profession, having regarded as a noble profession and an equal influence on the minds and moralofmora morals of the people. the pulitzer prize still has that tone to this day. it calls us to produce work that has impact and makes us a better people. the pulitzer's invite us to unearth what we never knew or draw attention to what we failed to notice. it invites us to hold powerful interest to account and to give voice to those who have been fall n or pushed to the margins of our society. it invites us to clarify a world that often defies underinstandi. it also invites us to understand the best of our craft in video

and graphics and presentations. perhaps you feel as i do, every time we have not won a pulitzer prize is a great injustice. apparently you do. but we know the truth and the truth no matter how much or organizations and journalist cawe covet this and should be heartened by the experts we see in the finalist. amid this year of celebrations, it is worth reflecting that the

pulitzer's represents standards. high standards in an era where we have seen standards erode or under frontal assault. when we see distortion and disception and lazy reporting, the pulitzers remind us week take a different route. in pointing us in that direction, the value of the pulitzer is greater than it has ever been. today we have two sessions that will allow us to do what the pulitzers sask us to do; dig

deep. the second is an interview by eugene robison. winner for columns during a historic election. the first panel will address the oba administration. joel becker will -- joe becker will be the questioning person. her book, forcing the spring inside the fight for marriage equality was recognized was one of the most notable books of 2014. earlier in her career, she wob the pulp -- she won the pulitze prize award for reporting on

dick cheney. i am pleased to turn it over to joe and the distinguished panel. [applause] >> thank you for being here. we have a lot to talk about and not a lot of time. we will get right to it and at the end we will try to save time to take your questions. bob woodward is next to me. one of america's most important investigative journalist. he led the investigation on watergate. he was the main reporter when the post won the 2002 pulitzer for the coverage of the 2001

terrorist attacks. and next to him is the vice president of the washington journal after working with the asian wall street journal he was assigned to washington and wrote a weekly column that won the

pulitzer. >> i am going to start with you dave, david. , how mache how much do thunk he is thu >> i grew up with old men in suspenders and what this place is a is a different world. you know, barack obama throughout this presidency has thought about it deeply. he has met with a group of historians. i don't know if anyone on the stage was part of that. i certainly wasn't. but over the course of many years he would meet with thrum to them about what it meant to be a great president. legacy is written by the winners. but the first legacy to be written by barack obama himself. he will write a book that will probably get more money than any book in presidential history.

when he was just starting, if you remember, he compared himself not to bill clinton but ronald reagan. he wanted to be a president of consequence. and i think that no matter what your ideology is he has done that from obamacare to opening up relations with cuba and what he is doing in iran whether you disagree or agree to bailing out the auto industry. there has been a series of actions he has taken that i think add up to a president of consequence. i think also, you know, there are many politicians and, you know, people of all sorts who don't change they just become more so. i think one of the things that president obama's legacy will show is what he learned on the

job and the final, whether you agree or disagree, he became more effective even as he lost control of congress. >> danielle, what do you think his legacy will be? there are events that we won't understand the consequences of for many years. >> this is a funny thing to suddenly get out the telescope and pretend you are 50 years from now and see what is durable and what is very much influx. i think one thing that requires recognition, and i thought i got summi something out of my wap wallet it was the transit ticket from seeing obama speak. we have had the first african-american president and now for african-americans i think there is a sense of ownership in this country and i think it will affect the issues

we see raised with the police force brutality and issues playing out. and i believe the obama administration and president obama has secured the principle that health care should be available for all. the shape that will take is an open question but i think the principle is now secure as it was not prior to his administration. for me the areas that look open and uncertain are the interesting combinations of the relationship between the move for energy independence and foreign policy. i think there are ways in which ba obama's foreign policy would make sense if it were possible to achieve energy independence over overnight but it is not so the foreign policy looks erratic, uncertain, and it is difficult to figure out the long-term impacts. that is how i would split up what i think to be certain and

durable. i mind be surprised in if 50 years we will not talk about the changed relationship with african-americans and the change of agreeing on secure health care for all. >> paul, what do you think? transformative or transitional? >> i feel i have been invited to be the skunk at the garden party. >> didn't you invite yourself? >> i did not. i invited marty to host an event and weeks later marty said we better get somebody on the right so i think they invited me. let me thank marty and the post for hosting this and jeff and fred it is wonderful you did this. and on behalf of my colleagues on the board thank you very much. this is great event and this is a wonderful space.

i agree with a lot of what david and danielle said. david is right, the president is wanting to be had -- to be the reagan in reverse. and the question is has he achieved that and i think the jury is very much out. his legacy, domestically in particular will depend upon the election of another drouthic president. i say that because so much of his domestic agenda has been done through executive order and regulati regulations. his entire climate change agenda is through regulations. the health care agenda, while i agree even if republicans sweep the elections this time, they will not roll back coverage -- they will rewrite the bill and replace it. and i would argue even if a democrat wins one of them will

attempt to rewrite the affordable care act because it is not sustainable in its present course. quick point on foreign policy, i hope we will talk about that more, but i think if you look at the world that is more up in the air in question of legacy. while the cuba and iran deals are yet to be played out particularly iran. that has a chance to work, although you can count me a skeptic. i think the middle east -- if you look at the world the president inherited and you look around and say where is that world more stable, more ordered, where is there more peace and prosperity and i have a hard time looking around the world and finding many places where that is the case. from putin in europe, to it south china sea where china is pushing to the middle east which is a complication. >> i want to come back to foreign policy.

but first, bob, there is nothing knew about republicans disliking democrats and vice versa. but pugh found the level and depth that people feel toward the opposing party has surged with many going as far as saying the opposing party policies threaten the nation's well' -- wellbeing. president obama wanted to change that. does he get a pass on this? >> i hate to talk about something karl rove once said and that is everything depends on outcomes and we don't know the outcomes on lots of these things. paul, you muted your criticism, really. you wanted to prove you were not

a skunk. >> he is a chameleon. >> we read your work. >> and i consider that a high doc compliment. >> i read it very careful laech. i think there is a way to describe this and david hit on this. you have to measure how presidents learn and change. and in obama the trajectory at the beginning, his first term, particularly on domestic policies, he was not a negotiat negotiator. i think he has become a negotiator now and realizes inevitability and deal making and relationships with people in the congress particularly didn't work with democrats. it was awful. i remember when the democrats controlled the senate one key

senator, one of the very powerful committee chairman i was talking to about this, and i was saying obama hasn't connected with people. and he said i don't know how you can say that. why in five years he has called me twice. i told that story and said don't tell it in public because the senators who only got one call or zero calls will feel totally out of the loop. on foreign policy, i think he started out -- i remember a couple years ago having breck breakfast with the key leaders of one of our biggest allies who said he likes obama and he is smart but then he said something true and he said no one is afraid of him in the world. and i think that is true.

and i think he said the message of i want to negotiate and he has toughened up. the world is a dangerous place and i think the instability is lit in so many places. if one goes off in the next year or the next two or three years people are going to go and do the backbearing on it and how did we get to this point and not enough tough stuff -- back bearings -- >> can i add? i don't know want to talk about foreign policy but i don't know it but i understand obama and i would like to compare him with clinton in terms of dealing with congress and the best of the world. >> and relationship building. >> they both came out of nowhere. out of southwest arkansas and

hawaii. they came from dysfunctional families with alcoholic step-fathers and obama had the extra burden of figure out who he was. they had a lot to deal with and dealt with it incompletely opposite ways. bill clinton just plowed right through it. he learned how to get past it without resolving things and became the ultimate survivor. he needed people to do that. transactional politics in life was what defined bill clinton. that got him all the way to the white house, in trouble in the white house, out of trouble in the white house and into trouble again. a repeati -- repetative cycle. barack obama spent time dealing

with and felt like we was a quote integrated person. and that got him to the white house and got him into trouble because he thought if i can resolve my internal conflicts why can't everyone else? that has played out throughout his presidency. >> so it is the fault of mom and dad in congress? >> no, not at all. i am saying that is the reason he is the way he is. >> he is a smart man. there were many articles about his failure to reach out to congress and bob has written about i think you talk about the economic deal. scom >> i think it is a overwhelming self-confidaence that helped hi rise to some extent but made it harder to deal with people in congress. when you meet with president

clinton he would want to convince you that what you said was the smartest thing he ever heard. man, paul, that is just fabulous. >> even me. >> did you believe it? >> of course i didn't. but just for a moment. you are a smart guy, mr. president. and i would talk to ceo's coming out of meetings with him saying it will all turn around and be fabulous. president obama wants you to think he is smarter than you, has you beaten in an argument and this is why your argument is wrong. that is a different kind of peterso personality. >> that is not a personality. as president you have to figure out a way to work your will. this is what reagan did and clinton did in so many ways. this we are going to find out in

history. and you know we don't know if the big stories of this year will be domestic and economy or foreign affairs? they may be both. but what he has done or not done is going to be tested and certainly going to be tested and in the lap of the next president. >> i would like to add a footnote to the conversation about relationship building and the way in which president obama has or has not done that. i think in all honesty it isn't just an issue in congress and politics in washington, d.c. and so forth. but an issue with the conversation he had with the american people over time. he has no surrogates. this is an unusual feature to have no sayurrogates conveying s story. he hasn't build that conversational network. there is a link of two expressions in regret the one in

the state of the union where he could not bridge the gap and the one of not bringing the office of communication together. it is a core piece of the presidency and being a politician. not a lawyer. there is a distinction between a president and a lawyer. >> even if he had those skills in the polarized world live in is it possible to bridge that divide? we live in an environment where people need their views reinforc reinforced. or should leaders rise above that? >> i think it is a question of rising above it but there is infrastructure questions. there really are question about how we put conversations together in different context.

what is the underlining structure that makes conversations possible? we cannot blame president obama more than we can anyone else but it is something we have to do. it is not optional. it requires the underneath thinking about the construction of the conversation. >> it is about time against the problem also. you have to spend time with people and you have to listen and the negotiating process is very complex. i think like the iran deal, paul disagrees, but i think the iran deal is a significant and brave accomplishment. and anyone who knows anything about nuclear war will realize if even though it might take ten years to get the bomb or the likelihood they might get a bomb

that is a big deal. and barack obama lives in that world and he is the commander and chief in charge of the nuclear war planes and if you do any reporting on those you find it is frightening. if you were the person who had to make decisions on that you would work like i think he has done and john kerry have done to get a deal imperfect but wow think if it works. >> if it works. and i would just make a couple quick points. one is, if after ten years, iran doesn't have a nuclear weapon or it isn't making progress toward it, and there is no proliferation elsewhere in the middle east, then it will have been a success with one other cavb ought and -- caveat and that is will iran use this to

increase their position in the middle east? the jury is out. we don't know how it will end up. >> of course we don't. but if you are the president and have the military aid that carries the football around and has a book of options that tells you you can just by yourself, no committee meeting, no nfc meeting, launch nuclear weapons and in the last category casu i casuality 40 mill -- 24,000.

>> what might it looked like had he developed the skill quicker? >> i think given the fact he wasn't good at that he accomplished as much or more than bill clinton who was the best at it. >> clearly he had a robust legacy. if he had made the grand bargain with john boehner maybe. but there are other variables going on there that bob has written about. >> bob, you want to jump in? >> look, both sides are to blame. they are deals that obama should have taken at the same time boehner didn't know how to do it. in some of these meetings effectively blackmailed or tried to blackmale obama. and it is kind of shocking

blackmail -- >> he started as a community organizer. if an issue like gun control was so much at the heart of what he believed in his inability to develop a counter to the nra is a failing. if you look at polling, the huge majority support not just controlling the automatic weapons -- >> right before the election he doubled down on this. >> he could have developed something there if he had better skills at -- his oratorical

skills are overrated to develop a public following on actually issues as opposed to getting elected. >> i want to turn to foreign policy. obama aids summed it up to don't be stupid. hillary clinton said that is not a policy but a slogan in a rare moment of peak. danielle, how much from departure of the historic norm is his foreign policy? >> that is a good question. i think in the long ark of history there are accounts of people he fits with. it is not like we always have a strong and aggressive foreign policy. we had periods where we are more inward looking. i think in terms of history the effort to steer the ship that

was established in the bush administration. but without sufficient clarity about the world or the emerging shape of the world. it is a hard problem. >> that the a communication issue or a deeper issue of the foreign policy being incoherent? sgr >> i think it is incoherent and it is smart to focus on asia and that is a success. but doing it at the expense of our engagement with europe has cost us. we have been relatively disengaged in europe and we see the results of that and that is critical for what we are able to do in the middle east. so i do think that there were sort of some smart ideas but the whole picture didn't --

>> he really said unintentionally, and with good will, a message that was interpreted properly as weakness. this paragraph from this first inaugural, stunning to go back and look at this, where he says our security imminates from the justice of our cause, the new horizons of our example, and the tampering qualities of hew ma mail -- humility and restraint. that doesn't work in a world with russia, al-qaeda and isis. when people do the serious histories you will see the leaders abroad said he is begging to not have a fight. and a president who has the biggest and most potent military

in the world needs to scare people. and he didn't. >> i am going to jump in. the "washington post" wrote about syria and how obama could have and should have done more to support the syrian rebels against assad. and then fred hyatt wrote nis might be t-- this might be the most surprising of the foreign policy plans of obama. he is suing the american people into no responsibility of the tragedy. fair criticism? >> good piece. >> it is a signal of weakness but more than that. these are strategic things the president did.

he wasn't going to commit american forces in a way president bush had. >> there wasn't a lot of bipartisan support for another war anywhere to be fair. >> absolutely. that is why one reason why he won the election. but that has consequences. and just you can say iraq is the overintervening syria is what happens when you look at a burning county and just let it burn. general patrius called it a cherylnoble radiating throughout the world. that was the incubatur of tof te islamic state. i think he is handing the next

president a real problem in the middle east. >> is the middle east better now than it was in 2009? that is the key question? >> was it better in 2009 than to 2001? >> it is tough territory. i don't think they were st stretegic decisions. you pointed out there is an intarnternal drive. obama is in charge and he hates war. he wants to avoid war. >> i think what they would say is -- and when you talk to the aids, he doesn't like slippery slopes. is there something in his dna that makes him worried about that and try to figure out the

endgame? >> he doesn't like war. but he did say in the speech that got him elected in 2002 his first words were i am not against all wars. >> just dumb wars. >> he is not a pacifist. >> i spent a lot of time on this subject with him and others. i think like he said in the noble prize expectance speech war is an expression of human falling. >> he is right. >> we have to go to the audience. i am going to ask one more question and then we will take your question because we don't have a lot of time left. in 2007, bill keller, the executive editor of "the new york times" said the bush administration was the secretive and his successor said obama was the most secretive white house

she had ever worked with. a sentiment ecoed by the "washington post" saying this administration trying to control is the most aggressive. we all rely on linked stories -- >> no, no, no. leaks are when the wall street time and the washington journal have a good story; right? >> do you agree with the assessment? most secretive. >> you know, of corpse knurse n likes secrecy. how do you compare this and that? you know, david spent time with obama, i have been able to interview obama and find out what goes on.

you need a lot of time -- >> so you don't agree it is the most secretive since the nixon administration? >> i am going to give the nixon the administration the academy on this. >> lifetime achievement award. >> how do you feel whitehouse high ranking officials who talked to you and many of us about things that are classified don't get prosecuted but lower people do? >> well, they made a mistake and it is a stupid system. but, you know, we can still find out some things but never enough. that is a big -- all of us are, in a sense, begging for transparency. and you know, the key is time. you have to be able to spend months and sometimes years on these things and you can chip away and the internet environment of impatient and

speed doesn't lend itself to that. >> hopefully we have time for a couple quick questions. anybody? there is microphones. >> hey, bob. >> i have a question that goes back to what danielle said. in some ways this president peeks out on his first day. >> i didn't say that. >> i said it. >> where is the question? >> the moment he becomes the first african-american president he knows he made a mark in history. i wanonder in the long span of thing what everyone on the panel thinks that will look like in 50 years from now in terms of of the change of those different franchised citizens? we end his presidency at time of

real racial strife how is this going to play out? >> let's get an answer. >> yes, racial confrontation, rather than strife i would say, but it is within the groups of people who are organized and organizing and working with a sense of a political stake in the country and are engaging in seeking legal changes and policy changes. so a greater degree than gets covered perhaps. i do think that is a different picture of politics around race than we had prior to barack obama's election. i think it is a significant energizing of people as political actors. i would not be surprised if we see people who enter into politics coming out of this moment as well. >> i totally only have time for one more question. anybody? >> there is one over there.

>> i have a question about rom emanuel and what impact he had on obama's legacy and what impact obama has now had on chicago. >> david? you want to try to take a stab at that. >> i would say, and i am a fan of rom emanuel unlike a lot of people these days, but i would say his impact on the obama administration hasn't been big. he was a short timer as chief of staff and i think most of the key stindecisions didn't come f rom. >> we could go on and on because we didn't get to half of everything we want to talk about but we have to turn it over.

now

>> hello, everybody. hello, first of all let me thank our first panel. you heated it up nicely for us. i am gene robinson and i am here with our special guest who took time out from his busy schedule and it is one of the busiest in washington -- the president is somewhat demanding. the 27th whitehouse chief of staff is here. the previous 26 are the stooped and broken figures you see wandering around washington occasionally because of the nature of the job. dennis joined the administration in 2010 as the national security council head of strategic communication and quickly became the deputy national security advisor and chief of staff in

2013. dennis, thank you so much for being here today. we heard the federalist panel giving us a fairly definitive assessment of the obama legacy. but by my count there is a year left minus one week. so, could you tell us, what can the president get done in this lame duck year? can you name his three top priorities that he can actually accomplish in the last year. >> yeah, first of all thanks for the opportunity to be here. it is a beautiful building and i thought the panel was quite nice. i would say just a couple things. that is the way we see it as the way you finished the question. mainly, we have yet another half of the forth quarter of this administration and so we are working hard on that. we are not coasting through the year. what the president said to us about three weeks ago is he said

he was going to be asking himself throughout this year whether we would do something and he would say why not. we will be pushing very hard on that as we did the last year when people were asking us the same question and i think last year i had stacked up and i would leave it to the historians but i would stack up his year seven against any year seven when why think about things we can -- when -- accomplish from iran to cuba to the budget agreement to the imf reforms and the xm. but i am happy to come back to that. in terms of the year ahead, we are open for business. we are open for business in congress but we will pull ever lever we can. criminal justice reform. there are things that we think we can and should do with congress. but there are things we know we will do on the president's own accord. on the economy, we have an

opportunity with the biggest free-trade agreement in history in the ttp and we will continue to press congress to do that. i think those are two pretty big examples that in the main we will push congress to work with us. but we are open for business on that. but if they are not willing to act we will pull ever lever we can. >> how much concern is there in the white house that much of the what the president did could be seen as fragile in the sense if it was done by executive order or regulation can be undone by executive order or regulation? what he did with guns and climate change and so on came through the regulatory process rather than congress and could be undone. >> yeah, look, i mean i worry

about a lot of things. do i wish that congress would have passed cap-and-trade back several years ago? sure. but the steps we are taking on the clean power plant, now affirmed by the court are within the mainstream authority of the president, and ride in the first instance a wave of transition from coal to cleaner natural gas and we are trying to give it a boost to cleaner still renewable. and i think that there is a question of policy on that. and i think we are pushing as hard as we can on policy. but there is a question of what is actually happening on the ground. and because of the tax changes that went through at the end of last year with dramatic extension of the solar and wind

tax credits you will see a pace that will keep up with what we need to do on clamaimate and wh we are pushing for but will exceed that. so i don't think the next president will be inclined whether he or she won't want to undo. that >> so donald trump won't want to undo these things? >> that is my belief and that is the case across the board. in terms of the energy revolution we have seen i think it is way beyond what anybody would have thought when we made those investments a couple years agoop go. >> let's talk a little bit about foreign policy. and you can't start that discussion, i think, without mentioning syria. >> i agree. >> you know talking about the

problem from hell. it is the problem from hell. but what kind of syria will the president leave behind in a year? a syria still in the throws of civil war, humanitarian disaster, part of it in the hands of the isis caliphate or some different syria? >> i think what we have laid out is a strategy that recognizes that this will not be the first civil war that is resulted by a mean other than politics. that is to say there is going to be a political settlement among the syrians to what happens in syria; one. two; we have an overriding and immediate concern about the threats posed to us in the homeland to our friend and family from isil so we will push with our own kinetic force but

by mustering syrian and iraqiforce that will have to govern the spaces they push isis out of. and we will have to be a leader to handle the chaos going on. we want to present the next president a stable set of partners. as we address those we would like a political process that all parties in syria have engaged in. i think we have made progress on that. not withstanding today's news. and we will see an isil on a pathway to ultimate destruction. >> when do you project that will start and the policy will ba bare -- bear fruit? >> i would say we have seen

progress over the last several months. it is not sufficient and we will continue to press that aggressively with partners in the region, state actors, and forces on the ground who have to take the fight to isil, and then of our own accord using the kinetics we have seen. we have seen good progress but it is insufficient and we will continue to lean on that. as it relates to the political process, we have through secretary kerry's efforts in the geneva process a pathway forward for the parties to work. and the biggest and most immediate challenge, i think particularly as it relates to the spillover is had refuge challenge and we will continue to work that. >> continue to work that including perhaps opening our doors to more refuges? >> not opening our doors but

rather continuing decades long and generations long tradition of maintaining the doors open in this country as a source of refuge to to the world's most vulnerable. that has been the case, i think admirably since our earliest days. >> in the first term an official told me once of the conversation with the president in which the president was asked how do you wish to be remembered context was foreign policy and the president answered he wanted to be remembered as the president who began a repair moment between the muslim world and the west. that hasn't happened. is that a disappointment? how does he think about the fact

that he came into the office perhaps, uniquely suited, because of his father's heritage, because of who he was and where he came from. perhaps uniquely suited to be a bridge figure between the two civilizations and it hasn't happened. sdwl >> yes, it doesn't sound familiar to me. i think when i hear the president talk about foreign policy i think he talks first and foremost about maintaining the strong national defense and protecting this country, expanding our influence overseas in the most general sense, and i think in both of those there is no question he succeeded in that. i think as it relates to the broader question of the relation between this broadly defined

muslim world and the west -- i think the president has set out a series of challenges to our friends in the muslim world because i think, first of all, to suggest there is one muslim world is a mistake. i think the saudi arabians and iranians for example have deep division between the sunni and the shitte. but what we are seeing play out among the sunni to include actors like isil there are deep divisions within sunni islam. those divisions won't be resolved by the united states. they have been to resolved by those countgies religious leaders.

what we'll do in that context is partner with those friends who want to partner with us and we will aggressively, very aggressively defend our interest and that includes against this perversian of islamic groups namely isis. >> we are involved in aggressive action against isis in iraq and syria and elsewhere as well. recently there has been a lot of talk about perhaps a more dramatic esculation of what we are doing in libia. >> i think the reporting included by not only people who work in this building but people

in the audience and among the press generally on isil and on the expansion of its kind of brand is really remarkable. it rivals and it is as good as anything that we have access to. so i think people we owe a debt of gratitude for thprofession. i think what the reporting tells us is isil is for a variety of reasons to include the pressure they are under in syria and because of the chaos in a place like libia is looking to expand. we are eyes wide open. -- libya. -- what the president said is we will exercise all of the elements of our power to protect our interest where we need to do include the use of force and you saw that last november in libya

that led to the demise of the leading of isil at the time. i am not saying we are at at point of dramatic esculating, but we need to be open about where they are trying to grow as they were under pressure in that strip of land along the afghanistan and pakistan border. they sought to move out and i have every believe that isil will do the same. we will not let up as they do that. >> since we are in a roomfull of journalist, that brings me to my

next question and that is relati relations among the obama administration and media have been scratchy at times. >> really? >> i don't know if you notice. >> we have heard people say this is a closed administration. >> yes. over zelious and is locked down and doesn't tell us what we need to know. how do you respond? >> i think we had a nice conversation on this. this is something we thought about. i think if there is not a degree of friction between any white house and any press core then someone is not doing their aub job, us or the press, then friction is a very influential

guy. without the music there is no democracy. and i think that friction is something we need. that is the most important point. you know, in terms of access to the president and policymakers i think this is something that we -- as any administration struggled with. i think there are things about our record i am very proud of in terms of access to the president. i think there is certain things as the media environment changes and our obligation is to make sure the american people has complete understanding of the president's policies as possible. we have to use every channel we can to get that thought out. on my run today, i was struck that there are families in iowa

who are convinced that the president wants to take their guns. >> yeah. >> we have no policy proposal and we have never indicated any interest in a policy proposal to take guns from law-abiding citizens. nevertheless, that is an understanding. so the question is when that understanding develops, either because of misinformation or otherwise, it is incumbent on us that people don't have a misrepresentation. some of the friction between us and the white house core stems from our effort to use all sorts of new media channels to get a more complete picture of our policies out there. but i think that in the main we have lived up to our commitment

to the american people to be a transparent administration, to be an open administration. and in as much as you all will n n not grant that fact i think it is evidence of the needed friction we will continue to operate under and i have ever expectation we will continue to operate under. >> this is good. >> especially characters who have been generating some of that friction. >> well i promise to be respectful of dennis in the sense we have time for a couple questio questions. anybody? just yell. [inaudible question] >> it is my perception that

under the obama administration americans have become more afraid. what can obama do to relieve the fears and actually put terrorism in per spebtiv fb sive? -- perspective? >> i think the principle challenge we have is to be successful against an enemy that either a; because they are successful of you even when they are not have very low barrier to entry, a very low barrier to success. ...

really colors that effort which i think is a shame. at some point we will get back to the watershed mentality convert -- colored foreign-policy. we have to be better at

getting outing in testing these ideas. i think that the ability of some of the most heinous actors on the face of the earth to get some unbelievably hateful propaganda is a huge challenge it makes what is in some ways a distant threat very personal and close. and until we are as effective in that space as we can be, and the leaders in that technological menu then we will continue to confront greater unease among the american people. so this is the area where,

in my view, i feel the pres. most dramatically since ii have gotten into these jobs over the course of the last several years. we are bound and determined to leave the ex-president much more effective infrastructure to allow us to confront the stuff. >> all of the president share his feelings. i think that there is -- part of my answer will reflect back to the last part of my last answer,

which is asked -- and i think the president's speech addressed some of this, we are at this moment where ironically super dynamic global economy and a dynamic economy, the benefit the most. so the strength of us in this economy is a threat to us in this economy, like the threats and national security, not a weakness economically or otherwise but the weakness of other states of players nectars. so notwithstanding those trends or maybe perhaps because of those trends people feel on the outside.

the institutions are not keeping pace with the change , whether they are congress, the administration , or colleges which are getting more and more expensive even as they get more -- get to be more and more baseline requirements. people are feeling caught out of the dream in a waya way that they have in a long time. and i think the challenge for us is governors in this effort, as people running the government is to figure out how to make the government responsive to people's concerns again, answering questions people are asking and at the moment i think in the political debate you have a lot of emotion and energy around the questions.

i wish there were similar amounts of energy and emotion around the answers. which are quite limited. >> now our publisher will say a few words. >> thank you everyone who is part of that discussion that got us started. i just want to say we were thrilled. in almost any endeavor is a recognition for excellence.

many platforms a seek to entertain we rise for the standards of quality in our profession and the standards set by the pulitzer prize. and we started when those not just -- just for bragging rights,rights, although those are nice. they have contributed something meaningful. the humility and honor to have those words but ii want

to set those aside for another occasion. but it was a much bigger day for jason and his family and all of us because he is a free man now. [applause] and i think it is really a bigger day than that and jason would agree, victory for everyone who has chosen the brave course of journalism knowing that it comes with risk that sometimes includes imprisonment and losing one's life. we all of the terrifying stories of journalists around the world being imprisoned simply for doing their job. others lose there lives in war zones as collateral damage and sometimes direct targets and had a great dinner tonight's ago, jason, his wife, and marty in bob

woodward and couple others and jason share this remarkable story. they had the port of entry. phone, documents, everything and there were not sure what would happen. jason was telling us this big burly guy walks up to them and says they need to no that when they mess with one of us the mess with all of us. and that was aa powerful statement about how we stick together with americans. but i want to use my moments to say thank you to you for standing together as fellow journalists and members of the creative community conditions cause. thank you for locking arms and uniting find a global

effort. from the great work the national press club did, the terrific editorial pieces in the new york times and other publications at a terrific coverage. i think that played an enormous part and can contributing to the efforts to secure justice freedom. i can tell you at the "washington post" we know there are more jason's out there who sit in prison is now and there are sadly future jason's doing our jobs today and maybe in prison tomorrow. for everyone on the "washington post", thank you for your role and please know we will send together with you and your colleagues who take these risks to perform the essential role of media and society.

though we hope it never happens we will be there with you. i want to take a moment to personally thank someone who played an important role. yesterday we were able to take secretary kerry for serving as a.man in the negotiations are gratitude goes to someone else who played a very important role [applause] for my own perspective dennis made this a personal mission. engaged, proactive, willing to spend long days and

nights to explore any and all options. he kept confidential information. accessible by phone, email, multiple times face-to-face to your views and think creatively about how we might get jason back. and you have to have the ability to drink out of multiple firehouses at once. dennis found time to make this a priority. the work reflects an excellent profession that is

temporary right now thank you for coming and we look forward to hosting you again soon. [inaudible conversations]

>> simulcasting. >> here in iowa. >> go iowa. >> the republican party of iowa. >> people didn't know much about the iowa caucuses. >> the 3rd one i have been to. they are all different.

>> you have to show respect for islands. >> i love you all. if i i lose iowa i will never speak to you again. >> road to the white house coverage continues on sunday talk to supporters and council bluffs iowa at 2:00 p.m. eastern. then senator bernie sanders talks to voters at a campaign rally. live at 3:00 p.m. eastern also on "kcal 9 news".

>> the director of the national institute on drug abuse says the overprescribing of painkillers must be addressed if the nation is to address the heroin addiction epidemic. also on c-span2 9 news". >> america is experiencing an historic epidemic of drug overdose. also on c-span2 9 news". 47,000 died from overdoses and 2014. to put this in perspective, more deaths resulted from either car crashes or gun violence. addiction to opioids primarily prescription painkillers and heroin is driving this epidemic, destroying lives, families,

and the fabric of entire communities. it is something i am hearing about in iowa and other parts of the country that have been hit harder. at today's hearing the committee will learn more about this terrible epidemic , what is being done to address it and how congress can help. the result of the leadership some senators white house, portman, clover char, a yacht on this important issue. over the last 20 years or so doctors have increasingly prescribed opioids to help patients manage pain.

treatment admissions link to them more than quadrupled between 2002, ten years later, 2012. the use of heroin has also spiked sharply. the national survey on drug use and health reports over 900,000 americans who used heroin in 2014 and the previous year.

this year or last year that number rose to 38 percent more than any other drug. according to numerous studies prescription opioids and addiction mexican cartels are expanding into new territory because the administration has not secure the border.

indeed, heroin seizures have more than doubled since 2010. this is a complex crisis requiring a multifaceted solution. the most important part must be prevention to head off addiction before it can begin. the dangers of the substances including the important work of anti-drug coalitions andanti- drug coalitions and educating doctors, taking a hard look at perverse incentives that may lead to overprescribing.

exploring whether patient satisfaction surveys linked to higher medicare payments friends or relatives. i was pleased when da at the same time it is concerning

the department of justice continues to the client forcing our federal drug laws in this area. according the cdc report a person who is addicted to marijuana better treatment options for those who become addicted. so along that line overdose deaths may be reduced by the

more widespread use of melodic son we can continue to crackdown on unlawful prescribing practices, enforce our border with mexico and target the violent cartels trafficking heroin in this country. so i get back to something else, member of this committee and i have been involved in. senator feinstein and i introduced the transnational drug trafficking act of 2015 making it easier for the department of justice to prosecute cartels it harm our communities from abroad

in october our bill passed the senate for the sort -- the 3rd straight congress but has not found success in the house. it is critical that the representatives finally pass this legislation which will help protect our communities from transnational drug trafficking threats. so i welcome our guests and i will introduce them and turn to senator leahy. >> you look around this committee. we know that there are communities whether urban or local no matter what their size grappling with the tragic effects of the epidemic of heroin and prescription opioid abuse. we have all seen the

statistics. i will tell you one thing about the dramatic rise in overdose deaths, particularly among young people. trying to find the treatment for loved one hooked on pain killers. left behind. victims field by addiction. law enforcement community officials overwhelmed by the floater opioids and cheap heroin.

the stories we have heard from families and parents had a couple. got a question of whether there is no epidemic but what we do about it. it does like many other states have not been immune to discourage. but what we normally do is rally together to tackle the problem head-on through community-based and comprehensive strategies. it makes me proud. we heard testimony during a series of field hearings that convened, and in one city they went to the mayor, strong republican and said

do we want to talk about this? and we had to keep changing the venue we heard from all of them. and all of my conversations with vermonters from law enforcement down through one thing is clear, we cannot arrest or jail our way out of the problem. we lost the war on drugs because we rely primarily on unnecessarily harsh

sentencing laws. we cannot repeat the mistakes of the past. we also must work on the demand. if we have demand in this country it will come from somewhere else. it will come here we have got to stop the demand. we have to identify and support the prevention or treatment recovery programs and cannot pay lip service to the communities. advocated for new federal grant programs for heroin opioid abuse. going after drug traffickers 65 percent increase in the number again treatment for

addiction. but on any given day there are hundreds more to find themselves on waiting lists. additional public health outreach and treatment. proudly cosponsor the comprehensive addiction recovery act. we can talk about it, have bills and resolutions the spend the money. this is a great danger and we can spend money on it

governor, you have been a national local leader on the issue and a lot of people want to pretend we don't have the problem. the governor gave a state of the state address in the past. did not say everything was going great. he talked about this problem. that was the whole issue. it's about time someone speaks up. so i thank you for convening this hearing. provide the resources and support necessary, but we must act. we will not rest our way out of it. everyone knows out of -- everyone knows that. they will come from another.

we have got to attack and work and do all of the comprehensive programs, the faith community, educators, law enforcement, medical facilities to stop the demand. we will always have the problem. >> continue your introduction. >> thank you. >> go ahead. >> obviously when your introducing colleagues like i am you know what awful lot about them. >> can't do that. >> i can say all of them are extremely dedicated to fighting the opioid epidemic sweeping the communities and i'm grateful that they are all interested in this and i think from an initial

discussions with members of the colleague we feel both from a cost standpoint that we might be able to move ahead. at least i hope that is the outcome. our 1st witness is senator ayotte new hampshire, co-author and original cosponsor of the bill, s 524 comprehensive addiction recovery act, former prosecutor and attorney general comeau one of the leading voices in congress seeking solutions to opioid epidemic. our 2nd witness, senator shaheen also cosponsored and highly effective leader. new hampshire is fortunate enough to have two senators working across the aisle. next line the robert portman

from ohio co-author and lead republican sponsor of terror working tirelessly in bringing awareness to the epidemic throughout the state including the drug free community act and also 20 years ago came to my state to help me with a nonprofit organization that i started in my state as well. our relationship goes back a long, long time. now it is your opportunity on the government. >> served as governor of vermont since 2010, small business owners, public servant, father of two, two wonderful young women, committed entrepreneur, longtime codirector along with his brother the 81st

governor of vermont.

and having served as the attorney general of our state i can assure you i've never seen anything like this in terms of the epidemic were facing. the timing of this hearing cannot be more important. the homeland security committee and heard from people in new hampshire but also heard from director botticelli of the office of national drug policy has been a strong partner with new hampshire.

fond coalitions across the country and now working with some of his close shower and white house i was proud in september of 2014 to introduce the comprehensive addiction recovery act. i want to thank the members of the committee for sponsoring the act, ranking member, senator hatch, blumenthal's and donnelly for the work we have done on legislation. today you will here from the police chief of our largest

city manchester, new hampshire who will talk about the epidemic facing our state, how we can address it together, both law enforcement working with those in prevention, treatment, recovery command i have the privilege of doing a ride along and evolve with the manchester fire department. i was there an hour and a half and we went to to heroin doses within an hour and a half. this is sitting every family in some way new hampshire. i watched the 1st responders bring people back to life. but for them being there they would have died. and it just struck me how devastating it is because one of the cases i wenti went to there was a baby in a crib in the corner. we think about this. it is not the impact of the struggling with addiction

but the impact on all of our quality of lives in the future for our children. in new hampshire in 2014 we had 320 drug overdose deaths a 60 percent increase from the year before. this year chief medical examiner tells us 385, 148 of those deaths are attributed to a devastating drug called sentinel which the dea tells us is 50 times more powerful than heroin which is an issue i believe needs to be addressed by the committee as well. solving this crisis requires a holistic approach, and the comprehensive addiction and recovery act that so many members command i appreciate the leadership on the committee, it's critical. we brought together over 120 stakeholder groups around the country but this legislation together.

those on the front lines in every aspect command has the endorsement of the national district attorneys general, the major county sheriff's association, the community and i drugi drug coalition of america and the national association of attorney general. my attorney general from new hampshire has endorsed it, theit, the iowa attorney general has endorsed it, the vermont attorney general and many others have said please pass this legislation. it focuses on a holistic approach, expanding opioid abuse and prevention and education efforts.

identify and treat incarcerated individuals so that we can and the revolving door we see, expand drug take back effortstakeback efforts to promote the safe disposal of unused on more prescriptions , strengthen prescription monitoring drug programs and launch prescription opioid and heroin treatment intervention program. we can administer narcan in our 1st responders are doing an amazing job, but if we do not get the support and treatment for those struggling with addiction and deal with underlying issues we will not solve this problem. as the chairman -- and you will hear from chief willard today -- we cannot arrest our way out of the problem. this is not just about statistics. it is about real people dying, real people like courtney griffin, 20 years old, such a promising life before her. realreal people like the grandmother told me as she waited on me in the store, i lost my granddaughter.

we can make a difference in the senate and in this committee the passing the comprehensive addiction recovery act, by working together to not only support our 1st responders but to make sure we are focusing on prevention, those who are struggling with addiction, that we get them support for treatment and recovery and most of all that we can turn this around because i have also heard the redeeming story, people like eric stoppard addicted to heroin and now has established treatment facilities and new hampshire and is turning this around, but we need to act immediately. this is a crisis. i am glad you're holding the hearing. i think all of my colleagues and this committee for its leadership and look forward to working with you. thank you. >> thank you. >> thank you, chairman, ranking member, members of

the committee for giving me the opportunity to testify this morning. i am a cosponsor of the comprehensive addiction and recovery act and appreciate the leadership of my colleague. working on that legislation. i am actually here to testify not on that bill but onto bills that i have introduced, that is a mouthful, but what the bill would do is allocate 600 million in emergency funding to address this national crisis. the 2nd bill is the combat heroin epidemic and backlog act which would authorize a grant program to reduce the chronic backlog of heroin and fentanyl cases at state police crime lab's and you and senator leahy in my colleague talked eloquently about the statistics that

affect this epidemic. epidemic. the fact is, i believe that we have is a pandemic affecting young and old, urban and rural, rich and poor, white and minorities and is burning to every state in the country, including alaska and hawaii. in new hampshire we are losing more than a person the day and we just had a study come out on mortality rates in this country that show that mortality rates among middle-aged white americans are actually increasing for the 1st time in decades rather than decreasing which was attributed primarily to the rising substance abuse disorders. so as the sen. said, those statistics do not adequately describe the devastation to families who lost loved ones

and do are stillyou are still struggling with trying to get loved ones and the treatment. but despite the statistics public health and law enforcement agencies at all levels lack the resources, and effective response. nearly nine out of ten people who needed drug treatment we need to mobilize a national response specifically providing an additional 200 million under the edward burrell memorial assistance grant fund for state and local efforts and

less you think 600 million is too much $5.4 billion in emergency funding to compat the ebola outbreak last one person to ebola congress passed 2 billion. we need more resources and you will here the challenges they are having. i also want to touch briefly on the combat heroin epidemic and backlog act designed to help drug labs across the country, crime labs across the country as they analyze drugs. this is modeled on what we did in 2,005 to combat methamphetamine and what we are seeing across the country is that state police

forensic laboratories have accumulated backlogs of heroin and fentanyl cases because they do not have the resources to do the testing. the state forensic lab received 750 testing requests each month but can only process 450, and the growing backlogs result from an increase in heroin cases and a dramatic surge in fenton on cases, and to give you some idea and new hampshire in 2013 we had 193 overdose deaths, 18 of which were fenton not related. in 2014 we had 100 25326 overdose deaths, 145 or fentanyl related and in 2015 we had 385 deaths from overdoses, 253 were fenton

all related. we have to act with a sense of urgency because delays and processing drug samples have disrupted every stage of the policing and judicial processes. no longer able to identify combination and designer drugs by site, undercover law enforcement are forced to way to verify samples before continuing investigations and prosecutors and judges are less likely to offer plea deals with the lab confirmation of the drug's authenticity. put simply, thesesimply, these backlogs are keeping us from putting dangerous criminals and drug traffickers back in jail and getting them off the streets. i believe it is something that we can overcome.

thank you very much. >> thank you for having the hearing and letting us come before you. it does so in a comprehensive way. we have been working on this for a few years now.

i was encouraged by your comments earlier and by the ranking member's comments about this issue in a comprehensive way and the importance of moving this legislation forward and i thank you for that. it is the appropriate federal response. i also want to thank those from every area of prevention through recovery who have worked over the past years in putting this together and participated in the forms we have had with a have come in and given input. and no matter where i go i here the same story, from mothers,, from mothers, fathers, sisters, brothers, friends, heartbreaking stories how addiction is running lives. tearing apart families, devastating communities. this epidemic is striking close to home.

and you are hearing that as you go home. last year 2,482 ohioans died from a drug overdose. this should demonstrate how difficult it is to break through this addiction, the bonds of addiction that are so strong. i was in the hospital last week looking at the amazing care that they are giving to addicted babies. had a chance to talk to some others that is how strong is bonds of addictions are. thousands more are surviving overdoses but are still struggling to hold the job, take care of families. addiction costs the country's $700 billion every year more crimes, cost of

incarceration, policing, a lot of money. y'all talked about that this morning. this hearing will be effective in helping bring awareness to the severity of the problem but it is just as important we talk about the reasons for hope, there are alternatives, ways to address this, make progress in combating this epidemic and lives can be slaved. i have been at this now we need to do more not just on the prevention and education but dealing with recovery. i have seen amazing people

who actually work, visited with men and women who struggle with addiction and have been fortunate enough to get to know a lot of ohioans have channeled grief in the something constructive. help others break the stigma of addiction. you will hear from one of those women his morning. i 1st met last fall, came here for the rally on the mall against addiction and she told her story to me, one that breaks your heart. her daughter was 21 years old when she died of a heroin overdose. she did not fit the stereotype of someone who

was a heroin addict, excelling in school, a lot of friends, selected for homecoming prom, building a life for herself coming days to be married in the 20th birthday celebration of friends of hers is about to try this. when she added in the grips of addiction. as you will hear later she did what any mom would do helping her daughter trying to get into treatment. went to rehab, gained a. teefive gained a period of sobriety but then addiction to go. she overdosed and died. again, taken that tragedy and used it in a constructive way to help others. she now has 40 chapters around ohio in the country

and it is in the hopes that other guys will not follow that similar dangerous path. i commend her. there are so many others who have done the same thing. last week i visited marion and met bethany the struggle with heroin addiction, as, as a teenager, promising athlete, going to college, had a scholarship, but got sidetracked through addiction, and expecting mom and used and says that tearfully now, arrested. law enforcement tried to deal with her issue by not putting her in jail but finding alternatives. she finally figured out that she had to beat her opiate addiction because of her kids.kids. and she did it. detox was hard, recovery harder. she went on to graduate from

the treatment where to provide resources for mothers facing substance abuse and for five years of being sober she now leads that as a coordinator to help other month in recovery. to my colleagues this morning that story tells us why there is hope in the face of addiction. you have seen it in your states. we have seen it around the country. people, listening and learning from these families is what helped us form every step of the way. from prevention efforts to law-enforcement strategies to addressing overdoses and expanding evidence -based treatment this legislation is comprehensive, will help entities command we need them all, not just one. i am committed to passing this bill in getting its signed and the law.

so the nine members of this committee who cosponsored legislation, thank those who are willing to work on getting misreported out onto the floor for a vote. it is an investment. an investment at a time when communities are desperate. it is a small investment for the future. we will know success by empty jail cells, the number of people who never have to struggle with addiction in the 1st place. the message is simple. there's something we can do. you are not alone. we are with you. there is hope, and that can

be furthered by this committee leading the way. thank you. >> thank you. >> governor. >> go ahead. >> inviting me down. glad to have my us attorney here with me. i would say, when governors give the state of the state it is kind of a big deal and we spend a lot of time on it and layout proposals that make a difference. i made the mistake of doing that. acknowledging two of my favorite people on this earth.

they get the longest biggest standing ovation of the speech and they get the biggest ovation. i will not make that mistake again. i was going to share with you many of the stories that you just heard from your extraordinary colleagues, so i won't. vermont has the same heartbreaking stories. but i dedicated my address to the subject it was a lonely place to be. there was a long debate about whether they havehad that big a problem and should the governor be spending this much time. it gives me hope to hear from your colleagues as well

as to see the committee focusing intently on the challenge that we are all facing together. i came into this knowing very little about addiction that i was listening and started asking how we get into this mess and what we do to get out of it. when i started talking i learned we were doing almost everything wrong, almost everything wrong. first, criminal justice was designed to maximize addicts going to prison and not treatment. plain and simple. i learned that the most likely chance you have to move someone from the nile -- in denial of this addiction is extraordinary.

but the most likely chance you will get to get an opiate addicts to agree that they have a problem to go to treatment is that moment when the blue lights are flashing, hank server on, and they have bottomed out. ..

father and. >> we are moving on to treatment, recovery, not that there are not failures another they do not have setbacks but it actually moves them into recovery. it has reduced our incarceration population dramatically. from $50 million in the last year's not locking folks up but putting them into a treatment program. it is working as well as one might hope. second, we have expanded treatment like mad. even with tough budget times we have made tough choices but we are building out our treatment centers as fast as we can. that too is having a huge affect.

our problem is, as we remove the stigma, as you're helping to do in this hearing today, we have more folks who are willing to come forward and say i have the disease, i need help. as we build up the treatment centers and i know new hampshire is fine in the same challenge we are literally fighting longer waiting lines because there's more demand. we have to keep building out treatment centers. we need help help in building out those treatment centers. third, the rescue kids that your calyx mentioned about the narcan is absolute critical. we are the first state to get it into police hands and law-enforcement at every level, together they have the firefighters, we have saved hundreds of lives. this is expensive. this is expensive stuff. we need help saving lives. prescription drug monitoring program that senator has mentioned to build upon it is critical. we have governors over new england working together to improve the data were people are

shopping for prescription drugs across state lines. so without telling you more about what i think we're doing right and what is giving me hope, i want to mention a little about about what is not given me so much hope. listen, we need financial help. the states cannot do this alone. as an example, when senator leahy help give us for 3,000,000 dollars, it seems like a small amount of money in washington but it was huge for remount allowing us to get it to the howard center, the resource center, to actually help us build out the treatment centers. we are scraping together pennies to try to make our treatment centers stand on their own. so financial help from washington is critical area dynamic urged by the bipartisan support in the senate to help us

get the financial resources that every state needs to fight this battle and to win it. money is huge, second, we have to look at what is holding us back a treatment. one of the things i have things i have to tell you that i found in vermont is as we build out treatment centers, particularly true of small rural states where we are having challenges getting enough primary care doctors in the medical field to deal with illnesses that we are all facing with the medicaid underpayment to them and so forth. we do not have an extra physician force to deal with the magnitude of treatment that is necessary to successfully when this crisis. to get treatment to people that needed. you have to ask this question in this is a federal change that i beg you to make. why is. why is it that physician assistants and nurse practitioners can prescribe oxycontin and other drugs that lead to heroin addiction that they cannot prescribe the treatment drugs that would allow someone to get off the stuff ..

to normal life? why is that? i ask you to help us in expanding the force on the ground that will help us be able to treat folks by making it immediately possible for physician assistants and nurse practitioners, under the direction of a physician to be able to prescribe the maintenance drugs that allow us to move from addiction. i just want to close by saying this. we do need to ask this question, why are we in this mess? what led us into this mess? why are all 50s the untrained states on a bipartisan basis saying we need help? this is everybody having this problem. this disease knows no racial boundaries, no income boundaries, no partisan boundaries. everybody is in.

i think we have to have a more honest discussion about what led us into this mess. listen, i know our instinct is to say wow, those folks in south america and other places are sending us lots of heroin and it is a huge problem. well of course it is. but i ask you is that a new problem? has something something changed dramatically in the last decade or so that has brought this heroine to america? i would say no. we have always had this problem of drug dealers trying to get support their countries and their wars and everything else by sending illegal drugs to america. so then what did change? i think an important a to have an honest conversation about this. what change was we changed our attitudes in america and our practices in america in the late 1990s about how we deal with pain. why are we talking about that?

this i can tell you. i have a lot of hope for where we are headed, i am incredibly discouraged that we still have more people signing up for opiate addiction in vermont then we had when we launch this battle two years ago. why? the facts matter. when the fda approved oxycontin, purdue, several years later the manufacture of that drug pleaded guilty to two for telling physicians and dock that this painkiller was not addictive. he paid a fine in the same year that 11,000,000,000 dollars worth of oxycontin of the painkillers were sold in america. these facts matter. in 2010, we prescribed enough oxycontin in this country to keep every adult in america high for one month. we did. those are just facts. in 2012, we prescribed 250 million prescriptions of

oxycontin. now there is only, bless him i checked 250 milli-people in our country, so that our country, so that is a prescription for every living american. just a few years ago the fda approves the soul hydro. i call it oxycontin on steroids. we are about to do this all over again team and guess what? when they approve that they did not make it tamper-resistant so you can snort it, you can shoot it. that is what led us into this mess. just this year they approved oxycontin for kids. you can not make this stuff up. so i ask us, to pause, to take a deep breath and to ask this question, are, are we willing to have an honest conversation about the way we are dealing with pain medication and america? i can tell you that until we do,

all of the good work they were trying to do together will lead to more tragedy, more loss loss of life, more of our sons and daughters dine of opiate addiction because that is what has changed. what has changed is that we simply pass out painkillers like candy in america and we are unwilling to have that conversation. thank you. >> mr. chairman i assume arsenic colleagues probably have to leave, i have seen the senate schedule, it's not the house schedule but the house schedule is pretty busy. -- left i asked that those senators to be excuse, but i do have a question. >> i don't have questions for you we can talk any time and i look forward to continue conversation on this legislation

with my colleagues. so you can stay if you want to, go ahead asked the governor your question. >> thank you, governor you and i have talked about this a lot. i appreciate your passion, evan over everybody here this is not just something that governor says publicly, he has talked about it a lot privately. i think it is fair to say that you feel the same way i have heard from police officer all over the state of vermont, it is not just the law-enforcement problem. i think a lot of them certainly tell me that both the federal level please, the state police, local police, county, and they tell me if they could get people into treatment they would much prefer doing that. is that the same thing you're

hearing? >> absolutely. i have to to say law-enforcement has been an extra in her i'll lie in this battle. that's true across the country. i was i was recently on a panel with the police chief in massachusetts who literally said, here is my policy, and now hams sure new hampshire sure and vermont are doing the same thing. if you are addicted to opiates, come to my station, we will not arrest you, will get you into treatment. we are not arresting any more folks were addicted to this disease and are nonviolent. i sometimes think we do not give law-enforcement enough credit for being on the frontlines of this. for years we said to law-enforcement this is your problem, go problem, go settle it. if i was law-enforcement i would be a little raw about that. instead, they have said we want to partner with the medical community and treatment folks, with families to try and solve this problem as a disease not a crime.

without them we would not be where we are. >> but we also have to have a place where they can bring them who have a diversion program. i think would all agree you have to then have the people there. >> absolutely. we are literally scraping together the resources to try to pull this off. i cannot tell you that vermont, i bet the senator from new hampshire and i will would say the same thing, we are not there yet but we are doing the best we can with the resources we have. >> senator grassley mentioned to me nurse practitioners, i think we ought to follow up. >> we the attitude towards nurses in america you can have a nurse unless you have a dr. looking over you, we have to change that. i think your suggestion. i think. i think in rural america we are going to have to make greater use of nurse practitioners. >> i am somewhat partial to nurses as you know, i have a daughter-in-law who is an active nurse practitioner.

>> i want to thank my colleagues were coming. i have done roundtables around illinois, there is there's no town too small, no suburb to wealthy not to have heroin overdose deaths in the state of illinois. i want to especially thank the governor because i think you pointed to something that we need to point to. we can all indoors the legislation that has been described, every single piece of it nice thought i am for that. you go to the heart of our responsibility. the fda, the farm industry, the dirty docks. we don't have to go to the border here to see the source of opiates. you go to the pain clinic in the mall, you go to the dr. just around the corner. you go to the pharmacist to look the other way. clearly i think we have responsibility here. farm is making a fortune off of this.

i will concede the fact that over the last ten years we have decided to tackle pain directly and i'm glad. for a lot of people it is the difference of quality of life and we have to readily acknowledge. with it has come a dramatic abuse to think that the prescriptions, legally written prescriptions in this country, result in a bottle of pills for every single adult american. as you said, to treatment with this drug for at least one month tells me it is out of control. congress, what are you doing about this? senate, what are you doing about this? the fda is? the fda is dreaming up new application for children and first super opiates? where in the heck is the congress in terms of our responsibility when it comes to this? the second point i would like to make is, the police chief and closser ought to be here today, because dixon,

illinois population 20,000 went to visit with him and decided after four heroin overdose deaths in one weekend they were going to buy into his program. twenty-five kids, young people came forward. they went into treatment. you know what happened to the jail? it was empty. the petty crimes, burglaries, thefts started disappearing. but there is a creep key element here. how do they get into treatment? if they are lucky enough, if they're lucky enough to have health insurance and their families have access, if they're lucky enough to the affordable care act to have access to medicaid the may get into treatment. we all know that we do not have enough resources to treat these people. we absolutely positively have to do it. i want to commend two, we have senators from minnesota here, in

a bipartisan effort they demanded and family after you're succeeded in bringing reform to health insurance so it now covers mental health counseling. and now covers addiction services. those who those who want to repeal the affordable care act, if but your hand up if you want to repeal that part of it. it would be disastrous across america when you consider this drug overdose and other things. thank you thank you for turning the spotlight back on us. it is not just all of the things we have her, we have to look at fda, pharma, pharma, we have to look at what is going on with illicit prescription and filling out prescriptions across america. that is is our responsibility. thank you. >> will go back and forth. >> i just wanted take a second to think our colleagues for your powerful presentation here today. i think what we are seeing in america is that we are reconsidering a lot of our criminal justice policies. this committee is under the leadership of chairman grassley has passed out criminal justice reform bill, i know other

senators have worked on it a lot. i hope that as we look at this terrible pandemic that we look at this comprehensively. i do not know if you can draw any artificial lines between dealing with mental health issues in the criminal justice system and drug addiction issues because we know talking to her sheriffs that many of our jails are populated by people with mental health issues for which they self medicate. if they're unable to find other places where they can get some help. i'd also like to make a plea of my colleagues on behalf of someone who represents a state with 1200 miles of common border with mexico. demand is a big problem. governor, thank you very powerful testimony. we also need we also need to deal with the supply issue as well.

i know it is tough, our friends in mexico say what we would not have all of the drug cartel activity and all of the transportation of drugs into the united states if there was not such a demand in the united states. so we do have to deal with both of these. i hope as we look at these will not draw any artificial lines or create stovepipes and we will try to find a way to deal with this in a broader, more liberal sort of way. >> mr. chairman, i will put my segment of the record so we do not go on to great length. we have two panels ahead of us still. while the senators are here i wanted to thank them for their terrific work they did as original co-authors of the bill, we are very grateful and they were joined by others very early on in the proceeding. i thank them but i also want to particularly thank senator hatch and senator graham who were the first to committee sponsor of a

committee site for this bill. they helped make sure that we had this hearing today. i just want to make a record of how important they have been in getting us to this point. thank you very much and the rest i went to the record. >> thank you mr. chair. thank you for being here and thank you for your work on this, i have already expressed thanks to you who wear panthers black and blue after your patriots got illuminated. [laughter] governor,. [inaudible] [laughter] i think it's a great -- i look forward to seeing them move through the process. governor governor i had a question for you. i'm a personal friend of your speaker, i have known him for about five years, to the point

that senators making, and i do agree to a large extent to what senator durbin said but if we focus on, for example the prescribed painkiller problem that i think we're going to see an increase in uptick in heroin abuse. this happened in north carolina, we've done a number thinks a crackdown on drug shopping and the things that we have seen and there is a direct correlation between a reduction in those prescribed opiates and an increase in heroin abuse. so as a matter of state policy, what are you looking at? almost the very struck by the fact that some states there's great disparities between overdoses and deaths. i was shocked to know that ours had gone up 40 480%.

what are we doing to address the specific issues and what risk do we run a federal policy potentially hampering what you think in your speaker when your senate leader need to do to address the things that are unique to some of the state seem to have disproportionate problems. >> that's a great question. i can't tell you why some states are being hit harder than others. this i am convinced out. i i do not think that we would have the heroine problem in america if we were not starting folks out on opiates that are sold over the drug counter source. it is not coincidence that our exuberance around painkiller is matched by the rising heroine crisis. so i'm convinced that if we went

back to the old policy on pain medicine which is, when someone has chronic pain treated and treated hard. but do not pass the stuff out as if it is not a problem, which is what we're doing pretty i will give you an example and i know we can tell this story's. i i had reporter come into my office and she just had surgery for carpal tunnel and i said how many did you get? is that what you mean? and i said how many axes did you get and she said 80. i said how many did you take? she said half of one. so there 79 and have left behind. three weeks later my head of healthcare daughter later my head of healthcare daughter comes by she's a sophomore college. she had four molars pulled out. i said did they give you any pain killers? she said yeah. i so what did they give you? and she said oxycontin and how many did you get? she supported. said 40. how many did you take? she said none. so there is 40 more. my point is, there is no

question that when we made a tamper-resistant folks went to the heroine because it is cheaper and it is easy to get. but, we cannot lose sight of the fact that we are not having this problem prior to the invention of oxycontin, we just were not. we have got to go back to the source. i think the senator from illinois said, just remember so hydro, when the if da approves so hydro, its own advisory panel voted 11 - two, do not approve this drug. they did. my point is, there is a correlation if you talk to folks are at it. many times, 89% of the folks say i had a car accident, had surgery, this happened to me, whatever it was that led me into

this mess. >> the senator want to test some. >> i think we have talked about the fda, everybody here has talked about pharma and the role of prescription drugs. what we have not really talked about his medical schools and doctors. it is my understanding that most medical schools do not have any courses on prescribing medication, on recognizing drug abuse and it seems to me that we also have to get some attention from medical schools who are turning out doctors who are prescribing practices without the history of what has been race at the hearing. >> amen. >> i certainly fully agree with you on this. we have to engage the medical community on this. also for example in new hampshire, back when i was attorney general i was fighting for prescription monitoring then and our state was late to the game on it. when we look at this data and

giving positions the information that they can have and that is one of the pieces of this bill is to support the prescription monitoring program, physicians that want to do the right thing it gives them the data to understand if someone is dr. shopping. it also gives us to know about particular doctors actually exceeding his or her bounds because it's all focusing on them. so that allows us to address that. we have to engage the medical community. i. i think sampson who you will hear from will tell you that four out of five people started with overusing or misusing prescription drugs. your point chairman that you raised in your opening, we also right now with the patient survey are encouraging reimbursement based on how satisfied people are with pain. that has to be addressed as well. i know that cms is working on this but it has to be a priority because we do not -- and this is brought to our attention to doctors who are concerned that

if they are worried about an addiction issue they are being judged on a survey that is a, how's your pain satisfaction? that needs to be addressed as well. >> just quickly mr. chairman, i don't don't disagree with the, made here. as a result, and this legislation we not only have a drug monitoring programs which are incentivized and two senators question about how the states will respond to this legislation, does not mandate the states to do this. i think it's very important to that point that every state is going to be different. some states have done cutting edge which work. think about it, interstates we may have a great program in my state of ohio, west virginia and kentucky have different programs. you. you don't know someone has a prescription pill in ohio that something the government can exclusively do. we have legislation on that. second, this drug take back program is incentivized to this legislation. we focus on getting the drugs

off the shelves which you're absolutely right. the final thing i'll say is that having talked to hundreds of people who are recovering, who have been at x because of prescription drugs, i understand that issue very well including the athlete i talked about early. i will also also tell you that there are people i talk to who jump that step. they went straight to heroine. holly is an example of that who we will hear from her mom later. i think now because heroine is so plentiful, is just with the fbi in ohio yesterday talking about this, the drug cartels from mexico are in ohio, illinois, interstates, because it interstates, because it is so plentiful and cheap, it's not just about prescription drugs anymore. it has been a a gateway for a lot of people. now there is a problem directly with heroine, even first use.

back in the days where we worked on this issue of cocaine and marijuana, heroin was not first used drug. it was a drug you use after other gateway drugs. with young people as he has 13, 14, 1513, 14, 15 years old, they are using heroin today. this legislation is comprehensive it deals with a prescription side but it deals with the heroine issue which that we need to confront perhaps because of this onslaught that came from the overuse of pain medication but now the heroine is upon us. >> thank you very much mr. chairman. i want to get to this point about what we should really be looking at here and what we have some control over and the congress. i'm a a former prosecutor, i know these drugs have been coming in as you stated, but i think the number one thing that we can do right now in addition to funding are law-enforcement, making sure we have efforts with dea fund a, is

really go after what is been happening with prescription drugs. while it. while it is true that there are people who are originally hooked on heroin, the fact is a fact, four out of five, 80% of these heroin users started with prescription drug. what the governor has been telling us somewhat senator has been telling us is that this is different than it was even when i started as a prosecutor in 1998. this is a different situation. we have these prescription drugs, but everyone in this room you have some in their cabinet or has some or know someone in their family, where he just took one or two as the governor pointed out and there's 20 left or there's 30 left. they're sitting in there. we passed the prescription drug takeback law years ago and we finally got the rules of the dea to get that moving. that's not going to solve it if it is just keep happening over and over again. in this bill are the works that the senator and i did on the prescription drug monitoring. just having, come from a state where we are not just the state

of 10,000 lakes but of 10,000 treatment centers. i know from talking to those the doctors and experts that we are not really going to change this until we change the way these painkillers are given out. that is. that is why the dr. monitoring, the have a more limited dispatch in of these kinds of drugs is going to make the biggest difference here. i am all in all trying to do everything we can to give these dangerous drugs out of our time. the change here and what what we have more control over is how we give these people hooked on drugs in the first place. sometimes they are such innocence, they just have a bad back. no one warns them that even their particular makeup if they take these drugs for four days instead of maybe just one day or just want, they are going to get hooked. we are doing this in our country. our policy, not a drug dealer on the corner. that is what we need to focus on. that's why i'm pleased with this bill. >> i think senator is correct.

and a point to the report on the new york times that is written an online book that says these pills delay healing. the paint peels, the where you take the longer you have these problems. a lot of points that we really need to reduce the amount of prescription drug. as a former prosecutor myself, we targeted prescription drugs in mobile, alabama that most -- it can be the most successful reduction of drugs there is because they're not many sources. only a certain doctors are of the list, we found really the legality was coming from drugstores, to drugstores. when you eliminate that you do not plea bargain with people until they tell you where they got their pills. you can quickly go back to the sources that are out there. this is a minimal thing thing and it does lead to additional drug use. thank you.

>> think it's chairman grassley. i just hope the american people notice the striking bipartisanship of this panel has shown. senators and governor the questions, the, so we have heard from members of the judiciary committee, the input we have heard from senators i've worked so hard on this issue for a long time. my home state of delaware, like your status also struggling with an opiate addiction challenge that has penetrated every level of society and background. i have stories that we can share about our local law-enforcement, paramedic and first responder committee. i'm just. i'm just thrilled to support up bipartisan bill that lays out the authorizing background for expanding prevention and supporting recovering an emergency supplemental to make sure we have the legal framework in the financial resources. this is a genuine genuine problem in all of our states.

it is my hope that people watching will recognize that you have republicans and democrats working together to craft a thoughtful, broad strategy, it is my hope that will get these bills moved. thank you mr. chairman. >> we have had a forceful discussion, very seldom to our colleagues get involved with questions from their colleagues. thank you all for your patience. i'm going to move on to the second panel now and i know that i don't have to tell you that will be talking about this in the future because you are going to make sure we do. okay, well we we have commotion i'm going to call the second panel. our first witness is michael botticelli, director of the national drug control policy at the white house. as director he has the obama administration drug policy efforts and is responsible for creating the annual national drug control strategy. previously he served a director of substance abuse services in

massachusetts, he has an undergraduate degree from siena college and a masters of education, education, st. lawrence university. second witness, doctor nora director of the national institute of drug abuse which supports most of the world's research on health aspects of drug abuse addiction. previously she worked at the department of energy's brookhaven national laboratory where she held several leadership positions, she earned her medical degree at the national university of mexico. our third witness, cana, she serves as the acting administrator of substance abuse, mental health services administration. that agency leads public health efforts to advance the behavioral health in our country. she has worked at -- since 1998, heard a bachelor's a bachelor's degree at a masters degree in psychology from ucla and is also

a graduate of harvard kennedy school of government. our final witness is louis, deputy assistant administrator office of the division of control within the drug enforcement administration. in that that position he was responsible for overseeing and coordinated major pharmaceutical and chemical division investigation drafting and promulgating regulations. he he has been with the dea and multiple capacities since 1997 and holds a ba from villanova university. we will go the way that we energy. >> thank you for the opportunity to be here today.

as you know it is an important issue for president obama. during his state of the union address early this month the president specifically mentioned addressing prescription drug use and heroin as a priority. an opportunity to work with congress on an issue that transcends party, income level, gender, and race. i also want to think many of the members that are here today for their ongoing leadership and support of the work of our office on this most pressing public health and public safety issue. the national drug control policy produces the national drug control strategy which is our blueprint for drug policy. using our role as courtney deferred drug control agencies in 2011, the 11, the ministration released a plan to address the rise in prescription opiate drug use. this plan categorized in four

areas, many already discussed today. educational prescribers and patients. increase and use of prescription drug monitoring programs. proper medication disposal. an law-enforcement effort. since this plan law-enforcement effort. since this plan was released, this crisis has clearly evolve. with an increase in heroin use and frontal use in overdose death. the administration is but for new initiatives to help deal with emerging issues. as you know we need to a comprehensive approach in response. opiates are taking a horrific toll across the united states. we talked about the number so i will not repeat them. these numbers are harrowing but we are making some progress. this past month nonmedical use of opiates by americans 12 and older was lower in 2014 from its peak in 2009. the number of people initiating nonprescription use also

decreased significantly. this progress has been counteracted by an increase in the availability and use of heroin. although nonmedical prescription opiate use continues to suppress her when use. heroin. he has been rising while prices remain low. the harrowing crisis has been compounded by the reemergence of illicit fentanyl, a synthetic opiate that is added to heroin to increase its potency or used on its own. since fentanyl is is more potent, it has increased risk and overdose death in the united states. although the transition from obedience to heroine occurs at a low right, recent article concluded that this transition appears to be part of the progression of the disorder among those with frequent, nonmedical prescription user dependence. we have talked about the need for enhanced prescriber education because they do not

provide a company has a identification and treatment of opiate use for safe and affected opiate prescribing. what are the most jarring studies i have seen in my ten years of doing this work, recent evaluation of healthcare claims data from that the majority of nonfatal opiate overdose victims were receiving an opiate prescribed at the time of their overdose the most alarming, 91% of them received an opiate prescription again from a prescriber. 70% from their own prescriber before they overdose. response president obama released a presidential memorandum requiring training on the appropriate prescription. the ministration continues to press and will continue to work with congress to pass mandatory

prescriber education tied to controlled substance licensor. the ministration is focused on several areas to reduce opiate overdoses including average kid in the public on overdose risks and intervention, increasing third-party and first responder access to the opiate reversal medication, working with states to promote good samaritan laws, and connecting connecting overdose victims and persons with opiate disorder treatment. we appreciate that congress provided more than $400 million in funding in the fy 16 appropriation act to address the opiate epidemic an increase of more than 100 million from 2015. to address emerging rise in heroin fentanyl use, the 2015 strategy focuses on identifying and disrupting criminal organizations. working with the international community to reduce poppy, and

we have also been enhancing our efforts along the nation's borders and have been actively engaged in government of mexico on supply reduction issues to decrease the flow of these drugs in our country. finally this past summer, we committed 2,500,000 to our high intensity drug trafficking area program to develop a strategy to respond to the heroin epidemic providing resources and addressing heroin threats across 15 states and the district of columbia. the sum ministration continues to work with our federal, state, local and tribal partners. to reduce the public health burden consequences of prescription, opiate, and fentanyl. i want thank you for your ongoing commitment to address this public health, public this public health, public safety concern. thank you. >> thank you. >> good morning everyone.

i want to thank you all for giving me the opportunity to participate in this hearing. what is the nature of the problem? chronic pain is the monk the most prevalent and debilitating medical conditions with over 30%% of americans suffering from some form of chronic pain. the effectiveness of opiate for severe acute pain and the alternative for chronic pain have combined to produce an over reliance on opiate pain medications even when the benefit for chronic pain are questionable. what is no longer questionable is that opiate medications are being widely diverted and have produced an epidemic of opiate overdose deaths and addictions including those from heroine. opiate medications such as oxycontin and hydrocodone have been abused because just like

harold, they bind to opiate receptors. upbeat receptors are located in regions of the brain that regulate pain which is why they're such potent, but their concentrated also in regions which is widely produced addiction. opiate receptors are also located in brain regions that controlled breathing which is also why they can produce overdose and death. so how can we help with the issue. they supported the development of the three medications that are currently approved for the treatment of opiate addiction. their strong evidence for the effectiveness of these medications in the treatment of opiate use disorders in the prevention of overdoses, and the the prevention of infection such as hiv, and an improving the outcomes of opiate addicted

pregnant women. despite the strong evidence, less than 40% of those being treated for opiate addiction receive these medications. expanding medication is a critical part for the hhs strategy. the research to develop implementation strategies for the use of medication and substance abuse treatment programs, and the healthcare system, and in criminal justice settings. examples include administering the drug an emergency room or integrating the management of medication with an infection disease clinic. in criminal justice setting it includes administering the drug the month prior to release --

thus interfering with lots then overdose. we also fund research on develop treatments that will improve compliance such as things that require dosing every six month. where new transformative solution such as the development of a heroine vaccine. oxycontin component of the strategy against this prescription epidemic is expanding by -- a medication that can reverse an opiate overdose. to this this end we have funded the development of drugs that are now requiring injections making them much easier to use for those that have no medical training. one of these products was just approved by the fda last year. finally, the limited treatment

alternatives for the management of severe chronic pain has led to the over reliance on opiate medication, we also fund development of better and safer treatment for chronic pain, including drugs that are less addictive, pain medications that are not relying on the opiate stem and not medication interventions. yet the opiate prescription abuse and the rising heroine of use result both from the lack of knowledge of healthcare providers on the management of pain including appropriate use of opiate medication, as well as the lack of knowledge around identification and management of addiction. thus a fundamental component to reverse this epidemic required the education of healthcare providers both in management of pain and in disorders. to help address this in partnership with other nih institutes have created centers of excellence for the development of education curriculum for pain.

the urgency to address this epidemic is highlighted by the nearly 30,000 debts for opiate overdose that are occurred in 2014, the highest ever recorded. solutions highest ever recorded. solutions are already available. the challenge is implementation. we will continue to work closely with other federal agencies, community organizations and private industries. >> thank you. >> chairman and members of the committee thank you for inviting me to represent today. it's a great honor to talk with you against the role we play an offense in the behavioral health and what we are doing to address the opiate crisis. i want to thank the first panel for providing great leadership to wendy's awareness and catalyze action. i know this creates has

devastating consequences in all of your states. i agree agree with you, this is a winnable battle. you have already heard that we're facing the treatment gapped of honest acceptable proportions. as a nation, we will not stand the rising tide of this public health crisis if only two out of ten patients get the treatment they need. it wouldn't work for diabetes, it would not work for hiv and it will not work for addiction. like many other issues we face closing the gap will be complex effort required and multifaceted approach. the federal government needs to work with prevention as, healthcare providers, payers, treatment systems, public health officials, states, tramps, and many others to tackle the challenges ahead. as you heard it addressing these issues are key to this administration. we we are proud to support the strategy. the goal of the hhs initiative is to reduce opiate dependence

and has three main aims. changing prescribing behavior, increasing access, -- today i will focus on the role in each of these areas. with respect to prescribing behavior it is an obvious tactic to prevent misuse by reducing the number of pills and peoples medicine cabinet. to do that as we noted that physicians and other providers need to be better educated on proper prescribing to manage chronic pain as well as to prevent and treat addiction. we understand that the vast majority of physicians and other prescribers are not bad actors, in fact most are dedicated, well-trained dedicated, well-trained professionals were committed to their patients could help, but they are very busy. it is hard to find time for elective training, training that is not required.

since 2007, we have provided clinical support system for opiate their pace, have provided continuing education to over 72,000 primary care physicians, dentists and other healthcare professionals physicians, dentists and other healthcare professionals per that's tremendous progress. we have long way to go. we've also addressed the issue of prescribing actresses to grants and interoperability and in fy 2016 with congress support of a new grant program, we will support tribes and territories to utilize data to identify communities with greatest need of prescription drug programming. we we also reach local communities to prevent substance abuse through the grants we administer with owen dcp. these coalitions create community environments that promote health. the second aim of the secretaries initiative is increasing access to know oxen. it can reverse a potential overdose but it only works if you got it when you need it.

one targeted strategy to ensure its nearby is to co-prescribe the the product with opiate and ugly six particularly for patients at high risk of overdose. another important is a toolkit which is the most downloaded publication on our website. in the coming months we will issue a funding announcement for grants and states for the purchase and dissemination and for training and first responders in high need. imagine how many lives will say. the third aim of the secretaries initiative is expanded use of medication assisted treatment. there are many pathways to recovery and it is critical to ensure that each individual has access to the full continuum of evidence-based services, research tells us that medications along with behavioral health treatment and are important component of an evidence-based treatment plan. however we we remain significantly underutilized. today there are only a few fda

approved medications to treat addiction and access may be limited. we're so grateful that in fy 2015 at 2016 congress provided congress provided new funding for states to expand treatment capacity both are increases of substance abuse treatment block grant and discretionary funding specifically for mat. we have also worked with owen dcp in d.n.j. to clarify and enhance the connection between mat and the criminal justice system. drug courts are the most successful criminal justice response in our nation's history, transforming transforming lives, supporting lifelong recovering, reunited families, reducing rides, saving tax dollars and serving as the foundation of criminal justice reform in the state. this year will year will prioritize treatment that is less susceptible of abuse and expand to make sure that evidence-based practices are implement it. a secretary announced in september of last year hs chest has initiated the rulemaking process to increase the cap on the number of patients to whom

physicians may prescribe the drug. because we are in the middle of rulemaking i look for to coming to talk to you about the future. finally it would not be hearing about behavioral health if we do not talk about the workforce. together the aca are expected to expand protection to 69 people. we must act swiftly to ensure the behavioral health workforce is sufficient to meet the growing demands. the expanded workforce includes prescribing and non- prescribing professionals, psychiatrist, psychologist, and others. we are grateful for the administration and congress support in this crucial area. members of the committee, committee, thank you for convening this important hearing. you know all too well that substance abuse disorders come at a great cost to society. the impact of untreated or undertreated behavioral conditions on the labor market, the criminal justice system, schools, and communities is tremendous. above all the impact is greatest on individuals and families.

our budget accounts for just over 10% of what the nation spends on substance abuse treatment annually. we are small but muddy. we are steadfast and committed to using our investment strategically, responsibly and effectively to deliver the greatest possible impact for the american people. thank you very much. >> thank you chairman grassley it is an honor to appear before you today. da views the combined prescription opiate and heroin abuse academic is the number one drug threat facing our country. i appreciate the opportunity to appear before you today and talk about what we have the dea are doing to address this threat. we understand that we need a balance, holistic approach to this epidemic. our efforts are designed to ensure patient access to the medication while the same time preventing the

diversion of these highly addictive and dangerous trucks. we stand with our interagency partners including those represented here today and embrace comprehensive prevention, treatment and education efforts as critical to our success. however, the porcelain has be a key component of that strategy. we need to investigate and bring to justice not those suffering for opiate use disorder but those that are exploding human frailty for profit. our answer to this drug threat attackssupply, reduce command. there are three prongs to. law-enforcement, the written control, community outreach. my initial comments focus on divergent control but we would be more than happy to follow up with others. rolling thunder is the heroine of force and prong of the stretchy that focuses on the toxic business relationship between the mexican cartels that are flooding our country with heroine and the violent distribution cells that are flinging it in our community.

with 1,600,000 dea registrants, dea diversion is uniquely positioned to assist in this fight with enforcement, education, and engagement. the vast majority of the 1.6 million registrants are law-abiding citizens, their spread across the country. we investigate the very small percentage that are operating outside the law but could inflict considerable harm in our country. for example, practitioners not prescribing for legitimate medical purpose outside the usual course of practice. pharmacists not performing their responsibility to ensure a prescription is valid. manufacturers and distributors not polling the regulatory to prevent diversion. how do we do it? with our tactical diversion squads in our diversion groups. our tactical diversion squad specialize units made of agents, investigators and intel analyst. we have 69 to play nationally.

where in the process of creating two mobile tactical diversion squads that give us the ability to deploy where the need is. given it the fluid enforcement capability. we have more than 600 skilled diversion investigator spread across the country and our diversion groups. both the tactical diversion squads in the diversion groups work with the respective u.s. attorneys offices to bring criminal or civil charges and where appropriate, administered of action. our orders show causes our immediate suspension orders, revoking registration. as i said earlier, enforcement is a key part of the strategy but engaging with that large registrar immunity and educating them are just as critical. in the last two years dea conversion has connected more than 300 events providing education and guidance to thousand of dea registrants and others. in the coming weeks will be meeting with industry leaders to discuss areas of concern. increased dialogue and appropriate collaboration with industry or is crucial to our collective efforts.

finally, we'll continue engaging with her inner agencies partners on these initiatives. expanding access to treatment, mandatory prescriber education in the safe and responsible disposable of unwanted come on use prescription drugs. we look for to the day when drop boxes are so commonplace rudder communities at chain pharmacies and elsewhere that people can dispose of their unwanted drugs, conveniently, frequently, safely. ensuring that those pills do not get in the wrong hands and start someone down the journey of opiate use disorder. until that time, the dea will continue our national takeback initiative with national events every six months. during the september 2015 we collected over 2000 tons of unwanted unused. our next one is scheduled for april 2016. the da stands with her partners and embraces a balance approach attack supply, reduces command

and empowers communities. for 20 years i've had the privilege of working with the brave men and women of the dea along with her counterparts investigating the most entrenched domestic and foreign criminal investigations threatening a country. this current prescription epidemic is unlike anything i've ever seen. statistics have been münchen but in the last four years more than 100,000 americans have died of overdose. ..

>> nizolek but the task force mission statement included creates the framework for efforts to restrict heroin supply and don this point i have some questions because they think there is a full up its -- a fall took no attention to that with the massive influx of heroin traffic to into this country by mexican drug cartel. they don't even mention that seizures at the border of more than doubled since 2010

and don't even mention a few weeks before the report was released to being an incredible 62 percent between 13 and 14 years. how can it be the national heroine task force that is related to this supply part of the problem for specific solutions to address it. before you answer that isn't the least part of the answer to this epidemic securing the border for the mexican cartels and what can we do about that part of the problem? >> i agree with many comments focusing on supply reduction has to be part of comprehensive response. we know what we are seeing is a tremendous increase of

very cheap and dampier europe -- heroin the task force focus exclusively on what we could do domestically but part of the national drug control strategy has been to focus on the government of mexico with enhanced eradication and to take them down. and october forming a national coordination group working in security with the national security council for what additional actions we can take including those at the border to reduce the flow of heroin into the united states it has to be part of our comprehensive response. so i would agree we have to focus on supply reduction

efforts with prevention treatment a and recovery because we know that is part of what is fueling the overdoses we have seen in the united states. >> you say you are dealing with it and i respect that but to have essential document like the report this aspect should have been mentioned and it seems to me it could be a problem with the administration avoiding at all cost to face the issue squarely. the relationship between the prescription painkiller crisis and the heroine crisis is a specific study and debate. we hear a lot of discussion about this. the heart of the question is

to what to the over prescription of painkillers and subsequent efforts to reduce debt version to lead some users to crossover to heroin as opposed to a rapid increase of supply over the last few years. but could you tell us what the studies tell us how much you should a tribute to the crisis to our experience over the last 20 years with prescription opioid? >> it is sent in either/or but as dramatic increase that led people to become addicted. and with an increase and

then it was more available. but then some of the opioid medications were more difficult some have transition and because of that. but that source of the epidemic we want to address that or the diversion because it is the origin of the epidemic. >> a couple of other questions were answered. >> we were just talking with members of the staff with a 72 hour period in chicago last year there were the overdose or death. it was just tremendous.

i have travelled around restate it is an american problem. we went to dickson illinois inspired by the chief of police. we were taken into treatment and petty crime disappeared virtually. as a result. what do you do about treatment? now that they acknowledge it? it is an hour-and-a-half drive. to the closest treatment facility if the person was a user has the good fortune to someone who will pay forfeit

to increase our commitment to mental health counseling and addiction services. the fact this is no longer in inner-city minority problem but an american problem predominantly white white, creates a political force. i welcome your comments. >> i would a cue -- echo that sentiment law enforcement has stepped up to the table to acknowledge we can arrest our way out of the problem. we have law-enforcement agencies across this country as and when you hear the stories they tell it is amazing. second we have seen that program take off nationally in so a lack of treatment

availability to capitalize on their goodwill. despite the things we have done collaborative flee $2 a fact we have significant treatment capped as the administrator talked about only 20% debt people get treatment in the united states. we wouldn't accept that any other way. but we have to combine that with an increase of the workforce. but we need more physicians will live to work with congress sanders practitioners. >> i endorse this tool allows physicians to dramatically expand the caseload. there are so few who can take on these cases. that is a temporary answer but the real answer is bring

in professionals to deal with this epidemic. >> one of the things we have seen is the expansion into rural parts of the united states. we have to focus on those strategies. and those who don't have a dedicated treatment. >> going back to earlier observation of 30 doctors prescribing pain clinics from those that were sold into commerce tell me if you can't play redoing his working with the medical societies and professionals? they are the gatekeepers. senator sessions talks about a couple drug stores and now

you have a city under siege leading to these addictions. order redoing to encourage the profession to clean itself up? so to be held accountable and very publicly. >> the fundamental problem if you think of 750 million prescriptions a annually in the united states that leaves an enormous amount of diversion it clearly tells us we're over prescribing but the practices that we have in this country that is the main source that is diverted. >> is there a conversation

with the medical profession? >> one of the things we have done is work with most major medical societies to gather a commitment to train half-million of their physicians and scribers but it isn't enough. we're 10 years in to this epidemic. i don't think it is too much to ask to support a minimal amount. >> so in order to trade the prescription end opioids. so there is a direct conflict. so actually to be coordinated also nurses and

pharmacists with the proper management of pain. we have been working with the different medical agency for the development of guidelines. >> this is very important. the senator is correct on those points he has made. a star as physicians are concerned they knew people complain about pain many have other sources or doctors giving pain pills and they have supported those as allowing a physician to check the computer system and other doctors are providing the same leaf. to you agree that could be helpful to give doctors an opportunity to push back?

>> that is the main goal to have good prescription drug monitoring programs easy to use in interoperable across state lines so they could have a good actor information romney prescriptions they're getting it is a prime part of the strategy because the network in many states where it is implemented where prescribe errors use the data in the database. >> da has great power. you can monitor the number of prescriptions coming from any physician as part of your ability? >> those are state programs we support all state partners. >> if you have information a physician in is prescribing an extraordinary amount you could interview them and examine their records?

you need a search warrant or ask for their records a drug store or pharmacist you could examine their records? >> correct. investigation could start in a number of ways men over prescribing more information from other sources. >> if the doctor is clearly abusing it we saw that in my community doctors and pharmacists that we did not suspect. the dea and local police chief signed a one-page memorandum nobody has a plea bargain until they told where it came from. it was a very limited number of sources. to somebody goes to jail is cents a message does it not?

>> certainly. >> that is important. >> looking at a new report from the "new england journal of medicine" they conclude there is no consistent evidence of the association between the implementation through prescription and opioid and the rate of heroin use or death alternatively the market forces with a high purity of perelman is the major driver of use. do you agree? >> we're focused on the prescription. >> do you agree? >> it is not yes or no.

>> you're supposed to set drug policy for america do you agree that increase accessibility of heroin is a major driver the recent increase of the rates of heroin use? >> this study was undertaken that i had what we were hearing about his reduced availability of prescription drugs drive people to heroin? some have said it to clamp down. >> the question is. >> i would agree to availability of very cheap and your hair when in the united states as well as untraded addiction has significantly increased heroin use in the united states. >> i think that is a good answer.

enforcement at the border is a big part. i have a personal story in the '70s i was given 17 cases to prosecute to. it was almost all coming from turkey. president carter was very aggressive and i give him credit per cry came back in 1981 as united states attorney we worked seven years with the supply is important. we can impact supply and heroin high purity and low prices are dangerous and prosecutions are critical. people need to go to jail if they are pushing this type of addictive power into our community. , to destroy the whole families.

we can do better by prescription drugs. taxpayers pay on medicaid and medicare bills and insurance rates are higher. is important issue. thank you for your leadership. >> who again my appreciation for holding this hearing is important and comprehensive addiction recovery act provides a means to get our arms around it. thanks for being here and congratulations on the terrific 60 minutes appearance. that was wonderful. i have to go to another event so i want we here when

you testify but i want to welcome, linda from rhode island to has been on the ground seeing this problem over 20 years he brings a great perspective. pollen to ask unanimous consent national district attorneys association in 126 organizations that our active in this area admitted to the record to support this act. >> without objection. >> finally i assume all the witnesses on this panel support that but if you could confirm the for the record? >> there is clear evidence of a comprehensive response multi dimensional aspects l

are indebted are tremendously important. we know we need to do more and all those components before ridden the bill for critically important to make headway with this epidemic. >> agreed? >> yes. >> we are so excited to implement programs like the medicated prescription drug congress appropriated in 2015 that is similar to the programs that were described in the care act. thank you for your leadership on this issue and continue support of our

mission of that public health approach of the care act is vitally important. >> happy to work with your new one and any legislation. >> very good. >> thinks for being here and your service. i just want to go back to say i am happy to have a growing consensus in to do what we need to do to address the problems in terms of the prescription drug problem and the heroin problem. and it was you a doctor who said something intriguing that a potential heroin vaccine? the reason i mention that is ironically apart of the

solution to the problems with the drugs prescribed is relying on the very community that created these to come up with solutions and treatments. we need to make sure nothing make sure they are dispensed properly we don't is incentivize the very people we have to rely on to try and come up with solutions. and with that rhetoric we can't demonize people that are part of the solution. >> but my question, i am very curious. commander kelly was talking about how frustrated he was

with very clear knowledge. we know where these people are and where they get up or what votes are leaving the shores but yet and we haven't recognized the death toll of narcoterrorism. hundreds of thousands of people died as a result of drugs coming to this country. what are your thoughts? of the drugs flowing into the country? many think they are distributed at of mexico but is it primarily heroin that comes across the mexican border but origination is somewhere else? to make cannot give you exact but primarily mexican trafficking groups obviously some come from colombia or south america but they have taken over a great deal of

that with the distribution networks. >> do you agree that a part of the strategy when we talk about border security if we spend more time focusing on the southern border of mexico with more introjection money that may be a higher benefit to reduce the supply chain? >> we target network san leaders and said distribution cells domestically. in the foreign arena will have a great presence with the threat and we work with them side-by-side spare a cow was ready you characterize cooperation with your efforts? >> we have a great partnership in mexico. >> good. >> yield to the next panel.

>> thanks to the witnesses. i want to start with what i mentioned is the drug takeback work that we passed in 2010. we took a very long time to get those rules done but they are finally done in makes it easier for the drug takeback program with assisted care facilities but we would like to see the pharmacy's start doing that. of macon much more widespread than libraries we are ahead of the curve but i think it would be much easier to be in places where they buy the drugs. what could we do to incentivize that? been a great question in the concern for everyone to work

with the interagency partners to find a long-term sustainable solution to a b grade of a drop boxes all over the country until then we will do the takeback event an opportunity to get them off but also to educate to the link between prescription opioid and her when the we will try to expand the drop box. >>. >> once the regulation passed actually we have had conversation with large pharmacy chains to see what we could do and if there are other possibilities. >> two years since the past and five years to get the rules we cannot take six more years if we need more rules as people are addicted so that is the answer the

pharmacies need more rules or force a regulation and then we can do that but then we better get it done. then they should do it you will join with you to get that done. also on the record that testimony from the court one of the leading treatment centers in the country based in minnesota. in talking to the chief medical officer about the need to mandate the programs in those measures already already, could you talk about what barriers there are to make this a reality?

and but we can do to move that along? >> it is unjust having those programs. we're happy there are additional resources is this year with a prescription in drug much during programs. and how do we accelerate the use of that information to diminish the burden from checking various databases as well as interstate upper ability? and what we have seen is relatively low utilization. >> we have to make it mandatory that it doesn't seem to be working. >> i agree. to implement the mandatory use we have seen the dramatic decrease of doctor

shopping when they access the information. >> making a voluntary does not appear to be working. >> a think the urgency that waiting until we get more uptake on the programs is not enough to. >> then the core issue with the governor of vermont to make it easier with more of the products are up there to be approved. do we need to change the standards the fda uses to take better consideration? >> might take this isn't the amount of the medication but prescribing behavior it is how they are prescribed. >> than the amount per cry

go back to the study that i cited it is about physicians to continue to prescribe in spite of the fact they have an overdose. >> if you could wave a magic want your number one thing would be to make them more mandatory so physicians have more limits and they could have limits on how much they prescribe and when? >> i would absolutely agree. >> mr. chairman and syria was not here for your testimony i was in other meetings and i did not read your testimony until late last night. it is a subject that has interested me for decades. talk about over prescription of these but the senator mentioned this is medical

school. medical school and nursing school. something i have heard about for decades but it doesn't seem to be corrected the we have had addiction problems in this country for a long time. this is not new. why don't we have in medical school, mandatory instruction to doctors or medical students about what addiction is? we don't seem to have it. but if doctors are prescribing and the drug monitoring programs should be mandatory and anytime you

prescribe the opioid you should book and see the history because we know now what a serious problem it is. to anybody here have a strong view on medical school to train physicians in this country and what addiction is? >> we have several investigators and one of the challenges is the medical schools is their overloaded and don't have time for more question so we try to put them in the medical exam because that will incentivize and that's to save strategy and the hours

that they get on the invitation they fanned out approximately least five times more hours of education on how to handle pain in animals and humans. we have a need umbel sides. >> if they spend five times as much time. >> and now they get much more training and then a medical student said the amount of that time. >> that is crazy. if you look at the data data, addiction has other has health problems to. and mandel lot of what people come into the doctor's office with is the result of addiction. if the doctor understood

that this is about other diseases and it has been a vexing me for a long time. i just want to touch on a couple of things but also in minnesota the american indian population in the there is an epidemic. only 2% is native american and native american babies are 20% of babies born addicted to opioid. we need to address that. we have seen some good things. there is a project in one county to reduce the number of children born in mistral -- withdrawal and was

strategies can we close the gap between the need in the rural community in the available resources that brings me to the other question of how are we going to gear up treatments when only 20 percent of people who have addiction can get treated? >> the problem of neonatal abstinence syndrome of children that are born of women given opioid. some are women that our pregnant that have pain that cannot prescribe that during their pregnancy. to 18 to 24% will receive that during their pregnancy. if it is the last trimester that increases the likelihood they will have the child with this syndrome.

and then you have those of prescription medication not properly treated have a severe case of the syndrome. one of the questions that is rising that the consensus is usually give it to a very unique situation. studies have shown treatment for patients or addicted to heroin. in the third item regardless ultimately of the syndrome but to recognize so you can intervene because if you don't the newborn can die

senate thank you senator for convening the hearing in my colleagues for their active the engagement. i was very pleased last summer to see my home community added to the high intensity drug trafficking ring and i know you firstly visited my state and county to recognize is facing a real challenge to the increased frequency and intensity of abuse and addiction. as part of the response strategy we receive additional funding to replace jut -- drug intelligence officers in the analyst. i am interested in an up day by using these efforts are working in either five regional areas and how you see your larger strategy to

add additional law enforcement personnel? how does this help local law-enforcement have the abilities they need to tackle this challenge? >> i was pleased to announce a think having the resources is important so we're grateful we have the resources to do that. and those additional dollars bill also public health coordinators' to diminish the supply without robust community response to do that. and we're getting a briefing next week. we are happy to provide you with an update of where they are.

and how we might continue to focus on the law enforcement and public health aspect spirit we do need a combined strategy that is reference so broadly to join as a co-sponsor. but yet when the dea has additional resources to interface, how do we sustain that over time? that it isn't just a temporary your transitory problem? how to read better support programs like these in congress? >> this is ben the bread and butter for decades.

if it has to do with the heroin to read to attack the networks. to value those relationships >> and building an infrastructure. remember the thing that has impressed me of our programs to focus on the threat. we're talking about opioid debt mess continues to be a problem. it allows that a very low-key do -- local level for those evolving trends. committed is incredibly

important to the height of management. >> in the public health sector with the health services that we have moved toward law enforcement and what we need to do to get to a strategy to address this issue for the long term. >> but with that assisted their peak set to follow that in order to give those medications. it is not as well integrated. but with those individuals

going out into the community or how the states are managing that. >> to be acutely aware to partner with the veterans or their counterparts so they're out the programs of my fellow operating positions that incorrigible and require that. to mirror that collaboration that we developed at the federal level with the interagency and we encourage the localities to do the same. >> i hope the chief has an opportunity to day with state in local law enforcement. spin again i think the panel

for your testimony. the chief of police to attack the epidemic the hallmark of his tenure as chief in to be serving in various capacities in that department. in prior to that serving in the u.s. airforce with a degree in criminal justice from the technical institute and their a graduate of the fbi national academy. the second witness and after

losing her daughter to a heroin overdose in 2014 to find a song of hope of a nonprofit group for those struggling with addiction. since that time she has been an outspoken community leaders seeking solutions to is the epidemic. she has traveled here today. in their final witness his director of clinical services that kodak and was working in substance abuse with a health care for more than 20 years and has been there since 1993. she received her be a and

earned. >> a we have had acclamations for you. >> thank you. before i begin because i will be talking about something it is considering the state of new hampshire. it is important to note that the city of manchester is a vibrant and exciting city had an incredible string band connectivity and producer of. i think it is important that the state of new hampshire

is incredible beautiful state with mountains and rivers and that ocean. i don't want to give the impression the state is falling into the abyss. it is still wonderful state. and tourism is rather well. thank you freddie institution it is an honor to share space dealing with on a daily basis for:in addition to the increasing role fatal overdoses as bin alarming. also senators whitehouse for their leadership of a comprehensive addiction and recovery act.

what law-enforcement needs is a sustained approach in the attic where resources is state and local law. who won the front lines? in representing huge step in the right direction and hope the committee will pass this legislation. with a continuum of care in the city of manchester and a partner with the health director to work on the issues i see in that bill. as the exceptional legislation. in 2013 the city, we really haven't talked about fentanyl but it is killing citizens. 30% of the overdose were heroin 7% was a heroine makes of fentanyl 22 of

which were heroin and 21 was strictly fentanyl alone then receive the uptick of the overdoses and in 2015 we suffered in the city of manchester 69 of reduces with 33 percent being straight fentanyl 26% with a mix of cocaine and another 9% with mixed with heroin so that is what was killing our citizens in 2015 now is sentinel citizens are dying because of the synthetic labs produced in mexico by the cartel. the poison is on america is an affront to carrying committees and devastating families and leaving children without parents.

we have case after case children are finding their parents dead from a drug overdose. to have an american actor go celebrate and romanticized the same cartel the poisons and kills our citizens is disturbing. the senator noted in her testimony to bring parity to trafficking in heroin. i encourage the committee to pass that bill. recently they just passed a bill for drug dealers who dispense on the streets of new hampshire. there is to priorities to support and boost the morale

of frank of officers. and the negativity about law-enforcement. this to prairies are related at this point. officers are trying to make the committee stage in spite of the national discourse. with that in direct cause of the public safety health issue. officers responded to the overdose calls the service. >> 46. >> manchester police officers responded a 16 overdose calls with 69 fatalities.

each number represents a person, a human being. and the loved ones and the co-workers. i need to tell people this but your opening statements told me i tend to go off the

rail program after previously testifying we partnered with the federal government with a strike force going after the cartel that they want to romanticize. and that is partnering with local and federal agencies working collaboratively we will goa after the dirty doctors. they are playing a role in it is unfortunate senator sessions isn't here about the "new england journal of medicine". i not know the methodology but it is nonsense. when new hampshire of the top three states

prescription of the top five premeditation's per capita in the same three states that know that methodology but we did at an to i also invited the police to work collaborative flee with a full set pollen dash force multiplier. so the person in said the third floor apartment is bringing in prostitution prostitution, they're breaking into your cars. i want to shut those down in realtime. had been hit the streets in this in his remake the by we arrest a person in go in the house. and with those

investigations with which we allow them to continue to work in the it has extended 4 grams of heroin and other drugs in most recently we seized over 500 grams of pure fentanyl. everyone is a potential fatality overdose. before that one investigation working in collaboration with the dea and local partners, a 27,000 grams. and all of two dozen teen, -- to have a stock increase. but the supply it needs to

be a leader in -- reduced drugs are coming across the dea is doing a phenomenal job. it is taken twice the amount of the street since 2010 because if we can take 27 grams of heroin of the street in the next night we buy another 33 figures which is to engrams surfing gear we're not even putting your finger into a. id to recognize this problem for what it is a public safety issue. we cannot arrest our way out of this crime treatment and support are critical for law-enforcement last summer the city of manchester

cojones to comprehensive plan to confront the epidemic. one part of the plan was part of a continuum of care by mapping all assets allowing someone struggling at any point during the continue of. we're making great strides in the 24 hour care continue a facility. i heard talk of the model but eventually this will be the winchester model. the hope for new hampshire a 24-hour facility to house medical and counseling and recovery coaches it in one location. what does that allow me to do? my apartment to have a more compassionate alternative to breast. i can bring them directly to the facility. table drive out to the

location of of police officer to get a ride instead of the rest. we'll have a car coming get you to bring you directly to a facility. and to fight to support the recovery community with everything we have. and will prevail through tireless action. >> your first in the nation primary i heard the case adjectives and all apply to iowa. [laughter] >> thank you so very much

and thanks for giving me the opportunity to share my story here today. and not certified educated i will not go off my statement [laughter] but i will keep this short. and i'll pollen nephew blanks from what i have heard today. every day i speak with those inactive addiction with the families of those and

recovery from what i have seen the but i feel is important because that has been said many times that carolyn is cheap but believe it or not especially parents don't understand how cheap and that is very important for them to know. they don't realize when you give your kids $20 to go to the movies on a friday night, you could have easily bought heroin for them with that $20. . .

they've done for years in the navy and now has her bachelors in business. one of the things i see happening in our little town that frustrates me is, you are saying disconnect. our officers have worked so diligently to arrest people that they know are bringing this and to have them go in front of our judges and our