management team, which has the oversight of the best and the ibet programs and we have a yearly meeting coming up called project north star in spokane, in which we will again sit down with our canadian colleagues as well as our state and local officials and federal agencies, again to strategize and to implement those strategies in the near future. >> that's great. i appreciate the collaboration that we have with our neighbors to the north. through this process, have you seen any joint initiatives where the canadians have actually pushed back or they don't wish to collaborate with u.s. authorities? are there any of those instances out there? anybody? none that you've experienced? >> no, i wouldn't say -- the only reticence sometimes is the sharing of targeting information. they have certain privacy rules which they have to abide by.

and so sometimes that can be a little bit difficult. i think we talked about the mlats and the information that is provided via that type of format. so -- but, i think those are overcome on the -- in the field, with operational matters. and between the different agencies. >> okay. >> senator, from a prosecutor's perspective, we have made great efforts and i think great strides to bring our prosecution teams together, to address some of the challenges that we face when we do cross border operations and investigations. sometimes there can be challenges sharing information. we have to make sure we're in compliance with the rules of each country. sometimes we have to make charging decisions, who are we going to charge and what jurisdiction are we going to charge them. there are different considerations that come into play, based upon the law of canada or the law of the u.s. so i think we have come a long way in bringing our prosecution teams together, bringing our --

the canadian provincial prosecutors and federal crown prosecutors together with our u.s. attorneys to work some of those differences out. >> that's very good. i appreciate it. it is good to know what works and then if there are challenges out there as well. thank you, gentlemen. my time has expired. >> thank you, chairman johnson, for -- mr. chairman, for the introduction and for the opportunity to talk about a border that we don't talk a lot about in this committee, which is the northern border. and it is interesting, senator mccain is still here because i think one of the challenges we have both on the north and on the south border is as we have put and deployed more resources at the points of entry, we have opened up rural america, whether it is on the northern border or the southern border, to mischief. things that used to happen through the port of entry now could, in fact, are happening on the southern border in very

remote locations which creates huge disturbance to local communities, to rural america. i recently hosted ali maorcas in south dakota and i want to applaud blue and green. we gave him a great look at how cooperation works in north dakota. and your folks have been just absolutely fabulous on the northern border and cooperating with local law enforcement, cooperating with canadian officials, cooperating with local chiefs and sheriffs. it is just -- it is seamless. and the applause is all around. but there is challenges. in minnesota, the challenges are wooded. in north dakota is open prairie. miles and miles. if i took you up there, farmers are farming around the boundary posts. so this is not what you see typically on the southern border. one of the big challenges we have is getting staff in remote locations. and i think you both can say the challenge -- i think we're down a number of custom and

border protection officers in -- and we continue to struggle to get border patrol to stay on the northern border. and so my question to you is what are you doing within the department of homeland security to secure additional incentives for workforce to stay on the northern border? >> thank you. >> so we recently commissioned an internal work group to look at exactly that. we have a lot of places that it is hard to maintain staff at. so we're looking at what are the options that are at our disposal now as far as relocation incentives, paid moves, promises of limited assignments there of a couple of years and looking at what is the right options to offer at the -- >> are you meeting with any resistance internally in making pay adjustments or incentive adjustments to secure staff on the northern border? >> no. we haven't. it's just a matter of finding the budget funds to do it and

figure out what is the right approach at each of the locations. >> we're back to budget constraints, giving us a less secure border? i think is the point that senator mccain was trying to get at. >> we have -- >> i know you don't want to say that, but -- >> i'm happy to say that. because, i mean -- >> we would like it if you say that. >> we submitted the staffing needs as part of the annual budget for the last couple of years. we did receive 2,000 more cbp officer two years ago and are in the process of hiring them. but the need still remains for 2,624 more. and it's just finding ways to pay for that. and these would be distributed in amongst with the work load staffing model to do that. >> i think we would be foolish to say that lack of -- that we can manage the borders, either the northern borders or the coastal borders which we haven't yet talked about, or the southern land border without additional resources. be it additional aircraft that can monitor the border, basically transport folks in

north dakota, we don't have any capacity for detention. and we have a huge number of what i would tell you are undocumented workers, who are working in construction in north dakota, who are pulled off roofs and pulled off construction projects, only to be on those construction projects the next day. and so i understand the lack of capacity, but i also think that we have to be realistic about the squeeze that we're putting on rural borders. we're trying to take care of it, whether it is san diego or mcallen or el paso, we see the problems there, and we ignore cochise county and to the west. so you guys have to help us work through this because as we push the envelope, and put more and more restraints on those border crossings, we're going to move the bad guys to rural america, whether it is on the southern border or the northern border.

the other question that i just want to broach quickly because i think the focus here is all people coming to this country, but we have a fair number of people who are crossing into canada from this country and that causes concern for canadian officials. mr. wagner, i was interested in your exchange with senator booker, because it seemed like we were maybe two ships passing in the night. do the canadian officials not share their watch list with us? >> i don't believe we get their actual watch list. >> why is that? >> i don't know. >> is that because we won't give them ours or is it because they have privacy regulations that we can't work through? >> the fbi manages it for us. and we're users and consumers of it and we contribute to it, but we're not the owners of that. >> what i heard all of you talking about is this extraordinary cooperation you get from the canadian officials. sometimes laws don't allow it to be seamless, but i can tell you as a former attorney general

from my state when we used to do intel briefings on the northern border with local law enforcement, whether it's break ins, burglaries drugs the royal canadian mounted police were at those events. so i can tell you locally it works very well and it sounds like you believe that it works pretty well kind of country to country. if you were going to make any changes in that relationship, what would you recommend? any of you? >> i mean it really strengthening the information exchange and the access to the information that you have internally within your organization or your country. we exchange a lot of information with the canadian government, the land border, our entry records are serving as their exit records and vice versa so we can start the exchange and identification of who is overstaying and we can also see then who left the country. in the commercial aviation environment, we're doing joint -- what rules creation and joint targeting efforts to look at threats to north america.

not just necessarily the u.s. or canada, but it is what access do they have to be able to share with us, which brings up the watch list. >> are we sharing lists of folks who are on the list for deportation with the canadian officials? >> i'm not aware -- i don't know. >> mr. chairman, i'll submit some additional questions, but i do want to once again give you a high five for all the great work that is done in north dakota with constraints on resources and for the extraordinary cross border cooperation and local government cooperation. you guys are doing a great job up there. your folks should be make you proud. >> thanks, senator hidecamp. i wish i would have been here for your questioning because i know this obviously affects your state quite a bit in what is happening on the border. chief fisher, i do want to go back a little bit to the question from senator mccain in terms of what is going to happen

this year with the unaccompanied children. we shouldn't be minimizing this. yeah, it is down from last year, but last year was a humanitarian crisis. i don't know what you call, you know, 60% level or where are we at in terms of the total number that have come compared to last year? somewhere around 60, 70% of last year? correct? >> just so i'm clear it was not my intent to minimize that flow, what happened last year by any stretch. and just looking at it because it is more of a statistical anomaly last year. for us, it is people coming across the border for a variety of reasons. we see what happened for instance, last year in south texas. what the department of homeland security did this year, and each year over last three years we have seen increases from individuals from central america coming between the ports of entry. what changed last year was not

necessarily the seasonal trends. that continued almost exactly the way it has been over the years. but what did change was the volume. and what we try to do, what we did do with the secretary's leadership is start looking at after july when the numbers started going down, was really looking back and saying, one, how can we be better prepared to not just react to it but really to bet predict it. the other interesting -- at leigh it was interesting for me -- to see in how the secretary approached this the department of homeland security was one of three departments that had equities and jurisdictional authority to respond to this. when you take a look at health and human services, that is a very big piece when it comes to unaccompanied children. you look at the department of justice, in terms of not just the prosecution, but, you know what do we do across the board between the three different departments. that, i think, was the first time in my experience we started seeing peaks of volume along the border.

>> i just have to stop you. you used the word -- that was an anomaly, far more than a statistical anomaly. it was a humanitarian crisis. >> i don't disagree with that. >> and it was one that was fuelled by the actions of this government and this administration. i don't have the chart here. we used in other hearings, but we have a chart that shows the number of unaccompanied children coming from central america declining. i guess, call it a managerable level. don't know the exact numbers, i don't have the chart, but then that just -- you had deferred action on childhood admissions and that shot up. i mean, it was cause and effect. it was very clear. by the way, in our trip down to mcallen, texas, i want to commend the custom border patrol and the really tremendous effort that they put forward to address that humanitarian crisis, but it continues at, what, a 60 or 70% level. still a problem. and, you know, just having met with general kelly, i don't want

to put words into his mouth, but i think he is confirming what is my sense is that no matter what deferred action childhood admissions says, no matter what the deferred action on parents, you know, whatever -- no matter what those -- those memorandum, those executive actions say, it is what is the reality and the reality is if you're a parent or a child in central america, you send your child or you come up and you get into america, bottom line is you're staying. that's what the coyotes are telling them. even though we have a counter-communications strategy to say, no no this doesn't apply to you, the reality is, it does apply and i have to admit as i delved into this problem, i know you are custom and border protection, the conclusion i'm really coming to is you could almost be renamed custom and border processing. because that's certainly what i saw in mcallen, texas.

as long as we continue to apprehend these individuals, as long as we have these incentives for people to come into this country because they realize they get here, they aren't going to be able to stay, as long as we detect them, apprehend them and process them with the notice to appear, and then disperse them around america into the shadows, we're going the continue to have that problem. we need to recognize that reality and start addressing. i guess this is a pretty good staff work here. they have given me my chart, which pretty well shows the reality of the situation. so this is far more than statistical anomaly. this is something that our immigration laws, executive actions actually caused. and until we're actually -- until we're willing to admit that reality, we're not going to stop it, we're going to continue to have this human crisis occurring, maybe only 60 or 70% level, but still a humanitarian crisis from my standpoint. do you want to respond to that

at all? tell me if i'm wrong. >> senator, i do want to thank you for complementing the men and women in rio grande valley and greater south texas. i've been down there and very proud of the work they do each and every day. thank you, sir. >> i do want to get back to the northern border and the drug trafficking there. because, again, if you really take a look at the root cause of so much of our border insecurity, it is the insatiable demand for drugs in this country, and what that has spawned over the last 50, 60 years. really, our demand has caused so much of this problem, so much of this crisis. so i want to get some kind of sense of what is happening on the northern border, where it is flowing. listen, i go every year, fishing to canada, i've gone through the ports of entry, pretty calm. bunch of folks with fishing boats. but i also understand the -- how porous that border is as well,

just hop in the canoe and you're a camper and who knows what you're transporting. understanding we don't have the statistics, which is part of the problem, by the way, in evaluating how to provide greater security of the border, we don't have the information. and there is a real disparity in information, whether customs border patrols or protection is talking about 70% -- 70%, 75% apprehension rate versus agents on the ground saying it's only 30, 40%. i want to get some sense of what is happening on the northern border specifically as well as people can tell. i realize you don't have exact information but is the drug smuggling, human trafficking, would potential terrorists we're concerned about, are they going to come through ports of entry or are they going to be coming through the areas between the ports of entry? can anybody address that basic question? mr. spero? >> yes, senator. thank you. you know, from our

investigations, and, again, we get a lot of referrals, a lot of our case work comes from referrals from the ports of entry or ports of the border patrol, but not all of our investigations are referrals. some are from our own confidential informants or state and local partners. we understand that, you know, one day the vulnerability could be at the port. one of the ways that we look at national security is that it is our job to make sure that we're investigating criminal fraud cases when it comes to people either pretending or appearing to make themselves appear that they're eligible for an entry visa to come into the country, whether that's a student who is coming in under a different name or doesn't intend to go to school or whether it is a worker who claims they're going to be working at a particular job in a particular industry and purchase

that visa. or whether it is in the interior where the fraudsters are trying to go to one of our other sister agencies, citizenship and immigration services, to obtain a permanent residence or maybe even eventually u.s. citizenship by any kind of fraud. so through our document and benefit fraud task forces, through our participations, on the joint terrorism task forces where we can bring -- hsi can bring our title eight civil immigration authority, our abilities to investigate fraud or our title 19 customs fraud, you know we're looking at all types of vulnerabilities, we're not just focusing on one. so whether that is people who are flying directly into the country, right into the interior, but maybe on a fraudulent visa or applied for asylum with fraudulent application, that's a big vulnerability and that's something that we take seriously. but also some of our other national security strategies are

to make sure that sensitive technologies are -- we use our export enforcement and counter-proliferation program to make sure the sensitive technologies are not getting out of the country -- >> again, with a i'm not getting or hearing is some sense for how much of the problem is coming through our ports of entry and whether we have to beef up personnel or improve -- fund them in a deficit neutral fashion or whether they're coming in between the ports of entry. how do we ever get the information? we realize it's not the volume so we're not calculating percent apprehensions or anything else. chief fisher, would it make sense to utilize what drone flights we have? would it make sense to use what detection capabilities we do have? would it make sense based on the anecdotal arrest and apprehension rate to do some level of statistical sampling

some measurement to get some kind of information so that the policymakers who are going to be tasked with allocating those scarce resources from some sense of where the problem does lie on the northern border? do you understand the issue, the information i'm looking for here this terms of where the problem lies and what we need to do to really assess the extent of it and direct proper solutions? >> i believe i do, senator, and one of the things that -- and certainly with the sake of time i'd offer up the briefing to you or your staff. as was mentioned earlier, it's not as simplistic just to say it's just happening at the ports or it's just happening -- the metrics that we use in terms of between the ports of entries, there are 12, and we take a look at trends, not just on the southern border, we take a look on the northern border and we get, for instance with john's folks and try to figure out, say for instance, in a place like swanton. so what is the dynamic there?

what is the business model of the elicit networks that operate in canada that are exploit ploiting the u.s. border. that scenario is likely to be different than blaine, washington or in detroit. so for us to just -- at least for me to simplistically say it's at the ports of entry, between the ports of entry, it really depends on the area of the border. and we do have methods to be able to inform our judgments on where those redeployments should go. and we would be happy to -- >> first of all, i'm not asking for simplicity here because i realize it doesn't exist, this is incredibly complex and it's sector by sector and area by area and state by state and even beyond that. again, i realize the montana border is completely different than the canoe area up in minnesota and lake superior and detroit. i mean, this is a vast, vast border and all kinds of differences. i guess what i'll ask you, yeah, let's do a briefing. i want to understand the complexity. i want to understand exactly what you do know about

anecdotely, have people loaded up canoes? are they flying it in small planes? are they catapulting drugs across the board with cannons? it's unbelievable as i've delved into this situation the number of methods, the ability to avoid detection, the use of the drug cartels blocking off the bridges to these kids so they can funnel them and put pressure and overload the system over here so they can divert customs and border patrol so they can smuggle the drugs over some place else. trust me, i understand the enormous complexity of the situation, but i don't have the information. okay? i know it's complex, but i really don't know how complex, i'm not sure anybody does, but if we're going to start crafting solutions to provide better border security, you know, we need to better understand the complexity of it. >> agreed. >> i would look forward to a briefing. i was hoping senator ayotte wanted to come here and offer some questions.

let me first offer all of you the opportunity to make a final point, you know this is something that senator carper has done, i loved from it. if i was a witness i'd be sitting here going i want to make this point. here is your opportunity, make that final point if senator ayotte gets here we'll finish with her. >> thank you for the consideration and obviously the opportunity to be here today. it was brought up a couple of times this morning alluding to some of the effectiveness of reporting in terms of what my office reports versus what may have been in the recent past articulated specifically by mr. cabreta. i know there's been a lot of questions. for the sake of brevity let me say this, one, i have seen what mr. cabreta mentioned in terms of a host of things, the effectiveness rate, what he is hearing, what the policy is based on presumably what i have

directed to the work force in the field, among other things. let me state for the record that none of that is based on truth. it is true, however, that mr. cabrera is entitled to his opinion. he is not, however, entitled to his own set of facts and i would, not now, but with your staff be able to clear that and tell you, in fact, what the policy is by my handwriting, what the transition has been over the last couple of years and what i expect from each and every border patrol agent in uniform as it relates to data integrity and reporting if there are any allegations of misconduct. thank you again for the opportunity, senator. >> i appreciate that. again, i have a keen understanding how difficult it is to get this information. this isn't like a manufacturing setting where you can study it, it's all right there. this is enormously difficult, enormously complex. we're trying to wade through that and try as best as possible to describe the reality and try to ascertain the truth here

knowing that you're never going to get the full reality of the full truth. we certainly do appreciate your service to the nation and, you know doing what you can to grapple with a difficult situation. deputy commissioner wagner. >> it's really just a recognition of some of the economic activity that crosses that northern border, what it means to the economy of the united states and to canada. you know, looking at -- within the office of field operations, we have a huge workload of not necessarily just enforcement work, you know, there's the regulatory functions, there's the processing, like you mentioned. of the commercial vehicles that cross the border. we're welcoming our citizens home, welcoming visitors, tourists, business tourists ensuring their compliance with all the laws and regulations, but the majority of the transactions we do, every truck, every piece of cargo, every person, every train, every boat, everything has to be seen by a cbp officer and admitted and released by the cbp officer. the great majority of those transactions are good law

abiding companies and citizens and visitors. it's layering our enforcement processes on top of that without stopping or hindering that movement back and forth. and really ferreting out those bad actors and things from coming in. that's where we try to reply really a dedicated and targeted effort based on intelligence, based on our analysis and based on cooperation with our foreign partners and our partners within the governments at the federal and state and local levels to be able to best do that so we don't stop that commerce because that would be just as devastating as an attack. >> i agree. thank you. thank you for your service. special agent spero. >> thank you, senator. i guess for my final point i would just like to add that i understand the -- your frustration with our ability to necessarily pin down exactly -- or identify exactly where the

threats are because in immigration customs enforcement or homeland security investigations point of view our focus is to attack transnational criminal organizations no matter what they're doing because what we're finding at hsi is these organizations are smuggling guns, drugs, people, weapons. it's the roots that we're trying to identify and attack and the organizations. that's why we feel like our elicit path attack strategy puts us on the right path. we are not focusing on the individual committing the crime. when we had hit that -- when we stop that seizure, we make that big seizure or get a referral that's the beginning of the investigation for us. that's not the end. it doesn't stop there. what our strategy is to attempt to identify the whole scope of these global organizations, whether it's terrorist organizations or other criminal organizations. so that's, you know, reaching back and using that foot -- our international footprint to

identify the bad actors or members of the organizations in the source countries, in those transit countries, here in the united states if the united states is the ultimate destination country, but also working with our canadian partners. so, you know, we're kind of changing the way that we measure success. i understand that the -- the old methods of straight indictment, convictions and arrests and seizures and comparing them to the previous years or matching up with what the resources are isn't necessarily the best way to determine success. we're moving towards a model. we've implemented a model where we're looking at what are the cases that we're doing that are having the biggest impact on border security, public safety and national security. so i absolutely i want to thank you for holding this hearing and bringing the attention to the northern border and certainly for giving me the opportunity to

represent the men and women of immigration, customs enforcement and homeland security investigations. i know that they're out there every day trying to do the best they can to enforce the immigration and customs laws of the united states. >> we thank them and thank you for your service. mr. rodriguez. >> thank you, senator. i wanted to make a couple of notes from an operational perspective. again, when we talked about additional resources for the northern border i want to make sure we don't overlook our intelligence capabilities and the challenges that we face and to that aspect i think our most critical support that we provide our partners is with intel analyst support. so i know we talked about agents, investigators, but i don't want to leave that component out as far as the need for intelligence analysts. they play a critical role this our investigations. secondly, i just want to point out a few gaps that my partners wanted to make sure i mentioned, and that was radio inter operability along the border. it continues to be a problem especially in those remote areas

that you're familiar with as well as our radar coverage, especially over the cascades where we have these deep canyons and we can't get radar to look down in there. so that also is one of the gaps we still need to address. and finally, as far as looking at specifically drug trafficking organizations, we measure our success with the numbers that we dismantle and disturbance and again, a third of our numbers are multi-national poly-drug organizations that are impacting not only our southern border but also the northern border. because we're seeing more of our southern borders dtos coming up and again as i mentioned trafficking more meth and cocaine through the united states into canada. >> they're businesses and they're looking for additional product lines and looking for additional markets and they're finding them and they're growing and metastasizing and it's an enormous problem. i also want to comment on the radio -- what we hope is

complete operate rablt or interon rablt. it's consistently mentioned to us as a problem, it's probably not the sexiest technology cure but it's an incredibly important one so we have definitely heard that message as well. >> thank you, mr. chairman. i would agree we face all the threats you've described and it can be frustrating, threats from potential terrorists, drug smugglers, alien smugglers, human traffickers, you name it, and those are the threats that we face. i think we should think about it in terms of how we address those threats and we do it in a couple of ways. first, we have to have really robust prosecution regimes, i think our u.s. attorney offices along the northern border, i now them all. i know their offices. they work hard. they bring good cases and now that we're staffing back up after some of the lean budget

years that we experienced, i think that things are look up and the future is bright for us. robust enforcement certainly very important. the second thing we need is close collaboration between our law enforcement agencies and with our canadian counterparts. and we could use some assistance perhaps with some of our doj law enforcement agencies having resources to work within some of these task force formats, atf and dea in particular, but we have to work toward integration i think with our canadian counterparts and we're taking steps to get there. finally as you described, we have to address some the root causes. i think we have to take a comprehensive approach to the -- to the drug problem that we have and to the crime problem that we have and that means to do other things other than just prosecute and incarcerate people. we can't just do that, we have to take a more well-rounded approach, we have to spend effort on reentry and on prevention and i think the attorney general's smart on

crime program is i think well-designed to take a comprehensive approach toward our crime problem. so thank you for the opportunity to be here today. i appreciate it. >> thank you. we're actually working on right now a field hearing on high levels of incarceration rates, we will probably do that in milwaukee, somewhat talking about the issue you raised there. i did want to -- did want to ask you a question because coming as a district attorney in the northern border sector when we were down in mcallen, we just did a sunday driving around with people off hours and local law enforcement was telling me that the fight over prosecutorial jurisdiction isn't the fight that i would have expected. normally i'm hearing people, they want the collar, they want to be able to prosecute that criminal. that's not the case in the southern border because it's so expensive to prosecute and people's budgets are strained,

basically they're fighting over not having to prosecute individuals and as a result we got again, anecdotely, we were told, unless for example there is at least 500 pounds of marijuana, they don't even both the prosecution. that's on the southern border. as long as you are a district attorney on the northern border, what is the jurisdictional battles, what is the type of prosecution's threshold, the discretion that you use. >> we do have thresholds, you know, typically large drug quantities are -- the larger drug quantities are prosecuted in federal court primarily. we work very closely with our local district attorneys, particularly along the northern border, four-county border area in the northern district of new york. when we have a case that perhaps doesn't rise to the level of a federal prosecution, we'll consult with our state counterparts and the case may end up being prosecuted in state court. i think we work collaboratively with them. i wouldn't say that there's a

competition or desire to hand cases off. my experience is that we work very well, that we have a particular interest and needs and priorities and i think we can meld those together quite well. >> i've got four minutes left to vote. you've already voted. will you close out the hearing? is that okeydokey. i'm kind of a rookie here. okay. let me just say again, thank you all for the time you took. i read the testimony. it's all very thoughtful. i know there's a lot of work and detail that goes into it. thank you for taking that time, taking your time here to come and testify. you're very thoughtful answers to our questions and i want to thank all my colleagues, this is a very well attended hearing which i think indicates how importantly we view this problem, but it also speaks to the complexity. there is an awful lot of -- awful lot of questions that need at least some answers and i know those answers are very difficult to get to. so again i want to thank you and i will turn it over to our ranking member. >> thank you, sir.

thank you all for hanging in with us, at this point in time the finance committee has been in a mark up, we don't call it a business meeting but mark up on the trade legislation so i'm trying to be in two places at once not doing it too well and we're voting. it's a full morning. i want to ask a question that goes back to something that -- i don't know, chief, if you said it or mr. wagner said t but somebody said it, you mentioned maybe -- maybe -- mr. hartunian it was you, but the party of native american lands was mentioned. this action on the border between our country and canada and we have a similar situation with -- in -- along the border of mexico and at times i've heard from the mexican border that sometimes the smugglers, drug smugglers human traffickers

use that land as a conduit to get through and try to get the cooperation of the folks who own that and live in that land -- live on that land. whoever raised this, would you and others just chime in about how this is of interest to us on the north as well as on the south, southern border. >> you go ahead. >> mr. spero? >> yes, senator, thank you. there are -- that is true, there are some -- there certainly are some complexities when conducting investigations of crime on the native american reservations. one of the complexities certainly on the northern border in the area of the mohawk indian reservation that mr. hartunian and i share jurisdiction is is just plain the geography. it's tough terrain up there and ripe for smugglers to exploit in all seasons and then certainly

you have that added -- the winter months. >> which country is it in? >> the indian reservation actually has territory both on the canadian side and on the u.s. side. the geography itself poses a lot of challenges towards law enforcement. on top of the geography in addition to the geography there is some political sensitivities with the native population wanting to maintain as much sovereignty as they can, so sometimes it's difficult for us to conduct -- we have to overcome that challenge of gaining their trust. in some cases it's a very close-knit small population and that, again, poses some issues or challenges for us that are somewhat unique, but, on the other hand, one of the things that is getting better from our standpoint and we're making a

lot of progress is macina best up there. >> i'm sorry. >> our macina border security task force. we actually have the mohawk police service representatives on that -- participate on the task force as well as the st. regis police officers on our task force. they have been -- there are members that have been cross-designated with title 19 authorities so they're essentially they are deputized customs agents with us and are working those case with us. in reality we know all of the challenges, i met the smuggling organizations know what they are, too, and they try to do their best to exploit everything. so we're trying to do a better job with our outreach on the indian reservation, our close coordination and collaboration with the -- with the native american police forces on that reservation and working together to do everything we can to

mitigate that threat, sir. >> all right. others on this point, please. anybody? chief, mr. wagner, let's go down to the southern border with mexico. do we have a similar situation in some areas along the southern border? and how do we figure out how to work with the native americans to be able to secure that portion of the border? >> yes. senator, as described in the -- on the tohono o'odham situation which the geography takes on the western portion in arizona, both in tucson and what we call the west desert, that tribe does extend in the united states and into mexico. so part of their -- when you look -- when we look at the border in terms of trying to, you know, identify, you know, likely routes of entry, over the years as we have built both primary pedestrian fence and vehicle bare kids, it was -- it's always challenging to try to work with the tribe, work

with the leadership in the tribe and letting them know if they will allow us to put some impediments along the border or bring infrastructure or technology to help increase our situational awareness. early in those discussions years ago it was very difficult to make the case until the infrastructure and technology started to manifest around the reservation, which obviously the path of least resistance came through the tohono o'odham nation. matter of fact, up until the middle of 2013 the vast majority of trafficking across the southern border came through arizona and the vast majority of that traffic came through the west desert and the nation. they realized the vulnerability and we are working a lot better with them. as a matter of fact, we are currently in the process of developing integrated fixed towers. now, the first phase of that as you well know was in nogalus. in late summer we were in the process going to transition into phase two and we currently have authorization from the tribe to

be able to move into deployment of integrated fixed towers to cover a vast region of that reservation. so that will be for us something that's been a long time in coming, sir. >> all right. thanks very much. last question i will present to all of you here today is -- goes back to something i oftentimes say. i like to say. find out what works, do more of that, find out what doesn't work and do less of that. that advice was presented to the finance committee a couple years ago when i was serving on it at a hearing by allen blinder. allen blinder when he was asked what should we do on deficit reduction with respect to healthcare and reigning in healthcare costs and he said i'm not an expert on this stuff, i'm not a health economist but here's what i would do. find out what works and do more of that and i said find out what doesn't work and do less of that and he said yep. so with that spirit and that

thought in mind could you all just take maybe a minute or so apiece and just talk to us again about what is working on the northern border that appears to be working, that is replicable particularly along our southern border. maybe you could each just pick one point. something that is working on the northern border that is working and can be exported to the southern border and make some of the best practices from your experience and observation on the northern border that would be smart to try on the southern border? mr. hartunian. >> yes. thank you, senator. great question. what's working, robust enforcement. that's not it to say that's not happening on the southern border. i think our u.s. attorneys offices all along the borders are working hard. their ausas are working hard to get the job done but it's a critical component. i think what works on the northern border is close collaboration with the canadians, while that may be a bit more challenging in mexico i

think it can be done and close collaboration between the prosecutors of both nations. and that is something that we're seeing happen more and more. we're working to improve make that happen more frequently. and i think that that's certainly an important approach that we can take. so i like those two things. >> is one of the reasons why we work better with the canadians in terms of sharing information is we have less concerns about that information finding itself in the wrong hands in canada? >> well, i think -- you know, i think that there is cooperation with the mexican authorities, you know, i think in all cases we have to be careful how we share law enforcement information. that's certainly not a barrier that can't be overcome. >> okay. good. thank you. mr. rodriguez, please. >> from -- >> you were in dea weren't you for a number of years. >> for 27 years. >> that's great. thank you for that as well. >> from my perspective it's

just not the one meeting the one event, the one policy discussion. we have a number of conversations both with our federal partners on the border as well with the canadians year-round. it could be case specific. it could be program specific. but -- and if we have to we then follow up on these discussions where we will put a working group together to work on maybe some ship rider issues or some intel issues that we need to look at specifically dma or ecstasy. so i think those are the best practices that work well for us on the northern border and that makes us unique and that we need to keep going and hopefully we can have those types of processes in play on the southern border to help there. >> all right. thanks. mr. spero, same question, please. >> senator carper, i appreciate the question. i actually had a little bit of extra time to formulate my

answer and i guess the best way for me to describe it or the way i look at it is that it's not necessarily how do we take what's working on the northern border and bring it down to the southern border, but it's an exchange of best practices across both borders as well as the interior of the united states and i use the border enforcement security task forces or the b.e.s.t. as example. the b.e.s.t. was originally created in larae doe in 2005 to combat the violence associated with the transnational criminal organizations that were affecting specifically the southern border. that model, the success of that model with the collaboration and cooperation of working together on the cases was then brought up to the northern border and now we have four northern border b.e.s.t. task forces. i happen to oversee two in my aor of buffalo, the port of

buffalo b.e.s.t. as well as the macina b.e.s.t. but at the same time we don't bring what we learned from the southwest border and bring it up to the northern border. we had a great framework to start with, but then we take that to the next level. so our abilities to expand those b.e.s.t. we actually have over -- just about 43 members now of our b.e.s.t. team in macina. so our abilities to incorporate our canadian law enforcement counterparts at all levels, whether it's the rcmp and the cbsa, but the -- quebec or the regional police offices and having as much not just information sharing, because of course, information sharing is extremely important, but we're able to actually take the information and those collaboration sessions and put

them to use in our investigations and that's how we complete that last piece of identifying, disrupting and dismantling the transnational criminal organizations that are the biggest threats to the homeland. >> good. thank you. mr. wagner? >> senator, at the ports of entry it's really we focus on the risk segmentation of the workload and looking at ways to better utilize the physical infrastructure that's there and getting the most efficiency we can out of it. how we define something as lower risk or high remember risk is dependent on what access to the information we have the analysis and targeting capabilities that's also enhanced by what our foreign analysts are sharing with us. we have very good data exchange information exchanged with the canadian government and the mexican government. they have different capacities as to what access they can get and what information they collect and then within their own privacy constraints what they can share with us, but it's a little different within both

countries but we do a very robust information exchanges with the mexican government as well as the canadian government that helps us make that risk segment men station development. >> my time was expired and my colleagues are back. would you answer that question for me for the record, please. >> yes, senator, you mentioned it briefly. i think the institutionalization of what we see on the northern border in terms of shared information, integrated planning and execution which then you have a degree of sustainability in that effort. we can do a lot better on the southern border in that regard. thank you, senator. >> thank you all, great job. >> thanks for holding down the fort. >> the senator floor picking up senators, thank you all for being here. i appreciate it and, you know, representing new hampshire, northern border is pretty important to us and i'm not sure if you've been asked this question yet but one of the

directors of national intelligence, james clapper has identified drug trafficking obviously, as a major transnational organized crime. in my state we're seeing a heroin epidemic and i know a lot of that's coming over the southern border. heroin epidemic and i know a lot of that is coming over the southern border. so what's the biggest issues that we're facing on the northern border and how -- can you help me understand how is the information sharing with canadian authorities because that's where my local law enforcement and my state police and even the federal officials that work in new hampshire would be working on the canadian side. whoever is best to take that question. yeah. >> thank you, senator. well, with specific to heroin, you're right, we are seeing heroin that's coming up through mexico and the intelligence that we're developing from our ongoing criminal investigations and our closed investigations is

that, you know, we're seeing either precursor chemicals or heroin coming from china, it's getting into -- it's being imported into mexico under the control of the cartels, the cartels are using the existing smuggling get works to get them into the united states through the southwest border and whether those smuggling networks are -- you know, the smuggling networks you use to smuggle anything, so whether it's people or whether it's drugs, the cartels have control of the networks and the pathways and they're using that to get heroin into the country for either ultimate consumption here in the united states or in some cases on into canada as well. one of the things that we had -- we were talking about was our ability and our need to make sure that we do everything that we can across all levels of law enforcement, whether it's federal, state or local law

enforcement or, in my particular neck of the woods even travel law enforcement and international law enforcement as well, particularly with our canadian counterparts on the canadian side of the border. where we have the biggest issues in my particular area the macina or rouses point area. we use our security task forces as a mechanism to share information back and forth with our canadian counterparts. so we have -- we actually have crossed-designated -- we've given essentially title 19 or customs authority basically making state and local law enforcement designated customs officials. but also, we are able to do that with canadian local law enforcement officials as well and then they can come on and work the networks on this side

of the border. so that the idea here is to open up information sharing, work the cases together and instead of -- not only trying to remove the u.s./canadian border as a potential barrier to law enforcement, in some cases we're even actually able to use it to our advantage. so we understand it's a problem, you know, heroin seems to be on the rise, but one of the things that we think is the best way to conduct any -- to identify, disrupt or dismantle these transnational criminal organizations no matter what commodity they smuggle, whether it's heroin, cocaine or marijuana, or firearms for that matter, is to identify the scope of the organization. in the source countries, transit countries, destination countries and work together with law enforcement at all levels to share the information and work the cases. >> so i get all that, just

thinking about how do we drive up the price of heroin? because one of the problems we have right now with heroin is it's so cheap. obviously the more we can make it tougher for them to transport this stuff over -- it's so cheap that some people are addicted to prescription drugs, they go over to heroin and it's really fueling this huge public health epidemic, not just in new hampshire, it's across this country. i mean, do we need to give you bigger -- what do we need to give you to help you to drive up the price to really come down on the people transporting heroin? >> one of the things that we look at in any of the drug trade and whether it's the heroin, you know -- and i should have also mentioned before one of the newer trends that we're seeing with respect to heroin is the heroin laced with the fentanyl which would be the deadliest part of the drug. >> it's heroin on steroids basically. >> absolutely, ma'am. almost with any business model i think that, you know, if we can be more effective at reducing,

you know, the supply, then that would drive up the -- that would be one way to drive up the price. another thing that we're trying to do is with almost every enforcement program that we have at homeland security and investigations, there's also a public service announcement message that goes along with it. so if we do have a particularly big search warrant where there's a big seizure or arrest or big sentence, we try and get out to the you be public that, you know, hey, if it's the kids that are using the heroin laced with fentanyl to get out there and say, look, you don't know -- you don't know what you're using, what the impacts are on you. so not only did we just conduct this investigation and make this arrest, but this -- parents, this is where -- kids, this is why it's important that you don't use it, because you don't -- >> we've got to do a better job overall with that. i have a question about in terms of canada. as i understand it right now,

and i'm not sure whoever the best person to answer the question i will just field it. right now, as i understand it, canada doesn't have a is it system in place to screen inbound airplane passengers against the terrorist watch list and so they are moving toward the capability. is this true? and, if so, those on the terrorist watch list can presumably enter canada on an airplane. is that true? who knows about that and can you help me understand that? because i'm really worried about, you know, we've got these foreign fighters that have gone to obviously syria, iraq, yemen, some of these are canadians, we've had some americans, too, but, you know, canada is fairly -- we have a great relationship with canada and so if you can get to canada without getting through the watch list it's really not that hard to get to the united states of america. so what are your thoughts on this problem? >> i don't know if they have direct access to the u.s. government watch list and that

they screen against that directly, but they have a similar system that we do of screening airline passengers against the airline reservation systems and the airline manifest before that person comes into that country. we work very closely with them and we identify similar approaches to how we screen that. we call them rules and we set rules against how we scrub that data and how we identify national security or any other types of concerns. we do joint rule creation, we do rules exchanges and we have certain protocols in place that when certain rules fire we'll exchange information and ask each other about additional information. >> do you know if they have the equivalent of our terrorist watch list? war they checking their passenger list against? >> it's against their own systems and their own list. they do, i believe, have a national security list, customs records, immigration lookouts, access to the interpol. access to the inter poll. >> thinking about a friendly neighbor like canada, why can't we -- why couldn't we join forces on some of that in terms of terrorist watch lists information?

i know we do information sharing, but it seems to me that we've got some -- some -- if we can't trust the canadians, we're in trouble. any thoughts on that? >> we don't own that information so it really wouldn't be ours to exchange with them. but as consumers and users of it, we would welcome access to any additional sources of information. >> maybe i'm asking that of the wrong person. i serve on the aviation -- i'm the chairman of the aviation committee and i think this is perhaps a question i should direct to tsa. >> if somebody does fly into canada and drive across the border we run the same database and watch list checks at the land border as we do in commercial aviation, they are the same systems and same data. >> good. so you would catch it there if they were presumably on our list? >> correct. >> catch an individual there if they presumably were on our list even if canada didn't catch it? is >> correct. >> thanks. >> thanks, senator. that is a really good point. my understanding is same as yours, is that they are not

using our watch list and that's something i think we need to press to see what we can do to cooperate between the two governments. >> especially two governments that have a good relationship. >> correct. so, again, thank you for coming. again, thank you all for your time, your efforts, your testimony. this hearing record will remain open for 15 days until may 7th for the submission of statements and questions for the record. this hearing is adjourned. the new congressional directory is a handy guide to the 114 congress with handy photos of every senator and house member, plus, bio and contact information and twitter

handles. also, district maps, a foldout map of capitol hill and a look at congressional committees the president's cabinet, federal agencies and state governors. order your copy today. it's 13.95 plus shipping and handling through the c-span online store at c-span.org. coming up tonight on c-span 3, a hearing on combatting prescription drug abuse. then, a look at integrating women into military combat rules. and later, officials from the national institutes of health discuss their 2016 funding request and initiatives in ned sin and biomedical research. next, a house subcommittee looks at the efforts of fed agencies and courts to combat prescription drug abuse, particularly pain-relieving medications. witnesses include the policy director and officials from health and human services, the

national institutes of health and the centers for disease control. from capitol hill, this is two hours. well, good morning. welcome here to the oversight investigation and subcommittee hearing. it's health month so it's fitting that we are here today on this issue. this is a third in a series of hearings examining the growing problems of prescription drugs and heroin addiction that is ravaging our country. this is our nation's single biggest public health concern. over the past five weeks a subcommittee has heard from addiction experts working with local communities and our leading academic and research centers. dr. robert dupont, former drug

control policy and director of the national drug abuse testified that federal programs lack direction and standards on treating addiction as a chronic addiction and note whadt is being done to prevent relapse. he challenges us to ask the most fundamental question, what is rediscovery? dr. anna lemke provided critical testimony on how we must revise our health care quality measures to reduce overprescribing, reform privacy regulations and incentivize the ooze of prescription drug monitoring programs. we know that those addiction disorders need a broad treatment options that many with substance abuse disorders have a psychiatric disorder. about three weeks ago one of today's witnesses mr. michael bottacelli, presented a slide.

i'm going to show it here at the national summit on major causes of death from injury from 1999 to 2013. quite a revealing slide. while the trends of other major cause of death such as auto accidents went down, drug poisoning goes up 21% from 2008 until 2013. in many states these numbers are soaring at high double-digit rate increases. as the doctor has indicated to me at the summit, we must do better and we have much work to do. today, we will hear from federal agencies charged with providing guide guidance and leadership to the opioid epidemic. the department of health and human services, or hhs, and its substance abuse and mental health administration also known as samha regulates our

countries 1300. according to testimony provided in april of last year there were nearly 1.5 million people treated with these opiate medication with a five-fold increase in the last ten years. has samsa defined the role of recovery for what these treatment programs are supposed to accomplish? are they collecting data at an individualized level that would hold individuals responsible for the results? so far the answers indicate that it is no. when you don't define where you are going, every road you take leaves you lost. we are hoping that we can get some direction today. the numbers indicate we are failing as a nation. we darn well better come to terms with that. the 43,000 lives lost year the thousands of babies born

addicted to opiates tell us the terrible toll that this epidemic has taken. you heard my thoughts about the addiction maintenance and i've referred to heroin helper, not because it's altogether lacking but rather because infrastructure the federal government has used for this highly potent medication is not fully working and worse yet, in many cases it's contributing to the growing problem. this has to be fixed and i hope we'll find solutions and that's what we need to discuss today openly honestly, and humbly. if we do not reverse the current trend, where is this going to end? how many millions of citizens do we want to have on opiate maintenance? how many more must die and how many more lives and dreams must be shattered before we recognize the depth of this. i don't believe better living through dependency. this is not a general indictment of opiate maintenance. for some people it's the bridge

treatment and there should be no shame or stigma associated with it. but it should not be the only thing offered and it's not the only goal. what patients can be successfully transition off of these medications or protocols best for effecting this transition. what are the best practices for prevention of relapse for those patients who end opiate maintenance treatment. there are nonaddictive medications approved for this use but are the medications widely available and how well do they work? the diversion for illicit nonmedical use is how the opiate addiction can be spread. where is the call to modernize existing treatment system tone sure the right patient gets the right treatment at the right time? why aren't we hearing about expanding access to nonnarcotic

treatments? these are all incredibly important tools and we want to make sure hhs talks more about these. last week dr. wesley clark the former director of samsa center and who oversaw the growth over the last decade declared before the american society of addiction medicine that many practices have become pill mills where doctors and dealers were increasingly indistinguishable laboratory fraud prevailed. the problem is not with upineprine, however. and this is what we need to discuss. i consider this as a bridge to cross over in the recovery process. as i said, it's not a final destination. we seek to lay out a recovery that is an option. for cancer, diabetes, aids, we want people to be free of the diseases, not just learn to live with it. we need to commit the same sorts of things to research and clinical efforts that boldly

declare what we must change here. i thank our witnesses for being here and i recognize ranking member of the subcommittee mrs. degette from colorado for five minutes. >> thank you, mr. chairman. i think it's really important to hear from our witnesses about the work that the federal government is doing to address this serious public health issue and i know all of the agencies represented before us do critical work to prevent and treat this ep depidemic. in march i applaud the department's actions and i'm gratified to hear that this is one of the secretary's top priorities. i want to hear more about this initiative today and how all the agencies before us are working together to accomplish its goals. but at the same time, i have some hard questions about our approach to caring for those who have substance abuse disorders. last week we heard from a panel of medical experts who have vast

experience in treating opioid addiction. unfortunately, as the chairman said, they gave us a fairly bleak view of the opioid treatment landscape in this country. for example, one witness, a psychiatrist as columbia university and a research scientist at the new york state psychiatric institute, told the committee that the majority of patients being treated for opioid addiction received treatment that is both, quote, outdated and quote, mostly ineffective. he described this approach of rapid detoxification followed by an absence only method without the use of important treatment medications. the doctor added that this is potentially dangerous because it raises the risk of an overdose if a patient relapses. as troubling as this testimony from our last hearing was, today we have dr. volkow on our panel, one of the world's top experts

on addiction research. and she notes, i'm sure you'll talk more about this doctor, in her written testimony that, quote, existing evidence-based prevention and treatment strategies are highly underutilized across the united states. why is that mr. chairman? why do we have experts week after week telling us that the bulk of the treatment that americans are receiving for this devastating disease are ineffective, outdated and not evidence-based? we need to be asking ourselves some tough questions. for example, the president of the american academy of addiction addiction said that detoxification treatment and drug-free counseling are associated with a very high risk of relapse. are patients enrolled in treatment getting sufficient data so they can make medley informed choices? are family and loved ones being told what approaches have high

failure rates before choosing an approach to treatment? frankly, this is not a decision that should be taken lightly. getting ineffective treatment may not only be financially costly but it may result in a fatal relapse. finally, mr. chairman, recent testimony, including some i saw in the written statements for today, raises important questions about whether taxpayer dollars should fund certain approaches for combatting this opioid epidemic over others. this is an issue i've been talking about week after week. we all agree we need the most effective treatment. and our experts agree that this treatment needs to be a broad menu of options that is different from patient to patient. so we might not have a silver bullet to cure opioid addiction at this point but we know what treatment works better than others. evidence tells us and all of the

experts agree, that for most patients, a combination of medication-assisted treatment and behavioral treatment such as counseling and other supportive services, is the most effective way to treat opioid addiction. if that's the case, we should pursue more policies that encourage this approach as a clear option and steer away from any efforts that are not evidence-based. it's costly and it's dangerous to the patient. so i hope we can all work together to fight this epidemic. and i do look forward to hearing from all of our witnesses. i'm glad secretary burwell and the department are devoting serious attention to both the prevention and treatment sides of this problem. mr. chairman, this has been a really great series. i'm happy to have a whole investigation like this in this committee. there is one group that we haven't heard from yet. i'm hoping -- >> we will. >> good. we haven't heard from the states yet.

it's critical we hear from them because that's where the rubber's hitting the road. we need to hear what the states are doing to address this problem and understand the reasoning between -- behind some of the choices being made. some states are picking effective treatment methods and others are not. so i think we need a multifaceted approach. this is what our research has showed. i know we can work together to continue this important investigation. i just want to add one more note, the witnesses and the audience may see members jumping in and running out. we have another hearing in energy and commerce committee going on down on the first floor. so people will be coming and going. but i know certainly from my side of the aisle people recognize this as a very serious issue. thank you. >> and i know they'll be calling votes at 9:30. >> i thought it was 11:00. >> i'm here for the duration. so we want to hear from you. and hopefully the members.

now we recognize mr. upton. >> we really are going to have votes at 9:30? >> we are. >> i'm going to submit my statement for the record then. yield back. >> all right. mr. pallone five minutes. >> i'll do the same because we both have to go to the other hearing. >> see how much we get along? is there anybody else on either side that needs recognition? >> no let's go into this. >> wait. mr. kennedy. >> mr. kennedy? >> he wanted a minute. can i -- mr. chairman, can i yield just one minute? >> yes, you can yield your minute to mr. kennedy of massachusetts. >> thank you very much for the consideration. i yield back. >> all right. let me now introduce the witnesses on the panel for today's hearing. we have the honorable michael bottacelli, part of the executive office president, welcome. dr. frank, secretary for planning evaluation of health and human services dr. volkow,

dr. douglas throckmorton a deputy director of the drug evaluation for the food and drug administration, dr. deb before houry. director of the national injury and prevention and control at the center's for device control and prevention dr. honorable hyde and patrick conway, innovation and quality for medicaid and medicare services. welcome. you are aware that the committee is holding an investigative hearing and when doing so has a practice of taking testimony under oath. do you have any objection to testifying under oath? none of the witnesses are -- have objection. the chair advises you under the rules of the house and committee that you're entitled to be

advised by counsel. none of the witnesses say so. so in that case, please rise raise your right hand i'll swear you in. do you swear that the testimony you're about to give is the truth, the whole truth and nothing but the truth? >> yes. >> thank you. all witnesses answered in the affirmative. you are now under oath. and subject to the penalties under section 1001 of the united states code. you may all give a five-minute statement. please stick to the five minutes. >> we're not going to get through it. >> thank you, chairman murphy, member degette for the opportunity to provide testimony to you today about the administration's efforts to address the opioid academic in the united states. mr. chairman, as you recognized in 2013, almost 44000 died of a drug overdose. that's one death every 12 minutes. using the rule as the coordinator of the federal drug

control agencies, in 2011, we pursued the prevention plan to address the sharp rise in prescription opioid drug misuse in this country since 1999. as you know, the plan consists of action items categorized under four pillars. education of patients and subscribers, increased prescription drug monitoring, proper medication disposal and informed law enforcement. with the work of our hhs partners here today and other federal partners as part of the work group convened by ondcp we have made some strides in each of these areas but there is much more to be done. since time and education programs devoted to the identification of treatment of substance use disorders is rare we have worked with our federal partners to develop continuing education programs about substantial abuse, managing pain appropriately and treating patients using opioids more safely. many prescribers in federal agencies, including hhs are

receiving this important training. despite this, a large percentage of prescribers have not availed themselves of this training. therefore, the administration continues to press for mandatory prescriber medication. i am pleased that secretary burwell has expressed her support to set requirements for specific training for opioid prescribers. today, all states but one, missouri, have prescription drug monitoring programs that allow prescribers to check on drug interactions as well as alert them to the signs of dependence on opioids. missouri is working to authorize that program. with all states implementing pdmps, we are working on state-to-state data sharing within the health record system providers use every day. in october, the drug enforcement administration's final regulation on controlled substances disposal became effective. our stakeholders have looked for

ways to stimulate more local disposal programs in partnership with pharmacies, local government community groups and local law enforcement. in the work of our law enforcement partners at the federal, state and local levels is ongoing. those engaged in fraud across the drug control supply chain are being investigated and prosecuted. recent data shows we are seeing an overdose from prescription opioids leveling off in this country but a dramatic 39% increase in heroin overdoses from 2012 to 2013. this is creating an additional need for treatment in a system where a well-known gap between treatment capacity and demand already exists. therefore, we must redouble our efforts to address people who are misusing prescription opioids since we know this is a major risk factor for subsequent heroin use. earlier this week, the administration held the inaugural meeting of a congressionally mandated interagency heroin task force.

mary lou leery is one of the co-chairs for this committee. in addition, the president's fy 16 budget request includes $99 million in additional funds for treatment efforts. we have also been working to increase access to the emergency opioid overdose reversal drug naloxone so witnesses can take steps to help save lives. many police and fire departments have already trained and equipped their personal with this life-saving drug and loved ones with opioid drug abuse disorders are equipping themselves as well. while law enforcement and other first responders have an important role to play the medical establishment must become more engaged to identify and treat heroin and opioid prescription disorders. every day these people appear in our emergency departments and other medical settings and more models and interventions are needed to get these individuals engaged their care. we need to extend availability

of evidence-based opioid treatment. medication assisted treatment combined with behavioral and other recovery supports have been shown to be the most effective treatment for opioid disorders. decisions about the most appropriate treatment options and their duration need to be agreed upon by both the patient and treatment provider. we must also provide community support, such as access to housing, employment and education to give patients the functional tools they need to lead healthier lives and integrate into the community as part of their recovery process. while we support multiple pathways to recovery, the literature shows that short-term treatment, such as detoxification alone is not effective and carries risk of relapse and overdose death. because of the lack of availability of evidence-based treatments and the strong connection between injection of opioid drugs and infectious disease transmission, we also promote the use of public health

strategies that will help prevent the further spread of infectious disease. the hiv and hepatitis c outbreak in indiana is a stark reminder of how it can spread other diseases, how health strategies such as syringe exchange programs need to be part of the response to the opioid epidemic and how rural communities that have limited treatment capacities, may have additional public health crises. finally, we're addressing neonatal absence syndrome. research shows that the incidents of nas has grown five-fold between 2000 and 2012 and 81% of the hospital charges for nas were attributed to medicaid. we must consider that the best interest of babies with nas is often served by best addressing the interests of the mother. therefore, we need to provide safe harbor for pregnant and parenting women seeking prenatal care and treatment. in conclusion, we look forward

to, working with congress on the next stage of action to address this epidemic. thank you. >> thank you. dr. frank, we're going to try to get your testimony and then we'll run off and vote and come back. go ahead. >> chairman murphy, ranking member degette and members of the subcommittee, thank you for the opportunity to discuss how the department of health and human services is addressing the opioid abuse epidemic. the abuse and misuse of opioids and heroin is a high priority for the hhs leadership team and we're pleased to be with you today. i'd like to give you an overview and describe how we're working to develop a multifaceted solution to this problem. it's going to take a lot of collaboration. addiction to an abuse of opioids, including both prescription painkillers and heroin and the terrible outcomes associated with them are growing at an alarming rate. just over a third of drug

overdoses in 2012 and 2013 were from prescription opioids while heroin-related deaths have spiked dramatically almost tripling since 2010. the sharp abuse places a burden on the health system. there were 259 million prescriptions filled for opioids in the u.s. in 2012. a large increase over just a few years prior. the medicare program under part d spent $2.7 billion on opioids overall in 2011. 1.9 billion, or 69%, was accounted for the top 5% opioid abusers. the cost of abuse and misuse of opioid shows up in preventible use of very expensive health care. heroin presents an equality troubling but different abuse in overdose pattern. we saw increases between 2002 and 2009 in a number of people

using heroin. but that number has held fairly steady since 2009. the striking new trend is that there's an increasing share of the users that are dying from heroin overdoses. so what i'm telling you is that we have an opioid prescribing problem sitting alongside a drug abuse and misuse problem. secretary burwell has committed to addressing the epidemic. she's driving us towards two main goals. one, reducing opioid overdoses and opioid -- and overdose-related mortality and, two, decreasing prevalence of opioid use disorder. she directed us to use the best science and to focus on the most promising levers that can make a difference for the people who struggle with opioid addiction and their families. hhs agencies have been collaborating on this problem for some time and we hope you will agree after today that the sum is -- that their hold is greater than the sum of the parts. our action informed by the evidence and discussion with

states and other stakeholders fall into three general categories. one, addressing opioid prescribing practices, two, expanding the use of naloxone and, three, promoting medication-assisted treatment. let me outline the plan in a bit more detail. first, pdmps. we're increasing investments in prescription drug monitoring programs among the most promising clinical tools to curb prescription opioid abuse. we're investing through state grants and technical assistance in supporting best practices to maximize the impact of pdmps. second naloxone, a life-saving drug that can reverse overdose from boltth prescription overdoses and heroin. we are working with state and local governments to support training and other measures that get naloxone into the hands of those that are in a position to reverse overdoses. finally, we have plans to support the appropriate use of

medication-assisted treatment or m.a.t. the enactment of the addiction equity act opens new opportunities to expand access to these evidence-based treatments. we also are working on identifying best practices in primary care settings increasing access to m.a.t. through grant support and potentially increasing the supply of m.a.t. providers by reviewing the policy and regulations of one of the types of the individuals certified to prescribe. our commitment to halting this complex public health epidemic is set out in the president's 2016 budget that includes a $99 million increase for parts of our initiative. finally, evaluation will help us identify the most effective activities allow us to continually learn and in order to address this public health concern. in closing, this is critical for hhs and for the nation and with can't do it alone. we need help.

thank you for encouraging an open discussion of this today and we are committed to turning the tide on the opioid epidemic. >> thank you. now, votes are in progress. even though time is running out, only about 20 people voted so far. so this is throwing everybody off and their schedules. i apologize. this is what happens on capitol hill. but we're committed to hear from you. we know how important this is and we value your testimony. so we're probably going to be back in a little under an hour. so we look forward to hearing from you then and getting to the rest of the testimony. thank you.

all right. thank you for being patient. all right. dr. volkow, you're recognized for five minutes. >> good morning, chairman murphy ranking member degette and other members of the subcommittee. i want to thank you for organizing and inviting me to participate in this important hearing. the known use of prescription pain relievers is a public health challenge and demands solutions on the one happened to prevent their diversions and the misuse while at the same time demands solutions that will not

jeopardize access of these medications for those that need them. opioid medications are probably among the most effective painkillers that we have for the management of acute severe pain. and the proper use can actually save lives. they act by activating opioid receptors that are located in the areas of the brain that persist pain but very high concentration of opioid receptors in brain regions and hence the problem. activation of these receptors is what is associated with the addiction potential. there are also high levels of receptors in areas of the brain that regulate breathing, which is why their use is associated also with the high risk of death from overdoses. we have heard that devastating consequences from the escalation of the abuse of prescription medications in our country the overdose deaths, the transition to injection of heroin and

associated infections with hiv and hepatitis c and increasing numbers that we're seeing on the neonatal abstinence syndrome. the role is to support the research that will help develop solutions to prevent and treat abuse of prescription medications that could be implemented now while at the same time funding research that, in the future will provide transformative solutions. there are already evidence-based practices that have been shown to be effective in the prevention of overdose deaths. that include the use of medications for opioid addiction and the use of naloxone to reverse opioid overdoses. there are three medications currently available to treat opioid medications, methadone and when used as a treatment

plan have been shown to facilitate abstinence and reduce overdose and hiv infections. also when coupled to prenatal care pregnant women addicted to opioids, these medications reduce the risk of obstetric and neonatal complications. yet, despite the strong evidence, less than 40% of those receiving treatment for opioid addiction get treated with this medication. the funding research on strategies that facilitate the use of medications for opioid addiction in the health care system. another key component to reduce overdose deaths is to expand the use of naloxone so they have partnered with pharmaceutical companies to develop user friendly effective delivery systems for naloxone that will facilitate their use by those that have be a loosely no medical training.

in addition neither supports research on the treatment of pain and on the treatment of opioid addiction, they will offer new solutions for the treatment of these two disorders. examples -- for example, for the management of pain including the development of drug combinations or new formulations with less addiction potential. the development of analgesics that do not rely on the opioid system. and the development of nonmedication interventions, such as the use of magnetic or electrical brain stimulation for pain management. examples of research on the treatment of opioid addiction includes a development of slow-release formations that need only once or once every six months dosing that would work with vaccines against heroin which will prevent the delivery of the drug into the brain

hence interfering with the rewarding effects and reverse consequences. because the epidemic of prescription drug abuse results from a lack of knowledge from health care provider, the importance of developing curriculum to train both in pain and substance abuse disorder is a priority which neither has developed in partnership with the other institutes, nih centers of excellence. there are over 24,000 deaths from opioid overdoses in 2013. 24,000. this highlights the urgency to address this epidemic. solutions are already available. the challenge is the implementation. this requires strong integration of efforts and neither will continue to work closely with other federal agencies community organizations and private industries to address this complex challenge. >> thank you. dr. throckmorton, five minutes.

>> mr. chairman ranking member degette and members of the subcommittee, thank you for the opportunity to be here today to discuss fda's role in combatting opioid abuse. our goal is to find the balance between needing to treat patients with pain and needing to reduce drug abuse and this work is being done to address other parts of the federal government and we know a successful and sustainable response must include federal and state government public health officials, opioid subscribers and researchers and manufacturers and patient organizations. for our part, fda plays a central role in the regulation and use of drugs from their discovery and throughout their marketing. for example, when fda reviews a drug for possible marketing, we also approve drug labeling, which includes approved uses of

the medicine and as well as information about the safety risks. fda also follows drugs after they are marketed carefully, including opioid drugs, when necessary, this enables us to take a variety of actions to improve their safe use, such as changes to approved labeling. the first area of fda activity i'd like to highlight is our work to support the development of abuse that make it is harder or less rewarding to abuse. while this is not a silver bullet that will reduce all abuse, they believe it can help reduce opioid abuse. to incentivize this they issued to meet with sponsors interested in developing them. to date, the fda has received some 30 investigation new drug applications from manufacturers. in addition, we have approved four opioid drugs with abuse to turn claims in their labeling. overall, we are in the early stages of their development and

i am encouraged by this level of work. fda envisions a day not far in the future where they are an effective abuse reforms. next, with regard to prescribing opioids, we know they are critical medications and they have to have high-quality education. over the past several years the fda has done several things to improve educational materials on opioids. for example, we recently finalized required changes to approve labels of the extended release long-acting opioids changing their indication to inform prescribers that these drugs should only be used for pain severe enough to require daily around the clock treatment when alternative treatments would not work. at the same time, fda strengthened significantly the opioids and we want prescribers to use them with care and today it's among the most restrictive of any drugs that we have in the

center. and have clear language that calls attention to the potentially life-threatening risks. the fda is working to approve the information available for prescribers in other ways. under certain circumstances fda can require manufacturers as a part of the risk evaluation and mitigation strategy to address safety concerns such as opioid abuse. in 2012, fda required manufacturers to fund the development of unbiased continuing education programs on opioid prescribing practices for prescribers. in the first year since that program has been in place, approximately 6% of the 320,000 prescribers, around 20,000 prescribers have completed one of those courses. we believe this training for prescribers is important. we also support mandatory education for prescribers of opioids as called for by the administration in the 2011 prescription drug abuse plan and re-empathized in the 2014

drug-control strategy. finally, fda has been working with many other stakeholders, including the agencies here today, to explore the best ways to prevent overdose deaths by the expanded use of naloxone. as others have said, it can and does save lives. fda is working to facilitate the development of naloxone formulations that could be easier used by anyone responding to an overdose. first, fda meets with manufacturers whenever needed and is using whatever tools we can to expedite product development. we approved the formulation of naloxone, which is intended to be a administered by people witnessing an overdose such as family caregivers. we've approved this product in 15 weeks. going forward, we will work on how best to use naloxone and the fda and many other agencies are planning a public meeting in july to deal with questions of access and state and local best practices.

in conclusion, as a society, we face an ongoing challenge and a dual responsibility. we must balance efforts to address opioid drug misuse abuse and addiction for need for access to appropriate pain management. these are not simple issues and there are no easy answers. the fda is taking important actions that we hope will achieve this balance. we welcome the opportunity to work with congress, our federal partners, the medical community advocacy organizations and the multitude of interested communities and families to turn the tide on this devastating epidemic. thank you for this opportunity to testify. i look forward to answering any questions that i can. >> thank you. >> chairman murphy, ranking member degette, i'd like to thank you for inviting me here to discuss this very important issue. i'd like to thank the committee for opioid prescription abuse. i'm the director of the national center prevention and control at the cdc. as a trained emergency room

physician, i have seen firsthand the devastating impact of opioid addiction on individuals and their families as well as the importance of prevention. together, we have witnessed a deadly epidemic unfolding in states and communities across the country. the overdose epidemic is driven in large part by fundamental changes in the way that health care providers prescribe opioid pain relievers. enough prescriptions were filled in 2012 for every adult to have their own bottle of pills. as the amount increased so has the number of deaths. an alignment with the department initiative, i want to highlight cdcs work in developing opioid prescribing guidelines for chronic pain and providing direct support to states to implement multisector prevention programs. cdc is currently developing guidelines for prescribing of opioids for noncancer pain. this undertaking is responsive

to a critical need in the field. these guidelines will redefine best practices for chronic pain and make important advances in protecting patients. the audience for these guidelines are primary care practitioners who account for the number of prescriptions for opioids compared to other specialties the guidelines process is under way and public comment by the end of this year. we have plans in place to encourage uptake and usage of the guidelines among providers which is key for prescribing practices. the second activity i'd like to highlight is our major investment and state level prevention. states are at the front lines of this public health issue. and cdc is committed to equipping them with the expertise they need to reverse the epidemic and protect their communities. utilizing the newly appropriate $20 million, we recently published a new funding opportunity called prescription drug overdose prevention for states. it builds upon existing

cdc-funded state programs and targets states that have a high drug overdose burden and those that demonstrate readiness needed to combat the epidemic. it requires collaboration across sectors for a truly comprehensive response. the goals for this program are to make prescription drug monitoring programs more timely easier to use and able to communicate with other state pdmps. to implement medicaid or workers compensation prevention and data driven prevention to the community struggling with the highest rates of drug abuse and overdose. states also will be given the flexibility to use the program to respond to emerging crises so they know what works to prevent overdose and save lives in their community. the development opioid prescribing guidelines and our state prevention program are two key ways that cdcs broad work

contributes to the initiative. we're examining overdose heroin doubled since 2010 and prescription opioid abuse a key risk factor for heroin use, has contributed significantly to this rise in heroin use and overdose. we will leverage our scientific expertise to improve public health surveillance of heroin and evaluate effective strategies to prevent future heroin overdoses. addressing this complex problem requires a multifaceted approach and collaboration among a variety of stakeholders. but it can be accomplished. particularly with the ongoing efforts of all of the organizations represented here on this panel. cdc is committed to tracking and understanding the epidemic supporting states working on the front line of this cry saysises and pro i had vooing providing the tools and

guidance. thank you again for the opportunity to be here with you today and for your continued work and support of us protecting the public's health. i look forward to your questions. >> thank you doctor. welcome back. >> good morning, chairman murphy ranking member degette. thank you for inviting samsa to be part of this hearing. according to samsa's national survey, the nonmedical use of prescription opioids is high, approximately 4.5 million individuals in 2013. heroin use is much lower about 289,000 individuals reporting past month use but that's doubled in five years. fortunately, the nonmedical use of pain relievers has decreased some from 2009 to 2013, especially among young people ages 12 to 17. however, as you know overdoses and overdose-related deaths from prescription death and heroin

has risen dramatically among all ages. few who need treatment are receiving the community-based services that they need free of addiction. samsa believes recovery is the goal. the data and public education and regulatory efforts are all designed to prevent overdoses help provide the treatment and services needed for people with substance abuse disorders to achieve recovery support their families and foster support of communities. samsa together with six other medical societies to train prescribers with the best approach to pain management. the addiction technology transfer centers provide training and materials on opioid abuse disorders to distribute research-based best practices to the treatment field. to help prevent opioid related deaths, the funds may be used to

purchase and distribute naloxone and increase training on its use. also in 2014, they updated their opioid overdose prevention tool kit to education individuals, families and first responders and others about steps to prevent and reverse the effects of opioid overdoses, including the use of naloxone. this tool kit is one of the most downloaded resources on the website. the president's 2016 budget includes $12 million in discretionary budget for states to deliver naloxone in high-risk communities and distribute education for overdose prevention strategies. as part of a recovery-oriented care model, medical assisted treatment is not meant as a stand alone approach but rather is designed to include medication, counselling, behavioral therapies and recovery support. in march 2015 samsa revised guidelines for opioid treatment programs to highlight the care

model and encourage the use of any of the three fda-approved medications for the treatment of opioid abuse disorder based on an assessment of the needs. they are taking an integrated care approach as part of the new 2015 grant program to expand and enhance the availability of medication assisted treatment and other clinically appropriate with states with the highest rates of opioid admissions. the president's 2016 budget proposes to double this program. in collaboration with doj, samsa added language to the grant requirements to make sure that drug court do not have to stop the prescription as part of a regulated opioid treatment program. samsa regulates the treatment programs which are expected to provide a full range of services for their patients. in collaboration with a drug enforcement administration,

samsa provides treatment in a practice setting other than in an opioid treatment program. we fund efforts to help prevent prescription abuse and heroin use. for example, in 2014 samsa strategic framework partnerships for success program made preventing and reducing heroin use one of its focus areas along with prescription drug misuse and abuse and underage drinking. the president has proposed $10 million for the framework rx to help states use data, including pdmp data to identify and assist the nonuse of drugs. we want to thank you again for taking on this issue and allowing samsa to share its efforts with you and we look forward to answering your questions. >> dr. conway, you're recognized for five minutes. >> chairman murphy and ranking member degette and members of

the subcommittee, thank you for inviting me to discuss the situation preventing prescription drug abuse. as we heard from other witnesses, they have been implicated in drug deaths in the last decade. as a practicing physician i understand the importance of this issue. cms recognized the responsibility of ensuring appropriate safeguards are in place to prevent overuse. ensuring they can access needed medications and treatments for substance abuse disorder. since inception in 2006, medicare part d prescription drug benefit made medicines more available and affordable leading to improvement in access to prescription drugs. despite successes part d is not immune from the nationwide epidemic of opioid abuse.

cms is trying to address potential fraud by making sure they have coverage for drug therapies that meet safety and efficacy standards. we believe that will protect beneficiaries of damaging echkts associated with prescription drug abuse and to prevent overutilization. the strategy is to monitor part d drug utilization management programs to prevent overutilization of medications. to accomplish this goal the medicare part d overutilization monitoring system or oms was implemented in 2013. through this system cms provides reports to sponsors on beneficiaries with potential opioid overutilization identified through analysis of prescription druggy vent data and through beneficiaries for the cms program for integrity. sponsors are expected to utilize

various drug utilization monitoring tools to revent continued overutilization of opioids. from 2011 to fourth they reduced users by 26%. they use medic charged with investigating fraud and abuse, developing cases for referral to law enforcement agencies. in 2013, cms directed the medic to address drug analysis. creating new tools against problematic prescribers and pharmacies. we finalized a provision that requires providers to enroll or have an opt out affidavit on file and establishes ref indication authority for abusing prescribing patterns. state medicaid agencies have taken action to attack that epidemic. efforts include expanding medicine dade to include

behavioral health service for those addicted to drugs and pharmacy management review programs. cms are encouraged by states effected strategies tore designing benefits for the population. we launched the accelerator program to provide states with technical assistance and other support to address this important issue. cms in coordination with cdc and nih, issued informational bulletin on medication assisted treatment for substance abuse disorder in the medicaid program. it outlined that medication and behavioral therapies is the most effective combination of treatment. issued a similar bulletin focused on these services in pediatric and youth population. cms is dedicated to providing the best care to beneficiaries with opioid addiction. working with state medicare programs to have safeguards to prevent the abuse and treat them

effectively. we have made progress but there's more work to be done. they're taking mumt am interventions to reduce the addiction and overdoses and medicare and medicaid. previous testimonies i have never had family here or time to thank them. i want to thank my mother diane conway is here, my son jack who is out of school as well as my wonderful wife heather, daughters alexa and savannah. and without their love and support, i would not be able to work on issues like this. they're critically important to our nation so thank you. >> thank you, doctor, thank you for recognizing to take your family to testifying day. apparently everybody else didn't get the memo. i just want to start by saying if talents and dedication alone could solve this crisis, we'd be there with the dependent of today and other days. obviously we still have problems. let me start by asking a few

questions. for the director, office of national control policy uses the term recovery, does it mean to include patients with opioid addiction in buprenorphine or methadone treatment program still using heroin or illicit drugs or would you say that's not recovery. >> from our perspective and as a person in recovery, clearly we want to make sure that people are continuing to progress in recovery, free from substances is the ultimate goal of recovery programs. i think everyone would agree on that. we also know that substance use, particularly opioid use disorders are a significant chronic disorder and that often times and even my own experience show me that people often will experience relapse and will often need multiple attempts at treatment to get to that final goal of long term recovery and long term abstinence. we want to be sure we are continuing to engage with patients, that we are moving them toward better health,

better recovery and being free from substance use as part of long term recovery. >> let me ask miss con tee this, we heard last week there was not uniform definition of recovery. this is the talent pool, you're the ones that do these. do you all meet on a regular basis to talk about these issues? when was the last time you got together to talk policy issues, pam? >> let me start. >> you'll start. >> let me start. it is actually part of our statutory authority that we set in conjunction not just with hhs but all federal agencies that have a role in substance use and opioid use disorders. we have been engaged with dod, va, bureau of prisons. >> you meet regularly? >> we do. we have quarterly meetings. >> let me move on that too. that's important. miss hyde let me ask you in response to our bipartisan letter of march 18th concerning

the national registry of evidence based programs you noted that, quote, new submission and review procedures will improve rigor of registry and bring into closer alignment of other evidence based programs in the federal government. prior to entering into the july 2014 contract, did samhsa feel it needed strengthened? yes or no. do you feel it needed to be strengthened? >> thank you for the question. we thought the process we used for determining what practices were reviewed needed to be strengthened, and in the process we have also increased the rigor with which we look at them. >> can you give us a list of what you consider to be models in the federal registry we can review as part of that as evidenced based programs? >> certainly. >> thank you. your response also indicates an outside contractor will assume role of gate keeper determining which studies and outcomes are

reviewed in the screening and review of an intervention with aim of preventing bias in the developers. was samhsa's prior system for selecting interventions prone to any kind of bias or conflict of interest was that a concern? >> yes, mr. murphy, it was a concern. it was pretty much developer driven so a developer had to want their practice to be reviewed. then they had some control over what research we looked at. we changed that with the new contract that began last year and we will help decide priorities together with public input, but the contractor will help us look more objectively at evidence. >> thank you. just hold up. i got a note, an article, is this one of your constituents from eastern colorado? i don't want to take your colorado thunder a fascinating article.

made reference to the increase use of emergency departments with opioids. they said that's 10.5 million with this is probably an underestimate, that people go to emergency rooms for treatment for withdrawal, but also many trying to get more opioids. when you have users with prescriptions from more than one physician, they're more likely to be involved in riskier practices. could any of you comment on that's an area we are addressing? some of you comment on the issues? >>. >> yes the article, referring to new england journal of medicine article that shows there's been a very significant quadruple number of cases in intensive care units. this does reflect the fact that there are many women being

prescribed opioid medications during the pregnancy itself and based on another study was estimated 21% of women that are pregnant are going to receive an opioid medication, which again highlights the need to enforce bertha guidelines on management of pain need to be enforced in better ways. there's a study that evaluated the extent that physicians are following guidelines by the main medical organizations as relates to management of pain. that's an area where there needs to be an aggressive increase in education and enforcement of guidelines. >> thank you. i am out of time. i ask unanimous consent to submit for the record. >> thank you, mr. chairman. doctor, as i mentioned in opening statement, you're one of the world's top experts