doing together, the dea and the fda, why are we losing this battle against the prescription drug epidemic? and you have mentioned a lot of progress we have made, particularly in florida. but prescription drug abuse has not decreased. what is the next step? >> i think the fact that all of these things are coming together, that we actually are starting to see some fruition to all of the work that has been going on. for instance, in the most recent monitoring, the future survey, 8th, 10th, and 12th graders have actually reduced their use of prescription drugs. but i couldn't agree with the chair more that it is an epidemic, that it is so widespread, and that people still don't get it. they don't understand that these are dangerous. they can be deadly, and they can certainly be addictive. i think that one of the greatest hopes will be in the next step forward, and that is mandatory prescriber education. physicians must be told and must

have unequivocal information about the dangers of addiction, pain management, tolerance, dependence, and they really don't get that in medical school. the second part i know you'll hear from the drug enforcement administration is on enforcement. the laws have to be enforced, and people have to be prosecuted. >> i appreciate that. and especially your viewpoint on prescriber education. but a problem for me too as we examine this problem is there are clearly gaps in the data. and we don't really know the extent of the problem. what are the gaps and how can they be filled? >> well, quite often we rely, for instance, on fatal data to come from the individual states. and we know that depending on the particular state whether it's a medical examiner system or others, those states can often be delayed. we also know that at times, whether it's from the fatalities from driving accidents or others

that the level of examination ises to determine what the cause and whether or not that person had the drugs in their system is not always as thorough as it can and should be. there are data gaps. but i'll be happy at another time to tell you about this new initiative to take some of the data and really identify and drill down into it. >> i'd be happy to work with you on that. i think they're critical, even for policymakers. we need that data critically. the dea is going to testify that there are 1.4 million dea registrants. that seems awfully high. you think that 1.4 million registrants is about right for america? or is that kind of a crazy number? >> chairman, i actually wouldn't know what the right number would be. but i think when you look at nurse practitioners, physicians, and all of the other people that hold those dea registration licenses across the country and in the health care field, that

the number doesn't seem completely out of line to me. i think more importantly, it's how they're policed. >> thank you. and lastly, should we be thinking about creating new classification schedules under the controlled substances act with stricker regimes for the drugs that are clearly the biggest problems? >> i know that issue has come up before. to put those into the higher schedule. i think the more important part is to try and keep them out of the hands of the abusers, but not at the same time make it so restrictive that the issues that led us to where we are today 15 years ago, which was the clear indication that pain was not being adequately treated in the united states, i think the pendulum was too far over there. clearly today the pendulum is too far over here. when it comes to the available of these. i'm not sure scheduling would be the right answer, but we have to

bring this back to some eek l equilibrium. >> are you working that this is hurt mortgage people than it is saving? >> i have. i heard from a number of physicians that want to be much more flexible in understanding and treating pain, rather than writing prescriptions for 30, 60, or 90 days' worth of very powerful painkillers. they also want to make sure that there are systems in place where they can be adequately rehm b rd for what right now seems to be a simple and effective but not always effective in writing a skrip. >> the opiate babies. can you speak briefly to what you have learned about opiate babies? >> i can. i can tell you in the past and having visited one of the centers for newborns in seattle, the issue always centered around newborns and the addiction through heroin.

today when i met and saw all of those infants and actually held one of those infants, the issue was all about prescription drugs. and there was very little discussion about mothers using -- using heroin. and so we're building some tremendous health care costs as a result of not treating this adequately. >> thank you very much, director. i'm happy to recognize mr. butterfield for five minutes. >> thank you. again, thank you very much for coming forward today with your testimony. we have heard your testimony, and we appreciate so much what you do. i have a question that i would like to ask, and i may even ask it of the other panels as well. but i believe it's very critical, and it's central to the problem that we are dealing with. efforts in one state may yield declines in the number of pills dispensed, hospitalizations or

deaths, any which are very depend commendable achievements. how can we be certain that they simply don't go to another state? >> i think the key and the example would be the fact that florida had become such as has been talked about so publicly an epicenter for not only the use of these very powerful -- use and misuse of these very powerful prescription drugs for people within the state of florida, but for people traveling all the way through appalachia nationally, new york, connecticut, and other places. the regulation of medicine is done at the state level. it is not done at the federal level. and we have to provide the training, the technical assistance, the startup money for the computer systems, and the assistance to law enforcement, particularly state and local law enforcement to understand how to investigate these complex cases.

i would tell you that greater use of the pdmps is necessary. not as many physicians or people in the health care industry utilize them as should. and that they need to be real-time, and that they need to be interoperable across states. when those things come together, and i think we're seeing some of this in a number of states that are sharing the information, i think that that way we can stop that balloon effect that you were talking about, congressman. >> we've been looking at the data in our office, and the data seems to suggest that the total number of elicit drug users was constant for two years, even though we have seen great strides in states like kentucky and florida and even ohio. are we on the right path with this? >> i think we are on the right path with this, with what i believe is a very balanced way and a very comprehensive way of looking at this. if i go back and look at where we were, and believe me, i'm the

first one to tell you that a lot more has to be done, particularly in redoubling our efforts in some of these areas. but i look at where we were three years ago as a chief of police of a city of almost 700,000 people. i was really unaware of this prescription drug problem. and i think that my colleagues who were sworn to protect people in their city and learn about what are the dangers, when you don't realize it, when we didn't realize it, and prosecutors and judges and many others did not realize it, we weren't paying attention to it. because after all, it's a prescription. it's coming out of a medicine cabinet. it was huge mistake. this is on the front page of every major newspaper on a regular basis. it's on television. we're moving in the right direction. >> let me talk about travel communities for a minute. as the national drug control strategy points out, tribal communities have been particularly hard hit by unemployment. and combined with problems

accessing health care, education, and other services, tribal communities can be vulnerable to prescription drug abuse. a 2009 study by the substance abuse and mental health administration found that american indians are more than twice as likely as whites to abuse prescription drugs. what is the administration doing to help tribal communities address these unique challenges? >> we started looking at that almost immediately. and a couple of things are done. first, the assistant secretary, echohawk from the department of the interior has been a great partner, along with the indian health service and along with the bureau of indian affairs. we've made trips to a number of the tribal lands, for example, to tahonto odom nation that is

around the prescription drug issue. >> are you working with it instead of databases? >> so the education and prevention and working through the indian health service and treatment service. and let me just mention on the enforcement side, for the first time, one of our high intensity drug trafficking groups in portland includes a member of a tribal chief to help direct those needed enforcement resources back on to tribal lands. >> that includes databases and resources? >> i don't know about the database in particular. i would think that the health source would be more knowledgeable that. >> thank you. you've been very kind. >> thank you. >> the chair recognizes mr. stearns for five minutes. >> thank you, madam chair. is it true that prescription drug overdose deaths now surpass our car-related fatalities? >> it's true that all overdose

deaths from drew, misuse and abuse, not accidental are the number one cause of accidental death in this country, ahead of gunshot wounds and ahead of car crash deaths, driven by prescription drugs. >> that's a startling fact, don't you think? >> yes. >> do you think based upon that that we should have a radical change in our approach? >> i think that we haven't gotten anywhere near the attention or near the traction to something that is killing more people in this country than the car. >> 10 or 20 years ago i wouldn't find the statistic like it is today? >> not at all. >> and why do you think that has occurred? >> one, i think the driver of the prescription drugs as we've been -- as has been mentioned a little bit, people don't see them as addictive, they don't see them as dangerous and they don't see them as deadly. because they're after all a prescription. >> i think in your opening statement, you are talking about opiates are sold in 2010 to medicate every american adult

six times for a month. that was in your statement. >> yes. >> you put a lie to the claim that we're just getting better at pain management? >> when have i spoken with the physicians who looked at and were instrumental in the early days of undertreating and the recognition of undertreating pain, i think that was a clear recognition. and as i mentioned a minute ago, i think the pendulum was there, and that in very good faith ways, they worked very hard to make sure that people actually were adequately treated for pain. two things were missing. one is the amount of education that a physician would need to clearly understand and recognize some of the dangers of these. the other is that as many people have mentioned, we have become kind of an overmedicated society. >> how would we educate americans to not be an overly medicated society? >> it's a pretty tough issue.

it's kind of like dealing with the obesity issue. >> do you think it's something to do with our culture today? >> i think that the more important part is to educate the physicians around this as physicians are so much more knowledgeable about dietary issues and the causes. i don't see the same level of knowledge among them and among health care practitioners when it comes to the addictive problems of these drugs. >> could you from your department make it more difficult for the doctors to provide prescription drugs in the areas that are causing the overdose? is there something that you could do? >> we are kind of a small policy shop. >> you couldn't make any recommendations. >> these folks together. i think the key will be education, and then making sure that they follow the rules. and i think that we're well on the way to hopefully getting that done. >> you mention in your opening statement the actual costs to

society estimate at 56,207,000 and maybe likely higher today. so you have any what the cost in terms of devastating effects on families and communities? if it was $56 million in 2007, what do you think it is today? >> well, i think the most recent study on the costs to the united states taxpayer on drug abuse was well around $190 billion. >> 190 billion? >> and that includes all types of heroin, cocaine, marijuana issues, et cetera. but i think that you couldn't be more correct in putting forward the fact that it's not only a huge cost in our health care system, it's a huge personal cost and a huge personal tragedy. the child that doesn't graduate from high school, the employer that wants to start a new business and can't find people that are drug-free so that they will have less accidents and be

more productive. all of these things play a huge part. and to the dollar cost is one thing. the tragedy to this country is another important part. >> lots of times all of us talk about the legal war on drugs. but we're also -- i think we have to consider the war on prescription drugs. and so i guess the question is where does the current prescription drug war rank compared to our war on illegal drugs? >> i think my colleagues, particularly in the drug enforcement administration, when they set their goals and they move forward each year in recognizing what the drug threat is, several years ago they recognized this issue much more quickly and actually changed their direction and focus. i think you'll hear about the number of what are called tactical diversion squads, the number of investigations, the number of local law enforcement and prosecutors that have been trained in how to investigate these complex cases, because

these are actually legal drugs that are manufactured and often through prescriptions or pill mills. so those are important steps forward. >> are we winning or losing? >> we're moving ahead. i'm encouraged by a couple of things. one, the number of dispensed opioid prescriptions has flattened. and if you lack at the charts in a number of years, it looked like the space shuttle taking off. with the amount of opioids manufactured has flattened. and the fact that in this most recent monitor in the future, 8th, 10th, and 12th graders actually decreased in their use of one of the very powerful painkillers, vicodin. i think we're moving there. but as the chair and others know so well, it's not enough. and it's not fast enough. >> thank you very much, mr. stearns. and then pleased to recognize mr. mckinley for five minutes for his questions.

>> thank you, madam chairman. briefly, i think you and i had a little conversation beforehand we began, and we were concerned about privacy. i still would -- i'd like you to expand a little bit about that. what to me from an engineering from a small business perspective, i'm a little concerned about -- very concerned about the privacy. but i know and i think you would recognize that if there were a national registry of all the prescription drug use in america, the pharmacies could be held responsible to check that registry and find out that they just got oxycontin just one day earlier for three months' supply, and they would be able to say no. isn't there something, some form -- i know we don't want to have -- because as we've had other hearing here of somebody being able to hack into that

information. >> right. >> there are penalties that are related to that. but we all know if we had a list, if someone had a list, we could go -- hold those people responsible more so than the distributors that are doing the best they can to curtail that. tell me a little bit about what efforts we can do in security, the privatizing those names so that individuals can't be identified, but yet a pharmacy would be able to know that they have now -- this is their third prescription for the same medicine in the last two weeks. isn't there something you're doing on that? i saw this other, and i think that's just great, education. it works so well with teenaged pregnancies and everything else, hasn't it? sanctions against governments that they continue to do. so i really want something with

more substance to it that is going to solve the problem. >> sure. i think the answer is the prescription drug monitoring plans that are done by the state. since the federal government doesn't regulate the practice of medicine and the state does, having the pdmp, that electronic database that would be used by all physicians and health care professionals that would be real-time, and in states, particularly neighboring states, that information could be share aid cross the states. when it's led and directed and the startup money comes from the federal government, but led and directed by the state government, they can put in the protections about patient confidentiality and privacy. i think in the best of all worlds, that national database would be a wonderful thing. i think it would be difficult to implement because of the protections that would be needed to prevent exactly as you said hacking. and i think that part of that

national database would be the fact that it would be five or six or seven years in the making when right now we have all but two states that have pdmps. and as they become more well well-used and more robust, we'll actually make a difference with their use. >> are you suggesting, i think i understand, would not work with mail orders because they are ordered some place else other than just in the state. tell me again, do you think that if -- if pharmacists knew, by looking at a computer screen -- that that person, would he, or she, still fill that prescription? if he knew it was being violated? >> when i speak -- with all of the different groups and the individual pharmacists and you look at their -- their ethical standards and their patient safety practices, and the number of pharmacists that have picked up the phone and either said, either called the physician saying something isn't right, or

the ones that have told that patient you know what i am not going to fill that because i have that information, i'm pretty heartened by where the pharmacists are. but i think going upstream a little bit, that doctor that realizes that that patient that has come into his or her office has been to two or three other physicians, or that patient that walks in on friday evening, to an emergency department, and says, gee, i am traveling, or i lost my prescription or i need something look that, when that front line, upstream person, can take a look at that system, and say, well this is the third hospital you have been to this weekend, or, you are seeing two other doctors with a similar complaint. i am not going to be dealing with this. i think that is a help also. >> so what do we do with that individual when they come in? are they held? >> they're not held. i think because unless they actually get the -- unless s there is a law violation, they're not going to be charged or they're not going to be held.

but i think the other important part of this education piece is that they need to get into the treatment. i have met so many people now, across this country, and these travels, that become addicted to prescription drugs, have received proper quality treatment. they're back, they're back take care of their families, they're back paying taxes, they're back working and i think this is, this its the entry point to get them the help that they're needed. because the we are talking about a disease. we are talking about addiction. >> thank you, i guess we have run out of time. >> thank you very much. >> thank you, congressman. >> thank you, mr. harper. you are recognized for five minutes. >> thank you, madam chair. >> thank you for your time here and all you are trying to do una serious situation. with regard to the pdmps, what do you think the biggest barrier is in implementation of a drug monitoring program for states whose programs have yet to go online? >> one of the barriers is the

fact that it needs to be real-time and it needs to be -- ease of use. physicians have about, as i have been told, about 16 minutes with a new patient to assess everything. these are busy practices and busy offices. and they need to be given a tool that its easy, that its accessib accessible, in order to use it. of course once they do and they become schooled in it, and rely on it, the physicians that i have spoken with tell me it is a patient's safety tool. >> you know, we have 48 states have authorized programs. 40, i understand have operational programs. are all of these state pdmps, created equal? >> no. >> okay. they're not. but, but, we are fortunate at brand spech brandeiss university, a center of excellence that takes the best practices. and the heads of each of the

agencies come together several times a year for us to be able to speak with them. we want to be able to make them as rope bust and helpf-- as rob possible. some are better than others. >> are there some you would hold out as a role model for the other state or for those that have yet to go operational? >> i think you will hear from attorney, attorney general conway, and i think kentucky, is clearly, one of those states that -- that, has addressed this not just with the very robust and smart pdmp and some pending changes. that they have planned in their laws. to make it an even better system. i would tell you that, from what i have looked at in california, the cures system, is another one. but this center for excellence, they have done a very good job of putting in the hands of the people that use these develop these systems information that's necessary. >> what are you seeing as

strengths and weaknesses as communication between the various states with their monitoring programs? is that a -- a weak link. do you feel like the communication between the states can be improved? and if so, what would you suggest? >> you ask the million dollar question. and, and i think you are exactly right. some states are -- are -- easier to get along with. amongst each other. on this particular issue. and to work together. some states -- when you look at -- at these systems and the -- it its not a huge amount of money. every state is facing difficult budget times. how many of of a priority is it? when i talk to these physicians, or listen to the physicians in other states. said look if i am in eastern kentucky. i really don't want to spend the time to check ohio and west virginia, and, i, i need to get to -- to a system that is already linked to those neighboring states. >> uh-huh. >> do you -- are the pdmps the

only option out there for states to implement the sharing of this information? >> right now on the prescription drug abuse and misuse issue those are the options. i think the, health care -- technology, in the future, e-prescribing, all of these other things will play a big role in the future and make it easier and more helpful. >> we want to thank you for your work on this very important topic. with that i yield back, madam chair. >> thank you. director, thank you so much for being here today and all your hard work. you have been generous not only today but every day in working with me on these issues. the i applaud you for raising the profile for many years and, and -- and especially cuppiomin from somebody, you didn't know three years ago. you know now. i don't know if we have all the answers. we are starting to confront it. i look forward to working with you. thank you for being here today. its there anything you would rather close with, rather than a second round of questions,

something you would like to say. >> i am indebted to the committee, the members of congress that take this issue on. you have so many issues in front of you. yet as the i mentioned to the president president, on the drug issue when we think about keeping our kids in school, we think about who is going to be the work force we are all going to depend on in the future, i think about health care costs, i think about, law enforcement issues. the more that we can do on the drug prevention side and the more that we can do to get people adequate treatment and get them back into the, into being productive members of society. none of that could happen without the, without the will and support and the help of members like y'all. thank you. >> thank you very much. >> with that we will take a brief recess. just while we seat a second panel. hopefully 30 second. or so. we ask the second panel to join the table.

attorneys general of kentucky, florida and ohio talk about efforts to track and prescent the diversion of prescription drugs to illegal markets. in 1:10, the final panel, testimony from officials from the pharmaceutical industry. all righty. on the second panel we have four distinguished witnesses who are very deeply involved in the issues of prescription drug abuse and prescription drug diversion which clearly go hand in hand. we are honored today to have with us the honorable, pamela joe bondee, attorney general, state of florida, jack conway a. toern j -- attorney general state of

kentucky, and senior assistant attorney general for state of ohio, and the deputy administrator for drug enforcement administration. thank you all for being with us this morning. to help you keep track of tomb. there is a timer light on your table. when it turns yellow you have 1:00 to wrap up. so again you don't have to come to a screeching halt when it turns red. if you can wrap up your comments. we would appreciate it it. with that we are happy to recognize attorney general bondee, for five minutes. remember to turn your microphones on. and you may begin. >> thank you, congresswoman. >> green. got it. thank you, congresswoman, and thank you for championing this cause. on behalf of our country. and, thank you as well, ranking member, butterfield for having us here today and also to congressman sterns from florida. and to all the committee members. we truly appreciate this.