reform. what's different now? why do you think? >> it wasn't just, it wasn't just republicans. that's a wrong premise. a lot of people ran for cover on both sides. it was a must vote, and then all of a sudden it stopped being a must vote, and people got scared, and they went from 61 to 62 people supporting the bill to 39, i think, or 40 at the end. so -- >> what's ooh different now? -- what's different now? >> what's different now i think is, a, people do see it as an issue of great opportunity, many do. b, i think both parties realize that we have to do something for political purposes and that the policies need to be implemented. and, c, i think that there is a, the people, american people contrary to the poll you brought up are generally, by a matter of 2 to 1, supportive of the initiatives being proposed in congress right now. ..

>> this is part of the equation for getting us back to the kind of growth that we're used to, that we can have, and kids and grandkids deserve. >> are you concerned about the heritage foundation report that

came out a couple months ago that claimed immigration authorities across the u.s. $6.3 trillion over the next 60 years? you and others have criticized it for not taking into account the benefits that would come from immigration reform. how do you plan to fight that? it's already been mentioned. >> well, of course, everybody knows it's a political document. it was designed to be a political document. that there is a reason that we don't expect the government to make predictions about spending and taxes for more than 10 years. the idea that we're going to predict 50 years into the future to precision within a few tens of millions of dollars is silly. we can't do that. people know you can't do that. but it is also so obviously a political document that is now starting to be compared to other

people's studies, which i very different results. the heritage foundation has been an ally of mine when i was chairman of the party, when i was governor of mississippi. they helped us with lots and lots of things. my wife doesn't agree with me on everything, so the fact that the heritage foundation doesn't agree with me isn't a big deal to me, but the fact of the matter is it's a political document. it is not a serious piece of work. you know, you don't find people who just are your top, top studies. your most important political document, you don't the next week fire the guy who did it -- >> yes, you do. >> if everything is going peachy keen. >> yes, you do. >> i wanted to ask you one more thing. the republican national committee in march came out with a very strong report saying we

must embrace and champion conference immigration reform. if we do not our party appeal will continue to shrink to its core constituencies only. what happens to the republican party if it doesn't get through congress this time? and if republicans are seen as being responsible for not passing immigration reform, what happens republicans? >> i think the system will be blamed, not the one party or the other if both parties are engaged. that's why i'm pleased that rather than say no, for principled reasons, but say no to what might be proposed by democrats, the old school way has been applied here, which is people of good faith quietly gone about their business to forge a consensus to be submitted to the regular order

way of the judiciary committee. now it's on the floor of the senate and the house will have a version, their version of that, and it's kind of, it validates the city books. we're starting to work would have to republish all the civic books in america because the process totally ignored what they written about how the thing was supposed to work. so i don't think that the political aspects of this are because of engagement. i think we're in pretty good shape. it would be hard to imagine if republicans in the house passed the bill, and you can't forge a consensus in the conference committee or whatever reason that someone could be blamed politically. i'm sure there will be efforts to try but i think making a good-faith effort with sincerity and believing any other side's views, you know, you can have a conversation about them, very helpful in that regard. >> i just would say the biggest issue that you're bringing up is if it doesn't pass, the news media has already decided it's

the republicans fault. if it fails because of border security, because the democrats say that that's a poison pill, is that the words are used a while ago? >> harry reid. >> the left, liberal media elite is prepared to say it's the republicans fault. the fact of the matter is there are a lot of republicans who want immigration reform as bad as anyone else. and to pre-determined today that if it doesn't fail, it's republicans fault. that is something we have to work on to try to see what happens, hopefully we will get a bill, we'll get a bill that passes both houses, the president suspect that if we don't, republicans have got to make sure that if they try to support a bill that they couldn't get past because the senate wouldn't take it or the president would sign it, or name 100 things, that there isn't just predisposition no matter what the facts are, well, it was the republicans fault. >> i would say that, going to

transfer from the heritage foundation report to the political world to reality here for a second. the heritage reports logged in my mind because it's baseless in his thinking. i was on the board and i greatly admire their work, has been in the forefront of advocating dynamics, that life is full of people interacting and creating far more than what the social planners could ever come up with. and so to have a report that assumes just kind of this constant trendline i think is flawed, not getting any credit for any of the economic activities that every study shows that immigrants bring to the equation. politically we're in the same situation. everything has got to be all about politics, never changes, it always come immigrants don't like republicans. they all -- why? why do we assume that? it's not part of our history. it's never always been that way. why do we assume it will be that way because it got is that why?

so i would argue that republicans win, when we are positive and hopeful and aspirational and we draw people toward our cause when we do that. and if we just play the game that we are for less government, you know, not as, we don't believe in a muscular government, that message is not aspirational. it's not very hopeful. it's not particularly optimistic and we could lose. my guess is that the messaging will change in that we could garner significant support amongst immigrants from africa, from fdasia, from latin america. it's in that way pretty regularly, and my guess is it will continue to be that way. the final point i would make is that if we do nothing we will have family union be the dominant 75% of immigrants that come are legally our petition by the family members, and they're not necessarily as aspirational as those that if we create a strategic approach to this.

and if you believe in the this is all about politics, then republicans are doomed. i would just disagree with that. >> let's go to questions. if you would, we have a microphone near, give us your name and who you are affiliated with, please, first. >> thanks. thanks holding this. in the congressional correspondent for the hispanic outlook on their education. i've been coming immigration for seven years, wrote a book about it about four years ago. let me say first, i do think the press, not me, but keeps saying that the republicans and hispanics don't like republicans, but the fact is hispanics and republicans are driving the debate right now. that there are five hispanics elected in 2010 and the congress, all republicans. the first governor, latina

governor of the united states is a republican but i think the press has to get off the message that hispanics a republicans. it's absolutely not true. >> do you have a question? >> my question is -- >> keep talking. [laughter] >> i have a little think about that but it makes me. anyway, my question is, why do you think, why is the urgency right now? this immigration was absolutely not an election issue. nobody really cared about it, and even hispanics, it was number four and five on the list of concerns. so why now? why is it suddenly obama's legacy? we never even talked about it? >> because it's going to continue to get worse. i mean, we've got a system as jim said -- as jim said is broken.

it doesn't work. it doesn't serve the purposes that the country needs to be served. and there is an appetite, go get it. that's mighty. when something is broke, fix it. >> when it's an opportunity, sees it. that's, i, i don't come here enough i guess. everything doesn't have to have a deep political motive. it could be that actually people think that our country can grow and that immigrants can play a huge part of the. the more entrepreneurial, they said it more businesses, they buy more homes. they are more family oriented. they work in jobs as haley said, in many cases when they start our jobs that have gone unfiltered on the high-end we're missing huge opportunities to invest back in our own country. every time we make that decision, mumbai and other places end up being the beneficiary. so this is an opportunity to fix it. now, i have a confession to make. i don't live in washington where

this is a political world and i'm sensitive of that and i respect that. i live in miami where half the people in my vibrant, beautiful place were born outside the united states. when i finally make it home, normally on a friday afternoon and i get to spend the night with my lover, it's my wife who was born outside of the united states. and on sunday sunday's when i get to be with georgia, lena walker bush, my little munchkin 22 month old granddaughter, her mom was born in canada of iraqi national parents. that experience actually i think georgia is probably going to b-52. that will be her nickname. i think she'll be the president, maybe -- [laughter] that experience is one that we should not ignore. that is the unique american experience that i've had the blessing, killing -- told a blessing to expect in the way

that added to ms. amount of vitality in my life. and it's something that no other country has done as well as we have done. why can't that be what the debate is about? why kennedy about these bigger things that tied your heritage and make us a better country? >> another question? right here. >> by the way, to mention my lover was my wife? last night spent -- [laughter] >> let's circle back. >> i'm with world magazine. i had a question about raul labrador in the house had played a role in house negotiations and he said that he joined the group in part because democrats made some concessions and agreements that in some cases he said have now gone back on.

case in point specifically with the health care issue. he said illegal immigrants if legalized would have to, for them to agree to do it would have to cover the cost of the home health insurance and his democrats have reneged on that so we dropped out of the crew. to questions, and one from i do see the health issue coming down? from a political aspect are you concerned there may be any bait and switch been negotiating going on in the house? >> i don't know, i hope not. i don't know that. i think the concern about the health care issue is that there may be some executive authority to waive parts of the afford will correc care after somethin. i think that's one of the issues on health care. and so i believe that there's a senate amendment to do with that that might alleviate problems concerns. but this is sausage being made and there's a lot of give-and-take. and actually for washington this seems to be done outside the,

you know, like. it's been done in a quieter way more than most bills. let's see what it looks like two weeks are now or three weeks from now. and let's see what happens after the senate passes a bill, which seems to be likely. i think the house will respond. >> the gentleman right here. >> thank you. my name is celeste are and i'm the director for continental application. i live in maryland and i'm a business owner. i've of what you just said. i'm an immigrant. i came here in 1999, set out -- [inaudible] and have hired almost 200 security personnel in his company. company. >> i rest my case. >> this is my question and danger. i believe the abolition of immigration from citizens are

unfairly affect legal immigration from africa. since most people the benefit from the worker immigration are going to be africans. is a really unfair? and also if this is done, is going to break family fabric. i believe it is discriminatory so i want a comment from you. >> sure. well, i think definition of family out to be the traditional one in our own country. we are the only country as understanding the world that has as a part of its immigration policies this broad definition, the broadest definition possible. no other country has that, and there will be opportunities if we have a legal immigration system. we should eliminate the lottery, the diversity lottery. if you had a legal immigration system you wouldn't need that. knowing the number of people that come through families occasioning creates hundreds of thousands of positions open for people that i aspire to come here and work. and so it's not, i'm not

suggesting nailing the total number. in fact, the proposals i've seen actually may increase the number of legal immigration but i'm all for the. we are the country. i think detroit we do real well if we started repopulating it with young aspirational people, people like yourself that have built a business. i don't consider it discriminatory to have a policy that is similar to that of the rest of the world. >> another question. >> yes, i'm julia press on i'm a correspondent from the new york times. governor bush, i wanted to ask you to clarify your position a little further on the citizenship issue because this has become quite central in the discussion, both innocent and the house. -- both innocent and the house but there are discussions underway in the senate that would make it very complicated for immigrants to obtain some

legal status of then go on and become citizens eventually. and so and also there is this a become a central issue in the house as well. so i'm wondering do you think that it is not essential for immigrants have been in the country illegally to have a path to citizenship, or how would you describe what you think the purpose and goal of citizenship should be for those people? >> i think the senate bill that requires 13 years, as i understand it, 10 years to get a green card, 13 years in accelerated path from green card status the citizenship status with gates that you have to go through as it relates to some which is being discussed right now, how did you this, to make some clear statement that our borders are secure based on some objective means, where you learn

english and you don't access government benefits. that reaches the proper balance. the bigger issue to me is getting people out from the shadows, the majority of which may not even want to be citizens. for our country's sake and for their sake, having come and for the tamest sake, and for other people that we have all these people in limbo, getting a bill passed to improve our laws is a very valid deal. now, if the law, if it was to be like it was where you could become a citizen over a shorter breed of time, i would have opposed that, but i think they've done the right thing about creating, you know, the proper balance. and i applaud marco rubio's work on this to be able to bring a consensus between right and left that is uncommon in american politics today. and others, not just more ago that he has taken the lead on this and i trust him to reach the proper balance and help the

democrats will stay with this and will pass a law. >> so you support the path to citizenship the? >> i support the senate bill that takes 13 years with find and learn english and is related to border security. >> thank you for clarifying. question here. >> and i supported that from the beginning. no new news there. >> thank you. thank you for being here. president pro tem of the utah senate. i'll use your style of asking a question and given the context of what you said and the. the question is what role should the states play, and the context is as, through federal action and inaction, federal action, the supreme court state, states are mandated with providing health care and education to all of the other benefits and yet we have very little in way of tools to address that short of federal action. in utah, we in 2005 we started

down the road with immigration reform at the state level with a driving privilege card. 2011 we pass copperheads of immigration reform. today in the salt lake tribune the polls show that 71% strongly or somewhat strong support bipartisan immigration. 74% -- 64% say they're more likely to vote for an elected official who support comprehensive immigration reforms to over 90% say we need to fix our broken immigration system. as former governor, what role should the states play in this debate? >> i know people are shocked at left wing utah -- [laughter] [inaudible] >> twenty-nine members, five democrats out of 29, 24 out of 29 or republicans. and the house is a 75 member house. 14 democrats out of 75 in the house.

so we are a left wing -- [laughter] >> your question is very important for governors because when the federal government fails to do its job, and that is control the board -- border, that we get it fixed. so we have people that are here illegally, and when states try to take action to do something about to protect their resources, the federal government often stops, stopped you from doing it. i mean, a lot of people have lost track of the initiative in california back in 1994, prop 117, whatever it was. it was all about illegal immigration. it was not, it was not about legal immigrants at all, but it became politically symbolic that

the california republicans were against immigrants, and which was not the truth. the problem is california was trying to deal with just what you're talking about. they were being flooded with health care costs that the federal, because the federal government failed to do the job. the federal government didn't pay the bill and the federal government doesn't pay the law enforcement bill, the federal government doesn't pay the incarceration bill. in fact, my law enforcement people, when someone gets taken away iis to the local children they will, they won't tell us, well, they're not very good partners at this. they've got a hard job and this law, we did get a good immigration reform it will make the federal government's job easier and it will take these burdens off of us because the federal government presumably won't be feeling. now, you do understand why some people think, let's see or do it

first. we would like, you know, we've taken this on faith once. let's get something in place. let's get something going here to help the state. >> i would like to pay tribute to utah. i think it's its international heritage a lot of the residents in utah are not, they don't fear the outside. they embrace the outside. utah is a very forward leaning state because of that. and the policies that you will adopted in 2011 got no attention, should've gotten a lot of attention because it was a nice counterbalance to a reaction in the neighborhood that i think, you know, has been adjusted over time. but utah is a fantastic place and its quality of life is enhanced by this embrace of diversity, and embrace of the rest of the world. as it relates to the state and local responsibilities, bylaw

state and local law enforcement are really are prohibited from being partners in this. it wasn't that long ago i was governor in, i think it must've been 99. i got briefed on the federal law enforcement presence in the state of florida come and there was one border patrol agent between palm beach and jacksonville. you know, the first reaction is exactly what, you're kidding me. i started laughing because it seemed ludicrous to me. the law as it was, if someone came across which they did pretty readily back then by boat, landed on the beach in florida, and even happened just like pure going to bump into a border patrol officer, then it all worked out pretty good. but if it didn't work out that welcome which is probably 99.999% of the cases, you have to hold the person in a car for,

you know, a discrete amount of time, or release them. since there was no one there on the other side to pick them up, i said maybe we'll got to do is go up to washington and see if we can get some kind of an agreement with the justice department where our guys and gals could be trained to be the eyes and ears of the federal immigration border patrol folks to extend the reach. and first go round, this was under the 40 administration, we to administration. we got rejected. the attorney general was a great floridian, janet reno. they didn't have this would work. we got the deal done and the other states have done that i think we should expand that. state and local enforcement is significant. there are multiple force players on the. is in local and state law-enforcement could help the federal government enforce its laws with proper training, with protocols that are established

to protect people's rights and all, just as they do with legal citizens and residents of our country. they could do the same for people that are not here legally. and it would solve much of a law-enforcement problem that we have. and there's a huge resistance to that in the federal government right now. >> i'm afraid that we're going to have to cut things off. can take a few more minutes? we got started late, didn't we, about 10 minutes late rex [inaudible] >> one more. i'm sorry. >> we will take one more. sorry. >> i'll be fast. my question is, both of you can all of the dismissive of the politics behind immigration reform process, both of your politicians. what would you say the biggest threat on both sides is to reform efforts at this time, republicans and democrats? >> from our side there is fear of costs and fear that we won't

have sufficient and border security. i think from their side the unions are very cautious, to put it mildly, about this. and then also how much border security is the right amount from the democrat side? i think border security could be a place where both sides could be concerned. and, finally, i think work versus family unification is a potential, a potential issue. some of the unions want less, fewer workers coming in. and that could affect some democrats. most of the republicans think that this is a very important way to grow our economy. >> the greatest political risk is that people look at this through a political lens, and

the minute that happens we go back to the old way which is we have two armed camps. and the center then dissipates. i think if it's focused on policy as it is right now, at least from my reading of it, there's a higher probability it will pass. >> thank you all for joining us. i'm sorry we couldn't take everyone's questions. we could go on all day i think. [applause] >> governor bush will be signed some books in the lobby in a few minutes. there are some personal. if you'd like to join us after that. so -- [inaudible] >> and if you want to continue this conversation, join us on twitter i go to the website bipartisanpolicy.org. thank you all very much. [inaudible conversations]

>> live to capitol hill not passed the house energy and commerce subcommittee on health hold the hearing today on government efforts to fight prescription drug abuse. witnesses today include white house national drug policy director gil kerlikowske and the center for substance abuse treatment director, dr. westley clark. according to the centers for disease control, prescription painkiller abuse is the fastest growing drug problem in the united states.

>> the subcommittee will come to order. the chair will recognize himself for an opening statement. today's hearing is the first in a series of hearings this subcommittee will hold on the subject of prescription drug abuse, which has been described by the centers for disease control and prevention as an epidemic in the united states. in 2010, 7 million individuals aged 12 or older, that's 2.7% of this population, were current non-medical users of prescription, or psychotherapeutic drug. and over 1 million emergency department visits that year involve nonmedical use of pharmaceuticals. nearly all of these drugs were originally prescribed by a physician. according to the national institute on drug abuse, prescription drug abuse is most prominent among young adults, age 18-25.

also in 2010 almost 3000 young adults died from ascription drugs mainly opioid overdose is which is more than the total number of people that die from overdoses than any other drugs, including heroin and cocaine combined. opioid pain relievers such as vicodin and oxycontin are the largest class of abuse prescription drugs followed by stimulants for treating attention deficit hyperactivity disorder. adhd, such as adderall and ritalin, and central nervous system the presence for relieving anxiety such as valium and xanax. according to the national survey on drug use and health, published by the substance abuse and mental health services administration, samhsa, of those individuals or use prescription painkillers not medically in

2010 and 2011, nearly three quarters received the drugs from a friend or relative, either for free, that's 54.2%, through a purchase, strong .2%, or by stealing the drugs, 4.4%. today's hearing focuses on the federal government's response to the prescription drug abuse epidemic. it should be noted that this committee has played a key role in facilitating prescription drug monitoring programs by authorizing the national all scheduled prescription electronic reporting act, master, cosponsored by whitfield and ranking member blew. nester which is housed at the department of health and human services was signed into law in august 11, 2005 to assist states in combating prescription drug abuse of controlled substances

through the pnp. it provides grants to set up or improved state systems that meet basic standards of information, collection, and privacy protections that will make it easier for states to share information. pd indeed authority to a different prescription drug abusers as well as the problem doctors who either overprescribed or incorrectly prescribed prescription drugs. while nasper is an excellent step in the right direction, the program has not been funded since fiscal year 2010. although hhs continues to fund state pdmp through grants to support interstate interoperability and integration of pdmp with electronic health records and to prove that i'm in this of access to pdmp data. it's abundantly clear that prescription drug abuse epidemic is a crisis in the united

states. however, while we discussed this complicated and dynamic issue, we need to keep in mind that many of these medications that so many are abusing our critical for many patients living with chronic pain. the institute of medicine estimates that there are more than 100 million adults in the u.s. living with chronic pain. it is critical as we move forward that we remember that these medications are vital for many americans expensing such pain. this thing will help us better understand and define that there is components of the issues and the challenges we face. in addition this subcommittee will learn about programs we currently have in place and the level of effectiveness. today's witnesses represent the office of national drug control policy, the fda, and the substance abuse and mental health services administration. i look forward to hearing the testimony. thank you, and does anyone seek -- thank you. ideal the balance of my time and i recognize the gentlelady,

ms. jackowski, for five minutes for an opening statement. >> thank you, mr. chairman. first i would like to ask if i could put the testimony of the opening statement of mr. waxman into the record? >> without objection, so ordered. >> thank you. i'm happy that we're having this hearing on drug abuse in the united states and i'm glad that we can work together in a bipartisan manner to tackle this problem but i want to welcome all our witnesses today. this hearing provides an opportunity to raise awareness and discuss action that we can take to end the crisis that is truly destroying lives, hurting families and communities across the country. my constituent, peter jackson, tragically lost his 18 year old daughter, emily, to this epidemic while visiting family. emily's cousin offered her and oxycontin tablet that they belong to her uncle had recently died of cancer. after taking the oxycontin tablet while drinking, emily went to sleep and never woke up.

she died from respiratory depression. she stopped breathing. while emily's story of dying after taking a single unprescribed oxycontin tablet may be extremely rare, death from the abuse and misuse of prescription opioids drugs are not the prescription opioid drugs were involved and 16,650 overdose deaths in 2010. accounting for more deaths than from overdoses of heroin and cocaine combined. this represents a 313% increase in death over the past decade. in addition to the tragic deaths there are other negative health consequences that result from prescription drug abuse. for every overdose death in 2010 there was an additional 10 abuse treatment admissions, 26 emergency department visits, 108 people with abuse or dependence

and nonmedical users of those drugs. in addition to the human toll there are financial cost associate with prescription drug abuse that our health care system simply cannot afford. the direct health care costs of prescription drug abuse is $70 billion each year. researchers have found on average opioid abuse, 8.7 times higher than non-abusers each year. it is national event that would work in this crisis. reducing the prevalence of prescription drug abuse will save lives and save money. there are actions underway at helping to combat this problem at the federal level. last year we passed several positions as part of the fda safety and immigration act to combat prescription drug abuse including a requirement that the fda hold a public meeting on the scheduling of hydrocodone and issue guidance on developing products. federal agencies are also

operating programs to combat prescription drug abuse including developing and supporting efforts to educate providers of populations at risk for prescription drug abuse. while federal efforts are critical we must partner with states if we are to be successful in anything prescription drug abuse with the state's response but to license and train health care professionals that prescribe and dispense these drugs. we must also build on current efforts by identifying additional steps that we can take to tackle such abuse. we must make drugs containing hydrocodone schedule ii drugs. while it will be important to take steps to ensure this change is does not limit access to patients with legitimate medical needs, this change is needed to adequately reflect potential risks these drugs pose to public health. we should also take steps necessary to restrict the use of oxycodone, rather than moderate to severe pain energy prevent the overprescribing of these

powerful medications. i look forward to hearing from our witnesses about the federal government's efforts to combat prescription drug abuse to learn additional steps we can take to stop the abuse and misuse about opioid drugs and appreciate any comment on the suggestions. and i yield back. >> the chair thanks the genuine and now recognizes the vice chair of the subcommittee, dr. burgess, for five minutes for an opening statement spent i thank the chairman for the recognition. the fact of the matter is we lose more people in this country to the drug overdoses that we did to automobile accidents. and of those drug overdoses, two-thirds of them are prescription drug overdoses. so that it plenty big problem. the good news is there's plenty we can do about it, but, unfortunately, the agencies and lawmakers have so far not taken up anything other than a short-term approach. we really need a broad-based comprehensive strategy that is focused on going after the bad

actors. soda so we could go after the pill mills. they may be hard to find but maybe not. they advertise, so we're very fortunate to they tell us what they are, what their hours are. they tell us their charges. so if i can find them, how come the board of pharmacy can't? how come law enforcement can't? and take a hard look at this. iran and medical practice for 25 years, never once did i advertise a free initial visit, coupon included. this warrants a hard look at it just doesn't fit a normal type of medical practice. we should re- authorize and fight to find nasper to this committee we authorized in the past the it's the only legislation that encourages state prescription drug monitoring programs. nasper was a product of this committee bipartisan drafted with medical providers, states

and patients in mine. we should encourage qualitative drug screening and reject contrary medical policies. we should encourage abuse current formulations and reward investment in these technologies. we might also work with canada to align our policies in improving and reimbursing these technologies. we should look at and examine the personal use exemption to see if it encourages building controlled, bringing controlled substances into the country. we should do more to shut down the rogue internet pharmacies at home and abroad. it boils down to this. right now you could go to publication, you could go on the internet and by a controlled substance pointing and clicking at two things, to statement you have to make. one, i need the drug, and two, i ain't lying. most people meet that bar. i'm open to discussing provider education if it does not subvert medical judgment. we have allowed a few bad actors

to jeopardize the doctor's ability to offer pain care and care for the patients. this is an important point, being someone has written prescriptions, i do have a perspective on this process would got to stop the diversion, but we also need to be careful that would have we do is not so prescriptive, that it prevents people who need, have a legitimate need and use of this medication did not obtain it. so pain cause our estimate a more than $100 billion yearly, and they're the cause of 25% of sick days. prescription medications may be an important part of pain therapy. if we don't stop the bad actors, we're going to hurt the people who have legitimate uses for these medications. the bad actors cannot be allowed to jeopardize the doctor's ability to alleviate human suffering. again there's much we should do. i understand why this may be a series of hearings, and then two of the four to working with you.

we need to involve doctors. we need to involve patients as witnesses. thank you, mr. chairman for the consideration and i will yield the balance of my time to dr. gingrey. >> i appreciate for yielding to me, because i agree with so much of what he said. you know, the problem is a huge problem, and not only the cost of the legal, prescribing of these types of medications, pain medications, antidepressants, whatever, but just think about the cost of decreased productivity in individuals that may be are a little bit, just a little bit overmedicated. you know, this might sound a little harsh but honestly i think maybe a little pain or a little anxiety in our lives is a good thing. it can be a productive thing.

and it makes you appreciate that chapter work through that, and that if you try to completely eliminate each of those things, then that's we get to the to and say, the addiction, the decreased productivity, the cost to society. so i think physicians have a big role to play in this. and even the ones that are prescribing legally. and i'm not talking here about the pill mills. the states are doing i think a good job of trying to crack down on that. but finally we must take a close look at how we as a society support treatment and recovery of patients talking to overcome addiction. ..

>> secondly, dr. this this rock morton, deputy director for the center for drug evaluation and research. u.s. food and drug administration. finally, dr. wesley clark, director center for substance abuse treatment, substance abuse mental health services administration. thank you for for coming. your written testimony will be made part of the record. mr. kerlikowske, you're recognized for five minutes for your opening statement. >> thank you, chairman pitts and representative schakowsky and members of the subcommittee, and thank you for the opportunity to address the important issue of prescription drug abuse in this country. preventing prescription drug abuse has been a major focus of our office since my confirmation

now four years ago. we have worked very collaboratively with a number of federal agencies throughout government to address what the cdc has rightly termed an epidemic. my position allows me to raise the public awareness and take action on drug issues that affect the nation, and the administration recognizes that addiction is a disease, that prevention, treatment and smart law enforcement all have to play a part of a comprehensive strategy to reduce drug use, to give help to those who need it and to insure public health and safety. we're here today because the prescription drug abuse has had devastating consequences for public health and safety in the country. increases in treatment admissions for substance use disorders, emergency department visits and the, sadly, the deaths that are attributable to prescription drug overdoses place an enormous burden upon communities across the country. in 2010 alone more than 38,000 americans died from a drugover dose, 22,000 of those deaths

with attributable to prescription medications, and most of those deaths, almost 17,000, were attributable to prescription painkillers. and in response the administration released a comprehensive program. the plan brings together a variety of federal, state, local and tribal partners to focus on the four major priority areas dealing with this. education, monitoring, proper disposal and enforcement, and the plan for most mandatory education and safe prescribing addiction practices for prescribers and dispensers, current training for health care providers on safe opioid prescribing in addiction can be inadequate and inconsistent. medical school students receive an average of 11 hours of training on pain education. most schools do not offer specific training on opioids at all. we've come a long way in

educating the general public about prescription drug abuse. we've worked with a wide array of state government leaders, medical associations, public health and safety organizations to prioritize prescription drug abuse and overdose prevention. the second pillar of the plan focuses on strengthening the prescription drug monitoring programs. in 2006 only 20 states had pdmps. today 49 states have authorized legislation, 46 states have operational pdmps. there are currently 14 states that are able now to share data across state lines, and we're supporting that expanded interoperability. the administration has worked with congress to allow the department of veterans affairs to share prescription drug data with pdmps, and we're pleased to say that the va's rulemaking process is nearing completion, and va has authorized its health care providers to access those state pdmps with consistent with state laws.

third, the administration has continued to expand safe and proper disposal of unused and expired medication. since 2010 the drug enforcement administration has partnered with thousands of local law enforcement agencies and our drug-free community coalitions to hold six national takeback days collectively, disposing of -- safely disposing of over 2.8 million pounds of unused medication. lastly, the administration plan focuses on improving law enforcement capabilities to reduce the version. the national methamphetamine and pharmaceutical initiative funded through our office of high intensity drug trafficking areas has trained more than 2500 law enforcement and criminal justice professionals on pharmaceutical crime investigations and prosecutions. the federal law enforcement continues to partner with state and local agencies around the country to reduce the pill mills and prosecute those that are responsible for improper or illegal prescribing. the administration is working to

expand access to an emergency overdose reversal medication for first responders who may encounter overdose victims and can help prevent a fatal opioid overdose. we're also addressing many of the other consequences of the epidemic including the emerging issues like neonatal abstinence syndrome and indications of increased heroin use in places, in other places throughout the country. in closing, let me recognize that none of these things would be possible if my executive branch colleagues and i want to accomplish for this nation without the support, the ongoing support of members of congress. and thank you for the opportunity to testify. >> chair thanks the gentleman. doctor, you're recognized five minutes for an opening statement. >> mr. chairman and members of the subcommittee, i'm dr. douglas lock morten, deputy director for the center for drug evaluation and research at the fda. thank you for your opportunity to be here today to discuss the

misuse and abuse of prescription drugs. especially prescription opioids. the importance of this problem is hard to overstate. beyond the sobering statistics of our individuals and their families whose lives have been shattered by prescription opioid misuse, abuse and addiction, it is a crisis that affects us all in many meaningful and enduring solutions will require all of our collective efforts. balancing the needs of patients suffering from pain with the need to combat opioid misuse, abuse and addiction is a priority for the fda and for me personally. in seeking this balance, fda has pursued a targeted, science-based approach aimed at critical points in the development and use of oip yoid medications. while additional work remains to be done, i'd like to mention some of the activities fda is doing now. first, we are a science-based agency and are focusing on improving the safe use of pain medicines, including recent work we've done to encourage the development of abuse deterrent

drug formations for oip yoidz. the fda believes the development of these new formulations to successfully deter abuse is an important part of our efforts to improve their safe use. for example, in january of this year fda issued a draft guidance document for industry outlining the development of abuse deterrent the oip yoid drug products. and in the fall the fda will participate in a public meeting to discuss the issues addressed in that draft guidance as well as issues surrounding the development of abuse deterrent formulations for generic drug products. in addition, the fda has taken recent regulatory actions concerning two opioid products, oxycontin and to panama er charm reformulated with the intention of making the products more difficult to manipulate and abuse. the data for these two products were reviewed carefully and independently by fda scientists and resulted in a change in the labeling for oxycontin. our decisions relied on the

totality of the evidence for the or particular drug at hand, and given where we are in the evolving science of abuse deterrence, were made on a case-by-case basis. a second critical area where we have devoted time and resources is prescriber education. the interaction between prescribers and patients plays a critical role in improving the safe use of these drugs, and fda has taken a number of steps to improve the educational materials that are available for patients and prescribers. for example, in july of 2012 we approved a risk evaluation and mitigation strategy known as rems for manufacture user of over 20 extended release and long-acting opioids. manufacture manufacturers are required to support training programs offered by accredited, continuing education providers and to make them available at little or no cost to health care professionals. the training is based on a syllabus developed by the fda with input from other

stakeholders. we are currently posting those educational material on our web site to make them easier for prescribers to make use of. a third critical area where we have devoted time and resources is on ways to prevent the overdose deaths associated with prescription opioids by improving the treatment of overdose. the standard treatment to rapidly reverse the overdose of either prescription or illicit opioid, and when given quickly, it can and does save lives. at a public meeting the fda convened last year with several other parts of the federal government, stakeholders encouraged the exploration of new ways to administer the drug that may be easier than currently available such as autoinjecters or via intranasal administration. in this area fda is working to provide regulatory priority assistance to manufacturers who are working on assessing these new ways to give the drug. to finish my remarks, our society faces two important challenges. we must balance efforts to

address the misuse, abuse and addiction that harms our families and communities and the need for appropriate access to pain medications for patients that need them. there can be no doubt there's much to be done and that we must act now. these are not simple issues, and there are no easy answers. given the complexity of the issues surrounding this problem, real and enduring progress will require a multifaceted approach combined with the dedication, persistence and full engagement of all parties. fda continues to priortize our efforts to combat this significant health crisis. we welcome the opportunity to work with congress, our federal partners, the medical community, advocacy organizations, patients and families to turn the tide on this devastating epidemic. thank you for your continued interest in this important topic and for the opportunity to testify regarding fda's contributions on this issue. i'm happy to answer any questions you have. >> chair thanks the yes nan and -- gentleman and now recognizes dr. clark five minutes for an opening statement. >> good morning chairman pitts,

congresswoman schakowsky and members of the subcommittee. i'm the director for the center of substance abuse treatment. thank you for inviting me to testify today red regarding oure in preventing nonmedical use prescription drugs. our mission is to reduce the -- >> [inaudible] >> okay. yes, samson's mission is to reduce the impact of substance abuse and mental illness on america's commitments. we envision a nation that acts on the knowledge that behavioral health is essential for health prevention works treatment is effective and people recover. the challenge of prescription drug use and misuse requires end deem logic surveillance, prescriber education, access to effective treatment services and continued research by the private and public sectors. samson's strategy to reduce use and misuse aligns with the four-part strategy. we work across u.s. department of health and human services by

participating in the behavioral health coordinating committee's prescription drug abuse subcommittee. we are an active partnership with the cdc, the fda, the office of the national coordinator health information technology, nih and others aimed at preventing and treating prescription drug use and abuse. according to our 2011 national survey, nonmedical use ranks as the second most common ill lis sis class drugs in the united states. you've mentioned these data, and there's no need for me to repeat it, but it is important to note that there was a slight decline in nonmedical use between 2010 and 2011 which suggests that the national, state and local efforts to reduce prescription drug misuse may be having an impact. state prescription drug monitoring programs are an important component in government efforts to prevent and reduce drug abuse. pdmps have the goal of preventing prescription drug use

and misuse as well as illegal diversion. in 2005 the national all schedules prescription electronic reporting act created a department of health and human services grant program administered by samsa. we received funding from congress in fiscal years 2009 and 2010 which resulted in us providing 26 grants to 14 states. however, in fiscal years 2011 and '12, congress did not appropriate funding for the program. in 2011samsa funded the enhanced access to pdmp through health i.t. projects which was managed in the collaboration is samsa and odcp. its purpose was to use health i.t. to increase timely access to data. the electronic health record integration program was funded by samsa. this complements existing federal efforts by improving realtime access to pmp data into

existing technologies such as electronic health records. samsa is also engaged in the efforts to prevent and treat prescription drug misuse and abuse through education programs, prevention, treatment of prescription drug abuse as well as through regulation. we support the education of current prescribers through continuing medical education courses and other less formal efforts such as webinars. the referral treatment program is an important tool for the early identification of persons who might be at risk for opioid abuse and other substance use. samsa provides grants to states, territories and tribal organizations to implement -- [inaudible] for adults in primary care. we have a residency grant program to address future prescribers that include screening for prescription drugs. we support prevention and early intervention through several oh grant programs. our block grant programs is targeted toward funding to states and territories for their

prevention and treatment and services efforts. the strategic prevention framework partnerships for success program is designed to address two of the nation's top substance abuse prevention priorities including underage drinking and prescription drug misuse and abuse among persons age 12-25. we work on our drug-free communities effort in collaboration to make sure that communities can prioritize prescription drug abuse. we're working with other federal agencies to explore telemedicine to address the need for increased access to in rural settings. our strategy to reduce prescription drug misuse includes the expax of improved access -- expansion of improved access to treatment, permits qualified physicians to prescribe certain medications for the treatment of opioid addiction in outpatient settings. we also regulate opioid treatment programs that use methadone approved by fda to treat patients. we work in collaboration with the dea. through these and other efforts,

samsa is working daily to address the issue in order to reduce the significant long-term impacts of the serious public health problem. thank you for the opportunity to testify regarding our efforts in this area, and i welcome any questions that you might have. >> chair thanks the gentleman. chair apologizes, we're trying to get the jackhammer to stop. but until that time, if you'll, please, speak directly into the mic, we'd appreciate it. thank you for your testimony. i'll begin the questioning and recognize myself five minutes for that purpose. director kerlikowske, the ondcp oversees and coordinates the many agencies involved in prescription drug abuse. please describe the advantages and challenges that come with having so many agencies and departments involved in the fight against prescription drug abuse. >> congress clearly recognized the need for coordination, the fact that there are 15 primary federal agencies that all have a

role in the drug issue. i don't think anything is more complex or challenging than the prescription drugs. it's not like an issue where it's coming across the board, or it's coming right out of our own medicine cabinets. the fact, the mere fact that it was not recognized as a significant problem except by subject matter experts in the health field, people that ran treatment programs, but generally the public did not even begin to understand the magnitude of the prescription drug problem. we worked to bring everybody together to sit at the table and to develop a plan knowing that any one component whether it was the law enforcement agencies, whether it was the regulatory agencies, that any one component would not be able to solve or at least significantly reduce this problem. our partners, two of which are here but a number of them are out as part of our program, all came together with one goal, and that is to reduce this tragedy

not only in the loss of life, but the expense. so we couldn't be more pleased with, one, their cooperation and, two, at least the inkling, as dr. clark said, of some success in this area. >> thank you. dr. throc kmorton, generics entered the market in january of this year. does the agency intend to monitor realtime data in order to evaluate whether such entry affects opioid abuse, and how will realtime data like this be utilized by the agency now and in the future when the fda is evaluating the science regarding claims of abuse deterrence? >> mr. chairman, the goal that our agency has set is to incentivize the development of successful abuse/deterrent formulations and find ways to move them onto the market. our intent is to set forth a road map that makes that

successful, makes that happen in good time. following up on that, we need to work to develop ways to move generics that also have abuse deterrent technologies, make them possible to come onto the market as well. you asked about monitoring of the response in the marketplace to those sorts of decisions. we do watch that information. we have an office of epidemiology that focuses on marketing issues as well as postmarketting safety issues. we use that information as we look at individual decisions to understand the impact that a decision that we might, ours might have with regards to the use of products in the market. >> to follow up, the fda has committed through the user fee process to increase transparency and predictability around the drug review and approval process. earlier this week we wrote to dea regarding delays in reviewing fda scheduling relations for -- recommendations for new drug approvals containing controlled substances. does the agency have

recommendations in improving this process to address the issue of dea delays? >> be -- the focus, it's an important question that we make sure that we have timely access to do medicines that are recommended for controlling, but we need to remember that the final decision about the controlling is made by the drug enforcement administration under the controlled substances act. my focus in the center for drugs has been to make certain that there's a timely scientific assessment from the fda that can, in fact, can work to inform that decision by the drug enforcement administration. so what we've been doing is looking back at our process to make sure that it is as efficient and timely and scientific as possible. so we get our recommendations in good order to the drug enforcement administration through our office of assistant secretary for health which is at the health and human services level. >> thank you. dr. clark, can you discuss your relationship with the 46 states

that operate prescription drug monitoring programs? >> we're working in concert with the department of justice, the hal rogers program. we have through our special initiatives reaching out to as many jurisdictions as possible so that we can link the pdmps with electronic health records. as you know, as i mentioned, the and a half saw program which was targeted towards grants to the states has not been funded. we've shifted our focus from that effort to looking at other technologies so that we can address the public health aspect of this by linking electronic health records to pdmps so that we can have realtime data so that the practitioner in the clinic or in the emergency room has access to information about the client sooner than some of the delays associated with current state pdmp programs. we can't wait two weeks to inform the clinician, we'd like

to be able to give that clinician realtime access to information is they can make appropriate decisions about the care. sometimes it's someone who's running a scam on the doctor, sometimes it's a patient who is having a reaction to the medication. so it's really useful to have realtime access to the clinical context of using prescription drugs. >> chair thanks the gentlemen. my time's expired. chair recognizes the gentlelady from california, ms. capps, five minutes for questions. >> thank you, mr. chairman, and i'm so glad we're here today having a hearing on ab issue -- an issue that, clearly, cuts across party lines. while it clearly impacts families and communities across our nation, it also affects our health care system. however, i want to make sure that efforts to address this issue, important as they are, do not cause other problems, especially those for, regarding people with chronic pain. this is a delicate balancing act in way.

in a way. americans' struggle with pain has been an important issue for me for many years. in 2007 i introduced the national pain care policy act and was pleased to see that part of it was included with the affordable care act. as a result, the institute of medicine was directed to do a study on pain, and what they found is that pain is the most common reason people seek medical care. over 116 million u.s. adults suffer from chronic pain. the severity, duration and disabling consequences of pain vary from person to person as does the response to treatment. but pain accompanies a range of other clinical conditions as all of you know, including cancer, diabetes, arthritis and on and on. access to medications is critical for these patients and their, and survivors in order to complete other prescribed treatments and maintain other activities of daily living. and many medications prescribed to patients for acute pain as

well as chronic pain contain hydrocodone. so, dr. throckmorton, as fda reviews the potential rescheduling of hydrocodone containing medications, does sufficient data and analysis exist about the potential impacts reindividualing could have on patient access to hydrocodone-containing medications? >> thank you, congresswoman. first, let me say i agree with you. finding a balance between the necessary access for pain medications for patients that require them and addressing this crisis of abuse is absolutely essential, something that the fda keeps in mind as we're thinking about or regulatory activities. with regard to assessing access to pain medications, it's something we've worked on internally, i've discussed with outside groups extensively. i know there are a number of people looking at better ways to measure that. as a part of our rems

implementation that we put in place last year, for instance, we required the manufacturers to assess the impact of that rems on access to pain medications because we understand that it's an important aspect of our regulatory activities and whatever we end up deciding to do in the future. with regards to hydrocodone, congress in the recent food and drug administration safety and innovations act directed us to hold the public hearing on hydrocodone and upscheduling and in that direction included language directing us to talk to patients and groups that had experience on the impact that this might have with regards to the upscheduling of hydrocodone. we held that meeting. we have over 700 comments to the docket about that meeting that we're currently looking at. a large number of them comment on the effects that different activities might have as regards to access, something that we're reviewing as we think about making our decisions. >> thank you. and if there are access problems, could you elaborate?

i know there's not much time left, but on the process available to individuals who are rightfully prescribed these medications but encounter problems accessing them? >> the, um, the reason why they're having trouble getting the medicine would be important to understand. so if there is a drug shortage, for instance, and there are challenges getting a drug that's not available anywhere in their area, fda has a drug shortage staff that i supervise, and we would love to hear from you. we'd want to work with you to find other ways to make that pain medicine available to you. if it's, if it's due to lack of availability at a pharmacy or pharmacies near you to -- because, you know, because of concerns over scheduling or something like that, those things i would have less clear answer on, but i would suggest the boards of pharmacy or other local area groups like that might be somewhere to talk to. >> thank you. mr. chairman, i'm about out of time, and i didn't even get to ask the other two members of the panel. this is such an important topic

to me, i think for us to be discussing. and i would certainly hope that we could have, that this is just one hearing that we have many more because i wanted to get into prevention, and that's a whole other topic that involves maybe some other people too. but you certainly are experts on this. we could certainly use some more hearings on this topic, in my opinion, so thank you very much for scheduling this one. >> chair thanks the gentlelady, and this is just the first in a series of hearings we plan. chair now recognizes the vice chairman of the subcommittee, dr. burgess, five minutes for questions. >> thank you, mr. chairman. mr. kerlikowske, you sent a letter -- you heard me reference the alignment of our policies with those to our neighbor to the north, and you sent a letter about this. you got doctor, the hrockmorton deliberately working on deterrence and oxycontin, but how do we align our policies

with canada to prevent the older generic form from coming across the border? because i, probably as we speak about this, i can see someone developing a business plan that would involve the importation of large amounts of generic oxycontin that didn't have an abuse deterrent. >> it's an important issue because the united states has done a lot to reduce the easy availability and also the fact that the opioid prescription painkillers here are not as easily manipulated. but the fact that canada has that was of great concern to us. so early on before they hit the market, we had written to the health minister. the health minister from canada replied that she actually didn't have the authorities within canadian law to limit this. but she had not only heard from us, she had also heard from the provinces who were also concerned that this would be widely and easily available within the provinces.

so we notified customs and border protection first to identify and be aware of this in case they see these coming through. so far in milwaukee that is the only location that we've received a report of seeing some of these, and it was not a great number of them. we have a meeting scheduled in july with our canadian counterparts who will be here in washington, d.c., and i will be traveling to ottawa hopefully with a colleague from the food and drug administration to also work with them. >> so you'll be monitoring it >> absolutely. >> and would you be averse to providing periodic reports to this committee, to the staff of this committee? >> i'd be happy to. >> about that ongoing effort. let me just ask you, on your four pillars in your testimony, the last pillar was the enforcement piece, and, you know, despite the salacious nature of the covers of these magazines, i submit to you that i could help you locate the bad

actors. they advertise. and it's not hard to pick them out of a crowd. so i hope you're focusing some efforts on disrupting the supply chain, because, again, these people are not shy about telling you who they are and where they are, their hours of operation, their prices and a discount coupon. >> you can see, certainly, broward county, florida, was the kind of epicenter of this. they had 90 of the top 100 prescribing and dispensing -- >> this magazine is from broward county. i wasn't going to identify the location, but since you did. doctor, let me just ask you, are there efforts at the fda to make -- [inaudible] an over the counter preparation like an inhaler or an auto pen? >> we think it's important to, first, understand how best to use the drug. so we're working as a part of a much larger group of federal agencies to understand the best

uses as a regulator my job in that discussion is not to decide as a policy how naloxin should be used and instead it's to lay out the regulatory pathway should a firm be interested in developing one of those products. so we've met regularly with the makers of auto injector products, makers of inhalation products to lay out the pathways that are necessary for them to get approval as prescription products. at the meeting that we held last year attended by nida, attended by the office of national drug control policy and samsa, we heard loud and clear there was an interest in moving it to over the counter status. >> let me just interrupt you. i'm not sure i agree with that, but we live in a world that -- [inaudible] now is available over the counter with the tootsie rolls and snicker bars. if interdiction and abstinence is not going to work in other

areas, you know, maybe this is something that needs to be looked at. because anyone who has ever seen the dramatic reversal of an amp of narcan on an opiate overdose will understand that you go from crisis to normal in the space of 26 seconds, and it is dramatic. again, i'm not saying that i advocate that, but i just wonder in this brave new world that we've entered, is that a consideration? so i hear that you are, in fact, entertaining that. mr. kerlikowske, i also have to mention about drug diversion. you mentioned the 11 hours in medical school. you do learn a lot in your very first years in residency and in practice, and i just recall very vividly when i was a resident at parkland hospital moonlighting at community hospitals and someone would come in with a textbook description -- in fact, they probably memory rised the -- memorized the description, were savvy enough to bite their lip and spit in the cup before they collected a

intention men for you so they had blood in their urine and fit the bill pretty quickly. i know what it is, doctor, i have an appointment with my urologist, i just need something to get me through the night. and about the fourth time you hear that story, you think there's something fishy here. of course, doctor shopping is a big problem, and the doctors who are just leaving training and getting into practice, this is where a lot of that educational activity could do a lot to prevent diversion. thank you, mr. chairman, i'll yield back. >> chair thanks the gentleman and now recognizes the gentlelady from florida, ms. castor, five minutes for questions. >> thank you, mr. chairman, and thank you, gentlemen, very much. i'm especially grateful to director kerlikowske because you have given us such great guidance in the state of florida where it's, colleagues, it has been a horrendous problem in the state of florida. you would not believe, you could drive by some of these pain management clinics and see lines of people early in the morning.

and i would, we would often hear from our colleagues in kentucky, in virginia, in tennessee about how folks would just travel down to florida, find a pain management clinic that would prescribe, give them on site hundreds of pills, go back, and this pipeline -- fortunately -- has been squeezed now. florida finally adopted a prescription drug database. we have some stops and starts with that. i'm concerned there are physicians and pharmacists that are not using it. it's voluntary. i'm a little bit concerned the state hasn't provided a long-term commitment to make it work, and i'd like you all to address that. but local law enforcement, they're seeing some improvements from where we would have at least one death per day in our community from prescription drug abuse, they say now with county

ordnances on these pain management clinics, new requirements for, to go after the docs, arrest of doctors and prosecutions. but i know local law enforcement can't do it all. can you all give me a -- how is the state of florida doing? because i know it's been, unfortunately, one of the worst in the country. and at the federal level, what can we do to provide greater tools to local law enforcement? and then one of my local sheriffs says it's not all up to local law enforcement. this is an addiction, and we've got to do more. director? >> as a graduate of the university of south florida, i had a special affinity for the problems in florida in particular. but i can tell you that florida is doing markedly, remarkably better. the leadership of the attorney general, pam bondi, on this issue has been very good. we have worked hard with a

number of groups there, and florida has actually reduced the problem i think from seven overdose deaths a day, they've been able to make progress. i think from the federal government standpoint what we need to be able to do is to make sure that these prescription drug monitoring plans are interoperable. fourteen states now can share data, but we saw a movement of some of the physicians that were suspect, as the vice chair mentioned, from florida to other states. and so that information needs to be done. so that's one thing the federal government can continue to do. >> the, you know, our database is voluntary, and the -- it hasn't been up and running for very long, but still there's some frustration that you only have 10% of pharmacists that are using it and not many doctors. so if we have interoperability between states, that still doesn't get to the problem of

incentivizing pharmacists and. doctors, prescribers to use that. how do we, how do we better incentivize the use of -- >> and we're actually seeing significant improvements. one that the electronic health records system, which eventually will be compatible with these kind of systems so that you don't have one pdmp, stand-alone system, and then you've got your own electronic health records. is -- the other is the e-prescribing that has taken hold. physicians are not very happy about being able to prescribe electronically a large number of different types of drugs, but when it comes to controlled substances, they go back to paper and pencil. all of these things are kind of underway. but i think the amount of education and information that is being made to the physicians as a result of using a pdmp and the stories that they've told and the fact that we are strongly encouraging mandatory prescriber education will

helpful. thank you. >> okay. and, gentlemen, can you all tell me -- i'm a co-sponsor of a bill, h.r. 1285 by congressman buchanan and congressman markey from the energy and commerce committee that would amend the controlled substances act to make any substance containing hydrocodone a schedule ii drug. do you all support that? could you just say yes or no, because my time's limited. >> i don't believe the administration has taken a position, and we have strongly encouraged the science-based evaluation for the scheduling. so i wouldn't be able to tell you right now. >> okay, doctor. >> he's speaking for the administration. >> okay. and same answer, dr. clark? >> speaks for the administration. >> thank you all very much for your efforts in this area. >> gentlelady's time's expired. at this time i request unanimous consent to include a statement from the national association of chain drugstores into the record. without objection, so ordered. chair now recognizes the

gentleman from illinois, mr. shimkus, five minutes for questions. >> thank you, mr. chairman. and i just have two brief questions. one is i understand in europe 85% of the prescription drugs is in blister packaging. whether that's correct or not, that's what i've been informed. do you think that would have any positive effect on some of these specific prescription drugs, especially for those that might be going to, you know, families or families who are taking care of seniors and really the accountability and the inability to really just disperse that without -- disburse that without breaking up the package? >> i think it's a very good question, and the use of innovative packaging and storing techniques to make a difference in this particular crisis is one of the things that we've not had an opportunity to think through as fully as we'd like to. i formed a group within the fda to start looking at these

issues. i have a part of my center that focuses on packaging and labeling and those things, and i've asked them to look at issues like this. one of the challenges about putting blister packs, creating -- requiring blister packs for one part, one kind of drug is that it spills over to requiring blister packs potentially for other kinds of drugs that have similar kinds of dangers. and there's a concern about access and impact on other areas of the health care system. so we need to look broadly at how to use packaging more creatively than we have, i believe. >> anyone else want to add? no. then let me just on this one, we were talking about some of the -- and i'm not a medical doctor, so i don't remember all the names and stuff of the various drugs or the drugs to remediate the drug effect. but how -- i'm curious as to how much coordination there is between each of you when there is a development of a promising treatment which could help address the national priority of

abating the drug abuse crisis. and i do know fda really has the approval, but are you all involved with them especially in this case? dr. clark? >> yes. not only the fda has the leadership in that, but we work in collaboration with ondcp, nih and others as the literature which as the doctor mentioned, that the science-based literature produces new ideas. we have this ongoing dialogue. we have working groups that are multiagency, multidepartment to examine the implications. we also work with the organized medicine in the various medical societies to address these issues. we try to track these developments so that we can decide whether they can be moved into clinical practice. >> we spend more time with each other than our families. [laughter] >> that's true up here, too,

many times, unfortunately. so, mr. chairman, that's all i have. i yield back the balance of my time. thank you. >> chair thanks the gentleman. now recognize the gentlelady from illinois, ms. schakowsky, for five minutes for questions. >> thank you, mr. chairman. i wanted to also reinforce my view. i think i do have something as a comment that's already in the record when it comes to the changing the scheduling. of hydrocodone from its current schedule iii to schedule ii of the controlled substance act. that was one of the suggestions that came from my constituent who lost his daughter. the other was he suggested, and i don't know if this is under

consideration, take steps necessary to restrict the use of ox si codone pain relievers to severe pain rather than moderate to severe pain, so that would change the packaging. in order to prevent the overprescribing of these powerful medications. um, i wonder if any -- actually, whoever knows best. >> yeah. that's probably something, that's something that i can comment on. there are citizens' petitions. there are requests for action before my agency about the changes in labeling that you're referring to, so i won't be able to talk in great specific about the changes in what's called the moderate to severe language that's in current opioid indications. i will say, however, that the fda has always had an interest in making sure that our labels are accurate and fair and include all of the information that we know to be scientific. i had a public meeting earlier in this year where i posed a

series of questions to academics, add slow kits, family members -- advocates, family members asking for their help in understanding how our current labeling for opiates might be improved, in general asking them for suggestions. and we got a number of comments. we're in the process of looking at those comments, looking at other ways to make sure those labels say what they need to. we believe educating prescribers begins with the approved labeling which outlines how the products are best used based on our scientific judgment. and we need to make those as fully accurate as we can. >> i wonder if part of the customer, the consumer education includes encouraging families with children between 12 and 18 to have a lock box for certain drugs so that they keep them out of the hands of children? dr. clark? >> yes. we do believe that prescription drugs should be treated very

carefully. lock boxes are good ideas. we, as chairman pitts pointed out, a lot of prescription drugs are shared between friends and family, so you've got this cultural dynamic that we also have to deal with. so consumers and family members need to be brought in, and our prevention efforts include not only takeback efforts that mr. kerlikowske mentioned, but the idea of promoting the appropriate management of prescription drugs in the home. if we -- so lock boxes are one strategy, making sure that we have an informed consumer, another strategy, making sure that the delivery system educates the consumer about the potential risk of misuse and diversion of the medications, yet another strategy. and as was pointed out, we need to reach out to consumer groups and parent groups and consumer coalitions so that we can promote this cultural shift in

attitudes about these medications. >> okay. i have one more question. it appears there's a new trend of manufacturers seeking approval of new abuse-deterrent formulations near the time of the expiration of their patents. and in marketing exclusivity. so they then withdraw the original formulation from the market claiming it's no longer safe in light of the availability of the abuse-deterrent formulation. and if the fda agrees that the original formulation was removed for safety reasons and the fda is precluded from approving generic competitors without comparable abuse-deterrent formulations. and in the absence of generic versions, then patients are forced to pay higher monopoly prices for extended time periods which in turn has the potential to decrease patient access to these drugs.

um, have you heard about this? >> yes. and this is back to one of -- the discussion of the balances that are, you know, that need to be kept in mind as we think about addressing this abuse crisis. so in this case we have the necessary balance between incentivizing the development of abuse-deterrent formulations that work. we want to have opioids in formulations that deter abuse. that, i just believe that's everyone's best interest, to find a way to incentivize that while at the same time recognizing the impact and importance of the generics in the u.s. market. currently, well more than 75% of the total prescriptions, etc. accomplishing that balance is something that the fda's thinking and working very hard on. our first action was earlier in the year when we put out the guidance laying out how we would try to incentivize the development of new formulations following up on that, we're now

thinking about ways to develop guidance on abuse-deterrent formulations and how -- to generics to allow them to come on the market as well. in other places and in this place i would expect our focus would be on the performance of those generics and not on the technology that was used to make that generic. so we would require that the generics demonstrate they are abuse-deterrents. the thing that we would all want to have rather than they use the same technology. we think that would incentivize the development of appropriate generics, generics that work while recognizing the important role that the innovator plays here in terms of developing new, innovative products. >> chair thanks the gentlelady and now recognizes the gentleman from louisiana, dr. cassidy, for five minutes for questions. >> thank you, mr. chairman. mr. kerlikowske, what percent of docs write what percent of pain, of narcotics?

>> congressman, i actually don't know. i know that the information about the doctors that do prescribe, for instance, oncologists write a large number of the -- >> the oncologist pain doctors? >> the pain doctors, etc., and i think dr. throckmorton could also help me. i just play a doctor on tv. i'm with a real doctor. >> and i won't be able to give you specific numbers, we could certainly get that, by the majority of pain prescriptions are written by primary care doctors -- >> that's the majority, but if we look at those who write an extraordinary amount, you know, those that are two standard deviations out, by definition if you're two standard deviations out, you're 5%, right? so intuitively, it makes me -- if we're looking at the folks who are concerned about, i'm suspecting that it's going to be a small prosecutor writing a lot of inappropriate prescriptions. you're nodding your head. do you think that's correct? >> it depends on where you cut,

where you cut that line off, 5% or something like that. but there's clearly a minority of physicians that are writing for large amounts of these opioids, i agree with that. >> i'm not sure to whom this would go, i think one of the two of you because i'm not sure this is samsa's gig, but if you've got 46 states that have a prescription drug monitoring program, i'm a doc. i have a dea number. every time i write that number in, they know if i've written an rx. i think although was not able to confirm, these databases likewise have patient information. i keep on wondering if our goal is to find that small percent of docs who are writing inappropriately and we have a unique identifier for whom that doc is and we can look up in the phonebook and see what their practice is, why don't we just turn it over to google, let them data mine and tell us who are the crooks? do you follow what i'm saying? if we have all these unique identifiers and all these databases are realtime data,

what's the challenge in figuring out which docs are the bad actors? >> there are a couple of challenges that really do come up. one is that things can change particularly in rural areas pretty dramatically. if a physician leaves a practice or is gone and suddenly that physician taking his or her place begins to write a lot more prescriptions because they've actually taken over. >> but, but as we look at the data, i mean, knowing that the urban settings are where most of this is happening, but even if it's rural, what you describe as a little kind of codicil but still broad sweep, it seems as if we've got a unique identifier, you've got a realtime database and 46 states with it, it doesn't seem like it should be such a challenge. >> you're right. but, also, actually the real devastation has been in the rural areas. kentucky, southern ohio -- >> i'll accept that as well but, again, you've got a unique identifier, you've got a realtime database, what is the great challenge? >> i think the other challenge is that because these are individual state programs, some

within the law enforcement component, some are within the medical practice component, and each state uses those individually to determine -- >> so does doj have access to these patient, these prescription drug monitoring programs? >> does who have access? >> department of justice, or do you or does the executive branch? >> no. >> so it's entirely state jurisdiction. >> exactly. >> and so, now, we mentioned interstate compacts. i presume the states are communicating one to the other as to, listen, this fella just dropped out, he moved to your state, he's someone you should watch for? dr. clark, do you have a thought? i mean -- >> well, there are -- we are moving toward that position. it is really important to recognize that the electronic health record integration and interoperability activity is moving towards that. some jurisdictions are, in fact, trying to come up with algorithms where you can identify the outliers in terms of pain -- >> it just seems like a sort.

>> it is a little more complicated than that as dr. throckmorton pointed out in part because you do, in fact, pull in the cancer doctors or the arthritis doctors. >> i know that. but you know who the cancer doctors are. if there are 100,000 docs, there's going to be 5,000 who are cancer and 5,000 who are legitimate pain docs, and there's going to be somebody who you know just moved to this state from that state into that state. >> indeed. and that's what the electronic health records -- >> now, see it concerns me because really i don't want the government snooping in my electronic medical records. on the other hand, if we have a realtime database, your prescription drug monitoring program, that is the subset of folks who are writing rxs, and it's centered upon the position, and you can look and see here's my top thousand writers, 500 are pain docs or orr though do you see what i'm saying? >> hhs has actually done a

survey looking at part d programs and discovered it was a little more complicated because, indeed, trying to pigeon hole a practice isn't as simple as all that. but you're right with the advent of increasing monitoring capability and big data, we'll be able to make some kind of reasonable assessment -- >> [inaudible] >> of a practitioner and at least explore what he or she is doing. >> okay, i yield back. thank you. >> chair thanks the gentleman. now recognizes the yes nan from north carolina -- the gentleman from north carolina, mr. butterfield, five minutes for questions. >> thank you so much, mr. chairman, thank you for convening this hearing and thank the three witnesses for their testimony here today. prescription drug abuse is certainly a serious problem that impacts an estimated 12.5 million americans. and now it's considered a health epidemic by the centers for disease control. and so it's a serious problem. this hearing today is very appropriate. this is a conversation that we must have, and we must do something about it if we can.

in the last congress, i served as ranking member of the commerce manufacturing and trade subcommittee under the then-leadership of chairwoman mary bono. the issue of prescription drug abuse is one that was and continues to be very important to her and to me. our subcommittee held several hearings on prescription drug abuse last congress, and so i have a somewhat keen understanding and interest in stemming the growing problem. the chair then and i shared deep concern for individuals' well being, especially young people who gain access to and abuse prescription drugs. the multiple hearings that we had on this issue during the last congress made very clear to me that drug manufacturers and the drug supply chain are not the problem. with the development of next generation crush-resistant drugs, the industry is playing an increasing role in stopping illicit use. nefarious black markets and drug

diversion at the end user stage are the problem. and so the question is, how do we address this problem? while aborting burdensome regulations on manufacturers and others along the supply chain. and so i just want to follow up just a bit on ms. schakowsky's line of questions a few moments ago. abuse with-deterrent -- abuse-deterrent drugs are a fairly new addition to the market, and so what impact, what impact have abuse-deterrent drugs had on the illegal and illicit use of prescription drugs? and so just thinking out loud, i would just imagine that if one drug is made abuse-deterrent, the person will just find another drug that is not abuse-deterrent that produces similar results. shifting but not reducing the abuse. should the fda, and i guess i can go to mr. throckmorton on this one, should the fda remove roadblocks to manufacturers who

want to produce abuse-deterrent drugs so that they can speed the new formula to market to reduce overall abuse? >> yes, we should. um, and we're working to do exactly that. um, i view the development of abuse-deterrent technologies and encouraging their use in opioids as an incremental progress, process. we're beginning now to walk a road where i'd hoped to see a broad majority of opioids in abuse-deterrent formulations. that's going to help address your concern, the squeezing the balloon, if you will, the people moving from other abuse-deterrent formulation to another formulation that's easier to abuse. in the short term here, i think we'd be fooling ourselves if we imagined that wasn't going to happen. so my job, i think our agency's job is to incentivize the development of those new technologies broadly and to make certain that those technologies

demonstrate that they work. so we should be developing abuse-deterrent formulations that successfully reduce abuse through reviewing of the data. i believe the fda plays a critical role there. and then reward those new formulations and labeling, rewarding them in ways that will encourage their use by prescription -- by physicians and by patients. with a long-term goal of having a broad range of opioids that are in abuse-deterrent formulations. >> all right. let me now go to dr. clark, if i can. dr. clark, how can we educate health care providers to spot the warning signs, the warning signs of frequent flyers who might not have a legitimate need for powerful prescription drugs? do you think the implementation of interoperable electronic medical records -- you mentioned that earlier -- would help to flag these individuals who are doctor surfing only to get more and more prescriptions that they need to sell? >> indeed. we think that the

interoperability between electronic health records and the prescribing is very important. we're working with the office of the national coordinator health and information technology to achieve that. we think that educating practitioners is important. we work with the fda and the national institute of drug abuse. we both have training programs, nida med and samsa has a training program associated with boston university. we've trained over 13,000 prescribers. we work with state medical societies, sams sponsors state medical society training, and we have as a result of this broader effort that the congress has mobilized, we're fighting more and more practitioners showing up at our conferences to listen and learn about prescription drug abuse, to listen and learn about adequate pain management strategies, to listen and learn how to monitor for deviant

behaviors and also while maintaining a good balance of care because, indeed, pain is a problem. so we want to continue that effort. we think that's a useful effort. >> thank you, dr. clark. my time has expired. i didn't get to mr. kerlikowske, and i spent considerable time rehearsing your name, and i won't be able to use it. [laughter] but i yield back. >> chair thanks the gentleman, now recognizes the gentleman from virginia, mr. griffiths for five minutes. >> thank you, i appreciate it. can you please update the committee as to where the agency stands related to requirements of the food and drug administration public safety act surrounding the scheduling of combination hydrocodone products? now, i know you mentioned in your testimony that a public meeting had been held, and you said you all were relying on science, but can you tell us, you know, what you hope for or we're hoping for an update and what you think is the process

going forward on this rescheduling it? >> sure. i won't be able to talk in any detail because we've not yet formed a recommendation about the matter. our task was to respond both to the science, the request from the drug enforcement administration, to reconsider our recommendation from 2008. as well as respond to the language that congress gave us directing us to hold a meeting that included membership to solicit input on things like the impact of scheduling. we're taking those two things very seriously. as i mentioned previously, that meeting, um, elicited 760 some comments. over a hundred of them making specific recommendations for us to consider instead of scheduling. so making recommendations for other activities. we're trying to work through all of those to form the best

science-based -- >> any idea of a timeline on when you think something might come out? >> i'm afraid i can't give you a timeline. i can tell you that i understand your frustration, i understand that this is an important issue that we want to move forward. my people are doing everything that we possibly can. >> i appreciate that. thank you. now, it may come as a surprise to some of you all that virginia actually has the oldest medicinal marijuana law on the books dating back to the 1979 act. that was, however, unlike some of those where some of those states that have said where, you know, if it makes you feel good, do it, virginia actually requires there be a medical reason and there be a prescription which is not currently allowed. wouldn't you agree, doctor, that we need to have a discussion about the legitimate uses of medicinal marijuana and freeing it up so that virginia can exercise its will so that doctors can actually prescribe it in those areas that are authorized by the virginia law?

>> my own personal views aside, the fda would not have a clear role in responding to issues around medicinal marijuana. we do have a role in the scheduling of marijuana in a somewhat similar fashion that we have a role to may in hydrocodone. so there is a recommendation process that the dea requests of us. that's regarding the development of marijuana -- >> but you would agree that we probably ought to be having a public discussion about legitimate medicinal marijuana usage? >> i think i'm not going to be able to comment -- >> all right. i appreciate that. the center for substance abuse treatment recently red.c.ked an rfa -- released an rfa for medication-assisted treatment to support be physician education on the use of medications to treat opioid addiction. my understanding is the number of treatments have been approved by the fda to directly treat opioid abuse, one such drug that i'm aware of is vivitrol.

how does csat increase knowledge about those new medications? doctor? or either one of you. >> one of the things that we're doing is working with medical societies, working with the treatment programs so that they're very much aware of the existence of medication. we've promulgated advisories so that people can understand, and we're also meeting with the manufacturers so that we have a better understanding of what their strategies are. so we think this is an important issue. we work with the fda and ondcp so that we can promulgate increased access to treatment, because that's one of our concerns, making sure that people have access to new treatments as they develop and that consumers have access to those. >> i thank you. i would point out, mr. chairman, that i've heard a lot today about electronic medical records, and dr. cassidy issued

a concern, a warning. a broad interpretation of the smith v. maryland case upon which the nsa relies on in its current standing would say that if you shared your medical records with a third party insurance company, you may also not require -- i don't agree with that interpretation, but you may also not require a search warrant to get those records. i don't think that's right, but that's another day. thank you, mr. chairman. yield back. >> chair thanks the gentleman. now recognizes the gentleman from pennsylvania, dr. murphy, five minutes for questions. >> thank you, mr. chairman. appreciate the panel being here. i want to follow up on some of the questions here about drugs used to treat opioid addiction. the current published information published by the fda, and i address this to dr. throckmorton and clark, allows for the use of generic -- [inaudible] which is a drug in the context of the doctor-patient joint decision. however, there's a concern from psychiatrists who treat persons with addictions that the published indications are vague

enough to allow for misinterpretation. now, i've heard from doctors in my district there's misinformation about when a doctor can prescribe generic versus the banned strip. so it's leading to access issues because pharmacists are concerned about prescribing the generic. are any of you aware of a problem with this issue? and if not, is that something you can get back to me on or we can communicate on later? i'm not trying to trip you up, i'm just seeing if we can start a dialogue on that. >> it would probably be better if we had a little more specifics about that one. >> thank you. >> there were recent issues about generic and innovator -- [inaudible] there was a citizens' petition that was submit today our agency that we responded to. i'm not sure if that's exactly it, but we'd be happy to -- >> i'd appreciate it if we can talk directly. we're aware of all the overdoses and how much they have killed with prescription painkillers. we know that states are collecting information on prescriptions. but how this helps is still a concern. people can, one person can go to

ten different pharmacies with ten different prescriptions and collect those, and the states can sometimes then pick up if it's the same person. but, of course, john doe can also say i'm filling a prescription for my grandmother, my aunt, other things -- and the question is can we find that person in the current system who may be using legitimate prescriptions or the next step is false names, etc. how does this collecting information by the states help us in finding such persons? could some of you comment on that? yes, sir. >> congressman, the two important parts of these pdmps which are then run by the state boards of licensure, one is that a physician can have that instant access to, say, to a new patient or, you know, the number of doctors that that patient is also seeing. because these require when they fill these prescriptions identification. the other is that a board of

licensure in the states regulate medicine, not the federal government, can use that to identify a prescriber who may be above and beyond and then take appropriate steps for inquiry. i think that people do look at innovative ways around this, but the states with -- and i would recognize kentucky as an example -- that have the most knowledgeable people running their pdmps have been pretty successful in bringing this down. and, of course, the other part of that goal then is to get somebody into treatment to reduce the problem. >> well, let me add another element to this. a couple years ago congress passed a law saying people were picking up sudafed had to show a photo id, etc. >> right. >> and our concern is in terms of what you understand very well for all of you is that one person picking up multiple prescriptions for themselves, we can pretty much identify that may be an abuse, and that person can be picked up by the pdmps,

etc. one person who may be legitimately gathering prescriptions to pick them up for other family members, we have to somehow identify who's the person with the problem, who's not. can any of you comment on perhaps extending that, requiring a photo id so that person's name could be checked if they are picking up more? >> i'd certainly be happy to tell you what the state pdmps are seeing as a result of that question. be glad to do that. >> any others have any comments on thoughts that agencies may have about extending that? >> well, one agency that's not here would be the drug enforcement agency, and i think there are limitations on how people can fill prescriptions that are not written directly to them. and it'd be important just to look into that. i don't know those details so wouldn't want to try to answer. >> dr. clark, do you have any comments? >> and while we are thinking about this in a more formal way, i do know that mr. pharmacies, especially the chain pharmacies,

are requiring photo id on presentation even for the person for whom the prescription is written and whoever picks up the drug, the photo id is required. so i know that people are concerned about the issue. >> and i understand the chain drugstores then, they will begin to raise questions themselves by contacting the doctor. and, obviously, we want to stop the illegality of this, and we want to help the people in need. so i hope that's an area where we can move towards some -- this is a concrete action that congress can take on this, and i look forward to talking more with you about this. thank you very much. >> now recognize the gentleman from texas, mr. green, five minutes for questions. >> thank you, mr. chairman, and thank you for having the hearing today. dr. clark, you talked about efforts to prevent prescription drug abuse in the first place, and you've also describes samsa's treatment activities when addiction disorders rise. treatment of addiction and crucial drugs is of crucial important and we all know promising behavioral and medical approaches exist to treat this

form of addiction. the affordable care act builds on bipartisan legislation co-sponsored and supported by many members of this committee the mental health parity and addiction equity act of 2008 to insure that more individuals suffering from substance abuse use disorders receive the care they need. my first question is how do you anticipate the affordable care act will impact access to services for people who are addicted to prescription drugs or have other substance use disorders? >> one of the things that is in the affordable care act is the provision of services for mental health and substance use disorders which means that individuals who have no coverage currently and -- that has been one, that's been one of the barriers for people seeking treatment -- that barrier would be removed. so the affordable care act will allow health coverage for individuals who cannot afford the cost of care and, therefore,

would be able to engage in care. it will also allow for a broader reach for using structures like accountable care organizations so that we can identify individuals early before they develop full-blown addiction issues, risky behavior, if you will, so that we will be able to intervene at an earlier point in time. >> so medicaid and the marketplace exchanges whether they're state or national exchanges will expand the population for those who receive substance abuse treatment? >> indeed. >> okay. it's clear from your comments the affordable care act made it possible for many people with substance use disorders whether it's addiction to prescription drugs or illicit drugs to access treatment. mr. chairman, i know we've had differences over the affordable care act, but i hope we all share the goal of providing more robust treatment to those who are working over, working to overcome prescription drugs.

director kerlikowske -- close enough, i hope. with your name like green, it's not hard to pronounce. how do you track the progress in completing action items identifying the administration's plan in meeting the goals you've set? >> when we put together the prescription drug plan, we brought everyone to the table for a number of months, and all of the agreements that are made there continue into an interagency work group. so we set some specific goals, and then we bring out where those people that are closest to the problem and on the ground and had a responsibility for each of their agencies together on a quarterly basis to go over their progress. so we're starting to see -- and i come from a profession that isn't known for its optimism, in law enforcement -- but i can tell you that seeing the changes that dr. clark and the chairman

talked about from 2010 to 2011, i think we're starting to turn the corner on this prescription drug problem. >> good. dr. clark, i'm interested in hearing more about samsa's coordination with the centers for disease control and prevention on surveillance activities. for example, you testified that samsa funds is national survey collecting data on use of prescription drugs and other things, also the drug abuse warning network, drug-related emergency department visits and drug deaths. is that partnership going to continue, and if you have any more to share with the committee on that partnership. ..

>> doctor delaney is working with national center for health statistics to make sure that we get the best data possible given with the epidemiology and substance issues. >> thank you, mr. chairman. i yield back. >> the chair thanks the gentleman. recognizes the gentleman from kentucky for five minutes. >> thank you, mr. chairman. the first couple of question is for dr. throckmorton. i'm from kentucky and we been real aggressive with trying to do with the drug problem in our

area, prescription drug problem. technology has been important. in your written fisma you talked about there were two recent determinations on the fda on different formulations of oxycontin, and kenya to commit to explain why they're two different determinations of those two cases about the drug uses and technology? >> sure. i will speak in general terms. in both cases we looked at the available data on that product in specificcompan, the new form election and looked at it in comparison with the early formulation, the families that have been originally developed. and asked questions about whether not new technology promised to reduce abuse. we think it's terribly important that this bar, this bar of concluding something be high enough to be worth developing, make it an incentive, make a something we can reward in

labeling terms to make those products attractive for manufacturers to take the time and money to develop. in the case of oxycontin when you look at the data, there are important aspects of the new formulation that really did predict is going to be harder to abuse. one particular one is when people tried to make it ready to inject. it turns into a jail that is physically impossible to inject into someone's arm. some of the testing involves using people who are addicts trying to do things that would allow this to be used. and they were unable to do it. so those sorts of evidence strongly suggests that a product with those promotion characteristics is going to have reduced the attractiveness to of users in the real world. tracking the real world now going forward on the other hand when looke the look at the totaf the data around the a panicky our product we didn't see data of that same time.

it is suggested that that product was really going to be meaningfully harder to be is come meaningful meaning we would see less of you -- >> one more i want to ask. thank you for that. on capitol hill there's been a lot of discussion about whether generic prescription opioid must have identical deterrent technology or whether they would be comparable on either accede the other drug. can you discuss your perspective on this debate what you're doing and what process remains science-based? >> absolutely. i think it's very important question. we will be talking about and working internally on an planning on talking about at public meeting at the end of september and early october. what i anticipate is that we're going to rely on the generics demonstrating they are abuse deterrence, not that they use the same technology. that would be the approach that we use in other places. so the testing that we will lay out, will develop will be to decide whether or not the new formulation, however it is made,

is abuse deterrence and level it needs to be compared with the in invader. >> i would like to ask mr. kerlikowske a question. just bring this up, a very good friend of mine, tommy, head of our drug task force, you know tommy, and very aggressive in this. we get together quite often. i seem in the morning. i see them for coffee. he brought to me a few months ago that anyone has really showed itself in an alarming statistic. that seems like something that was 1970s i guess and he said because our legislators have been so aggressive with pharmacies, with a tamper resistant, another prescription drugs are more difficult to get an era when. and i just want to see, i know you're aware that. the strategy, the prescription drug abusers are now finding that out and it's easy to get harewood than prescription drugs because we been so good in

instead of trying to control of. >> and that has been going on for quite a while. the evidence across the country is that there's an increasing harewood and some of the survey instrument are showing that we have the overpopulation. there's another component about this, too, and that is young people are harewood naïve. older people really have an understanding of the dangers of heroin. young people believe that it's not that powerful, that as long as they smoked or snorted that they won't become and injecting drug user and, of course, within a few weeks they do become injecting drug user. at the same time that prescription drugs are being made less available through all of the things that you've heard about today, and the cause. and heroin is much less costly. so we have some real concerns about the heroin issue, and i couldn't agree with the drug task force commander more. >> thank you and i yield back. >> chair thanks the gentleman.

now recognizes mr. whitfield. >> thank you, mr. chairman. thank you for being with us today. i want to give a historical perspective on the prescription drug monitoring program, and since my facts are oftentimes wrong, if i'm wrong you all can correct me. and then i want to just ask a couple of questions. kentucky is my understanding in 1998 start a prescription drug monitoring program. in 2002, started the national common the prescription drug monitoring national training and technical assistance program at the department of justice. now, that was an unauthorized program because this committee has the jurisdiction. since that time it's received an average of seven or $8 million a year, and we all acknowledge and say that it's been an

ineffective program. i don't think anyone would dispute that. but in 2005, this committee that does have jurisdiction recognizing the success of that program initiated nasper. the only difference is how rogers program was centered at the department of justice and nasper was over at hhs. nasper receive funding in 2011-12, i believe, did not get funding. and as a medevac someone at the appropriations committee in the report language in the omnibus bill even specifically said no money will be spent on nasper. which i thought was a little bit mean-spirited myself, but regardless of that you three fellows are the experts in the area, and i would ask you the question, do we need nascar?

maybe we should just eliminate nasper and focus on hal rogers program. or should we try to combine them? or should we try to reauthorize nasper? i think a lot of the problems we have in the federal government, a lot of programs is that congress does not have a coherent, organized approach to dealing with the problem. so we all just give, i mean, our committee does have jurisdiction to me we should reauthorize it ends start over but i would just ask for your guidance on this issue. and each one of you would comment i would appreciate it. >> i know that nasper was designed to have a bit of a different take on the program versus the high-technology of the hal rogers pdmp. we are pleased that there is still money, seven to $8 million

each or that is made available to the states to start up these pdmps. and i would be happy to sit down with some of these interagency people, and provide some level of our expertise in what we've seen as to nasper. we would be glad to do that. >> i agree, i agree with director kerlikowske, there needs to be shy we say, a convening of mind to look at what is we're trying to achieve and how best can we achieve it. the specific program may not be the issue, it's a technology that exists that is bridging some of the limitations and it's also dealing with some of the conflicting imperatives associated with both programs. so our focus on linking prescription drug programs with electronic health records within

off the national guard in health information technology and with the support of ondcp en route to give practitioners real-time access to the amount of money pdmps has not been a large amount of money in the first place. so the strategy might be how do we best use limited resources to enhance our effort to do with prescription drug abuse problem without compromising the health of people who suffer from pain or other conditions requiring -- >> i might suggest, maybe in a private setting, some of our staff have worked with these three gentlemen, their staff, to determine what do we do to make this program even more effective? maybe all of the efforts should be generated and hal rogers program, or maybe it would be a combination of maybe there's something we could do that since the program is no longer, it's

expired at looking at we authorization i think it would be helpful to have these discussions. thank you. >> we will pursue that, thank you. chair now recognizes the gentleman from north carolina for five minutes for questions. >> thank you, mr. chairman. and thank you for holding this subcommittee hearing. thanks to our panel. i have a couple of questions in regard to patient safety for those who truly are in need of pain medication, and how, as we're trying to make the system more effective, for coming in, identifying abusers and how to use and work on the problem, how do we protect the patients as well? the first thing that comes to my mind is the sudafed issue, and how an individual has to basically show their license or

identification. and i know why that has been put in place. i'm curious as to why that approach was taken. is iis a because it was an over-the-counter drug initially? and because it is used to formulate other drugs -- dr. throckmorton, can you tell us a little bit about that approach? because i'm concerned that we might take an approach like that into the future with others. >> i want to make sure that i understand the question you're asking. so, sudafed itself is not abused. it is used to create highly dangerous methamphetamine, and you're right, it was over-the-counter. congress felt the additional restrictions that were necessary for the safe use of the product. that's different than the conversation but having around hydrocodone, where it is in and of itself is a product of the

potential abuse. one that's already under some control, the schedule iii already has -- >> so basically the difference being that the sudafed was an agent that was used to create another, and so, therefore, the idea was to find out, you know, make sure those individuals who are actually purchasing it were identified. the other issue i guess then on that is white, what other protections is the fda putting in place to ensure that patients who, who really are in need of those critical pain medications for whatever, whether they be chronic pain or acute pain, you know, what protections are in place so that again we might, you know, i hate when the pendulum swings one way when really what we neede need to dos kind of come up with a real balance. >> we think there's several things to do.

so first and foremost we've been listening carefully. so i've been now working on the opioids for substantial fraction of my time for the last several years, and a pickup or to be to sit down with hospice care workers. i sat down with cancer survivors but i've sat down with the groups that perceived need for access to pain medicine for patients that need them. i've also said that with groups that see the cost of prescription drug abuse is is having in america. so to fully understand sort of the broad spectrum of views we we're going to listen as carefully as we can. at the end of the day, one of the things we concluded was the better educated people were about how best to use these medicines, and that means multiple prescribers and the patients, the more comfortable we believe they would be in making the right choices. the right choices here could be not prescribing an opioid to avoid abuse, avoid misuse, or it could be to make a choice to prescribe it because they are

not educated well enough to know how to do it well. how to monitor the patient well, how to spot the signs of abuse, and so they are not, they are not scared to use a word, to use the opioids right. >> on that, and thank you, because i think that is the best approach as well. but it is an individual right now who, and i appreciate especially working with hospice and you know, sort of that's an area where those medications are used and i can see that issue occurring. but if there is an individual feels that their pain, for whatever purpose, whatever reason has an issue with access and feels that they're having difficulty obtaining, is there a phone number? is there a way, who does that individual reach out to? and any of you can comment on any of these things.

>> partly it will depend on what the source of not being able to get the medicine is. so if it's a drug shortage, for instance, that the drug is not available the way sometimes drugs have gone into shortage recently and where shortages within know, for instance, periodically or whatever. that's up for something the fda wants to do. i have a staff that works on a 24/7 trying to understand, prevent, minimize the shortages and weird website our website at the fda to allow people to report. if it's a pharmacy not caring the drug, those are decisions that the fda doesn't have a clear role in. and i would suggest boards of pharmacy or some other local authorities would be -- >> thank you but i apologize, mr. chairman, my time ran over. thank you very much. >> chair thanks the gentlelady and iraq dices the gentleman from florida.

>> thank you, mr. chairman. i appreciate very much and thank you for this hearing, and i thank the panel for the testimony. along with many of the floridians on concern about alum and chris a drug abuse and illegal sales of prescription medication. i believe that issue of all the prescribing and illegal use and these drugs should be addressed. prescription drug abuse is both a federal and state issue, and i've worked with both local and federal officials to take on this issue. in my district that had some of the highest oxycodone causes death with 197, hillsborough county, tampa bay area, 128 deaths from oxycodone. sadly, a nose can also lead the state and methadone death and had to go to deaths. the number of er related visits from misuse or abuse of prescription drug has nearly doubled in the past five years. recently though there was a --

pasco county where both health officials discussed the growing problem of babies born addicted to prescription drugs. pinellas county ranks first in the state for babies born a decade. florida has taken some positive steps to apply prescription drug be such as -- bill nelson to 11 the florida currently runs more drug tracking programs in addition to the controlled substance recording system. the number of doctors on the list of top 100 purchasers of oxycodone declined by 97% in a single year, and pain management clinic registration decreased by 36%. this is a good start but is much more work to be done. i'm sure you will agree. that's why i've instructed my office to look into issues of prescription drug abuse in developing of course future legislation. and again, mr. chairman, i really appreciate you holding this hearing. i had a couple of questions. mr. kirk lonski, the growing

problem of babies born addicted to prescription drug such as the oxycodone. this is a serious problem in our commuters. i would like to have you come down if you will to tampa bay area and meet some of the local officials, the health officials and providers were dealing with this growing problem. i want to ask you a question, are there any front or programs available for the local community to tap into to help with the problem either on the prevention or treatment side? and also want to talk, ask dr. clark, are the resources for my community from samhsa? so those are the questions. >> congressman, we find these grassroots program to do prevention. and, of course, oftentimes that local voice is more powerful and more important to people about prevention. and we have worked with them to help them understand and become

more knowledgeable. we find almost 700 of them around the country. to become more knowledgeable about this neonatal abstinence syndrome. because we are seeing in a number of states, florida, and i attended the first meeting of the advisory committee that has worked so hard under the attorney general to reduce that problem. it's a complex problem because there are women in pain but also pregnant that are being treated. there are women in drug programs at the same time, and so there has to be a very careful balance. but i would also tell you i would be happy to visit the tampa bay area with you and examine this more closely. >> thank you very much. i appreciate that very much. anyone else wish to comment? >> we have targeted capacity, if instead of able to states, states can use their block grants to help promote education. we are developing a strategy to

deal with the and it's a to recognize it's much broader the prescription opiates, but as you know any time a woman has to take medication while she is pregnant is some associated risk for the neonate, and so we'll try to do, promote adequate education of consumers and practitioners so that we can address these issues. we have a women's program that allows women who have addiction problems to get into treatment during the time that they are pregnant. and when they deliver, we can deal with both a mom and a child. and the data do show that the outcomes of the birth are much more positive women have those kinds of programs. but the most important thing is having concerted effort involving multiple layers at the state level, the local level, community level involving practitioners as well as our

constituents. >> thank you very much. i yield back, mr. chairman. >> chair thanks the gentleman. the house is voting on the floor. there is less than 10 minutes left to vote. that concludes the questions from the members. there might be other questions. we will submit to those inviting if you would please respond quickly. june 28, so thank you very much to the witnesses, to the members were attending. without objection, subcommittee is adjourned. [inaudible conversations]

>> if you missed any of this discussion come you can see it again at a website, go to c-span.org. we are learning that congressman mike rogers says he will not run for the u.s. senate in michigan next year. the seven term republican made the announcement today in a note to supporters but democratic senator carl levin is retiring at the end of his current term in 2014. senator rodgers chairs the house and citizens committee and he says he can have more impact staying in that job and going to be a freshman in the senate. >> media reports as saying president obama has decided to authorize lethal a decision rebels out of the white house announced it had conclusive evidence that seem president bashar allsop regimes use chemical weapons against opposition forces. the u.s. officials are still looking into what type and how much weaponry to send the opposition. arizona senator and armed services committee ranking

member john mccain made remarks about the situation in syria on the senate floor yesterday. >> the american people are war weary. they are weary because of what happened in iraq, and we remain in afghanistan. iraq is unraveling by the way, but americans are weary. they are tired of reading the casualty risks and the funerals, and the terrible tragedies that have befallen american families. that's why neither i nor the senator from south carolina are saying we want boots on the ground in fact we don't want boots on the ground. we know we would be counterproductive. we know it would not lead to victory. but we do know we can provide incredible assistance and change this battlefield equation. and, finally, because a lot of americans haven't paid perhaps as much attention as some of us, and maybe because they are war weary, i think it would be wise if the president of the trend in

-- united states would go on television and explain to the american people why we are stopping this genocide. why we're assisting these people who are struggling for the same things that we stand for and believe in. why the united states of america went to bosnia for their power, not put boots on the ground. why we went to kosovo and didn't put boots on the ground. and how we can help these people while alleviate the unspeakable misery of the syrian people. >> and during today's white house briefing we do expect questions on syria to. that is scheduled for 12:30 eastern. live coverage here on the c-span network. >> the chairs of the u.s. house and senate tax writing committees are speaking to reporters debate about what the committees might do on tax reform. you can see the comments by democratic senator max baucus and republican congressman david

can't tonight at eight eastern on c-span. >> i do think what we are doing does protect american civil liberties and privacy. the issue is the date we have not been able to explain because it's classified. so that issue is something that we're wrestling with. how do we explain this and still keep this nation secure? that's the issue we have in front of us. and so, you know that this was something that was debated vigorously in congress. both the house and senate, within the administration, and now before the court. when you look at this, this is not us doing something under the covers. this is what we are doing on behalf of all of us for the good of this country. now what we need to do, i think, is to bring as many facts as we can out of the american people. so i agree with you but i just want to make that clear because

from the perspective is that we'rweare trying to hide somethg because we did something wrong. we are not. >> this weekend on c-span, the senate appropriations committee look that u.s. intelligence agencies secret data collection programs saturday at 10 a.m. eastern. also this weekend on c-span2's booktv coverage of the publishing industries annual tradeshow. book expo america saturday at 1:30 and on c-span trees american history tv lectures in history from the end of slavery to separate but equal, sunday at 1:00. to c-span to libra has reached a milestone. since its online launch in 2007, there are now more than 200,000 hours of original c-span programming, public affairs, politics, history and nonfiction books all totally searchable and free. a public service created by private industry, america's cable companies. >> former suggested hillary

clinton says she's going to be focusing on early childhood development, women, children and job creation in her new role as in the clinton foundation. she made those comments at the third annual clinton global initiative meeting in chicago. you will first hear from former president bill clinton. this is about half an hour. >> this last six months for our foundation has been a very interesting time. for the last couple of years, chelsea has been spending about half her time on foundation were. just got back from asia using our projects in malaysia and cambodia and visiting the efforts of our cgi partner, proctor and gamble, amy marr, burma, where our foundation is also so to do a lot of work. and i'm very grateful to her for helping us spearhead a realization and try to put all of our forces in one place.

and i was thrilled when the third member of our tiny family, hillary, said that she wanted to come in to the foundation and resume her work. i learned all about ngo work from hillary when we were going out. she was already active in many kinds of nongovernmental activities. ..

people who really know what they are doing. so i would ask you to join me in the first he's been at many cgi meetings in the past but never as a principal in the clinton foundation, former senator and secretary of state, hillary rodham clinton. [applause]

thank you. thank you so much. [applause] good morning. thank you. it is such a pleasured to be here in chicago participating as a private citizen, as a co-host of cgi and as a representative of what we are officially remaning the bill hillary and chelsea clinton foundation. i am thrilled -- [applause] to fully join this remarkable organization that bill started a dozen years ago, and to call it

my home for the work i will be doing, some of which i will outline today and also will have an exciting announcement tomorrow as well. i listened to my friend referenced a black hawken gain and i can remember listening to the black hawk game on the radio when i did my homework all those years ago. my father and brothers and i were great blackhawk fans. but the free olver times? really? i can imagine there is a sense of euphoria and exhaustion affecting many of our chicago participants today. i heartily endorse the mayor's call to go black hawks. i want to take a privilege first to acknowledge the imaginative

and the visionary work bill has done with the foundation and all of its constituent parts. i personally believe he is given philanthropy and problem-solving a new paradigm. and we have seen already this morning starting with the reports of the commitments following with the mayor's what that means to look at solving partnerships through collaboration. and i am very proud of what he has accomplished. i am also a very proud mother because charles c.'s role is expanding and this is a labor of love for our entire family. in just a few short years, she has helped the foundation why in the reach to a new generation of young people through the cgi

university most recently this year held at washington university in st. louis. we are bringing together more than a thousand innovative students from around the four old to work on tough challenges, many of them are inventing products, creating new approaches to problem-solving and chelsea has been our leader there. she also has become the foundation's action program to organize community service campaigns across the country as well as working on the range of the initiatives in childhood obesity to other health disparities. i was thrilled when bill said she was in myanmar burma delivering the 6 billion with, with a b, as part of a cgi commitment by procter and

gamble. we are so excited to have in this partnership among the three of us. [applause] this is my first time at cgi america. i was fortunate to attend the annual cgi meeting in new york speaking on behalf of the administration in the past years. i want to thank the terrific staff and all the sponsors, and particularly prime sponsor and long-term friend, jd prisker. people have really made this conference a destination. it's not surprising that it would be held in chicago since the conference itself began as an effort to put our heads

together about renewal in america. and chicago has long taken its inspiration as a rising phoenix, and i think that is absolutely appropriate as someone who was born in this city and has spent so many years growing up here and coming back and visiting, it is exciting to see what it looks like, what it's doing, and i appreciated the mayor emmanuel telling us about all the other tasks that are being undertaken to ensure that chicago is a global destination and in fact a competitive cities across the world. now over the years there have been more than 2600 concrete commitments to action at cgi.

i traveled the world quite extensively the last four years and one of the lessons i took away is that this model of partnership and commitment is at the heart of what we need to do to meet the challenges of the 21st century. the world is increasingly interdependent and interconnected. all the problems that we face from climate change to financial contingent to nuclear proliferation are complex and crosscutting for any one government for any government to solve alone. what i call smart power at my time in the state department included reaching out to tap the energy and experience and expertise in the civil society and the private sector of course, anyone who was working

to solve problems and wanted to collaborate with others who sought the same way. i wanted to encourage diplomats at development experts to view public-private partnerships as one of the most important problem solving tools. it's more important that we do that here at home and around the world in order to unleash the talent of the american people and catalyze the investments that we need. we understand you can't look to the government to solve all of our problems and you can't trust the market will solve problems. we need partnerships that bring public servants and private leaders together. that's what you will see here at cgi america. we have a lot of work ahead of us, and i excited to be putting

my efforts into it and i wanted to just briefly describe to you what i am going to do in my role at the foundation. certainly i will be focused on applying the lessons learned from and around the world and building new partnerships across our entire portfolio, but particularly in a three brought the areas that have been close to my heart my entire adult life. early childhood development, opportunities for women and girls and economic development that creates jobs and gives more people in more places the chance to live up to their own god-given potential. i will start with the early childhood development. and i want to begin by thanking jd and the pritzker on this

issue. it may surprise some that early childhood development is adopted as an issue at the very first cgi america gathering because people don't necessarily equate babies and toddlers and preschoolers with competitiveness and also help the kids and loving families need no economic specification. that's what everyone should want and work for. but ask yourself if we don't apply what we know to help and prepare our kids to the best of their abilities, to take their role in our country and in the world are we really going to be given to maintain the american dream? are we really going to be able to provide that upward mobility that has been a hallmark of america's journey?

but don't take my word for it. ask yourself this colin why is it china is providing 70% of its children with three years of preschool by 2020? why does the united kingdom decide in the late 1990's to invest in universal free preschool on a community-based centers and encourage businesses to provide workplace flexibility for parents. only half of our children receive early childhood education, some of it very honestly is not of high quality. very few parents, whether they are in a two-parent family or a single parent family have the kind of flexibility that enables them to do the most important job in their life, parent while doing their job bringing home the income that keeps their family going.

so the fact is jb pritzker and i talked about this at length last night. there are huge economic implications and how our kids are prepared. the new brain research bill was referring to tells us what happens in the first five years of life has a dramatic effect on leader development to lead a 700 new connections are for murphree second laying the foundation for learning behavior, health and all the other things we need to do to grow up as productive adults. right here in chicago, the nobel prize-winning economist, james had men at the university of chicago, has pioneered research into the broad benefits to our society and our economy from early childhood development. he has proven time and time

again and he will tell any group that is willing to listen every dollar we invest can yield savings of more than $7 down the road by improving achievement and graduation rates while reducing problems like teen pregnancy and crime. some of the answer does lie with the government like president obama's proposal to expand access to high-quality preschool. but, there's also the responsibility that has to be met by parents and families, by businesses and communities who are at the center of this challenge. so, i particularly want to applaud the commitment progress that jb announced this morning and the the ways he's going to be modeling along with goldman sachs and other partners new ways to finance early education for some of the most vulnerable

children. these social impact bonds can be an important innovation for learning community and the broad impact investing community. i also want to recognize the commitment by the david and vlore the foundation and its partners to create networks of child care and early learning provider's the will pool the resources, share best practices and create economies of scale to lower cost and improve quality. from my early days of the children's defense fund working on behalf of special needs children being denied access to education to bringing a program called the home instruction program for preschool youngsters from israel to arkansas to give parents support and guidance and hosting the first ever white house conference on the early development and learning to

working and expanding early headstart this has been a cause of my life and will now be a growing priority of the clinton foundation building on the work that we are already doing. [applause] and committed to rigorous measurement and evaluation. here in chicago we will be developing with the early childhood working group and with leaders and that the kids who are here and putting sarah martinez who you will hear from shortly, and tomorrow the clinton foundation will launch a major new partnership on early childhood development and collaboration with the scientific health and advocacy communities. i can't give you the details today but our goal is to help parents, teachers, businesses and communities learn from and apply the latest brain research

to take meaningful and manageable steps to improve the lives of their kids in the first five years. some of it is found so simple you will ask why would we be even talking about it like encouraging parents to spend time reading and even talking with their children especially their infants, their babies. but we know it stimulates cognitive development. how do we make sure that parents know that it's an absolutely free way of helping to prepare their children's preschools. how we make sure that pregnant women particularly poor women understand the nutrients they should take to support their own and their babies' health? how do we inspire more businesses to ease the work related burdens for parents of

young children? so i look forward to talking and working with many of you, of course those of you in the early childhood community, but also expanding this conversation to the private sector, to government officials, to everyone who connects district line by what happens in those early months and years of whether or not we are going to maintain our standard of living as a nation. now second, it will not surprise you i want to work to create more opportunities for women and girls. i made it is a focus of american foreign policy because it's not only the right thing to do. i think it is the great unfinished business of this century, and it is also something that will enhance our competitiveness and the stability of the world at large. now research shows that when women participate --

[applause] when women participate everyone benefits. this also should be a no-brainer. when women participate in peacekeeping, we are all safe and more secure. and when women participate in politics, the effects rippled across the society. [applause] american women went from holding 37% of all jobs 40 years ago to nearly 48% today. the productivity gains attributable to this increase account for more than $3.5 trillion in the gdp growth over the last four decades. yet when the economist magazine recently published a glass ceiling index ranking the

country is based on factors like opportunities for women in the workplace and equal pay the united states isn't in the top ten. one of the factors they look at, women hold less than 17% of the seats on corporate boards in the united states far behind other developed economies in norway for example it is more than 40%. research by the world bank and the international monetary fund shows that eliminating barriers to the women's participation in the economy boosts productivity and gdp for the entire economy is. i think that is growth we can't afford to ignore. other countries are taking notes. just this month the prime minister of japan said he wanted to put women at the heart of his economic agenda to expand access to affordable child care and parental leave and from

businesses to appoint at least one executive. he said women are japan's most underused resource, and he's right women are the world's most underused resource so i will continue championing their rights and opportunities of women around the world, but i don't want to forget the women and girls here at home making equal pay a reality and expanding family and medical leave benefits encouraging more women and girls to pursue careers in stem, science and technology engineering mathematics, and we heard a great presentation and the manufacturing community to improve productivity for the women and production. now we need more efforts like the commitment by capital one to create a training program for the veterans who want to start and grow small business. that is a wonderful idea.

let me thank all of our american partners and i look forward to working with you on behalf of the women and girls here and around the world. that brings me to the third area of my passion which is very related. economic development that creates good jobs and opportunities especially for young people, who face an unemployment rate double the national average, and for all of those left behind for our fast-changing economy. now there are important debates to be had about how the government policies can best stimulate growth and increase economic and social mobility. but this can't be just a conversation about washington. we all need to do our part. that's why the u.s. conference of mayors work on infrastructure is so important and such a good example because we have to prove again to ourselves as well as the rest of the world that our public and private sectors can

work together to find common ground for the common good. so smart investments in infrastructure are important, and over the next two days we will be highlighting dozens of commitment and partnerships to improve the country's competitiveness from boosting energy efficiency to expanding work force training to the supporting small businesses. we will hear from practitioners like the school superintendent in texas who started a door to door counseling for people in his district who dropped out and a new vocational training program to prepare students for good jobs or the mayor of rockford a lawyer working with local businesses is launching manufacturing co lops to offer opportunities for residents in public housing coming out of the prison system and others who often find every door closed or the head of the american federation of teachers who

brought together 100 partners from government, business, labour foundations to revitalize a county in west virginia where more than one-third of the residents live in poverty, two-thirds of the home are substandard and only half of the residents have a high school degree. this is not limited to one county in west virginia. in too many places in our own country the community institutions are crumbling. social and public health indicators are cratering and jobs are coming apart and communities face the consequences. you probably have seen that the life expectancy come along devotee for the american women has dropped without high school educations.

one, smoking and the member to, the lack of a job and connectivity and meaning and purpose. the disconnected young men in the society. we have to tackle these problems. so whether it is in west virginia or anywhere else, the problems didn't start with the latest recession. there is no single program or investment will turn things around immediately. schools, jobs, infrastructure, public health are all connected. that is what they are designed to do as well, to bring together the best ideas that wherever they come from the find the most innovative solutions, most committed partners in an integrated collaborative way.

after 112 nations for four years i'm still jet lag. [applause] i.t. we treat basic lessons to but i look at the international polling data to try to figure out what people in the world particularly in the developing countries really wanted because the headlines are often filled with all kinds of stories what it adds up to give it all the research needed the same point. what people wanted was a good job. it didn't matter where they live or their race or their religion they wanted a good job, governments and business haven't been able to do that in many places in the world today.

our country's greatest advantage lies in the values that the man at the heart of the american experiment. freedom, equality and opportunity. my husband is fond of saying if you play by the rules, you will prosper. you will be able to make a better life for yourself and your family. we cannot afford to lose that core belief. i learned that lesson not far from here growing up in park ridge. one of my earliest memories as a little girl is helping my father in his small fabric printing business here in chicago lifting the silk screen, holding the hand squeegee. a lot has changed since then. technology and globalization, remaking our economy and our society, but our values still

inspire the world and they still can buy our way forward. finally, third, but this meeting is about and what i feel we have to be about is working together, overcoming the lines that divide us whether it is partisan, cultural, geographic, building on what we know works, we can take on any challenge that we confront. i'm excited to be here to be one of your new partners. thank you for participating in cgi america for your ideas coming your perspective and most of all for your commitments. you really are part of the solution. thank you. [applause]

>> president obama heads to ireland next week for the group of eight meeting for industrial nations. last year it was at camp david maryland. they will meet to discuss economic growth are not the world pity couple of the president's advisers will be at today's white house briefing to explain the goals for the meeting. the deputy national security adviser for strategic communications and special assistant the president for international economic affairs carol lynn atkinson will preview the trip to germany. we will have live coverage of today's briefing that will start in about half an hour, 12:30 eastern on c-span2. the chair of the u.s. tax committee are speaking to reporters today about the committees might do on tax reform. you can see the comment by the democratic senator max baucus and republican congressman tonight at eight eastern on c-span. born in charleston in 1898. of the father was a slave.

she started her teaching career in 1916 and a rural school on john's island, which is off the coast of charleston. she continued her career in an urban schools in south carolina and spent most of her teaching career in south carolina. then in 1956 the state of south carolina passed ball for the state employees from the longing to be subversive organizations such as the naacp and she lost her job and her retirement and then she developed a citizenship education program to be used during the civil rights movement. >> the life of the teacher and civil rights activist. this weekend as book tv in american history tv look at history in the literary life and rolling -- raleigh north carolina.