work with you on fixing this, we know we will have problems and disagreements down the road. as you run in the blockages were you can say comeau we could do this faster and keep your deadline or shorten it if i could have this authority or if we could change this law, legislative fixes or things that you are not able to do under current rules, please let the fda know, let us know. if you are you are not getting the kind of support from wherever we need to know, and i invite the listening public and those ago on blogs of whatever name, you let us know your experience, take those pictures. when i was on the transportation committee people would send me

pictures of road problems. i would be able to send them right to the department of transportation. it always got handled much faster. we have people on these trains every day you are dealing with things. take those pictures, send it up, give that attention. then there is nowhere to run two. it is there. we are working through the problems in a systematic way. i ask all of us to be partners in helping you do your job. i ask unanimous consent that the record of today's hearing remain open until such time as witnesses have provided answers to any questions that may be submitted to them in writing and unanimous consent that the record remain open for 15 days for additional comments and information submitted by members of witnesses to be included in the record of today's hearing, and without objection it is so ordered,

and if no one else has anything to add, the subcommittee stands adjourned. [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations]

[inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] [inaudible conversations] >> president obama traveled today to hiroshima becoming the 1st sitting us president to visit the japanese city where the us

dropped an atomic bomb august 61945. here is a few minutes of the president's remarks. >> the united states and japan forged not only an alliance, but a friendship that has one far more for our people than we could ever claimed through war. the nations of europe build a union that replaced battlefields with bonds of commerce and democracy. across peoples and nations, and international community establish institutions and treaties that worked to avoid war and aspire to the strict and rollback and ultimately eliminate the existence of nuclear weapons.

still, every active aggression -- every act of aggression, every act of terror and corruption and cruelty and oppression that we see around the world shows that our work is never done. we may not be able to eliminate man's capacity to do evil, so nations and the alliances that we form must possess the means to defend ourselves, but among those nations that all nuclear stockpiles, we must have the courage to escape the logic of fear. pursue a world without it. we may not realize this goal in my lifetime, but persistent effort to roll back the possibility of

catastrophe comeau we can chart a course that reads to the destruction of these platforms, secure deadly materials from fanatics. and if that is not enough. for we see around the world today how even the cruise trifles and barrel bombs can serve of violence on the terrible scale. we must change our mindset about war itself. to prevent conflict through diplomacy and strive to end conflict after they had begun. to see our growing interdependence is a cause for peaceful cooperation and nonviolent competition, to

define our nations not by our capacity to destroy but by what we build. and perhaps above all we must reimagine our connection to one another as members of one human race. >> you can see all of president obama's remarks in hiroshima tonight on c-span and you will hear from the japanese prime minister at 8:00 p.m. eastern. >> aa senate foreign relations subcommittee held a hearing on drug trafficking. heroin and prescription painkillers. we will hear from the deputy assistant secretary of state for international narcotics and an official with the office of national drug control policy.

>> good morning, this hearing will come to order. thank you for being here today. the title of the hearing is cartels in the us heroin epidemic combating us health and drug crisis. i want to acknowledge the contributions of a loyal and dedicated staff are because behind everyone of us are loyal and hard-working people, literally you sit behind us at these meetings and do the hard work behind the scenes to make sure we are briefed and prepared to cast votes in advance of public policy, and since 2,011 maggie has been an instrumental part of our policy team logging countless hours working on complex and important issues and is also logged in countless hours sitting behind us and committee meetings but no longer. today is maggie's last

senate foreign relations committee meeting and in one week's time she will depart our office to bigger and better opportunities. opportunities. i wanted to thank her for everything she has done for us. [applause] >> the title of this hearing is cartels and us heroin epidemic. the 1st is an official daniel and mr. kemp chester, associate director for the national heroin coordinator group for the office of national drug control policy. the 2nd panel will present the honorable teresa jacobs and mr. steven dudley. thank you all for being here today. we appreciate your time and dedication and ii would like to thank all of those who worked alongside my staff in making this hearing possible.

drug cartels operate out of countries in the western hemisphere by using sophisticated distribution systems that move narcotics into and across the united states. heroin supplied by these cartels has created a public healtha public health epidemic and fuel drug violence across the country. unfortunately it is becoming part of everyday events in society. it is our duty to find the best possible avenue to allocate resources to provide the best tools to equip those on the front lines to fight this crisis. we must examine what the united states, mexico command of the regional partners are doing to address the rising heroin and drug trafficking promoting the efficacy of proper execution of us initiatives to stop the spread of heroin and combat the drug cartels from being one of our top priorities. one of the primary culprits is called fentanyl, synthetic opium 20 to 40 times more potent than

heroin and may be used to treat patients with advanced cancer. the cdc states most cases of fentanyl related overdoses are associated with nonpharmaceutical fentanyl, the type used as a substitute for heroin or mixed with heroin or other drugs, sometimes without the user's knowledge. the dea national drug threat assessment summary reported mexico and china have been cited as a primary source country, though some are manufactured in china, often trafficked into the united states across the southwest border or deliver through mail couriers, transnational criminal organizations also use florida has a.of arrival for south america cocaine and heroin. much found in the same us markets were white powder heroin is found. according to the substance abuse administration the estimated number of individuals was 914,000 people and 2014.

in addition there are 586,000 individuals were basically .2 percent of the 12 and older population had a heroin disorder in 2014. while there has been an increase across the united states, the midwest and the northeast regions have been areas of particular concern. to this day the administration's efforts -- despite the administration's effortsadministration's efforts heroin related overdose deaths increased by 244 percent between 07 and 2013. leveraging upon the 15 high intensity drug trafficking areas across the country. mexico has displayed willingness to cooperate with us authorities, but despite operations the international narcotics control strategy report estimates less than 2 percent of cocaine that comes through mexico is seized by this country's authorities. congress has provided funds

to the mexican government to improve security and the rule of law, and i applaud the continued efforts to continue the drug crop eradication efforts and to arrest druga restaurant kingpins, however, we are still far from the finish line. congress can work in constructive ways to promote legislation addressing opiate abuse. i am proud to be a sponsor of a bipartisan bill that overwhelmingly passed the senate and i applaud the house working to address this issue and hope soon we can send this legislation to the presence desk. it is my hope today's hearing will shed light on the consequences that this epidemic will have on our society and future generations of left unaddressed. the opportunity to learn about the administration's priority and combating the heroin epidemic and drug violence, andviolence, and i hope you will address these issues in your testimony as well. with that i turn it over to our ranking member for her

opening statement. >> thank you so much for holding this important hearing. first i ask if i can put in the record the opening statement. >> without objection. >> thank you so much. the abuse of illegal and legal drugs in america is an absolute crisis, and to fight it we need to act on many fronts. taketake the case of opioids. legal prescription drugs that are killing approximately 125 people every single day here at home. the cdc says that in 2014 47,000 people died opioid abuse, and just imagine that. we need to do much more than we have so far to put real dollars behind the effort to stop this madness. then there is the issue we will focus on today, illegal drugs being transported in the country. recently i visited costa rica, and i learned that this big peaceful country is

alarmed about drug cartels infiltrating their population. stop this real threat command i hope to ask a question about that. and while we are working cooperatively with the mexican government specifically on an initiative called the merida initiative, and where we have to date more than 4 billion seized in narcotics and those currency, that is a drop in the bucket. we simply have to address the demand in the united states for these lethal products. and i know that is not your job,job, and i will not ask you about it, but i am making a statement as united states senator. we have to address the demand in the united states for these lethal products. supply and demand go hand-in-hand. a long time ago i was an economics major. it is economics 101.

when people demanded product you know what happens to him of, the supply will come. and when even more people demanded product the price will go up, and it goes around in a circle. years ago, too many to mention, imention, i don't know where my chairman was at that time it was so long ago,, when i 1st came to congress i wrote a bill call treatment on demand because what i found out, mr. chairman, members, when there is a person in america with a terriblethe terrible addiction, at that time, and it is still true today, they wake up one day, ii have done it, i have had it, they can't get anywhere. people say good. comegood. come back in two weeks. this is an emergency circumstance in many ways, but it is not considered as such. they will go in, get a pat on the back, come back in two weeks and by then maybe

they have overdosed. now, i know we are working with columbia and guatemala helping farmers develop alternatives to opium production, but again, we must be more aggressive in our policies regarding drug production, trafficking, and here at home consumption. in california we have four of those areas that my chairman spoke of that are designated as high intensity drug trafficking areas by the obama administration. i am extremely grateful to the administration. we had that help under george bush as well. when you identify an area it means you are going to get attention, federal dollars, federal help because a lot of these local people are police forces and so on and really do need to help. so i am grateful for that. they have also discovered tunnels from mexico to san diego which act as conduits

for thousands of pounds of cocaine -- cocaine. this pointscocaine. this points to the continuous challenges we face dealing with dangerous cartels. they are good at what they do. and they intimidate everyone, and that is why this fight is so critical. we need even stronger partnerships with mexico and other countries in the region command i wanti want to say, alienating our latin american neighbors and our latinos here at home is the worst possible thing that we can do. first of all, on a human level because in my view it is prejudice and bigotry, but it does not make sense if we are really trying to crack down on these cartels. we need our friends to work with us, we do not need to escalate some kind of ridiculous debate about walls and all of the rest. i do want to thank our witnesses for being here today. there is a lot of burden on you, and this is difficult. the war on drugs has not been a success, and i

believe the reason is we have not done enough on the demand side or on any side. we must do better command i want to thank my chairman because i think this is well timedwell-timed given what we are facing with the opioid crisis. thank you. >> before we begin, i want to recognize the senior senator from new jersey who has done an extreme amount of work on western hemisphere issues but issues regarding transnational crime. okay. with that, please join me in welcoming our 1st witness. thank you for your testimony before us are today. >> chairman, sen., sen. menendez, gardner, thank you, thank you for this opportunity to appear before you to discuss the work of the state department bureau of international affairs -- i'll be okay, bureau of international narcotics and law enforcement affairs to combat the production and

trafficking of heroin, particularly by mexican-based drug trafficking organizations that are responsible for the vast majority of the heroin on american streets today. in the united states we face an epidemic of opioid abuse. well over half of the more than 47,000 american deaths from drugs last year were due to either domestically produced control prescription painkillers or heroin which is often combined with other deadly drug such as for not -- teenine. in mexico drug trafficking organizations have killed tens of thousands of citizens. these organizations continue to create violence command stability, corruption, and addiction. this is broader this is broader than the us, and we will not solve alone. the overwhelming majority of the heroin in the us is produced or distributed by mexican drug trafficking organizations.

for many years they have been trafficking not only heroin but also much of the cocaine, methamphetamine, and other illicit drugs that enter our country. most of these drugs enter through our border with mexico. the united states and mexico developed the initiative in 2007 with major focus on combating the production and trafficking of illicit drugs across our borders. today the administrations remain committed to the strategic goals. our partnership which brings together significant investments and capabilities of both countries continues to help build mexico's capacity to fight organized crime and violence. together we are aggressively responding to the threat by putting the leaders of drug trafficking organizations in jail, by seizing drugs and money, and dismantling the organizations. today i announce professionalizing -- i an

ounce training to law enforcement officers, investigators command analysts increasing mexico's ability to identify, investigate, and dismantle clandestine heroin and fentanyl labs. with ourlabs. with our interagency partners we are improving information sharing between the governments on heroin and fentanyl working together to get better assessments on opium poppy cultivation and heroin and fentanyl production in mexico and continuing to explore other avenues to enhance bilateral cooperation and effectiveness.

the institutions capable of confronting organized criminal enterprises is a difficult,a difficult, long-term challenge. this work must be sustained. a coordinated effort that is on a sustainable capacity to ensure cultivation, trafficking of illicit drugs. significant investment of both of our governments are producing results,results, and with your continued support the successful collaboration with mexico will continue. thank you. >> thank you. associate director for the national health heroin coordination group, please begin your testimony. >> chairman, ranking member, members of the subcommittee, thank you for inviting me to discuss the public health and safety issues resulting from heroin use. the government to mexico's efforts to reduce the availability of heroin

command us-mexico cooperation to address heroin issues in both countries. in 2014 the most current year for which we have data, more than 47,000 americans are approximately 129 people each day died from a drug overdose. the threat of the overdose deaths in 2014 posed 22% involved22 percent involved heroin. the threat has continued to grow dramatically over the past several years, and since 2007 deaths involving heroin have risen 340 percent from 2,402 and 2007 to 10,574 in 2014. heroin use is spreading to suburban and rural communities and is growing among most socioeconomic classes, age groups command races. mexico is currently the primary supplier of heroin with mexican drug traffickers cultivating opium poppy,, producing

heroin, and smuggling the finished product into the united states. poppy cultivation in mexico has increased substantially in recent years rising from 17,000 actors in 2014 to 28,000 actors in 2015 which video potential production of 70 metric tons of pure heroin. theheroin. the heroin crisis is being compounded by the reemergence of illicit fentanyl, powerful synthetic opioid more powerful than heroin. illicit fentanyl is sometimes mixed with powder heroin increase affects or mixed with pollutants and sold the synthetic heroin. increasingly fentanyl is being pressed in the pill form and being soulless counterfeit prescription opioid pills. the majority is clandestinely produced in mexico or china. it is extremely dangerous and deadly.deadly. in 2014 there are more than 5,544 drug overdose deaths involving synthetic narcotics other than methadone to my category

that includes fentanyl. this number is more than doubled from two years earlier. us-mexico engagement regarding heroin has been robust. in october 2015 omd cp director michael botticelli participated in a bilateral security dialogue with the importance of increased efforts by the government of mexico as well as drug interdiction, clandestine laboratory instruction, and the disruption of precursor chemical trafficking were all highlighted. in early march director botticelli, ambassador william brownfield of the assistant secretary of state and i met with an mexican attorney general gomez, and she announced her role as a synchronizer of mexico's efforts to disrupt the production of heroin and illicit sentinel. importantly we agree then them to jointly develop the focus national plan to concentrate mexico's efforts

the urgent need to sustain progress toward addressing the nation's heroin and fentanyl crisis requires increased collaboration between federal agencies and with our partners working at the state, local, and tribal level with the crisis felt most deeply. in november 2015 the team i lead, the national coordination group was created within the office of national drug control policy to form the help of a network of interagency partners who will leverage home agency authority and resources and to harmonize interagency activity against the heroin and fentanyl supply chain to the united states. they funded high intensity drug trafficking areas, locally-based program that response to issues facing specific areas of the country has also been instrumental.

can rent to the prevention, education, intelligence and enforcement resources to address the heroin threat through several covering 17 states and17 states and the district of columbia. while we have laid a firm foundation much remains to be accomplished. for example,example, we have gaps in the capability to detect illicit fentanyl at the border command are mexican partners to do more in the areas of opium poppy eradication. while my remarks are focused on addressing the supply side, we must address disorders withof the balanced approach that also regards addiction is a public health matter. using substance abuse prevention and treatment strategy in recovery support services. as fy 2017 budget president obama proposed 1 billion in new mandatory funding to expand the availability of evidence -based strategy such as medication a quick

-- medication assisted treatment and extend the ability of substance abuse treatment providers. we will continue to work with partners, departments, agencies command our partners to reduce production and trafficking and the profound effect of these dangerous drugs are having in our communities. thank you for the opportunity to testify today command i am happy to answer any questions. >> thank you, and i will defer my questions. i know members need to be in other places command i will be here throughout the duration. >> thank you. i have two questions. in 2008 mexico's congress passed a series of significant reforms to its criminal procedure, new laws to promote greater access to justice and strengthen measures to combat organized crime, measures that would

make the mexican justice system with a little bit more like our own, these reforms were intended to be implemented by 2016. where does the implementation of these judicial reform stand, and how as the united states assisted in this process? how do you feel about whether they are really doing with the committed to do? >> thank you, senator. as you know, mexico committed and passed legislation to implement a new criminal justice system which is an accusatory we will justice system, much like ourselves. at this point of the 32 mexican states, 24 have implemented this with federal level crimes, and i believe nine have implemented it at state level crimes. obviously this is a long-term process, and some

of the states and mexico will not need next -- will not meet next month deadline. we remain committed and continue to work closely on a number of issues thanks to the gracious appropriations of congress we have dedicated approximately $250 million to these efforts between the department of state and usaid through issues such as training judges, prosecutors, courtroom personnel, law, law students, over 4,000 have been trained to date through the department of justice is opt at prosecutorial training program. we alsowe also have a number of law school and institutional exchange programs through the american bar association and the number of universities here in the united states. wewe are preparing law enforcement for their new roles in the accusatory we will justice sector, for instance, the department of

justice partners in his have trained thousands of law enforcement and crime scene investigations, provided equipment for units and forensics so that mexico can comply with international standards. >> thank you. what i'm getting from you is that there is progress being made, although not everyone will meet the deadline. an optimistic report. that leads me to my final question, which i alluded to in my statement. as we continue to work with the mexican government command that is is critical. we have to work across the border to reduce the supply. that is where the rubber meets the road in both of these areas, but we need to work with mexico. i am concerned about the rhetoric in the presidential campaign describing our relationship with mexico. i know it is a tough

question. we need to know. mexican officials have said on record that some of the proposal mentioned on the campaign trail, we know we are talking about. some of the proposals would have a cataclysmic effect on our bilateral relations. has this divisive rhetoric effective diplomatic relations with mexico at this point? has an impact of the united states ability to work with the mexican government to combat drug trafficking, and are you concerned that that type of rhetoric could just completely undermine what we are trying to do here? >> just for the record, she is not talking about me.

>> i'm not talking about you. >> excellent. >> i will try to strike a balance between answer your question and not answering too deeply into our own domestic politics. >> it is a tough one. but when people talk it has real-life impact. especially a presumptive nominee. >> you have all seen some of the reactions from south of the border, from our mexican brothers and sisters. it seemed president vicente fox's reactions and others. from the embassy bilateral level to date we continue to work closely together. in my personal opinion, we don't -- i do not believe it has greatly affected our ability to do business together. mexico in the last several months has reiterated its commitment to continuing with the initiative where the populace of mexico stands on this may be another matter, but we continue to be able to work

closely together bilaterally >> no impact on what is going on at the top level in your opinion? >> not in their dealings with us. >> excellent, and now we have to make sure policies never come into effect. thank you very much. >> thank you. >> thank you, mr. chairman, for calling a calling a hearing tonight. thank you for your service to our country. how many agencies are involved us agencies. >> thank you.

i am now department of state, department of justice, dea, fbi to an extent, department of homeland security is heavily involved to the customs and border protection, immigration's and customs enforcement, homeland security investigation, military support some of the border effort, mexico's military and then we have some ancillary agencies based in mexico city while their chief focus is not the border, they do peripherally work on it such as atf in the us mark. >> spent on eradication interdiction efforts in mexico. >> my understanding is two and a half billion has been appropriated of which approximately 1.5 billion has been obligated or committed to specific projects of which we still

have at this point about -- new initiatives for about $700 million. >> are you speaking specifically? >> largely. >> there certainly is. i am not in a position to comment. i just don't have the figures. >> i was not looking just appropriation. i look at all the agencies you mentioned. i now, department of justice, dea, fbi, alcohol, tobacco, firearms, and i think to myself it has to be billions collectively. and i was one of the architects of the initiative which i support. one half billion later,

billions between our respective agencies and what we have is an opioid epidemic. and so one has to come as a policy maker, take a step back and say to themselves, what is not working? something is not working. billions of dollars later and what you see is a spike versus a trend in the other direction than something is not working. so if i were to say to you, what is not working, what do we need to change, your answer would be? >> first of all, sen., i think in the past two years we have come to the realization that this is a shared responsibility between the united states and source countries and trafficking countries. i am heartened by the senate's recentsenate's recent passing of the opioid legislation as something that will help us. certainly mexico's specific air capacities are far

greater than they were when we started the initiative in 2007 them information sharing and collaboration has let our own us law enforcement agencies to interdict significantly more our southern border due to mexico's cooperation. we still have a ways to go. i think we need to get better in the united states. demand reduction and treating the health issues of addicted people. it is a shared responsibility that is no longer just a supply-side issue. >> i listened to your response, everything that we are doing, more significant effort on demand reduction, but it is not suggesting that there is anything that we are not doing, and all i can look at and say, if you're spending billions and instead of the trend going the opposite direction it is rising, you have to raise

the question, what is it that we are either doing wrong or what is it that we are not doing that we need to do in order to meet the challenge because otherwise we can appropriate billions and billions and still find ourselves in a trend that is undesirable. the only thing i heard from you in your response to me was doing more in demand of reduction, which i, which i certainly believe is true. but i did not hear about anything else. you know, you have to question whether or not the continuation of this type of expenditure in this manner is the right policy. do you believe that there is sufficient coordination, seamless coordination between at least on our side of the border as it relates to agencies that you suggest are engaged? >> sen.,senator, obviously we can get better at everything that we do. the department of state

works from the southern border south. i do not feel that it is our position to comment on interagency coordination north of the border. south of the border we have robust interagency coordination. we can always get better, but -- >> your mexican partners, are they doing everything that they can in order to meet the challenge on their side of the border? >> during the beginning part of the administration there was a pause, as i, as i think we did a mutual assessment of the security relationship, particularly on their side, and over the past year and a half we have seen much closer collaboration and unprecedented openness and frankness in our bilateral

dialogue. his mexico doing everything that they can? they could improve. some improve. some of their efforts are not yet at the optimal level. optimistic and positive. >> i appreciate the optimism. introduce a little dose of realism, and so part of the challenges that you have a lawless state and some of the northern part of mexico or i have heard us citizens from the region have come to talk to me and say that many you had relationships on the other side of the border that basically cannot operate their because the federal government is present. so if you have lawlessness and if you have uncontrolled states and you have the opportunity for drug traffickers to avail

themselves of that. and it seems to me that, while i am an incredibly strong supporter of the us-mexico relationship, we must be honest in this relationship in order to make sure we're making the progress we need here andfor mexico to be able to gain his sovereignty. thank. thank you. >> let me use some of my time to follow up. the assertion made by experts from the commission on human rights. packed with heroin bound for the us. >> thank you for that. >> a great position, will be

happy to answer that for the record. >> i think the witnesses. first, the idea of the scope of the challenge. black tar heroin, the poppy production still significantly can find to the state? is it more broadly distributed? we talk about a problem in mexico. >> yes, senator. our latest crop estimate that was produced is two major growing areas in mexico. one in the state of guerrero and another in what is called the tri- border region of the the northern part of the country. as of the two major growing areas. very, small sporadic spots

but there basically concentrated in those two areas. >> the fentanyl is made in labs. i goti gather most of it is coming in made in china are also made in labs in mexico. >> that is correct. and i will tell you, our understanding and awareness has evolved dramatically as we have seen the crisis rise. so an order of magnitude i cannot tell you, but china is a significant supplier. it is ordered by individuals on the dark weber on the internet and then using parcel post ship directly to them. we also know that it is shipped in the mexico, in some cases mixed with the

luton's and smuggled across the border and that there are aprecursor chemicals that are shipped in the mexico that can be used for the production of teenine, clandestine fentanyl and laboratories in mexico. as you look at the vectors, those are the two main ones that we see. >> i want to talk about your written testimony. on page one there are several principal factors contributing, the increased availability of heroin, the availability of pure forms of heroin, it's relatively low price, and the relatively small percentage of nonmedical users of opioid transition drugs. i'm trying to unpack that statement, and am wondering if your statement puts enough of a finger on the prescription opioid problem. >> i heard it stated that 80 ped

on heroin in his country, 80 per addiction by prescription opioids and then transition because they can get it for a lower price. is that an accurate statement? >> no, and i'm glad you asked that question. of the numbers of individuals who nonmedical use opioids and then transition into heroin, that number is relatively small. >> that's correct. >> the nonmedical use of prescription opioid, the percentage of those individuals who transition is relatively low.

but conversely, of individuals who are non- treatment users, 80 percent of them actually abused the prescription opioid in the past. while there is not a direct causation, and the nonmedical use is aa strong risk factor for eventual heroin use, and even the medical use can be a risk factor for eventual heroin use. >> correct. >> you know, and opioid in and of itself, it's a drug and affects the body and unique ways. whether they get them from a dr. or a friend or family member, they are at risk for eventual opioid addiction. you cite the relatively low price of heroin bed the past

trends in the cost of opioid -based prescription drugs. >> that's correct. so the street price of a gram of heroin compared to the street price of an opioid pillar occipital, that is correct. the availability and the purity that have been contributing factors. >> he talked about the work we have done, we really believe it that if we don't get a hold of the altar over prescription you know we are just following out, and this is a drug addiction. a trusted professional or white coat handing

prescriptions saying this will do you good. and that is inextricably related to this heroin issue. it is hard to deal with the heroin issue in the abstract without talking about this culture of addiction. it is probably too early to know this, but in terms of prop to the poppy production in mexico, to have any evidence to suggest whether that is connected with marijuana legalization? i have heard it said and i don't know whether there is evidence to back it up, legalization of marijuana has taken pictures of land that were used for marijuana cultivation and don't have

the market for marijuana anymore so they switch to something like poppy. >> we have actually looked closely at the crop transference, and at this time whether it is to earlier does not exist, we can definitively say that farmers have decided to switch from one crop to another. we cannot say that within a degree of authority. >> it is something you will continue to monitor. >> it is something we do watch. >> to interject,interject, it is my sense that very few people wake up in the morning and say, i'm going to go shoot heroin. there is a gateway for heroin use. they go through severe withdrawal and the only thing that addresses it is

access to heroin. absent that how to someone to dependent? >> is a difficult question because your dealing with a number of variables at the individual level as to the reasons engage in the behavior. heroin in general terms is at the end of the trajectory of long-term drug use and the high number of heroin users are actively drug users. they are not an exclusive heroin user. they get the drugs available. a lot of times that is heroin. the other thing that we look at command we do a number of surveys, but what we realizes youth behavior from the ages of about 13 to about 18 is a strong factor

in terms of risk-taking behavior, underage drinking, tobacco, marijuana shaping youth attitudes in terms of risk-taking behavior for using other drugs. so what we can't say as we can put aa finger on this or that particular reason why a person does something, but we do know that the availability of drugs in society obviously increases the chances that an individual inclined to use them a 2nd some particular point, and that is one of the discussions we had about the availability of heroin. >> understand your testimony, we understand the bill problem. someone at some point earlier in her life begins to use a substance, alcohol was out they're it's better,

stronger? once you cross the barrier it can unleash the cycle that ultimately leads you to the heroin. >> it certainly is risk-taking behavior. and patterns of behavior which is why the prevention strategy particularly through programs is incredibly important because their locally -based and they allow trusted individuals to be able to speak to people and very young ages about things just like that. so they are able to talk to people when they are vulnerable. >> thank you for this

hearing. this is the most important hearing we will have on our relationship with mexico and china this year in congress and i thank you. this issue of fentanyl is, to my way of thinking, the most important threat that we have to families in the united states at this time. i will give you numbers. massachusetts, 2015, 57%, 57 ped related overdose deaths in massachusetts have a positive screen for fentanyl .-dot specifically of the 1300 individuals who steps -- deaths were opioid related or toxicology screens were available, 754 of them had a positive screen for fentanyl.

we talk about prescription drugs and heroin, but fentanyl is now the issue. we are at the epicenter of it. it comes up from mexico to lawrence, massachusetts, and then it goes out in to new hampshire, other states in massachusetts. the pathways china and mexico then into lawrence method should -- massachusetts, ohio, virginia, florida. and when it is over half of the deaths now in massachusetts it is clearly a looming threat, a preview of coming attractions to every single city and town of our country. that is why this hearing is so important because it gets to the question of what is mexico doing in partnership with china, specifically mexico and china at the highest governmental levels doing in order to interdict

this knew synthetic of formula that is placing heroin with the drug 50 times more powerful than heroin, so powerful that the dea does not even let it starts in the longer sniff grau fentanyl for fear that the dog will die with the 1st sniff. three grams, the equivalent of salt grams could kill human being if they gained access to it. what is mexico and china doing in cooperation with you and in order to interdict that drug? >> sen.,senator, 1st, i'll touch on mexico and china's bilateral relationship. with our support mexico and china are meeting and discussing fentanyl regularly every year.

they arethey are both involved and multilateral side of things. just last month at the un general assembly special session on drugs they were both there. china, the minister of public security, led the conclusion statement, fully on board, and they are member of both countries. we also sponsor in the united states to annual fentanyl and precursor chemical conferences with mexico and china. >> how successful is this effort so far? >> that's a good question, senator. fentanyl is a new problem for the department of state. while more we are applying lessons learned with other substances and other crime areas i can't quantify.

>> elevated to the highest level? in other words with human rights and copyright infringement? is this issue now at the highest level of negotiations? >> mr. chester went down in march with our folks and spoke to a large interagency group headed by the attorney general and mexico. we regularly engaged with china, diplomats are going to china next week at a very high level, diplomatic engagement. we raise it regularly in the joint liaison group on law enforcement which is a counter narcotics working group that meets throughout the year, and we have actually seen some positive signs from china. >> what is the evidence? but with the evidence be? >> to convict. >> china have actually doing

something to block this from coming in the mexico and in the united states. >> of doing good. >> okay. we have seen encouraging progress. there is still plenty to do. last year the minister of public security officially control 160 new substances including several analogs of fentanyl, and they have expressed high arrest activity and are continuing to receive information on new synthetic substances to officially control them. so they are doing something. there is more that can be done. >> clearly. we have the evidence in 2015 massachusetts, and it will be worse this year. slim evidence that this thing is being slow down. .. key

>> can we go to mexico? what is the level of cooperation you are getting from the mexican government in interdicting fentanyl coming into the united states? we know it is el chapo because he goes to massachusetts. >> senator, i would tell you that i personally have been down there twice and have dealt with the mexican embassy here in the united states. i will tell you they understand how seriously we take this issue in the united states and that

this is our top elicit drug priority and they understand it is not just heroin but heroin and fentanyl. in a meeting in february, i put fentanyl on the table and i will not say it was a first heard for them but they were not really familiar with how seriously the issue was in the united states. by the time we went down later with the director and ambassador that was part of the problem they agreed to work with us moving forward on. i will tell you the mexicans are understanding of the importance we place on this issue. they are engaged and willing to conduct joint planning with us on the issues of poplar er eradication but lab identification on issues of fentanyl creation or the milling of fentanyl with dilutants

across the border. >> it is a liting disturbing that from your testimony it is a case of the officials in mexico just hearing about fentanyl and it is just getting on their radar and it is february of 2016. given the fact more than official of the people that died in massachusetts opioid related had fentanyl in their system. it is a little bit disturbing to me. i don't like it to have just been introduced at at level. i mind like to hear president obama has raised this issue with the president of mexico and the president in china just because of the incredible level of fatalities across our country. we know specifically what the source is.

so, you mind if i just continue a little bit. thank you. it has been elevated to a level where there is a no non-sense expectation going on. >> in response to your concern, i know the president raised this with the president from china, the heroin/opioid issue. >> he raised the fentanyl issue? >> i will check if it was specifically fentanyl but i know the heroin and opioid issue was raised. >> i am asking about fentanyl. fentanyl is the epidemic. fentanyl is the epidemic. it is not heroin. fentanyl is 50 times more powerful and showing up in the majority of the deaths.

we have next week -- >> what is the highest level? >> next week our deputy secretary will be in china and this is high on the agenda, if not top on the agenda. >> why lawrence, massachusetts and new hampshire and in florida, central florida, how does the community bind up targeted by these gangs?

>> in some cases, the traffickers have personal or business relationships or that geographically -- >> but the northeast is far from the mexico border. why didn't stay stop along i-95 and target? is it had existing structures from before? >> yes. when we specifically talk about fentanyl one of the things that we looked at as we tracked the fentanyl crisis. we believe one of the strong contributing factors is the fact fentanyl is easier mixed into

the white powder heroin which was preferred in the eastern part of the united states and the black tar heroin in the western parts and that is traditionally been the heroin market in the united states. fentanyl introduced is being mixed into powder heroin. it landed in the united states. we are seeing it being press into pill form and sold as counter fit opioids. fentanyl found a market in the eastern united states because of those two reasons. >> i spent time in new hampshire last year and found myself in a lot of small townships that faced an overwhelming problem. is there evidence that in essence they looked fed-up where

they can overwhelm local law enforcement and capabilities? >> i don't know whether that was, you know, the size of the population or law enforcement, was a particular reason why. but to your point, it is a matter of concern thatia find an increasing number of heroin or fentanyl users in rural areas who are starting to use the product alone. they are far from treatment and further from first responders. those are all things that make this particular crisis particularly dance. the supply means the traffics have to be more aggressive at

finding marketshares. they were targetting treatment centers where they knew people were getting treatment because of addiction. they were waiting for them outside. they were specifically targeting recovering individuals for the sale of this. this is a pernicious, disgusting industry we are dealing with here. in that realm, since the arrest of el chapo, secretary foote, this part of mexico, i believe, is a concerted policy to conduct high profile arrest of drug lords. while it is positive these organizations are being decapitated, have we seen evidence that the arrest of a high profile individual impacts the ability of these organizations to continue to function? specifically since el chapo's arrest. is there any evidence the operation has been impacted or is it just one of those things that is functioning the way a corporate entity would?

>> sir, my personal experience is far more robust with columbia where i led our programs several years ago. we have seen where the kingpin being arrested does certainly affect an organization. the question is how big is this structure? how organized is it? and how quickly can it recover? that is a question far better posed to our drug enforcement administration guys than the state. >> let me ask you about columbia, it is not directly related to the opiate issue, but nonetheless, the counter argument some made and i find credibility in, that this is part of the peace process. in essence, this eradication

process was an irritant and we see numbers for the first time in a long time there has been a massive increase in cocaine production in parts of columbia we have not seen. and the assumption is that is going to get sold and we should expect at some point to see a spike in cocaine sales in the united states in the next few years. do you have a few irrespective of why they are doing it what these new numbers mean for the u.s. and years to come. >> we are concerned about the suspension of eradication. it is a sovereign decision of president santos and the columbia government. we believe they are not magic pills they are valuable tools on the supply side intervention on narcotics. it has been a big part of the strategy in columbia.

we continue to work closely with the columbians. we work with the paz columbia and are in close contact to which direction they decide to go, if and when, president santos gets the peace process resolved. >> here is my final question for the panel. and i thank you both for being here and your testimony and the work you do. we have two separate interrelated problems, the production of synthetic fentanyl, the growth of opiate poppies. the amount of poppy-based opiates grown in the western hem hemisphere is a small production of what is grown around the world. if a poppy-based opiate is

produced or fentanyl is produced in mexico or anywhere else what percentage of that is destined for the united states? >> we believe mexico is the primary supplier of heroin to the united states and the united states is the primary customer for heroin. that relationship in the western hem hem hemisphere. we don't see afghan but the government of candidate believes southwest asia is its primary supplier of air heroin. one thing we discovered as a risk and identified as a risk is if we are successful in bringing down the supply of mexican heroin to the united states do we open up the door for others.

>> i think it is clear if you see a heroin overdose in the united states, that heroin or fentanyl came from mexico through china in the mail. that is clear. is the opiates being grown or produced in the case of fentanyl being sold anywhere else in the world or should we assume all of it being grown there, you can see it from the camera pictures being taken, all of that is headed to a city near you in the united states. >> that is assumption we make. that is correct. >> did you have a final question? >> no, i thank you so much and again to me, this is the top topic. doesn't get any bigger than this. so having them here and to know they are the principle people working on the fentanyl issue, i think, is absolutely central.

let me just ask you, your title is associate director for the national heroin coordination group, do you think it is time to change the name to the national heroin and fentanyl coordination group? do you think we should change the name so it advertises directly what is going on to the american people? >> when we began our work this fall, and after the director stood up this group in order to provide focused efforts against the heroin and the fentanyl problems, in our work we determined that we were going to determine heroin and fentanyl as part of the same problem set for a lot of different reasons. what has evolved over time in the work with planning and the inner agency is we discovered the importance of fentanyl more so than six or nine months ago. the other important thing about

fentanyl that i would like to bring up is the fact the emerging and visibility of fentanyl is driven almost entirely by the post-mortem testing that is done on individuals in overdose deaths around the country. in those areas where the testing is done and fentanyl is tested on the panel you see more. so it leads to believe looking at the heroin and fentanyl problem, we have a significant fentanyl problem, that we believe is being masked by this increaset availability in heroin. we handleal them both as part of the same problem set because it allows us to be able to deal with the trafficking, supply chain and effects on the community. >> i appreciate that. in your opinion, does it make sense to add fentanyl to your title? given to what you know and how

little mexico knows when you had the con variation in february of 2016. same thing for the chinese. what do you think? >> the issue being raised to the chinese -- >> no, i am talking about mexico. specifically about mexico right now. they didn't know. >> right. and by the way, even when i say 57%, a lot of experts think that is an understated number because of the poor reporting that goes on in terms of the total number of deaths. and by the way, it is no secret while we do it, 300 percent markup, you know, in terms of their ability to make money off this as opposed to heroin or other drugs. again, from my perspective, this

is the issue. this topz any terrorist threat. this is what is going to kill anyone. hundreds of thousands of americans. it is this fentanyl coming into our country. you are the front line on this. mexico just heard about it. i am not sure the chinese understand the priority we expect them to deal with this issue. you said in your testimony that gaps in the interdiction of fentanyl from mexico coming to the united states from mexico. can you explain in detail what those gaps are? >> we are speaking about the ability to detect fentanyl at the border. the ability of canines is what what was brought up.

we work closely with cpd in terms of intelligence and policy to address those gaps, to better detect fentanyl at the southwest border and air freight locations in the united states whether it is u.s. postal service or commercial company. that is a discussion so we can understand how much fentanyl is getting in the country and detect it when it arrives and whether that is detecting the fentanyl itself or the dilute it is mixed with. >> in 45 minutes, i have to preside over the floor and turn into a pumpkin so we have to -- not literally. >> i would strongly recommend to the administration that when the president meets with the president of canada and mexico that he raise fentanyl to the highest level and let's them

know that is a threat to our country and the same thing is true in asia and communication with the chinese government. it has to be at the highest level. >> this is an important issue in the northeast and i thank you both. we will welcome our next panel. we keep the record open for a few days. if you receive any questions in writing, if you would respond as quickly as possible so we can close the record. we thank you both for being here. as they are getting seated and situated i will reintroduce the members of the second panel. the honorable teresa jacobs, the mayor of orange county, florida, which we hope will be the site of the pro-bowl in 2017; right? >> yes. >> maybe you can give us an update. and steven dudley. mayor, if you are ready your testimony has been submitted in

writing and we look forward to hearing you. thank you for being here. >> thank you, chairman rubio and thank you for calling this important hearing and allowing me to share a local perspective. the conversation this morning has been informative for me and everyone here. a little background on orange county. nothing you don't know but for the record. orange county is home to the city of orlando and 12 other municipalities. we have a strong economy and exceptional quality of life and 1.2 million people call orlando home. but we have 66 million visitors on an annual bases and continue to shatter national records for tourism. that is the good news. the bad and very sad news is we like too many other communities have seen an alarming increase in the number of heroin overdoses and related deaths. when i say heroin, i mean opiates, opioid, fentanyl, all

of them combined. we lost 85 lives to heroin and 62 lives to fentanyl last year. we heard this morning testimony about the increase in deaths related to opiates and opioids of anywhere from 200 pin 2007. in orange county we have a 600 increase and already this year we have had 90 reported opioid overdozes and about 1-10 resulting in death. florida's fight against the current wave of opioid addiction began about five years ago. in 2010, florida was known as the pill mill capitol of the country. florida practitioners were describing oxycodone at levels that were higher than all states combined. we responded by out lawing unauthorized pain clinics. today we might heroin and fentanyl.

given the dramatic rise in the flow of heroin and fentanyl into our community one can only surmise that drug cartels perceived us as a right marketplace. unfortunately it is nearly impossiblely to accurate assess to size of the heroin threat in florida and across the nation. there is a few things we know. in orange county we know that 2,000 heroin users moved through our county jail alone. on any given day we treat roughly 200 heroin addicts in our jail. 100 expectant mothers were being held who were addicted and babies will be born addicteded to heroin. we know 60% of overdose patients are not insured but we have only one facility with 26 beds available for the uninsured. simply put, we we know our county jail is the treatment

center of last resort for far too many people who find themselves addicted to heroin, fentanyl and other opiates and opioids. we are fighting back. we convened the orange county heroin task force chaired by myself and our sheriff. we passed the 2016 voter legislature which passed a measure allowing narcon sales without a prescription. we know there are many effective approaches, many discussed here today, but at the heart we have to recognize we must address the demand side while we attack the supply side and an either or policy will not work. on the demand side we have joined forces with our k-12 systems, universities, faith based communities, medical communities, together we are launching a social media campaign to educate the public

on the risks of this highly addictive and deadly drug. we are trying to convince our citizens and warn them in advance this is something they want to avoid at all cost. we are not only treating heroin addicts in our jail, we are impleme implementing a new program and this is an option for all of our addicts leaving the jail. we need the federal government's help to treat more addicts. we are woe fullly short on beds and other resources. on the supply side we are doing our best to arrest traffickers on the street. our local efforts are no match for the cartels coming across the border. that is wie we need your help. to end the crisis, to save lives and save communities we each have a role to play. local governments have a crucial role, the state government and

the federal government does. but the efforts need to expand beyond government. we need every citizen that is a mother, father or friend of an addict, we need our entire communities engaged. we need doctors, we need the clergy, we need the counselors, we need the teachers and that is why i think we need a nationwide awareness campaign. we have talked briefly about fentanyl and it needs to include the high risk of fentanyl and the low cost. quite frankly today it is less expensive for many of our addicts to get high on opioids than it is for them to go and get a happy meal. that is a sad state of reality that has to be addressed. thank you for this opportunity and mr. chairman, thank you for your and your committee's continued leadership. >> thank you, mayor and thank you for your work on this. you have been involved in this

for a while back from the pill mill days. mr. dudley, thank you for being here and we look forward to your testimony. >> thank you very much, chairman rubio. the u.s. portion of the world heroin market is quite small by comparison in terms of user but really out sized in terms of potential earnings. the rand corporation estimated in 2014 u.s. consumers spent as much as 27 billion on heroin each year an increase from 20 billion in the year 2000. mexican and columbia organizations have reacted to the changes by producing more heroin. as noted mexico counts for the bulk of the poppy production in the region. seizure data of heroin along the southwest border indicate that mexican criminal groups are moving increasing amounts of heroin in the market. they are also the key transporters of columbia heroin to the united states and manage

and purchase the heroin produced in guatemala or by the opium gum to profit and turn it in mexico. the trend appears to be the same in the u.s. mexican groups are seeking an increase amount of marketing share and displacing other wholesalers. it is a lucrative market with large mexican criminal organizations managing the products from the point of production to the point of sale and seeking a greater market share of these sales. the reality of the supply chain is more complex. what helps us to use well warned monquers when talking about the organizations. names such as the the cartels may evoke fear but they are not organizations as much as brand names. in many cases, the individual ports of the organization have

as much contact with the bosses as the local coca-cola bottling manager may have with heard quarters. take the recent case of the brothers in chicago. the flores brothers were said to be seen with cartel members in chicago and they were. but the federal inteections with cartel leader chose the two brothers negotiated independently with the top two members of a criminal organization obtaining different prices for the product they were selling. even after a war started between the cartels the brothers continued to purchase drugs from portions of the organizations. this case shows two knits. this is one single organization and number two that it is

tightly control bide a singer leader or single group of leaders. as shipments get further and further from mexico's wholesale points the lawyers are disperse and disappear. this is true in the u.s. market where violence is not a long-term option to insure loyalty or be a monopoly. it makes violence terrible. this is evident in other ways. the amount of seizers indicate it is moved in small quanties. in 2014, the single measure was a kilo gram. in denver a 10-12 pound shipment is considered large. the case of a laredo brothers, indicted in eastern pennsylvania, are indicative of

these trends. they moved about 14 kilos per month over a six year period. the organization was so subtle and mom and pop as one analyst put it the mexican authorities were not even aware of the group. this brings us to mexico -- excuse me. the horizontal nature of the change makes it difficult in mexico as well. as noted, the once monolithic organizations are shells of what they used to be. many of the fragmented pieces formed their own criminal organizations and brand names. the upshot is the chain of production in mexico is broken into numerous pieces including small and large producers of opioid gum producers, processors, wholesale, and transporters.

the laredo brothers were purchasing opium gum from an independent broker, processing it themselves, and distributing in small quanties in the u.s. for years without running into the trouble with the large, supposedly all controlling, cartel. to be sure violence is still a viable option so it may swing back to monolithic organizations but for the moment there are dozens of small criminal organizations involved in the trait from the point of production to the point of sale. in some, a level of control that is exerted over the chain it is clear we are not talking about one or two groups but dozensf of interlo interlocking organizations. it appears to be a diversified operation with multiple actors and one that is obedient to

market forces rather than one or two single integrated distributors. law enforcement efforts are muted. you are hendering a small part of the overall production and chain. if you slowed the heroin from mexico, you would face the task of stopping the flow from other countries which would undoubtedly fill the void. candida canada gets 90 of its heroin from the asian market. thank you for your time and attention. i look forward to your question. >> i want to begin with a question i alluded to during the testimony and that is, i cannot prove it, but it has been anecdotal and we don't have a number behind it, but the notion that these criminal groups are

specifically targeting people recovering. in essence, they station themselves outside of a rehabilitation outpatient center or in-patient center knowing these people are vulnerable and enticing them to fall into addiction. mayor, have you seen evidence of this? mr. dudley, have you heard about this reoccurring issue of the tactic of targeting people in recovery for sales? >> i have not seen evidence of targeting our treatment facilities. i will say that it does -- it certainly appears on the surface there has been a target effort toward which communities to in filtrate with heroin. and certainly, i look to in -- to the inkreegs of -- i look to

the increase in heroin and fentanyl at the same time we cracked down on the prescription drugs and suspecting a correlation but i don't have direct evidence. it seems hard to imagine there wouldn't be a direct relationship between them. >> thank you, senator. i also don't have direct evidence of this activity on a local level. i will say in mexico, criminal groups have targeted recovery facilities, but more as recruitment centers. >> recruitment centers? >> for them to basically build out their own criminal operations. >> you mean for like dealers? >> not for dealers, but memberships. people who participate in the criminal organization. that has certainly happened especially with regard to one of the very famous groups there. the upshot of this is to say

whether or not they are targeting to pushing drugs in certain areas, i am not sure is as relevant as this sort of whole picture which is what the mayor alluded to which is this idea that this is largely driven from former people who use pharmaceutical drugs. those people you can find all over. that accounts also for the disbursed nature of this epidemic as oppose today the 1970s where you had it in urban areas now it is spread out. >> this weekend i have a personal friend who is a police officer in miami-dade county and recounted a story of pulling up to a car pulled over on the side and the woman in the driver seat was slumped over. it was a nice car by the way. obviously this is a person of financial means.

knocks on the window and the person pops to attention and he can see in her arm there was a needle. she was shooting up on the side of the road in a luxury vehicle. knocked on the window and rolled down the window and hawaii begin to interact and he has a decision to make about how to treat her. this is someone who said ten years ago he would have arrested her and taken her in as a criminal. today his perception changed because he has had several interactions, including this interaction with a person when by the way is a member of the florida bar, a successful, functional attorney whose husband apparently also has a problem. he doesn't want to take her to jail. he doesn't view her as a criminal but as someone who has a disease and is in treatment to overcome it. her gateway to heroin was the u.s. of a pharmaceutical for a surgery six or seven years ago

and she lost access to the medicine and this happened. the concern is two-fold. number one, if today, you are dependent on an opioid suspect, regardless of how you got there, but there is a stigma associated with it like you are a bad person doing a bad thing and need to be punished. and even if the stigma changed so we can get people to treatment and i am physically dependent on the substance. in many communities there is nowhere to take them and some place it is the jail where you hope their withdrawls will be managed. we don't have the capacity to lead to the reality and the third problem is the number of people in a jail cell going

through with drawl and don't realize their tolerance dropped and when they go back out they go to the levels they were using before the arrest and it kills them because they lost their tolerance. i am sure there are hundreds, if not thousands of cases like that, what are the impediments of getting someone, who i don't think so, but might be watching c-span, not many people watch c-span, what is missing for someone who needs the treatment and doesn't know what to do about it next? especially for the uninsured there are not many options. >> thank you, mr. chairman. i think that is a key part of addressing the demand side. part of it is to educate people and help them make the right choices to avoid overuse of prescription drugs but the other part is how do we provide the resources to treat people that

are addicted and the treatment options are limited. for the uninsured 26 beds for 2.4 million people. our jail alone, 1-4 jails in the region, we have on average 200 people we are treating for with drawl symptoms. we need more treatment facilities. when you ask me the question are traffickers or dealings preying on people coming out of treatment centers and the reality and we don't have enough treatment centers to prey on. >> you said you believe florida was targeted because of the pill mill program and once that was cut off these folks will need -- >> that is what i believe. i don't have empirical evidence but the evidence of the increase in the flow of heroin and death-related to heroin in correlation to our cutting off the pill mills.

let me say while we were dispensing more oxycodone most of it was leaving the state and these pill mills you could drive up and look at the parking lot that was full and only a small percentage were local license plates. the cartels may have misjudged the appetite but they have floodfloo flooded us with cheap drugs. the number of youth struggling with addiction and have turned a corner and have been able -- have had the good fortune and money to find treatment, the insured portion of that population, to see there is life after heroin addiction is very encouraging but what is very discouraging is more people that are addicts have no idea there is life. and most people that are addicts have no opportunities to get to the treatment centers. >> just to fill in the gaps who

may not be aware of the pill mill problem. we had a facility you would pull up and say my neck hurts and they would give you a package of prescriptions. you would have bus loads of people coming in. it was a huge problem and the florida legislature closed the loophole that was allowing this to happen. we are not talking about the oxy prescriptions at his or her office. did you want to add something on the treatment side? >> very quickly. this is obviously framed as a law enforcement debate and i was asked to talk about the criminal organizations but as you rightly pointed out this is a public health issue. at the heart of it, this is a pharmaceutically driven epidemic and a public health issue. that is really the difficulty in facing up to this; it isn't necessarily a strict law

enforcement and throwing people into the jail. we need to talk about getting them better treatment. >> and my sense is i don't believe anyone wakes up in the morning and says today is the day i become a heroin addict. there is no responsible way to use this. its impact on everybody is different. some people are more sensitive or susceptible to addiction than others. but it restructures the brain's chemistry in the way a disease would and has to be treated as that. i looked at statistics, orlando 83 heroin deaths in 2014. other communities have large numbers. miami at 60, sarasota 55. but that number pops out as a place that has been targeted and you see the rise and death and spike we have seen across the country in heroin and opiate deaths where the take off point

has been the introduction of fentanyl, which as we have seen from testimony is an incredibly powerful and lethal substance, which in fact from my understanding, is not prescribed outside a hospital setting to begin on with the pharmaceutical side. i want to go to senator kaine so i want to leave with this thought. i read a report where someone who was a former now recovering addict was asked about this instead. when you hear someone died that was sold by a particular dealer, it makes you want to buy from that dealer because you know what the selling is the strong stuff. i think many of us would be

surprised that the number of people we interact on a daily bases at some level have a dependence problem. maybe not to street heroin but as some sort as a result of what we have seen and hopefully week make advances in pharmaceuticals so we can draw the line and treat people effectively without putting them at risk. >> thank you, mr. chairman. mayor, i will start with you. i was a mayor in richmond and it was only as mayor that i fully grasped the demand side of this chal challenge. if the demands have hooks in people so deeply the dealer will appear tomorrow. we had a tough problem in richmond and a lot of drug

related homicides were taken place near a church i go to. and the number of stories of somebody coming in and getting shot at the corner of second and maryland you would think five stories people would quit driving in to buy drugs but they kept doing it. and that is evidence of how powerful addiction is. this is going to be dangerous to go, i could get shot, but the need is so intense i am going to go. i was a mayor 20 years ago and drugs were different but it is the same thing. that is why the treatment issues are so important. and we used to hear anecdotally whenman is under the grips of addiction says i want treatment that is a window that opens where you know, treatment, if not there, the window can close.

when the bed opens up in a month the victim may have od or lapsed back into behaviors not desiring treatment. i appreciate what the chair and you are saying about the need for treatment. i am curious if you can talk about as a mayor the way to solve some of these challenges is through partnerships, state and federal, talk about what you have done on the partnership side in your county? do you have the right stakeholders around the table? things we can do from a federal level to issue funds that requires regional cooperation. >> thank you, senator. red is on. in orlando, one thing we have done effectively is regional cooperation and collaboration.

i think that is crucial on tackling any large issue such as this. one reason we pulled together the task force like we did is we brought in disciplines to make sure we could attack this problem from all angles. i would suggest it is so important, we have limited resources at all government levels, it always seems like the demand for resources outpaces supply. it is important it is structured in a way that puts the funding to use. i think that collaborative effort is important. we have the metropolitan bureau of investigation that pulls together the fdle, fda, local law enforcement, sheriffs, state attorney's office. that has been effective for us on the enforcement side of this. in terms of your comments about the window of opportunity for addicts.

i cannot understand it, either because i have never experienced a feeling of needing something so badly that i am willing to risk my life to have it, but i do understand that is the reality. i know enough people, once we formed a task force enough people came forward literally walking up to me on the street, you know what it is like being a local mayor people recognize you and come up and pour their heart and soul out to you. it as a blessing to be at that level where you can really hear first-hand. i have seen young people that you would never in your wildest iimagination thought were heroin addicts tell me their story. i always saw the other side. i saw they came out the other side of heroin addiction and they are living full lives and getting college degree and they are going to be productive members of society. i think most heroin addicts do not believe that is a possibility. if they have that moment, if it

is 15 minutes, two hours a day, where they say i want to kick this, the reality is they will not be waiting a week or two. they will be waiting longer to get into a treatment facility unless they have a substantial amount of money and that is a huge problem. as i said in my testimony, the best option is our county jail right now and that is a lousy option. not to say we have a bad jail. we do our best. but having a record does not help the situation. so we really need to have options available, we need to have education, we need to have hope, a whole community that is engaged. it is destroying more than lives. it is destroying entire communities. >> we have a chart placed before us at another hearing recently about overdoses per capita and

it was unlike any chart i have ever seen. if you look at a chart about a problem, crime, or social brokedown, high income states are at one part and low income at other parts. if you look at the top ten most affected states it included some of the poorest and richest states in the county. and the bottom ten effected states included the poorest and richest states in the country. this is really unlike any similar epidemic or law enforcement problem i have seen in that traditional demographics are not a predictor. it is rural, urban, suburban, it is all regions. i went to a drug court graduation, the founding drug court in virginia is in roanoke and the judge who founded it was this far sided thinker about the need for drug courts had a child

who many years later was killed in a drug-related incident. after i spoke at the graduation, one of the probation officers who helps the court run, and is a spectacular advocate, said this is my second drug court graduation. and i said did you have another class? and he said no, i went to my son's graduation class two hours from here. this effects every level. we haven't spent time on it in this committee and it is important we do so. this is not -- just like it doesn't have demographic borders it isn't a problem with national borders even. we have to grab ahold of the dimensions, mexico, china and other nations experiencing this and build those partnerships in a metropolitan region and law enforcement internationally. thank you for being here. >> and mr. dudley, about the

transnational groups targeting us, i think in your testimony you talked about this and i want to reiterate it. whether it is fentanyl being produced synthetically or poppy-based opiates being grown in the western hemisphere they are coming here. this is the exclusive market for those trafficking networks; that the correct? >> that is correct. absolutely. there is a small local market they can satisfy but it is minimal. so, yeah. >> you heard the testimony before, you would think logically they are crossing the border and the easiest would be flood it into texas or california or into a border state. but you are hearing where the outbreaks are, this is a national problem, there is no community in the country that doesn't face it, but you see the

outbreaks in the northeast and places like florida. so it isn't even i-10 alone. how is it winding up in these pockets? you heard the previous testimony of the government witnesses, what in your view, is the distinguishing characteristics that turn a community into a high-propensity, high-risk area? >> you know, it is such a new phenomena because it is so disbursed. the fact it is so disbursed is really what leads to the criminal organizations being so disbursed. the notion that we have one single all encompassing embassy and once we incarerate el chapo everything is resolved is not correct. because of the disbursed nature of the market and the way in which these criminal

organizations will satisfy that market. this is, you know, it is an odd thing because in a way, you know, there are certainly elelements of this epidemic where we are victims of our own success. the fact that you would create ways so you cannot tamper with oxycotin. you cannot snort it anymore and that makes it less available and they search out other things. the way in which the mexican government along with the u.s. government has captured or killed several of the larger leaders of the criminal organizations has led to a fragmentation of these groups. so you have groups like you referred to [foreign word] responsible for the supposed massacre of those 43 students

that disappeared. the 43 are currently still disappeared. this was an offshoot of a larger organization and there are several like them. in order to wrap your hands around this as a law enforcement issue, it is incredibly different because the terrain is so much more horizontal than vertical. you are left with a fragmented criminal landscape and a landscape that doesn't, as the cocaine market might depend on getting products into other countries like they do from the andes region and other criminal organizations, but they don't have that dependency when it comes to the poppy production which is local and the heroin production which is local. so they can produce all of this themselves which makes it much more difficult to wrap your hands around as well. >> well, do you have anything further senator? i want to thank you both for being here and sitting through

the previous testimony and i tho hope that was insightful as you go back and continue your work. there has been a lot of debate about what is being done domestically on this issue. but there is not one law we can pass that deals with this. it to be dealt with on the treatment side for people to recover, pro vention side, and targeting these organizations who are in the business of murder basically which is what this ultimately is. and not murdering each other just for territory but the direct murder of americans by targeting us with the distribution of these products in our count raechlt i want to thank you for being here and i also want to ask consent to enter a statement for the record of jack riley who is the acting deputy administrator of the drug administration and without objection so ordered. the record for the hearing will remain open until the close of business on tuesday may 31st.

you might receive questions in writing and if possible i would ask you to respond so we can close the record. i thank you for being here and this meeting is adjourned.

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[inaudible conversations] [inaudible conversations] >> tonight on c-span2, a congressional hearing on alengthalengtleged misconduct by john holocaust -- john koskinen. and then an update from the pentagon for the u.s. strategy for combating isis. >> house oversight committee chair representative jason chaffetz testified on the alleged misconduct of irs commissioner john koskinen