the inspection of hardware and source code that are not typical of the regulatory machines that we see in many places around the world currently. >> watch the communicators on cyber security, tonight at eight eastern on c-span2. this week, facebook ceo mark zuckerberg will testify before senate and house committees on facebook's handling of user information and data privacy. tuesday at 2:15 p.m. eastern on c-span three, he will answer questions during agility senate judiciary and, searing. then on c-span three, you can watch live coverage on c-span three and online at cspan.org. listen live with the free c-span radio app.

>> over the next couple of hours, a look at local, state and federal efforts to combat the opioid epidemic. we will show you portions of events c-span has covered in 2018 featuring state governors, white house officials, health experts and president trump. we begin with the senate health and education committee hearing and remarks by authors sam. [inaudible] >> i am pleased to welcome sam and his family today. thank you for taking the time to be here. he has 30 years experience as a journalist and author. he has written extensively on the opioid crisis and drug trafficking. he is the author of three acclaimed books, his most recent book dreamland, the tale of america's opioid epidemic won the national circle award for general nonfiction. early in his career he was the recipient of the maria moore's cabinet price, the oldest international award in journalism for the work covering latin america. it was also the recipient of a fellowship awarded to

outstanding print journalists who pursue stories in the public interest. welcome again. you will have ten minutes to give your testimony and senators are looking forward to having a conversation with you. >> clearly i am a rookie here. senator murray and honorable members of this committee, i would like to thank you for these hearings on a national epidemic of opioid addiction and to allow me the honor to address you. i'm very happy to be here with my wife and daughter who are part of producing dreamland and without whom the book would never have been finished. this is the deadliest drug scourge we have known in this country, hitting areas of the country that has 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 that we are 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 a quick and easy end to pain. isis could not have dreamed of inciting the kind of torment and death that we have visited upon ourselves through this over use of opiates. these drugs are a symbol for our era. for almost four decades, we have exulted the private sector, the individual while we ridiculed government as inefficient, incompetent and wasteful. we admired wealthy business people regardless of whether the way they made their money produced anything of value to our country and our communities. we brought a second gilded age.

this epidemic of addiction to a class of drug that thrives on isolation reflects all that. this epidemic has cost have been borne by the public sector although its profits have been private. i believe this is far deeper than drug addiction. it's about the effects of this very cultural shift. it's also about isolation in areas rich and poor, about the hollowing out of small-town america and the middle class, of the silos of our society and it's 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, a jail cell for every addict.

we exulted the private and marked the public in the communal and in so doing we rid ourselves of things so essential to us that they have no price. we haven't been invaded by cheap junk as a result. we dug up dreamland pool and replaced it with a strip mall. we do things like that across america for years. heroin is what you get when you destroy dreamland. i believe isolation is heroines natural habitat. i believe this epidemic therefore is calling on us to revert these decades of isolation and come together as american. i believe more strongly than ever that the antidote to heroin is not locked down, it is community. : : :

must be funded fully and for a long time. but the good news is that none of them is sexy your none wille trick alone. i believe across america today communities are finding the solutions. the more they band together the more the leverage all that talent and energy bring in pga, pastors, athletes, recovering addicts and primary care doctors, librarians and the chamber of commerce. the more cops and public health nurses who go out for a beer bridge that cultural chasm between them. and i do believe as i said this is happening in counties across america. it's my opinion and evidence shows that supply has ignited all this. we did not have this demand, this widespread addiction until

he unleashed a large supply of powerful, illegal narcotics on the public for the last two decades. i believe it is essential doctors reassess how and to whom and in what quantity they prescribe these drugs. that does not mean just cutting people off who are on high doses of these drugs in leaving them to fend for themselves. it does mean lobbying insurance companies to reverse her pain strategies that do not involve narcotics, allowing doctors a wider array of pain strategies and simply paying bills. young doctors need more education in med school and both pain management and addiction treatment. i have to say that it 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 into areas with walls already here i

believe and wall will, in fact, grow the only thing that will truly help stop these drugs employed into our country and that is a deep respectful but also forthright and sometimes blunt, certainly honest relationship with mexico that will lead to a file becoming the kind neighbor and partner we can work with effectively. and in so doing become the kind of neighbor that country needs of us. another wall seems to me is just like heroin. it feels good for the moment but it will leave us worse come in a worse place in the long run. another silver bullet for complicated adult problem. sometimes solutions are about the monday mechanics of governing. we should find, for example, new ways of funding coroner's office around this country expand our national forest of 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 the country will be helped by transforming jail into the place of nurturing recovery, instead of the place of predation and keep him. becomes an asset as that of a liability and this is happening, particularly i would note in the state of kentucky. i would also like to add that all across america are families who are suffering due to the addiction of a loved one or the loss of that loved one. i believe they are our raw material to be marshaled, harnessed in the site. meaning i want to be involved, need to be involved, to help solve the last rating wounds that will last a lifetime. i believe u.s. senators could help this by recruiting them, 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 awful stigma of addiction will be reduced. i'm happy to elaborate on any of this. before i do 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. the roots of our national epidemic of narcotic addiction live there while the epidemic itself in turn stance in the way of the revival. many of these regions cannot revive until enough of the people can pass a a drug test o fill new jobs. indeed, this is that only a story of a drug addiction. it's a story at economic affliction. as politicians, i suspect your natural response for a crisis like this is to look about for things you can do quickly to show constituents you are taking

action, and i believe that is entirely understandable. i would caution, however, against believing in short-term responses. 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 what you might take guidance and inspiration. versus 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 an outboard good for our country, though they were about doing things that seemed on first blush far beyond our own short-term self

interests. the marshall plan was about building up ravaged regions to allow them to function independently while containing the virus spread of soviet communism. it allowed reborn country to prosper and contribute to the world again. a marshall plan for american recovery might focus on rebuilding those regions that event caught and 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 no economic benefit, increase in knowledge, and in simple human inspiration is beyond calculations. seems to me that we might profitably apply these examples, the marshall plan and the space

program, to regions of forgotten americans where this problem began. let's do it perhaps not because it is easy but because 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 to last for years to be effective. focused far beyond the immediate goal of drug addiction and on the more profound problems of community destruction and the hollowing out of stretches of this country. i'm here today to urge you to say this not only as the catastrophe that it is, but also as the gift that it can be. it offers an opportunity to reinvest in areas that need it most. a chance to inspire us as americans again through something great. it's an opportunity to bridge that political polarization that so gnaws out our country. it's one of the few issues today that can do that.

do not miss this opportunity. it does not come around often. this college i suspect is the very reason many of you got into public service in the first place, and you are lucky to be when it has again. you will be remembered for acting when 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. >> next a portion of the annual conservative political action conference in washington. this panel includes former vermont governor peter shamblin who first called attention to the opioid epidemic during his 2014 state of the state address. the panel was moderated by commentator greta van susteren.

>> good afternoon. good afternoon. very happy to be here today to moderate this fabulous panel about a very distressing issue coming issue i might add is bipartisan. it affects republicans, democrats, independent of libertarians, it affects everybody and my panelists if by person as well i do want to get started right away because this really is a problem that we all need to sort of think about a talk about. i'll start with you, lieutenant governor of ohio. why is this topic important? is there a lot of that we could betide about jobs in ohio and have a job to get open. why do much talk about this what? >> this is an issue that impacts of the family and has impacted my family but also seen it in the state above. i talked to parents who have lost loved ones. i've talked to people who are suffering in the crisis that is

the addiction issue. it's touched every single person that i've come across. we need good leaders who will stand up and provide real solutions to give hope and help in healing to so many individuals today that suffering. >> andrew, government can't solve every problem. government can help solve problems. what do you see as the role of government in this crisis, , ths epidemic which is nationwide and a health epidemic? >> thank you. i want to set grateful i am coming back to see back. thank you, cpac. this is a critical issue. you opened up saying it's not a conservative issue or little issue. as a conservative this is an important issue. working for president trump who campaigned vigorously during the campaign on this issue in state that event devastated by this epidemic helps us understand why it is issue. you're right, government has a

legitimate role to play in tackling certain issues. we love living in a free society where government doesn't do everything but the important things the government has to do and it has to do them well. this is an area where government has really failed. that something president trump talked about as a candidate and has led on this last year over and over and over again talking about the need for states and localities for the medical professional to law enforcement to come together to address this crisis in our community. >> if it were easy would been solved a long time ago. like north korea. to give a little statistic from 2016, 64,000 people died from this. car accidents took the lives of only 40,000 people. this is not easy. this is a challenge. governor, what strategy or what new ideas i would us can be done? everyone is with him. >> first of all thanks for having me because this is a

bipartisan issue and as a governor we are all dealing with. doesn't matter what state or what your politics are. the question is first of all to answer your question of what a doing, what's a solution, i think this is an easy one to solve. most people don't say that. this is an easy way to solve if we have courage. what are we in this mess? why are we on the stage reaches for from eric about his son, the lieutenant governor next year with his chums with both of her sons. why are we all in this mess? why have lost more folks opioid addiction since the year 2000 and we lost in world war ii and vietnam combined? what changed? in the 1990s we approve oxycontin. the manufacture of oxycontin told the public healthcare professionals and the fda we've got the first nonaddictive painkillers and we all were so rejoice for. it turns out they were wrong, and out on whether wrong but he pleaded guilty to lying to the fda. this is a best-kept secret in

america. they got, paid the fine of three top execs of roughly 400 million for life for the fda. 85% of the folks addicted to heroin start with fda approved bills that you pick up a new drugstore. the question is what's the solution? my view is if governors like me we do criminal justice reform. we build out treatment. we get rescue kids. we all do the same things but it's after folks have become addicted. this is the worst disease to have that one can contract entrance of the fight, the struggle, what it does to family members, what it does to your life. my answer is a simple one. there's two things we can do in this isn't hard. number one, the fda should revisit the decision they made about passing a painkillers like candy. now that we've admitted they got like two in the first place. second -- [applause]

second, just like what happened with tobacco, we've got governors like me, we've got attorneys general, i know lieutenant governors working on this in ohio, all over the country, mayors, municipalities are also in the folks that put us in this mess to try to get money for treatment and change in behavior. why don't we do we did with tobacco, get them all in a room, the president of the united states, president trump assiduity to be the winner of this that i can tell you president obama messed this one up when he reduce the burden of proof for the pill mill folks that were having these trucks truck to step to the pill mills if that's what folks get a lot of these pills here the obama administration literally reduce the burden of proof, sorry, raised the burden of proof so that the enforcers literally have to get these folks to plead guilty before they can stop the trucks are moving to the pill mills. here's my plan. there's no one in my view who knows more about this kind of

issue than john cole who happens to be a today, sorry john, just to be cute. standup because of our folks to know who you are. this guy got tobacco in the room back years ago and got them to pay -- >> my husband. >> each relator to greta. my point is president trump has the ability to be a hero. he can put them in a room at sake don't come out of that room until you settle this. it's time for the taxpayers to stop paying for treatment. you guys have to pay. you guys got today and you got to change her behavior and you're not coming out of the room interview do. i i think that's the opportunity for the president of the united states. >> governor, a two-part question for you. what is the great thing about this, we can talk and discuss, to what extent do you agree or disagree with governor showman as were trying to come up with something of idea but before you get to that i get so many tweets for people saying people are in real pain. they said don't take away my pain pills.

some people need help. >> i'll start with first of all, that is the conservative solution to this and i believe government has a role to play but government is not the solution. we do need comprehensive care we need to make it available to citizens living in addiction today. it is a a long road as you saio health and recovery. there is a role for government to play. it's to incentivize the private sector, to build up the type of care necessary, to restore lives. we also have to foster and encourage looking for alternative ways to treat pain. as patients we shouldn't accept that these addictive pain pills are the best we could do. individuals living in pain today i would recommend we need to open up the opportunity for these alternative ways to treat pain and not just accept the

best i i can do is pain felt. >> let me ask you this. before the war. came on the scene which was what the late to mid 90s next people at pain, right? was there inadequate pain management, or do we had something that helped and it wasn't quite as addictive? >> my understand based on what i've read speedy and you to jump in. >> you probably know as much about this is anybody, andrew, but when they started treating pain as as a vital sign, in my opinion it all shifted to our medical community now being judged and being rated based on how well they were treating pain, yet pain is subjective. i'm not a medical professional at but pena subject of and by minutes and how was your pain? >> ten. >> right. i've to treat you because you're going to evaluate me. >> i'm afraid if i don't say can you give me too and i will be in pain. >> but it all started my opinion when i look back at history to

get all seem to start to shift at that point and that's, compatible to play. they are the ones that said we're going to treat pain like a vital sign and it became the fifth vital sign and it's not measurable. we created this crisis. >> let me give you another statistic which i find quite stunning. between 2006-2016, out-of-state drug companies shipped almost 21 billion opioid pills the two pharmacies in west virginia who had a population of 2900. andrew, i'm not a doctor but that doesn't seem right either to me. >> that's right. i want to follow up on the point the governor about law enforcement. we saw in the last administration president and attorney general who i don't like respect of the block of respect to due process rights or vigorously enforce the law. we now have a president and and attorney general --

[applause] or vigorously enforcing the law and that starts with enforcing the law against companies that are broken the law. that it can include criminal investigations, civil investigation as well but also going after people on the streets who are pushing drugs into archimedes. the last administration said it was okay to do drugs. they downplayed as an issue. we need to do a better job teaching our young people don't go down the path of addiction. we need to provide treatment and treatment is a hard road. i'm sure most of the people in this room have that family members that are struggled with an addiction and needed treatment in one way, shape, or form. the president spoke harshly about this lecture that his own family where he saw the light of his older brother did with alcoholism and what that did. the most important message we need to do is ensure that people do not start down the road of doing drugs, and leading down this path towards addiction that is so hard to come back from. the best thing we can do for him

based treatment is a prevention action that prevents people from starting to use drugs. >> that is one of the biggest problems, if you're at the point we need treatment and some people need treatment you've already lost your job, lost her family, you're completely been terrible pain to your friends. everybody. governor, how do we start come realize my to do with those are not addicted, we need to have pain pills with those, how do we start at the beginning so that we don't have this whole universe of people? >> let's just back of the second because everything that is being said here is to accept that we has spent to point out that in most issues that i faced as a governor, and i'm sure all governors face this, when you get into the details of policy gets it gets a little more great. it's not quite as clear, not quite as black and white. this one is black and white. america did not have someone die

every 15 minutes from smoking addiction before we brewed oxycontin. these are the facts. we passed it out like candy. these are the facts. we now have thousands and thousands of good people dying every year from this disease. so why wouldn't we if the fda admitted, had the folks who like to then come up and say sorry, we didn't tell you the truth, why would we simply go hey, wait a minute, we got that information. as the lieutenant governor pointed out we configured the way we judge our healthcare system based upon oxycontin so it's now the fifth criteria to be judged by. let's undo that, back it up and have the folks who lied and created this disease pay for the treatment and a prevention should be, in my view, stop passing get out like candy.

revisit the fda decision. let's start when we began with a more sane policy on drugs in america. [applause] >> i always think the power of the government or the white house can we all know is so incredibly potent in terms of helping solve things but it's oftentimes dependent on the political parties working together because they're so many interests interesting fault and this is a nonpartisan issue. could you work together? whatever differences, could you to work together, you got the congress and the president of the united states right there. do you have new ideas you could ask him for help on? >> absolutely. killing iq is a bipartisan problem. no one says this is a good idea, let's get as many folks as a camp addicted to this stuff. >> the problem is just the lieutenant, go to the white as an astronaut or someone, republican asking, if you go committed democrat. you two are in a unique

position. you both come from states with this is been discouraged every state is. you seem like you want to work together. >> we haven't talked about this. i am a republican, i'm a conservative and one of the challenges we face in this country is we know where it's coming from. it's coming from mexico, from china. when you start talking about fentanyl. i would say build the wall because i'm a conservative republican. you may not. you may not agree with that but i bet you and i can get on the same page of how do we help reinforce law enforcement to keep the drugs out of our country? >> i just want to say an important part, we've seen this skyrocketing of overdose deaths just in the last few years. our country has been suffering from the scourge of drugs used for decades but the reason why it's become such a potent point in so making birdies and films is the number of overdose deaths just in the last few years has gone up dramatically. that is largely due to fentanyl.

the importation by drug cartels and other criminals bringing fentanyl in from china or mexico into our country has got to stop. the last administration failed to protect americans from fentanyl. the trump administration is working day and night to keep these horrible drugs out and that's why we have to build a wall, increase our border security can provide homeland security, the topical resources they need to screen the stuff from coming from china and it's got to stop. >> can i make a quick point? my point is this. we've always had drug problems in america and we all have different views probably on how to solve it or maybe we have the same views. here's what's changed on this one. 85% of folks who go to the heroin that has the fentanyl in it start with fda prebuilt. they are not getting those from the drug dealers of south america. they are getting those from the corner drugstore. >> can we develop? >> we have to do both. we must devote.

>> stop the importation and stop the abuse of those that are prescribing. >> this is, i think president trump has a unique ability, and you and your job at the white house, to be the president who solves this problem because of bipartisan consensus. we want to stop the dying, tragedy. i always say the biggest victims of this disease are the kids of the attic. as as a government that is most heart wrenching thing you can experience. >> what's the biggest challenge in solving this? what you see as the biggest impediment? >> wow, there's several. if the supply and demand issue so we got to get off our streets. >> does the white house up without? >> that's both, federal and the state problem. we need to keep the drugs offered streets get we need to hold drug dealers accountable. law enforcement needs additional

resources to get these guys that are killing our kids and throw them in jail. >> what about the pharmaceutical industry, those that are producing this and the companion of those awful lot of money in this down the coast over the transom on capitol hill both sides of the aisle? how do you fight that issue? >> what we've done in a while is with issued, and i'm not all for regulation, i'm not a government regulation person but this is a public safety issue. with issued regulations where you could only prescribe a pain pill for acute pain for seven days if you're an adult and for five days if you're. you have to take the steps. >> that's not federal? >> that state. we did in ohio. >> why don't we have that federal? >> as conservatives we recognize the state government needs to make most policies in this country, okay? every problem. every problem is not a federal

problem. every probably is not a federal problem. every problem the federal government need set some sort of response to making sure we show leadership as a nation. let me finish this. states right now are being smart and innovative and passing new good legislation that bans prescriptions or limits prescriptions in certain amount and that's great. the worst thing we could have happened is for the federal government to intervene and pass laws the uniform across the country that try to solve this problem because we seen this happen and health care, we seems happen across the state the time of the gentleman has expired again with good intentions thatf the government passes some law. the unintended consequences of that law trickle down through use and take it ago to never come back and fix those problems. governors and legislators pass these laws every year. we should encourage our state leaders to pass these laws to take these issues on. >> which brings us back is the power of the white house come up out of oval office with a buddy

into one room it basically lock them in room until they do this. every state. governor? >> let's for a minute put our hearts the site and just use our math heads on this one. it cost me $25,000 to treat someone as they become addicted. it costs you $25,000 as a taxpayer every time someone gets addicted to the substances. it's a huge cost to taxpayers. if we've got an industry which we do, perdue and others, it's not just the manufacturers and distributors, the pharmaceuticals, they are all in this. if they are making billions and $ off this disease that is killing people i think the white house has a unique opportunity to replay the tobacco tape. get the folks in a room, close the door. because these lawyers were run this thing like asbestos for

ever and still listen, this isn't this is about lawyers making money. this is about taxpayers getting paid for the building are paying now for disease that was created by lies to the fda. let's make that happen anything president trump would be a hero to america if you facilitated that process. >> panel, thank you very much, and once again this is the problem that affects all of us. you do a huge service to the country. this specific problem. thank you. >> earlier this year massachusetts governor charlie baker led a discussion on opioid crisis at the winter meeting of the national governors association. we will show you his remarks followed by health and human services secretary alex azor. >> my name astronomy, governor of the of the, with the massachusetts and i'm the chair of the nga, health and human

services committee. looking at all to this conversation about an issue that the nga has been engaged in in a big way for the past several years. i think it's fair to say that every governor of every state has made dealing with this particular issue a significant and important priority in their work and that has been true in the commonwealth of massachusetts. i did run for governor to work on this issue but it sounded because whatever i campaign i ran into people who talk to me about it and their stories frankly broke my heart. over the course of the past several years working on a bipartisan basis with the legislature and others, we have made some progress in dealing with his terrible epidemic. now, in massachusetts after years and years and years of double-digit increases in opioid prescriptions overdoses and

deaths, literally for the first time in a very long time in 2017 we had a 30% reduction of prescriptions. overdoses leveled off and deaths dropped by 8%. now, the way that was referred to by most people was sort of positive but muted. the reason it was muted is because with so far to go and so much more to do. but literally after that news every single year for year after year after year people did take some comfort in the fact that a trend that it like this for a very long time started to go like that. there's a lot that went into that. today the conversation is to talk about what's working and what we should be going next. some of the things that i believe have worked which i'll speak to and others i'm sure will add to that as we go along would be the following. in massachusetts we now require

everybody who graduates from medical school, dental school, nursing school, pharmacy school and social work school to take a class as part of the core curriculum a class in opioid therapy and pain management. and if you're a prescriber, as part of your continuing education for getting your license renewed, you have to take and pass the course in opioid therapy and pain management. we were also one of the first states to put a limit in on first prescription. ours was '70s. several other states have followed since then and we dramatically upgraded and simplified prescription monitoring program it as a result of that we finally got to the point where the vast majority of prescribers were working on that system and using it as a search engine every time they wrote prescriptions and in addition it finally got to the point where it could start giving them some pretty decent information on the own prescribing patterns relative to

their peers. we also created programming to do assessment work in our middle schools and high schools for students, to our health departments. and also created as part of our sort of annual program for all athletes and the parents and the coaches, and occlusion of the discussion about opioids, the positive and the negative, along with discussions about hydration and how concussions and all the rest. that's kind of a prevention and education site. on the treatment and recovery site we added 1100 treatment beds come increased state spending by about 60% on a variety of addiction based programs and make medication-assisted treatment a much larger part of our repertoire in our portfolios that it'd been previously. one of the other elements we pursued on a pilot basis that's turned out to be reasonably effective is we invaded recovery

coaches in some of our hospital ers around the commonwealth to engage in discussions with people who overdose and to see if they couldn't talk them into moving into treatment. most of the folks who are in, play that recovery coach role our people in recovery themselves. it turned out that their ability to reach out and speak to people who just overdose and where the throes of his addiction was pretty powerful ones. in some cases we saw as much as 80% of those who were contacted and touched by this program find their way into treatment. that doesn't mean 80% got out of treatment but the bottom line is for the first time we found a a mechanism that releasing to nudge people, many for the first time, into pursuing treatment as a possible option for them. with respect to what's next, we filed legislation that is truly

before our legislature that is called the care act which has a number of elements to build on some of the things we've done previously. one of which is to take this whole notion of recovery coaches and turn it into a bona fide clinical program, to create a credentialing process for it. and really make it a fundamental part of the way we deal with addiction, especially opioid addiction where a recovery coach can be a big part of what help somebody, whether they are medication-assisted treatment or some other form of treatment, stay on the positive side of the treatment program as they battle their way out of this terrible addiction. the legislation also includes elements that would expand some of our school-based assessment and service programming. and also for the first time we will have us engage with the folks in the farmer to me to see if we can create something that

looks like a blister pack which we have in the other parts of healthcare to provide the very small numbers of opioid that you might want to make available to somebody who had the wisdom teeth out or had minor gum surgery or spray the ankle or something like that. the reason for that was a lot of the conversations we've had with prescribers had been we write 30 days, that's what we do, the lowest thing we ever do, 30 days. 30 days for a lot of this stuff associate with what we've been writing opioid prescriptions for, for the better part of the past decade make no sense at all. if we can create a delivery model that makes it possible to get somebody that you are three field they might need to deal with whatever the particular acute pain is coming out as a minor procedure, we might be able to take a lot of this stuff off the streets to begin with. and the final think i'll speak to is fentanyl. in 2014, fentanyl was was present in about 30% of overdose

deaths in massachusetts. in 2017 it was present in over 80% of the deaths in massachusetts. if it wasn't for fentanyl, the success we've had in reducing overdose deaths would have dropped dramatically more, but the simple truth is we can do a lot of things in prevention and education, and i believe we are here we can do a lot of things on treatment and recovery, and i believe we are. but we've got to come together, state local federal, and chase this did not issue a lot harder than we are chasing now if we truly want to protect and preserve the opportunity for treatment to be successful for many of our people in our states. >> am grateful to be a today to share how we see our role as covenanting and empowering this great work that you already have been doing. as many of you know president trump has made the opioid crisis a top priority.

hds has declared he has toured nationwide public health emergency last year bringing a new level of urgency to our response across the federal government. but president trump and visit administration recognize that it's not the federal government is on the front line of this battle. it's all of you. your law enforcement officers, your teachers, your school counselors, your community leaders, your doctors, emts and nurses, enter faith-based partners. we are dedicated to empowering you and your allies in this fight. that is what undergirds the comprehensive strategy for fighting the opioid crisis that hhs introduced last year. it brings the unique powers and resources of the federal government to bear in empowering those on the front lines. many of you may already be familiar with the strategy but the five points put as previous possible our data, research, pain, overdose reversers, and

access. after running through the strategy i want to highlight a couple pieces of news from the fda that underscore our commitment to advancing effort to get access to effective addiction treatment. the first point is better data on the epidemic. we have to understand this crisis in order to stop it, which is why hhs is working with states and other stakeholders to support more timely specific public health data and reporting. the centers for disease control and prevention works with your state health offices and local corners in monitoring overdose data. the second point of the strategy is better research on pain and addiction. we clearly need more tools to help us win this fight which is why we support cutting edge research on pain and addiction in parts of national institutes of health. the potential advances we're seeing at nih and in the private sector, like not addictive painkillers and new methods of addiction to treatment are

incredible. as we they get closer to realie look forward to partnering with states and private partners to understand how these can best be put into practice. the third is pain management. we need to do better job of addressing the real problem of pain in america which is why hhs wants to ensure everything we do, payments, , prescribing guidelines, best practices, and more, promotes healthy evidence-based methods of pain management. we look forward to continuing to work with you on disseminating best practices including the work of a federal agency pain management task force that we are standing up. fourth is better targeting of overdose reversing drugs. people in committees all across america and our own cities and towns are alive today because of the progress that's been made in making drugs like naloxone available when and where they are needed. we are committed to working with you to ensure communities have access to these life-saving

drugs to hhs grants, research and technical assistance. the fifth point of this of they is better prevention treatment and recovery services. we know directly providing these services often falls on state and local governments and community groups. but we can help by issuing grants to support access, expanding coverage to hhs programs, providing guidance and technical assistance. as many of you know the president's budget proposes $10 billion in funding to address the opioid epidemic in serious mental illness. that comes on top of $3 billion in planned opioid funding for fiscal year 2018 that we hope will be in the omnibus appropriations in march. the budget includes a range of different investments, $74 million to improve targeted distribution of naloxone, for instance, and $115 billion for rule substance abuse treatment.

it also takes the state targeted response grants to $1 billion a year, twice what we have i detroit for such good people for to build a base of experience from these grants, hearing from you about how you have used this money. one particular point we want to emphasize for the 2018 grants is states have a wide range of options for using them. this includes treatment vouchers which allow for the use of funds for evidence-based services from faith-based providers. americans of faith have taken a leading role in compassionate approach that we need to take, that we have to take to this crisis and were eager to support the work however we can. on top of the sdr grants we release guidelines to accelerate the approval of substance use disorder waivers within the medicaid program, three of which we've already granted this year for indiana, kentucky and louisiana. i would just want to note for our governors that if you have

waiver request with us and you have a particular waiver of this kind we can also streamline point is that were constructed with cms for approval around those concrete waivers so it doesn't have to be caught up in broader way for discussions that have to have. >> what works? medication-assisted treatment. one particular piece of our work on treatment is supporting access medication-assisted treatment. part of the title of today's session is what's working. and as i said hhs is always dedicated to advancing our understanding of what does work when it comes to public health challenges opioids. but we only know some important facts. one of them is this. medication-assisted treatment works. the evidence on this is voluminous and ever-growing. one study from governor bakers

state massachusetts found that putting survivors of overdoses on medication-assisted treatment, along with the appropriate therapy and social support, reduced future chances of death by more than 90%. that is a remarkable number of lives saved and speaks to the number of lives we could be saving by expanding access to treatments that work. hhs has long been dedicated to promoting access to and awareness of medication-assisted treatment. we still have a long way to go. according to sam should data just one-third of specialty substance abuse treatment programs across the country offer medication-assisted treatment. for many people struggle with addiction, failing to offer business trying to treat an infection without antibiotics. given what we know and given the scale of this epidemic, having just 130 treatment programs offer the most effective intervention for opioid addiction is simply unacceptable. under this administration we

want to raise that one-third number. in fact, it will be not possible to turn the tide on this epidemic without doing so. we know that there is sometimes stigma associated m.a.t., especially long-term therapy. but someone on medically assisted therapy, even one who requires long-term treatment, is not an addict. they need medicine to return to work, reengage with the families and regain the dignity that comes with being in control of their lives. these outcomes are literally the opposite of how we define addiction. our goal and citizens who commit to treatment should not be treated as pariahs. they are role models. >> c-span's program on the opioid epidemic continues with marilyn governor larry hogan and oregon governor kate brown testifying before the stint health and education committee.

they describe the impact on their states and answer questions on the spread of fentanyl. the role of the federal government and lawsuits against pharmaceutical companies. >> we have been sounding the alarm and shone a spotlight on this issue for about four years now. it was during my campaign for governor as i traveled all across the state of maryland i would go and meet with local officials and community leaders and i would ask them, what was the number one problem facing their community? everywhere i went, whether it was in the wealthy suburbs of washington, or the inner city of baltimore or we were in small towns and rural communities, the answer was always the same. it can it took me by surprise, but we learned about the magnitude of this problem. in one of my first actions as governor reestablish an emergency opioid and heroin task

force which as the chairman said keep up with 33 recommendations, most of which we implemented, focus on a four pronged approach of education, prevention, treatment, and enforcement. i was the first governor in american to declare a real state of emergency on this issue because we decided that we needed to treat this crisis just like we would treat any other natural or man-made disaster. we have already committed in our small state more than half a billion dollars towards fighting the heroin, opioid and substance abuse epidemic from all directions. yet in spite of the efforts we still at nearly 2000 people die last year. that's far more than those killed by firearms and motor vehicle accidents added together. the good news is that with her efforts we've been able to bend the curve downward on

prescription opioids and on heroin, but a new and even more deadly drug is now growing out of control across america, and that's no. overdose deaths from fentanyl were up a staggering 70% in our state last year. a majority of these things always been shipped in from china or its crossing the border in being smuggled in from mexico. we simply can't stop it without federal government stepping up. this crisis going to take it all hands on deck approach from the federal, state and local governments, along with community organizations and faith-based organizations and others in the communities. we all need to be working together on this issue. i urge you and your colleagues to make increased funding for the opioid crisis a top priority. maryland and many other states are all working to provide naloxone to all of our local

jurisdictions, but greater federal support would help make this life-saving medication available to even more of our first responders, our police officers and emergency room personnel. i would like to recommend that the federal government encourage advertising public-service campaigns to educate the public about how lethal fentanyl and these other drugs are here we also need more targeted and aggressive federal enforcement interdiction efforts when it comes to fentanyl and these other opioids to initiatives like the synthetic trafficking and overdose prevention, or stop act. as this crisis evolves, so much of our response to it. and i agree with senator murray, this crisis is not just a health crisis. this is tearing apart families and communities from one end of the country to the other, from maryland to oregon and every place in between.

and ultimately this really is about saving lives. it will take a collaborative, holistic and bipartisan approach to accomplish that. so again thank you for having us and we look forward to the dialogue and answering any of your questions. >> thank you, governor open. governor brown, welcome. >> chairman alexander, ranking member murray, committee members, thank you for having me here today. i'm also honored to be sharing the diced with my colleague governor larry hogan. by providing other states perspectives, i we can underscore the urgency of tackling the opioid crisis that has touched every single corner of every state and our entire nation. part of what makes opioid so dangerous is the fact that they're so much of it, , and ist hard to get. abuse can begin as easily as reaching into the average family medicine cabinet. that's what happened to max

pinsky at southern oregon. he was a poet and a chef. when he was 17 he got into a car accident and was prescribed opioid painkillers. what started as therapy became self-medication, and spiraled into abuse. from prescription pills he moved on to heroin. his mother julia was devastated as she watched the group of opioids can sue his life. he died of an overdose at age 25. it's hard to look back on his story and wonder what could have been. what if we live in a society where he was in shame for having a problem with reaching out for help? what you get access to better treatment? what if the first responders had life-saving overdose drugs? addiction is blind to circumstance but the high cost of addiction are borne by our children whose parents are unable to care for them while struggling with substance abuse. right now the federal government recognizes the problem but is

focused on punishment. that leaves us, the states, to right the wrongs of a war on drugs that has been nothing to address the issues that drive this public health crisis while our prisons and our foster care systems are filled to capacity with its victims. i have seen it firsthand. prior to becoming governor i worked as a lawyer representing parents and children in the foster care system. i watched children come in and out of foster care as their parents struggled with substance abuse disorders. as children struggled with a foster family they barely knew, their parents struggled with addictions that overwhelmed our treatment systems. in oregon, 60% of foster children have at least one parent with a substance abuse issue, including opioids. if we can make meaningful change in prevention, treatment and

recovery from substance abuse, we can create better lives for our families. we can see more success for students in schools. we would lift the burden off our hospitals and our law enforcement, and our prisons. in my own family, access to comprehensive behavioral health treatment changed the trajectory of addiction. my stepchild started abusing drugs in high school. my husband and dan and i watched him change and felt powerless to do anything about it. eventually a teacher caught in using at school. instead of taking outcome she called us. we knew that just trying to stop using wouldn't work. his daily routine had become centered around getting high. he needed an immersive treatment program, but our insurance policy stood in the way. he had to go through two separate outpatient and inpatient treatments, and

relapses before our insurance would cover the residential program he desperately needed. fortunately, for us, our families story turned out very differently than maxes but it taught me how different recovery can look for every individual. we need to think about it as a process that needs to be tethered to a person to make circumstances and environment. turning away from a failed first model. that something were working on in oregon. we're also getting more life-saving overdose drugs into the hands of first responders and implementing creative programs to provide a warm handoff from emergency room to treatment and recovery. in addition to increasing treatment resources, we need to make sure we're focusing on decreasing stigma as well. we must break through the barriers of shame to provide the best treatment possible first

and the most effective assistance now. we need to let people know that it's okay to come out of the shadows, that it's okay to ask for help and that there is help that is available for them. at the federal level they're so much that can't and must be done, improving data sharing from the federal to the state level, making affordable generic overdose drugs more available, rejecting a punitive approach to addiction. who knows, maybe this could have saved max life. we know it can save millions of others. thank you. >> i know you and i share, i know your story with your back surgeries and i'm sure they prescribe opioids to you. i i went through 18 months of battling cancer i first two years as governor and i had four or five surgeries and i know at one time three different doctors within a matter of weeks prescribed me 30 day supply of three different opioids.

that can't happen anymore in our state. but the fentanyl, we are really trying to crack down but it's coming, a lot of it is come to the u.s. postal service. it seems like nobody uses the postal service anymore but the drug data from china are because they are not checking the packages the way the other delivery services are. we've got to put some federal funding in that. it's now being manufactured or transported and smuggled in across the border from mexico. this is actually can we got to do it began on the local level on interdiction at the federal government has got to step up keeping you from coming into the country. >> would you agree with me it's also not totally an addiction problem, it's a one-time problem works because fentanyl is so powerful, that a person can get one pill, they are not an addict, never were one, but that one pill could kill them. >> there's a question people that are addicts are killing themselves and people don't even

know are doing it once and killing themselves. it is a deadly deadly thing and it's 50-100 times worse than heroin. >> governor hogan, i want to start with you. this month as we been howling up the numbers in 2017, we've been hit by a series of heartbreaking statistics -- tallying -- just a few weeks ago we learned that last year drug overdoses killed a record 418 people in the state of maine. that's an 11% increase. we're going in the wrong direction. this week the cdc announced that in maine, emergency visits for opioid overdoses jumped by 34% last year. in the past three years the number of people in maine who died by drug overdoses has doubled. and at the same time, we at the

federal level have increased funding and federal efforts year after year to combat this crisis. so my question to you is, what do we not doing right? you talked about the multi-pronged approach that i told agree with, education, prevention, treatment and enforcement. due to the leadership of this committee we have poured a lot of money into all four of those categories. what is it we are not doing right? >> senator collins, thank you. we ask ourselves the same question nearly every day. i mentioned in my testimony at the beginning that we were sort of ahead of the curve on focusing on this issue, going back to 2014. we immediately took every action that anyone could think of, from

every direction. we put half a billion dollars into in our little state, state money. then we created the first state of emergency where we stood up our emergency operations center to coordinate every single state and federal and local agency to provide real-time assistance on all these different directions. as i said we make slight improvements in prescription opioids and heroin but because of these new synthetics, fentanyl/carfentanil, we still had more people die. .. knowing what can we each do to collectively to make this happen

and i think we do need more federal funding with some flexibility for each state how they can utilize these funds depending on the issue is shifting and where they are at that point in talking with governor brown but all is not yet a big issue in oregon but i believe it will be. other things are starting in the west coast and coming out to us. i talked to other governors and we were all together last week at nga and they were all talking about crystal meth is now reviving in their states and lacing that with fentanyl. they don't even have opioids in heroine. i think it will take all of us working together. the federal government in your committee has been on top of this issue and it's been a focus in i know there was a task force together with smart people in recommendations but it was federal funding and the stop act on fentanyl to interdict is

important. the opioid response enhancement act and happiness of addiction recovery act and synthetic trafficking overdose prevention act in their immensity many acts as we pass in the senate coming from both sides of the aisle in both houses and they all ought to be considered because we've got to look at this thing from every direction. >> far too many families in massachusetts and all across the country have had to bury someone they love because of this opioid crisis and more deaths and more funerals but this crisis did not happen overnight and did not happen on its own. a big reason it happened is because the biggest drug companies in the country pushed powerful and addictive pills, lied about how addictive those pills were and made billions of dollars doing it. i think it is time to start talking about holding these companies accountable and holding their executive accountable for the crisis they helped create. in massachusetts, attorney

general is helping lead a bipartisan coalition of 41 states investigating drug manufacturers and distributors for their role in the opioid epidemic. more than 30 cities and towns in massachusetts have already filed lawsuits in a number of native tribes including the cherokee nation have also sued in both tribal and federal courts. let me ask this. governor hogan, maryland is also part of this investigation and baltimore several counties have filed lawsuits against manufacturers and distributors and do you agree that part of tackling this crisis is holding this company accountable? >> no question. we have directed our attorney general, brian ross, who also took action and to sue some of these pharmaceutical manufacturing companies and there is liability. some of them knowingly pushed the sale of some of these drugs

knowing that they had these addictive capabilities and did not disclose it. you can't paint all the people with a broad brush but those who knew should be held accountable. i agree with you absolutely. unfortunately we can take away some of those actions but it won't stop those were dying on the streets. >> i understand. the investigation is ongoing and we should let the attorney general to their work but if it turns out that the drug companies from the law, lied about it in her people in order to rake in profits it won't be the first time on this. a few years ago corporation called made a spray out of fentanyl, powerful opioid, and the fda told the company that

it's spray was approved only for use in cancer patients who were in such pain that other drugs like morphine weren't enough to control that pain. it turns out there weren't enough of these cancer patients for the company to make buckets of money so it started illegally marketing the drug to people with milder forms of pain and bribing doctors to over prescribe it. a lot of states sued them including massachusetts. oregon was one of the first states of the country to reach a settlement and forced the company to pay up. brown, that settlement occurred up for you after months of rent month after you took office in 2015. has the money that organ recovered from this company help the state to fight the opioid epidemic? >> absolutely. thank you for the question. we received a little over a million dollars in over half of it went directly to opioid substance abuse treatment and

recovery. a portion of it went to oregon health sciences university and they are well renowned research medical university and they are doing incredible work. i was very pleased with how the dollars were targeted. >> good. what it. here's the thing, when a company breaks the law it is because people running the company broke the law and a few months ago the department of justice announced that founder and owner along with executives had been indicted for fraud and racketeering because of their actions. let me ask you this, governor brown. do you agree that ceos deserve to be held personally accountable when the companies they run break the law and hurt people? >> and egregious case like this case, absolutely. obviously, these need to be taken on a case-by-case

approach. this is a particularly egregious case and people should be held personally responsible. >> i agree on this one. this crisis is not a democratic issue and neither is holding drug companies accountable. the department of justice announced last week they are forming a task force to target opioid manufacturers and distributors that have contributed to the academic and i'm very glad to see it. i think it is important. families and communities have already paid an enormous price for this crisis. it is time to start holding companies and their ceos accountable. thank you both. >> we are joined by the kaiser health news. what is is doing now in response to the opioid epidemic? >> congress is really interested in this. they put 4 billion towards general different kinds of treatment prevention, law enforcement and that is the tip of the iceberg right now. we have a bunch of hearings

happening in energy and progress committee in the house and they're looking at law enforcement side it with prevention and treatment side and try to come up with different and the chairman says he is hoping for a package on the floor by memorial day and the senate you have this bipartisan group of senators hoping to put a billion dollars toward at this other bill called car 2.0 that started under obama and it has some traction in the senate but everyone i talk to his leisure about where it might go in the house. >> initial funding under the on the bus and as you mentioned some hearings moving forward on different legislation but we look at the white house, back in october, they declared in opioid epidemic and where has the administration's emphasis then? lot measures or emphasizing better prevention and treatment? >> white house call this a public health emergency in october in the recently renewed this and it's an odd mix because

rhetorically there is a lot of interest in this law-enforceme law-enforcement, law and order and headlines about the death penalty and that was a big focus of the president speech in new hampshire last week and the department of justice has been the directing at attorney general's to seek the death penalty for high-level drug traffickers and expanding treatment and making sure that first responders have the anti- overdose drug and that is interesting we talked about by a lot of public health officials at the emphasis on law enforcement and on law and order is different from what we have seen before in giving them pause. >> what have we seen before with the obama administration for example? >> they were interested in this public health response if you will and there was talk about making sure that if they have access to medication it would

get them weaned off the excuse me, opioids but it is a shift in terms of how we've looked at addiction from any time before pretty much in this country's history and it's an interesting thing to watch and see if that will continue moving forward. >> we have been showing and will continue to show comments from a number of state governors, charlie baker from massachusetts and the governor from hogan testifying and what are our states doing in terms of the epidemic and what they say they need from the federal government. >> the big thing states want is money. they need money to give to first responders who get this and get medication and get folks into treatment and you have all these other systems that have been burdened as well.

i wrote last summer about the spot foster care system which has seen huge inboxes in kids going to them because the parents can take care of them anymore and they are looking for all the resources they can get to address this issue from every angle possible. >> back to congress. new studies from the national manufacturer alliance and the american action forum show that the harmful impact of opioid abuse on manufacturing in the broader employment sector in the us and you talk about a number of congressional hearings on different laws and our employers and industry lawyers passing members of progress to do more on the opioid issue that you know of? >> there are certainly concerned about the impact on economy and product to be at large and the research done by congress with where they show that people are less productive in part because they are grappling with addiction and unable to work and going through the systems that we been unable to be as productive. >> aside from the terrible

increase in the death numbers how has the nature of this epidemic changed over time especially just in recent years? >> this is an interesting story. this comes from we think painkillers. vicodin, percocet like sorts of things and in the '90s doctors were taught they should treat pain aggressively and told that these opioids are great and not addictive and will take care of the patients pain needs. they prescribed them and the story you hear so often was the girl who skateboards and gets in an accident breaks her arm and she's prescribed percocet to take care of it. she goes to a prescription and doesn't realize that she's addicted so she goes into withdrawal and its people and then she switches to haran which is cheaper and more potent and continues from there. i put that often going out in the field and you go to where we are now with their of your paint colors out there but people are in withdrawal intravenous drug and they switched to haran which much more common and switch to fentanyl which is deadly and coming from experts say china

and mexico and can kill you and produces a greater height. >> one more thing in one of your pieces you lead by writing the nations opioid epidemic has been called today's version of the 19 '80s aids crisis. solving that health pandemic took years and how long do health experts think it will take to get control of the opioid epidemic in the us? >> i don't think they have an end date. it's an ongoing commitment there needs to be a promise from congress to give tens of billions not just this year but every year as they are saying. there is one of public health commissioner from baltimore has talked about the importance of creating almost a ryan white which is the hiv-aids separate and out of funding program for treatment because we need one for opioids as well. i think she is not alone in making that argument. our guest from kaiser health news, thank you for joining us. >> thank you.

>> our program on combating the opioid epidemic continues with remarks from a senior trump administration officials. camp chester serves as the office for national drug control policy. he spoke in march at an event on opioid trafficking posted by the helsinki commission. >> as you know, the office of national drug control policy craft the strategy of the president and oversees all federal government counter drug activities and related funding. i serve as its associative director in charge of the national heroin coordination group with an open dcp an organization responsible for guiding integrating federal government activities related to the illicit. problem. first, please allow me to take a couple minutes to address the magnitude and fixity of this crisis and mentioned some of the things that the federal government has been doing to address it. according to the centers for disease control and prevention in 2016, the year for which you have the most recent data

available, 63632 americans died due to a drug overdose. the 1% increase from 2015 amounting to about 174 americans every single day. opioids make up the largest category of drugs contributing to overdose deaths in america with 15472 overdose fatalities involving heroin, 19431 involving synthetic opioids other than methadone, a category dominated by conventional. the illicit. crisis is a complex national security, law enforcement in public health crisis and is the nation's number one drug priority. first, i should mention that while fentanyl has been the primary driver of the horrific number of deaths we have seen still have an enormous problem with heroin. it is too abundant in the market and far too available in our

communities. along with our heroine crisis we are currently facing the additional and related problems of illicit fentanyl and fentanyl analogs. prudent and deadly been anywhere from 50 to 10000 types important as morphine and in many forms. we truly have watched the crisis of illicit fentanyl involved before our very eyes over the last two years. from fentanyl powder mixed with heroin, often without the users knowledge and conventional testing to perform and sold as counterfeit medications and fentanyl being bought and sold over the internet through the proliferation of sentinel analog now available for sale which brings us to where we are today. we have among us a family of drugs that are extremely addictive and deadly and sometimes ordered over the internet and just using crypto currencies and coming into the country at a high volume to the mail system or commercial carriers or sometimes smuggled

across our land borders with a low signature in a variety of forms that are incredibly hard to detect. this should tell us a great deal. more than anything we must accept fentanyl while a crisis in its own right is very likely a window into the future of the drug problem in america. we know that we must reduce the size of the user population through prevention, treatment and recovery support services and at the same time, we are reducing the availability of these drugs as two complementary efforts to reduce the market forces pulling these drugs across our border. we could very well be seeing a move away from the plant -based drugs toward synthetic drugs with lower overhead on the front and in lower risk and greater profits for traffickers on the backend. we have to accept a more expanded image of the using population and the prototypical experience intravenous drug user is now being joined by those who

think they are buying off market prescription opioid pain relievers but in fact are buying into often dying from fentanyl preston to perform. there should be no doubt that the internet has made purchasing drugs much easier. in the online marketplace and the use of the currencies have empowered a democratization of the drug trade. the hierarchy drug trafficking organizations we have traditionally seen in normal posture to address may no longer have a monopoly on supplying drugs to the us market. rather, individuals can simply go online to one of the many internet drug marketplaces and purchase drugs like fentanyl for their own personal use or for further sale creating a constellation of micro- networks across the country. what we do now is not only important to get ahead of the deadly personal crisis ahead of us but also establish the framework of relationships and laws and regulations and

technologies and procedures that set the conditions to deal with the future of drug cases that set the precedent for years to come. i can tell you we know more now about fentanyl and its ally analogs that were to be manufactured and how they're getting into the country more than ever before things to the intelligence committee, federal law enforcement and our partners at the state level is below. greater testing of seizures and better postmortem testing by medical examiners and foreigners is telling us more about the specific conventional analogs in our communities and that are killing our people. our international partners specifically mexico, canada, china, have internalized this problem in our taking active measures to help us address and right here at home to target the efforts of our law enforcement professionals help us narrow the universe of all inbound items to those more likely to be seen fentanyl. as this crisis is to get hold here in america we have been

building and sustaining architecture with the entire federal government is applying its time in energy focusing on compass problem and a network of partners each taking their own share of the task in achieving complementary affects. what you seen recently from the role congress has played in keeping this issue at the forefront of our national consciousness from the president signing the interdict act to the recent announcements of the opioid initiative to tangible efforts from every department in agency across the government from the enormous commitment and resolve at the state level into the energy and innovation in our communities across the nation which speaks to the seriousness of this issue and our common commitment to addressing it in a meaningful and sustainable way. the drug market is vast, dynamic and adaptive. it is not without its own vulnerabilities. i will tell you that it is no match for our own intelligence in determination and the very best talent we can bring together against it.

maybe kent is the right person for this question but we've had a great discussion already and thank you for your statement. one surprise that didn't come up as the postal service. i thought of the postal service as a humongous piece of how these drugs are entering the country and are you the right person to speak to this. >> yes, this is my favorite topics. the postal service is doing a tremendous job. postal service in specifically the postal inspection service which is a law enforcement arm of the u.s. postal service was very early to understand the magnitude of the problem and the fact that the u.s. postal service was a critical vulnerability that we had and that it could be used as a vector for the drugs to get into the united states. we began working with him closely and worked across the interagency with other federal law and is meant to do a couple of things. the first thing is to get the

advanced electronic data from the shipping company or from originating country so they know the shipments that are coming in to the united states before they get here and that is usually about 72 hours out. that's tracked and untracked packages. the vines we're talking about are enormous. up to about 144,000 packages every single day into one international service center so when you get advanced electronic data that they can share that with customs and border protection so that they can pull aside and give separate attention to those companies that are most related to the illicit shipment of goods so that is the first thing. the second thing is the nonintrusive detection capability that is there at the international shipping center for them to be able to detect illicit substances that are in their and the third thing is to be able to work with other

law-enforcement orders from dhs or the department of justice in order to get a prosecutorial outcome for those the interceptor will tell you the postal packet inspection is done a tremendous job in helping us better understand how they get to the united states and doing two things against and over the last year and a half or two years. >> fabulous. the follow-up question, when these drugs are ordered off the dark marketplaces are they shipped almost exclusively by the postal service or private delivery services use like buttocks et cetera? >> private services are used as well so that all of your major express consignment carriers and all done a tremendous job in the federal law enforcement to share information and to allow them to intercept packages before they can be delivered to the end-user. when we say the postal service is one element of it to express

consignment products, dh s, they also provide a means for the drugs and their working hard at the federal government to interdict those shipments. >> on march 1st the white house hosted a summit on the opioid epidemic. this portion of the event features marks by jeff session, kiersten nielsen and don sullivan. a reminder you can watch this event in its entirety at our website c-span .org. >> thank you all. it is good to be with you and we are at a point where we are going to make some progress in america. i am convinced that prices for illegal drugs are down and the availability is up and the purity is up and the addiction is up and that death is up and the danger of a drug particular

defense in heroin that we are seeing are extraordinary. i was involved in the early '80s and the '90s state attorney working on these issues and we never saw anything like the deaths we are seeing today. this is totally unprecedented in the history of this country and it cannot continue and will not continue. the president has made it clear we are going to be resolute in the entire administration is going to respond to his declaration of emergency and we are going to make a difference. i believe it and i can sense it already and some of the policies that are ongoing out there. we announced in july the largest medical takedown in the takedown and history of our country we had over 120 professional nurses and doctors who had been at a 400, i believe, arrestees and they were involved in illegal

drugs and we know that as much as 80% of addictions today start with prescription drugs and it's an extraordinary number we will continue to research it but those are the numbers we have and i have no doubt it's an ordinary high amount. we had a week later a shutdown of alpha bay and this is important -- if the dark web site in which it had 220,000 sites where people could order directly to the mail illegal drugs and sentinel for example is so small and so compact and such a little bit and so powerful that it is easy to ship these kind of drugs for mail and the fbi has doubled its resources to fight will not let

them get that big in the future. that is our goal and will continue to work on that. we have had 3000 defendants and we have created the opioid fraud and abuse and detection network which is a data analytics system that is well within the existing computer system of the drug enforcement administration so we can easily determine what positions pharmacies and other distributors are moving prescription drugs and some of them are extraordinary outliers and they give us indications of where fraud and abuse is occurring and we can move quickly on that and that has not been done before in target packages are being sent out right now through investigators in cases are being made. one attorney general said i didn't think too much about it but when i looked at what

happened we knew there were six professionals mostly positions in pittsburgh and every one of those were on this list and so it made me a believer in a lot more from the list that we did not know about. we sent out 12 special experiences on it experienced assistant attorney general's to hotspots among the country and most of that is coming from china and often through mexico and sometimes directly through the mail to our communities and we established a new program called [inaudible] that's the fbi program with the ea to identify through the darknet and purchase undercover drugs in that way and to target those and we announced prescription intervention in litigation task

force that would utilize our civil department to file civil lawsuits and we believe we can get an injunction to stop a position attend position or pharmacy immediately from prescribing drugs because they have to comply with the law and civil injunction and continue if need be a clinical investigation and i'm excited about that and we have filed litigation today and we have announced a statement of interest with the multidistrict litigation effort by a lot of the attorneys generals around the country on that. [applause] thank you. i will just and there to say this is what we're doing in our

department. he saw earlier in the first panel and i believe that we do these things effectively we can reduce the amount of death, did addiction and destruction that these drugs are causing today. it is unacceptable in this great country and we will do our part. killian, i have to say that kellyanne leadership is going to be so important in this because we do want to mention and we do need to educate people and the president has used a phrase just don't start and if you don't start like he never started and you don't get addicted so we need to be cautious about that and encourage people not to do that and kellyanne knows how to communicate well it will be a great asset to us. killian, think it. >> thank you very much, mr. attorney general. [applause] i was down on tuesday when you had the press conference and the

acting director of the dea and others and was struck by the bipartisan approach that they had for your prescription and your intervention litigation announcements. going on to secretary kiersten nielsen on the torment of homeland security so many aspects of the law-enforcement front in waiting this battle against this crisis falls under dhs and we are most curious to hear progress reports and also the vision of the future. >> good afternoon everyone. i appreciate the opportunity to join you today. it truly is a shared site and i'm sure you've heard before and will continue to hear for the rest of today we must do this in partnership. i am particularly honored to be joined by the leadership from the department politically. we have ice and kevin and tom

and they do this work everyday day in and day out to protect our borders from all threats and our interior from all threats but that includes opioids. the president he declared in opioid crisis as a public health emergency he sends a very strong statement and the statement to us as america was fighting back. will continue to do that all the tools that we have at our disposal and in conjunction with our partners in the department of justice and the time in the state amongst many others. since october dhs had proactively assessed the current bret and determine where we might have gaps and what else we can throw at it, if you will. this has allowed us to leverage our investigative intelligence effort and you may or may not but dhs may or may not know it's a long agency and we have 60000 but we have multiple agents throughout the department that play a role in this and through leveraging our investigative we

do interdiction operations with our international partners and have had great success on that front particularly with our friends and partners in mexico continue to look for new partners because the dreaded drug continues as the attorney general mentioned to come in packages of all sorts and sizes and gets in the hands of those that use it in the drug flow. we look at this two ways. within our borders and we look at stopping across our borders if you will. front entry we work with doj in the states and our law-enforcement counterparts in mexico and south and central america and china as well. this will prevent the flow but also possibly to share the information in the sharing information has two main purposes. one is to hopefully stop the

drugs before they come into our country the other is to help us as partners dismantle the force behind the epidemic. this information sharing helps us to stop the flow and facilitates the dismantlement and it also provides clear rules and responsibilities among all partners to bring all that we have to bear. wanted to use one example. we have border enforcement security taskforces which has one of those acronyms and some of our acronyms and dhs are not so well done and these are our primary problems to investigate those smiling domestically so it leverages more than 1000 federal state, local law-enforcement officials and represents over 100 monitors and agencies. we also have officers at hundreds of ports of entry and

they not only check billions of dollars of cargo each day but millions of passengers a day but they are particularly focused on that. we have significantly increased over the last two years and about 2 pounds in 2013 we had 1485 pounds in 2017 and remember this drug in extraordinarily small quantities is lethal. 1485 pounds is substantial and is an epidemic. we've expanded the use of canines and all canines working in international mail and environment have the ability to detect drugs. don't see a significant amount of opioids be trapped by see the us coast guard have seen other narcotics increasing and that deprives funds to otherwise would use the funds to traffic

in the opioid and conventional. prevent the sale and let's talk about that permit. we are committed to not only preventing a source but preventing their movement into sales in our country. the attorney general mentioned the dark web and we support his effort in our united states secret service has capabilities on investigation side and they also contribute to the site and sodas ice and homeland security investigation. dhs has a broad mission set but we do in all times were to bring everything we have to bear. the darknet i would add one comment the attorney general said it is anonymous. it makes it that much more difficult to track is doing what on the darknet in terms of buying and selling but with our partners at justice in fbi we're doing just that.

the job doesn't and there. we work to support the apprehension of persecution. we work closely with our law-enforcement brother and and i would say in closing is the sheer magnitude of this means we have to partner and as i said many times today in another forum there is not one entity that has all of the authority and ability and capacity to buy this alone. we greatly appreciate everyone in this room and your interest and support and partnership and we can't do it about you. we think the president and the vice president for their continued leadership and certainly, kellyanne, for her work that you been doing to bring us all together. >> thank you very much, secretary nelson. [applause] it's been terrific to have a state department and have involved in this effort as well. i'm happy to present to you for his remarks the deputy secretary of state, mr. sullivan. >> thank you, kellyanne. it's an honor to be here and delighted to see everyone here.

thank you for your leadership and to general sessions and secretary nelson, you might wonder why the state department is here but this is a whole of government effort. the president has made this a top priority for his administration and the state department is involved is the problem we confront is not merely domestic but the opioids that are killing american citizens today produced overseas and traffic by criminals and criminal organizations that operate transnational he. the state department is to stop transnational control organizations and so-called tco's and the networks of criminal activity they perpetuate in trafficking drugs in destroying the lives of our loved ones. addressing the opioid crisis as i say is a whole of government

effort in the state department role is to apply its resources abroad with our partners, allies and others to support all the work that the department of justice and the department of homeland security to address this problem and enormous scorch that we have to enlist the support of our allies and partners in neighbors in particular. it's our highest in the same department and this is our highest goal priority and the bulk of the counter narcotics work is focused on countries where opioids originated. opium harvest in mexico is the root of over 90% of the us supply of heroin. pco that smuggle it across our border to be sold by dealers of the country that the target the dhs and justice are working to stop. we are strengthening cooperation with mexico to the merit initiative to interdict illegal transports and find and punish

criminals involved in these organizations and cut off their sources of funding. in december of last year secretary tillerson to my along with general sessions and secretary nelson continued the strategic dialogue we have with mexico in disrupting transnational control work and we are working with our mexican counterparts to find new ways to disrupt the revenue scenes that are responsible for trafficking heroin and other illicit drugs into the united states and we are also working with mexico to more aggressively eradicate drugs, and his for security and bring drug chapters to justice. over 100 of the high-value targets have been arrested, killed or extradited to the united states. we support mexico's effort to find investigate and destroy clandestine drug labs. since 2014 the department of state is funded dea training of

over 300 mexican counterparts in special tactics to go after those and since 2008 the united states has donated and supported more than 500 canines were assigned to mexican, federal, state law-enforcement agencies and we sponsor daca for teams to detect weapons, cash and drugs. this includes for the very first time that all detection training to cooperation with our neighbor to the north and last fall the one commission put new international controls on their two primary ingredients that are used to produce conventional and this action was taken at the request of the united states in such measures and are already producing results and due to this change and other efforts dea has seen a decline in the presence of these chemicals in the illicit drug market and in two weeks at our request the un

commission will address synthetic opioids including the deadly opioid called at all. the state farm and has driven partnerships to effectively stop the drugs from the international mail and create systems which general sessions mentioned in these allow for law enforcement to easily interdict any packages that may contain illicit personal. china is a growing area focused on the fight against opioids and energized by resident trumps visit to china last november the united states and china have forged a productive counter to kardex relationship and as a result of our corporation china has established domestic response ability on 143 substances and including a number of conventional related compounds. china is tightening regulations that significantly contribute to

the reduction of these substances in the streets of the united states. unfortunately we have seen are beginning to see a new trend of rogue chinese chemist who are manufacturing illicit opioids and selling them online to drug traffickers and users and shipping them in small quantities through the mail. secretary nelson mentioned the amount of conventional was necessary to convey a lethal dose is extremely small and were talking about small quantities of these illicit substances. in response we are working closely with china to improve coordination and screening of mail packages between our two countries. we are on aggressive timetable to get all packages coming from china tagged with advanced electronic data and were going to continue that close cooperation with china and other countries that are sources of these chemicals and illicit opioids. collaboration is the only way to tackle a problem that has no regard for international borders and the state department was to

address in a pursue this fight against opioids in partnerships with all other nations. thank you. >> house energy and commerce committee is considering a number of bills addressing the opioid epidemic and it held a series of hearings on the issue in march and we will show you portions of hearings including testimony by dea acting administration robert patterson, fda commissioner scott gottlieb, doctor and of the cdc and doctor christopher jones director of the national mental health policy laboratory. >> over the past ten years our nation has been increasingly devastated by opioid abuse. and it's an epidemic fueled for a significant period of time by the overprescribing of patent prescription opioids for acute and chronic pain. this indiscriminate practice created a generation of opioid abusers presently estimated at

more than 3 million americans. over the past few years we've begun to see a dramatic and disturbing shift. as a result of the increased awareness prescriptions for opioids have started to decline obviously somewhat a success. organizations in particular well-positioned mexican drug or tulsa fill this void producing and shipping cheap powdered heroin often mixed with illicit sentinel and other personal related substances. in selling it to users both in traditional powder form and in some cases pressed into counterfeit bills made to resemble illicit pharmaceuticals. there are two essential elements we are addressing as part of this administers collective efforts to turn the tide. a third piece must also be addressed. first and foremost is enforcement. based on investigations actions undertaken everyday using our criminal, civil or image data pools to attack the traffic

illicit drugs and the diversion of the illicit supply. second is education. we strongly believe there's real value in a natural fit for the dea in the space and whenever possible to partner with leaders in prevention and education. the third element is treatment. the da is committed to doing what we can to improve access to drug treatment and recovery in services working alongside our partners with the department of health and human services to utilize evidence-based strategies that minimize the risk during the public health emergency. ultimately the only way to fundamentally change his epidemic is to decrease demand for these substances and address the global illicit and illicit supplies concern the efforts of dea and all of its partners. the action of dea's version control division are critical with respect to addressing the illicit supply. diversion of prescription opioids by a few is a dispassionate impact.

the fact remains that a majority of new heroin users stated that they started their cycle of addiction on prescription opioids. as a result we are constantly evaluating ways to improve our effectiveness to ensure that are more than 1.7 million registrants comply with the law. for use of administrative pools and legislation that teens are has been the subject of media reports. let me address that issue up front. dea has continued to revoke approximately 1000 registrations each year through administering of tools such as orders to show cause and surrender some cause. we have and will continue to use all of these tools protect the public from a very small percentage of registrants who explained human frailty for profit. we have aggressively pursued civil actions and mo used to you get compliance. over the last decade we've levied by nearly $390 million

against her superiors open wide. dea has reprioritize the portion of its criminal investigators and investigated the men and enforcement groups referred to as tactical diversion squads. currently we have 77 of these groups nationwide and are solely dedicated to investigating, disrupting and dismantling individuals and organizations of all involved in schemes. cemeteries he worked to improve with the registered community. as an example of this outreach we offered year-round training free of charge and the pharmacist, distributors and manufacturers. dea just completed training more than 13000 pharmacists and pharmacy technicians on the important role they play in ensuring they only fill valid prescriptions. in may, the dea initiated

similar nationwide effort to provide training on the vital role subscribers play in curbing this epidemic. this effort will start with specific focus on states where we have seen little decrease or in some instances an increase in opioid prescribing rates. the administrative actions and grandma cases are important steps and where we have fallen short in the past is by not leveraging the data that has been leveled to us. i'm happy to discuss what happened in the past but focused my time on moving forward and appreciate the opportunity to update you on where we are today and where we intend to go. for example, in january we overlay data from hhs and when available state programs. the response was we had multiple leads [inaudible] while we work with all the federal agencies in the space, i'm sorry, we are

working with all federal agencies and space we continue to work well with our colleagues at on tcp, ccd, night of, the mutual issues that we face today have graded stronger and critical partnerships with fda and hhs. i finish up by saying electric is the health of subcommittee's efforts to hold a legislative hearing starting tomorrow on more than 25 pieces of legislation in that effort not only underscores the unprecedented complexity of the pure crisis but demonstrates that we must take action to address the threat together. >> good morning. thank you for your opportunity to discuss the role in combating the ongoing crisis. confronting this epidemic remains one of my highest priorities and i'm grateful for the committee's commitment in combating the epidemic and for your interest in their tools that enhance the ability to respond and those that would support with illegal epidemics

in the mail agencies. we are taking steps to improve our medical technology and this means better drugs to treat addiction through medication assisted treatment and new paint remedies that are resistant to manipulation and misuse or aren't as addictive as traditional opioids. second, we are pursuing measures to reduce the rate of new addiction and this means trying to reduce overall prescribing in the number of pills for prescription. among other things we are taking new steps to require sponsors to provide education to providers and other healthcare practitioners while also exploring ways to change opioids for better management of their prescribing in one of the things we are considering and steps to hire sponsors so that they provide specific application for prescription for a specified amount and this would define the proper length of treatment for

treatment. we are ramping up our efforts for illegal drugs within our narcotics and this includes new authority resources aimed at working the initial mail facility. it's a mutual flood of dangerous products entering the united states through mail packages that expose americans to dangerous bills and were dealing with sophisticated bad actors that are aware of the gaps in our tools and try to exploit them. primary responsibility for imported narcotics and anything believed to contain controlled substances goes to cbt before packages are sent to us at fda. we are still seeing more and more controlled substances hitting our investigators and in fact, in one recent six-month period where we inspected 6800 packages hundred 76 contain controlled substances including opioids. i'm increasingly worried that those seeking opioids for the mail will discuss them as ordinary drugs to evade detection. it's estimated that less than

one tenth of 1% of the packages that contain drugs actually undergo physical inspection and the risk is that many illicit drugs are slipping through our grasp. as you know, we prioritized our work and invested to strengthen our present capabilities they are there's more he must do. we've increased our staffing and seeking support to grow our footprint addiction work further. additional staffing is critical but to maximize what we can do, i want to focus on additional authority that we have discussed with congress. the flu search engine authorities. first, our operations at ims routinely with the packages that are partially labeled coming to the facilities and some are in boxes and many in thousands of loose pills and huge boxes. we are required to open every package and document the conscience and find supporting evidence of the articles in order to detain or refuse the article. when evidence is insufficient we often simply refuse entry and

send the package back to its source. it's not uncommon for us to see the same package again and again as they resend the same box the second or third time for this process is not a deterrent. if fda had the authority to detain reviews and destroy unlabeled imported products that are found to contain active ingredients that are fda approved drugs we could more quickly move dangerous drugs from the supply chain. second, this is a numbers game. bad actors can send in hundreds of thousands of small particles through international mail to individual recipients in these shipments are wholesale quantities of illegal in canada drugs intended for further domestic distribution in each package may violate fda loss but they know that fda can't examine or stop the mall because current law requires us to detain and pursue legal proceedings against each package separately. they simply overwhelm our system and volume. improving fda authority so we can more efficiently detain or refuse bulk shipments from a

single source we create a big difference and better protect americans from danger and third, while the pieces scheduled are generally referred to cdp at the border and contains substances i have yet been scheduled fda is responsible for that product. this is an issue at the high volume of synthetic narcotics coming primarily from china. right now we can't refuse or destroy the unlabeled products without drug claims because they are articles of concern to dea. the ability to reserve -- it would keep dangerous articles that are currently not usually detained off the street. these are just some of the tools that could enhance our mission in a particular support and your interest in our work in this effort look forward to working closely with you to help save lives. >> thank you very much judgment. the template is organized five statements. >> good morning.

cdc has vast experience in tackling epidemics and i perceive the chance to talk today about our work fighting the nations of your crisis. at cdc we are focused on using data for actions to inform strategies to prevent opioid misuse, abuse and overdose instrument health related consequences of opioid use including the spread of infectious diseases like hiv and hepatitis and the impact of opioids on mothers and babies. cdc leaves comments of efforts by promoting responsible is opioid prescribing and driving community-based prevention activities. america's opioid overdose epidemic affects people from every community. the problem is getting worse. in 2016 more than 63000 people

died of drug overdose in preliminary data indicates that the trend were sent in 2017. we've seen increases in babies born with drawing from narcotics, new data suggests one baby is born with signs of neonatal syndrome every 15 minutes about 100 babies a day. we've also seen a drop in life expectancy for the first time since 1993. for every one person who dies of an opioid overdose over 60 more are already addicted to prescription opioids and almost 400 misuse them. cdc supports state health department providing resources and guidance to implement evidence-based prevention intervention. states can rapidly adjust as we learn more about what works best in this very fast-moving epidemic. a nimble federal and state response is crucial. cdc now funds 45 states and washington dc to advance prevention including by improving monitoring or programs and improving prescribing practices and gathering timely

high-quality data and involvement. we hope to expand this funding to 50 states. states are making progress in working toward a more comprehensive ineffective monitoring through their pdm piece which is essential to improve clinical decision-making and use data as a public health surveillance pool. with cdc funds many are increasing use by providers and pharmacists, enhancing the timeliness of reporting and integrating with electronic health records. for example, in north carolina they have integrated prescribing data from the pdm be within the clinical work slowed of existing health information system across the state. improvements like that show how we can make vital data actionable with the mice. cdc is leading improvements to the public health data needed to understand and respond to the crisis. we improve the timeliness of reporting updating on overdose

deaths on our website every month. through our funding for states we are ramping up our efforts to get more comprehensive and timely data from emergency rooms and emergency medical services, medical examiners and foreigners. we are tracking non- bill overdoses and as you heard we really reported on the 30% increase across the country. we also recently released data using logical in evidence from funded states for allowing for more robust characterization. that analysis found that sentinel was involved in more than half of the recent opioid epidemic deaths. cdc continues to educate providers in the public on opioid use to the implementation of our guideline for prescription opioids for chronic pain and the rx awareness prevention thing. we're making the guideline more accessible to clinicians through interactive training in a mobile app in the campaign focuses on the risk of prescription opioids.

it features real-life accounts of individuals living in recovery and those who lost someone to this terrible problem. in addition to our partnership with state cdc believes this epidemic requires a collaboration across sectors. we have been working side-by-side with one cement like the dea to determine risk factors for illicit opioid and target implementation plans for communities specific prevention strategies. we draw on experts from across our agency to address the many facets of the crisis. the comprehensive public health approach is playing a key part in addressing the epidemic. we didn't get into this epidemic overnight and we are not going to get out of it overnight and we need intensified, sustained effort to reverse the epidemic. thank you. >> thank you.

>> thank you. thank you for the opportunity to discuss beer. crisis in the federal government response. from the start of the imagination present made addressing the opioid atomic a top priority and we stand with the participant to bring into the crisis. families and communities have been impacted by increasing prescription and illicit opioid addiction and overdose and in the emergence of install and other synthetic opiates has fueled the crisis. as the department lead agency for behavioral health we have been at the forefront of the response to the opioid crisis. under the strategy we focus on advancing prevention, treatment and recovery services in overdose prevention through funding to build state and local capacity and provide education, training and technical assistance and data collection, evaluation to attract a track emergent trends to support evidence into practice. today focus on several recent actions taken to enhance our response to the opioid crisis. it's funny, we distributed $485 million to other states and

territories. this funding supports state efforts to reduce opioid desk and provide a full complement of prevention treatment and recovery support services. in november 2017 they announced it was accepting applications for $1 million to expand those states hardest hit by the epidemic. in month by monday we accepted grants to massachusetts, new hampshire and west virginia. in september 2017 we awarded nearly $10 million over three years for new state pilot grants authorized by [inaudible] that enable a patient's care for pregnant spartan women and nearly $50 million over five years in new grants. we have been a leader in efforts to reduce overdose deaths by

increasing access and availability to reverse over death. in september we awarded funding in 22 states for programs authorized to provide resources to first responders and treatments on his work directly with populations of high risk for opioid overdose. developing a well-trained workforce and facilitating the integration of evidence-based interventions are key goals of our education, training and technical assistance effort. in january 2017 they awarded $2 million to create on-site january 2018 we awarded $12 million to create the opioid technical assistance program. this program will provide the assistance to states and local jurisdictions to support the implementation of evidence-based practices that are tailored to the state specific contacts. last month they released medication that includes

information of the approved medication of opioid use disorder as required. in addition the providers clinical support system for medication assistant treatment which provides initial training and mentoring to support clinicians interested in providing addiction care has also revived the state training to include information on all fda approved medications for opioid abuse disorder. given the importance, last month we released clinical guidance for training, parenting parenting women and their infants. this guidance provides clear information on a range of real-world scenarios based on huskers the fighters who are caring for mothers innocence. in january 2018 we issued a final rule pertains to substance abuse disorder records commonly referred to as part two. as required in 21st century we

held a public meeting in january to obtain feedback from stakeholders on part two. the vast majority of those who spoke at the meeting expressed their support for further aligning part two in tampa in a knowledge that congressional action would be needed to achieve many of their goals. in the era of data analysis and evaluation we are standing up for the national mental created under the 21st century transect. it supports innovation, examines approaches in facilitating the adoption of evidence-based priorities. finally, the fiscal budget for us includes a $50 million to establish the drug warning system. we are committed to combating the opioid crisis and work with congress to advance us to work. thank you for inviting me to testify look forward to your questions. >> the final portion of our program on the opioid epidemic

features president trump at manchester community college in new hampshire. he traveled to the state on march 19 to announce a plan aimed at addressing the epidemic to through accommodation of law enforcement and health measures. this portion of his remarks is about five minutes. >> i especially want to acknowledge all of the families with us today we have endured terrible hardships because of the opioid crisis. especially those who lost precious loved ones. i have been saying this for a long time that it all started right here in new hampshire. i see you are going through. it's about as bad as it is anywhere in the country and i said i would be back and we are pouring a lot of money and a lot of talent into this horrible problem. we pledged to honor the memory of those you lost with action and determination and resolve and we will get it. we will not rest until the end and i will tell you this gorge

of drug addiction in america will stop. it will stop. [applause] everyday 116 americans die from an opioid -related overdose. in new hampshire the overdose, really jeffrey, can you believe this? the death rate is double the national average. it's got difficulties like people wouldn't believe. defeating this epidemic will require the commitment of every state, local and federal agency failure is not an option. addiction is not our future. we will liberate our country from this crisis and it has never been like this and hundreds of years never been like this. we will raise a drug-free generation of american children

and last october we declared the opioid crisis a public health emergency and should have been done a long time before. since then we worked with congress to ensure at least 6 million additional dollars going through right now in new funding between 18 and 2019 to combat the opioid crisis and we will be spending the most money ever on the opioid crisis. [applause] on our most recent national prescription drug take back day people across the country turned in more than 900,000 pounds of unused or expired prescription drugs and more than the weight of three boeing 757. our custom and border protection and these people in the job they do is incredible.

bases nearly 1500 pounds of sentinel last year and nearly three times the amount seized in 2016 and i told china don't send it and i told mexico don't send it. [applause] don't send it. [cheering and applause] in 2017 ice arrested criminal aliens with 76000 charges and convictions for dangerous drug crimes. last year the department of justice prosecuted more than 3000 defendants in cases involving opioid and all of the trafficking and related crimes, 3000 cases including a pharmacist, a physician's assistant and an opioid trafficker. each were charged with committing serious drug crimes in new hampshire. whether you are a dealer or

doctor or trafficker or a manufacturer if you break the law and illegally pedal these deadly poisons we will find you and arrest you and hold you accountable. [applause] thank you. here in new hampshire i applaud all the drug enforcement agency and lawn officers who recently coordinated operation granite shield, an 18 hour enforcement action targeting drug traffickers that resulted in the arrest of 151 people, terrible people and have to get tough on those people because we can have all the blue ribbon committee's we want but if we don't get tough on the drug dealers we are wasting our time but remember that. we are wasting our time. that toughness includes the

death penalty. [applause] it is an amazing thing that some of these drug dealers will kill thousands of people during their lifetime, thousands of people and destroy many more lives than that but they will kill thousands of people during their lifetime and they will get caught and get 30 days in jail. or they go away for a year or they are fine and yet, if you kill one person you get the death penalty for you go to jail for life. we are not going to get tough on the drug dealers kill thousands of people destroy so many people's lives we are just doing

the wrong thing. we have got to get tough. this isn't about nice anymore and a committees and this is about let's get everyone and have dinners and have everyone go to blue ribbon committee gets a metal. frankly, talking and doing nothing. this is about winning a very, very problem and if you don't get very tough on these dealers is not going to happen, folks. it will not happen. i want to win this battle. i don't want to leave at the end of seven years and have this problem. okay. right? [applause] thank you. not going to happen. thank you all. >> this week facebook ceo mark zuckerberg will testify before the senate in-house committees facebook's handling of user information and data privacy. to stay at 2:15 on c-span3 he

will answer questions during a joint committee hearing. on wednesday at 10:00 a.m. eastern on c-span3 will be here for the health and energy committee. spirit congress returns from a two-week recess today. the senate convening in about 20 minutes to debate a judicial nomination. they will also swear in their newest member, cindy hyde smith, who takes a seat left open by mississippi pat cochran who retire. live coverage of the senate when they travel in at 3:00 p.m. eastern on c-span2. they plan to consider a balanced-budget constitutional amendment with a vote on thursday