[captions copyright national cable satellite corp. 2016] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] campaign 2016 is taking you on the road to the white house to the iowa caucuses. at 7:00erage begins eastern on c-span and c-span2. we will take your phone calls, tweets, and texts. then we will take you to the republican congress on c-span and the democratic caucus on c-span2. join the conversation on c-span radio and www.c-span.org. more road to the white house coverage tomorrow. rick santorum with a town hall meeting in iowa. live coverage begins at 1:00 eastern on c-span. republican senator rand paul is holding a rally at drake

university at 4:00 eastern. paul take, senator your calls on c-span. and donald trump saying he will not attend the foxnews debate. instead, he is holding a campaign event in des moines with military veterans. we will have live coverage starting at 9:00 eastern. governor and dea officials testify about what they call the nation's heroin and prescription drug abuse epidemic. this meeting is three hours 10 minutes. senator grassley: the procedure will be that i'll make an opening statement. senator leahy will. and then we'll go to the order that we have established as you see people sitting at the table there. i'll introduce the senators and senator leahy will introduce the governor. america is experiencing an

historic epidemic of drug overdose deaths. over 47,000 died from overdoses in 2014. that's an all-time high. to put this in perspective, it's more deaths that resulted from either car crashes or gun violence. addiction to opioids, primarily prescription painkillers, and heroin, is driving this epidemic. it is destroying lives, families and the fabric of entire communities. it's something that i'm hearing about in iowa. of course, other parts of the country have been hit even harder. at today's hearing, the committee will learn more about this terrible epidemic, what's being done to address it and how congress can help. the committee looks forward to learning more about the comprehensive addiction and recovery act, which is the result of the leaderships of

senators whitehouse, portman, klobuchar, ayotte and over the last 20 years or so, doctors have prescribed opioids to help patients manage pain. for many, these medicines have been the answer to their prayers, but for others they have led to a nightmare, a nightmare of addiction. the new england journal of medicine estimated that over 10 million persons reported abusing prescription opioids at some point in 2014. the emergency room visits involving the misuse of the prescription opioids increased over 150% between 2004 and 2011. treatment admissions linked to them more than quadrupled between 2002, 10 years later, 2012.

the use of heroin has also spiked sharply. the national survey on drug use and health reports over 900,000 americans used heroin in 2014, nearly a 35% increase from the previous year. heroin deaths more than tripled between 2010 and 2014. in 2007, only 8% of state and local law enforcement officials across the country identified heroin as the greatest drug threat. now, this year -- last year that number rose to 38%, more than any other drug. according to numerous studies, prescription opioids addiction is a strong risk factor for heroin addiction.

in some cases, those addicted to painkillers turn to heroin to get a similar high because recently it's become cheaper and more easily available. now, very important question -- why has cheap heroin begun flooding into our communities? well, mexican cartels are expanding into territory because the administration hasn't secured the border. indeed, heroin seizures at the border have more than doubled since 2010. the senate caucus on international narcotics control, joined by our colleague senator ayotte, sought accountability for this alarming development at a hearing in november. so this is a complex crisis requiring a multifaceted solution. the first and most important part must be prevention to head off addiction before it can even begin.

prevention includes educating the public about the dangers of these substances, including through the important work of will anti-drug coalitions. it also includes educating doctors, taking a hard look at perverse incentives that may lead to overprescribing. for example, a few weeks ago, senator feinstein, ayotte and i wrote to h.h.s. to seek a progress report on a federal review exploring whether patient satisfaction surveys linked to higher medicare payments actually encourage doctors to prescribe opioids. many people who abuse prescription drugs get them from friends or relatives. so prevention always -- also involves support for initiatives that allows patients to safely dispose of old or unused medications.

so that brings me back to something i was involved in to have -- to help start these takeback programs by working with senators klobuchar and cornyn in 2010 to pass a secure and responsible drug disposal act. and i was pleased when d.e.a. acting administrator rosenberg voiced his support for them very recently. at the same time, it's concerning that this administration is muddling prevention efforts by sending mixed signals to young people about the danger of addiction to marijuana. the president has even excused smoking marijuana as just another bad habit, and the department of justice continues to decline enforcing our federal drug laws in this area. but young people don't need increasing access to another potential pathway to addiction.

according to c.d.c. report, a person who is addicted to marijuana is three times more likely to be addicted to heroin. another part of the solution needs to include better treatment options for those who become addicted. the use of medication assisted treatment appears to show promise, so along that line, overdose deaths may be reduced by the more widespread use of naloxin, a drug proven highly effective in reversing overdoses. and finally, law enforcement will play a very critical role. we can't arrest our way out of this epidemic, but we can continue to crack down on unlawful prescribing practices, enforce our border with mexico and target the violent cartels that are trafficking heroin in this country. so i get back to something else

a member of this committee and i have been involved in. senator feinstein and i introduced the transnational drug trafficking act of 2015. our bill would make it easier for the department of justice to prosecute cartels who harm our communities from abroad by trafficking heroin, other drugs and precursor chemicals, the ultimate delivery for -- for ultimate delivery here in the united states. in october, our bill passed the senate for the third straight congress by unanimous consent but hasn't found success in the house, so it's critical that the representatives finally pass this legislation which will help protect our communities from transnational drug trafficking threats. so i'm finished. i welcome our guests, and i'll introduce them. i now turn to senator leahy. senator leahy: well, thank you very much, mr. chairman.

i think you look around this committee, republicans and democrats, from representing all parts of the country, we know in our communities, whether they're urban or local, no matter what their size, they're grabbling with the tragic effects of the epidemic of heroin and prescription opioid abuse. we've all seen the statistics. i tell you one thing about the dramatic rise in overdose deaths, particularly among young people, but go behind the numbers, as i have, governor shumlin and our state has, eric miller, our u.s. attorney has. and behind the numbers you see the human impact of this epidemic. families trying to find the treatment for a loved one hooked on painkillers, children neglected or left behind by an

addicted parent, victims of crime fueled by addiction, law enforcement community officials overwhelmed by the flood of opioids and cheap heroin. my wife is a retired registered nurse. she and i sat around some of the kitchen tables in vermont, and our governor knows some of these locations. some of them are very affluent areas and some of them are very poor areas. but the stories we have heard from families and parents -- and we've gone there just ourselves. no press, nobody else. just wanted to talk to these people. we had a couple times we have driven away, we were both in tears what we heard. these are human stories. go way beyond the statistics. so it's not a question of whether there is an epidemic. the question is, what do we do about it? like many other states, we have

not been immune to the scourge in vermont, but in following what we normally do in vermont, we rallied together to tackle the problem head on to community-based and comprehensive strategies. that makes me proud to be a vermonter. in one city, in rutland they went to the mayor, strong republican, i might say, and they said, do we want to talk about this in our cities? and we said, we want to talk about it. and we had to keep changing the venue because more and more people wanted to come. we had city officials, their project vision, city officials, law enforcement, residents and we heard from all of them knowing that this is not just a law enforcement and it's not just a medical profession. we had the faith community, parents, educators, they're all in it together.

the boys and girls clubs throughout vermont are working with schools and public health officials to help children who are swept up by this. from all of my conversations with vermonters from law enforcement down through, we cannot arrest or jail our way out of this problem. we've lost the war on drugs because we relied primarily on unnecessarily harsh sentencing laws. we can't repeat these mistakes of the past. we have to work on the demand. we can close everything -- let's assume we can close everything coming from mexico. if we have demand in this country, it will come from somewhere else. so long as we have people who spend the money who want to buy the opioids, who want to buy the heroin, it will come here. i don't care which border we close, it will come here. so we've got to stop the demand.

we have to identify and support effective prevention treatment and recovery programs, and we can't just pay lip service to our communities. after the field hearing i convened in rutland, i asked for a new federal grant program for expanded treatment options of heroin and opioid abuse and help to get more funding for law enforcement to go after the drug traffickers. in vermont we've seen an 65% increase in the number of vermonters getting treatment for their addiction in the last couple years, and governor, i thank you for that. it's great progress, but we know on any given days, there are hundreds more that find themselves on waiting lists. other patients of rural corners of my state travel hours just to get their medication. so i see senator shaheen. i co-sponsored her supplemental appropriations bill to fund additional public health outreach and treatment and recovery and law enforcement efforts.

i'm proud to co-sponsor the comprehensive recovery act. the committee will report that bill soon. we can talk about it, we can have bills, we can have resolutions, let's spend the money. spend the money for things outside of -- let's not spend the money for things outside our country. we should spend money within our country. this is a great danger, and we should spend money on it. i will close and thank governor shumlin. he's been a national local leader on this issue. when a lot of people want to pretend we didn't have the problem, the governor gave in his state of the state address in the past -- instead of saying everything is great, as most do, he talked about this problem. that was his whole issue. boy, the reaction around our state and around the country was saying, it's about time. it's about time somebody speaks up. senator grassley, i thank you

for convening this hearing, but we have to find comprehensive and enduring solutions. the federal government will do its part to provide the resources to support it. that's important. but we have to act. we're not going to arrest our way out of this. everybody in law enforcement knows that. we're not going to do it simply by saying, let's close a source from one country because it will come from another country. we've got to attack and work and do all the comprehensive programs in the faith community, the educators, law enforcement, parents, medical facilities to stop the demand. until you stop the demand, we'll always have the problem. thank you. senator grassley: why don't you continue your introduction of the governor, if there's anything else you want to say at this point. senator leahy: go ahead. and i will introduce him. senator grassley: obviously when

you're introducing colleagues like i'm doing, you know an awful lot about them that ought to be said. you have to kind of keep -- senator leahy: can't do that. senator grassley: so -- but i can say all of them are extremely dedicated to fighting the opioid epidemic sweeping their communities, and i'm grateful that they're all interested in this and that they've been asking me to move along with this hearing and i think from initial discussions with members we believe both from a cost standpoint and from a substance standpoint we might be able to move ahead. at least i hope that's the outcome after i talk to all my members. our first witness is senator ayotte of new hampshire. she is co-author and original co-sponsor of this bill, s. 524, the comprehensive addiction and recovery act. she's a former prosecutor and

attorney general, was one of the leading voices in congress seeking solutions to opioid epidemic. our second witness, senator shaheen, also from new hampshire, she is also co-sponsor of kara and have been highly effective leader on the issue. new hampshire's fortunate, obviously, to have two senators working across the aisle on this very important crisis issue. next, senator rob portman from ohio co-author and lead republican sponsor of cara. he's worked in bringing awareness to this epidemic throughout the state and has long been a champion of the anti-drug initiative, including the drug-free community act, and also probably 20 years ago came to my state to help me with a nonprofit organization that i started in my state as well.

so our relationship on this issue goes back a long, long time. and now it's your opportunity on the governor. senator leahy: well, peter shumlin has served as governor of vermont since 2010. a small business owner, public servant, father of two from putney, vermont. two wonderful young women. he's a committed entrepreneur. he's a longtime code director, along with his brother, of putney student travel, national geographic student expeditions. your brother told me at the opening of the session, he's counting the days to get you back there in the company. the company sends students on educational programs and service projects across the globe. partner with several real estate companies to provide housing and commercial space. southeast vermont. i've known him forever, it seems. his public service began 30 years ago at the age of 24. he was elected to serve on the town select board.

in 1990, the governor appointed him to fill an empty seat in the vermont house of representatives. he served for three years. he served for eight years in the vermont senate. he was elected by his colleagues, republicans and democrats alike, to lead the senate as president pro term. he's the 81st governor of vermont and is a very close personal friend. senator grassley: thank you, all, very much. and we'll do it in the order that i introduced you. so it will be senator ayotte, senator shaheen, senator portman and then governor shumlin. go ahead, proceed. senator ayotte: thank you, chairman grassley, ranking member leahy, members of the committee. i am so pleased you are having this hearing today, because it's the most urgent public health and safety crisis facing my home state of new hampshire. and having served as the attorney general of our state, i can assure you i have never seen anything like this in terms of the epidemic that we are facing.

so the timing of this hearing could not be more important. i'm very honored to be here with my colleague, senator shaheen. in the fall we held a hearing, a field hearing of the homeland security committee and heard from people in new hampshire, but we also heard from director the office of national drug policy, who has been a strong partner with new hampshire. i appreciate the work we have done for our state. i'm very honored to be here with governor shumlin who has been a real leader in vermont, a neighbor of our state, and had an important keen work on this issue. i want to thank senator portman, has been a leader on the comprehensive addiction act. he has a long history with this because he started his anti-drug coalition in ohio. he's also led the effort when he was in the house of representatives to pass the

drug-free communities act, which spawned drug-free coalitions across the country, and now working with senators klobuchar and whitehouse, i was proud in september, 2014, to introduce the comprehensive addiction and recovery act. i want to thank the members of this committee who are sponsoring this act. certainly ranking member leahy, senator hatch. i know senators blumenthal and i also want to thank senator donnelly for the work we have done on legislation together on this important issue. today you will hear in the third panel from the police chief, nick willard from manchester, new hampshire. he'll talk about the epidemic facing our state, how we can address this together, both law enforcement working with those in prevention, treatment and recovery. and i had the privilege of doing a ride-along with the manchester police department and i also did one with the manchester fire department. i was there an hour and a half, we went to two heroin overdoses within an hour and a half. i can assure you, this is

hitting every family in some way in new hampshire. i watched our first responders bring people back to life with narcan. but for them being here and having this life-saving drug, they would have died. and it's just really struck me how devastating this is because one of the cases i went to, there was a baby in a crib in the corner. so when we think about this, this is not just the impact of those struggling with addiction. it's the impact on all of our quality of lives and, of course, on the future for our children. in new hampshire in 2014 we had 320 drug overdose deaths. that was a 60% increase from the year before. this year our chief medical examiner tells us that 385, 148 of those deaths are also attributed to a devastating drug called fentanyl which d.e.a.

tells us is 50 times more powerful than heroin and that's an issue which i believe needs to be addressed by this committee as well. solving this crisis requires a holistic approach and the comprehensive addiction and recovery act that so many members -- and i really appreciate the leadership on this committee on this act -- is critical i believe. we brought together over 120 stakeholder groups around the country to put this legislation together. those who are on the front line in every aspect. it has the endorsement of the national district of attorney -- attorneys association, the major county sheriff's association, the community anti-drug coalitions of america and the national associations of attorney general. i would note, by the way, my attorney general from new hampshire has endorsed it. the iowa attorney general has endorsed it. the vermont attorney general has endorsed it, and many of the attorney generals have said,

please pass this legislation. it focuses on a holistic opioid abuseanding and prevention and education efforts. the chairman is right, we've got to get into the schools. we got to get the prevention focused on opioids, prescription drugs and also heroin. expands the availability of narcan to first responders and law enforcement. supports additional resources to identify and treat incarcerated individuals so we can end the revolving doors in our prisons. expands drug take back efforts for safe disposal of unwanted prescription. strengthens prescription drug monitoring programs. and launches heroine intervention programs. and we can administer narcan and our first responders are doing we can administer narcan and our an t responders are doing

amazing job of bringing people back to life. get support and treatment for those struggling the addiction and deal with underlying issue, we're not going to solve this problem. you'll hear from chief willard today, we cannot arrest our way out of this problem. this is not just about statistics. real people dying, real people like courtney griffin from new hampshire who old and had such a promising life before her. people like the grandmother who told me the other day as she waited on me in the store, i grand daughter. we can make a difference in the senate and in this committee by passing the comprehensive addiction and recovery act, by working together to not only responders, irst but to make sure that we're focusing on prevention, make are that those who struggling with addiction that we get them support for recovery.and most of all, i want you to know that we can turn this around also heard the

redeeming stories. spaford who wasc ddicted to heroin and now has established treatment facilities in new hampshire and is turning this around. immediately.to act crisis.a i'm so glad you're holding this hearing today. i thank all of my colleagues who are working on this issue. i thank this committee for its forward toand i look working with you. thank you. thank you, senator. now senator chooe nooe. -- cheney. >> senator cheney: thank you for allowing me to testify this morning. i appreciate senator ayotte and all of you on the committee working on that legislation. testify on the two

opioid introduced, the and fundamental separations act. that's a mouthful. $600 million ate to combat y funding this crisis. the next is the heroin and act to reduce the hronic backlog of heroin and entinal cases at state crime labs. ayotted senator leahy and talked about the statistics that epidemic.is the fact is i believe we have a pandemic. old, urbang young and and rural, rich and poor, white minorities, and spreading to every state in this country including alaska and hawaii. we're losing re, more than a person a day to drug overdoses.

last year twice as many people lost to drug overdoses as traffic accidents. the mortality rates among middle are white americans increasing for the first time in decades rather than decreasing. primarily toibuted the rising substance abuse disorders. o, as senator leahy says those don't adequately describe the devastations to families who have lost loved ones and who are still struggling of trying to get treatment.into and the he statistics stories that senator ayotte eard in new hampshire and all of you hear in your home states, levels gencies at all lack the resources to mount an effective response to the heroin and opioid epidemic.

nationwide in 2013 nearly 9 out 10 people who needed drug treatment did not receive it. this is tragic and it's unacceptable. and we need to mobilize a national response. ou know, my legislation proposes $600 million. specifically it provides an dditional $200 million under the edward baerl grant fund to und state and local efforts including law enforcement, prosecutions, court programs, drug treatment and enforcement well as prevention and education. lest you think $600 million is remember last year, passed $5.4 billion in emergency funding to combat the ebola outbreak? only one person in the united states to ebola? in 2009, congress passed nearly $2 billion in emergency funding ust to fight a swine flu epidemic.

so we need better coordination resources and ie think you'll hear from chief willard, the challenges they're having in new hampshire. because they don't have the resources they need. i want to touch briefly on the epidemic act to combat drug labs across this country. crime labs across the country. this bill is modelled on what we did in 2005 to combat methamphetamines and what we're new hampshire and across this country is that tate police forensic laboratories have accumulated fentinol of heroin and they don't have the resources to do the testing. in new hampshire, the state forensic lab receives about will 50 testing requests each month but it can only process 450. nd the growing backlogs result

from an increase in heroin cases dramatic surge in fentinol cases. you an idea, senator ayotte touched on this. n new hampshire according to ur chief medical examiner, in 2013 we had 193 overdose deaths, 18 of those were fentinol-related. 2014, we had 326 overdose deaths, 145 of those were fentinol-related. and in 2015, we had 385 deaths in overdoses, 253 were fentinol-related. we have got to act with a sense delays in because processing drug samples have isrupted every stage of the policing and judicial processes. we're no longer able to identify designer drugs by sight, undercover law forced to wait to verify samples before

investigations, and prosecutors and judges are less deals to offer plea without lab confirmation of a drug's authenticity. backlogs are ese putting s from dangerous criminals and drug traffickers back in jail and getting them off of the streets. so, mr. chairman, there's lot of work that we eed to do to address this pandemic. i believe it's something working overcome.we can but it's going to take a multifaceted approach as you we have to act now before things get worse. thank you very much. >> thank you, senator shaheen. the members of the committee for having the us come to letting an talk about an issue we face single one of our

states, that's the epidemic of opioid abuse. we talked about the 524, it's a bipartisan bill that addresses head on and does so in a comprehensive way through prevention, treatment, and recovery. i had the privilege to work on with my colleague and who's on this committee. ayotte and senators clobechar. a ve been working on it for few years now. we brought people around the country to give us their best advice. this committee has done very good work already. about your aged earlier and about the ranking member's comments about the importance of moving this legislation forward. again, i thank you for that. appropriate the response to the growing epidemic. experts out nk the

in the field from every area, prevention all the way through recovery who have worked with us over the past few years in putting this together and articipating in a half a dozen forums we've had here in washington, d.c. where they've input.us their we've all been back home too getting input. i go in my home state of ohio, i hear the same story. fathers, from mothers, i hear heart-breaking stories ruining addiction is lives, tearing apart families, devastating communities. close idemic is striking to home. and i know you're hearing that too as you go home. 2,482 ohioans died of a drug overdose. to all uld demonstrate of us how difficult it is to break through this addiction, the bonds of addiction are so strong. recently i was in the hospital last week in cleveland, ohio at the amazing care

they're giving to addicted babies. to talk to some others. during theirto use pregnancy. that's how strong these bonds of addiction are. more, of course, are surviving these overdoses. struggling.still they're struggling to hold a struggling to take care of their families. addiction now costs this country $700 billion every year. that's lost productivity, it's more expensive health care, its's what's happening in our emergency rooms and all of our states. its's more crimes, it's the cost policing.eration, that's a lot of money. but, of course, this it doesn't tell the true costs in struggli lives. talked about that this morning. it's the cost in dreams that are never fulfilled. this hearing will be very effective in helping to bring awareness to the severity of the problem. and we've heard it already this morning. it's just as

important that we talk this morning about the reasons for hope, there are alternatives out there. ways to address. this there are ways to make this ss in combatting saved.ic and lives can be no one knows this better than senator grassley and senator leahy. they've been at this for a couple of decades. i worked with them back on prevention strategies that worked and we spawned more than 2,000 community coalitions together with the drug free communities act. we need to do more. we need to focus more not just

on the prevention and education but on dealing with treatment and recovery. i have seen some amazing people who lead programs in my state who actually work. i have visited with a lot of men and women who struggle with addiction and have the courage to seek treatment and get on the road to recovery. i've heard ohioans channel their grief into something constructive. story to help others avoid addiction or help others break the stigma of addiction. you're going to hear from one of those women here this morning. tonya deray, i first met last fall. she came here for the rally on the mall. and she told ion her story to me. one that breaks your heart. daughter, holly, was 21 years old when she died of a heroin overdose. to the outside world, holly didn't fit the stereotype of someone who was a heroin addict. she excelled in school. she had a lot of friends. she was selected for homecoming and prom court. she was building a life for herself. married.engaged to be and then on her 20th birthday, friends bration, some of hers said, why don't you try this?daughter, holly, was 21 years old when she died of a heroin overdose. to the outside world, holly didn't and they gave her some heroin. she thought she would experiment with it.

grips of t into the addiction addiction. would id as any mother do. helped her daughter get into treatment. rehab.ent to she gained a period of sobriety. but then the addiction took over. overdosed and she died. has taken that tragedy and used it in a constructive way to help others. holly's song of hope. he has 40 chapters, she tells me, around ohio and around the country. it's in the hopes that other daughters will not flow that path.r dangerous i commend her. there are so many others who have done the same thing. i've met in the state of ohio. last week i visited marion, ho bethany who struggled with heroin addiction. teenager, a d as a promising athlete. she was going to college.

scholarship, but she got sidetracked through her addiction. she was an expecting mom and shep used. and she says that tearfully now. she was arrested, law deal with tried to putting her in jail but finding alternatives. she finally figured out she had to beat her opiate addiction kids.e of her and she did it. detox was hard. recovery even harder. graduate fromn to marion county's family ependency treatment court and alternative sentencing program where they provide resources to abuse. with substance after five years, bethany leads coordinator to help other mothers in recovery. to the colleagues this morning, tells us of bethany there is hope in the face of this addiction. you've seen it in your states. we've seen it around the

country. people can break this grip of get into treatment and recovery. it's hard, they need our help. listening and learning from these families is what helped us inform our work on kara, every be way as sheldon whitehouse will tell you. from prevention efforts, to law strategy to supporting evidence-based treatment to supporting those in this is comprehensive. we need them all, not just one. committed to passing this bill and getting it signed into law because i truly believe it the ake a difference in lives that i represent and the families that you represent. once again want to thank the nine members of this committee who have co-sponsored this legislation. who are thank those willing to work on getting this the floorut and on to for a vote and again i'm this aged by what i heard morning. kara is an investment, it is an investment.

not inexpensive. but an investment at a time when communities are desperate for resources and expertise. practices that come to this legislation, it's a small effort for the future. empty know success by jail cells. by the number of people who never have to struggle with addiction in the first place, by the moms and dads who now can with reunited with their kids. simple today. there is something we can do to help. to those who struggle and think overcome, to those who believe there's never anyone out there to help them, you're with you. we are there is hope. and that hope can be furthered this committee leading the way by reporting out this legislation. thank you, mr. chairman. enator grassley: thank you, senator portman. now governor shaman. go ahead. governor shaman: thank you, mr. chairman. it's an honor to be here to share my story with you. friend o thank my

senator leahy inviting me down for this experience. my u.s. attorney here, eric miller. add to your i colleagues' extraordinary comments on this crisis, i have to tell you this, when governors give their state of the states or inaugural addresses, it's kind of a big deal for us. it.spend a lot of time on we lay out proposals that we think would make a difference. mistake this year of doing that and halfway through the speech acknowledging two of people on this earth -- senator leahy and his wonderful wife marcel. got the longest, biggest standing ovation of the speech needless to say, the press wrote senator leahy and marcel biggest ovation in speech. that's all vermonters heard of the state of the state. i won't make that mistake again. share i was going to

with you many of the heart breaking stories you heard from your colleagues in new hampshire ohio. so i won't. vermont has the same heart breaking stories. hen i dedicated the state of the state address to this subject, needless to say, it was pretty lonely place for vermont to be. there was a long debate about whether vermont really had that problem. and should the government spend this much time on this one. to tell you, gives me a lot of hope to hear from your see agues as well as to this committee focusing so intently on this challenge we're all facing together. knowing very is little about addiction. but i was just listening to like senator leahy has as he travelled around the state and the heart breaking stories. asking how do we get in this mess and what do we do to get out of it. started to talk to the addicts, to law enforcement, to

nurses, to prevention folks, i learned that we're doing almost everything wrong, almost everything wrong. why? criminal justice system was designed to do -- to maximize addicts going to prison going to treatment. just plain and simple. that the most likely chance that you have to move from denial and denial with this addiction is extraordinary. it makes denial for alcoholism adicks t -- addictions that we all face with our family and look small. but the most likely you're going opiate addict n to admit they have a problem and go to prison, the blue lights flashing, the handcuffs are on and they've bottomed out. vermont, weer with missing that opportunity every single time. it took four or five months getting charged and going before the judge to wind your wait through the court

system. by then, you're back using, abusing, back in the streets feed their habit. we changed that. we moved to what we call a rapid system where i literally fund for every state's state, but the state funds a assessor, a third-party assessor who every time there's a bust goes in and this a determination, is person someone we should be scared of? through the we go old system and end up most likely in jail. or is this someone who we should getting to treatment, moving back to a productive life? and all i can tell you is it's working. we're finding the vast majority of folks who are suffering from this disease won't hurt you. just hurt themselves. and we're moving them from recovery, to a spoke ensive hub and system. not that there aren't failures, and not that they don't have setbacks, but it moves them into

recovery. it's reduced our incarceration population dramatically. in the saved $50 million last several years not locking folks up, but instead getting programs e treatment and back into a productive life. as well as oneng might hope. second, we've expanded treatment like mad. times, we tough budget made tough choices but we're building out our treatment centers as fast as we can. that, too, is having a huge effect. our problem is that as we have the stigma, as you are right here in this hearing today, mr. chair, we have more and more folks who are willing to come forward and say, 've got the disease, i need help. and as we bill out the treatment centers, i know new hampshire is same challenge, we're literally finding longer and longer waiting lines because demand.more and more but we have to keep building out

treatment centers. help in building out those treatment centers. kits that yourue colleagues mentioned about the narcan is absolutely critical. e're the first one to get to state police hands, to law enforcement in every level of it cipal and county, to get to the hands of firefighters. we've saved hundreds and hundreds of lives. stuff.s expensive we need help saving lives. monitoringption drug program that senator shaheen mentioned she wants to build upon is critical. we had governors all over new working together to folks aree data where shopping for prescription drugs across state lines. so, without telling you more about what i think we're doing right and what's giving me hope, i want to mention a little bit what isn't giving me so much hope. listen, we need financial help. the states cannot do this alone. as an example, when senator

grant elped to get us a for $3 million, it seems like a small amount of money in washington, but it was huge for vermont. it gets it to the howard center, he regional center, the clinics, to help build out our treatment centers. e're scraping together pennies to try and make our treatment centers stand on their own. so financial help from washington is critical. encouraged by the bipartisan support here in the senate to help us get the financial resources that every state needs to fight this battle and to win it. money, huge. second, we have to look at in 's holding us back

treatment. in vermont, as we build our treatment centers, particularly true in small rural states where we have challenges getting primary care docs in the medical field to deal with the illnesses we're all facing with the medicaid and medicare underpayments to them and so in h, we do not treatment. in vermont, as we build our treatment centers, particularly rue have force to deal with the magnitude of treatment that is necessary to successfully win this crisis, to get treatment to folks who need it. we have to ask this question. this is a change i beg you to make. why is it that physician ssistants and nurse o -- tioners can prescribe oxycontin and other drugs that but to heroin addiction can't prescribe the treatment drugs to allow people to get off normal stuff and back to life. why is that? o i ask you to help us in expanding the force on the ground that will help us treat making it immediately possible for the nurse practitioners under the of physicians to be ble to prescribe the maintenance drugs that allow us

addiction.m i want to close by saying need ask this question -- why are we in this mess? what led us into this mess? why are all 50 statuses on basis saying we need help? this s everybody having problem. this disease knows no racial income es, it knows no boundaries. it knows no partisan boundaries. everybody is in. need to have a more honest discussion about what led us to this mess. instinct is to say, wow, those folks down in south america and other places are us lots of heroin and it's a huge problem. well, of course, it is. but i ask you, is that a new problem? as something changed dramatically in the last decade or so that's brought this heroin to america? would say no.

we've always had this problem of dealers trying to get -- support their countries and and everything else by sending the legal drugs to america. so then what did change? and i think an important for us an honest conversation about this. what changed was is that we americaour attitudes in and our practices in america in the late 1990s about how we deal with pain. why aren't we talking about that? this i can tell you. i have a lot of hope for where we're headed. i'm incredibly discouraged we have more people signing up for thane addiction in vermont we had when we launched this battle two years ago. well why? the facts matter. oxycontin,a approved the purdue several years later, he manufacturer of that drug, pleaded guilty to telling

physicians and docs that this addictive. wasn't they paid a $60 million or $70 million fine in the same year $11 billion worth of painkillers other were sold in america. matter. these facts enough we prescribed oxycontin in this country to keep every adult in america high for a month. we did, those are just facts. 2012, we prescribed 250 million prescriptions of oxycontin. only, the last time i checked, 250 million people in our country. a prescription for every living american. the fda w years ago, zohydro. on ll zohydro oxycontin steroids.

we're about to do this all over again, team. guess what? approved it, they didn't make it tamper resistant so you can snort it and you can shoot it. that's what led us into this mess. listen, this year, they approved oxycontin for kids. i mean, you cannot make this stuff up. us to pause, to take a and to ask this question, are we willing to have an honest conversation about the we're dealing with pain medication in america? because i can tell you that we do, all of the good we're trying to do together will lead to more tragedy, more loss of life, more dying sons and daughters of opiate addiction, because that is what has changed. what has changed is that we painkillers like candy in america. unwilling to have that

conversation. thank you. senator grassley: senator leahy? chairman, i y: mr. assume our senate colleagues leave.o i've seen the senate schedule, it's not the house schedule. pretty te schedule is busy. i ask that the senators be excused. for the a question governors. senator grassley: if you want to go, go. i don't have questions. can talk any time. i look forward to continued conversation on this legislation colleagues. you can stay if you want to. shumlin , ask governor your question. senator leahy: thank you, mr. chairman. talked , you and i have about this a lot. i appreciate your passion. would note for everybody here his is not just something that the governor says publicly. he talks about it a lot privately. and i think -- i think it's fair

o say that you feel the same way as i heard from police officers all over the state of vermont, it's not just a law enforcement problem. lot of them hink a certainly tell me both that the police, the state county, local police, they tell me if they can get people into treatment they'd much prefer doing that. is that the same thing you're hearing? shumlin: i have to say law enforcement has been a battle.in this not only in vermont but across the country. i was on a panel with the police gloucester, massachusetts who literally just policy.isten, here's my and now new hampshire and vermont law enforcement folks re doing exactly the same thing. if you're addicted to opiates, my station.

we won't arrest you. we'll get you to treatment and recovery. we're not arresting anymore folks who are addicted to this nonviolent. are and you know sometimes i think we don't give law enforcement enough credit of being on the front lines of this. years, we said to law enforcement as a nation, this is your problem, go settle it. id if i were law enforcement, would be a little raw about that. but instead, they've said, hey, with the partner medical community. we want to partner with physicians lks and and families to try to solve this problem as a disease, not a crime. them, we would not be where we are. leahy: we have to have a place they can bring these people. a we're going to have diversion program, i think we'd to havee, you then have the people -- governor shumlin: absolutely. literally scraping together the resources to pull this off. vermont and the senators of new iowa would say the

same thing, we're not there yet. we're doing the best we can with the resources we have. leahy: you were mentioning to me nurse practitioners. >> the attitude to nurses to do anything can't as a nurse unless you have a doctor looking over you. we have to change that. your suggestion, in rural america, we have to make a reater use to nurse practitioners. senator leahy: i'm somewhat partial to nurses. i have a daughter who was a nurse practitioner. in the order of durbin and whitehouse. >> no town too small, no suburb wealthy not to have heroin overdose deaths in the state of illinois. i want to thank governor shumlin. we need to something

point to. endorse every bit of the legislation. you go to the heart of our responsibility. the food and drug administration, the pharma industry, the dirty docs. e don't have to go to the border here to see the source of opioids. you go to the pain clinic in the mall. to the doctor, you know, just around the corner. you go to the pharmacist who looks the other way. clearly, i think we have responsibility here. making a fortune off of this. the seed effect and over the last 10 years we've decided to tackle pain directly. a lot of people it's the difference in the quality of life that we have to readily acknowledge. it has come a dramatic abuse. prescriptions he legally written prescriptions in a bottle ry result in every single adult

american. treat them with this drug for at least a month tells me it's out of control. congress, what are you doing about this? senate, what are you doing about this? fda dreaming up new applications for children and for super opioids? where in the heck is the congress in terms of our responsibility when it comes to this? and the second point i'd like to make is that police chief in gloucester ought to be here dixon, illinois where in the heck is the congress in terms of population 20,000 went to visit with him and decided after four overdose deaths in one weekend, they were going to buy into his program. kids came forward, young people came forward. they went to treatment. what happened to the jail it was empty. the etty crimes, burglaries, the thefts to sustain the habits started disappearing. here.'s a key element how did they get to treatment?

if they're lucky enough. have y're lucky enough to health insurance in their families, they have access. if they're lucky enough through affordable care act to have access to medicaid, they get to treatment. and we all know -- we don't have treat resources here to these people. we absolutely positively have to do it. i want to commend, too, we have our senators from minnesota here. it was senator wellstone and senator dominici, a bipartisan effort, that demanded and finally after years succeeded in bringing reform to health insurance so it now covers mental health counseling, it addiction services. those who want to repeal the affordable care act, put your you want to repeal that part of it. it would be disastrous across consider the e drug overdose and other things. thank you for turning the spotlight back on us. the things t all of we heard.

fda, pharma, we have to look at elicit oing on with the prescription and filling of prescriptions across america. that's our responsibility. thank you. >> cornyn, then whitehouse. >> i want to thank our colleagues for your presentation here today. a lot of our criminal justice policies. senator grassley passed out the bill. senator portman and others have worked on it a lot. look at this terrible pandemic as senator haheen called it, we look at this comprehensively. because i don't know if you can draw any artificial lines mental dealing with criminal ues in the

justice systems and drug issues. to our sheriffs that many of our sheriffs are there issues for which they self-medicate if they can't find places where they can get some help. also like to make a plea on my colleagues on behalf of somebody who represents the with 1200 miles of common border with mexico. demand is a big problem. governor, thank you for your powerful testimony. but we also need to deal with the supply issue as well. know, it's tough. well,riends in mexico say, we wouldn't have all of the drug artel activity and all of that if there wasn't such demand in the united states. so we do have to deal with both of those. this, hope as we look at we won't draw any artificial lines or create any stove pipes and we will try to find a way to deal with this in a broader, more deliberate sort of way. thank you.

senator grassley: senator whitehouse. senator whitehouse: i'll put my record so we he don't go to great length. ayotte is here, i them.d to thank senator klobuchar are thankful. they were joined by senators the proceeding. inthank them. i want to particularly thank hatch and senator graham who were the first two committee on the majority side. want to say how important they've been to getting us to this point in addition to the chairman himself who maid the call. thank you very much. whatever else i'll add to the record. senator grassley: senator klobuchar.en senator

tillis: thank you very much, senator ayotte. blue afterr carolina your patriots got eliminated. [ inaudible comment ] >> senator tillis: it's a great step. i look forward to seeing it move through the process. i have a question for you. speaker, nd of your i've known him for five years. been a speaker down in north carolina. the point that senator cornyn is making, and i do agree to a what senator o on,in said, but if we focus or example, the prescribed painkiller problem, then i think we're going to see an increased uptick in heroin abuse. i mean, it's obvious it's happening in north carolina. it's a matter of state policy. number of things to

crack down on drug shopping and the sorts of things that we were seeing in the state. and there's almost a direct correlation between a reduction those prescribed opioids and an increase in heroin abuse. policy, matter of state what are you all looking at? i'm also very struck by the fact states are great disparities between overdoses and deaths. i -- i was shocked to know that ours had gone up 480% over three but it's still a fraction of a state that's got 1.5 versus the state that has 10 million people. doing to address these specific issues and what isk do we run of a federal policy potentially hampering what you think and your speaker and your senate leader need to to address the things that are unique to some of these have that seem to disproportionate problems?

governor shumlin: that's a great question, senator. i can't tell you why some states are getting harder than others. i'm convinced of. i don't think we would have the heroin problem in america if we starting folks out on the es that are sold over drug counter stores. that our oincidence irrational exuberance around by the ers is matched rising heroin crisis. so i am convinced that if we policies on the old pain medicine, which is when someone is chronic pain, treat treat it hard. but don't pass this stuff out as if it's not a problem. is what we're doing. you know, i'll give you an example. can all tell these stories. the other day, i had a reporter and she had fice surgery for carpal tunnel. i said how many did you get? mean?aid what did you

i said how many oxies did you get? 80. said i said how many did you take? she said half of one. behind. 79 1/2 left later, my head of health care comes in -- his daughter comes by. a sophomore in college. she had four molars pulled out. i said did they give you painkillers? she said yeah. i said what did they give you? she said oxy. i said how many did you get? she said 40. i said how many did you take? she said none. so there's 40 more. and my point is, there's a soph. she had four molars pulled out. no id did they give you question that when we made it tamper resistant, folks went to the pure heroin because it's cheaper and it's easier to get. but, we cannot lose sight of the fact that we're not having this problem prior to the invention oxycontin. we weren't. the e've got to go back to source. i think the senator from illinois said eloquently,

listen, let's remember, this the fda approved it, the own advisory panel voted do not approve this drug. they did. so, my point is there is a folksation if you talk to who are addicts, which i've done, and many, many times, 89% me, i time, folks said to go it in a car accident, i had surgery, this happened to me. knee, whatever it was. that led me to this mess. grassley: senator shaheen wanted to add something? did.tor shaheen: i i think we talked about the fda. everybody talked about pharma role of prescription drugs. but we haven't talked about is medical schools and doctors. understanding that most medical schools don't have any courses on prescribing on recognizing drug abuse. and i want seems to me that we attention from

medical schools who are turning out doctors doing these without ng practices the history of what has been raised here at this hearing. shumlin: amen. senator grassley: senator ayotte? senator ayotte: i fully agree this.enator shaheen on we have to engage the medical community on this. in new hampshire, back when i as attorney general, i was fighting for prescription monitoring then. our state was late to the game on it. and we look at the data giving the physicians the information that they can have. that's one of the pieces of the kara bill to support the monitoring programs, the physicians who want to do the ight thing, it gives them the data to understand if someone is doctor shopping. it gives us the focus to know if doctor is actually exceeding his or her bounds because it's all focusing on them. addresshat allows us to that. we have to engage the medical community. you'll hear who

from said the work they've done people ly, 4 out of 5 started with overusing or misusing prescription drugs. with r point, chairman, your opening, we also now with the patient survey are based ging reimbursement on how satisfied people are with pain and that has to be addressed as well. that cms is looking at this. it has to be a priority. ecause we don't -- this was brought to our attention from doctors who are concerned that if they're worried about an they're being , judged on a survey that's saying how's your pain satisfaction? that has to be addressed as well. senator grassley: senator klobuchar.hen senator senator portman: i don't disagree. we have the drug monitoring incentiveized re tillis's point about mandating the state. every state will be a little

different. have done cutting edge work and they should be the laboratories of democracy on this. we're helping on the prescription monitoring program. including across state lines. a great ates we have program. in southern ohio, west virginia, and kentucky have different programs you. uh don't know if someone got a trigs filled in ohio without having better intrastate. that's something that the federal governor can do. we have legislation on that. takeback he drug program is incentiveized in this legislation. so we focus on getting some of drugs off of the shelves. which governor shumlin is right.ely the final thing is having talked to hundreds of people who are ecovering, who have been addicts because of prescription drugs, i understand that issue ery, very well including the athlete i talked about earlier. but i will also tell you there's to who people i talked jumped that step and went straight to heroin. holly is an example of that as we'll hear about later from her mom, tonda.

and i think now because heroin is so plentiful, i was just with yesterday ohio talking about this, the drug cartels from mexico are in ohio, illinois, they're in our states. because it's so plentiful, because it's so cheap. about prescription drugs anymore. it has been a gateway for a lot of people. there's a problem we dreirectly with first use. e worked on the issue of cocaine and marijuana. marijuana was not the first gateway drug. it after other gateway drugs. young as 13, 14, 15 years old, heroin.using this legislation is comprehensive. t deals with the prescription side but the harnisch shoe which we have to confront because of the overuse of pain medication. but now the heroin is upon us. senator grassley: senator

klobuchar? senator klobuchar: thank you, mr. chairman. get to ant to say -- this point about what we should really be looking at here. and what we have some control over in the congress. i'm a former prosecutor. i know that these drugs have coming in as you've stated, senator portman. number one thing we can do right now in addition to funding our law enforcement, making sure we have efforts with dea funded is go after what's happening with prescription drugs. that e while it is true there are people that originally get hooked on heroin, the facts ayotte facts as senator just said, 4 out of 5, 80%, the had, 4 out of 5i of these heroin users started with prescription drugs. governor has been telling us, what senator durbin has been telling us here is that different than it was when i started as a prosecutor in 1998. situation.different we have the these prescription drugs. has everyone in this room

had some in their cabinet, has their r knows someone in family where you just took one or two as the governor pointed ut and there's 20 left and 30 left. they're sitting in there. senator cornyn passed the takeback on drug planet years ago. we got the rules out of dea to get that moving. to solve it if it keeps happening over and over again. in this bill, senator ayotte and i did on the prescription drug monitoring. a state g come from here where we're not just the land of 10,000 lakes but 10,000 centers, the home of hazleton, betty ford, i know rom talking to the experts and doctors that we're not going change this until we change the way the painkillers are given out. doctor hy the monitoring, they're having more of -- dispension dispension of these kinds of drugs is going to make the biggest difference here. all in on trying to do everything we can to keep these angerous drugs out of our

towns. but the change here and what we have more control over is how we these people hooked on drugs in the first place. and sometimes there is such innocence. back and nove a bad one warns them that given their articular makeup if they take these drugs for four days instead of maybe just one day or maybe just one, they're actually get hooked. we are doing this in our country. our policy, not a drug dealer on the corner. so that's what i think we need to focus on. that's why i'm pleased with this bill. senator grassley: senator sessions? senator sessions: well, i think klobuchar is correct. an important point -- a reporter ith "the new york times" has written an on-line book says these heals delay healing. the pain peals. -- pain pills. the more you take, the more you problems. amount of reduce the prescription drugs out there. as a former prosecutor myself, we targeted prescription drugs

alabama, it can be the most successful reduction of is.s there because there are not many sources. certain doctors. we found the illegality was drugstores to drugstores. so when you eliminate that, you don't plea bargain with people tell you where they got their pills, you can pretty quickly go right back to the are out there. this is a winnable thing and it to additional drug use. thank you, mr. chairman. grassley: senator cohen. senator cohen:thank you, senator grassley. senator leahy. i hope people notice the striking bipartisanship. we heard from the members of the judiciary committee, the input we heard who worked so rs hard on this issue for a long time. like e state of delaware your state is also struggling with an opioid addiction

quickly to anslated a heroin epidemic that translated to every level of sighting and every background. i have stories i can share about our local law enforcement and paramedic first responder community. pleased to support the bill out the background for suspending and reporting ecovery and senator shaheen's suplemental. this is a genuine problem in all of our states. it's my hope that folks who are watching recognize you have republicans and democrats working together to craft a and htful, broad strategy it's my real hope we will get these bills moved, thank you, mr. chairman, thank you, members of the panel. senator grassley: we've had a forceful discussion. seldom do the colleagues get in to questions from their colleagues. all very much for your patience. i'm going to move on now to the second panel. to tellhat i don't have you that we'll be talking about this in the future. because you're going to make

sure we do. thank you. okay, the second panel -- while have commotion, i'm going to call the second panel. michael witness is botecelli, director of the national drug policy at the white house. heads the obama administration drug policy efforts and is responsible for reating the annual national drug control strategy. previously he served as director services, e abuse massachusetts. he has an undergraduate degree rom sienna college and a masters of education at st. lawrence university. second witness, the director of institute of drug abuse which supports most of the orld's research on health aspects of drug abuse addiction. previously she worked at the of energy's brookhaven national laboratory here she held several

leadership positions. she earned her medical degree at national university of mexico. a third witness, akana animoto, serves as the acting administrator substance abuse ental health services administration. that agency leads public health the ts to advance behavioral health in our country. samsa since d at 1988, earned a bachelor's degree and a master's degree in psychology from ucla. also a graduate of arvard kennedy school of government. louie al witness is melahone, deputy acisse about administrator. office of division and control within the drug enforcement administration. he's t position, responsible for overseeing and coordinating major and chemical

division investigations drafting promulgating regulations. dea in en with the capacities since 1987 and holds a b.a. from villanova rutgers.ty and j.d. we will go in the way we introo introduced us. you've appeared before our committee many times. thank you for returning. >> thank you for the opportunity to be here today to discuss the opioid drugs ding and fentinol in the united states and our response. is an important issue for president obama. during the state of the union this month, the president mentioned addressing prescription drug use and heroin as a priority and an opportunity to work with congress on a that transcends party, income level, gender, and race. want to thank many of the

members here today for their ongoing leadership and support or their work in our office on this pressing public health and public safety issue. drug control policy issues the drug control strategy. our role as federal drug control agencies, in 2011, the dministration released a plan to address the sharp rise in prescription opioid drug use. items ntains action categorized in four areas, many of them discussed today. prescribers and patients. increase in use of prescription programs.oring proper medication disposal, and law enforcement efforts. since this plan was released, crisis has clearly evolved. with an increase of heroin use fentinol use in overdose deaths and the administration new initiatives to help deal with emerging issues. have you know and indicated we need a comprehensive and multifaceted

in coordination with the federal, states, and local levels. terrific e taking a toll on public health and safety across the united states. e talked about the staggering numbers. i won't repeat them here. these numbers are harrowing, but progress in some addressing prescription drug misuse. nonmedical use of opioids by americans 12 and lower in 2014 than during the peak in 2009. number of people initiating the nonmedical use of prescription pain relievers in decreased ear significantly. by has been counteracted the increase and availability of though opioid in use far surpasses heroin use. purity has been rising while prices remain low. and it's been compounded by fentinol, a synthetic opioid to heroin to d

increase its potency or used on own. since that, there's an increased overdose death in the united states. although the transition from nonmedical prescription opioid occurs at a low rate, a recent article concluded be transition appears to part of the progression of the along with nonfrequent opioid use and dependents. e talked about the need for enhanced prescriber education programs because they do not focus on comprehensive identification and treatment of opioid voice or safe and prescribing.oid in one of the most jarring studies that i have seen in my work, rs in doing this our recent evaluation of health are claims data found that a majority of nonfatal opioid overdose victims were seeking an opioid from the prescriber at the time of their overdose and

91% of them g, received an opioid prescription again from a prescriber. from their own prescriber before an overdose. and in response, last year, issued a obama presidential memorandum federal agencies to the extent permitted by law to provide training on the appropriate and effective prescription of opioid medications for their staff who prescribed controlled substances. the administration continues to press and will continue to work pass mandatory prescriber education tied to substance lie censu censure. administration has focused n several key areas, including educating the public on overdose risk and interventions, party and first responder access. promote with states to good samaritan laws and connecting overdose persons and

an opioid es with treatment. we appreciate that congress provided more than $400 million the fy-16 in appropriation act to to address emerging rise in heroin use, our strategy focuses on identifying, disrupting and dismantling criminal organization who is traffic in opioid drugs, working with the international community to reduce the cultivation of poppy, identifying labs creating dangerous opioids. and we have also been enhancing our efforts along the nation's borders and have been actively engaged with government of mexico on supply reduction issues to decrease the flow of these drugs in our country. finally, this past summer ondcp committed $2.5 million to our high intensity drug trafficking area program to develop a strategy to respond to the heroin epidemic providing resources, enforce resources to address heroin threats across 15 states and the district of columbia. this administration continues to

work with our federal, state, and local tribal partners and reduce the public health burden and consequences of prescription opioid, heroin, and fentanyl and i thank you for your commitment to address this public health concern. senator grassley: now dr. volkow. push the red button. dr. volkow: good morning, everyone. i want to thank you-all for giving me the opportunity to participate in this hearing. what is the nature of the problem? chronic pain is among the most prevalent and debilitating medical conditions with over 30% of americans suffering from some form of chronic pain. the effectiveness for severe acute pain and the limited alternatives for chronic pain have combined to produce an overreliance on opioid pain medications even when the benefits for chronic pain are questionable. what is no longer questionable,

is opioid medications have been diverted. opioid medications such as oxycontin are diverted and abused because just like heroin they bind to opioid receptors. opioid receptors are located in regions of the brain that regulate pain which is why they are so potent. but they are concentrated also in brain required regions which is also why they produce addiction. opioid receptors are also located in brain regions that control breathing, which is also why they can produce overdose and death. so how -- nida supported the development of the three medications that are currently approved for the vehement of

opioid addiction, methadone and others. there is strong evidence for the effectiveness of these in the treatment of opioid disorder in the prevention of overdoses, in the prevention of infections such as h.i.v., and improving the object stet trick and neonatal outcomes of opioid addicted pregnant women. despite the strong evidence, less than 40% of those being treated for opioid addiction receive these medications. thus, expanding the access to medications for addiction is a critical part of the h.h.s. strategy. towards this end neither funds research to develop implementation strategies for the use of medications in substance abuse treatment programs in the health care system and in criminal justice settings. examples include initiating the

emergency room and integrating the management of medications, of these medications with an infectious disease clinic. examples in the criminal justice setting include drugs prior to the release, once a month injection that blocks the action of heroin or other opioid drugs. thus interfering with relapse and death from overdose. nydia also funds rich to develop treatment that will improve clines that requires dosing every six months or new transformative solutions such as the development of the heroin vaccine. as a component of this strategy section spanning the use of nyloxin.

a medication that can rapidly reverse an opioid overdose. do this end nida has funded the development of medication that is do not require injection thus making them easier to use for those that have no medical training. one of these products, was just approved by the f.d.a. last year. finally, since the limited treatment alternatives for the management of severe chronic pain has led to the overreliance on opioid medication, nida also funds development of better and safer treatments for chronic pain, including others that are less addictive pain medications not relying on the opioid system, and nonmedication interventions. the epidemic of opioid prescription abuse and rising heroin abuse resulted both from

a lack of knowledge of health care providers and the management of pain, including appropriate use of opioid medications, as well as the lack of knowledge around identification and management of addition. thus, a fundamental component to reverse this epidemic requires the education of health care providers both in management of pain and in substance disorders. to help address this nida in partnership with n.i.h. institute has created centers of excellence for the development of education curriculum for pain and substance abuse disorders. the urgency to address this epidemic is highlighted by the nearly 30,000 deaths from opioid overdose that occurred in 2014. the highest ever reported. solutions are already available. the challenge is their implementation. nida will continue to work closely with other federal agencies, community organizations, and private industries to address this complex challenges. >> thank you for inviting me

here today. it's a great honor to talk with you about the real sense of advancing the nation's behavioral health and what we are doing to address the crisis. i want to thank the first panel. for providing great leadership. i know this crisis has had devastating consequences in all of your states, but i agree with you, mr. sessions, this is a winnable battle. you are already heard we are facing a treatment gap of unacceptable proportions. we will not stem the rising tide of this public health crisis if only two out of 10 people get the treatment they need. it wouldn't work for diabetes. it wouldn't work for h.i.v. and it will not work for addiction. but like many other issues we face, closing achievement gap will be a complex effort requiring a multifaceted approach of the the federal

government needs to work with preventionists, payers, treatment systems, public health official, states, tribes, law enforcement community organizations, and the recovery community in order to tackle the challenges ahead. as you have heard, addressing substance abuse disorders related to prescription opioids and others are key priorities for this administration and samsa is proud to support the president's national drug control strategy and secretary burwell's opioid initiative. the goal of the initiative is to reduce -- changing prescribing behavior. two, increasing access to nyloxin. today i'll focus specifically often samsa's role in each of these areas. with respect to prescribing behavior, it's an obvious tactic to prevent prescription opioid misuse by reducing the numbers of people's medicine cabinets. to do that, physicians and other providers need to be better educated on proper describing and dispensing opioids. to manage chronic pain and treat addiction.

we understand that the vast majority of physicians and other prescribers are not bad actors. most are dedicated, well trained professionals who are committed to their patient's good health, but they are very busy. and it's hard to find time for elective training. training that's not required. since 2007, samsa's provided clinical support system for opioid therapies has provided continuing education to over 72,000 primary care physicians, dentists, and other health care professionals. that is tremendous progress, but we have a long way to go. samsa's also addressing the issue of prescribing practices through grants to increase interoperability and in f.y. 2016 with congress' support of the new grant program, samsa will support states, tribes, and territories to utilize pdnp's to provide communities with the greatest need for prescription drug prevention programming. samsa also reaches local communities to prevent substance misuse and abuse to the drug free community grants we administer. these coalitions do yeoman's work to create university

environments that promote health and prevent drug use drug the misuse of prescription drugs, heroin, and fentanyl. the secretary aim sin creasing access to naloxone. it can reverse a potential overdose but only works if you got it when you need it. samsa offers an overdose prevention course for prescribers and pharmacists. one strategy to ensure it is nearby when needed is to co-prescribe the product with opioid analgesics, particularly for patients with high risk of overdose. another resource it our opioid overdose tool kit. it is the most downloaded publication on our website. samsa will release a funding announcement and training to first responders. imagine the lives we'll save. the third aim is expanding the use of medication assisted treatment. there are many pathways to recovery and it is critical to ensure each individual has access to the full continuum of evidence-based services,

research tells us that medications along with behavioral health treatment and supports are important components of an evidence-based treatment plan. however it remains significantly underutilized. today there are only a few f.d.a. medications. that's why we are so grateful that in f.y. 2015 and 2016 congress provided new funding for states to expand treatment capacity both through increases to the substance abuse prevention and treatment block grant and discretionary funding specifically for a.m.t. samsa also worked with d.o.j. and others to clarify and enhance the connection between m.a.t. and the criminal justice system. through a drug court grant program. drug courts are the most successful criminal response to addiction in history. supporting lifelong recovery. reuniting families. reducing crime. saving tax dollars. and serving as the foundation of crimes in a justice reform in the states this.

year we'll prioritize treatment that's less susceptible to abuse expand assistance to ensure it's fully implemented. as the secretary announced in september last year, h.h.s. has initiated the rule making process to increase the cap on the number of patients to whom physicians may prescribe. because we are in the middle of rule making i look forward to coming back to talk to you. it wouldn't be a hearing about behavioral health if we didn't talk about the work force. we are expected to expand coverage to 60 million people. we must act swiftly to make sure we meet the demand. the work force including prescribing and nonprescribing professionals. psychologists, counselors, therapists, and pearce both youth and adult and others. we are grateful for the administration's and congress' support of samsa in this crucial area. members of the committee, thank you for convening this important hearing.

you know all too well that substance use disorders come at great cost to society. the impact of untreated or undertreated behavioral conditions on the labor market, the criminal justice system, schools, and communities is tremendous but above all the impact is greatest on individuals and families. samsa's budget accounts for just over 10% of what the nation spends on substance abuse treatment annually. we are small but mighty. we are steadfastly committed to using our investment strategically, responsibly, and effectively to deliver the greatest possible impact for the american people. thank you very much. senator grassley: thank you. >> thank you, chairman grassley, ranking member leahy, senators. it's an honor to appear before you today. d.e.a. views the combined prescription opioid and heroin abuse epidemic as the number one drug threat facing our country. i appreciate coming before you

to talk about what we are doing to address the threat. we understand we need a balanced approach to this yep. our efforts are designed to ensure patient access to the medications while at the same time preventing the diversion of these highly addictive dangerous drugs. we stand with our interagency partners, including those represented here today. and embrace comprehensive prevention, treatment, and education efforts as critical to our success. however, we need to investigate and bring to justice not those suffering from opioid use disorder, but those exploiting human frailty for profit. our answer to this drug threat attack supply, reduce demand, and power communities. d.e.a.'s 360 strategy. there are three prongs to it. law enforcement, divergent control, community outreach. my initial comments today focus primarily on the office of diversion control role in that strategy, but we would be more

than happy to follow up on rolling thunder. it's the heroin enforcement prong of the strategy that focuses on the stocksic business relationship between the mexican cartels flooding our country with heroin anti-distribute cells slinging that dope in our communities. the vast majority of those 1.6 million registrants are law-abiding citizens. these are practitioners, pharmacist, manufacturers, distributors spread across this country. we investigate the very small percentages that are operating outside the law that yet inflict considerable harm on our country. for example, practitioners not prescribing for legitimate medical purpose outside the usual course of professional practice. pharmacists not performing the responsibility to ensure a prescription is valid. manufacturers and distributors

not upholding the regulatory obligation to prevent diversion. how do we do it? with our tactical diversion squads and groups. our tactical diversion squads are specialized units made up of agents, diversion investigators, and intel analyses, we have 69 deployed nationally. we are in the process of creating two mobile tactical diversion squads that give us the ability to deploy where the need is. giving us a fluid enforcement capability. we have more than 600 skilled diversion investigators spread across this country in our diversion groups, both the tactical diversion squads and groups work with the respective u.s. attorneys' offices to bring criminal and/or civil charges and where appropriate administrative actions. our order is to show causes are immediate suspension orders, potentially revoking a d.e.a. registrant's registration. in the last two years d.e.a. diversion has conducted more than 300 events, providing

education and guidance to thousands of d.e.a. registrants and others. in the coming weeks i'll be meeting with industry leaders to discuss areas of mutual concern. increased dialogue and appropriate collaboration with industry are crucial to our collective efforts. finally, we will continue engaging with our interagency partners on these important initiatives we discussed earlier today. expanding access to treatment, mandatory prescriber education, and the safe and responsible disposal of unwanted, unused prescription drugs. we look forward today that drop boxes are so common in pharmacist and elsewhere, that people can dispose of their unwanted drugs conveniently, frequently, and safely. ensuring that those pills don't get in the wrong hands and start someone down the journey toward opioid use distoward. we'll continue our takeback initiative with national events approximately every six months. during our september 26, 2015

take back, we collected 741 tons of unwanted, unused, drugs from 5,202 collection sites. our next one is scheduled for april 30, 2016. the d.e.a. stands with our interagency partners, embraces a balanced approach that attacks the supply, reduces demand, and empowers communities. for almost 20 years i had the privilege of working with the brave men and women of the d.e.a. along with our federal, state, local, and foreign counterparts investigating some of the most entrenched, domestic, and threatening our country. this current prescription opioid and heroin epidemic is unlike anything i have seen. i know statistics have been mentioned, but in the last four years more than 100,000 americans have died, overdosed and died. this is an unimaginable tragedy.

we at the d.e.a. will do whatever it takes to engage in this fight. i thank you for the opportunity to appear before you and look forward to answering any questions you have. senator grassley: assuming it's just those of us that are here it will be in this or. i'll speak then senator durbin, then senator sessions, then senator klobuchar unless senator tillis comes back. i'm going to start out with director botticelli. i refer to the final report of your office and d.o.j. co-chair and the national heroin task force. there are a loft good ideas in there to attack this epidemic from many different directions. but the task force mission statement included among other things creating a framework for efforts to quote-unquote, restrict heroin supply. on this point i have some

questions because i think there's a fault in not enough attention. it didn't mention heroin that's been trafficked into this country by mexican drug cartels. they don't mention that heroin seizures at the border have more than doubled since 2010. they don't even mention that the few weeks before the report was released your office announced that mexican heroin production jumped an incredible 62% from 13 to 14 years. my question -- how can it be that the national heroin task force didn't even acknowledge these dramatic developments related to the supply part of the heroin problem let alone suggest specific solutions to address it? before you answer that, isn't it at least part of the answer to this epidemic securing the

border from mexican cartels? what can we do about that part of the problem? dr. botticelli: i agree with many of the comments here today that focusing on supply reduction has to be part of our comprehensive response. we know part of what we are seeing in the united states is a tremendous increase in very cheap, very pure heroin in many part of the country where we haven't seen it before. as well as an increase in fentanyl. the task force, senator, focused exclusively on what we can do domestically as it relates to both public health and law enforcement. but part of our national drug control strategy, part of our work in general around this issue, has been to focus on one, how can we work with the government of mexico to look at things like enhanced eradication, to look at taking down heroin labs, finding other labs, taking them down. we also in october i formed a national heroin coordination

group that's been working in concert with the national security council to look at what additional actions we can take, including those at the border and in other parts of the country, to reduce the flow of heroin into the united states. it has to be part of our comprehensive response to do that. i would agree that we have to focus on our supply reduction efforts as we look at things like prevention treatment and recovery, because we know that that is part of what is really fueling the heroin and particularly the overdose that is we have seen with fentanyl in the united states. senator grassley: i hear you say you are dealing with t i respect that. but it seems to me where you have a central document like the report is, that this aspect of it should have been mentioned. it seems to me that it could be a problem with the administration avoiding at all costs and facing this issue squarely.

i'll go to dr. volkow. the relationship between the prescription painkiller crisis and the heroin crisis has been the subject of some specific study and debate. you touch on this in your testimony. we have heard a lot of discussion about this very day. the heart of the question is, to what extent the heroin crisis is attributable to the overprescription of painkillers and subsequent efforts to reduce diversion that may have led some users to cross over to heroin as opposed to other factors such as the rapid increase in heroin supply over the last few years? so, question, clearly it's not an either/or situation, but

could you tell us more about what the studies tell us about how much we should attribute to the heroin crisis to our experience over the last 20 years with prescription opioids? dr. volkow: it's not an either/or. what happened was a dramatic increase in the number prescriptions that led people to become addicted to them. in parallel there was an increase in the entry of heroin. and the resultant increase in heroin abuse by people addicted to prescriptions and started to use heroin because it was more available. indeed, however, as. so opioid medications became more difficult to divert, some individuals transitioned to heroin because of that. but we address the problem, the source of the heroin epidemic that we have, is the addiction to prescription opioids. if we want to address it, we need to address the abuse and diversion of prescription opioids. it's the source. it's the origin of the heroin epidemic. senator grassley: a couple other questions i had were answered in

your testimony. i go to senator durbin. senator durbin: we were just talking, members of my staff, i was trying to remember a 72-hour period in chicago last year, i know there were 74 heroin overdoses or deaths, could have been deaths. it was horrendous. when it came in to the supply there. as i mentioned earlier, i traveled around my state, it isn't a chicago problem. it's an american problem, sadly. in every town, large and small. that we get into. when i went to dixon, illinois, population 20,000, inspired by the chief of police to have people step up and admission their addiction. they weren't arrested. they were taken to treatment. petty crime in the community disappeared. virtually disappeared as a result. they were saying knee, what are you going to do about treatment?

now that they have stepped up, now -- it's an hour and a half drive from dixon, illinois, to the closest treatment facility. if the person who is a user happens to have the good fortune of someone who will pay for it, health insurance plan, medicaid plan, whatever it might be. talk to me for a moment about the treatment side of this. it strikes me that we need to dramatically increase our commitment to mental health counseling and addiction services. i'll just add parenthetically, the fact that this is no longer an inner city minority problem but an american problem, predominantly a white american problem, i think creates a political force that might see us to the right conclusion. i welcome your comments. anyone who would like to speak to it. >> i would echo the sentiment of many people here we have seen law enforcement step to the table in a dramatic way and acknowledging we can't arrest our way out of the problem.

director botticelli: we have law enforcement agencies across the country administering lockdown, when you her r hear about them reversing people's lives it's amazing. we have seen nationally where police are not only saving people's lives but accelerating and i think we need not frustrate them by a look of -- lack of treatment availability. we should capitalize on their good will. despite i think all of the things that we have done collaboratively to expand treatment, even president obama in west virginia acknowledged the fact we probably have a significant treatment gap here, administrator enomoto talked about only 20% of people get treatment in the united states. that's abysmal. we wouldn't accept that with any other disease. the last thing i'll say is -- we also have to combine that with an increase in the work force. we can put money out to expand treatment. we need more physicians who are able to prescribe these medications. we'd love to work with congress on expanding who can prescribe those, including physician assistants and nurse practitioners. senator durbin: i endorsed this.

i have a measure with senator markey to allow physicians to dramatically expand their caseload. there are so few willing to take on these cases. that is a temporary answer. the real answer is to bring in the professionals who in the proper numbers to deal with this epidemic that we are facing. director botticelli: what we have seen is the speanings into the rural parts of the united states like the governor talked about. we have to focus on those strategies that gets some of those resource, some of those folks in rural parts of the country that don't have a dedicate the treatment. senator durbin: going back to the earlier observation about dirty doctors who are prescribing pain clinics that end up being on the street and sold into commerce here, tell me

if you can, do i know which one of you wants to. what are we doing working with the medical societies and medical professionals? they are the gate keepers for these prescriptions. senator sessions talks about a couple drug stores a couple drug stores and dozen dirty docs now you have a city that's under siege. what are we doing tone courage the profession to clean itself up and police the ranks for those abusing it so that they are held accountable in a public way? dr. volkow: i would state fundamental problem in all of this issue if you think about 750 million prescriptions annually in the united states which leads to an enormous amount of diversion. and 741 one pick up and take back day, we are overprescribing medications.

it's not just drug doctors which are very few, but the practice that is we have in order to treat pain in this country that are the main source of the prescription opioids being diverted and leading to it leads to addiction and overdose. conversation? a thing we did was work with the medical society to get a onmitment with physicians opioid prescribing.

. issues is training with prescription of opioids. direct conflict. the national institutes of health coordinated nurses, properies, for the prescription of opioids. the development of guidelines. important and senator durbin is correct on many points. they come in and complain about

checked they have computer system and other doctors. do you agree that this could be helpful and provide doctors with the opportunity to not over-strive? >> there could be prescription drug monitoring programs on the line and there are the prescriptions they are getting in many a crime part states where they use the database. dea has great power, it seems to me.

you can monitor the prescriptions. can you not? programs and state we support those. with you have information youextraordinary amounts, do not need the search warrant. you can just ask for the records and the drugstore can examine the records. is that correct? >> that is correct. information that leads to the investigation. community, we had some doctors and pharmacists and the simple deal was the dea and a

police chief signed a memorandum and nobody had a plea bargain until they knew where it came from and they came back from a limited number of sources and the problem was virtually ifminated for a while and somebody goes to jail, it sends a message to others. >> certainly does. >> looking at the new report from the new england a couple of they concluded no consistent evidence with implementation of policy leading to prescription opioid increasing heroin use. the data is sparse.

includingket forces, increased accessibility, reduced crime, and higher purity of heroin seems to be the leader of increase in use. do you agree with this? >> we are focused on the prescription. >> it is not yes or no. >> it is. you set policy. you are what they used to call drug czar.re -- do you believe this is the recent increase -- responsible for the recent increase? >> we have what we are hearing about reduced availability driving to heroin and some have said --

>> i am sure that some do. i do not dispute. >> i actually agree that the availability is in the untreated the increased heroin use. and i will say this in the 1970's. 17 harrowing cases. and it was coming from turkey. carter was aggressive and i give him credit. we went several years before seeing heroin supplies.

it is important. we can impact supplies. is purity on the street dangerous and the prosecutions are dangerous and people need to go to jail who are pushing this addictive power and destroying lives and families. important and i thank you. we can do better with the prescription drugs and the medicare bills with the insurance rates higher because of overdoses and the prescription drugs. it is important. thank you for the leadership. >> thank you. i appreciate you holding the hearing on the issue had the comprehensive recovery act

provides support around it. thank you for being here and congratulations on the terrific 60 minutes appearance. i was slipping through the channels and you were there. i have another piece of bipartisan legislation and i will not be here when ms. hurley testifies. , who has beeney dealing with the problem for years and will bring perspective. and, of course, tom. i do want to ask unanimous consent that the letters for the national associations for the us ernie general -- the attorney general and the organizations

that are active in this area be admitted into the record. -- without objection, they will be included. assume thati everyone on the panel supports the act. if you can confirm that, i would appreciate that. >> looking at dimensional aspects of this that are important, we know that we need to do more than that all of the components in the bill are making headway with the epidemic. >> yes. agreed. >> your microphone is not on. excited to implement

this and congress appropriated these in 2015 and there was another increase that was very similar to those programs described. thank you for your leadership on the issue and the continued leadership on the issue. we believe the public approach is vitally important to moving forward on the issue. you.n we work with >> thank you very much. >> thank you. thank you all for being here. i want to go back and say that i am happy to say that we have a growing consensus around doing what we need to to address the

problems with prescriptions and the heroin problems. said something that was intriguing to me and it vaccine.ential the reason i mentioned this was oft it was ironically a part the solution to the problems that were being prescribed that relied on these very communities to come up with solutions and treatments to solve the problems. as we are to fix the problems and make sure they are expressed , we have to make sure we do not rely on the community. policy will not

be balance. sometimes, we demonize people who are part of the solutions. is that i met with the outgoing commander and he was talking about how frustrated he was. we know where these people are and when they get up in the morning. and we really have not withnized the death toll hundreds dying as a result. thoughts of the drugs flowing into the country?

drugs that are border and thehe theination is across border? >> i could not give a percentage. you obviously have some from columbia and south america. the mexicans took over a great deal of that. agree that part of the spent onis more time the border of mexico with a collaboration to provide interdiction money and it may be a supply chain. and theeaders astribution sales, we have

foreign counterpart in mexico and elsewhere and we work side-by-side with those cases in the entire network. >> how would you care to rise the efforts? >> we have a great partnership in mexico. >> thank you. thank you to the witnesses here. i want to start with my opening statements here with senator the drug disposal act that took a long time. and ite finally done makes it easier for some of the places and other

what we would like to see is the pharmacies doing this. and wes it widespread have been ahead of the curve on this and i think it would be much easier. ?hat do you think we could do >> it is a concern for us and we went ahead to work with agency partners to find private industry. inil that point, it would be drop boxes all over. to educate and we will engage in any effort to expand the dropbox. regulation, we thought we

would see better take-up of this. andre seeing what we can do other possibilities. >> it took two years to pass the rules,d, if we need more we have more people addicted and dying. if that is what people say they regulations,ceful we should do that. if that is not what they need and they can just do it, they should. recordwant to put on the testimony from a leading treatment center. >> without objection. or --lking to dr. marv

marvin about a need to mandate a drug monitoring program and you noted that a number of states had elected to do this and we introduce this as part of the bill. can you talk about the state different?ing >> a thing we have done is physicians and we have looked at drug monitoring programs. we are also looking at how we accelerate the use to diminish and the interstate operability. i think that we have seen good

programs and low utilization. >> are you saying that we need to make it more mandatory? more and more are getting addicted and dying. good successing with the use of the programs and withmatic decrease prescribers accessing the into -- the information. >> it does not appear to be working. get moreg until we uptake on the programs is not fast enough. issueissue is the core with the governor of vermont and making easier out there to get approved. what do you think needs to be done? do we need to change the

standards they used to take better consideration of the risk ? >> my take on this, quite honestly, is that this is not just about the medication and it how the drugs are prescribed. >> and the amount they are can not about how many medications. i'm sure the number one thing mandatoryo make this for the physicians to have more limits so they can limit how they prescribed. >> thank you.

i'm sorry i was not here for the testimony and i had other meetings. the office did not get it until we werethis morning and talking about prescribing and mentioned. medical school and nursing school have been something i have heard about four decades and it does not seem to get better. we have had convictions. why don't we have mandatory doctors ors to

medical students with information about what addiction is. because we do not have it and we should have it at nursing school have theseld monitoring programs being youatory and any time prescribed the opioid, we should know where the serious problem is. does anybody have a strong view on medical school and what addiction is? investigatorseral challengesthe big are not that they

prepared with more questions. we have been working for questions with medical exams because this incentive i is this and a strategy that is in approximately animalses more hours in then in humans. send -- spent five times as much time? andhey get more training the amount of time you spend

screening -- >> that is crazy. you look at the data and addiction has other health components. into of what people come the doctor's office with is the result of an addiction. if the doctor understood, this is not just about overdose. this is about other diseases and vexingng that has been me for a long time. >> we talked about this affecting the rural white people affecting the american indian population. them are native

american and native americans addicted to% opioids. we need to address that and we have seen some good things that have reduced the number of anddren born in withdrawal i was wondering if there was a strategy to close the gap between the need in rural communities and the available resources and it brings me to ,he other question that i have which is how we europe treatment addictione with getting treated. is children and

women with different sources. one of them is women who are is 18%-20 4% and we get into the last semester and it increases the likelihood with andr women linked to heroin , if they are not properly treated, there is a severe case. thedifference is that medical community needs to have a consensus and you should only get it on unique situations. the second one is methadone patients who are addicted to heroin and the outcome.

thed, what is important is importance of training physicians to recognize the risk and intervening. if you do not, the newborn dies. >> thank you for the hearing and like to thank my colleagues for the active engagement. and i was pleased to see the county added to the high-intensity drug trafficking i recognize the real challenges with the increase

frequency and heroin addiction. fundingeived additional wardrobe policy analysts in pennsylvania and delaware and i would be interested to hear how you think these are working and how you see the larger strategy adding additional law enforcement personnel and how to tackle the challenge. that havinge resources in trafficking areas is important and we are grateful to have those. of aeds to be part for publicd also

health coordinators to diminish ae supply and to have response to do that. briefing on a response strategy and would be happy to provide you with the update of where they are and how focus withntinue to the aspects. thatwelcome and appreciate andthink that we need this i think we need a comprehensive strategy. i would be interested in a comment on one the additional resources interface with state and local law enforcement and

how that gets sustained over time and it is not a temporary or transitory problem. we better support congress.ike these in these.elcome and engage if it has to do heroin or prescription opioids, we will andinue to attack resources we will continue down the path. value know, i think the of building on the infrastructure is really important and it is not just around the epidemic. a thing that impressed was how they really focused on the emerging drug threat. you know, we are talking about

we have seen the increase in psychoactive substances and it allows focusing on issues that really trend andds the having the state and local are the height of management. do we, and the public health sector, have the same sustained coordination around public health services that we have moved to a aunt what more do we need to to address the situation? >> the public health policy and some states,

and action follows that you do of have to have a series roadblocks and we are limited by thertain number of time and implementation of the system varies, as long -- as well as the criminal justice system in the community. there is no consensus on how to manage this. countye are state and leaders who are acutely aware of a need to partner and throughout my fellowm's of divisions, it monitors

the departments where we encourage localities to do the same. >> i think fulks for leadership today and i hope there is the opportunity to talk about the local plays and reducing dependency. >> i think the panel for your testimony and i will dismiss you. while you are leaving, i will call in the next and final panel. is the chiefllard of police in manchester and he has made attacking the epidemic a hallmark of his tenure as the served in various capacities in the department.

served as the he security policeman and has a degree in criminal justice from the new hampshire technical institute and is a graduate of fbi economy.the heard after losing shehter to an overdose, founded a nonprofit group that is dedicated to providing support and education to those struggling with addiction and she has been an outspoken leader who seeks solutions and traveled here today from ohio. the chief operating

nonprofitth a provider and she is working in substance abuse treatment and behavioral health care for more and she got the ba . , we in the case of hurley have senator whitehouse. thanks and thank you, members of the panel. because i am talking about

consuming the state of new hampshire, with the eyes of the primaries upon us, the city of manchester is a vibrant city with engaged citizenry and incredible strength. moreover, the state of new an incredibletill and beautiful state with the ocean and lakes. i do not want to give the impression that we are falling into the abyss. we are dealing with human tragedy. it is still a wonderful state. come and spend the dollars. tourism is alive and well. >> it is an honor to share with

you what i am dealing with on a daily basis with opiate issues and the ever-increasing issue of fentanyl. fornt to thank the senators their leadership on the comprehensive addiction recovery act. approach comprehensive to putove treatment individuals in recovery and adequate resources for the people on the frontlines of the crisis every day. i hope that the committee passes the legislation. partner with the health rector and we worked on the same

iitiatives i see the bill, encourage that you pass it. fentanyl.get to it is killing our citizens. overdoses were heroin 2014, we experienced 19 fatal overdoses -- 90 fatal overdoses and 22 were heroin. alone. simply fentanyl suffered in the city of staggering 60%. and heroin was killing our

citizens. in 2015, it is fentanyl. our citizens are dying because of this synthetic labs by the cartel. the poison they are putting is an affront to our life. communitiesorating and we have case after case with toddlers, children, a 10-year-old finding their children dead. actor the american romanticizing poisoning our citizens and killing them is disturbing. it isnator noted that much more deadly fictional.

-- fentanyl. i would prosecute those who are trafficking it. forecently passed a bill drug dealers who manufacture and, when i took over as the chief, i had a priority to deal with the issue of boost morale among officers in the police department, given how text they are and the negativity i'm seeing in the media. aree, the priorities inter-related. , they are trying to make the community safe, despite the national discourse. numbers ofok at the

been,x the officers have there were calls to service. and the police officers responded to 616 calls. each one of these numbers represents a person, a human loved ones and coworkers. i do not need to tell everybody this. what your opening statement said was that there is a sense of pride that you understand this.

and i was encouraged that we are on the right track and each one of you tells me that we are on the right track. now when i hear senators and how past -- -- did they are, i live in the best state in the union. i have a tendency to go off of the royals, by the way -- the rails, by the way. did was go after the romanticized.re

they worked collaboratively with a prosecutor to go after them. after thely, they go dirty doctors who play a role thei would love to answer questions about the new england journal of medicine. i think that it is nonsense. new hampshire, maine, and vermont are the top states with pain medications and those states are in the top five in heroin abuse, i do not know what the methodology is. have invited the dea to work collaboratively. , in the communities and they

are bringing in the cars. i want to shut those down in real time. we go in the house and we do not do these elongated investigations. so, we have done six of these a large quantity of other drugs. we seized 500 grams of pure fentanyl. and we see over 27 grams of fat

no. -- a fentanyl. -- 27 grams of fentanyl. -- stark stock increase. it needs to lessen the demand they need to reduce the interdiction efforts. the border is a sieve and drugs are coming across the border. anddea is doing a great job they have taken the drugs off of the streets. of heroinake 27 grams off of the street and by 10 me that wehe tells

are not even putting a finger in the dike. we must do more now and recognize the problem for what it is. a safety issue. it certainly has been. it is critical to the work in law enforcement. manchester lost a comprehensive and part the epidemic of the plan was to develop the continuum that allowed someone struggling with addiction to go further. strideslso making great and i am almost done. a facility.

this will allow me to have a more compassionate alternative to arrest. to the drive out this will be the model. you do not need to come to the police department and give us the drugs. we will bring you directly to bypass lawy and you enforcement. and we support the recovery community. this is a community issue and we will prevail. thank you.

>> your commercial for new hampshire, first in the nation primary. -- >> i want to thank you for giving me the opportunity to share the story. certified or educated. lot, like everybody else and i'm not going off of my statement. i will keep this short.

few blanksill in a i speak and deal with people who are in active addiction recovery and the families of those in recovery. if you different things i have importanti feel are the cost hasnd and .een said many times heroin is cheap. believe it or not, i do not believe parents understand how cheap and that is important for them to know. they do not realize that, when you get your kids $20 for the

, yous on friday night could have bought heroin for $20.for >> i live in a small community it is in a small town with no hospital. a lot of them went to school for girls. my oldest is 26 and has done for they havehe navy and

the bachelors in business and one of the things i see happening is the disconnect and diligentlys were --y slap their children these people on the wrist. i cannot tell you how often i get these boys who i can that her son, because i -- i consider sons because they have grown up. they give them a dad wrapped and it frustrates me. butts. them bust their they arrest these people send them in front of the judges and

the judges put them back on the street. daughterhat sold my the hair when they killed her, he went back in front of a judge for his fourth offense. he was given five months. how is that possible. that is so frustrating. imagine what law enforcement deals with in that situation. these are things that have to be dealt with. know?en, what do i i know that, when you find a withar-old on the floor

bruises on her for head and knows from slamming into the fast,ecause she died so it sticks with you the rest of your life. hope -- yound yet hope someone shows up. long and waited for help and you want to put. you cannot quit. that is your baby. you cannot stop. hair -- air going into the lungs and the crackling and popping that i still here -- my night nurse

nightmares, we have to put a face to this and help the kids. ,hen they say they want to quit we cannot say, "i am sorry. -- give us a week and we will get back to it. hope.ives me a little something to help the children. thank you. >> thank you very much. >> thank you so much.

included -- i >> pull the microphone. >> i would like to thank you for the opportunity in the treatment field. to provide the perspective of what it is like when the rubber the road and i will quickly go through statistics that everyone has tord over and over and get the complexity of what is needed. i may not correlate completely to the testimony that you have right now. overdose of the epidemic -- the overdose of them because result that it that's a good to use to

grow. doubled andhis have nearly quadrupled in the united states. the pain medication has increased dramatic. new portable populations are emerging. -- vulnerable populations are you merging. diseases are on the rise and other numbers have increased with you alarming rates. there are often permanent diseases of the brain that is costing taxpayer dollars and is causing society to lose the creativity and contributions ith fear and grief and terminated -- permeated

communities. my understanding of the experience is that the treatment of the disease and the related tragedies is the result -- makes honor to be here today. populations are being most affected and what are the treatment challenges we face? in five minutes, the growing trends are becoming addiction -- becoming critical. we assist the people who come to us for care. the developers of the dependent individual reflects the age of 42. it is more urban than rural.

shift in then a center referenced mortality with for the population police data that is reflective of opioid use. and the emerging vulnerable women, populations are young adults, adolescents, middle-aged adults, returning veterans, patients receiving care for chronic pain and those in criminal justice. us are not lot of impacted by this. challenge is providing

care that is individualized. and the code for norms with the individual readiness for change it is successful treatment. the mentalme with health and psychiatric evaluations. is highly complex and to be prepared for the complexity with thetreatment providers and practitioners and counselors needing knowledge of treatment

options and a clear defectiveing with the researching of the disease. methadoneention with is an established practice and replace the receptor the replacement there p with the current dosage of and this provides the opportunity to heal, spiritually

and physically. i'll jump ahead here. medication-assisted therapy can preserve life and allow an individual to work on their recovery. sustain long-term recovery ideally includes health, home, community and a purpose. medication addresses none of these but allows an individual to work on all of these. buprenorphine is a partial replacement therapy developed to address opioid dependence. this medication is extremely effective, particularly in populations more physiologically naive, those that haven't used as long or much where the brain change has not been as severe or as permanent. the assessment process to determine which medication is indicated requires a deep understanding of the disease. buprenorphine, though well-researched and now evidence-based, it is not heavily regulated and it is attainable like any other medication through a primary care physician's office. this can dramatically increase accessibility.

however, at the same time these less stringent regulations do not require the same level of expertise. physicians are only required an eight-hour training to prescribe this. this speaks to the need, that you've spoken to, some attention to this in the medical schools and nursing areas. it is another challenge to confront this epidemic arises, clearly we need more accessible, effective treatment but there's no magic wand to providing only medication will not be successful for the majority of patients receiving m.a.t. we need more prescribing physicians and practitioners knowledgeable in this addiction. another medication that's been recently used is depot-naltrexone and it blocks the drug's euphoric effects. that medication works really well in populations that show a high amount of motivation because you have to be motivated to take it, to not have the euphoria. therefore, if you're experiencing cravings, it doesn't work for you.

complicating matters, there continues to be a social veil of moral judgment stigmatizing this disease, those who come for care and even those who provide care. the stigma can be seen in the regulation of methadone treatment and those environments in which it's provided. the regulation appears to reflect the stigma attached to the population for whom it was created. the harsh laws incarcerating individuals for symptoms of the disease versus assisting them in rehabilitation and recovery fill our prisons and destroy lives. i'll just jump ahead here as well. this practice, which resulted in the u.s. of having the highest incarceration rate in the world, is ineffective of reducing relapse and reincarceration. -- reducing drug use with high rates of relapse, crime, and reincarceration. stigma is also reflected in the ongoing struggle with the implementation of mental health and substance misuse parody and reimbursement rates. this is a critical issue when we're talking about someone coming to the door and saying, i need care.

difficultyainable or obtaining authorization to provide care creates a significant barrier to treatment, and this is for folks who have the benefit of the affordable care act, and who have the benefit of insurance. and visualses and do not have the resources to advocate for themselves and develop one's print treatment providers don't have the staff hours to assist, and low reimbursement rates paralyzed the provider and the complexity of the benefit utilization paralyzes the consumer. in addition to this challenge of stigma, we see challenges of meeting the growing needs of populations. inadequate treatment capacity and an act -- an adequate provider competency come i cannot say that enough. we're not developing our workforce quickly enough to where not paying them enough to

allow them to stay. systemsd hold our accountable to the best practices, reimbursed -- , and reversedrate the crisis. to speak on prevention which i will speak briefly on here. much of what was already here was already stated in terms of the surge of prescriptions. one piece that has not been stated and his deadly is that concurrently with the surge in opioid prescription medication there has been a rise in the prescription of benzodiazepine for anxiety and other sedatives. in 2014 and 2015 in rhode island, 33% receiving open oid -- opioid prescriptions were co-prescribed benzodiazepines.

this is a tremendous deadly combination. this has been a significant variable in the increase in opioid depths -- deaths. at the codeook --scription of co-prescription of benzodiazopine. family education is needed, continuesed public health. , continuedducation public health education venues, and the use of community. covering resources. treatment within a recovery-oriented system of care individualized for the patient that is easily accessible can prevent the progression of disease and overdose. i will skip here -- i am coding here from the rhode island governor's prevention and intervention task force. this is a dynamic epidemic exposing the the need for public

health and safety. -- safety, and behavioral health, reaching into the medical, pharmacy, harm reduction, and recovery communities and in partnership with civil society. this for me is one of the most exciting parts of the bill itself is that there is a piece there that mandates interagency collaboration, and i believe the interagency collaboration is going to be able to start to remove some of the silos created by funding streams. a huge reason that we have the silos that we do and that's going to create the foundation for the answer to this. and i know i represent a task force and those of us in rhode island providing treatment support. senator grassley: three questions one for each of you.

i'm going to start with ms. dare . thank you for sharing your tragedy with this. i know and we can tell it is not easy for you to do that. you have not given up. i felt out to give you the opportunity for you to tell us about holly's song of hope and how the organization works to provide community support for those struggling with addiction. >> a lot of people say, you are so strong, have you do this? >> it is not strength, it is that fight or flight. and to get off the couch in the mornings or get out of bed and not lay there and cry all day. i realized that what was lacking when i was going through everything after losing holly was family support. there's tons and tons of programs out there for those who are caught in the depths of this disease and fighting it, but the

family support is greatly lacking. and the little bit that i did find that i was going to get charged for and i thought that was ridiculous. we started holly song of hope on -- however i also realize that i did not tend to appreciate somebody else talking to me unless they had been there and been there through it. they truly understood where i was coming from. it just made sense for me to offer that to others. we started holly song of hope on facebook for friends and family to have memories -- to post memories about holly and maybe what things were going on with this heroin epidemic and things like that.

somehow under a year's time, i ended up with 1,000 members and very active members. and i realize, yeah, this is something that we need. members from australia and scotland, and ireland, as well as across the united states. we started posting questions every couple of days that have to deal with addiction and in some form or another so people are constantly learning as well as getting support. and i had so many people saying you really need to take this outside of facebook. so i started talking to members

, and they started sending me, i want, i want, i want and currently working with just under 50 different facilitateors -- facilitators in states all across the united states looking to start their own chapters. i started actual meetings in carroll county. they run every other week at this point. we cover co-dependency or enabling. those two go hand in hand. i cover a street drug of some sort, make sure that people who come to the meetings see what it really looks like and what signs they need to pay attention to and how much it costs, so on and so forth. i firmly believe education is

what's going to change every single piece of this puzzle. every single one. we hear about educating doctors. we need to educate the families. stigma. education is the only thing that is going to change that stigma. i can't tell you how often every single day -- i'm sure there is going to be a story on this and if you look in the comments you are going to see people say to me if you had done your job as a parent and your child wouldn't -- and raised your kid right, your child would not be dead. let me give you a for instance -- in the fifth grade my , daughter was going to a sleepover one weekend and came to me and said, mom, one of the girls got a joint for that sleep over this weekend and i'm , scared to death. i don't know what to do.

rqdon't want to mark -- na anybody out. absolutely, don't worry, you're not going. and i will give you a good excuse, something came up, that we didn't expect. i would have never went to my mother and said something like that. i don't know how many people in here would have went to their mother and openly said something like that. we talked our girls all the time. there was no taboo issues. we discussed very honestly and open with them. i thought i had done good and you know all those parent markers that you were a good parent, got them both through school, no trouble with the law, no pregnancies, no drugs. they both graduated. they were very popular in school for different reasons, but loved by all of their classmates.

my oldest went into the navy and she is now a veteran. and boom, i have a child lying dead on the floor. senator grassley: thank you for that. senator franken. senator: thank you for sharing your experience and your strength and your hope for what you're doing. ms. hurley on the treatment side. you talked about a number of things, work force, need to train providers. my understanding is that -- 21%

of the people who need treatment get it. -- senatorabout durbin talked about the domenici act which is mental health parity and addiction act. -- equity act. you talked about having problems with parity and reimbursement and -- low reimbursement rate of insurance companies on this. can you talk about this area, about what we need to do to meet the needs that we have of people who need treatment and what we should be doing and where we're not -- what barriers there are to meeting this need.

ms. hurley: i think everyone has spoken on what's needed of the medical community i think at this point and that's the training and to increase capacity. and one of the methods by which to increase capacity, and i will say it again, is for someone to please hear that the independently licensed practitioners be allowed to prescribe medication for opioid dependence. that would increase capacity with training that would also correlate to competency. i cannot say often enough how complex this disease is. it is not just biological, it is psychological, spiritual. emotional. cooerms of -- i can use the

side of my head here, the operational side, reimbursement rates have historically been lower than other mental health rates for substance abuse. and that continues. you can look at any of formulation of reimbursement rates for either commercial or medicaid. medicare is an area in which we desperately need. we desperately need. senator: how is it determined. how are the reimbursement rates determined? if someone goes into the hospital for cancer treatment, they get reimbursed and no one is saying it's their fault they have cancer. what seems to be going on? what's the -- what is the

justification, but also as the coo what's going on on the other side in the insurance industry and in terms of the federal government and state governments on this reimbursement? ms. hurley: we can start with medicaid and each state is different. and i believe the medicaid rates have been historically lower than other commercial insurance provider rates. and what ends up happening particularly in the behavioral health side is we very often have a very high percentage of those who are medicaid eligible. therefore a treatment facility is going to have anyone from 60% -- anywhere from 60% to 90% of the folks who are coming us -- to arthrocare reimbursed at a medicaid rate. the medicaid rates are not negotiable. they are issued through human and health -- health and human

services in each state. we choose to do the best with those and stay committed to our missions, most of us. on the commercial side there are negotiations that go on over and over. we don't have a lot in those negotiations. i have been part of this for 20 some years. we don't. that's the real issue and the results -- senator: i know i'm running out of time -- ms. hurley: i'm sorry i missed your question. senator: you are speaking to the question. medicaid reimburses lower than some private and other areas, too. but is there a particular disparity between the actual costs and the reimbursement in recovery, in the rehab? ms. hurley: yes.

senator: that's what i wanted to know. we have run out of time. i think that is interesting. ms. hurley: not quite the word i would use. senator grassley: chief. senator: like senator grassley, a lot of the adjectives you used to new hampshire i would use about north carolina. we're further away from the arctic circle. it is a beautiful place. you should be proud of it. i'm glad that you pointed out it and thriving state community with this challenge that is not unique to new hampshire. chief,stion for you is a what sorts of obstacles are either the federal government in this case -- i won't speak to state issues, what things have you seen as a matter of policy

that are either helping you are giving you pause to take the fight into local law enforcement. chief: the relationships we have with federal agencies are really robust. i'm concerned about the recent doj decision to freeze forfeiture. i understand it is a hot button issue here in d.c.. i have read articles about some law enforcement agencies that have maybe abused the practice of it. but there should be oversight as opposed to shutting it down and having this conversation that it's not being used properly. what does drug forfeiture look like for the manchester police department. i use drug forfeiture money to fund my drug unit. that means i have a location away from the police department i pay a monthly rent on. all of the undercover vehicles that we have come i pay monthly leases on. all of the equivalent of the

drug investigators use, surveillance equipment cameras, , any of the specialized they need, cowvert mics, all that -- covert mics so no one but knows -- no one knows there they are mic'd. money for these there is a push in the state of . there is a push in the state of new hampshire to take that money and put it into the general fund. it is unfathomable for me to think that they would do that when we are in this epidemic. what would it look like if d.o.j. doesn't open this money. i hope the split stays the same. and if the state of new hampshire does the same thing. manchester police department has two decisions, i have to can do -- i have to shut down my drug investigations because i cannot afford it. i can only do so much. or i can go to the city

government, and they are extremely cooperative, and supportive of the manchester police department. i need all of, these line items, whatever that number is that you will have to pass on to the taxpayer. instead of using the drug dealer's ill-gotten gains, it will -- we will shift the burden on the taxpayer. it is counterintuitive, and i think it is bad policy. there is something nefarious afoot with law enforcement -- senator tillis: the reason i wanted to ask that question it's , a matter of balance but i think there is a clear nexus between the source of that money, and its use filing a back into law enforcement and preventing the kinds of cases that she continues to deal with. ms. hurley i had a question. you mentioned variations among states and with colleagues and any professional affiliations

that you may be a part of, are there any states that seem to be a best practice and going about providing care back in their communities? ms. hurley: i'm most familiar with the new england area. i think that each state has a strength. vermont, what they refer to as the hub and spoke model to access rural areas and part of the new england school of addiction studies and i have worked with some of those physicians and in rhode island, the governor's task force on opioid overdose prevention has brought together -- it is an interagency, department of health, behavioral health, hospitals, a.g.'s office.

17 people are on the committee and they have had done a tremendous job at creating strategies looking at dollars communely. i believe it's a move forward that may be a very good model for addressing this. and we have been looking at every single thing that has been noted here today. senator tillis: i want to thank all the witnesses and thank senator ayotte for demonstrating her interest in this important matter. this will conclude the meeting. the record will remain open for one week to provide additional information potentially and respond to any questions to members who were not here. thank you all very much. god bless you. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2016]

announcer: iowa presidential caucuses are next monday. up next, texas senator ted cruz campaigns in west des moines iowa. is withnie sanders actress susan sarandon. later, mike huckabee speaks with voters and names, iowa. in ames, iowa. on our next washington journal we talked to former michigan congressman peter hoekstra about national security in the 2016 campaign. he chaired the house intelligence committee. after that, david red sox of the drake university institute on a

role in history of the iowa caucuses. iowa."k is "why you could join the conversation by phone or on facebook or twitter. >> we have main engine start 4, 3, 2, 1 and lift off. lift off of a toy fifths they shuttle mission. it has cleared the tower. announcer: every weekend on american history tv on c-span3 we feature programs that tell the american story. the highlights for this weekend include saturday morning at 11:15 eastern, author and new york state supreme court judge diane keys all discusses the life and a couple friends of dorothy ferebee. at 10:00 p.m. eastern on real this week years ago the spatial challenger exploded shortly after liftoff, killing all seven crew members. addressesident reagan's

the nation about the explosion. and a nasa video report detailing the causes. dire camegan: nancy a to the core with the tragedy. we share this pain with all the people in the country. this is truly a national loss. announcer: sunday morning at 10:00 on road to the right house -- white house rewind a look at the caucuses featuring howard dean and his scream. and the history of the caucuses whose speakers include tim kraft who is the iowa caucuses campaign manager for jimmy carter in 1976. also two panels of former campaign managers and political reporters. at 8:00 journalist paul brandon on his book, "under this roof." he explains how presidents from george washington to barack