Today the subcommittee holds a hearing entitled combatting the opoid crisis, battles in the states. Make no mistake, the term combatting and battles are entirely appropriate. Our nation is in the midst of a tremendous fight against death affecting every corner of our nation. There were more than 52,000 deaths in overdose. A 20 increase in the prior year. It was almost seven time it is rate of death from the heroin epidemic of the 1970s. We learned we have lost roughly 60,0 0 people to Drug Overdoses. That is more in one year than all the names on the vietnam veteran memorial wall. That is likely underestimated because much of the data will not be in until the end of next year. For every fatale overdose there is 20 nonfatale overdoses and for 2016 that could be near one million. More than 130,000 lives have been lost between 1999 and 2015. Thats about 50,000 oh 500,000 will be lost over the next decade. The roots began in 1980 when a letter was misinterpreted as evidence it was unlikely that someone would become addicted. About 20 years later the joint commission on accreditation of Health Care Organizations following the American Medical Association that pain h be assessed established standards for Pain Management interpreted by many doctors as encouraging the prescribing of opoids. A question specifically asked was their pain adequately addressed. Based on their answer, a hospital may receive more or less money. The opoid epidemic is an Urgent Public Health threat fueled by fentanyl and a clear and present danger to america. Who states represented on todays panel in rhode island and maryland were the first ones hit by the wave and it seems this wave will sweep the nation as it is increasingly attracted to manufacturers and easy to manufacture or obtain over the internet. This is an extreme moment requiring all the experience, resources, cooperation by federal, state and local governments as it was all the different industries, professionals and experts to curb this terrible outbreak. We will focus on the actions to find out what efforts are working, what is not working, how we could Work Together to save lives. We want to know the problems and please be candid with us. As drug industry as drug policy expert noted, quote, it is at the state and county levels that the Real Progress will be made. It makes sense to find inspired solutions be most concentrated there. Serving the front lines of the opoid epidemic, they have been more structured medication, assisted treatment, more comprehensive Prescription Drug monitoring. States such as maryland are making the best use of the guidelines to help push back on the overprescribing. Kentuckys reporting system, a web based Monitoring System is helping state legislature identify questionable prescribing practices by physicians. Virginia has greatly expanded access to the locks on the drug that could reverse an opoid overdose but could have its own risk in its use. Some states are expanding the use. Rhode island has developed the anchor ed program that matches overdose victims with peer recovery coaches. Much of the work of the states should help inform the president s commission on combatting drug addiction and the opoid crisis. Oversights have helped Congress Enact provisions. And it will help the administration. We put one billion collars into grants for the next two years, but we want to know if this money is being used wisely. Were eager to learn about those programs. But the 21st Century Program is just beginning. Our State Government witnesses can help this committee develop a National Strategy to combat the opoid crisis in substance prevention and education, physician training, treatment of recovery, Law Enforcement, expanded assets, Data Collection, examining what reforms could be made to the 42 cfr part two so there is better coordination of care and we could help prevent relapses and improve patient safety. We are in one of the worst medical tragedies of our time. Perhaps the worst. And although this committee that has given its attention to many other problems in the past, we recognize this is paramount among them. This is a National Emergency, and we look forward to hearing from the states on what you were doing on the front lines of this. I yield to my colleague for five minutes. Thank you so much, mr. Chairman. I appreciate this most recent hearing on opoid addiction. As you said so accurately, this crisis is really devastating america as all of us have seen it play out in our communities, urban and rural alike. Not a day passes without a report about children watching their parents overdose, about lie brians and School Nurses being trained to administer overdose victims or local and State Governments trying to respond to the issues surrounding addiction. All at the same time trying to stay within their budgets. There is some good news. The cdc reported that opoid prescriptions peeked in 2017 and have fallen by 41 . Thats the good news. The bad news is opoid prescribing remains untenably high and im hoping our future investigations will concentrate on this. In addition, as you pointed out, mr. Chairman, is the emergence of illegal fentanyl, which is an exceptionally potent opoid. It overtook heroin and prescription opioids as the leading cause of death in many places. Each of the state who is are here today, and i want to thank you all for coming, have faced alarming overdose outbreaks due to this drugs pervasive nations. This committee has done good work, investigating the seemingly voluminous amount of bills distributed in west virginia, and i know were planning to do more. As you see, a number of state attorneys general are investigating manufacturers and in some cases distributors. The attorney general in my home state of colorado has joined a Bipartisan Coalition looking into whether manufacture even gaged in illegal or deceptive practices when marketing opioids. Coming up with an effective solution to the opoid epidemic will require us to understand the actions of all actors. I hope to hear from some of the states today on what role they believe drug manufacturers and distributors may be adding to the crisis. Also i look forward to hearing from the panel about the impact of fentanyl on the towns and communities in which they work. States really are on the front lines of fighting this crisis. And i look forward to hearing from all of you. I know that rhode island, for example, has led the way in reconnecting people with in connecting people with Substance Abuse disorders to highlight trained coaches to guide them through recovery. Kentucky has established a program to provide medication assisted treatment to individuals in correctional facilities and to continue supporting them after their release. Maryland has just committed to establishing a 24 Hour Crisis Center in baltimore city. Mr. Chairman, i know these are all great state efforts. We have made some efforts here in congress. And i appreciate you referring to the 21st century legislation that congressman upton and i sponsored and that this whole committee Work Together on a bipartisan basis to pass. But as we move forward on this issue, we really need to Work Together to continue to address this. And thats why i kind of hate to be the fly in the ointment and talk about what these efforts to repeal the Affordable Care act will do to the fight against the opoid epidemic. As you know, the aca has helped nearly 20 million americans obtain health care coverage. In addition, its enabled governors to expand Medicaid Services that are critical tools in the fight. For example, studies that show that since 2014 1. 6 million uninsured americans gained access to Substance Abuse across the 31 states that expanded medicaid coverage. This is particularly true for states like kentucky where residents saw a 700 in medicaid beneficiaries seeking treatment for Substance Abuse. Many people think that the house passed bill that undermines the aca will threaten peoples ability to get opoid treatment. In its assessment, the nonpartisan cbo said the house bill will cost 23 million 22 million americans to lose Health Insurance. Now, there have been discussions, both in the house bill and the senate discussions, about adding some money for opoid treatment. But, for example, the most recent senate suggestion is an additional 45 million dollar, the governor said, quote, it is like spitting in the ocean. Its not enough. Weve got to get real and understand that access to Health Care Treatment is what is going to help with the health of all americans, including treatment of opoid addiction. And weve got to move forward to work on this together. I hope we can do that and with that ill yield back, mr. Chairman. And i recognize the chairman, mr. Wallden. Addiction is a crisis that does not pick people based on their age, race or status and does not pick them based on political parties. My round tables through oregon, it didnt matter if i was in a Rural Community or more populated, the stories are more similar. My state, more people now died from drug related overdoses than from automobile accidents and sadly that is not unique. According to preliminary data analysis, Drug Overdose deaths in 2016 exceeded 59,000 people. Thats the largest annual jump ever recorded in the United States. And whats worse, some of their preliminary numbers from the states indicate their numbers within the First Six Months of this year are already surpassing last years total numbers. And other the past seven years, opoid addiction diagnoses are up 500 according to a recent report. Despite a report released last week, which indicates the number of opoid prescriptions has decreased over the last five years, the rates are three times as high as they were back in 1999. The amount of opioids prescribed in 2015 was enough for every american to be medicated around the clock for three weeks. That report also found that counties in oregon have some of the highest levels of opoid prescriptions in the country. Of the top ten counties in my state for opioids prescription five of them are in my district. People aged 65 and older are being hospitalized at a far higher rate than any other state in the union. Sadly, Overdose Deaths continue to escalate, and this epidemic is simply getting worse and more severe. So challenges remain, and we need to get after it. First we need to improve Data Collection. In a few states are already requiring more specific information related to Overdose Deaths. Quite simply we cannot solve what we do not know. We need to be able to have more timely and reliable data, so we could better understand and address the full scope of the problem. There also needs to be an increase in Overdose Prevention efforts, improvement with respect to utilization and Prescription DrugMonitoring Programs and we need to increase access to evidence based treatment including medication assisted treatment. Combatting this epidemic requires an all hands on deck effort from federal, state and local officials and all of us spanning from Health Care Experts to our local Law Enforcement communities. It is why we are having this hearing today. Last Year Congress took action to combat this crisis by passing legislation, including the come pro hen sieve Addiction Recovery act and the 21st century cures act and states pursued programs to strength p our fight against this epidemic. Much more needs to be done. We need to Work Together to ensure the tools and Funding Congress has created are reaching our state and localities and being used effectively. We hope to hear from the state officials today so see how theyre utilizing these funds and whether these programs work or not. We appreciate the witness who is agreed to come before us today. We hope to have a dialogue about what the states are doing, what initiatives are working, what isnt working and how the federal government could be a better partner. I look forward to your testimony and working with all of you and our Community Leaders to help get our hands on this horrific crisis. With that, i know i have two members that want to introduce witnesses, so ill go first to mr. Guthrie. Thank you for letting me sit in. I want to introduce our secretary of justice in Public Safety in kentucky. Weve been friends for a long time. We served in the General Assembly together. He had a strong reputation, strong work in the houseworking with the senate to produce legislation that i think is landmark and was very important. And we have so much to do in kentucky. We have 1,404 people that died last year in opoid addiction. Were saying thank you for the work we have done. I can tell my colleagues on the committee here and my friends that i can think of nobody else in kentucky id rather have sitting where you are and leading this effort and i applaud the governor for making the choice and appreciate your willingness to do so. I yield back. Now i recognize the gentleman from virginia for the purpose of introduction. Thank you very much. Id like to introduce secretary ryan moran. He came to the Virginia House of delegates where we served together for a number of years. He was always a pleasure to work with and appreciated his work very, very much. And then he became the first director or secretary of ho Homeland Security and has oversight over 11 agencies. But he is generally well reasoned. Every now and then we would disagree on the floor of the house. But we worked together on a number of things. And i apologize. We have to run to another committee where we have two bills that are upstairs, so i wont be able to stay, but i will read with interest your testimony and learn from my colleagues the good words that you have to say and welcome you to our committee. And apologize that i cant be hear because im depending a bill upstairs. With that i will yield back the balance of my time. And unfortunately, i too must go to this subcommittee. Come on back. Secretary moran is a spitting image of his brother. I recognize mr. Cologne for five minutes. Thanks for holding this hearing on this critical issue. Our Committee Held several hearings on the ongoing opoid crisis. The opoid epidemic is not letting up and neither can our efforts to fight it. Since our last hearing, many more lives have been destroyed. There is no community that remains completely untouched by the opoids crisis. The cdc reported that the opoid prescribing rate has peaked, but remains far too high with enough opioids to keep every american medicated around the clock for three weeks. Id also like to hear from our witnesses about how the federal government can help. While it is important the state bs empowered to address the particular challenges of their communities, our response to this epidemic cannot be 51 separate efforts. But as we talk about a Public Health crisis of this magnitude, there is an elephant in the room that needs to be addressed. Coverage for Substance Abuse treatment is how an individual in society has a fighting chance to kick the opoid epidemic for good. Yet, republicans persist in their attempts to gut the Medicaid Program by capping it permanently and ending Medicaid Expansion as part of its efforts to repeal the Affordable Care act. Repealing the Affordable Care and replacing it with trump care would be devastating to 17 million americans who receive Health Care Services from the program. Half of all the babies born in this country are financed by medicaid and to the working poor, many of whom are hit hard by the opoids epidemic and eligible for medicaid for the first time through the ac as expansion, medicaid is the only Affordable HealthCare Insurance available. And state Medicaid Programs are at the center of the opoids epidem epidemic. 23 million americans would lose coverage. The majority uncovered through medicaid with 834 billion in cuts to the program. The senators version of trump care is no better, cutting by 35 . These cuts could not come at a worst time for states and people who depend on the coverage medicaid provides. There is no substitute for coverage for our states or the people that need the care. As the Senate Continues to make cosmetic changes to its bill with only one goal in mind, pas