>> tonight on c-span2 the european parliament debates the nsa's electronic surveillance program. that is followed by a discussion about protests in turkey and later a house hearing on the problem of prescription drug abuse. the european parliameparliame nt delayed at the nsa's electronic surveillance program on tuesday. e.u. ministers were critical of the u.s. government's collection of private data as a violation of privacy. here is part of that debate. >> a commission statement on u.s. internet surveillance on european citizens. the nsa's presence --

i would like to inform my colleagues that during this debate there will be a round of speakers on the various political groups you will not deal to use your blue cards and i will now give the floor to commissioner borge. >> yes madam president. thank you. i'm reading the statement on behalf of the commission and i'm here today instead of the vice president who was unavailable. the commission is concerned about recent media reports that the united states authorities are processing on a large scale the data of european union citizens using major u.s. on line service providers.

programs such as the so-called prism and the laws on the basis of which such programs are authorized in danger the fundamental right of privacy and to data protection of e.u. citizens. the prism case as reported in the media is also likely to reinforce the concerns of e.u. citizens regarding the use of their personal data on line and in the cloud. already in 2012, 70% of the e.u. citizens were concerned that their personal data could be used for the purpose of their been the one for which it was collected. the prism case as reported in the media also highlights the difference between the european

union and the united states approaches to data protection. whereas in the united states legal system only u.s. citizens and residents benefit from prosecution and safeguards. in the european union everyone's personal data and the confidentiality are recognized and protected as fundamental rights irrespective of their nationality. these reports are particularly worrisome. the issue at hand is not a new one. it has been tackled by the commission in the past. and to give a single example. the commission has raised the access to personal data of europeans, of european citizens in the framework of the negotiations with the united states for the general data

protection in the field of police and judicial corporations. as you know very well vice president redding has received a mandate to negotiate this agreement with the united states and she is keeping this house and its particular members of the labor committee informed about the progress of these negotiations. the commission is asking for clear commitments from the united states to the fundamental right of e.u. citizens for data protection and in the same way as it is afforded united states residents. as far as the prism program is concerned, the commission will raise this matter with the united states at the earliest possible opportunity.

it will request verifications as to whether access to personal data within the framework of the prism program is limited to implemented cases and based on increased suspicions or if it allows bank transfers of data. vice president redding will raise this issue with force and determination at the upcoming e.u. u.s. ministerial in on friday in dublin. beyond context with united states, the european union can also act by making sure that it equips itself with robust legislation, able to confront such situations and i referred in particular to data collection. under the current new legislation the 1995 data protection directive, when the

rights of a member states are concerned, it is for a congressional judge to determine whether the data can be lawfully transmitted in accordance with requirements with a national, european or international. the commission believes that these concerns need to be further addressed. this is the aim of the proposed general data protection regulation. the reform proposed by vice president redding maintains current high-level of data protection in the e. u. by updating citizens rights, guaranteeing they know when their privacy has been violated and making sure that when they are -- is required the consent israel. more specifically, the e.u. data

protection reform should ensure that the european union is able to in particular situations such as the prism program through its data protection rules with a clear vision of territorial scope. non-european companies when offering goods and services to european consumers will have to apply the e.u. data protection law, a broad definition of data, clear responsibilities for processors and strong rules for international transfers. the proposed general protection regulation reflects our view that in order to avoid -- access by third country law enforcement

authorities to the personal data of e.u. citizens held on the servers of u.s. companies should be done via establishing terminals such as the e.u.-u.s. mutual assistance agreements. the european parliament has submitted amendments to further clarify in the provisions the conditions under which the judgment of a tribunal of a third country is enforceable under e.u. law. the commission will look at these proposals. madam president the commission believes that the quick adoption of this proposal would resolve any major loopholes created when companies collect personal data

of european citizens and different sovereigns. the commission therefore comes on this parliament to support the objectives and principles of the e.u. data protection reform with adoption. thank you very much. >> thank you very much commissioner borge. i would like to give the floor to claudine pepper. >> and president, commissioner, my data belongs to me. that is the cornerstone of the european thinking on delta protection. the state also recognizes that my data belongs to me. i decide what happens with it. that principle must be respected by the state. at those boundaries must be

taken seriously. reports from the u.s. are cause for great concern. it is good that we are discussing the matters here today. it is good. we need to look at the right way to handle personal data. it is completely unacceptable and i would like to make that clear on behalf of the edp, it's completely and acceptable to the united states of america has different rules governing access to personal data particularly u.s. citizens and citizens on the other hand. we now need to define our targets and object this. first and foremost we need transparency we need to know what's going on. vice president redl in and the commission as a whole has the full support of the european parliament when she calls for clarity in dublin.

we need to look at the implementation of existing rules. we want transparencies from companies at google, facebook and other companies active in the u.s.. in europe their customers need clarity. it's access his access being provided to the state or not? what about the u.k. likes there are reports that the u.k. service -- secret services are allowing access to the data of european citizens. we need clarity from the british government. we need common standards, joint standards. the commission is working on a framework agreement for judicial cooperation. this is good. this is something we welcome. perhaps we also need a framework agreement on the private data. we need local state standards agreed with u.s.. that is something that we should work towards for personal data.

we need the european cloud. if european data is to be stored in the cloud it should he held in europe. then we can guarantee to our companies and citizens that the state is being stored and secured according to european standards. we need the modern e.u. data protection legislation. we cannot call our u.s. friends to order if we do not have the highest most modern standards implemented here in europe. there are developments that i have concerns about that regards the quantity of data being stored. we need to look at the technology to analyze this data where progress is made. we must be brave enough to set clear limits and standards along the lines of what the commission is proposed. on the ninth of july we will be voting in the committee. we cannot leave ourselves open to blame. we cannot hesitate. i will call on the council to stop focusing on the minor

points of detail and relook at the major challenges being faced today and come up with the results. finally it's important for the epp today that we reiterate that the u.s. is her partner. our partner. we are not in a position to build standards when it came to international terrorism, organized crime, european authorities however did benefit from the analysis carried out. bomb attack was prevented in germany because we have been tipped off by u.s. authorities. a second attack was prevented so i would like to reiterate loud and clear that the u.s. is our partner. when it comes to swift we are still waiting for the commission to come forward with the european proposal and for the european system to analyze financial transactions. the u.s. approach u.s. approach is not our approach that we work together as but we work together as partners to achieve our common goals. thank you very much madam president read.

>> thank you very much. now on behalf of the -- for four minutes. >> and president and commissioner the events of the last few days the information published by the guardian last week with regard to the u.s. system surveillance called prism and acted by the nsa allegedly in cooperation with i.t. world giants like apple, facebook, google, microsoft, skype, you youtube and al well trusted major giant companies of course shocked they are european citizens and for the acidity group we are very clear that while security is important this has caused for our citizens a major breach of trust and for us in the snd group the ministerial meeting on the 13th and 14th of june is something that we regard as vitally important for the parliament and all the

political groups give the commission their support and holding to account eric holder, the united states for what they have done in transferring allegedly bulked information, information of our citizens which may be completely unnecessary in the fight against terrorism and the fight for security of our citizens, unnecessary information which then breaches trust in the way that data is secured under the fight against terrorism and the fight to maintain security. it's that balance between our security and the need to protect data but a vital balance. the report in the guardian and "the new york times" assures that these companies that required by the nsa to share information for antiterrorism purposes under the visa -- fisa court orders are set to do so and facilitate access to their servers to u.s. intelligence agencies possibly offering the

u.s. intelligence community the possibility to send directly to company managed secure on line rooms. they are particularly concerned that generalized access to mass processes of e.u. citizens data for law enforcement or other purposes may have taken place after the responsibility of the above-mentioned companies and the framework of this program in a way that is not compliant with e.u. data protection legislation in force. we are also worried by the absence of an overall framework for ensuring the protection of personal data especially considering negotiations with the umbrella data protection agreement to join the e.u. and u.s. are ongoing since 2011 seemed to have stalled. for all of these reasons we wish to ensure that the commissioner holds to account the u.s. and to ensure that the u.s. public authorities when they are

processing u.s. citizen data do so within our standards. secondly we wish to reaffirm our commitment to high-level data protection reform package along the lines originally in her proposals reinforced by amendments tabled by the profiteers improving protection requires. in this context became a quite clear that an e.u. data protection for law enforcement and security purposes by public and private actors remains extremely relevant and cannot be delayed. and finally we believe that the special data protection and data loss will be required while negotiating the e.u. u.s. tt ip agreement in order to safeguard the maintenance of primary e.u. legislation in this field. we are well aware of the commitment of the commission to hold the u.s. to account in relation to data flaws but is extremely important in light of

the prism and nsa issue that you citizens are assured of what happened in my own member state united kingdom. there is serious concern as to what has happened and trust is clearly has clearly been breached. it's up to the e.u. to play its role in ensuring that we hold to account what the united states has done in this case and that our standards are being assured that the right standards are maintained. >> thank you very much. colleagues let me remind you that the decision of the political groups, there is no procedure or blue cards in this debate and that was not -- speakers of the political groups. now i will kindly ask colleague in feld to take the floor for three minutes. >> thank you chair. colleagues, commissioner,

500 million european citizens were very shocked last week to find that a foreign nation has unlimited access to every intimate detail of their private lives. this is a very big issue. in the united states this is considered to be -- as the germans say. it was the president himself who came and answered questions of congress and the media. so what do they see in europe? first of all with all due respect to the commissioner we get the commissioner for public health to deal with this issue. while president barrasso who should have stepped into his helicopter and flown to strasbourg to answer to citizens we have at least the responsible commissioner to come to the house. where's the responsible commissioner? why are there prime leaders of your peer? we also need to look at ourselves, colleagues. look around you.

this house just over a decade ago when faced with similar situations something called echelon we decided to set up an inquiry into echelon. today we address 500 million citizens. we are failing the european citizens at a time when trust in the european union is at an all-time low. we should be ashamed of ourselves. and then to the subject matter itself. first of all, we have to be very surprised to find that the americans are spying on us because we knew about it. we have been asking questions again and again and again but asking questions to the commission is like talking to a wall. i have a long list of long answers about fisa, but the patriot that and about the application of u.s. law and we get no answers from the european

commission. the member states because there's a national debate about the same issue everywhere now, mrs. merkel we are asking the air americans for an explanation. all the member states including the u.k. and any member state, the member states are speaking doublespeak to the citizens. are we surprised that they are losing trust and actually you can say the citizens don't trust their governments anymore but the government seem to trust their citizens even less. we are also losing moral authority here. how can we tell the governments they say egypt, iran, and the other country that they should not spy in their citizens because that has no place in democracy. if we are doing the same for our citizens we are losing credibility here. on the special relationship ,-com,-com ma i have heard nearly all the colleagues here refer to the special

relationship with their best friends and closest allies, the united states but i don't know if you listen to the statement of president obama when he was addressing the american audience who were worried. he said don't worry, we are not spying on u.s. citizens. we are only spying on foreigners. foreigners, so that is us. that is the european citizens. so what kind of a special relationship is that? over the last 12 years europe has bent over backwards to be the closest ally of the americans in the fight against terrorism and i'm sure we will continue to be their ally. we need to see eye-to-eye and we expect the commission and with all due respect and i'm grateful you are here commission aboard, this is a matter for political leadership. we need political leadership in europe to defend the rights of our citizens and the time is now. [applause] >> thank you. now we will give the floor to --

[inaudible] >> thank you very much chair. dear colleagues and dear commissioner i completely share the concerns which have been raised by all the political groups here and i would like to say that it's not only data protection, it's not only the small technical issue. this is about the rule of law and about democracy because both of them are not in line with mass survey ends, they can't be in line with mass survey and said answer people all around the world so we need to stand up here to say clearly mass surveillance is not what we want to have and we need strong data protection rules. we needed as a reconditioned for democracy for rule of law and also for security and trust in the market as a whole. so therefore it's a very good issue that we react as europeans

with creating our own standards of data protection safeguarding the rights of our citizens in the first place and decide as quickly as possible on the proposed regulation on data protection with strong standards and also with regard to state transfers. this is about companies processing personal data, masses of personal data and giving the opportunity to states authorities to access them. if you really want to have a safe european cloud we need to make sure that we have strict and strong e.u. data protection rules which are then also enforceable and which create clear set of state transfers only that will help for the framework agreement for data protection with the u.s.. i would like to work on it and i would like to agree on standards with the united states but therefore we need movement on the other side of the atlanta.

we planet. we need some legislation. we need some legislative changes because without legislative changes we will not come to a common basis. thank you very much. >> thank you very much. >> i will give the floor now to my colleague. >> commissioner, the debates here today are about increasing the trust and the faith of citizens and holding to account governments and agencies that serve and protect them. those companies already named and shamed have so far denied acting outside the law. governments in the european commission have expressed concern this morning but rightly acknowledged that it is currently two early to draw final conclusions. yet here we are already pointing the finger. some of you are the expressing strong anti-american or anti-commission rhetoric that is all too familiar as is the

opportunism and grandstanding without pausing to gather facts or proof. because this is most danger to the practice of convicting a defendant before the trial, this problem is currently working hard on reforming its data protection rules and still pursuing agreement on data exchange with the united states something which i and my group support. key to the success of being able to protect our citizens beyond their own borders is the relationship with other countries. yet i would caution the way some members in this house articulate themselves does little to bring us together and values but instead pushes us further apart. her texting citizens from threats is a balancing act. intelligence agencies are often lambasted for not acting soon enough and then equally condemned for going too far. their successes are celebrated in private and their failings are only to the public.

increasingly as we know terrorists and organized criminal groups use information a tech knowledge he against innocents and sons. therefore there must be an expectation that the same technology will be used in our response. that information must have course be used and respected in the confines of legal oversight. we must understand that we do not gain more freedoms by taking others away and their greatest asset will always be the rule of law. that is why sometimes it is necessary for us politicians to remind those with less visible power that ensuring freedom and the safety of our citizens must not, the ultimate price of sacrifice of democracy. but it might also be worth some people in this room remembering who the real enemy is and where it is and when we want answers

and the truth the friends lists and most when you talk and not when you shout madam president. >> thank you very much. >> thank you very much. dear commissioner, i am disgusted by the leaks of the secret prism program of the nsa. the agencies since 2007 has been harvesting information and assessing information on our citizens. all electronic medication passing through american channels. this shows that they are violating the privacy of our citizens and our rights. we must not admit this spying on

european citizens. ill eagles monitoring of citizens is illegal. that is why american companies which have about access to this type of data, to the u.s. government, they have violated e.u. legislation and we have to investigate this issue and we have to adopt the same measures and sanctions against these companies which we apply to others who violate our laws. the behavior of our american partners is regrettable. >> now i give the floor to colleague benazir. >> thank you madam president. hearing you speak commissioner i

have to ask -- and i know it should have been mrs. redding hand but there's nothing but the revelations that confirm the fact that all of us have been announcing for some time regarding the privacy rights in the united states. in may 2010 the president told us himself how well the u.s. constitution protected u.s. citizens rights. thanks to snowden we know that the nsa has the service of at least nine major internet companies. now others say we didn't know this at all. we examine requests very carefully. the source of the greatest concern to us is something said

by president obama himself. he said this quite boldly. he said internet surveillance does not lies u.s. citizens or people living in the u.s. territory. a judge has to authorize -- it has clearly been violated. we have proof here that anybody else can be put under surveillance freely. the european citizens do not enjoy the same rights as u.s. citizens. data is being garnered in bulk without any way of -- you are confirming this. we can't anymore allow achieving

absolute nothing. we want our citizens in europe to have their day to protect it. the situation has been going on far too long. let's put an end to all this hypocrisy. the evidence of the facts are perfectly clear. we must make sure that u.s. respect the privacy rights of the european citizens. thank you. >> that next speaker for one minute. >> president, ladies and gentlemen what would you say if the u.s. secret services were watching you night and day, tapping your day then recording it? you wouldn't be happy with that. that is what they are doing with internet traffic of millions of people. this house is responsible for the protection of fundamental rights. this program breaches basic

rights. what are we going to do? when it came to swift -- we were taken for a ride that the u.s. authorities. it cannot be this time with the grasp and we lift up our responsibilities and put our minds to ending the program. we should instigate an inquiry to see what legal implications arise from the program, what european secret services benefited from the data. and finally we should have u.s. representatives invited to this house to be accountable to it. the way we are going now is just leading away from free democracy. >> finally i will give the floor to commissioner borg. >> thank you very much madam president and the commission i must say shares the european

parliaments concerns on this prism scandal and i shall inform vice president breading of our conversation today. mrs. redding would address the -- on the 19th of june which we will -- which means she will discuss the development which will take place until that day but will also refer to her negotiations and meetings in dublin next friday. in fact she will raise our shared concerns at this meeting next friday in dublin and also address further -- with united states attorney general holder. of course, there are two trains of thought that are not related

to each other. one of them is that we should clarify with united states and make it clear that whenever a european citizen's information is concerned european rules should apply and that we are not happy with the level of detection of data information from the united states in particular even if he read as mr. mariah said, there is a difference in the whistleblower of a facility for which information could be accessed by a person who has leaked this information. in fact he said the government has granted, referring to his government, the government has granted itself outward. it is not entitled to it. there is no public oversight. the result is people like myself

have the latitude to go further than they are allowed to so we are entitled to ask questions in the next summit on whether this has been done with regard to the european citizens. at the same time, i appreciate the remarks. let us not forget who the enemy is and i can comment as a former ministerial leader leader for 10 years. what would a for -- fight against organized terrorism be without the collection of proper intelligence? but the frustration of any law enforcement agency is it should not be a frustration. that is why terrorists and organized crime have no rules to go by law enforcement agencies in a democratic country by rule

of law cannot use anything but the gloves of law and order to fight -- which is why i appreciate the comments of others who have said we have a special relationship with our u.s. partners. we have solved important investigations regarding the prevention of terrorism through shared information with our special partnership but no one should use this special relationship not to abide by the law. and not to abide by international -- so this is a balancing act of retaining this partnership. but because there is a partnership that involves not only rights that keep our obligations because of the relationship as special than the obligations should be special as well and no one should be taken

for granted. i appreciate also madam inver's comments on this issue and also what mr. -- said about who the proper enemy is. i would like also to record within the context of the proposal for the reform of data protection you appreciate the positive comments which have been made by different members as to the importance of adopting this new package proposed. the commission has made it clear that the extraterritorial application of laws by countries may be in breach of international law and establishes, the reform establishes legal channels that should be used. the commission is ready to consider any improvements they european parliament would consider necessary in this respect. that is why we need to work for

swift adoption of a package that some of the member states would like to see delayed. it is our common interest to work hand-in-hand in the direction but more so in view of these reasons. thank you madam. see the following day in the european parliament e.u. foreign affairs chief catherine ashton briefed members about political unrest in turkey where protesters have been demonstrating against the government of time minister erdogan. this is an hour. >> there are sound reasons in terms of our debate on turkey and by way of information i would like to give the floor to the heads of the eea s.. lady ashton from the european commission reports to us on the situation in turkey. >> thank you very much mr. president. as you said in many ways a sad

situation. can i say to you distinguish members of european parliament i am very grateful for the discussions i've had with some of you over the last two days here. as you have seen last night turkish police launched major offenses to remove -- the intensive use of water cannons and tear gas and violent scenes we saw in ankara and reports of widespread injuries. once again police tactics are a major cause of concern. i followed the events closely from the start and issued two statements one through my spokesperson in direct myself and last night i spoke with foreign minister -- of course i have coordinated closely with my colleague and dear friend commissioner kula who was on the ground in turkey last week and he is meeting with

the prime minister as well as the meeting with civil society representatives and many of you will have seen what he said in the speech is that he gave and i pay tribute to his work not just them but always. i think it's fair to say that we have seen too many examples of excessive police force over these last two weeks. a close range use of tear gas, water cannons, pepper spray, plastic bullets against protesters who have been overwhelmingly peaceful. several thousands have been injured and many of them severely. some have lost -- from excessive use of pepper spray and at least three have died. a serious situation has become a tragedy. i express again on behalf of myself and a few deep sympathies we have been very clear in her statements and i repeat again excessive use of force by members of the police against peaceful demonstrators must be swiftly and thoroughly

investigated and those responsible held accountable. the emma -- environmental concerns of the demonstrators developed into a wider concern of significant portions of society who feel their voice is not heard today in turkish politics. there is a real polarization. major akp rallies in istanbul this week and could risk adding to the tension when we need to see a de-escalation. the answer i believe and as we have said is engagement in -- the president's call for a decrease deputy prime minister and union leaders and representatives of the protesters promise that lessons will be learned about the need for greater public dialogue in the future. prime minister erdogan is due to meet representatives today. this is an important opportunity

to find a way forward based on dialogue, tolerance and mutual respect. we know that turkey is a candidate country needs to aspire to the highest possible democratic standards and practices. these include the freedom to express opinions and assemble peacefully, the freedom of the median media and freedom of religion, belief and thought. democratically elected governments even the most successful of them which have enjoyed three election victories and have support still need to look at the needs and expectations of those and peaceful demonstrations are a legitimate way to express their views. i've also been surprised by the best domestic media coverage given to demonstrations in turkey and by attempt to condemn the use of social media which has been the prime form of communication throughout. freedom of the media is a concern in turkey. it is right that the european

union should champion a channel to exercise freedom of speech. social media too should not be seen primarily as a source of problem but a valuable, indication for protest and dialogue. members this is an important moment for turkey. the chance for to renew its commitment to european values, to embrace the culture which values different opinions different lifestyles and open debate. turkey's reforms over these past year have already been truly impressive and let's remember that it is this turkish government, this young statesmanship vision and bravery embarking on a peace process to resolve the kurdish question. i'm convinced it can lead to the challenge and i use this moment to take further steps forward in expanding the fundamental rights and freedoms. this is not the moment to disengage from turkey but to

engage more closely. and for turkey, to engage more closely with the e.u. too. my own foreign-policy dialogue with turkey is increasingly close and fruitful. i visited ankara in april. there dialogue at the highest level must be kept up. although more so when times are challenging. last december's counsel stressed the importance of negotiations and the need for those negotiations to regain momentum. we are on course to negotiate the chapter this month within reach of a new piece of dialogue and the signature readmission agreements. in light of current events we should engage with turkey more negotiating chapters, most fundamental to its reform efforts. members are relationship with turkey gets a surreal opportunity to.

we need to make the most of all the tools we have and of course turkey needs to work with us. it's clear to me that the case for engagement is doubly compelling now. thank you mr. president. [applause] >> thank you very much. this brings us to the speaker starting with -- [inaudible] >> what started peaceful turn now into violence. the images have made an impact on all of us, not only in turkey, in europe and the world. we in this parliament have always underlined the importance of turkey to make reforms, reforms in order to safeguard

fundamental freedoms and they also include the right to protest. dear colleagues it's not about about -- it's not only about legal reforms. it's also about perception. if the comments of prime minister erdogan would have been more sensitive, the language would have been more sensitive and also the style of governing, then the style of governing to those who did not vote for him would have been more representative would have been more representative than it would not have happened. therefore i totally agree with president -- democracy is about more than elections. a majority always needs to consider the position of the minority. and today mr. erdogan is meeting and i sincerely hope that he will use that opportunity to

present himself as the leader of all citizens. however, a vibrant democracy also needs a competent constructive opposition and that also fits so i would say i believe that there are at least challenges for the opposition. dear colleagues, this european parliament has consistently emphasized the media freedom in turkey and i think that the past two weeks have confirmed our concerns. i hope that the recent events are as -- might prove to be a turning point for turkey. i thank you. >> thank you. first of all i want to thank cathy ashton the vice president and the commissioner for their

clear statements. this time erdogan will not change mr. erdogan said in and that is a threat, a dangerous threat because he has to change unless he wants to lead turkey away from europe and away from the respect of european ways. yes, a majority has supported erdogan at the last election and maybe they still do, don't know but i know those who are not on this erdogan side that are demonstrate them in taksim square. he started his political career as prime minister to fight against and pushed the military back which is a good thing but uses the same especially the police to effect peaceful

demonstrators. police in uniform and those in plain clothes. he is still here and using this instrument. after 10 days of protests, four people dead, 5000 injured and many people in prison is this the reaction of the democratic government with demonstrations? yes there were hooligans there as well. in demonstrations all around the world you have peaceful demonstrations and some people, and try to misuse peaceful demonstrations but it is not justified for mr. erdogan to say these demonstrations are hooligans and should not the -- i fully agree with the vice president when she said we need more engagement. therefore we should start immediately to make a she ate chapter 23 and 24 with turkey. these are the issues where we can put a test to the turkish

government. if they are ready to go to europe or not. if turkey today is the country with the highest number of journalists imprisoned relative to the number of journalists all around the world, this has nothing to do with democracy. if mr. erdogan wants to solve the kurdish issue which i would like to see at the same time he puts a lot of people in prison because they are simply -- the kurdish issue or haps the kurdish issue that gets kurdish votes in the parliament to change the constitution for him to have a stronger president in turkey. the last point, erdogan wants to play a big role in the arab world but how can mr. erdogan be the role model for the airport

old and arab presidents and politicians if it is the young generation like it does. so if it wants to come back to the normal way and be a good president and prime minister to be a role model mr. erdogan would have to change. that is the message we have to come to from here. we want turkey but this turkey is represented by mr. erdogan and cannot have a place in europe. mr. erdogan would have to change. [applause] >> i have got a blue card. >> thank you. a question to the speaker is very interesting.

a lot of analysis which i could've read in the media but a question mr. spoke to do, a few weeks ago you had to debate on recent freedom for the west balkans and you want to find a total solution there, a solution to everything and you want freedom from -- but how does that fit in with the reality? have you changed her mind? have you thought again? what is your attitude with the air of negotiations now? >> my dear colleague, your ideology blinds you and prevents you from seeing reality. nobody said that we wanted to include everybody east of croatia. it has nothing to do with accession. we have a lot of countries with

no prospect of accession. we have got to give people a chance. the people of turkey must take that chance and what erdogan is doing is not taking that chance. he has to change so that turkey can be a democratic country. >> thank you. >> first of all let me say that i found the first statesman of the union on the second and the ninth of june at least in one aspect inappropriate. he was more outspoken when he went to turkey but i'm both statements on the second in the ninth not only did you express your concern but more important and i quote now restraint on all sides. could you please explain what sort of restraint you expected from the peaceful demonstrators

and taksim square? peaceful demonstrator confronted with brutal police forces and also peaceful demonstrators facing tear grass, water cannons and rubber bullets. so i was surprised mr. chairman and let me be honest and facts disappointed that the union has again chosen to be ambivalent in the face of what is a clear violation of human rights by the states for the moment in turkey, a state by the way with accession to the european union. because what is happening and what has happened in turkey is a clear violation of human rights. we all know that it is not an isolated case. in turkey we have seen over the last years a growing reiteration of the fundamentals of democracy. look at the media for example. mr. swope would that has given this is an example. turkey today i call it mr. swill

but that the biggest prison for journalists in the world. according to reporters without orders it's a record 154th and three places above the elastic tatar ship in europe which is belarus. that is what is happening today in turkey. so in my opinion and i didn't hear that from the european union in their message. what is happening in turkey is the constant abuse by an excessive state. i thought the majority, system in which decisions taken by a majority are always more important than the rights of minorities. always more important than the rights of individual people. it's a trend going beyond turkey into russia and i should even say to hungary.

now we are talking about turkey and erdogan, let me be clear i'm not questioning and i'd don't ask you to question the democratic mandates of the electorate government of turkey. what i'm questioning and what i'm asking is that you stand up against deterioration of the democracy that is becoming more and more what i call a demagogue and my final word mr. president before you use your hammer is my group is a strong supporter of the european turkey. let me be clear not a turkey that turns its back on the european principles and european rights. >> thank you. a question. >> thank you very much.

you are talking about stopping the negotiations for accession because as you said turkey cannot join because it doesn't meet the criteria. now i want to ask my question. i'm a european federalist like you but you know we could have the european federation but you know it's been alive for years. we could have european federation. >> i don't think that turkey is a non-european country. if you go to istanbul you are and constantinople and constantinople in my opinion was always part of europe. more than ever the ottoman empire was part of the allies always in europe so for me it's not a question of religion. it's not a question -- by think we are moved to cultural and europe, multi-religious in

europe and there can be a place for turkey. [applause] there can be a place for turkey in europe if, and that's the point, if they apply european values and european principles, freedom of speech and a real democracy. that is the key question. not an old-fashioned discussion about culture or languages and i know what i'm talking about. i have come from belgium. [applause] >> thank you. >> thanks mr. president. i am very pleased that we are having a debate on this in the house today. it shows that we all have understood something is really going on in turkey because of what is going on. i think it's something that is actually something we should be pleased about but also worried about.

one feels that we see society and citizens getting involved in that is promising for a completion of turkey's democracy but also worrying because we see the authority response of far. authoritarian repressive road using the security forces and that moves us in that direction toward a russian style brute force democracy. so what can the european institution due? this situation which is fluid and changeable i think we can try to move the energy in the direction of deepening democracy. ..

people are imprisoned, people have got files opened up on them and there is no people and peoples lawyers today. demonstrators are in jail. something which has everything at stake. we want to see people expressing their opinions. that is what europe is all about and what is that date.

i think that the gaddy changes brought about is a large condoleezza people part of turkish society who have gravitated around this cause and they've done so because they are up against a regime, which up to now has still not -- i'm being careful what i say that this government will go down the road of consultation, discussion, dialogue and combing things down. that's not the case at the present time however. we need to stress what's happening in the prize and all the concerns expressed in this house about turkish democracy and journalism in our report. true, we've seen the three or four biggest papers in the country are basically ignoring what's happening here that's

astonishing. if we want to help, if we want to be useful, we as europeans should make a proposal and say let's open these chapters in negotiations on development open 23 and 24 so we have a dialogue about fundamental freedoms that have been in touch since her demanding today. thank you. >> translator: thank you very much. let's try to make true today and say what we think that when we have blue cards and months to do the time please. >> thank you very much. i say we need to step back and be a little cautious in our analysis. of course we will condemn the heavy-handed police response to the demonstration.

indeed, these actions have been condemned by president aragon. verifiable case of riots and popular discontent to continue to fester when it clearly needs to be addressed. many of us want the best for turkey. it would be ashamed of the the legacy would be diluted in particular is modernization, tolerance, democratization and removal of religious influence from political life while remaining islam. more recently we've seen adherence to nato and great progress towards western liberal democracy and of course market capitalism, which is delivered in economic progress. i've always said if we appear to close the door in turkey's face, we should not be surprised if she turned another way. in any case, i hope the great

changes in the shape and direction of the european union that will have to take place in the next few years within end to an ever closer union and a looser, more flexible european union focused on the single market rather than political integration at this sort of european union will more easily accommodate. >> thank you. >> thank you. thank you, mr. president. throughout the decade in which turkey has made significant achievements in reducing the debt and paying off imf lauds, erdogan's policies nurtured the emergence of the turkish middle-class. a big achievement indeed.

ironically, today this nature class represent the large majority of the people that are out in the streets protesting against what they believe to be a violation of their freedoms and secular lifestyle. i think it is safe to say that we are witnessing the effort of the development of a nonsecular political islam in turkey, which create absolute terror among the secular tags that we see now in the street. so the question is, are we moving away from the model of secular democracy in turkey and hope this model could be replicated in other countries in the middle east? mr. erdogan among others mistakes called this issue on

him so personally. it is very typical for him to back up now, so i think that we must put our confidence and faith despite putting his signature of legislation is the only politician has shown compromise and reconciliation. thank you. [speaking in native tongue] >> translator: thank you very much. >> thank you, mr. president. i firmly believe democracy means full respect to the minorities. democracy means listening carefully to the people who may not agree with us. but freedom is coupled with the others, that is democracy. it is more than obvious the turkish government has no idea what respect of giving an opinion needs. one who respects mr. erdogan to

be more understanding and tolerant to those who find themselves today in the same position as he personally was a decade ago. we fully support the demonstrators because they have the right to demonstrate to my call upon the turkish government and police forces to refrain from any further acts of violence and suppression. i have a word of advice for the government as well as for the demonstrators. there can be no ian turkey without giving to the talents their fundamental freedoms. there can be no democracy in turkey without restoring the fundamental right. i insist that democracy will arrive in turkey, that day the turkish government decides to withdraw its occupation army from a country.

>> translator: democracy in turkey will flourish when they withdraw their troops from cyprus. thank you, the man. >> thank you very much. >> thank you, president. last month, mr. rampart that is a good idea to speed up with what he called progress in turkey. he even invited mr. erdogan to brussels. that is an epic mistake and look what type may now. demonstrations in turkey might seem to be very sudden, but she can't say the same about islamization and depression. we've got our warnings, but the european union is going to reality.

erdogan is now a very lax aptitude on the part of the european union. ms. ashton says the european union is too maintained a dialogue with turkey. and so once again, will be rolling out the right traffic. this is completely absurd. as far as my party is concerned, mr. erdogan is not welcome at all in brussels. it is very much indeed. thank you. [applause] >> thank you, by representative. he is a gentleman, i think our first duty as members of this house is to express our regret for the violence and the loss of life in instant role. also, we need to express their firm commitment to expression freedom to demonstrate freedom of conscience.

but i also think we need to act in a responsible way in the e.u., not leading towards radicalization of polarization and coming up with solutions based on dialogue, and racial understanding and mutual respect. we shouldn't ignore the importance of what's happening in turkey. i think the debate is in the question of whether we have react well or badly where they. i ink the high representative habits bonded well and i think the important thing is the way we remember to see turkey destabilize. turkey is positive and active partner of the e.u., introducing many reforms is a firm ally within the atlantic alliance, taking risks to the invasion of kuwait. it is important as far as the

trafficking of oil across the black sea is concerned. it's an important element in the air of spring and has received more than 400,000 syrian refugees. lady ashton, we need to make sure that the e.u. keeps a close eye on the situation where it doesn't interfere too much. we need to manage this by allowing responsibility to be taken by the right people and act in a consistent way consistent with the values in europe. thank you, president. >> thank you. >> thank you, president. none of ashton commissioner, colleagues. turkey made in the last 10 years tremendous economic progress. it tripled the size of its economy. it tripled the standard of living of ordinary people, but in spite of this progress, we

see these demonstrations. why? because they -- it shows that people don't just want redenbacher. they want freedoms. they want human rights, civic rights, they want me. they want rule of law. they want to take part in the decision-making, whether it's the future of istanbul for the future of their country. this is for mr. erdogan and in my view a wake-up call. turkey can go either on the way towards more democracy on the way to europe for a turkey can slip into unfortunately a cowardly situation that's developing in the middle east. thirdly, it needs a new constitution, not because of the

e.u., but because of the democracy and development of turkish society and turkish economy. in this process of creating new constitution, not only the ruling party, but also the opposition should be included, the civil society, the journalists, the lawyers, everybody was willing to take part and i think turkey in this process also needs our help because if we let this progress, not only for a certain port country slipped down on the slippery slope, it will have terrible consequences for us. so i think in order to strengthen the turkish perspective, we should open the chapter 23 and 24 because only in this way there is a chance that turkey can move forward and we can help in this process.

thank you very much. >> thank you him and mr. story. >> translator: in the event of the last two days in turkey, a terrible blow to the rule of law in that country and they are about to turkey succession of europe, but at the same time they represent a progress for turkish society has become more pluralistic than mr. erdogan wants to believe. people like religious, nonreligious liberal people and so on have all profess from other teams to gather and these demonstrators are the others are here. we need to know how many people have been arrested, how many journalists, how many human rights lawyers, hamid

demonstrators is even iran present. we demand for these people to be released. we ask for justice in this country can move towards zero. mr. erdogan needs to change, please send gentleman. we are not in a psychological debate here. we want a political debate here. turkey is the change. they need to make it possible for civil society to be represented as a nighttime for parliament otherwise you can't get in at all. we need the political culture to change in turkey, not a dictatorship of the majority, but minorities need to be respect to and have their voice heard. quite clearly we need to carry with turkey. is also one thing.

today is not the day for us to talk about these chapters. another one that is unfairly oppressed good to see progress made if we talk about these people released a many to see political change in turkey. [applause] >> thank you. >> thank you. the violence against the people in the gezi part in also in turkey simply not acceptable. besought protesters have been beaten up, tear gas, and shared and have been massively arrested. some have even died. the people simply because they spread news and use social media. all promises of dialogue have been empty promises so far. i urge the high representative as well as the commissioner to

step up their efforts to use tools to pressurize the turkish government to stop their authoritarian rules and violent. the turkish government needs to realize there's a great chance if they embrace pluralism, if they encourage civil society and if they involve the population. going against environmentalists, students workers, artists, everybody is going in the completely wrong direction. the people in turkey need our support, have to give them a very strong signal of our support and a very strong signal that the european union will not accept such a violent. thank you very much. >> thank you very much. >> translator: disproportionate unwarranted use of police force against people who demonstrate his outrageous.

restraint and understand with respect to those who protest should be a guarantee of four freedoms with fundamental requirement in order to follow the aspirations of turkey to come true. in other words, we must be made turkey as the leader of democratic transformations and as an example of reforms by other countries. its contribution to the economic development of europe are very important as we talk about her political ossetians. under the rule of prime minister erdogan, another reform has unimplemented and stabilization of the country. is also important to look at the involvement of his government as the conflict in syria and assistance to refugees. every country has tradition on

the respect for religion. unfortunately, we can to deny the site is within the european -- >> thank you. in turkey, what was originally an environmentalist demonstration, political issues have now become an all-out. as the government becomes less secular and more and more fundamental, the violent repression is not just on moral grounds. it violates fundamental rights, which is an important pillar of the treaty of lisbon and of our security policy. any agreement with turkey cannot be done without this. it is being shown that freedom

and democracy that young people take into the streets and squares of turkey have never been surprised and governments that do this thing off and show themselves to be more anti-democratic and fundamentalist than the ones overturn to put them in place. i agree with the high representative that we need to keep channels of communication and dialogue open to turkey to present a dangerous isolation, which might drive mr. erdogan into the arms of the fundamentalists. i also think turkey is a vitally important part there, destabilization of turkey in a very unstable region could mean a very serious threat to the peace security of the middle east. thank you. >> thank you. >> thank you, president. i have to say i was appalled by the statements he put out on

sunday night calling for restraint. at that stage i was traveling back from istanbul, were a witness in the working-class suburb of this symbol, cause he has some massive use of tear gas, teargas being shot against protesters, the massive use indiscriminately of water cannons against protesters. your statement came over 24 hours before the retaking by the police, turning it into a war zone from watching television in a move that was entirely anticipated by protesters and many others. they are guilty of that to many democratic rights and freedoms. it's the government responsible for cracking down on those rights, police brutality, responsible for julie morris making a statement against policies. if the government responsible

for the neoliberal environmental restructuring of the symbol for the repression of the kurdish people for the imposition of conservative policy against kissing in public to divide and rule the people. the people were absolute consideration. i say to them, do not show restraint. do not be afraid of returning the streets to demand their rights. they clamped down by socialist alternatives next weekend for one-day general strike and to make sure erdogan is forced to resign. thank you. >> translator: mr. clash, the extremely weak reaction to events in turkey have made the e.u. completely incredible, lost all credibility.

we are being made to look like fools in the islamist government, which they believe everything that is against any such succession. if i listen to my colleagues here, you think it's a violation of human rights, a reason for rewarding the turkish government by opening a chapters in negotiations. at the start of the negotiations, we said that they could be stopped at any time if it became clear they would not be meeting the requirements. what more do you need to do to? turkey to even start a negotiation must be stopped now for good. [applause] >> thank you very much.

>> as president, commissioner, colleagues. what's going on in turkey against human rights, against demonstrators, and this is unfeasible and we must put an end to it. that's all that needs to be said. in terms of what is done with the demonstrators. there are huge amounts of journalists in prison. we need to try the rule of law, but boosting the outcome of the tax regime and not much is being said about that. it seems to me europe is being used to get over the old obstacles and for people to do what they want to do themselves and get rid of secular society and so on, basically as a rising of the secular -- the society, the internet generation, the modern turkey rising up and

pushing against erdogan. something has gone wrong in our policy here emesis, then the questions today. we need to look at new ways, norway's style situation, getting nato in here. turkey is a very important country here. we need to find the right way of doing things, which is carrying on a new chap or here would be a terrible thing for those in prison for the moment, so we need to change our approach here. we need to get a modern turkey that stands together with the west and human rights and that's something we need a norway's style solution as opposed to

accession two. [speaking in native tongue] >> i think president, when he too began by expressing their solidarity with those people suffering repression and condolences to the families of the guns. where the entire violence has occurred. the best way of showing our respect to the people who have come into the street in the squares of turkey in the last couple of weeks would be a thing to try to interpret what their message is, what is coming out at the square. a pluralist body that is intergenerational, various classes are working together and i tank is relatively easy to

interpret what they're trying to say. it's not the arab spring, nor is it an occupied wall street, nor is it the angry ones are the people rioting in suburbs in the u.k. or france as a soph years ago. if a specific message, a turkish message being conveyed. people are saying something very simple, although what they want to achieve, they want a legal system that's independent to be free and then they believe that in turkey they should recognize that oster minorities. they believe in turkey we shouldn't have any polarization or confrontation through nationalist or religious reasons. if people aspiring for a mature

democracy. they are due on government, those in power being addressed to the opposition. the opposition is to become credible. it's also directed to us in europe. europe needs to act in a mature fashion. it shouldn't react in a contradictory way. we need to assess without interfering and hope these people achieve their goals. thank you. >> what i see through the clouds of tear gas is a demographic revolt. clumsy, complex, messy, but also

moving. in style, it reminds me of chicago and paris in 1968. and like the follow-through from such spontaneous revolt, indiana and, turkish democracy is to emerge stronger with political parties that will be less authentic of their leadership, with a turkish parliament, which is more pluralistic and with ideologies who both secular and

religious, which i must preoccupying. i believe that turkey has a great capacity to become the world's first liberal modern must on european country. i rejoice at the event that are now in thank you. >> thank you. >> thank you, colleagues. >> my dear colleagues, the revolt in turkey as an expression of fear, the fear that turkey will become a state

in which authoritarian approach takes precedence over democracy and free choices. democracy consists of freedom of opinion and freedom of assembly. turkey really must apply those free guns and not just as mr. faller said earlier and the high representative has repeated, aim for the highest democracy -- democratic practices and principles. it must apply them as a former journalist has said just as partially immune system of a healthy society. i want to go down a different road. and the race on the extension of the middle east if democracy in turkey is nothing more than a mask behind which the estate is two faced it got to take countries especially in a negotiation talks and the

resolution. >> hi, representative. we have very much concern for the installation of the situation vis-à-vis thousands of people, people defending their right to live in a party for free democracy and a secular democracy on the road set up. we've seen journalists and so on, people that believe in freedom of the press been imprisoned and that's very concerning absent violence against people demonstrating and the fact that some police people have committed suicide or set down from their posts. important we take note of the turkish people's -- turkish

people's request to press ahead, to live in peace, democracy and freedom. thank you. >> thank you. the turkish minister for european affairs yesterday called the head of his government to mr. erdogan a gift from god for the turkish nation that political evaluation matches the complete lack of a sense of reality that he himself has shown in these turbulent tax stays in deep his actions in public characterized by deliberate polarization of society. sadly, mr. erdogan keeps on heating up the public atmosphere and speaking outright untruths

about the behavior of the demonstrators of istanbul. the desecration of a mass, what is worse is to come pehrson he made yesterday between the demonstrators and those who carried out a murderous attack early last month in the southeast of turkey. and he's doing that against a backdrop against violence by the police politics. council and commission must absolutely not let go this complete lack of political self-criticism and sense of responsibility. can you make that point, please? at the end of last week, mr. erdogan didn't even bother to listen to what commissioner fuller had to see through the interpreter and that is someone who is the head of the government of the country who wants to join the e.u. the economic power created by a

decade of dominance shirt and they should get close. the turkish government is opening the floor of money from the 40 billion euros in public german every year on both public and private sometimes told to be silent about serious cases of corruption. the controversial editor really admits that the demonstrators don't realize they don't take decisions. it's our bosses and they have fingers in every pie in the economy and, you know, we cannot stand in the way of those entries. turkey of course has enough critical media. in 2006, there were no more than 70 cases of akp manipulation with public procurement brought to light. but the point is main guilty

party not only got a free, but today is part of trains devens private staff and comes to brussels attend. is this massive nationwide protest in the past three weeks that should drive the akp to put its own house in order, not by expelling members of the party. honesty is the best policy. that applies for a turkish society as well and i will be looking forward to the talks next week in turkey. >> thank you. [speaking in native tongue] >> translator: the communist party condemns the turkish government against the demonstrators we express solidarity with the working class and the people of turkey is struggling for freedom. on the seventh and eighth of june, i was then the square and the state violence toll is

terrible. the turkish government have attacked ordinary people, political parties struggling against the anti-working class party at the government. they even attacked the communist party of turkey's headquarters and the cultural center. they are now trying to expel members of that party. the turkish government policy against the people of syria, the intervention links in with the peerless intervention of nato, the e.u. and the u.s.a. as well as the 27th of may decision for the right waving of the embargo on supplying weapons to the syrian opposition. we see now the possibility of an increased imperialist war of the wider area. we need to stop the violence and repression of the demonstrator. many to release everyone arrested in the people responsible for the need to be

brought to boot. >> i know in my small experience at these organizations, edc people, older journalists would not cut it today. that doesn't mean they are good at what they do, but the demands of their generation in our generation are very different. i think older people who decried with this media saturation is doing to us and the constant newsstand, i think the argument of take your time, get your facts right is always going to be true. we sought on the health care rolling and we sat in the boston marathon army and the pendulum swings back and forth an hour at a time where people are reconsidering how important is to get your facts right a double source thinks.

>> mead takes command on sunday morning at 2:00 a.m. in against the headquarters to assume command from and is such a poor theatre, he hasn't even gathered one single detailed map of southern pennsylvania. when mead takes command, lease in pennsylvania and he doesn't have a map.

>> of mass, today passed a prescription drug abuse. will hear testimony from drug pose a direct their, r. gil kerlikowski and the food and drug administration and the center for substance abuse treatment. this is just under two hours. [inaudible conversations] >> 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 hearing the subcommittee will hold on the subject of prescription drug abuse described by the centers for disease control and prevention as an academic in the

united states. in 2010, 7 million individuals aged 12 or older, that's 2.7% of this population were current nonmedical users of prescription or psychotherapeutic drugs 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's most prominent among young adult age 18 to 25. the data also reports in 2010 almost three dozen young adults die from prescription drug, mainly opioid overdoses, which is more than the total number of people that died from overdoses of any other drug including and

combined. vicodin and oxycontin of the largest class of the abuse prescription drugs followed by stimulants for treating attention deficit hyperactivity disorder, adhd, such as adderall and ritalin and central nervous system for relieving anxiety such as valium and xanax. according to the national survey on drug use and how, published by the substance abuse and mental health services administration, of those individuals who use prescription pain killers non-medically in 2010 and 2011, nearly three quarters receive the drugs from a friend or relative either for 54.2% three purchase, 12.2% were 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 this committee has played a key role in facilitating prescription drug monitoring programs by authorizing the national all scheduled prescription electronic reporting act sponsored by representative whitfield and ricky member pullout. housed at the department of health and human services were signed into law in august 11, 2005 to assist states in combating prescription drug abuse of controlled substances. it provides grants to set up or improve state systems that meet basic standards of information collection and privacy protection that make it easy for state share of the nation. enable authorities to identify prescription drug abusers as

always the problem doctors with their overprescribed or incorrectly prescribed prescription drugs. an excellent step in the right direction. it has not been funded since fiscal year 2010. although hhs continues to fund grants and immigration with electronic health records to improve the timeliness of access to a pdmp data. it is clear the academic is a crisis in the united states. while we discussed this dynamic issue that these medications that so many are abuse in her critical for many patients with chronic pain. it estimates that there are more than 109 adults in the u.s. living with chronic pain.

remember these medications are vital for many americans experience in such pain. it will help us better understand components of the issue and challenges we face. we currently have in place their level of effectiveness. they represent the up is of national drug control policy. the fda and i look forward to your testimony. >> thank you. i guess you don't have time. yield the balance of my time. channel it into shake a ski for five minutes for an opening statement. >> thank you, mr. chairman. per se but to ask to put the testimony of mr. waxman to the record. >> i'm happy we are having this hearing on drug abuse in the

united state and i'm glad we can work together in a bipartisan manner to tackle this problem. i want to welcome madrassas today. this provides an opportunity to raise awareness and discuss action taken take to end a crisis that is truly destroying mites hurting families and communities across the country. i can switch back to peter jackson tragically lost his 18-year-old daughter emily to this epidemic while visiting family and on and oxycontin tablet. after taking the oxycontin tablet while drinking, emily went deep and never woke up. she died from respiratory depression. she stopped breathing. what emily's story at dying after taking maybe extremely rare, dutch and the abuse and misuse of prescription opiate drugs.

prescription opioid drugs were and six in six of the 50 over does deaths in 2010. accounting for more deaths than overdose of heroin combined. it's a 313% increase over the past decade. in addition to those tragic deaths come other negative health consequences result from prescription abuse. in 2010 there were additional 10 treatment admissions, 26 emergency department visits, 108 people with dependents and 733 nonmedical users of those drugs. in addition to the human toll, this financial cause better health care system simply cannot afford. the drug abuse exceeds $70 billion at researchers found on average opioid abusers generate direct cost 8.7 times

higher than non-abusers each year. it is a national imperative we were to end this crisis producing prevalence of prescription drug abuse will save lives and save money. their actions underway hoping to combat this problem at the federal level. buster repass several provisions as part of the food and drug administration safety innovation act to combat drug abuse, including a requirement the fda held a meeting of the scheduling of hydrocodone and issued guidance on developing abuse to turn products. federal agencies are also operating programs to combat prescription drug abuse including developing and supporting efforts to educate providers in populations at risk for prescription drug abuse. while federal efforts are critical, we must partner with state to be successful in any prescription drug abuse due to statius possibility to license and trained health care professionals prescribe and

dispense these jobs. we must build on current affairs by identifying additional steps we can take to tackle such abuse. drugs containing hydrocodone, scheduled to drugs. while that will be important to take steps to ensure changes that limit access to patient with legitimate medical needs, this change is needed to adequately reflect the potential risk these drugs pose to public health. we should take steps necessary to restrict the use of oxycodone, pain relievers rather than moderate to severe pain to prevent the overprescribing a powerful medication. i look forward to hearing witnesses to combat prescription drug abuse to additional steps we can take to stop the abuse and misuse of opioid drugs and i appreciate any comment on the suggestions they made my testimony and i yield back.

>> the gentlelady now recognized as dr. purchase. >> i think for the recognition. with this more people in this country due to drug overdoses than on the mobile accidents and that this drug overdoses, two thirds are prescription drug overdoses. we have a planning big problem. could insist there's plenty we can do about it, but a portion of the agencies and lawmakers have so far not taken anything other than short-term approach. but in a broad-based comprehensive strategy focused on going after the bad news. to start we can go after the pill mills. it may be hard to find, but maybe not. they advertise, so were very fortunate. they tell us where they are come with their hours are in their churches. so if i can find them, how come on first and it can't?

takeover of the cookies. i ran a medical practice for 25 years. ever wants to advertise dispensing onsite discounts often a comic you bought included. this war is a hard book. it just doesn't fit a normal type of medical is, which reauthorize and try to find this committee reauthorized in the past. it's the only authorizing legislation that encourages state prescription drug monitoring programs. master was a product of this committee, bipartisan drafted with radical providers in the states impatient for nine to encourage encourage qualitative drug screening to reject contrary medicaid policies. we should encourage abuse formulations and reward investment of these technologies. might also work to align policies of reimbursing technologies. we should look and examine the personal use exemptions he

encourages building -- 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 can go to a publication come up on the internet by a controlled substance by pointing a look into things, two statements you have to make. i need the drug into my line. most people can meet that. i'm open to discussing provider education if it does not subvert medical judgment. we let a few bad actors to jeopardize the doctor's ability to offer paid care for their patients out of fear or patient abuse and diversion. this is an important point. someone has written prescriptions either perspective is as we got to stop the diversion, but we also need to be careful that whatever we do is not a prescriptive that it prevents people who have a

legitimate need and use of this medication do not obtain it. so paying costs are estimated at more than $100 million yearly in the cost of 25% of sick days. prescription medications may be an important part of pain therapy. if we don't stop the bad actors, we are going to hurt the people who have legitimate use for this medication. the bad actors cannot jeopardize the dock or's ability to alleviate human suffering. again, there's much we should do. i understand why this may be a series of hearings and obviously look forward to working with you. we need to involve doctors, patients. thank you for the consideration and i yield remaining time to duck or camry. >> i agree with so much of what he said. the problem is a huge problem

and not only that caused of the legal dispensation or prescribing of these types of medication, pain medications, antidepressants, whatever. but just think about the cost of decreased productivity and individuals that may be a little bit, just a little bit overmedicated. this might sound a little harsh, but honestly maybe a little pain for a little anxiety in our lives is a good thing. it can be a productive thing and makes you appreciate that you have to work through that and if you try to completely eliminate each of those things, that's where you get to the dependency, addiction, decrease per dvd of the cost of society. physicians have a big role to

play in this and even the ones prescribed legally and i'm not talking about the pill mills. the states doing a good job of trying to crack down on that. finally we must take a close look about how we as a society support treatment and recovery for patients struggling to overcome addiction. we must look for new and innovative treatment plans, which treat dependents and leave the abuser without new addictions, where they are on some other medications supposedly helping them and are almost just as addicted as they were before. >> mr. chairman i got back in thank you or the time. >> that concludes the opening statement. the committee has one channel before us today and i'll introduce those numbers at this time. mr. gil kerlikowski, director office of national drug control policy is with us.

secondly, dr. throckmorton, deputy director of regulatory program center for drug evaluation and research, u.s. food and drug administration. finally, dr. westley clark, center for substance abuse treatment, mental health services administration. thank you for coming danger but testimony will be made part of the record. to be be given five minutes summarizer testimony. mr. said to come you recognize for five minutes for your opening statement. >> thank you, chairman pitts, ranking member czajkowski in thank you for the opportunity to address the important issue of prescription drug abuse in this country. perfecting prescription drug abuse has been a major focus of our office sent my confirmation four years ago. we work collaboratively with federal agencies throughout government to address with the cdc has turned an epidemic. my position allows me to raise public awareness and take action on drug issues that affect the

nation and the administration recognizes addiction is a disease that prevention treatment and smart bomb first and have to play a part of a comprehensive strategy to reduce drug use and give help to those need it and ensure public health and safety. we are here because the prescription drug abuse has had devastating consequences for public health and safety of the country. increases in treatment admissions for substance use disorders, emergency department visit and the deaths attributable to prescription drug overdoses place an enormous burden upon communities across the country. for than 38,000 americans died from a drug overdose. 22,000 attributable to prescription medications and most of those deaths, almost 17,000 attributable to prescription painkillers. in response the administration released a comprehensive program called prescription drug abuse prevention plan.

the plan brings together a variety of federal state, local and tribal partners to focus on the major priority areas dealing with this. education monitoring come proper disposal and enforcement firmest manager education and addiction practices for prescribers, current training for health care providers and safe opioid prescribing an addiction can be inadequate and inconsistent. medical school students receive an average of 11 hours of training education. most schools do not offer specific training on opioids at all. ..

we are supporting that interoperatability. the administration working with the congress to share prescription drug data with pdmd to say that the rulemaking process is nearing completion and va authorized the health care providers to access the state pdmp when consistent with state laws. third, when used expired medication. since 2010, the drug enforcement administration has partnered with thousand of local law enforcement agencies and the drug free community coalitions to hold six national tackback

days collective disposing of unused medication. lastly, the administration plan focus on improving law enforcement capabilities to reduce the diversion. the national meth meth and pharmaceutical initiative funded through our office of high intensity drug trafficking areas 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 mill and prosecute those that are responsible for improper or illegal prescribed. the administration is working to expand access to an emergency overdose reversal medication for first responders who may encourage overdose victims and can prevent a fatal overdose and addressing many other consequence of the epidemic

including the issues like neonatal abstinence syndrome and increased heroin use in other places throughout the country. in closing, let me recognize none of these would be possible we want to accomplish for the nation without the ongoing support members of congress. thank you for the opportunity to testify. the chair thanks the gentleman. you are recognized for five minutes for an opening statement. >> mr. chairman, and members of the committee. i'm deputy director for regulatory programs and 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. the importance of the problem is hard to overstate. beyond sober stakes of our individuals and families whose lives have been shattered by prescription drug use, abuse and

addiction it's a crisis that affects us all and. balancing the needs of patients suffering from pain with the need to combat misuse, abuse and addiction is a priority for the fda and for me personally. in seeking this balance fda pursued a targeted science-based approach aimed at critical point in the qoment and use of these activities include recent work we have done to encourage the development of abuse deterrent drug formulation. fda believes the development of the new formulation to successfully deter abuse is an important part of our effort to improve their safety use. for example, in january of this year, fda issued a draft

guidance document for industry. open the fire department arvetion has taken recent regulatory. oxycodone and reformulated with the intention of making the product more difficult to manipulate and abuse. the data for the two products were reviewed carefully and independently by fda scientists and resulted in a change in the labeling for oxycodone. for the particular drug at hand and given where we are in the involving science of abuse deterrent were made on a cay by case basis. a second critical area is the dwofm of effective patient and described education. the interaction between prescribers and patients plays a

critical role in improving the safe use of the 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 mitigation for manufacturers over 20 open yoidz make them to available for little or no cost. the training based on a syllabus developed by the fda with input from other stakeholders. we are currently posting those educational material on our website to make them easer to find and make use of. a third critical area we have devoted time and resources is way to prevent the overdose death by improving the treatment

of overdose. the standard treatment to rapidly reverse the overdose of prescription. when given quickly, it can and does save lives. in public meeting the fda convened last year with several other part of the federal government stakeholders encourage the exploration of bays to administrate it that may be easier such is currently available. in this area, fda is working to provide regulatory priority assistance to manufacturers. who are working on assessing these new ways to give it. to finish my remarks, our society faces two important challenges. we must balance efforts to address the misuse of the use and addiction that harms our families and communities, and the need for appropriate access to main medications for parents that need them. given the complexity of the

issue surrounding the problem within real and progress will require a multifaceted approach defined with a full engagement of all parties. fda continues to prioritize our effort in the area to combat the significant public health crisis . we welcome the opportunity to work with congress, advocacy organizations, parents, and families to turn the tide on the devastating epidemic. thank you for your continued interest in the important topic and for the opportunity to testify regarding fda construction on the issue. i'm happy to answer any questions. >> good morning, everyone. i'm the director of the senate for substance treatment within the administration. thank you for inviting me to testify today regarding the role in preventing nonmedical use of prescription drugs and individuals who abuse the drugs.

our mission is to reduce the -- [inaudible] okay. the mission is to reduce the impact of substance abuse and mental illness on america's community. we envision a nation that acts on behavioral -- [inaudible] treatment is effective and people recovery. the challenge of prescription drug misuse and abuse is a compression issue that requires surveillance, intervention, education, access to effective treatment services, and continued research by the private and public sector. the strategy to reduce prescription drug misuse and abuse jot line the strategy of -- we work across the by participating if the behavior subcommittee. we are an active partnership with the fda, the office of the national coordinator health information nih and others aimed at preventing and beating prescription drug abuse.

according to the national survey on drug use and health, nonmedical use of prescription drugs rank as the most common class of drugs in the united states. you mentioned data and there's no need or it me to repeat. it's important to know there was a slight decline in nonmedical use between 2010 and 2011 which suggested that the national, state, and local efforts to reduce prescription drug misuse may be having an impact. state prescription drug monitoring programs are important component in government effort to prevent and reduce drug diversion and abuse. pdmp monitor and analyze schedule prescription drug with the goal of preventing it as well as illegal diversion. in 2005, the national schedule electronic reporting act created a department of health and human services grant program administrated by them for enhanced pdmp. they received congress from fiscal year 2009 and 2010 which

resulted in this them providing 26 grants. through elt i.t. project managed by omc and collaboration with. the project was unlike the grant in that its purpose was to use health i.t. to increase timely access. in 2012, the electronic health record immigration and interoperatability expansion program was funded. this program complimented existing federal effort by improving real time access to pdmp data through the immigration and existing technology such as electronic health records. they are engaged misuse and abuse through education programs and prescribers and future prescribers prevention and early intervention program. treatment of prescription drug

abuse and regulation. we support the education through continuing medical education courses and other less formal effort such as web are in. the treatment program is an important tool for the early identification of persons who might be at risk for the abuse and other substance use. they provide grant to state, territory, and triable organizations to implement it adults and primary care. we have a residenty grant program. territory and prevention and treatment and services efforts. the strategic prevention framework partnership skeet success program is designed to address two of the nation's top

to make sure that communities can prioritize prescription drug abuse. we're working with other federal agencies to explore medicine to dread the need for increased access. our strategy to reduce prescription drug misuse includes the expansion of improved access to treatment, the drug treatment act certain medication for the treatment of open yoid addiction. we work in collaboration with the dea. these are through these and other efforts we are working to reduce the significant long-term impact of a serious public health problem. thank you for the opportunity to testify regarding effort in the area. i welcome any questions you might have.

i'll begin the questioning and recognize myself. the director, the omdcp oversees and coordinated 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 there are fifteen primary federal agencies that 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 border. it's coming out of the our own medicine cabinet. the mere fact it was not recognized as a significant

problem except by subject matter expert in the health field, people that ran treatment programs. generally the public didn't begin to understand the magnitude of the prescription drug problem. we worked to bring everybody together to sit at the table and develop a plan knowing that any one component whether it was the law enforcement agencies or whether it was the regulatory agencies that one component wouldn't be able to solve or at least significantly reduce this problem. our partners, two of which are here, a number of them are out as part of our program, all came together with one goal. that is to reduce the tragedy, not only in the loss of life but the expense of -- we couldn't be more pleased with their cooperation, two, at least the ink ling as dr. clark said as some success in the area. >> thank you, doctor.

yes net rick enter the market of january this year of does the agency intend to monitor real time data in order to evaluate whether such entry affects opioid abuse. how will real time data be utilized by the agency now and the future where the fda is regarding the claims of abuse detemps? -- deterrence. >> mr. chairman, the goal is to incentivize the -- formulation and find ways to move them on to the market. our intent is to set forth the road map that makes that successful and happen in good time. following up on that, we need to work to develop ways to move agree near rick that make them a possible to come tonight market as well. you asked about monitor of the response in the marketplace those sorts of decision.

we watch that information. we are an office of epidemiologist that focuses on marketing issues as well as post market safetying issues. and we use that information as we look at individuals decisions to understand the impact that a decision we our might have with regard to the use of products and market. >> to followup, the fda committed through the user fee process to increase transparency and approval process. earlier this week, we wrote to dea regarding delays in reviewing fda scheduling recommendation for new drug approvals containing control substances. does the agency have recommendations that improving this process to address the issue dea delays? >> it's an important question. we make sure we have timely access to medicine that are recommended for controlling. we need to remember that the

final decision about the controlling is made by the drug enforcement administration under the control substances act. my focus in the center for drugs has been to make certain there's a timely scientific assessment from the fda that can in fact work to inform that decision by the drug enforcement administration. what we've been doing is looking back at our process to make sure it's as efferent and timely as possible. we get our recommendations in good order to the drug enforcement administration through our secretary of health which is at the health and human services level. >> thank you. doctor 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 about the program. we have through our special initiative reaching out to as many jurisdictions as possible.

so we can link the pdmp with health records. as you know, as i mentioned the program which was targeted toward -- states hasn't been funded. we have shifted our focus from that effort to looking at other technologies so we can address the public health aspect of this by linking electronic health records to the police department mp we can have real time data. sooner than some of the delay associated with pdmp program. we can't way two weeks to inform the collie in addition. we would like to give them real time access to make appropriate decisions about the care. sometimes it's someone running a scam on the doctor. sometimes it's a patient who is having a reaction to the medication. so it's useful to have real time access to clinical context using

prescription drugs. >> thank you, gentleman. my time is expired. the chair recognizes the gentlelady from california. five minute for questions. >> thank you, mr. chairman. i'm glad we are hear today having an hearing on an issue that cuts across party lines. prescription drug abuse is a real and pervasive problem. while it clearly impacts families and community across our nation, it also effects our health care system. i want to make sure that effort to address this issue important as they are do not cause other problems especially those for regarding people with chronic pain. it's a delicate balancing act in a way. americans struggle with pain has been an important issue for me for many years. and 2007, i introduced a national pain care policy act and pleased to see that part of the included affordable care act. as a result the institute of medicine was directed to do a study on pain.

what they found is that pain is the most common reason people seek medical care. over 116 until 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 and companies arrange of other clinical conditions including cancer, diabetes, arthritis and on an on. access to medication is critical for the patients and survivors. in order complete other prescribed treatment and maintain other activities of daily living. and many medications prescribe to patients for acute pain as well as chronic pain. contain hydrocordon. as the fda reviews the -- containing medications does sufficient data and analysis exist about the potential impact

of rescheduling to have on patient access to hydrocordon containing medications. >> thank you, congresswoman. let my say i agree with you, finding a balance between the necessary access for main medications and patients that require them and addressing the crisis of abuse is absolutely essential. something that the fda keep in mind as we think about the regulatory activity. with regard to assessing access to pain medicine it's something we worked on internally and something i doesed with outside groups extensively. i know, there are a number of people looking at better way to measure that. it was a part of our implementation we put in place last year. we required the manufacturers to assess the impact of that on access to pain medication. we understand it's important aspect of our regulatory activity and whatever we end up deciding to do in the future.

directed us to hold the public hearing on hydrocordon. included language directing us to talk to patients and groups that had experience on the impact that this might have with regards to the schedule of hydro cordon. we have over 700 comments to the docket about the meeting we're currently looking at. a large number of them comment on the effect that different activities might have with regards to access something we rerevering. >> thank you. if there are access problems, could you elaborate, i know there's not much time left. on the process available to individuals who are rightfully prescribe the medications but encowrnlgt problems accessing them. >> the reason why they're having trouble getting the medicine would be important to understand. if there's a drug shortage, for

instance, and challenges getting a drug not available anywhere in their area fda has a drug shortage staff i supervisor. we would love to hear from you. we have a website. we want to work with you to find other ways to make it available to you. if it's due to a lack of availability at the 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. i would suggest the court and pharmacy or other local area groups might be somewhere to talk to. >> thank you. mr. chairman, i'm about out of time. i didn't to ask the other two member of the panel. it's an important topic -- i think for us to be discussing. and i would certainly hope that we could have -- this is such one hearing we have -- many [inaudible] because i want to get in to prevention and that's a whole

another topic that involves maybe some other people too. but you certainly are expert on this. we could certainly use some more hearing on the topic in my opinion. thank you for scheduling this. >> thank you. first in a series of hearings. the chair reck vises vice chairman of the subcommittee. >> thank you, mr. chairman. letter you heard me reference alignment of our policies with those to our neighbor to the north. you sent a later about this. you have the doctor over there diligently working on abuse deterrence how do we align our policies with dan to prevent the older generic form from coming across the border? i probably, as we speak about this, i can see someone developing a business plan that would involve the importation of large amount of generic ox

sincerity didn't have a 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 dan 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 she didn't have the authority within dan law to limit this. but she had not only heard from us, she also heard from the provinces who are concerned that it would be widely and easily available within the provinces. so we notify custom and border protection first to identify and be aware of this in case they see these coming through. so far in milwaukee, that's the only location that we have

received a record of seeing some of these and it was not a great number of them. we have a meeting scheduled in july with our canada counter parts who will be here in washington, d.c., and i will be traveling to oat with a, hopefully with a colleague from the food and drug administration to also work with them. >> you'll be monitoring it. >> absolutely. >> would you be adverse to providing periodic report to the committee to the staff of the committee? >> i would be happy to. >> about the ongoing effort. despite the sleighs nature of the cover of the magazine, i submit to you i can help you locate the bad actors they advertise. it's not hard to pick them out of a crowd. i hope you are focusing some effort on disrupting the supply

chain. again, these people are not shy about who they are and hour much operation, their prices and discount coupon. >> you can see certainly in brow ward county, florida was the epicenter of this. they had 90 of the top 100 describing and dispensing. >> the magazine is from brow ward county. i wasn't going identify the location. since you did. doctor, are there any effort of the fda to make it over-the-counter preparation? like an inhaler or auto pen? >> we think it's important to first understand how best to use it. we are working as part of a much larger group of federal agencies to understand the best uses of it. as a regulator, my job in that discussion is not to decide as a policy how it should be used. it's to lay out the regulatory

pathway. should a firm be interested in developing one of those products? so we have met regularly with the maker of an auto injective problems. to lay out the pathway necessary to get approval as prescription product. at the meaning that we held last year, attended by nida and the drug control policy we heard loud and clear there was a broad interest in moving it to over-the-counter status. >> let me interrupt you. i'm not sure i agree with that. we live in a world where -- it is available with a toot sincerity roll and sticker bars if interdiction and abstinence is not going work in other areas. then, you know, maybe this is something that needs to be looked at. because anyone who has seen the dramatic reversal on an opioid overdose will understand you go from crisis to normal in the space of 26 seconds.

it is traumatic. i'm not saying i advocate that. i wonder in the world we have entered is that consideration? i hear that you are in fact entertaining that. you mention the 11 hours of medical school. you learn a lot in the first years of resident sincerity and practice. i recall vividly when i was moonlighting at community hospitals and someone would come in with a textbook description description, they probably memorized it. a textbook description of renal pain and savvy enough to bite the lip and spit in the cup before they collected a spes min. they had blood in the urine and fit the bill quickly. i know, what it is. i have an point with my urologist. i need something to get me through the night. the fourth time you hear the

story you think there's something fishy here. doctor shopping is a big problem and the doctors who are leaving training and getting in to 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. >> thank you. i gent nice the gentlelady from florida. five minutes. >> thank you, mr. chairman. and thank you gentlemen very much. i'm grateful to the director, because you have given us such great guidance in the state of florida where it's colleagues that has been a horrible problem in the state of florida. you would not believe -- you could drive by some of the pain management clinics and see license of people early in the morning. we would often hear from our colleagues in kentucky, virginia, and tennessee about how folks would travel down florida, find a pain management

clinic that would prescribe, give them onsite hundreds of pills go back, and this pipeline fortunately has been squeezed now. florida adopted a prescription drug data base. we have some to be and starts with that. i'm concerned there are physician and pharmacists 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. i would like you to address that. but local law enforcement they are seeing some improvement from where we would have at least one death per day in our community from prescription drug abuse. they say now with county ordinances on the pain management clinics new requirements for to go after the docks, rest 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? i know it's been unfortunately one of the worst in the country. and then what -- at the federal level, what can we do to provide greater tool to local law enforcement and then one of my local sheriffs said it's not all up to local law enforcement. this is an addiction. we have to do more. districter? >> as a graduate of the university of south florida, i had a special affinity for the problems in florida in particular. i can tell you that florida is doing markedly remarkably better. the leadership of the attorney general pam bonn i did on the issue has been very good. we have worked hard with a number of groups there in florida has actually reduced the problem i think from seven overdose deaths a day. they have been able to make progress. fringe the federal government standpoint what we need to be able to do is to make sure that

these prescription drug monitoring plans are interoperateble for fourteen states can share data. 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. our data base is voluntary. it hasn't been up and running for very long. there's some frustration we have 10% of pharmacists that are using it and not many doctors. if we have interoperability between states that still doesn't get to the problem of incentivizing farmists and doctors prescribers to use that. how do we better incentivize? >> we are actually seeing significant improvements. one is that the electronic health records system, which

eventually will be compatible with the kind of systems. you don't have one pdmp stand alone system. you have your other electronic health records. 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 type of drugs. when it comes to control 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 story that they have told and the fact that we are strongly encouraging mandatory prescriber education. will be helpful. >> thank you. >> gentlemen, could you tell me. i'm a cosponsor of a bill hr1285 by congressman buchanan from czar sarasota area, and congressman markey from the energy commerce committee.

it would acommend the control substance act to make any substance containing hydrocordon a schedule ii drug. do you support that? could you say yes or no? my time is limited. >> i don't believe the administration has taken a position, and we have strongly encouraged the science-based evaluation for the scheduling. i wouldn't be able to . >> doctor? >> he is speaking for the administration. >> okay. >> and same answer, dr. clark? >> thank you for your effort in the hearing. >> gentlelady's time expired. at this time, i request unanimous incent to include a statement from the national association of chain drugstores to the record. without objection so order. recognized the gentleman from illinois. >> thank you, mr. chairman. i have two brief questions. one is, i understand 85% of the

-- drugs is in blister packaging. whether or not that's correct that's what i've been informed. do you think it would have a positive effect on the specific prescription drugs. especially for those that might be going to, you know, families or families woo will taking care of seniors and really the accountability and the inability to really just disperse it without breaking up the package? >> i think it's a very good question, and the use of innovative packaging and storage technique to make a difference in this particular psoriasis. one of the things we haven't an towbt think through as fully as we would like to. i formed a grouch within the fda to start look agent the issues. i have a part of the my center that focuses on packaging and labeling this those things. i asked them to look at issues like this. one of the challenges about putting blaster -- blister pack through 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 ways on the health care system. we need to look broadly at how these packages more creatively than we have, i believe. >> anyone else want to add? >> let me just on this one. we were talking about some of the -- i'm not an doctor, i don't remember all the name and stuff of the various drugs or the drugs to remediate the drug effect. but i'm curious how much coordination there is between each of you when there is a development of a promising treatment which help address the national priority abating the drug abuse crisis. i know, fda has approval thought. will you involved with them especially in the case? >> dr. clark? >> yes. not only the fda has the

leadership in that. we work in collaboration with pdmp and the literature which is the doctor mentioned that the science-based literature produces new idea. we have an ongoing dialogue. we have working groups that are multiagency. multidepartment. to exam the implications. we work with the organized medicine and the various medical society to address these issue. we try to track the development so that we can decide whether they can be moved in to clinical practice. >> we spend more time with each other than our families. [laughter] >> that's true up here too many times, unfortunately. i yield back the balance of my time. >> u.n. that. >> gent nice the gentlelady from illinois. 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 is already in the record when it comes to the changing the scheduling. of hydrocordon schedule ii to schedule iii of the controlled substance act. that was one of the suggestions that came from my constituent who lost his daughter. the other of was -- he suggest the. i don't know if it's under cross-question take steps necessary to restrict the step to severe pain rather than moderate to severe pain. that would change the packaging. in order to prevent the overprescribing of these powerful medications.

eastbound whoever knows best. >> that's probably something i can comment on. there are citizen petitions. there are requests for action before my agency about the changing in labelly. i won't be able to talk about the changes in moderate to severe language in current open yoidz indication. ly say with; however, the fda had an interest in making sure our labels are accurate and and include the information we know to be scientific. i had a public meeting earlier in this year we pose a series of questions to academics, advocates, family members asking for their help in understanding how our current labeling for opioid might be improving.

begin with the approvalled labeling. which outlike how the product are best used based on our scientific judgment. 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 defeat 12 and 18 to have a lock box for certain drugs so they keep them out of the hands of children. dr. clark? >> yes. we believe that prescription drugs should be treated very carefully. lock boxes are good ideas. we as chairman piths pointed out, a lot of prescription drugs drugs are shared between friends and family. so you have the culture dynamic

we also have to deal with. consumer and family members need to be brought in and our prevention effort include not only take back programs that they mentioned the idea of promoting the appropriate management of prescription drugs in the home. lock boxes is our one strategy making sure we have an informed consumer. another strategy make sure the delivery system educates the consumer about the potential risk of issue and diversion of medication. another strategy and as so we can promote the cultural shift in attitudes about these mid indications. >> okay. i have one more question. it appears there's a new trend of manufacturing -- near the

time of the exper ration of their patent. so they then withdrawal 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 reason and the fda precluded from approving generic competedble without abuse i did tesht formulation. and in the absence patients are forced to pay higher monopoly prices for extended time periods which has the foacial increase patient access to the drugs. have you heard about this? >> yes. this is back to one of -- the discussion of the balance system that need to be keep in mind as we think about

formulation that work. we want to to have open yoidz in formulation that deter abuse. ii believe that's everyone's best interest to find a way tone creant vise that. while at the same time recognizing the impact and importance of the questioner in rick in the u.s. market. accomplishing -- our first action was earlier in the year. we put out the guidance laying out how we would try to increant vise the development of new formulations. following up on that, we're now thinking about ways to develop guidance on abuse deterrent form laces and generic to allow them to come on the market as well. in other places, and in this place i would expect are focus

would be on the performance of those generic and not on the technology that was used demonstrate they are use -- the thing we want to have rather than they use their same technology. while recognizing the important role the innovator plays in term of developing new innovative products. >> thank you. recognize the . >> thank you. imha percent of docs what what percent of pain of narcotics? i actually don't know. i know, the information about oncologists write a large number

of . >> oncologists pain did doctors. >> the pain doctors, et. cetera. i think the doctor can probably also help me. >> i play a doctor on tv. and i won't be able to give you specific number. we we can get that. the majority of pain medications are written for by primary care doctors and general. >> that's the majority. if we look at those who write an extraordinary amount. those two standard deviations out. you are 5% right? it make -- if you are looking at the phones who -- folks who are concerned -- it depends where you cut the line off 5% on something like that. it's clearly a minority of physicians that are writing for large amount of these opioid. >> i'm not sure. one of the two of you, i'm not sure it's sampleson's gig.

but i know if you have 46 states that have a prescription drug monitoring program, i'm a dock. i have a dea number. every time i write the number in it goes to data base. they have known if i rein an rx. i was not able to con virm they have patient information. i keep on wondering if our goal is to find that small percent of docks who are writing inappropriately, and we have a unique identifier for whom the dock is. we could look up in the phone book and see what the doctor is. let them data mine. you know what i'm saying? aside from the tongue in cheek. it we have the unique identifiers what is the challenge in figuring out which are the bad actors? >> there are a couple of challenges that come up. one is that things can change particularly in rural areas. pretty dramatically. if a physician leaves a practice

or gone and suddenly that physician taking his or her place begins to write a lot more prescriptions because they have actually taking over. >> as we look at data, i mean, knowing that the urban setting where mo is happening. but even if it's rural, would you describe what is little cod sincerity but a broad sweep. it seems as if we have a unique identifier. a real time data base and 46 states with it. it doesn't seem like there's a big challenge. >> rural area, kentucky, southern ohio. >> you have a unique identifier. you have a real time data base. what is the real gauge. >> i think the other challenge because these are individual state programs some within the law enforcement component. some within the medical practice component, and each state uses those individually to determine. >> doj have access to the patient prescription drug monitoring programs? >> does who from.

>> department of justice. or executive branch? >> no. >> it's entirely state jurisdiction. >> exactly. >> i aassume in the interstate exact they are communicating one to the other as to listen this fellow dropped out. he moved to your state. he's someone you should watch for. dr. clark, do you have a thought? >> we are moving forward that position, it is really important to recognize that the electronic health record innovation operatability stft moving toward that. some jurisdictions, if in fact, trying to come up with algorithm where you can identify the outliers in term of pain . >> it seems like a sort. >> it is a little more complicated as the doctor pointed out. in part because you do in fact pull in the cancer doctors or the arthritis doctors. >> but you know the cancer

doctors are. if there are 100 docks there's going to be 5,000 cancer or 5,000 legitimate pain docs and spb you know moved to the state from this state to that state. indeed. that's what the electronic health records and interoperatability. >> it concerns me that the electronic medical record. i don't want the government snooping. subset of folks writing our x and centered upon the position. you can see my top 1,000 writers. 500 are oncologists or pain doctors. you see what i'm saying? >> hhs is actually done a survey to looking at part d. program and discovered it was a little more complicated d. trying to pigeon hole a practice is simple as all that. but you're right with the advent of increasing monitoring

capability and big data will be able to make some kind of reasonable assessment of a practitioner and at least explore what the practitioner what he or she is doing. >> i yield back. thank you. >> thank you. recognize the gentleman from north carolina. mr. butterfield. >> thank you, mr. chairman. thank you for convening the hearing. 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. the issue of prescription drug abuse is one that was and

continues to be a very important to her and to me. our subcommittee held several hearings on pripg drug abuse last congress. i have somewhat key understanding in interest and stemming the growing problem. the chairman and i share deep concern for individual's well being especially young people who gain access to and abuse prescription drug. at multiple hearings we had on the issue during the last congress made clear to me that drug manufacturers and the drug supply chain are not the problem. >> resistant drugs industry is playing an increasing role in stopping use. the black market and drug diversion and end user stage are the problem. and so the question is how do we address this problem? while avoiding burdensome regulation on manufacturers and others along the supply chain.

what impact have abuse deterrent drugs had on the illegal and illicit use of prescription drugs? thinking out loud. i would imagine if one drug is made -- the person just find another drug that is not abuse deterrent that produces similar result. shifting but not abusing the. i guess the fda -- should the fda remove roadblocks to manufacturers who want to produce bruce detercht drugs so they can speed the new formula to market to reduce overall abuse? >> yes, we should.

i view the technology and couraging their use in opioid as an incremental progress. process. we beginning to walk a road i hope to see a broad majority in abuse deterrent formulation. that's going depress your concern. the squeezing balloon. people moving from an abuse deterrent formulation to another formulation that is easier to abuse. in the short term, here i think we be fooling ourselves if we imagined it wasn't going happen. so my job, i think i guess our agency's job is incentivize the development of new technology broadly and to make certain those technologies demonstrate they work. so we should be developing abuse successfully reduce abuse through reviewing of the data, i believe the fda plays a critical role there.

>> let me go to dr. clark. how can we educate health care providers to spot the warning signs. the warning signs of frequent fliers who might not have a legitimate need for powerful prescription drugs? do you think the implementation of interoperateble electronic medical records. you mentioned that earlier would help to flag the individuals who are receiverring only to get more and more prescriptions they need to sell? >> indeed. we think that the -- working with the national coordinator technology to achieve that. we think that educating

practitioners is important. we work with the fda and national student drug abuse. we both have training programs for the national student drug abuse and we have a training program associated with boston university. we trained over 13,000 prescribers. we work with state medical societies, sample is a sponsors training and we have as a result of this broader effort that the congress has mobilized. we finding more and more pray ticksers are showing up at the 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 dev yent behavior and also maintaining the good bans of care. 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 is expired. i spent several hours practices your name. >> gent nice the gentleman from virginia. >> thank you. i appreciate it. the doctor, can you please update the as to where the agency stands related to requirements on the food and drug administration safety and innovation act pertaining to public meetings surrounding the scnging of hydrocordon product. you mentioned a public meeting had been held. science and straight to reschedule some of the drugs. can you tell us what you hope for or hoping for an update when you think is the process going forward on this rescheduling.

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 including moip to solicit impact on the scheduling. we take it seriously. as i mentioned previously, that meeting is lis ited 670 some comments. over 100 of them making specific recommendations for us to consider instead of about scheduling. making recommendation for other activities. we're trying to work through all of those to form the best science base . >> any idea of the time line when you think something might come snout. >> i'm afraid i can't give you a time line. i understand your frustration. i understand 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. it may come as a surprise to some of you all that virginia has the oldest medicinal marijuana law on the book dating back to 1979 act. that was; however, unlike some of those states that said, you know, if it makes you feel good, do it. virginia require there be a medical and prescription which is not currently allowed. wouldn't you agree with me, doctor, we need to to have a discussion about the legitimate uses of medicinal marijuana, and freeing it up so virginia can exercise itself will so doctors can actually prescribe it in those areas that are authorized by the virginia law? >> my own personal view aside. the fda would not have a clear role in responding to issue around marijuana. ..

how does csa t. plan to expand knowledge and awareness about these medications? either one of you.