e availability of i agree the availability in the united states as well as the untreated addiction has significantly increased the rate in the united states. >> i think that is a good answer mr. chairman. >> it's a big part of this. i would say this personal story i was given 17 systems to prosecute and was almost all coming from turkey. president carter was aggressive inenough and i give him credit.n the

heroine at low prices and purity on the streets are dangerous and prosecutions are critical to this and people need to go tof jail that are pushing this kind of addictive power into the communities destroying lives andmr. families. it's a very important hearing. thank you. we can do better with prescription drugs.s it is in the prescription drugs and the issue thank you for your mon leadership. >> after the senate judiciary committee hearing the full senate considered legislation that would authorize the federal government to issue grants for drug addiction prevention andd treatment programs.

the senator from new hampshire offered an amendment to the bill that would provide $600 million for these programs. >> we are voting on a very good legislation with the comprehensive recovery act. this is a way to expand programs that work to address what is a pandemic in the country of heroine and opioid abuse. but the reality is unless we provide the resources to make these programs work it's like getting a drowning person a life preserver that has no air it doesn't make a difference. we are losing 47,000 people a year.rd 120 people a day from overdoses. our law enforcement needs additional funding. the substance abuse treatment folks need additional support. is what's my emergency supplemental amendment would do is to support

the programs that are in the the legislation. it's about dividing between the support for law enforcement and support for treatment that helps with prescription drug monitoring with education and recovery. it is the kind of support that we need to provide if we are really going to make a difference a in the epidemic we are facing so i would urge my colleagues not just to support the underlining what is vision. that's good, we should support it but unless we provide the funding we will not have done what we need to to accomplish change and keep people from dying. i would urge my colleagues to support this amendment.>> >> mr. president. >> to appropriate 600 million on top of the 571 million provided

in the bill as reported by theperiod. judiciary committee in the 2020. appropriators have. in the discretionary caps the amendment would designate new spending as an emergency not subject to budget enforcement. it lacks specificity and how the funds are allocated and for example it provides 300 million to the substance-abuse administration for the substance abuse treatment to address the opioid crisis. the opioid abuse must be addressed and the belt provides a better framework to tackle this problem and provides a comprehensive specific evidence-based approach to help americans combat this epidemic. in the meantime the senate appropriations committee shepards resources to the problems and the consolidatedla

appropriations bill signed into law late last year. nearly 600 million was includedesmu to start down the road helping communities address this problem. the appropriators working inside t of the framework and develop. >> the senator's time has expired. from new >> amendment 345 offered by the h senator from new hampshire will cause the level of the budget authority for the fiscal year 2016 as established in the most recently agreed to conquer and resolution on the budget therefore i raise a point of order in section 311 of the congressional budget act of 1974. >> i would point out that despite what the audible chairman of the budget committee said the fact is the emergency supplemental funding amendment that we introduced is very specific about where the funding

goes. it goes to programs that are addressed and expanded and improved. the substance-abuse preventive and treatment block grant go to the states to be distributed and funding to wall enforcement to the grants are very specific and how they can be used to fight terror win and opioid abuse. and like my colleague, i am disappointed, not surprised but disappointed. i appreciate the people that voted for this amendment that were willing particularly some of my colleagues on the other side of the aisle who are willing to step forward and say if we are going to address this problem we have to provide the resources that the states need to fight this addiction. and the question i have for

those people that didn't vote to support this amendment is how many more people have to die before we are willing to provide the resources that are needed to fight this epidemic? 47,000 people in 2014. in new hampshire, we are losing more than a person each day. in 2015 we lost over 400 people to overdose deaths from opioid and heroine. three times as many people as we lost in traffic accidents. so, how many communities will continue to be ravaged? we are not willing to commit the resources to tackle the pandemic and what do we tell the families of those people who have like courtney overdosed? what they told the parents of young people like courtney griffith whose father came and testified at the hearing the senator and i had last fall in

new hampshire? he talked about the difficulty of getting her treatment before she overdosed and died. i met a man at a treatment center in lebanon new hampshire. a man and recovery who had been in and out of prison and i thought he put it well. he said it costs about $35,000 a year to keep somebody in prison. wouldn't it make more sense to put dollars into treatment because it is a whole lot less f expensive to provide the funding to treat people who are using opioids and heroine and who are substance abusers then to put them in jail. so, mr. president, to all of my colleagues come, i'm disappointed

but i'm not defeated. the fact is this is coming back. it will come back in the appropriations process and it will come back at every opportunity because i'm not going to quit on those families in new hampshire who need help. i'm not going to quit on the treatment professionals who are trying to provide treatment to the people in need. i won't quit on the wall enforcement and, the police officers the sheriffs and all of the people on wall enforcement in new hampshire who are trying to put people behind bars and get people off the streets and into treatment. and i hope at some point the rest of the members of this body are willing to take up the cause and provided the resources people need because i will tellworth you it's certainly worth it to address the 47,000 people we

lost. we were willing to pay 5.4 million in the fight and we lost one person in america. flu epidemic. we have not been willing to put funding in to address the thousands, tens of thousands that we are losing each year in this country. we are going to keep at it. we are going to fighting until we get the resources that families and communities need to fight this scourge. mr. president, i healed to my colleague -- i yield to my colleague from maine who has been a real leader in trying to address this issue. >> mr. president. >> the senator from maine. >> mr. president, i rise in disappointment

confusion that we have this bill , it's been unique, i went to the judiciary committee, the bill came down this week and there's tremendous interest in this subject. when i talked about it at home i said to my people in maine, this is something were going to be able to do because every member of this body is being affected by this tragedy that engulfing our country. this is something were going to be able to do together and indeed, we have done a lot together. we've got a good bill. ur we passed some good amendments, one of the presidents amendments was in the bill we passed this afternoon. this is important work but it has to be funded.the old of saying in maine and i suspect me everywhere else is put your money where your mouth is. i was on a teleconference with some folks in maine just to our hours ago talking about this and what the chiefs of police said it's time to move from

talking about being interested in this to investing in it. we cannot solve this problem without money. it would be nice if we could. there is a drastic and dramatic shortage of treatment facilities in this country and the only way we are going to be able to do it is to pay for it. now, we had a point of order on the budget. i have to tell you i'm confused io because i stood here less than three months ago when we passed of the budget bill and $680 w billion of tax expenditure, where was the point of order then? it wasn't funded , a dime of it wasn't funded.maybe there was a point of order but it was rejected, it was overridden so fast none of us noticed it. it was the speed of light. so we swallow, my mother used to say we straining at gnats and swallow camels . we swallowed $680 billion of entirely unfunded tax expenditures and we can't solve

it and bring it into our hearts to save lives for 1/1000 of that amount. 500 million, one 1000 of the amount that we passed in a matter of minutes back in december. now i'm confused by this. i don't understand it. and by the way, 87,000 people, that sounds like a lot but here's what really sound like a lot. since this debate started at 2:00 this afternoon, 10 people have died. 10 people have died in the last two hours , 47,000 people is five people every hour, 24 hours a day, 365 days a year. were not talking about abstractions here. were talking about people's lives.were talking about what

i consider one of the most serious problems i've ever seen in my state. and we talk about ebola, we talk about isis, all these challenges that we have and yet this is something that's killing five people an hour. and we're not willing to put the funds into do it. it's a false promise. i believe this bill is going to do a lot of good. but it's not going to meet the promise that we're making to the american people by all this drama this week about drug abuse. and that we're going to do something about it. but we're not going to do enough about it because in order to deal with this problem and this is true everywhere, it's going to take money to provide treatment for people that need it. the tragedy and i talk about this this morning, the tragedy is when someone is ready to change their life and ready to try to defeat this awful disease and they can't find anyplace to give them treatment. i was at a detox center in

portland just last week . they're turning away 100 people a month from a detox center. not even a treatment center but a detox center because they don't have the beds. so i'm delighted that we are working on this bill. i'm delighted we're passing it. i think there's a lot of good in it and it is in fact a bipartisan bill but to venture up to the edge of this problem and then step away because we're not willing to pay for what in my mind is one of the most recent emergencies we face since i've been in public life is disappointing surprising and it's just, it's a great miss opportunity for the country so i join my colleagues in regretting the decision that was just made . i think it was an opportunity where we could have spoken as one to realistically , realistically attack this

stirred that is devastating our people. we are losing lives , we are squandering treasure, and we're breaking hearts. and the only way we are going to be able to solve this problem or at least make a dent in it is to provide the wherewithal to the program throughout the country that are struggling mentally and mightily to confront the problem and defeat it. thank you mister president . ideal. >> senator from ohio? >> mister president, thank you and let me see for a moment in response to the comments that were just made by my colleagues on the side of the aisle about the legislation before it which is legislation to address this horrible problem that's now in all of our states of the addictions that are caused by heroin and prescription drugs . about 100 people will die today

from overdoses and that's just the tip of the iceberg because there's so many other people whose lives are being ruined, families being torn apart, communities devastated and this legislation was drafted by senator whitehouse, myself , other members of this body over the period of the last few years including five summits we had here in this congress to bring in experts from all over the country on prevention and education treatment and recovery dealing with the law enforcement side and the importance of having narcan available, also helping to get prescription drugs off the bathroom shelf and it's a comprehensive approach. i will say i disagree a little with my co-author , my colleagues from over rhode island saying if we could pass this bill there would be no funding for it somehow. re there was a huge increase in funding. as everyone knows at the end of the year for opiates. myself and others, the appropriators asked anthony making sure that funding was consistent and then the judiciary committee when they

had some jurisdictional issues, we work hard to draft legislation so if we could get enacted, that's between now and september 30 there would be funding to help us be able to topless what's in the legislation . however, as my colleagues know this is an authorization bill. that's a bill that directs how funding will not be spent. it's not a spending bill. having said all that as senator shaheen knows i supported her efforts to add additional resources over and above what could be spent this year. because i believe this is a national problem and i believe it does rise that level of being an emergency. that's saying a lot. me i'm a fiscal conservative but h that means it's not a fourth but offsetting other programs, is just additional funding because it is such an urgent need. we've done this on other occasions with health care emergencies , when we have something like the evil of crisis , but i think this is a crisis also so i voted with senator she had today, i'm a cosponsor, i supported but i don't support the efforts of

some who say somehow there's no money in here. this is an authorization bill. this is the first step toward getting this money not just this year but into the future . that's the point . back in the house i was the author of the drug-free communities act, 19 years later $1.3 billion has been spent. in support of the drug-free communities act helping to cr create over 2000 community coalitions including in just about every state represented in this body. was that expanding no question mark now. it was an authorization bill that directed spending based on research and efforts, evidence-based practices we know would work, that's what this is. this is taking it to the next level. and specifically directed at points that my good friend from maine just mentioned about treatment centers being . detox centers not having room for someone to go to get the detox and get into treatment. these are real problems in our communities right now. that's what this legislation is meant to address, not just by an appropriation for one year. but by changing the law for the

future and if we do this and do this right in the next 19 years in this legislation we will spend even more than we on the drug-free communities act. it will be well over $2 million will have been spent that would not have otherwise gone out because of this legislation. just as senator whitehouse said that he strongly supports this bill because it is evidence-based, we spent the th right time putting time and effort into making sure it will be money well spent , this bill is really important. i appreciate the support of my colleagues, senator shaheen, senator king, senator whitehouse and i've been asked for a few years together , it's the right thing to do for our country at a time when we do face a crisis and again, i will support the additional spending because i think this is so critical but that's let's not go forward with this intent that somehow this doesn't matter. this does matter in a big way. this is the necessary first step and in terms of this year, we increased funding dramatically at the end of the

year for this fiscal year, not one penny of that has been actually outweighed by the way , it's been appropriated but there's been no outlay. i believe anything we could get done this year, getting , the president signed would be funding we could use for these important care programs just in the next seven months of this fiscal year but certainly we should right now as i have done ' and i know senator whitehouse is doing and others are doing, go to the appropriations committee and same with regard to the next fiscal year let's be sure we have the entire bill clinton and again i would support the additional funding beyond that but at a minimum, let's get this done.this is an opportunity on a bipartisan basis to get something done to help people who are crying out for our help , communities that need our help, family being broken apart need our help so i appreciate the fact that senator shotton made her best effort today, she was right in my view but let's also continue

to work together to get this legislation passed with whatever funding we can add to that, that's great with me but let's get this bill passed to ensure that going into the future we are directing this funding effectively and increasing this funding to help those that need it most.i have received my colleagues and i'm sorry to take too much of his time. class before the senator departs, the senator from iowa island i would like to end this conversation on a happy note after what i considered to be a very unhappy boat and that is to express my appreciation to corbin for his collegiality and his work over many years to get this building where it is now on the set, i express my initiation to voting for senator sheehan amendment , express my appreciation to him for publicly letting to work as hard as we can together to get funding for this bill into the appropriations process that is underway right now. and i look forward to working with him on all those endeavors

, i do believe that we did miss a big opportunity because the editor had passed would have flooded a lot more money a lot faster into the solution of this problem and with that idea. a week after voting not to add $600 million to the legislation, the senate passed the comprehensive addiction and recovery act by a vote of 94 to 1 . the bill authorizes grants to states for addiction treatment, prevention and education programs . it expands the availability of a drug that can block the effects of opioids and prevent overdoses and it strengthens en prescription drug monitoring programs. companion legislation has been introduced in the house . last week the house oversight committee held a hearing on opioid abuse , the first from elijah cummings who asked whether drug companies promote the prescription of painkillers so they will make more money. will also hear a discussion on whether marijuana is a gateway drug.

>> at the beginning of today's hearing we put into the record and op-ed from the baltimore sun , the effects of opioid over prescription are evident in the emergency room as entitled. the author explains that one reason we are now seeing such a huge increase in heroin overdoses because legal prescription painkillers are being overprescribed. she says and i quote, once the patient is hoped , he or she often turns to street drugs o which can be easier and less expensive to acquire. i think everybody else said that this morning. i want to be clear, i'm not trying to blame the doctor. they have a very difficult job. doctor, do you agree one reason we are seeing an uptick in heroin overdose is because of the abuse of prescription opioids? yes, sir no? >> yes . >> op-ed says and i quote,

world population we are consuming over 80 percent of the worlds painkillers . the op-ed explains that drug companies are actively promoting this problem . it it says and i quote, prescriptions from opioids that had been traditionally limited to cancer pain , countermeasures but in the mid-90s drug companies began marketing the bills as the solution to a new plethora of illness . in their efforts to expand the market , produces understated and willfully ignored the powerful properties of their drugs . now that sounds like companies are almost like drug pushers . the op-ed cites several examples for instance, it says this and i quote . the program promotion of oxycontin by purdue pharma was the most aggressive marketing of a schedule to drug ever

undertaken by a pharmaceutical company. this is big business. how in the world do we combat this massive and aggressive effort by drug companies ? when they are making millions? go ahead, i'm listening. >> thomas, thank you for asking that question and i appreciate your saying that . doctors want to do the right thing. we want to do the right thing and actually went out we talked our communities, our youth also recognizes in schools, is fairly good or bad customer they're going to say heroin is that but we have a culture of excess . we have aggressive marketing of drug companies. we had this expectation that there should be a pill prescribed for every pain. this is what we have to change so we have to make sure doctors

get the resources, the tools they need including prescription drug monitoring programs , including guidelines that can help with safe prescribing but also we need resources when we are in the er. we need resources to connect our patients to treatment because otherwise we also feel frustrated at knowing that our >> patients need care but we can deliver it to them. >> .about some guidance you sent out . does that guidance also include using painkillers that are not so addictive or not addictive at all? >> yes. our guidelines include three things, the first is the necessity of co-prescribing with any opioids because somebody could die from their they should get that as well. the second is to be careful about the opioid medications knowing they are not first-line medications. they should only be prescribed for severe pain and the third is for the danger of benzodiazepines which are also killing our residents .

the op-ed goes on to explain why drug companies are doing this and there's no surprise, it's about profit. it says the sackler family which owns purdue pharma , achieved the place on 2015 list of america's wealthiest families , the sackler's, the richest of the list are worth an estimated $14 billion. that's appalling. and i call that blood money. because people are dying, big time. i want to go back to something that was shown on a motel and maybe some of you all can answer this. yesterday i was talking to a reporter and he was saying that , are you concerned that with even more money being requested for treatment and to deal with this problem because there are so many more people getting into opioids and heroine, that money will be put spread so

thin that it will not have the kind of impact that you're hoping for? >> so to your point, i think we have to have a comprehensive response. first and foremost we need to rein in prescribing behavior in the united states . the centers for disease control just without recommendations last week that followed guidance that doctor wayne put out because that is where we know is a significant driver to the problem but we also know that despite all of our efforts , we still have to many people overdosing and nine, largely because they can't access treatment programs when they need treatment programs and this is why i think the president has put forward a significant proposal to extend treatment capacity in the united states. i hear this wherever i go. i just did a town hall in toledo ohio where the sheriff , i asked the sheriff what one single thing the federal

government should be doing to address this opioid academic and he didn't say we need more police officers, he said we need more treatment capacity because we're arresting too many people who haven't been able to access treatment so we took a careful look at how many people need treatment and tried to adjust that proposal to really focus on making sure that as many people as possible have access to treatment when ee they needed it . >> one more question. w what happens ? in other words, this was not a problem before, not as much a problem but then something happened. can you tell me what happened ? i mean, the numbers the gentleman cited and i realized that people are moving from the opioids to heroine but i mean, what happened with regard to the opioids question mark to get so many people wanting them and then to move to the heroine? do you know? >> my understanding is that er there was aggressive marketing by drug companies so that the

pain scale is something that every patient all the time in the course of their hospital stay but the goal should not be getting pain-free. the goal should be appropriate treatment and yet this is the expectation that's placed on patients and on doctors so the doctors are put in a hard place also of satisfying those requirements when all of that was done for drug companies benefit . >> so doctors have a tough time . in other words the patients keep coming in and the pain could be at two , being the ti mildest okay . the pain could be added to and then he comes in or doesn't tell the truth , says i've got , i got a nine. is that what happens? >> that definitely happens and then doctor steele they have to get the patient's pain 20 which includes overprescribing of narcotic painkillers in order to do so. >> wow. you look like you want to say

something . i would agree that we set up an expectation whereby opioid , are the first line of defense around painkillers and they think what were trying to do is through the guidance of doctor when is particularly with people with chronic pain, opioids are not first-line defense to really substantially reduce pain , that we have to focus on other , and the evidence seems to be pretty strong that people who are in chronic pain don't have significantly better functioning when they're on opioids , that we need to be thinking about things like exercise and diet and cognitive behavioral therapy and not opioid-based herpes particularly with people with chronic pain. >> last question . what do you, mister turner asked the critical question about, i guess he was talking about treatment in prison is that right? and what stops you from ,

providing treatment in prison? is that when he was asking? >> yes. >> there's a regulation that says you can't do that? yes and i guess i want to check into that but make sure i get you a complete and accurate . >> i'm wondering if it's something that congress should be dealing with. i don't know whether that's in your control or our control , do you follow me? ro i appreciate an answer , do you know? and while i don't know if marijuana is a gateway drug to ay heroine, but every single kid that i'm dealing with who's on opioids and on heroine started with marijuana . >> so there's a perfect match, 100 percent. everything i'm dealing with for heroine and for opioids, when i asked them what did you start out with they all say marijuana so maybe there's a

susceptibility there or something, i'm not sure . re this is not anecdotal, it's empirical over thousands of kids but it certainly point in d that direction so i think it deserves a cautionary note in terms of some of this marijuana legalization . i think were buying ourselves a huge problem. one thing i want to talk about and get your opinion, we haven't talked about the power of these opioids. and i'll give you a couple examples. a young woman in my district had two problems, she had an extraction that gave her a large prescription of oxycontin. she consumed that, went back and complain, falsely she tells me now and she knew pain, got another prescription and actually went back in and complained another term was hurting so she's thinking out of her head just so she could get prescriptions of oxycontin. that is unbelievable and i talked to some of my doctors in the boston area and they tell me the chemical changes in the

brain , overrides , the oxycontin and hydrocodone hydrocodone, overrides the endorphins creation in the brain so it's more powerful than the endorphins the brain can produce on its own so that's what, when they come off that, when they need that that's why they're going for more oxycontin or heroin , that's the only thing that can stretch it so we got to think about this . these drug companies are creating customers for life. customers for life. and another young father in my district, shoulder pain, same deal. gave him too much oxycontin prescription , two or three scripts later, pam. now he's lying on the street and a good dad, the family, just totally fell into that trap so we got to figure out, you know, i think it's a huge commercial advantage for some of these companies to produce a

product that creates a customer for life. we got to think about what were doing in that regard. that's a huge commercial advantage and i think that governor baker and the mass legislature has come out and said, if you are going to prescribe this stuff you can only get so many pills. were not going to let you refill them so it's also part of our drug monitoring piece that we're doing along those lines as well but is there anything on the front end mites that we could be doing to stop the number of people because once they get in there, we're having terrible problems . we've got a lot of recidivism, a lot of relapse, a lot of money we are spending for rehab and we need to do that, i'm not discounting that but on the front end, to stop these kids from being tracked and in other unsuspecting patients from the track in the cycle . is there anything else we can do up front to stop that from happening? >> i think the question because i think it's really

important and again, we thought , the cdc just released guidelines that their only guidelines and i agree that i think the vast majority of physicians and dentists are well-meaning and part of what massachusetts has done , 16 other states, there's legislation in congress now, we love to work with you on mandatory restrictions so we feel this is not about bad doctors. they got a lot of misinformation largely from drug companies that these are not addictive medications and that we continue to hand them out and i don't think quite honestly in the middle of an academic it's unreasonable to ask the prescriber to take a minimal amount of education as it relates to safe and effective opioid prescribing . if you look at the overdoses that we've seen here, there's a direct correlation between the amount of inspections that we are getting out and overdose deaths and it's been going on for's 10 years and i think the medical community has a role to play and that's a good start . >> what about liability?

there's liability for drug companies and doctors to push the stuff out there because these people are unsuspecting and are getting evicted like that. >> i agree and there's been legal action against purdue pharmaceutical for that reason . they have a role to play not only in terms of making sure their meeting the letter of the law about marketing but also encouraging abuse the trip formulations is another important area. we do need to work with the dea and others to go other outline prescribers who are wantonly ignoring the law on this but you're right. so we need prescriber education, good prescription drug monitoring programs so physicians can identify people who might be going from doctor to doctor to do that but to your point, if were really going to reduce the magnitude t of the problem we've got to scale back on the prescribing and identify people who are starting to develop problems. expect the chairman i feel that. >> also mister lynch i went into one of our drug organizations in our community and talk to every kid i could

and they're all in the treatment program , every kid tells me the same thing. he started with marijuana and they go on to all the rest of it so we had a very serious ou situation in this country , the gentleman from virginia mister calvin #ácustomá thank you mister chairman. i will say, mister micah and i had a series of hearings the previous congress on this drug policy and it included marijuana and forced me to re-examine some things i thought i knew or believed about our drug policy with respect to marijuana. but what is disturbing to me , if there's a gateway drug to heroin it's opioid prescription drug addiction. far more than marijuana. and that's why this hearing is

so timely . it's affecting every community we represent here in this spot. it's not a rural phenomenon or an urban phenomenon or a suburban phenomenon and you know, well, let me ask you mister botticelli , how did we get to this point? i mean, i don't want any doctor to leave a patient in pain. serious pain . you know, it's a terrible affliction. and how do we draw that line between pain management and just an unbelievable avalanche of prescriptions for opioids that has now led to an epidemic of addiction in america ? presumably the best of

intentions originally . >> i agree and you know, i think when you look at the roots of this epidemic and one of the significant drivers, there are other issues going on. it's really about the overprescribing of these pain medications that we have to. >> but why? how did we get there? the doctors are stupid people. >> well, i think that doctors were given a significant amount of misinformation from pharmaceutical companies and even from the medical profession themselves that these were not addictive medications right? so that was really the start of this that despite scientific evidence there was this full-court press to basically educate positions and saying that these medications were not very addicted and at the same time we had which i think was a very noble and it should be a noble goal, that we have to do a better job of pain treatment in the united states . there are a lot of people who

have significant pain and we need it so i think in terms of really full-court press to treat pain right? fu d a even talked about pain is the fifth final sign but there's been little education on the part of these prescribers about how addictive these substances were, about how to identify people so physicians in the united states get very little training on appropriate paint prescribing . i think there was a gao study that showed veterinarians get more trade training on paint prescribing and positions get little to no training on substance abuse issues so it was this mixture of a whole set of factors that really drove addiction and overdose in the united states and i think of late, now we have compounded by heroine availability . >> doctor nguyen, what is effective treatment and now, i mean what's the system for recognizing hey, somebody has a problem and we need to get them treatment .

what efficacious for trying to turn this around early or it moves on to say heroin or something worse? >> it's often said that medicine is not completely a science because even something like pain is subjective. what is pain to you is not the same as for somebody else so that's why doctors do need discretion about how to treat each individual patient based on their symptoms and who they are , also recognizing that is not just about medications. we also have to deal with physical therapy and counseling and education that sometimes he is okay. we don't have to treat everything with a pill and so we very much agree with increase in the use of pd and peace, recognizing though that some bmps are cumbersome to use and if i'm seeing 40 patients in eight hours, i can't be spending an hour of that time figuring out how to get ins to

every patient pd mp. >> we are running out of time so what efficacious treatment? what do you recommend to our health department? >> we were we recommend for small judicious use of pain medication i'm talking about treatment. we've got a problem, what's the treatment? what have we learned? because look, we're policymakers up here. we want to solve the problem. we get that part but if we got to the point where we got an addictive problem but were trying to prevent that person from going on to heroin parts , what works? what in your experience, what works by way of intervention? >> one thing. recognizing that addiction is a disease and we have to get people to get into addiction treatment which is medicine treatment, psychosocial counseling and wraparound services. we know the world health organization shows for one dollar invested in treatment that saved $12 for society and that's something we should invest in. >> thank you very much and

thanks mister chairman and thank you for the hearings you held that were quite informative . >> probably the only ones in congress and we got criticized for them but we went for government operations, he was a ranking member and it's now 1:00. we started this some three hours ago. some 15 people in the united states have died from drug overdoses, three of them from heroin . before the day is over, 120 americans will die, 24 of them from heroin. we heard different things touted here today. some people have said we just need to put more money into treatment. treatment is essential but treatment is at the end of the line. and you would hear, you heard a couple comments from the other side of the eyes today that we need to act before we go home at easter to put more money into the heroine and drug overdoses situation.

this is the remarks of senator grassley on the floor. in fact, according to the office of national drug control policy, the appropriations act passed in december provided more than $400 million in funding specifically to address the opioid epidemic . this is an increase of $100 million over the previous year. that's 25 percent increase okay? none of that money when he said that just a few months ago has been spent. all that money is available today , is that right? i or most of it? tell me . most of that money is available today and you would think were going out of here not providing money. 25 percent increase. i want this in the record and then let's put in the record also , the record of how much

was asked for, how much was appropriated . how much money was taken from interdiction and law enforcement and put into treatment? okay? these are just the facts. we don't want to deal with the fact that were going to put this also in the record so you can see that again, that there is money there and i want reports . i want reports, i'm telling you . this week of how much money is spent and i want that in the record okay? mister botticelli and then i want something from you also mister director of our health and substance abuse office okay? i want to see how much money is pending and i want it in the record and i want in my office okay by friday . close of business. because i know the money is there, it hasn't even been distributed so we're not going to play these games, i want the facts there and we want , we need to stop this stop at our

border. it's coming in and i just showed my mayor, also i think i cited it. it's coming in by the boatload across the borders . i have one question also. i talked about choco , the biggest drugs are coming across the border like it was some kind of a vacation holiday . i was told speaking of weapons which are used in most drug offenses that most of the murders are killed in baltimore, their killing people with drugs. in orlando, he killed them at o the mall, we kill them in our streets, in our communities, our poor communities , we're killing them but most of them are gun deaths and their related to drug trafficking. our mister baloney? he >> yes . >> and a lot of those are illegal weapons. now i'm told i just got this this morning , l choco who is coming back and forth, he also

one of the weapons he had was traced to the fast and furious so the weapons that were supplied by the united states government and a principal drug trafficker whose traveling across the border like a holiday visit , he had one of the fast and furious so were you aware of that? >> unaware from the press report can you confirm that also for the committee. >> i would be the best position to do that. it would be another agency. >> well, i want you to check on it for me and let me know okay? and i'm very pleased with the people out there but i've met with some of your people and the prosecutions are not what they should be . you know, you go to singapore and they do not have a treatment program. i want to put you out of business miss when . all treatment programs, i want to put them out of business because our kids and adults should not have to go to treatment. but we're allowing this crap to

come into the united states, it's offensive . we're killing tens of thousands folks and anything else, people would be outraged. just say no and say just say maybe , there are consequences or just say okay makes a difference . there are young people in what's happening so you can tell a little hot italian comes out of me but i've seen them. i see men dying in the streets of baltimore and i see them now dying again in my community and we need to do something about it , that supply has to be cut off and then i can put this miss when and others out of business, we won't have to be treating people. we won't have the surge on our streets. there being no further business before this committee, it's this hearing is adjourned. thank you. >> .

>> c stands issues spotlight program looking at prescription drug in heroine abuse and addiction and there's more to come. we're just going to stop now to take a break and hear from you on what you've seen so far and the problem of the prescription drug abuse, in particular asking you governments role in solving the problem. what were going to do. go take your phone calls in a couple of minutes here on c-span for democratic and i'm going to use this number, republicans 202-748-8921 and for independence and all of his 202-748-8922 . send us a to, you are at c-span. we will get your calls momentarily but the most recent comments came at a summit in atlanta yesterday , president obama visited there on the

opioid addiction problem in the us, the president saying the issue is not a law enforcement problem but a health problem in the us. here's part of what he had to say. >> the most important thing we can do is to reduce demand for drugs . and the only way that we reduce demand is if we are providing treatments and thinking about this as a public health problem and not just a criminal problem plus . [applause] this is a shift that began early on in my administration and there's a reason why my drug is our is somebody who came not from the criminal justice side but came really from the treatment side and himself has been in recovery for decades now. because it's b.

[applause] this was something that i think we understood fairly early on. now i'm going to be blunt, i hope people don't mind, i was saying in a speech yesterday , your last year in office just gets a little loose so . gh [laughter] but i said this in west virginia as well. o and i think we have to be honest about this. part of what has made it previously difficult to emphasize treatment over the criminal justice system has to do with the fact that the population in the past were viewed as poor stereotypically identified as poor minority and as a consequence, the thinking was it is often a character flaw in those individuals who live in those communities and

it's not our problem, they're just being locked up. and i think that . [applause] one of the things that's changed in this opioid debate is a recognition that this reaches everybody and so there's a real opportunity , not to reduce our aggressiveness when it comes to the drug cartels were trying to poison our families and kids, we have to stay on that and be just as tough on the recognition that in the same way that we reduce tobacco consumption and i say that as an ex smoker . [applause] in the same way that as i mentioned earlier we greatly reduced traffic fatalities because we applied a public health approach . >> president obama yesterday in atlanta at the opioid abuse

summit. the president not only speaking at that roundtable but also bringing money that the executive branch can provide in particular, $94 billion for community health centers and 270 health centers to expand their addiction treatment programs, $11 million for state drug and lock so or narcan that is used in three treating individuals undergoing an overdose situation and 1.1 , $1.4 million for rural education program incentives , anticipating that this plumbing which does not need a congressional approval can provide some 124,000 additional locations across the us. we get your phone calls momentarily so 8924 democrats, 2027 48 8920 once the republicans, independents , all others 202-748-8922. on the government's role in ending and combating opioid addiction. we are going by sarah carlin

smith with politico who covers this issue for political . sarah collins said in the event we just showed at the house here in a few weeks ago we talked about the drugs are there, the head of drug policy and he made the case about this is really an issue largely of overprescribing. recently just a week ago or so, the center for disease control and ask new guidelines for prescribing for doctors. why did the cdc do that? so the cdc really does see this mi as an epidemic in the health care system that often does start with doctors prescribing a patient a prescription and so over the past a little over 15 years since 1999, the cdc says that sales of prescription opioid medication on hold so horse funny with that is also a quadruple the number of overdose so the cdc guidelines

are trying to change how doctors about prescribing opioids and encouraging them to prescribe much shorter , lower ny doses of medications and also in many cases encouraging them to think about not starting a patient on an opioid if that's really not necessary for trying other kind of prescription medications, even trying not medication first to deal with pain . >> executive action from the present yesterday, the cdc making some initial guidelines on overprescribing, about on capitol hill? as that they had just passed the bill dealing with opioid addiction. what would that do? >> that bill with direct some money that the federal government had already appropriated and the wood do two things. it would try to help support prevention programs , programs that tried to help prevent addiction or drug abuse from

the beginning and also help support treatment programs that go on to help people suffering from drug abuse . >> one of the amendments was some $600 million by senator shaheen that amendment defeated , what with that money have done and why was it defeated? >> at this point there's not a lot of appetite on the republicans in congress to spend new money . so they basically just kind of took money from what had nd kind of rerouted and a lot of democrats working the machine for congress to give more money to fight the problem and it does seem like in the next set of appropriations bills , if those go through a lot of even republicans in congress are thinking about providing more money to address the opioid

epidemic so let's see how that plays out and also the house considers potentially considers similar legislation, whether they decide to add a money component were not . >> any word on whether the house will take up that senate? >> it's not clear yet that they will , they chaired the house judiciary committee who would be the committee that would take up the still there , t interest in it, he said he does want to look at some of the costs of the bill and whether it's the best way to address the crisis so there definitely is momentum, a lot of ckd groups are pushing the house to take it up similar s measures have been proposed before in the house but they had started any work on a comparable bill yet . >> and viewers can follow more on the story on the bills in particular and also the opioid problem in politico.

political.com, our healthcare s reporter, sarah carlos , thank you for being with us thank you very much. >> let's get your call ,, what should be the government's role in combating opioid addiction and abuse smart but spoke to strasburg pennsylvania and heal from barbara who's on our other's line. thanks for waiting, go ahead with your comment. >> i think the advertisements for the drugs , educating the public to turn to drugs , as we all know advertising increases drug sales. this has been proven to be true just as they banned cigarette ad they need to prescription drug. when a patient season and are told to go ask their doctor. the drug companies educate the doctors to prescribe drugs. where this conversation money from the drug companies the same way they got that money from the tobacco companies for addiction to tobacco and i'm sure the drug companies will approve any bill that approved drug companies advertising and cut into any of their billions of dollars they're getting.

>> let's hear from reba was in california . reba hello there. >> high. my husband is has been prescribed that and opiates and he's been on them for quite a few years because they tried everything else, they tried stimulators, they tried pain pump, they tried everything now . with the new california law, everything has to go through utilization review board, all the doctors are quitting ri because they got to fight and fight the utilization review board and now all of a sudden they're just lowering his opioids really fast and he's going through withdrawals and everything else so i think there should be some kind of law to help people on workmen's comp. that are already stuck on opioids are you concerned that all these new guidelines that the cdc is putting up about overprescribing will affect your husband's situation? >> probably because he's not the kind that would overdose. he's the kind that absolutely

needs them because there is nothing else . they tried everything else before they ever started him on that. >> more about issues spotlight program coming up on opioid addiction. we are asking you about the government's role in addressing the problem. let's hear from paul on our other's line . >> thank you so much for c-span. what i want to point out is if the nsa can report every single conversation and email in any ui form of communication for the purposes of terrorism, which is quite awful but is not doing that many people as compared to all the other forms of international criminal activity that kills us, why don't they turn those resources and tell us who's bringing all this done? there certainly using phones, faxes, emails and every other form of communication, credit cards . you can tell me who's telling us through terrorism but you can't tell me who's bringing in the dough? >> what you do about illegal the ? what about that part of the

problem? >> that the corporate problem. we've got corporations controlling the government to the allowed to use this and just consumers not citizens. we are just here to eat and consume and chew up resources in return for whatever little value we can get in return . >> that you're from saginaw michigan, johnny on our democrat line. >> good evening. the other man just had a comment about you know, i was listening to him and i was concerned about that i go to my doctor for prescription drugs for the pain and then i notice a lot of times they tried to push the pain killers and other drugs for a new doctor that's coming in.

and a lot of it is just, i've got other medications that are on me, they got to prescribe, overprescribed this to get prescription because they're saying that they can't have a controlled substance without regular medication and a lot of times i'm getting no medication that i need just to give a one time pain medication that i might only need like once a month and so they had been coming in to the doctor and more aware i'm having more medication that i really need just to get this other medication where i really don't need it all the time. ha >> do you want to share with us what kind of medication you take, what kind of pain medication? >> i was taking on , what was it? vicodin or what they called hydrocortisone but i was just

doing it on just here and there but they wasn't really, if i needed that and then other medications i had they were giving me too much of that just to come and get the one medication i needed periodically ask johnny, thanks for sharing your story. question to you is the government's role on combating opioid abuse , opioid addiction and part of the government effort has been the senate bill, we talk to sarah carlos smith about it and to recap the senate before they went on their break and what that bill would do, would be to grant additional grants for addiction treatment and prevention and education programs, it would expand the ability of naloxone or narcan, that's on the use in overdose situations and it would strengthen prescription drug monitoring which seems to be quite the focus obviously of

the centers for disease control. checking a couple of weeks , we are at c-span if you want to send your comment that way. ron says the federal government should stay out, legalize cannabis, decriminalize and use money for treatment , funnier says i wonder what type of incentives are given to doctors to prescribe drugs and jurassic says not picking which going to combat, where was the government during the crack epidemic mark at c-span is how you send us a treat . next up is mike in westfield pennsylvania on the other's line x high . i want to comment on the fact that a few of these people were saying how marijuana is a gateway drug to heroin. i didn't start with marijuana, i started with cigarettes in high school because i smoke cigarettes in high school, i fell into a particular quick .

that had different types of drugs. i started with pcp and angel dust. he i've been smoking marijuana for 40 years. i've held good jobs, i've run companies, i've raised a family. no problem with marijuana. lve once i started buying marijuana going to these places where people sold marijuana i came across the other drugs. if marijuana was legal i would never have been exposed to all these other drugs that these drug dealers had that deal with marijuana. so i want to get that point across that everybody doesn't start with marijuana all right? and the fact that it was legal and the government control that and i was able to go to a store and buy i wouldn't have access to all those other drugs throughout the years how do you keep that go from being a gateway drug? he said you'd been using it for four years . are there times when you are tempted to use something stronger? >> over the years i did all kinds of things but it wasn't because i was smoking marijuana, i have five years addiction to methamphetamine, visors addiction to crack cocaine, i was able to be all that and i'm still smoking

marijuana and it's not creating problems in my life all right? again, if i didn't have to go to these drug houses to buy marijuana i wouldn't have been : subjected to the crack cocaine, heroin, >> mike , thanks so much. will hear from fred next in michigan, democrats line. >> yeah, here, what is the government going to do to save the people who are absolutely crippled and are in need of opiates mark i myself have been told twice that i was going to die. once from a car wreck, once from people breaking into my house for drugs , my ex-girlfriend told them that i had 20 pounds of pot and $20,000 and the next thing i know i'm nearly beaten to death with a hammer and a back . >> so you were prescribed some sort of opiates for percocet at that time? >> oh, i was on norco and i

was on ms contin 15 and they walked away with $178 and about 15 pills , and eight of pot and they put in the paper as a drug case and all these doctors are running out of this area , it's for people don't have the ability to make it to a doctor . >> we got about 10 more minutes, a little less than 10 minutes of your phone calls but i did want to share your graphic look at how the problem has expanded. this is a graphic that was done online at on time. the epidemic of drug overdose , get ripples across america. this is a map of the red part, the orange part is the expansion of overdose deaths per 100,000 since 2003 and you're focusing on 2014 and that has gotten a pretty broad

across the united states. the couple sat there. they say the deaths from overdoses are reaching levels similar to the hiv epidemic at its peak.again this is from the new york times and the statistics from the cdc and there's a map currently. the overdose deaths in 2014 which were in the neighborhood of 28,000 i believe . let's get back your calls, here's mary kate in greensburg pennsylvania, republican line. so >> i'm a 75-year-old person with all kinds of ailments and i've been on a georgia last for about 10 years. now they are trying to take ot this away from me and i'm not iv selling it . i'm not giving it to anyone. i change it every three days that's not the only problem i have . i just don't understand, if teenagers know? host: mary, how are they trying

to take this? are they offering you another painkiller or are they raising the price? caller: no, let me explain. they want me to go to a pain clinic. because i cannot take anything with aspirin, my doctor said i would lead to death. >> caller: they want me to go to a pain clinic but because i can't take anything with aspirin because my doctor said i would plead to death, okay, i can't means your immune take anything because i've been exposed to tb and many of these drugs that means your immune system is way down and you're going to get an infection. i mean, i just don't understand it. if you want to call me a drug addict, that's fine. i'm a drug addict and i need this patch. but somebody's going to find my death certificate because if i don't get it, i don't know what i'm going to do. >> host: here we go to

madison, alabama. the governments role in. combating opioid abuse. >> caller: i'm coming at this from two sides.an my dad takes a lot of opioids mainly hydro- codeine. he switched to a different drug and he needs it for back pain. but for me i started opioids and became addicted to the point i wasthat i was buying it off the black market and i almost overdosed. i went to the hospital. luckily i was put through aand i gratefully recovering addict. i have as many friends as i can do past four years. i have seen four of my good friends overdose. at the age -- im a 30. i know there needs to be stricter way of dealing with

this, but i don't know that taking it away from people with chronic pain is the way. i think the police need a betterhe way of finding people that are failing because if i'm 30 and i can find on the streets i'm street i'm sure with a little bit of effort that the police could find the peoplele selling it. >> host: what's your from new p york on the republican line. i hope i have your name right but my producer tells me that you are a doctor? >> caller: yes, correct. >> host: welcome. go ahead with your comments. >> caller: i am a physician who treats addiction and addictive disorders in my community. i have the opinion that this is completely and absolutelyrvene and manage this epidemic.erioration and disruption

all of the callers are indicating that they have a deterioration or disruption in their life due to the drug and they have their opinion but maybe meanwhile they all have witnessed people that have overdosed and died. the issue is that without government intervention the bill that is being passed only has to do with expanding the prescription monitoring program for example expanding the view of capturing the people that are taking it the wrong way. the people that need the medication are going to be prescribed this medication and there's nothing against those people although they are the people that are using it to sell and that are treating themselves are the ones who need to beci stopped and this issue has to do with the core system. a society cannot intervene in the way the government would intervene.

>> host: it sounds like it is a very busy practice for you. we will get one more view on the governments role in the opioid addiction problem in pennsylvania on the other line. good evening. a >> caller: i was in an accident years ago and have seen five different doctors. the last one left me two months ago. i am on morphine for my pain and breakthrough pain medications and she's cut me down, this new doctor copper two months, she's cut me down and i mainboard that because i can't walk. >> host: she has you down in terms of your prescription? >> caller: yes. i have 27 days and that's it.

i had over 30 and i asked her to please look up because you have to show a license, sign that you are picking it up and as you look at the three pages on the clipboard you will see that the day that i pick them up is always a week and a half to two weeks later. i do not overdo my medicine but when i needed, i needed. >> host: i know it's a difficult conversation to make that we appreciate you calling. the issue spotlight program. tonight is available at up, we go to a heroin c-span.org. more comments on this on facebook.com/c-span. next, we are going to take you to a harrowing abuse summit and the program includes members

from the national institute onim drug abuse and substance abuse and mental health services administration.th it reminds us of the tremendous number of deaths associated with drugs of abuse in general, the painkillers prescription opioids over 19,000 of the most recent data and over 10,000 from heroine. we will look at these in detail but i will point out that even the surveillance data has some messiness. drug overdose when we look at how the death certificates are are coated there's an awful lot that areoded as drug overdose and don't specify whether it may have been related to prescription opioids or heroine. so there may be even greater numbers that are specified in the national data. as you have already mentioned it's the increasing rate of prescription that have given so many people in this country a

taste for an opioid. that means their brain has been exposed to it at some point or the communities are exposed in a way that the pills can be diverted into misused and take in non- medically by so many people in the u.s.. >> what we have seen is the number of prescriptions that have been increasing as well so there's about a fourfold increase in deaths associated with these opioid painkillers that his drugs like oxycodone, demerol and the like all of these are narcotic opioid pain relievers. now the reason i'm starting with the prescription opioids is because that is the upstream driver of this epidemic that seems to be the deciding factor i that has exposed so many people andand lead them step by them step-by-step towards the pathway to the heroine addiction or problem. the brain doesn't distinguish between different types of opioids.

it sees them as not quite identical but a very very similar. it's about heroine as a street drug has pretty much the same impact on the brain as oxycodonest or hydrocodone so in a controlled laboratory studies people can't even distinguish if you give them one or the other they can't tell the difference necessarily.we b >> as the rate of the prescription drugs have become more available within a corresponding increase in reading these are related and important ways because of the initial exposure to the opioids and then the availability of heroin in so many communities around the country. as you've already heard it skyrocketed the last five years and they have seen a corresponding increase. it's almost an exponential increase in the last few years and as an epidemiologist, it certainly concerns me because we would like to see the curve bending and eventually coming down and we don't know where this will end. it's still on the upswing.

there've been increases everywhere. if i only showed you it would be doubling of the terrible scourge and increase. but look what is going on in the midwest in the mid-east. it's got all the different major ethnic racial and age groups but and i point out those of young and middle-age where we see the sharpest increases. this is consistent with data doing outreach among the y injection drug users from the northeast that show that the new injection drug users tend to be younger more equally male and female and that is a novel change we think of most as being more common in male and female and that isn't so true in these new injection drug users so that is another concern in this epidemic. so why do people abuse these? because they have an impact on the circuitry.

that is a basic principle from the science that but i'm not going to go into detail that is but that is the underlining features but these are habit forming and that is a sort of conundrum some people take these drugs and find it extraordinarily unpleasant but some like it and are going on to do it again and keep on doing it. i'm pleased that the secretary has made this one for keynote issues shortly after she was confirmed and took office, she convened a small group in the department to help her address this in a proactive and e consistent way. we developed three priorities these are not the only things we are doing in the area of the opioid epidemic but thoses related to the prevention approach lets change how many are available in the community by focusing on prescriber practices. let's focus on saving lives

immediately with the a use in the larger numbers so greater access to the life-saving overdoseioid treatment. and as the particular treatment for the opioid addiction to reduce the likelihood of. opioids that one of the issues we tried to address in the department relates to the guidelines for the prescribing opioids payingf clinicians use that come from a variety of different sources. some of them indeed are not without the conflicts of interest at who wrote them to increase the sales of some of these communications. so as an alternative they've been taking the prescriptiong guidelines and we expect these to be released to assist in the proper prescribing of opioids

for themfor the noncancer non- end-of-life care to get them outside of the end-of-life care. when it comes to the overdose we are pleased neither was able to work.ul the formulation instead of the only airport approved formula there isve now a nasal spray that is approved just in november and it should be on the market very shortly. let's get to the main issue that has to do with medications. there was a study in baltimore just a couple of years ago that the availability of methadone there was a drop in the city so we see this as a population-based example of how you can utilize by increasing

the access and a large population. i've already mentioned to you methadone those are bothy substitution treatments so methadone is a fancy way of saying that it works as another opioid selegiline mean by that? let's take one quick lesson in the cellular chemistry. when a chemical is administered or taken it works by fitting into a receptor. think of it like a key going into a lock. when morphine or heroine or methadone glinted receptors in the brain. it goes in and it doesn't turn so it fills the keyhole and

keeps others from getting in the lock but doesn't produce any action. asit's a partial agonists which turns the lock but the door doesn't open fully opens partway. that is a quick way to think of the classes of medications. so the blocking agent is one of the tools that could be given in a long-acting form and when people take it successfully they don't get high if they use there are other opioids. the same thing happens with methadone and they are taking them successfully and they might slip and he was heroine or other drugs they generally won't getri any intoxication or high so they learned not to use those. that is the key for the medication it is a learning experience. >> is a short version of the history and we will go into this

in more detail. i want to tell you about what you're doing to develop new approaches. we have been focusing on the extended release medication that i will tell you a little bit about that. we focused a bit on medications that we are very pleased to have partnered in the release of the long-acting use for opioid addiction and finally, we've even been developing vaccines is another way of keeping drugs out of the brains of the won't have an impact. one of the new medications is a long-acting and one of the issues is people will take these medications but there's an issue. my patient has to make a decision whe stay clean and sober, stay in treatment, take their medication, go to the treatment or they want to not do that and head back into the path towards relapse. sometimes it is a conscious decision and sometimes not quite so conscious that they want to make the decision every day. they need not make that decision quite as often.

so it is an implantable device way, rather than to. it's rather than once a day. it's to be compliant when they take this into certainly produces greater abstinence so that some of the hopeful possibilities. it is an expedited reviews we expect and whether the data supports its actual use of. the next area we want to focus on is the vaccine development. for the drugs that have an impact they have to get from the

blood system through the cross capillaries into the brain. vaccines attached to those so they create a protein binder to those drugs and keep them in the capillary to the keep them in the circulatory system and not in the brain. that is the theory. there's quite a bit of preclinical research with animal models and there is now some emerging research to suggest that this might be able to be effective but we have vaccines that will be useful to the administered on a regular basis. it's what we can do today to always be charting a path forward for what we can doen tomorrow even better. next we want to focus on implementation. we've had these medications like methadone for about 50 years and f close to 15 years we have had now as an oral medication and we

have had as an injectable for the last couple of years. u so what's going on? not very many people are treated so this is a major data force. we are pleased to see that restrictions, so that suggests that more people are unveiling a themselves as we've been we have been pleased to try novel trials. the group at the universitylems noticed she was seeing the same people over and over again coming in with either an overdose or with problems related to their heroine and other opioid issues. so she said maybe we can start than here in the emergency department. they are not seeking our advice and going down the clinic down the hall so why don't we act as the primary condition. they did that and found that they were much more likely to be in treatment and they were also less likely to be using drugs when they were reevaluated a few weeks later so this is just one center top-notch centers we are not sure everyone else can do it

as well but we think that is very promising and we are working right now on testing this in a number of others to see how it might be rolled outmi to emergency departments. not every place showed that those that are seeing a lot of addicts might want to do this. i'm really saddened by the story of the representative that was relayed about patient who died shortly after being released from prison. people drop out of the patientth mental activity readily. sometimes working together for models like the drug core models and extensive active work with probation and parole we can do a better job using the best pieces of both whether that's the close can

provide a. of the models that have been shown to work coming on morere than 20 years but we don't see them. it seems to be the area we are doing research and we think that there can be some improvements. just remind us that even medications can be used in this setting coming out of baltimore. they are about to be released in the long-term incarceration and had a heroin addiction in theone actively, which past. they actively referred them which means that they actively made that referral and engage them in the treatment after they were released and start than a few weeks after the release.

they are this speaks to the importance of being practical and thinking through what happens. they are paying attention as their first goal when they are released to starting the treatment of setting them on the right foot could be very important. thanks for your attention. thank you v if i could have the congresswoman have the introduction. we welcome doctor melinda for the pharmacological study for center for substance abuse treatment. she said physician board-certified in family

medicine with additional credentialing and addiction medicine. thank you for being with us. it is my pleasure. thank you for having me. i want to take a moment to thank you. we are supporting a new round of grants to the states to improve thanks to the access to high-quality medication assisted treatment and have the funds to dedicate overdose prevention thanks tock the budget he worked so hard to pass. i want to thank you for setting aside this block of time together to gather more information about the treatment options for the disorder are the critical issues that you are faced with and that demand your attention. i came away from the first form a few weeks ago really deeply impressed with the urgent need of it i felt from the members attendance out of the directions for what could be applied to

help the constituents in your communities right now so i'm going to try to be concrete today in this presentation and not be too high-level or repeat much of what has been presented. so, the other thing i want to tell you about myself is that i spent ten years as a morphine prescriber before i came to government. five years in my private practice during the medicine. i've maintained my private practice over that time. i can tell you the single most therapeutic thing for everybody was provide respectable medical treatment whether that includeddit alm medication and that is listening

and thein the device and coordination of the ancillary services it almost didn't matter which. obviously the medication was an important part and i'm going to spend a lot of what i talk about today on that.parity this is for me to use these photographs and teaching medical students about the bias and the disparity in the healthcare and this is far less than half the people i saw on that day. of the people who gave me permission i removed the children and the adult that are now fully able to consent and it so happens that there are som' people here i was treating her addiction and the thing is in my private practice you can't tell one from the other they waited their turn and she was there to

refill her blood pressurently, i medicine. nobody could tell what was there for and you may have been surprised sometimes to find out. you in that e subsequently i saw some of the same people in my opioid such that i treatment program and in that environment isolate different behaviors. b now you see what they are really like because there is a clinicll and maybe the behavior is more so this is what they are really like what they are like is how i became to the office when they were treated with respect and seeing in a pleasant place where they got the care. not that we didn't do our best in my treatment program to do that for people and i will go into that a little bit here. so to reiterate what was said as far as your brain is concerned

with opioids, while the problemxp may have its origins in the prescription overprescribing being exposed to the opioids to start with, once that is out of the barn die disorders are disorders so you may have different strategies you want to apply on the prevention and treatment and looks pretty much the same for anybody.re now in addition to a different inherent qualities or characteristics, how intense it is and how quickly it affects you, the individual person brings risk factors. the biology, genetics and the social situation. and unfortunately this is why we see worsening in their illness. conse

we may be getting calls from a friend and if they keep the social front intact. the consequences are usually less. if the personal safety is at risk and if you have been subject to trauma as a result of risks that you've exposed yourself to as a result of her you addiction than it does snowball and there is a cumulative risks as it begins to compromise your health physically, mentally and emotionally. whatever so it is whatever way that we as a society need a role in how harmful it is and how we define what we expect from people.

so the one from that point so the essential ingredient of the columbia life. it's the antidote to the poison in a. of. no air and bring that person to live back to alert talking to you not always very happy to see you but alive again. it's astonishing the effect of that drug. so it is absolutely essential to any treatment that people have access to the antidote of poisoning when they need it.

that means making my locks on available to people that are leaving the detention or incarceration. they are extremely vulnerable to any opiate and it's important that people likely to be on the scene of an overdose whether that is their friends and family or possibly other drug usersrs have the locks on. one was at the moloch so i'm prevention program. the training was used in the jails where we were not at that time able to offer offer a locks on some programs are now doing a training and putting moloch so in your personal attacks so when you leave jail or prison you have it with you when you walk out the door. so, there's all sorts of

innovation going around that will result in lives saved instead of lives lost. so, they are updating the toolkit to reflect the new product that's been approved for my walks on and that should be publicly available later this month as a piece of work that we are proud of. another take-home pay for plate for you detoxification is not treatment. the detoxification is necessary to break the cycle of dependence, tolerance and withdrawal. it's not always necessary to begin treatment for example you don't have to be detoxed to start methadone. you do have to be detoxified to start my trek's own and if you are choosing to be detoxified because that is what is best for you, then being offered should be considered an important follow-on step.

it should be standard for that person who isn't taking the opioids. of it doesn't change the course of the disease are the risk factors for the course of the disease. it does increase the risk of of fao overdose should the person relapse after the detoxed even unfortunately if that is followed by the relapse. medication isn't a treatment by itself. it will control the disease much the same way that it will not change the course of the diseaseexercising, you have to itself your doctor is probably telling you you have to lose some weight and start exercising and stop smoking and control

your stress differently. hi blood pressure is common and i'm sure some of us here are being treated for it now and i would think that what we would want is to be treated with the medication that's going to be most effective for us and be given the opportunity to end the education necessary to change our lifestyles. a treatment of socially and culturally the way that we have looked at the medication assisted treatment is that it is kind of a treatment that trains the treatment of last resort. if you have gone to rehab and it hasn't worked and you have done it however many times you want to pick, pick a number, then while you are just going to havet to go on medication and that isn't how we look at your blood pressure. we say let's put you on medication so you don't have a stroke and damage your kidneys while you get this weight off.

you have to get on if to get your ducks in a row. i still have mine in my office because i used to use that a lot lot. the difficulty that we and the people interact with can have a. asa. but as it was laid out for you as you get on the right to does like take methadone. the more you take the more effects it has.

it controls your withdrawal so that you can stay engaged in treatment and function but also fills up your receptors and keeps them on even keel so that you are not constantly being driven to the views but also the receptors are full so if you do relapse and use something there is the place for them to go. there is no receptor for them to buy into to reward you for that so you are more likely to be able to say okay that didn't pan out and move on with your recovery instead of the whole bottom out of the tub. so it's not just about getting the dough was in the right frame each. it. it's so tightly to the receptor nothing else can compete with it

it. most of what people are going to take on the street if they relapse they will not be able to budget that but in that receptor it doesn't fully stimulate the receptor.. it's only working part-time basically so your body says my receptor isn't so busy i don't need as many receptors. you will enjoy that aspect. now the antagonist of course on the receptor blocks off and makes it impossible for any opioid effect for whatever reason to have been a. of your system has to be cleansed of opiates to be able to take that blocker.

it rips off the receptors and blocks them off the. the. the process of getting on it as a couple of steps that you have to go through so clinically and in terms of how you will interact with a patient i want to treatment the pathway is a little bit different depending on the medication that you choose a. of the senate will come in on a brief pro forma scheduled session scheduled for 6:30 eastern. no legislative business as scheduled. the chamber will be back to work on the bills on monday including the debate on the measure to combat the corporate trade secrets.

>> politico writing that this

happened two days after a visit out of the pledge to support the eventual gop nominee. the presidential candidate entered the building shortly after 2 p.m. eastern and the meeting lasted about 50 minutes to. mr. trump left that meeting and leader donald trump just had a very nice meeting with the gop and looking forward to bringing the party together and it will happen. >> senator sanders is holding a rally in the bronx this evening. the front man for the group will join the democratic presidential candidate and above billboard magazine online writing that the singer confirmed his appearance by sending the tweet to more than 5,000 followers.

the scheduled start time we will have it for you live. tuesday april 19. here are some political ad from the democratic candidates. senator sanders and hillary clinton. >> no, we don't all look the same or sound the same either. but when we pulled together we do the biggest thing in the world. some say they are banning people based on their religion into turning against each other. 850,000 jobs lost, special trade status with china and jobs lost now the transpacific trade deal could cost 248 jobs and only one

has opposed every disastrous deal, bernie sanders. while others supported the deal he stood with american workers to take on wall street and the deal because he doesn't take their money. for jobs for us. >> during campaign 2016, c-span takes you on the road to the white house today as we follow the candidates on c-span c-span radio and c-span.org before the live coverage of the senate pro forma session and the senator bernie sanders rally we watched the activists of what what we call the sharing economy. from the consumer consideration of the annual meeting, this is an hour and a half.

>> good morning everyone. welcome to the second day of the consumer assembly. so glad you are here. sworn in as the tenth chairman of the consumer product safety commission on july 30, 2014. from 2013 until his confirmation as the chairman previously served as the chief of staff chief counsel, deputy chief of staff and senior counsel to the chairman from 2010 to 2013. during that time among other

issues, he worked to address the chemical burn hazard to children from the ingestion of the quaint old batteries and played a key role in coalescing of the leading organizations and companies in american football around the common goal of creating the culture of a culture of change to reduce the risk of brain injuries in football. from 2007 to 2010, he was an attorney and prior to this he was an attorney at llp for the honorable sterling johnson junior of the united states district court for the eastern district of new york. he served in the numerous senior staff positions for the representative. as the chairman she has identified three major areas of focus that will advance his collaborative approach. he harnessed the experience and expertise as agency that agency staff and safety experts in the private

sector to achieve achieve our safety more safety advancements for the american public. they continue to prioritize and work to accelerate a the cultural change around the safety and sports and they are committed to strengthening the line of defense at the ports to keep the dangerous imports out of the hands of unsuspecting consumers. anyone who has heard the chair man speak at a hearing or at a conference leads with two strong perceptions. first, being a father to his boys profoundly shapes the way that he uses his work. being a parent in our complex world influences his mission. second, he has a deep and an impressive understanding knowledge of the many issues before the agency. he can definitely talk about the big picture policy issues as well as the details of a particular safety issue as you

are about to hear. it is my honor to introduce the chair man. [applause] >> good morning, everybody. i want to start and this is by far the most important part of the speech so you can tune out after writing i do the introduction. i want to acknowledge rachel weintraub. [applause] >> to be clear i would have done that even if she did a different intro for me. it says it right here in my notes. in all seriousness and as mentioned, i've been in washington for a long time. i've been honored and privileged to work with many different talented people to see the

different skill sets that are offered and i have to say there's nobody that i've come across who better combines both talent and skill and passion and knowledge of the issues and the effective advocacy than rachel weintraub and that matters. it matters in terms of the credibility of the entire movement. in many ways, she speaks for and is the face of the consumer movement in the united states especially when it comes to our agency in the consumer product safety commission. and so, she bears the weight and she knows that when she comes to represent your causes which in many ways there are causes when she comes and talks in front of our agency and speaks on the hill. she knows she carries the weight and it is that much more difficult than she has to walk that fine line and cannot make mistakes and she does not make mistakes. she just doesn't. she's always right on.

she's always at the heart of the matter and is always the leading advocate when it comes to trying to affect change. the best example of that and i will call for one more round of applause when i'm done with the best example of that is the product safety improvement act of 2008. tangible real differences and changes, re- energizing an entireandentire federal agency because of the work. even consumers worldwide because this trickles outside of the united states, hundreds of consumers come hundreds of millions, their lives have been improved because of the work of rachel. let's do one more round of applause. [applause] >> it is such an honor to be here at the 50th anniversary. it's that much more special so

thank you for the invitation. i do want to acknowledge my colleagues for being here. i appreciate it and it also shows the spirit that we have collectively developed at the commission to try to engage and demonstrate a more collegial civil bipartisan and nonpartisan depending on the issue approach. it's not easy. there are a lot of pressures that pull in pulled in the other direction. every one pulls on the other direction. there is no internal or external force other than what they bring as individuals and what i hope to bring as an individual endeavor of her colleagues bring as individuals. no other forces to try to bring people together. it is as we see from the campaign season is in my mind it doesn't represent our best. i think we can do better as a society and the five of us and our staff trying at least as a commission to do it differently

in a way that represents what you want us to be and it gets in to get down to actually having solid nonpartisan discussions on the merit and we are a better agency for that and i think the commissioner for being here. >> as rachel mentioned and she is 100% spot on, my entire approach starts and runs throughout the day and ends with being a parent. before i even get to work it already begins when my now 11-year-old son and my six-year-old son wake us up usually earlier than we want to be woken up with something they believe is urgent meaning the ipad isn't getting reception if they can't do their video time. that is a crucial element that must be addressed by waking the parents up. and it begins our forever multi-15, 18 hour odyssey my

wife and me panting in the morning and they have very different styles. my 11-year-old is a regulator in training. when we are at birthday parties and he gets a gift he will turn to me and say is this compliant withcompliancewith the federal twee standards? [laughter] my six-year-old is that reese reason childproofing was invented and he runs the lab in the living room and can do things with products that i didn't think anybody thought was possible but it provides an incredible spectrum as i go into work each day and i framed a reference for how i do my job all throughout the day whenever we are talking about issues that