Good morning everyone. Today the subcommittee of oversight and investigation holds a hearing entitled combatting the Opioid Crisis battles in the states. Now, make no mistake the term combatting and battled are entirely appropriate. Our nation is in the midst of devastation around every corner of the nation. In 2015 there were more than in the u. S. , more than 33,000 deaths involved in opioid. 24 increase from the prior year. Overdose death rate in 2015 was almost seven times the rate of deaths from the heroin epidemic of the 1970s. For 2016 weve already announced from New York Times weve lost roughly 60,000 people to Drug Overdose and that is more in one year than all the names on the Vietnam Veterans memorial wall. And likely that number is underestimated because much of the data will not be in until the end of this year 2017. Its staggering. For every fatal overdose its estimated there are 20 nonfatal overdoses and for 2016 that could be near 1 million. More than 183,000 lives have been lost in the u. S. From opioid overdose from 1999 and 2015. About 50,000 to be lost 500,000 will be lost over the next decade. The route to this crisis began in 1980 when a letter to the editor by two doctors was misinterpreted, it was unlikely that someone would become addicted out of 40,000 cases they said there was only four addictions. 20 years later the joint commission under credit dags following the American Medical Association that pain be assessed the fifth vital sign establish standard for Pain Management by many doctors as encouraging the prescribing of opioids. Under the Affordable Care act prescribing painkillers is incentivized by questionnaires where a patient is asked if their pain is answered to satisfaction. Based on their answer the hospital may receive more or less money. As we learned in hearing in march the Opioid Epidemic is Urgent Public Health threat fueled by fentanyl. Two states represented on todays panel, rhode island and maryland, were the first ones hit by the fentanyl wave and unfortunately seems certain this wave will sweep the nation as low cost high profit harder to detect profile fentanyl is easily attracted to manufacturers and easy to obtain over the internet. This is extreme moment recurring all the cooperation federal, state and local governments as it was all the different industries, professionals and experts to curb this terrible outbreak. With this hearing we will focus on the actions of our State Governments to find out what efforts are working, what is not working, how well Work Together to save lives. Panelists say we want to know the problems and please be candid with us. Because as you know theres millions of families being torn apart by this. As drug policy experts noted, quote, it is at the state and county levels that the Real Progress will be made. It makes sense inspired solutions most concentrated there, we should invest in those solutions and learn from them, unquote. Serving the front lines of the Opioid Epidemic own initiative such as more inventive use of incentives, more comprehensive Prescription Drug monitoring. States such as maryland are making the best use of the centers for Disease Control opioid prescribing guidelines to help push back on the overprescribing. Kentuckys all schedule prescription electronic reporting system, a web based Monitoring System to help prescription use across the state is helping state regulators identify personal prescribing practice by physicians and abuse by patients. Virginia has greatly expanded access to naloxone. Some states are expanding the availability by limiting third party prescribing of family and friends of individuals high risk of overdose. Rhode island has developed the program that matches overdose programs with peer recovery coaches to encourage treatment who follow up with the patient the next ten days after the overdose. Much of the work of the states should help inform the president s commission on combatting drug addiction and the Opioid Crisis. We held a similar hearing on what the State Government opioid abuse epidemic. Such oversight help Congress Enact vision it will help the administration. We put 1 billion into grants over the next two years, but we want being used widely and how well its working. Were eager to learn about those programs. With the 21st century cures program is just a beginning. Our State Government witnesses can help this committee develop a more Effective National strategy to combat the Opioid Crisis in such areas as Substance Abuse prevention and education, physician training, treatment of recovery, Law Enforcement, expanded access while testing for drugs in correctional facilities, Data Collection, examining what reforms need to be made to the 42 cfr 2, that theres better coordination among care physicians and we can help prevent relapses and overdose and improve patient safety. We are in one of the worst medical tragedies of our time, perhaps the worst. And although this committee has given this subcommittee has given 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 the states of what youre doing on the front lines of this. Thank you, mr. Chairman. And i appreciate this most recent hearing on opioid addiction. As you said so accurately, this crisis is really devastating america as all of us on the 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 librarians and School Nurses being trained to administer naloxone to overdose victims or about local and State Governments time trying to stay within their budgets. There is some good news. Recently the cdc reported that opioid prescriptions peaked in 2010 and have since fallen by 41 . Thats the good news. The bad news is opioid prescribing remains untenably high. I am hoping our future investigations will concentrate on this. In addition, as you pointed out, mr. Chairman, is the emergence of illegal fentanyl, an exceptionally potent opioid. In 2017 fentanyl overtook both heroin and prescription opioids as the leading cause of death in many places. Each of the states who are here today, and i want to thank you all for coming, have faced alarming overdose outbreaks. This committee has done some good work. In particular, investigating the seemingly voluminous amount of pills distributed in West Virginia and were planning to do more. The attorney general in my home state of colorado has joined a Bipartisan Coalition of states nationwide looking into whether manufacturers engaged in illegal or deceptive practices when marketing opioids. Coming up with an effective solution to the Opioid 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 or in connecting people with Substance Use disorders to highly trained coaches to guide them through recovery. Virginia is working to implement a similar Peer Recovery Program and kentucky established a program to provide medication assisted treatment to individuals in correctional facilities and to continue supporting them after theyre released. Maryland has committed to establishing a 24hour 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 cures legislation that mr. Upton and i sponsored and that this committee worked on a bipartisan basis to pass. As we move forward, we 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 Opioid Epidemic. As you know, the aca has helped since 2015, 1. 6 uninsured americans gained access to Substance Abuse treatment across the 31 states that expanded medicaid coverage. This is particularly true for states like kentucky where one report says that residents saw a 107 increase in beneficiaries seeking treatment for Substance Abuse. Many think that the housepassed bill that undermines the aca will threaten peoples ability to get opioid treatment. In its assessment, the nonpartisan cbo said the house bill will cause 23 million or 22 million americans to lose Health Insurance. A lot of these people, they need opioid treatment. There have been discussions, both in the house bill and the senate discussions, about adding some money for opioid treatment. But, for example, the most recent senate suggestion of additional 45 billion to help combat opioid addiction, Governor John Kasich said, quote, its 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 opioid addiction. And weve got to move forward to work on this together. I hope we can do that. With that ill yield back. Mr. Chairman. Ill recognize chairman of the full committee, mr. Walton. Addiction is an kwool opportunity destroyer. Its a destroyer that doesnt pick people based on age, race or socioeconomic status. It does not pick them based on political parties. My round tables throughout the Second District of oregon, it didnt matter if i was in a Rural Committee or a more populated city, the stories were similar. We all know someone who was impacted by this epidemic. In my state more people die from Drug Overdoses than from automobile accidents. Thats not unique. According to Data AnalysisDrug Overdose deaths in 2016 likely exceeded 59,000 people. Thats the largest annual jump ever recorded in the United States. And whats worse, some of the preliminary numbers from the states indicate that their numbers within the First Six Months of this year are already surpassing last years total numbers, and over the past seven years opioid addiction diagnoses are up nearly 500 according to recent report. Despite a report released by the cdc last week which indicates the number of opioid prescriptions has decreased over the last five years, thats the good news, the rates are still three times as high as they were just back in 1999. And 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 opioid prescriptions in the country. Of the top ten counties in my state for opioid prescriptions, five of them are in my rural district. Moreover, oregonians aged 65 and older are being hospitalized for opioid abuse and overdoses at a higher rate than any state in the union. Opioid deaths continue to escalate, and this epidemic is simply getting worse and more severe. Challenges remain, and we need to get after it. We need to improve Data Collection. A few states are requiring more specific information related to Overdose Deaths. We cannot solve what we do not know. Overdose preconvention efforts, improvement with respect to the utilization and interoperability of Prescription DrugMonitoring Programs. We need to increase access to evidencebased 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. Its precisely why we are having this hearing today. Last Year Congress took action to combat this crisis by passing legislation including the comprehensive Addiction Recovery act and the 21st century cures act and states improved programs to strengthen the fight. Much more needs to be done. We need to Work Together to ensure the tools and Funding Congress created are reaching our states and localities and being used effectively. We hope to hear from state officials today to see how theyre utilizing these funds and whether these programs work or not. We greatly appreciate the witnesses who have agreed to appear before us today. We hope to have a constructive dialogue about what the states are doing, how to improve Data Collection, the initiatives that are working, what isnt working and how the federal government can be a better partner in the collective fight. 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. So thank you for being here. With that, i know i have two members that want to introduce witnesses. Ill go to mr. Guthrie and mr. Griffith. Thank you for letting me sit in for purposes of introduction. I want to introduce our secretary of justice and Public Safety in kentucky. Secretary tilley. We served in the General Assembly together. Secretary tilley had a strong reputation, strong work as judiciary chairman in the house working 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 1404 people that passed away last year from opioid addiction. It is so much to be done. We are saying thank you for the work that youve done. I know we have enormous work to be done. I can tell my colleagues on the committee and my friends, i can think of nobody else in kentucky id rather have sitting where you are leading this effort. I applaud Governor Bevin for making the choice and ask you to serve in his cabinet. Another committee where we have two bills that are upstairs. 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 here because i am defending a bill upstairs. With that ill yield back the balance of my time. Unfortunately i too must go to that subcommittee. Come on back. Its going to be exciting. Secretary moran is the spit and image of his brother. Recognize the gentleman from new jersey, mr. Pallone for five minutes. Thank you. Thank you for holding this hearing. Our committee has held several hearings on the ongoing crisis including one in march. Since our last hearing many more lives have been destroyed. There is no community that remains completely untouched by the Opioid Crisis. Recently the cdc reported that the opioid prescribing rate has peaked but remains far too high with enough opioids to keep every american medicated around the clock for three weeks. I am glad we have the states here today to hear about what theyre seeing on the front lines, what successful approaches they have found that deserve to be replicated and what challenges they still face. I would also like to hear from our witnesses about how the federal government can help epidemic. In the house passed trumpcare cbo determined 23 million americans would lose coverage, the majority covered through medicaid, with 834 million billion dollars in cuts to the program. The senates version cuts medicaid by a full 35 over the next two decades. The cuts could not come at a worse time from the perspective of the opioids crisis, for states and people who depend on the coverage medicaid provides. There is no substitute for coverage for our states or for people that need the care. As the Senate Continues to make cosmetic changes to its bill with one goal in mind, passing any bill out of the senate, lets be clear. No one time amount of funds, whatever the amount may be, whether replace the sernlt of comprehensive coverage. No cosmetic changes can offset the damage caused by repealing the acc a and putting hundreds of billions of dollar