state. now, i know there's some skepticism about my views on this. so let me state unequivocally, and here's the acid test -- i am ready to begin such negotiations immediately, without preconditions, anytime, anywhere. that's a fact. but president abbas is not ready to do so. that's also a fact. there is political will here in

jerusalem. there's no political will there in ramallah. for the last 5.5 years, president abbas has refused to sit down and talk with me even for a minute. but that doesn't mean he's been silent. he has helped inculcate a new generation of young palestinians with murderous hatred for israel. and my friends, this incitement has deadly consequences. palestinian children are taught to stab jews. they are taught that the goal of the palestinian people is not to establish a state on the west bank, but in all of israel -- in akko, haifa, nazareth, jaffa. now, what i'm about to show you is deeply disturbing.

i think you have to see for yourselves what the palestinians are teaching their children. i want you to see the daily pledge of allegiance of palestinian children. take a look. >> i am a palestinian child. >> many more cities. >> the 48 lands are all ours. >> they preach to kill israelis just because they are jews and children emulate the murderous videos online. >> this comes directly from the palestinian leadership. >> we welcome every drop of blood spilled in jerusalem. >> the results, hundreds of terror attacks in the past few months. about half of the terrorists are

under the age of 18. this fuels terror and prevents peace. prime minister netanyahu: this is sick. it's inexcusable. my friends, that little girl wasn't born hating. she was taught to hate, as were the palestinians who murdered the american student taylor force, and other american citizens in recent months.

you've already heard what an impressive young man taylor was, but president abbas's fatah movement praised taylor's killer as -- and i quote this -- as "a hero and a martyr." now, that's not from hamas -- that's coming from abbas. and now the palestinians will spur even more terrorism by rewarding the families of murderers -- including those who murdered americans -- with a regular monthly payment. so the message they send to palestinians is clear -- terrorism pays -- literally. if the international community really wants to advance peace,

it must demand that the palestinians stop poisoning the minds of their children. if the international community wants to advance peace, it must address the true core of the conflict -- the persistent palestinian refusal to accept a jewish state in any borders. so there's bad news, but there's also some good news. while the palestinians are stuck in their refusal to make peace, others are moving forward. first, israel's peace agreements with egypt and jordan have weathered many storms.

second, increasingly our other neighbors recognize that we have common interests. they understand that we face the same threats from iran and from isis. now, i can tell you from a perspective of my lifetime -- this is a historic change. i believe it offers a unique opportunity to advance peace. and we are working every day to seize that opportunity. ladies and gentlemen, i am confident that over time the trend of embracing israel will

overcome the trend of maligning israel, because ultimately freedom beats tyranny, and ultimately, when vigorously defended, truth beats lies. so i believe that israel faces a future of promise. i believe that when we stand together, all of us, we can overcome all the challenges facing us. and of these challenges, none is greater than iran's unrelenting aggression. iran remains fully committed to

genocide -- our genocide. its leaders loudly, openly, even proudly, they say and proclaim that their goal is to destroy israel. iran sends deadly weapons to hezbollah in lebanon against us. it bankrolls hamas and islamic jihad in gaza against us. it seeks to open a new terror front on the golan against us. and it offers thousands of dollars for each palestinian terror attacks against us. so here's what i believe -- i believe that both those who supported the nuclear deal and those who opposed it can, at the very least, work together to stop iran's aggression and

terror and hold iran accountable for its transgressions. since the nuclear deal, iran has continued to conduct ballistic missile tests, in defiance of its international obligations. as you've heard, iran recently fired a ballistic missile with a hebrew inscription painted on it. it said, israel must be wiped out. so ladies and gentlemen, the writing is not on the wall -- it's on the missile. now my friends, an arrow just like this was shot by a roman soldier at yodfat.

he was fighting to end jewish independence once and for all. but imperial rome is long gone and i am speaking to you today from our capital, jerusalem, as the prime minister of the reborn jewish state. we have restored our independence. we have restored our capacity to defend ourselves. iran should learn this history and it should have no illusions. israel will defend itself mightily against all those who seek to destroy us.and iran

should remember that today it's not only the enemies of the jewish people who have arrows. today, the jewish state can defend itself with powerful arrows of our own. take a look. prime minister netenyahu: the arrow missile defense system is the product of americans and israelis working together. so i want to say again to all of you -- thank you, america. thank you, aipac. thank you for helping secure our common future, and a happy purim to all of you. thank you.

>> house speaker paul ryan speaks on the state of american politics on wednesday at 8:00 p.m. eastern. you can see it here on c-span. >> c-span's "washington journal," live every day with news and policy issues that impact you. coming up wednesday morning, republican congressman limited lansing -- commerce and leonard lansing talks about progress being made to get the legislation passed by the senate. he'll also discussed colorectal cancer awareness month, and being named congressional chairman of health innovation by the leadership council. onn, eleanor holmes norton infrastructure and issues involving the d.c. metro, including a recent shutdown of the system. she will also discuss the flint, michigan water crisis and oversight. be sure to watch c-span's "washington journal," beginning live at 7:00 a.m. eastern.

join the discussion. >> in february, president obama announced his plan to close the guantanamo bay detention facility in cuba. wednesday, pentagon and state department officials testify before the house foreign affairs committee on the president's plan. see their testimony live at 9:30 a.m. eastern on c-span2. >> white house national drug policy director michael botticelli testified tuesday on the federal government's efforts to combat heroine and prescription opioid addictions. this hearing is about three hours.

>> good morning. i'd like to welcome everyone to is entitledwhich america's heroine and opioid abuse epidemic. i'd like to welcome our ranking member, mr. cummings, and all the members who are witnesses this morning to this hearing. i'd like to call the hearing to order. without objection, the chair is authorized to declare recess at any time. the order of business this morning will be as follows. we will begin the hearing with opening statements from myself, the ranking member, and other members are welcome to submit opening statements, and with mr. coming's support we will leave the record open for --

days, for legislative additional comments or statements. without objection, so ordered. when we complete the opening statements, we will turn to our panel of witnesses. the have five distinguish witnesses today, three at the federal level, one at the state and one of the local, for our hearing. we'll swear those witnesses in and we will hear their testimony, and proceed with questions. that will be the order of business. so, again, welcome, and i will start with my opening statement. the united states is experiencing an historic epidemic of drug overdose deaths. overdose is the leading cause of accidental

death in the united states. in 2014 -- i don't have the 2015 2014, 47,055- in deaths caused by drug overdose. --t means that this hearing if this hearing last for two hours, 10 people will die from drug overdose death. this is a chart showing the increase of 1999. i chaired the criminal justice drug policy oversight subcommittee from 19981999, and we thought we had an epidemic back in 1999 with 16,000. i can show you some of the headlines from my local where many people

were dying over a weekend. unfortunately that is what we are seeing in my community and across the united states. unfortunately, more americans have died from drug-related overdoses in one year than all that were killed in the link the korean war. if the current trend continues, the annual death rate could climb beyond those killed in vietnam over that multiyear struggle, in one year. the graph from "the washington post" illustrates the disturbing rise in drug overdoses between 1999 and 2014. 47,000, more than 10,000 americans died of heroine-related overdoses. heroin use is increasing at a faster rate -- you want to talk

about a war on hand war on young oin cancere heroine death killing women at twice the rate of men. , we have seen, according to the centers for disease control and prevention, deathsth heroin among our youth between 18-25 of the past decade have soared. leaving the deadly statistics. thess all demographics, rate of heroin-related overdose deaths has increased 286%. while the exact cause is up for debate, many experts believe

that the use of other drugs is also a driving factor. they could potentially open the door to anot the epidemic. those already addicted turned to hair when because it is cheaper and more readily available. mexican drug cartels have established heroin trafficking routes here in the united states and coming across our borders. now we see increased supplies in recent years. i had a chance to talk with my police chief in law enforcement folks in the district, dea folks, and we are seeing an incredible supply, and we will have some questions about where that is, specifically, coming from. we know a lot of it is coming

across the mexican border. the impact, unfortunately, is felt in communities across the nation. with a few weeks ago, i met all the local officials, and we have one of my local officials who we will hear from in a few minutes, teresa jacobs. our county mayor in orange county, who has been forced to deal with the heroin epidemic in central florida. orange county alone -- you will hear more about this -- we have had 475 related heroin bookings in 2013. by the end of 2015, we had 840. majority of those arrested were between the ages of 18 and 44. the obama administration, unfortunately, i believe, has been sending mixed signals about the use of substances such as

marijuana, which is one of the gateway drugs. talk to anyone who was in counseling, treatment, rehabilitation, and you will find out that marijuana is a and many of the heroin abusers start there and work their way up the chain of deadly drugs. according to the national institute on drug abuse, listened to this, for high school seniors are now using marijuana than cigarettes. adopted,that has been unfortunately, has consequences. policy, say no drug championed by the late first lady nancy reagan, has turned into a just say ok policy, and now we are seeing the consequences. while improving treatment is a key, enforcement is in the must remain an essential part of

combating harrowineroin epidemics. when i saw the numbers in our locale, i said, "well, it looks like you have been able to keep the lid on some of this, although it is now at epidemic proportions." they told me, "mr. micah," he said, "this is only because we tidotes that can bring these people back. the only reason we aren't seeing double or triple the deaths is because our law enforcement and first responders can bring these people back, if they can get to them in time." not only are illegal immigrants flowing over the mexican border, but also illegal drugs. we know that is the main source of the supply of heroin, cocaine , marijuana, and a host of other deadly narcotics.

stopping deadly drugs from entering the united states is a federal responsibility and we will hear from some of the officials engaged in that war . new statistics show federal drug prosecutions are down 6% in the last year. 14% drops after a since the beginning of the obama administration, so-called smart on crime initiative. our front-line law enforcement officers, if we are going to save these kids and others who should besing, they equipped with the resources to prevent and save them from overdose death, not just our emergency medical officers. people usually get there after the first responders, and it may be too late. this is something else we have learned from our local task force and law enforcement

officials. one of the police chiefs in my district informed me that just within the last month or so, we had one student who had to be revised from overdosing three times in one week. that's astounding. it's astounding, because he is still alive and we were able to catch it. speaker ryan announced addressing this current epidemic as a priority, and we have acted on some legislation. i believe that this is absolutely critical, that this whole drug situation, including the heroin epidemic becomes a priority for this congress. i look forward to hearing from our witnesses today as we examine how to protect our communities from this fast-growing and skyrocketing national epidemic. i am now pleased to yield to our ranking member, mr. cummings. mr. cummings, as my ranking

member, we together led the effort from 1998 to 2000. i remember going into baltimore with him and conducting hearings when people were dying on the streets in huge numbers. but we're back, unfortunately, backsliding, and here we are today. that he did a great job trying to save people in his community, and he is now the ranking member of our full committee. mr. cummings. >> thank you, mr. chairman. i want to thank the people holding the hearing on america's heroin and opioid epidemic. i want to take a moment before i prayers totend our the people of brussels, belgium. >> i would join you. and i would ask everyone for a moment of silence, if we could.

>> thank you, mr. cummings. >> thank you, mr. chairman. today's hearing is about a national public health emergency, and we need to treat it like one. people are dying in baltimore, orlando, salt lake city, manchester, and cities all across our nation. ignore thisnger public health emergency. its moneyeeds to put where its mouth is and actually fundedelp our state treatment programs to stop this epidemic in its tracks. drug treatment facilities without adequate funding are like firemen trying to put out a raging inferno without enough water. pelosi sent ader letter urging speaker ryan to

schedule a vote on $600 million in emergency funding to help states address this epidemic before this recess. ou colleaguer from connecticut is already introduced this bill, and senator sheen has been pressing it in the senate. town -- did not leave will not leave town until we take emergency actions to increase funding to help states combat this epidemic. we also must fully found president obama's request for $1.1 billion in 2017. this crisis will not end in a day. it will take our sustained commitment, and every one of us owes it to our constituents to make them a priority. they want us to take action, and they want us to take action now.

let me tell you why federal funding is so important. baltimore, in of witnessed with my own eyes, in my own neighborhood, the destruction drug addiction infliximab communities. the first time i ever heard of a drug overdose death was 55 years ago from heroin. 55 years ago. , then't understand it young man in our neighborhood who we looked up to, who turned to hair when. -- returned it to heroin. i will never be confused about .hat this was about i have seen neighborhoods and hard-working families and communities destroyed -- in baltimore, where many of the victims were poor and black, this went on for decades.

it was treated like a war rather than healt emergencyh. we incarcerated them rather giving them the help they needed. now things are changing. number 2006 in 2013, the of first-time care when users nearly doubled -- first-time heroin users nearly doubled. nearly half of them were white. this epidemic has become a runaway train propelling through every family and every community in its path. it has no respect for barriers. it is now responsible for the deaths of 78 americans every single day. every single day. why is this happening? in part, as a result of doctors overprescribing pain medication

and drug companies leading them on so they can make massive profits. i'd like to enter into the thatd an op-ed by -- appeared in "the baltimore sun." >> without objection, so ordered. >> i just want to read a paragraph in this article. haveription of opioids been traditionally limited to cancer, pain, and comfort measures, but in the mid-1990's, drug companies began marketing these pills as a solution to a new plethora of ailments. in their efforts to expand the market, producers understated and willfully ignored the powerfully addictive properties of their drugs. the promotion of oxycontin by purdue pharma was the most aggressive marketing of the schedule ii drug ever undertaken

by a pharmaceutical company. one family, which owns the stanford connecticut-based redo isrdue pharma, one of america's wealthiest families. the richest newcomers to the list are worth an estimated $14 million. -- $14 billion. $14 billion. explains, the united states has 5% of the world's population, but we consume 80% of the world's painkillers. tweet that. 5%, ladies and gentlemen, of the world' late, but 80 -- the world's population, but 80% of

the world's painkillers we consume. so yes, i believe it was unconscionable that the nation ignore this issue for decades, but now republicans and democrats are starting to work together. i thank god that this day has finally come, and the stars are starting to align, anfor meaningful change. we now have people like orrin hatch, chris christie, rob ayotean, kelly realizing the severity of this crisis and providing more funding to help our cities and states. they are beginning to realize that this is not an urban issue, april issue, a black issue, an hispanic issue, or a white issue. this is an american issue that affects your sisters, your brothers, your sons, and your daughters. here is something else we must do. we can no longer allow drug

companies to keep ripping off taxpayers for life-saving medication. the chairman mentioned just a nalaxonego the drug lock and its life-saving effects. cities all around the country are realizing the need to equip their first responders with axone, which can reverse opioid overdoses in a matter of minutes, but their abilities yave been directly ove undermined by corporate greed. as more first responders began using this drug, the company that makes it, amphistar, begin to increase its prices by staggering them out. it cost the, baltimore city health department roughly $190. guess what?

today it costs more than $400. for life-saving drugs. despite repeated efforts by my home state of maryland, this company continues to overcharge for this drug. the company also continues to obstruct congressional oversight by refusing to produce all of the documents i requested last may, last may, about their massive price increases. mr. chairman, today's hearing is really focused on the heroin and opioid epidemic. but i hope the committee will turn next to my request for documents, as well as my request for a hearing, with executives from amphistar. with that, let me welcome -- with that, let me welcome our esteemed panel of witnesses. i particularly like to welcome the baltimore city health commissioner, who has done an outstanding job.

she is a true national leader in developing and carrying out effective solutions to the opioid crisis. we are very fortunate to have her heading our health efforts in baltimore, and we are very pleased to have her here today. without, mr. chairman -- with that, mr. chairman, i yield back. >> thank you, mr. cummings. we will leave the record for those who came in late for five legislative days. we now want to welcome our witnesses and let me first introduce them, and then we will swear you win. in. i'm pleased to welcome the honorable michael botticelli, the director of office of national drug control policy at the white house. reall-- the assistant director of the version control at dea, the drug enforcement

administration at the department of justice. -- and she is the principal deputy administrator of substance abuse and mental health services administration at the u.s. department of health and human services. the healthe -- she's commissioner for baltimore city health department. i'd also like to welcome my requested witness, the honorable tracy jacobs, mayor of orange county, florida. some of you have been before us, some of you haven't. we ask that you limit your statements to approximately five minutes. you will see a little monitor. you can also request additional statements or information be

added to the record, so if you have a statement you want to summarize, you are welcome to do that. since this is an oversight and investigations panel of congress, i'd like you to stand now and be sworn. raise your right hand. did you sell only or affirm that the testimony you are about to give before this committee and congress is the whole truth and nothing but the truth, . all the witnesses have answered in the affirmative. we will let the record reflects that. ondcprst turn to our own representative, the director of the office of national drug control policy from the white house. welcome. you're recognized. >> chairman mica, ranking member cummings, members of the committee, thank you for the opportunity to appear here today

to discuss the issues surrounding opioid drugs, including heroin an, in the united states and our federal response. during his state of the union address, president obama specifically mentioned addressing heroin use is a priority in an opportunity to work with congress in a bipartisan manner on this issue that transcends party, income level, gender, race,. and geography. we reduce the national drug control strategy, which is the nations blueprint for producing consequences for drug use. as a coordinator of federal drug control agencies, in 2011 the administration released a plan to address the sharp rise in prescription opioid drug misuse that coincided with the surge in opioid drug prescribing at the beginning of the century. as this crisis has evolved, with an increase in heroin and administrationhe continues to put forward new initiatives to help deal with

emerging issues. for example, in october, the administration announced a series of steps it took with partners, as well as federal agencies, aimed at addressing this epidemic. anoids are having unimaginable impact across the united states. 57 people die each day from opioids in 2010, and by 2014, it was up to 78. the number of drug oveose deaths involving synthetic drugs has more than doubled since 2012. is overdose rates are harrowing, however we are making some progress. ofnmedical use b opioids for those 12 and under reduced significantly. unfortunately, this process

has been counteracted by the availability and use of heroin. heroin purity has risen while prices remain low. the crisis is compounded by the reemergence of sentinel, a powerful synthetic opioid which is sometimes added to heroin to increase its potency, or used unsuccessfully on its own. -- unsuspectingly on its own. its use increases risk of overdose death. while prescription opioid use a recenturpassed -- review article concluded that to be ansition appears part of the transition of addiction among those with frequent user dependence rather than a response to the reduction in availability of prescription medications, as some have speculated. graduate medical education programs do not provide a comprehensive focus on the identification or treatment of opioid use disorders. a startling evaluation of health

care claims data found that a the geordie of nonfatal opioid overdose victims were receiving an opioid from a risa prescriber. year, president obama issued a presidential memorandum requiring all federal agencies to provide training on the appropriate and effective prescribing of medications as part of their federal duties. just last week, the centers for disease control issued recommendations for primary care clinicians on the prescribing opioids. they also obtained commitments by more than 40 provider groups at more than 500,000 health care providers. the administration continues to work with congress to make mandatory prescriber education part of their controlled substance licensure. the administration has also

focused on several key areas to prevent opioid overdoses, including increased education, increasing third-party and first responder access to the opioid overdose reversal medication, promoting good samaritan laws, and connecting overdose victims and persons with an opioid overdose to treatment. yet there remains in this country a considerable gap that inhibits many victims of this epidemic from accessing the treatment they so desperately need. therefore, the presidents fy 2017 budget proposes $1 billion in new funding over two years to support cooperative agreements to expand access to medication assisted treatment and to expand access to substance abuse treatment providers in areas across the country most in need of providers. in just a few days ago, the secretary announced $94 million in affordable care act funding

to health centers to expand the delivery of substance use services, with a specific focus on medication addicted treatment for opioid use disorders. while we appreciate congress's president's proposal underscores the need for additional funding to address this epidemic. to address the increase in heroin and illicit fentanyl use, the strategy focuses on identifying, disrupting, and dismantling criminal organizations trafficking drugs, working with the international community to reduce the cultivation of poppy. year, ondcp last created the national harrow and coordination group, which is a multidisciplinary team of subject matter experts, to lead federal efforts to reduce the supply of heroin and fentanyl in the united states. we have also committed to $.5 million in high-intensity drug

trafficking area programs to develop a heroin response strategy. we have also been actively engaged with the government of mexico on efforts to reduce the flow of heroin and fentanyl into the united states. earlier this month, i met with the mexican attorney general and other interagency representatives. we agreed to further collaborations to disrupt the production of heroin and fentanyl. this bilateral cooperation will ly mutual l beneficial. we remain committed to working with our partners to reduce and prevent the health and safety consequences of nonmedical prescription opioid heroin and elicit fentanyl use. thank you very much. >> thank you. we will withhold questions until we have heard from everyone. let me recognize -- and welcome him, our dea representative. >> thank you, chairman mica,

ranking member cummings, and distinguish members of the committee. the combined prescription and opioid heroin abuse epidemic is the number one drug threat facing the country. i appreciate the opportunity to appear before you today and talk about what we at the dea are doing to address the threat. prescription opioids are walking users up to heroin's deadly embrace. mexican cartels are in communities throughout our country, exploiting the epidemic and flooding the country with high purity, low-cost heroin. aose cartels are forming toxic business relationship with violent distribution cells. what is the end result? almost 30,000 of our fellow americans died to prescription opioids are heroin overdose. everyone has a knowledge this is an unimaginable tragedy. need aerstands that we

balance, holistic approach to this epidemic. we stand with our interagency partners, including those represented here today, to embrace prevention and treatment. enforcement must be a key component of our overall strategy. we need to investigate and bring to justice not those suffering from opioid use disorders, but those who are exploiting human frailty for profit. our answer to dealing with this drug threat, attacks apply, reduce demand, and empower the community. there are three prongs to this strategy. law enforcement, divergent control, and community outreach. my comments today focus primarily on the office of the dea that we will be more than happy to follow up with details about operation: rolling thunder. strategy focused on the violent distribution in our

communities and the mexican cartels supplying them that is killing so many americans. with 1.6 million dea registrants, we are uniquely positioned to help with this fight. the the vast majority of those 1.69 registrants are law-abiding citizens, either our practitioners, pharmacists, manufacturers, and distributors working in communities. we investigate the small percentage of those operating outside the law, but yet inflict considerable harm on our country. practitioners not prescribing for a legitimate medical purpose outside the usual course of professional practice. pharmacists not performing their corresponding reonsibity to ensure the prescription is valid. manufacturers and distributors not upholding the regulatory obligations. how do we do that? with our tactical diversion squad, are groups, and great federal and state and local counterparts.

our tactical diversion squads are specialized units. we have 69 of them nationally. we are going to add 8 within the next six to nine months. mobilecreating two tactical diversion squad that can deployed where the need is, giving fluid enforcement capabilities. we have 700 skilled investigators spread across this country. both the tactical diversion squad and the diversion groups work with their respective groups to bring charges against those operating outside the law. where appropriate, they bring administrative actions. dea as order to show cause or immediate suspension orders, potentially revoking their registration. enforcementrlier, will be a key part of the overall strategy, but engaging with that large community and educating them are just as critical. in the last two years, we have

conducted more than 300 events, providing education and guidance to thousands of registrants. since 2011, with our great partners at the national association of boards of pharmacy's, we have created 64 pharmacy diversion awareness conference is in 29 states that have had the privilege of interacting with 10,000 employees about the risks of that version. -- of diversion. finally, we will continue engaging with our interagency partners on expanding access to treatment, mandatory prescriber education, and a safe and responsible disposal of unused prescription drugs. early in february, a leading national chain pharmacies said they would put drug-backed kiosks in 39 states and washington, d.c. we see that as a positive step in the right direction. we look forward to the day when those secure kiosks are so commonplace that people can dispose of their unwanted and

unused prescriptions frequently, safely, and conveniently. dea will also continue our national takeback initiative, with events every six months. during our september, 2015 take collected more than 370 tons of unwanted, unused prescription drugs. the next national event is april 30, five weeks from now. have hadt 20 years, i the privilege of working with the great men and women of the dea along with our federal, state, and local, and foreign counterparts. this current drug threat, the subject of this hearing, is unlike anything i have ever seen. we at the dea will do whatever it takes to fight this epidemic. we will attack supply, we will reduce demand, we will do our best to empower communities. i thank you for the opportunity to appear before you and look forward to answering any

questions you have. >> thank you.we will get to questions after all of our witnesses. let me recognize the deputy administrator or substance and abuse mental health services at the department of health and human services. welcome, and you are recognized. >> good morning. members of the committee, my name is -- and i am the principal deputy administrator, honored to have been delegated the authorities by secretary burwell. many thanks to all of you for your leadership to raise awareness and catalyze action on the nation's opioid crisis. as you have noted, this is truly a matter of life or death. i know prescription drugs, heroin, and fentanyl have had devastating consequences in many of your districts. i know this because we have partnered with leaders in your community as we implement life-saving programs for individuals with or at risk of opioid use disorders. the state of maryland and city of baltimore are addressing high

rates of opioid related emergency room visits and utilizing peers to recruit patients. our monitoring program helped to get critical data to the front lines of the fight to prevent prescription drug abuse. in wyoming, we have seen fantastic progress as the state has implemented our strategic prevention framework, using data and science to focus their efforts. utah, they are increasing access to residential treatment for pregnant women with substance use disorders. healthy babies are being born and progress is being made. while treatment is increasing, -- as a nation, we will not stem the rising tide if only two out of ten people with the disorder have access to the treatment they need. it wouldn't work for diabetes, it wouldn't work for hiv, and it

will not work for addiction. to ensurein together that everyone with an opioid use disorder who seeks treatment finds it. toward this end, we are proud to support the president's national drug control strategy and secretary burwell's initiative. in hhs, are initiative focuses on high-impact areas -- changing prescribing behavior, increasing access to and the locknalaxone - it is simple. to prevent opioid misuse, we need to reduce the number of pills in people's medicine cabinet. we will encourage the use of timelines in order to chart a --er, more effective course dedicated, well-trained professionals. we must give them the tools they need to deliver high-quality, safe, and effective care stop

since 2007, we have provided education to 72,000 health care professionals. we also reachlocal communities to get grants, administered together with ondcp. they do the yeoman's work to promote health and prevent drug use, including misuse of prescription drugs. the second aim of this initiative is increasing access to naloxone. can reduce noted, it a potentially fatal opioid overdose, but it only works if it is there when you need it. course, one of the targeted strategies would promote prescribing of naloxone , particularly for patients with high risks of overdose. we also let states now they may use it to block grant funds, to disseminate naloxone and for training and education on its use. soon we will be issuing and

announce -- we appreciate your strong support in this area. of therd area secretary's initiative is expanding use of medication assisted treatment. research tells us that medication, along with behavioral therapies and recovery support, are important components of an evidence-based treatment plan. however, resources are limited. as the director noted, the president's fy 17 budget requests $1 billion in new mandatory funding which would focused on the continuum of prevention and treatment use --s, expanding the and building the substance abuse treatment workforce. it also includes $30 million in new mandatory funding to evaluate the effectiveness of medications and treatment programs under different real-world situations. wethe discretionary side,

propose to maintain and grow investments made by congress in 2015 in 2016. we are providing for 23 more states with expansion capacity, and we are preserving the behavioral safety net by maintaining increases to the substance abuse, prevention and treatment bloc. we are also working with doj to clarify and enhance the connections between mat and the criminal justice system. drug courts are the most successful criminal justice response to addiction in our nations history. this year, we will prioritize treatment that is expanded to ensure every state has it fully implemented. with all this new care, who is there to provide it? we musensure that the substance use workforce is sufficient to meet growing demand. as such, we are requesting $10 million to test the safety and effectiveness of expanding it to nurses and physician assistants, and the administration has

requested $20 million for our colleagues at the house resources and services administration to grow the workforce. finally, we are proposing a new regulation to increase the patient limit for physicians who have a waiver to prescribe. members of the committee, thank you, and i look forward to working with you to ensure that we are using our investment strategically, responsibly, and effectively deliver the greatest possible impact. >> thank you. theow recognize -- with baltimore health department, city health department. welcome and you are recognized. >> thank you very much. members of the committee, thank you for calling this important hearing. i'm here as an emergency physician who has treated hundreds of patients with opioid addiction. i'm also here is a health commissioner, where i have declared the epidemic to be a public health emergency. last year, baltimore launched

our three-pronged approach to fight this on the front lines. first, we have to save lives. that is why we are making the opioid antidote, naloxone, available to every single resident. in the er, i have given naloxone to patients who are about to die and have watched them revive within seconds. naloxone should be part of everyone's medicine cabinet. trained 8000 people in the city on how to use it, including our police officers, who within six months have saved 21 citizens. in october, i issued a blanket prescription for naloxone 20 620,000 residents of baltimore. withoutng a life connecting it to treatment is just treading water, so our second approach is to increase on-demand prescription treatment. we believe that treating addiction is a crime is unscientific, inhumane, and

ineffective. our city's criminal justice and public health teams have partnered on drug treatment court's and on a pilot projects smallindividuals, amounts of drugs will be offered treatment instead of incarceration. for science is clear -- addiction recovery requires medication, psychosocial support, and wraparound services, yet nationwide, only 11% of patients with addictions get the treatment they need. imagine if only one in 10 cancer patients got chemotherapy. yet my patients come to the er seeking addiction treatment and i tell them that they must wait weeks or months. i have had patients overdose and die while they are waiting we have started a 20 47 phone hotline that includes immediate access to an addiction counselor or social worker and a direct

connection to make an appointment. our phone line was started less than six months ago and already has received about 1000 calls each week, including from police officers and family members. we have ample evidence to show what works for treating addiction, that we are nowhere near getting everyone treated and we are still very limited, especially when it comes to wrap around services. take housing. every year we estimate that there are 18,000 turn a ways for less than 100 recovery beds. addiction treatment reduces -- addiction treatment reduces crime and saves society's money. reducerd approach is to addiction through educating the public and doctors. we launched a campaign to encourage treatment at dontd ie.org. billboard adsudes

and targeted outreach in libraries, churches, and bars. a firstie" now has of its kind naloxone training. anyone can watch a 10 minute video and print out instructions. doctors want to do the right thing. we have to give them the tools to do so. sent best practice letters to every doctor in baltimore to set prescribing guidelines and to require the cold prescribing of naloxone with opioids. we are also alerting doctors to emerging trends. nationwide, one in three fatal overdoses from opioids involves benzodiazepine like valium and xanax. yet physicians routinely prescribed this dangerous combination together. last month by colette a petition to the fda with 40 other city and state health officials to call for a lock box warning, which is the fda's strongest opioids.unication on

there is a lot baltimore has model inemerge as a opioid addiction and recovery. we need to expand funding for on-demand treatment and wraparound services. local jurisdictions, those of us on the front lines, with highest needs. removing regulatory barriers, like the cap on buprenorphine and regular in the escorting price of naloxone. and funding a national stigma reduction campaign. the epidemic of a good addiction is a national emergency and we know addiction does not discriminate. we are all in this together, so i thank you for calling this hearing and look forward to answering your questions. >> thank you. we are not allowed to, unfortunately, in these committee hearings to express your opinion or your approval or disapproval. have to let the

public know that only your representatives can do that. i am pleased now to welcome and recognize from my district, the florida.orange county, some of you have asked where that is. orlando is the principal city and we have our mayor, who started a heroin task force when we were hit with this epidemic. she is accompanied by -- but they are not going to testify -- george, the public health director and david sega, who lost a daughter to a drug overdose and has turned that tragedy into a public effort and the former city commissioner from my fair city. i welcome all the guests accompanying and recognize mayor jacobs. >> thank you, mr. chairman.

this you for calling hearing and thank you for this opportunity to discuss serious threats facing our cities and counties across the country. as mayor of orange county, florida allow me to share a few specifics, but first, mr. chairman i would like to ask that a statement rum one of our constituents be added to the record. mr. segal is president of victoria's voice foundation and his father of victoria segal, who died last summer of a drug overdose at the age of 18. many of you know orange county as the home to orlando and 12 other municipalities. of 1.2 a population million people. last year we broke a national record for tourism, entertaining more than 62 million visitors. many of you probably don't know that last year we also lost 84 lives to heroin overdoses. probably will know that was a

600% increase since 2011. four years ago, like so many other counties across the hard andwe were orked adopted tough regulations at a local and state level. we provided resources to break opiate addiction and we were pretty successful. today the front line has moved,, but the battle is tougher than ever. too many prescription drug abusers have found an inexpensive and often, deadly alternative, heroin. despite central florida's strong economy and our extraordinary itsity of life, heroin as bloated. last year, approximately 2000 heroin users moved through our county jail. most of them were not heroin possession, but they were other es, resultings from the debilitating effect that heroin use has on its

users. we housed expectant mothers, addicted to opioids and heroin. quite frankly, our county jail has become the treatment center of last resort for so many people. yet, too many people still don't realize the severe threat that in poses, not only to the lives of the attic, but to the fabric of our community. for the good of our citizens, we are fighting and we are fighting hard. last summer i convened the orange county heroin task force. we have 22 high-ranking officials that serve only task force, from our chief judge to our state attorney, to medical professionals, to our superintendent of public schools, two representatives from our three colleges. of thend the effort orlando police department, as well as our metropolitan bureau of investigation. since we fully informed this

task force, they have arrested more than 370 heroin related incidents in a six months. last month we concluded our efforts and may 30 seven recommendations, similar to the comments you heard from my colleagues here. we recommend bond increases for trafficking. we recommend media and social media campaigns morning about the deadly nature of heroin. serial killer among our community and so few people recognize it for that. coordinated efforts to avoid fatal overdoses by demanding access to naloxone, i commend the work of my colleague. naloxone as you heard, is a life-saving drug used in severe overdose situations. and also, to look for new opportunities to fight addiction

by coupling detox at our jail with addiction treatment programs using the drug the vivitrol. forward,on to moving the implementation of these recommendations, we are working hash our partners, which teamed up with of the national league of cities, as well as with other organizations to implement the best practices. we know there is no single solution, but there are some universally effective approaches. enforcement is absolutely critical to combating heroin use. in educatingreless people that addiction is an illness that requires serious medical treatment. from law enforcement to families, the life-saving drug naloxone needs to be more accessible without a prescription and available at a reasonable cost. and once one point. i want you to know that in orange county through our

collaborative effort, we are committed to doing everything we can with the resources we have. here is where we need your help. help stop the influx of drugs across the border. to continue to expand your efforts to stop these deadly drugs before they enter our communities. law enforcement will do their part, but the federal government must do everything possible to keep this plague from our shores and communities. help us treat more addicts. with a regional population of 2.5 million, we have only 26 beds for the uninsured, and yet 62% of the overdoses in our community are among the uninsured. and help us raise awareness so that more people will choose not to try this deadly drug in the first place. to end this crisis and to save lives, we all need to be engaged. i thank you for your attention to this critical issue. i thianank you for your leadership and for your service

to this country. jacobs,nk you, mayor for participating today. now, we will turn to questions. i'll lead off. the scope of the problem that we , i don't think people are comprehending this. from 16,000 when we chaired the drug, criminal justice drug 16,000 to 47,000. we are approaching 50,000 in one year. heroin is only what? 20% of that, 10,000 deaths. when a the figures coming out? >> we hope to have those by the end of the year. >> by the end of the year? we can't get them until then? >> part of the issue is this

data gets reported from county -- 2014.000 from the is not count,, folks, 35,000 automobile deaths in the united states. half of those people have some kind of substance in their system when they are killing themselves. it used to be that the biggest killer of teens was automobile accidents. now it is drugs. given that right? >> that is correct. >> it is killing our youth. we we haven't even gotten into firearms. firearms are the tool of the drug trade and they have illegal weapons they are using to commit robberies, mayhem -- again, it is an astounding number. we haven't killed this many in multiple year wars as we are killing in one year. , half alose guys

million people in one decade at the rate we are going, or more. every family has been affected by it and now it is just a slaughter out of control. now, we have a lot of responsibility and i am all for treatment. treatment is at the end of the process. a have already been addicted. we have got to stop this stuff at our borders. i sat with our police chief. we put in place the -- i had to do that by legislation a number of years ago because they played political games. even the creation of high intensity drug trafficking areas. and here we are back where we were, far beyond where we ever were then. this is out of our newspaper from just a few days ago. six pounds of heroin at oia.

they are bringing in this deadly -- these deadly substances and it's not just heroin. not just illegals are coming across the border from mexico. they are coming across with drugs. isn't that right, mr. maloney? >> yes, that is correct. folksat with the haida and saw the pattern. did you all see what is his name, el chapo? he said he came across the border. --t was a major drug dealer the most sought-after drug passes across the border like it is some kind of holiday visit to the united states. so, somehow we have got to get a handle on this. i just looked up the prosecutions -- the prosecution when we looked at

trafficking with the legal weapons is down. and prosecution. i talked to some of my dea folks. they won't tell you this on the record. but it is very hard to make cases on these guys. a lot of cases are dropped. these are dealers in debt. we haveaware, sir, again, prosecution, you build the case and give them to the district. i am going to demand a meeting with my u.s. attorney in at the prosecutions are down. but they are down, did you know that? >> i have seen they are down, but i have seen that sentences are up and we are focused -- >> they are telling me it is hard to make the case. these are murderers and we can't stop them. they are bringing deadly substances in. some is coming through the u.s. mail. i will say they told me the mail is starting to crack that out.

they get across the border and then they enter the united states like it is coming from a gift package. is that correct, sir? >> in many ways -- they are intent on getting the package there on time. we have to get the deadly drugs there on time. we have to look at every avenue. these guys are using the border. i was in mexico years ago -- i don't know if you came with me on that trip, mr. cummings. you do a dea signature -- you can do that of heroin and cocaine, can't you? >> yes. >> where is the stuff coming from? >> mexico. >> 15 years ago, it was all columbia, wasn't it? >> it still comes from columbia. >> yes, but primarily it was very little. comingas black heroin out of mexico, but they were the imagamateurs.

now, they have become the pros. by the time we get to treatment it is way too late. -- andl for the naloxone having that with our first responsders. but one police chief tommy three times in one week a student, -- inef told me, three times one week, a student, they had to revive him. where is the chart? we have done a good job -- put the chart up on heroin versus the -- ok. opiod drugs of the top and heroin. we brought that on a little bit. somewhat effective in cracking down on prescription drugs, but look at what is happening with heroin. it is off the charts and it is being replaced by a

cheaper and more available -- they told me, sir that the prices down. >> that is correct. >> when is the price down? when the supply is all over the place. it is not just baltimore or washington dc or orange county, it is every state in the united states. army seeing this in every state, sir? >> yes that is correct. >> again, i get a little bit hot to trot over this. but our job is protecting the citizens of the united states. we saw what happened with the terrorist attack in brussels. we are being attacked in our streets and our schools and our families. again, they killed today about 40 people. in thelled 50,000 people latest statistics we have, which are more than one year old. and i know tough enforcement

works. i worked with mayor giuliani. they stopped a lot of the crime and drugs with zero-tolerance. mabye."ave "just say and a just announced the new retro policy, "just say ok," rather than "just say no." >> i would agree that part of our strategy is to focus on primary prevention. we know that by delaying when people use -- particularly kids use alcohol, marijuana, or tobacco, we substantially increase the fact that they will have a life with -- >> were you aware that high school seniors now abuse marijuana more than cigarettes? >> yes. >> that is great commentary in our success with combating this in our y outh. chair.k you, mr.

and thank you for your comments on the heroin epidemic. i want to commend you for the groundbreaking work you are doing in baltimore. you are not just talking the talk when it comes to speaking out about ending the stigma. you are walking the walk when it comes to expanding access to .reatment for your residents in your testimony, you discussed your efforts to provide treatment on demand, on a 24/7 basis for baltimore residents. having someone access treatment is a powerful tool for making sure that they actually begin treatment. and that your approach will save hundreds, or thousands of lives as a result. today, one of the barriers to

imdtment is the medicaid exclusion, which prohibits medicaid for paying for community-based nonhospital inpatient residential treatment in a facility of 16 or more beds. exclusionely, the imd means that if you are on medicaid you are treated like a second-class citizen unable to theess what may be appropriate care for your substance use disorder. for the residents you are responsible for and baltimore, do you agree they should have access to the medically appropriate care they need, whether or not they are on medicaid? >> thank you, congressman. i absolutely agree and i thank you for acknowledging that addiction is a disease. if a patient came to the hospital with a heart attack we

would never say, wait three weeks and maybe, if there is a bed available we will get you in then. the same thing should apply in the imd exclusion. it is not based on evidence. removing the waiver on the federal level will allow us to increase the ability to treat all of our patients, regardless of their insurance status. >> that would put those patients on equal footing with everyone toe, so that we don't seem be discriminating based on the level of care. >> yes, and it would increase more providers, whom we desperately need at this time, where our treatment capacity is just one in a 10 nationwide. >> and let me thank you for appearing here today. every city and county, mayor jacobs, should have a health commission, raising the alarm as forcefully and effectively as the doctor is and hopefully,

orange county has the. and congress will finally heed the call and do something significant about the opioid epidemic because it seems as though we as a country have come together in deciding, this is a national emergency. we should sit up and pay attention. so, let me thank you too mayor jacobs for being here and what you have done to raise the level of awareness in your community. miss enomoto. you testified about the work that samhsa does. can you describe the work in detail? you testified that of the $1 million in new mandatory 120ing, samhsa proposes

million over a couple years to support cooperative agreements with states to expand access to treatment for all opioid use disorders. why is it important that samhsa received these funds? enomoto: the need for early exceeds the capacity of our system today. we believe that every person who has an opioid use disorder needs treatment. 24 hour access to treatment, that should be the standard of care for everyone. with this proposal for $921 million to be infused across two years, we believe that would supercharge the capacity of our state and communities with the greatest need so individuals seeking treatment would have an open door when they are ready to get that treatment. as we know, the window can be small for some people and we need to take advantage of that

opportunity when they come knocking. >> thank you, so much for your response. mr. chairman, i yield back. >> let me recognize mr. turner from ohio. mr. turner: mr. chairman, thank you for holding the hearing and mr. cummings, thank you for your comments. in my community, i was touring a brand-new hospital. and i was taken back to a conference room to meet with the leadership of the brand-new hospital and ask them what is their most significant challenge. and they told me, babies being born addicted to opiates. brand new hospital, out of all the federal regulations, out of all the funding issues they would have, you would not have thought the biggest challenge in a brand-new hospital was babies addicted to opiates. thank you for all of your efforts. i appreciate your leadership. i think you are doing a great

job and i appreciate your advice to congress, as to how we might be able to formulate our to do list. mayor, you live in your to do list. thank you for your representation of your community. enomoto, i would like to put up a few slides that come from your fiscal year 2017 congressional budget justification. the first one being a quote that says that approximately one million americans need, but do not access treatment f a treatmn opioid abuse disorder. do these slides come from your fiscal year 2017 budget justification? when we holding hearings, we don't do them nearly four increased community awareness. we do them for a congressional to do list, but also for the agency to do list. that is why i am turning to your budget justification. we know one million americans need, but do not ask his treatment. the next slide, for example,

prisoners80% of state and 72% of federal prisoners and meet theil inmates criteria for having either a mental health or substance abuse issue. those are staggering numbers. 80% of the state prisoners, 72% federal, and 82% jail inmates. the next slide? studies show, again, your budget justification, miss eno moto.studies show that only 8.3% of individuals involved with of the criminal justice system who are in the need of substance use disorder treatment receive as part of their justice system supervision. after i left at that hospital, i then begin the quest of trying to find in my community, where are the resources? how can we find resources for treatment?

in our criminal justice system and in the community i was introduced to people who were struggling to find treatment for those who are incarcerated. and then i was introduced to a prohibition in your agency's funding that prevents it from being utilized for those people who are incarcerated. in your very agency's documents in indicates the problem -- and we have a self starting, right? we have people who present themselves in the criminal justice system with this problem. we have an understanding that without treatment, they will not be able to transition and we will, as our chairman has said, once again, be providing assistance to them in an overdose situation or see them again in the criminal justice system. in your funding, there is an exclusion that prevents communities from using dollars they receive from you to actually address that, for people who are incarcerated.

and to mr. clay's comments in medicare and medicaid there are similar exclusions that prevent people who are entitled to receive their treatment from receiving that treatment. hr4076 that would eliminate those restrictions, that would say, this is funding that is already there. it is not an increase of funding, though i am for increasing the funding. these are funds that are already there. , couldency by rule eliminate that restriction. why don't you? miss enomoto: i think the issue pointed out is so important to communities across the country. we know people in our jails and in our prisons are represented with substance used his orders and mental illness. getting them adequate care is

absolutely important for this nation. at the same time, we strongly 's earlythe drug court divergent, as well as reentry programs and we have made significant investments to make sure the evidence -- that, butciate all before it was my time, could you tell me why your agency won't waste the requirement and allow your funding to be utilized for those who are incarcerated? >> want to make sure i get you an accurate answer to that. so i am happy to follow up further either for the record or in person. >> excellent and i do appreciate your hard work. i know you are trying to assist us also. i would urge everyone to 4076.nsor hr >> thank you, mr. turning. we put into the record at op-ed into the baltimore sun the

effects of opioid prescription -- int and emergency room emergency room. the author explains that one reason we are seeing such a huge increase in heroin overdoses is because of legal prescription painkillers are being overprescribed. once a patient is hoped, he or drugs which street it -- which are easier and more expensive -- and less expensive. yes or no? >> yes. >> the op-ed has a startling stat that says "with only 5% of -- world population

consuming the world's and killers, the op-ed explains that the drug companies are actively prescriptions for opioids have been limited to cancer pain and comfort measures. the mid 90's, drug companies andn marketing these pills new plethora of ailments. and in the effort to expand the --ket, producers understated it was the most aggressive marketing of a scheduled to drug ever undertaken by a

pharmaceutical company. this is big business. how in the world do we combat this massive effort by drug companies? when they are making billions? forongressman thank you asking the question. i appreciate you saying doctors want to do the right thing. when we talk to our communities, our youth recommend -- they are going to say heroin is bad. we have a culture of excess. because of the aggressive marketing of truck companies, we have expectation that there should be a poem prescribed for every pain -- there should be a pill prescribed for every pain. guidelines that can say prescribing it we need the

resources when we are in the er to connect our patients to treatment. we also feel frustrated at doing our patients care but we cannot deliver. quest you took all guidance that you sent out. usinguidance also include -- sign >> including the necessity of cook prescribing naloxone with any opioids because anybody could die. the second is to be careful about the opioid medications knowing they are not first-line medications. they should only be prescribed for severe pain. the third is for the danger of -- which are also killing our residents. >> it is about profit.

pharma, the purdue list of america's richest families. estimated $14 million. yesterday i was talking to a reporter, he was saying that aren't you concerned that with more money being requested for treatment and to deal with this problem, because there are so many more people getting into opioids and heroin, that money that itspread so thin

will not have the impact you are hoping for? >> we need to rein in behavior in the united states. closely follow the guidance that dr. when put out. that is the significant driver. we also know that despite all of our efforts, we still have too many people overdosing in dying. the cousins cannot access treatment programs when they need to make programs. as is why the president has to put forward a significant proposal to expand treatment capacity in the united states. i hear this wherever i go. in toledo,nhall ohio, where the sheriff -- i asked the sheriff one thing the government should be adjusting this opioid epidemic, he did not say we need police officers, he

said we need more treatment capacity because we are arresting too many people who have not been able to access treatment. we took a careful look at how many people need treatment and tried to adjust the proposal to focus on making sure that as many people as possible have access treatment when needed. >> one more question, what happened -- in other words, this was not a problem before? not as much of a problem but then something happened? what happened? the numbers that determine -- i relies people are moving from , whatioids to the heroin happened in terms of the opioids to get so many people on them? and then for them to move to the heroin? do you know? >> there was aggressive marketing by drug companies, so that the pain scale is something that is asked of patients all the time.

the goal should not be to getting to get pain-free -- getting to pain-free. doctors are put in a hard place of satisfying those requirements when all that was done for drug companies. >> doctors have a tough time. patient gets coming in and the pain could be at a two. the patient has a two. he comes in and does not tell the truth and says i've got a nine. is that the kind of thing that happens? >> that happens. doctors feel they have to get the patient's pain 20 which includes overprescribing painkillers to do so. >> while. he seemed like you want to say something -- wow.

you seem like you want to say something. >> opioids are the first line of defense. opioids are not the first-line defense to really substantially reduce pain. we have to focus on other -- the evidence seems to be strong that people who are in chronic pain don't have significantly that are functioning when they are on opioids. we need to be thinking about things like exercise and diet and cognitive haverhill therapy .nd non-opioid-based therapies >> last question, mr. turner , ms. a critical question enomoto. he was talking about treatment in prison. from providing treatment in prison deck of his that what he -- in prison?

isn't that what he was asking you? >> yes. i guess i want to check into that. i can make sure i get you a complete and accurate -- >> please do. i am wondering if it is something that congress should be dealing with. i don't know if that is in your control or our control. i appreciate an answer. do you know? >> i do not. >> i think mr. turner said it is under their control. walker may recognize mr. . you are recognized. mr. walker: i appreciate this panel of witnesses. you talk about -- you talked about treatment. you mentioned the sheriff's that is the one thing the federal government to do. treatment is good and we need more of it. that is reactive after the problem already exists. is that fair to say?

let's start from the basis. right -- my wife writes prescriptions. as of the things i have seen a minister for two decades is the introduction of marijuana. we heard the statistic that more high school seniors do we instead of cigarettes you did -- cigarettes. you discussed the legalization during a 60 minutes profile. do you believe this could lead to future drug use among the youth? >> i think the evidence is pretty clear. when you're talking about early judges by youth, tickly alcohol, tobacco and marijuana, that increases the probability that people are going to have a more significant problem later in life. in that episode i talked about the fact that i in the federal government do not support the legalization of marijuana and when you look at the data in terms of the high levels of

marijuana use that we have among youth, in particular when we have an industry that is honestly targeting our youth with things like funny cartoon characters and edibles, that we are in more significant -- we are in for more significant problems here it >> -- problems. i hear we are replicating what has happened in the past. >> do we have to worry that what -- do we have to worry that legalizing marijuana could lead to more problems in the future? >> we have been tracking data for 40 years. isn you perceive using drugs less risky, we often see an increase in drug use. not only have we had very high marijuana use among youth, we are also seeing historically low levels of perception of risk of marijuana use. >> i don't want use all my time here, does anybody disagree with the findings for the record?

does everybody agreed that the marijuana usage is the beginning of a potential greater problem? just for the record, i am seeing everybody say yes except for dr. wen. >> it is one contributor. another is prescription drug price. >> through, but most high school students are not going to the doctor and getting described pain relievers. sometimes their first introduction is the purchasing of marijuana. is that fair to say? i want to come to that. i want to make sure we're not paying that -- painting the doctors as the bad guys. and counseling some of the people have gone through some of as the are, they have become master minute latest as far as going to the doctors officers and emergency rooms -- master manipulators as far as soing into the doctor's office

and emergency rooms. are trying to do the right thing. most patients are just trying to get the care that they want. unfortunately, patients at the expectation that they have to be pain-free. if i follow down and lose my knee, i will have pain. getting opioids is not the answer. >> we have to get away from the culture and we have seen a plateau, we have to continue to do better. i think of richard and jennifer in central china, they have a son -- essential no caps on a. they have a son -- central north carolina. they have a son. they have taken that message -- message out to bring

more awareness. i'm glad to see that as a plateau we need to stay on top of that. i am overwhelmingly alarmed at the spike. i like to see this -- i would like to see the 2015 numbers as soon as possible. it is a problem for all of us and we have to continue to do more. i yield back the balance of my time. thank you mr. chairman. >> thank you, gentlemen. >> i think the chairman and ranking member and all of the panelists for focusing on this crisis in health care in our country and it is encouraging to hear the testimony and efforts. we in congress need to put money where our mouth's is -- where our mouth is. i urge my colleagues to improve the $600 million in emergency

funding which the professionals are asking for to combat this epidemic. from dr. i am hearing wen and others is if we hit the treatment level when they are becoming addicted to the painkillers, you hit it then, it doesn't get to the other level of the opium. if we could find it, that would be important. the senate recently acted on this crisis. they passed the comprehensive addiction and recovery act of 20 skiing to help prevent -- of 2016 to help prevent addiction. it doesn't provide any funding. what good is a program that doesn't divide any funding? does this program help people suffering in your city? >> congresswoman, funding is a necessary component of any

program that we offer. if i could add one thing, because we talk a lot about treatment. we have mentioned that that is on the tail end that is reactive. this country came together, it galvanized around tobacco use. it profoundly changed the way our youth look at that. if this country could come together, if the congress and state and local level would come around the campaign of awareness about how serious heroin use is, opioid addiction, drug painkillers, all of those things. i think we could make a bigger impact on that level. stem the tide of this. >> i think that is important point, but that whole tobacco effort a lot of its them access. it stemmed access to tobacco. they made it more difficult to have access to tobacco.

i know the cdc just came out with some guidelines that says do not prescribe this so easily. you should have a higher -- as dr. wen said, when you fall down, you hurt yourself. you're not always -- you are going to have pain sometimes. you have to lower the expectation that no one can have any pain. if you have an operation, you're going to have pain. than better to have pain become a addicted to heroin or something worse. maybe some concrete guidelines on access to it. that maybe the scientific community should define what pain level should have access to opioids. that it should be -- should not be something that everyone should expect to be pain-free the whole time they are in the hospital. how would you react to that, dr. wen, to having guidelines that really stemmed access to very

severe pain levels, because what we are doing is for someone to become double for a week, we are turning them into attics. -- into addicts. this is a crisis. this has got to stop. iwas take my colleagues -- would say to my colleagues, we should not leave here until we vote that 600 main dollars that is needed -- that $600 million that is needed for the program. what they need is the treatment and the field. i would like to ask dr. wen, what do you think about reversing it? . just education, but giving doctors help in knowing what threshold of pain would be necessary before this dangerous addictive drug is allowed? >> dr. -- congressman -- congresswoman maloney, i think you for that point.

doctors need guidance and tools in on to make the best decision for the patients. having guidance would be useful because you do not want to punish doctors who are doing the right thing. when reimbursement is tied to getting the doctor or patient to become pain-free, that becomes very difficult for the doctor to practice appropriately. i'll to caution there are appropriate uses for opioid medication. it's a pain, surgeries. we don't want to eliminate that altogether. >> direct guidelines. who would be the one to do that? the cdc? have you looked at the guidelines they came forward with? >> i have the ones we agree with and hope they would go further and also in helping us to put further warnings, including -- highestarnings on risk recommendation to alert

both patients and doctors. >> my time is up. thank you. see it we have colorado. you are recognized. >> thank you mr. chairman. mr. lyons, i have a couple of questions for you. in 1970, congress enacted the poison prevention packaging act to adjust aspirin overdose cases with children. that, a tamper resistant container was developed for that purpose. we are now dealing with a situation where there are a huge number of young people to get -- who get these opioids from their parents medicine cabinet. i have been made aware of a product that i am holding which cost less than one dollar.

it would increase the cost of the print -- the prescription less than one dollar. it is a combination. it would require the parents to open that if a child do not have the combination and try to get into something like this, they would be evident to the parent. has dea look into a packaging like this? we suggestmeant, congressman, we support anything that would serve that purpose. we are aware of the company and device. are probably aware the company comes from the great state of iowa. >> we are aware of it and we were happy to listen to them about that technology. we would support that and the takeback kiosks to get drugs out of the medicine cabinets. any technology that would prevent those dangers drugs

getting into the hands of children or anyone, we would support you to >> what needs to be done? do we need a law for that? i am not a big proponent of the administrative regulations, but can you by regulation require dangers drugs be dispensed in packaging like this -- required dangerous drugs be dispensed in packaging like this? >> as far as how it is dispensed, i don't think we can. you got to navigate carefully because -- if this technology were made widely available, but that would have to come from a private entity. it would not be something we could mandate. >> would you need an act of -- we areo require not going to name a company or technology, but we would certainly require opioid to be dispensed in some kind of said container, would that be something that would help you in furthering this goal?

>> it would help event getting into the hands of children. it is something we would have to talk to you about a follow-up. >> i would appreciate that very much. botticelli, the federal government dispenses drugs to the v a and other agencies. would it require an act of congress? could the federal government for purposes of dispensing drugs to federal employees or veterans use packaging like this without a federal law for congress? >> i think we would have to go back and look at what kind of authority we would have or if the federal government and needs additional authority -- federal government needs additional authority and what we have been trying to do is ensure every

prescribe -- every federal prescriber has some level of education as a relates to those. in terms of mandating our package, i do not know if i would have the authority or need additional authority. >> if you could work with my office on that, i would appreciate that and look forward to working with you to try and develop this. i think the chairman and i yield back. >> i think the gentleman did i recognize now mr. lynch. a judgment from massachusetts. mr. lynch: thank you mr. chairman and i want to associate myself with the words of the chairman and ranking member early on. there is much we can do on the treatment side, but upfront, there is also the opportunity to reduce the number of people that require treatment. i think we have to double our efforts in that regard. mike botticelli, good to see you again. for those who do not know the head up our efforts in massachusetts. he did great work.

i want to thank mr. millie on. my district has an overrun so you have been kind enough to assign dea officers and agents up in my area working with local police. we appreciate the help. any individual state doesn't have impact on the border but you do. that has been an and or is help for us. trying to interject some of the heroin pipeline that is the coming up into the boston area. a house in boston that is an adolescent treatment facility, because our kids are coming in so young with addictions to opioids and heroin. 24 boys.asically 20 for girls. i have a line out of the door. it is happening over and over again. say as a sideline,

as i talked to our young people, and we have put thousands of kids through this home. it is a long-term rehab facility. know if marijuana is a great- is a gateway drug to heroin, but every kid i am dimwit who is on hbo it's an heroin -- every kid i started with who is on opioids started with marijuana. ,very kid i am dealing with when i asked him what did you start it with? they all say marijuana. maybe it is susceptibility, i am not sure. it is not anecdotal, it is more than that. over thousands of kids, but it points in that direction. i think it deserves a cautionary note in terms of some of this marijuana legalization. one thing i want to talk about and get your opinion, we have

not talk about the power of these opioids. i'll give you a couple of examples. had awoman in my district tooth problem. she had an extraction. they gave her a large prescription of oxycontin. she consumed that pearson went back and complained policy. -- she consumed that. went back and complained. she is yanking teeth out of her head so she can get prescriptions of oxycontin. that is unbelievable. i talked to some of the doctors in the boston area. they tell me the chemical changes in the brain. it overrides -- the oxycontin and hydrocodone actually overrides the endorphin creation in the brain, so it is more powerful than the endorphins that the brain can reduce on its own. when they come off of that, when they need that, that is why they

are going for more oxycontin or heroin. that is the only thing that can scratch that itch. we got think about this. these drug companies are creating customers for life. customers for life. another young father and my district a shoulder pain, same deal. give them too much oxycontin prescription. two of three scripts later, now he is buying it on the streets. justd dad, good family, totally fell into the trap. we got to figure out -- i think it is a huge commercial advantage for some of these companies to produce a product that creates a customer for life. we got to think about what we are doing in that regard. that is a huge commercial advantage. baker andat governor the mass legislation just said if you're going to prescribe the stuff, you can only give so many pills. it is also a part of our drug

munching pieces that we are doing along those lines. is there anything on the front end that we can be doing to stop the number of people, because once they get in there, we are having terrible problems. we've got a lot of recidivism, a lot of relapse. a lot of money where spending for rehab. we need to do that. on the front end, to stop these kids from being trapped and others unsuspecting patients from being trapped in this cycle. is there anything else we can do to stop that from happening? >> sure. i thank you for that question. we talked to the cdc -- they released guidelines. there only guidelines. i agree -- they are only guidelines. i agree that the -- 16 other states, there is legislation in congress. we will look to work with you on mandatory prescriber education.

they've got a lot of misinformation from drug companies that these are not addictive medications. think quite honestly in the middle of an epidemic it is unreasonable to ask a prescriber to take a minimal amount of education. if you look at the overdoses that we have seen, there is a direct correlation between the amount of prescriptions that we are giving out and overdose death did it has been going on for 10 years. i think the metal community has a role to play. >> what about liability? drug companies and the docs who push this out there. people are getting addicted like that. >> i agree. they have a role to play, not only in terms of making sure they are reading the letter of the law in terms of marketing.