>> the senate recessing for their weekly party lunches. lawmakers will be back at 2:15 2:15 p.m. eastern for confirmation vote on the nomination of the middle tennessee district court judge. about to limit debate on another district court nomination. senate leaders may also speak shortly before to 15 people eastern and we plan to have live coverage of that if it takes place. now to hearing from this morning on opioids. a senate committee heard from a journalist and author was written a book about the development of the epidemic and what may lie ahead. >> the senate committee on health, education, labor and pensions will please come to order. today we turn our attention again to the opioid crisis. the nation's number one public health challenge. our witness today is sam quinones, the author of

"dreamland: the true tale of america's opiate epidemic." senator murray and i will each have an opening statement and then i will introduce the witness, then with her from mr. quinones, and then senators will each have five minutes of questions. since his are only witness i suggested to him that if he wants to take a little more than five minutes to say whatever he has to say, we would welcome that, but who will be plenty conversation back and forth from members of the committee. mr. quinones, it is unusual to have a single witness at our hearing but this is an unusual topic, one you quote washington state research professor gary franklin is calling the worst man-made epidemic in history. the challenge this crisis present has captured the attention of a member of this committee. the research and writing has been acclaimed for the depth and breadth so this is what we call a bipartisan hearing, most of ours hour. one in which a a democrats and republicans agreed on the topic,

it's important, and on the witness. it's my hope we restate our habit of lecturing one another about health insurance and focus today on the topic, which is the opioid crisis. this epidemic kills more americans every day than car accidents. each of our state we are reminded of that almost every day. yesterday i drop by a meeting of the tennessee governors residence in nashville. the heads of all of our state institutions involved in training doctors were planning how to discourage the over prescription of opioids. the governor told me that in our state of the 6.6 million people, they were 7.6 million opioid prescriptions written in 2016. and that even though the state has reduced the amounts of opioids prescribed, that the number of overdose deaths is up because of the abuse of fentanyl, a synthetic opioid. rather than spend more time

establishing the crisis i want to focus today on what we can do about it. here are two things i'm hoping to learn from you. first, when 100 million americans live with pain, 25 million of them with chronic or severe pain, why is it not a good idea to continue to find the so-called holy grail of medicine, a non-addictive pain medicine? the second, if stronger communities by the ultimate solution to this crisis, as you often suggest in your book, what can the central government in washington do that actually helps? now, my first question come here for chapter in your book entitled searching for the holy grail, finding a non-addictive pain medicine. i've actually read your book. i think there are a number of others here who have and who have even brought it with them. this search for the holy grail began you say 75 years ago in 1928 with a committee on problems with drug dependence. that was the goal, as you described, cold, couldn't that

this site is find a a way of extracting a painkilling attributes from the morphine molecule while discarding is a miserable addictiveness? this effort to find a better way to treat pain, you say, led to a revolution in attitudes toward -- toward pain treatment for choosing ultimates relieve pain for dying patients, then for patients with chronic pain, then multitude of helpers from mexican gangs to pain clinic him over prescribing doctors and enterprising drug companies spiraling into the diction and consequences we find today. at least twice before this congress dr. francis collins, that of the national institutes of health, has predicted that the holy grail that was first sought 75 years ago is now within reach. last month he said perhaps within five years. with our encouragement dr. collins has organized and a h researchers and partnership with private companies to speed up the process, and the fda

commissioner dr. scott gottlieb is on board to fast-track the effort within the bounds of safety and efficacy. but i read at least some of your book to say that this holy grail may never be found. even some scientist who say it should not be found. so hope you will tell us what you think about this. should we not continue to try to find nonaddictive pain medicine to relieve suffering without addiction? is that not the obvious antidote to opioid epidemic? the secretary of a dope to learn from you about is what we can do from washington, d.c. we have tried in a foreign waster dreads the ravages of this crisis which we've all experienced in our states, in 2016 congress passed a comprehensive addiction and recovery act, and the 21st century cures act to give states and communities those on the front lines the tools and resources they need to combat this crisis. for example, provision by

senators warren and capital was included that made it clear pharmacies could only fill part of certain prescriptions like oxycodone, and opioid, that when a mom is going her sons pain medication could ask only for three days worth of bills instead of the 30 days he was prescribed. in addition to encouraging the development of a nonaddictive pain medicine, cures included more than $1 billion in state grants. we are considering additional funding for treatment, and to discover alternative pain medicines. we've held hearings on wellness, lifestyle changes, which are mentioned in your book, such as exercising, eating healthier that help people lead healthier lives and what incentives would help people make those lifestyle changes. you and i appear to have at least one thing in common, i am a skeptic of washington's capacity to solve problems that are essentially problems of

communities, families and lifestyle. you say that the opioid crisis is a problem of society, that when we lose our sense of community we become easy prey for quick external solutions for complex problems like opioids. in your words, quote, i more strongly than ever that the antidote to heroin is community. make sure people in your neighborhood do things together. break down those barriers to keep people isolated, unquote. in my own experts in public life including time as governor i been increasingly convinced of the problem-solving ability of communities with good jobs, good schools, strong families were everyone seems to be interested in the well-being of everybody else. whenever i've tried as governor or senator solve the problem come in the end it boils down to creating an environment in which communities could themselves fix problems, not sending in single shot solutions from a distance.

for example, after spending years on state reforms and education as governor, i ended up traveling the state to create 140 third middle schools committee taskforces because i believe that communities who wanted good schools could have been, and those who did not would not. i held the same views as we fix no child left behind in 2015 when we restored more decisions to classroom teachers, school boards and state. so exactly what does congress do from washington, d.c. about this opioid crisis? this committee has jurisdiction over a significant amount of what you've written about in "dreamland" but not the spending of money. that belongs in the appropriations committee. we are eager to hear testimony and to hear your solutions. senator murray. >> thanks very much mr. chairman. i'm glad to be continue our discussion on this important issue. i know our witness today has been following the opioid crisis and its growth into the

full-blown epidemic, families and community across the country are facing today. mr. quinones, thank you for joining us. i also want to welcome your wife and daughter whom i assume are sitting right behind you there. i'm glad they were able to be here with you today. i look forward to hearing your perspective on how we can better help our communities write this crisis and support all of those have been impacted, and i really appreciate the investigative work that you've done to help shed light on this challenge. of course amateur you would agree the rise of this epidemic is broader in scope than any one book can tell. there are people from every background and every corner of the country who have stories about the harm that this is done, and they are parents of lost children to an overdose, children have lost parents to an overdose, veterans in chronic pain or struggled with addiction, doctors are treating babies born addicted to opioids, and a lot more. i have heard these heartbreaking stories first-hand traveling drama home state of washington,, a meeting with doctors and

families in communities fighting this disease. i was visiting a local hospital in longview, a real community in my state and the staff told me that almost one out of every two babies born there have mothers who struggle with substance abuse. it was astonishing. and heartbreaking. but it's unfortunately not the only evidence of this epidemic. since 2000, nearly 10,000 people in people in washington state alone have died of opioid overdose. this isn't just happening in longview. capital and local hospitals across the nation. we're losing 91 people every day to opioid overdose. when i say this epidemic affects everyone, i don't just mean the individuals facing opioid addiction. there are other victims as well. this epidemic hurts families. it leads children struggling to cope with the impact of their parents addiction. it leaves many of them in foster homes. it leaves parents who are shattered with heartbreak of their child's illness and lease many struggling with the

financial cost of opioid misuse and treatment and recovery as well. and this epidemic hurts our communities as a whole. it takes up resources of public hospitals and law enforcement. it takes workers out of our local economy. it takes a toll on the morale of small towns and big cities alike with each new tragedy and we are behind the curve on fighting this epidemic. one of the stories invested it to me in your book was about a state employee from washington department of labor and industries. a woman named jamie may. jamie was a pharmacist charged with overseeing the cases of workers who were receiving prescription drugs for injuries pick after six months she noticed that some of these workers were dying from the same painkillers that they been prescribed. the paper she published in 2005 about the uptick in high-strength opioid prescriptions and deaths was one of the first papers in the country to document the impact of the crisis that we're now facing today.

but she published a paper over a decade ago which just shows we've been fighting this battle far too long, and we have to do more. i'm glad we have taken some necessary steps in 2016 congress baths a 21st-century 21st century cures act act which included nearly $1 billion of funding for states to address the opioid crisis through prevention and treatment and recovery efforts. and the comprehensive addiction and recovery act which supports specific outreach for veterans and pregnant and postpartum women expanded access to medicaid and assisted treatments and much more. but there is a lot more to do. along with many of my colleagues i hope we can move more funding in the upcoming budget for appropriations agreement. first responders can stay local officials, treat the professionals and families have made it clear continued federal funding is key to addressing this crisis. and, unfortunately, we have a lot of talk from the administration on this but we've yet to see the president take the kind of serious action that

this emergency demands and that he promised families on the campaign trail. the white house own council economic advisers released a report estimating the economic cost of the opioid crisis to be over $500 just for 2015. addressing a problem this big will take an enormous investment of time and energy and focus and robust funding. the president third-quarter paycheck is not going to cut it. our communities are crying out for serious solutions, not stunts. i'm eager to see this committee continuing its bipartisan approach and to take substantive action to address this epidemic over the next few months. mr. chairman, i look forward to working with you to have all of our members bring their ideas forward so we can work on moving policies that upper families and communities. we have to do a lot more to fund the prevention efforts and treatment programs and build on the gains we've made. this means immediately providing

supplementing fun states need that can help turn this epidemic around and we need to ensure that local stakeholders and partners, the people on the ground who know what works best in the community have the resources and information they need to respond to this crisis. it means going beyond prevention and treatment and recovery. we have to work to support not only the individuals facing addiction at the families and communities who are suffering as well. i'm interested to hear your perspective on this today and how we do that, and i'm really grateful for you coming today to testify before us. because if we're going to beat this opioid addiction, we have to find and index solutions that are as comprehensive as this challenge to thank you convey much for having this hearing. i look for to working with you and all our members. >> thank you, senator murray, and thank you for working this week at such an important hearing. i'm pleased to welcome sam quinones and his family today. thank you for taking the time to

be here. mr. quinones, has to use expense as a journalist and author cookies written extensively on the opioid crisis in drug trafficking, is author three acclaimed books, his most recent book, "dreamland: the true tale of america's opiate epidemic" won the national book critics circle award for general nonfiction. early in his career mr. quinones was the recipient of the maria moore's cabin prize, the oldest international award in journalism is work covering latin america, was also the recipient of a paterson fellowship awarded to outstanding print journalists who pursue stories in the public interest of block up again, mr. quinones. you will have ten ten minutes o give her testimony and then senators looking forward to having a conversation with you. [inaudible] >> there we go.

clearly i'm a rookie here. chairman alexander, senator murray and honorable members of this committee. i'd like to thank you for the sins of a epidemic of opioid addiction and for allowing me the honor of addressing you. i'm very happy to be with my wife and daughter who are part of producing united states and without whom the book could never have been finished jerk this is the deadliest drug scourge with known in this country hating aeries of the country that have never seen this kind of drug problem. it is the first in modern america to be spread not by mafias, not by street dealers but by doctors, overprescribing pain pills convinced they were doing right by their patients. urged on by the pharmaceutical industry, by the medical establishment and, indeed, urged on by us, by american health consumers who too often wanted to, a quick and easy end to

pain. isis could not have dreamed of inciting the kind of torment and death that we visited upon ourselves to the over use of opioids. these drugs are a symbol for our era. for almost four decades we have exalted the private sector, the individual while we ridicule government as an efficient, incompetent and wasteful. we admired wealthy businesspeople regardless of whether the way they made their money produced anything of value for our country and our communities. we brought i believe a second gilded age. this epidemic of addiction to a class of drugs that tries on isolation reflects all that. this epidemic costs have been borne by the public sector, all its profits have been private. i believe this scourge is that

issues far deeper than drug addiction. it's about the effects of his very cultural shift. it's also about isolation in areas of rich and poor. about the hollowing out a small town america and the middle class, of the cyclization of our society, and is about a culture that acts as if buying stuff is the path to happiness. i believe we got into this because we believe problems could be attacked in isolation, with one magical silver bullet, a pill for all our pain, jail cell for every addict. we exalted the private and mock the public and the communal, and in so doing we rid ourselves of thing so central to us that they have no price. we have been invaded by cheap junk as a result. we dug up dreamland pool and replace it with a strip welcome to things like that across america for years now. heroin is what you get when you

destroy dreamland. i believe isolation is heroines national habitat. i believe this epidemic is calling as to revert these decades of isolation and come together as americans. i believe more strongly than ever that the additive to heroin is not naloxone. it is community. people coming together and working in small and local ways toward solutions. no one saving the world alone. the good news and all this i believe is there is no solution. there are many solutions. each small, each must be tinkered with, and proved, some may be discarded. each must be funded fully and for a long time. but the good news is that none of them is sexy. none will do the trick alone. i believe that across america

today communities are finding these solutions. the more they band together, the more they leverage all that talent and energy bring in pdas, pastor, artists and athletes, recovering addicts and primary care doctors, librarians and the chamber of commerce. the more cops and public health nurses go out for a beer, bridge that cultural chasm between them. and to do believe as that this is happening in counties across america. it's my opinion evidence shows that supply has ignited all this peer we did not have this domain, this widespread until we unleashed a large supply of powerful illegal narcotics on the public for the last two decades. thus, believe it is essential that doctors recess how and to whom and in what quantity they prescribe these drugs. that does not mean just cutting people off or over on high dosf

these drugs and leaving them to fend for themselves. it does mean lobbying insurance companies to reimburse for pain strategies that do not involve narcotics, allowing doctors and wider array of pain strategies than simply pain pills. young doctors will need more education in med school in both pain management and addiction treatment. i have to say that i think it's delusional to spend time and money on yet another wall along the u.s.-mexico border hoping that this osama staunch the supply of heroin and fentanyl. these drugs are coming in through areas with walls already. i i believe in wall will, in fa, about the only thing that will truly help stop these drugs from flowing into our country and that is a deep respectful but also forthright sometimes blunt certainly honest relationship with mexico that will lead to a final becoming the kind of

neighbor and partner we can work with effectively and in so doing become the kind of neighbor that country needs of us. another wall however seems to me is just like heroin. it feels good for the moment but it will leave us worse, in a worse place in the long run. another silver bullet for a complicated adult problem. sometimes the solutions are about the mundane mechanics of governing. we should find, for example, new ways of finding coroners offices around this country and expanding our national force a forensic pathologist which is dangerously dwindling. this epidemic spread because so many of those offices are so poorly funded. i believe we must expand treatment options in this country. one place to do this, ironically, crucially i believe, is jail. consider how the country will be helped by transforming jail into a place of nurturing recovery

instead of the place of predation and tedium. becomes an asset instead of a liability, this is happening, particularly i would note in the state of kentucky. i would also like to add that all across america our families are suffering due to the addiction of a loved one or the loss of that loved one, i believe they are wrong but feel to be marshaled, harnessed in this fight. meaning i want to be involved, need to be involved to help solve the lacerating wounds that will last a lifetime. i believe you as sinners can help by recognizing them, giving them platforms from which to tell their story. maybe it's because i'm a reporter but i believe that through their stories, , the awl statement of addiction will be reduced. i'm happy to elaborate on any of this. before do that that though i want finally to urge you to do this as an opportunity.

view this as an opportunity to revive those regions hammered by globalization and free trade to the roots of our national epidemic of narcotic addiction lie there all the epidemic itself in turn stands in the weight of the revival. many of these regions cannot revive until enough of the people can pass a drug test to fill new jobs. indeed, this is not only a story of a drug addiction. it is a strip of economic affliction. as politicians, i suspect your natural response to a crisis like this is to look about for things you can do quickly to show constituents you are taking action, nobly that is entirely understandable. i would caution, however, against believing in short-term responses. cara and the cures act make up a great start and i thank you for them but they are only a start. everything i've learned about this issue has taught me the

importance of long-term community responses and commitment. i believe american history offers as two templates for action from which you might take guidance and inspiration. first is the marshall plan to rebuild europe after world war ii. second is our space program. each involve government and the private sector acting in concert over many years bringing money, brains, energy and, of course, long-term focus to bear. each achieved and on outlook good for country about doing things seems far beyond our short-term self-interest. the marshall plan was of building up ravaged regions to allow them to function independently while containing the viral spread of soviet communism. it allowed reborn countries to prosper and contribute to the world again. a marshall plan for american

recovery might focus on rebuilding those regions that event caught on doping ravaged by economic devastation to contain the viral spread of addiction. through our space program we were inspired as the people to spend years and dollars all to achieve something no previous generation ever thought possible. we ended up far beyond the moon. the spillover and economic benefit, increase of knowledge, and in simply human inspiration is beyond calculation. seems to me that we might profitably applied these examples, the marshall plan and the space program, to regions of forgotten americans where this problem began. that's do it perhaps because of this but as jfk said because it is hard, because that's what americans do and have always done at their greatest. like our space program i believe such an effort will have two

last four years to be effective, focus far beyond immediate goal of drug addiction and on the more found problems of community destruction and the hollowing out of stretches of this country. i am here today to urge you to see this not only as a cat -- adapter that is also as the gift that it can be -- catastrophe -- it offers an opportunity to reinvest in areas that need it most, chance to inspire us as americans again, to do something great. it's an opportunity to bridge that political polarization that so gnaws at our country. one of the few issues today that can do that. do not miss this opportunity. it does not come around often. this calling is very recent many of you got into public service in the first place, and you are lucky i think to be here when it has again. you will be remembered for

acting with acting was not easy to do. if you do i believe your hometowns will thank you, your counties will thank you, and we, your countrymen and women, will thank you long after you are gone. with that unhappy to talk about anything you guys want. >> thank you. we will begin now to the five-minute rounds of questions. i will say to senators, i'm going to try to stick to five minutes because we have lots of senators who want to ask questions and i'll be glad to stay for a second round of questions if senators would like to get senator paul. >> mr. quinones, thanks for coming. the book was great at it take when you write a book you're not sure how many will read it. you are also not sure how much alec policy affect why but i can see copies around the desk and i would say half or more of our committee have rigid book probably at least and that's why

you here. as i read the book i was her mind when as a kid used to visit my grandparents in pittsburgh and is a big pool like dreamland, when the charge long, probably in the '30s and an amazing pool, 100 yards long with a slight in the center secant see how the committee coy surrounding the pool and activities. as i read the book in which i think what we do better or change, the idea that big pharma lied and committed fraud is a part of the book and a part of the problem. they were punished but we need to make sure that people cannot lie and that it is wrought and punished and it is preempted. some of it to be federal or state law. as a physician i continue to become more and more alarmed that are professionals part of the problem. and we've tried to fix it. in kentucky we done a lot of things. we monitor. you can type into the computer patients name and find out if you're seeking different doctors, , have gotten opioids summerhouse two days before. we've got rid of the bad doctors, the doctors you mention

south of fort smith. they are mostly gone. the pill mills are no longer in kentucky, and yet when the kid up in the mountains that is 21,000 people. last year they had 2.8 2.8 miln doses of hydrocodone and oxycodone. this is after all the stuff it's all the stuff and we knows it's a problem cut of windows more people are dying that are dying from car accident, that it is horrible problem and it was worse last year in this county. they prescribed more. and, in fact, since medicaid expansion its 11% increase. when we look at what we do, we safe with the marshall plan and spend more money, to think about how we spend it and what we do because we want more people to have healthcare. we expand medicaid. if you look at expansion of medicaid, but that map overlying the united states, you have an overlay of the heroin problem in the open your problem and its related to poverty and the expansion of health care. and so in your book you talk about what you can do for three dollars, you don't spend $200,

you can pay three dollars a month and you can get it and trade and all that they can pick we have to figure out more rules on this. we have some new rules in kentucky on acute management but i think the hard part is the chronic. if i'm your physician and given on a it forever for low back pain how do i get off of it and how to get you to not choose another doctor if i take it off of it. that's the problem and the question is, we all know the knowledge. people have read your book. we know there's a problem out there. we done some changes in yet we still have this enormous prescription opioid problem. and so what do you think we do beyond that? i agree with you, community more local and federal is probably better but we still, how do we fix the medical aspect of this? how do we go a step beyond where we are? >> i mean, there's a lot, that's a massive question and to think there are smarter people than i who might also contribute to it.

i think one of the reasons that you find the kind of correlation between heroin overdose of medicaid expansion is begin more access to medical care meets more access to fields but we still have not changed the basic culture. one of the reasons of doctors to prescribe pills as a solution, and so it seems to me that crucial in all this is that we get back to what we're what wen the 1970s, and that is where insurance companies were reimbursing a wide array of strategies for pain. they have cut back significantly in many areas. for the long, things all acrosse country, some interns companies are stepping up a little bit more. but to me it gets back to what the doctor has available to him or her in the appointment, at the point of contact with the patient. to me that feels like a crucial

step in every place i go to speak on this topic, i went into doctors who tell me that they just don't have much in the way of other options to provide. >> i guess the hard part of this is, i live in the county will be a 4% and point and employers contribute safe we be safe we can't find enough workers who are drug-free and have work ethic. there's not enough workers. then i accounted with 3% of the people don't work and 30 present people are disabled, in my county 4% of the people are disabled. the problem is we have big hearts of people say let's help the disabled, help the unemployed and yet we give them stuff but perhaps once you become a permanent non-worker we get you into the cycle it's much more difficult. >> i agree. >> so we have to forget how to do it with both a heart and a brain where we have work requirements and where your only temp really disabled until you're back in the workforce.

in might involve money but we have to be careful about how do we do it such we don't have perverse incentives. thank you. >> my pleasure. >> as you can see little time clock we have these senators, everybody will be very interested having long conversations with you, so we will try to wrap each segment up in five minutes. >> all right. >> and we would keep going as long as we can. senator murray. >> thank you. thank you very much for a very compelling testament of phosphoric specifically, i want to talk about the federal government. we play a very critical role in preventing and tracking and solving this epidemic and in some areas has truly unmatched capacity and reach to be able to affect broad change. one example is the centers for disease control and prevention. they provide funding today to 45 states and washington, d.c. they support prescription drug monitoring programs, invest in running a much needed public when you skip it and managed a surveillance program.

which is the only surveillance program to capture nonfatal overdoses as well as fatal overdoses, and it uses an innovative ways to get timelier data. that public awareness program started under the obama administration back in 2016 to raise awareness of the opioid crisis and is funding states that actually personalize and disseminate this messaging. this administration is repeatedly requested cuts to cdc budget so wanted to ask you, you have mentioned in your writing that we need quality data collection and raising awareness in communities. can you share your thoughts on the necessity for continued robust funding for programs like that in cdc? >> yes. i would suggest that i think we need to greatly expand the amount of money we provide for research addiction as well as

pain management, of pain treatment. .. we need to facilitate or make easier their life and i think cdc has a number of proposals and programs that are, i think, extraordinarily effective. i would say that, you know, when i was doing the book i found almost nobody wanted to talk about this except for government workers. this was the first line of defense in this when no one really knew about this topic or

care. one i would get in enormous contract to write a book and my family in jeopardy and no one cared about, the people who did care in working on this from the beginning, cops, corners, cdc, prosecutors, public health nurses all of whom were gaining or earning a public salary and many at the local levels. i believe that the folks at cdc remarkable and i was a crime reporter and did not write a word about healthcare until he wrote this book. my overall feeling is one of off for our public health folks. honestly they have done amazing work in the face of prayer thanks, but that way. >> you've written about the importance of medicaid expansion to make sure that patients get medication assisted treatment, key to responding to part of

this complex crisis. in fact, medicaid expansion allowed 1.6 million previously uninsured people with substance disorder to get the healthcare and treatment that they need to fix this. can you talk about the importance of medicaid and making sure individuals with opiate -- >> medicaid expansion provided drug treatment for people who did not have hundreds of thousands of people in different states. it's extraordinarily important, i think. i think i know people in different communities who have been enormously helped by this. i don't want to downplay what senator paul was talking about which was that you do have increasespis are still in the ol treatment. >> important part of that is also the support mental health and everything else. >> course and when you have more access to health care there are other things that come along with it and i think one thing

that does come along with it is a reliance still to this day on these pills. we have dropped our prescribing but it still at about 2006 levels and almost triple what it was in the late 1990s. to me that means we still rely far too much on these. that said, of course, i do not understand the impulse to strip away medicaid expansion. particularly, in areas where this problem is so against itself and it feels like this is regions that deafly need the services that they have been provided for medicaid expansion. >> thank you, senator murray. senator collins. >> thank you. first of all, let me thank you for writing such an important

book that. >> thank you. >> the possibilities that what has been discouraging to me is despite much rater public awareness and much more money and much greater intentions that the problem does not seem to be getting much better. one possible community-based approach was described in the morning sentinel paper in waterville, maine and it struck a cord with me because law enforcement officials in my state tell me that their jail intake rooms resemble hospital emergency rooms so what some police departments in maine, including waterville, scarborough, and other areas are doing is they are telling the

attics that if they come in with their drugs and turn them in that they will place them in treatment facilities and this is a whole different approach for law enforcement to take rather than locking people up, helping them to get the help they need. it is also very community-based that you suggested in your book. in your experience have you seen that type of program work better than the traditional approach? >> a couple of things i would say. first of all in reference to your first point, senator collins, i think we need to keep in mind that this has been pestering for 20 plus years, 20 plus years of people come to me all the time and say it's been going on for 20 years and we've been at this for one year and a half or two years and it seems

to me that as a culture we need to learn patience and to not believe in the silver bullet answers to mysterious problems like the mysteries of human pain. there's a complicated things and cannot solve this problem in the last year and a half to two years then of course not and we just need to keep working at it. it's not, you know, these things exist because it took a long time for these things to exist. with in regard to law enforcement, in general, some of the most innovative folks and things that i have seen come from law enforcement. you think not anything law enforcement would hold onto the old ways of locking people up but i have been amazed to see the remarkably innovative ideas that are coming out of -- this the one you mentioned one that i mentioned in my written testimony is about the transformation of jails. i believe we come out of this

with a new kind of jail that a new way the way the jail is run as you see in the state of kentucky with 2000 jails doing this that would be and enormous advance in once more, jill would be an asset, not a liability. today's jail is a liability in a place where you take people who once they have detoxed want to see clearly the wreckage of their own lives and want to change and we put them in a place that is tedious predatory, ganged up, sexual stuff going on and all that baloney and the positives that i've seen in certain jails and one in particular in kentucky is that they are remarkable change in its nurturing and coming together and it's where you are working on your recovery from

the moment you get up at eight in the morning and make your bed military style to 11:00 o'clock when the lights go out. that change in jail would be enormous and as i said in my testimony i try to highlight things that i thought would not just be beneficial to this problem but for the next problem as well so not playing whack a mole with this stuff. i believe jail in fact is one of the great places of effervescence, you might say, when it comes to this epidemic and the way new ideas are being tried. it is in jail and i've never been to maine but it sounds like what you are highlighting is one of those. i do believe it's an essential part of this and if we come out with jail the weight we always used to run jail then we will not really have advanced and the next problem will hit us and we will wonder why were not making greater advances. my feeling is that changing jail

is the way it's happening and that is a revolutionary idea but you can find it in various examples of this around the country and it's very invigorating to see. >> thank you. >> thank you, senator collins. senator casey. >> thank you, mr. chairman. thank you mr. quinones for your test money and work on these issues. >> my pleasure. >> wanted to start with the realities that i see in the state like pennsylvania where we've had last year the last 164,624 over those deaths and that's up 37% from the prior year of 2015. in rural areas it is higher almost 10% higher in ways a percentage of an increase and that is overdose death overall. obviously a lot of that is being driven by the opioid crisis epidemic really. what i see and i missed some of your test money going back and fortetween hearings but what i see ipennsyania is a tremendous resource gap.

when we went across when i went across pennsylvania the last year especially this past summer we would have meetings with county officials often in small rural counties, small-town counties where you have an ad hoc group of people coming together. you have a mayor of a small town and the police chief and the coroner in the medical professionals, treatment professionals, all around the table meeting all the time every week because of the dead bodies keep coming in. one county, very small county said to us they be the most graphic metric was they did not have enough places to put bodies and that's how bad it was. it is everywhere but what i keep hearing from folks at the local level is we need more resources and we are getting our arms around this summer dealing with it as a local community but we need more resources. they need it for community health workers, social workers,

law enforcement obviously is bearing a lot of the burden, pathologist in otherwise. the first question i would ask use what recommendations you have for closing that resource gap which i think is even though the federal government has made strides, as you note, with cures and with [inaudible], what is your sense of the ways the federal government to primary sources? >> people with people in the counties this is one of the great places in america where this has taken place. counties are the levels of government most effective. quarters, jails, libraries, public health, sheriff, et cetera and i've been struck particularly in the last year year and a half to watch these organic taskforces or committees what have you sprout up and in county after county and in pennsylvania i was in [inaudible], a county which is

the home of williamsport have the little league and i spoke with those folks at some length and yes, these folks are coming together in various healthy ways and they are leveraging and there's a whole bunch of people on that committee and there's a recovering addicts, primary care doc and a lot of different folks be with the president there and she said one of the proms we have is we can find money for programming from whatever but we can't find money for the nuts and bolts that make it work like office space and that kind of stuff that this is as essential, if not as sexy, as the other stuff. to me i think that is for the federal government needs to step up. and as i said my testimony that the cures act is wonderful but do not think -- we been doing this 20 years overprescribing creating addiction unintentionally for 20 years and

one year, $1 billion is a lot of money in some sense but in comparison to what the country needs is in every state -- this is an unprecedented problem because it's in every state in america, coast to coast. this is a -- what i am suggesting is the evidence shows there's a need for sustained and i'm talking years worth of sustained investment and i think in speaking in terms of, for example, this more mundane idea of how -- it's their job to be easier to find the telephones in the office space and that kind of thing. again, we can talk later if you like about the issue of corners but to me that's a crucial part of as well. i think i know it feels like a lot of money, a billion dollars is a lot of money but not compared to the breadth and depth and length of time this

problem. it seems to me that this needs to go for some time. >> thank you for that and i know were out of time. i introduced a bill to commit 45 billion over ten years so roughly four and a half billion a year. i borrowed the idea from the republican version of the repeal of the aca where they were setting up a separate fund and i took what i thought was a good idea and made it into a different bill and we are hoping we can get support that will be bipartisan but we appreciate your testimony and your commitment to these issues. >> my pleasure. do you have any. >> thank you senator casey, senator young. >> mr. quinones, thank you for being here today. thank you for writing this important book and i put it your visit to indiana to visit with us last week. i'd like to discuss our children. thousands of children across my state and around the country are having their lives turned upside down on account of this

epidemic, not because they are addicts. per se but because they are being removed from the home and their parents have become addicted. they are entering and overwhelmed foster care system. you have identified in your book the need for more services for families. can you elaborate on what specifically and what needs there are for families or resources in your experience that might help mitigate this crisis? >> i think, honestly, the reporf talking to people who work in that field. i do think one of the areas that has been devastating his foster care. my goodness there is so much need now and if it weren't for grandparents in america today (it would be mind-boggling to

think of what the need would be. searcy, so many kids living with agreements now because her mom and then are gone or in prison or what have you. i feeling is on a very blunt, basic macro level that we need to look at how to fund more foster care and how to do foster care better is most likely another great question but is not one i feel i can answer. >> i thank you know your larger point about the solution, if you will to this broader academic is hundreds, thousands of individuals solutions and collectively many of them fall under the banner of community. >> absolutely. >> if we can persuade individuals that a fellow human beings plight, a fellow child, hardluck is actually their own plight then we can entice more

people to be foster parents and to care for these children and to lobby on their behalf and so forth. i think that's a good overall message that i've taken away from your book. we've discussed jails and in your book you have highlighted some jails that offer rehabilitation services and you yearly in those areas you have people putting themselves into the criminal justice system just so they can get assistance or you have other relatives or friends doing so and i would like i would like to discuss a different sort of setting. i visited -- i used represent often, indiana. you know that name because we have a huge hiv outbreak they are on account of the intermediates use of an opioid

by the name of [inaudible]. many local sheriff and communities like that around indiana have a strong suspicion and because i've spoken with them that their inmates have either hiv or hep c or something else that they might be test for they have a moral dilemma. they are on the phones and warns of a dilemma because if they test the individuals they are on the hook to provide medical services to them and in a place like scott county, indiana that would defeat their entire law enforcement budget for a year many of them tested positive. look, i'm not asking you to be a magician here but number one, have you encountered this dilemma? and if you have, do you have thoughts about -- >> honestly, senator, i don't doubt it exists. i have nothing surprises me

anymore about this topic i have to say but i don't but i don't doubt it exists. all i can say is that this is in the seems to be the nature of this problem that we are asking wellin one case foster care with another you just mentioned jailer to be again the magician and to figure out this deep social problem and that i don't think they have an answer for. they do not have an answer for nor to the have the funding for. what they go about doing is sometimes -- i am a reporter and sometimes i just have to say i don't know. i honestly sometimes it gets to that point where i'm overwhelmed by all of the ways that this problem manifests itself in there is -- it is weary i do

believe and locally that's the place where we find the solution but you all have an absolute role in facilitating and making sure that they have the resources they need because on the ground, i have to say the county and the people in those counties that i've been to are working hard and working imaginatively and so you going to them in finding out what they need to me seems to be the evidence would show the way we proceed on this. i don't believe i do not believe the most solutions emanate from washington dc and i do believe absolutely federal government has a profound role in helping those solutions and facilitating those solutions. >> i agree. thank you expect thank you senator young, senator [inaudible] >> i appreciate you having his hearing and it's nice to see

again. sprint u2, senator. >> one of the most compelling piece of nonfiction i want to read in a long time. it's very depressing. [laughter] there is a story you tell about something we haven't really talked about which is the heroine epidemic that road on the back of the prescription drug and you tell it brilliantly and my reaction reading it was this was all happening in plain sight but somehow we missed it. today 42000 people a year are dying from this and the white house estimated that this is costing the united states economy $504 billion a year so a billion dollars is a lot of money but it's point to percent what is costing our economy and the rural counties in my state in out this just isn't role counties anymore but the rural counties in my state for you go

and the sheriff tells you it's 92% of the people he's admitting in his jail are testing positive for heroin or the dealer who opens up his jail takes you back and opens the window and says look. and you say what are you showing me. there are women in my deal and i've never had women in my jail. the up to jail cells full. we are worse than 2% on treatment so i am all is a former local person all about people in the local community can't do it without resources. in the rural counties that i go to if anything they have less access today to addiction treatment than they did ten years ago. it striking that were moving in the wrong direction and i wonder whether you would want to comment on that. >> there is a lot to comment on. one of the problems is that with our opioid prescribing of these bills be in time created legions

of attics and that in turn awakened the vast logistics potential of mexican drug trafficking culture which i lived in mexico ten years and know fairly well. most traffickers never really cared to traffic heroine. it's viewed as a disgusting drug and people are far more enamored with coke and stuff. they want and they didn't really traffic heroine or they didn't want to get involved with it too much until we began to -- now of course their profit motivation is that radar is at a high level and they want to get involved and it's exploded the numbers of people who are trafficking from mexico and all sorts. that is one thing. as i said before i believe that the community solution and community is where it seems to me that i have seen people

working hard and coming up with solutions appropriate to their counties and regions. i do not believe that they continue long-term without a whole lot more help and sustained long-term focus. i believe that a lot of folks are looking to the federal government and republican and democrat right-wing and left-wing in this fight for sustained help not one off idea. >> you also say a word about you mentioned it briefly earlier about the ways in which health insurance reimbursement create challenges for the work at the local level what you are you are writing about the inability to be able to get low-cost social work for example reimbursed post two pills. >> initially, in pain management for many years you pain

management was to take one individual and design over a period of time in close connection to the patient and the doctor together design a menu of strategies that would help this one individual so one individual, many strategies. marital counseling, diet, acupuncture, on and on like that. physical therapy et cetera. job therapy, as we began to believe that one pill one kind of pill or drug would be the solution to all pain insurance companies dropped a lot of that in you couldn't design the full strategy and a doctor could not because you were never longer getting reimbursed for a lot of that. i think that is fundamental in this whole problem. doctors need they need to be more educated but they also need to have the tools doctors were

told there is a pain epidemic in this country and increasingly through the '90s into 2000 there were left with one tool and there's a big reason why we got into this. my believe strongly in this comes from talking with the doctors about their dilemmas is to find that they need more solutions in that moment when they are meeting with and some places are doing that. the va hats off to them, i think. they started a leader into all this and now we've done a u-turn and you can get yoga acupuncture et cetera as long and as well as some dose of opioid not to say that the drugs have no use. they are useful in certain windows but i think we are seeing these kinds of changes and it seems to me that the reimbursement for different

kinds of pain strategies is a fundamental part of this. >> senator michalski. >> thank you, mr. chairman. thank you for your leadership on this issue and really raising that level of awareness. as you point out this is been out there for a while. i think my colleague just mentioned it's been growing in plain sight here and thank you for acknowledging that there is no one silver bullet. i thank you said it's a complicated and no silver bullet are complicated adult problems. yet, we all know as has been mentioned it's not just an adult problem. our children are dying of overdoses and suffering because the parents are checked out. i went to a senior senator and sitting with a group of senior ladies and said if i weren't here having lunch with you today what would you be talking about. they looked around and said where we would find services for

our grandkids because all of us, all of us are taking care of our grandchildren because our kids are either in jail or have given up the kids whatever. this is truly a problem that consumes all ages, all spectrums, all classes. i'm interested in your suggestion that we need to look at this from a very broad perspective and strive high, a marshall plan, follow the same lines of the space program. the problem that i see that is we are still suffocated, strangled by the stigma that is attached. it seems like it is just been recently that you will see in the obituaries that there is an acknowledgment that this young person or individual died from an overdose. we have buried it because

there's a sense of i failed as a parent is my kid died from a drug overdose so until you can get beyond that stigma i think there's still so many that are like this is the ones couldn't make it and those are failures, losers, which is a horrible thing to say i even hate to say it in front of a microphone but there is that stigma out there. how do we get people galvanized to help and to be inspired to do something as big as i agree with you this needs to be in order to make that different are making headway restaurant in reducing the stigma? >> yes, great question, senator, thank you for asking.

i think definitely we are. i could tell you in 2013 i was writing this book and i had a conversation with my wife and said were to write this book and when you put out and fulfill the contract but the truth is it will die when it comes out because no one in this country cares about this problem. i cannot find anyone to talk about it except for public health nerds and the occasional narcotics officer but everyone else and the reason was one of the main reasons was that parents or families were mortified, embarrassed and this was a different kind of problem that existed in the past. people were mortified at what had happened to their children and you never ever saw an obituary that told the truth. it's like the eighth thing early on with that issue people he died of cancer and in this case it was he died at home at a heart attack each 25. i believe that what is helping to change that i think similar to the gate marriage issue which is a radical transformation in

public attitude in the last ten years is getting to know people who are affected and that is where i believe and i know you've heard about how you need to provide funding but i do believe you have a public profile role as senators. if you go to communities, find those parents and talk to them and point out the programs and meet with the county groups that are sprouting up all over the country. it's amazing to see this. lend your own public profile to them. meet with parents and say thank you, tell us your story, recruit them. i think frequently there are a lot of folks who would go a long and would do that if they were asked or played with. please do this and as i said in my testimony and maybe it's because i'm a reporter but i believe in the enduring power of story to change people's minds.

as human beings from the prehistoric times to today we always needed stories to help us understand and the only people and the reason it was not very well publicized years ago and hidden was because the people who could best tell the story didn't want to talk and now increasingly they want to talk and it's so important to embrace them, to bring them out of the shadows, they wanted many of them, some of them not yet, but maybe soon and without my feeling is the horrible stigma, exactly as you say, one of the main ways we defeat that is their stories. i believe as public officials you all could have a magnificent role -- whenever you go home or to some public event that we deal with this find those parents, bring them out, have them talk about their lives. with them and give them a call

saying i heard this happened and we would love for you to tell your story and if you can't right now, find but want them to know we are here. so many of them felt alone and they made horrible, bad mistakes because they thought there was no one else nearby to that they were all alone in this and i think defeating that isolation is part of the many solutions that have to be tried. >> great reminder to us. we can have that role to, thank you, mr. chairman. >> we have several senators remaining want to ask questions so i will try to stick to that five-minute just so that we have time for everybody to be involved. senator murphy is next. >> thank you very much mr. chairman. one of us were to go to the senate floor and give a speech on loneliness we would worry they would come off feeling or looking silly and yet if you look at the map of the suicide epidemic in this country the crisis is the worst where

socialized isolation is the greatest. if you read pete earley's great book about the mental health crisis in this country he comes to the conclusion that in the end the only effective treatment programs are the ones that build connectivity between people. you have entitled your book the great american heroin epidemic, you entitled it dreamland any major case in your opening comment this is about connecting. the story of dreamland is accommodated one. it's a private, low-cost community pool that closed in part because of factors that were outside of government control, people had more going on in their house and they had their own pools and they had more tv channels in kids had reasons to stay inside and yet you are and you content being critical about the decision by the government to let that pool close because theoretically there were other options.

they could've spent taxpayer money in order to keep it open and it probably would have been criticized during a weight money in a money losing effort but the result might have been that a community asset stayed open so i guess let me take you from where you left off and you focus your book on this question of building community and we are really awkward when we try to address the ways in which government can build community and attacked loneliness because it sounds like something were not supposed to do. at the heart this is a critique that we are thinking about these things. share with us your thoughts on how we can change may be the way we spend money or the way we do public policy to try to build communities rather than tear them down. >> i think it is to test idea that i can come up with is to

consult those people were already working on that and i think all across the country that is happening. that's another thing that has changed in answer to what senator murkowski said that we have up now on the ground lots of people working on this in a variety of ways. my feeling is as a reporter is always to go there and ask them but also understand that government has an essential convening role by providing the infrastructure that does bring people together. that includes stop signs and good roads, by the way. it also means funding to provide a community center in this kind of thing so i think my you might talk more about the senate floor honestly. i think it's not a conversation that we have enough in this

country and you all might be the ones to lead it. we would all be inspired if you did. seriously, that's my feeling anyway. so how do you do that? i am a reporter and i'm not sure i know all the ways. my impulse as a journalist is to go to those areas, talk to as many people as i can and highlight them. find the people who were working hard and find those communities coalitions, tax forces and your presence at one of those meetings would be huge. huge. trite doing that, it's a great idea. you know, try to be there with these folks and understand and see and it will be a pr event but who cares? you want to highlight these are the folks that we will -- and from that, that's how innovation works. you have factory floor and you

got the factory worker and the computer software and the accountant and are all putting their brains together in their finding incremental ways to make that product better and that is, i think, cities and towns work the same way. no magic bullet or civil or magic wand to slow incremental work. >> i raise the question because if we spend money on this epidemic is worth challenging -- >> most definitely and i am not saying we have all the answers. you know, i do believe in the overall -- someone asked me what are some of the details and i said i don't have a clue. i'm just a guy, a reporter out there trying to understand this enormous country we have and sometimes it's hard. >> thank you, mr. chairman. >> thank you. that's a good description the way we feel.

>> yes, i bet you do. i don't blame you. >> i want to ask you the holy grail, you are searching for the holy grail in what you think about that. you don't pretend to be medical expert but why is it not a good idea to search for or find nonaddictive pain killers? >> it is strange because my friends from college look askance when i say this but as i got into this story for the first time in my life i began reading philosophy about how we create happiness as human beings and how we achieve and how -- it seems like these people all across the country are looking to this substance in one form or another of opioids to be happy for a few hours and it seems to me that a few ways that the philosophers talked about working hard towards something that you are filled by and that's you love to do and it

comes with fulfillment that we call -- >> if i may interrupt, in your book you go through our first opioids were used to help people dying who were in horrible pain. then it appears erroneously that they might not be addictive and so this will revolutionary you describe it way of making pain a viable sign came about and then it turns out to be addictive but just because opioids turned out to be addictive is that a reason not to try to find other medicines that are non- nonaddictive or severe pain today and a hundred million who is something exactly. i would never stand in the way of science. but i feel that in the long run we are humans and humans have never done well when they have it all, when we have all the

pain treatment and none of the consequence. to me this is a hunch and if ten years from now, if i come up with a pill that reduces all pain to negligible amounts and does not addict anyone and i'll be happy for those who benefit. >> it sounds like your general approach and i don't want to put words in your mouth but it sounds like it would be possible and good if it were but i it would be one strategy. >> i believe other strategy, given the fact that we are humans and need friction in tension in our lives to be productive and be happy, in fact, i believe that there are other things that need to happen in american culture and i believe as individuals when i was writing this book i stopped drinking soda. i believe i wanted to be the

change that i wanted to see in the country so i stopped eating food that i saw advertised on tv. i felt that it was important to do things that would reduce the chance that i would have pain. i've no problem with research, trying to find a pill that would be completely painkilling but i have a skepticism that in the long run it would be that we would as humans be able to handle it and that some problem -- we behave very poorly and pain is a dictator and hollywood producers is a behave poorly when they have no other friction in their lives and no one to know credibility. >> i mentioned early that i drop by the governor's residence and he had a meeting of all the people in the state and the universities were in charge of training technicians with the goal of changing their attitudes

toward prescribing opiates. one of the health officials there said to me when i told them that i would be hearing from you today said ask him about the sentinel and where it fits and and 50 seconds can you tell us about that. >> sentinel has transformed the heroine market completely and it has democratized it. it used to be when haran was in the country you knew it came from four or five meccas and states and outcome from hungary or nebraska or canada and it has made heroine dealers far more willing to kill people. it used to be for many years you got one way customers you overdosed your clients and when someone overdosed that is not a warning, it was an advertisement on the street and a lot of

addicts iran to find that dope that od did that person or kill them. that was expensive to do and heroin trafficking and what you want to do is cut or reduced because he gets you more volume so you get 1 kilo and you cut into two or three and you sell that but it is weaker with less chance of od and fentanyl has made it far far cheaper to od people and therefore create buzz around your product. it's a diabolical thing to describe but that is the nature seems to be and it has allowed many more people to get involved in this and is coming from mexico but it's been sold on the dark web very prominently and that's a lot of people now getting involved in selling that never would have before. >> thank you. senator haskins. >> thank you for holding this hearing. thank you mr. quinones for being here in your work.

at the outset i would say that some of the themes you touched on today about community are also seems that the author in social i saw untrained social apologist robert putnam touched on. i think your book in his together are important. i want to start by laying groundwork. i was governor of new hampshire starting in january 2013. i'm also a governor who worked my republican legislator to implement medicaid expansion which was implemented in the middle of 2014 in august, i think. in 2013 we had 192 overdose deaths in new hampshire. in 214326 and we were on an upward trajectory even before medicaid expansion. in fact, one of the reasons we all came together to implement medicaid expansion was because he had a crisis in our behavioral health and drug overdose death in our state and we knew that medicaid expansion would get more treatment to

people. my own anecdotal sense that medicaid expansion did not, in fact caused an increase in opioid desk is reinforced by recent article in health affairs. i just want folks to have a sense of that. i think there may be a correlation here but to suggest that there is a causation is very troubling to me. i also think it speaks to the stigma issues that you have talked about. i do also want to thank you for your insistence that this is a problem that was decades in the making. it will be decades in the fixing and it requires subtle approaches and approaches that can evolve the way this epidemic is evolving to the germans point fentanyl in our state has changed a lot in the way law enforcement in the treatment community addresses this. i thank you for your advocacy

for that. i want to spend a little bit of time on one of the issues that i don't think we have touched on as much right now as it deserves. in your book you chronicle the so-called [inaudible] letter, 1980 letter to the medical new england journal that was misinterpreted and used to claim that their products are virtually nonaddictive. doctors also wrongly relied on the letter as scientific evidence that addiction is rare when using opioids. it is astounding that one paragraph jotted down in 1980 help fuel the horrible epidemic that we are seeing today. your book outlines how drug companies have played a big role here and how some of them have misled patients, providers and public officials about the addictive nature of their products. can you give us a brief overview of the role of the pharmaceutical industry in

creating the misconceptions about the letter? >> brief? [laughter] >> you have one minute 45 seconds. >> well, i think it shows that it was pivotal in all of this. it starts with pain specialists believing we were poorly treating pain. and we were. this is not a story of a lot of people doing what they thought was a great thing but doing so much of it and it turned out badly. i don't believe that they would have had the megaphone that they came to have were it not for a lot of the money and funding in the use of the selective use of their information by pharmaceutical companies. i think their money and influence was what really changed the tide and of course they were joined by certain institutions like the va and household accreditation organization and vital sign but

i think they sought early on and they saw they had tried time released opioid only for cancer patients and it was a magnificent truck. if they had stuck there we be applauding the. instead, what they saw was if it helped a dying cancer patient and that was small and there was a much larger base called chronic pain which is normal pain of americans basically. they got on board. this is also, by the way, an important part of this was these years were involved the industry went through a sales force arteries for every company is hiring more and more and more sales reps and these were not the older sales reps who were more grounded in fact. my impression that you doctors do these older fellows that were mostly guys these guys knew what they were doing and they were

not such a hard sell and they were more informational and then you hire a bunch of young folks a lot of very good looking young folks to inundate and sell our pharmaceutical reps went from 35000 to over a hundred thousand in about a five year period and all of that also is part of this story and i have to say this though. this is a compensated tail and i wanted to not blink at the complications. i believe we as americans play a huge role in all of this. our desire to have quick and to pain and to not be accountable for her own wellness. >> i think that's fair and i'm over time and i thank you for this. i also won't have a time for second round of questions but i will say that in my state the need for funding to support the grassroots effort like our safe station programs and some of the things our law enforcement is doing in treatment is critical and i would look forward to talking with you more about that.

thank you mr. chair. >> senator came. >> thank you mr. chair. i think dreamland in a factory land are the two best works of reporting that i've read in the last 25 years. >> thank you so much. >> twin's work. i want to ask two questions by can get to two. the first one is we've had witnesses here mr. quinones and i've asked them francis collins if we could set a goal addiction free by 2030. i mindful of your point that there is no silver bullets but i'm also mindful that if you don't have a target to organize around we will be on the move we will rebuild these economies and enable them to protect themselves from this if you don't set the target then you don't marshal your resources around meeting the target so if you were to advise us about what the target would be and again i posed the question to these

folks to reset the target of addiction free by 2030 and francis collins and they said yes, that's doable if you define it the right way and it's doable within the current scientific knowledge and technological likely near-term future but if you were to give us a target, what would you tell us. >> if i gave you a target we'd all be in trouble. [laughter] i would say that a target is good and as my hunch as an american that is something to strive towards is always good to have a deadline and always good to have a goal. what that you should be and whether or not humans can ever be addiction free is a debatable point in my opinion. however, as i said in some of my testimony and written and oral to me this is a supply story. i've lived in mexico ten years and when i was in mexico i not

having thought about it deeply i adopted the idea that all our american drug problem was demand driven and. >> and there's evidence for that. when you arrest a streetcorner dealer another one pops up and on the supply side but the demand is going to keep producing streetcorner. >> yes, and i agree but the primer in all of that in the thing that starts it, i believe his supply. i came to believe that after living in mexico where i believe the demand because mexicans like to believe that because it absorbs them of responsibility in our drug problem which is really not our drug problem but they buy national drug problem and it needs to be addressed as such. when i start doing this book i said that's not exactly what happened. we had no real problem with this before this overprescribing of all. the difference in the story is that the supply did not come from colombian dealers and

mexican cartel, it came from doctors buying into sincere well-meaning, good, well-trained doctors buying in to an idea that they could help their patients by massively prescribing these pills. so, the goal is a laudable one and the goal in a target but to my way of thinking there is supply is the issue and i mean the pills, heroin, fentanyl and in order to get there i believe it requires that there is a reason why all those guys from vietnam came back addicted and so many of them are kids. first of all, they were in rural tennessee and there was no supply. they found -- the more use separate the attic from the supply the better chance that attic has of success and that is what they're finding in some parts of ohio. >> let me ask you a second question. my brother-in-law dwight.

>> i know him well and i was going to say thank you. what a wonderful guy. >> he decided he'd be a substance abuse and suicide prevention lines for life and dwight says this. he told me this many times that there was a social movement force for recovering it would become the most powerful political movement in the united states. he's grappling with this issue of how do you get over the stigma and then democrats and republicans red state, blue state in this recovering social movement would be massive and would help us meet whatever target we set i'm curious we think about that. >> again, i believe in the more stories you tell and the more people who end up -- this is what happens to me on airplanes all the time. a certain theme of the book i just wrote what you do for living and i will tell them in a look around like this and will touch under their breath still go i'm a recovering and i've done five years or whatever and i think the more those stories come out in the more we all know

how many people around us have this issue in their lives the more it becomes and you don't have to lower your voice anymore the becomes natural and recovering from acts and i think it's important for recovering addicts to mention that a lot because it normalizes it and it makes us all understand that this is something that is going on all around us and it is amazing thing to have written a book like this and go on the road and have these encounters and airports in places like this sold the power of story, as i said. >> i'm over my time but a patient you be here today. thank you expect my pleasure, senator. >> senator warren. >> thank you for being here. thank you for your research on the rise in prescription opioid use and i want to follow up on your point about supply.

in your book you write about a hospital in columbus where a doctor in the adolescent medicine department helping heroin addicts get detoxed talks about the kids he was seeing what started with prescription pain killers. he says it was zoloft and that's how it got started. a story that is true i take it for far too many americans and according to the cdc people who are addicted to prescription painkillers are 40 times more likely to be addicted then to heroin. many people who misuse prescription opioids take the pills that were they start with legally prescribed pills to them or a friend or a relative and i know you've written about your own personal experience with opioid prescription when your appendix was removed and do you mind saying more about that experience? about how many painkillers you

are prescribed and how many you thank you actually needed? >> certainly. i don't think my story is multiplied by millions every year for 20 years. i had an appendix rupture at work when i was at the la times night shift and i didn't realize it and went home and went to the hospital later and they said my appendix had ruptured and i spent two days in the hospital and it was a perfect example of what to do and what not to do. each of the two days of the hospital to give me to vicodin perfectly acceptable in a very good idea. i just been cut open. then when i left they gave me a bottle of 60 vicodin and said take as needed. i'm a crime reporter and i've done work on games and stuff like that i have never written about healthcare. i do not know, plus i spent most

of my last ten years in mexico not paying attention to this issue at all. i did not know what vicodin was. i thought it was a glorified aspirin because they told me as i left take as needed. i'm like okay, that public aspirin to me. i don't like taking pills so i took two of them. >> so two is what you needed and you got 60. [inaudible conversations] >> it remained in my medicine closet until i got in the middle of this project and i knew now what bike it and wasn't sure enough, i found it indisposed of it. again, a couple of things. that is the perfect example of the supply that we have unleashed on this country. you multiplied my case by millions and millions of people every year for 20 years and you get to where we are. >> so there is data on this. there is a study in the journal of the american medical association the found between two thirds and 92% of patients

who underwent various surgical procedures like you did report that they end up with unused opioids "after words". and just like you a lot of these surround in the medicine cabinet and fall into the wrong hands. >> very easily. >> as senator alexander generously noted last congress senator and i had passed a bill to tackle this problem by letting patients request only a fraction only a day or two of their opioid prescription to be filled at the pharmacy and if they were still in pain a few days later they could get a few more pills if that is what they wanted to do. i know -- you talk about how complex but let's talk about that one little -- >> i think that is the kind of thing i'm talking. these small solutions with many, many small solutions. one of them is to take that kind of supply out of the medicine cabinet of america and i think

also to give doctors in the habit of questioning and i think it was routine for years in this country to prescribe 60, 90 of these bills and get doctors out of it. think of the windfall by the way, to a pharmaceutical company when a doctor in a white coat prescribes you ten times more of the pills that you need and you like i did okay. >> or in this case three times. >> plus then there's refills on so on. again, i get back to the basic dichotomy here. this is a story built on police in a magic bullet solution and i think there's lots and lots of little things and what you are outlining sounds like to me one of those little things. >> good. i just want to say on this we got the law passed here but that doesn't make it a reality. we have sent letters to every

governor in the country and two loads of different medical organizations asking them to back us on the implementation of partial phil also here we are more than a year after the law has changed in the drug enforcement administration still has the definition of partial phil that is out of date not in compliance so a couple of weeks ago senator o-uppercase-letter and i along with senator grassley and senator feinstein sent a letter to the dea to ask them to update these regulations. as you said big and complex problem and we've done her part and now we've got to get the bureaucracy to get in line with us. thank you. >> thank you, senator warren. senator baldwin. >> thank you. i really appreciate you being here today. >> my pleasure, senator. >> what an opportunity to have a

conversation. you chronicle this epidemic as having its roots two decades ago, at least. >> yes. >> and yet, we find ourselves still scrambling and in some cases not gaining ground but losing ground. i represent wisconsin and the new front of this battle appears to be conventional. >> it does indeed. >> and in a community like milwaukee county, largest county in the state of wisconsin, fentanyl specifically was the cause of 170 that's in 2017, combined with other opioid overdoses. there were about 420 in that county last year. >> i'm sorry. >> yeah, and it's one example in the state of wisconsin. at this point there is no sense

that 2018 will be a turnaround here. despite the fact that milwaukee county has a committed heroine test course and leaders from our local law enforcement and health providers have been collaborating to address this. i wanted to dovetail your conversation with the chairman about synthetic like all that have changed this epidemic in some ways. do we need to be prepared for even the next generation of synthetic opioid? and what is the federal role again in assisting communities? >> well, gosh, that's a huge

question. i'm not sure i have all the answers. >> i have a couple more huge questions, to. >> i'm sure. there's nothing but huge questions in this topic it seems to me. back fentanyl has been remarkable in its transformative and if the third stage with the pills and heroin an hour on conventional and car fentanyl which is a painkiller. i do believe it is my belief strongly having lived in mexico that it is calling on us to understand that the only way we will stop any kind of effect on fentanyl is by working with mexico, not at odds with mexico. there is no way you can stop the smuggling of fentanyl. we come alone, cannot stop the smuggling of federal into united states because it is so small. it's a sugar packet with a fentanyl will kill everyone in this room. and probably the sole floor. my feeling is that one thing we need that seems to be extraordinarily counter

productive in my opinion having lived in the country a long time is frederick that demonizes mexico. i am not saying that as a way of putting on rose-colored glasses with regard to mexico, i live there and i know the issues and i know the option and i know the depth of probably have their but nevertheless i think in a person to person connection with we really never have achieved as government, i don't think, and from what i can see that is how you advance. you know they both shut down an interesting case in july, they shut down a two major dark web marketplaces in july of last year and they did it with dutch police, interpol, dea and others and it was a classic example of making a huge dent in supply by working with these governments

and global economy. apparently the only governments attend groups that don't work globally is government. that's how you move forward and to be those are the ways that you help local law enforcement. being in local on wednesday feels to me like you're standing in the ocean trying to keep back the tide. >> yeah, you ask a question i don't think there will be time for an answer but maybe we can follow up. i've held a lot of roundtables with stakeholders from recovering addicts, family members, lost loved ones, law-enforcement, health, et cetera it around the state. you talk so much about solving this and ending isolation and having stronger communities and i do find significant variation between what i hear in urban centers, in wisconsin, in the

rural areas, everything from the availability of resources to help people who want to get treatment for their abuse even to what drugs are being taking and abuse. i would love to hear your thoughts and i will not be able to stay for the second round but perhaps in follow-up about you strengthen communities and all those different settings as they respond to sometimes unique and sometimes common challenges. >> thank you senator. senator collins. >> thank you, mr. chairman. i want to explore further with you the link between economic affliction and drug addiction. you have referred to many of the communities in your book like ohio have been devastated by

closures for example. it is also that you said heroin is what you have when you destroy dreamland. you said that isolation and its heroines natural habitat. in the state of maine the opioid crisis appears to have started decades ago in washington county which borders canada and it is an economic disadvantage county with very high rates of unemployment and a lot of isolated communities. it then spread everywhere in the main including our most prosperous towns and cities. the portland press herald last summer iran a ten part series on the opioid epidemic and it focused one-story on the lobster

industry highlighting the high entry rate and that industry and also the logistical challenges of securing treatment in rural communities. >> great story. i read it. >> they will be glad and impressed to know that i tip my hat. >> in your investigation did you find that drug dealers tend to target communities that are economically devastated? are they more fertile ground for addiction? >> i did not notice that. i don't think drug dealers are deep sociologist and they're just following the money and the first place where this began and again it began in areas that are economically devastated because pain treatment and resorting to

doctors was part of how you navigate economic disaster. you get this ability as we talked about earlier and i can't remember the senator but it was asked that people are trying to navigate and they get workers comp and they get ssdi or whatever and you need a doctor to get that. again, this seemed to be the pills came a resort to sustenance. you get high on them and people for the amount and some of the dealers were seniors and they were not young people at all. they were seniors who figured out these kids will buy the stuff and i'll sell keep what i need and sell the rest. that kind of thing. i do believe as you say that this starts in areas of deep

economic affliction and there viewed as the losers in the great tree trade gambit. now, of course, some of the things that i have begun to realize and made me change my view of the story that i was writing was that it switch to charlotte, doctor alina. it's a baking center, wealthy clubs, mansions, and it gets into larger questions and how we view pain and how quickly we want to and easily we want to deal with it. >> i also want to follow up on your comment about the heroic roles played by grandparents. i held a hearing in the committee to look at this issue of grandparents raising their grandkids due to the opioid

crisis and just as an important statistic i will tell you that in my state between 2010 and 2015 the number of grandparents taking care of their grandchildren and being solely responsible for their care sort by 24% and it is because of the opioid epidemic. >> yes, and that is what is happening and i don't think there's make that story is repeated almost -- many states. >> thank you for your good work. >> thank you, senator. >> senator murray, any additional questions? >> i want to thank our witness for being here today. your name has been pronounced a lot of the. can you pronounce it? >> yan