physical dependence and assume the addiction is cured and these are two independent processes. as a result, the patient feels they're safe and then they relapse because they're still addicted. ms. degette: thank you. thank you very much, mr. chairman. mr. chairman murphy: i recognize mr. collins for five minutes. >> mr. collins: thank you, mr. chairman. this is truly a fascinating topic we are discussing and it is obvious there's no easy solution. we heard it is a chronic disease, 10% are seeking treatment. i guess my question for miss hyde and samhsa is certainly with pregnant women that may have young kids at home, inpatient treatment might be the preferred, we just can't let perfect be the enemy of good. what other options are you

looking at for people that aren't going to enter inpatient, they may be part of 90% not getting treatment at all. some treatment better than no treatment, as frustrating as that might be? what are your comments to the young mother that's got kids at home, she's pregnant and dependent and just can't go into an inpatient center. what do we do for that patient? >> thank you for the question. the issue of pregnant and parenting women is a big one in our field. we have a small program to address your issue, but you're right, it is a residentially based program. we are increasingly looking for ways to take what we learned in the program about the best way to treat pregnant and parenting women and take it to other settings, whether it is opioid treatment programs or the training we do for physicians who are using medication assisted treatment to deal with pregnant and parenting women, so

we are trying in every way we can to make those services available to those women. representative collins: so with pregnant women, looking at other treatments, whether that's buprenorphine or methadone, are there studies that show whether that has an impact on the fetus and baby? >> you're right to be concerned about the child. what we see is that this prevents death, it prevents addiction of the baby, prevents a lot of other issues that come with allowing the young woman to continue with the prescription drug abuse or opioid misuse. definitely providing treatment helps both the woman and the child. representative collins: now that you've counseled these women what kind of reaction are you getting? are they recognizing, you would think genuine concern for the baby, very much

a complicated balancing act going on here. what kind of reactions are you getting from the women acknowledging the problem and wanting to treat it? m.s. hyde: you know, most pregnant and parenting women really want to do the best thing for their babies and they want to do the best thing for themselves, but as you've heard, addiction is a chronic disease, it is difficult. changes the brain, changes the ability to make decisions. the women in the programs we provide support for find it a helpful program with the kind of supports because we provide a range of programs and we have recently introduced medication assisted treatment into the programs as well. >> so are these women finding you on their own or are there physicians guiding them to you? >> the women that come to our programs come from a variety of places, some from correctional system, some from physicians, some from family some from self referral.

so they come from a number of places and we don't make a distinction between where they come from in terms of providing care. representative collins: now, something this committee is very concerned with, and again, mr. chairman, thank you for holding this hearing and for all of your testimony. i wish there was an easy solution, there just doesn't appear to be one. so this will have to be addressed on a lot of fronts. with that, i yield back. chairman murphy: you're recognized for five minutes. >> thank you, mr. chairman. let me welcome the connelly family to the hearing and let me compliment michael botticelli for having the roots origins in the 20th congressional district of new york. welcome all. one of the biggest concerns i hear from individuals and families struggling with addiction is difficulty they have accessing treatment. as you know, with the mental health parody and addiction equity act as well as with the affordable care act, millions more gained access to mental health and substance abuse services.

however, recent reports lay bare the fact that these new treatments as options sometimes exist on paper only. so my question first to assistant director frank, dr. frank, what is hhs planning to do to increase public disclosure of the medicaid management practices insurers use both on the commercial side and on medicaid and chip so that consumers can truly evaluate their health plans to ensure they're in compliance with parity. dr. frank: thank you for the question. we, too, view the mental health parody act as an incredibly important opportunity to increase the use of evidence based practice and access to treatment. we are doing a number of things. we work with both the department of labor on the erisa side of commercial health insurance

side. we trained the erisa investigators in how to detect deviation from parody arrangements within insurance, and so they're out there fully trained now working on these issues. we have a group within hhs who regularly provides technical assistance to state insurance commissioners and works with them to resolve complaints as they arise, and we've done continuing series of forms and technical assistance around the country. we are working with stakeholders some of whom are in this room today, to improve our ability to ask for disclosure and to offer up consumers the opportunity to really make that evaluation that you referred to. chairman murphy: thank you, assistant secretary. director botticelli would like to talk about another barrier for treatment to patients.

press accounts suggest that some states are denying patients access to drug courts if they're receiving medication assisted treatments or m.a.t.'s. i understand this is a problem in kentucky, according to some press accounts. so director, can you explain what's going on here, given the important of m.a.t.'s, why are some attempting to cut patients off medicines that can help them recover? director: thank you congressman. as many of my colleagues talked about today, increasing access to medication assisted treatment along with other behavioral therapies is the best course of treatment for people with opioid use disorders. one of the accesses we find in addition to issues around payment have been particularly lack of access within the criminal justice system and we know that many people with opioid use disorders end up in our system. some drug courts haven't adapted policies that national association of drug court

professionals endorse in terms of ensuring people who have an opioid use disorder get access to those medications as well as not predicating participation that they get off the medications. part of what we have been doing on the federal level is using our federal contracting standards to ensure people with opioid use disorders, whether in drug court or treatment program or other venues are offered access to medication assisted treatment and are not denied participation based on the fact that they are on physician prescribed medication. chairman murphy: dr. volcow, on that issue do you agree with the ai assessment? dr. volcow: i agree and developingopportunities that are more amenable, like prison and jail, there's no reason they shouldn't get access to medication. chairman murphy: ok. and another barrier that patients

face is lack of available treatment providers who can prescribe m.a.t.'s. director botticelli, can you comment on this dearth of providers that can prescribe buprenorphine, for example? what are the reasons for the shortage, what can we do to address it? >> director botticelli: one of the other opportunities we have is ensuring all of our treatment programs either -- low percentage of them incorporated medication assisted therapy into their programs. some of this, congressman, quite honestly, has been by myth and misunderstanding and this divide between abstinence based care and medication assisted treatment which i think is really unfortunate that we have here. we really want to make sure if a client is entering a treatment

program that has particularly federal funding, needs to offer by way of its own offering or through referral medication assisted treatment. chairman murphy: thank you very much. and thank you to the entire panel for guiding us on this entire situation. >> i want to ask as clarification for the question on drug courts and use of medication assisted treatment, you're recommending medication assisted treatment as part of an option package, although you say obviously we want to get people free from drugs all together. does it require recommended practice from your agencies to get drug courts to do that? does it require regulatory changes from one of the agencies or legislative solution from us to do that? dr. frank: another panelist -- we have actually been doing that as condition of their federal drug court language. you know, again, we want this to be decided by an expert in addiction services in consultation with the patient, but didn't want categorical denial.

chairman murphy: can you add into that? >> i did mention in consultation with ondcp and with department of justice we changed the language in request for applications for drug courts so that they can't require someone get off of or not be on medication assisted treatment, if it is prescribed appropriately by physician or certified program. representative degette: so i just wanted to add though, what you can do, you can make federal funding contingent on full programs but we can't force the states or whatever regulatory agency setting up the drug courts to offer this, they just can't get federal money if they don't offer it. dr. frank: going to be talking at state level as former state administrator, states play a crucial role. there are many, many programs out there that don't receive federal funding or drug courts that don't receive federal funding. we hope our policies and

procedures are adopted by those nonfederally funded programs, but states play a key role in licensing treatment programs. chairman murphy: thank you. dr. frank: and they can look at >> and they i think can look at the opportunities of increasing or ensuring that state license of treatment programs also have the same kind of language. chairman murphy: thank you. speaking of states, the gentleman from west virginia. >> thank you very much, mr. chairman, and thank you for the hearings on this topic. as an engineer, i need to see things in perspective. so been following this the last four years in congress and on this committee, trying to look at this issue. i think one of the last meetings we just had, i tried to put it in perspective by saying -- you said there were 44,000 overdose deaths. i want people to understand, that's more than died in vietnam in combat. i don't know that the american public understands that, and every day on the news, nbc or

whatever, they had body counts and had that and people were outraged over that. i am not getting the sense of outrage over every year we are lose as many to drug overdose as in a ten year war in vietnam. we just -- i am concerned when i had farme in west virginia, one in five babies born in west virginia and may be 1 in 4 in other states, but 1 in 5 have been affected with drugs. i keep things in perspective saying in europe, overdose rate is 21 per million. in america, it is 7 to 10 times that amount. i get on the verge of outrage, father of four, grandfather of six. these are what we are giving our kids, this is what the future

is. i hear this testimony from this panel of seven and seven before that and seven before that. quite frankly, i get confused. i don't know what the priority is. for the business community and you all here in washington everyone loves to plan. but they don't carry out. that may be insulting, and i don't mean it in insulting fashion, but we have 44,000 more people that will die between now and next year. we don't have a prior -- i would like to think we could come up with one way, at least one, prioritize it, what's one thing, and then put everything we have into it. that manhattan project, go after that one solution and see if that doesn't start the ball rolling in the right way. then we can do two, three, four with it. but a focus. i don't see a focus. i didn't see a focus from you. i heard seven or eight ways we

might be able to approach this problem because the plan everyone loves the plan but implementation falls short. so since you're meeting on a regular basis, couldn't you come up with one idea to where we ought to begin? the metrics, the optics, we can dig into that and then we can have plan b, c and d, but let's achieve one instead of continuing to meltdown like this. i don't want to see another statistic of 44,000 more people died of overdose. i hesitate to ask, can you come up with an idea today in the time frame? is there one, just one idea we should focus on? what's the best way? is that in the drug use, is that in real time, on purchasing prescription drugs, that it is a national database? is that the number one thing we should do? my god, the federal government

just changed sentencing guidelines for heroin. if you're caught with 50 hits of heroin, you get probation. what are we doing? are we fighting heroin or not? i am really frustrated with this. give me more guidance on plan one. dr. frank: i appreciate your attention to this and you know, myself and many of our colleagues have been doing this work a long time, i think are filled with a sense of tragedy in terms of where we are and know that we can do better and work with congress. you asked for one. i think there are three areas in the secretary's plan that we have to do. we have to change prescribing patterns, we are prescribing way too much medication. and that's starting the trajectory. we need to increase capacity to treat the disease so people that go down that path have adequate access. the third, that we need to focus

on reducing overdose deaths. those are three areas we can work with congress onto look at how do we increase our efforts. >> let me add onto that. seems that people from west virginia think alike that way and our secretary who is -- shares the same experience you do pushed us to focus and take action in those three areas. you know, with it this year, we more than quadrupled funding in those areas and we're going to triple that again if our plan goes through and these are in those three focused area because that's where the evidence says we should be doubling down. that's what is guiding us. >> thank you. is the secretary asking for legislation on this then to facilitate the answer to that question? >> there are some legislative proposals and some of it

is just increasing some of the use of discretionary funds and we got some additional appropriations this year, and then in the president's budget we have some legislative proposals. >> let the committee know if there's any language to address that question. miss clark from new york, you're recognized five minutes. representative clark bs: thank you very much, mr. chairman, and ranking member. thank you to all of our witnesses for giving the committee the benefit of your expertise and experience. i would like to focus on the prevention side of the equation, how do we prevent opioid addiction in the first place. dr. volkow, picking up on a point mr. botticelli made just a moment ago about way too many prescriptions, this is to you, why are so many prescriptions being written for opioids? are physicians not getting the appropriate level of training and education in pain management? responsible opioid prescribing practices? what would you say?

dr. val cow: they are both. actually what happened is we have to recognize that there's another epidemic of chronic pain in our country, estimated 100 million people according to the institute of medicine. as a result of pressure of need to go address this problem, the joint accreditation required that hospitals and physicians in hospitals ask questions about pain and treat them. this was in 2000. the problem was that that was not associated with the education required to properly screen pain, but also to manage it and to manage it and use opioid medications adequately. there was a pick up between need to implement better treatment for pain, but inadequate education of that system. so that's a major problem. in terms of prevention, we have to recognize two aspects on this epidemic different from the others. one, we have individual start diverting and get medication, they want to get high.

then there's the other element as important of individuals that are properly prescribed the medication because they have pain. in the past, it was believed you got an opioid and had pain, you will never become addicted. data shows that's not correct. we don't exactly know what percentage will become addicted. the range goes enormously from none to something like 40, 60, we have no idea. that's why i highlighted the notion of if we need to be very aggressive in education of health care providers on screening and management of pain but also be very aggressive on treatment of health care providers for recognition of substance abuse disorder to determine who is vulnerable. when a person is properly treated, to transition and how to intervene. representative clarke: thank you very much. director botticelli, do they

believe the federal government should mandate continuing medical education on responsible opioid prescribing practices as a precondition of dea registration to prescribe controlled substances? can you elaborate on how that would work if that's the case? >> sure. we support mandatory prescriber education for all of the evidence that you heard today, it is clear that if we want to prevent prescription drug misuse heroin use and overdose, we need to stop prescribing these so liberally. there was a recent gao report that showed physicians get little to no pain prescribing, veterinarians get more pain prescribing than physicians in the united states. so we don't think it is overly burdensome to require physicians in this epidemic to have education. i think as you talked about it we would have to work with legislature to look at changes to controlled substances act to

ensure that a certified continuing medical education program would be linked to the dea licensure or relicensure process and that we would monitor both -- oversee those courses we believe have core competencies we think are important and monitor who takes those. representative clarke: very well. thank you very much. manufacturers of opioid pain relievers are currently required to offer free voluntary education to physicians or responsible opioid prescribing practices. however, as i understand it physician participation rates for the voluntary education courses are fairly low. is that correct? >> we do have those programs in place. they were put into place about 18 months ago and so the initial year was spent putting into place a process to allow the education to be available, prescribers to make use of it. during that time we saw about

20,000 prescribers that are using extended release, long acting opioids sign up for one course. 20,000 out of 320,000 prescribers that prescribe the medicines is not a large fraction. it is progress. we hope in the second year that ends july this year, we will see a larger increase in terms of uptake and use of this education. we have been working with the continuing education community to make better use of it, make it more available. we are optimistic. we hope we will see more use. it is one of two pillars of education from our perspective, combined with mandatory education that mr. botticelli just spoke about, we believe both of these provide important opportunities to educate prescribers. representative clarke: very well. i yield back. thank you very much. >> thank you. miss brooks of indiana, five minutes. >> thank you, mr. chairman, for continuing the focus on this critical subject for our country. i want to start with you dr. volkow.

we talked about how the opioid addiction facing the country is in large part due to chronic pain. you mentioned 100 million people suffer from chronic pain. one in i heard up to one in three americans possibly suffer from chronic pain. one of the goals of this hearing is to focus on evidence based treatment and new treatments, try to find out what is working and obviously one treatment doesn't work for everyone as we heard. but there is, i learned about in the course of examining this that there are technologies that are new, not completely new, one being -- i was told about spinal cord stimulation which targets nerves with electrical impulses rather than drugs. clinical studies show it to be safe, 4,000 patients received the stimulator, so it obviously is a device, a technology that can actually stop that stimulation, it can help

hopefully end that addiction yet nih hasn't included it in the draft pain strategy, didn't mention technologies like scs. can you talk at all about why it wouldn't be promoting this fda approved type of technology and are there other technologies we ought to be talking about other than medication for chronic pain? dr. volcow: thank you for the question. indeed, this is an area that is rapidly evolving, and if it is not mentioned it is because many of the findings are too recent. the one that you're commenting in terms of stimulation is one of the strategies we are promoting research, and the same strategy can be utilized to be able to actually inhibit the emotional centers of the brain that react to pain. so researchers are utilizing a wide variety of tools and technologies that have a goal of the initiative to understand the brain, that again highlights but brings up something that i think that is facing us in this epidemic, the need that we have

to develop better strategies for the management of chronic pain because the physicians are forced, patients in great suffering, they don't know what to do and give an opioid, even though the evidence does not show us that they're very effective for the management of chronic pain but there are not many out there. so recognizing this is an area where we require to invest resources for patients with chronic pain is an important part of addressing -- how would addressing it. representative: how would you recommend we increase patient access and educate more physicians about this type of technology? >> well, this is new technology, some of them, actually the evidence is just emerging. it will have to be submitted to the fda for approval, then physicians as part of training should be exposed to them. i would say just highlighting in the notion because michael

botticelli -- it is important medical students as part of basic training have understanding of these technologies. almost of sever medical condition. pain is part of every medical condition, almost of every medical condition. representative: thank you very much. i would like to ask you, my state, state of indiana, recently passed a law allowing physicians to prescribe the naloxone to parents and others and friends giving them greater access to the reversal heroin drug. would you speak as to what's known about the impact of those naloxone programs and whether you have concerns about whether naloxone might encourage more risk taking because i met with law enforcement who said they had given people naloxone, saved their lives, and a couple weeks later saved their life again with naloxone. and so i am somewhat concerned.

i want to absolutely save lives and we must, but yet -- and we know there aren't enough treatments, this is a huge problem, but might that encourage an addict if they knew their mom, dad or friend had the save right there, can you talk to us about these naloxone programs? dr. frank: sure. so to your first question obviously naloxone distribution by people who have the potential to win this and overdose, law enforcement in counties play a key role in that effort. i will tell you by way of when i was in massachusetts, we significantly increased access to naloxone and did a peer reviewed study that showed when you introduced naloxone into a community, overdose rates go down. and the more naloxone you introduce, the better the scale effect. one of the pieces we are

concerned about but no evidence to show that naloxone distribution increases drug use, some of the issues that you mentioned become critically important that overdoses are often seen as a significant motivator for people to seek care, but having treatment on demand is a particular issue. treatment on demand, particularly in rural communities, is particularly an issue. interventions at emergency departments to get people into care are critically important. while we know addiction is a chronic disease, and some people continue to use when you have adverse events, but we also need a comprehensive response. not just saving someone's life. representative brooks: thank you. i completely agree. i hope the results in indiana prove to be the same as in your state. i yield back. chairman murphy: thank you. >> thank you mr. chairman. before i get to some questions,

i have a follow-up question for miss hyde. last time that you were in front of this committee which i really appreciate you coming back we discussed your websites and if they were an effective use of taxpayer dollars. at that time you stated that you were in the process of evaluating that. have you finished that process yet? >> that process continues. thank you for asking the follow-up question. the process continues. i think the website that you indicated most concerns about was one of the websites we were in the process of reviewing. it was originally developed based on data and knowledge from nida. >> that was for the three to six-year-olds for suicide prevention. have you finished that one yet? >> yes, building blocks i think is the one you were concerned about. >> right. >> we have worked with our colleagues at nida and determined the website hadn't been updated, needed to be updated, and we are in the process of updating that.

>> could you give me progress reports so i can know where you are at? we want to be sure taxpayer dollars are being used in an effective way. >> certainly. >> to get to questions, simple yes or no, does the fda recommend methadone be used as first line of therapy for chronic pain? >> methadone is approved for use for pain, yes. >> but specifically speaking to the first line, for first line of defense basically? >> it is one of the medications that we've have approved for pain. if you look at methadone, the labeling for methadone, it calls it out as far as a product that has particular characteristics that make it challenging to use for pain. >> that would be a no for the first line. >> our recommendation is prescribers think carefully before using methadone. there are things that make it a challenging product to use. it is approved for use in

that setting but i hope doctors think carefully before they do it. >> well, the fda put out a warning about the drug safety and basically said that you guys, that insurers should not, should not be referred as preferred therapy, unless special instructions in education was put on to it. so i would take that as the fda would by this statement, it would be a no, that you wouldn't recommend it unless there's a lot of consideration taken? >> personally what i just said is where i would be. i would need to look at the statement and get back with you about specifics of it. it is a drug that has a long half life, that's variable patient to patient. has unique cardiac toxicity. there are other drugs useful for pain that don't have those

characteristics. >> all i am looking for is yes or no. i am trying to get to another further down the line of questions. i appreciate you being here. i like the last name, my sister's last name. >> good last name. >> i have three beautiful nieces. the spelling is usually messed up. doctor, what about the cdc? do you guys consider this methadone as being first line of defense for pain? >> at cdc we focus on primary prevention, not as much as care. i would defer to sister agencies on that. >> which would be. >> the panelists here, fda. >> he gave his personal opinion, the statement of fda you heard about. would you follow the statement i am assuming? >> i would follow his statement. i don't have a person opinion on methadone for pain, it is not something i did in my prior practice. >> dr. conway, by the way, i am always jealous when people have their family with them. i have five wonderful kids. if you ever want to see me cry that's about the only thing will make me cry, i miss them.

>> how are your kids doing? >> thanks, i appreciate that. >> i'll take a deep breath, wipe the tear away. are you aware that methadone accounts for 30% of overdose deaths while only accounting for 2% of prescriptions prescribed for chronic pain? >> i am aware it is a higher percentage of deaths compared to prescriptions because of the long half life and risks described. >> would you personally recommend it as a first line of defense for pain? >> i am a practicing physician i do not as a practicing physician typically use methadone as first defense. however, i think it depends on the individual patient characteristics and would defer to the physician's judgment with that individual patient. >> according to the pew research, they put out a deal that said methadone is available in low cost generic form considered preferred drug in many states by their medicaid programs, despite fda warnings about the drug

safety and statements by american academy of pain medicine that insurers should not be referred this therapy unless specially educated and provided to the individual. i just kind of wonder if overall i would think we're considering it not being there, why is this still listed as a first line with medicaid when we are seeing so many deaths. it almost makes you think is the cost of a life not more valuable than the cost of a low drug? >> i would make a few points. statutorily, medicaid programs have the ability to set their preferred drug list. however, we have taken a couple of actions to try to address this issue. one, working with samhsa and others on the panel, put an informational bulletin to medicaid programs talking about this issue and complete array of pain both on the medication side, risks of methadone and the other options and importantly as

others have said, the importance of behavioral treatment and medication treatment. i also call out that our medicaid innovation accelerator program, the first area we are working on is substance abuse disorders. we have over 30 states involved and they're taking a comprehensive approach to the medicaid program to appropriate substance abuse treatment, including appropriate use of medications and other therapies. >> appreciate it. mr. chairman, i yield back. >> a followup. >> one of the questions or statistics i was giving in talking about perspective is the model or the situation that they're facing in europe. the average is 21 per million. i was just looking. that's the average?

italy, italy is below that. not yet, netherlands belgium, , greece, france, poland bulgaria, czech republic slovakia, turkey, romania all have less than that, significantly less. what are they doing right, what are they doing differently in europe than we are in america? are we learning anything from them? >> there's something we are doing very differently. you pick up exactly on the point. if you look at united states from some of the medications we may be consuming 95% of total production in the world. the question is are we a nation that is so much in pain that we require these massive amounts of opioid medications or is there something that we are doing in terms of their access to them that it is inadequate. i want again to reiterate the notion that yes, we are

overprescribing opioid medications on the one hand, but at the same time, not exclusionary, sometimes we are undertreating patients with pain. so we are in a situation that we have it bad in both ways. we overprescribe making these drugs available which then can be easily diverted and prescribing to those that need -- that don't need them can also result in adverse consequences. you don't see that level of prescriptions in none of the european countries. >> so what's the why not? what are they doing? are their doctors more sensitive than doctors in america? are they concerned about trial lawyers? what's the difference between it? 10 to 15 times more dying in america than europe, something is wrong. they're doing something differently. i would like to know what it is.

>> and that's exactly the way i said, we have to aggressively institute education of the health care providers on proper screening and management of pain. that's a crucial component while also educating them about the adverse effects as relates to substance disorders. and need to face the fact that we need to also provide with alternative treatments for the management of chronic pain that are effective. >> thank you very much. >> miss collins, you have a quick question. miss brooks. where am i going. >> thank you. this is actually i realize he mentioned it in his opening, i wanted to have an unrelated follow-up, if i might, mr. chairman. you mentioned we are having a crisis in indiana with respect in scott county, a community of 4300 people, an outbreak of hiv

due to needle exchange, and would i simply like and i hope many of you have been following what's been happening and the number of citizens in indiana who now have contracted hiv because of their in all likelihood heroin addiction, right, or prescription drug addiction, and possibly heroin addiction as well. i am very curious since i have this incredible panel of experts here what you might say to our state and to the health professionals who are dealing with this crisis to our state and local government officials what advice and thoughts do you have for our state.

truly, if we could, this is a crisis in our state that could be in any state in the country. >> so first of all just about staff from all of the agencies on this table coordinate on a daily basis in tight coordination with indiana health department to give scott county the resources to do that. >> i am sure dr. adams appreciates that. >> you're right. i think we are over 145 cases of hiv. one of the consequences nationally is increases in viral hepatitis as relates to sharing needles. and i think it also points to some issues that we need to include about access to treatment services. what's happening in indiana and scott count is emblematic of potential we could see in other parts of the country, but point to some issues we have been talking about today in terms of making sure that people have access to good care, both infectious disease and substance abuse. have adequate access to clean syringes so they're not increasing infection in this most poignant case of what we need, and that they're having timely access to treatment

services, all areas to do that. we will continue to engage with folks in scott county to make sure that whatever we can do on the federal side can help alleviate the situation. >> i would like to add to that i am proud of all the efforts cdc is doing on the ground in indiana in conjunction with agencies here. i agree completely with the director about access to medication assisted treatment and hiv therapy. the other thing i would add is indiana is number nine in the nation for prescribing. there's a lot can be done when you look at trying to stop the epidemic before it happens. looking at again, using prescription drug monitoring programs, having better prescribing guidelines, so people don't get addicted to opioids. and then inject them. that's the third component we need to add. >> maybe dr. volkow and floor -- administrator hyde.

>> there's another, i mean, we got caught by surprise with the indiana epidemic of hiv. i heard tom frieden, who said it is the fastest growing incidence of hiv cases since hiv entered the united states. but there's been extraordinary advance on hiv that emerged in the past two, three years, which is that if you initiate someone on anti-retro viral therapy, not only are you improving their outcomes but you're going to dramatically decrease infect infectivity. -- decrease their infectivity. when you see a case, you immediately treat with antiviral therapy. they'll do better and this is another aspect which relates to the issue, giving care to -- good infectious disease care jointly with intervention for substance abuse treatment. thank you. >> so i wanted to add, we are

working collectively on this issue and we understand there may be legal barriers that we have been talking to indiana about in terms of developing opioid treatment programs and there's not a lot of waivered physicians able to provide buprenorphine. the closest treatment program is 40 miles away. there may be transportation barriers, cost barriers and other so we're collectively working with the state to try to develop alternatives. >> thank you for allowing me to speak out of voice. >> first, ms. hyde, last week the subcommittee heard testimony from the program director of the stand ford university addiction medicine program that the 42 cfr part ii is an artifact of the past. she told us the laws consent requirements ourselves trenchant that two doctors seek to treat the same patient for opiate addiction can't community kate with each other. about the patient's medical condition. the rule was based upon a 1982

-- law and wreaked havoc in the 1972 records. so she strongly recommended that we change that so we are not over prescribing people. and a position -- physician can know who is in treatment. now my understanding is they're contemplating new part 2 rules. i want to know if you're committed to the rules that reflect the concerns that have been repeatedly voiced by so many in the medical community who want nothing more than to make sure patients aren't given double dozes. -- double doses. is that what samson is going to be working on? >> really appreciate that question because it is a complex issue. and you're right, the laws and regs are decades old bf we had -- before we had electronic records and other things we're now considering part of practice. we, a couple of years ago put some some regulatory guidance to help the issue. but that wasn't sufficient. last year we held a listening session for stakeholders and have taken those pieces of input

and are trying to balance the privacy concerns with the need for access to data. we hope that we will have something available for public input yet this year to try to address some of these issues. >> please let the committee know. thank you. and i wanted to follow up on this kentucky drug court issue. could the drug court decisions relate to the diversion? we heard testimony that the mills are popping up in kentucky and west virginia. and when entering the drug court system it's hard to determine whether it's from an illicit source or prescribed by a doctor. could this part of an issue that the drug courts could work and have some flexibility to deal with this on a case-by-case basis? >> i think there are a number of issues. the national association did a survey of drug courts in the

united states. and for those drug courts that were not referring, it was actually more about judicial bias than fear of diversion that kept people from doing that. i think the second piece that any treatment, whether it's medication assisted treatment or residential treatment requires a level of collaboration and relationship between the court and the provider to ensure that doctors who are referring to -- courts who are referring to treatment are referring to high quality treatment. you know, we do need to pay attention to diversion and drug courts i think in combination with treatment programs with ensure that these are appropriately prescribed and appropriately monitored medications. and they need to make sure that they're partnering with physicians who have prescribing medication in a quality way. >> i just got an article that was talking about in some of the courts they're using vivitrol. and for people in and out of incarceration, trying to keep them off by maintaining vivitrol.

i want to make sure i understand. they want to keep these people released from prison drug free. could you please clarify. are you saying that unless they have some synthetic opiates they're going to have federal funding cut or they can still maintain federal funding and vivitrol would be acceptable as another part of that program? >> so we don't dictate to drug courts what medication. that should be a decision between the treatment provider and the patient. our work was to make sure there weren't categorial classifications to not offer the -- categorical prohibitions for drug courts either to not offer the medical assisted therapies. and if someone was on a recommended course of treatment, that they not have to get off the medication to do that. we actually don't dictate what medications courts use to be able to do that. i think like any treatment you want to have an arsenal of medications.

>> dr. frank, could you respond to the vivitrol question, too? did you hear that? i'm wondering if that is an option for states as a diversion to be using vivitrol, that that could be part of what we could be -- microphone, please. >> i think that we are trying to have the full armor available to the treating providers, trying not to get between the provider and the patient as long as there's the opportunities to offer the most richest menu of evidence based treatments that are available. >> follow-up? >> mr. mckinley asked the witnesses what one thing you would recommend that we could do to try to start reversing this epidemic and this problem. he got as far as dr. frank when he ran out of time. so i just ask unanimous consent if we can ask each one of the other witnesses to supplement

their testimony. they don't have to say it right now. >> get back to us. >> get back to us with that recommendation. we recognize there's a problem and we're really struggling with the issue of what we do as a congress to remedy it. thank you. >> and i think what you're also talking about, a partnership with the states says we should be looking at kentucky and others indiana. >> indiana. >> colorado courts and see what else is going on. i want to thank this panel. we'll follow up with the questions. we will ask for more clarifications of this. i want to thank you. as i said last time, too, you know, if this was about a single airplane crash the room would be filled with media. but we've had more people die in the last year from drug overdose deaths than the come pi nation -- than the combination of every airplane crash in north america from to the present. 1975 this is a serious crisis whether it's education of physicians.

whether it is options out there. we want to make sure that federal funding is going to right direction. i'll remind members they have ten business day to submit questions for the record and i ask that all of the witnesses agree to respond promptly to the questions. with that, this committee is adjourned. thank you. [captions copyright national cable satellite corp. 2015] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org]

>> the senate this afternoon was scheduled to vote on overriding president obama's veto over a congressional legislation changing labor rules but senate members put off that vote and instead approved the nomination of willie mae to be commerce undersecretary. that vote happening now in the senate. we are expecting senators to continue legislation that would allow, but not required, congress to approve or disapprove a final nuclear agreement with iran. the senate is also scheduled to work on the 2016 budget. their life on c-span2. the house returns next tuesday. follow live coverage here on seas. the new congressional directory

is a handy guide with color photos of every senator and house member plus bios and contact information, twitter handles, and district maps, a foldout map of capitol hill, and they look at congressional committees, the president, and state governors and federal agencies. order your copy today. >> tomorrow, former governor arkin -- former governor of arkansas, my custody will make his presidential campaign announcement from his hometown of hope in arkansas, which is also the hometown of former president bill clinton. today, former hewlett-packard ceo carly fiorina announced she is running for president. she made her announcement in an online video.

missy arena: i'm running for president. our founders never intended us to have a political class. they believe that citizen leaders needed to step over. we know the only way to reimagine our government is to reimagine who is leading it. i'm carly fiorina and i'm running for president. if you are tired of the soundbites, the vitriolic, the goes, pettiness, and corruption, if you believe it is time to clear -- declare the end of identity politics, if you believe it is time to declare the end of lowered expectations for if you believe it is time for since to stand up -- for citizens to stand up to the political class and say enough, then join us. it's time for us to empower our citizens, to give them a voice in government, to come together and fix what has been broken about politics and our government for too long, because we can do this together. ♪

>> another republican jumped into the 2016 presidential race today. retired neurosurgeon ben carson will stop he made enough that the music call for performing arts at his hometown of detroit. [applause] [cheers and applause]

>> ladies and gentlemen, the committee for carson for president welcomes you today. please silence your cell phones. please stand for the presentation of colors by representatives of the myron h beals legion post number 32 of livonia, michigan. >> guard halt.

left face. post. post. present. ♪ >> the national anthem is presented by andy carson on the -- candy carson on the violin and the choir selected of god, directed by pastor larry callahan.

>> ♪ o, say, can you see? ♪ ♪ by the dawn's early light ♪ ♪ what so proudly we hailed ♪ ♪ at the twilight's last gleaming ♪ whose broad stripes and bright stars ♪ ♪ through the perilous fight ♪ ♪ o'er the ramparts we watched ♪ ♪ were so gallantly streaming ♪ ♪ and the rockets' red glare ♪ ♪ the bombs bursting in air ♪ ♪ gave proof through the night ♪ ♪ that our flag was still there ♪ ♪ oh say does that star-spangled banner still wave ♪

♪ o'er the land of the free ♪ ♪ and the home of the brave! ♪ ♪ the brave! ♪ ♪ the brave! ♪ >> [cheers and applause]

>> let us pray. god of all creation, we thank you. we come to give you praise and glory today. you are the source of our strength. we ask your blessings upon this gathering, dr. ben carson, his family, especially his mother, sonja. and committee. we ask that you would guide and direct his thoughts, his words and his steps. we ask that they would be full of wisdom, productivity, and guidance. god, as you protect this country

and protect us and cover us, cover dr. ben carson and his family. protect even the committee, god. we ask these blessings upon us and we expect you to do the supernatural. it is in the name of jesus that we pray and we believe it to be so. amen, amen. now to hear two selections from selected of god. ♪ ♪

>> [choir sings] ♪ >> [cheers and applause] ♪ ♪ >> [choir sings]

♪ ♪ >> [choir sings]

♪ >> ♪ you better lose yourself ♪ ♪ in the music, the moment ♪ ♪ you better never let go, oh! ♪ ♪ you only get one shot ♪ ♪ you better lose yourself ♪ ♪ ♪ you only get one shot ♪ ♪ you better lose yourself ♪ ♪ you only get one shot ♪ ♪ ♪ you only get one shot ♪ ♪ ♪ you only get one shot ♪

one shot ♪ ♪ you better lose yourself ♪ one shot ♪ ♪ ♪ you only get one shot ♪ ♪ ♪ you only get one shot ♪ ♪ you only get one shot ♪ >>[cheers and applause]

♪ >> [choir sings] ♪ ♪ >> [choir sings]

♪ ♪ ♪ >> [choir sings] ♪ you are the source of my strength ♪ ♪ you are the strength of my life ♪ ♪ you are the source of my

strength ♪ ♪ you are the strength of my life ♪ ♪ ♪ amen ♪ ♪ amen ♪ ♪ amen, amen ♪ ♪ amen, amen ♪

♪ amen, amen ♪ >> [cheers and applause] ♪ you are the source of my strength ♪ ♪ you are the strength of my life ♪ ♪ ♪ amen ♪ ♪ amen ♪

♪ amen, amen ♪ ♪ amen, amen ♪ ♪ amen, amen ♪ >> [cheers and applause]

>> ladies and gentlemen, please give a warm detroit welcome to a powerhouse of musical excellence. from nashville, tennessee, veritas. >> [applause] >> ♪ >> ♪ when you walk through the storm hold your head up high >> ♪ at

-- up high and don't be afraid of the dark >> ♪ at the end of the storm is a golden sky ♪ and the sweet silver song of the ♪ -- of the lark ♪ >> ♪ walk on through the rain ♪ ♪ [singing] ♪ ♪ you'll never walk alone ♪

♪ you'll never walk alone ♪ ♪ ♪ when you walk through the storm, hold your head up high ♪ ♪ don't be afraid of the dark ♪ ♪ at the end of the storm is a golden sky ♪ this sweet silver song of the

lark ♪ ♪ walk on through the wind, walk on through the rain ♪ ♪ the your dreams be tossed to and fro ♪ ♪ walk on, walk on ♪ ♪ and know in your heart that you'll never walk alone ♪ ♪ you'll never walk alone ♪ ♪ you'll never walk ♪ ♪ you'll never walk alone ♪

♪ ♪ you'll never walk ♪ ♪ alone ♪ ♪ >> [cheers and applause] ♪

>> ♪ o, beautiful for spacious skies ♪ ♪ for amber waves of grain ♪ ♪ for purple mountain majesty ♪ ♪ above the fruited plains ♪ ♪ america, america ♪ >> ♪ god shed his grace on thee ♪ ♪ and crown thy good with brotherhood ♪ ♪ from sea to shining sea ♪

♪ >> ♪ god bless america ♪ new ♪ land that i love ♪ ♪ stand beside her ♪ ♪ and guide her ♪ ♪ through the night with the light from above ♪ >> ♪ from the mountain ♪ ♪ to the prairies ♪ ♪ to the oceans white with foam ♪ ♪ god bless america ♪ ♪ my home sweet home ♪ >> ♪ god bless america ♪

♪ my home sweet home ♪ ♪ >> ♪ he is trampling out the vintage ♪ -- ♪ mine eyes have seen the glory of the coming of the lord ♪ ♪ he is trampling out the vintage ♪ ♪ where the grapes of wrath are stored ♪ ♪ he has loosed the fateful lightning ♪ ♪ of his terrible swift sword ♪ ♪ his truth is marching on ♪ ♪ glory, glory, hallelujah ♪ ♪ glory, glory, hallelujah ♪ ♪ glory, glory, hallelujah ♪

♪ our god is marching on ♪ >> ♪ in the beauty of the lilies, christ was born across the sea ♪ >> ♪ with the glory in his bosom that transfigured his you and me -- that transfigured you and me ♪ >> ♪ he died to make men holy, let us live to make men free ♪ while god is marching on ♪ ♪ glory, glory, hallelujah ♪ ♪ glory, glory hallelujah ♪ ♪ glory, glory, hallelujah ♪

♪ our god is marching on ♪ ♪ his truth is marching on! ♪ his truth is marching on! ♪ >> [cheers and applause] ♪ >> historians will write about this critical turning point for

a nation and tell we have responded to the dynamic forces changing our world. we can no longer afford the continuing dysfunction. of opposing particle partisan rancor or the rhetoric of the political class. if america is to survive the challenges of the modern world we need to heal, we need to be inspired, and we need to provide the exceptional spirit that built america. never before have we been so closely connected to each other but more divided as a country. we have created so many boundaries for ourselves by forcing friends and neighbors to pick sides, that we have stifled all productive debate. respect for one another has become the exception, not the rule. our government was devised to represent our citizens and promote common welfare for the pursuit of life, liberty, and the pursuit of happiness.

instead, we find ourselves grounding in government -- drowning in government deception, dependency, and debt. our government was designed to reflect the will of its people. instead, washington has become a parlor game for special interests and the political elite. america's individuality is both brilliant and unstoppable. that same driven ingenuity once built this nation into a world power of commerce and thought leadership of free expression and unbridled opportunity. these are the values that caused america to become respect did and admired across the globe and it must be the same values that inspire our american revival. it is our time to work together, all of us, each with their own unique talents, to bring insight to the challenges we face. it requires the full capacity of our gifted thinking, constrained

only by the limits of our imagination and our willingness to see the job through. the generations before us built an exceptional nation and we can become the authors of ideas that have such profound magnitude. great transformations begin from a single event and, with directed focus, can we can -- we can propel nation into the future with the government of, by, and for the people. first, we must heal. healing requires a leader with calm, unwavering resolve more concerned about the next generation than the next election, someone who knows the pursuit of happiness best fostered with opportunity and justice for all. we need a leader that inspires us, someone dedicated to investing in the next-generation of great thinkers, doers, and their own destiny.

someone who will protect their freedom to discover and forge their own path. we need a leader to revive the true promise of america. spreading open the doors of opportunity for individual advancement. giving each of us a greater chance to flourish together. engaging people with their government and a mandate for those better off than the one we inherited. we have the fortitude to heal and the imagination to inspire and the determination to revive the americans dream. one nation under god indivisible, with liberty and justice for all. we can see this together. with a leader that derives his strength from god and his duty from the american people.

♪ ♪ >> [cheers and applause] host: thank you. dr. carson: thank you very much. [applause] dr. carson: thank you. we have limited time. thank you. thank you so much for that warm welcome. this is my wonderful wife candy. who is also a detroiter. [applause] dr. carson: even though we are both from detroit, we had to go to new haven to meet each other.

kandi has been by my side for 40 years. [applause] dr. carson: it is my best friend -- she is my best friend. she even learned how to play pool because she knew i was a good player. [laughter] dr. carson: most of the times i beat her. there are media here and their headline will be that carson admits he beats his wife. [laughter] dr. carson: if you guys would not mind sitting down, so that i can introduce our son -- my oldest son, murray and his wife are right here. stand up, please. [applause]

dr. carson: murray is an engineer and his wife is an analyst. my middle son cj and his wife marlen is right here. [applause] dr. carson: he is an entrepreneur and merlin owns a company that does placements and they do a lot of things. they own a lot of stuff. very cool. my youngest son is right here. his wife is at home with the baby. [applause] dr. carson: royce is a cpa and they all three got married in 2011. [laughter] [applause] dr. carson: now, i have

introduced my family. you say, who are you? i am ben carson and i am a candidate for president of the united states. [cheers and applause] thank you. thank you. america remains a place of dreams. a lot of people are down on our nation. they want to point out all of the bad things that have happened here. have you ever noticed that there are a lot of people trying to get in here and not a lot of people trying to escape? [laughter]

dr. carson: it says something. it was a place of dreams for my mother. she came from a large rural family in tennessee. she always had a desire for education. she was never able to get beyond the third grade. she married at age 13 with the hope of escaping a desperate situation. she and my father moved here to detroit. he worked in a factory. in fact, i remember one christmas being in this auditorium, sitting right over there. it was for gm employees. they had a christmas program for the kids. some years later, my mother discovered that he was a bigamist and had another family. that occasioned the divorce. she only had a third grade

education. consequently, we were thrown into a situation of dire poverty. she still maintained that dream of education. now, it was for us. more so than for herself. we moved in with her older sister and brother-in-law in boston. typical tenement. large, multifamily dwelling. sirens, gangs, murders. both of our older cousins, who we adored, were killed. i remember when our favorite drug dealer was killed. [laughter] he drove a blue cadillac. they brought us candy, so we likes to see the drug dealers.

the rats and the roaches. in the more upscale area, they call them water bugs, but we knew what they were. [laughter] my mother was out working extraordinarily hard. two, sometimes three, jobs at a time. trying to stay off of welfare. the reason for that which she noticed that most of the people she saw go on welfare never came off of it. she did not want to be dependent. she wanted us to be independent. she said she would work long and as hard as necessary leaving at 5:00 in the morning and getting back after mid-night, day after day after day, doing what other people did not want to do to maintain your independence. she was very thrifty. she would drive a car until it would not make a sound.

dr. carson: then she would go and collect all of for dimes and nickels and quarters and buy a new car. they would say, how does that woman afford a new car? she knew how to manage money. i am fond of saying this. if my mother were secretary of treasury, we would not be in deaf sit situation. [applause] there are many people who are critical of me because they say carson wants to get rid of all the safety nets and welfare programs, even though he must've benefited from them. this is a blatant lie. i have no desire to get rid of safety nets for people who need them.

i have a strong desire to get rid of programs that create dependency in able-bodied people. dr. carson: we are not doing people a favor when we pat them on the head and say, they are, they're, you poor little thing we are going to take care of all you needs, you don't have to worry about anything. you know who else says stuff like that? socialists. their programs always end up looking the same. they want to take care of people from cradle to grave. they want to be involved in every aspect of their lives. they want most of their earnings. they say it will be a utopia and nobody will have to

worry. the problem is that all of those societies end up looking the same. with a small group of elites at the top controlling everything, a rapidly diminishing middle class, and a vastly it spanned a dependent class. that was not the intention for this country. this country was envisioned by individuals who wanted everything to be surrounding the people. of, four, and by the people. not, of, for, and by the government. the government was to respond to the will of the people, not the people to the will of the government area i am not an antigovernment person by any stretch of the imagination. i think the government, as described in our constitution, is wonderful. but we have gone far beyond what our constitution describes and we have begun to allow it to expand based on what the political class wants. i think it is time for the people to rise up and take the government back.

[applause] now, the political class won't like me saying stuff like that. i will tell you a secret. the political class comes from both parties and it comes from all over the place. [applause] it includes, unfortunately, even the media now. the press is the only business in america that is protected by our constitution. you have to ask yourself a question. why were they the only ones protected? it was because our founders envisioned a press that was on the side of the people, not a press that was on the side of

the democrats or the republicans or the federalists or the anti-federalists. [applause] and this is a direct appeal to media. you guys have an almost sacred position in a true democracy. please don't abuse it. [applause] my mother's dream was for us to move back to detroit and we were eventually able to do that. but i was a terrible student. my brother was a terrible student. she did not know what to do. so she prayed. she asked god for wisdom.

you know what? you don't have to have a phd to talk to god. you just have to have faith. god gave for the wisdom. my brother and i did not think it was that wise. turning off the tv making us read books and turn into her written book reports which she could not read. but it worked. i started reading about people of accomplishment. i started to recognize that the purse who has to do the most with what happens in your life is you. it is not somebody else. you do not have to be dependent on the good graces of somebody else. you can do it on your round if you have a normal brain and you are willing to work and you are willing to have that can-do attitude. it was the can-do attitude that allowed this nation to rise so quickly.

we had people who did not stop when there was an obstacle. that is how those early settlers were able to move from one seat to the other seat across a rugged and hostile terrain. they knew how to do things. there were many communities that were separated from other communities by hundreds of miles, but they thrived. why did they thrive? because people were willing to work together, to work with each other. if a farmer got injured, everybody else harvested his crops. if somebody got killed everybody else pitched in to take care of their families. that is who we are. we, americans, we take care of each other.

that is why we are called the united states of america. what we have done is we have allowed the purveyors of division to become rampant in our society and to create friction and fear in our society. people are afraid to stand up for what they believe in because they do not want to be called a name. they do not want an irs audit. they do not want their jobs messed with or their families messed with. but isn't it time for us to think about the people who came before us? and what they were willing to do? so that we could be free. nathan hill, a teenage rebel, caught by the british, ready to be executed -- he said my only regret is that i have but one life to give my country. a couple of nights ago, i was in mobile, alabama. there were several world war ii

veterans there in uniform. i took pictures with all of them. they were thanking me for being courageous enough to do what i am doing now. i said, no, it is you who we must thank. [applause] we think about all of those brave men and women who sacrificed life and limb over the years so that we could be free. we dare not soil by being -- their efforts by being timid now and not standing up for what we believe. to recognize that one of the rules for radicals is that you

make the majority believe that what they believe is no longer relevant and no intelligent person thinks that way and the way you believe is the only way intelligent people believe. and that way they will keep silent. i will tell you something. they don't care if you don't believe what they believe, as long as you keep your mouth shut. that is what we have to start doing. we have to start opening our mouths for the values and principles of america. [cheers and applause] and i have to tell you

something. i am not politically correct. [cheers and applause] i'm probably never going to be politically correct because i'm not a politician. i don't want to be a politician. [applause] because toll tigses do what is politically expedient. i want to do what's right. [applause] we have to think about that once again in our country. this past couple of weeks, there has been a great deal of turmoil in baltimore. i spent 36 years of my life there. and we see the turmoil in our cities all over our nation.

we need to start thinking about how do we get to the bottom of this issue? i believe that the real issue here is that people are losing hope and they don't feel that life is going to be good for them no matter what happens. when an opportunity comes to loot, to riot, to get mine they take it -- not believing that there is a much better way to get the things that they desire. interestingly enough, many of these people buy hook, line, and sinker, the idea that our economy is getting much better and that the unemployment rate is down to 5.5%. you know what? if the unemployment rate was down to 5.5%, our economy was

humming. it is not. our freedom and our way of life is dependent upon a well-informed and educated populace. what you have to know is that you can make the unemployment rate anything you wanted to be based on what numbers you include and what numbers you exclude. you have to look at the labor force participation rate. that number has been steadily going down since 2009 and is now at a 37-year low. unless you understand those things, it is possible for slick politicians and biased media to convince you that everything is wonderful when your eyes tell you something different. i am saying to people around

this nation right now, stop being loyal to a party or to a man and use your brain to think for yourself. [cheers and applause] that is really the key to us as a nation becoming successful again. not allowing ourselves to be manipulated by people who think that they are the kingmakers. who think that they are the rulers of thought. they are not the rulers of thought. we, the people are the rulers of thought in this nation. other people cannot dictate it for us. we never allow anybody to take the right away from us. we do that when we submit from

silliness. the majority of americans were opposed to the so-called "affordable care act." they just rammed it down our throats and said, this is the way it is going to be. if you don't like it, too bad. that was never supposed to be the way that this country was designed. if we accept it, it will continue that way and it will get worse. we have to get the right people in place. we need, not only to take the executive branch in 2016, and when i say we, i'm not talking republicans -- i'm talking anybody who has common sense. [applause]

we have to have another wave election and bring in people with common sense, who actually love our nation and are willing to work for our nation and are more concerned about the next generation than the next election. that is what is going to help us. dr. carson: we also are going to have to concentrate on fixing the broken economy. $18 trillion plus in national debt. and we have representatives who applaud themselves if the deficit does not go up as much this quarter as it did last quarter. they are completely out to lunch. dr. carson: we have got to drive that thing back down. it is our responsibility. you need to know who your representatives are. you need to know how they voted. not how they said they voted.

if they voted to keep raising the debt ceiling, to keep compromising the future of our children and our grandchildren you need to throw them out of office. dr. carson: $18 trillion. think about what that means. if you try to pay that back in a rate of $10 million per day, it would take you over 5000 years. we are putting that on the backs of people coming behind us. this will be the first year that the national debt exceeds the gdp. economists will tell you that when the debt to gdp ratio reaches 90%, at that point economic slowdown is inevitable.

we have been doing this for a while now. from 1850 through 2000, our economy grew at a rate of 3.3%, at least, even during wars. from 2001 through 2014, it grew at a rate of 1.8%. that seems to be the new norm. you probably saw the headlines recently in the last quarter. it grew at like 0.2%. this is not good. i don't care how anybody tries to spin it. this is what happens when you have a gdp-debt ratio of 103%. this is what we have got to fix. we have got to fix it immediately. we cannot continue along that pathway. it will have dire consequences in the long run. i will be giving an in-depth economic speech in weeks and months to come with a lot of

details about things that have to be done. we need to fix it. we cannot just talk about it. how do we fix it? we have the most dynamic economic engine the world has ever known right here in america. we cannot work it when we wrap it in chains in fetters of regulations that come out all the time. it does not work when you have high taxation rates. which are absurd. we have the highest corporate tax rates in the world. and yet some of our officials sit there and wonder why people do work overseas. they obviously do not understand business. people do not go into business to support the government. they go into business to make money. dr. carson: we obviously have to create an environment that

is conducive to them making money. that means lowering the corporate tax rate, making it competitive. if we were really smart, we would do another big stimulus. you are saying, what? what did he just say? remember that big stimulus that we were supposed to have at the beginning of the obama administration? whatever happened to that? i know where we could get a big stimulus. there is $2 trillion of offshore money because they will not bring it back because it will be taxed at 35%. what if we give them a tax holiday and let them bring it back, repatriate that money? it won't cost us a dime. dr. carson: that is the kind of thing we have to start thinking about.

if you go to the financial advisor and you are in trouble they'll tell you there's a few -- they'll ask you four questions. what do you own? and what do you owe? well we owe a lot. it's not just the $1 trillion. -- $1 trillion. but what do we own? we own a lot also. i mean, just in terms of land and the mineral rights for it, we are probably at least $50 trillion. we own dams. we own levees. we own railroads. the government owns 900,000 buildings. 77,000 of which are being not utilized or underutilized. think about that. at the same time, the government is leasing over 500 million square feet from the private sector, using your taxpayer money. it is totally horrendous when you look under the hood. you just want to shut it back

down. dr. carson: it is that bad. i want to tell you what we are going to do. if god ordains that we end up in the white house. i will to you what we are going to do. we are going to change the government into something that looks more like a well-run business than a behemoth of inefficiency. dr. carson: when i say we, i am talking about our team. when i started this endeavor, i

am familiar with a man who has started over 30 companies, is extraordinarily successful. i asked him to put together the rest of the team in order to be able to do this. his name is terry giles. where are you? dr. carson: now that we are transitioning from, you know an exploratory committee, i have asked terry if he would take the lead in helping to select the people who will be able, who have had enormous experience with business and with making things work, so that we can transition our government from this inefficient thing that we have into something that really works and something that works

the way it is supposed to, according to our constitution. we have barry bennett. and we have our director of communications. who does wear a tie. and we have our treasurer and finance director.

i don't have a lot of experience busting budgets and doing the kind of things that have gotten us into all the trouble that we're in now. but do i have a lot of experience in solving problems. complex, surgical problems, that have never been done by anybody before. do i have experience -- [cheers and applause] do i have corporate board experience, 18 years where kellogg and 16 years with costco, as well as a biotech company. we do have experience starting a national nonprofit scholars

fund. nine out of 10 of those fail. ours is thriving and all 50 states -- is thrivinging in all 50 states and has won several national awards. so the point being that you can gain experience in other ways. it doesn't have to be just in politics. i can name a lot of people in politics who have been there all their lives and you wouldn't want them to polish your shoe. we need to be smart enough to think for ourselves, to listen for ourselves and in terms of a pedigree that thank we need and you know something, i have to tell you, everybody's been telling me, are you ready for this? they're going to come after you with everything under the sun. they're going to look through every record you have. they're going to try to say you're a horrible doctor. everything that you can possibly imagine. i know that. that's the way they are. i expect that. it's ok. don't worry. just listen to what's being

said. i'm not even asking everybody to vote for me. i'm just asking people to listen to what i'm saying and listen to what politicians are saying and make an intelligent decision based on your intellect. because the real pedigree that we need to help to heal this country, to revive this country someone who believes in our constitution and is willing to put it on the top shelf. [applause] someone who believes in their fellow man and loves this nation and is compassionate. somebody who believes in what we have learned since we were in kindergarten. and that is that we are one nation under god, indivisible,

with liberty and justice for all. god bless you and god bless the united states of america. [cheers and applause]

♪ [cheers and applause]