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 prog@ams. 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. directthank 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 yellowou 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. i'm here to tell you about what florida is doing to try to stop prescription drug abuse. as the congressman told you to

put it in perspective. of the top 100, oxycontin dealers in the country. 89 were in florida now we have 13. with legislation in effect barely a year. last year we had over 900 pain management the clinics registered within our state. today, we have 580. and i guarantee you, that number is going to continue to plummet. i want to outline now briefly, our comprehensive legislation and what we have done in our state. as you know, we have become the oxy-expre oxy-express. that's why i worked closely with general conway, and general dewine in ohio. what was happening people were buying their drugs in florida, taking them to kentucky. i had to hug a mother in kentucky when high was with general conway who lost her daughter two years ago to prescription drugs that were bought in florida. and that had to stop.

so we passed with that, we passed tough new legislation in our state. we are very proud of that legislation. it was long, long, overdue. let me tell you that. the common characteristics of a pill mill in florida, little to no medical equipment at all, shelves and shelves of pills. these doctors we call drug dealers wearing white coats sitting in a back room signing prescription pads. and it was legal. and it was killing our kids. so we had, very weak regulatory oversight of the pain management clinics. we had limited oversights of physician whose were dispensing which was very important. and we had a nonoperational prescription drug monitoring program. so, with that -- we passed tough legislation, we are

proud of that. one of the most important things to me. we banned doctors from dispensing, most abused narcotics. we made that a violation, of the ban. third degree penalty. and have you about a doctor, take their lice aense a. with the dispensing ban we feel we have been very successful as well. we created a standard of care for physicians, we required these doctors to either electronically prescribe or to use counterfeit proof prescription pads. none of which had been done unour stauin our state. we add enhanced criminal penalties that were very important and required all these pharmacies to be re-permitted by the state of florida. we did great things. we now have the pdmp up and running. if you have any questions i can discuss that with you as well. with that, we can create tough

new laws and move on to something else. the but what we did in florida, with governor scott's help, we started a strike force. that's joint, with federal, state and local officials all working together. you can pass these laws and move on. it's not going to work. we are targeting these guys and we are putting them out of business. and with that, just -- we have seven strike forces through our state. if you have question as but the strike force i can explain that in greater detail. but what we have done since we have had the strike force, we have truly gone in and started putting these guys out of business. we are targeting them. we are not letting up on them. we also have an educational component of this legislation. and that involves narcotics ed nope. this task force, amazing, remarkable people have gone into our schools and educating our children about this. we have also instituted along

with dea state drug take back days. i have participated, personally, in as many as i could. you would not believe the drugs that are being turned in. and it's gotten so successful that we plan on putting permanent drop boxes up at our police stations and our sheriffs offices as well. at two drug take back day as len -- days alone we seized five tons of prescription drugs. we are very pleased to announce, as of february 2012, our strike force efforts have resulted in 2,040 arrests. 34 of those are doctors. have seized 390 weapons. almost $5 million. but there is one other problem. i have run out of time. that's the babies being born addicted to prescription drugs. and that is our newest fight this session. we are not going to give up on that. as well. thank you for all of your efforts. and we do know we have a long way to go but i don't think any

of us in this room are going to stop. thank you. >> thank you very much. and geral conway you are recognized for five minutes. >> well, thank you, chairwoman, and representative butterfield for your commitment to this issue. i want to recognize, the congressman, not here, a fellow kentuckian, who works on our drug task force on this issue. prescription drug abuse is the reality that touched the lives of just about every kentucky family. it touched my family's life in a very personal way. ravaged communities, shattered families, and it's fueled crime. depending which study you leave, kentucky is the third or fourth most medicated state in the entire country. the four you hear at the top of the list, kentucky, west virginia, tennessee, and oklahoma. last year in kentucky, we had over 1,000 people that we documented, died, from prescription painkiller overdoses. more than weep lo lost to auto . we actually think that is

undertrort unde underreported. only half the people who die from overdoses are autopsied by medical examiner offices. when you talk a look at unnatural deaths in the commonwealth, of kentucky. last year, kentucky hospitals treated over 5,000 overdose paush e patients. an epidemic in the 1990s in eastern kentucky, a region of heavy industry, laborers, coal mines. we have more injury prone jobs. but also an area of economic depression. we had too many doctors who overprescribed. and too many people became hooked. because of the economic depression, people figured out they could sell their pills on the street. black market was born. today when you go through eastern kentucky which high do on a regular basis you will find that 80% of the crime according to law enforcement and pros s c -- prosecutors. it spread across the

commonwealth. not just in eastern kentucky. according to a lexington herald study, not too long ago. 120 of our counties we, have total. 118 were up in the schedule two and three narcotics prescribed. i'm sad to report, estimates from law enforcement in the health care community say that we have only about 10% of the treatment beds that we need in the commonwealth of kentucky. you know, i am suck aick and tif losing a generation to prescription pill abuse. we start aid public education program for doctors and school children in kentucky. i travel around the commonwealth with two mothers from moorehead, kentucky who lost their daughters to prescription pill abuse. really important to get feel like that, who look like the mothers of the kids, to tell them their story. they will listen to an elected official for five minutes or so. when the mothers talk they really listen. here's what's disheartening. middle schoolers, highschoolers, okay. tell the truth. just because i am the attorney general tell the truth.

f you have use aid prescription bill or best friends used it for an off label purpose. sad to report, 70%, or 80% of the hands go up. how many think prescription pills are easy to go? 70% or 80% of the hand will stay up. i will ask how many parents lock their medicine cabinets? all the hands go down. i realize not a problem that starts with grandma. in some instances particularly in kentucky an addiction starting in our homes. i have tried to do all i can. create the the state's first prescription pill task force, my drug investigators working with law enforcement. trying to collaborate, share resources in a time of dwindling law enforcement reforces. we participated in operation flamingo road. at that point we thought about 60% of our pills on our streets were coming from florida. they executed a search warrant on main -- pain management

clinic. of the 1700, of the individuals they seized records, 1,100 are from the commonwealth of kentucky. that's what we in law enforcement call a clue. we had people by the van load going to kentucky to bring pills back. not only hap to have a friendshipith general bondee, i an freightful s fulam gratefu. she said florida was home to 97, 98 of the top 100 proscribers. now down to 13. this issue knows no party. it is an american tragedy. we have entrepreneurs getting in the pill mill business. we need to stop them. we have mail order pharmacies shipping 90-day supplies of narcotics. i understand efficiency in our health care system that needs to be 30 days wecht ne. yes, we have casper, our pdmp, a

good system. 25% of our doctors are using it. on top of that, those of us unlaw enforcement can't see the data to do the investigations. i would be happy to talk with you more about that. i have heard the questioning here today. i am out of time. i will wrap up. if you want to know what you can do to help, help us get all 50 states up with pdmps and systems that talk to one another. we can do our jobs if we get the systems up and running and get the doctors to use them. thank you very much for the opportunity to be up here. >> thank you, general conway. you are recognize ford fid for minutes. >> thank you, chairman, ranking member and distinguished members of this committee. i thank you on behalf of the ohio attorney general, mike dewine and ohio for the opportunity to address you today. as the chief assistant prosecutor and later elected prosecutor in adams county, ohio i had a front row seat for the devastation that this scourge can cause on a community.

in february 2011, mike dewine recruited me to lead his prescription drug task force. attorney general dewine has been committed to using every resource ohio has to fight this scourge. and in hoip hohio we have taken nationwide stance in fighting back, changes in legislation, proactive law enforcement actions partnering with prescribers, dispensers and being proactive with awareness, education and treatment. through this effort, ohio has raised public awareness, increased public education, and improved ohio's investigations and prosecutions and in both criminal and regulatory cases. however, to make a real difference, we must limit the availability of prescription drugs to those individuals and actual need and in the proper quantities. in ohio, drug poisonings cost ohioans $3.6 billion annually. between the years of 1999 and

2007, ohio's rate of opioid distribution increased. ohio's drug death rate increased 305%. if you will look to my left see the remarkable correlation on the graph located closest off to the back of the room. in 1997, ohio averaged 7 doses of opioids per cap tachlt in 2010, our average dose of opioid per capita increased. in less than 15 years. ohio watched the average dose, increase almost 900%. the chart to my left, the closest off to the front of the room will illustrate, death rates during the current prescription drug scourge is hyper higher in ohio than tt heroin epidemic in the 70s and the crack epidemic in the 1990s.

ohio's leaders recognize the seriousness of ohio's prescription drug problem. on february 8, 2011, representatives terry johnson, and dave burke, a physician and pharmacist, in troep dugsd house bill 93 in ohio. the bill passioned through the, through the house and the senate unanimously. with the support of the attorney general, governor, john kasick signed the bill, 2011 and it be cam law. much like florida, our pain clinics, pill mills were not regulated. however bill 93 regulated pain clinics in ohio. it required physician ownership of pain lyclinics it requires tm to review our prescription monitoring program in hoip hohi. they had to do that treating chronic pain patients. attorney general dewine has worked tirelessly to create a

multidisciplinary approach to the investigation and prosecution of prescription drug cases. attorney general dewine worked with law enforcement at the local, state, federal levels in ohio to investigate prescription drug cases. we are currently working with prosecutor as cross ohio to prosecute these cases. he is proud to be part of the statewide team in an effort to protect ohio's families. our next step, the attorney general, believes is to build a bridge with state and federal officials across the nation. to have a true impact, we must collaborate on a multistate approach to combat this scourge. ohio and the nation must be proactive working with all the stake holders to take m this epidemic. when this happens you will see success. for example, in a county, one of ohio's hardest hit quoucounties border county to kentucky. the last pill mill was closed this past s december.

the county has population of approximately 78,000 residents. at one time it housed 12 pill mills prior to its efforts. today it houses zero pill mills. last week, the county learned that accidental overdoses decreased 17%. drug related deaths, decreased 42% in 2011. this was the first decrease, the county had seen in the past decade in these numbers. it had been a steady increase prior to 2011. i will end with a quote from reverend martin luther king jr., we may have all come on different ships but we are in the same boat now. each of us have arrived at the prescription drug scourge on a different ship. today we are all in the same boat, more importantly people will die if we continue to ignore the scourge. thank you. >> thank you very much. you are recognized for five minutes. >> thank you. chairman, ranking member, butterfield, distinguished members on behalf of

administrator michelle lynnhart and men and women of the dregug enforcement administration. before i get going i would just look to thank the chairman and this committee for the leadership on this problem. and i also want to thank you for promoting the national take back program. if i may throw in a plug, we will be doing it again, april 2th, saturday, state, fed lle r, local agencies, community groups work together to collect the drugs i would look to thank you. i would look to thank the leadership, who has gone out of his way to make sure that we get all the resources we need to dupe o do our job. the abuse of pharmaceuticals continues to be a problem in the united states, based on pharmaceutical diversion from

the supply chain and medication delivery system. and we believe that is the major reason, there is just holes in the system. over the last few years individuals and organizations have created keeps within the health care delivery system that are pure legitimate but noth morgue than illegal operations to facilitate the illegal distribution of pharmaceuticals. pharmaceutical diversion can be created if dea registrants would fulfill their on li gagbligatio. each dea registrant is a link. each registrant, manufacturers, whole wholesalers, distributors, pharmacies have a critical role to play in keeping the chain closed two. major schemes have emerged to divert millions of dosages of powerful addictive drugs. the first one a few years back was the internet pharmacy scheme. you could go online. and purchase pretty much any schedule 3, 4, 5.

hydrocodone, it came out of the distribution chain. and no one fulfilled their obligations to the chain. you had distributors weren't doing due diligence on pharmacies ordering huge amounts of hydrocodone. pharmacists weren't inspecting, they were issued for legitimate purpose. and in the use of traditional practice. doctors were doing the same thing. they were prescribing without a legitimate reason for prescribing. there was no medical determination made. but because of law enforcement's focus on that problem and then congress coming in and passing the ryan-hait act, we basically shut down that system. unfortunately, that system moved back to florida. and turned into pain clinics. and pain clinics grew. now these pain clinics -- besides the fact that they're operating illegally. they're doing the same thing that the internet pharmacies did. the only difference is, an internet pharmacies there was no

face to face visit. in pain clinics they see patients. again doctors are moving huge amounts of prescriptions out the door. pharmacists are not checking validity of the prescriptions, not ensuring they are valid prescriptions. and the whole sales and distributors continue to ship large amounts of drugs to those pharmacies without doing due diligence, what knowing their, their, their customer. without saying, why are youed or snerg why are you ordering this amount of drug when every other average pharmacy in the u.s. only orders this? you are 10, 12, 14 times more than that. they have a responsibility. they choose not to abide. comply with that obligation. we are fighting through education and regulatory control and enforcement. through 2005 we have a distributor initiative, distributor of their obligations under the act. when distributors fail to adhere. dea takes civil action against

their registration from 2010 through end of 2011 we took action against five wholesale distributors for unlawfully supplying florida, pain clinics, associated pharmacies with controlled substances. actions included, issuance of suspension orders and the prestripr restriction of loss of duty. practitioners that issue the prescriptions. these practitioners, feed addiction of drug seekers and allow drugs to enter the illicit market. rogue practitioner activities not limited to florida, rogue pain clinics are in georgia, tennessee, kentucky, southern ohio now in addition to out west. a dea investigation, with state and local and federal agencies of a pain clinic doctor operating in ohio culminated with the doctor sentenced to four life terms for overdose deaths. of four individuals. i would have to wrap it up here. we are making