prerelease. states would be able to more readily provide effective addiction treatment prerelease and would allow for smoother transitions to community care, striking an overall wiser use of scarce medicaid dollars. this legislation that i've introduced would not expand medicaid eligibility in any way. it would simply grant states new flexibility to restart an individual's medicaid benefits 30 days earlier than allowed under current law. this increased flexibility would dove tail with reentry programs already being championed by republicans and democrats in states across our country and would give individuals reentering society a fighting chance to live a healthier drug free life. let me end with an urgent plea for action and brieipartisanshi. these are not normal times. when your house is on fire, you don't look to see whether the firefighter is wearing red or blue uniforms before they turn their hoses on. if we are truly going to make a difference and save lives we have to have a big heart and an open municipal bond. -- mind. mind. mind. mind. -- mind. mind. mind. mind. mind. mi. . . . . . . . . . . . . >> thank you for giving me the opportunity to speak on behalf of my constituents. this is a nationwide issue and it serves our at text. the "new york times" noted last month that the opioid epidemic is killing more people right now than the hiv epidemic did at its peak in the '90s. they destroy lives, families, marriages and careers. in my home state of north carolina, the opioid epidemic has really hit hard. one particularly devastating story that stuck with me while touring a treatment facility last year. he was a police captain, the son of the police chief in the same town. he injured his back on the job and was prescribed an opioid following surgery. he told me he vividly remembers the moment he became addicted the first time he took one of these medications. within a year, he was a full blown heroin addict. he's since recovered and now mentors addicts through treatment. fayetteville is the home of soldiers and veterans who have become addicted. the tragedy is that the va does not have enough inpatient beds to treat every veteran. so oftentimes veterans go without help and are forced to self-medicate. this is outrageous and unacceptable. we need to find real solutions so we can put an end to this haer heart break. . these laws have made huge steps forward in the treatment and prevention of opioid addiction. but it's clear we have work left to do. one idea is expanding safe ways to dispose of prescription drugs. dispose rx is a company in my district that manufactures a powder that mixes with water in the pill bottle and renders opioids unusable and biodegradable. thank you, mr. chairman. i yield back. >> chair recognizes the gentleman from massachusetts, mr. kennedy for three minutes, please. >> thank you, mr. chairman. many thanks to the ranking member mr. green as well for convening this hearing. i also want to thank my colleagues that have testified already. their comments i think are right on. i think they show the depth of this ep dimmic across the country, how it's affected so many in our districts from around our nation and the myriad ways our federal government can help respond to it. there's no silver bullet but there are ideas out there that are genuine that have widespread support. addiction, as many know, is not a disease that knows congressional districts or state borders or electoral college results. it doesn't care how much money is in your bank account or how much children you have. for patients on the front lines it is personal, painful and petteri fpe petrifying. this is not enough. we need to strengthen our medicate programs to ensure that everybody gets the care they need when they need it. that means not just ensuring access to medicaid, but it means flushing out the networks that medicaid provides so you don't have the stories that so many of us have heard from folks around the country that there are not providers that will take medicaid. and if providers do take it, they would have to wait months in order to get a slot to get into treatment. there's complex reasons for that, but many my own opinion a big portion of that comes to low medicaid reimbursement rates that ends up putting the burden of treatment on the backs of providers rather than making sure patients get the care they need. second is law enforcement. folks we lock people nup in thi country that are sick. we need to make sure that safety net for mental health is not our criminal justice system. put in an impossible place of forcing to have to arrest people, forcing to put themselves in danger because our mental health system is not robust enough. i was a state prosecutor. we threw people in jail that were sick, that were breaking into homes and cars to try to satiate an opioid addiction because they didn't have anywhere else to go. finally the medical community. you heard ms. brooks talk about education. we've heard folks talk about prescription guidelines. all of those need to be on the table. i, like mr. mullen, have had surgery before. i got in an argument with a surgery technology on my hospital bed who tried to prescribe me opioids that i wouldn't take because i am so deathly afraid of these things. >> chair thanks everyone on this panel. we'll allow you to depart and we have a panel that will be mr. costello of pennsylvania, mr. wall bu wallburg of michigan and chairman goodlat of virginia. mr. wallburg with your permission i'll go to the chairman of the judiciary committee since he's made time to be with us this morning. >> mr. chairman, ranking member green, thank you very much for the opportunity to testify about the opioid crisis in america. this crisis affects americans across all socioeconomic levels in all regions of the country including my home district in virginia and has rightfully gained the attention of congress. they have seen 11 opioid overdoses resulting in four deaths since september 20th, making 33 deaths in that portion of my district so far this year. just recently i met with a mother in roanoke whose daughter is an opioid addict living on the streets. sadly i know that every member of congress in this room has heard the stories of upright futures wasted away and lives taken too early. we at the judiciary committee have been pleased to work with the committee on energy and commerce in this fight to combat this epidemic. just since last year the judiciary committee has passed seven legislative measures that address the multifaceted nature of the opioid epidemic. the committees worked collaborate ively to see cara signed into law last year. this bipartisan legislation combats the opioid epidemic by providing a streamlined grant program, including vital training and resources for first responders and law enforcement. criminal investigations for the unlawful distribution of opioids, drug and residential treatment. we also target those who traffic in the poiopioids. the law improvements law enforcement's ability to pursue international drug manufacturers, brokers and distributors in source nations. prosecutors can use the important tools in that bill to pursue drug traffickers who are poisoning american citizens. additionally the committee reported the stop the importation and trafficking of synthetic analogs act. it is an unfortunate reality that synthetic drug use and the opioid epidemic are linked. this bill eninsured that our laws keep pace with the creation of any chemically altered drugs. mr. chairman and members of the committee, i appreciate the opportunity to testify. my dedication to curtailing the opioid crisis is unwavering. i look forward to our continued workout together to that end. >> we sincerely appreciate you being here. we will work together on this. >> i'm always delighted to go behind the chairman of the judiciary committee, es sfeeshl since there's some of my bills in this committee. but let me say chairman burgess and ranking member green. i want to thank you for holding today's hearing to receive input from members who represent different corners of our country and yet the very same problem. since the heroin/opioid crisis came to the forefront, i've heard so many devastating stories about families losing loved ones. i've towered recovery centers, talked with survivors and reason along with law enforcement to understand the challenges they face in keeping our neighborhoods safe. i've also met a number of amazing, compassionate individuals, fellow citizens who have stepped up and are leading the fight in their communities. a few weeks ago i had the opportunity to meet with a constituent from monroe county. he established ryan's hope foundation a nonprofit organization named in honor of his son who died from a heroin overdose in 2012. he was only 25. ryan's hope funds structure long-term residential treatment for addicts. so far they've helped nearly 40 addicts bysending them to rehab. in my own home county, the pathways recovery engagement center just opened its dors lor last week. i got a chance to see the center in august when it was in the final stages of construction. this program is the result of a community partnership between local police and the county sheriff's ary clubs. just two shining examples of constituents in my district making a difference. we need more community brace eb initiatives to get resources to those in need. congress still has more to do. one example is jessie's law. it's named after jessie grub, who died last year of an opioid overdose. jessie had battled a heroin addiction for nearly seven years but had been clean for six months. she had made a new life for herself in michigan and was training for a marathon when an infection related to a running injury required her to have surgery. jessie's parents told doctors she was a recovering addict and shouldn't be prescribed opioitug physician sent jessie home with 60 coxycodone pills. such information is crucial to provide patient centered care, prevent relapses and ultimately save lives. as we work together to address this crisis, it's my hope the stories and ideas shared today will inform our efforts and ensure we pursue meaning full solutions to remove obstacles to care and empower local communities to tackle the opioid crisis head on. i thank you for listening to my story. >> gentleman yields back. the chair thanks the gentleman. i believe this concludes all of the energy and commerce members seeking to give testimony. if any arrive, we will allow them to testify as they come in. but i think our panel now will be chairman rogers, mr. marshall of kansas, mr. turner, mayor of dayton ohio. if you wish to join us now, that would be good as well. chairman rogers, thank you for being here. you're recognized, sir. >> thank you, mr. chairman and co by operation unite in issue that ignores lines on a map. and i hope to work with the committee on this issue in the future. today, however, i'd like to focus on treatment. despite the light we've shone on addiction, only 10% of those needing treatment actually receive it. 10%. underlying challenges in the treatment work force further compound this lack of access. there are simply not enough incentives for health profess n professionals in training to specialize in addiction medicine. treatment professionals work in stressful environments, receive relatively low pay and turnover at rates much higher than other health professionals. nih pioneers addiction science and new ways to treat this chronic disease. this is a patient safety and public health calamity. patients in need of addiction treatment often have access to specialized care in every corner of the country. that's why i will soon be introducing legislation with my colleague catherine clark to create a student loan prepayment program for qualified substance use disorder treatment professionals. this program will not only encourage health professionals to pursue careers in add zix medic -- addiction medicine but steer them toward areas most in need of their services. even though it's not a silver bullet, this will be a substantial step in the right direction. thank you for allowing us here today. >> the gentleman yields back. the gentleman from georgia wished to join us at the table. mr. carter, if you're ready, i will recognize you for three minutes. >> thank you, mr. chairman and ranking memb ining green. i want to thank you for holding this hearing today. as a pharmacist i've always made it a priority to advise and assist my patient where is the medicines they're prescribed. one of the largest concerns i've seen is the increased prescribing of opioids for pain relief. we need to look at other options and find a good medium. i believe we can work with the fda to prioritize nonopioid treatments for patients. in addition as it currently stands, prescribers are able to write up to three 30-day prescriptions for schedule two drugs for patients. i believe it would be percetine to -- rather than three months of prescriptions. similar to that notion, allowing pharmacists to have a greater say would help to address the transix tion to addiction. a pharmacist is only able to partially fill a prescription under cara with the consent of the patient or prescriber or in the essence it doesn't have enough stock to fully cover the perception. prescription drug monitoring programs are a great resource in combatting the prescription drug abuse, but they can be strengthened. one way is to better align the data so that states can collaborate to pcreate a more comprehensive look at the damage. drug take back problems continue to expand across the country. currently 19 states have some form of take pack programs and 23 states have programs allowing pharmacists to accept unused and unwanted drugs. one of the most common ways teens get drugs is there the medicine cabinets of their parents and grandparents. the creation of middle grounds of therapies will provide for opportunities that are missing in today's market. by facilitating research and develop -- currently there are a few options left between tylenol, tramedol and opioids. thank you, mr. chairman and committee for the opportunity to provide testimony here today. >> chair recognizes the gentle lady from illinois for three minutes. >> thank you. i'd like to start out by telling you a story about a young man from my congressional district in rockford illinois. he passed aw eed away in 2013. soon after that he became dependent on that prescription opioid and found out that he could go to the street and find something very cheap called so he continued this cycle of overdose, rehab, relapse, and he was on the right path. he enrolled in a college called rock valley college, where he was studying construction management. but a year after being clean, he relapsed again and ended up passing away. and we know stories very similar to this are happening all over our country. and i was so proud when we came together, democrats and republicans, and actually passed the meaningful legislation to help address this opioid crisis. one of those bills that was included in that was the cure for infants born with an opioid dependency due to their parents' addiction. in fact, we received the government accountability report that my bill called for very recently. and it reviews and makes recommendations to care for these infants. but what it really ended up showing is that we have a very long way to go. the department of health and human services has a strategy for improving infant care, but they haven't yet put this into practice. there's not even a protocol to screen and treat these newborn babies who are born addicted because of their parents' addiction. so it further re-enforces that this is not the time to cut medicaid. medicaid pays for four out of every five babies that are suffering from opioid withdrawal upon their birth. it's helped 1.6 million people with substance abuse disorders and access to treatment. and so i just really more than anything want to make the point that medicaid has to be protected and not cut. i want to stress one other point because of the congressional district that i represent, and that is that the opioid crisis is actually worse in rural communities. where the drug-related deaths are actually 45% higher. rural states have higher rates of overdose, especially prescription opioids like the kind that chris had been prescribed for his back injury. so, you know, we don't have the resources to fight back at the level that we need to, and we don't have enough physicians in rural america. we don't have enough hospitals that are with up to date technology to help with this crisis. we don't even have the needed transportation to reach these treatment centers. so that's why earlier this year, i introduced a bipartisan piece of legislation to help rural communities better leverage the u.s. department of agriculture programs to combat heroin and opioid abuse. we need to continue to look at solutions that work in rural areas like telemedicine which will help us overcome the transportation access issues i mentioned earlier. with that, mr. chairman, i yield back the rest of my time. >> the chair recognizes the gentleman from dayton, ohio, mr. turner for three minutes. >> thank you. i want to thank you for the opportunity to appear before you today on this important issue. as the chairman said, i come from dayton, ohio. my counties in ohio are montgomery, green, and fayette, and despite our community's efforts to battle the opioid epidemic for years, the epidemic continues to destroy my community and my constituents on a daily basis. this year, current estimates suggest that 800 people could die in my primary county, montgomery county, due to opioid overdose. sadly, that would more than double the 371 drug overdose deaths from 2016, the highest number recorded to date. imagine 800 families receiving notice that someone in their family has died as a result of opioid overdose. heartbreaking numbers like this have made montgomery county, ohio, ground zero in opioid abuse and addiction. i have called for a dayton area drug czar to dreamline our response to this epidemic. my work on the local basis to help stem the tide, today, i would like to highlight my bill, hr-92, the reforming and expanding access to treatment act, the treat act, as a title suggests, the treat act would provide access to substance abuse treatment by lifting two restrictions that hamstring full deployment of resources. medicaid's institutions for mental disease exclusions state facilities with more than 16 beds are not eligible for reimbursement. compounding the problem, a substance abuse and mental health administration policy dating to 1995 limits the use of grants from its center for substance abuse treatment, csat, to only community based treat facilities, excluding those who are incarcerating. i offer a commonsense solution to limit these barriers to individuals who are incarcerated by allowing medicaid to reimburse. there's no reason why someone who is medicaid eligible should lose their benefits when they're incarcerated. limiting the policy that provides grant funding for substance abuse treatment for individuals would also assist. since i first introduced the treat act in november of 2015, and reintroduced it in this congress, there was a broad spectrum of support, the president's commission on combatting drug addiction and the opioid crisis interim report which was just issued july 31st, 2017, strongly endorsed this concept that is in the treat act. the white house commission called lifting the imd exclusions, quote, the single fastest way to increase treatment availability, noting every governering, numerous treatment providers, parents and nonadvocacy groups have urged this course of action. chairman burgess, ranking member green and members of the subcommittee, lives are at stake. this would be an important step to bring treatment to those individuals who are at a time we have an ability to intervene in their lives. thank you. >> chair thanks the gentleman. chair recognizes the gentleman from kansas, dr. marshall, for three minutes. >> thank you, chairman, very, very much. thank you for the opportunity to come and talk and share some of my 30 years of experience as an ob/gyn in rural kansas. as most of the members of the committee know, 92 people die in this country every day, 92 people die in this country every day from opioid addiction. what i wanted to do is describe a couple sentinel events. why? why did we end up in this situation? as i look back in these last ten years, the number of pills that i would send home for a post-op patient doubled. for the average c-section, the average hysterectomy, all of a sudden, each week, people who post-opvisit, the number of pills they would need doubled. i went back to try to figure out why and how come. the first thing i think of, the patient bill of rights came about in 1993 or so, and it was the next ten years, there was a great document, patients suddenly began to expect they should have no pain. no pain after surgery. they would come into the e.r. with a sprained ankle and expect to have no pain and the demand for narcotics went up and up. somewhere in the early 2000s, something was introduced called a pain scale. they called dethe fifth vital sign. it's fraenl the worst thing i have ever seen introduced in my medical career, where they suddenly described the amount of pain they had, which was very subjective, and beyond that, it basically became part of a measure of how good of medicine you were practicing, even tied to your reimbursement. suddenly, patients were getting double and triple the medications, and then in the post operative floor, rart than getting percocet every six hours, they were getting them four hours, and the pumps increased doses. we almost doubled the amount of narcotics people were getting in the hospital, and then they wanted twice the amount to go home with as well. so physicians were faced with this struggle of saying i don't think you need this much, but patients becoming more and more in control of how many -- of their own health care. so i think those are a couple reasons why we ended up here, and i think there needs to be some re-education done. i would like to point towards valley hope in norton, kansas. they have treated over 300,000 patients over the past 50 years. they have kept incredible statistics. they have incredible treatment plans. what they taught me is about a month after release, a month after they started their path to recovery, that they had a second physiological reaction, and that's when these people o.d. and die. people need to recognize that for a month, they need to have very close treatment and probably for two months and even a year, so it's during the second episode when before they had treatment, they were taking a certain amount of heroin and a handful of pills and a pint of whiskey, when they retreated from that for a month and they went back to that same dose, they overdosed and started dying. we need to understand what kills people is that if i gave anybody enough morphine, you would stop breathing. so they're unable to metabolize it. we need to recognize that's a very critical moment. treatment plans cannot last a week. they're going to last months and years, probably. we need to make sure we're adequately funding out-patient treatment and making sure there's good follow-up at home and we need to reward facilities like valley hope who have great outcomes. great long-term outcomes. mr. chairman, thank you so much taking on this task and look forward to working with you as also. >> chair thanks the gentleman. the chair recognizes the gentleman from ohio for three minutes. >> thank you very much, mr. chairman. appreciate you holding this hearing. appreciate the ranking member green and all of you looking at solutions for this opioid crisis that's plaguing all of the communities across this country. congressman turner already alluded to it, but in ohio, opioid overdoses now exceed car accidents as the leading cause of death for most ohioans. and there have been a lot of great ideas presented here today and i really have appreciated learning from many of our colleagues. i, for the last five years, have held opioid roundtables, drug roundtables, in my district to talk about solutions, and we have come up with some ideas from the field of folks that know what is driving this crisis. and i'll talk about some medicals in a second, but the first thing i know we have to do is bring back hope and economic opportunity to people. and i think what you're doing, mr. chairman, with regulatory reform and what we're doing with tax reform is going to help with that. but there are a lot of other things we can do first. you know, the idea that came out of our roundtable this year was on evidence-based treatment. if you have been to one treatment facility, you have been to one treatment facility, because they all do things differently. too many of them do things that when you walk out that door, there's nothing tying you to the treatment anymore. and that's a problem. and they need to -- i think we should have evidence-based treatment. it should be based on the science of the day and how recovery works. and i think we need to build that into our reimbursement standards. i think that's so important. dr. marshall already talked about the second issue i want to bring up, which is pain as a vital sign. every other vital sign you can think of, you know, your temperature, your blood pressure, your pulse, can be measured by a machine. pain can't be measured by a machine. it's a subjective number and it should not be the fifth vital sign. it's led to our overprescribing culture in this country. and we have to try to fix it. i appreciate what cms has done to remove the reimbursement based on the surveys of pain management. but i think we need to remove pain as a vital sign. the third idea is encouraging alternatives. there's lots of ways to manage pain, including acupuncture, chiropractic services and other things that don't involve a pill and we need to change the culture on that. the fourth idea is prescription changes. i know buddy carter who is a pharmacist talked about a couple of these. i sponsored the partial fill legislation that was rolled into care and became law. but i believe that pharmacists should be empowered to authorize partial fill of opioid prescriptions on their own, and buddy already said it, but 70% of the folks who misuse prescriptions get it at some point, bridge that addiction through their friends and family's medicine cabinets, and we've got to fix that. the final issue that i don't hear talked about enough is tapering doses. when somebody is on an opioid for about 30 days, they have a physical addiction to it. and if you talk to most pharmacists, they'll talk about a tapering dose. and instead of going off cold turkey, and i think that's something we need to bring culture around of having folks understand that, because a lot of primary care physicians, mr. chairman, feel very uncomfortable with doing, issuing more prescriptions, but a tapering dose actually will reduce the physical addiction and actually will result in less people wanting to feed that addiction in other ways. so those are just five ideas of some proposed solutions. many of my colleagues also have great ideas. i really appreciate, mr. chairman and ranking member, you holding this hearing, and we are committed to working with you to driving the scourge of drug addiction out of this country. and i really appreciate what you're doing. i yield back. >> the chair thanks the gentleman. i want to thank all of you for providing your testimony today. this panel is excused, and our next panel will be dr. winstrip from ohio, mr. schneider from illinois, ms. clark from massachusetts, mr. jeffries from new york city, and mr. jenkins from west virginia. >> representative snyder, you're recognized for three minutes. >> thank you. thank you, chairman burgess. ranking member green, for inviting me here today to discuss the epidemic of opioid addiction, abuse, and overdose that is ravaging our communities. i represent the people of illinois' tenth district, including parts of cook and lake counties. and the opioid crisis has hit our neighborhoods extremely hard. in cook county, which includes the city of chicago, opioid overdoses increased by 87.4%. i repeat that, 87.4% between 2013 and 2016. over the same period, we witnessed a troubling increase in fentanyl. synthetic opioid which is even more deadly than heroin and whose overdoses are often fatal. in the face of these challenges, i would like to recognize the lake county opioid initiative and chicago area opioid task force along with other area organizations for their work to prevent opioid abuse, addiction, overdose, and death. in this epidemic, our adversary is constantly shifting so we must insure our doctors are up to date with the most recent best practices and research for preventing and treating this disease. earlier this year, i noted a bill called preventing opioid abuse through continuing education or opioid pace act. this bill would require providers who treat patients with prescription opioid for pain management to complete 12 hours of continuing education every three years. this would be linked to renewal of the provider's drug enforcement agency license. in an effort to cut down on overprescribing, they would focus on pain management guidelines and best practices. earlier detection of pain disorder and the treatment of patients with opioid use disorder. i'm proud a modified version of this bill at the department of defense was included as an amendment to the nda authorization. our men and women in uniform are not immune from the damages of opioid addiction. in fact, the national institute of health reports that rates of misuse are higher among service members than civilians due to the use of these drugs to treat symptoms of ptsd and chronic pain. as we seek new solutions, i urge my colleagues to support these prms we have in place to fight back. in particular, the affordable care act greatly increased our ability to counter opioid epidemic by expanding medicaid and requiring individual market policies. they would cover services related to treating substance abuse disorders. the states with the highest rates of substance overdose dets would suffer from the expansion. it would add to the fire. i urge my colleagues to consider new solutions to address this crisis, including the opioid pace act and preserve the programs we have in place to address this epidemic. with that, i yield back. >> chair thanks the gentleman. chair recognizes representative jeffries from new york for three minutes, please. >> thank you, chairman burgess and ranking member green, for holding this hearing as well as for your leadership on this very important issue. areeshate the opportunity to testify today on the synthetic drug awareness act of 2017, hr-449. the opioid crisis ravaged families across the country without regard to zip code, income, race, religion, or gender. like a malignant tumor, the opioid crisis is eating away at young people in urban america, rural america, as well as suburban america. one reason the opioid abuse has become so prevalent and so deadly is the emergence of the synthetic drug called fenltinal, a substance that can be 50 to 100 times stronger than morphine. in order to address the health crisis we confront, it's important to consider both the cause and effect. hr-449 addresses a critical and sometimes overlooked threat, the use of synthetic drugs by teenagers. it requires the surgeon general to prepare a comprehensive report on the public health effects of synthetic drug abuse by 12 to 18-year-olds in america. with the information the study will provide, congress can work to prevent substance abuse by younger americans through an enhanced and enlightened lens. nationwide, the drug overdose death rate has more than doubled during the past decade among younger americans. many experts believe this troubling phenomenon results from the rise in availability of potent and dangerous substances like illicit fentanyl and other synthetic drugs. teenage fentanyl use is a vicious cycle. adolescents have a still developing prefrontal cortex which can facilitate drug seeking behavior. the drug then altered the development of the area of the young brain, making that behavior permanent. in fact, more than 90% of adults who develop a substance abuse disorder begin using prior to the age of 18. in new york city, overdoses now kill more people each year than murders, suicide, and car crashes combined. this phenomenon we have seen repeated over and over again, all across america. this bill has significant support amongst republicans and democrats and has been incorporated into the legislative agenda for the bipartisan heroin task force. it also has support from a number of health and patient advocacy groups including the american academy of pediatrics, american association of nurse practitioners as well as the national association of police organizations. thank you again for this opportunity to testify. and i respectfully request committee consideration at your earliest convenience. >> chair thanks the gentleman. chair recognizes the gentleman from west virginia, mr. jenkins, for three minutes, please. >> thank you so much, mr. -- thank you so mump, chairman burgess, ranking member green, and members of the subcommittee for giving me the opportunity to discuss this most challenging public health and safety issue of our time. my home state of west virginia is ground zero for the opioid epidemic. west virginia has the nation's highest overdose rate and the highest rate of newborns exposed to opioids and other drugs known as neonatal abstinence syndrome or nas. from this tragic epidemic, however, has come an exceptional response from communities across my state, coming together to find solutions. one shining example is lily's place. a unique facility that specializes in treating newborns suffering from n.a.s. i was proud to work with two nicu nurses and a passionate community leader to start lily's place after they saw, we saw the dramatic rise in newborns with n.a.s. lily's place has been operating for three years and has cared for more than 190 precious newbo newborns. lily's place has brought national attention to west virginia solutions. just yesterday, the first lady, melania trump, visited lily's place in my hometown of huntington, to talk with the caregivers about helping the most vulnerable in our society. lily's place provides a great environment with care given by doctors and nurses in a nurturing setting conducive to recovery. mothers and families are included in the healing process. lily's place and others advocating for this model of care have struggles dealing with cms. making it harder to replicate this model. that led to my introduction of the nurturing and supporting healthy babies act. last year, through this committee's work, my legislation was incorporated in care which of course became law and was passed. thank you for your work. my legislation requiring gao to closely look at the different care models for n.a.s. in medicaid coverage and the gao report was just released last week. it found that non-hospital settings like lily's place, are a proven model of care to treat n.a.s. newborns. it identified this model of care as a proven effective treatment approach and can actually reduce the cost of care. here is my ask. i would encourage this committee to advance two measures critical to the care of these precious newborns. first, i have sponsored the crib act pending before this committee with congressman mike turner, which makes sure these models of care are included in non-hospital treatment facilities or recognized by medicaid to remove the barriers. second, based on the gao report, i ask you working with me, this committee, to memorialize in legislation the recommendation in this report and have these become law so these precious newborns can receive the very best possible care. thank you, mr. chairman, for your interest in this issue. and i yield back. >> chair thanks the gentleman. dr. winstrip, you're recognized for three minutes. >> thank you, chairman burgess and ranking member green, for hosting us today. i mean that sincerely. we're hearing a lot of good ideas and it gives us a lot of food for thought. the opioid crisis is affecting each and every one of our districts across the country. that's very obvious. and i appreciate the chance to come and speak today and share with you some stories from ohio's second district. my office recently sent a survey to the constituents of our district, and we asked them to share their stories and experiences with the opioid epidemic. and the results are heartbreaking, as you might imagine. we received hundreds of responses, up to seven pages of responses. i want to share a couple of those with you. one said my brother unfortunately became adistricted as a teenager. he's very lucky because at 33 years old, he's still here, but he's still fighting every day to stay sober. these drugs have no place in our country. they're ruining our youth, our future. another one, a woman said i have four boys, and three of them are struggling with this addiction. the cost of going to a methadone clinic is very difficult. the cost of treatment facilities is too expensive. i'm going broke trying to get my children sober. clearly, this epidemic is devastating for southern ohio as it is across the country. in one county alone, the overdose death rate was 37.5 per 100,000 residents, and in another county, 318 residents died of an unintentional drug overdose in 2016. this spring, the columbus dispatch reported at least 4,149 ohioans died from an unintensional drug overdose in 2016. and one local newspaper called the overdoses the new normal in that county. i appreciate what dr. marshall had to say earlier, as a doctor, i can agree with him on many of the factors that have driven so many people into addiction. and i would really like for us to talk some time about prevention, which i think is the long-term vision for our country. i can tell you as a doctor, i had someone come up to me just last year and say, my friend wanted me to thank you if i met you. i said why is that? because she was addicted to prescription pain meds, and when she came to you, you gave her alternatives, and you didn't give her any. we search for answers. we're all searching for answers. one of the sheriffs in my district, he's working hard on this solution, and he's using prevention, because he said i can't incarcerate our way out of this. but he did show me what one patient received on medicaid in a year, what one patient in one year received from medicaid as far as narcotics, and i promise you it was more than i prescribed in my entire surgical practice in a year. then he showed me what medicaid paid for it. so while i understand that medicaid is providing help and care for a lot of people, it may be driving the problem as well. because as some are getting treatment, many are getting fed. and the problem is being exacerbated. we need to look at that, and there needs to be a better oversight of how we're handling this. this sheriff directs an essay contest asking local students to write an essay about the dangers of opioids and how they hope to become the generation to stop the epidemic. as i said before, he said he can't incarcerate his way out of this. we can't always treat our way out of this. but i hope that we take some time in this process for a long-term vision of how we can prevent people from ever getting in this situation to begin with. with that, i yield back. i thank you your time and attention today. >> thank you. the chair in absence is recognizing congress woman clark. >> thank you to you and chairman burgess for holding this member day today. we're all here because we lose 91 americans a day to the opioid epidemic. and every one of those 91 deaths affects not only the victim but also their loved ones, their work place, and their community. now is the time for us to come together and find solutions to end this national health emergency. and with that in mind, i would like to speak in favor for commonsense proposals i'm leading, each with a great republican partner, aimed at addressing a different aspect of the opioid epidemic. the first is the youth act, which i introduced with my colleague from indiana, dr. bucshon. the opioid epidemic has had a tragic impact on our young people. from harmful changes in brain and social development to long gaps in education and job training, the effects can be profound. the youth act would expand access to evidence-based medication assisted treatment for adolescents and young adults. giving them the best possible chance at recovery. the second proposal is the prescribing support act, which i introduced with my colleague, congressman evan jenkins. tragically, opioid addiction often begins in the doctor's office where patients are often prescribed more medication than they need or without being informed about the risks of addiction. the prescriber support act would establish state-based resources for prescribers to consult when making decisions about prescribing opioids. third, a recently introduced ever prescription conveyed securely act with my colleague from oklahoma, congressman mullin. this proposal would insure that all prescriptions for controlled substances filled through medicare part d would be transmitted electronically. electronic transmission would help doctors and pharmacists spot patients attempting to doctor shop and it would make it more difficult to forge a prescription. all the while saving taxpayer dollars. finally, i will soon be introducing a bill with my colleague from kentucky, congressman hal rogers, that will create a student loan forgiveness program for professionals who enter and stay in the substance use treatment field. in my district, i have heard time and time again from families and providers that there simply aren't enough treatment specialists available to help the growing number of americans struggling with substance use disorder. our bill will help build this critical workforce. there is no single solution to the opioid crisis. however, these four bipartisan solutions can help put us on a path to beating this epidemic. i thank the chairman and the ranking member for giving us this opportunity to have this conversation, and i look forward to working together. i yield back. >> the chair thanks the gentle lady. the gentle lady from connecticut is recognized for three minutes, please. >> thank you, mr. chairman. chairman burgess and ranking member green, thank you so much for holding this important hearing on the growing opioid epidemic. everywhere i go in connecticut, i meet people whose families have lost loved ones to drug addiction. moms and dads, sons and daughters, brothers and sisters. it's an epidemic that affects families and communities across the country, regardless of age, race, gender, socioeconomic status. during one of my visits recently to an addiction treatment center in waterbury, i met a young woman who has been struggling on the streets with addiction. she has a new child, and she's so grateful to be in a program that is allowing her to stay clean and helping her keep her child. i met a 45-year-old man in the fail treatment center in new britain, who for 20 years has been battling his addiction and is coming to terms with it and is able to hold a steady job. these are real people, real families and real lives affected by this crisis, and the stakes are high. if these vital treatment centers are forced to close their doors or if we limit access to them, people will die. in my hometown of cheshire, a neighbor whose daughter was a class mate of one of my children contacted the office that they had lost track of their daughter. she had bn on the streets addicted to drugs. we were able to help them find her. she wouldn't accept the treatment, and a week later, she was dead. that's what it's like now in america. the situation is so dire in connecticut that our chief medical examiner lost its accreditation. they cannot keep up with the autopsies. we're expecting more than 1,000 deaths this year. that's the third highest rate in the country. they literally cannot keep up with the autopsies. we need to do something. and this congress needs to act. i'm pleased at our good bipartisan work last year. my bill of the prevention drug addiction act of 2016 was included as part of the conference committee and our good bipartisan work to insure that we're addressing the issues of prevention that many of my colleagues have addressed here today, bolt provider education on how to prescribe as well as for parents, coaches, and others who need to be aware of the risks of prescription drugs. but there's important work at stake. i do want to say something about the affordable care act. we need to protect the funding, which is providing vital access for people across america. and we're at real risk now as we consider that funding and whether the medicaid access will be cut off, which is funding so many more programs in my state. again, i want to thank this committee for the good work and encourage all of our members come together and help address this vital need, this growing epidemic that is affecting all americans. thank you, and i yield back. >> chair thanks the gentle lady. chair recognizes the gentle lady from utah for three minutes, please. >> thank you, mr. chairman, for such -- talking about such an issue. i would like the thank the ranking member green, also, for giving us the opportunity to speak about the opioid epidemic and crisis. nationwide, the rate of deaths has exploded to over the last ten years to now more than 60,000 deaths every year. in utah, the department of health says that more people are dying from opioid and heroin overdose than ever before. six people die from opioid overdose per year. alarming increases from 2013 to 2015. utah's seventh highest for those deaths per capita in the united states. here's what hits me the hardest. the innocent children that are being affected by the opioid epidemic. in too many cases, parents are no longer parents. their children are parenting themselves, and the parents are now slaves to their addiction. this is actually happening in elk ridge, utah, a place where, which is just a few minutes away from my home. there's a boy who is in third grade who talks about his life with his mom, who is addicted, and his stepfather, who is addicted. he talked about waking up by himself and getting himself ready for school. and also getting his brother ready for school and his newborn sister. he makes breakfast for them and prepares a bottle for his newborn baby. who is his sister. he talks about the fact that many times, he misses the bus when he's going to school because he's taking care of his brother and sister. and there's no one to take him to school. his brother cries, asking for his mom and dad, and he as a third grader, has to try to explain to his brother why mom and dad aren't around. that's not the end of the story. his newborn sister is actually addicted to opioids because his mother took the drugs while she was pregnant. and while in the hospital, for fear of getting caught, she actually took opioids and would rub it on the gums of her baby so that the baby wouldn't show signs of withdrawal. this is what is happening in america. this story is not unique to utah. it's happening everywhere. the parents are now in jail. they were arrested for trying to return stolen merchandise at the local walmart and neglect of their children. but i have to say that the children's lives aren't better now without mom and dad. their nightmare is just beginning. so i feel very strongly about this. at a time where there's so much partisan politics, this is an issue where so many of us are standing together. i believe american democracy is at its best when two people are talking about what we are for. here woo are in a room talking about what we're for. i'm so proud we're coming together, but coming together is not enough. we actually have to apply some of the solutions we're talking about when it comes to the crisis and i think the opportunity to -- i'm thankful for opportunity to work on this. thank you. and i yield back. >> chair thanks the gentle lady. let me take the new jersey delegation in seniority, and mr. pascrell, i'll go to you first for three minutes. >> thank you, chairman burgess. ranking member green. i don't have to tell you or anyone here that opiate abuse and misuse is one of our country's fastest growing problems. it is also one of the most vexing problems we face. and there are no simple solutions. prescription drugs serve a valid medical purpose. but many of them carry a high risk of addiction and abuse. many of my colleagues have good ideas about steps we can take to address opiate abuse and misuse, so i commend you for giving us the opportunity to share them. today, i would like to share some information about a program that was developed and is in use at my hometown hospital, st. joseph's regional medical center in paterson, new jersey. as the busiest emergency department in the state of new jersey, st. joe's commitment to reducing abuse can serve, i believe, as a model for emergency departments across the state and across the country. we need to recognize that emergency departments are in a unique position with respect to prescription drug abuse. on one hand, a component of pain that legitimately -- many other health settings. to prevent addiction where it often starts with a valid prescription in the emergency room, st. joe's initiated a first of its kind alternatives to opioids, or alto. alto program. the alternatives to opiates. this new approach utilized protocols primarily targeting five common conditions. the alternative therapies offered through st. joe's alto program include targeted nonopiate medications. trigger point injections. nitrous oxide. ultra sound guided nerve blocks to tell a patient's pain management needs, and avoid opiates whenever possible. in the first year of operations, this program decreased emergency department opiate prescriptions by more than 50%. the goal is not to eliminate opiates all together, because these drugs remain an important part of pain management. however, the alto program reserves their use for severe pain, end of life pain, surgical conditions. that's it. as a result, only about 25% of the acute pain patients treated with non-opiate protocols since the program's launch eventually needed opiates. i believe that the initial successes of this program make it very important that we have a broader implementation and study. i leave this to your discretion. that is why senator booker and i plan to introduce legislation to establish a national demonstration program to test pain management protocols that limit the use of opiates in hospital-based emergency departments. it's my hope that strategies that provide alternatives to opiates can become a larger part of the discussion of how to combat this opiate epidemic. and that this committee will review and consider my legislation upon its introduction. with that, mr. chairman, mr. ranking member, i yield back to you. >> chair thanks the gentleman. mr. mccarthy, you're recognized for three minutes, please. >> i thank the chairman burgess and ranking member green for hosting this opportunity today for those of us not on this committee to share our thoughts. we have all seen the numbers. last year, over 60,000 deaths from overdose, opioids involved in the vast majority of those. in ocean county, new jersey, my home county, we're losing somebody every 43 hours. and a couple weeks ago, my county was designated a high intensity drug trafficking area, desperately needed, but also disturbing sign of where we are. it may be unusual for a member to sit here and promote other people's bills, even bills written by the other party, but as the republican co-chairman of the bipartisan heroin task force, representing over 90 members of boat parties, that's exactly what i'm here to do today. as your committee considers legislative next steps to pursue, i want to recommend the bipartisan heroin task force's legislative agenda for your consideration. we are committed to being rigorously bipartisan. we did not include any bills in our agenda unless it had bipartisan cosponsors and both the republican and democratic chairs, co-chairs, agreed to it. five of the bills that were recommended fall within your jurisdiction. representative tim walberg's jesse's law, will insure that doctors have access to a consenting patient's prior history of addiction. so they can make informed decisions. representative david joyce's stop o.d. act, will increase first responders' access to narcan and synthetic opioid testing. representative hakeem jeffries' synthetic drug awareness act requires we investigate how the synthetic opioid crisis is affecting young people specifically. representative evan jenkins' crib act will insure treatment for babies with neonatal syndrome, and representative brian fitzpatrick's road to recovery act addresses the imb excluz, which is one of the barriers preventing access to substance abuse treatment. we're proud of our members' work. i would also note many of our ideas coincide with the white house's opioid commission recommendations and i note the good work done by the republican main street on the same issue. on behalf of my democratic co-chair, annie kuster, our fice chairs, brian norcross and brian fitzpatrick, i urge you to consider these bills. we'll continue to expand and update our legislative agenda as we tackle this critical issue facing our country. thank you and i yield back. >> gentleman yields back. the chair recognizes the gentleman from arizona for three minutes, please. >> chairman burgess, ranking member green, members of the committee, thank you for allowing me to come before you today to testify on an issue that has had a devastating impact on my district. i want to first of all echo the sentiments of representative mcarthur. i'm also on the task force. at least two arizonians die every day from opioid overdoses. last year, deaths due to opioids rose 16% from the year before. as a former law enforcement officer, some of what i see today is familiar from my time serving communities. the harrowing stories of addiction, the pain family members face, including child abuse, domestic abuse, and the loss of a loved one. and also the relationship to organized crime. but i must tell you that what we are seeing today, the devastation that opioids have wrought on our communities is far more impactful than the drugs i fought to keep off the streets when i was a cop. over the summer, i held a roundtable in my district on opioids. i heard from families, first responders, local law enforcement, and health care providers. i'm here today to bring their voices to you as we commit to tackling this issue in a bipartisan and comprehensive way. as you work to develop policies to combat this epidemic, i implore you to consider the impacts to rural communities and to tribal communities, which face unique obstacles and barriers to treatment, care, and recovery resources. according to the cdc, american indian and alaska natives have the highest death rates from opioids than any other community. american indians and alaskan natives have long faced disparities when it comes to resources for mental health care and substance abuse. that's why funding created by the 21st century cures act in addition to expanded medicaid coverage in arizona have been crucial in helping families get the care they need. as many of you know, access to crucial health care services in rural communities and across indian country can be scarce. and often requires families to travel long distances. providers in rural america have benefitted from expanded medicaid coverage and are now seeing lower rates of uninsured patients than ever before. in states that expanded medicaid, the share of uninsured substance use or mental health disorder hospitalizations fell from 20% in 2013 to 5% in 2015. the increase in coverage has allowed rural providers to operate on the thinnest of margins. to help keep their lights on and their doors open. if congress repeals that coverage, rural providers will close their doors and patients who need the help will face fewer choices. we need to give states local law enforcement and tribes more resources and more flexibility to assess what works, but we must approach this problem comprehensively, and with a robust commitment to those we represent. i urge your committee to thoughtfully consider these issues and how they affect communities across rural and tribal communities. those voices must be heard when it comes to this crisis. i thank you, and i yield. >> the gentleman yields back. the chair thanks the gentleman. if you wish to be excused, you may do so. but we're all anxious to hear what the gentleman from maine has to share with us. so you're recognized three minutes. >> thank you, mr. chairman, very much. thank you, ranking member, for the opportunity to be in front of you today. in our great state of maine, mr. chairman, we have on average one person dies every day from a drug overdose. there is a recent study that said that six out of ten families in our great state, six out of ten, mr. chairman, are impacted directly or indirectly by this epidemic, including, i might add, my own family. rural maine has been hard hit. rural america has been hard hit with this epidemic. that's why i join the bipartisan task force to combat the heroin epidemic, and that led in part to a very comprehensive bill that we all passed in a bipartisan way last year, the comprehensi comprehensive addiction recovery act that sent about a billion dollars back to our states so they had better resources and more flexibility to address this scourge on our kids and our family members directly on the ground in our respective districts. now, the model, mr. chairman, of the great state of maine is i lead. for are a bunch of things we have been doing in maine to help fight this epidemic that i think the rest of the country can learn as we learn from others. we have put in place a prescription monitoring program that is very tough and very effective. in particular, it sets very strict limits on what opioids are prescribed. it mandates the use of this system by prescribers, and if you are prescribing opioids in the state of maine, you must check this program, this database on a regular basis to make sure those that are being prescribed should be in fact those that are receiving the pain killers. if folks are coming from out of state or they're paying with cash, it also triggers a review of the program to make sure that these drugs are falling in the hands of the right people. now, i also serve, mr. chairman, i might add, on the house veterans affairs committee. and along with mr. dunn, mrs. tenney, jody harrington from texas, and mr. tonko, we have introduced a bill that asks the veterans administration facilities in the state of maine and hopefully around the country, to use their local state prescription monitoring programs or to interface with those because they're more comprehensive in many cases, they're tougher. i would also encourage you, mr. chairman, and mr. ranking member, as you're going down this path to make sure we do everything humanly possible to hold those that are manufacturing synthetic opioids like fentanyl, hold them accountable. these drugs are horrible. they're not expensive to manufacture. and they're anywhere from 50 to 100 times more potent than heroin and methadone. so with that, sir, i appreciate the opportunity to participate here. i know that my associates on either side of me have a lot to say, but we have done a lot in maine, but we have a lot more work to do. thank you, sir. >> the chair thanks the gentleman. would the gentleman entertain one question on your pripg drug monitoring program? >> yes, sir. >> do you provide feedback to the prescribing doctor, this is a list of patients we have for you that you have prescribed? is there a two-way street? >> it is, but the system is quite accurate, mr. chairman. such that the prescriber can see that data online. >> very well. representative, you're recognized for three minutes, please. >> thank you, mr. chairman. and the other members of this distinguished committee, for your work to bring awareness to this opioid epidemic. as well as your work to bring forward solutions to help address it. i'm particularly grateful for your willingness to allow members who do not serve on this committee the opportunity to share how our districts have been impacted by this scourge. opioid addiction has become a growing problem throughout north carolina and particularly in the southeastern part of the state, home of the seventh congressional district which i have the privilege to represent. it's a growing and significant challenge for our communities, parents, law enforcement, local health departments, treatment facilities and schools, to name just a few. this epidemic is so ramp nlt, in fact, it would not be a stretch to say that if a family doesn't have a relative suffering from this addiction, they know a friend or family who does. perhaps the most alarming to me are the reports out of my district about narcan parties. that's right. narcan parties. these are parties where teens and others go intending to get as high as possible with the expectation that they will be brought back to life by an injei injection of narcan if needed. i also hear from members of the law enforcement community that they are administering narcan to the very same individuals on a regular, even weekly, basis. now, if this isn't a sobering fact of how this addiction is destroying lives, i don't know what is. in 2015, there were more than 1100 opioid-related deaths across the state of north carolina. the three counties most impacted by the opioid epidemic in the seventh congressional district are brunswick, newhanover, and pender counties. in 2015, there were 24 deaths in brunswick death. 45 in newhan over, and 14 deaths in pender county. now, i have met with and heard from parents who have lost a child to an overdose, law enforcement officers who were struggling daily to prevent this epidemic from further penetrating into our communities, and individuals working at treatment facilities who do not have enough resources or beds to keep up with the demand. as with every complex problem, there is no silver bullet answer to this epidemic, unfortunately. however, it's my belief that congress can play a significant role by facilitating collaboration among the very best and brightest to bring solutions forward that will enable the country to turn the tables on this scourge. in the seventh congressional district, we're fortunate to have many bright and committed individuals who have been working diligently on this issue for some time. many of whom serve on my law enforcement and health care advisory committees, and each of them, mr. chairman, stand ready to assist this committee and congress as we work to address this problem in a comprehensive and effective way. thank you again, mr. chairman, for the opportunity to testify today. i yield back. >> chair thanks the gentleman. chair recognizes the gentleman from iowa, mr. young, three minutes, please. >> thank you, mr. chairman, ranking member. i would like to thank the committee for holding this hearing and i really wants to tell a story. i want to highlight the actions the community of bridgewater, iowa, has undertaken in the last year to take back their town. it's a small town of 200 people in southwest iowa, facing a problem with opioids and a range of other drugs. as drug use there slowly started to rise in the community, which relies on the county sheriff's office to keep them safe, the residents were unable but not unwilling to stop the influx of drugs into their town. residents of bridgewater started to see cars coming into their town with out of state license plates, and from counties across the state, as the cars came, so did the crime. residents and law enforcement noticed an uptick of crimes, theft, and vandalism which traced back to drug users and dealers coming to town. empty houses came into drug houses. powers by gas and generators which led to more than four houses burning to the ground. last spring, residents were fed up as they saw the town they were raised in slipping away. they decided to take action. concerned residents met in the basement of a church to find a way to save their town. this is when they decided to take back bridgewater. residents formed a nonprofit group to fight the drug crisis together. as word spread, media outlets across the state came to the small town to shed a light on one of many communities suffering in this third district. i visited bridgewater in april to meet with the residents in that same church basement. as they began their mission to make sure that their town was safe again. i studied their faces. listened intently, and their mission is my mission. they started to hold forums with drug counsellors, law enforcement, state and local legislators and other individuals offering help, as residents start to clean up their town, they're met with hostility and retaliation from drug dealers and users. leaders of the take back bridgewater movement were run off the roads, swerved at by those who want to protect the status quo, and a number of other incidents occurred, but the residents pressed on. the citizens of bridgewater will not surrender. as neighboring communities saw what the residents of bridgewater were doing, they wanted to do something in their communities. leaders in towns in southwest iowa often discuss strategies together to protect their neighbors. that's what iowa is all about, neighbors helpingnerics. communities helping communities. just last night, residents of bridgewater gathered in the basement of that very same church to kick off a fund raiseer for their nonprofit. they'll be going throughout southwest iowa to sell christmas wreaths to adorn the home doors of homes throughout the region. residents will use the funds to take back the community. bridgewater will not turn a blind eye to opioids and drugs in their community. and we must not forget the human tragedy of addiction and desperation. this epidemic is enslaving and killing our sons and daughter, our mothers and fathers. as the federal government addresses this issue, it''s my hope we use bridgewater as an example that local communities can have the largest impact if we partner with them in having the tools they need to be successful. a one size fits all program will not save as many slievs as a solution tailored to one community. take back bridgewater is not just a slogan. it's an action plan. it's a reality. and it's happening. and it's not just happening in bridgewater. it's happening all around the country. thank you for holding this heari hearing. >> chair thanks the gentleman. the gentleman from oregon recognized for three minutes. >> thank you, mr. chairman. i appreciate the focus on the opioid crisis that grips every community to some degree and affects every state. especially critical for our veterans who are twice as likely to die from accidental overdoses. as we're slowly acknowledging the depths of the opioid crisis, which is good, we seldom acknowledge one of the simplest, most effective solutions. medical marijuana. cannabis. now available in 28 states, largely driven by the voters. not the politicians. most recently in florida, where their voters approved it by over 70%. i have distributed some information here entitled the physician guide to cannabis assisted opioid reduction. on the back are the citations for each of the points that are on this chart. references referencing cannabis-reducing opioid overdose mortality, how canis bus reduces opioid consumption, how cannabis can prevent dose escalation and the development of opioid tolerance. cannabis alone or in combination of opioids can be a viable first line analgesic. mr. chairman, we don't talk much about this although on the floor of the house repeatedly over the last three years congress has been moving in this direction and voted last congress to have the veteran's administration be able to work with veterans in states where medical marijuana is legal. but i focus on one simple item, not the fact, which i hope this committee would look at. but there is one piece of legislation that i have introduced with dr. andy harris, somebody who doesn't agree with me about the efficacy of medical marijuana, but he strongly agrees with me that there is no longer any reason for the federal government to interfere with research to be able to prove it. the federal government has a strangle hold on this research. we have bipartisan legislation, 3391, which would break that strangle hold and be able to have robust research to resolve these questions so there would no longer be any doubt. this is cheapest most effective way to be able to stop the crisis where people have access to medical marijuana, there are fewer overdoses, and people opt for it dealing with chronic pain. i would appreciate the subcommittee looking at this issue as your time permits. thank you mr. chairman, ranking member. >> chair thanks the gentleman, gentleman yields back. chair recognizes the gentle lady from georgia for three minutes. >> thank you mr. chairman and thank you for holding this hearing. the opioid crisis has hit the counties of fulton, dekabul as hard as in any part of the country. in 2016, 72.3% of all drug-related fatales in cobb county were caused by opioids, that was an increase of 16.8% over the year before, in 2015 the narcotics team seized more heroin than in the previous 20 years combined. in future ton county the medical recorder's office recorded 77 heroin deaths in 2014 compared to just four in 2010. behind the statistics are hurting devastated families, family that are being torn apart by addiction, facing financial ruin in their desperate effort to try anything to make things right, or worse, losing a loved one to a drug overdose or suicide. the opioid crisis as we've heard is indeed a complex one. it's an incredibly sensitive issue, particular ecally for communities that have long felt immune to fatal substance abuse problems. still community threw churches and non-profits with the support local state and federal government are coming together to take action. this year in the city of alpharetta they created a new program designed to key crease painkiller abuse across the down. with the help of the roadary club in that city the city purchased special boxes that were used to collect unused or unwanted medications and located them at police and fair stations across the county. while the boxes cost $1,000 each they are designed and constructed specifically to prevent anyone from stealing the drugs inside. this may seem a small measure but it is making an impact by providing a safe secure disposal point. in the city of john's creek the hub community resource center is acting as a life line for those seeking drug abuse and mental health attention. ultimately, we have to continue to look for root causes. as the district attorney in cobb county said we are not going to be to arrest our way out of this epidemic. the road to recovery must be lined with treatment options. further, non-opioid and non-pharmacological treatments do exist. the university recognized pain awareness month in september by educating our community about those alternatives. we also need to do a better job of data sharing. important information that exists at the local, state and federal level. i stand ready to help you in any way. thank you mr. chairman for this opportunity. >> chair thanks the gentle lady, who yields back. chair recognizes the gentleman from florida. three minutes. >> i would like to thank the chair and ranking member for providing us this opportunity for members to sew share how the opioid crisis is affecting their constituents including my neighbors in pinellas county, florida. our society's use of opioids has truly become an epidemic. last year, 11.8 million americans aged 12 or older misused opioids, including nearly 900,000 children aged 12 to 17. over 50% of the people with both substance abuse and a mental health disorder do not receive treatment for either issue. tragically, my home state of florida was a prescription drug abuse capital of the united states in last decade. they were known as pill mills and described massive amounts of otherwise legal narcotics which were then distributed into our neighborhoods, schools, communities, and throughout the country. when i was governor we went after pill mills and put them out of business. while florida wave won the battle against these pill mills our country is losing the war against opioid addiction. we are underfunding addiction treatment side stepping what the science tells success the best way to fight the addiction. now the scope of the crisis has broadened beyond prescription drugs into heroin and tent till. my home of pinellas county was no exexception. last year we saw a strichk deaths from xanax mixed with fentan fentanyl. in 2015 heroin fentanyl and o oxycodone were responsible for over 3800 deaths in florida alone. it is a tragedy, an epidemic and the need for action is immediate. i saw the devastation firsthand recently when i visited the non-profit operation par in my district just a few months ago. i heard directly from those in recovery being helped by their innovative more holistic approach. if we are going to combat this problem we can't concentrate on law enforcement alone. florida should serve as an example to the rest of the country that only going after suppliers is inset. let's be clear. the people who misuse opioids aren't the worst of the worst. they are our neighbors our friends our parents and children who are desperately in need of help. they offer suffer in silence and isolation because of the stigma and shame surrounding drug abuse. unfortunately, america learned this lesson the hard way treating the crack epidemic as simply a law enforcement exercise. we can't combat our opioid crisis without investing in new treatment options long term mental health and substance abuse recovery resources, and the men and women on the ground working in non-profits in government, collaborating with first responders and law enforcement to help those in need in all of our communities. this includes funding for the substance abuse mental health service and the national institutes of health, which provides the research and innovative treatments not often permitted using traditional funding. this funding provides grants, including in pinellas down for innovative local solution force treating mental health and substance abuse disorders like what is happening at operation par and bed not broken organizati organization. this includes funding overdose reversal. we will lose this fight without naloxone, americans will die unnecessarily, and because florida did not expand medicaid funding for these organizations is even more vital and something i hope your committee continues to prioritize in this ongoing battle. thank you again for this opportunity to share how my home of pinellas county is combatting this ep emdiddic thank you mr. chairman and this committee. >> gentlemen yields whack back. chair thanks the chair. chair recognizes mr. faso for three minutes. >> thank you chairman, ranking member, and members of the committee for holding this important hearing and hosting all of us today. i appreciate and understand many of the testimonies we have heard from our colleagues. it's important to note that we represent district that are often extremely different from each other, democrat, republican, rural, and urban. it is rare when an issue can unite not only an conference but an entire congress. at the risk of speaking for my colleagues, i would like to express that we all stand together against the opioid epidemic. now, in my district in the 19th district in upstate new york, i can tell you a couple of stories. green county emergency responders recently reported to me they came upon a scene where they had two individuals who had overdosed. one individual required eight doses of naloxone in order to be revived. another required six. this is not an uncommon phenomena. county sheriffs have reported to me going back to the same household, the same apartments, on the same evening to administer narcan to revive people who overdosed. other county sheriffs have told me that every single drug dealer they arrest has public benefit and food stamp cards in their possession. it's ironic that we the public are often sustaining economically those that prey upon our citizens. in my district, the board of supervise in columbia county recently passed an opioid epidemic response plan. this plan is an enormous step forward to combatting the opioid crisis in our region. allster county has also substantially increased local funding to fight the crisis. twin county recovery services in columbia and green counties is also serving those with addiction through clinical, residential, and educational programs. i think the bottom line, mr. chairman, my colleagues, we have got to have educational programs that help us staunch the demand for these substances and not just try to staunch the supply. congress must continue to help our local communities by ensuring they have the support and the 21st century cure examines kara, supporting sam is a legislation and passing legislation such as the stomp act by making it more difficult for the postal service to ship fentd nil and car fentanyl through the mail. i recommend more research into how opioids affect the brain and learn maw on how to defeat this chemical dependency. our work is far if finished. we must stay engaged with each other, with our communities and stay engaged with victims and families to truly effect your way and facilitate an authentic reversal. this dangerous and upward tend of opioid addiction in our communities. i thank the committee for their service and for eye louing to us bring this testimony forth today. >> chair thank the gentleman. gentleman yields back. chair recognize mrs. katco for three minutes. >> thank you mr. chairman and ranking member green. i appreciate being given the opportunity to testify about this topic and giving me the opportunity to not only discuss what has been being discussed but a partial possible solution, hr 2851 to stop the importation, trafficking of sin ed athletic analogued act of 2017 which i will refer to as sitsa. i'm driven in my testimony today and for my support for this bill by two things. one is my 20 years as a federal organized crime prosecutor, prosecuting every manner of drug known to unanimous and knowing that based on that experience i have never seen anything that remotely resembles the tragic consequences of the current synthetic drug problem and the heroin issue in this country. and they are intertwined. i can talk chapter and vrs about what's going on in my community but i want to introduce you to people we have lost since i have been in congress. john and tina sochi lost their daughter who was murdered in front of her 18 month old child by her boyfriend who was addicted to opioids. two years later, still grieving the loss of their daughter, their lost their swn son to a heroin overdose. their son was a drug counsellor. joe camp nola lost his son, and his son was a drug counsellor at the time. and john and tina lost their son as well. kevin jones lost his steb daughter. theresa wilson lost her son after he ingested synthetic marijuana that was purchased over the counter at a local head shot. he had convulsions and drowned. deanna x. all these stories are tragic. this one perhaps the worst. deanna was a high school athlete a great individual. she got involved in hair wane after abusing opiates. thee became pregnant, went cold turkey and quit. she was five months pregnant, had not had relapses. i drug dealer who i can describe as one of the worst individuals on earth cajoled her into trying a new mixture. she tried it that one time, died, and lost her unborn child as well. that's the face of this trajectory de, the face of what's going on here. that's what i'm trying to address with respect to the sitsa act. toxic and synthetic drugs are designed to mimic straight drugs like marijuana. what this drug is trying to do is to recodify the problem. the problem i encountered when i was a prosecutor doing synthetic drug prosecutions is that the statutes don't keep up. the drug that killed theresa wilson's son took four and a half years after they identified the chemical compound before it was listed in a drug analogue statute. this bill that i have that already passed the judiciary and is simply waiting to get out of brks and c before it can get on the floor turbo charges that process, reduces it to about 30 days. it also in a nutshell will give individuals in coming who disagree with the classification of one of these drugs 180 days to have it removed from the act. i can tell you looking through the prism of a prosecutor there are three ways to address this. number one is law enforcement, two is prevention, and number three is treatment. as 234r fossa noted we have done a lot to address prevention and treatment this. sitsa act is something law enforcement needs it is and a game changer. i hope anc will examiner it in a swift manner so we can get it on the floor and put it in the arsenal for law enforcement to be able to attack this problem in meaningful manner. i yield back. >> the chair recognizes gentleman from massachusetts mr. keating for three minutes. >> thank you, mr. chairman. let me go off my notes and try speak from the heart. before i was a member of congress i was a d.a. for 12 years. started a task force. now it's over a decade and a half on at the time a heroin task force. but it was as a result of my work as a d.a. we'd go to unattended deaths. we would find out that the person there had no criminal record, they started their addiction with prescription drugs, went to heroin, custom is cheaper and more available, believe it or not, and then they die. i consoled parents who lost a child. i worked with grandparents who were raising their children. in my own family, i lost a cousin to an overdose right after he was coming out of detox. most dangerous time. on a brighter note, i have another family member who is a decade and a half in recovery. i have seen this firsthand. in my district since we are sharing that, one of my communities, fall river, they are on pace for over 1,000 overdose this is year, just this one city. and over 100 deaths. in my district i have four of the five leading counties in terms of the opioid deaths. i want to thank this committee for the work they have done with the kara act w-21st century cures that you are working. i think that works's at risk if we backtrack on the availability of treatment through the aca or another source because, as you know, 34% of the people before them did not have the guarantee of that treatment, which is important. 18% didn't have the coverage for mental health treatment that's necessary as well. and the medicaid expansion those states that did it there is no 11 million low income americans covered by this. i also want to thank you on the efforts that we've worked on a bipartisan basis. it's worked on efforts of the stop act, which is in front of this committee. i hope it moves forward. some of that is being done administratively where we look at making our drugs that are there ever at thatter resistance, abuse resistan. cosponsoring a saves act character allows coprescription of naloxone that's there. it solves a problem for the medical community and work with the veterans in terms of making sure they are educated. i just heard my colleague talk about the fact we deal with in this three ways. interdiction is limited. i had a private meeting in my office with the leaders in terms of customs and border patrol and what's going on. it's limited because so much of it has increased through the mail, through fedex, through ups, very hard to deal with in that respect although we should do what we can to prevent it. prevention is important, obviously when dealing with medical treatment and the middle school population. let me conclude with think. i was up last night thinking about what i was going to say to you today. when i got to congress we sat down with the fda and people to air out concerns. only myself and representative hall rogers is still here from that group. at the ends of listening to us, all these experts came and they said congressman, you don't understand. you don't understand about medicine. you don't understand about mediterranean medical treatment. we are there to deal with some pain, and you know that's part of our reason. and i slammed the table. i said, you don't understand about pain, the pain of losing a son or a daughter a grandchild, the pain of families, the pain of what it does to your income and work when this happens. that kind of pain doesn't go away. and we haven't progressed enough from that, frankly. it's great for this committee. it's great i think for myself to take whatever expert advice week. but on this issue, people are depending on us. we've got to create the urgency and deal with it ourselves. we can't rely on other people to do it n. many cases, we are the court of last resort. we can do this. week work together and we can make sure it can be done. but let's do it ourselves and let's take that leadership. i want to thank you for the leadership you have shown in this. and i plan to work with you any way i can. >> chair thanks the gentleman. gentleman yieldsback. chair recognizes the gentleman from minnesota mr. paulson for three minutes. >> thank you mr. chairman for this opportunity to speak about the opioid addiction in minnesota. minnesota is like the rest of the country. it is struggling with the crisis that's tearing fams apart through addiction and death. and the numbers are only getting worse. minnesota saw a 12% rise in opioid deaths from 2016 over 2015. the crisis affects minnesotans of all backgrounds in rural communities, big cities, and in our suburbs. just in year and a half ago in my home town we saw the passing of music legend prince due to an opioid overdose n. minnesota there are 50 opioid prescriptions written for every 100 patients that visit our doctors. clearly we need to change the culture in our delivery of care to stop the flow of opioids when there are pochb alternatives. when someone requires surgery for back pain they can choose between minimally invasive surgery or the long surgery that includes a stay in the hospital and powerful painkillers. one way to reduce the use of opioids is to use the more minimally invasive procedures. an champl is minimally invasive si infusion, which has been shown to reduce the need for dangerous painkillers. unfortunately, some private insurers don't cover this procedure forcing people to choose the standard surgery that requires opioids for pain management. instead of simply prescribing a drug for the pain providers you this look for other therapies and insurers so people are given more choices to manage their pain. we must hold providers and patients accountable and ensurge insurers to cover more types of procedures. local pharmacies. according to the d.e.a. in 2014 there were 16 armed robberies involving stolen opioids at minnesota pharmacies. last year that number doubled. people get hurt and die during these crimes. drugs get put on the street. communities lose vital resources and neighbors because of addiction and the crime that goes with it. he willier this year i spoke to a moment from maple grove minnesota whose son bought carol fentanyl on line consumed it and died. we need increased funding for safety resources, for trained law enforcement officers to spot and stop opioid-related crime. our communities depend on access to health care and we need to do more to reduce the crime and death associated with opioid addiction if we are going to help people get the care that they need. i want to naunk mr. chairman, i look forward to working with you and your committee for bipartisan solutions. >> chair recognizes the gentle lady from rochester for three minutes. >> thank you mr. chair thanman. i want.to start off by saying as a former deputy secretary of health and human services secretary in delaware as a former community leader and family member, substance abuse touched my life and so many others, from our economy to our prison system to our families. from crack, to heroin, to all forms of opioids. in many ways, delaware reflects our nation, geography. we're urban and rural. we mirror the country in terms of demographics. unfortunately, like the rest of the nation, we are facing a growing opioid crisis. just yesterday, our death toll from this horrible disease rose to 171 delawareans for the year. that might not seem like a lot to some, but to put that into perspective, that many deaths in the state the size of delaware made us number 13 per capita in the country last year for opioid overdose deaths according to the kaiser family foundation. this public health crisis is prevalent in districts across the country. and congress has the opportunity to impact it in a meaningful way and take action. this is why it's so important to tackle this issue on a bipartisan basis. the opioid addiction has taken a strong hollywood across the nation, and we must work together to combat the flow of drugs throughout our country. this is a problem for all states but particularly on the east coast where compact states means that none of us can act alone. drug trafficking doesn't stop at delaware's bore kearse with maryland, or pennsylvania, or new jersey. and neither does this public health crisis. delaware and our neighbors have made great progress through collaborative programs like hida and prescription drug monitoring programs. but that should just be the beginning. we aren't doing enough. but it is also important to remember that there are people in delaware and in all of our communities making a difference. every day on the ground, for people, for families, and in neighborhoods, they are combatting this crisis on the grounds. i want to thank all those people who are fighting, whether they are in public health. whether they are doctors, first responders, the faith community, community groups. families, all those who are doing their part to make sure that we tackle this issue. we in congress need to join them. i hope that we in congress will also continue the work together and address this epidemic by providing resources for preessential, support for recovery, and access to care. thank you owe much. i yield back my time. >> chair thanks the gentle lead lady. yields back. we are going to have a series of votes. it is my hope that we will adjourn when votes occur. i'm going to ask the members who are here, and i appreciate you staying with us for so long. let's -- i'll continue the yield three minutes but let's try to do it in two so everyone gets a chance to testify before the vote. so all the members who remain, if you will join us at the table, and you are recognized for three minutes. >> mr. chair, i want to start by thanking you for allowing members to testify on this issue. today i would like to draw the subcommittee's attention to the significant needs of those who have sought help for addiction completed treatment and are just beginning to lover in recovery. these individuals often choose to live in sober living facilities after completing treatment in order to ease into the routines of daily life. however, there are far too many sober homes that are commonly unequipped to handle patients at risk of overdose or do not employ staff with specialty training for individuals in recovery. worst of all, some of these facilities do not encourage recovery but exploit vulnerable people recently released from treatment in order to collect insurance payments. this can mean life or death for people like tyler from my district of pasadena california who died from an overdose after his sober home didn't recognize the symptoms of his overdose and didn't have naloxone. tyler was only 23 years old. unfortunately, this is not an isolated issue. i have heard from advocates in arizona, pennsylvania, missouri, ohio, and countless others who are concerned for their friends and neighbors living in unregulated sober living facilities. i would like to submit for the record a "new york times" article from 2015, and a may 2017 report from the department of justice outlining abuse and fraud at sober homes in new york and florida. >> without objection. so ordered. >> these reports describe sober living facilities that lacked access to naloxone ordered unnecessary tests on respects to exhaust their insurance benefits and required respects to relapse and re-enter treatment so resident directors could claim some of the medicate benefits. licensing for recovery reasons or sober living facilities varies substantially from state to state and there are facilities in every state operating without licenses at all. further, oversight of these facilities is minimal. so patients with loved ones in recovery struggle to distinguish good actors from bad ones. for some individuals they may not discover somebody is negligent until it is too late. that is why this week this week i plan to introduce the ensuring quality sober living act. my legislation would require the substance abuse and mental health services administration to develop a set of best practices for residential recovery facilities so patients families and states can distinguish quality sober living facilities from sites that are fraudulent or you unequipped to offer appropriate assistant. the bill would require sam is a to disseminate these to each state and require them to pry technical assistance and support. my bill would help to distinguish quality sober living facilities. these best practices would allow the guidelines for common sense measures like requiring that all fees and charges be explained to residents before entering a binding agreement and that naloxone is available and accessible and that staff and residents are trained to use it in emergencies. thank you very much. >> gentle lady's time is expired. recognize the gentle lady from indiana for three minutes. >> thank you mr. chairman. indiana is no different from any other state that we have heard from sitting here. pain is the number one reason why americans seek health care, the number one cause of disability that costs the u.s. economy more than $600 billion in direct health care cost and lost productivity. the veteran population is particularly impacted by the chronic pain crisis with more than 50% of the va patients responding and reporting chronic pain. we can reduce demand by effectively treating chronic pain and providing better access to non-opioid pharmaceuticals, medical twidevices and therapie. we should recognize the importance of a multidisciplinary approach. chronic pain is pervasive and largely unaaddressed by the health care system, number two, promote cutting edge research to -- high quality evidence is urgently needed for physicians to understand chronic pain. advanced best practices in pain management in medicare. in 2016, one in three medicare party ben fish years received a prescription opioid. they should offer evidence based pain management as an alternative to opioid prescriptions. i hope these ideas will be helpful in future planning discussions to reduce the abuse of opioids in our communities. thank you mr. chairman. i yield back my time. >> chair thanks the gentle lady. mr. donovan you are recognized for three minutes. >> thank you mr. chairman. chairman burgess, ranking member green and member of the subcommittee thank you for the opportunity to testify before you today to irshare my thoughts on opioid crisis this. year alone there have been more than 100 reported overdose deaths in my district. that number would be much higher if it weren't for the 574 naloxone saves reported. before i came to congress i served as district attorney of richmond county which comprises of staten island new york. based on that experience my time in congress and input from local experts like the staten island partnership for community wellness i support a three tiered approach to this problem that addresses education, treatment and enforcement. targeted education kpabs can teach the next generation of potential users about the dangers of abuse particularly of sinister kpounts like tent nil. treatment is crucial. we have learned that recovery is cycle and relapses will happen. our policy should reflect that reality. our society understand addiction is a medical illness not a criminal act. let's help not punish the addicted. grants for local treatment programs is the most effective way to help end the cycle of addiction from the federal level. lastly we cannot ignore the importance of evers ever enforcement particularly against traffickers. my comprehensive fentanyl control act would update sentencing guidelines to reflect the fact in a a few grains of rice worth of fentanyl can kill an individual. i firmly believe that the experts on the ground are best equipped to taylor their approaches to meet their communities needs. it's our job as legislators to provide them with the resources necessary to accomplish their igs in. legislation like the cures act and the comprehensive addiction and. >> referee: react are exactly the right approach. thank you again for the opportunity to share my thoughts. i look forward to working with the subcommittee and continuing to address this national crisis. >> chair thanks the gentleman. represent heartsel, you are recognized for three minutes, you can only use two. >> thank you for this unt too. in missouri the scourge of drug abuse is a growing prolk. it will take all of us to help solve it. i have heard stories of families torn apart. to this end i ask the question to explore ways to make it easier for faith based organization to offer addiction treatment programs. i have seen the power of faith based programs in treating addiction. in my district i have visited multiple prison organizations that have high rates of success in treating addiction. by centering on a community of faith these organizations provide support structures that stay with recovering addicts their entire lives. in some cases they also provide services that aren't available in other addiction recovery programs in the area. for instance, one religious organization in my district provides housing for both mothers and their children while the mothers seek treatment for their addiction. no doubt, their recovery is greatly facilitated by the additional support of their children. i firmly believe faith based programs are part of holistic programs that treat the body and the spirit during their darkest times. i ask the committee to seriously consider making available and expanding any and all funding opportunities to faith based organizations providing addiction treatment and programs. in addition, on a second topic, the imd exclusion caps the number of beds mental health facilities receiving medicate can have at 16. multiple health care groups have come into my office saying this blocks critical access to treatment for people who need inpatient treatment for addiction including some of the society's most vulnerable, veterans, pregnant addicted women, women with dependent children and ut yao. i encourage the committee to explore ways to provide some relief to this outdated rule. thank you very much, i yield back. >> chair thanks the gentle lady. gentleman from pennsylvania is recognized for three minutes but only use two, please. >> thank you mr. chairman. as this committee aware drug overdoses involving prescription opioids and heroin quadrupled since 1999 and are the leading cause of accidental death in this nation. substance abuse cost our country over $600 billion annually. in my state opioid related debts were amongst the highers in the nation. one one year they rose 20%. my district's increased by 50%. mr. chairman this epidemic is costing resources and precious lives. my constituent carlos castellanos. he loved sharing his talent and love of music playing the drums at school and a local church group. however he got involved with drugs during his time in school and spent time in jail w. the strength and support of his family he began receiving treatment and his life improved. he helped others by volunteering at a recovery home and he brought people suffering in similar situations to treatment programs. last december carlos walked his mother pamela down the aisle for her wedsing. he was getting ready to get back to school. he had a steady job and a girlfriend. would seem many of his battles with addiction were headed in the right direction. a point of hope in the war that caused so much in devastation. on december 23rd, days before christmas who police detectives showed up at pamela's door to tell her the devastating news that no mother can prepare for. carlos overdosed on a drug laced with fentanyl and was unable to be saved. carlos's life and his death cast a bright light on the fact that addiction is nothing short of a chronic disease. i would also like to bring to attention what my colleague did, imd expollution prohibits federal matching unts funds to states for services rendered to medicaid enrolies who suffers from substance abuse addiction or mental illness. with limitations on population size and facility size and length of stay. this blocks access to treatment for people who need treatment for addiction including some of society's most sluler inible. i encourage my colleagues to adopt the road to recovery act, which expresses concerns by local and community leaders and health care professors. >> chair recognizes the gentleman from pennsylvania for three minutes. >> thank you mr. chairman. speaking with constituents about the opioid epidemic i learned firsthand the impact this epidemic is having on our communities in pennsylvania. it is affecting families and individuals of all ages, races, and socioeconomic grabbing rounds. throughout my congressional district and throughout this nation there are parents, teachers, athletes, doctors, teenagers, and is struggling with addiction, a disease that has no boundaries when it comes to who it affects. these families and these individuals are why we must continue our work to pass legislation like the come prehence addiction and recovery act and the 21st century cures act two bills i supported that are both now law. these bipartisan bills are helping our communities through increasing access to treatment and expanding prevention, education, and intervention efforts. in the communities i represent, a recurring sentiment i heard was, you would not believe how many treatment costs. the cost of treatment and recovery is indeed crippling for so many families, even for individuals who have insurance. $35,000 for a 30-day at a treatment center. $10,000 for a ten-day detox. hundreds of dollars spent on flights to recovery programs across the country. families are being forced to refinance their homes, parents are taking on second jobs, and retirees are re-entering the work force to help pay for treatment for a family member struggling with addiction. those seeking help should not be faced with insurmountable cost. to help individual provide financial assistance to family members struggling with addiction i added my name to ha 1775. under current law individuals can only use funds in their health savings account, flexible spending account or health reimbursement arrangement to pay for treatment. this bill will give people the option to give extended family members treatment. this legislation is a step in the right direction in alleviating the financial burden of substance abuse treat. i'm proud of the work the committee has done to face this epidemic and i am continuing this work. >> the chair recognizes a final gentleman from pennsylvania for three minutes. only use two. >> thank you for holding this important hearing today. i think it's interesting that you have had three pennsylvaniians right in a row. it represents the geography of pennsylvania, eastern, middle, and western. certainly communities in western pennsylvania are among the hardest hit in the opioid epidemic. there has been a staggering be in of deaths in my district. 648 died in allegheny county. last year that number was 4342 in pps pennsylvania alone. according to a recent article in the pittsburgh post gazette in 2016 the number of overdose deaths in pennsylvania was four times the number of deaths cause by car accidents. in other recent reports three people in my district were revived by narcan after each overdosed at a convenience store. while it is encouraging to see both congress and the administration have taken action to address this issue we have a long way to go. from my perspective we should be taking a three prong approach to combatting the epidemic, implement measures to prevent addiction, treat it once it has taken hold of someone, finally we must stop drug traffickers. to help combat this, i led an effort to include language that will help ensure our veterans who are at significant risk to get the program they need to overcome opioid addiction. another area where congress should spoke us, one of specific interest to me is increase and strengthen our partnership with mexico, through the merita initiative. our nation to the south has suffered a significant level of murder by drug cartels. by increasing our partnership with mexico we can defeat the cartels that cause so much pain there and here in the u.s. overlooked is that many of the narcotics that mexican cartels traffic end up in the hands of americans. increased use of technology, cameras, and manpower is necessary to interdakotaing drugs. border security for america act will do just that. another bipartisan bill that i hope will end the crisis was introduced with congressman collin peterson. i look forward to that moving forward. again i thank you for the opportunity to testify before the committee this morning on an issue that greatly affects the constituents in my district. >> chair thanks the gentlemen. gentlemen yields back. all members having had a chance to speak with votes on the floor the committee stands adjourned. we have more live coverage from capitol hill coming up later today. the house foreign affairs subcommittee on the middle east and north africa holds a hearing on policy of north lebanon. testifying the secretary of state for near eastern affairs and the head of the middle east bureau. that hearing gets underway at 2:00 p.m. eastern. we will have it live here on c-span3, also at c-span.org, and listen with the free c-span radio app. coming up this weekend on c-span3, american history tv in primetime will look at the 60th anniversary of little rock central high school's desegation grags. that's 8:00:p.m. eastern here on c-span3. tomorrow we are live in nashville tennessee for the next stop on the c-span bus 50 capitals tour. former governor phil bredson will be our guest on the bust for the washington journal starting at 9:30 a.m. eastern discussing the top public policy issues facing tennesseeans. and join us tomorrow for the ti

Related Keywords

United States , Alaska , Vermont , Ocean County , New Jersey , Allegheny County , Pennsylvania , Delaware , Pinellas County , Florida , Minnesota , Whitehouse , District Of Columbia , New Mexico , Connecticut , West Virginia , Mexico , Arizona , Wilson County , North Carolina , Massachusetts , Iowa , Hollywood , California , John Creek , Chicago , Illinois , Montgomery County , Ohio , Rochester , New York , Georgia , Dayton , Missouri , Texas , Washington , Kentucky , Indiana , Virginia , Togo , Capitol Hill , Tennessee , Oregon , Michigan , Jersey , Staten Island , Oklahoma , Maine , Cook County , Houston , Kansas , Monroe County , Utah , Americans , America , Mexican , American , Sam Isa , Theresa Wilson , Andy Harris , December Carlos , John Kasich , Hakeem Jeffries , Hal Rogers , Brian Norcross , Kevin Jones , Tim Walberg Jesse , David Joyce , Catherine Clark , Evan Jenkins , Chris Parker , Jody Harrington , Annie Kuster , Tina Sochi ,