if we had one or more that really bent a particular way because of open-ended funding, i think would change the landscape as we know it. >> okay but you just said you cannot arrest her well this problem. let me ask, why not? why not just arrest anybody who is misusing drugs and put them where they belong and call it a day? isn't that a more effective more effective strategy. >> no, unfortunately that is not the case. >> ..

and so law enforcement across the land has had a paradigm shift and understand for that very reason it is a cliché now. can't arrest our way out of the problem, nor do they want to. addiction is a disease and needs to be treated however those that capitalizing benefit of the ones we are after. >> final question, you talked about budget reductions. can you expand on that and what the impact has been? >> the program has historically been very valuable and using the funding appropriated. we have in the past provided a very substantial return on investment.

to reduce the program would put us back many years in the progress we have made. the language in the authorization -- >> have we reduced the program? >> no comeau we have not. >> you talked about a budget reduction. >> while he is checking, i'm taking a little more time. >> the dollar amount reflected was actually taken from the president's fy 16 budget proposal and not representative of level funding. >> my testimony, what we are recommending, the program, congress awarded us 245 million. we have done tremendous things with that money. to go back to 193.4, and it

comes out of appropriation. the language. >> you know we discussed that judges and prosecutors have said that upwards of 75 pee individuals arrest or prosecutor suffering with substance abuse or addiction. the government has barriers in place that in heaven ability for someone

incarcerated to receive treatment. i want to talk about doesn't get your thoughts. the policy, the substance abuse and mental health services administration has set a policy in place that prohibits the use of grants from the center for substance abuse treatment for treating individuals who are incarcerated. obviously we aren't talking about additional resources. our 2nd one is medicaid imd exclusion, the institution for medical disease exclusion expressly prohibits reimbursement for services provided for individuals who are incarcerated, individuals who are entitled to receive medicaid and the treatment services they would receive are not permitted during incarceration. heroin addiction often leads

to theft to feed the addiction are other types of criminal activity that results in incarceration. i have introduced hr 40 which40 which would repeal both of those and allow money to be used for treatment and for those individuals who are medicaid eligible during their incarceration from medicaid to be able to reimburse for those expenses for treatment people are not receiving treatment what they are incarcerated. i was wondering if you would speak about those exclusions and whether or not you believe lifting those barriers might help others get treatment. >> it was a pleasure to meet with you. to your point, we want to divert people away from incarceration. really innovative program where the police chief is

holding community forums. but to your point, we want to ensure they have access to high-quality treatment. unfortunately that takes a tremendous amount of resources. because of the prohibition that often goes to the state corrections or the state public health agency to help support treatment but unfortunately too few people have access. and the opportunity we have to work with congress to look at how we ensure people who are incarcerated good care behind the walls becomes important because those people come back to our community. untreated addiction would perpetuate the cycle. >> the grants that are being made available are excluded to be used. >> we would be happy to work with you.

any opportunity we have to increase the capacity of jails and prisons, to expand capacity is a top priority. >> i appreciate your interest in this. i appreciate your bringing into focus the resources that. >> and bring those comments because i'm well aware we deal with the correctional institutes on a fairly frequent basis on a number of issues. i can tell you from past experience most if not all issues have some relation to drugs and drug abuse and there were a number of people that went into the correctional institute, came back out and without treatment they were back committing crimes. it is important from a

personal standpoint. >> we have done some work looking at the federal prison system. the bureau prison has expanded the amount of resources, specifically on drug treatment programs for inmates in the federal program. one of the incentives to take advantage is if they successfully complete the program's. >> i think the gentleman for his insight. the chair now recognizes the gentlewoman from the district of columbia. >> i appreciate this hearing, mr. chairman. we have heard from mr. marrow about the increase, and i am certainly

not going to blame that on the administration, nor to see. in fact, staying ahead of the drugs law has become such a challenge that i think we ought to, that it will always be a challenge. if we can see that looking into what we can really do would make sense. i have a question on the drug is your and the district of columbia. another question on marijuana, but we certainly remember when the drugs that the entire nation was focused on was crack cocaine. now, of course, everyone is focused on opiate and

harrowing, and it will change tomorrow. i was interested in mr. turner's question. about treating people and they are behind bars because i had a roundtable last night. you know there are 6,000 federal returning citizens now all around the country because of the reduction in the sentence for mandatory minimums. this was one of the great law and law enforcement tragedies. we treated crack cocaine differently from cocaine, and you essentially or we essentially, democrats and republicans, certainly not partisan, essentially destroyed what was left of the african-american family. most of these were black and latino in the mid- 30s,

right at the prime of life. so today you hear about opiates and harrowing. and about the law enforcement approach that you have been authorized to pursue. but i must ask you, and light of prevention i don't see how you can prevent the next drug of the day. i am cosponsor with several members on the other side of the bill to deal with that knew phenomenon. but if -- you cannot expect law enforcement to prevent new drugs or drugs from changing. i'm not sure why they change.

at the very least it seems, at least by roundtable told me that once you have somebody will often find, as we did when we have these witnesses who have just been released from mandatory minimums have there mandatory minimum reduced by an average of two years command questioning them these were drug traffickers, got into drug traffickers by using drugs. i could not help but believe that the treatment have been earlier available we might have prevented what was one of the worst tragedies and law enforcement in american history command now we are trying to make up for it. you say should not be 5%. it should be 10%. that 10 percent. that has the ring of a number pulled out of the air

because you have 5 percent and because you don't think you can get anymore. is that essentially the long and short of it in terms of what is effective as you pursue new were and newer drugs every decade? where did you get 10 percent from? especially. >> we got the 10 percent, that was a figure that was derived in two different ways. using the prevention history even though 5 percent of funding has been available for some period of time across the nation. many have never approach that. >> treatment. >> treatment has never been. >> except in this region. >> you were grandfathered in. >> the experience that the

ranking member has spoken about educated you will? >> certainly. in fact, i said peak for all directors when they recognize the value of treatment. >> what is the basis? >> 10% was10 percent was based on -- >> i'm not suggesting another percentage. they may not be evidence -based. >> it was more based on the budget,budget, and the fact of the matter is that historically we have never exceeded more than 5 percent. i also spoke about the partnership and the fact that we value that and the fact that by elevating it to increasing and almost doubling that would give the executive boards fairly wide discretion in using an effective baseline.

the baseline differs across the nation. some of those, the new england baseline is 3.1 million. that would allow the executive board upon approval of the directive used upwards of $3,000 is a maximum. that is also very important to realize that that is not the only source of funding for treatment that would be available. the beauty of the program is our partnerships across the spectrum. in coordinating within coordinating with other people we can maximize that impact, but it goes back to allowing for treatment, allowing for prevention, allowing for enforcement. we recognize that but we also recognize the fact that we are flat funded. discretionary funding sometimes varies.

discretionary funding would allow them to use more money for these kind of programs. >> i think the gentlewoman for your response. the chair recognizes the gentleman from wisconsin for five minutes. >> how many people died of heroin overdose the last year in this country? >> over 8,000 people. >> that was data from 2013. >> are you sure? >> that's the best available data that we half. there has been some estimation that because of the information variability that comes from medical examiners and corners it might be underreported. >> when i geti get around my district i talked to my sheriff's.

and i don'ti don't really think of wisconsin as being the heroin center of the world. it would be higher than that by a factor of three times. are you sure it's even close? >> this is 2013 data. we expect inwe expect in the next few weeks to have 2014 data available based upon what i havei have heard i would highly anticipated the number of heroin associated deaths is far higher than that. >> that just bothers me off the top. how are you getting that data? is every county reporting? is that comprehensive? >> so the way that the reporting work says county medical examiners or corners

report the data to the state and federal level. there is probably wide variability in the reliability. we have been trying to work at enhancing the quality. again, this is 2013 data. >> why don't you give me the data folder wisconsin. and i can tell you whether it's accurate. second question, where is this coming from? >> this majority is coming from mexico. this compels us to not only work domestically with demand reduction strategies do with our colleagues in mexico.mexico. i was just in mexico two months ago meeting with our colleagues, and one of the main agenda items was what additional actions the mexican government can take in terms of eradication of poppy fields, going after heroin labs. we are seeing a dramatic increase infant know associated deaths, this very powerful morphine like drugs

, but much of it appears to be coming from mexico as well. so part of our overall strategy has to be looking at working with mexican colleagues, reducing the supply and working at our border to intersect more heroin. >> ii was under the impression a lot of these were grown in afghanistan. walking down the southern border. how much prison time do you expect to get? is it a federal crime? >> are you sure?

if i am caught, what type of prison system -- sentence can i expect? >> i don't know the exact answer. we do promote comeau we know that many people who sell small amounts of the drug largely to feed their own addiction, these are not the folks who are praying on our community. we want to make sure those folks who are doing that largely because of their own addiction are getting good care or treatment. >> it is a little shocking that you don't know. to me and wisconsin we have money for treatment. but the frustrating thing is the cost to solo, and the reason is that people who are selling it are not

paying enough of the price. heroin was around in the 1970s, but it was not abused like it yesterday. one of the reasons the cost is going down on learning today, i don'ti don't think you guys consider enforcement enough of a priority. people are killing people. i believe more people are dying of heroin overdose then murder in automobile accidents combined. that is certainly true an individual counties. something the federal government can do is make the cost go up a little bit. i am concerned that you guys are not 250, we can't prosecute our way out of this. >> i would tell you that honestly we look at public health strategies decreasing the availability and increasing price has been a

prime strategy. because of that cheap availability we know that that has prompted the dramatic increase. that is part of why we are focusing on working on law enforcement to dismantle organizations, while we continue to work with mexico on reducing the supply for how we work with customs and border protection. we know that there is a nexus between the supply and demand. i will be the 1st to admit that while we need to continue to ramp up demand reduction that will ramp up ourwrap up our supply reduction. we have to agree how we look at how we diminish both the supply and the trafficking organizations who are moving it. >> i hope you do that sincerely because i am afraid you are just throwing up your hands and saying all we will do is education. >> vigilance time is expired

>> a little shorter than the last one, but that's okay. >> thank you, mr. chairman. thank the witnesses. let me ask, director botticelli, and let's stay on the subject of heroin addiction. we are afflicting americans of every part. it's timely and urgent. i have heard you speak eloquently and powerfully about how treatment is one of the ways that we can reduce the 17,000 deaths annually from prescription painkillers and 8,000 deaths annually from heroin. and i have seen firsthand the value of life-saving and life renewing services

offered by community-based nonprofits the provider residential treatment for substance use disorder. they provide the full continuum of care for addiction from residential treatment outpatient to active care support. upon completion of the program that is essential to them staying clean and being a productive member of society. it should not be all about throw them in jail and lock them all up. i think this is a disease that needs to be treated. and i agree with mr. turner. unfortunately, if you are poor and rely on medicaid for your healthcare, which we know a lot of states have not expanded under the aca there is an outmoded policy

of 50 years old now is the institution of mental diseases exclusion. better known as the imd exclusion which bars medicaid from paying for residential treatment at a facility of more than 16 beds and the new york times coverage is extensively last year about how the imd exclusion prevents people from accessing the care they need. they lose access to the treatment that may have been clinically indicated in medically necessary. this is wrong and must be changed, and i want to join with my friend from ohio and trying to change.

do you agree that people on medicaid should have access to the same kind of treatment for substance use disorder? >> thank you for that. one of the things we know to be effective with dealing with substance use disorders is people need to be conducted have connected to a continual of care and moving people from their environment, getting the new skills and jobs is particularly important. we want to make sure people have access, that everybody has access to the continuum of care, not just people who can afford it out of their own pocket. the administration has taken a look at the exclusion of the secretary just sent out a letter to state medicaid directors basically saying there are a number of levers

that medicaid can use to help support a continuum of care but also waiver from the current imd exclusion. i know as i traveled around the country i used to administer state-funded treatment programs and many are under significant demand and that imd exclusion's exclusion's can seriously limit the ability of our treatment programs to serve more people. we should want to look at how we expand treatment capacity, how we can ensure folks who are on medicaid have access to care. the last thing i will mention, in spite of the affordable care act to medicaid expansion in many states, there are many people who remain uninsured command ii want to make sure they have access to all that care as well.

>> everybody has access to the full continuum of care. >> and i'm glad to hear about the plan. what happens in those states that don't seek waivers? shouldn't this be a national policy? >> through not only the affordable care act but the implementation of the mental health equity and addiction parity act we have to look at making sure that we treat addiction like we do any other chronic disease and reimburse for services like we do with any other chronic disease. we need to use every tool in the toolbox whether it's parity enforcement can't block grant to make sure people have access to care when they needed not just because they can afford it. people who realize they need care often have to wait weeks before they get in the

care and often get limited duration when they need long-term care and rehabilitation. >> my time is up. >> i think the gentleman. the chair recognizes the gentleman from georgia. >> thank you for being here. as you can imagine, prescription drug abuse is important. as the only pharmacist in congress i have dealt with this, experienced it. i have seen it ruin lives maroon families and it's obviously very important to me. as a member of the georgia state senate has sponsored senate bill 36. something am very proud of. i want to ask you, can you tell me what the national drug control policy for what is your direct role in combating prescription drug abuse. >> we play a prime role.

let me express my appreciation. particularly your focus on prescription drug monitoring programs. every state should have a robust prescription drug monitoring program. that was one of our main goals. we started the only had 20 states and today we have 49. firewall is to make sure they adequately resourced. data availability and sharing information becomes important. >> let me ask you. how do you fund those, through grants? >> those are through grants that are bureau tested. >> i remember when we set up our program we were eligible for certain grants because we did not have certain programs within the prescription monitoring program that we needed, sharing information across state lines my could not get the bill passed with that

included in it which made us an eligible. >> to my knowledge i am happy to work with you. if there are additional requirements that you feel like have become a burden in terms of states not having access am happy to work with you. >> that is an important element is my hope is that we can get that changed. the practice on the georgia florida line. i get prescriptions -- are used to practice. i get prescriptions quite often from the states and the that information as well. you mentioned a while ago, legalization of marijuana in the decriminalization of marijuana, i suspect that has had an impact i was wondering if you had done any studies i always viewed

marijuana, and full disclosure i am adamantly opposed to the decriminalization or legalization. for practicing pharmacist for over 33 years and i spent my career using medication to improve people's health. it is a pet peeve of mine. what i want to no is, in the states that have legalized are decriminalized, i have always viewed it as a gateway drug. have we seen a decrease or an increase or any impact at all and other drug use in this particular states? >> we currently have a report going through final processing looking a part of the issue. it will be issued at the end of this month, and the state of colorado and more specifically with the department of justice is doing or not doing involving there use. that report may address some

of your questions in terms of preparing for today's hearing i don't have any specific information, but it is right on.than an important issue that needs to be addressed. >> right. another point that was brought up i found interesting. they have done quite a bit of criminal justice reform in the state of georgia and talked about it here in congress. certainly having programs in our prison system because of prisons are full of people in there for drug abuse problems and illegal drug use. we need to have programs in our prison system that will treat them because it is a disease. it is a disease and something that needs treatment. what are we doing to help with those type of programs? >> in the federal system inmates are eligible for a residential drug treatment program.

if they have come into prison with an addiction they can get that treatment and get reductions in their sentences if they successfully complete the program. >> is voluntary. why is not required? >> why are they required? >> if you go into prison for drug dependency why are you required to go through therapy? >> that's a great question to ask the bureau of prisons the ability to have inmates have a sentences reduced creates a pretty strong incentive. for a number of years the bureau of prisons did not have adequate resources to meet the demand. they have sincethey have since made a lot of progress in addressing that issue. i can't speak to whether every single inmate actually gets treatment. many want to those to address their addiction. >> many inmates may want to, but i suspect that they all

want them to get it. thank you and i yield back. >> the chair recognizes the gentleman from massachusetts for five minutes. >> thank you, mr. chairman. i want to thank the witnesses for your excellent testimony. mike botticelli is a power mine. mr. kelly, my district is a high intensity drug trafficking area. mr. kelly has been a frequent flyer to my district trying to address the problems. most pointedly we have had a critical situation in massachusetts in my district as well as other parts of the state, and maybe just explaining that will offer some value to what the office of national drug control policy actually does. we have had a pernicious problem with heroin coming

into my district from mexico , and it was through the directors help that we figured all of this out, but it is coming out of mexico and colombia. the earlier drug trafficking network was to the dominican republic. as mr. kelly has informed us, be of the national drug control policy we were able to bring in resources. we are dealing with a system will we have local towns, cities, counties, the state. now one of the areas was providence, rhode island. and thenand then we are dealing with the mexican border and the mexican government. elaine dcp polls all of that together. i had a number of homicides

in my district that have the population full on. brutal, brutal murders directly tied to the drug trade. and so zero in dcp did a remarkable job. from member to member, they are very important part of that. that is how we bring these resources together. i want to express support for the idea. they are short funded on that end as the director pointed out. maybe we can do something on the pilot program were county prisons were state prisons might identify a program in a certain area where we are trying some innovative stuff to deal with the potential inmate population.

i appreciate the work you have been doing and thank you for your testimony. i want to back up a little bit. one of the problems i see on a day-to-day basis command i am up to my neck in the stuff, the power of oxycodone. i could tell you some horror stories about young people that we have been dealing with. one young woman had a tooth extraction. and then she tells me now she falsely claimed have persistent tooth pain. two later she is fully addicted command then she started complaining about other teeth, having other extractions. having teeth pulled out of her head. now, when people are doing that it tells you that this is a powerful, powerful drug.

because of the tolerance comeau what it does to the brain and the tolerance and resistance that develops greater dosages are needed. using that as one example, why is it that we are allowing drug companies to produce these powerful, powerful drugs by which they are building a customer base for life by getting people on this. it is overloading membranes and just grabbing them. there is a commercial advantage to producing customers for life. if you can get these people hooked you have got them forever. and now the fda, they just expanded they used to children. it seems like we are not all rolling in the same direction. when i was 1st filed a

bill to ban oxycontin. i did not have a prayer. what is it that we could do to look again at the substance that we are allowing people to sell commando not against pain management that this is ridiculous. how do we address that issue? >> if you could briefly respond. >> thank you, congressman. we are prescribing enough prescription pain medication the us to give every adult american their own bottle of pain pills. we all want a balanced approach. we continue to work with the fda, but one of the areas we have not made enough progress is ensuring that

every prescriber has a minimal amount of education around safe and effective opiate prescribing which is why we are thrilled. that is often the place where it starts. i am sure the dentist is very well intended. we have to work not only on making sure we make the medications more abuse deterrent but also that we are stopping the overprescribing that we see throughout the country. it is critical to rein in the prescriptions. and that is often with the doctor-patient relationship. >> thank you. >> the chair recognizes himself for a series of questions. let me be brief in terms of

the introduction. i think we have a bipartisan agreement that this is something we need to address. the question becomes, with the reauthorization and some of the suggestions that have been made in that, is that the appropriate place and money back i can tell you that i started a nonprofit with a good friend of mine who lost his grandson, and there is a cycle within that family of drug abuse. we went in and developed a nonprofit to work on the prevention side of things. this is something near and dear to my heart. i want to go a little closer because this is all about coordination. we talked about this early on. there is virtually little if no coordination command yet we spend billions of dollars

you are talking about increasing the authorization amount. i am willing to look at that to make sure that you have the resources necessary, but as we look at these's, i want to make sure we are not taking away from this which i consider more of a law enforcement component, and in spending the money on prevention and treatment when it would be better allocated in a different agency that already does prevention and treatment. this gets back to the mission. let me ask my tougher question 1st, that is, in the reauthorization language there is talk about getting rid of the new performance reporting system. >> one of the things we looked at as we have undertaken this is how we achieve greater efficiency within the organization to focus on the main goals and mission. one of the things we looked at and are fully cognizant

of the role to ourselves as an agency, to congress, and the american people that we monitor performance. >> you came up with this system. why get rid of it? just cut to the chase. >> part of what we are trying to do is achieve greater efficiency. >> how do you do that by getting rid of an evaluation program? >> we have existing mechanisms within our current administration the monitor performance. >> who made the mistake of doing the new performance? you created a new one and are now doing away with it command i don't understand why. >> i want to be clear end up front. there were elements that help in the ability to continue to monitor. >> let me be clear end up front. i want you to work with gal to keep the system a performance review in place,

make it meaningful measured because the appearance -- and i am willing to look at increasing the authorization the appearance is that you did not meet your performance standards and got rid of the program. that is not satisfactory. do i have your commitment to make meaningful and put it back in? >> i would be happy to work with you and the gal that we satisfy your request to make sure we are monitoring. >> performance, and if we are spending billions of dollars and not getting what we need and we need to reallocate funds. >> if you can put up a chart , this gets back to how i opened up a little bit. i believe this chart is one that comes from the performance fy 2014 or 16

budget and performance summary that was produced by your group. we can see there the prevention and treatment across agencies is substantially higher already i guess that is 11 billion. and soand so some of the wonderful programs that have been talked about today that actually i have taken advantage of and used with grants, they are working in treatment and prevention. the drop down to the next group. let me be specific knowing that you have a willing participant here to help you with the reauthorization. i am concerned that we are taking this and making them in treatment and prevention group when we are already spending 11 billion and other agencies to do that when just better coordination would actually

address it. so what i would like us to do is look at that again and look at, and if we are not meeting the in the gentlewoman from the district of columbia and the gentleman from maryland talked about how that treatment component is effective but are still not meeting the 5 percent, what i want to do is make sure we are allocating the money with the proper agency to perform those functions and not making a law enforcement officer do treatment and prevention because i want to give him the tools to refer, but they are not in the treatment and prevention business. and when you do that it is concerning. will you agree? >> i would agree.

one of the things i want to point to is despite the fact we have significant and increased funding we know we have gaps. >> i will agree with that. is this the best place to do that? i can tell you, my biases that it is not. >> you can sell me. i am waiting to hear it. >> making sure that if they are investing that they go toward evidence -based programs. >> i understand. i have a program in three counties. mcdowell, buncombe, and henderson. and the only common thread is transportation. we are looking at corridors coming from the south command to do away with money from the program there is not addressing the treatment or prevention aspect because it is all about transportation which goes from a democrat and republican share working in

those counties, they work better together. and to reduce there funds concerns me. >> i appreciate your comments. let me reiterate, our purpose here with the language was in no way, shape, or form to dilute the main mission. >> i believe that. what i am saying is it could do that. will you agree address the reauthorizing language with that in mind? i will give you after this time because i may be going to my other colleagues. you can try to sell me. >> i think that we can. maybe establishing better criteria. >> let me put it bluntly. will my sheriff's agree that we need to increase the amount of money going to treatment and prevention and go away? >> i honestly don't know.

i will say that they probably would eject and we would object. >> if they object we will have an issue. >> they are probably on the board. >> the gentlewoman from the virgin islands for five minutes. >> thank you very much and good morning. thank you for the work that you do. i am incredibly appreciative of everything that you are putting forward in your testimony. my 1st job out of law school was a narcotics prosecutor in the bronx. ii understand this completely and the importance of the work you do. as a member of congress representing the united states virgin islands i very much strongly support the bipartisan effort of reauthorizing the office of national drug control policy. i see how important it is not only for the nation in terms of treatment but preventatives as well in

terms of stopping the flow of drugs in and out of the country and its transportation throughout. for years the otherwise peaceful communities in the us virgin islands have been experiencing elevated levels of crime and violence, much of it related to the economy which has in turn moved tremendously to a growth and illegal drug trade. we are grateful presence and would be in favor of increased presence because we are aware that much of the traffic of drugs coming into the mainland is coming through the caribbean corridor which many people are not aware of how much drugs are coming into the country through such a small area of the united states. you can imagine if it's coming through such a small

and porous border in the small community, the tremendous affected is having on the people that live there, neighborhoods, individuals completely afraid to go out only at night but even during the day where we are having drug wars and shootings occurring not even blocks away from schools in the middle of the day. although a significant effort has been made in recent years to address drug trafficking through the us territories in the caribbean , and our opinion much remains to be done to help stem the flow of drugs and related crime as well as to diminish the negative impact of drug abuse in the community across the united states virgin islands and puerto rico. in response to a congressional directive earlier this year zero in dcp took a major step forward in helping to promote a well coordinated federal response by publishing the 1st ever

caribbean border counter narcotic strategy. i would ask you as well as mr. kelly as to whether or not you believe that explicitly including the us virgin islands and puerto rico and statutory mission would help ensure the drug related issues facing the american caribbean border are fully included in aspects of your work. because we are small in numbers and population people are unaware that almost 40 percent of the drugs that come into this country come through those two areas. >> thank you for your question and concern. we share your concern in terms of looking at trafficking and increasing crime. we have seen an increased flow in the caribbean as it relates to some of the drug flows, and we are happy to comply, to produce the 2015

caribbean counter narcotic strategy which addresses some wide-ranging issues. we will be convening the relevant stakeholders in early 2016 to review progress and have every intent going forward to include specific action items in our strategy that address the caribbean and us virgin islands. >> i will work as closely and be as supportive of you as possible. you know, families and elders and children really need your support. do you have any thoughts? i have visited the group and puerto rico about a month ago and was impressed by the work they are doing, have been speaking with our coast guard who is doing quite a bita bit of the work as well and would like to get your thoughts. >> thank you. in fact, you have struck a number of points that are very germane. the program has been intimately involved with the

caribbean, not only through our program that is there presently but on a monthly basis we have a conference call, sometimes with as many as 90 people on the call the caribbean intelligence conference call were members of all the federal agencies here in the united states talk about the transportation of drugs and the sharing of intelligence and have made some great, great progress, so much so that it has been a repetitive conference call and we will continue to do it. to your point on including in the reauthorization and the type of border strategy, i think it is important. as we look at the drug issues we had only look inward but insulate ourselves from the outside, whether it is a northern

border strategy, southwest border strategy, or caribbean border strategy with those of the transportation corridors. it makes perfect sense to me with the strategy that just came out the caribbean is a very, very important partner in this issue of reducing the supply that comes from elsewhere command we know that we have to take greater strides in protecting not only the people of the caribbean and those nations in those territories but to prevent the transportation of drugs to make that a no go zone for these drug trafficking organizations. >> thank you very much. i will be so impressed with working with you while in that. i will be on you. i will be watching. >> i think the gentlewoman. >> mr. director, why are you

requesting 22 percent less for the program? >> part of the challenge. >> you were just talking about what a good job they do. >> again, this is not reflective r-value of the program. >> my wife was a waitress. she said appreciation is green. what is it reflective of? >> it is a reflection of some challenging priorities. >> rated the other money go? >> i can get back to the committee. >> i'm concerned. i will recognize the gentlewoman from new york. >> thank you very much. thank you for the hearing. i join the chairman and underscoring that you should not be eliminating the

review processes the strengthening them, and certainly knowing the problem that we have, we should not be reducing what we are spending but maintaining it and hopefully growing. i want to get back to the conversations we have been having on opiates, that they have been described deeply and strongly. the increase of prescriptions. i.e. tracking whether the prescriptions are coming from doctors, or are they illegal? >> as we look at data, the vast majority of prescription pain medications are coming from legitimate prescriptions. we only see a small percentage coming from internet sales or street-level purchases. 70 percent of people who start misusing prescription pain medication get them free from friends and family who often got them from just one dr..

as people progress they often do move from dr. to dr., but that comprises a small proportion of overall prescription pain medication in the supply. we know if we are going to deal with the issue we have got to diminish the prescription pain medication. >> and also, the reports are that people on opiates then become addicted to heroin. have you been tracking that? apparently helen is cheaper than opiates. is that in your database? then often harrowing goes to crime. >> we know that about 80 percent of people, new users started misusing prescription pain medication because they are both opiates. we do know however that when you look at heroin use being much lower as a percentage of use, so we know that only

a small percentage of people are progressing from prescription drug misuse to heroin. however, because of the magnitude that has led to aa significant increase in the number of people using heroin. >> is there any punishment to doctors that abuse these opiates? i thought the example from congressman lynch was astonishing. ..