health care professionals, drug manufacturers, patients, and even the care dwifrs. and we will work together to shape policy to control the misuse of pain medications we must recognize that the overwhelming majority of individuals including millions of senior and cancer patients rely on these important medications to help treat their pain. in our collective efforts to curb drug diversion, we must carefully but not inadvertently punish the patients who need these medications. we should punish the criminals who illegally acquire and sell these products outside the normal chains of distribution. members are committed to the safe and reliable manufacturing and delivery of generic drugs. we have invested millions of dollars in technologies and deliver systems to help assure that our products reach our destinations safely and securely. our industry works with the dea through the closed system that you've heard about before of distribution to prevent diversion and also to ensure they do not fall in the hands of

abusers, drug allotment and accountability systems to ensure against loss and diversion of controlled substances. some have questioned whether the q quota system needs to be re-evaluated we do not believe that doing so is an appropriate way to address concerns with prescription drug abuse. further restrictions of the quota system could hinder access to medical therapies for the parents who rely on them. for example, there are drugs designed for attention deficit disorder and attention deficit hyperactive disorder in the quota system that are currently on the fda's drug shortage list. thus, we are concerned if congress starts to tip the balance in the quota system it could actually have unintended consequences on the patients who need these medications. gpha has also been participating in the pharmaceutical distribution security alliance or the pdsa to develop a consensus technology model for increasing the security of the drug supply chain in the united states. as part of this model manufacturers have committed to

maintaining a database that would associate unit level data and lot number association. gpha believes this model will deliver greater safety to the patients and help to achieve fda stated goals of enhancing the identification of suspect products. but no matter how secure we make the supply chain for prescription drugs ensuring safe use of these drugs is a responsibility that rests on all of us. in fact, recent studies suggest that the problem with prescription drug abuse in the united states today primarily stems not from drugs that are outside the legitimate supply chain or have been obtained ill heelly through the black market but from those who legally prescribe and are available in the homes. more than 70% of people abusing prescription drugs are doing so with products obtained either from friends or relatives. the generic drug try has been a leader in addressing on diversion. we believe education is the key component to addressing this issue and as such support

efforts such as the american medicine chest challenge, smart rx, and the national council on education. in addition, our industry has focused its efforts in the area by joining the brand industry, patient groups, and the fda to develop the long acting and extended release medications. risk evaluation and mitigation strategies are used by the fda to prevent adverse outcomes for the patient. through the education of key participants about the risk with the proper and legitimate use of these medications. madam chairman, thank you for the tireless efforts to combat the problems of the prescription drug abuse in this country. you know more than anyone this is very much a multifaceted issue. thank you and i'll be happy to answer any questions. >> thank you, mr. gaugh.

i recognize myself for five minutes for questioning and i just want to say i get very frustrated anytime i hear denial from anybody in front of this committee as if they don't have a role in this. i think that there's plenty of blame to go around. there's no doubt and in the private sector if anybody was analyzing statistics and looking at the number of overdose deaths screaming upward. donald trump would say you're fired. these statistics are staggering. the attorneys general pointed that out. they did a fantastic job. something that really struck me and it's to the pharmacy -- the two pharmacy representatives, the murders of the four people in new york -- now the bad guy, the assail apt, was an addict, too, correct? and it seems are these robberies, are these crimes on the uptick because of the prescription drug epidemic?

are they addicts themselves and are they actually -- which is worse? i've seen people trying to go through withdrawal. they'll do anything to get the drug. anything at all. so are you seeing it because they're addicts or just people trying to divert it to the black market? >> i can't speak with a great deal of authority here. i think it is a combination. to the best of my knowledge. i have never seen a patient come in that i could say this person is in withdrawal. i think there is so much money involved with the black market of this. i think there are so many people that enjoy the euphoria. there's a demand and somebody is going to meet that demand. some of them are evil enough they will do whatever it takes to get it. >> but it's not the euphoria. they need a basic level to sustain themselves. so let's make it clear that it's not to sustain the euphoria.

at any point in time it becomes so that they can live, correct? >> yes, ma'am. but what i mean by euphoria, it has been proven over and over people in true organic pain do not get euphoria from the pain relieving drugs. if they are an addict they do -- the threshold to keep down the withdrawal syndrome does keep rising. they do have to have more and more probably more often and more often. >> right. >> but i don't know the people committing the crimes are addicts or salespeople. >> mr. nicholson, do you want to weigh in on that? >> thank you, madam chairwoman. first, i would add that i start off by saying nothing is more important to our members than the safety of their patients and their employees. and i would also add that the incidents that you're talking about with respect to deaths from pharmacy rob sis, the pharmacy robbery problem is, in fact, not -- from what we're

hearing is not at a nationwide spike but it is spiking in certain geographic areas such as the greater -- in the northeast and in the new york metropolitan area. to help address these issues, we work on a number of initiatives. we have been recently meeting with the officials at the office in that area to develop solutions that would help pharmacies to prevent these types of circumstances in the f future. >> do you all flag and identify willingly if an addict is willing to disclose to you he's addicted to opiates and -- i just want you to know in my record if i come asking for these -- i know it presents a whole host of other problems but there are these sorts of things pharmacies are not addressing right now currently, correct? are you able to say -- i know you can say you have an allergy to eye dine and you can put that on a patient's record but you

can say a known addiction to a substance with a patient's willingness to provide that kind of information? do you track that data? >> well, we -- i mean, the information that goes into a patient profile is provided either by the patient themselves. >> that's what i'm asking. do you specifically, if a patient says to you, i'm in recovery for an opiate addiction, if i come to you with a prescription for whatever, vicodine, whatever opiates, please talk to me, counsel me, do you do that now? >> the basic code of practice would be in the situation where a patient comes to you and says they're an addict, you would -- the ultimate goal would be to refer them to treatment. >> do you keep it on their record? it's a yes or no question. >> i can't answer. >> because the answer is no. but let me just move on because my time is limited. i just want to go down t lhe li if i might and get a yes or no answer out of each of you. do you agree with me that there is -- is there an epidemic on prescription drug abuse?

>> yes. >> absolutely yes. >> yes. >> yes. >> do you agree each of you have a responsibility in finding a solution to this problem? >> yes. >> yes. >> yes. >> yes. >> thank you. lastly, i'm just going to close with this one thought that i am a little bit frustrate d by the notion that a prescription drug monitoring program is punitive. it shouldn't be. my daughter is a professor -- my father was a professor of medicine and i really hold in very high regard doctors and understand their limited time, the same with pharmacists. when we're thinking this is a punitive measure, the ability for each of you to see a patient in their entirety perhaps if we change the language, it's not punitive but is supposed to be an added tool that will actually help you provide better health care to your patients, your consume consumers, your customers.

i think that would help if we could change the feeling and the language, and i'm happy to work with all of you. my time has expired. i'm happy to yield to mr. butterfield for five minutes. >> thank you. i'm happy that the chairman went a little bit over time because that kept me from having to ask each of you the question about whether or not you feel some shared responsibility in curbing the abuse of drugs and each one of you answered the question as i thought you would. i don't get the sense for one minute that any of you are not sensitive to what we're talking about today, and so i thank you for coming. i thank you for what you do in your industry and just encourage you to let's work together to try to solve this huge problem that we're facing. i asked this question of the first panel and i'm going to try it again and then i will close it out and head to the airport. law enforcement efforts in one state may certainly yield reductions in the number of pills dispensed or hospitalizations or deaths. all of this is commendable if it

happens within the state's border but how can we be sure that addicted individuals simply don't go to another state and continue to commit the crime? we've asked other panels about that, and it's the elephant in the room. i mean, that is the big problem. if we fix the problem in one state, it's very simple for the addict to go to a neighboring state. help us with your ideas on that very quickly, mr. gray? >> please make sure your microphone is on. >> here we go. all they have to do is get in a car and go. ultimately the solution is going to be the ability to link up these systems and other health i.t. records across the kcountr. and where doctors in florida or doctors in michigan can look at -- can go online and see what each individual patient is doing. that's the only way to kind of link up the information flow so a pharmacist in tennessee can

look up and understand that this patient is also just recently a pharmacy in florida. and now they're up here. but right now, as you heard the earlier panel, these systems are discreet by their states, they're not connected so the thfgs flow isn't there. >> thank you. >> all right is it on? >> yes. >> i don't know why they can't be connected. there are nationwide systems right now that we deal with every day with insurance that will feed back to us in a matter of seconds. there's a drug allergy on record for this, they've had it refilled too soon, it's not on o formulary. i don't know why something like this. but i'm the most technically illiterate person in this room. i don't know why it can't be done. >> i would agree with mr. dwra and mr. harmison that, yes, we need -- the major solution is to

connect the prescription drug monitoring programs. we support appropriations for nspr and for the prescription drug monitoring program to provide fund iing to the stateso they can upgrade and better maintain their drug monitoring programs and work on programs to interconnect them with each other. i also would add that we are hopeful that as the health care delivery system becomes more interoperable that pharmacies and prescribers and hospitals and other entities will have better access to patients' full record so there won't be gaps that would allow a patient to go from prescriber to prescriber or from state to state. >> similarly prescription drug monitoring programs can be an efficient and effective tool in

helping to identify folks for treatment as well and some of those solutions talked about today include making sure that information is provided to these state prescription drug monitoring programs in real time, but also enhancing their interoperability across state lines so that you can utilize this data to its maximum effect. >> all right. 50 seconds. >> i would concur with my colleagues on the panel that pdmp is a system that is in place but it does not cross borders at this point in time, and as mr. harmison said the reimbursements are instantaneously why can't this be instantaneously? >> thank you. >> thank you. mr. mckip ly, you are recognize for five minutes. >> thank you. mr. gray, i think you started in a direction and i want to follow back up again. but then you stopped short of going in that direction.

question, when we spoke with the dea they claim for distribution groups they give you very specific suggestions for improvements or otherwise how to -- >> right. >> i have a feeling that there is a breakdown from what they say they're doing and from you in the distribution business. are the distributors getting good advice, good direction when they go to the dea and ask for improvements to their delivery system about before they pull the registration? >> that's the big debate, and if you talk to high members, they would tell you those meetings particularly at the regional level tend to be deficient in solid advice at the end of the day as to whether or not a particular pharmacy should be having a stop order as far as delivery. our members started in this process with the dea four years ago. as i said, this is a relatively

new program. it was certainly a novel idea to consider the distributors a choke point. i think that's kind of a pejorative term for what we are trying to do as a teams as attorney general bondi said. we should be working in collaboration with the dea and we shouldn't be in an adversarial posture which these things when you issue an iso, that's where you end up, as was stated earlier. so what happens, and i've talked to most of my members about this, and a common situation that will occur is that there will be a discussion. the distributors will sit down and say we have reason to believe we see some spikes, something is wrong with the ordering of this particular pharmacy. we think maybe they should be cut off. what do you think? and the common refrain, there has to be some element of truth, that is a business decision for the distributor to make. well, sure it is, but then that business decision can be used against you if you decide not

to. and the questions that we submitted to the dea last june 1st, to administrator leonhart, attempted to get answers to some of those specific questions within the confines of these meetings, question the distributor 0 would have about a pharmacy practice. and this all stems from the data discussion earlier. they have data we cannot see. we cannot see that a pharmacy may be delivering -- may be receiving deliveries from more than one wholesaler. all we see are our numbers. and that has been a source of frustration. today i'm hoping we can turn the dialogue into a constructive one. it's not us versus them but how can we work together? i think we can make a lot of progress. >> let me stay on that question. there are two other issues. first, the pharmaceuticals that distributors are compensated for doing this police work for the dea? >> oh, no, this is all out of the distributors' pocketbooks.

we have invested tens of millions of dollars in doing this. >> thank you. so a smaller distribution firm, how do do they do that? >> very expensive. if you want to talk to some of them -- >> i just wonder, is the long and short of this with the dea trying to put the smaller d distributors out of business? >> i wouldn't want to speculate on that. i can't imagine that that would be the case. i think the dea is absolutely fervent and correctly so in attempting to stop this problem but i think like any new initiative we're in our dating period trying to figure out how to get along. >> is this one of those unfunded mandates that we're passing on to the companies to do and we're not going to compensate, then we're going to turn around and criticize them for the cost of pharmaceuticals? >> well, that's an interesting way to put it. well, as i say, the hard core facts when we put in these monitoring systems, it is at the company can's expense to do so. >> i want to see this in a most

robust way to try to correct the problem. i have this nagging feeling here that there are parts of the chain not being treated equally and i hope that the dea will revisit how they work with each. >> we do, too, because we have a long history since i've been onboard in '04. we were the first responders in katrina. our companies are the ones who got in -- we were the only ones that got medicine to the people stranded in new orleans. we were the ones that set up the vaccine tracking system with the cdc in a co-op operative effort. we worked with the secretary of hhs to develop the system for bird flu, maintenance and stockpiling around the country. we have a long track record of working with federal agencies and the government. i would love to see that same level of participation co- cooperation with the dea because i believe they are correct. together we can solve a lot of this problem. if they help us help them, we can make a lot of strides to

solving this problem. but we're working in a vacuum. >> thank you very much. and i'd like to begin wrapping things up. i thank all of our panelists for being here, for your time and commitment to this krcritically important issue. if 30,000 americans died every year from food poisoning, congress would take action. if 30,000 americans die from pesticide exposure, congress would take action. for that matter, if 30,000 dolphins died and washed up on our beaches every year, congress would take action. so why can are the victims of prescription drug abuse treated any differently? working together as we've all said, i know that we can come up with good answers and can save lives. so i again thank you all very much for being here and especially for weathering the delay we had this morning. if you have ten business days to submit questions. i know we will have one about on dose marketing and so we will submit questions to you and i would ask the witnesses to

please respond promptly to any questions you might receive. again, thank you. the hearing is now adjourned. on tuesday civil rights will hold a hearing on racial profiling. senators will examine the impact of newly enacted immigration laws. anti-terrorism efforts and discriminatory law enforcement practices occurring around the country. watch live coverage getting under way at 10:00 a.m. eastern here on c-span 3.

jury selection began this week in the retrial of former major league pitcher roger clemens, charged by federal prosecutors with knowingly lying to congress in february 2008 on performance enhancing drug use in baseball. >> let me read to you what his wife said in her affidavit. i do depose and state in 1999 or 2000 andy told me he had had a conversation with roger clemens in which roger admitted to him using human growth hormone. mr. clemens, once again, i remind you, you are under oath. you have said your conversation with mr. pettitte never happened. if that were true, why would laura pettitte remember andy telling her about the conversation? >> once again, i think he misremembers -- our relationship was close enough to know if i

had known he had done agh -- if he was knowingly knowing that i had taken hgh, we would have talked about the subject. he'd have is come to me to ask me about the effects of it. >> watch his 2008 testimony online at the c-span video library. with over a quarter century of american politics and public affairs on your computer. at a security forum in washington last week, military analyst anthony cordesman criticized policy in afghanistan. the former adviser said afghan forces were not ready to take over as the u.s. preps to withdraw in 2014 and he questioned the credibility of the afghan government. he was joined by the former u.s. ambassador to afghanistan at this event hosted by the center for strategic and international studies. it's an hour and 15 minutes. good morning. >> morning.

>> my name is robert lamb, on conflict, crisis and cooperation. thanks to all of you for coming this morning. i want to start by thanking you for making this entire day possible. i would like to request that you all please silence your cell phones so we are not interrupted during this, what i think will be a lively and interesting discussion on afghanistan and pakistan. we will be live tweeting this event from csis-org. he's tweeting this entire event. we will take questions from the audience following the panel. please wait for the microphone to come to you because we are live streaming this over the internet, and we want to make sure everybody can hear your question. when you do get the microphone please identify yourself and phrase your question as a

question. please don't give any speeches. keep your questions limited. lunch will be served during the third session beginning at 12:30. this session ends at 12:15. a little bit about our program, the program on crisis conflict and cooperation, known as c-3, the post conflict reconstruction proje project. we're now in our tenth year at csis during a time when the field has changed fairly dramatically ten years ago after 9/11 there was a lot of hope about post con mrikt reconstruction in the wars in afghanistan and iraq. we've had quite a lot of experiences with post conflict reconstruction and we have found that it's time to rethink where we are in the field, where we've come. a lot of what we do in our program looks at development in governance in particular in crisis and conflict areas, in particular the risks, challenges

and opportunities for cooperation that might exist. i'm thrilled today to be sharing the stage with three distinguished panelists. anthony cordesman to my immediate left here is the chair in strategy at csis, defense department distinguished service medalist. he participated in the 2009 afghanistan review and has done quite a bit of advising on the conflict in afghanistan, iraq, and obviously many other places as well. going back many years his service to the field of strategy goes back all the way to vietnam. he has -- [ inaudible ] he has studied probably every issue that has arisen from nuclear to middle east and we're looking forward to his comments today on afghanistan and

pakistan. dr. kori schake joins us as well, from hoover, has taught at west point, hopkins school of advanced international studies, and the university of maryland school and public policy where she and i both got our ph.d.s. during the bush administration she was at the department of state in the office of policy planning and also at the national security council where she advised on defense issues and including coordination and working with our allies in afghanistan and iraq. and finally, all the way to my left we have ambassador neumann, former ambassador to algeria, bahrain and afghanistan, spent a good deal of time in baghdad advising on political affairs and any other number of issues. he was once a deputy assistant secretary in the state department, is a published author and very well known

expert on all things having to do with the subjects we're talking about today. so i thank all of you for being here. it's very easy to be pessimistic about the situation in afghanistan, the transition in afghanistan, and the u.s. relationship with afghanistan. clearly in both countries there are problems with corruption, with relations between civilian and military parts of the government. there is a good deal of violence in both countries. some related to insurgency. some more terroristic in nature. strange relationships between government officials and various maligned actors, criminals, former warlords and commanders. it's a very challenging environment to work in. in pakistan with the death of osama bin laden, the relationship with the united states broke down pretty severely and here we are nearly a year later and we're still

struggling to redefine that relati relationship. it's somewhat harder to be optimistic about the situation in both countries. but saying the situation is completely hopeless is not particularly helpful to those who are trying to figure out how to move the situation in both countries forward. in afghanistan we can observe at least that ten years ago the country was essentially a medieval theocracy and say what you will about the state of the government and the economy, both of which are bad, they are at least not taliban-era bad. there are a number of former warlords and combatants who are participating in the afghan political process and not necessarily still as combatants in the civil war as they had been in the past. that's not to say that they might not be again in the future. but there is participation in political processes, formations of political parties.