>> the ways and means committee

will come to order. good morning. i am delighted to see all of us back here at what i always considered the best address on capitol hill. we are hoping today's hearings -- we holding today's hearings. before we begin i want to remind members of the few procedures. first, consistent with regulations, keep microphones muted to limit background noise.

members are responsible for an meeting themselves --unmuting themselves. when members are present, they must have the cameras on. if you need to step away, please turn your camera off and audio off as well. i will turn to the topic of today's hearing. substance use and suicide risk in the american health care system. exactly one month ago, we held the first hearing on examining america's mental health crisis. our discussion underscored how multidimensional the issue really is. the covid-19 pandemic

complicated this long-standing crisis, causing increases in social isolation and anxiety. all of which heightened mental health conditions. during today's hearing, we will take a deeper look at the interrelated mental health issues, overdose deaths and suicide. these are somber issues that affect each and every one of our communities. we were very pleased to pass a bipartisan support legislation called the support act, which added policies like opioid treatment programs. data shows that more work must be done to help those who are suffering. in 2020, more than 40 million people over the age of 12 struggled with a substance use

disorder. that same year, the united states set the record high 100,000 overdose deaths. suicide rates also remain at historic levels. america has the highest suicide rate of any wealthy nation. during last month's hearing come out we spoke about the stigma around mental health issues. it is a conversation we intend to continue this morning. the history of substance abuse disorders is one marked by stigma, criminalization and a lack of recognition that these require evidence-based treatment in the same way you treat diabetes. without support, millions of america's -- americans face incarceration and death.

historically marginalized groups in the united states face bleak outcomes. it will take all of us working together to address this often invisible suffering. the white house also recognizes the need for urgent collective action. i am grateful that president biden announced his strategy for addressing the nation's mental health challenges. together, we can build on the foundation we laid in the american rescue plan to ensure that everyone who needs mental health care is able to access it. today's hearing is an important step to access the problem. -- addressing the problem. with that, let me recognize the ranking member, mr. brady. >> thank you mr. chairman for

holding this important hearing. thank you to our witnesses. with substance abuse on the rise , american families are facing a real mental health crisis. we will hear about those challenges so many americans are struggling with. these problems can impact anyone. seniors, veterans, and our children. everybody is touched by these issues. we need to recognize and get back to working together to strengthen america's communities. i worried the biden administration is mishandling this pandemic, including tests and therapies with prolonged shutdowns. half of all seniors reported that during the pandemic they

were isolated and spending less time doing the things they enjoyed. without the routine and social environments, suicide attempts by teenage girls increased by 50%. two out of three people reported the pandemic had an negative impact on their recovery. america is in the midst of a drug epidemic fueled by fentanyl . it is now the leading cause of death for americans 18 through 45. these are real families and real communities that are being devastated. we must do more together to reduce the wounds of fentanyl. we see this in texas where the open border policy allows fentanyl to flow across our southern border and into our

communities. in the fallout of president biden's open border policies, the administration diverted money meant to support the covid-19 testing capabilities and instead used it for individuals who crossed into america illegally. he told me about the challenges local law enforcement is facing with fentanyl. there are all kinds of fentanyl laced drugs, including marijuana. american families will continue to suffer. we can work together to fight the rise of opioid use. this is an important issue for

republicans. we let it lend investment in combating the opioid crisis by enacting the support act. the bill put in place many common sense measures. to help those who become addicted. i am afraid we have taken our eye off the ball. the influx of drugs resulting from open borders, it is clear america has lost momentum. it is critical we renew our commitment to every american who is impacted by substance use disorder and mental health challenges. we can build on the support act and accept new challenges in combating these issues. we can work together to make telehealth excess permanent. -- access permanent.

telehealth was critical for delivering health services. by increasing access, it saved countless lives of seniors and those facing direct mental health issues. we will work together on the bipartisan basis to permanently extend many of the telehealth capabilities. -- flexibilities. this committee should work together to get more americans out of the sidelines and ensure our economic recovery. we heard from president biden last night that this is something that he would like to work on. i urge the president to abandon his plans of crippling tax hikes on mainstream. i will close here on the heels of the region pandemic and a terrible recession, we know the

mental health crisis is real. i believe we have the tools to fight it and i believe that together, taken a bipartisan approach, i am convinced we can do that. with that, i yield the balance of my time. chairman neal: all members opening statements will be made part of the official record. i want to thank our witnesses. i am pleased we are able to welcome five very impressive guests to discuss this important issue. first i have the honor of welcoming dr. jonathan m. metzl, professor of sociology and psychiatry and director of the department of medicine, health, and society, at vanderbilt university. next, we have dr. edwin c. chapman, private practice physician specializing in addiction medicine. regina labelle, director of the addiction and public policy initiative at the o'neill institute.

next we have dr. marielle reataza, executive director of the national asian pacific american families against substance abuse. finally, we have jessica hulsey, founder & ceo at the addiction policy forum. each of your statements will be made part of the record in their entirety. i would ask you to summarize your testimony. to help you with that time please keep your eye on the clock. i will notify you when your time has expired. dr. metzl, please proceed. >> it is an honor to speak here today. hopefully the next time we do this can come in person.

i think hopefully my message will come through nonetheless. i am on one hand a trained psychiatrist and over the course of my career i have seen up close the devastating effects of the topics we are talking about today. depression, suicide, addiction. i agree with everything we just heard. they cross -- they cut across party, ideology and jeff graphic locale. -- jack rfid locale. -- geographic locale. rightly described as a national emergency about the need to address mental issues broadly. i think we need more and better treatment, more specific

treatment. i think we need to reach out to people in communities in ways that they understand to address what i think the president rightly called last night a national emergency. i started thinking about everything we have all been through over the past two years. who would have imagined that even breathing somebody else's air or walking into a room or thinking about whether or not somebody is carrying a virus, we have all been through this national trauma. we have dealt with it in ways that highlight historical polarizations. mental illness is an extreme point on the continuum. this pandemic has taught us we are all on a spectrum of vulnerability.

i do not think we really have a national conversation just about what mental health means after what we have all been through over the past three years. i suggest we have a national referendum. a non-polarizing national referendum on just what mental health means in this new world we are all living in. and how do we come together? because i will say, there are so many groups voicing despair right now, it is my hope we can build mental health. as a psychiatrist, i can tell you many of my colleagues will be saying, many important things we can do at the moment. we heard about the crisis of isolation that is happening. i know the president talked about technology last night. it is time to think about how can we reach out to people. how can we create networks. how can we contact them and bring the cycles of isolation.

-- break the cycles of isolation. i agree completely with the need for telehealth right now. it is an opportunity for us to use technology for good. but my written testimony is also that of a sociologist. i think mental health with larger structures and systems. the other part of my written testimony is that the pandemic highlighted structural inequities that underline mental illness. i think the chairman highlighted this very well in the opening statement. there was also a call to action to fix the underlying structural inequities that we have. there is a lot of evidence that societies that bound together and fix social cohesion and up breaking cycles of despair in

important ways. i think we have an opportunity to build social structures that emphasize the importance of communal infrastructure for mental and biological will be. i realize i am out of time. you very much. i look forward to having this discussion today. chairman neal: dr. chapman, please proceed. >> thank you for allowing me to participate in today's hearing. for the past 42 years, i have been in practice in internal medicine just two miles from our nation's capital. in 2005, i began choosing

another fda approved medication. treating patients in my personal office. over the past 17 years, i treated over 1100 patients and currently take care of 225 patients. what we found was that these patients have a plethora of problems. including the fact that 10% of my patients have spent at least 10 years or more in jail. 50% initially tested positive for hepatitis. 12% tested positive for hiv. historically, we know epidemic outbreaks are related to untreated substance abuse. as we have seen in indiana,

illinois, west virginia, massachusetts. i was appointed in 2019 to a year-long study of the use of opioid use. we identified nine major barriers, including stigma. we also noted prior authorization for medications are consistently noted as the number one barrier but the medical associations. in the district of columbia, there is currently a six page authorization form.

it ranks number two in per capita overdoses. that means it is far easier for a person to get fentanyl outside of my office than a prescription. the national standard of care have different ways of doing this, including medicare and medicaid. we all thought -- we often do not allow people same day services. the 2020 fr pointed out it cost $42,000 to not treat a patient.

it only cost $7,500 to treat a patient. costs could easily exceed hundred thousand dollars per patient per year. we envision a more centralized payment system appropriately scaled, encapsulating all the savings described here. and a prescription formula that will save lives and money. we actually have that formula through the american society of medicine.

this model was put together in 2018 and was never adopted by any state or any insurance plan. we should explore this option as a fast-track option. i will stop there. chairman neal: thank you very much. ms. labelle, please proceed. >> thank you for the opportunity to speak to you. in 2021, i served as the acting director of the o'neill. currently, i direct the addiction at georgetown law center where we use law and policy to promote access to quality treatment.

i am here today to discuss this critical issue affecting our country. as we all know, the cdc reported that from april 2022 april 2020 one, over 100,000 people died of a drug overdose. the situation calls for heightened attention by policymakers to provide resources but also acknowledge the need for tailored responses to the challenge of addiction. in 2021, the biden harris administration published its first-year drug policy priorities.

the health of people with substance abuse disorders is often determined by social factors. this requires tackling comprehensive solutions to provide greater stability and community connection, which is especially important during this time of covid-19. i want to highlight three areas for action. first, protecting children from harm. legislative initiatives can provide services to families -- to keep families intact. also, stigma toward people with substance abuse disorder not only increases the harm, it can also prevent people from receiving needed services.

we have to move aggressively to limit the stigma. strength housing security. stable housing can improve health outcomes for people with addiction. there are a couple of pieces of legislation that is being considered. the first is the affordable housing resident services act of 2022. this creates grants. another critical area for intervention is reduced -- a greater focus on substance abuse in corrections.

in 2019, suicide was a leading cause of death in jail. depths are increasing year after year. from 2009, the rate of the jail depths due to alcohol or drugs more than tripled. these deaths are preventable if they are provided with access to longer-term treatment. they recently use the research to develop a set of recommendations. the lack of treatment during incarceration and a lack of community-based care placed individuals a great risk. that is why the medicaid reentry act would ease reentry by enabling patients to reestablish medicaid benefits before they reentry -- reenter communities.

too often we think about these issues as being resigned to their intractability. but these challenges do not have easy solutions. i think there are concrete policy steps that can make a big difference. thank you for your time. i look forward to your questions. chairman neal: thank you. >> edis an honor to testify today. -- it is an honor to testify today. i am dr. marielle reataza, executive director of the national asian pacific american families against substance abuse. i have 14 years of experience. i am here today as an asian american. i have concern over the health

of api communities. there is already an ongoing stigma when it comes to seeking care. the stigma can be so strong that they are delayed seeking care. sometimes individuals will seek services in private and that happens when telehealth is available which can be challenging since we live in multigenerational households. language excess and technology are already barriers. an estimated 34% have limited english proficiency and finding

language appropriate care continues to be difficult. understanding cultural nuances is critical to serving us. it is not surprising that apis demonstrate the lowest health seeking care. we are creating the illusion that we do not need them. a team of researchers found that apis have the highest cap and at in the u.s. which has been contributed to inequities. many asian americans have received imprecise or no information in their native make wages better languages. -- languages.

this has resulted in a significant rise in asian hate crimes. 10,300 hate incidents against apis were reported. one in five experiencing racism have been found to show symptoms of depression and posttraumatic stress disorder. substance use disorder among apis is believed to be on the rise. suicide is also reported as the leading cause of death among apis in young adults. despite it being the 10th leading cause of death in the u.s.. this is the cause of death for

33% of our young adults. i have much reason to believe that cases go underreported and require more investigation to be well understood. one way in which this can be improved is increasing capacity for these communities in research. we are on rep -- underrepresented in these studies. i urge the committee to build capacity to build language access services. i urge the committee to proceed with the adoption of principles

and practices. harm reduction is science-based and community vetted. i worry about the long-term impacts. i acknowledge the challenge. we need help. i think the committee for allowing me to testify. chairman neal: thank you. >> thank you for having me here today. my name is jessica hulsey, founder & ceo at the addiction policy forum.

over the last two years, addiction has worsened at historic rates. the isolation of the pandemic made too many cases catastrophic. we conducted a survey during covid and one of our patients shared that living in recovery in this time has been disappointing when they keep liquor stores open. the society is so twisted. we also saw a patient journey map which helps us understand the journey from input from our patients. one of the most difficult points in the process highlighted higher patients is how hard it is to find health care. one of our patients shared that

she was not able to get help when she needed it. to make matters worse, the introduction of fentanyl has increased mortality rates. fentanyl is 100 times more potent than morphine, 50 times more potent than heroin. it has devastated our communities. there were 285 deaths per day. like a plane crash every single day in america. like losing a high school class of seniors in one day, every day in this country. i lost both my parents to be owed use disorders. -- opioid use disorders. i would like to take a moment to

share letters from families that are a part of our campaign. we have hundreds of these letters. christina lost her son to a fentanyl overdose. she says people need to know this was a disease and not the choice. after three years in recovery, scott relapsed which led to suicide just a few days before his birthday. he left a letter which said he had not found one person who can help me. i just cannot stand being in my own mind. it is torture and it hurts. and denise, one of our moms, she

lost both her beautiful sons. she said her boy's a bright future ahead of them but because of their illness and lack of adequate treatment and medical coverage, their lives were cut tragically short. had they suffered from diabetes or cancer, they would have been provided the medical care necessary to live a full life. we have most of the proven tools to address the crisis, yet we do not implement these interventions for those in need. medications to treat opioid disorder reduces deaths, criminal activity. research shows that they have a 40 or 60% reduction in mentality.

only 30% of the patients will actually receive it. can you imagine if less than half of oncology such as provided chemotherapy? and in that half only one in three patients receive the medications needed. our recommendations for the committee is to expand critical services that are proven by science. like contingency management therapy. we need to have more solutions for stimulant treatments. build the addiction workforce by addressing lack of coverage, low reimbursement rates. and finally, go upstream.

addiction is a pediatric brain disorder. thank you so much for your focus on this important issue. chairman neal: thank. without objection, each member will be recognized for five minutes to question our witnesses. we will go in the order of seniority. before questioning, i would like to put into the record. the national suicide health

hotline number, anybody can call anytime to be connected for help. this past december, the biting administration -- president biden's administration announced millions of dollars to strengthen it. let me turn to our questions for our witnesses. let me begin by recognizing dr. chapman. i want to thank you for your testimony. as part of our bipartisan work,

it is clear this is just a first step in ensuring that medicare beneficiaries have access to a full continuum of services for all types of substance use disorders. you talked about the challenges that americans face in getting necessary care and whether as a result of gaps in health care coverage, intervene. >> thank you mr. chairman. we have tremendous gaps in care. in the district, 98% of our patients recover. i was on the panel about three years ago and alice asked a question. is it money or is it structured?

the consensus was that it is both. the fact that we have the structural barriers to care. i mentioned prior authorization, but there are many other barriers. if a patient comes to see me in my office, we set up telemedicine six years ago anticipating the needs. but most insurance companies do not pay for multiple services on the same day. under the old system, a patient came in and they wanted to see a psychiatrist or primary, one of us would not get paid. the idea of value-based treatment, we are encountering

patients with limited resources, so we want to do everything we can. when patients came in needing to see a social worker and did not have a telephone, we could put them in touch with that for telehealth. we have been doing this for six years but there is no payment structure to support that. we are looking for a payment structure for medicare, medicaid, across the board that would support these very necessary programs. there are other issues like transportation, housing is a major issue. anywhere from 25 or 50% of our

patients are homeless depending on how you depend -- define homelessness. that puts those patients in dangerous situations. without housing, we are creating a problem, discharging them back to the same dangerous environment. chairman neal: thank you dr. chapman. i want to reference a follow-up question. the sheriff's office runs a number of programs. the services provides a

significant conduit to employment and housing opportunities. the sheriffs pointed out to me that up to 90% of the inmates either have an alcohol, drug or mental health issue. can you talk a little bit about why programs are needed to address some of these issues inside of these institutions? >> absolutely. less than 5% of jails across the country use medication assisted treatment. they would take patients off of

methadone if they were incarcerated, which means, if you could imagine a diabetic being incarcerated and taken off their insulin. it is unheard of. it boils down to stigma. without education and understanding what these medications are used for, our criminal justice system considers this replacing one drug with another. we have to start with professional education, both in the medical field as well as in the criminal justice field. so they understand what these medications do. untreated, the worst place to put the patient who is using drugs is in jail because that

will be the highest rate of transmission of infectious disease. a number of years ago, they prohibited the medication because they said it was being smuggled. which means that you create a black market within the jails. the easiest way to stop that black-market is to provide medications to the jail and then have those patients transition from jail back into the community. just like any other medication. we can stop this black-market and these gaps that we are currently having by providing those services and making it

provided in advance. many of them need insurance that should be access 30 days before. if you talk to regina labelle, they have these policies nailed down to the nth degree in terms of what needs to be done. chairman neal: thank you for testifying today. we want to continue the conversation. in may of 2020, the committee held a hearing. it was clear the pandemic was exposing long-standing inequities in our health care systems. you highlight how the system

exacerbates risk factors for suicide and addiction. what can congress do to address these issues? >> thank you so much. i would say first of all, it is not reinventing the wheel. there is a great deal of sociological and medical literature. some of which i cite in my report. that talks about how in moments when societies are challenged by wars, famines, pandemics. in ways that highlight structural inequities. if you create social capital or social cohesion, if you move not to talk about people's identities, but say here are the fault lines that are being exposed by this moment of crisis. what we are going to do is we are going to have a national effort to fix these fault lines,

to help people who are the most vulnerable, but also to protect society. the effect of providing health care networks in low income communities, people are able to access all kinds of care, mental health care and physical care. the unintended effects of broadening health care networks have all of these other, people feel like they are part of a network, so you will see optimism, participation go up. we really need to think about infrastructure as not just come up let's just fix them bridges that are broken, but how can we

fix infrastructure in a way that enhances people's sense of connectedness. the other part is that the early stages of the pandemic highlighted weak points of our society. people at length in multigenerational homes, they had jobs where they could not social distance. they had unequal access to information from the internet for example, so they did not know the up-to-date safety information. these structural inequities were brought into focus in the first moments of the pandemic. as a society, we can say they are dying those people who are less fortunate than us. or to say that we are dying, our fellow citizens. at vanderbilt, we have structural competency. we trained health professionals to understand systems, but also

to seat weak points in structures. the upstream factors that might lead to downstream mental health issues and to inequities. we are training mental health practitioners who are versed both in individual treatments, but also in these upstream factors about who do you need to partner with to help people pay their bills. how can we reimagine medical clinics in that way? chairman neal: thank you. your testimony was superb again. we acknowledge that the mental health crisis and its impact on asian americans is clear. we have much work to do. can you highlight ways that we can overcome some of these challenges to ensure that everyone has access to the care that is both structurally and culturally competent?

>> thank you. i appreciate the question. i agree with the of what has been said by my colleagues. a lot of the things we have to understand as health care practitioners is that we do not understand oftentimes how the systems work for different communities. i advocate for better understanding what is going on in the community level structurally. identities also impact the way in which people interact with the health care system. there is a lot of gaps that everyone has identified. there is difficulty in navigating the system.

and even when people have access , often they are under insured and access to these services are expensive. and really challenging to navigate. we often see that someone has to go and see a provider. that means they have to take the day off. they have to look for child care. there are so many issues that are complicated by trying to get well, so i think that ultimately the system is challenging. we have to find ways to help people access it and navigate it. it has to be affordable, equitable. a lot of that involves learning how different cultures interact with the system and how to better address them appropriately. with also research as well and better understanding of those ends. chairman neal: thank you. with that, let me recognize the

ranking member, mr. brady come out for five minutes. >> i did not catch what the timetable is on that. when does that happen? chairman neal: i think it is shortly. >> we ought to do her best to get the word out. i know our law enforcement community deals with medical health issues every day and i am pleased to see our former colleagues from the ways and means committee has joined us. a terrific guy. it is good to see you. thank you to all the witnesses. i want to direct this question

to ms. hulsey. thank you so much for being here and sharing those stories. the devastating effects of mental health problems and substance use disorders have on communities. i would wager every member of this committee has a story as well. a friend, a colleague, a loved one who we have lost. i remember when we were first working on the support act. the dangers of fentanyl were just coming into view for us in congress. now it is the number one bank killer of young adults in americans -- america. if you have a child, your biggest fear about losing them does not come from cancer or car accidents. it comes from fentanyl.

it is a shocking change how quickly this has occurred. how has, since we passed the support act, how has fentanyl change the substance abuse landscape? how do we catch up to these challenges? >> i think fentanyl is driving overdose deaths and fatalities. we need to have ways to address this, to intervene sooner, to have the prevention, law enforcement strategies. it is making its way into so

many communities with the devastating effects. one of our moms wrote in. her name is angela and she lost her beautiful daughter to a fentanyl overdose. she has six times what a therapeutic dose of fentanyl would be when she lost her daughter. there so much we can do with law enforcement and policymakers makers, families. >> you are in the trenches. you run a terrific program. you deal with this every day. you see the successes and you see the shortcomings. what is, for congress, the most important thing we can do to help you succeed? obviously, in prevention and provided services. -- providing services. >> the number one thing we need

is to implement and scale all the things we have learned. it is frustrating to be in the space. our families are at the epicenter of this and there was so much loss we are experiencing. the scientists told us all these things we need. we would like some medications for stimulant use disorder. we need more tools, but the tools we have and we have decades of research that they were. but they are not implemented to scale. we have programs for kids impacted by parental substance abuse disorder. one in massachusetts that is amazing. but we do not take them to scale. we do not implement systematically. we do not make them available in all of her counties.

>> thank you so much. thank you again to all of the witnesses. i yield back. chairman neal: let me recognize gentleman from california. >> thank you mr. chairman. thank you for holding this important hearing. thank you to all of the witnesses. i want to go back and comment on one thing that was said earlier that i think was incorrect. president biden has handled this pandemic quite well. she did not deny it was real. he encouraged people to get vaccinations and to be careful. she provided critical funding for shots and tests and to get kids back into school. today, 98% of our schools are open.

that is an important thing to mention. also, as we talk about drug addiction and mental health, it is critically important to note that 25% of our world population is impacted by a mental health issue. and at least one mental health event, in their life. and at the same time, 70% of people with mental health issues do not have access to, noted they receive, -- nor do they receive, treatment. we can talk about this all day but unless we make investment in neurological research, we are never going to get ahead of this curve. it is important to point these things out. it is a bar -- it is a bipartisan issue that we all

should be concerned with, and figure out how we conduct and fund that research to deal with this problem that affects every one of us and every one of our families, somehow or another. dr. chapman, i have been working on telemedicine since my time in the state legislature in california in the 1990's. i am convinced it is not only important, but critical that we take advances in this area. i want to thank ranking member brady for voicing his support for telehealth in his opening statement. this is something we all need to work on, to make sure we make the advances necessary. but dr. chapman, you mentioned telehealth and you mentioned the key barrier for treatment for those struggling with addiction

and mental health, and that is the stigma of both. do you believe that by using telemedicine more generously, that we can help deal with the stigma issues that surround addiction and mental health? dr. chapman: thank you for the question, and absolutely. i am not a psychiatrist. in 2013, i went back to howard university. i am an intern. i went back to howard university because i needed the support of the psychiatrists and social workers and psychologists. when we designed this telehealth platform for an urban population , we looked at the profile of our patients, the homelessness

statistics, you know that the patient's don't have internet connections, their cell phones are very limited, so we have designed a process for a practitioner like myself that is in the city and not connected to the hospital, how am i going to get those services for a patient that walks into the office and their number-one issue is that someone very close to them died? they lost their housing last night? those are the types of things that make providers not want to treat, because they don't have access to those services. by bringing telehealth into my office, i am able to access simply by putting a patient in one of the exam rooms and

connecting them to a social worker or a psychiatrist. or if they are having legal problems with the parole office, i can help them navigate. that takes the burden off of me. that reverses provider burnout and provider burnout is the number-one reason providers like myself will not treat these patients. many providers that have been certified and have an excellent number, because of these support services, they are not -- these support services they are not able to institute easily, it scared them off, and they back off treatment. representative: thank you. i yield back. chair: let me recognize the gentleman from florida, mr. buchanan. representative: thank you. i can't imagine anything more

important than mental health, especially today. i thank all our witnesses. miss huskey, i want to ask you, all the stories were so powerful , i have a nephew who is struggling, semipro hockey player, got addicted on drugs and they have been battling, my sister, with him for 20 years. it has been an incredible struggle. it seems that once they get addicted, they go through that door, and if you don't get to them early, there is a good chance you lose most of them. what more can we do up front in terms of prevention? it seems whether it is the kids or anybody, if we catch them early, it makes a big inference because, from what i have seen over the years, many of them, even if they figure out a way to manage it, it is brutal trying to manage it, the process. i know people who have been

successful in addiction on cocaine or alcohol and they are going to rehab every year and a half or two and they are going to lose everything. i guess there is two questions. once they go through the door, what is the chances of coming back, based on what you have seen? but the bigger question for me is, how do we do more in terms of revenge and on the front-end? -- in terms of prevention on the front-end? >> thank you. i am so sorry that your family has struggled with this as well. going upstream in both preventing addiction indent or green early is so critical. and no other area would we wait for it to get worse before we

intervene. we would never wait for stage iv cancer before we engage a patient in care, and the same is true or addiction. i think everyone can recover. recovery is possible and it is beautiful and we have so many positive, inspiring stories about recovery and how people got there. even put -- we are even putting out a patient journey map later this month to detail that. you are right, though, the quicker we intervene, the better the outcomes. and most addiction begins in adolescence or young adulthood, so making sure we are intervening at the time of onset, most of our treatment is set up for adults, yet onset is in adolescence paid that is something we need to address. we all know what employee assistance programs are, but there are really successful student assistant programs in middle and high school. representative: as a member,

nobody wants to get the call i got last week. we probably all got the call. as a family, they found their son, three tutors in afghanistan, committed suicide in an area i represent. it seems it is 50% greater than the general population in terms of suicide deaths among our veterans. what are your ideas about where we are and what more we need to do? one thing i got left with, he says we do a good job bringing the kids in, this is a marine, into boot camp. we don't do a good job in his opinion in terms of when they come out of service. they should also have a boot camp, his term, on their way out. their son finally took his life last week after struggling for quite a while. >> i am very sorry to hear that. we do have treatment and interventions for those who have

concurring -- have recurring disorders. the services need to be available to our veterans. we have interventions that work such as the veterans treatment court which combines wraparound services we need for our veterans. but we don't apply those solutions at scale to all who need it. it should be a huge priority area that we focus our time and resources to make sure there is a safety net there. representative: thank you. i yield back. chair: that me recognize the gentleman from connecticut, mr. larson. representative: thank you for holding this important hearing. i commend president biden last night, for underscoring the need for us to come together around issues that i think everyone in this committee agrees are nonpartisan and deserve our

direct attention. ms. labelle, you spoke about social determinants of health, which impacts substance use. in my district, the city of hartford, a community which is deep poverty levels, accounts for over 25% of accidental overdoses. what policies do we need to pursue to address this addiction holistically? ms. labelle: thank you. from connecticut, i am very familiar with hartford. i was there last year with the office of national drug control policy. i think there are a couple of things. first, there are good harm reduction programs in hartford. they get people who may not be receiving services elsewhere.

they get vulnerable populations that help that they need. they get them naloxone if they inject drugs. they get them syringes that can prevent them from having infectious disease. that is one piece. i think the prevention programs, there are good examples of prevention programs in those areas that work to build communities with wraparound services for families. and i mentioned in my testimony, i am a strong believer in the child tax credit to help families experiencing poverty, to lift children out of poverty and also address some adverse child experiences and trauma that often accompany poverty. those are three areas i believe strongly in, and that can help in that area. representative: thank you for your clarity. i yield back. chair: let me recognize the

gentleman from nebraska, mr. smith. representative: thank you thank you to our panelists as well for this timelyion that i think is needed across our country. i appreciate the opportunity to continue this conversation that we began exactly a month ago with our lustful committee hearing on how mental health care has been impacted by the pandemic. events over the last two years have made clear how important the mental health component is to our health care system, especially when dealing with trauma and tragedy. whether our constituents are impacted directly or indirectly, natural disasters like putting or hurricanes, infectious disease outbreaks like covid or ebola, or even terrorism or barbaric wars like in ukraine can impact that'll health and increase risks of developing problems with substance abuse. we saw this risk clearly during the early days of the pandemic as alcohol sales shot up as

in-person support meetings were being banned. we see people now returning to normal social interaction, but long-lasting damage has been done and nothing can bring back those who died of suicide or overdose while isolated from society for their own protection. appropriate treatment is more complicated than managing other conditions where a simple prescription can manage the concert for months or years. instead, a major component is interaction with a therapist, counselor, support group or other human being, but especially in rural areas, access to these resources is limited by distance and population density. rural areas have consistently experienced shortages of all kinds of skilled health care providers, but especially those who work in mental and behavioral health. addressing these long-term shortages requires innovation and creative approaches, from -- often leveraging technology. one option is options in

underserved communities, the peers act, and initiative to allow peer support to be integrated into medicare coverage. train, pierce support specialist -- trained, pierce support specialists provide inexpensive and effective resources to address the provider shortfall. another important opportunity is to continue to grow telehealth capacity. in rural areas, we lack a lot of opportunities. there is widespread high-speed broadband manned. it is not currently available and it is impossible to appropriate your own engagement. there are areas in my district you can't get a strong enough signal to make a call on a cell phone and are likely monday --

likely many miles away from a mental health professional. requiring these individuals to have a high-resolution internet connection to access mental health care is not realistic. i introduced the rural telehealth access act which, in addition to removing barriers for rural mental health, would allow for audio-only provision for mental health services for those with mental health or substance abuse disorders. i hope these concerns will be incorporated into a long-term telehealth package which we need , to chart a viable post-covid course into the future. i am wondering what you think are the most effective communities to use telehealth to improve treatments for those with substance abuse disorders, especially in underserved areas? and you think audio-only options for behavioral health telehealth

can be used to expand access and provide support in underserved areas without crating too much from your ability for fraud and abuse -- too much vulnerability for fraud and abuse? >> expanding and making permanent changes to telehealth that we saw during the pandemic will be helpful to increase access moving forward, including audio-only options for our physicians. it can be tricky to turn on that video component, and we need to make sure we have better access and connection to the right clinicians for all our patients. we still struggle with reimbursement rates for services in the addiction treatment field, so we would like congress to be able to work on that so that we can keep and retain our clinicians that we have in the addiction field. and there are other solutions. and i think telehealth and digital therapeutics have applications for rural communities where you might have

gaps in access to care or not enough variation in the types of care plans some of our patients are looking for. digital therapeutics allow us to use smartphones to help with peers services, rick -- peer services. recovery and peer service are important and i think congress can help us with those next steps. chair: let me recognize the gentleman from new jersey, mr. pasquarell -- pascrell. representative: thank you. there are things that we can work on together and we should because that is part of our mental problems here, that there is a democratic way and there is

a republican way. when i was mayor of one of the largest cities in new jersey, i knew there was no democratic way to pick up the garbage. when we look at those tangible things differently -- and we look at those tangible things differently than we look at problems each of us have, because no one is totally free from those problems. the last two years made us painfully aware. our witnesses are excellent, each one of them. the testimony today removes all doubt that the mental health and addiction is a crisis we face. tens of millions of americans are suffering from social isolation, fear of infection, job loss, burnout. the statistics are startling. some of these things are easier

to talk about than others. the reduction in the use of fentanyl is easier to talk about than it is transgender and what those folks had to go through over the last few years from remarks from people in our own group, our own congressman. that's congress -- congressmen. not only hurtful, but very, very hurtful. during the pandemic, drug overdose deaths rose by 40% between 2019-2021, an increase of 29,000 people. assess -- access to treatment is inadequate. medicare is not subject to

parity requirements for it often, one must be hospitalized to even access treatment. congressman chu are drafting legislation to modernize medicare. our fix requires mental health and substance use treatment across the continuum of services and settings. it is going to take a long time to break away from stigma, a longtime -- k long -- a long time. this will improve access to mental health services. 25%-50% of all people served by the mental health system have a lifetime history of brain injury, a loss of consciousness -- many of our soldiers. those individuals often have longer and more severe histories of substance use, and more

behavioral health issues. we must support the to visuals with substance use disorder to access and navigate treatment. i've been to too many wakes for friends and neighbors, for our mental health system failures. i have attended too many funerals for young people who could not overcome their valiant struggles with addiction. and we have failed to help tens of millions of americans access to care. more americans will suffer, more americans will die. dr. chapman, thank you for your great testimony, as each of the witnesses provided. your testimony highlighted the gaps in substance use disorder treatment across various pay

years -- various payers. can you talk about the barriers medicare beneficiaries face, and what are some solutions? dr. chapman: thank you. absolutely. support services that i mentioned, including social workers having peer support staff, that is critical. they save me so much time. and the system we have set up allows me to introduce my patients to a social worker while they are in the office, and the social worker is at a remote site. once those connections are made, then we are able to give 24/7 access. so, that same patient can either call me if they have a problem, they can call the social worker or they can call a peer support

specialist that they have been introduced to. in this model has just been fantastic in terms of closing some of those gaps. when we look at the safety, one of the problems is worrying about how we approach a pay for new services, but look at the savings. look at the federal register and what it costs the system not to treat a patient -- $32,000. comprehensive treatment spread across a population -- i have a population of 225 patients, so you spread those costs across that population. and it may come to about $1.5 million, but every patient does not need that service every day. but when you spread it across

the population, you end up saving honey through the criminal justice system because they are not going to jail, you save money because they are not overdosing or going to the emergency room and you are also able to reengage patients, especially if they have children. representative: thank you. i yelled back. chair: let me recognize the gentleman from new york, mr. reed. representative: i want to recognize miss halsey, it is my understanding you have family members tuning in today, and i recognize denise, angela, jim, who are watching this hearing, obviously thinking about their loved ones that have been lost to addiction and opioids in fentanyl -- opioids and fentanyl and all the issues we are talking about. our thoughts go out to you, and

we appreciate you using that horrific situation in a positive way by participating today. i will open my remarks by confronting the issue of stigma. as someone who surrendered to his higher power almost five years ago, dealing with the demons we are talking about today, i have to tell you it is time for us to come out of the darkness. it is time for us to celebrate, as has been indicated by each one of these witnesses, recovery. the best decision i ever made in my life was that decision i went to my knees and turned to a higher power in the program i was associated with, and wrestled that demon under control. and my life has improved so drastically in a positive way, that i am here to be a message for all those in the darkness still, all those facing addiction, all those that, when they reach out for help and are

denied, and i know exactly what that experience is, i would tell you, don't give up hope. don't turn back to the demon. don't give up. because if you embrace recovery, if you have the strength to ask for help, i can assure you there are millions of us around this globe that are pulling for you, standing with you and will do whatever it takes to get you out of that dark place and into the light of recovery. with that being said, one of the things i experienced, and i think alex talked about it directly, it is a question of money and a question of structure. i want to focus on the structure side of this conversation. because what i have seen is that we have a silo effective substance abuse counselors and

then we have mental health counselors. they are not reimbursed in a way that makes any sense under our federal health care system. that needs to change in my opinion and i hope everyone disagrees with that. i have also seen that when we talk about a 12-step program where a call is made to surrender to your higher power, that often come our treatment providers will not talk about spirituality issues, will not talk about the power of religion because somehow, that is something that should not be discussed in our public system. and i got to tell you, if you do not have a spiritual reawakening as part of recovery, it is very difficult to succeed. i am going to ask you, ms. huxley, how or is there a structural barrier to

incorporating documented, successful treatment programs based on a 12th step spiritually based recovery program that prevents you from treating or giving your patients the best opportunity to get into recovery and succeed in life? are there barriers that you face in your treatment models that we need to change to encourage that piece of the treatment protocol to be therefore those that are suffering in addiction and until health? >> absolutely. congrats on your many years of recovery, and for sharing your story. this is one of the pieces we need to do more of to drop the shackles of addiction and tell our story. the 12th step program and variations of support groups out there are the foundation and

beautiful part of our recovery system in america. it is proven by science. we have the data. it has worked. and our research and our work with our network of patients in recovery from addiction, 64% of them rely on support routes for the long-term. this is what we need to stay well and stay healthy and if you look at the scientific components, you are attaching to your community, you are dealing with shame itself stigma, you are creating positive peer connections. there is cbt built into the programs. there is treating a knowledge you need to manage your chronic health condition. it is one of our most important sources. some of the barriers can be misinformation and not understanding that you don't need to choose a brand of mutual support. there are so many different ones, depending on your secular or religious program, some that

are focused on certain substances. i think if we have more education for our providers and practitioners in the field to let them know how important it is to be aware of what resources are in the communities and making sure that if we have gaps, we feel them. representative: i appreciated. my time has expired. we could talk about this for hours. i think the chairman for highlighting this, and there are solutions here, especially with a program such as 12th step, a 64% success rate. we should be embracing that and removing all bears so that people get the help they need. chair: i appreciate the gentleman's courage in stepping forward in a public arena. let me recognize the gentleman from chicago, mr. davis. representative: thank you. and let me thank you for this very important hearing.

and thank you for your testimony, all of the witnesses, but also your interaction with my office. as chairman of the subcommittee with jurisdiction over child welfare, i am deeply concerned about 40% of the youth who come into foster care due to prolonged substance abuse, including about 20% of infants. this committee has bipartisan nly invested in policies to strengthen families so these children can grow up at home, policies like federal reimbursement for family substance abuse treatment and outpatient services for parents to keep children from entering care, and regional partnership grants like that received by kentucky's start group, as well

as various tax credits for children in moderate and low-income families. ms. labelle, can you speak about how family-centered approaches to treat -- approaches for treatment to provide wraparound care for families can limit adverse childhood experiences and children entering care? ms. labelle: if we separate it into three stages of the child's life and taking into account a pregnant woman, first, make sure pregnant women get the prenatal care they need, particularly if they have a substance use disorder. the stigma attached to women with substance use disorder often keeps them from getting necessary prenatal care. the second piece is that once that child is born, too often, postpartum women are no longer

eligible for medicaid, which often causes, again, women not to get the type of treatment they may need if they have a substance use disorder. and lastly, those wraparound services, that family-centered care that takes into account that a child is not separate from the parents and the parents and child all need services. the parent may need treatment but also may need other services such as housing, parenting skills, again, to prevent foster care placements. the family prevention act that passed a couple years ago, the renewal that is happening right now, all those things can take into account that family reunification goal we have. representative: thank you very much. i have been told drug addiction is a complex brain disease characterized as an

uncontrollable desire to continue taking drugs, with the pendency to -- with dependency to increase over time, resulting in physical and psychological dependence. without-risk youth, there are many factors involved in drug addiction -- early stress, use of drugs by a family member, having friends who use drugs, financial crisis, academic crisis, all kinds of things. what seems to work best? what are best practices for preventing and successfully treating youth using drugs? ms. labelle: pediatricians, for many people, play a really important role for young people in identifying risky substance use. they may not be at the point

where they have a substance use disorder, but that is why early intervention by a pediatrician or primary care doctor is really important. the second thing is the role of parents. many of us are parents and we all think that kids don't listen to us. i certainly think about that with my son. but they do. and if you talk to kids about how risky early substance use is and makes her they know that if they are using substances, that they can talk to you so that you can get them the kind of early intervention that they need. i think the role of the parent as well as schools, and communities, and also the substance abuse and mental health hhs as really good tools for parents on how to talk to their kids. it is called utah, they listen -- it is called you talk, they listen.

it is about talking to kids on alcohol and marijuana use, to the most commonly-used substances by young people. representative: i yield back. chair: let me recognize the gentleman from pennsylvania, mr. kelly. representative: thank you, chairman. great hearing. mr. reed and i are friends and i know he has gone through something and it is really good that he put it out there so that people know. i have a similar situation that happened with a family member. i have been going through this for 28 years. many people who have this problem which they were the only family that had it, but it is not true. i am trying to get my eyes and my brain around this because the

size and scope of this problem goes far beyond anything. all of you on the panel, thank you for what you do. you start pushing that rock up the hill, as soon as you let go, it goes back down to the bottom and i can tell you that because i have been in so many starts and sets her at culmination senate felt so good coming out of that, only to find out that disease was waiting for this person out in the parking lot as soon as they left wherever they were. i don't know where this ends. it is my understanding that there is around 14,000 addiction rehab centers in the u.s., serving report 7 million individuals. talk about a big business, this business in 2020 was worth $42 billion. it is slated to grow to 53 billion dollars by 2025, driven largely by private equity

investments. this is a big business. 11,200 pounds of sentinel were seized at the border last year, enough to kill every american seven times over. according to the border patrol, in texas, 87,600 52 pounds of narcotics including 588 pounds of encinal were seized from mexican cartels. the street value is $786 million. why do i bring this up? i remember president trump talking about what he told his kids, don't get started on alcohol or drugs, because then, you won't have to stop. there are no secrets in our family, there are a lot of things we don't talk about. the stigma of having this happen in your family can reflect on me that somehow i didn't do enough, i should have done more. we all have these wonderful

pieces of legislation that we are telling people about and saying this is what i sponsored and all this stuff. it hasn't made a damn difference. we are spending like there is no tomorrow. in the rate of recidivism on this -- and the rate of recidivism on this, we are always very optimistic that it is going to be ok. i just went through another program that started 28 years ago with the same person and i am trying to figure, is there something out there that we don't know? duckett started and you won't have to stop -- don't get started and you won't have to stop. anything we can do, i know you guys are dedicating your life to it, but we are chipping away at an iceberg. i don't know how we change it. i wish we could have more briefings. chairman, you are doing a wonderful job. we have to find out where to direct the money.

we are throwing money at a problem and we are not getting a very good return. maybe we are throwing it in the wrong places at the wrong time to the wrong folks. but i am with you on this. all of you to wonderful jobs. thanks. we are no longer republicans or democrats, we are americans facing the greatest threat to the generations that come after us right now. and i know you don't have much time to follow up, but we will stay in touch with you. any other ideas? i used to coach youth sports. i thought that was important. you have got to get these kids when they are young and the destruction of the nuclear family is one of the things i really worry about. anything you could come up with that would be a positive like do this today, now? >> you are completely right about not starting and going down that road, it is easier. those people with an addiction

[indiscernible] prevention is about pushing back when you start using anything. we don't do a good job of telling teachers, coaches, parents that fact, we just put out an awareness campaign called protect your brain because there is misinformation. the other part of this is just addressing the myths and misinformation that exist, from age of onset, waiting for rock bottom, acute issues about a chronic condition we need to manage for years, these are all things that we need to change in congress can play an important role in helping us get information out. representative: thank you. thank you, all. we have got to defeat this or we are going to lose our country. chair: let me recognize the gentlelady from california, miss sanchez. representative: thank you for

your leadership, mr. chairman, on this issue. i am glad to join the committee as we take a step towards addressing our mental health crisis. i want to thank all the witnesses today for your testimony, it has been very enlightening. over the last decade, our country has seen an increase in addiction and suicide. and for too long, the statement associated with drug use disorders and mental health needs has determined how we respond to these crises. shame and barriers to care have made it difficult for many americans to access support they need. and the consequences have frankly been deadly. in 20 20, nearly 150,000 lives lost to overdose and suicides and thousands more were impacted by the loss of a family member. we have, and my family, a struggle with addiction, so we know how heartbreaking that can be. my heart goes out across the

nation to those who lost a loved one either due to overdose, covid, or anything caused by the pandemic. as our witnesses shared, there is urgent need for more equitable care systems so americans can get the care they need where they need it. we have an opportunity to follow evidence-based strategies that will support all americans across a continuum of care, and that is why i am troubled that despite rising suicide rates, states like florida and texas are advancing policies that place lgbtq youth at increased risk, and youths of color facing greater risk than that of their white counterparts. texas is encouraging state agency workers who are paid through taxpayer dollars to investigate parents who support their children for expressing who they are.

i am a mom and firmly believe that no child is part of a loving and affirming community should fear being taken away from them. doctor, given your expertise on factors that impact mental health, can you address [indiscernible] >> thank you for the question and that is exactly what my research focuses on. i am not an addictions shall is it i just wrote a book on suicide in america, i am looking more at the suicide component of this. there are several forms of discrimination that happen here, certainly feeling there is xenophobia or hatred directed toward somebody's own roop, or the -- own group, or their group is not recognized by the

government or state or treater, certainly contributes to a sense of despair. that goes hand-in-hand with socioeconomic disparities that accompany stigma. one of the sources that eyesight cite in my report says basically depression affected two out of 10 adults in the pandemic but it was five out of six adults who have less than $5,000 in savings in their account. this despair goes hand-in-hand with socioeconomic factors that face members of disadvantage groups as well. so, there is a really imperative to address economic activity in a way that people feel like they have a safety net. and then, there are also stress factors and known risk factors for issues like suicide. the last book i wrote looks in-depth that gun suicide. i know it is a very contested topic. i am not coming at this as a pro-gun or anti-gun person. i was born on a military base,

grew up in missouri, i have been around guns my entire life but i could also say that in moments of despair, having firearms around the home, giving firearms to people who might be at risk, increases negative outcomes. i do worry about what has happened with firearms in the context of isolation, people particularly in the 18-21 age group, and also economic stress leads to that despair. when you look at issues of disparity, you start to see that they link not just to societal attitudes to her -- attitudes toward particular groups, but they intersect with all these other issues on social and economic class that are a vital part of this story. >> i grew up in a tightknit

community. that doesn't always mean that it is easier to openly talk about these issues. what role do community-driven and responsible services play in getting people to help that they need? >> ultimately, the role we play at organizations such at ours -- such as ours, we help direct services and provide access to services but are otherwise inaccessible to communities such as ours. i am a resident of california in los angeles. we grew up with a large number of other minorities and communities and we see time and again that the models that work prioritize our own community

members, our community leaders, our own researchers to go into communities and be able to ask questions we would otherwise not be able to talk about. there are also great models that help us in the latinx community in terms of being able to engage with community members and topping them find erect services. this goes along with health care and mental health and behavioral health services. it is similar to what we are seeing in the aa and nhpi community. people trust members of their own community a lot more and i think one way we can strengthen how we address stigma is to talk to each other better. and that involves community leaders and access to communities that would otherwise not be accessible.

chair: the gentleman from missouri, mr. smith, is recognized. representative: thank you. substance use disorder is plaguing our nation, and issue republicans take seriously and we have the record to prove it. in, republicans passed the comprehensive recovery and addiction act, the first federal legislation devoted to combating substance use disorder in 40 years. we didn't stop there. in 2018 with president trump's leadership, we passed the support for patients and communities act. this included important provisions including one i worked on and wrote that was designed to monitor the use of opioids during surgery to reduce the chance a patient suffers from addiction later.

but washington democrats have destroyed all the momentum and made a problem worse. addiction is a disease of isolation and during the pandemic, washington democrats and joe biden promoted isolation and lockdowns and mask requirements. it is hard to believe they care about substance abuse disorder after keeping liquor stores and marijuana stores open as essential services while shutting down addiction support groups. just last month, they proposed distributing free crack pipes to those suffering from disease. the failure of democrats to address substance use continues to hurt americans. my district suffered over 350 overdose deaths in the calendar year during the pandemic.

in the state of missouri, we suffered over 2000 overdose deaths while our nation suffered over 100,000 overdose deaths. this made 2021 the deadliest overdose year for any country in history. this increase is directly tied to the emergence of fentanyl, which is shipped from china to mexico and smuggled into our country through the gaping hole in our southern border. fentanyl is deadly, with 50 to 100 times the potency of morphine. and cartels are mixing it with other drugs to make them more addictive and dangerous. cartels are also producing lethal counterfeit prescriptions laced with fentanyl.

republicans won't stop fighting to protect americans from fentanyl. we tried to pass legislation that would have made it illegal to use fentanyl and similar drugs outside research purposes, but washington democrats blocked that legislation even though the biden administration recommended a similar strategy last september. we must empower our law enforcement to stop fentanyl before more families have to bury their loved ones. could you elaborate on the harms of these counterfeit fentanyl pills? would restricting the supply of fentanyl coming into our nation save lives? >> absolutely. anything we can do to prevent fentanyl from being prevalent

immediately. we have math -- methamphetamine, cocaine, counterfeit adderall and opioids and the effects are devastating. so many of our families share the stories of someone taking what they thought was a prescription medication, not from the right source, but they have a substance use disorder. and any fact, it is poisoned. we need more resources, more tools, all hands on deck, to help with the issue. there is a good awareness campaign the dea put out called one pill can kill. so, just to talk about this to make sure people in your districts are aware of the street the and counterfeit

prescriptions written i would be a very helpful awareness campaign. chair: let me recognize the gentleman from new york, mr. higgins. representative: substance abuse disorder continues to be a public health crisis that affects millions of americans. as disheartening as the numbers can be, it is important to remember, as we heard from our colleague mr. reed in his compelling testimony, that there are good people and organizations that thrive every day to help those recovering from substance use disorder. in my district in buffalo, new york, the save the michaels of the world is a nonprofit that works to educate communities about substance use disorder and provides important resource for individuals with substance use disorders in their families. save the michaels was founded

by a couple left of their son michael died by suicide after struggling with addiction. when it comes to treating substance use disorder and opioid use disorder, we know what works and what does not. medication-assisted therapy, of which 1.4 million americans are now seeking, in conjunction with therapy and community supports, offers the best chance for folks recovering from opioid use disorder. medication assisted treatments are controlled substances and we should be deliberate and how we regulate. but providers wishing to offer medication-assisted treatment face a complicated web of regulatory guidelines and can make medication-assisted treatments financially and sustainable -- financially

unsustainable. diversion of medication-assisted treatments is a real concern but evidence suggests that if you want to reduce the inappropriate use of medication-assisted treatments, the solution is to make them more accessible and get more patients into treatment. dr. chapman, can you speak about your experiences navigating the rules administering and being reimbursed for medication-assisted treatment, and how we can increase access responsibly and make the process less confusing for providers? dr. chapman: thank you. from my perspective, expending medication-assisted treatment is going to be the key to curbing this epidemic.

opioids, unlike any other addiction, has a 90% relapse without treatment. the problem is, it closely mirrors our own dopamine system, our field-good system -- our feel-good system. that we know now that there is a genetic component to it. a young person may break their arm or sprayed their ankle and go to the emergency room and with that first dose, feels that this is the greatest thing that ever happened. on the other hand, i am allergic to morphine. there is this wide spectrum of how each of us responds to these medications. so, medication-assisted treatment needs to be available to everyone in the country.

and we know from our experience that if we leave pockets of patients untreated, that drug suppliers and patients will find each other. because of this, we cannot leave any community untreated, any person untreated and i think free access similar to france and portugal, where they had similar problems 20 years ago, the same kind we do, and they turned to medication-assisted treatment with methadone. and there was a there is a dramatic decrease in crime, hepatitis c and in overdose deaths. we know from international studies that because of our system, our fragmented system,

the fact that we don't have universal health care makes it very difficult to penetrate and replicate what we know works in other countries where they do have universal health care. >> thank the gentleman. let me recognize the gentleman from south carolina to inquire. >> thank you for calling this very important hearing. thank you to the witnesses for sharing their stories. this is certainly a topic that we need to do everything we can to tackle, the rise in drug overdose deaths is shocking by any measure. i have been in congress for nine years and i think every year, we have adopted at least one or two or three bills to put more money into fighting drug overdoses, to adopt new programs to fight overdoses. i am sure all of them have helped at the edges, but i agree

with mr. kelly that it just seems like we are attacking an iceberg with an ice pick and we are just chipping around the edges and it almost seems hopeless. if you look at the numbers from 1999 until today, i mean, the graph just goes like this. i mean, almost straight up. and it starts out with the cocaine type drugs, and then heroin kicks in and makes it rise further. finally, synthetic opioids, fentanyl. the reason is because fentanyl is so extremely cheap and it is so extremely available. a street dose costs less than five dollars. it shouldn't. there is so much of it on the street that it is widely available to everybody and it results in this straight up graph. and it mostly affects, you know, it affects everybody, but it inordinately affects africa

n-americans and people in poor communities. last year, opioid deaths were 100,000 people in the united states for the first time. south carolina last year, opioid deaths increased by 50%, 50%. the primary driver is vast, cheap, available drugs. i have a chart here from the national biostatistics system that tracks these deaths and i would like to enter it for the record. if you would get this chart, interesting thing, though, where it goes up almost every single year, it actually does go up every single year from 1999 until this year, except for one year, and that year was from 2017 to 2018. and then in 2019, it goes up, but not that much, and then with

covid, it starts going up radically again. what was different? what can we learn from that? if you look at our southern border, 90% of the heroin that kills people in the united states comes across the southern border, cocaine, 90%, fentanyl, we had 2600 pounds in 2019, 94% of the fentanyl seized in the entire country was at the southern border. in 2021, it was 10,589 pounds, 95% of the fentanyl seized in the entire country was seized at the southern border. that weight is enough to kill every person in the united states six times over with a single dose. homicide, if you just don't look at the drug deaths and you look at the homicide deaths in the united states, 29,000 people were killed in on the sides. 2/3 of that was related to the

drug trade. homicides have increased dramatically in the last two years as a result of the defund the police campaign, increased violence and increased drug flow at the southern border. these homicides mostly affect poor communities, african-americans are eight times more likely to die in a homicide. and then, if you don't just look at our homicides, you look at mexican homicides, 36,000 people in mexico die from homicides, six times the rate of the united states. i would venture to say 90% of those were related to the drug trade, cartels, and gangs, resulting in 36,000 deaths. so folks, this isn't rocket science. if you look at what happened when president trump came in and we clamped down on the southern border, for the first time in 30 years, the number of drug deaths

actually decreased, for the first time in 30 years. and the policy of the biden administration to encourage people to come to the southern border, number one and number two, to relax restrictions at the southern border is killing people, absolutely killing people. this is not a question, it's a fact. just look at the graph. i would say, you know, so many of these programs, so many of these additional dollars we throw our chipping at the edges. if we really want to make a difference to the people who need it the most, if we really want to save tens of thousands of lives, we've got to increase our interdiction at the southern border. we've got to have a real southern border, we've got to seal it up. i yield back. >> let me recognize the gentlelady from california to inquire. >> i would like to thank the chair for holding today'

importants hearing and for continuing our focus on mental health issues, and i was so glad to hear president biden address mental health last night. i look forward to soon introducing legislation with representative pasquell to close many of the gaps for substance abuse, including for intermediate levels of care, expanding the list of eligible providers and improving reimbursement. i welcome the support of my colleagues on both of -- both sides of the aisle with this legislation. doctor, thank you so much for being here. thank you for your testimony for highlighting the impact that the past two years of increased violence and abuse of asian americans have had on the mental health of our communities.

can you expand on how the rising anti-asian hate -- rise in anti-asian hate in the pandemic has influenced substance abuse in the appi population -- aapi population? have your organizations seen more outreach for support? >> thank you for acknowledging the needs that our communities really face, especially at this time, as you mentioned, where we have seen an increased rise in asian hate or violence directed at ages during this time -- asians during this time. yah, we have seen an increase in stress and anxiety, as well as altogether mental behavioral health challenges and concerns that our communities are facing. ultimately, people are afraid. there are afraid for their lives, they are afraid for their loved ones, especially our

elderly and our women and our girls. and ultimately, that has resulted in an increased use of substances. you know, we've seen a lot of increased use in tobacco and other things that can be smoked or inhaled. we also have seen some increased use in alcohol, and you know, ultimately, we have seen a rise, as i mentioned, an accidental overdose related deaths. i think this is something that has been highlighted by a number of individuals already on this discussion that we've seen substance use rise altogether. i think even when it comes to stimulus and opioids -- stimulants and opioids, a lot of stimulants are even laced with hope you it's. there's been a lot -- with opioids. there's been a lot of deaths related to those and in those capacities as a. the opioid -- as well. the opioid crisis was also

driven by industry. we have seen it trickle down in aapi communities as well. so the short answer is yes, absolutely. >> i also wanted to follow up on the stigma aapi case in seeking behavioral health care, both from within our community and externally. that's why i introduced the stop mental health stigma in our communities act, because of this barrier, and that's in addition to the linguistic and cultural differences that you noted in your written testimony. can you discuss how the act can help increase access to care for minorities struggling with substance use disorders, especially in the api community -- aapi community, and also how immigration status could prevent aapi from seeking the help that they need? >> thank you again for this very

important question. and you know, everyone on this discussion addressed stigma today. i believe stigma is a huge barrier to addressing mental health behavioral health, substance use, and a kind of addiction, including problem gambling, which is a big part of our community. when we are not able to talk about issues, either you know, openly admitting them with their close family and friends are outside of our communities, it just does not get addressed. it does not get addressed and what we cannot -- when we cannot address them, how do we know what the needs are, how do we know how to properly address them and how do we know how to serve our communities in the way everyone on this panel is really striving to? a bill such as this one is an important one. i think this is important for aapi communities, for perhaps developing a model for our communities for how we address

traditionally marginalized and underrepresented communities on issues that are already really difficult to talk about and to address system. >> let me recognize the gentlelady from indiana to inquire. >> thank you. hoosiers have experienced firsthand the consequences of biting's open border policies that continue -- president biden's open border policies that continue to wreak havoc on. it has spurred a plaque of illicit drugs, including fentanyl, heroin, methamphetamine and even fentanyl laced marijuana that are being trafficked into local communities. this open borders approaches pardoning everyone in my district. and first responders to our workforce and child low for system and it's costing less. the previous administration took meaningful steps to secure the southern border and reduce drug smuggling but all that work has been lost.

it's obvious president biden lacks the fortitude to stand up to the left-wing extremists in his party. he's stepping aside and allowing regular drug cartels to prey on americans. the scourge of these illicit drugs has a real effect on indiana. a recent fire captain in my district pointed out a warning that fentanyl laced marijuana has caused a string of dangerous overdoses. a local tv station put together a three-part series in which they told the story of an infant who was brutally murdered by an adult who was entrusted to babysit her. every murder case has multiple leaders, but a major issue underpinning the eventual murder of this child seems to be meth and drug abuse by those who were responsible for her care. the baby's grandmother also believed that the 11 month old was suffering from withdrawals from exposure to meth. this woman alleges a sibling is also suffering from the ramifications of their parent's addiction. that's just one example. a four-year-old was tortured and beaten to death by his father.

while the murder of this child also has many lawyers, there is still a common theme, there was drug abuse in the home. the child's aunt often worried about the child's well-being and told the news that because of the drug use and the way their relationship was, it was very toxic, and the way they live was filthy. children in indiana and across the country are suffering from the ravages of drug addiction. . we need to take a strong bipartisan approach to protect children and help individuals get. on the road to recovery. however. , we will not be able to get to that point until we stop the flow of drugs coming across the border and into our own communities. you mentioned the ace intervention programs on the start programs in rent testimony. both tried to abuse substance abuse disorders in the child welfare system. do you have recommendations on how we can move coordinated interventions upstream? and how can we protect children from abusive parents with

substance abuse issues while also helping to get those parents into recovery programs? thank you so much -- and like >> thank you so much for highlighting such a critical part of our solution. i'm a grown up now, but i was a kid impacted by parental substance use disorder. i've seen firsthand the difficulties that parental addiction can create. there's some amazing programs and innovations that are out there. kentucky starts as a child welfare intervention. it's also in ohio and several other jurisdictions now, where our teams work with both the parents as well as the children to increase, so keeping the kids and home, but also making sure, addressing recovery, evidence-based treatment and support for children. kids who have experienced average childhood experiences, childhood trauma due to parental substance use disorder are also high-priority. there's a program in essex county, massachusetts that works

with the school system and kids that have addiction at home. it has a social, emotional learning curriculum, connection to counselors and behavioral health care. the results of this program are tremendous. you know, sort of higher graduation rates, lower substance use, the kids are heading off to college. district attorney set the program seven years ago -- led and set up the program seven years ago. we know this is one of the most important populations to work with. we can implement things that address this really critical time when someone in a family is involved in child protective services due to an sud. we can also have better screening for all children with adverse childhood experiences to give them the care that they need. >> kenya -- can i ask you one more children before i run out of time? >> homeless use is also another problem.

are there any programs that connect homeless use with substance abuse services offered at qualified health centers? >> i am not aware of any specific programs but we are happy to connect with our network and report back to you. >> i appreciated. thank you. >> let me recognize the gentlelady from wisconsin, ms. moore, t inquireo. >> i want to thank all of our witnesses for participating in this very important hearing today. i do want to thank mr. reed for sharing his very personal story and really helping us move toward a point where the stigma of substance abuse is no longer there and that we can work on this systemically. mr. kelly talked about us dealing with this program -- problem like chipping away at an iceberg. i say that it is similarly like grabbing a problem that is sort of like jell-o.

i appreciate the fact that most of our witnesses have really at least helped me appreciate that we've got to start young, and sort of deal with, you know, delaying the onset of use of substances, and that we need to be careful with our brain injured athletes, foster youth, and others. this has been very informative. dr. chapman, i appreciate your bringing up the importance of having social workers involved. every year that i've been here, i've put in a bill to try to have social workers in our schools so we can identify these problems early on. that being said, may my first question to the doctor. you talked about the structural competency. you talked about how there's no magic bullet, that there is a myriad of factors that contribute to it. we've got the poorest of the poor, who are subject to the

opinion of the rich kid on the hill. i fear that we are going to, we hear it's all about the southern border and if we can just fix that, then we would no longer have substance abuse. i'm wondering, i was curious about your truth and reconciliation provision under structural competency. how do you see truth and reconciliation as really helping us prioritize where to put the resources that we have? and also, you know, i think that we heard the doctor saying that we have to bring stuff up to scale. what should we bring up to scale? i would ask the doctors to talk about what we can bring up to scale that would help us with this problem. i would yield now for the answer. >> thank you so much. wonderful question. as these are. i wish there was an easy answer.

i wish i could say there was one policy at this one moment in time. but unfortunately, when we look at substance abuse issues and depression and suicide, what we see is that these are the result not of something that happened in a particular year because of a particular decision, but because of long-standing neglect about support systems, about infrastructures, about factors like that. just to be clear again, i'm all for doing anything that will help here, but i think especially when you look at the impact on communities of color, what you are seeing is that really there's a long-term neglect of all kinds of infrastructure, health infrastructure, support infrastructure, substance abuse treatment, factors like that that go hand-in-hand with economic inequity, particularly -- >> let me make an intervention here. are you saying that these poverty indicators make you more at risk than say the rich kid on the hill or prince or michael

jackson? would you say that poverty and inequality is more indicative of risk? >> directly coming us. eyesight -- directly, yes. i cite several things in my testimony. i say economic despair is one part of it. you referenced a paper that we wrote at the beginning of the pandemic. what we did was we kind of called for an open, honest conversation about the structural upstream drivers that are producing despair in unequal ways. but linked to one of the comments we had before, we also called for reimagining health care clinics, not just telemedicine, but actual health care clinics where people could go to the clinic and that clinic would not just treat their medical conditions and their substance abuse issues, but also there would be resources within particular clinics to address issues that cause a kind of structural vulnerability.

so, you could have a clinic with an internet provider, with a resource for helping people pay their heat bill. >> again, thank you, sir. >> what should we bring up to scale that you think would be most helpful? >> i appreciate this question. i think what we have to understand is, why do people resort to substance use? why do they get addicted to substances? there are a number of issues that we are not addressing as far as thinking that -- as far as really caring for our communities. people don't have appropriate access to health care, child care, job training. they are not -- a lot of people don't have a livable wage, stable housing. we really have to address all of these issues that, one, impact people socioeconomically, but also when we are looking at,, you know ethnic and racial disparities and we know, we have seen it that these are also issues that combined together as far as what we are seeing, as far as trends on a local and

also national scale with substance abuse and other addiction kind of behavior. >> thank you so much for your time -- thank you so much. my time has expired. >> let me recognize the gentleman from ohio to inquire. >> thank you all for being here today. this is a very important issue, very important to my district. i am glad we are discussing substance abuse, mental health,. the pandemic has fully exacerbated these conditions, in my mind. the last hearing we had here in ways and means, i touched on a couple stories, one about a veteran, a double-amputee and his last facebook post was an empty refrigerator and a couple bottles of water, and then he took his life. i shared a story about a gentleman from my district was scheduled for his painful hernia to be operated on and they canceled his surgery and he took his life. the isolation, the pain, the

lack of treatment. a lot of lessons learned through this pandemic. one of the other things that bothered me through this pandemic is when we told some people they want essential -- weren't essential. i think that had a big impact on a lot of people, to be told that, well, you are essential, we need you, we essentially don't need you. we made a lot of mistakes. in addition to the pandemic, the current border free for all is a part of this, and i will get into that in more detail in a minute. and it is -- that empowered the cartels to go ahead and continue and exacerbate and grow their business, if you will, of human trafficking and drug trafficking. if you've read the book "dreamland," which i imagine most of you have had, that's my district on the cover. so i know firsthand all the effects of what has been taking place. i would like to describe the problem.

it's a problem that goes from our border all the way to work. you do have a problem at the border with the drugs coming across, the supply chain is great. we should do what we can to stop that, everything that we can to stop that, and then stop the dealers that are running around our country. and then, we have to take with our youth and everybody else and prevent people from ever getting in that situation. i am a doctor, a surgeon. i never thought that those drugs were not addictive. i always felt that they were. i never prescribed oxycontin for my patients. as a surgeon, i managed their pain and a lot of other ways and limited their use of opioids. there is onus on the medical community, too and i think, the medical community has responded to this. but we can do more than just cash under these. ones -- catch and release. when someone goes into rehab, that's a good thing, but there has to be something at the end of that, there has to be purpose, there has to be a job,

or else they're going to end up right where they are. its all-encompassing of what we need to do to address these problems. i am grateful for the hard work of some of the folks in my district, like the center of hope and hamilton county addiction response coalition. they've done some great work. 2018, passed the bipartisan support act, the alternatives to opioids in the emergency department bill, and really throughout medicine is what we should be approaching. i think at the end of the day, we need to always address the events and issues in someone's life that led to the thoughts and the feelings that lead to the behavior. and if we don't do that, we may never solve these issues. as we try to be supportive of trying to solve these issues, one question i would ask, are

their provisions in the support act that don't apply to fentanyl, for example, that we can update, or other things in that act that we can update to address some of the heightened challenges that we have today? >> yeah, absolutely. i think both care and support act were both important pieces of legislation with resources to improve treatment and support really helped us integrate treatment into the health care systems. fentanyl, looking at treatment options, making sure we have medication for opioid use disorder, more widely available, making permanent some of our telehealth expansion pieces, and the wraparound services that are needed. it's not just one thing that an individual in treatment and recovery from an opioid use disorder needs. they need wraparound care and its management of a chronic health condition, so looking at support and new vehicles to add more of that i think would be a

huge benefit to our patient population. >> i appreciate that, as you heard me go through all those components that lead to the situation that we are in, that the patient is in. we do need more wraparound services and i appreciate the input and i yield back. >> let me recognize the gentleman from michigan to inquire. >> well, thank you, mr. chairman, for holding this really important here again for the focus on this issue. like others, i want to share a bit of a personal story. last year, i publicly shared that i began receiving treatment to help with traumatic stress that i and a number of us have experienced as a result of the attack on the u.s. capitol. i was in a unique situation with a few other members who were trapped when the insurrection occurred and we were in a violent situation. that had an effect on the.

i didn't expect it to, but it did. i'm lucky. i had access to a great professional doctor, dr. jim gordon, who has been working with me on, you know, the techniques and skills that i need to deal with stress. i went public with that because i felt it was a small opportunity for me to help reduce the stigma of. . mental health care. but despite the improvements and the understanding of the importance of mental health and mental health care, that stigma still persists, and can manifest in stereotypes, prejudiced, other aspects. in our business, we expect those sort of attacks. or someone who's dealing with a mental health issue privately, quietly, painfully, that stigma can keep them from making the choice to get help. and we know that a lot of people struggle with issues and never do get help, and we know sadly what sometimes the result of

that will be. access to health care is a huge factor but the stigma plays a role, too. i wonder, and i know this has been addressed, but i wonder if you might talk about how u.s. policies may have stigmatized care for mental health or substance use disorders, and help us understand, from your point of view, what we should and can be doing to reduce stigma associated with mental health among communities, among health care providers particularly, but just generally in the population. >> thank you so much. i will make two points. you talked about traumatic stress and it's important to note that traumatic stress resulted people -- when people feel like their lives are in danger. the original studies were done with fighter pilots in vietnam. if you flew 10 hours, you had a 10% chance of getting ptsd, if you flew 40 hours, you had a 40%

chance. and think of it, we've all gone through this pandemic where just stepping outside the door and breathing air that other people breathe putting us all at risk. i feel like even though some people, like yourself, are involved in direct conflict, i feel like there's a national moment of stress where we've really had to rethink our own being, our own vulnerability because we really had to ask, what is a safe space? number one, as i was mentioning before, creating a national conversation about what mental health means where we can have an open, honest, bipartisan conversation just about the trauma that we've all been through over the past two years, and think about ways to come together. i really think that's vital to reimagine what mental health means in this context. the other part, of course, is that fighting stigma is an ongoing battle. i wrote a book called "the protest psychosis" about michigan actually that came out a couple of years ago. it looked at how unknowingly the

diagnosis of schizophrenia in the 1960's was reflecting cultural attitudes about political protest, incarceration, all these factors. doctors thought they were helping people, and they were in some ways, but just the idea of what mental health was reflected -- mental illness was reflected cultural attitudes. fighting stigma is an ongoing battle. it's not just like, here's this one thing we have to nip in the bud. as much as we can be active about it and continue to engage with their own reflections, and having a national debate about this, i think the better off you will be in the longer. >> i wonder if i might quickly pivot. i represent flint and saginaw, both majority minority communities, both historically marginalized communities. in flint especially, having now gone to this pandemic and also the trauma of a spate of violent crime going back decades, and in

flint, the water crisis, i wonder if you might comment on community issues, and on sort of how we deal with these historically marginalized communities, who has a community may be dealing with community trauma and impacting addiction and illness as a result. >> thanks for that question. about two or three years ago, the lancet magazine put up an article evaluating communities, actually, automobile assembly plants, and they found that five years after an assembly plant closed that there was a dramatic increase in opioid use disorder and alcoholism. , s -- so, we know there is a close association with economic distress from not having a job. the same thing happened in cecil

county, maryland. an automobile assembly plant in delaware closed and five years later, there was a dramatic increase in foster care. this was noticed by the state trooper who happened to be evaluating some of the schools. he realized there was a 30% increase in foster care. and the fact was that the parents had overdosed or died. there was all these things. >> i would love to get more information. you've allowed me to go beyond my time. i appreciate that and i yield back. >> let me recognize the gentleman from texas to inquire. >> thank you. let me dive right in. on the drug addiction and the drug, illicit drug epidemic, we have in our country right now. it boggles the mind what's happening and what our nation

and our, the people's government is doing or not doing to stop a major contributor factor to this epidemic in our country. we have lost last year 100,000 americans to drug overdose. the leading cause of death for americans age 18 to 45 is a drug overdose, mainly fentanyl, which is 2/3 of the contributing drug to the overdose. and 100% of those drugs are coming from across the border. the 100,000 people who have lost their lives in our country, are fellow americans, is a 50% increase over the last year. the fentanyl seized at the border is up over 130%.

we are losing a generation of americans to this. -- to this epidemic. and we are seeing record volumes , increasing exponential volumes of drugs continuing to flow into our neighborhoods and to kill our fellow americans and our family members, and we are seeing nothing stopping the drug cartels who control the border from pushing this product onto our citizens. i'm going to ask every witness to answer this directly and to seek to with a yes or no -- succinctly with asr no -- a yes or no. is this dynamic of drug cartels in control of our border pushing record volumes of drugs a major factor in the drug epidemic and the overdoses that are at record

highs in the united states of america? and so, i will start from the very top. i would like to hear from these experts as to whether or not it consumes them. so, does that concern you, is it a contributive factor on the supply side -- contributing factor on the supply side, at a minimum, yes or no? yes or no? >> it is not a yes or no question. >> thank you. it is a yes or no question. i'm not saying there aren't other factors, i'm not saying there aren't more complicated and nuanced discussions to have, but is the border wide open, pouring drugs that are killing americans at rates that defy logic because of our ability to stop it concerning? yes or no -- concern you? is it a concern? >> supply-side is a major aspect of addiction, i would certainly agree with her that.

>> dr. edwin chapman, you're a physician. is it a concern was happening at our southern border? it is one factor, but is it a big one and are you concerned, yes or no? >> i think it's a chicken and egg phenomenon. i grew up in gary, indiana in the 1960's and we did not have this problem until the steel mills closed. >> are you concerned, mr. chapman? does the open border concern you and the drugs flowing across the border via the drug cartels that are in control of the border, does that concern you? >> we have new synthetics now. >> the synthetics are coming from china. the synthetics are coming from china, mr. chairman and their part of the input to making this manufactured product that's being laced with the marijuana

that kids are taking up in the northeast, killing teenagers. this is a big deal. i respect these witnesses and i know they care about this, but the fact that they cannot just say yes, what's happening at the border and all of the volume of drugs that are coming from across the border by the cartels with aiding and abetting by chinese synthetic materials, i just can't believe it. i can't believe i'm sitting here with nobody to bang the table and say you are right. we can talk about other issues, but you are right. >> i don't intend to speak for the witnesses, but i think that we are all concerned. i think that the witnesses have suggested that there may be additional answers, but i think everybody would preface the comments by saying we are all concerned about it. >> i know my time has expired. as a person who lives at a state that is on the border and at ground zero, i'm telling you, we've got to do something about

that. i know there are other complicating factors but we got to do something and i'm very frustrated that we haven't. >> let me recognize the gentleman from virginia to inquire. >> thank you very much. thank you so much for having this hearing today on suicide risk and substance use disorder. i'm so proud that we are having a hearing where suicide is actually the headline. suicide rates in the u.s. have increased by 35% over the last decade, and remain high during the pandemic, with nearly 46,000 people dying by suicide in 2020, more than the total of car crashes and gun fatalities combined. suicide was not talked about by members, except in reaction to the veteran suicide crisis. folks knew we had a veterans issue, we also had an active suicide crisis in the broader population. we were seeing a 30% surge and no one was talking about. i talked with a representative,

a republican, and a democrat, and john and i started the suicide prevention task force to improve suicide prevention on the civilian side. we focused on restoring the suicide line at the cdc, tackling the glynn issues we knew we could help with, like the suicide lifelike, which was under resourced and could not keep up with demand. we restored the suicide account at cdc and slowly have been able to work to allocate more funding to the lifeline. we hope representative crist were, a republican -- chris stewart, a republican, and a democrat to change the number to the easy number which goes live this summer. i hope everyone will remember that. during main mental health month last year, energy and commerce advanced a mental health package that included a great number of suicide prevention bills, the campaign to prevent suicide. this is a bill that we put together with the goal of bipartisan efforts to educate

the public about the numbers so that people know about it, but also generally to change the culture around suicides, so that people know how to engage and connect individuals in crisis to resources. unfortunately, the house is taking suicide prevention much more seriously than the senate. much of that bipartisan legislation is stalled in the senate. i want to use a little bit of time to draw attention to the fact that the senate cannot, should not delay. we have to advance this legislation as soon as possible. i was fascinated in your written stuff that you talked about polarization as a national health crisis. the divisiveness is a vector that weakens our nation in moments of crisis. eminent bodies that congress can change the algorithms, the structures that foment divisiveness. i just looked at the difference in the opening statement's tone and content of our chair and drinking member to the. i want to blame all divisiveness on republicans, that wouldn't be

fair. can you talk more about how divisiveness is affecting the american people and their mental health? >> sure. there is so much research that talk about how when we face a crisis, a pandemic, and epidemic, one of the most important currencies that you can have is what's called social capital, or social cohesion, this notion that we are all in it together. i realize that our political system is kind of a zero-sum formulation. it's a winner take all election system. compromises very difficult. but what happens a lot of times is that issues around which we should all agree, things like mental health, like we are talking about today, addiction, they become polarized and identity issues in a kind of way that might make sense in a political arena, but when they filter down, they really become moments of discord and despair which can directly lead to poor

mental health because people feel like they are literally fighting with their neighbors. and certainly, i think that is fomented by some of the algorithms on social media. when i was writing lebron statement, i thought, what are the ways in which we can think about polarization itself as being almost a crisis moment? i thought mental health was one of the areas where we might figure out how we can come to some kind of common agreement. i have much more to say about suicide but i will save that for later. >> i have a couple seconds left. more than half of suicides are gun related. 2/3 of gun deaths are suicides, yet my republican friends have an inversion to recognize how easy it is for a person in suicidal ideation to get access to a gun. this would be a great place to start to overcome that divisiveness. >> much to say about this. that's the focus of a lot of my

research. what's important to know about gun suicide, we have 27,000 gun suicides a year. it's very often an impulsive act, not someone who's been seeing a therapist for 25 years. i was drunk, i lost my job, i found out something happened in my family and within 59 minutes or less, the availability of a firearm is there, and that leads to gun suicides very often. having urgent resources, a hotline at that moment, some access to help at that passing moment of crisis is vital. gun suicide is a different kind of suicide, that's what i argued in my work. we need urgent resources that are available in those moments of crisis. >> let me recognize the gentleman from georgia, dr. ferguson, to inquire. dr. ferguson: i am going to go back to the topic that my friend from texas touched on. first of all, let me say addiction is an incredibly

difficult disease. i have been involved with that, both from a health care provider standpoint, and as just a general member of the community, and it is devastating. one of the key components is the supply of drugs. i think my colleague from texas asked a really important question. can we all agree and can we objectively say that the drugs flowing across our southern border are a major problem here? this is devastating. and i want to continue down and ask, do you agree that this, yes or no, that this is a major problem at the board? can you objectively say that drugs flowing across our southern border is a major problem? >> thank you for the question. i think illicit drug trafficking is an international problem. and going after illicit finance as well as making sure that we have protections at the border is a way to approach it, comprehensive approach. >> going down, again, this is a

major problem, and we've got to objectively look at where it's coming from, and we've got to objectively look at the problem and we've got to secure our southern border for a lot of reasons, human trafficking, you know, the illegal immigration. but this drug issue is so serious in our communities. i want to change gears and want to talk a little bit about, you know, the mental health issues that are schoolchildren are seeing, not just in k-12, but also in college. you have been able to dive into this. i introduced a bill last year called the big act, which is an early intervention bill helping universities and schools put together best practices on how to engage very early on students. can you talk you little bit more about what we should be doing in the arena -- that arena?

can you touch on the importance of telehealth and also not only providing, not only training providers in this area, but also the resources that we need to be giving those in our education community to recognize these problems at an early time? >> thank you so much. absolutely. early intervention, all programs and research back to solutions that we can dedicate -- research backe solutions thatd we can dedicate to middle school, high school, college aged young adults, these are the ages that typically coincide with the onset of a substance abuse disorder. the fact that we delay and don't have proper early intervention mechanisms in place is a huge gap in our system. we have the, we just need to implement them. things like screenings, youth intervention, student assistance programs, programs that deal with aces, helping children impacted by addiction, primary

and universal prevention to help us delay the onset of substance use, all of these are critically important. i think your second question was about telehealth. absolutely. the more access we can open up, the better, to all different types of providers, psychologists, psychiatrist, counselors, pure navigators. we need more access. i would love at some point to tackle some of the life insurance issues that we have across state lines. we could really open up the amount of workforce we have available if we looked at this may be from a different lens. and then on the provider side, retaining and training and looking at the pipeline of those that are coming into the addiction workforce is incredibly important. are workforces paid less than other health care professions with the same training and education. we need to dedicate i think resources and time to figuring out how we have a plan for the clinicians that we need

long-term. >> thank you. going back to this topic, and dealing with early intervention in schools, i just feel like this is so important that we focus on this, that we get the early signs, we get the children and the young adults to help that they need very early on. i realize it is a multifaceted event. we are dealing with social media influences, we are dealing with the isolation that's occurred during covid under lockdown's. i have a high school senior. i can tell you the impacts on him have been very real, and i see that with not only him, but his friends. i truly believe that we can solve this issue in rural america -- we cannot solve this issue in rural america if we don't have access to broadband and telehealth services. that is just something that we've got to get right in all this. with that, i yield back. >> let me recognize the gentleman from illinois to

inquire. >> thank you, mr. chairman. i want to thank you and the raking member for having this hearing, are witnesses for joining us today. and for your commitment to patient care and your perspectives of -- perspectives you bring here. i want to thank the committee for continued discussion on a very challenging and important subject. i think you made a very important point in your testimony, addiction, depression, suicide do not discriminate. there are groups with particular concentrations, in particular, veterans and young people. as we all know, the pandemic has led to a spike in stress, addiction, and tragically, suicide. i am sure each of us here today have many personal and often tragic stories. just last month, a dear friend of mine got a call every parent fears. she was a vibrant, smart,

beautiful 19-year-old. no one, not her family, her friends, her teachers understood her anguish. if we did, we all would have done what we could to help. everyone's challenge and expense with mental health are unique. there are signs that people need help. other times, there are no warning signs that any of us could see. sadly, in illinois and around the country, too many people are unable to find the help that they need. long before this pandemic, we had shortages of the resources necessary to care for those struggling. we've seen an increase in the suicide rate by 35% of the last decade and nearly 46,000 americans died by suicide in 2020. that's an average of nearly 300 people a day in the united states who die every day to drug overdose or other struggles. to me, these statistics indicate that we need to be more

aggressive about dealing with these crises. during last month's hearing on mental health crisis, i emphasized the need for more mental health resources, better education and smarter reimbursement policies for mental health providers and services. i richard is my substance use disorder workforce act last year to increase the number of medicare eligible residency positions eligible at hospitals that have addiction, psychiatry or pain medication programs. this is one real way to help deal with disparity in behavioral health services but we must continue to do more. while we cannot always recognize the signs, we must empower adolescents and adults to be brave enough, confident enough to reach out for help. when people do, we have to ensure that there are mental health services and trusted, reliable resources waiting on the other end at the suicide prevention hotline, which thankfully soon will be a three digit crisis 988 number this summer. we must recognize the challenges

certain populations face, like african-american men are dying from increased rates of orders. or white americans, who represent 92% of all guns was such. return to -- gun suicides. last year, i received a letter from a high school senior outlining her findings on the disparity of mental health resources at her school. she highlighted the value placed on new gym flooring and new scoreboards but the lack of investment in mental health counselors. they lost a classmate earlier this year to suicide. i also became more aware of suicide websites and social media influencers on our children's mental health. can you please explain how stigma and chronic disinvestment in mental health services can lead children to turn to some of these websites and what we can do to better understand or support mental health for school-aged children? >> thank you. i appreciate this very, very important question. you know, this is something i

was constantly worried about when teaching high school. it is something that also personally impacted me. when i was in high school, one of my friends and classmates also committed suicide during spring break, and it impacted all of us. i think overall, when we think about what's happening in schools, you know, our children spend the most time at school. and if we don't have services that students feel safe accessing, and i can come in a lot of ways. yes, we need more student, -- we need more counselors, but we also need to be able to work with teachers, are educators, and the entire workforce at schools to be able to address at risk youth if there's any kind of suspicious behavior. to your question about -- not suspicious behavior, but potentially dangerous behavior which involves yourself. with regards to access to social

media, i think that social media is a big concern among youth, because i think that it paints a picture that can be damaging, and if we don't have the appropriate awareness or regulations on damaging social media and access to that, if youth are accessing that and we are not addressing those in a way where we can -- sorry -- let me come back to my words here. the issue is that when we have websites that go unmonitored and we don't have a way to actually discuss with our youth with the issues, these issues continue to be stigmas. we will continue to fail addressing them. and we will continue to see these deaths come together. unfortunately, sorry. >> you are fine. we will just finish up.

>> this is my first hearing. >> you are doing great, let me assure you. you've done great. >> so you know, i think overall, we are not having the conversation. we are not having the conversation, what's really happening, and what students are seeing at home, at school, what they are talking about what their friends, what they are seeing on social media. if we cannot talk about these things, this stigma will persist and continue to harm all of our communities, especially youth. >> thank you. i'm glad that the witness mentioned social media. that's a very important consideration here. >let me recognize the gentleman from kansa to inquire. >> thank you, mr. chairman, for holding this very important hearing. thank you to each of our witnesses for joining us today. as her talk about the tragic rise in mental health issues, including cases of severe anxiety and depression and the rise of substance abuse

disorders and suicide, i hope that we can address the underlying causes be twine -- behind the rapid decline in our nation's health. i also hope that we can address while we are seeing so many of these dangerous drugs become so widely available across so much of our committees. in kansas, the first half of 2021 showed methamphetamine accounted for 40 person -- 44% of overdoses. the wide dispersal of this and other dangerous drugs like sentinel is destroying families and whole communities across kansas and across the country. no matter how much some of us here want to ignore the crisis we are facing on the board, the factor means that legal drugs are pouring in. the number of fentanyl debts has doubled in 30 states in the last two years, fiber which saw a fivefold increase. the dea has confirmed that mexico is one of the primary sources for the flow of fentanyl in the united states. just this past week, border patrol officers seized close to

$3 million worth of meth disguised as onions. i am proud to say that our border patrol caught this shipment, but too much is being missed. without proper enforcement of america's laws at the border by this administration, the substance abuse crisis and many other associated crisis will only get worse. in kansas, we have heard our large enforcement sound alarm bells over the rise in crime linked with drugs, especially with meth. in my home county, it is reported that 70% of all drug crimes involve meth. while there is a sister treatment for those addicted to opioids, resources for those struggling with meta-fees -- methamphetamines are scarce. as we talk about the horrible rise in drug overdoses and suicides, i think it's time to recognize the fact that many of the measures that are clearly causing the issue must be addressed. in your testimony, you mentioned the importance of increasing availability of medicaid assisted treatment,

unfortunately, map does not exist for meth addiction. is this something that should be further explored through research? >> absolutely. top of my wish list every year is a medication to treat stimulant use disorder, opioid use disorder, crack cocaine, it's a devastating illness. we need more tools in our toolboxes. we do have contingency management, which is behavioral therapy, preventer work for stimulant use disorder, for cocaine yes, we need more tools, and we need to actually use the tools that researchers and clinicians and scientists have developed for us. >> you talked about contingency management. what are the barriers to being able to use those services? is it because prohibited --

prohibitive, is there too great demand? >> we could use your help removing barriers around contingency management. it uses incentives to the part of the brain that is affected and incentivizing popular behavior through awards, through a gift card that keep someone participating in the behaviors we need to see. there are prohibitions on using federal money for contingency management that we would love your help to address. we have a lot of stigma around these programs, and it should not be there. when we can incentivize and build these programs and behavioral therapy into all of our treatments, you can use

digital management through therapeutics. we can layer interventions that work. someone who is on mat, contingency management can be used in combination with cognitive behavioral therapy and other support. yes, there are barriers. we would love your help limiting those, particularly with the use in cocaine and methamphetamine overdoses that we should be doubling down on the availability. >> thank you, and mr. chairman, thank you for holding this important hearing. there are too many americans suffering and we cannot continue to rely on our jails and hospitals as a place for last resort. i yield back. >> let me recognize the gentleman from california to inquire. >> thank you, mr. chairman. and thanks to our witnesses. the on this hearing all of us have seen over the last three years what the pandemic has to as the toll that it has taken on

our nation's mental health, but obviously for many people including people in my community it has exacerbated long-standing problems. for the last three years they have laid bare the challenges facing our health care system, first responders and many of our most vulnerable and under rep scented communities. thanks to all of the witnesses were sharing their time but also their expertise. i am hopeful that this hearing will help us better serve our many diverse communities and youngest constituents who have often been the victims of the substance abuse epidemic. you are doing so good in this hearing i will continue to ask you a couple of questions. obviously, in your testimony you mentioned suicide is the leading cause of death among asian americans aged 15 to 24.

and california as you probably know, three in 10 asian americans reside there, 17% of my great state. these communities face unique stigmas and stressors that increase the rate of youth suicide and make mental health outreach much harder. in your testimony, you also point out some barriers to care that are common across the aapi population, and you make it clear how much diversity there is between aapi communities and cultures. my first question is, can you disaggregate some of the cultural barriers to care in different aapi communities, and are there any communities in particular we have to do a better job of reaching out to and how do we do it? >> thank you. thank you for being gracious, i

really appreciate it so much. yet, i think it is very clear within aapi communities there are a number of ethnic groups and subcommunities constantly and consistently marginalized, so for instance i mentioned native hawaiian and pacific islanders are generally a smaller proportion of the larger collective umbrella, and because of that a lot of their needs and priorities actually do not get met. the data is not collected properly, and we do not have the access to actually reflect what is happening. other things that impact our communities very much, this is an issue that does not impact just aapi is immigration.

a lot of us come as immigrants here. specifically a lot of southeast asians have undergone tremendous amounts of trauma that involve war, authoritarian rule, poverty, famine, and a lot of these issues are very specific to our communities, and those ethnic group specifically talking about cambodians, laos, there are a lot of issues we are not seeing in my community, colonialism is something we have been trying to peel from as well. i come back to the question of disaggregation, and do we better address these communities. we have to do a better job of addressing what is actually going on. we have to be very intentional in how we are collecting data, and how we are doing -- dealing

with communities and partnerships with committees and reporting back. this data does not come back to communities, or there is a long stretch of time before it is actually published, and what happens is time changes and needs become different to help the populations that are already marginalized. i think there is an urgency we are trying to address with data disaggregation that it must be done urgently at the relay. >> great, thank you, outstanding articulation and outstanding answer. i yield back. >> let me recognize the gentleman from oklahoma. >> thank you for hosting this hearing today on substance abuse, suicide risk, and the american health system. as i explained it this hearing a few weeks ago, our country is facing multiple crises. we must look at what has worked during the covid-19 pandemic to address those challenges and

issues that remain.

have health care services to address these problems. rakes in mental illness such as depression and anxiety disorders have skyrocketed since the beginning of the pandemic and as we all know, drug overdoses hit an all-time high in the united states between may of 2020 and april of 2021. some of these provisions have expired, such as the cares act provision that allows high deductible health plans to cover telehealth services. i worry what impact the lack of coverage will mean for those who have relied on those health care services over the last two years and i look forward to working

with this committee to make sure that we provide that coverage in future legislation. i have been listening to some of my colleagues on the other side and i want to make one thing clear. there may be a correlation between economic conditions such as poverty, but that is not the cause. if we really want to help our fellow neighbors and family members who suffer from substance abuse and mental illness, we should avoid placing blame particularly on efforts that are trying to eradicate those challenges. one example would be the child tax credit that has lifted 50% of children out of poverty. more than 100,000 million americans died of an overdose in the last year. the tragedy of this loss of life

is compounded by the fact that it is almost entirely preventable. according to the cdc, the state of nevada experienced a 30.4% increase in overdose deaths between september 2020 and september 2021. this is almost double the nationwide increase. medications for opioid use disorder reduce mortality for drug overdose by as much as 50%. because of outdated federal regulation, only a few receive these medications. what specific actions can congress take to expand action -- access to this life-saving treatment? >> thank you, congressman. a couple of things are before you right now. there is the mad act as well as the maid act. the mad act would eliminate the requirement for someone to go

through an eight hour or 24 hour trading before they prescribe. the maid act also has provisions that would increase the training that needs to be done so that more health care professionals, nurse practitioners, doctors understand addiction treatment. we have a problem not only with medical schools not teaching about addiction, but we have a number of health care professionals who are not only not sure how to identify whether someone is a substance abuser but they also don't know where to refer them for treatment. those are two pieces of legislation that can be done. >> thank you for that response and i will have my staff look into those options. on the topic of preventing suicide, america has the highest suicide rate of any nation, nearly double that of the u.k.

it is the second leading cause of death for individuals ages 15 to 24, and the risk of suicide increases significantly after the age of 65. your research touches on social and structural deterrence is of mental health and suicide, so what are the ways we can rebuild our mental health system to ensure those in crisis have access to key resources and treatment? >> very quickly, i realize the time is short. suicide -- what are the resources who are available to someone contemplating on site at the moment, so something like a national suicide hotline is a great idea. how can we expand those resources? and how can we refund things that build social capital, things like education, the ability to create a social

network, job training, all of these factors? these things make people feel connected and they give them a pathway out of what would lead them to suicide. >> thank you very much. >> lets me recognize the gentlelady from west virginia. >> thank you to all of our witnesses for being here today. the topic before our committee today is devastating. i have seen it firsthand in my home state of west virginia how the opioid epidemic deeply impacted our families, children, and our communities. i must also point out that dr. ferguson, and everyone else alluded to the difficulty of drugs coming through our border and how important it is to secure our border. the despair i have seen in my community, they have come

together in amazing and inspiring ways. we have so many facilities, programs, and individuals who have risen up to address the epidemic and help find healing for patients and their families. one of these is the recovery center in my district. they utilize an evidence-based approach where they provide a wide variety of services including cognitive haven euro therapy -- behavioral therapy. they also have a room where they focus on the social determinants of health such as housing and security, food insecurity, workforce issues, and educational development. they ensure that patients not only heal while they are in the centers but also that they have control to remain sober once they leave. i am thankful for all of the work that they do. we are two years into this pandemic and as a result we have

seen an increase in the drug overdoses thanks to historic investment from congress and the support act, i hope that as we emerge from this pandemic, we get back on track in addressing the substance abuse disorder. i want to thank you for sharing your story and i am sorry about the loss of your parent. in your parent -- the near testimony, you discussed the dangers of fentanyl. west virginia had the largest number of fentanyl deaths in 2020. can you discussed how the changes are presenting themselves in the country? for example we are now seeing counterfeit pills. >> thank you for your kind words. fentanyl is changing a lot of this space. so many individuals with different substance abuse disorders nasa find -- disorders

and now find fentanyl in their supplies. they are not expecting to take opioids who have fatal doses of fentanyl. it is high risk, it is scary for patients and families. they need to be able to address this and keep themselves safe. things like fentanyl test strips. we need intervention efforts to reduce the amount of fentanyl in our supply and we also need to make sure we have treatments and services. it might be medications to reverse the fentanyl overdose just because of the potency. might need modifications to your treatment plan, ensuring that we engage people in medications for opioid abuse disorder who are struggling because of fentanyl.

it is affecting every aspect of addition -- addiction crisis and i want to double down because of the loss of life. it shows in the numbers and what is happening in the community is hard. >> you mentioned how 78 percent of the patients have a history of family with substance abuse disorders and those rates grew during the pandemic. children with parents who have substance abuse disorders are at greater risk in the home. what message can congress consider to provide support to the children and adolescents whose parents and caregivers are struggling with addiction? ms. hulsey: absolutely. the risk, genetic factors, it is not simply one thing and it is complicated, lots of genetic

factors and we need to make sure that we support families that are struggling. of the 20 million people struggling with addiction today, 2 million of them have an alcohol disorder. while we are experiencing overdoses and so much difficulty in the opioid space, we need to look at the big picture. there are programs that work through services that help keep families together and gives them the treatments they need. i would love to have had something available like that for my family before i went into foster care. we need to see what works and take it to scale. >> thank you so much. i have used up all of my time. i yield back. >> lets me recognize the gentlelady from the virgin islands. >> thank you, mr. chairman, and

thank you for this hearing. i want to thank you and the staff for putting this together. you have been absolutely informative. i am grateful to members from other sides of the aisle who have asked thoughtful questions and the information we have been able to glean from this. these are huge epidemics in this country where we stand on these issues, we look at the rates increased exponentially over the past decade. what is being done to stem the tide of something that is absolutely overwhelming. the need for greater awareness for policy, and also giving treatments for those struggling with substance abuse disorders and suicide ideation. i am grateful for you, mr.

chairman, and other members of the committee for shining a light on this throughout the country and even within our own lives. i have a couple of questions here. one of the things i noticed, and i don't mean to spill any cold water on the concerns, but memory -- many of the members have a stark, glaring absence in some of the discussion i have been hearing. i know some of my colleagues earlier in the session talked about communities. we also mentioned the comprehensive addiction recovery act of 2016. federal regulation focuses squarely on opioids, which is

something that is going out of control within the country. i can't help but notice the fact that we have the same kind of discussions and the need -- the ability to call the individuals who are having a mental disease, and those who do crack cocaine or heroin in communities of color as being criminalized to drug addicts. -- rather than support the individuals who are addicted and supporting those in those come -- those communities as well. at the beginning of the crack cocaine pandemic, early on during the aids epidemic, i

wanted to ask these practitioners what do think has penn inspired -- transpired over the last 30 years who are now allowing us to call prescription drugs and addiction and the mental health is a disease? and other drugs which are predominantly in people of color communities to mark them as criminals. >> thank you. my presentation for the office of minority health three years ago emphasized the historical difference of africans in america. we started with slavery, we went through the post-slavery era of reconstruction, then the jim

crow era with hangings and segregation. we show that this is continuous and it has not changed instantly post-civil rights era. our community has always suffered from post traumatic stress disorder and it has been intergenerational. >> does anybody else want to offer any thoughts on this? >> my research shows that when you call something and addiction versus criminalizing it, it leads to different outcomes. and addiction leads to support, whereas criminalization of something leads to the prison pipeline. this has real consequences. we need to broaden the definition of addiction and also the alternatives for people.

>> i would ask my colleagues across the aisle to show empathy that they liken prescription drugs to opioids to the ravages across my community, cocaine and heroin that you are criminalizing. i yield back. >> thank you. let me recognize the gentleman from north carolina to inquire. >> thank you to all of the witnesses who have come out today. i appreciate the hard work you guys do and it is a very difficult environment. i have treated patients for 30 years, many of whom have had substance disorders and have had treatments for cancers and everything else making that difficult. it is also personal to me where i have known nine young men that were from my school, church,

scout group that have died from overdoses. the challenges and implications to public health that i believe deserve some retrospective analysis, it is many and distance -- many instances where these crises have been self motivated political decisions. the unnecessarily prolonged lockdowns brought isolation which served as catalysts for suicidal ideation and substance abuse. public health, mental health deterioration through substance abuse has led to many committing suicide or accidentally overdosing. building societal structures is a good thing and i believe in that. i believe it is beneficial but i will also admit that the problem with societal structures will be traced back now to 1965 and the

creation of society programs was the destruction of nuclear families. when we closed businesses during the pandemic, people sunk into a dark place and sadly clinical science overtook political -- -- political science overtook medical science. you can see the despair on the youth. you look at the walls of the kids who have painted pictures for us and you can see that what was normally a happy picture has oftentimes now turned sad. we need to move away from this, play our part as parents and leaders of the community. we took leadership in the opioid epidemic and we stopped the over prescription of opioids. sadly now, addiction is now with illicit fentanyl and 80% of those come across our poorest.

seizures are up 134% in 2021, totaling 11,000 plus pounds, which is enough to kill seven americans enough times over. we know that is not enough because 100,000 americans died in a 12 month period even further. the prices on fentanyl for the streets has dropped so the southern barter -- southern border has a part in exacerbating this prices -- this crisis. overdose deaths have increased 25% in north carolina this past year. we need to do something about this and i appreciate the work you are doing. my deepest condolences to you and sympathy upon the loss of your parents, the tragedy. you spoke of the need to enhance the substance abuse use disorder treatment workforce in your testimony.

the support act was a loan repayment to incentivize students to enter the profession. are there any avenues that you can feel will enhance the programs to different geographical regions and provide a diverse set of needs? >> you for highlighting that. i think there are enhanced modes, whether it is more loan repayments, incentivizing more bachelors and masters degree positions, going upstream in the workforce place. how do we have more people entering addiction workforce and the -- getting college students to talk about this as a priority? and if we don't pay them the same as other health care specialties, how do we retain our workforce?

there is a provider in illinois and he was sharing that the reimbursement rate for the case managers is $15 an hour, minimum wage. we need to address the wage disparities and make sure we can keep our workforce focused on this growing health condition, that we need to have a whole host of clinicians ready to treat our patients. >> thank you. i will go back to the fact that we do need all of the armaments ready to help us in this go back again and again and i will talk about the disruption of the nuclear family and how it has led to so many of the societal ills we have today. i agree with my colleagues across the aisle that the criminalization of addiction in different forms, addiction is a disease. it changes your brain chemistry.

i do not care for it is prescription opioids or heroin. it changes your brain. i do agree that incarceration for individuals should be done for people pushing, but i believe in our prisons. we need more of a health individual -- health intervention for those individuals. these other substances, the addiction is tremendously high so the intervention is within our criminal justice program are necessitated at this point in time. you and i will yield back. >> as we conclude this informative session, we have heard a great deal talked about the southern border. we acknowledge the testimony here today and the commentary that was offered. this is a supply and demand issue and has to be treated as such.

as dr. murphy just indicated, we don't want to miss the point that substance abuse as a mental health disorder and disease. it is a disease that existed before drugs came across the border and will exist even if we close down the border. we need to work on this and everybody acknowledges that. for the record, a list of actions taken over the last year. in 2021, order patrol seized as much -- border patrol seized as much fentanyl as they did in 2019. it is a complex issue. we learned a lot because the witnesses were superb today. the best way to fight substance abuse disorders is to eliminate the factions that cause

instability in the first place. preventing addiction is the first and most robust access that we need to evidence-based treatment that will support our priorities. i stand committed to encourage terms today to pursue this objective. millions of americans and their families know what we speak. everybody in this room today know somebody, has a family member or acquaintance, a neighbor down the street that has had this issue. the best way to address it is to continue to understand that we need to treat the disease while addressing the supply issue simultaneously. please be advised that members have two weeks to submit written questions to be answered later in writing. those answers and questions will remain part of the official record. with that, the meeting adjourned.

hello to the audience in the hours of the morning. a president and ceo of the atlantic council. on behalf of the cyber state initiative within the schoolcraft center for strategy and security, thank you for joining us. today's conversation comes at a perilous moment, the likes of which we haven't seen since the end of the second world