other areas. they are telling addicts if they come in with the drugs, and turn them in, 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 that they need. and it is also very community-based that you have suggested in your book. in your experience, have you seen that type of program work better than the traditional approach? >> a couple of things and i would say. first of all, in reference to the first point senator, i think we need to keep in mind that this problem has been festering for 20+ years. 20+ years. people come small time and say why is this? and i say has been going on for

20 years. we've been at this for a year and and a half or two years. it seems to me as a culture we need to learn patience. and not believing silver bullet answers. like the mysteries of human pain. it is a complicated thing. we've not solve this problem in the air and half or two years i would say of course not. we just need to keep working at it. these things exist because they took a long time for these things to exist. and law enforcement i would say, in general, some of the most innovative folks and innovative things i have seen come from law enforcement. we think not. think law enforcement will be holding onto the old ways. no. i've been amazed to see remarkably innovative ideas that come out of law enforcement. the one that you mentioned is one of them. one that i mentioned in my written testimony is about the

transformation of jail. i believe if we come out of this with a new kind of jail, the new way that jail is run as you see actually in the state of kentucky, 2000 jails during the spring that would be an enormous advance. what is more jail would then be a asset again. not a liability. today jail is a liability. as a place we take people who, was a detox, want to see clearly the records of their own lives and want to change. then we put them in a place that is tedious, predatory, ganged up, sexual stuff going on. all of that kind of spell only. and the pods that i have seen in seven jails and and one in particular in kentucky, a remarkable. a change of nurturing. one of time together. it is where you're working on

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

happening. not just the revolutionary idea. you can find this in various examples around the country. it is very invigorating to see. >> thank you. >> thank you, senator collins. senator casey. >> thank you, mr. chairman. mr. sam quinones, thank you for your testimony and i would like to start with some of the realities in a state like pennsylvania. we have had last year, 4624 overdose deaths. that is up 37 percent from the prior 2015. and rural areas are higher. almost 10 percentage points higher byway percentage. of an increase. and that is overdose deaths overall. obviously love that being driven by the opioid crisis epidemic really. what i see and i miss some of the testimony going back and forth between hearings but what

i see in pennsylvania is a tremendous resource. when we went across pennsylvania last year, especially this last summer, we would have meetings with county officials. often in small rural counties. small-town counties where you have a group of people coming together. the mayor of a small town in the police chief in the corner. and any medical professionals that treatment professionals. all around the table meeting all the time every week. because of the dead bodies that keep coming in. one county, a very small county said to us, maybe the most graphic metric was they did not have enough places to put bodies. that is how bad it was. it is everywhere but what i keep hearing from folks at the local level is we need more resources.

we are getting our arms around this. we are dealing with this is a local community but we need more resources. they needed for community health workers, social workers, law enforcement. they obviously are bearing a lot of the third. i guess the first question i would ask is what recommendations we have for closing the resource gap which i think is a, in the federal government has made some strides as you know, with cures and -- what is your sense of the way the federal government can provide resources. >> counties and the level of government most affected, corners, gels, libraries, public health, cherif, etc. i have been struck particularly in the last year year and and a half to watch the very organic taskforces, committees or what you have you. sprout up in county after county.

in pennsylvania, i was in -- i spoke with those folks at some length. yes. these folks are coming together in very healthy ways. they are leveraging, there's a whole bunch of people on the committee. our recovering addict, primary care doctors. i spoke with the president that recently she said one of the problems is we can find medical programming. for naloxone and whatever. but we cannot find money for the nuts and bolts that make it work. like office space and you know that kind of stuff that as essential is not as sexy as the other stuff. to me, i think the federal government needs to step up. and the are wonderful but i do not think that we have been doing this for 20 years over

prescribing and creating addiction unintentionally 20 years. one year, $1 billion is a lot of money. but in comparison to what the country needs comets in every state. it is an unprecedented problem because it's in every state in america. coast-to-coast. this is, what i am suggesting is that this evidence shows that there is a need for sustained, i am talking years worth, sustained investment in i think, thinking in terms of for example, there is more mundane idea of how to, that their job easier. on telephones. that kind of thing. and we can talk later if you like about the issue of corners. but to me the crucial part of this as well. i think i know it feels like a lot of money, $1 billion is a lot of money. but not compared to the lack of

depth and length of time that this problem ãof this problem. it seems to me it needs to go. >> thank you for that. i know we are out of time. i have done to commit for now billion a year. if the idea from the republican version of the repeal of aca where they were setting up a separate fund. so i just took what he thought was a good idea and made into a different bill. we are hoping that we can get support that will be bipartisan. we appreciate your testimony and your commitment to these issues. >> my pleasure. if you have any. >> thank you can senator casey. senator young. >> mr. sam quinones, thank you for being here and thank you for writing this book. you came to indiana to visit with us last week. i would like to discuss our children. thousands of children across my state and really around the

country are having our lives turned upside down. on account of this epidemic. not because they're addicts per se. but because they are being removed from their home. their parents have become addicted. they are overwhelmed in an already overwhelmed foster care system. if identified in his book the need for more services for families. can you elaborate on what specifically, what sort of needs there are for families or resources in your experience that might help mitigate this crisis. >> well, i think honestly, as a reporter i like to say that probably the best to talk to people that work in that field. one of the areas that has been devastating is foster care. my goodness, there's so much need now. the word for grandparents in america today, it would be -- just, mind boggling to think

with the needed b. searcy, so many kids are living with their grandparents not because the mother and father are gone or in prison or what have you. so, my feeling on a very blunt basic kind of macrolevel that we need to look at, and how to fund more foster care. how to do foster care better is most likely another great question. but not one that i feel like i can answer. >> you know you are, your larger point about the solution, if you will to this order epidemic is, hundreds, thousands of individual 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's hard luck is actually their own

plight. then we can entice more people to be foster parents. to care for these children. to lobby on their behalf and so forth. i think is a good overall message. taking that away from your book. we've already discussed the jails. in your book you have highlighted some gels that offer rehabilitation services. and particularly, in those areas, you have people putting themselves into the criminal justice system just so they can get assistance.or you have relatives or friends doing so. and i like to, i would like to sort of discuss a different sort of setting. i visited with jails. i used to represent the house of representatives, austin, indiana. you know that name because we

have a huge hiv operation out there on account of the intravenous issues and nlp are named opana. many communities like that around indiana have a strong suspicion because i've spoken with them. that their inmates have either hiv or hepatitis c or something else. that they might typically test for. they have a moral dilemma. there on the horns of a dilemma because if they test these individuals, there legally on the health to provide medical services to them. and in a place like scott county, indiana, that we deplete the entire law enforcement budget for a year if 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 yes, do you have any thoughts about how check

request honestly senator, i have not. i do not doubt it exists. i mean nothing surprises me anymore about this topic i have to say. but i do not, and sandra do not -- you know, all i can say is that this is, it seems to be the nature of this problem that we are asking in one case, foster care. in another case that you just mentioned, a jailer to be the again, the magicians. to figure out this deep social problem and i do not think they have an answer for. they do not have an answer for this nor do they have the funding. what they go about doing sometimes, i'm a reporter. sometimes i just have to say -- i mean, i don't know. honestly, sometimes against the program overwhelmed by all of the ways that this problem manifests itself. there is a -- it is, i do

believe locally, it is the place where we find the solutions. but that you all have an absolute role in facilitating. making sure that they have the resources they need because on the ground i have to say, it -- the county, the people in the counties that i have been to our working hard and working imaginatively. ... and helping those solutions and facilitating the solutions. >> i agree.

senator bennett. >> i very much appreciate you having this hearing. one of the most compelling pieces of nonfiction i've read in a long, long time, and it's very, very depressing. something we haven't really talked about which is the heroin epidemic that rode on the back of the prescription drug. utility for lee and he. my reaction reading it is this was happening all in place but somehow we missed it. and today 42,000 people a year are dying from this. white house estimated that it's costing the united states economy $504 billion a year comes wit, soa billion is a lott it's .2% of what it's costing the economy. it isn't just about the rural counties anymore.

the sheriff tells you a 92% of the people he's admitting our testing positive for heroin. the jailer that opens up and take us you back and opens up the window and says look what are you showing me? there are women in my jail. i've never had women in my jail and we are spending .2% on treatment, targeted treatment. so as a former local perso persm all about people in the local community but they can't do it without resources. if anything, they have less access today than they did ten years ago so it is striking we are moving in the wrong direction and i wonder whether you want to comment on that. >> one of the problems is with

the overprescribing of the pills we created legions of addicts and that a weekend the vast logistics potential of the mexican drug trafficking culture which i know fairly well and that is when most never really cared to traffic heroine. it's viewed as a pretty disgusting drug and people are far more enamored with meth and coke and stuff, so they didn't really tragic heroine or they didn't really want to get involved in it too much until we began to explore and now the prophet motivation is at a very high-level and thehigh level ant involved in that and it exploded on the numbers of people who are trafficking from mexico and so forth, so that is one thing. as i said before, i believe that

the community solution is where it seems to me i have seen people working hard and coming up with solutions appropriate to their counties and their regions. i do not believe they can continue long-term without more help and sustained as i've seen a long-term focus from the federal government. i believe a lot of folks are looking to the federal government republican and democrat, right-wing and left-wing in this fight for the sustained health and not one off. >> you mentioned very briefly earlier about the ways in which health-insurance reimbursement are creating challenges for the work level.

initially in pain management for many years pain management was to take one individual and design over a period of time ind close connection to the patient and doctor together a menu of strategies. marital counseling, diet, acupuncture, things like that, physical therapy etc.. as we began to believe that one kind of drug would be the solution to all the insurance companies dropped a lot of that and you couldn't design the full panoply. because the were no longer getting reimbursed for a lot of that. to me i think it is fundamental in this whole problem.

doctors need to be more educated that when they get educated they need the tools and doctors were not told that there is a pain epidemic in the country and they were left with one tool. the reason we got into this. ibb strongly and this comes from talking with lots of doctors about their dilemma is to find that they need more solutions in that moment when they are meeting in some places. now they can get to the acupuncture etc. they are absolutely useful.

it seems to me the reimbursement for printing strategies. senator murkowski. >> thank you for your leadership on this issue and really raising the level of awareness. as you pointed out, this has been out there for a while but i think my colleague just mentioned that it's been growing in plain sight and thank you for acknowledging there is no one silver bullet. it is a complicated problem and yet we all know and have been mentioned it's not just an adult problem.

this is a problem that consumes all ages and spectrums and classes. i'm interested in your suggestion that we need to look at this from a very broad perspective and really strive high on the marshall plan to follow the same lines of the space program. the problem i see with that is we are still suffocated and strangled by the stigma is attached. but is attached. it seems like it has just been recently that you will see in the obituary that there is an acknowledgment this young person, this individual died of

an overdose. but we have very good because there is this sense of wide field as a parent if my kid died of a drug overdose. until you can get beyond the stigma i think there are still so many like those are the ones who just couldn't take it. those are failures, losers, which is a horrible thing to say and i even hate to say it in front of a microphone but there is the stigma that is out there. so how do we get people galvanized to help and to be inspired to do something as big as i agree with you that this needs to be in order to make the difference. that difference. are we making headway in reducing the stigma? >> guest: crate question, thank you for asking. i think definitely we are.

i was writing this book and i had a conversation with my wife i said we are going to write this book and put it out and fulfill a contract, but the truth is that is going to die when it comes out because nobody cares about this problem. i couldn't find anybody would want to talk about it except the occasional narcotics officer or judge. the reason was common one of the main reason most parents or families were mortified, and barest. this is a different kind of problem and people were mortified at what had happened to their children. you never saw an obituary that told the truth. it was like he issue. in this case it was he died at home of a heart attack at age 25. now, i believe that what is hoping to change that i think similar to say the marriage

issue it is getting to know people that are affected. i know you've heard a lot about how you need to provide more funding but i do believe we have a public profile role. if you go to the communities and find those parents, talk to them, meet with the county groups that are sprouting up all over the country. it's amazing to see this and when your own high public profile meets with parents and say thank you, tell us your story and helped recruit them. i think that there's a lot of folks who would go along and do that if they were asked. if they were flooded with, please do this. and as i said maybe it is because i am a reporter but i

agree with the power of the story teaching people's minds. as human beings from the prehistoric times to today we've always needed stories to help us understand and the reason this wasn't very well-publicized is because the people who could best tell the story didn't and now increasingly they want to talk and it's so important to embrace them and bring them out of the shadows they wanted many of them not yet but others someday soon and with that my feeling is there's a horrible stigma exactly as you say and one of the main ways we defeat that is through stories and i believe as public officials, you all have a magnificent old whenever you go home or go to some public event that may deal with this, find those parents com,bring them out, have them tk about it, and recruit them to

give them a phone call saying i heard this happen and we would love to hear your story. we just want them to know we are here because so many of them also on. they made bad mistakes because they thought that there was nobody nearby and that they were all alone in this. defeating that isolation is part of the solutions of things that have to be tried. as they make a great reminder it's not just all resources. >> thinks senator murkowski. we have several senators remaining so i'm going to try to stick to the five minutes if i may just so we have time for everybody to be involved. senator murphy is next. thank you mr. chairman. if one of us were to go down to the senate floor and give a speech on loneliness, we would worry that it would come off feeling or looking silly. if you look at a map of the

suicide epidemic in this country, it is the worst and if you read the great book about the mental health crisis in this country, he comes to the conclusion that in the end the only effective treatment program is the one that builds connectivity between people and you did entitle your blog the great american heroine epidemic, you titled it dreamland. you made your case in the opening comment. the story is a complicated one. it was a private low-cost community pool that closed in part because of factors that were outside of the government's control. peoplesoft war going on in their house, had more pools, tv channels, kid had lots of reasons to stay inside, and yet you are sort of hinting at being critical about the decision by the government to let the pool close because theoretically

there were other options. they could have spent some taxpayer money in order to keep it open and probably would have been criticized for throwing away money in a money losing effort, but the result might have been that the community assets stayed open, so i guess lets me sort of take you from where you left off in your testimony. you focus your book on this question of building community and we are really awkward when we try to address the ways in which the government can build the community and attack loneliness because it sounds like something we are not supposed to do and yet at the heart this is a critique that we should be thinking about those things so share with us your thoughts on how we can change may be the way we spend money and do public policy to try to build communities rather than tear them down.

>> the best idea that i can come up with is to consult the people that are already working on that and i think all across the country that is what is happening and that has changed that we have nobut we have now d lots of people working on this in a variety of ways. my feeling as a reporter is always to go there and ask questions but also understand that the government has a convening role by providing the infrastructure that does bring people together, that includes stop signs and good roads by the way that kind of thing, but also funding to provide community centers and this kind of thing.

we would all be inspired if it did, seriously, my feeling anyway. i am a reporter. i'm not sure if i know all the ways. my impulse as a journalist is to go to those areas and talk to as many people as you can and highlight them. find people working hard and those coalitions and task forc forces. will it be will it be a pr even, who cares. these are the folks working and

from that that's how innovation works. you've got the factory floor, factory worker, the supervisor, computer software guy, they are all putting their brains together and finding little incremental ways to make the product better and that is i think cities and towns work in the same way no magic bullet, sulfur magic wand, just slow incremental work. >> if we are going to spend an awful lot on this epidemic thank

you senator murphy bed is a good description on the way we feel. >> i want to ask about the holy grail. what do you think about that, you don't pretend to be a medical expert but why is it not a good idea to try to find nonaddictive pain medicine? >> it's a strange thing. 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, how we achieve, what is happiness, because it seems like all these people across the country are looking to this substance, one form or another to be happy at least for a few hours and it seems they talked about working hard toward

something more fulfilled by god you are excited by and about you love to do and along the way comes a fulfillment. first it was to help people dying who were in horrible pain. then it appeared they might not be edited as revolutionary as you describe it way of making pain a vital sign came about but just because opioids turned out to be edited, is that a reason not to try to find other strategies that are nonaddictive?

to me this is a hunch. i'm not saying ten years from now or five years if i have to come up from the bill that reduces all to negligible amounts and does not they would be thrilled and happy for those that benefit and i would be one of them. it sounds lik like you would sut it could be possible. we need friction and tension in our lives to be productive and be happy and back. i believe there are other things that need to happen.

when i was writing this book i stopped drinking and wanted to be the change i wanted to see in the country so i stopped eating food i saw advertised on tv. i felt that it was important to do things that wil would reducee chance that i would have pain. i just have a skepticism that in the long run he would be able to handle it, that we behave very poorly when they have no other friction in their lives and public accountability. >> he had a meeting of all of the people in the state and universities who were in charge

of training with the goal of changing their attitudes towards prescribing them of opioids. one of the health officials said to me when i told him i would be hearing from you today, he's asked him about fentanyl. so in 50 seconds can you tell us about that? >> it's transforme transformed e market completely. it has democratized. it used to be when heroine was in the country we knew it came from mexican states and what can come from hungary, nebraska, canada. it has made heroine dealer is far more willing to kill people. used to be for many years you ht it by overdosing clients when somebody overdosed that was not a warning, that was an advertisement on the street.

and heroine trafficking what you want to do is reduce the number because it gives you more volume so you cut it into two or three at a south that there's less chance of being people saw what he has donit has done is it's mr cheaper to b go to the people ad then therefore create bugs around your product. it's a diabolical thing to it scribed leakages cried that is in the nature of which seem. also, it has allowed many more people to get involved in this and by the dark where that's coming from mexico but it's also being sold. prevalently and that has allowed a lot of people not to get involved in selling its probably never would have before. thank you for being here and for

your work. just at the outset, i would say some of the things you've touched on today about community also seems that the author a sociologist robert putnam has touched on and i think that your book and his together are really important. i want to start by laying a little bit of groundwork. starting in january 13 i was also a governor that worked with my republican legislature to implement medicaid expansion which was implemented in the middle of 2014 in august. in 2013, we had 192 overdose deaths in new hampshire. in 2014, 326. we were on an upward trajectory even before medicaid expansion. and in fact one of the reasons this all came together to implement if he'd expansion is because we had the crisis in the interval health and drug

overdose deaths in our state and we knew medicaid expansion would get more treatment to people and my own anecdotal sense is that it did not in fact cause an increase in opioid deaths slide just want folks to have a sense of that. i think that there may be a correlation here, but to suggest there is a causation is very troubling to me and i also think it's the sum of the stigma issues that you've talked about. i do also want to thank you for your consistent that this is a problem that was decades in the making. it's going to be decades in the fixing and it requires subtle approaches that can evolve in the way the epidemic is evolving to the chairman's point. in our state it has changed a lot in the way law enforcement

and the community addresses this, so thank you for your advocacy. i want to spend a lot of time on the issues i don't think we've touched on as much right now as it deserves. the new england journal of medicine was completely misinterpreted and used to claim that their products are virtually nonaddictive. doctors only rely on the letter as scientific evidence that it is rare when an opioids. it's astounding that one paragraph jotted down in 1980 helped fuel the horrible epidemic that we are seeing today. your book outlines how drug companies played a big role in 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 and creating the misconceptions? >> brief? >> you have one minute and 45 seconds. >> well, it would be pivotal in all of this. it starts really with specialists believing we purportedly treating pain, and we were. this is the story of a lot of people doing what they thought was the right thing but doing too much of it maybe. i don't believe they would have had to megaphone that they came to have were it not for a lot of the money and funding and selected use of their information by pharmaceutical companies. i think that their money and influence is what's changed thee tide and then of course they were joined by certain institutions like the va and other possible accreditation

agents with a vital sign and all that kind of stuff that i think they saw early on that they tried a time released opioid and that's costing only for cancer patients. had they just kind of stuck right there, we would have been applauding them. instead, what baseball is a dying cancer patient market was pretty small and there was a much, much larger one called chronic pain which was normal pain of america basically and they got on board. this was also by the way what the industry went through was a arms race where every company was hiring more and more and more sales reps and these were not the order sales reps it's my impression talking with the

doctors they knew what they were doing and it went from 35,000 to 100,000. it was also part of this story and i have to say that this is a complicated tale and i want to not blink at the complications. i believe also we as americans play a huge role in this. our desire to not be accountab accountable. >> i think that is fair and i thank you for this. i also just won' won't have thee for second round of questions that i will say that in my state, the need for funding to support the grassroots efforts and some of the things that law enforcement is doing is critical

and i would look forward to talking with you more about that. >> thank you. >> i think these are the best works of reporting i've read in the past 25 years. tremendous work. i want to ask two questions if i can get to the two. we have had witnesses here and i've asked them the questions could we set the gold addiction free by 2030 i'm mindful of your point that there is no silver bullet but i'm also mindful if you don't have a target to organize around. we will rebuild these economies and enable them to protect themselves. if you don't set the target, then you don't marginalize your resources around meeting the target so if you were to advise us about the target would be,

again i pose the question to these folks could we set the target by 2030 and francis collins they said yes, that is doable if you define it the right way it is doable within the current scientific knowledge and technological likely future but if you were to give us a target, what would you tell us. >> we would all be in trouble. i would say that a target is good and my hunch as an american is i that is something to strive towards and it's always good to have a deadline and a goal on what that year should be and whether or not humans can ever beat addiction free is a debatable point in my opinion. as i said in some of my testimony, to me this is a supply story. i lived in mexico for ten years and when i was in mexico, i grew

up having thought about very deeplit verydeeply i adopted tht all of the american drug problems were demand driven and -- >> there's a lot of evidence for that when you arrest a street corner dealer another one pops up but the demand is going to keep producing. >> i agree, but the thing that starts it i believe is supply, and i came to believe that after living in mexico because it absorbs them of responsibility and our drug problem which isn't just our drug problem, it needs to be addressed as such, us and them, that's when i start doing the book and began that is not exactly what happened. we had no real problem with this before the overprescribing. the difference in this story is that the supply didn't come from colombian dealers and mexican

cartel, it came from doctors buying into sincere, well-meaning, and well-trained doctors buying into this idea that they could help their patients by just massively prescribing these pills. so the goal is in my way of thinking the supply is the issue and therefore to get there i believe it requires. the reason why all those guys in vietnam came back addicted first of all no longer worked for them but now in rural tennessee and there was no supply so they found the more that you separate the addict from the supply, the better chance they have of success and that's what you're finding. >> let me ask a second question. i have a brother-in-law.

>> i know him well. >> a u.s. attorney in portland who then decided he would be the ceo of a substance abuse organization and he says if there was a social movement for the recovery, it would become the most powerful political movement in the united states each grappling with how you get over the stigma and the democrats and republicans, red d state and redstates and blue sts recovery movement would be massive and help us meet the target so i am curious what you think about that. >> the more stories you tell, the more we start to get talking about the book i just wrote and told them they will start looking around like this and say my cousin is doing five years in prison and i think the more

those stories come out the more we all know how many around us have this issue and you don't have to lower your voice anymore. it becomes natural well, you know, recovering from, and i think that's why it's very important for recovering addicts who mentioned that i want. just because it normalizes it and makes us all understand this is something that is going on all around us and it is an amazing thing to have written a book like this and then go on the road and hav have encountern airports and places like that. so in the power of the story as i said. >> i'm over my time, but i'd appreciate you being here today. >> mr. chairman, and thank you for being here. thank you for your research. i want to follow-up o follow upr

point about supply. in your book you write about a hospital in columbus where a doctor in the adolescent medicine department helping heroine addicts get detox talks about the kids he was seeing started with prescription painkillers and he says it was all of them. that's how all of them have gotten started with superstition painkillers. a story that was true i take for far too many americans. according to the cdc, people that are addicted to prescription painkillers are 40 times more likely to be addicted than to hear when and many people who misuse prescription opioids take the pills that started out as legally prescribed whether to them or a friend with a bulleted and i know you've written about your own personal experience with opioid prescriptions when your appendix was removed. do you mind saying a bit more

about that experience about how many painkillers and you can keep it short, how many you were prescribed and how many you think you actually needed? >> sure and i 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 might shift one night and i didn't realize it, went home, went to the hospital later and they said i appendix ruptured. i spent two days in the hospital and was a perfect example of what to do and what not to do. each of the two days i was in the hospital they gave me to vicodin, very good idea, i just had been cut open, good idea. and then when i left, they gave me a bottle of 60 instead take as needed. again i am a crime reporter and i've done work on games and stuff like that and i'd never written about health care. i didn't know, not really paying

attention to this issue at all i didn't know what vicodin was, i thought it was a glorified aspirin because they told me as i left, take as needed. okay that sounds like aspirin to me. i don't like taking pills, so i took two of them. thethe remained of my medicine cabinet for four years and i said i think i still have that. i knew what it was and sure enough, we found it and disposed of it. but again, a couple things. that is a perfect example of the supply that we have unleashed on the company. multiply my case by millions of people and you get to where we are. >> there is actually some data on this but found that between

two thirds to 92% of patients who underwent various procedures like you did reported that they end up with unused opioids afterwards and just like you a lot of them stood out in the medicine cabinet and can then fall into the wrong hands. >> very easily. >> as senator alexander noted earlier, last congress senator capito and i passed a bill to try to tackle this problem by letting the patient's request only a fraction, only a day or two worth of their opioid prescription to be filled at the pharmacy and if they are still in pain a few days later they can get a few more pills if that's what they want to do. i know it's not coming you talked about how complex this problem is but i want to talk about it one little part. >> i think that's exactly the kind of thing i'm talking about, the small solutions, many small solutions one of them is to take that kind of slide off out of

the medicine cabinet of america basically and i think also to get doctorgive doctors in the hf questioning i think it was routine for years in this country to just prescribed 60 or 90 of these pills and give doctors out of it. think of the windfall by the way a pharmaceutical company when a doctor in a white coat prescribes you ten times more than the pills that you need and you like i did say okay. >> or in your case, 30 times more. >> and there's refills and so on. again, i get back to the basic dichotomy here. it's a story built on bbc in a magic bullet solution. i think that there's lots of little things and what you're outlining sounds like to me one of those little things. >> i just want to say on this, we got the law passed here but

that doesn't make it a reality, so we have sent letters, senator capito and i come to every governor in the country com, the different medical organizations asking them to back us on the implementation of the partial fill. and also, here we are more than a year after the wall has changed and the drug enforcement administration still has definition on partial fill that is out of date, not in compliance suggest a couple of weeks ago senator capito and i along with senator grassley and senator feinstein sent a letter to the dea to ask them to update these regulations, so as you said a complex problem. we've done our part and we need to get if you proceed in line with this. >> thank you senator warren. senator baldwin. >> i really appreciate you being here today. >> it's my pleasure. >> what an opportunity to have a conversation and so you

chronicled this epidemic as having its roots to decades ago at least and yes, we find ourselves still scrambling and losing ground. i represent wisconsin and the new front of this battle. in a community like milwaukee county, fentanyl was the cause of deaths combined with other opioid overdose is about 420 in that county last year. it's just one example in the state of wisconsin.

and at this point, there is no sense that 2018 is going to be a turnaround. despite the fact that milwaukee county has a very committed here when task force and leaders from the local law enforcement and leaders from health providers have been collaborating to address this. i wanted to sort of dovetail on your conversation with chairman about synthetics like this sort of changing this epidemic in some way. we need to be prepared for a next generation of synthetic opioid and what is the federal role in assisting communities?

>> that is a huge question i think and i'm not sure i have all the answers. >> i have a couple more huge questions for you. [laughter] there's nothing but huge questions on this topic seems to me. yes, fentanyl has been remarkable and transformative. it's like the third stage, pills, heroine and fentanyl. it is my belief strongly having lived in mexico that it is calling on us to understand that the only way we are going to talk any kind of an effect is by working with mexico, not at odds with mexico. there is no way you can stop the smuggling, but we a alone can stop the smuggling into the united states because of his so small. a sugar packet worth could kill everybody in this room, so and probably on this whole floor.

so my feeling is one thing that seems to be extraordinarily counterproductive in my opinion having lived in the country for a long time is the rhetoric i'm not saying it is put on rose-colored glasses. i've lived there and they know the issues and the corruption and depth of the problems that they have but never the less, in a person-to-person connection which we never have achieved as government to government from what i can see, that is how you advance. they just shut down. it was an interesting case in july. they shut down the marketplaces in july of last year and they did with the fbi an it with thee others i think. it was a classic example of how you make a huge dent in the

supply by working with these governments, global economy copy only groups that don't work together in the governments and that was one example i thought was fascinating is how you move forward, and to me those are the ways that you help local law enforcement. being in local law enforcement today feels like you are standing in the ocean trying to take back the tide. >> i'm going to ask a question but i don't think there will be time for an answer. maybe we can follow up. i have held a lot of roundtables with stakeholders from recovering addicts, family members who've lost loved ones, law enforcement health etc.. around the state you talk so much about solving this through the ending isolation and having stronger communities. i do find some significant variation between what i hear in

urban centers in wisconsin and what i hear in rural areas come everything from the availability of resources to help people who want to get treatment even to what drugs are being taken and abused. i would love to hear your thoughts. i'm not going to be able to stay for the second round, but perhaps a follow-up in helping strengthen communities and all those different settings as they respond to sometimes unique and sometimes common challenges. >> thank you, senator. >> thank you mr. chairman. >> i wanted to explore further with you the link between economic affliction and drug addiction that you refer to. many of the communities like

portsmouth ohio have been devastated by ease closures for example. you said heroine is what you get when you destroy dreamland and use that isolation is the natural habitat. in the state of maine, the opioid crisis appears to have started decades ago in washington county that borders canada and it is an economically disadvantaged counties very high rates of unemployment and a lot of isolated communities. it then spreads everywhere in name including our most prosperous towns and cities. the portland press herald last summer ran a ten part series on

the opioid epidemic and it focused one story on the lobster industry highlighting the high entry rate in that industry and also the logistical challenges of securing treatment in the rural communities. >> it's a great story. i've read it. >> they will be interested to know that. in your investigation, did you find that drug dealers tend to target communities that are economically devastated, are they more fertile ground for addiction fax >> i did notice that. i don't think drug dealers are deep sociologists. i think they are following the money coming into the first place this begins his

economically devastated because teepain treatment and resortingo doctors was part of how you navigate economic disaster. you get disabilities as we were talking about earlier. you have people who are trying to navigate and to get that, you need a doctor and again, this seemed as time went on the it became something to result to a substance. you get pills and you can solve them and people figure that out. some of the first dealers were seniors, they were not young people at all, they were seniors that figured out that kids will buy this stuff and so the rest. i do believe as you said that

this is it starts in areas with deep economic affliction and in the areas that are viewed as kind of the losers and the great free-trade we had over the last 30 or 40 years perhaps. now of course that made me change my view of the story charlotte north carolina, banking center, very wealthy country clubs and mansions, they have the problem a that problemi think that it is into some larger questions of the as americans how we view pane and what we want to deal with. >> i want to follow-up on your comment about the horrific role that is played by grandparents. i held a hearing in the committee to look at this issue

and grandparents raising their grandkids due to the opioid crisis. just as an important statistic i will tell you that in my state, between 2010 to 2015, the number of grandparents taking care of their grandchildren and being solely responsible for their care soared by 24% and it's because of the opioid epidemic. >> i think that is what is happening. i think that story is repeated in many states in the country. thank you for your good work. senator murray, do you have additional questions? i just want to thank the witness for being here today. your name has been pronounced a lot of different ways. [laughter] can you pronounce it. quinoes. [laughter] [laughter] >> it's been pronounced to me in numerous different ways through my life. >> thank you for your excellent

work and i look forward to working with you and all of the committee members. thank you senator murkowski has questions and then we will wrap up the hearing. so many statistics you have cited in your book but one that floored me was the reference to the volume goes in the united states consume when it comes to narcotics and you state that the united states consumes and they are writing 83% of the votes oxycodone and 99% of the world's hydrocodone. gram for gram a group of specialists wrote in 2012 people in the united states consume more narcotic medication than

any other nation worldwide. okay, so people can become addicted whether you are a u.s. citizen or some place in south america, what is it about this country that has us at only 99% of the world's hydrocodone and vicodin? what is it that has happened here? >> that is a terrific question and one that began to hit me as i got into this book and realized it wasn't just a story about a drug addiction but who we've become as americans. >> two generations ago or so, about a million people joined the army and the whole country participated in defeating the nazis and now we can't get our

wisdom teeth out without getting massive doses of opioids. i mean, i sought the answer to that. what is the common denominator between words of ohio, a town battered by almost every economic force the last 30 years in charlotte north carolina which is a very wealthy town, salt lake city and these towns have done very well. what is the overriding common denominator? it isn't economics obviously. you have two very different economic situations. by way of feeling is that it is a combination of isolation and also frankly maybe this was an essay on the dangers of prosperity that too much stuff given to freely people are not expecting. everybody fearing that its

scanning thei their anemia due o keeping them outside for keeping them indoors and all across the country. >> but is it interesting to you that those that were doing the deliveries didn't use the stuff. >> they were addicted to something else. they were addicted to the resources that came back. >> but you look at that and say what is it about americans that has pushed us in this direction in such an extreme direction? you have other countries that have the same issues that we have. they have economic decline, isolationism, the same things that we have come and get me have turned to opioids to done -- numb it all. >> we focused on the individual and great ideals of american

kind of experiments that have become twisted and the pursuit of convenience and be entertained us with self-reliance ifor self-reliancs isolation. accountability becomes tantrums whenever any political official oor cough call for doctor doesnt exactly what we say it seems these are things behind of whatf this but maybe we have had too much. we've become pampered in some sense. i don't pretend to know at all. these are questions that i'm fascinated by and i would love to talk about them but i make no claim to know all the answers to these questions you are posing. >> so, this statement was made back in 2012 in the journal of pain physicians. what do you assumwould you assue numbers have continued to

increase? part of it bears noting part of that is because a lot of the countries don't use enough of these drugs. people die in horrible agony from cancer when they shouldn't be. there is a proper role for these drugs and inhuman medicine and distrust the debate over what that role is is a very, very important one and up to now in the last 20, 25 years in the country, the proper role would appear to be a bottle in every medicine cabinet and that is where he got into trouble. >> thank you. thank you mr. chairman. >> mr. quinoes, if i need to make a couple of quick observations about her testimony had been one of your space shot marshall plans ideas. listening to this, one thought i had is with your family here especially as i mentioned before, you should be glad you were not nominated for some

think were some senator would have kissed you under the table and confused using the process. >> we thoroughly benefited from your testimony. it strikes me that with your book and with her testimony you may be helping to lead a revolution in a different direction than the one you describe in your book. ..

one of the leading states for this problem. working together with the governor is change the way they teach doctors on what to do about opioids. you have many prescriptions of three days worth instead of 60. there are some steps that we can take and i congratulate you for that. on your testimony, he wanted to demonstrate humility and you don't claim to know everything. we find around here that's a very useful attribute because we don't know everything either. helps hear from you and second you are wonderful storyteller. he reminds me of my friend alex haley who wrote roots and he told me after he made his speech he said men make a suggestion when you begin you would say may i tell you a story instead of making a speech? someone might ask and listen to what you have to say so because of your storytelling we listen to what you have to say. finally on the marshall plan and

the space shot i think senator murray and murkowski worked together fixed "no child left behind" a couple of years ago. one of the things "no child left behind" in education is have as a goal 100% of children would be proficient in reading and math by the year 2014 and i remember when that was set i was not in the senate and i thought i guess that's all right. we say all people are created equal and samuel huntington a professor at harvard said most of our politics is about setting high goals for ourselves so we never reach in dealing with the consequences so not having reach them a sort is sort of what we do as a country. then i was thinking about a created a lot of problems for us and the consequences that were attached to that. on the marshall plan and this they shot i think it might be more like the marshall plan. as they shot was a high goal and

inspired everybody but it was done from washington. he was essentially organized single shot efforts and the marshall plan actually was a request of european countries to come up with their own plan. it wasn't marshall's plan or president truman's plan. those countries came up with a plan and we funded it but then they implemented it and some succeeded more than others. it's probably what will happen here. some sort of hide whole but i think the better example may be the marshall plan. >> and you are right to cause each of the states are different and i like the fact that you talk about parts of the country that are ravaged by a globalization and on line purchasing and leaving main streets empty and people without

things to do but then we have charlotte and nashville. the complex problem and you've helped us understand it. thank you for your leadership and we appreciate your family coming as well all the way from los angeles. senator murray anything else? the hearing record will remain open for 10 days. members may submit additional information to the record within that time if they would like. the committee meeting on thursday january 11 for the executive session on nominations, thank you for being here. the committee will stand adjourned. [inaudible conversations] [inaudible conversations]

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>> good afternoon. as members