social media to express the diverse values and opinions of our world. >> to watch all the prizewinning documentaries in this year's student cam competition, visit studentcam.org. ♪ >> over the next couple of hours, a look at federal efforts to combat the opioid epidemic. we will show you portions of events that c-span has covered in 2018 featuring state an maybe -- we begin with the senate health and education committee meeting and comments by author sam quinonesas -- . >> i'm pleased to welcome sam quinones and his family today. thank you for taking the time to be here.

quinones past 30 years experience as a journalist and author. he has written extensively on the opioid track -- crisis and trafficking. he is the author of three acclaimed books. he won a circle award for general nonfiction. early in his career, he was the recipient of the maria morris prize. he was also the us -- recipient of the alicia patterson fellowship to print journalists who pursue stories in the public interest. welcome again. you will have 10 minutes to give your testimony and senators looking forward to have a conversation for you -- with you. >> there we go. clearly, i'm a rookie here.

honorable members of this committee, i would like to thank you for these hearings and for allowing me the honor of addressing you. i'm very happy to be here with my wife and daughter, who are part of producing dreamland and without whom the book never could have been finished. this is the deadliest drug scourge we have known, hitting areas 11 everything this drug problem. it is the person modern america to be spread not by mafia or street dealers but by doctors overprescribing pain pills, convinced we are doing right, urged by pharmaceutical industries and medical establishment and urged on by us, american health consumers who wanted to quit and an easy end to pain. isis could not have dreamed of

inciting the kind of torment and death we have consumed upon ourselves lose use of opiates. these drugs are a symbol for our era. from us for decades we have exhausted the private sector, the individual while we ridiculed government as an efficient, incompetence and wasteful. we admired wealthy businesspeople, regardless of whether going we made their money produce anything of value for our country and our communities. we brought a second gilded age. the seven demographic diction to a class of drugs in the tribe on isolation reflects all that. this has been borne by the public sector was profits have been private. i believe this is deeper than the drug addiction.

it is about the efforts of the shift and isolation and rich and poor. ugly problems can be if i could isolation with one magical foldable everyday bill for all our jail cell for every attic. we exalted the private and not the public in the communal and in so doing we rid ourselves of things so essential to us that they have no price. we have been invaded by cheap junk as a result. we don't have dreamland and replace it with a strip mall. heroine is what you get when you destroy dreamland. i believe isolation is the natural habitats.

i believe this epidemic is calling on us to revert these decades of isolation and come together as americans. i believe my strongly than ever that the antidote to heroine is not naloxone. it is community. people coming together and working in small and local waste for solutions to know one thing the world alone the good news in all of this is that there is no solution. there are many solutions. it's not each must be tinker with an improved spirit each must be funded fully and for a long time for the good news to us that that of them is sexy that will do the trick alone. i believe that across america today, communities are finding more solutions, the more they been together the more they leverage all the talent and

pta's, pastors, artists and athletes, librarians and chambers of commerce. this is cabinet and counties across america. it is my opinion that supply has ignited all this. we do not have this demand, this widespread addition, until we release a large supply of narcotics for the last two decades. i believe it is essential that doctors reassess how and to whom and in what quantity they prescribe these drugs. that does not mean just cutting people off that are on high doses of these drugs and leaving them to fend for themselves. this has been strategies that do not allow the narcotics allowing

a larger array of pain strategies and pain pills. the doctors need more med school in pain management and addiction treatment. i have to say that i think it is a little fun time and money on another wall -- delusional spent time and money along another wall. these drugs are coming in with areas with authority and a wall will corrode anything that will really help. that is a deep, respectful but , for once,ight certainly honest relationship with mexico that will leave to it finally becoming the kind of neighbor and partner we can work with effectively. in so doing become the kind of neighborhood country needs a bus

-- needs of us. another wall seems to me is just like heroine. buteels good for the moment it will leave us in a worse place in the long run. another silver bullet for another complicated adult problem. sometimes the solutions are a mundane mechanics of government. we should expand our national force of forensic pathologist, which is dangerously dwindling. this epidemic spread because so many of those offices are so poorly funded. i believe we must and treatment options in this country. one place to do this is jail. consider how the country will be helped. transforming jail into nurturing recovering. this becomes an asset that of a liability particularly, in a

state of kentucky. i would also like to add that all across america are families who are suffering due to the addiction of a loved one or the loss of that loved one. i believe they are a raw material to be harnessed in this fight. many want to be involved and need to be involved to help solve the last rating wounds that will last a lifetime. i believe u.s. senators can help by recruiting and recognizing and giving conference with -- giving them platforms from which they can tell their stories. many it is because i am a reporter by believe that through their stories, thoughtful stigma of addiction will be reduced. i'm happy to elaborate on any of this. before i do that, i want to urge you to view this as an opportunity. view this as an opportunity to revive those regions hammered by globalization and free trade.

the roots of the epidemic of narcotic addiction lie there while the epidemic stand in the way of the revival. many of these regions cannot revive and tall enough of their people can pass a drug test to fill new jobs. this is not a story of a drug addiction. this is a story of economic addiction. as politicians and a natural response to this, it is to look about for things that continue quickly. i believe that is entirely understandable. i would caution against believing in short-term responses. this makes up at star and i thank you for its but it is only a start. everything i've learned about this issue has taught me the importance of long-term community responses and commitments.

i believe american history offers of -- offers to templates in which you might take guidance and inspiration. versus the marshall plan to rebuild second is our graham. -- rebuilt europe after world war ii. second is our space program. each involved in government and the private sector acting in concert over a year's money , brains, energy and long-term focus to bear. each achieved and unallocated unhallowed good for our country. those were about doing things that seemed far beyond our own short-term interests. the marshall plan was about building up ravaged regions to allow them to function independently while maintaining the spread of communist. it allowed me one countries to and contribute to the world again. a marshall plan for american rep -- focused on building those regions that have been caught on independence and to contain the

viral spread of addiction. through our space program, we were inspired to spend years and dollars all to achieve something no previous generation ever thought possible. we ended up far the on the moon. that spillover increase in knowledge and in simple human inspiration is beyond calculation. seems to me we like profitably apply these examples the marshall plan and the space programs to region of forgotten americans with problem began to let us do it not because it is easy that because if they said because it is hard and that is what americans do. and have always done at their greatest. our space program, such an effort will have to last for years to become effective and focused far beyond the immediate

goal of drug addiction and the problems of community destruction and the hollowing out of stretches of this country . i'm here to urge you to see this not only as the catastrophe that it is but also as the gift that it can be. it offers an opportunity to reinvest in areas and most. it is an opportunity to bridge the political polarization that is so nodded at our country is on a few issues that you do not miss this opportunity and is not from around often it is calling -- come around often. luckyalling -- you were to be here when it has again. you will be remembered for acting when it was not easy to do.

if you do, i believe your hometowns will thank you. your counties will thank you. and we, your countrymen and women, will think you long after you are long gone. the politicalf action conference in washington. this panel includes peter shumlin who called attention to the open epidemic to his desk during his 2014 state of the state address. >> we will be all right. good afternoon. very happy to be here today to moderate this panel about a very distressing issue.

this is bipartisan. it affects everybody, and my my panelists as well i want to get started quite right away. we honest think about this and talk about it. the louisiana governor of ohio. why is this topic important? we can be here talking about jobs in a ohio? >> this impacts every family and has been impacting my family. i also see it in the state of ohio. i've talked to parents who have lost loved ones. i've talked to people were suffering the crisis that is the addiction issue. it has touched everything the person i've come across. leaders to stand up and provide wrist solutions to give hope and help and healing to so many individuals today that are suffering. >> government cannot solve every problem. government can help solve problems and lead. what do you see as the role of

government in this crisis which is nationwide and a health epidemic? >> thank you and i want to say am to be back here cpac. i love coming every year. working for president trump who campaigned vigorously on this issue in states that have been devastated by this epidemic, it helps us understand why it is an issue. government has a legitimate role to play in tackling certain issues. we love living in a free society. this is an area where the government has really failed. this is something president trump talks as a candidate and lead on this last year. talking about the need for states and localities for the medical professional and law

enforcement to come together to address this crisis in our community. >> it was easy would've involved a long time ago. 64,000 people died and car accidents took the lives of 40,000 people. this is not easy. this is a challenge. what strategy or new ideas can be done? >> thinks are having me, because this is a bipartisan issue. i think this is an easy solution. most people don't say that. why are we in this mess? you heard from eric about his son.

lost more folks to opiate addiction since 2000 and we lost in world war ii and the nine -- and vietnam combined? what changed? in the 1990's, we improved oxycontin. health care professionals and the fda, we have the first non-addictive painkiller, and we all were so rejoice for. it turns out they were wrong and not only were they wrong but they pleaded guilty. pleaded guilty to lying to the fda. they got fined for lying to the fda. 85% of the folks, will start with fda approved pills. what is the solution? governors like me, we do criminal justice reform. we build up treatment.

get rescue treatments and we all do the same things but it is after folks who have become addicted. this is the worst disease to have that one can contract in terms of the fight, the struggle, what it does to your family members, what it does to your lives. my answers are a simple once. there are two things you can do in this is not hard. number one, the fda should revisit the decision they made about passing out painkillers like candy. now that we have admitted that they have lied to and the first place. [applause] second, just like what happened with tobacco, they have governors like me and attorney general's and i know you lieutenant governor is working on this in ohio. we are all suing the folks that put us in this mess to try to get money for treatment and change behavior. why don't we do what we did with tobacco? get them all in the room president trump has the ability to be the winner on this.

i can say president obama must -- messed this one up when he reduced the burden of proof for the pill mill. having these for the pill mills. that is where folks get a lot of these pills. the obama demonstration raised so they have proof to get these people to plead guilty. here's my point. there's no one in my view that knows more about this issue than john cole. stand up. this guy got tobacco in a room back years ago and got them to pay. my point is, president trump has the ability to be a hero. he can put them in a room and

tell them not to come out of the room until they settle this. it is time for the taxpayers to stop paying for treatment. you guys have to pay. that is the opportunity of the president of the united states. >> i have a two-part question for you. we are trying to come up with some sort of ideas. before we get to that, they say do not think may my pain pills and we do need to keep the ball out of pain. there is another element. some people generally have pain. they need help. there's art with conservative solution to this and i believe there is a role that government is on the solution. we need comprehensive care and we need to make a available to

citizens living in addiction today. there is a role for government play, to incentivize to private sector, to build out the several care necessary, to restore lives but we also have to foster and encourage looking for alternative ways to treat pain. as patients, we should not accept these addictive pain pills as the best we can do. we need to open up the opportunity for these alternative ways to treat this. >> let me ask you this. before these openness came onto the scene, mid-to-late 1990's, people have pain. adequate pain management? or do we have something that helped that was not quite as addictive? >> my understanding based on what i have read --

you probably know as much about this of anybody but when they started training pain is a vital sign, in my opinion it shifted to our medical community are being judged and rated based on how well they were treating the greate pain. just treating pain. pain is subjective. if i came in and said, greta, how is your pain? >> 10. >> i have to treat you. intend,fraid if i don't you are going to give me a two. >> started to shift at that point. government had a role to play. now the ones who said we are going to treat pain is a vital sign. it became the fifth vital sign. it is not measurable. we created this crisis. >> let me give you another statistic which i find quite stunning.

between 2006 and 2016, out-of-state drug companies shipped 21 million opiate pills to two pharmacies and williamson, west virginia with a population of 2900. that doesn't seem right. >> that is right. i'm up to call out a point that the governor made about law enforcement. we saw the president attorney general who do not fully respected the rule of law, respected due process light or enforced the law. we now have a president and in attorney general -- [applause] who is vigorously enforcing the law, and enforcing and companies that have broken the law. that could include criminal investigations, civil investigations. also going after people on the streets pushing drugs. 11 measures and said, it was ok to do drugs and downplayed this as an issue. we need to do a better job telling our young children not to go down the path of it -- of addiction.

we need to provide treatment. i'm sure most of the people in this room have had family members struggling with addiction. the president spoke passionately about this lester that is on family where he saw the life of his older brother dealing with alcoholism. most important message we need to do is to ensure that people cannot start down the road of doing drugs and leaving down this path toward addiction that is so hard to come back from. the best thing we can do for me treatment standpoint is a prevention action that prevents people from using drugs. point where at the you need treatment and some people need treatment, you have already lost her job and family, you completely have been a terrible pain to your friends. we start atw can the beginning realizing that to

deal with those were now addicted? we do have pain pills. how do we started beginning so that we do not have this whole universe of people? >> let us just back up a second. everything being said here is true except that we are hesitant to point out that most issues i face as the governor, and i'm sure all governments face this and gets a little more gray and it is not black and white. this one is black and white. america did not have someone dying every 15 minutes smoking -- 15 minutes from opiate addiction before we proved oxycontin. those are the facts. we passed out like candy, these are the facts. we now have thousands of thousand of good people dying every year from this disease. if they had the folks that like

to them, but that we did not say you the truth, why wouldn't we simply go wait a minute, team, wegot that information? reconfigured the health care system based on oxycontin. back it up have the folks who pay in created this disease for the treatment and prevention stop passing it out like candy. revisit the fda decision and start where we began with a more sane policy on pain drugs in america. >> i think the power of the government is incredibly potent on how we saw things. it is dependent on the political parties working together because there are so many political interests involved. this is a nonpartisan issue.

could you two work together. and if you got the congress to president of the united states. you can ask him for help on? >> absolutely and killing our kids is a bipartisan problem. no one says this is a good idea. let us get as many folks as we can as agents of the stuff. the problem is, if you to just go about democrat you are served as a unique position they both come from states where this has been a scourge. every stage have on through has gone through that. coco i am a conservative republican. one of the challenges we face is we know where it is coming from. it is coming from mexico, china. when you start talking about sentinel, i would say builds of the wall because i am a conservative republican.

>> you may not. you may not agree with that but i bet you when i can get on the same page of how do we help reinforce law enforcement to keep the drugs out of our country. >> to that point i just want to say an important part, we have seen this skyrocketing of overdose deaths in the last few years. our country is been suffering from the scourge of germany's -- scourge of drug use for decades the reason why this has become a pleasant point percent -- potent point for so many communities and families is largely due to fentanyl and the importation by drug cartels and other criminals bringing fentanyl in from china or mexico into our country, it has got to stop. the last administration failed to protect americans from fentanyl. the trump administration is working day and night he and that is why we have to build a wall, increase of border security, provide homeland security the technical resources

they need to screen the stuff from coming in from china. >> can i just make a quick point? we have always had drug problems in america. we have different views on how to solve it. here is what has changed. most 85% of folks who go to heroin that has the fentanyl in it and start with fda approved pills. they are net -- they are not getting that from south america, but from the quarter drugstore. -- from the corner drugstore. >> can we do both? >> must do both. we have to stop the abuse. >>we have to stop the abuse. president trump has a unique ability to be the president who solves this problem because of bipartisan consensus. we want to stop the dying.

the biggest victims of this disease of the kids of the attics. .- addicts >> what is your biggest challenge? >> a supply and demand issue. we've got to get it off our streets. >> is that an ohio problem? >> the federal government and it is a state problem. we need to keep the drugs off our streets and hold drug dealers accountable. law enforcement need additional resources to get these guys that are killing our kids and throw them in jail. >> what about the pharmaceutical industry, those that are producing this? how do you fight that issue? >> what we have done in ohio,

and i am not all for regulation, this is a public safety issue. we have issued regulations we can only prescribe a pain pill for a cute pain for seven days if you're an adult and five days if you are a child. this is state. we did it in the state of ohio. >> as conservatives, we recognize that state governments that -- that every problem is not a federal problem. the federal government needs to have a response to leadership as a nation. states right now are being smart and innovative and passing good legislation that limits prescriptions in certain amounts. the worst thing we could have happen is for the federal government to intervene and pass laws uniform across the country to try and solve the problem.

we have seen this happen and health care and across the states. we have good intentions and the federal government passes some law and the unintended consequences trickled down to three years and decades and congress can never come back and fix it. as limited government conservatives, we should encourage state leaders to pass these laws. house power of the white is to get everybody into one room. until they do this. to lock them in the room until they do this. >> let's put our hearts aside and user mastheads on this one. it costs $25,000 every time

someone gets addicted to the substances. it is a huge cost to taxpayers. it is not just the manufacturers, distributors, they are all in this. these lawyers will run this thing loik ass to forever. this is about tax payers getting paid for the disease created by lies to the f.d.a. let's make that happen and i think president trump would be a hero to america if he facilitated that process. >> thank you very much. and once again this is the problem that affects all of us.

to the extent we're talking about it trinding to do something we -- you do a huge service to the country. >> i'm is the chair of the nga health and human services committee. i want to welcome you to the conversation about an issue that the nga has been engaged in in a big way for the past several years.

over the course of the past several years working on a bipartisan basis with our legislature and others, we have made some progress in dealing with this trible epidemic. now, ma massachusetts, after years and years in double digit increases in opioid prescriptions overdoses and death literally for the first time in a long time, in 2017, we had a 30% reduction in prescription overdoses leveled off and deaths dropped by 8%. w, the way that was referred to by most people was sort of positive but muted. and the reason it was muted is

because we have so far to go and so much to do. but literally after fwad news every single year for year after year people did take some comfort in the fact that a trend that had gone like this for a vor long time finally started to go like that. now, there's a lot that went in to that and today's conversation is to talk about what's working and where should we go next. some of the things that i believe have worked, which i will speak to and others will add to, will be the following. in massachusetts, we now require everybody who graduates from medical school, nursing school, pharmacy school, dental school, and social work school, to take and pass as part of their cor curriculum a course in opioid therapy and pain management. if you're a press criber, as part of your continuing education, you have to take and pass in opioid therapy and pain

management. we are also one of the first states to put a limit in on first prescription, seven days, several states have followed. and we have dramatically upgraded and simplified our prescription monitoring program. as a result of that, we finally got to the point where the vast majority of prescriptioners were working on that system and using it as a search engine every time that wrote prescription and can start giving them decent information on their own prescribing patterns relative to their peers. we also created programming to do assessment work in our middle schools and high schools for students through our health department, and also created as part of our sort of annual program for all athletes and their parents and coaches an inclusion of a discussion about opioids, the positive and the negative, along with discussions about hide ration and health and concussions and

all the rest. that's kind of the prevention and education side. on the treatment and recovery side we added 1100 treatment beds, increased state spending by about 60%, and a variety of addiction-based programs and made makes assisted treatment a much larger part of our portfolio than previously. one of the other elements that we pursued on a pilot basis has turned out to be reasonably effective is we have embedded recovery coaches in some of our hospital e.r.s around the commonwealth to engage in discussions with people who overdose and to see if they couldn't talk them in to moving into treatment. most of the folks who play that recovery coach role are people in recovery themselves and it turned out that their ability to reach out and speak to people who had just overdosed

and were in the throws of the addiction is a pretty powerful one. in some cases we saw as much as 80% of those contacted and touched by this program find their way into treatment. that doesn't mean 0 prs got out -- 80% ot got out of eatment but we found an -- a mechanism to help. with respect to what's next, we filed legislation that's currently before our legislature that's called the care act which has a number of elements that build on some of the things we have done previously. one of which is to take this whole notion of recovery coaches and turn it into a bona fide clinical program to create a cred delltionle process and -- credentialing process and make it part of the way we deal with addiction especially opioid addiction where a

recovery coach can be a big part of what helps somebody whether they're in treatment or some other -- form of treatment, stay on the positive side of their treatment program as they battle their way out of this terrible addiction. the legislation also includes elements that will expand some of our school-based assessment and service programming and also for the first time will have us engage with the folks in the farma community to see if the we can create something that will look like a blister pack which we have in many other parts of health care to provide the very small number of oimeds that you might want to make available to somebody who had their wisdom teeth out or something like that. the reason for that was a lot of the conversations we've had with prescribers has been we write 30 days, that's the lowest thing we ever do.

30 days for a lot of the stuff associated with what we've been writing prescriptions for for the better part of the past decade makes no sense at all. if we can make it where we can give two or three people to deal with whatever the acute pain is, we might be able to take a lot of this stuff off the streets to begin with. he final thing i will speak to , in 2014 fentanyl was present in about 30% of the overdose deaths in massachusetts. in 2017, it was present in over 80% of the deaths in massachusetts. if it wasn't for fentanyl the success we've had in reducing overdose deaths would have dropped dramatically more but the simple truth is we can do a lot of things in prevention, and education, and i believe we

are. we can do a lot of things in treatment and recovery, and i believe we are. but we have got to come together, state, local, federal, and chase this fentanyl issue a lot harder than we're chasing it now if we truly want to protect the opportunity for treatment to be available for people in our states. >> i'm grateful to be here today to share how we see our role in complimenting and empowering this great work that you've already been doing.

we're dedicated to empower you and your allies in this fight. that is what undergisheds the omprehensive strategy it brings the powers of the federal government to bear and empower those on the front libes. many may be familiar but the five points put are data, research, in pain, overdose reversers, and acta. after rubbing through the strategy i want to high -- running through the strategy i want to high light a couple pieces of news that underscore our commitment to advancing effective addiction treatment. the first point is better data on the epidemic. we have to understand this crisis in order to stop it, which is why h.h.s. is working with states and other stakeholders to support more

timely specific public health data and reporting. the centers for disease control and prevention, for instance, works with your state's health offices and local coroners in monitoring overdose data. the second point of the strategy is better research on pain and addiction. we clearly need more tools to help us win this fight which is hy we support cutting-edge advances. the potential advances we are seeing are incredible. as they get closer to reality we look forward with part nerg with states and private partners how these can be putt in practice. the third is pain management. we need to do the a better job of addressing the real problem of pain in america which is why h.h.s. wants to ensure that promote we do

healthy evidence-based methods of pain management. we look forward to continuing to work with you on disseminating best practices including through the work of a federal interagency pain management task force. fourth is better targeting of overdose reversing drugs. people in communities all across america in our own cities and towns are alive today because of the progress that has been made in making drugs available when and where they're needed. so we're committed to working with you to ensure communities have access to these life-saving drugs, through h.h.s. grants, research, and assistance. the fifth point of the strategy is better prevention, treatment, and recovery services. we need directly providing these services often falls on state and local governments and community groups. but we can help by issuing grants to support access, expanding coverage through h.h.s. programs, and providing

guidance and it cancal assistance. the president's budget proposes $10 billion in funding to address the opioid epidemic and serious mental illness. that comes on top of $3 billion of planned opioid funding for fiscal year 2018 that we hope will be in the omnibus appropriations in march. the budget includes a range of different investments. $74 million to improve targeted distribution of nal ox on and $150 billion. it takes the grants to $1 billion a year twice what we have under 21st century cures. we look forward to building a base of experience, hearing from you about how you have used this money. one particular point that we want to emphasize for the 2018 grant is that states have a wide range of options for using them. this includes treatment

vouchers which allows for the use of funds for evidence-based services from faith-based providers. americans in faith have taken a role that we have to take for this crisis and we're eager to support their work however we can. on top of the grants we've released guidelines to to accelerate the approval for substance use disorder waivers three of which we have granted for indiana, kentucky, and louisiana. i would just want to note for our governors that if you have waiver requests with us and you have a particular waiver of this kind we can also streamline pulling those out and working directly for approval around those concrete waivers so it doesn't have to be caught up in broader waiver discussion that is we have to have. so what works? makes assisted treatment. one particular piece of our

work on treatment is supporting medication kes -- assisted treatment. h.h.s. is always dedicated to advancing our understanding when it comes to public health challenges like opioids. but we already know some important facts. one of them is this. medication assisted treatment works. the evidence on this is volume nuss and ever growing. one study from governor baker's state massachusetts found that putting survivors on overdoses on medication assisted treatment reduced further future chances of deds by more than 50%. that is a remarkable number of lives saved and speaks to the number of lives we could be saving by expanding access to treatments that work. h.h.s. has long been dedicated to promoting access to and

awareness of treatment but we still have a long way to go. according to data just one third the of specialty substance abuse treatment programs across the courbletry offer medication assistance treatment. for many people struggling with addiction, without is like trying to treat an infection without antibiotics. having just one third offer the most effective intervention is simply unacceptable. under this administration we want to raise that one-third number. it will be impossible to turn the tide without doing so. we know that there is sometimes stigma associated with this. especially long-term therapy. but someone on medically assisted therapy even one who requires long-term treatment is not an addict.

they need medicine to return to work, regain the dignity that comes with being in control of their lives. these outcomes are literally the opposite of how we define addiction. our fellow citizens who commit to treatment should not be treated as pariahs. they are role models.

>> we have been sounding the alarm now for several years. i would meet with leaders and ask them what was the number one problem facing their community? the answer was always the same but we learned about the magnitude of this problem. one of my first actions as governor, we established an emergency opioid and heroin task force which as the chairman said came up with 33 recommendations most of which we implemented. we focused on a four-pronged approach of education, prevention, treatment, and enforcement. i was the first governor in america to declare a real state of emergency on this issue because we decided that we needed to treat this crisis

just like we would treat any other natural or man-made disaster. we have already committed in our small state more than half a billion dollars towards fighting the heroin, opioid, and substance abuse epidemic from all directions. yet, in spite of our efforts, we nearly had 2,000 people died last year far more than those killed by firearms and motor vehicle accidents added together. the good news is that with our efforts we have been able to bend the curve downwards on prescription opioids and on heroin but a new and even more deadly drug is now growing out of control across america, and that is fentanyl. overdose deaths from fentanyl we're up a staggering 70%. the majority is being shipped in from china or crossing the border being smuggled in from mexico. we simply can't stop it without

the federal government's stepping up. this crisis is going to take an all hands on deck approach from federal, state, and local governments. along with community organizations, faith-based organizations, and others in the communities. we need to be working together on this issue. i urge you and your colleagues to make increased funding for the opioid crisis a top priority. maryland and many other states are all working to provide nal oxen to all of our local jurisdictions but greater federal support would help make this life-saving medication available to more of our first responders and emergency personnel. i recommend the federal government advertise about how lethal fenltnol and these other drugs are. we also need more targeted and

aggressive federal enforcement interdiction efforts when it comes to fentanyl the and other opioids through initiatives like this trafficking and overdose prevention. as this crisis evolves so must our response to it. i agree with senator murray, this crisis is not just a health crisis. this is tearing apart families and communities from one end of the country to the other. from maryland to oregon and every place in between. and ultimately this really is about saving lives. will take a collaborative holistic and bipartisan approach to accomplish that. so again thank you for having us and we look forward to the dialogue and answering any of your questions. > thank you, governor. >> chairman alexander, ranking

member murray thank you for having me here today. i'm honored to be sharing the dais with my colleague governor hogan. i hope we can underscore the urgency of tackling the opioid crisis that has touched every single corner of every state in our entire nation. part of what makes opioids so dangerous is the fact that there is so much of it. and it isn't hard to get. abuse can begin as easily as reaching into the average family medicine cabinet. that's what happened to max of southern oregon. he was a poet and a chef. when he was 17 years old he got into a car accident and was prescribed opioid painkillers. what started as therapy became self-medication and spiraled into abuse. from prescription pills he moved on to heroin. his mother was devastated as she watched the grip of opioids consume his life. he died of an overdose at age

25. it is hard to look back on max's story and wonder what could have between. what if we lived in a society where he wasn't shamed for having a problem or for reaching out for help? what if he had had access to better treatment? what if the first responders had had life-saving overdose drugs? addiction is blind to circumstance but the high cost of addiction are borne by our children whose parents are unable to care for them while struggling with substance abuse. right now the federal government recognizes the problem but is focused on punishment. that leaves us to states to right the wrongs of a war on drugs that has done nothing to address the issues that drive this public health crisis while our prisons and our foster care systems are filled to capacity with its victims. i have seen it first-hand. prior to becoming governor i worked as lawyer representing

parents and children in the foster care system. i watched children come in and out of foster care as their parents struggled with substance abuse disorders. as children struggled with the foster family they barely knew, their parents struggled with addictions that overwhelmed our treatment. in oregon, 60% of foster children have at least one parent with a substance abuse issue, including opioids. if we can make meaningful change in prevention, treatment, and recovery in substance abuse, we can create better lives for our families. we can see more success for our students in schools. we would lift a burden off our hospitals and our law enforcement and our prisons. in my own family, access to comprehensive behavioral health treatment changed the trajectory of addiction. my step child started using

drugs in high school. my husband and i watched him change and felt power less the do anything about it. a teacher caught him using at school. instead of kicking him out she called us. we knew that just trying to stop using wouldn't work. his daily routine had become centered around getting high. he needed an immersive treatment program but our insurance policy stood in the way. he had to go through two separate outpatient and inpatient treatments and relapses before our insurance would cover the residential program he desperately needed. fortunately, for us, our family's story turned out very differently than the pinski's. but it taught me how different every recovery can look for every individual. we need to thing about it as a process that needs to be tailored to a person's

circumstance and environment. turning away from a failed first model, that's something we're working on in oregon. we're also getting more life-saving overdose drugs into the hands of first responders and implementing creative programs to provide a warm handoff from emergency rooms to treatment and recovery. in addition to increasing treatment resources we need to make sure that we are focusing on decreasing stigma as well. we must break through the barriers of the shame to provide the best treatment possible first and the most effective assistance now. we need to let people know that it's ok to come out of the shadow, that it's ok to ask for help, and that there is a help that is available for them. at the the federal level, there's so much that can and must be done improving data sharing from the federal to the state level, making affordable generic overdose drugs more available, rejecting a punitive

approach to addiction. who knows, maybe this could have saved max's life. we know it can save millions of others. thank you. >> i know that you and i share -- i know your story with your back surgeries and i'm sure they prescribed opioids to you. i went through 18 months of battling cancer my first two years as governor and four or five surgeries. i know at one time three different doctors within a matter of weeks prescribed me 30-day supplies of three different opioids. that can't happen any more in our state. but the fentanyl, we are really trying to crack down but it's coming on through the u.s. postal service. plus drug dealers from china, because they aren't checking the packages the way other delivery services are. we have to put funding in that. it is now being smuggled in.

this is actually -- we've got to do what we can on the local level under interdiction but the federal government's got to step up keeping it into the country. >> would you also agree it's not just an addiction problem? it's a one-time problem too? fentanyl is so powerful a person could get one pill and that could kill them alone. >> it's no question. and who are addicts people who don't know are using it once and killing themselves. it is 50 times more than worse than heroin. >> this month as we've been telling of the numbers from 2017, we've been hit by a series of heartbreaking statistics. just a few weeks ago, we learned that last year drug

overdoses killed a record 418 people in the state of maine. that's an 11% increase. so we're going in the wrong direction. then this week the c.d.c. announced that in maine emergency visits for opioid overdoses jumped by 34% last year. in the past three years the number of people in maine who died by drug overdoses has doubled. at the same time, we at the federal level have increased funding and federal efforts year after year to combat this crisis. what question to you is are we not doing right? you talked about the multipronged approach that i totally agree with, education, prevention, treatment, and

enforcement. we due to the leadership of this committee have poured a lot of money into all four of those categories. so what is it that we're not doing right? >> well, thank you. we ask ourselves the same question nearly every day. i mentioned in my testimony at the beginning that we were sort ahead of the curve on focusing on this issue going back to 2014 and we immediately took every action that anyone could think of. from every direction. and we put a half billion dollars into it in our little state. then we created the first state of emergency where we stood up our emergency operation center to coordinate every single state, federal, local agency to provide realtime assistance on all these different directions. we plead slight improvements in prescription opioids and in heroin but because of these new

synthetics we still had more people die. we had nearly 2,000 people died in our state. and a 70% spike in this new drug that no one knew anything about. i mentioned a few things but i think more coordination and more cooperation from the federal government with the state and local so we all are knowing what can we each do to collectively to make this happen. and i think we do need more federal funding with some flexibility for each state, how they can utilize these funds depending on how the issue is shifting and where they are at that point, in talking with governor brown fentanyl is not yet a big issue in oregon but i believe it will be. other things are starting on the west coast and coming out to us. we had all the governors together last week and there

were people talking about crystal meth is now reviving that in their states and they're lacing that with fentanyl. so i think it's going to take all of us working together. the federal government and your committee has been on top of this issue. it's been a focus and i know that there was a task force put together but it's going to need federal funding i think the stop act on fentanyl so we can interdict is important. the opioid response enhancement act, comprehensive and addiction recovery act, synthetic trafficking and overdose prevention act. there are many good pieces of legislation that should be passed and they're coming from both sides of the aisle in both houses and they ought to be considered because we've got to look at this thing. >> far too many families in massachusetts and all across the country have had to bury someone they love because of this opioid crisis.

more deaths, more funerals burks this didn't happen overnight and it didn't happen on its own. and a big reason it happened is because the biggest drug companies in the country pushed owerful and addictive pills. lied. and made billions of dollars doing it. i think it's time to start talking about holding these companies accountable and holding their executives accountable for the crisis they helped create. in massachusetts, attorney general is helping lead a bipartisan coalition of 41 states for their role in the opioid epidemic. more than 30 cities and towns in massachusetts have already filed lawsuits and a number of native tribes, including the erokee nation have also in both tribal and federal court. so let me ask this.

maryland is also part of this investigation. baltimore and several county governments in maryland have filed lawsuits against manufacturers and distributors. do you agree that part of tackling this crisis is holding these companies accountable? >> there's no question about that. and we have directed our attorney general to also take action and to sue some of these pharmaceutical manufacturing companies. there is liability. some of them knowingly pushed the sale of some of these drugs. knowing that they had these addictive capabilities and did not disclose it. you can't paint all of the people that are trying to help people with pain in a broad brush but the ones knowingly doing this should be held accountability. unforblee we should take the action, and we should, but it's not going to help the people

dying in the streets. >> i understand. but yet the investigation is ongoing and we should let the attorneys general do their work on this. but if it turns out that the drug companies broke the law, lied about it and hurt people in order to rake in profits, it won't be the first time on this. a few years ago, a corporation called insist therapeutics made a spray out of fentanyl of powerful opioid. the f.d.a. told the company that its spray was approved only for use in cancer patients who were in such pain that other drugs like moir fin just weren't enough to control it. but it turns out there just weren't enough of these cancer fishtse make buckets of money and so it started illegally marketing the drug to people with milder forms of pain and bribing doctors to overprescribe it. a lot of steats sued, including

massachusetts. oregon was the first state to reach a settlement and forced the company to pay up. so governor, that settlement occurred a few months after you took office in 2015. has the money that oregon recovered from this helped the state fight the opioid epidemic? >> absolutely. thank you for the question, senator warren. we received a little over $1 million over half of it went directly to opioid substance abuse treatment and recovery. a portion of it went to oregon health sciences university. they are a well-renowned research medical university. they're doing incredible work. i was very pleased with how the dollars were targeted. >> i'm glad to hear it because here's the thing. when a company breaks the law it's because people running the company broke the law. a few months ago, the department of justice announced that the founder and owner,

look with six top executives had been indicted for fraud and racket tiering because of their actions. so let me ask you this. do you agree that ceo's deserve to be held personally accountable when the companies they run break the law and hurt people? in egregious cases, absolutely. but obviously these cases need to be taken on a case by case approach. this was a particularly egregious case and people should be held personally accountable. >> i agree on this one. this crisis is not a democratic or republican issue. and neither is holding drug companies accountable. the department of justice announced last week they're forming a task force to target opioid manufacturers and distributors that have contributed to the epidemic and i am very glad to see it. families and communities have already paid an enormous price for this crisis and it is time

to start holding companies and their ceos accountable. thank you both. >> congress is interested in this. they passed the omnibus. there are hearings. they're looking at the law enforcement side, the prevention and treatment side trying to come up with a bunch of different bills. the chairman says he is hoping for a package on the floor by memorial day. in the senate, you have this bipartisan group of senators hoping to put maybe $1 billion , ards this as other bills it's got some traction in the senate but everyone i've talked

to is less sure about where it might go in the house only because it's a lot of money. >> you mentioned some hearings moving forward. the white house back in october declared an opioid epidemic. where has the administration's emphasis been? law enforcement measures or better prevention and treatment? >> the white house calls it a public health emergency in october. they renewed it recently. it's kind of an odd mix because there's a lot of i want rest in this law enforcement law and order, these headlines about the death penalty. that was a big focus last week in new hampshire and the department of justice has been directing u.s. attorneys to seek the death penalty for high-level drug traffickers. but there is some talk of expanding access to treatment and making sure that first responders have nal oxen,

that's intrelinging and has been talked about by a lot of public health officials but the emif a sice on law enforcement and law is different from what we've seen before and has given them some pause. >> what have we seen before with the obama administration, for example? >> the obama administration was certainly interested in this public health response. there's a lot of talk about nal oxen and making sure that people had access to makes that would help them get weaned off opioids that is a shift in terms of how we've looked at addiction from any time before pretty much in this country's history. it's sort of an interesting thing to watch. >> we've been showing and will be showing comments from a umber of state governors testifying. what are states doing in terms

of response to the oipt epidemic? and what do they say they need from the federal government? >> the big thing that states want is money. they need money to give supplies to first responders to get this to get other medication, to get folks into treatment. you have these systems. last summer about the foster care system which has seen a huge influx of kids because their parents can't take care, they're looking for resources to address this issue from every angle possible. >> back to congress. new studies from the national manufacturer's aslyance and american action forium show the harmful impact on manufacturing and the broader employment sector in the u.s. you talked about a number of congressional hearings on different laws. are employers and industry leaders pressing members of congress to do more on the opioid issue that you know of? >> there's certainly a lot of

concern about the impact it's had on the economy, on productivity at large. there's tons of research done by economists where they show that people are less productive in part because they are sort of grappling with addiction, unable to work, going through other sorts of systems that leave them unable to be as productive. >> aside from the terrible increase in the death numbers, how has the nature of this epidemic changes over time especially just in recent years? >> i think this is a really interesting story. this comes from we think painkillers, vike din and the perk set like sorts of things. in the 90s doctors were really taught that they should treat pain and told that the opioids are great, not that addictive. and so they prescribed them. the story you hear so often was the girl whose skate boarding, gets in an accident and she's prescribed perk set to take care of it.

doesn't realize she's addicted until she goes into withdrawal and it's painful. and she switches to heroin because it's cheaper and more potent. and it continues from there. that was the story we heard for a while. then you get to where we are now. there's this crackdown on opioid prescribing so there are fewer painkillers but people are still craving this drug and so they switch to heroin, which is much more common and they switch to fentanyl which is deadly and has been coming in more from experts say china and mexico, and can kill you much more easily but also produces a much greater high. >> in one of your pieces you lead by writing the nation's opioid epidemic has been called today's version of the 19 0s aids crisis. solving that took years. how long do health experts think it will take to get control of the opioid epidemic? >> i don't think they have an end date to be honest. this has to be an ongoing

commitment. there needs to be a promise from congress to give tens of billions not just this year but every year. there's the public health commissioner from baltimore has talked about the importance of creating almost a ryan white, the hiv aids separate funding program fror treatment. i think she's not alone in making that argument. >> thanks so much for joining us. >> thank you. >> as you know this office crafts the drug control policy, oversees all counter drug activities and related funding.

i serve as the associate irector. so first please allow me to take a couple of minutes to address the magnitude and complexity and mention some of the thing that is the federal government has been doing. according to the centers for disease control and employee vention, in 2016 the year for which we have the most recent data available, 63,6 32 americans die due to a drug overdose, a 21% increase from 2015 amounting to about 174 americans every single day. opioids make up the largest categories of drugs contributing to overdose deaths n america with 15,472 overdose fatalities involving heroin, d 19,431 involving synthetic

opioids. illicit opioid crisis is a complex national security, law enforcement, and public health crisis, and is the nation's number one drug priority. first i should mention that while fentanyl has been the primary driver of the horrific numbers of deaths we have been seeing we still have an enormous problem with heroin. it is too abundant in the market and far too available in our communities. along with our heroin crisis we're currently facing the additional and related problem anlogs, t fentanyl potentially deadly being anywhere 50 to 10,000 times more potent than moir fin and comes in many forms. we truly have watched the crisis of illicit fentanyl evolve over the last two years from powder mixed in to heroin

often without the user's knowledge. the fentanyl pressed in to pill form and sold as counter fit medications, being bought and sold over the internet, through the anlogs now available for sale which brings us to where we are today. we have among us a family of drugs that are extremely addictive and deadly sometimes ordered over the internet and purchased using crypto currency coming in through a high volume through mail system, commercial carriers or sometimes smuggled across in a variety of forms incredibly hard to detect. this should tell us a great deal. more than anything we must accept that fentanyl is also very likely a window into the future of the drug problem in america. we know that we must reduce the size of the user population through prevention, treatment, and recovery support services at the same time we are

reducing the availability of these drugs as two complementry efforts to reduce the market forces pulling these across our border. but we could very well be seeing a move away from the plant-based drugs towards synthetic drugs with lower overhead on the front end and lower risks and greater profits for traffickers on the back end. and we have to accept a more expanded image of the using population. the proto typical experienced intravenous drug user are now joined by those who are thinking they are buying pain relieves but are too often dying from fentanyl pressed into pill form. there should be no doubt that the internet has made urchasing drugs much easier. empowering a democratization of the drug trade. a hire arkcal drug trafficking organizations we have traditionally seen and are well

postrd to address ma no longer have a monopoly. rather, individuals can simply go on line to one of the many internet drug marketplaces and purchase drugs like fentanyl for their own personal use or for further sale creating a conflation of micronetworks across the country. so what we do now is not only important to get ahead of the deadly crisis in front of us but also establishes the framework of relationships and laws and regulations and technologies and procedures that set the conditions to deal with the future of drug use and its consequences for years to come. i can tell you that we know more now about where fentanyl and its anlogs are being manufactured and how they're getting into the country than ever before thanks to the intelligence community, the federal law enforcement community, and our partners at the state level and below. greater testing of seizures and better post mort m testing by medical examiners and corn no,

sir is telling us more about the anlogs in our community and killing our people. our international partners, specifically mexico, canada and china, have ibtnalized this problem and are taking measures to help us address it. here at home, our law enforcement professionals help us narrow the inbound items. as this crisis has taken hold here in america, we have been building and sustaining the architecture where the entire federal government is applying its time and emergency focusing on this complex problem and a network of partners each taking their own share and achieving complementry effects. what you have seen recently from the role that congress has played in keeping this issue at the forefront of our national consciousness from the president signing the interdict act to the announcement of his initiative, the tangible efforts from every department and agency from across the

federal government to the enormous commitment to resolve at the state level and to the energy and innovation in our communities across the nation which speaks to the seriousness of this issue and our common commitment to address it in a meaningful and sustainable way. the drug market is vast, dynamic, and adaptive. but it is not without its own vulnerabilities. i will tell you that it is no match for our own intelligence and determination and the very best talents that we can bring together against it. >> i thought of the postal service as the way they're entering the country. >> yes. this is one of my favorite topics because the postal service is doing a tremendous job. the postal service and

specifically the postal inspection service, the law enforcement arm of the u.s. postal service, was very early to understand the magnitude of the problem in their -- in the fact that the u.s. postal service was a critical vulnerability that we had and that it was being used as a vecter for these drugs to get into the united states. working closely across the agency with other federal law enforcement to do a couple of things. the first thing is to get advanced electronic data from the shipping company or from the originating country so that they know the shipments that the are coming in to the united states before they get here. and that's usually about 72 hours out. that's for tracked and untracked packages. the volumes that we are talking about are enormous. up to about 144,000 packages every single day into one international service center.

so when you get advanced electronic data that can share that with customs and border protection so that they can pull aside and give separate attention to those companies that are most related to the illicit shipment of goods, so that's the first thing. the second thing is the nonintrusive detection capability there at the interaction shipping center for them to be able to detect illicit substances in there. and then the third thing is to be able to work with other law enforcement partners whether from d.h.s. or the department of justice in order to get an outcome for the things they intercept. the postal inspection service and postal service writ large has done a tremendous job to help us better understand this vecter and actually doing tangible things against it. really over the last year -and-a-half or two years. >> in a followup question about, when these drugs are ordered off the dark web market

places, are they shipped almost exclusively via postal service or private delivery services used like fedex? >> private delivery services are used as well. so that's all of your major kind of expressed consignment carriers. all who have done a tremendous job working with federal law enforcement to share information and allow federal law enforcement to be able to assist in intercepting these packages before they can be delivered to the end user. so when we say the postal service, that's kind of one element of it but the expressed consignment, fedex, those others, they also provide a means for the drugs to get into the country but those companies are working very hard to interdict those shipments. >> on march 1, the white house hosted a summit on the opioid epidemic. this portion of the event features remarks by attorney general jeff sessions homeland

security security and secretary of state. you can watch this event in its entirety at our website. >> we know that prices for illegal drugs are down, the availability is up, and the purity is up. and the addiction is up and the deaths are up and the danger of the drugs particularly at the fentanyl and heroin combinations we're seeing are just extraordinary. i was involved in the early 0s as a united states attorney working on these issues and we never saw anything like this. this is totally unprecedented in the history of this country. it cannot continue. it will not continue. the president has made it clear we are going to be resolute.

the entire administration is going to respond to his declaration of an emergency and we're going to make a difference. i believe it, i can sense it already in some of the policies that the are ongoing out there. we announced in july the largest medical takedown in the history of our country. we had over 120 professionals, nurses and doctors who have been out of 40, i believe arrestees that were involved in illegal prescription drugs. we know that as much as 80% of addictions today start with prescription drugs. that's an extraordinary number. we'll continue to research it but that's the numbers that we have and i have no doubt it's an extraordinary high amount starts as prescription drugs. we also had a week later the dark n of alpha beta, a

bsite in which had 220,000 sites where people could order directly through the mail illegal drugs. of course fentanyl is so compact and such a little bit is so powerful that it's easy to ship these kind of drugs through the mail. the f.b.i. has doubled its resources to identify earlier. we are not going to let those sites get that big gn in the future. that's certainly our goal and we are going to continue to work on that. we have indicted some 3,000 defendants for distributing drugs in 2017 and we have create it had opioid fraud abuse and detection network which is a data analytic system that is well within the existing computer systems of the drug enforcement administration so we can easily

determine what physicians, pharmacies, and other distributors are moving prescription drugs. some of them are extraordinary outliars. they give us indications of where fraud and abuse is occurring and we can move quickly on that. that's not been really done before, target packages are being sent out to investigators and cases are being made. one assistant united states attorney said i didn't think too much about it but when i looked at what happened we knew there was six professionals, mostly physicians in pittsburgh and we -- every one of those were on this list. so it made me a believer and a lot more on the list that he didn't know about. we sent out 12 special experienced assistant united states attorneys to hot spots around the country to focus on that. we've indicted two chinese nationals for the first time on

fentanyl charges. most of that is coming from china as you know often through mexico sometimes directly through the mail to our communities. we established the -- a new program called j code. that is the f.b.i.'s program with d.e.a. to identify through the dark net and actually purchase under cover drugs in that way and to target those groups, and we announced the rescription intervention and investigation task force that will utilize our civil department to file civil lawsuits. we believe we can get an injunction to stop a physician or pharmacy immediately from prescribing drugs because they have to comply with the law and we can get a civil injunction and then continue if need be a criminal investigation. i'm excited about that. and we've also filed litigation in support i believe it will be

filed today. we have announced our intention to file a statement of interest with the multidistrict litigation efforts by a lot of the attorneys general around the country on that. i will just end there to say this is what we are doing in our department. we see it in the people you saw earlier in the first panel. i believe if we do these things effectively we can reduce the amount of deaths, addiction, and destruction that these drugs are causing today. it's just unacceptable in this great country. we'll do our part and kelly an i know, i have to say her leadership is going to be so important in this because we do want prevention, we do need to education people, and the

president has used the phrase just don't start. if you don't start like he never started and you don't get addicted. so we need to be cautious encouraging people not to do that and kelly ann knows how to community kate and will be a benefit to that. > thank you. i was there on tuesday when you had the press conference with the state attorneys general and the acting director of the d.e.a. and others and was really struck by the bipartisan approach that the attorneys general had to prescription intervention and litigation announcement. going on to secretary nielsen at the department of homeland security. so many aspects of the interdiction and law enforcement fronts in waging this battle against this crisis falls under d.h.s. so we're most curious to hear

the progress, report and also the vision for the future. thank you. >> good afternoon, everyone. i appreciate the opportunity to join you today. this truly is a shared fight. i'm sure you've heard before how we must do this in partnership. i'm particularly honored to be joined by leadership from the department of homeland security. this e i.c.e. and they do work every day to protect our borders from all threats and our interiors from all threats but that increasingly unfortunately includes opioids. the president when he declared an opioid crisis as a public health emergency, sent a strong statement. the statement to us in is america is fighting back and we will continue to do that with all the tools we have at our dispostal at department of

homeland security along with our other departments. since october we have proactively assessed the threat and what we can throw at it. this has allowed us to leverage our intelligence efforts. d.h.s. is a law enforcement agency. e have 60,000 in crmp bc alone but we have multiple agents that play a role. leveraging their efforts. we also do interdiction operations with our international partners and we've had great success on that front particularly with our friends and close partners in mexico and we continue to look for new partners because as we know this dreaded drug fentanyl continues as the attorney general mentioned to come in packages of all sorts and sizes and then get in the hands of others that use it in the drug

flow. so we look at the sort of this two ways within our borders and we look at stopping across our borders. to prevent entry we work with d.o.j. and states and our law enforcement counterparts in mem co, south and central america, and china as well to prevent the flow but also most importantly to share the information. the sharing information really has two main purposes. one is to stop the drugs before they come into our country but the other is to help us as partners dismantle themselves the force behind the epidemic. this helps us discuss the flow, facilitates the dismantment and also provides clear roles and responsibilities amongst all partners to bring all that we have to bear. so i just wanted to use one example. we have border enforcement security task force which is luckily enough has one of those

good acronyms, best. some of ours at d.h.s. are not so well done. the primary platform to investigate opioid smuggling. so in 50 locations leverages more than 1,000 law enforcement officials, and represents over 00 law enforcement agencies. also has officers at hundreds of ports of entries and check billions of dollars of cargo and millions of passengers a day but particularly focused on fentanyl. seizures have significantly increased over the last three years, yet about only two pounds in 2013 we had ,48r5 pounds in 2017 and remember this drug in extraordinarily small quantities is lethal. so 1,485 pounds is substantial.

that is an epidemic. it confirms the explosion they've expand it had use of k-9s and all k-9s working now have the ability to detect drugs and fentanyl in particular. while we don't see yet a significant amount of the opioids being trasked by sea, u.s. coast guard's of other narcotics are increasing. of course that supplies the funds who are then otherwise able to use the funds to traffic in opioids and fentanyl. to prevent the sale, we're also committed to not only preventing them at their source but then preventing their movement into and sale within our country. the attorney general mention it had dark web. we support his efforts. our united states secret service has extensive cyber capability and also contribute to the fight.

so does ice homeland security investigation. the broad mission set but we do in all times work to bring everything we have to bear. the dark net i would just add one comment is synonymous -- anonymous so it makes it much more difficult. but with our partners at justice and f.b.i. and within d.h.s. we are doing just that. the job doesn't end there. we also work to support the apprehension and prosecution again we work closely with our law enforcement breath ren. what i would say in closing is the sheer magnitude of this means we have to partner. as i said many times today actually in other forums there's not one entity that has all the authorities, capabilities and capacities to fight this alone so we greatly appreciate everyone in this room, your interest, support, partnership. we can't do it without you. we thank the president and vice

president for their continued leadership, certainly kelly ann. >> thank you very much secretary nielsen. thank you. it's terrific to have the state department involved as well and today i'm happy to present to you the deputy secretary of state mr. sullivan. >> thank you. it's an honor to be here. i'm delighted to see everyone here. thank you for your leadership and to general sessions and secretary nielsen. you might wonder why the state department is here. this is a whole of government effort. the president has made this a top priority for his administration. the state department's involved because the problem we confront is not merely a domestic problem. the opioids killing american citizens today are produced overseas and they're trasked by

criminals and criminal organizations that operate transnationally. the state department's role is to stop transnational criminal organizations and the networks of criminal activity they perpetuate in trafficking drugs and destroying the lives of our loved ones. the addreading the crisis is a whole of government effort and the state department's role is to apply its resources abroad with our partners, allies, and others to support all the work that the department of justice, the department of homeland security, and the other cabinet departments are doing to the address this problem and this e norms scourge that we have in to enlist the support of our allies and partners and neighbors in mexico in particular. it's our highest at the state department this is our highest drug control priorities. the bulk of the state department's counter narcotics work is focused on count rids

where opioids originate. opium harvested in mexico is the root of over 90% of u.s. supply of heroin. the tc omp's that smuggle it across our border to be sold by dealers throughout the country the countries that d.h.s. and department of justice are working to stop. we're strengthening cooperation with mexico to interdict illegal transports, find and punish criminals and cut off their sources of funding. in december of last year secretary tillerson and i along with general sessions and secretary nielsen continue the strategic dialogue we have with mexico on disrupting transnational criminal organizations. we're working with our mexican counterparts to find new ways to disrupt the revenue streams of tcos responsible for trafficking heroin and other

ill lissyith drugs into the united states. we're also working with mexico to eradicate poppy crops, train law enforcement, enhance border security, and bring drug traffickers to justice. over 100 afmexico's most-wanted high-value's targets have been arrested, killed, or extradicted to the united states. we support mexico's efforts to find investigate and destroy clan destined drug labs. since 2014 the department of state has fundedday training of over 300 mex can counter parts to go after those labs. since 2008 the united states has donated and supported training of more than 500 k-9s who are assigned to mexican federal state law enforcement agencies. we sponser training for k-9s and handling teams to detect weapons, cash, and drugs. this includes for the very

first time fentanyl specific detection training through cooperation with our neighbor to the north, canada. last fall the commission on narcotic drugs put new international controls in the two primary ingreed ynts used to produce fentanyl taken at the request of united states and such measures are already producing results. due to this change, and other efforts, d.e.a. has seen a decline in the presence of these chemicals in the illicit drug market. in two weeks, again at our request, the commission will address controls on five other synthetic opioids including the deadly opioid car fentanyl. the state department has also building partnerships to more effectively stop the traffic of synthetic drugs sent through international mail and courier systems. these efforts allow for law enforcement to more easily interdict any packages that may contain illicit fentanyl.

china is a growing area of focus in the fight against opioids. energized by president trump's visit to china last november, the united states and china have forged a productive counter narcotics relationship. as a result of our cooperation, china has established domestic redirections in the production and sales of 143 substances including a number of fentanyl-related compounds. china's tightening of regulations has significantly contributed to the reduction of these substances on the streets of the united states. unfortunately we're seeing -- we're beginning to see a new trend of rogue chinese chemists selling them on line to drug traffickers and users and shipping them in small quantities through the mail. as secretary nielsen mentioned the amount of fentanyl necessary to convey a lethal dose is extremely small so we're talking about small

quantities of these illicit substances. in response, we're working closely with china to improve coordination and screening of mail packages between our two countries. we're on an aggressive timetable to get all packages coming from china tagged and beel continue that close cooperation with china and other countries that are sources of these chemicals and illicit opioids. clabt ration is the only way we can tackle a problem that has no regard for international borders. the state department will continue to aggressively pursue this fight against opioids and partnerships with all other nations. thank you.

>> over the past 15 years our nation has been increasingly de stated by opioid abuse, fueled for a significant period of time by the overprescribing of potent prescription opioids for aculet and chronic pain. prescriptions for opioids have started to decline obviously somewhat a success. but organizations in particular the well-positioned in particular mexican drug cartels have filled this void by producing and distributing

cheap powdered heroin and selling it to users in both traditional powder form and in some cases pressed into counter fill pills. there are two central elements d.e.a. is addressing to turn this tide. with a third piece that must also be address thed. first and foremost is enforcement. based on our investigations, actions are undertaken every day using our criminal, civil, or administrative tools to attack traffic and illicit drugs and diversion of supply. second is education strongly believe there's a real value and a natural fit for the d.e.a. in this space and look whenever possible to look for leaders to partner with. the third element is treem. the d.e.a. is committed to doing what we can to improve access to drug treatment and recovery services working alongside our partners to utilize evidence-based strategies that minimize the

risk of diversion during this public health emergency. ultimately the only way to fundamentally change this epidemic is to decrease demand for these substances and ddress the global littlice and i will lissity supplies concerning d.e.a. and all of its partners. the action of the diversion control drigs is critical. diversion by a few has a disproportionate impact on the availability of prescription opioids. the fact remains that a majority of new heroin users stated that they started their cycle on prescription opioids. as a result we are constantly evaluating ways to improve our effectiveness to ensure that our more than 1.7 million registrants supply with the law. our use of administrative tools and legislation that changed our authorities in this area has been the subject of numerous media reports. let me address that issue up front.

d.e.a. has continued to revoke approximately 1,000 registrations each year for administrative tools such as orders to show cause, immediate suspension orders and surrenders for cause. we have and will continue to use all of these tools to protect the public from a very small percentage of registrants who exploited human frailty. where a license is not necessary we've used mous to the ensure compliance. leveling fines nearly $3 million in fines and entered into m.o.u.s with each. also reprioritized the portion of its criminal investigationors and enforcement groups referred to as tactical diversion squads currently have 77 of these groups nationwide and are solely dedicated to investigating, disrupting, and dismantling organizations.

d.e.a.'s diversion control division is sime tainly worked to improve communication and cooperation with the registrant community. as an example of this outreach d.e.a. offers year round training free of charge to pharmacists, distributors, supporters and manufacturers. d.e.a. just completed training more than 13,000 pharmacists and technicians on the important role they play. in may d.e.a. will initiate similar nationwide efforts to provide training on the vital role that prescribers play in curbing this the epidemic. this effort will start with specific focus on states where we have seen little decrease or in some instances an increase in opioid prescribing rates. administrative actions, civil fines and criminal cases are all important steps where we have fallen short in the past it is by not proactively leveraging the data that has been available to us. while i'm happy to discuss what happened in the past i'm

focusing my time on moving our agency forward and appreciate the opportunity to update you on where we are today and where we intend to go. for example, in january we utilized data from h.h.s. and when available state pmp programs. the result was approximately 400 targeted leads that d.e.a. was able to send to its 22 field divisions nationwide for further investigation. while we are working with all the federal agencies in this space, -- we are working with all federal agencies in this space while we continue to work the mutual leagues, issues we face today have created stronger and critical partnerships. i would like to recognize the ske's efforts to hold a legislative hearing starting tomorrow on more than 25 pieces of legislation. in a not only underscores the complexity but also zems straits we must take action to

address this threat together. >> good morning. thank you for the opportunity to discuss the role in combating the i don't know going crisis. confronting this epidemic remains one of my highest priorities. i'm committed to reexamining all of our authorities and further steps that can be taken and grateful for this ommittee's role. to address this crisis, f.d.a. working across three broad do mains. first taking steps to improve our medical technology. this means better drugs to treat addiction, and new pain remedies that are resistant to misuse or aren't as addictive. second we're pursuing measures to reduce the rate of new addiction. this means trying to reduce

overall prescribing and the number of pills that get dispensed. among other things we're taking new steps to require sponsors to provide education to providers and other health care practitioners, also ways to change how opioid's are pack adged. one of the things we're considering is steps to require sponse rsd to ensure providers provide specific documentation. such a framework would be based on evidence-based guidelines that define the problem treatment for a given indication. third we're ramping up our efforts aimed at the interdiction of illegal drugs. this includes new authorities and resources aimed at our work in the international mail facilities. the virtual flood of dangerous products entering the united states through mail packages that expose americans to dangerous pills. we're dialing with sophisticated bad actors that are aware of the gaps and weaknesses and our tools to try to exploit them. the primary responsibility

anything believed to contain controlled substances goes to c.b.p. before packages are sent to us. we're stim seeing more and more controlled substances hitting our investigators. in one recent period 5800 packages, 376 contained control substances including opioids. i'm worried that those sneaking through opioids through the mail will disguise them as ordinary drugs to the evade detection. it is estimated that less than one tenth of 1% undergoes a physical inspection. the risk is that many are slipping through our grasps. we have prioritized our work and invested our capability there is but there is more that we must do. we have increased our staffing. additional staffing is critical but to maximize what we can do

i want to focus on additional authorities we have discussed with congress including certain detection and destruction authority. first, our operations at the imf where routine or partially packaged pills many simply in thousands of loose pills in huge boxes. we're required to open every package to document the contents and find supporting evidence of the arls intended use. where the evidence has been sufficient under our existing standard we often simply refuse entry and send a package back. it is not uncommon for our investigators to see the same package again and again as shippers resend the same box second and third times. this is not a deterrent. if f.d.a. had the authority to detain and destroy products we could more quickly remove potentially dangerous products from the supply chain. second, this is also a numbers game.

the bad actors could send in hundreds of thousands of small parcels. these are whole sale quantities of illegal drugs intended for further distribution and each may violate f.d.a. law but they know they can't stop them all because current law requires us to detain and pursue each package separately and overwhelm our system with volume. improving authority to more efficiently detain bulk shipments would create a big difference and better protect americans. third, while substances already scheduled are generally referred to c.b.p. at the border, when they contain .ubstances not yet scheduled, right now we can't refuse or destroy these unlabeled products simply because they

are articles of concern to d.e.a. extending the ability to refuse, detain or destroy before the scheduling takes place would keep articles not easily detained off the streets. these could enhance our mission. i appreciate your support and interest and i look forward to working closely with you to help save lives. good morning. we have vast experience tackling eep demics and i appreciate the chance to talk today about our work fighting the nation's opioid crisis. we're focused on using data for action to inform strategies to revent use abuse and overdose. and the impact on opioids on mothers and babies.

responsible opioid prescribing, tracking trends, and driving community-based prevention activities reduce opioid overdose deaths and related harm. america's opioid overdose epidemic affects people from every community. the problem is getting worse. in 2016, more than 53,000 people died of drug overdose and preliminary data indicates that the trend worsened in 2017. we have seen increases in babies born withdrawing from narcotics. these suggest one baby is born with signs of noo sin drome every 15 minutes, about 100 babies a day. we've also seen a drop in life expectancy for the first time since 199 . for every one person who dies of an opioid overdose over 60 more are already addicted to prescription opioids and almost 400 misuse them. c.d.c. supports state health

departments providing resources and guidance. so states can rapidly adjust as we learn more about what worked best in this very fast-moving epidemic. a nimble federal and state response is crucial. c.d.c. now funds 45 states and washington, d.c. to advance prevention including by improving programs can, improving prescribing practices, gathering timely high quality data and evaluating policies. we hope to expand this to the 50 states. states are making progress and working towards more comprehensive and effective monitoring which is essential to improve clinical decision making and use data as a public health surveillance tool. many are increasing use by providers and pharmacists, enhancing the timeliness of reporting and electronic health

records. in north carolina they have integrated prescribing data within the clinical work flow of existing health information systems across the state. improvements like that show how we can make vital data action nabble with the goal of saving lives. also leading improvements through the public health data needed to understand and respond to the crisis. we improve the timeliness of the reporting, updating preliminary data on overdose deaths. through our funding to states we're ramping up our efforts to get more comprehensive and timely data from emergency rooms, emergency medical services, medical examiners and coroners. we're tracking nonfatal overdoses and as you've heard we reported on the 30% increase across the country. we also recently released data using tox clodgecal and death scene evidence from ten funded states allowing for a more robust characterization of

opioid deaths. that found that fentanyl was found in more than half of the recent opioid overdose deaths. c.d.c. continues to educate providers and the public through the implementication of our guidelines and the awareness communication campaign. we're making the guidelines more accessible to clinicians through interactive training and mobile app. focusing on the risk of prescription opioids and features real life accounts of individuals in recovery and those who lost someone to this terrible problem. in addition to our partnership with states, c.d.c. believes this epidemic requires a collaboration across sectors. we've been working side by side with law enforcement like the d.e.a. to determine risk factors and target implementation plans for community specific prevention strategies. we draw on experts from across our agency to address the many

facets of the crisis. the comprehensive public health approach is playing a key part in addressing the epidemic. we didn't get into this overnight and we're not going to get out of it overnight. we need intensified sustained efforts to reverse the epidemic. thank you. >> thank you. >> thank you for the opportunity to discuss the opioid crisis and the federal government response. from the start of hids administration president trump mad addressing the epidemic a top priority and we share the president's commitment to bringing an end to the crisis. families have been impacted and the emergence of illicit fentanyl have only fueled the risis in recent years. sam is a has been at if forefront of the opioid crisis.

under the strategy our work focuses on advancing treatment, and overdose prevention through funding to build state and local capacity, providing education, training, and technical assistance and data collection analysis and evaluation to track emerging trends and support the integration of evidence into practice. today i want to focus on several recent actions to enhance our response to the opioid crisis. in the area of funding, sam is a distributed $485 million to states targeted response in may 2017. this funding supports data efforts to reduce overdose deaths and provide the full complement of prevention, treatment, and recovery services. in november of 2017, asmsa announced it was accepting applications for grants to enhance those efforts in states hardest hit. in monday of this week, supplemental grands were

awarded. also provides critical funding for treatment and recovery services for specific high-risk and vulnerable populations such as those involved in the criminal justice system and regnant and post part m women. awarding $10 million over three years that enable outpatient care and nearly $50 million over five years in new grants to support residential reatment services. samsa has been a leader in nal ox on to. funding to programs authorized to provide resources to first responders who work directly with populations at high risk. developing a well-trained workforce are key goals of the education, training, and

technical assistance efforts. awarding $12 million to create the opioid technical assistance program. this new program provides direct technical assistance to states and local jurisdictions to support the implementation of evidence-based practices tailored to the state specific context. last month releasing med cakeses for opioid abuse disorders which provides information about the treatment of opioid use disorders. in addiction, providers clinical support system for medication assisted treatment provides treatment and mentoring to support clinicians provides the training to include on all disorders. given the importance of providing clinicians with actionable information about opioid interdiction and egnancy, last month data

guidance provides clear information on a range of real world scenarios faced by health care providers caring for mothers and infants. ? january 2018 issuing a final rule commonly referred to as part two. as required in 21st century cures, held a public meeting to obtain feedback on part two. the vast majority who spoke expressed their support for further aligning part two and acknowledged additional action would be needed. in the area of data analysis and evaluation, we're standing up the policy laboratory created under the 21st cures act the policy lab charged by congress with supporting innovation, and facilitating the adoption of evidence-based policies. finally, the president's fiscal

year 2019 budget includes $15 million to reestablish the warning network a national public health system that will improve emergency room moptrg. we are committed to combating the opioid crisis and looks forward to working with congress to advance this important work. thank you for inviting me to testify and i look forward to your question. >> the final portion of your -- our program features president trump at manchester community college in new hampshire. he traveled to the state on march 19 to announce a plan aimed at addressing the epidemic through a combination of law enforcement and health measures. this portion is about five minutes. >> i especially want to acknowledge the families with us who have lost precious loved ones. i have beep saying this for a

long time and it all started right here in new hampshire. because i see what you are going through. about as bad as there is anywhere in the country and i said i would be back, and we are back. and we're pouring a lot of money and talent into this horrible problem. we pledge to honor the memory of those you lost with action and determination and resolve. we'll get it. we will not rest until the end and i will tell you this scourge of drug addiction in america will stop. it will stop. [applause] every day 116 americans die from an opioid-related overdose. in new hampshire, the overdose -- comfortable this. the death rate is double the

national average. it has difficulties like people who wouldn't believe defeating this epidemic will require the commitment of every state, local, and federal agency. failure is not an option. addiction is not our future. we will liberate our country from this crifle. it has never been like this. hundreds of years, never been like this. and we will raise a drug-free generation of american children. last october we declared the opioid crisis a public health emergency. it should have been done a long time before. since then, we have worked with congress to ensure at least $6 billion additional going through right now in new funding in 2018 and 2019 to combat the opioid crisis and we will be spending the most money ever on the opioid crisis.

[applause] on our most recent national prescription drug takeback day people across the country turned in more than 900,000 pounds of unused or expired prescription drugs nor than the weight of three boeing 757s. our customs and border protection, and these people, the job they do is incredible. seized nearly 1,500 pounds of fentanyl last year. nearly three times the amount seized in 2016. and i told china don't send it. and i told mexico, don't send it. [applause] > don't send it. in 2017, ice arrested criminal aliens with 76,000 charges and

convictions for dangerous drug crimes. last year, the department of justice prosecuted more than 3,000 defendants in cases involving opioids. all of the trafficking and the related crimes, 3,000 cases, including a pharmacist, a physician's assistant, and an opioid trafficker. each charged with commiting serious drug crimes in new hampshire. whether you are a dealer or doctor or trafficker or a manufacturer, if you break the law and illegally pedal these deadly poisons we will find ou, arrest you, and hold you accountable. [applause] thank you. here in new hampshire i applaud all of the drug enforcement agents and law enforcement

officers who recently coordinated operation granite shield. an 18-hour enforcement action targeting drug traffickers that resulted in the arrest of 151 people. these are terrible people and we have to get tough with those people because we can have all the blue ribbon committees we want but if we don't get tough on the drug dealers, we're wasting our time. just remember that, we're wasting our time. and that toughness includes the death penalty. [applause] you know, it's an amazing thing. some of these drug dealers will kill thousands of people during their lifetime. thousand offers people. and destroy many more lives than that. but they will kill thousands of people during their the

lifetime. and they will get caught and get 30 days in jail or they will go away for a year or they will be fined. and yet if you kill one person, you get the death penalty or you go to jail tor life. so we're not -- if we're not going to get tough on the drug dealers who destrow so many people's lives, we are doing the wrong thing. we have got to get tough. this isn't about nice any more. this isn't about committees. this isn't about let's get everybody and have dinners and let's have everybody go to a blue ribbon committee and everybody gets a medal. frankly talking and doing nothing. this is about winning a very, very tough problem. and if we don't get very tough on these dealers, it's not going to happen, folks. it's not going to happen. and i want to win this battle. i don't want to leave at the

end of seven years and have this problem. i don't want that. right? thank you. [applause] it's not going to happen. thank you all. >> sunday on c-span's q&a theatrical physicist and author talks about his career in science and his latest book, the future of humanity. >> the norms for mother nature is extinction. if you don't right under our feet right now you will see the bones of the 99.9% that no longer walk the surface of this earth. now, we're different. we have self-awareness. we can see the future. we splot, we scheme, we plan. and so perhaps we're going to evade this conundrum and maybe survive but we need an insurance policy.

that's why this book is different baw the other books talk about the steps but what is the goal? what is the pot of gold out there? >> next week, facebook ceo mark zuckerberg will testify before senate and house committees on facebook's handling of user nformation and data privacy. watch live coverage and listen live with the free c-span radio app. >> next, president trump meeting with west virginiaance to assess how they're doing after the package of tax reformulate last year.