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 judges let these people on the wrist and send them right back out the door. i i cannot tell you how often i get these boys that i consider sons because i have watched them grow up. people say oh, they are are terrible they are not doing anything at all, and give them

such a bad rap. that frustrates me because i watch them, they are busting their butts but what you expect them to do when they keep arresting the same people and sending them in front of these judges for the judges to turn him right back out on the street. the boy that sold my daughter the heroine that killed her just recently went back in front of a judge for his fourth offense for trafficking heroine. fourth time he has been arrested for this. he was given five months. how is that possible? that is so frustrating. it frustrates me of course but i cannot even imagine what our law-enforcement deals with in that situation. these are things that have to be dealt with. lastly, what do i know?

i know that when you find your 21-year-old on the floor, blue, with bruises already on her for head and her nose from slamming into the sink because she died so fast, that sticks with you for the rest of your life. that when you do cpr, praying for someone to show up and help your child in your arms are burning because you have done it for so long, waiting on help, and you want to quit but you can't quit, it's your your child, that's your baby, you

can't stop. the sound of my air going into her lungs, the crackling that i still here in my nightmares, we have to put a face to this. we have to help these kids. when they say i want to quit, i need help, we can't say to them, i'm sorry give us two or three weeks and get back to us. the legislation gives me a little hope. please, please do something to help our children. thank you. >> thank you. thank you very much. thank you.

>> thank you so much. much of what i have included. >> could you pull the microphone in front of you. >> first of i would like to thank you for this opportunity. i've been been in the treatment field for 26 years and i was asked to participate today to provide the perspective of life what it's like when the rubber hits the road. what what are the problems, what are the challenges. i'm going to quickly skim through the statistics that everyone has heard over and over, astounding as they are and get to the complexity of the disease and what is needed. so i may not completely for the

testimony that you have right now. the opiate overdose epidemic has resulted in an average of 125 people daily in this country, and it continues to grow. since 2002 the heroin addiction has doubled and deaths have could you build in the united states. the rate of opiate team edit prescription has increased dramatically. new problems are emerging. parts of our country are faced with limited or no resources to assist those needing care. midwest states, northeast. infectious disease such as hiv, aids is on the rise in numbers have increased in an alarming rates. the disease of addiction with chronic relapsing and often permanent disease of the brain is costing taxpayers dollars and causing society to lose the creativity the individual

contributions that each loss life represents. it is replacing those contributions with fear and grief, the pain, distress is the result of lost lives have permeated our communities and have become a part of the problem. my understanding and 26 year experience in the treatment of this disease and its related tragedies is the reason i am honored to have been invited to participate in the conversation today. from the treatments perspective i've been asked to speak of the prevalence of the need, what what populations are be most affected, what are the treatment needs of the individuals and families and what challenges do we face in five minutes. the growing numbers reflect new trends and those that are becoming addicted to opiates. this is critical when we are creating effective treatment

modalities to assist the people who are coming to us for care. the traditional bell curve of a person coming to treatment has reflected an age of 39-42, 30% female, 70% male. there is but i can vicious shift in the demographics between 2004 and 2014. i believe it was reference the mortality rates, there's also mortality rates that are changing in the mortality rates for young, white adults. the numbers correspond with increases in emergency room visits, treatment episodes and police data all reflected of opiate use. what we're seen seeing is an increase of opiate dependence and older and younger white populations, female populations. emerging are growing vulnerable populations are women, young adults, adults, adolescents, middle-age adults, returning vets, those receiving multiple coal prescription, patients receiving pair for pain.

i don't believe it leaves a lot of us out there that are not impacted by this. and no longer follows gender, race, socioeconomic boundaries. the challenge of treating multiple populations is in providing care that is individualized, effective and evidence-based for each of the populations. cognitive and emotional the moment, cultural norms, experience trauma, the individuals redness for train, the resiliency is in recovery supports are some of the clinical variables that need to be addressed. over 50% of those who come to treatment, with at least one other mental health or psychiatric condition. as well as multiple is a go conditions. most commonly forms of depression, excite in other manifestations. this is a highly complex highly complex

biological, psychological, social and spiritual disease. to be prepared to address the complexity with confidence, treatment providers, physicians, and independents practitioners and counselors need knowledge of treatment options, compassion and an understanding of the neuroscience of addiction. medication assisted treatment for opiate dependence have been the most effective research and regulated evidence-based treatment for this disease. the phonological intervention assisting individuals from regaining their lives worked by replacing the heroine or prescribed opiates on the receptor sites in the areas of the brain affected by those opiates. signs signs have shown over again the replacement therapy works with behavioral health counseling. the current

dosage of medication, the correct dosage of medication allows an individual to not feel the extreme pain of withdrawal but also does not provide the high associated with misuse and dependence. this in turn provides the individual an opportunity to heal physically, emotionally, and spiritually. medication assisted therapy can preserve life and allow an individual to work on their recovery. sustain long-term recovery ideally includes health, home, community and a purpose. medication addresses none of these but allows an individual to work on all of these. a partial replacement therapy, extremely effective in populations were physiologically naïve, those who have not used as longer much, where the brain changes not been as severe or as permanent. the assessment process is determine which medication is indicated requires a deep understanding of the disease.

it is obtainable like any other medication through primary care physician's office. this can dramatically increase accessibility, however at the same time with less stringent regulations do not require the same level of expertise. physicians are are only required an eight hour training to prescribe it. that speaks to the name that we've all spoken to in the attention to this in the medical schools and or areas. it is here that another chair arises, clearly winning more accessible, effective treatment. there is no magic wand, provided only medication will not be successful for the majority of patients receiving mat. we of patients receiving mat. we need more prescribing physicians and practitioners knowledgeable in the specialty of addiction. another medication has been recently used is a medication that blocks the drugs euphoric

effects. that work well in populations that show a high amount of motivation. you have to to be motivated to take it. therefore be experiencing cravings it does not work for you. come to kidding matters there continues to be a social veil of moral judgment, stigmatizing this disease. those who come for care and those who provide care the stigma can be seen in the regulation of methadone treatment in those environments in which it is provided. the regulation appears to reflect the stigma attached to the population for whom it was created. the loss and incarcerating individuals for symptoms of the disease instead of assisting with rehabilitation and recovery destroy lives. this practice which has resulted in the u.s. having the highest incarcerated rate in the world is widely known to be ineffective at reducing drug use with high rates of crime and

incarceration. stigma is also reflected in the ongoing struggle with the implementation of mental health and substance misuse. he and reimbursement rates. this is a critical critical issue when we're talking about someone coming in saying i need care. often, on obtainable or difficulty obtaining authorization to provide career creates a barrier to treatment. this is for people who have medicaid and the benefit of the metal care acts. often often families and individuals do not have the resources to advocate for themselves and loved ones. treatment providers do not have the staff hours to assist. low reimbursement rates paralyze provider and the complexity of the benefit paralyzes consumer. in addition, to this challenge and stigma we see challenges to meet in the growing needs of the growing population and

accessibility geographically and financially. treatment capacity and inadequate provider competency. i can't say that enough. were not developing our workforce quickly enough. were quickly enough. were not paying them enough to allow them to stay. if we can build on what we know works, holder systems accountable to the best practice standards, reimbursement and a realistic rate and continue to build an easily accessible continuum of care we can reverse this. i was asked to speak on prevention which i will speak to briefly much of what is here was already stated in terms of physician education and the surge of prescription. one one piece that has not been stated in his deadly is that concurrently with the surge in opiate prescription medication there has been a rise in prescription of benzodiazepine frag signed the and other

hypnotic needs. in 20,142,014 and 15 in rhode island, 33% of those receiving opiate prescription were coke prescribed benzodiazepine. this is a deadly combination has been a significant barrier and the increase of opiate death. this statistic showed nationally as well. we need to look at the cope prescription. other strategies for their prevention initiation include but are not limited to patient education and the use and storage of medication, family education, continued public continue public health education and the use of community. resources. treatment within a system of care individualize for the patient that is easily accessible can prevent the

progression of the disease and the possibility of overdose. this is a dynamic epidemic exposing the need for collaboration between's public health, public safety, and behavioral health. reaching into the medical, pharmacy, farm reduction in recovery communities, farm reduction in recovery communities and in partnership with civil society representing a communal call fraction. for me for me this is one of the most exciting part of the bill itself is that there is a piece there that mandates interagency collaboration and the i believe the interagency collaboration is going to be able to start to remove some of the silos created by funding streams, it's a huge reason we have the silos we do. that is going to create the foundation for an answer to

this. i know that i represent the task force and those of us in rhode island providing treatment strongly support cara. it in its focus on interagency collaboration. thank you. >> i've three questions, one for each of you. thank you for sharing your tragedy with us, i know and we can tell that it is not easy for you to do that. you have not given up and i thought we ought to give you an opportunity for you to tell us about holly's song of hope and in particular how the organization works to provide community support for those struggling with addiction. >> a lot of people how to do this. it's not strength it's that fight or flight and to get off the couch in the morning or get out of bed and not lather and cry all day.

i realize that what was lacking when i was going through everything after losing holly was family support. there is tons of programs out there for those who are caught in the depths of this disease and fighting it, but the family support is greatly lacking. the little bit that i did find i was going to get charged for. i thought that was ridiculous. however i also realize that he didn't tend to really appreciate somebody else talking to me unless they have been there and been through it. so that they truly understood where i was coming from. it just made sense for me to

offer that to others. we started holly's song of hope on facebook just as a group for friends and family to have memories about holly and maybe what things were going on with this heroin epidemic and things like that. somehow in under a years time i ended up with 1000 members very active members. i realized that this is something that we need. i mean members from australia, scotland, ireland, as well as a cross the united states. we started posting questions every couple of days that have to do with addiction in some

form or another so that people are constantly learning as well is getting support. i had so many people say you need to take this outside of facebook. so i started talking to members and they started sending me, i want i want, i want. i'm currently working with just under 50 different facilitators in states across the united states looking to start their own chapters. i started actual meetings in carroll county they run every other week at this point. we cover codependency or enabling, those two go hand-in-hand. i i cover a street drug of some sort make sure that people that come to the meeting

see what it really looks like and what signs they need to pay attention to. also how much it cost and so on and so forth. i firmly believe education is what is going to change every single piece of this puzzle. every single one. we hear about educating doctors, we need to educate the families, the stigma education is the only thing that is going to change that stigma. i can't tell you how often every single day i am sure there's going to be some story in this that if you go in and look in the comments you're going to see a lot of people who are going to say to me well if you would have done your job as a parent and raised your kid right your child would not be dead. well let me give you a four

instance. in the fifth grade my daughter was going to a sleep over one weekend and she came to me and said, mom one of the girls got it joint for that sleep over this weekend. and i'm scared to death i don't know what to do. i don't want an arc anybody out, absolutely don't worry, you're not going. i'll give you a

. >> you talk about problems with having parity in the reimbursement and about insurance and the level of reimbursement rate. could you talk about this area,

about what we need to do to meet the needs that we have with people who need treatment? and what we should be doing and where we are not, what barriers are there to meeting this. >> i think everyone has spoken on what is needed of the medical community. at this point. that is the training and to increase capacity. one of the message to which to increase capacity and i will say it again is for someone to please here that the independently licensed practitioners be allowed to prescribe medication for opiate dependence. that would increase capacity with training that would also

correlate to competency. i cannot say that often enough how complex this diseases. it is not just biological, psychological spiritual, emotional. in terms of i can use the co side of my head here, the operational side, reimbursement rates have historically been lower than other mental health rates for substance abuse. that continues. you can look at any formulation of reimbursement rates for either commercial or medicaid or medicare is an area in which we desperately need. we desperately need. >> and how is that determining quote mark how are reimbursement rates determined? i mean if if someone goes into the hospital for cancer treatment they get reimbursed and there is not

anyone going well, it's their fault may have cancer. what seems to be going on, what is the one justification but also also was as a coo, what is going on the other side with the insurance industry? and in terms of the federal government state governments reimbursement. >> we can start with medicaid in each state is different. i believe that the medicaid rates have been historically lower than other commercial insurance provider rates. what ends up happening, particularly in the behavioral health side is we very often have a very high percentage of those who are medicaid eligible.

therefore a treatment facility is going to have anywhere from 60-90 for% of the people coming to us for care reimbursed at a medicaid rate. medicaid rates are not negotiable they are issued through health and human services in each state. we choose to do the best weekend with those and stay committed to our missions. on the commercial side there are negotiations that go on over and over. we don't have a lot of juice. we simply don't in those negotiations. i've been part of this in one way or another for 20 some years. we don't. so that's the real issue. the result. >> let me just ask, i know them running out of time. >> i'm sorry missed your question. >> no you didn't. your speaking to the question. medicaid obviously reimburses lower than some private and other areas to come as their

particular disparity between the actual cost in the reimbursement in recovery and in rehab? >> yes. >> okay that's what i wanted to know. we have run we have run out of time. i think that's interesting. >> thank you. >> i used to live in manchester, new hampshire, i'm now down in north carolina like senator grassley a lot of the additives you use for new hampshire i would attribute to north carolina. we're just just further away from the arctic circle. it's a beautiful place and you should be proud of it. i'm glad he pointed out that it's a thriving state and community with this challenge that is not unique to new hampshire.

one question i have for you is the chief, what sort of obstacles are either the federal government in this case i will speak to state issues but what kind of things have you seen as a policy here or give you pause in terms of taking this fight to law enforcement? >> the relationship we have with the federal agencies in new hampshire are robust. i am concerned with the recent doj decision to freeze assets. i understand at the hopman issue in dc. d.c. i've read some articles about some law-enforcement agencies that have may be abuse the practice of it, i think there should be oversight as opposed to shutting it down and having this conversation that is not being used properly. what does it look like for the manchester police department? i use it drug forfeiture money

to fund my drug unit. that means i have an off-site, i have a location away from the police department that i play rent on. all the under cover vehicles we have i pay leases on. all the equipment the drug invested gators use, cameras, any sort of specialized stuff that they need, covert need, covert mike so nobody knows that there miked up, all that stuff costs money. i take it directly out of the drug forfeiture money. i'm using drug dealers money to do drug investigations. there is even a push in the state of new hampshire now to take all that money and put it into the general fund. as such a time it's unpalatable that they think about doing that when were in their throes of this pandemic. i think it is a pandemic. what would it look like if the doj doesn't open up this money, i hope the split stay the same, i, i hope they don't diminish that split.

if the state of new hampshire does the same thing, the manchester police department has two decision. i have to shut down my drug investigations because i can afford it out of my budget. the city only to do so much. or, i can go to the city government and they are extremely cooperative and supportive of the manchester police department i can say i need all of these line items, whatever that number is the year that you're now going to have to pass on to the taxpayer. instead of using a drug dealer's ill-gotten gains where shifting the burden on a taxpayer. it's countered to attend and i think it's bad policy. i understand that there is something affairs afoot with law-enforcement,. >> ,. >> the reason i wanted to ask that question, it's a matter of balance but i think there's a very clear between the source of that money and it's used put it back into law-enforcement preventing the classic cases

they had to deal personally and that she continues to do within her service. i thank you for that. this really i had a question for you. you mentioned variations among states with colleagues and any professional affiliations that you may be a part of with networks, are there any states that seem to be a best practice and going about providing care back to their communities? >> i'm most familiar with new england area each state has a strength they're doing a phenomenal job with that i've worked with some of those positions and they have done a phenomenal job. i have to say that in long

island the governor's task force has brought together all of -- it's truly an interagency collaboration, department department of health, behavioral health, hospitals, ag's office, she has 17 people on the committee, they've done a tremendous job of creating strategies and looking at dollars communally. i believe going going forward that may be a very good model for addressing this. we've actually been looking at everything that is been noted here today. >> i want to thank all of the witnesses, i want to thank the senator for continuing to demonstrate her interest in this matter by sitting here and beginning and ending the committee with us. this will conclude the meeting, the record will remain open for one week to provide additional information and potentially

response any questions of members who were here are not able to attend may have. thank you very much, god bless you. [inaudible] none. [inaudible] come the state department released its latest batch of emails from hillary clinton's secretary of state. spokesperson announced that 22 email threads were with help from the disclosure because they contained top-secret information. let's take a look. >> i can confirm that is part of this monthly investigation the state department will be denying

a full seven e-mail chain founded 22 documents, representing 37 pages. the documents are being upgraded at the request of the intelligence community because they contain a category of top-secret information. these documents were information. these documents were not marked classified at the time they are sent. we work closely with our partners on this matter and the dialogue is exactly how the process is supposed to work. as to whether they were classified at the time they're set, the state department the process is focused on whether they need to be today. classification at that time they are sent are being and will be handled separately by the state department. the emails will be denying them full meaning they will not be produced online, on our foia website. i do not mean to remind you that in response to foil request is not unusual to deny a request to document in full.

i will not speak to the content, i understand the curiosity. i am not going to speak to the content of the e-mails. were aware that there is intense interest but the process has been completed. we have requested a a month extension to complete the entire review, we do not need the extension for these particular documents. these emails denied of all are among the emails discussed recently by the intelligence community inspector general in a letter to congress. will not however be confirming or speaking as i said to every detail provided in the documents or in the icg letter. one of these e-mails was also among those identified last summer as possibly containing top-secret information. to remind, we are focused as a secretary secretary wants us to remain focused on producing the e-mail through the foia process.

there's approximately 55000 pages is a major undertaking. our staff is working hard to get fore leaving a manner that will caucus leaders held a press conference. it is about half an hour. [inaudible] none on. [inaudible]

[inaudible] >> good morning we're joined by our leadership in each of our members of the leadership will have an opportunity to speak. i will introduce the leader momentarily. we still have a day to goats so it is to have to say it is but a great success and we're thrilled that the work we have been able to accomplish in the people where been able to hear from, because we still have tom sire, one of the leading experts on energy and how we go about making this a world where we can survive and thrive. richard will no doubt echo the theme of working on the half of working americans. trevor noah will say whatever he wants to say and we're hope where able to finish this off

with a real hurrah as we move forward and get work done in 2016. everything we have heard and everything we have done as colleagues, families, gather here in baltimore has built on our theme, united for opportunity. we want we want to say thank you to the mayor of baltimore, to our cohosts elijah cummings a member of congress from baltimore and quite honestly the people baltimore maryland because this is been a great venue. the city is treated us so well and i hope you have found this to be addressed in accommodating place but a city on the move. everyplace has its ups and downs in baltimore is no exception. clearly it has more obstacle than downs. looking forward to continue to work with mayor of baltimore and the people of baltimore as we move for. a couple more thoughts, i will

remember the one word that stuck in my mind, why? why are you here? why did you want to be a member of congress? why do you want to do the things you want to do the things that you tell people you want to do? if you can tell people why then you have a place among leaders in america. i i think we take that seriously. the other thing that i recall of the many things the speaker said was the president and talking about where we are said, we should not be about subsidizing the past, we should be about investing in the future. i think that's exactly what democrats are about. investing in the the future not trying to subsidize the pass. we have work to do and we know it. i think we leave here more united there would we keep.

this report lithic were very focused and we understand it's about opportunity for all americans, by providing them the security they need economically, nationally, and personally. they have a place they can go. as we. as we told the president vice president when they're here with us we tell this to the american people, we have your back, let me handed over to our leader, nancy pelosi. the american people certainly have been great in congress. >> thank you very much. i want to thank you and congratulate you and mr. crowley for next line issues conference. united for opportunity. that is not only the title of our conferences week going forward it is a description of a house credit caucus over the years. we express our determination to stay united for the good of the american people. not only did one of our speakers pose a question why, one of our

locations did in terms of key fellas, what what is your statement of purpose? what have you decided to dedicate your life to the public good. so that is why, our purpose is to meet the needs of the american people. in a way again that takes us into the future. here we were with this conference which i just thought was one of the best in terms of the unity of the caucus, the the attitude of the members in terms of being united. it had vision hearing from the president vice president, but also vision each member brings to all of this. a vision of a future where many more people participate in the prosperity of our country. of future that respects god's creation in terms of our responsibility to future

generations to pass along the planet in a serious way. the list goes on and on. our chairman and vice chair provided us with experts to keep us up-to-date on the knowledge so that we made the right judgment. we had the vision, our dream, we had the knowledge to base our judgment on, and we had a plan. we are dreamers with a plan. that's a manifested buyer leadership here. our other members of leadership indeed, every member of our caucus. dreamers with the plan, strategic thinking. really important to how we communicate with the american people is the emotional connection we made with them. i do not think i've ever been in a room where there is a stronger

bonds or emotional connection than the vice president talking about his role in the members recognizing his role in the fight against cancer. to hear public policy makes a difference. allocations of resources make the different. different. freedom of investigation, scientific investigation makes a difference. collaboration, it requires leadership, it requires a sense of purpose of how we do this in a public, private way. it recognizes that institutions of higher learning are places where much research is done but much of that research is funded by the national institute of health. it also respects with the private sector is doing. it it is an example of the importance of public role, recognition of the private role, sense of urgency for the american people and personal stories.

a colleague from hawaii was receiving treatment from hopkins in the morning, i don't think think he would mind me saying. treatments in the morning and was speaking to the vice president about this at lunch. again, why are we here, what is our purpose? we purpose? we note that is in it all relates to the well-being of the american people. i think a chairman and vice chair for excellent caucus that focused on her vision, jewish information and knowledge about how to move things in a more entrepreneurial way it was very informative and strengthen our plan on how to go forward to connect in an emotional way with the american people. with that that i'm pleased to go chart distinguished assistant leader was very much a part of all of this discussion is a former

chair of the caucus, the former house democratic in the majority, an assistant leader. >> thank you very much. let me offer my thanks and congratulations to the chair. thank you all so much. yesterday as i listen to the vice president and witness, as we all did, the reaction of our colleague i looked over and i mouth something to the leader and she can hear me. i was thinking, mime mom and father both were c