tv Key Capitol Hill Hearings CSPAN March 31, 2016 2:00am-4:01am EDT
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but she wouldn't listen. she kept going on and on. she was angry. she said, daddy you missed my swim meet when i was in high school. and i remember telling her, miriam, you have a son. a sixth grader, he needs you. but she didn't want to listen. she wasn't prepared to change the path she was on. and she wouldn't change. so i ended up, i just started a law firm, i was a brand-new lawyer. loans butn of student i ended up taking a $20,000 cash advance on a credit card, and using that money to put my school,n a boarding valley forge military academy.
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they took him in. it was actually a wonderful environment for my nephew, having some structure, having some order, having some discipline, having some basic stability. by the end of that year in school miriam had come back to him. she was out of the crack house, she was still struggling with but itd alcohol abuse, was not as bad as it has been. she was able to care for joey again. and then a few years ago miriam died of an overdose.
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joey, her son, found her in her bed. the coroner ruled it asks said -- corn ruled it orner ruled it accidental. these tragedies are hopping all -- are happening all over this country. with peril and sometimes people make decisions bound and determined to destroy themselves. as a family you wonder if i could have done more, was there a way to pull her back, was there a way to change the path she was on.
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there are other journeys that have happier endings. journeys like the one paul briefly described. that journey was my father's journey. which occurred when i was a little boy. that is one of the reasons his first family broke up. my mother was not a christian. --were living up in the time up at the time in calvary. my dad went down to texas and decided he didn't want to be married.be he decided he didn't want to be
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a dad to his son anymore. my mom was a single mom raising me. and a friend invited my father to a bible study. reason my dad came to the bible study. at the end they were taking prayer requests and they were praying. indeed one of the women described how her son beat her to get money to buy drugs. what struck my father was the had what aing there scripture calls a piece to the path of understanding. he couldn't understand it, it made no sense to him but he knew he wanted it.
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so he left that bible study. leaving the folks hosting it gave him a little pamphlet. i suspect a lot of you have read the four spiritual laws. they said read this and come back next week. he did and he came back. the asked him, did you read pamphlet. he said he yes, but it can't be that simple. that's too easy. it can't be that simple. so he began asking questions. the folks hosting the bible study were fairly new christians. they said tell you what, tomorrow our pastors coming over to the house. would you be willing to come by and ask him the questions. he said, sure. next day he went by the
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house at about 7:00 and my dad -- spent fourrs hours arguing with the pastor. he was young, he was brilliant, he was an atheist. he was convinced he knew everything. withe argued and argued the pastor. finally at 11:00 at night my dad said, what about the man into tibet who has never heard of jesus? pastor -- brother wiley didn't take that date. that bait. he said, i don't know about the man in to that. jesus, --ve heard of i don't know about the man in to tibet, but you
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have heard of jesus. it's your excuse -- what's your excuse? fellas april 15, 1975. that wasmonth my -- april 15, 1975. airport, hethe bought a ticket and he flew back to my mother and me. it turned his life around. my father hasn't had a drink in 40 years. [applause] everyone of us who has dealt has dealt demons are with loved ones grappling these demons, everyone of us
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understands these are personal there is no uniform solution that fixes it all. it is certainly not going to be washington, d.c. that steps in and solve these problems. it's going to be friends and families, churches and charities, loved ones, treatment centers, people working. -- people working to help those struggling to overcome drug addiction. is a disease,ion it is a vicious disease. there are so many working in the field. helping people get that monkey off their back.
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helping people overcome that addiction. faith and relationship with god can be a powerful element. the church plays such an important role. aayou look at the history of we were80 years ago facing an epidemic of alcoholism. doctors had given up. alcoholics were put in asylums to die. the northeast was a battleground for this devastating disease. the founders of aa were from the neighboring state of vermont. when they formed aa there were no government grants.
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there were no nonprofits working to help alcoholics. the program was so successful at the time that wealthy donors often wrote checks to undermine aa. turned down the money to not corrupt the organization. today they take no money from -- outside a prices enterprises or sources. and a program of person helping person to find god, there understanding and relying on ,hat higher power to guide life and protecting the program as it still works today. those programs are more and more of the need, helping people get back on their feet.
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not everyone is going to be of us can makeh a difference. >> the senate judiciary -- ittee to combat opioid addiction. we will hear from michael, the director of the white house office on the national drug control policy. i have a question for you, i have a personal friend -- i am a personal friend of your speaker. point the senator was making, and i do agreed with -- agree with what senator durbin said. if we focused on the prescribed , then i think we are
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going to see an increased uptake in heroin abuse. in north carolina it was a matter of state policy, we did a number of things to crack down on drug shopping. there is almost a direct correlation between the reduction in those prescribed opioids and an increase in heroin at buse -- heroin abuse. i am also struck by the fact that there are great disparities between overdoses and death. i was shocked to know hours had still a but it is fraction of a state that has 1.5 million people versus a state that has 10 million people. what risk to be run of federal policy, potentially hampering what you think and your senate leader needs to do to address to theseat are unique
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things that have disproportionate problems? >> that is a great question. can't to you why some states are being hit harder than others. this i'm being convinced of, i don't think we would have the ifoine problem in america the didn't start people out with opiates that are sold at over-the-counter drug stores. is -- the irrational exuberance around painkillers is matched by the crisis. convinced if we went back to the old policies on pain medicine, if someone has chronic pain treated and treated hard. but don't pass the stuff out as if it is not a problem. had a reporter come into my office and she just
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tunnel.ery for carpal i asked how many ox ease she got . she said 80. took, shew many she said half of one. so there are 79 and-a-half left behind. comes by, she is a sophomore in college but she had four molars pulled out. they gave her ox see -- gave her oxy. i asked her how many she took, she said none, so there is 40 more. there is no question when we resistant, folks went to your heroin because it is cheaper and easier to get. we cannot loose side of the fact that we are having this problem prior to the invention of oxycontin.
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to the to go back source. the senator from illinois said -- i remember when the fda -- fda do notro approve this drug is into two -- .his drug 11 to two there is a correlation if you talk to folks or addicts, and 90% of the time folks say to me i got an a car accident, i got surgery, this happened to me. >> senator sheen wanted to add something. >> i did. everybody talked about the fda, pharma, and the role of prescription drugs. but we cannot talked about medical school and doctors. we understand medical schools don't have courses on prescribing medication, on
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recognizing drug abuse. it seems we have to get attention from medical schools who are turning out doctors doing these practices without the history of what has been raised at this hearing. >> amen. >> i agree with senator shaheen on this. we have to engage the medical community. but for example, in new hampshire, back when i was attorney general, i was fighting for prescription monitoring. our state was late to the game. when we look at this data, in giving physicians the information -- and that's one of the piece of this bill, to support prescription monitoring programs. physicians that want to do the right thing, that gives them the data to understand if someone is dr. shopping. it gives us the focus to know if a particular doctor is actually exceeding his/her bounce because it's focusing on them. -- his/her bounds so it's
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focusing on them. samsung will tell you -- some of the work they have done nationally. 4 out of 5 people started by overusing or misusing prescription drugs. to your point that you raised in your opening, with the patient survey, we are encouraging reimbursement based on how satisfied people are with pain. that has to be addressed as well . i know that cms is looking at this. it has to be a priority. this was brought to our attention from doctors concerned that, if they are worried about an addiction issue, they are being judged on a survey -- how does your pain satisfaction? that has to be addressed as well. >> senator portman and then senator klobuchar. >> i don't disagree with the comments made here. we not only have the drug monitoring programs, which were incentivized. and how the states will respond to this legislation, it does not
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mandate the states to do this, it just provides incentives. every state will be a little different. some states have done cutting edge work and should be the laboratories of democracy. but we are hoping with this prescription monitoring, across state lines. we may have a great program, in southern ohio, west virginia or kentucky. you don't know if someone has a prescription filled in ohio without having infrastructure. that is something the federal government can exclusively do. we have legislation on that. second, the jug takeback -- the drug takeback program. taking those drugs off the shelves. the final things is, having talked to hundreds of people who are recovering, who have been addicts because of prescription drugs, i understand that very well, including the athlete i talked about earlier. there are a lot of talked to that went straight to heroin.
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holly is an example of that, as we will hear from her mom. i think now, because heroin is so plentiful. i was just with the fbi in ohio yesterday talking about this -- drug cartels from mexico are in ohio, illinois, in our states. because it's plentiful and cheap, it's not just about prescription drugs anymore. it has been a gateway for a lot of people. but now there is a problem we have directly with heroin, even first use. in the days when we worked on this issue of cocaine and marijuana in the 1990's, heroine was not a first use drug. he was one you used after other gateway drugs typically. with people as young as 13, 14, 15 years old are using heroin today. this legislation is comprehensive. it deals with the prescription site and the heroin issue, which we sadly have to confront perhaps because of this onslaught from the overuse of pain medication. but how the heroin is upon us.
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>> going back to the earlier observation about 30 doctors prescribing in pain connect -- pain clinics, things that are not needed that end up on the street and sold. can. what are we doing working with the medical societies and medical professionals? they are the for these prescrip. what we doing to clean this up and hold those accountable in a public way? >> a fundamental problem is thinking about 750 million prescriptions annually in the
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u.s., which actually leads to an enormous amount of diversion. tons, it's clearly telling us we are overprescribing medication. it's not just drug doctors, which are actually very few, but the practices we have in order to treat pain in this country. that leads to addiction and overdose. >> is there a conversation with the medical profession about this. >> one thing we have done as part of west virginia, we have worked with matter -- major medical societies and trained half a million of their physicians on safe and effective opioid prescribing. it is not enough for my perspective. when we look at the data, we are 10 years into this epidemic. i don't think it is too much to ask medical professionals and
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medical societies to purport a minimal amount education as it relates to save and effective opioid prescribing. >> i also want to include, many of the guidelines currently available for physicians about the use of prescription opioids has been developed by the pharmaceutical industry. there is a direct conflict. the national institute of health has coordinated with many to generate a curriculum for not just medical students and physicians, but also nurses, pharmacists, and dentist for the proper management of pain and use of prescription opioids. there is interest, and we worked with different medical agencies for development of guidelines for the better management of pain. >> senator sessions. sen. session: thank you. this is very important. i know senator durbin is correct on those points he's made.
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pain physicians are concerned about this. they know people complaining about pain. many of them have other sources, other doctors giving them pain pills. things such as allowing a position to check -- a physician to check that if other doctors are providing the same relief. do you agree that could be helpful? and does it provide good doctors an opportunity to push back and not overprescribing? >> yeah, i think this is the main goal of drug monitoring programs that are easy to use, that are interoperable across state lines. physicians can have good accurate information about how many prescriptions one of their clients can get. it's a prime part of our strategy. we have seen the work in many states that have implement it. sen. session: dea has great
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power, it seems to me. you can monitor the number of prescriptions coming from a certain position, can you not? senator, those are state programs. we support all are state partners and the national association-- sen. session: but if you have information a physician is prescribing extraordinary amounts, you can interview them and examined the records. you don't need a search warrant. you can just ask for their records. and a drug store or pharmacist, you can also examine their records, is that correct? >> that is correct. investigation insert in a number of different ways. patterns of oversubscribed -- patterns of overprescribing can lead to an investigation. sen. session: if a doctor is clearly abusing, we've had doctors and pharmacists.
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dea and the local police chief signed a one page memorandum that nobody would have a plea bargain on prescription drug until they were told where it came from. it came from a limited number of sources. that particular drug was virtually eliminated in alabama for a while. if somebody goes to jail, that sends a message to the other doctors and pharmacists, does it not? >> certainly it does. sen. session: i think that is important. looking at the reports from the new england journal of medicine, they conclude there is no consistent evidence of an association between the implementation of policies related to prescription opioids increases in the rates of heroin
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deaths. alternatively, heroin market forces, including increased accessibility, reduced crime, and high purity of heroin appeared to be the major drivers of the recent increase in rates of heroin use. do you agree with that? >> senator, we are focused both on the prescription-- sen. session: no, do you agree with that or not? >> it's not an yes or no answer. sen. session: well it is. you are used to be what is called the drug czar. do you believe high purity and accessibility of heroin are the major drivers of the recent increase in heroin use? >> this study was undertaken for a question that i had about what we were hearing about, does reduced availability drive people to heroin?
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there has been folks that have said, if you clamp down on heroin-- sen. session: the question is as i ask it. >> i would agree that the availability of cheap and pure heroine in the u.s. as well as untreated addictions has significantly increased heroin use rights in the u.s. sen. session: i think that is a good answer, mr. chairman. and lack of enforcement at the border is a big part of that. 1970's, i was assisting a u.s. attorney. i was given 17 heroin cases to prosecute. they didn't trust me for anything bigger. it was almost all coming from turkey. the president was very aggressive in that. i give him credit. i came back in 1981 as a u.s. attorney.
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we went several years before we saw a heroin case. supply is important. we can impact supply. heroin is low-price and high purity on the streets, is dangerous. prosecutions are critical to this. people need to go to jail who are pushing this kind of addictive power into our community, destroying lives anf fd families. mr. chairman, it's a very important hearing. thank you. we can do better about prescription drugs. taxpayers are paying on their medicaid, medicare bills. their insurance rates are higher because of overdoses and over prescription of drugs. it's an important issue. thank you for your leadership. host: 2 months later, the full senate consider legislation that would authorize the federal government to issue grants for
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drug addiction prevention and treatment programs. senator shaking from new hampshire offered an amendment that would upright -- would provided $600 million for the programs. on very gooding legislation with the company since it addiction and recovery act. unless we provide the resources to make these programs work, it's like giving a drowning person a life preserver that has no air in it. it doesn't make a difference. we are losing 47,000 people a year. 120 people a day from overdoses. our law enforcement needs additional funding. the substance abuse treatment
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folks need additional support. what might emergency supplemental amendment would do is support the programs that are in the kennel legislation. it's about equally divided between support for law enforcement and support for treatment. it helps with prescription drug monitoring, with education, with recovery. it is the kind of support we need to provide if we're going to make a difference in this epidemic that we are facing. i would urge my colleagues not just to support the underlying legislation. that's good, we should support it. but unless we provided the funding, we will not have done what we need to to accomplish real change, to keep people from dying. i would urge all of my colleagues to support it is amendment. >> mr. president. >> the senator from wyoming. >> pending amendment offered by the senator from new hampshire
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topopriates $600 million on of the $571 provided in the bill as reported by the judiciary committee over the 2016-2020 period. unlike the underlying bill which requires appropriators to provide authorized funding within the discretionary spending caps, the shaking amendment would designate you spend in -- the shaheen amendment would designate new spending. the bill provides $300 million to the substance abuse and mental health services administration for substance abuse treatment to address the heroin and opioid traces. -- opioid crisis. while we agree this epidemic must be addressed, i believe the underlying bipartisan bill provides a better framework to tackle the problem. it provides the comprehensive pacific's evidence-based approach to help americans combat this. in the meantime, the senate
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appropriations committee shepherded resources to deal with problem in the consolidated appropriate bill signed into law late last year. nearly $600 million was included to help states and communities address the problem. the appropriators working with authorized inside the framework of the bill. >> the senator's time has expired. ask the pending amendment offered by the senator from new hampshire would cause the aggregate level of budget authority for fiscal year 2016 is established in the most recently agreed to concurrent legislation on the budget to be exceeded, therefore i raise the point of order under section 311 2a under the congressional budget act of 1974. sen. shaheen: i would point out, despite what the honorable chairman of the budget committee said, the fact is that the
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emergency supplemental funding amendment we introduced is very specific about where the funding goes. it goes to programs that are addressed and improved. the substance abuse prevention and treatment block grants go to the state to be distributed. funding to law enforcement through the grants that are very to specific in how they can be used to fight heroin and opioid abuse. like my colleague, i am disappointed, not surprised, but disappointed. i very much appreciate those people that voted for this stepment, who were willing forward and say, if we are going to address this problem, we've got to provide the resources that communities and states need to fight this addiction.
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have, foron that i those that did not vote to support this amendment is -- how many more people have to die before we are willing to provide the resources that are needed to fight this epidemic? 47,000 peoplein 2014. in new hampshire, we're losing more than a person a day. in 2015, we lost over 400 people to overdose deaths from opioid and heroin. 3 times as many people as we lost in traffic accidents. so how many communities will continue to be ravaged because we are not willing to commit the resources to tackle this pandemic? and what do we tell the families of those people who have overdosed? what do we tell the parents of young people like courtney
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griffin, whose father testified at a hearing we had last fall in new hampshire. he talked about the difficulties of getting courtney treatment before she overdosed and died. i met a man at a treatment center in lebanon, new hampshire. a man in recovery who had been in and out of prison. i thought he put it really well. about $35,000sts a year to keep somebody in prison. wouldn't it make more sense to put dollars into treatment, because it's a whole lot less expensive to provide the funding usingat people who are opioids and heroin, who are substance abusers, than to put them in jail.
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so mr. president, to all of my colleagues, i am disappointed, but i an not defeated. that fact is, this is coming back. it will come back in the appropriations process and it will come back at every opportunity. because i am not going to quit on this families in new hampshire that need help. i'm not going to quit on the treatment professionals that are trying to revive treatment for those in need. i'm not going to quit on the law enforcement, the police officers and sheriffs and all of those in law enforcement in new hampshire trying to put pushers behind bars and trying to get people off the streets into treatment. and i hope at some point the rest of the members of this body are willing to take up this cause and provide the resources that people need. i will tell you, it's certainly
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worth it to address the 47,000 people who we lost. we were willing to put $5.4 billion into fighting ebola, and we lost one person in america. we were willing to put $2 billion into fighting swine flu, and we lost about 12,000 people in the swine flu epidemic. we have not been willing to put funding in to address the thousands, tens of thousands that we are losing each year in this country. we are going to keep at it. we are going to fighting until we get the resources that families and communities need to fight this scourge. mr. president, i healed to my colleague -- i yield to my colleague from maine, who has been a real leader in trying to address this issue. >> mr. president.
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>> the senator from maine. >> mr. president, i rise in disappointment, surprise, and some confusion that we have this bill. we spend a week. i went to the judiciary committee. it came out unanimously. there is tremendous interest in this subject. when i talked about it at home, i said to my people in maine, this is something we will be able to do! because every member of this body is being affected by this tragedy engulfing our country. this is something we can do together. and indeed, we have done a lot together. we have a good bill. we passed good amendments. this is important work, but it has to be funded. the old saying in maine and i suspect everywhere else, put your money where your mouth is. i was on a teleconference with folks in maine two hours ago talking about this. one of the chiefs of police said, it's time to move from
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talking about being interested in this to investing in it. we cannot solve this problem without money. it would be nice if we could. there is a drastic and dramatic shortage of treatment facilities in this country. the only way we can do it is to pay for it. we had a point of order on the budget. i have to tell you, i'm confused because i stood here less than three months ago when we passed $680 billionll and of tax expenditures. where was the point of order then? it wasn't funded, a dime of it wasn't funded. maybe there was a point of order, but it was overwritten so fast that none of us noticed it. it was the speed of light. so my mother used to say, we strain at nats and swallow camels. we swallowed $680 billion, and
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entirely unfunded tax extenders are, and we can't solve it and bring it into our hearts to save lives for one 1000 of that amount. -- one oion, one 1000 ne thousandth of what we had. i am confused by thsi. i don't understand it. --the way, 47,000 people that sounds like a lot. here's what really sounds like a lot. since this debate started at 2:00 this afternoon, 10 people have died. 10 people had died in the last 2 hours. 47,000 people is 5 people every hour 24 hours a day, 365 days a year. we are not talking about obstructions here. we're talking about lives. when i consider one of the most serious problems i have ever seen in my state.
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and we talk about ebola, isis, all of these challenges that we have. and yet this is something that is killing five people an hour. and we are not willing to put the funds in to do it. it's a false promise. i believe this bill is going to do a lot of good. but it's not going to meet the promise we are making to the american people by all this drama about drug abuse. that we are going to do something about it. but we're not going to do enough about it. because in order to deal with this problem, and this is true everywhere, it's going to take money to provide treatment for people that need it. when someone is ready to change their life and ready to try to defeat this awful disease, and they can't
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find anyplace to give them treatment. i was at a detox center in portland just last week. they are turning away 100 people a month from a detox center. not even a treatment center, but a detox center. because they don't have the beds. i'm delighted we are working on this this. i'm delighted we are passing it. there is a lot of good in it. and it is in fact bipartisan. but to venture to the edge of this problem and step away because we are not willing to pay for what, in my mind, is one of the most serious emergencies we've faced since i've been in public life, is disappointing, a great missed opportunity for the country. i join my colleagues in regretting the decision that was just made. i think it was an opportunity
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where we could have spoken as one, to realistically, realistically attack this scourge that is devastating our people. we are losing lives. we are squandering treasure. and we're breaking hearts. and the only way we can solve this problem, or at least make a dent in it, is to provide the wherewithal to the programs throughout the country that are struggling manfully and mightily to confront the problem and defeat it. thank you mr. president. >> senator from ohio. >> thank you. if my colleague from nevada will let me speak to the comments about the legislation before us, which is legislation to address this horrible problem in overstates -- problem in all of our states.
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about 100 people will die today from overdoses. that's just the tip of the iceberg. there are so many other life that are being ruined, families torn apart and communities devastated. this legislation was drafted by senator whitehouse, myself, other members of this body over the last few years, including 5 summits in this congress to bring in experts on prevention, education, treatment, and recovery. dealing with law enforcement's side and the importance of having narcan available, also getting prescription drugs off bathroom shelves. it is a comprehensive approach. i disagree with my co-author from rhode island insane that if we could -- in saying that with we could pass this bill, there would be no funding. we have had huge increases in funding for opioid addictions. senator whitehouse and myself is that funding was consistent.
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the judiciary committee worked hard to drop legislation -- to draft legislation to get this within a fiscal year. there would be funding to get this legislation. however, as my colleagues know, this is an authorization bill. it directs how funding will be spent, it's not a spending bill. having said all that, as senator shaheen knows, i supported her efforts to add additional resources over and because i believe this is an urgent problem and it rises to the level of being an emergency. , anda fiscal conservative that means it is not paid for by offsetting other programs. we have done this with health care emergencies when we have something like the ebola crisis. i think this is a crisis.
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i'm a cosponsor of senator shaheen's amendment. i do not support the efforts of some who say there is no money in here. this is an authorization bill, the first step towards getting the money in the future. that is the point. drug the author of the free community built. $1.9 million has been spent, creating coalitions in just about every state represented in this body. was that a spending bill? no. it was an authorization bill. evidence-based practices we knew would work. , andis what this is specifically directed to the beingof treatment centers built, detox centers not having room for somewhere to go. these are real problems in our community.
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that is what this legislation is by anto address, not just appropriation for one year, but by changing the law for the future. the nextthis right, in 19 years, we will spend even more than we have spent on the drug-free community at. it will be over $2 billion that would not have otherwise gone out. just as senator whitehouse said he supports this bill because it based, because we took the time and effort to make sure it will be money well spent , this bill is important. i appreciate the support of my --leagues, senators sicking senator shaheen, senator king. it is the right thing to do at a time when we face a crisis. will support additional spending because i think it is so critical. let's not go forward with this sense that somehow this does not matter. this does matter in a very big way.
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this is a necessary first step. in terms of this year, because we increased funding dramatically at the end of this fiscal year, not one penny has been appropriated. there has been no outlay. i believe everything we could get done this year would be funding that we could use for these important programs just in the next seven months of this fiscal year. certainly, we should, right now, as i have done and others are doing, go to the appropriations with regards say, to next fiscal year, let's make sure we have the bill funded. at a minimum, let's get this done. on ais an opportunity bipartisan basis to help people who are crying for help. communities that need our help, families that are being broken apart. i appreciate the fact that senator shaheen made her best
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effort today. she was right, in my view. let's also continue to work together to get this legislation passed. istever funding we can add great, but let's get this bill passed to ensure we are increasing funding to those who need it most. i appreciate my colleague in about a. i yield back -- nevada. i yield back. >> the senator from rhode island. >> i would like to end this conversation on a happy note. that is to express my appreciation to senator portman for his cooperation to get this where it is now. i would like to express my appreciation for publicly pledging to work as hard as we can together to get funding for and through the
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appropriations process that is underway right now. i believe we missed a opportunity because senator shaheen's would have flooded more money into the solution of this problem. >> a week after voting not to add $600 million to the legislation, the senate passed the comprehensive addiction and recovery act by 94-1. the bill authorizes grants to states for treatment and education program. of apands the availability drug that can block the effects of opioids and prevent overdoses and strengthens prescription drug monitoring programs. companion legislation has been introduced in the house. house oversight committee held a hearing on opioid abuse. we will hear from elijah cummings, who asked whether drug companies promote over prescription so they will make more money.
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we will hear a discussion about whether marijuana is a gateway drug. record thento the baltimore sun, the effects of opioid over prescription. explains one reason we are seeing such a huge increase in heroin overdoses is because legal painkillers are being overprescribed. she says, once a patient is hooked, he or she often turns to street drugs, which can be easier and less expensive to acquire. everyone else said that this morning. i want to be clear. i not trying to blame the doctors. or, do you agree one reason we are seeing an uptick is because of the abuse of
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opioids? >> yes. op-ed says with only 5% of the world population, we are consuming over 80% of the world's painkillers. op-ed explains drug companies are actively promoting this problem. prescriptions for opioids have been traditionally limited to cancer pain. but in the mid-1990's, drug companies began marketing these pills as a solution to a plethora of ailments. expand theforts to market, producers understated and willfully ignored the powerfully addictive properties of their drugs. it sounds like drug companies are almost like drug pushers. cites several
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examples. oxycontin by of perdue was the most aggressive marketing of a schedule 2 drug ever undertaken by a pharmaceutical company. this is a big business. how in the world do we combat this massive and aggressive effort by drug companies? you know, when they are making billions? go ahead. >> congressman, thank you for asking that question. i appreciate your saying that. doctors want to do the right thing. when we talk to our communities, when we ask our youth in schools it heroin is good or bad, they will say it is bad, but we have a culture of access. we have this expectation there should be a pill prescribed for every pain.
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we have to make sure doctors get the resources they need, including prescription drug monitoring programs and guidelines for prescribing. we also need the resources when we are in the e.r. we need the resources to connect patients to treatment. otherwise, we feel frustrated knowing that our patients need care but we cannot deliver. >> you talked about guidance you sent out. include using painkillers that are not so addictive or not addictive at all? >> yes. our guidelines include three things. first is the necessity of prescribing naloxone with any opioids. 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.
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the third is the danger of benzodiazapene. profit.ys this is about perdue achieved its place on the list of wealthiest families. $14 billion. that is appaling. i call that blood money. people are dying, big-time. . want to go back to something you can answer this. yesterday i was talking to a reporter. concerneding, are you that, with even more money being requested for treatment, because
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there are so many more people heroin,into opioids and that money would be spread so thin it would not have the kind of impact you are hoping for? your point, i think we need to have a comprehensive response. we need to rein in prescribing behavior. the centers for disease control put out recommendations last week that follow the guidance dr. wen put out. that is a significant driver to the problem. we know that, despite our efforts, we have too many people overdosing because they cannot access treatment programs when they needed treatment programs. this is why i think the president has put forward a significant proposal to expand treatment capacity in the united states. i hear this wherever i go.
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i did a town hall in toledo, ohio. thingd the sheriff one the federal government should be doing to address the opioid epidemic. he said, we need more treatment capacity. we are arresting too many people who have not been able to access treatment. we carefully look at how many people need treatment and try to adjust the proposal to focus on making sure that as many people as possible have access when they need it. >> one more question. dr. wen, what happened? in other words, this was not a problem, not as much of a problem. then something happened. can you tell me what happened? e numbers the gentleman cited, and i realize people are moving from the opioids to heroin. what happened with regard to opioids to get so many people on them that they moved to heroin.
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my understanding is there was aggressive marketing by drug ispanies so the pain scale something that is up during the course of a hospital stay. the goal should be appropriate treatment. but an expectation is placed on patients and doctors. doctors are put in a hard place of satisfying those requirements. >> doctors have a tough time. in other words, the patient keeps coming in, and the pain -- be a 2, being the mildest the patient has a 2. then he or she comes in and does not tell the truth and says i am at a 9. is that the kind of thing that happens? >> that definitely happens. doctors feel they have to get zero,tients pain to
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which includes overprescribing painkillers in order to do so. >> would you like to say something? >> i agree we set up an expectation whereby opioids are the first line of defense around pain therapy. i think what we are trying to do , specifically for people with chronic pain, is that opioids are not the first line of defense to reduce pain. we have to focus on others -- and the evidence seems to be strong that people in chronic are not significantly better functioning on opioids. we need to be thinking about exercise and diet and cognitive therapy, not opioid-based therapy for people with chronic pain. >> last question. mr. turner asked a critical question.
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i guess he was talking about treatment in prison. is that right? what stops you from providing treatment in prison? is that what he was asking? there is a regulation that says you cannot do that? >> yes. i want to check into that and make sure i get you a complete and accurate -- >> please do. i am wondering if it is something that congress should be -- i do not know if that is in your control or our control. do you know? >> i do not. >> thank you. while i do not know if marijuana is a gateway drug to , every single kid i am dealing with who is on opioids started with marijuana. there is a perfect match, 100%. onry kid i am dealing with
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opioids, when i asked them what they started with, they all say marijuana. maybe it is susceptibility or something. it is not anecdotal. it is empirical. thousands of kids. it certainly points in that direction. i think it deserves a cautionary note in terms of marijuana legalization. one thing i want to talk about and get your opinion -- we have not talked about the power of these opioids. i will give you a couple examples. a young woman in my district had an extraction. they gave her a large prescription of oxycontin. she consumed that and complained falsely of pain. got another prescription and went in and complained. heris yanking teeth out of
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head to get prescriptions. that is unbelievable. i talked to some of the docs in the boston area. the chemical change in the brain overrides-- oxycodone endorphin creation in the brain. it is more powerful than the endorphins the brain can produce on its own. when they come off of that, that is why they are going towards heroin. the only thing that can scratch that itch. we need to think about this. these drug companies are creating customers for life. another young father in my district, shoulder pain. same deal. much oxycontin. now he is buying it on the street. a good dad, good family, just
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totally fell into that trap. it is a huge commercial advantage for some of these companies to produce a product that creates a customer for life. we have to think about what we are doing in that regard. that is a huge commercial advantage, and i think that should have just come out and said, if you are going to prescribe this stuff, you can only get so many pills. it also talked about the drug monitoring peace we are doing along those lines. but is there anything on the mike, we can be doing to stop the number of people? once they get in, we are having terrible, terrible problems. recidivism, relapse. we need to spend money for rehab, but on the front end, to stop these kids from being trapped -- is there anything
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else we can do to stop that from happening? >> i thank you for that question because i think it is important. c just released guidelines, but they are only guidelines. i agree the vast majority of physicians and dentists are well-meaning. part of what massachusetts has done, there is legislation on mandatory prescriber education. but is not about bad docs, they have gotten misinformation from drug companies that these are not addictive medications. the middle of in an epidemic it is unreasonable to take arescriber minimal amount of education with regard to prescribing. thereg at the overdoses, is a correlation between the amount of prescriptions we are giving out and overdose deaths that has been going on for 10 years.
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i think the metal goal community has a role to play. >> what about liability? what about liability for drug companies and the docs that push this stuff out there? >> i agree. there has been litigation against purdue pharmaceutical for that reason. they have a role to play in meeting the letter of the law about marketing and deterring abuse. andeed to work with the dea others to go after outline wantonlyrs who are ignoring the law. we need drug monitoring programs so physicians can identify people who may be going from doctor to doctor. reduce theoing to magnitude of the problem, we have to scale back on prescribing and identify people who are developing problems. >> thank you. >> also, i went into one of our
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drug programs in my community, talked to every kid i could. they are all in the treatment program. every kid told me the same thing. key started with marijuana and they go on to the rest of that stuff. we have a serious situation in this country. >> gentleman from virginia. >> thank you, mr. chairman. , mr. mike and i had a series of hearings on drug policy that included marijuana. it forced me to re-examine some abouti thought i knew drug policy with respect to marijuana. what is disturbing to me is, if it is a gateway drug to heroin, it is opiate prescription drug
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addiction. far more than marijuana. that is why this hearing is so timely. it is affecting every community we represent here in this body. it is not a rural or urban phenomenon or suburban phenomena in. you, mr. botticelli -- how did we get to this point? i do not want any doctor to leave a patient in pain, serious pain, you know? it is a terrible affliction. first, you do no harm. how do we draw that line between pain management and just
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avalanche ofle prescriptions that has led to an epidemic of addiction in america, with presumably the best of intentions? >> i agree. ofn you look at the roots the epidemic, it is really about the overprescribing of addictive pain medication. >> why? how did we get there? doctors are not stupid people. >> i think that doctors were given a significant amount of misinformation from pharmaceutical companies and medical professionals that these were not addictive medications. scant scientific evidence, there was a full-court press to educate physicians in saying that the medications were not very addictive. had a nobletime, we
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goal -- we have to do a better job at pain treatment in the united states. there are a lot of people with significant pain. you have these complements of a full-court press to treat pain and little education on the part about howscribers addictive the substances were, how to identify people. so physicians in the united states gave very little training on appropriate pain prescribing. veterinarians get more training in pain prescribing, and physicians get little training on substance abuse issues. with this mixture of factors that really drove up addiction in the united states, i think, of late, you have that compounded by heroin and fenta nyl. , what is effective
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treatment and the system for recognizing that, hey, someone has a problem? ficacious treatment in trying to turn this around early before it moves onto heroin or something worse? >> it is often said that notcine is an art and completely a science because pain is subjective. that is why doctors need discretion about how to treat each individual patient based on their symptoms and who they are, also recognizing it is not just about medications. we have to do physical therapy, counseling, education that sometimes pain is ok. we do not have to treat everything with a pill. we agree with the increased use of pdmp, though recognizing that
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some are cumbersome to use. ini am seeing 40 patients eight hours, i cannot spend an hour trying to figure out how to get into a pdmp. >> so what is efficacious treatment? what do you recommend? >> we recommend judicious use of pain medication. >> i get that. we're talking about treatment. what have we learned? look, we are policymakers. we want to solve a problem. a point where we have an addictive problem and are trying to prevent that person from going onto the heroin part, what works? >> recognizing that addiction is a disease. therefore, we have to get people into addiction treatment, medically assisted treatment, social counseling, and wraparound services.
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the world health organization shows for one dollar invested, it saves $12 for society. >> thank you very much. thank you for the hearings. they were quite informative. them.got criticized for it is now 1:00. we started some three hours ago. in the united states have died from overdoses, three of them from heroin. 120re the days over, americans will die, 24 from heroin. we have heard different things today. some people said we need to put more money in treatment. treatment is essential, but treatment is at the end of the line. you heard a couple comments from the other side of the aisle that we need to act before we go home
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at easter and put more money into the heroin and drug overdose situation. this is the remarks of senator grassley on the floor. in fact, according to the office of national drug control policy, passed inpriations act december provided more than $400 million in funding specifically to address the opioid epidemic. $100is an increase of million over the previous year. that is 25% increase, ok? none of that money, when he said that a few months ago, has been spent yet. all of that money is available today. is that right? most of it? tell me. most of that money is available today.
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you wouldn't think we are going out of here not providing money. 25% increase. i want this in the record. let's put in the record of how much was asked for and how much was appropriated. how much was taken from interdiction and law enforcement and put in treatment? these are the facts. we do not want to deal with the facts, but we will put this in the records so you will see there is money there. and i want a report. telling report, i am you, this week of how much money is spent. i want that in the record, ok, mr. botticelli? i want something from you too, director of our health and substance abuse office. i want to see how much money is pending. office byin my friday, close of business.
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i know the money is there. it has not even been distributed. we are not going to play these games. i want the facts. we need to stop this stuff at our border. boatloading in by the across the borders. i have one question. i talked about el chapo, biggest czar, coming across the border like it was a vacation holiday. weapons,d, speaking of which are used in most drug in orlando, we kill them at the mall, at our streets, great communities. we are killing them. most of them are gone deaths related to drug trafficking, our debate mr. maloney? -- aren't they mr. maloney?
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a lot of dems are illegal weapons. el chapo, who is coming back and withinhe also had a traced to the fast and furious. -- weapon traced to the passenger is. supplied by the u.s. government and the stroke traffic or --- drug trafficker crossing the border like a holiday visit. are you aware of that? can you confirm that for the committee? >> i would not be in the best position to do that. i will take it back to the department. rep. mica: i want you to check on it and let me know. i am pleased with the people out there. i met with some of your people. the prosecutions are not what they should be. you go to singapore. they do not have a treatment program. i want to put you out of business. all the treatment programs.
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i want to put them out of business because our kids and adults should not have to go to treatment. but we are allowing this crap to come into the united states. it is offensive. we are killing tens of thousands, folks. and anything else, people would be outraged. where are you? just say no, and just say maybe. there are consequences, just say okay. it makes a difference to our young people and what is happening. hot.an tell i get a little the italian comes out of me. i see them dying in the streets of baltimore, diane again in my community. we need to do something about it. that supply has to be cut off. then i can put others out of business. we don't have to treat people and have the scourge on our streets. there being no further business
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before this committee, this hearing is adjourned. thank you witnesses. host: c-span's issue spotlight looking at prescription drug and heroin abuse and addiction. there is more to come. we will just take a break and hear from you what you've seen so far in the problem of description drug abuse. in particular, government's role in solving the program. we will take your phone calls in just a couple minutes on c-span. for democrats-- you can send us a tweet. we are @cpsan.
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comeost recent comments from a summit in atlanta yesterday. president obama visited there on the opioid addiction problem in the u.s. the president saying the issue is not a law enforcement problem, but a health problem. here's part of what he has to say. pres. obama: the most important thing we can do is to reduce demand for drugs. and the only way that we reduce demand is if we are providing treatment and thinking about this as a public health problem and not just a criminal problem. [applause] this is a shift that began very early on in my administration. drug is a reason why my czar is somebody who came not
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from the kernel justice side, -- the criminal justice side, but the treatment side. [applause] this is something that i think we understood fairly on. i will be blunt. i hope people don't mind. i said in a speech yesterday, your last year in office, you are getting a little loose. [laughter] in west virginia as well. i think we have to be honest about this. part of what made it previously difficult to emphasize treatment over criminal justice has to do with the fact that the populations affected in the past were viewed as or stereotypically identified as poor minority and, as a
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consequence, the thinking was it is often a character flaw in those individuals that live in those communities. and it's not our problem that they are being locked up. [applause] one of the things that changed in the opioid debate is that recognition that it reaches everybody. there is a real opportunity not to reduce our aggressiveness when it comes to the drug cartels trying to poison our families and kids. we have to stay on them and be just as tough. but a recognition that in the same way that we reduce tobacco consumption -- i say that as next smoker. -- that as an ex-smoker. [applause]
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we greatly reduced traffic fatalities because we applied a public health approach. host: president obama yesterday in atlanta at the opioid abuse summit. the president not only speaking at the roundtable, but bringing money, money the executive branch can provide. in particular, $94 billion for community health centers. some 270 centers to expand and addiction treatment programs. 11 are in dollars for states to buy the drug narcan, used in treating individuals undergoing an overdose situation. $1.41.4 billion -- million in rural education programs. this funding, which does not need congressional approval, could provide 124,000 additional drug patients across the u.s. we will get to your phone calls momentarily.
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we are asking the government's role in combating and ending opioid addiction. we are joined by a political correspondent, who covers this issue. -- a politico correspondent, who covers this issue. we talked about the drug czar being there. he made the case that this is an issue of overprescribing. a week ago, the cdc announced new guidelines for prescribing for doctors. why did the cdc do that? >> like you said, the cdc sees that as an epidemic in the health care system that often does start with doctors prescribing a patient a prescription. 15 years, since
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1999, the cdc says sales of prescription opioid medications have quadrupled. corresponding with that is a quadruple in the number of overdose deaths. the cdc guidelines are trying to change how doctors think about prescribing opioids, encouraging them to prescribe much shorter durations of treatment. lower doses of the medications. and also in many cases, encouraging them to think about not starting a patient on opioid, if that's not necessary. other kinds of perception medications, even trying modification first to deal with pain. host: executive action from the president yesterday, the cdc making initial guidelines on overprescribing. what about on capitol hill? as the senate left, they just pass the bill dealing with opioid addiction. what would that do? sarah: that bill would direct some money the federal
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government already appropriated. it would do two things. it would try and help support prevention programs, once that's try and prevent drug abuse and from even beginning. also help support treatment programs throughout the country to help those suffering from drug abuse. host: seems like one of the big amendments was some $600 million by senator shaheen. that amendment was defeated. what without money have done, and why was it defeated? -- what would that money have done, and why was it defeated? sarah: there's not a lot of appetite in the republican congress to spend new money. so they basically took money that had already been given out and regarded it here. a lot of democrats were pushing for congress to give more money to fight the problem.
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and it does seem like in the next set of appropriation bills, assuming those go through, that a lot of republicans in congress are thinking about providing more money to address the opioid epidemic. we will see how that plays out. also when the house considers some more legislation, whether they decide to add a money component or not. host: any word whether the house will take up that senate bill? sarah: it's not clear yet that they will. the chair of the house judiciary committee, who would be the committee taking up this bill has expressed interest. he says he wants to look at the costs of the bill and whether it's the best way to address the crisis. there is a lot of momentum. a lot of advocacy groups are pushing measures forward.
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the house is not quite started any work at. host: viewers can follow more on the bills and the opioid problem politico.com. sarah, thanks for being with us. sarah: sure, thank you very much. host: let's get to your calls and comments. what should be the government's role in combating opioid addiction and abuse? barbara on them s line. caller: i think the advertisements from drugs and education to the public -- this has been proven to be true just as they banned cigarette ad. we need to ban prescription drug ads. when a patient season at, they are told -- patient sees an ad, they are told to ask their doctors. congress gets money the same way they got money from tobacco
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companies. i'm sure drug companies will suppress any bills that would suppress any of their money they are getting. from reba inear california. hello there. caller: hi, my husband has been prescribed that. opioids. he has been on them for quite a few years. they tried everything else. they tried stimulators, pain pump, they tried everything. with the new california law, with workers compensation, everything has to go through a board. all the pain doctors are quitting because they have to fight the review board. all of a sudden they are fast.ng his opiates he's going through withdrawals. i think there should be some kind of law to help people on work comp that are already stuck on opioids. host: are you concerned about the new guidelines the cdc has
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putting out about overprescribing? caller: probably. my husband is not the kind that would overdose. he is the kind that absolutely needs them because there is nothing else. they have tried everything else. host: moreover issue spotlight program coming up on opioid addiction. the government's role in addressing the problem. let's hear from paul in new orleans. welcome. caller: thanks so much for c-span. host: you bet. caller: i'd like to point out, if the nsa can record erything will conversation and e-mail in any form of communication for the purposes of terrorism, which is quite awful, but is not killing that many people as compared to all the other forms of international criminal activity that kill us. why don't they turned those resources and tell us who is bringing in all this dope? they are certainly using faxes, e-mails, every other form of communication.
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you can tell me who is killing us with terrorism, but you can tell me who is bringing in the dope? host: what do you do about the legal-- the legal prescriptions? what about that part of the problem? that is a corporate problem. you have corporations controlling the government to be allowed to use us as guinea pigs and consumers, not citizens. we are just here to eat and consume and chew up resources. in return for whatever little value we can give in return. host: let's hear from saginaw, michigan. johnny on the democrat's line. caller: good evening. host: go ahead. comment -- when , i am astening to this patient.
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i've noticed a lot of times, they tried to push pain pills and other drugs for new doctors coming in. , they have to overprescribing-- have ay they can't controlled substance without regular medication. a lot of times i get more medication than a i need instead of a one time payment occasion that i need once a month. medicationsof the than i really need to get this other medication. ust: d want to share with
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what kind of medication you take? taking vicodin, what they call hydrocortisone. and there. it here it, they wered giving me too much of it to cover the one medication that i needed periodically. host: the question this evening, is the government's role in combating opioid abuse? part of the effort has been the senate bill. just to recap the senate passed, this bill before the went on break. grant additional money to education and treatment programs. it would expand the ability of
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naloxone, or narcan, the one they use in overdose situations. and it would strengthen prescription drug monitoring, which seems to be the focus of the senators for -- the centers for disease control. checking a couple of tweaks, we are at @cspan. "the federal government should stay out. states should legalize and tax cannabis, use the rest of the money for treatment." "i wonder what types of incentives are given to doctors to prescribe drugs." @cspan is how you send us a tweet. mike from pennsylvania on the others line. caller: hi, i want to comment how these people are saying marijuana is a gateway drug to heroin. i did not start with marijuana, i started with cigarettes and high school. because i smoke cigarettes i
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fell into a particular clique. in that, there were those that had various types of drugs. i started with pcp and angel dust. i have been smoking marijuana for 40 years.i've held good jobs , i run companies, raised a family. no problem with the marijuana. once i started buying the marijuana and going to these places where people sold it, i came across the other drugs. if marijuana was legal, i would never have been exposed to all of these other drugs that these drug dealers had to deal the marijuana. so i wanted to get the point across. everybody does not start with marijuana. legal and i could go to a store and buy it, i would not have access to all those other drugs throughout the years. host: hey mike, had you keep that from being a gateway drug? you said you have been using it for 40 years. are there times where you are tempted to use something stronger? caller: in all the years i have done all kinds of things. but it wasn't because i was
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smoking marijuana. i had five years in addition to methamphetamine, five years to crack cocaine. i was able to be all that. and i am still smoking marijuana and is not trading problems in my life. --creating problems in my life. if i did not have to go to these drug houses to buy marijuana, i would not have been subjected to the crack cocaine, heroin, the meth, etc. host: mike, thanks so much. we will hear from fred in michigan, democrat's line. governmentt is the going to do to save those that are crippled and in need of opiates? twice --have been told that i was going to die. once from a car wreck, once from people breaking into my house for drugs. my ex-girlfriend told them that andd 20 pounds of pot $20,000 and the next thing i
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know, i'm nearly beaten to death with a hammer and a bat. host: so you were prescribed some sort of opiate? on norco and oxycontin. they walked away with hundred $78 and about 15 pills. and 8th of pot. and they put it in the paper as a drug case. all these doctors are running out of this area. poor people don't have the ability to make it to a doctor. host: we've got about 10 more minutes. i did want to show you a pretty graphic look at how the problem has expanded. this is a graphic done online at bytimes.com. -- at nytimes.com. how the epidemic of drug overdoses deaths ripples across
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america. this is a map, the red and orange part is the expansion of overdose deaths per 100,000 s ince 2003. you focus in 2014, and that map has gotten pretty broad across the u.s. just a couple of stats from that. they say the depths from overdoses -- the deaths from overdoses are reaching similar to the hiv epidemic at its peak. times, from the new york statistics from the cdc. there is the map currently, overdose deaths from 2014, in the neighborhood of 28,000. let's get back to your calls. here is mary in greensburg on the republican line. caller: hi there. i'm a 75-year-old person with all kinds of ailments. i've been on a patch for at least 12 years. and now they are trying to take this away from me. on not selling it. i'm not giving it to anyone.
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i change it every three days. that's not the only problem i have. i just don't understand, if teenagers know where to go buy this stuff, why don't the cops and undercover people know? host: mary, how are they trying to take this? are they offering you another painkiller, or are they raising the price? caller: no, let me explain. they want me to go to a pain clinic. because i cannot take anything with aspirin, my doctor said i would lead to death. -- i would bleed to death. i can't take anything, if i have been exposed to tuberculosis, so many of these means your immune system is way down and you'll get an infection. i mean, i just don't understand it. if you want the call me a drug addict, that's fine, and i need this patch.
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but summary is going to sign my death certificate, because if i don't get it, i don't know what i'm going to do. host: thank you for the call. we go to lee, in medicine, alabama. -- lee in madison, alabama. the government's role in combating opioid abuse. caller: i'm coming from this from two sides. my dad takes a lot of opioids, mainly hydro-coding. he recently switched to a different drug. and he needs it for back pain. but for me, i started opioids due to a car wreck and became highly addicted to the point where i was buying it off the black market. i almost overdosed. i went to the hospital. luckily i was put through a program and am greatly recovering. i help as many of my friends as i can. in the past four years, i've seen four of my very good
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friends o.d. i'm 30. benow there needs to stricter ways of dealing with this. that takingknow away from people with chronic pain is the way. i think that the police need a better way of finding the people that are selling. if i'm 30 and i can find it on the back streets, i'm sure that with a little bit of effort, the police could find those that are selling. host: i appreciate your input. let's hear from new york on the republican line. my producer tells me you are a doctor? caller: yes, correct. host: welcome, go ahead with your comments. caller: yeah, i'm a physician who treats addictions and addictive disorders in my community.
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i have the opinion that this is completely and absolutely required of the government to intervene and manage this epidemic. all the colors -- the callers are indicating they almost have a deterioration and disruption in their life due to the drugs, every single one. cannotle, they all control it. they have also witnessed those that have overdosed and died. without government intervention, this is only going to grow. in the bill that is being passed has only to do with expanding the prescription monitoring program. capturinge, expanding those that are taking it the wrong way. those that need the medication will be prescribed it. there is nothing against those people. but those that are using it to sell and are treating themselves
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are the ones that need to be stopped. this issue has only to do with the court system. the medical society cannot intervene the way that the government could. host: doctor, appreciate you joining us. sounds like a very busy practice for you. one more you on the government's role in the opioid addiction. barbara from pennsylvania on the other's line. caller: good evening. i was in an accident 20 years ago. i went to five different doctors. they left, they died. in my past doctor left me 2 months ago. i am on morphine and delighted dilaudid.e and this new doctor cut me down for 2 months. and i am more and more in bed
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because i can't walk. host: she's cut you down on the amount of your perception? caller: yes. i have 27 days. that's it. i had over 30. up,sked her to look it because in pennsylvania, you have to show your license even if the nurses know you. you have to show your license, sign that you are picking them up. and if you look at the three , you'll see that they pick them up always a week and a half to 2 weeks later. i don't overdo my meds, the when i need one, i need it. host: another difficult call to make, but we appreciate you joining the conversation. we want to remind you all of the video in our issues spotlight
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are available at c-span.org. more comments on this at facebook.com/cspan. next up, we go to a heroine abuse summit held back in january a program that includes members from the national institutes on drug abuse and substance abuse and the mental health services administration. >> most important information on this first slide reminds us of the tremendous number of deaths associated with drugs of abuse in general, the painkillers, prescription opioids over 19,000 deaths in the most recent data from 2014. over 10,000 deaths from heroin., i will point out that even this surveillance data has some messiness in it. deaths look at how certificates are coded. there are an awful lot that are coded as drug overdose generally, and don't specify
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whether it is in opioid or even heroin. -- it is prescription opioid or even heroin. there may be even greater numbers specified in the national death data. is the increasing rates of prescriptions that have given so many in this country a taste for an opioid. that means their brain has been exposed to it at some point. or the communities are exposed in a way that these pills can be diverted and misused and taken nonmedically by so many around the west -- aruound the u.s.. as the number of prescriptions go up, the number of deaths increase as well. a fourfold increase in the deaths associated with these we would painkillers. that strokes like oxycodone, hydrocodone, all of these narcotic opioid pain relievers. witheason i am starting prescription opioids that is the upstream, driver of the recent heroin epidemic.
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that seems to be the deciding factor that exposed so many to opioids and let them towards that pathway into a heroin addiction. the brain does not distinguish between different types of opioids very well. the brain sees them almost all as not quite identical, but very similar. heroin as a street drug, has pretty much the same impact on the brain as oxycodone or hydrocodone. in controlled laboratory studies, people cannot even distinguish when you give them one or the other. as those rates of prescription drugs become available, we seen a corresponding increase in heroin. we believe these are related in important ways because of the availability of heroin in so many communities. as you've already heard alluded to, the number of those misusing heroin has skyrocketed in the last five years. overdose deaths have seen a
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corresponding increase. it's almost an exponential increase in the last few years. as an epidemiologist, it concerns me. we like to see a curve venting and eventually coming down. we don't know where this curve will end. it's still on the upswing. there have been increases everywhere. if i only showed you the south and west, we would have thought it doubly was a terrible scourge. but look what is going on in the midwest and northeast, somewhere between a four in sixfold increase in overdose deaths. all the different major ethnic, racial, and age groups. but particularly, non-hispanic whites of young and lh -- youing and no age seeing the sharpest -- young and middle age seeing the sharpest increases. it shows these new injection drug users tend to be younger, more equally male and female. that is a novel change. we think of most drug uses being
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more common in males than females. that is not so true in the new injection drug users. that's another concern with the epidemic. why do people abuse things? they abuse them because these drugs have an impact on the central reward circuitry. they make you feel good by rewarding and relaxing. that is a basic principle from much neuroscience, that i will go to in detail. that is the underlying feature here. these are habit-forming, not for everybody. that is a conundrum here. some people take these pills or drugs and find it extraordinarily unpleasant. but some really like it. and they are the ones at risk for doing it again and keeping on doing it. i'm very pleased that our secretary of health and human services may do this one of her keynote issues. shortly after she was confirmed and took office, she convened a small group within the department to help her address this in a proactive, consistent way. we've developed three priorities.
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these are not the only things we are doing in opioid epidemic, but three priorities relate to prevention. let's change how many prescription opioids are available by focusing on prescriber practices. let's focus on saving lights immediately with the use of no locks on in greater numbers. greater access to the lifesaving overdose treatment martin. let's focus on treatment. medicated assistant therapies as the proven treatment for opioid addiction to reduce the likelihood -- to increase the likelihood of those going on and recovering their lives. i'm going to focus on the first two. when it comes to prescribing there are guidelines for prescribing opioids that plane -- that pain clinicians use. those sources have been inconsistent. some of them are outdated. some are not without their conflict of interests.
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as an alternative, the cdc has undertook the development of prescription guidelines. we expect these to be released to assist in the proper prescribing of long-term opioids for noncancer, not end-of-life care. when it comes to the overdose, we are pleased on working with one of the pharmaceutical industries and with the fda for the recent approval of an intranasal. instead of the only fda approved formulation being an injection, there is a nasal spray. as soon as it was approved in november, it should be on the market shortly. let's get to the main issue, medications. there was a study in baltimore
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couple years ago that showed us that as they increased the availability of methadone, they showed a corresponding drop in heroin overdose deaths in the city. we see this as a population-based example how you can save lives by increasing treatment access any large population. i've already mentioned methadone. that is in opioid substitution treatment. methadone is in opioid agonist. that is a fancy way of saying that it won't work as another opioid. what do we mean by that? let's take a quick lesson in cellular chemistry. when a chemical is administered were taken, it works by fitting into a receptor. think of it like a key going into iraq. -- into a lock.when morphine or heroine agonists go, opioid into the brain, they go into the
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receptor and produce a lot of activity. kind of like turning a lock, and the templars move and the door opens. -- and tumblers move and the door opens. morphine is like a dummy key. if sills the keyhole -- it fills the keyhole, prevents other keys from getting in that locke. a full agonist like opioids -- we have and in between agent that is somewhere in between the two. is a partial agonist. but therns the lock, door only opens partway. that is a quick way to think of these classes of medication. a blocking agent is one of our tools that can be given in a long-acting form. when people take it successfully, they don't get high if they use heroin or other opioids. the same thing happens with methadone. when they take those
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successfully, and they might slip and use heroin or other drugs, they generally want get any high. -- won't get any high. the key is a learning experience. that is a short version of what history is. melinda will go into this in more detail. we have focused on extended relief medications. we focused event on medications and have been pleased to partner in the release of a long-acting naltrexone. we've finally been developing vaccines as another way of keeping drugs out of the brain. one of our new medications is a long-acting beeper northing. people will take these medications, but there is an issue. my patient has to make a decision everyday whether they want to stay clean and sober, stay in treatment, take
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medication, or if they want to not do that and had back into a path towards relapse. sometimes it's a conscious decisions, sometimes not so much. they need to make that decision every day. with a long acting injectable form, they may not need to make that decision quite as often. in particular we are interested in this idea of an implantable device. a long-acting implant that only needs to be implanted once every six months. means someone only needs to make a decision about their life and turning things around about once every six months in some fundamental way, rather than every day. patients are more likely to be compliant when they take this, certainly producing greater abstinence. that is one of the hopeful possibilities. this was submitted to the fda in september. review,er an expedited
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so we expect an answer from the fda and whether the data supports its actual use by clinicians within the next couple months. the next area is promising vaccine development. for drugs to have an impact, they have to get into the brain. they go from the blood system, across the capillaries into the brain. vaccines attached to those drugs, so they create a protein binder to those drugs. they keep them in the capillaries. they keep them in our circulatory system and not in the brain. that is the theory. there is quite a bit of preclinical research with animal models. there is now some emerging human resource -- human research that suggests this to be effective. but we have a ways to go before we have vaccines to be useful and administered on a regular basis. i remind you that our job is to support what we can do today and to always be charting a path
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forward tomorrow even better. is last challenge implementation. we've had these medications like methadone for about 50 years. had naltrexone as an oral medication for 40 years and in injectable for the last couple years. what is going on? not very many people are treated, even when you go to specialty care. this is a major gap for us. people are more veiling themselves of us. we have been pleased to try novel trials. a group at yellow university -- a group of yale university noticed they were seeing the same people with either an overdose or problems related to heroine and other opioid issues. she said, maybe we can start them on it here in the emergency permit. why don't we act as their
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primary care physician? they found they were much more likely to be in treatment. they were also less likely to be using drugs when they were reevaluated weeks later. this is just one center, a top-notch center. we don't think everyone else can do it as well. we think that is very promising and are working on testing this in a number of other centers. butevery place should, those that see a lot of opioid addicts might want to do it. saddened by the story representative custer relate about patient who died shortly after being released from prison because they cannot get into treatment.this speaks to the important of linking our kernel justice and public health effort. -- our criminal justice and public health efforts. i have issues with high attrition. people drop out of this readily. with prison, they have
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recidivism and problems with mental activity and drug use. but working together like the drug court models, extensive work with probation and parole, we can do a better job using the best pieces of both. whether that's a close provision that provision and parole can provide, the treatment that providers cna provide. even incentives for people to turn their lives around through modification. these models have been shown to work for 20 years. we don't see them in white enough usage. these combined efforts seem to be an area where theere can be improvements.even medications can be used in this setting. a study coming out of baltimore took vendors about to be released long-term with a history of heroin addiction. this was in withdrawal.
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-- wasn't withdrawal. they are the referred them to methadone actively, which means they actively made that referral and tried to engage them in treatment after release. or they started them on methadone a few weeks before release. those where methadone was started prior to release had a better outcome, less criminal activity as well as less drug use. at least over the first few months after release. this speaks to the importance of being practical and thinking through what happens. when people get out of prison, they are not usually thinking about getting treatment. there are other motivations they are paying attention to as their first goal when they are released. starting treatment on the right foot could be important. thanks very much for your attention. i will turn it over to melinda from sampson. >> if i could have congresswoman custer make the introduction. >> thank you very much doctor.
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welcome the current medical officer for the office of pharmacologic studies at the substance abuse and mental health services administration. she is a position board certified in family medicine, with additional credentialing in addiction medicine. thank you for being with us. >> it's my pleasure. before i get down to the business of my presentation, i want to thank you. sam is supporting a new round of grantssa to improve access to high-quality medication assisted treatment. and funds to overdose prevention thanks to the budget you work hard to pass. similarly, i want to thank you for setting aside the block of time to together more information about treatment options for opioid disorders. i cannot begin to
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