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radioith the free c-span app. >> 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 -- state governors, white house officials, health experts, and president trump. we begin with a transportation -- hearing. from author sam quinones. >> i'm pleased to welcome sam

quinones and his family today. thank you taking the time to be here. he has 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. sam: thank you very much. their ego. -- there you go. clearly, i'm a rookie here. honor all members of this -- 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 of the country that have never seen this kind of 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 epidemic of addiction 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 energy, bring in 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 addiction until we released 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 than simply pain pills. the doctors need more med school in pain management and addiction

treatment. i have to say that i think it is 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 truly help stop these drugs from flowing into our country, and that is a deep, respectful, but forthright, sometimes blunt, 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 and another wall seems to me is -- needs of us. another wall, it seems to me is just like heroine. it feels good for the moment. it will leave us in a worse place in the long run. another civil proliferate complicated adult problem.

sometimes the solutions are a -- about the mundane mechanics of governing. fundd find new ways to coroners office, and expanding 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 -- expand 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 needs to be involved to help solve the last rating wounds that will last a lifetime. i believe u.s. senders can help -- senators can help by recruiting and recognizing and giving conference with should -- platforms from which to tell their story. many it is because i am a reporter, but i believe that through their stories the awful 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.

indeed this is not a story of a , drug addiction. this is a story of economic affliction. as politicians and a natural response to this, it is to look about for things you can do quickly to show constituents you are taking action, and i believe that is entirely understandable. i would caution against believing in short-term responses. the cures act make up a great start, and i thank you for them, but they are 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 us two templates in which you might take guidance and inspiration. first is the marshall plan to rebuild europe after world war ii. second is our space program. each involved in government and the private sector acting in

concert over many years, bringing money, brain, energy , and, of course long-term focus , to bear. each achieved in on allied 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 viral spread of soviet communism. allowed countries to prosper and itallowed countries to prosper and contribute to the world again. a marshall plan for american rep -- recovery might focus 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 at the people 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 like we might profitably applied these examples. the marshall plan and the space programs to region of forgotten americans with problem began too regions of forgotten americans were this problem began. as jfkause it is easy said because it is hard. because that is what americans do and what they have always done at their greatest. like our space program, i believe such an effort will have two last years to be defective, focus be on the goal of drug and then and the more hollowing out of starches of this country. onlyhere to virginia not the catastrophe that it is also as the gift that it can be.

it offers an opportunity to reinvest in areas that is needed most, a chance to inspire us as americans again to do something great. it is an opportunity to bridge that political polarization that so gnaws at our country. it is one of the few issues today. do not miss this opportunity. it does not come around often. is thisling i suspect very reason many of you got into public service and you are lucky to be here. you will be remembered for acting when acting was not easy to do. if you do, i believe your hometowns will take you, your counties will thank you and your country men and women will thank you long after you are gone. the portion of the annual

political action conference in washington. this panel includes peter shumlin who first called attention to the opioid epidemic during his 2014 state of the state address. it affects the republicans, rick -- democrats and everybody. i want to get started right away because this is a problem that we all need to think about. the lieutenant governor of ohio why is this topic important?

why do you want to talk about this one? -- an issuen impact that impacted my family. i talked to parents who have lost loved ones. i talked to people who are suffering. it has touched every single person that i have come across. we need to stand up and provide real solutions to so many individuals today. government can't solve every problem. .overnment can lead what can you see as the role of government in this crisis which is nationwide? >> i am thankful to be back at cpac. i love coming every year. this is a critical issue. you opened up things that is not

a conservative or a liberal issue. working for president trump who campaigned vigorously on this issue in states that have been devastated by this epidemic helps us to understand why it is an issue. government has a legitimate role to play in certain issues. we love living in a free society. there are important things the government has to do well. this is an area where government has failed. he has talked about the needs of states and localities from a medical professionals to law enforcement to help address this crisis. >> if it were easy it would have been solved long ago. 2016, 64,000 people died.

car accidents took the lives of only 40,000 people. this is not easy. governor, what strategy or new ideas have you done because everybody is at risk. >> thank you for having me. we are all dealing with it. ms. -- four isr what you are doing about it i think this is an easy want to solve. this is an easy one to solve it we have the courage. why are we in this mess? heard about this, why are we in this mess? why have we learned more people to opioid addiction than we lost in world war ii and vietnam combined. what changed? if not 1990's we approved

oxycontin. we got the first nonaddictive painkiller and we were so rejoicing. not only were they wrong but they perceive the realty -- they they find the three top execs of 700 million for lying to the fda. 85% of the folks addicted to heroin started with fda approved pills. the question is, what is the solution. my view is with governors like me we do criminal justice reform, we get -- we'll do the same thing but it is folks who get addicted, this is the worst disease to have that one can contract in terms of the struggle what it does to your family members and their lives.

there are two things we can do. the fda should revisit the decision they made about passing out painkillers like candy. now that we have admitted that we got lied to in the first place. second, just like what happened with tobacco, when you governors , allme, attorney general's suinghe countries, all the people that put us in this mess to try to get money for treatment. why don't we do what we did with tobacco, get them all in a room the president of the dates has the ability to be the winner on this. upsident obama missed this -- messed this up. mills, the obama

administration raised the burden of proof so that the enforcers had to get these folks to plead guilty before they can get the pill mills. in my view who knows more about this kind of issue that john cole who happens to be here today. just stand up because i want people to know who you are. this guy got tobacco in a room president trump has the ability to be a hero. said don't come out of that room until you settle this. you guys got to pay. and you have to change your behavior. you are not coming out of the room until you do. governor, first question, the great thing about this to what

extent do you agree or disagree governors -- i get somebody tweets from people saying people are in real pain, they are saying don't take away my pain pills. and we did he -- need to keep people out of pain. ,ome people genuinely have pain and they need help. there is at with conservative solution to this and i believe government has a role to play. care.need compress of -- comprehensive there. there is a role for government to play, to incentivize the private sector to build out the type of care that is nasa's very to restore lives -- necessary to

restore lives. we should not except that these addicted pain pills are the best that we can do. i would recommend we need to open up the opportunity for these alternative ways of treatment >>. >> before these opioids came on the scene the mid-to-late 90's, we had pain. was there inadequate a management or did we have something that helped and it wasn't quite as addictive? -- younderstanding is know about this is musas anybody know when they's dreaded -- started treating pain it shifted to the medical community now being judged and being rated based on how well they were treating pain, back pain is

subjective. if i came in and said how is your pay, -- how is your pain i have to trade you because you will evaluate me. started when i look back in history and it started to shift at that point. government had a role to play there. we are going to treat pain like a vital sign. it is not measurable. we created this crisis. >> let me give you another statistic. 2016 state drug company shipped over 21 million opioid pills to two pharmacies and williamson west virginia with a population of 2900. that doesn't seem right either to me. >> that's right.

lastw in the administration and a president and attorney general did not respected to process or the rule of law. we now have a president and an attorney general who are andrously enforcing the law not starts with enforcing the law against companies that have criminal andw, civil investigations as well and also going after people on the streets who are pushing drugs in our community. they downplayed it as an issue. we need to do a better job teaching our young people don't go down the path of addiction. we need to provide treatment and treatment is a hard road. most of people of this room have had family members who have struggled with it the action -- addiction.

the president said he saw his own brother deal with addiction. from.so hard to come back there is a prevention action to prevent people from starting to use drugs. >> if you are at the point where you need treatment, you have already lost your job, your -- gun, how do we start at the beginning realizing we had to deal, to have pain pills for those who have pain. how do we start at the beginning so we don't have a role -- a four people? >> anything that is said here is

true except that we are hesitant to point out that in most issues as a governor, when you get into the details of policy it gets a little bit more grade, it's not black and white. this one is black and white. america does not have someone , we pass its have out like candy. we now have thousands and thousands of people dying from this disease. why wouldn't we get the fda saytted -- had the folks they were severed we did not tell you the truth. why didn't we say wait a minute, we got bad information. we have reconfigured the way we judge our health care system based upon oxycontin.

up andndo that, back it have the folks who lie and created this disease pay for the treatment and prevention should be in my view stop passing it , review the fda decision and let's start with a more sane policy for drugs in this country. >> the power of the government and the white house can be potent in terms of helping to sell things. there are semi-political interests. could you to work together? do you have new ideas that you can ask him for help on? >> absolutely. this is a byproducts and problem.

nobody says this is a good idea. the governor goes to the white house, if you just go with a democrat. you are in a unique position you in both common states, seem like you want to work together. republican and a conservative. is of the challenges we face way know we are coming from. , i wouldng from china say build the wall because i am a conservative republican. butmay not agree with that i think you and i can get on the how do we help reinforce law enforcement to keep the drugs out of the country. >> we have seen the skyrocketing of overdose, just in the last

two years. >> our country has been prescription -- separate from prescription drug use for a long time. overdose deaths in the last few years has gone up dramatically. that is largely due to fentanyl and the importation of drug cartels and criminals from china and mexico into our country has got to stop. the last administration failed to stop americans from fentanyl. that's why we have to build a wall, increase our border security, but technical resources they need to stop this stuff from coming in from china. we have always had drug problems in america. 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 not getting that from south america, but from the corner drugstore. >> 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 are the children of the addicts, the most heartrending thing you can experience. >> what you see as the biggest impediment? >> a supply and demand issue.

>> 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. you can only prescribe a pain pill for seven days if you are an adult and five days if you are a child. this is state.

>> why don't we have that federally? >> as conservatives, we recognize that every problem is not a federal problem. the federal government needs to have a response to leadership as a nation. states rights 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 good intentions and the federal government passes some law and the unintended consequences trickled down to three years and congress can never come back and fix them.

as limited government conservatives, we should encourage state leaders to pass these laws. >> he is talking about the power of the white house to get everyone into one room. 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 thousand dollars to treat someone after they become addicted. it cost you $25,000 as a taxpayer every time someone becomes addicted to these substances. it is a huge cost to taxpayers. it is not just the manufacturers, distributors, they are all in this. they are making billions of dollars off this disease that is

killing people. i think the white house has a unique opportunity to replay the tobacco tape, get folks in a room, close the door, because these players don't from this things like this best of us forever. this is about taxpayers getting paid -- for the disease that was created by fda lies. i think president trump would be a hero to america if you pursue that process. greta: thank you very much. this is a problem that affects all of us. you do a huge service to the country. thank you. announcer: massachusetts governor charlie baker led a discussion on the opioid crisis at the winter meeting of the

national governors association. we will show you his remarks, followed by the health and human services secretary. governor. baker: i am the governor of the commonwealth of massachusetts. i want to welcome you to an issue we have been engaged in in a big way for the past several years. i think it is fair to say that every governor of every state has made dealing with this particular issue a significant and important priority. that has been true in the commonwealth of massachusetts. i didn't run for governor to work on this issue but it found me because were ever i campaigned, people talk to me about it, and their stories broke my heart. over the course of the past several years, working on a bipartisan basis with our

legislature and others, we have made progress in dealing with this terrible epidemic. in massachusetts, after years of double-digit increases and oak -- and opioid prescriptions, overdoses and deaths, literally for the first time in a very long time in 2017, we had a 30% reduction of prescriptions, overdoses leveled off and deaths dropped by 8%. the way that was referred to by most people was sort of positive, but muted. the reason is because we have so far to go and so much more to do. after that news, every single year, people took comfort in the fact this trend that went like this for a very long time finally -- finally started to go like that.

what is working? where should be go next? some of the things i believe have worked would be the following. in massachusetts, we now require everyone who graduates from medical school, dental school, nursing, pharmacy school, and social work school, to take a class as part of their curriculum a class and opioid therapy and pain management. if you are a prescriber, as part of your continuing education for getting your license renewed, you have to pass a course and opioid therapy and pain management. we are one of the first states to put a limit on first prescriptions. ours was seven days. several other states have followed. as a result, we finally got to the point where the vast majority of prescribers were

working on that system and using it as a search engine every time they wrote prescriptions. it got to the point where they could 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, and created, as part of our annual program for all athletes and parents and coaches, and inclusion of the discussion about opioids, the positive and negative, along with discussions about hydration and concussions and all the rest. on the treatment and recovery side, we added 1100 treatment beds, increased state spending, and a variety of addiction-based programs, and made medicaid-assisted treatment a

much larger part of our portfolio. one of the elements we pursued on a pilot basis has turned out to be reasonably effective. we added recovery coaches to some of our hospital emergency rooms around the commonwealth and engage discussions with people who overdosed to see if they couldn't talk them into moving treatment. most of the folks who play that recovery coach role are people in recovery themselves. it turned out to their ability to reach out and speak to people who just overdosed and were in the throes of this addiction is pretty powerful. in some cases, we saw as much as 80% of those who were contacted and touched by this program find their way into treatment. the bottom line is for the first time, we found a mechanism that

seemed to help nudge people, many for the first time, into pursuing treatment as a possible option for them. with respect to what is next, we found legislation before our legislature called the care act, which has built on some of the things we have done previously. one takes the notion of recovery coaches and turn it into a clinical program, to make it a fundamental part of the way we deal with addiction, especially opioid addiction, where a recovery coach could be a big part of what helps somebody, whether medicaid-assisted or another form of treatment, stay on the positive side of their treatment program and battle their way out of this terrible addiction.

the legislation also includes elements that would expand some of our school-based assessment and service programming, and for the first time, we will engage with folks in the form a community to 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 opioids you might want to be available to someone who had their wisdom teeth out, or surgery, or spring to their, or something like that. a lot of conversations have been with prescribers that say, we write 30 days, for a lot of the stuff associated with what we have been writing opioid prescriptions for, for a better part of the past decade, makes no sense. if we could create a delivery model to give someone the two or three pills they might need to deal with what ever particular acute pain is coming out of the minor procedure, we might be

able to take a a lot of the step off the streets to begin with. the final thing i will speak to is fentanyl. 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, our success in reducing overdose deaths would have dropped dramatically more. but we can do a lot of things with prevention and education, and i believe we are. i believe we are doing a lot of things with treatment and recovery. but we have to come together and chased the central issue a lot harder than we are chasing it now if we want to protect and preserve the opportunity for treatment to be successful for many of the people in our states.

alex azar: it is great to be here. president trump has made the opioid crisis a top priority. there has been a new level of urgency to our response across the federal government. president trump and his administration recognizes it is not the federal government on the frontline of this battle. it is all of you and your law enforcement officers, teachers, school counselors, community leaders, doctors, emts and nurses, and for faith-based partners. we are dedicated to empowering you and allies in this fight. we have unearthed a comprehensive strategy for fighting the opioid crisis last year. it brings the unique power and resources of the federal

government to empower those on the front lines. many of you may already be familiar with the strategy, but the five points are data, research, pain, overdosed reversers, and access. i want to highlight a couple of pieces of news from the fda that underscore our commitment to advancing particular access to 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 hhs is working with states and other stakeholders to support more timely and specific public health data and reporting. the cdc works with state health offices into local corners in monitoring overdosed data. the second point is federal research on pain and addiction. we need more towards to help us win this fight, -- tools to help

us win this fight, which is why we support tools on pain and addiction. the research we are seeing, like nonaddictive painkillers and new methods of treatment are incredible. as they get closer to reality, we look forward to partnering with state and private partners to understand how these can be put into practice. the third is pain management. we need to do a better job of addressing the problem of pain in america, which is why we have to ensure that everything we do, best practices and more, promote healthy, evidence-based methods of pain management. we look forward to continuing to work with you on disseminating a best practices with the -- best practices with our task force. fourth, overdose-reversing drugs.

people all across america are alive today because of the progress that has been made in making drugs like naloxone available when and where they are needed. we are committed to working with you to make sure communities have access to life-saving drugs through research and technical assistance. the fifth point is federal prevention, treatment, and recovery services. directly providing the services often falls on state and local governments and community groups. we can help by issuing grants to support access, expanding coverage, and providing guidance and technical assistance. many of you know the president's budget proposes 10 billion dollars in funding to address the opioid epidemic and serious mental illness, on top of $3 billion in planned opioid funding for fiscal year 2018 that we hope will be in the omnibus appropriations in march.

budget includes a range of different investments. 74 million dollars to approve targeted distribution of naloxone, and 150 million dollars for rural substance abuse treatment. it takes the state targeted response grants to one billion dollars a year, twice what we have in the 21st century. we look forward to building a base of experience from these grants, and hearing from you about how you have used this money. one particular point we want to emphasize for the 2018 grants 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 and faith-based providers. americans have taken a leading role in the compassionate approach we needed that -- that we have to take with this crisis, and we are eager to support their work. on top of this grant, we released guidelines to

accelerate the approval of substance use disorder waivers with the medicaid program, three of which we already granted this year for indiana, kentucky, and louisiana. i want to note for our governor is that if you have a waiver request with us and eight particular waiver from this time, we can streamline pulling those out and working directly with cms for approval around those concrete waivers, so they do not have to be cut up in broader discussions. what works? medication-assisted treatment. one particular piece of work on treatment is supporting access to medicaid-assisted treatment. part of the title of today's session is "what's working?" hhs is dedicated to advancing our understanding of what does work when it comes to public health challenges. we argue no important facts.

one of them is a medicaid-assisted treatment works. the evidence on this is luminous and ever-growing. one study found that putting survivors of overdoses on medication-assisted treatment, along with the appropriate there be and social support, reduced further future chances of death by more than 50%. that is a remarkable number and speaks to the number of lives we could be saving by expanding access to treatment. hhs has long been dedicated to promoting access to and an awareness of medicaid at--- medicaid-assisted treatment. we still have a long way to go. one third of specialty substance abuse treatment programs across the country offer medication-assisted treatment. for many struggling with addiction, failing to offer this treatment is like trying to

treat an infection without antibiotics. given what we know and the scale of this epidemic, having only one third of treatment programs offer the most effective intervention for opioid addiction is unacceptable. we want to raise that number. it will be nice impossible to turn the tide on this epidemic without doing so. we know there is sometimes stigma associated with an mhc, especially long-term therapy. someone on medically assisted therapy, even one who requires long-term treatment, is not an addict. they need medicine to return to work, we engage with their families, and regain the dignity that comes with being in control of their lives. these outcomes are literally the opposite of how we define addiction. our goal as a citizens who

commit to treatment should not treat them as pariahs. they are role models. announcer: c-span's program on the opioid epidemic continues with the maryland and oregon governors testifying before the senate health and education committee, as they describe the impact on their states and answer questions on the spread of fentanyl, the role in the federal government, and lawsuits against pharmaceutical companies. gov. hogan: we have been shining a spotlight on this issue for about four years now. when i asked community leaders what the number one problem was facing the community, everywhere i went, whether in the suburbs of washington or the city of baltimore, the answer was always

the same. it took me by surprise, but we learned about the magnitude of this problem. in one of my first actions of governor, we established an emergency opioid and heroin task force, focusing on a four-pronged approach of education, treatment, prevention, and enforcement. i was the first governor in america to declare a real state of emergency on this issue. we decided we needed to treat this crisis just like we would treat any natural or man-made disaster. we have already committed in our small state more than half $1 billion toward fighting the opioid and the substance abuse epidemic from all directions.

but we still have nearly -- had nearly 2000 people died last year, fire more than those killed by firearms and motor vehicle accidents added together. with our efforts, we have been able to bend the curve downward on prescription opioids and heroin, but a new and more deadly drug is growing out of control across america, fentanyl. overdose deaths from fentanyl, they were up a staggering 70% in our state last year. a majority of this fentanyl is being shipped in from china or crossing the border and being smuggled in from mexico. we can't stop it without the federal government stepping up. this crisis is going to take an all hands on deck approach from the federal, state, and local governments, along with community organizations, based-based organizations, and others in the community. we need to be working together on this issue.

i need you and your colleagues to make increased funding for the opioid crisis a top priority of maryland and many other states. -- crisis a top priority. maryland and many other states are working to provide support, but greater support would provide life-saving operations and help emergency room personnel. i would like the federal government to encourage advertising and public service campaigns to educate the public about how lethal fentanyl and these other drugs are. and we need more targeted and aggressive federal enforcement interdiction efforts when it comes to fentanyl and these other opioids through initiatives like synthetic trafficking and overdose prevention. as this crisis evolves, so must our response.

i agree with senator murray, this crisis is not only 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. this is really about saving lives. it will take a collaborative, holistic, and bipartisan approach to college that. thank you for having us and we look forward to the dialogue. >> thank you governor hogan. governor brown, welcome. governor brown: thank you so much for having me here today. i am honored to be sharing the dias with my colleague, governor larry hogan. by providing my state's, i hope we can underscore the burden of the opioid crisis that has touched every corner of every state. part of what makes opioids so

dangerous is the fact 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 is what happened to max in southern oregon. he was a poet in nation -- and a chef. he was 17 when he got into a car accident and was prescribed opioid painkillers. what started as therapy became self and spiraled into abuse. from prescription pills, he moved on to heroin. his mother was devastated as she watched opioids consume his life. he died of an overdose at age 25. it is hard to look back on his story and wonder what could have been. what if we lived in a society where he wasn't shame for having a problem, or reaching out for help? what if he had access to better treatment? what if first responders have life-saving overdose drugs?

addiction is blinded to circumstance, but the high costs 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, that is focused on punishment. that leaves the state to right the wrongs for the war on drugs that has done nothing to address the issues that drive this public health crisis, while our prisons and foster care systems are filled to capacity. i have seen it firsthand. prior to becoming governor, i worked as a lawyer representing parents and children in foster care. i watched children come in and out of foster care as their parents struggled with substance abuse disorders. as children struggled with the a foster family they barely knew, their parents struggled with addictions that overwhelms our treatment systems.

in the state of oregon, 60% of the 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, we can create better lives for our family. we can see more success for students in schools. we would lift the burden off our hospitals and law enforcement and our prisons. in my own family, access to comprehensive behavioral health treatments change the trajectory of addiction. my stepchild started up using drugs in high school. my husband and i watched him change and felt powerless to do anything about it. a teacher caught him using at school. instead of kicking him out, she called us. we knew 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 and inpatient treatments, before insurance would cover the residential program he desperately needed. fortunately, our family's story turned out very differently than max's. but it taught me how different recovery can look for every individual. we need to think about it as a process tailored to a person's unique circumstances and environment. turning away from a fail-first model is something we're working on in the state of oregon. we are also working on increasing treatment resources.

in addition, we need to make sure we are focused on decreasing stigma. we must break through the barriers of shame to provide the best treatments possible first and the most effective assistance now. we need to let people know it is ok to come out of the shadows, ask for help, and help is available. at the federal level, there is so much that can be done, including at the federal and state level, making affordable generic overdose drugs more available, rejecting a punitive approach to induction. maybe this could have saved max's life. it could save millions of others. gov. hogan: i am sure you were

prescribed opioids when you had your back surgery. i went through 18 months of battling cancer my first two years of governor and have four or five surgeries. at one time, 300 doctors within a matter of weeks described me a 30 day supply of three different opioids. that can't happen anymore in our state. with the fentanyl, we are trying to crack down, but a body that is coming through the u.s. postal service. it seems like no one uses that system anymore, but drug deal is from china are because they are not checking the packages the way the other delivery services are. it is now being manufactured or transported and smuggled in from mexico. we have to do what we can on the local level, but the federal government has to keep it from coming into the country. >> would you agree with me it is not totally an addiction problem, but a one-time problem, too?

fentanyl is so powerful. they are not an addict, but the one pill could do it alone. gov. hogan: if there is no question that people who have tried it once are killing themselves. it is a deadly thing, 50-100 times worse than heroin. senator: this month, as we've been tallying up the numbers from 2017, we've been hit by a series of heartbreaking statistics. we learned a few weeks ago that drug overdoses killed a record of 418 people in the state of maine, and 11% increase. we are going in the wrong direction. this week, the cdc announced that in maine, emergency visits

for opioid overdoses jumped by 34% last year. in the past three years, the number of people in the main 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. my question to you is what are we not doing right? you talk about the multipronged approach that i totally agree with, education, prevention, treatment and enforcement. the leadership of this committee has poured a lot of money into all four of those categories. what is it we are not doing right? gov. hogan: we asked ourselves that same question nearly every

day. i mentioned in my testimony at the beginning that we were sort of the end of the curve focusing on this issue, going back to 2014. we took every action anyone could think of, from every direction, and we put half $1 billion into state funding. then we created the first state of emergency, where we asked our emergency operations center to coordinate every state, local, and federal agency to provide real-time assistance on these different directions. we made a slight improvements in prescription opioids and heroin, but because of these new synthetics, we still have more people died. we had nearly 2000 people die in our state, a 70% spike in this new drug no one knew anything about. i mentioned a few things, but i think more coordination and more

cooperation from the federal government at the state and local level, so we are all knowing what we can each do collectively to make this happen. i think we do need more federal funding, with some flexibility for each state and how they can utilize these funds, depending on how the issue is shifting and where they are at that point. talking with governor brown, fentanyl is not yet a big issue in the state of oregon, but i believe it will be. we had all the nations governors together last week. there were people talking about crystal meth now reviving in their states and they are lacing that with fentanyl. they don't even have opioids and heroin. it will take all of us working together. the federal government and your committee has been on top of this issue. there was a task force working

with a lot of smart people, but it is going to need federal funding, the stop actr, the -- stop act, the opioid response and enhancement act, many good pieces of legislation in the house and senate that should be passed coming from both sides of the aisle in both houses. we have to look at these things from every direction, so they all need to be considered. sen. collins: families in massachusetts and all across the country have had to bury someone they love -- sen. warren: families massachusetts and all across the country have had to bury someone they love because of this crisis. but it didn't happen overnight. it happened because these drug companies pushed these bells and light about how addictive those pills were and made billions of

dollars doing it. it is time to talk about holding these companies and their executives accountable for the crisis they helped create. in massachusetts, the attorney general is helping lead a bipartisan coalition and 41 states to investigate drug manufacturers and distributors for their role in the opioid epidemic. more than 30 cities and towns in massachusetts have already filed lawsuits. a number of tribes, including the cherokee nation, have sued in tribal and federal court. maryland is also part of this investigation. baltimore and several county governments in maryland have filed lawsuits against manufacturers and distributors. do you believe that part of tackling this crisis is holding these companies accountable? gov. hogan: there is no question. we have directed our attorney

general to take action and sue some of these pharmaceutical manufacturing companies. there is liability. some of them have knowingly pushed the sale of some of these drugs, knowing they had to these addictive capabilities and did not disclose it. we painting this with a broad brush -- but the ones you are doing these things should be held accountable. we can take these actions and we should, but it won't stop the people who are dying on the streets. sen. warren: i understand. the investigation is ongoing and we should let the attorneys general do their work. but didn't these companies break the law and lie about it and hurt people in order to break it profits? it wasn't the first time. a corporation called instant therapeutics a few years ago

made a spray out of fentanyl. the fda told the company the spring was approved only for use in cancer patients who were in such pain that other drugs like morphine were not enough to control it. it turns out there were not enough of these peers or patience for the company to make buckets of money. it started illegally marketing the drug to people with mild forms of pain and bribing doctors to over prescribe it. a lot of states sued, including massachusetts. oregon's settlement forced the company to pay up. that settlement a card of a few months after you took office. has the money that oregon recovered helped the state fight the opioid epidemic?

gov. brown: absolutely. we received a little over a million dollars. a portion of it with to treatment and recovery. our state university is doing incredible work and i was very pleased with how the dollars were targeted. sen. warren: when a company breaks the law, it is because people running the company broke the law. a few months ago, department of justice announced that the founder and owner of this company, along with six top executives, has been indicted for fraud and racketeering because of their actions. do you agree that ceos deserve to be held personally accountable when the companies they run break the law and hurt people?

gov. brown: in such a cases, absolutely, that they need to be taken on a case-by-case approach. this was particularly egregious and people should be held personally accountable. sen. warren: this crisis is not a democratic or republican issue, and neither is holding drug companies accountable. department of justice announced last week they are forming a task force to target opioid manufacturing and distributors they believe should be held accountable. people of already paid an enormous price for this crisis and it is time to start holding companies and their ceos accountable. thank you both. >> we are joined by kaiser health news. what is congress doing in response to this opioid epidemic? >> congress is interested in this. they passed the omnibus, about

$4 billion, with general kind of treatment prevention and law enforcement. we have a bunch of hearings happening in the energy and commerce committee in the house. they are looking at the law enforcement side and prevention and treatment side to try and come up with some bill. chairman ms. hoping to have a package on the floor by memorial day. in the senate, you have a bipartisan group of senators is hoping to put a billion dollars toward groups. they have makes equal to a bill under obama, and it has some attraction in the senate, but everyone else's unsure where it might go, because this is a lot of money. >> so there is initial money under the omnibus, and let's look at the white house. they declared an opioid epidemic back in october. where has the administration's emphasis been?

has it been law enforcement measures, or emphasizing better prevention and treatment? >> they renewed that health emergency recently, and it is kind of an odd mix. rhetorically, there was a lot of interest in this law enforcement law and order, with headlines of the death penalty, and that was a big focus on the president's speech. the department of justice has been directing u.s. attorneys to see thae death penalty for high drug traffickers, but there is talk on expanding access to treatment and making sure first responders have naloxone, this anti-overdose drug. that has been talked about by a lot of public health officials. the emphasis on law enforcement and law and order is different from what we have seen before and has given us pause.

announcer: what did we see before with the obama administration? shefali: it was interested in this public health response. there was a lot of talk about naloxone and making sure people have access to the medication to help them get weaned off of opioids. that is a shift in terms of how we have looked at addiction from any time before, pretty much in the history of this country. it is an interesting thing to watch and see if that will continue. >> we have been showing and will be showing comments from a number of state governors, including at governor baker from massachusetts and governor hogan from maryland testifying. what are states doing in response to the opioid epidemic? what do they say they need from the federal government? shefali: they need money to get supplies to first responders, to get folks into treatment. you have all of these other

systems that have been burdened. i wrote last summer about the foster care system, which has seen a huge influx and kids going through because their parents can take care of them. they're looking for all the resources they can get to address the issue. >> back to congress, new studies from the national manufacturers alliance of american action show studies on employers and united states. are employers pressing members of congress to do more on the opioid issue? >> there is a lot of concern on the impact it has had on the economy and productivity. research has been done by economists, where they show people are less productive in part because they are grappling with addiction, unable to work, going through other systems that leave them unable to be as productive.

announcer: aside from the terrible increase in death numbers, how has the nature of this epidemic changed over time? shefali: i think this is an interesting story. andnc. of painkillers percocet and those kinds of aches. in the 1990's, doctors were taught a should treat pain aggressively. they were told that painkillers were not that addictive and would take care of the pain needs of patients. they prescribed them and the story you heard so often, a girl falls, breaks her arm, takes percocet, doesn't realize she's addicted until she goes into withdrawal, takes heroin, it is cheaper and more potent, and this continues. that was a story we heard. i would hear these stories out in the field. and then you get to where we are

now. there has been's crackdown on prescriptions, so there are fewer painkillers, but people still are going through withdrawal and/or craving this drug. they are switching to fentanyl. deadly and they switch to heroin, which is more common. it is coming from china and mexico and can kill you more easily, but also gives you a much greater high. >> in one of your pieces, you write by saying -- today's opioid epidemic has been called today's version of the opioid epidemic is equivalent to the 1980's aids crisis. how long do you think it will take before lawmakers get a hold of this? >> i don't think they have an end date. this is an ongoing commitment and has to be a promise from congress to give tens of billions every year. the public health commissioner from baltimore has talked about the importance of creating a ryan white, a separate, endowed funding for treatment.

she says we need one for opioids, as well. she is not alone in that argument. announcer: shefali luthra of kaiser health news, thank you. >> thank you. >> our program on combating the opioid epidemic continues, with remarks by senior trump administration officials. chester serves in the office for national drug policy. he spoken march on national drug control policy. he spoke in march at an event on opioid trafficking hosted by the helsinki commission. kemp chester: i serve as the associate director in charge of the national heroin coordination group, responsible for synchronizing federal government activities related to the illicit opioid problem. please allow me to take a couple of minutes to address the magnitude and complexity of this

crisis, and mention some of the things the federal government has been doing to address it. according to the senators for -- centers for disease control and prevention, and 2016, the year for which we have the most recent data available, 63,632 americans died due to a drug overdose, a 21% increase from 2015, amounting to about 174 americans every single day. opioids make up the largest category of drugs contributing to overdose deaths in america, with 15,472 overdose fatalities involving heroin, 19,431 involving synthetic opioids, other than methadone, a category dominated by fentanyl and its analogues. the illicit opioid crisis is a complex national security, law enforcement, and public health crisis. it is the nation's number one drug priority.

while fentanyl has been the primary driver of the horrific number of deaths be have been seeing, we still have in a norm -- have an enormous problem with heroin. it is too abundant in the market and far too available in our communities. along with the heroin crisis, we are facing the additional and related problem of illicit fentanyl and its analogues. they are extremely potent into potentially deadly, being anywhere from 50 to 10,000 times as potent as morphine. it comes in many forms. we truly have watched the crisis of illicit fentanyl evolve before our very eyes, from fentanyl powder mixed into heroin, often without the knowledge of the user, fentanyl pressed into pills and sold as counterfeit medications, being bought and sold over the internet, to the proliferation of fentanyl analogues now available for sale.

we have addictive drugs that are extremely deadly, sometimes purchased over the internet with crypto currency, coming through the mail system or commercial carriers at a high volume into the country, or sometimes smuggled across the borders of our land, with no signature and a variety of forms that are incredibly hard to trace. this should tell us a great deal. we must accept that fentanyl, while a crisis in its own right, is likely a window into the future of the drug problem in america. 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 complementary efforts to reduce the market forces pulling these drugs across the border. we could very well be seeing a move away from the plant-based drugs toward synthetics, with lower overhead on the front end and lower risk and greater profits for traffickers on the

back end. we must accept a more expanded image of the using population. prototypical experience, the intravenous drug user is now being joined by those who think they are buying opioid pain relievers, but are actually buying and too often dying from fentanyl, priced into pill form. there should be no doubt that the internet has made purchasing drugs much easier. the online marketplace and use of crypto currency's have power to the democratization of the drug trade. a hierarchical drug trafficking organizations we have traditionally seen underworld postured to address no longer , may have a monopoly on supplying drugs to the u.s. market. rather, individuals can simply go online, to one of the many internet drug marketplaces, and purchase drugs like fentanyl for their own personal use or further sale, creating a constellation of micro-networks

across the country. what we do now is not only important to get ahead of the deadly fentanyl crisis in front of us, but also establishes the framework of relationships, laws, regulations and technologies and procedures that set the conditions to deal with the future of drug use in this country and its consequences who for years to come. we know more now about where fentanyl and its analogues are being manufactured and how they are getting to the country more than ever before, thanks to the intelligence community is, the federal law-enforcement, and our partners at the state level and below. better testing by medical examiners and corners is telling us more about the fentanyl analogs in our communities and killing our people. our international partners have internalized this problem and are taking active measures to help us address it. here at home, the targeting

efforts of our law enforcement professionals help us narrow the universe of all inbound items to those more likely to contain fentanyl. as this crisis has taken hold in america, we have been building and sustaining the architecture, where the entire federal government is applying its time and energy to focus on this complex problem, and a network of partners is each taking its own share and achieving, mentoring fx. when you have seen from the role 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 the opioid initiative, to the energy and innovation in our communities across the nation, which speaks to the seriousness of this issue and addressing it in a meaningful and sustainable way. the drug market is vast,

dynamic, and adaptive, but it is not without its own vulnerabilities. it is not without a -- it is not without match to our determination and the best talents we can bring together against it. >> we have had a great discussion already in thank you. one issue that i'm surprised did not come up is the postal service. i thought it them as a humongous piece of how these drugs are entering the country. are you the right person to talk about this? kemp chester: the postal service was very early to understand the magnitude of the problem, in the fact the united states postal service was a critical vulnerability we had, and is being used as a vehicle for

drugs to enter the use -- to enter the united states. we are working with other federal law enforcement to do a couple of things. we are getting advanced electronic data from the originating country, so that they know the shipments coming into the united states before they get it, usually about 72 hours out, for tracked and untracked packages. the volumes we are talking about are enormous, up to 144,000 every day. when you get advanced electronic data, it can be shared with customs and border protection, so they can give separate attention to those companies that are most related to the illicit shipment of goods.

that is the first thing. the second thing is the nonintrusive detection capability, there in the international shipping center, for them to be able to detect illicit substances that are in there. the third thing is to be able to work with other law enforcement partners, whether from dhs or the department of justice, to get a prosecutorial outcome for the things they intersect. the postal service at large has done a tremendous job in helping us to better understand the vehicle for drugs getting into the united states. >> a follow up question. when drugs are ordered dark web places, are they shipped exclusively by the postal service, or are private delivery services used, like fedex? kemp chester: private delivery services are used as well. that is all a beer carriers.

all who have been a tremendous job working with federal government to share information and allow federal government to assist in getting the packets it to -- getting the packages. dhs also provided means for the drugs can get into the country, but those companies are working hard with the federal government to intercept shipments. announcer: on march 1, the white house hosted a summit on the opioid epidemic. this portion features remarks by jeff sessions, kierstin nielsen, and john solomon. a reminder, you can watch this on c-span.org. >> thank you. it is so good to be with you. point where we are

going to make progress in america. i am convinced. we know that prices for illegal drugs are down and the availability is up, and the purity is up, and addiction is up, and that death in danger of we are seeing are just extraordinary. i was involved in the early 1980's as the united states attorney working on these issues and we never saw anything like the deaths we are seeing today. this is totally unprecedented in the history of this country. it cannot continue. it will not continue. the president made it clear we will be resolute and the entire administration is going to respond to his declaration of an emergency and we are going to make a difference. i can sense it already in the policies that are ongoing. july the largest

medical takedown in the history of our country. we had over 120 professionals, nurses and doctors, who had been -- out of 400, who had been involved in illegal prescription know that as much as 80% of addictions today start with prescription drugs. that is an extraordinary number. we will continue to research it but that is the number we have and i have no doubt it is an extraordinarily high amount. it starts as prescription drugs. we also had a week later the shutdown of all fabey, and this is important. it is a dark website in which it had 220,000 sites where people could order directly through the mail illegal drugs. because fentanyl, for example,

a so small and compact, and little bit is so powerful that it is easy to ship the drugs through the mail. doubled resources to identify earlier. we will not let those sites get that big in the future. that is our goal, and we are going to continue to work on that. some 3000dicted defendants in 2017 for distributing drugs and we have created the opioid fraud, abuse and detection network, which is a data analytics system wiell -- system that is well within the existing computer systems of the drug enforcement administration so we can easily determine the position -- what physicians, pharmacies, and other distributors are moving prescription drugs. some of them are extraordinary outliers. they give us indications of where fraud and abuse is occurring. and we can move quickly on that.

that has not been done before. target packages have been sent out to investigators and arrests have been made. one united states attorney said, i did not think much about it, but when you look at it there -- but when you look at what happened, we knew there were six professionals in pittsburgh and every one of those were on this list. that made me a believer. and a lot more on the list that he did not know about. we sent out experienced 12 attorneys to hotspots around the country to focus on that. we indicted two chinese nationals for the first time on fentanyl charges, that is coming from china and mexico directly through the mail. we have established a new program called j-code, the fbi

program with dea to identify through the dark net and purchase undercover drugs in that way and to target that group. we announce the criminal prescription and litigation task force to file civil lawsuits. we believe we can get an injunction to stop a pharmacy immediately from prescribing drugs because they have to comply with the law. we have filed litigation in support, it will be filed today, we announced our intention to file a statement of interest with a multi-litigation effort in a lot of the country on that. thank you.

i will end there to say, this is what we are doing in our department. if we do these things effectively, we can reduce the andnt of death, addiction, destruction that these drugs are causing today. it is unacceptable in this great country. we will do our part. kellyanne'sy that leadership is going to be so important in this because we want prevention, we need to educate people. the president has used the phrase, just don't start. if you don't start, like he never did, then you don't get addicted. kellyanne knows how to communicate well. it will be a great asset to us,

so thank you. >> thank you, mr. attorney general. thank you. [applause] i was there on tuesday when you had the press conference with the state attorney general and the acting attorney general of the dea, and i was struck by the bipartisan approach that the general had against that prescription integration announcement. going onto secretary kiersten nielsen, there are so many aspects of the introduction law enforcement's front waging the battle, secretary nelson falls under dhs. we are most curious to hear the progress report and the vision for the future. thank you. secretary nielsen: thank you for the opportunity to join you today. this is a shared fight.

we will continue to hear that the rest of the day how we must do this in partnership. i am honored to be joined by leadership from the department of homeland security. we have ice here. they do this work every day, day in and day out to protect our and interior border from all threats. that unfortunately includes opioids. the president, when he declared the opioid crisis as a public health emergency, he really sent a very strong statement. the statement to us as america is fighting back. we will continue to fight with all of the tools we have at our disposal. in conjunction with our partners in the department of state and justice amongst many others. since october, dhs has very proactively assessed the current threat, determined where we might have gaps and what else we can throw at it if you will.

this has allowed us to leverage our investigative intelligence efforts, which you may or may not know, dhs is a law enforcement agency. we have 60,000 in cbp alone, and multiple agents in different departments who play a role in this. we are leveraging investigative and intelligence efforts. we also do interdiction, international operations with our international partners, and we have had great success on that front, particularly from our partners in mexico. we continue to look for more partners, because as you know, this dreaded drug, fentanyl, as the attorney general mentioned, continues to come in packages of all sorts of sizes and get in the hands of tcos who then use it in the drug flow. so we look at this within our borders, then we look at stumping across our borders. to prevent entry, we work with the doj and state and our law enforcement counterparts in mexico, south and central america and china as well, to prevent the flow.

but, also most importantly, to share information. the sharing of information has two purposes. one, stop the drugs before they come into our country, but the other is to help us as partners dismantle the tcos themselves that are the force behind the epidemic. this information sharing helps us to stop the flow, facilitate the dismantlement and provides responsibilities across all partners to bring all that we have to bear. i wanted to use one example. we have border enforcement security task forces which has one of those good acroynms, bets. some of our acronyms that dhs are not so well done. ice's primary platform to investigate opioid smuggling locally.

they have 50 locations in the united states and they leverage more than 1000 federal-state-local law enforcement officials and leverages over 100 law enforcement agencies. cbp also has officers at hundreds of points of entry and they not only check of billions of dollars of cargo, they are particularly focused recently on fentanyl. cbp seizures of fentanyl after -- have significantly increased over the last 3 years. we had about two pounds in 2015, -- in 2013. we had about 1485 pounds in 2017. remember, this drug in extraordinarily small quantities is lethal. 1485 pounds is substantial. it is an epidemic. so we have expanded the use of canines and we are happy to report all of the canines working in the environments have the ability to detect drugs and

fentanyl in particular. while we do not see yet a significant amount of the opioids being trafficked by sea, the u.s. coast guard interdictions of other narcotic are increasing. and of course, that deprives funds from the tcos who are otherwise able to use the funds to prevent the trafficking of fentanyl. to prevent the sale, we are also committed to not only preventing them at their source, but also preventing their movement into and sale within our country. the attorney general mentioned to the dark web. we support his efforts. our united states secret service has the cyber capability on the investigation side, and they also contribute to the fight. so does i.c.e homeland security investigations. again, dhs has a broad mission, but we do in all times work to bring everything we have to bear. the dark net, i would just add one comment, it is anonymous. it makes it difficult to track who is doing what in terms of

buying and selling. but with our partners at justice and fbi, and it dhs, we are doing just that. we also work to support the apprehension and prosecution. what i would say in closing date is the sheer magnitude of this means that we have to partner. we have heard it said many times today and in other forums, there is not one entity that has all of the authorities, capabilities, and capacity to fight this alone, so we greatly appreciate everybody in this room. your interest, your support, your partnership. we cannot do it without you. we thank the president and vice president for their continued leadership and certainly, kellyanne for all the work you have been doing to put this all together. >> thank you very much, secretary nielsen. [applause] kellyanne: really terrific to have the state department

involved in this effort and today i am happy to present to you for his remarks, the deputy secretary of state sullivan. secretary sullivan: thank you, kellyanne, it is an honor. 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. well, this is a whole of government effort. the president has made this a top priority for his administration. the state department is involved because the problem we confront is not merely domestic. the opioids that are killing american citizens are produced overseas, they are trafficked by criminal organizations that operate transnationally. the state department's role is to stop networks or criminal organizations, so-called tco's, the networks or criminal

activity of trafficking drugs, address in the opioid crisis in a government effort. the state department's role is to apply resources abroad to support all of the work that the department of justice and the other cabinet departments are doing to address this problem. and, to enlist the support of our allies and partners and neighbors in mexico in particular. this is our highest drug control priority. the bulk of the state department's counter narcotics work is focused on countries were opioids originate. ium harvested in mexico is over 90% of the u.s. supply of heroin. the tco's that smuggle it are the targets the dhs and the

department of justice are working to stop. we are strengthening cooperation with mexico through the merida initiative to interdict illegal transports, find and punish criminals involved, and cut off their sources of funding. in december of last year, secretary tillerson and i along with general sessions and secretary nielsen continued the strategic dialogue we have with mexico on disrupting transnational criminal organizations. we are working with our mexican counterparts to find ways to disrupt the revenue streams with tcos that are responsible of, for trafficking heroin and other illicit drugs. we working with mexico to more agressively eradicate poppy crops and bring drug traffickers do justice to justice. over 100 of mexico's most wanted targets, have been arrested, killed, extradited.

we support mexico's efforts to find, investigate and destroy clandestine drug labs. since 2014, the department of state has provided training of more than 300 mexican counterparts to go after the labs. since 2008, the united states has donated and supported training of more than 500 canines who are assigned to mexican and federal state law enforcement agencies. we sponsored training for canines and handling teams to detect weapons, cash, and drugs. this includes fentanyl specific detection training with cooperation with our neighbor to the north, canada. last fall, the human commission, the u.n. commission on narcotic drugs put to international controls in the primary ingredients used to, put -- used to make fentanyl.

these international controls in the primary ingredients used to produce fentanyl. this action was taken at the request of the united states and such measures are producing results. due to this change, dea has seen a decline in the presence of these chemicals in the drug, illicit drug market. in two weeks, again, at our request, the u.n. commission will address controls on five other synthetic opioids including the deadly opioid, carfentanyl. the state department is also building partnerships to more effectively stopping traffic of synthetic drugs sent through international mail and career systems. these efforts allow for law enforcement to more easily interdict any packages that may contain fentanyl. china is a growing area of focus on 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 the domestic restrictions on the production and sale of 143 substances. including a number of fentanyl-related compounds. china's tightening of regulations has contributed to the reduction of these absence -- of these substances on the streets of the united states. unfortunately, we are seeing a new trend of rogue chinese chemists who are manufacturing illicit opioids, selling them online to drug traffickers, and shipping them in small quantities in the mail. as secretary nielsen mentioned, the amount of fentanyl necessary to convey a lethal dose is extremely small. we are talking about small quantities of these illicit substances. in response, we are working closely with china to improve coordination and screening of mail packages between our 2 countries. we are on an aggressive timetable to get all packages coming from china tagged with advanced electronic data and we

will continue that close cooperation with china and other countries that are sources of these chemicals and illicit opioids. collaboration 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 in partnerships with all other nations. thank you. >> the house energy and common committee is considering a number of cells addressing the, held aepidemic, and it series of hearings in march. we will show you portions, including testimony by the , andg administrator of dea other doctors from the cdc and director of the national health policy laboratory. >> over the past 15 years, our nation has been increasingly devastated by opioid abuse.

an epidemic fueled by the ever -- overprescribing of potent opioids prescribed for treating pain. as a result of the increased awareness of the opioid epidemic, prescriptions for opioid have started to decline. somewhat a success, but organizations in particular, the well-positioned mexican drug cartels, have filled this void by delivering cheap, counterfeit heroine and selling it to users pressed into counterfeit pills. there are two parts the dea is addressing with this collective

effort. with the third piece that must also be addressed. first is enforcement. based on our investigations, actions are undertaken every day using criminal, civil and administrative tools to avert illicit supply. second is education. we believe it is possible to partner with leaders in prevention education. the third level is treatment. the dea is committed to providing access to drug treatment and recovery services. we utilize evidence-based strategies during this public health emergency. the only way to fundamentally change to this is epidemic, this epidemic is to address the global illicit supply for

concern, supply concerns. a majority of new heroin users stated they started their cycle on prescription opioids. our use of administrative tools and legislation has been the source of numerous media reports. dea continues to revoke 1000 registrations each year through administration tools such as surrenders for cause. we will use tools to protect the public from a small percentage of registrants who take advantage of the public. over the last decade, dea has continued to rebel approximately 1000 registrations each year. we will use tools to protect the public from a very small

percentage of registrants who take advantage of the public. over the last decade, dea has levied fines totaling $390 million against opioid distributors nationwide. dea has reprioritized a portion of its criminal investigators and divested the tactical diversion squads. we have 77 of these groups nationwide who are solely dedicated to disrupting and dismantling individuals and organizations involved in the version schemes. -- version schemes. the control division simultaneously works to improve cooperation with the restaurant, -- with the registrar community. the dea just completed training more than 13,000 pharmacists and pharmacy technicians with instructions that they only fill

valid prescriptions. the farming technician -- the pharmacy technician is important. the dea will start a nationwide effort to help prescribers with this role. this will start in states where we saw little or no increases in opioid prescribing rates. criminal cases as part of important steps. where we have fallen short, it is by not proactively leveraging the data available to us. i am happy to discuss what is happening in the past and i appreciate the opportunity to update you where we are today. and where we intend to go. datanuary, we utilized the overlaid from dhs. the report was approximately 400

leads the dea sent to its 22 divisions for further investigation. with we are working federal agencies, while we continue to work well with our colleagues in washington timothy d.c., thengton, partnerships have been growing in strength. we will hold a legislative hearing tomorrow on over 25 pieces of legislation that underscores the nature and complexity of the opioid crisis and shows that we should take steps to address this together. >> good morning members of the subcommittee. thank you for the opportunity to discuss fda's role of confronting opioid epidemics. this remains one of my highest priorities.

i am grateful for this committee's commitment to the role fda has in combating this epidemic. to address this crisis, fda is working across three broad domains. we are working on new paneer -- working to improve our medical technology. this means better treatment and new pain remedies that cannot be asked that the live as traditional opioids. second, we are taking new steps to require sponsors to provide better health care and finding prescriptions. toare taking new steps provide education to providers and health care practitioners. ways tolso exploring

look at mail packages. a framework would be based on evidence-based guidelines. third, we are ramping up our efforts aimed at the a diction of illegal drugs, including resources aimed at working in the national mail facilities. there is a virtual flooded dangerous entering the united states that exposes americans to do tricks. -- we aware of gases and are aware of gaps. bething believed to controlled substances coast to the company supply chain. this is a numbers game. these shipments are intended for

further domestic distribution and each package may violate fda law. it is estimated less than 1/10 of the 1% of packages that contain drugs do not undergo a physical transaction. andave prioritized our work strengthened our president's capabilities but there is more to do. we are required to obtain legal proceedings against each package separately. improving the fda authority so we can retain and destroy individual packages, it would protect americans from dangerous substances. when fda regulated article

contains substances that do not that have not yet unscheduled. this is an issue with the high volume of synthetic narcotics coming from china. where evidence is insufficient, we simply refuse entry and send the package back. it isn't uncommon for investigators to see the same package as they resend it a second or third time. this is not a deterrent. if fda had their toward the -- had the authority to delete analogs, we could more quickly remove potentially dangerous products from this supply chain. second, this is a numbers game and the bad actors can send games -- send in hundreds and these shipments are often counterfeit drugs, intended for --lier to messitte's

domestic distribution. current law requires us to detain and pursue leading proceedings. they simply overwhelm my system with volume. protectere officially americans and dangers from imported substances. and substances already scheduled quality at the border. this is an issue coming primarily from china. right now, we cannot afford to destroy those drugs simply because they are articles concerned to dea. keep dangerous articles that are not easily obtained off the streets. i appreciate your interest and work in this effort.

>> thanks, and the chair gives five minutes for an opening statement. >> good morning, chairman. members of the committee. cdc has bad experience tackling epidemics and i want to talk about tackling the nation's opioid crisis. at cdc, we are concerned about preventing health-related consequences of opioid use including the spread of infectious diseases, like hiv and hepatitis. and the impact of opioids and mothers and babies. cdc leads comprehensive prevention efforts by tracking trends and driving community-based prevention activities. america's opioid overdose epidemic affects people from every community.

the problem is getting worse. in 2016, more than 63,000 people died from drug overdose and preliminary data indicate the trend worsened in 2017. we've seen increases in babies on withdrawing from narcotics. new data says that a baby is born with neonatal withdrawal syndrome every 15 minutes. about 100 babies a day. we have seen a drop in life expectancy of the first time since for every one person who 1993. dies of an opioid overdose, over 60 more are already addicted to prescription opioid and almost hundred misused them. departments state providing resources to create evidence-based intervention so states can rapidly adjust as we learn more on what works best in this fast-moving epidemic.

a nimble federal and state response is critical. we find 45 states and washington, d.c., to advance prevention, including drug monitoring programs, improving prescribing practices, tim using -- gathering timely data, and evaluating policies. we hope to expand to 50 states. we're working for more effective monitoring which is effective in working with clinical decision-making and use data as a surveillance tool. with cdc funds, many are enhancing the timeliness of reporting and integrating with electronic health records. in north carolina, they've integrated prescribing data within the work flow of existing health information systems across the state. improvements like that show how we can make vital data available -- actionable with the goal of

saving lives. cdc improved the timeliness of reporting, updating elementary data on overdose deaths on our website every month. through our funding to states, we are ramping up efforts to get more comprehensive data, for medical examiners and corners. dachshund coroners. -- and coroners. we're tracking nonfatal overdoses and we reported a 30% increase across the country. we released data using toxicological and death scene data allowing for a more robust, analysis, that found fentanyl was involved in over half of opioid deaths. educate providers and the public on opioid use through the implementation of guidelines for prescribing opioids for pain and an

awareness campaign. we are making the guideline more accessible to clinicians through interactive training and a mobile lot. the campaign focuses on the risks of prescription opioids and features real-life accounts of individuals living in recovery. in addition to our partnerships with states, cdc believes this epidemic requires a collaboration across sectors. we have been working side-by-side with law enforcement, like a dea, to determine risk factors for opioid overdose and target implementation plans. we draw on experts from across our agency to address the facets of the crisis. the comprehensive public health approach is playing a key part in addressing the epidemic. we did not get into this epidemic overnight and we're not going to get out of it overnight. we need an intensified effort to reverse the epidemic.

thank you. >> thank you. chairman, and members of the committee, to record the opportunity to discuss the opioid crisis on the federal government response. from the start of this administration, president trump has made addressing the opioid epidemic a top priority. we share the president's commitment to solving the crisis. families have been impacted by opioid addiction and overdose. fentanyl has only fueled the crisis in recent years. as the department's lead agency for behavioral health, samsa has been at the front of the opioid crisis. our work focuses on treatment and recovery services, and overdose prevention with data collection and analysis annihilation to track emerging trends.

today, i want to focus on several recent actions we have taken. in funding, we distributed $485 million to states and under the grandson 2017. it is to reduce opioid gaps and provide recovery support services. in november of 2017, sansa announced it was expanding -- accepting applications for grants to expand and enhance those efforts in states hardest hit by the epidemic worried on monday this week, we awarded grants to new hampshire, massachusetts, and west virginia. we provide treatment and funding forvices vulnerable populations such as those involved in the criminal justice system and pregnant and postpartum women. we awarded nearly $10 million over three years for new state

pilot grants that enable outpatient-based care for pregnant and postpartum women. and nearly $15 million over five years in new grants to support residential treatments for pregnant and postpartum women. we have been a leader in efforts to reduce overdose deaths and accessibility to naloxone. we awarded funding to grantees and 22 states from programs authorized by carrot to provide resources to first responders entry and providers who work with populations at high risk for opioid overdose. developing a well-trained workforce and facilitating evidence-based interventions are key goals of our education training and technical assistance efforts. -- 2018, we017, we awarded $12 million to create the technical assistance program. it provides direct technical assistance to states and local

jurisdictions to support the implementation of evidence-based practices tailored to the --tes particular context in particular context. samsa's provider of national training and mentoring to support clinicians interested in providing addiction care. we have also revised data waiver training to include all information on da approved medic -- on fda approved medicine. providing information to patients, the release clinical guidance for pregnant and parenting women with opioid abuse disorder. this provides clear information on real-world scenarios based by health care providers you are caring for mothers and infants. in january of 2018, we issued a rule pertaining to substance

abuse records, commonly referred to as part two. we also held a public meeting to obtain feedback from stakeholders on part two. the vast majority of those who spoke at the meeting expressed support for further aligning part two and hippa. big knowledge action would be needed to achieve their goals. evaluation,and samsa is standing up the policy lab, charged with congress by supporting innovation, evaluating approaches, and facilitating policies, prioritizing the focus on opiods. the president's budget includes $15 million to druglish a morning -- a misuse network, and that includes opioid misuse. samsa looks for to working with

congress. alec baldwin to your questions. >> the final portion of our program on the opioid epidemic features president trump. he traveled to massachusetts on march 19 to announce a plan aimed at addressing the epidemic through a combination of law enforcement and health measures. this portion of his remark is about five minutes. [applause] president trump: i wanted knowledge all of the families with us who have endured terrible hardships because of the opioid crisis and especially those who have lost precious loved ones. i have been saying this for a long time and it all started here in new hampshire, i see what you are going through. about as bad as it is anywhere in the country. i said i would be back. we're back, and we are pouring a lot of money and a lot of talent into this horrible problem.

we pledge to honor the memory of those you lost with action and determination. and resolve. he will get it. we will not rest until the end and i will tell you the 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 death rate is double the national average. it has gotten difficulties like people wouldn't believe. defeating this epidemic will require the commitment of every state, local and federal agency. federal is not an option. -- failure is not an option. addiction is not our future.

we will liberate our country from this crisis. never been like this. hundreds of years, never been like this. we will raise a drug-free 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 dollars 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, more than the weight of three boeing 757s. our custom and border protection and the people and the job they do is incredible. they seized nearly 1500 pounds of sentinel last year -- nearly three year, times the amount seized in 2016. i told china, don't send it, and i told mexico, don't send it. [applause] don't send it. in 2017, criminal aliens had 76,000 charges and convictions for dangerous drug crimes. last year, the department of justice prosecutors in more than 3000 defendants in cases involving opioids. all of the trafficking and

3000 cases,es, including a pharmacist, a physician's assistant, and an opioid tropical -- trafficker, each convicted of drug charges. dr.,ou are a dealer or trafficker, or manufacturer, if these deadly poisons come will find you and arrest you and hold you accountable. [applause] thank you. here in new hampshire, i applaud all of the drug enforcement agents and law enforcement agents 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 on those people. can award all the blue-ribbon committees, if we don't get tough on the drug dealers, we are wasting our time. just remember that. we are wasting our time. that toughness includes the death penalty. [applause] it is an amazing thing. some of the drug dealers will kill thousands of people during their lifetime, thousands of people, and destroy many more lives. they will kill thousands of people during their lifetime, and they will get caught and they will get 30 days in jail or they will go away for a year or they will be fined. yet if you kill one person, you get the death penalty or go to

jail for life. so if we are not going to get tough on the drug dealers who kill thousands of people and destroy so many people's lives, wrong just doing the thing. we have to get tough. this is not about nice anymore. this is not about minis and not about let's get dinners and go to a blue-ribbon committee and everybody gets a metal, -- medal . this is about winning a very tough problem. if we do not get very tough on these dealers, it is not going to happen, folks. it is 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. [applause] right? thank you. it is not going to happen.

thank you all. quek next week, facebook ceo mark zuckerberg -- >> next week, facebook ceo mark zuckerberg will testify. in a joint hearing before the senate judiciary committee. on wednesday, before the house energy and commerce committee. watch live coverage on c-span3 and c-span.org, and listen live with the free c-span radio app. ♪ >> this month on c-span, we feature our studentcam contest winners. we asked middle and high school students to choose a provision of the u.s. constitution and illustrate why it's important to them. our second prize high school west winner is arundathi nair, a 10th grader, at laramie high school in laramie, wyoming, where c-span is available through spectrum. in her winning entry, titled