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there is something for every c-span fan. any time on c-spanshop.org. >> next, hearing on substance abuse, suicide and mental health from the house ways and means committee. they also talk about rising deaths due to to fentanyl and illegal drugs crossing u.s. borders.

>> the ways and means committee will come to order. good morning. i am delighted to see all of us back here at what i always considered the best address on capitol hill. we are hoping today's hearings -- we holding today's hearings. before we begin i want to remind members of the few procedures. first, consistent with regulations, keep microphones muted to limit background noise. members are responsible for an meeting themselves --unmuting themselves. when members are present, they

must have the cameras on. if you need to step away, please turn your camera off and audio off as well. i will turn to the topic of today's hearing. substance use and suicide risk in the american health care system. exactly one month ago, we held the first hearing on examining america's mental health crisis. our discussion underscored how multidimensional the issue really is. the covid-19 pandemic complicated this long-standing crisis, causing increases in social isolation and anxiety. all of which heightened mental health conditions.

during today's hearing, we will take a deeper look at the interrelated mental health issues, overdose deaths and suicide. these are somber issues that affect each and every one of our communities. we were very pleased to pass a bipartisan support legislation called the support act, which added policies like opioid treatment programs. data shows that more work must be done to help those who are suffering. in 2020, more than 40 million people over the age of 12 struggled with a substance use disorder. that same year, the united states set the record high 100,000 overdose deaths. suicide rates also remain at

historic levels. america has the highest suicide rate of any wealthy nation. during last month's hearing come out we spoke about the stigma around mental health issues. it is a conversation we intend to continue this morning. the history of substance abuse disorders is one marked by stigma, criminalization and a lack of recognition that these require evidence-based treatment in the same way you treat diabetes. without support, millions of america's -- americans face incarceration and death. historically marginalized groups in the united states face bleak outcomes. it will take all of us working together to address this often invisible suffering.

the white house also recognizes the need for urgent collective action. i am grateful that president biden announced his strategy for addressing the nation's mental health challenges. together, we can build on the foundation we laid in the american rescue plan to ensure that everyone who needs mental health care is able to access it. today's hearing is an important step to access the problem. -- addressing the problem. with that, let me recognize the ranking member, mr. brady. >> thank you mr. chairman for holding this important hearing. thank you to our witnesses. with substance abuse on the rise

, american families are facing a real mental health crisis. we will hear about those challenges so many americans are struggling with. these problems can impact anyone. seniors, veterans, and our children. everybody is touched by these issues. we need to recognize and get back to working together to strengthen america's communities. i worried the biden administration is mishandling this pandemic, including tests and therapies with prolonged shutdowns. half of all seniors reported that during the pandemic they were isolated and spending less time doing the things they enjoyed. without the routine and social environments, suicide attempts by teenage girls increased by 50%. two out of three people reported

the pandemic had an negative impact on their recovery. america is in the midst of a drug epidemic fueled by fentanyl . it is now the leading cause of death for americans 18 through 45. these are real families and real communities that are being devastated. we must do more together to reduce the wounds of fentanyl. we see this in texas where the open border policy allows fentanyl to flow across our southern border and into our communities. in the fallout of president biden's open border policies, the administration diverted

money meant to support the covid-19 testing capabilities and instead used it for individuals who crossed into america illegally. he told me about the challenges local law enforcement is facing with fentanyl. there are all kinds of fentanyl laced drugs, including marijuana. american families will continue to suffer. we can work together to fight the rise of opioid use. this is an important issue for republicans. we let it lend investment in combating the opioid crisis by enacting the support act. the bill put in place many common sense measures. to help those who become

addicted. i am afraid we have taken our eye off the ball. the influx of drugs resulting from open borders, it is clear america has lost momentum. it is critical we renew our commitment to every american who is impacted by substance use disorder and mental health challenges. we can build on the support act and accept new challenges in combating these issues. we can work together to make telehealth excess permanent. -- access permanent. telehealth was critical for delivering health services. by increasing access, it saved countless lives of seniors and

those facing direct mental health issues. we will work together on the bipartisan basis to permanently extend many of the telehealth capabilities. -- flexibilities. this committee should work together to get more americans out of the sidelines and ensure our economic recovery. we heard from president biden last night that this is something that he would like to work on. i urge the president to abandon his plans of crippling tax hikes on mainstream. i will close here on the heels of the region pandemic and a terrible recession, we know the mental health crisis is real. i believe we have the tools to fight it and i believe that together, taken a bipartisan approach, i am convinced we can

do that. with that, i yield the balance of my time. chairman neal: all members opening statements will be made part of the official record. i want to thank our witnesses. i am pleased we are able to welcome five very impressive guests to discuss this important issue. first i have the honor of welcoming dr. jonathan m. metzl, professor of sociology and psychiatry and director of the department of medicine, health, and society, at vanderbilt university. next, we have dr. edwin c. chapman, private practice physician specializing in addiction medicine. regina labelle, director of the addiction and public policy initiative at the o'neill institute. next we have dr. marielle reataza, executive director of the national asian pacific american families against substance abuse. finally, we have jessica hulsey, founder & ceo at the addiction

policy forum. each of your statements will be made part of the record in their entirety. i would ask you to summarize your testimony. to help you with that time please keep your eye on the clock. i will notify you when your time has expired. dr. metzl, please proceed. >> it is an honor to speak here today. hopefully the next time we do this can come in person. i think hopefully my message will come through nonetheless. i am on one hand a trained psychiatrist and over the course of my career i have seen up close the devastating effects of the topics we are talking about today.

depression, suicide, addiction. i agree with everything we just heard. they cross -- they cut across party, ideology and jeff graphic locale. -- jack rfid locale. -- geographic locale. rightly described as a national emergency about the need to address mental issues broadly. i think we need more and better treatment, more specific treatment. i think we need to reach out to people in communities in ways that they understand to address what i think the president rightly called last night a national emergency.

i started thinking about everything we have all been through over the past two years. who would have imagined that even breathing somebody else's air or walking into a room or thinking about whether or not somebody is carrying a virus, we have all been through this national trauma. we have dealt with it in ways that highlight historical polarizations. mental illness is an extreme point on the continuum. this pandemic has taught us we are all on a spectrum of vulnerability. i do not think we really have a national conversation just about what mental health means after what we have all been through over the past three years. i suggest we have a national referendum. a non-polarizing national

referendum on just what mental health means in this new world we are all living in. and how do we come together? because i will say, there are so many groups voicing despair right now, it is my hope we can build mental health. as a psychiatrist, i can tell you many of my colleagues will be saying, many important things we can do at the moment. we heard about the crisis of isolation that is happening. i know the president talked about technology last night. it is time to think about how can we reach out to people. how can we create networks. how can we contact them and bring the cycles of isolation. -- break the cycles of isolation. i agree completely with the need for telehealth right now. it is an opportunity for us to use technology for good.

but my written testimony is also that of a sociologist. i think mental health with larger structures and systems. the other part of my written testimony is that the pandemic highlighted structural inequities that underline mental illness. i think the chairman highlighted this very well in the opening statement. there was also a call to action to fix the underlying structural inequities that we have. there is a lot of evidence that societies that bound together and fix social cohesion and up breaking cycles of despair in important ways. i think we have an opportunity to build social structures that emphasize the importance of communal infrastructure for mental and biological will be.

i realize i am out of time. you very much. i look forward to having this discussion today. chairman neal: dr. chapman, please proceed. >> thank you for allowing me to participate in today's hearing. for the past 42 years, i have been in practice in internal medicine just two miles from our nation's capital. in 2005, i began choosing another fda approved medication. treating patients in my personal office. over the past 17 years, i treated over 1100 patients and

currently take care of 225 patients. what we found was that these patients have a plethora of problems. including the fact that 10% of my patients have spent at least 10 years or more in jail. 50% initially tested positive for hepatitis. 12% tested positive for hiv. historically, we know epidemic outbreaks are related to untreated substance abuse. as we have seen in indiana, illinois, west virginia, massachusetts. i was appointed in 2019 to a year-long study of the use of

opioid use. we identified nine major barriers, including stigma. we also noted prior authorization for medications are consistently noted as the number one barrier but the medical associations. in the district of columbia, there is currently a six page authorization form. it ranks number two in per capita overdoses. that means it is far easier for a person to get fentanyl outside of my office than a

prescription. the national standard of care have different ways of doing this, including medicare and medicaid. we all thought -- we often do not allow people same day services. the 2020 fr pointed out it cost $42,000 to not treat a patient. it only cost $7,500 to treat a patient.

costs could easily exceed hundred thousand dollars per patient per year. we envision a more centralized payment system appropriately scaled, encapsulating all the savings described here. and a prescription formula that will save lives and money. we actually have that formula through the american society of medicine. this model was put together in 2018 and was never adopted by any state or any insurance plan.

we should explore this option as a fast-track option. i will stop there. chairman neal: thank you very much. ms. labelle, please proceed. >> thank you for the opportunity to speak to you. in 2021, i served as the acting director of the o'neill. currently, i direct the addiction at georgetown law center where we use law and policy to promote access to quality treatment. i am here today to discuss this critical issue affecting our country.

as we all know, the cdc reported that from april 2022 april 2020 one, over 100,000 people died of a drug overdose. the situation calls for heightened attention by policymakers to provide resources but also acknowledge the need for tailored responses to the challenge of addiction. in 2021, the biden harris administration published its first-year drug policy priorities. the health of people with substance abuse disorders is often determined by social factors. this requires tackling

comprehensive solutions to provide greater stability and community connection, which is especially important during this time of covid-19. i want to highlight three areas for action. first, protecting children from harm. legislative initiatives can provide services to families -- to keep families intact. also, stigma toward people with substance abuse disorder not only increases the harm, it can also prevent people from receiving needed services. we have to move aggressively to limit the stigma. strength housing security.

stable housing can improve health outcomes for people with addiction. there are a couple of pieces of legislation that is being considered. the first is the affordable housing resident services act of 2022. this creates grants. another critical area for intervention is reduced -- a greater focus on substance abuse in corrections. in 2019, suicide was a leading cause of death in jail. depths are increasing year after year. from 2009, the rate of the jail

depths due to alcohol or drugs more than tripled. these deaths are preventable if they are provided with access to longer-term treatment. they recently use the research to develop a set of recommendations. the lack of treatment during incarceration and a lack of community-based care placed individuals a great risk. that is why the medicaid reentry act would ease reentry by enabling patients to reestablish medicaid benefits before they reentry -- reenter communities. too often we think about these issues as being resigned to their intractability. but these challenges do not have easy solutions. i think there are concrete policy steps that can make a big

difference. thank you for your time. i look forward to your questions. chairman neal: thank you. >> edis an honor to testify today. -- it is an honor to testify today. i am dr. marielle reataza, executive director of the national asian pacific american families against substance abuse. i have 14 years of experience. i am here today as an asian american. i have concern over the health of api communities.

there is already an ongoing stigma when it comes to seeking care. the stigma can be so strong that they are delayed seeking care. sometimes individuals will seek services in private and that happens when telehealth is available which can be challenging since we live in multigenerational households. language excess and technology are already barriers. an estimated 34% have limited english proficiency and finding language appropriate care continues to be difficult. understanding cultural nuances is critical to serving us. it is not surprising that apis

demonstrate the lowest health seeking care. we are creating the illusion that we do not need them. a team of researchers found that apis have the highest cap and at in the u.s. which has been contributed to inequities. many asian americans have received imprecise or no information in their native make wages better languages. -- languages. this has resulted in a significant rise in asian hate crimes. 10,300 hate incidents against apis were reported.

one in five experiencing racism have been found to show symptoms of depression and posttraumatic stress disorder. substance use disorder among apis is believed to be on the rise. suicide is also reported as the leading cause of death among apis in young adults. despite it being the 10th leading cause of death in the u.s.. this is the cause of death for 33% of our young adults. i have much reason to believe that cases go underreported and

require more investigation to be well understood. one way in which this can be improved is increasing capacity for these communities in research. we are on rep -- underrepresented in these studies. i urge the committee to build capacity to build language access services. i urge the committee to proceed with the adoption of principles and practices.

harm reduction is science-based and community vetted. i worry about the long-term impacts. i acknowledge the challenge. we need help. i think the committee for allowing me to testify. chairman neal: thank you. >> thank you for having me here today. my name is jessica hulsey, founder & ceo at the addiction policy forum. over the last two years, addiction has worsened at historic rates. the isolation of the pandemic

made too many cases catastrophic. we conducted a survey during covid and one of our patients shared that living in recovery in this time has been disappointing when they keep liquor stores open. the society is so twisted. we also saw a patient journey map which helps us understand the journey from input from our patients. one of the most difficult points in the process highlighted higher patients is how hard it is to find health care. one of our patients shared that she was not able to get help when she needed it. to make matters worse, the introduction of fentanyl has

increased mortality rates. fentanyl is 100 times more potent than morphine, 50 times more potent than heroin. it has devastated our communities. there were 285 deaths per day. like a plane crash every single day in america. like losing a high school class of seniors in one day, every day in this country. i lost both my parents to be owed use disorders. -- opioid use disorders. i would like to take a moment to share letters from families that are a part of our campaign. we have hundreds of these letters. christina lost her son to a

fentanyl overdose. she says people need to know this was a disease and not the choice. after three years in recovery, scott relapsed which led to suicide just a few days before his birthday. he left a letter which said he had not found one person who can help me. i just cannot stand being in my own mind. it is torture and it hurts. and denise, one of our moms, she lost both her beautiful sons. she said her boy's a bright future ahead of them but because of their illness and lack of

adequate treatment and medical coverage, their lives were cut tragically short. had they suffered from diabetes or cancer, they would have been provided the medical care necessary to live a full life. we have most of the proven tools to address the crisis, yet we do not implement these interventions for those in need. medications to treat opioid disorder reduces deaths, criminal activity. research shows that they have a 40 or 60% reduction in mentality. only 30% of the patients will actually receive it. can you imagine if less than half of oncology such as provided chemotherapy? and in that half only one in

three patients receive the medications needed. our recommendations for the committee is to expand critical services that are proven by science. like contingency management therapy. we need to have more solutions for stimulant treatments. build the addiction workforce by addressing lack of coverage, low reimbursement rates. and finally, go upstream. addiction is a pediatric brain disorder. thank you so much for your focus

on this important issue. chairman neal: thank. without objection, each member will be recognized for five minutes to question our witnesses. we will go in the order of seniority. before questioning, i would like to put into the record. the national suicide health hotline number, anybody can call anytime to be connected for help. this past december, the biting administration -- president

biden's administration announced millions of dollars to strengthen it. let me turn to our questions for our witnesses. let me begin by recognizing dr. chapman. i want to thank you for your testimony. as part of our bipartisan work, it is clear this is just a first step in ensuring that medicare beneficiaries have access to a full continuum of services for all types of substance use disorders. you talked about the challenges

that americans face in getting necessary care and whether as a result of gaps in health care coverage, intervene. >> thank you mr. chairman. we have tremendous gaps in care. in the district, 98% of our patients recover. i was on the panel about three years ago and alice asked a question. is it money or is it structured? the consensus was that it is both. the fact that we have the structural barriers to care.

i mentioned prior authorization, but there are many other barriers. if a patient comes to see me in my office, we set up telemedicine six years ago anticipating the needs. but most insurance companies do not pay for multiple services on the same day. under the old system, a patient came in and they wanted to see a psychiatrist or primary, one of us would not get paid. the idea of value-based treatment, we are encountering patients with limited resources, so we want to do everything we can.

when patients came in needing to see a social worker and did not have a telephone, we could put them in touch with that for telehealth. we have been doing this for six years but there is no payment structure to support that. we are looking for a payment structure for medicare, medicaid, across the board that would support these very necessary programs. there are other issues like transportation, housing is a major issue. anywhere from 25 or 50% of our patients are homeless depending on how you depend -- define homelessness.

that puts those patients in dangerous situations. without housing, we are creating a problem, discharging them back to the same dangerous environment. chairman neal: thank you dr. chapman. i want to reference a follow-up question. the sheriff's office runs a number of programs. the services provides a significant conduit to employment and housing opportunities.

the sheriffs pointed out to me that up to 90% of the inmates either have an alcohol, drug or mental health issue. can you talk a little bit about why programs are needed to address some of these issues inside of these institutions? >> absolutely. less than 5% of jails across the country use medication assisted treatment. they would take patients off of methadone if they were incarcerated, which means, if you could imagine a diabetic being incarcerated and taken off

their insulin. it is unheard of. it boils down to stigma. without education and understanding what these medications are used for, our criminal justice system considers this replacing one drug with another. we have to start with professional education, both in the medical field as well as in the criminal justice field. so they understand what these medications do. untreated, the worst place to put the patient who is using drugs is in jail because that will be the highest rate of transmission of infectious disease.

a number of years ago, they prohibited the medication because they said it was being smuggled. which means that you create a black market within the jails. the easiest way to stop that black-market is to provide medications to the jail and then have those patients transition from jail back into the community. just like any other medication. we can stop this black-market and these gaps that we are currently having by providing those services and making it provided in advance. many of them need insurance that should be access 30 days before.

if you talk to regina labelle, they have these policies nailed down to the nth degree in terms of what needs to be done. chairman neal: thank you for testifying today. we want to continue the conversation. in may of 2020, the committee held a hearing. it was clear the pandemic was exposing long-standing inequities in our health care systems. you highlight how the system exacerbates risk factors for suicide and addiction. what can congress do to address these issues? >> thank you so much.

i would say first of all, it is not reinventing the wheel. there is a great deal of sociological and medical literature. some of which i cite in my report. that talks about how in moments when societies are challenged by wars, famines, pandemics. in ways that highlight structural inequities. if you create social capital or social cohesion, if you move not to talk about people's identities, but say here are the fault lines that are being exposed by this moment of crisis. what we are going to do is we are going to have a national effort to fix these fault lines, to help people who are the most vulnerable, but also to protect society.

the effect of providing health care networks in low income communities, people are able to access all kinds of care, mental health care and physical care. the unintended effects of broadening health care networks have all of these other, people feel like they are part of a network, so you will see optimism, participation go up. we really need to think about infrastructure as not just come up let's just fix them bridges that are broken, but how can we fix infrastructure in a way that enhances people's sense of connectedness. the other part is that the early stages of the pandemic highlighted weak points of our

society. people at length in multigenerational homes, they had jobs where they could not social distance. they had unequal access to information from the internet for example, so they did not know the up-to-date safety information. these structural inequities were brought into focus in the first moments of the pandemic. as a society, we can say they are dying those people who are less fortunate than us. or to say that we are dying, our fellow citizens. at vanderbilt, we have structural competency. we trained health professionals to understand systems, but also to seat weak points in structures. the upstream factors that might lead to downstream mental health issues and to inequities. we are training mental health practitioners who are versed

both in individual treatments, but also in these upstream factors about who do you need to partner with to help people pay their bills. how can we reimagine medical clinics in that way? chairman neal: thank you. your testimony was superb again. we acknowledge that the mental health crisis and its impact on asian americans is clear. we have much work to do. can you highlight ways that we can overcome some of these challenges to ensure that everyone has access to the care that is both structurally and culturally competent? >> thank you. i appreciate the question. i agree with the of what has been said by my colleagues. a lot of the things we have to understand as health care

practitioners is that we do not understand oftentimes how the systems work for different communities. i advocate for better understanding what is going on in the community level structurally. identities also impact the way in which people interact with the health care system. there is a lot of gaps that everyone has identified. there is difficulty in navigating the system. and even when people have access , often they are under insured and access to these services are expensive. and really challenging to navigate. we often see that someone has to

go and see a provider. that means they have to take the day off. they have to look for child care. there are so many issues that are complicated by trying to get well, so i think that ultimately the system is challenging. we have to find ways to help people access it and navigate it. it has to be affordable, equitable. a lot of that involves learning how different cultures interact with the system and how to better address them appropriately. with also research as well and better understanding of those ends. chairman neal: thank you. with that, let me recognize the ranking member, mr. brady come out for five minutes. >> i did not catch what the timetable is on that.

when does that happen? chairman neal: i think it is shortly. >> we ought to do her best to get the word out. i know our law enforcement community deals with medical health issues every day and i am pleased to see our former colleagues from the ways and means committee has joined us. a terrific guy. it is good to see you. thank you to all the witnesses. i want to direct this question to ms. hulsey. thank you so much for being here

and sharing those stories. the devastating effects of mental health problems and substance use disorders have on communities. i would wager every member of this committee has a story as well. a friend, a colleague, a loved one who we have lost. i remember when we were first working on the support act. the dangers of fentanyl were just coming into view for us in congress. now it is the number one bank killer of young adults in americans -- america. if you have a child, your biggest fear about losing them does not come from cancer or car accidents. it comes from fentanyl. it is a shocking change how quickly this has occurred. how has, since we passed the support act, how has fentanyl

change the substance abuse landscape? how do we catch up to these challenges? >> i think fentanyl is driving overdose deaths and fatalities. we need to have ways to address this, to intervene sooner, to have the prevention, law enforcement strategies. it is making its way into so many communities with the devastating effects. one of our moms wrote in. her name is angela and she lost her beautiful daughter to a fentanyl overdose. she has six times what a

therapeutic dose of fentanyl would be when she lost her daughter. there so much we can do with law enforcement and policymakers makers, families. >> you are in the trenches. you run a terrific program. you deal with this every day. you see the successes and you see the shortcomings. what is, for congress, the most important thing we can do to help you succeed? obviously, in prevention and provided services. -- providing services. >> the number one thing we need is to implement and scale all the things we have learned. it is frustrating to be in the space.

our families are at the epicenter of this and there was so much loss we are experiencing. the scientists told us all these things we need. we would like some medications for stimulant use disorder. we need more tools, but the tools we have and we have decades of research that they were. but they are not implemented to scale. we have programs for kids impacted by parental substance abuse disorder. one in massachusetts that is amazing. but we do not take them to scale. we do not implement systematically. we do not make them available in all of her counties. >> thank you so much. thank you again to all of the witnesses. i yield back. chairman neal: let me recognize gentleman from california.

>> thank you mr. chairman. thank you for holding this important hearing. thank you to all of the witnesses. i want to go back and comment on one thing that was said earlier that i think was incorrect. president biden has handled this pandemic quite well. she did not deny it was real. he encouraged people to get vaccinations and to be careful. she provided critical funding for shots and tests and to get kids back into school. today, 98% of our schools are open. that is an important thing to mention. also, as we talk about drug addiction and mental health, it is critically important to note that 25% of our world population

is impacted by a mental health issue. and at least one mental health event, in their life. and at the same time, 70% of people with mental health issues do not have access to, noted they receive, -- nor do they receive, treatment. we can talk about this all day but unless we make investment in neurological research, we are never going to get ahead of this curve. it is important to point these things out. it is a bar -- it is a bipartisan issue that we all should be concerned with, and figure out how we conduct and fund that research to deal with this problem that affects every one of us and every one of our

families, somehow or another. dr. chapman, i have been working on telemedicine since my time in the state legislature in california in the 1990's. i am convinced it is not only important, but critical that we take advances in this area. i want to thank ranking member brady for voicing his support for telehealth in his opening statement. this is something we all need to work on, to make sure we make the advances necessary. but dr. chapman, you mentioned telehealth and you mentioned the key barrier for treatment for those struggling with addiction and mental health, and that is the stigma of both. do you believe that by using telemedicine more generously, that we can help deal with the stigma issues that surround

addiction and mental health? dr. chapman: thank you for the question, and absolutely. i am not a psychiatrist. in 2013, i went back to howard university. i am an intern. i went back to howard university because i needed the support of the psychiatrists and social workers and psychologists. when we designed this telehealth platform for an urban population , we looked at the profile of our patients, the homelessness statistics, you know that the patient's don't have internet connections, their cell phones are very limited, so we have

designed a process for a practitioner like myself that is in the city and not connected to the hospital, how am i going to get those services for a patient that walks into the office and their number-one issue is that someone very close to them died? they lost their housing last night? those are the types of things that make providers not want to treat, because they don't have access to those services. by bringing telehealth into my office, i am able to access simply by putting a patient in one of the exam rooms and connecting them to a social worker or a psychiatrist. or if they are having legal problems with the parole office, i can help them navigate. that takes the burden off of me.

that reverses provider burnout and provider burnout is the number-one reason providers like myself will not treat these patients. many providers that have been certified and have an excellent number, because of these support services, they are not -- these support services they are not able to institute easily, it scared them off, and they back off treatment. representative: thank you. i yield back. chair: let me recognize the gentleman from florida, mr. buchanan. representative: thank you. i can't imagine anything more important than mental health, especially today. i thank all our witnesses. miss huskey, i want to ask you, all the stories were so powerful , i have a nephew who is

struggling, semipro hockey player, got addicted on drugs and they have been battling, my sister, with him for 20 years. it has been an incredible struggle. it seems that once they get addicted, they go through that door, and if you don't get to them early, there is a good chance you lose most of them. what more can we do up front in terms of prevention? it seems whether it is the kids or anybody, if we catch them early, it makes a big inference because, from what i have seen over the years, many of them, even if they figure out a way to manage it, it is brutal trying to manage it, the process. i know people who have been successful in addiction on cocaine or alcohol and they are going to rehab every year and a half or two and they are going to lose everything.

i guess there is two questions. once they go through the door, what is the chances of coming back, based on what you have seen? but the bigger question for me is, how do we do more in terms of revenge and on the front-end? -- in terms of prevention on the front-end? >> thank you. i am so sorry that your family has struggled with this as well. going upstream in both preventing addiction indent or green early is so critical. and no other area would we wait for it to get worse before we intervene. we would never wait for stage iv cancer before we engage a patient in care, and the same is true or addiction. i think everyone can recover. recovery is possible and it is beautiful and we have so many

positive, inspiring stories about recovery and how people got there. even put -- we are even putting out a patient journey map later this month to detail that. you are right, though, the quicker we intervene, the better the outcomes. and most addiction begins in adolescence or young adulthood, so making sure we are intervening at the time of onset, most of our treatment is set up for adults, yet onset is in adolescence paid that is something we need to address. we all know what employee assistance programs are, but there are really successful student assistant programs in middle and high school. representative: as a member, nobody wants to get the call i got last week. we probably all got the call. as a family, they found their son, three tutors in afghanistan, committed suicide

in an area i represent. it seems it is 50% greater than the general population in terms of suicide deaths among our veterans. what are your ideas about where we are and what more we need to do? one thing i got left with, he says we do a good job bringing the kids in, this is a marine, into boot camp. we don't do a good job in his opinion in terms of when they come out of service. they should also have a boot camp, his term, on their way out. their son finally took his life last week after struggling for quite a while. >> i am very sorry to hear that. we do have treatment and interventions for those who have concurring -- have recurring disorders. the services need to be available to our veterans. we have interventions that work

such as the veterans treatment court which combines wraparound services we need for our veterans. but we don't apply those solutions at scale to all who need it. it should be a huge priority area that we focus our time and resources to make sure there is a safety net there. representative: thank you. i yield back. chair: that me recognize the gentleman from connecticut, mr. larson. representative: thank you for holding this important hearing. i commend president biden last night, for underscoring the need for us to come together around issues that i think everyone in this committee agrees are nonpartisan and deserve our direct attention. ms. labelle, you spoke about social determinants of health, which impacts substance use.

in my district, the city of hartford, a community which is deep poverty levels, accounts for over 25% of accidental overdoses. what policies do we need to pursue to address this addiction holistically? ms. labelle: thank you. from connecticut, i am very familiar with hartford. i was there last year with the office of national drug control policy. i think there are a couple of things. first, there are good harm reduction programs in hartford. they get people who may not be receiving services elsewhere. they get vulnerable populations that help that they need. they get them naloxone if they inject drugs. they get them syringes that can prevent them from having infectious disease. that is one piece.

i think the prevention programs, there are good examples of prevention programs in those areas that work to build communities with wraparound services for families. and i mentioned in my testimony, i am a strong believer in the child tax credit to help families experiencing poverty, to lift children out of poverty and also address some adverse child experiences and trauma that often accompany poverty. those are three areas i believe strongly in, and that can help in that area. representative: thank you for your clarity. i yield back. chair: let me recognize the gentleman from nebraska, mr. smith. representative: thank you thank you to our panelists as well for this timely discussion that i think is needed across our country.

i appreciate the opportunity to continue this conversation that we began exactly a month ago with our lustful committee hearing on how mental health care has been impacted by the pandemic. events over the last two years have made clear how important the mental health component is to our health care system, especially when dealing with trauma and tragedy. whether our constituents are impacted directly or indirectly, natural disasters like putting or hurricanes, infectious disease outbreaks like covid or ebola, or even terrorism or barbaric wars like in ukraine can impact that'll health and increase risks of developing problems with substance abuse. we saw this risk clearly during the early days of the pandemic as alcohol sales shot up as in-person support meetings were being banned. we see people now returning to normal social interaction, but long-lasting damage has been done and nothing can bring back those who died of suicide or

overdose while isolated from society for their own protection. appropriate treatment is more complicated than managing other conditions where a simple prescription can manage the concert for months or years. instead, a major component is interaction with a therapist, counselor, support group or other human being, but especially in rural areas, access to these resources is limited by distance and population density. rural areas have consistently experienced shortages of all kinds of skilled health care providers, but especially those who work in mental and behavioral health. addressing these long-term shortages requires innovation and creative approaches, from -- often leveraging technology. one option is options in underserved communities, the peers act, and initiative to allow peer support to be integrated into medicare coverage.

train, pierce support specialist -- trained, pierce support specialists provide inexpensive and effective resources to address the provider shortfall. another important opportunity is to continue to grow telehealth capacity. in rural areas, we lack a lot of opportunities. there is widespread high-speed broadband manned. it is not currently available and it is impossible to appropriate your own engagement. there are areas in my district you can't get a strong enough signal to make a call on a cell phone and are likely monday -- likely many miles away from a mental health professional. requiring these individuals to have a high-resolution internet connection to access mental health care is not realistic. i introduced the rural telehealth access act which, in

addition to removing barriers for rural mental health, would allow for audio-only provision for mental health services for those with mental health or substance abuse disorders. i hope these concerns will be incorporated into a long-term telehealth package which we need , to chart a viable post-covid course into the future. i am wondering what you think are the most effective communities to use telehealth to improve treatments for those with substance abuse disorders, especially in underserved areas? and you think audio-only options for behavioral health telehealth can be used to expand access and provide support in underserved areas without crating too much from your ability for fraud and abuse -- too much vulnerability for fraud and abuse? >> expanding and making

permanent changes to telehealth that we saw during the pandemic will be helpful to increase access moving forward, including audio-only options for our physicians. it can be tricky to turn on that video component, and we need to make sure we have better access and connection to the right clinicians for all our patients. we still struggle with reimbursement rates for services in the addiction treatment field, so we would like congress to be able to work on that so that we can keep and retain our clinicians that we have in the addiction field. and there are other solutions. and i think telehealth and digital therapeutics have applications for rural communities where you might have gaps in access to care or not enough variation in the types of care plans some of our patients are looking for. digital therapeutics allow us to use smartphones to help with peers services, rick -- peer

services. recovery and peer service are important and i think congress can help us with those next steps. chair: let me recognize the gentleman from new jersey, mr. pasquarell -- pascrell. representative: thank you. there are things that we can work on together and we should because that is part of our mental problems here, that there is a democratic way and there is a republican way. when i was mayor of one of the largest cities in new jersey, i knew there was no democratic way to pick up the garbage.

when we look at those tangible things differently -- and we look at those tangible things differently than we look at problems each of us have, because no one is totally free from those problems. the last two years made us painfully aware. our witnesses are excellent, each one of them. the testimony today removes all doubt that the mental health and addiction is a crisis we face. tens of millions of americans are suffering from social isolation, fear of infection, job loss, burnout. the statistics are startling. some of these things are easier to talk about than others. the reduction in the use of fentanyl is easier to talk about than it is transgender and what those folks had to go through

over the last few years from remarks from people in our own group, our own congressman. that's congress -- congressmen. not only hurtful, but very, very hurtful. during the pandemic, drug overdose deaths rose by 40% between 2019-2021, an increase of 29,000 people. assess -- access to treatment is inadequate. medicare is not subject to parity requirements for it often, one must be hospitalized to even access treatment. congressman chu are drafting legislation to modernize

medicare. our fix requires mental health and substance use treatment across the continuum of services and settings. it is going to take a long time to break away from stigma, a longtime -- k long -- a long time. this will improve access to mental health services. 25%-50% of all people served by the mental health system have a lifetime history of brain injury, a loss of consciousness -- many of our soldiers. those individuals often have longer and more severe histories of substance use, and more behavioral health issues. we must support the to visuals with substance use disorder to access and navigate treatment. i've been to too many wakes for

friends and neighbors, for our mental health system failures. i have attended too many funerals for young people who could not overcome their valiant struggles with addiction. and we have failed to help tens of millions of americans access to care. more americans will suffer, more americans will die. dr. chapman, thank you for your great testimony, as each of the witnesses provided. your testimony highlighted the gaps in substance use disorder treatment across various pay years -- various payers. can you talk about the barriers medicare beneficiaries face, and what are some solutions? dr. chapman: thank you.

absolutely. support services that i mentioned, including social workers having peer support staff, that is critical. they save me so much time. and the system we have set up allows me to introduce my patients to a social worker while they are in the office, and the social worker is at a remote site. once those connections are made, then we are able to give 24/7 access. so, that same patient can either call me if they have a problem, they can call the social worker or they can call a peer support specialist that they have been introduced to. in this model has just been fantastic in terms of closing some of those gaps. when we look at the safety, one

of the problems is worrying about how we approach a pay for new services, but look at the savings. look at the federal register and what it costs the system not to treat a patient -- $32,000. comprehensive treatment spread across a population -- i have a population of 225 patients, so you spread those costs across that population. and it may come to about $1.5 million, but every patient does not need that service every day. but when you spread it across the population, you end up saving honey through the criminal justice system because they are not going to jail, you save money because they are not overdosing or going to the emergency room and you are also able to reengage patients,

especially if they have children. representative: thank you. i yelled back. chair: let me recognize the gentleman from new york, mr. reed. representative: i want to recognize miss halsey, it is my understanding you have family members tuning in today, and i recognize denise, angela, jim, who are watching this hearing, obviously thinking about their loved ones that have been lost to addiction and opioids in fentanyl -- opioids and fentanyl and all the issues we are talking about. our thoughts go out to you, and we appreciate you using that horrific situation in a positive way by participating today. i will open my remarks by confronting the issue of stigma. as someone who surrendered to

his higher power almost five years ago, dealing with the demons we are talking about today, i have to tell you it is time for us to come out of the darkness. it is time for us to celebrate, as has been indicated by each one of these witnesses, recovery. the best decision i ever made in my life was that decision i went to my knees and turned to a higher power in the program i was associated with, and wrestled that demon under control. and my life has improved so drastically in a positive way, that i am here to be a message for all those in the darkness still, all those facing addiction, all those that, when they reach out for help and are denied, and i know exactly what that experience is, i would tell you, don't give up hope. don't turn back to the demon. don't give up. because if you embrace recovery,

if you have the strength to ask for help, i can assure you there are millions of us around this globe that are pulling for you, standing with you and will do whatever it takes to get you out of that dark place and into the light of recovery. with that being said, one of the things i experienced, and i think alex talked about it directly, it is a question of money and a question of structure. i want to focus on the structure side of this conversation. because what i have seen is that we have a silo effective substance abuse counselors and then we have mental health counselors. they are not reimbursed in a way that makes any sense under our federal health care system. that needs to change in my opinion and i hope everyone disagrees with that.

i have also seen that when we talk about a 12-step program where a call is made to surrender to your higher power, that often come our treatment providers will not talk about spirituality issues, will not talk about the power of religion because somehow, that is something that should not be discussed in our public system. and i got to tell you, if you do not have a spiritual reawakening as part of recovery, it is very difficult to succeed. i am going to ask you, ms. huxley, how or is there a structural barrier to incorporating documented, successful treatment programs based on a 12th step spiritually based recovery program that prevents you from treating or giving your patients the best

opportunity to get into recovery and succeed in life? are there barriers that you face in your treatment models that we need to change to encourage that piece of the treatment protocol to be therefore those that are suffering in addiction and until health? >> absolutely. congrats on your many years of recovery, and for sharing your story. this is one of the pieces we need to do more of to drop the shackles of addiction and tell our story. the 12th step program and variations of support groups out there are the foundation and beautiful part of our recovery system in america. it is proven by science. we have the data. it has worked. and our research and our work with our network of patients in

recovery from addiction, 64% of them rely on support routes for the long-term. this is what we need to stay well and stay healthy and if you look at the scientific components, you are attaching to your community, you are dealing with shame itself stigma, you are creating positive peer connections. there is cbt built into the programs. there is treating a knowledge you need to manage your chronic health condition. it is one of our most important sources. some of the barriers can be misinformation and not understanding that you don't need to choose a brand of mutual support. there are so many different ones, depending on your secular or religious program, some that are focused on certain substances. i think if we have more education for our providers and practitioners in the field to let them know how important it is to be aware of what resources are in the communities and

making sure that if we have gaps, we feel them. representative: i appreciated. my time has expired. we could talk about this for hours. i think the chairman for highlighting this, and there are solutions here, especially with a program such as 12th step, a 64% success rate. we should be embracing that and removing all bears so that people get the help they need. chair: i appreciate the gentleman's courage in stepping forward in a public arena. let me recognize the gentleman from chicago, mr. davis. representative: thank you. and let me thank you for this very important hearing. and thank you for your testimony, all of the witnesses, but also your interaction with my office. as chairman of the subcommittee

with jurisdiction over child welfare, i am deeply concerned about 40% of the youth who come into foster care due to prolonged substance abuse, including about 20% of infants. this committee has bipartisan nly invested in policies to strengthen families so these children can grow up at home, policies like federal reimbursement for family substance abuse treatment and outpatient services for parents to keep children from entering care, and regional partnership grants like that received by kentucky's start group, as well as various tax credits for children in moderate and low-income families. ms. labelle, can you speak about how family-centered approaches to treat -- approaches for

treatment to provide wraparound care for families can limit adverse childhood experiences and children entering care? ms. labelle: if we separate it into three stages of the child's life and taking into account a pregnant woman, first, make sure pregnant women get the prenatal care they need, particularly if they have a substance use disorder. the stigma attached to women with substance use disorder often keeps them from getting necessary prenatal care. the second piece is that once that child is born, too often, postpartum women are no longer eligible for medicaid, which often causes, again, women not to get the type of treatment they may need if they have a substance use disorder. and lastly, those wraparound services, that family-centered

care that takes into account that a child is not separate from the parents and the parents and child all need services. the parent may need treatment but also may need other services such as housing, parenting skills, again, to prevent foster care placements. the family prevention act that passed a couple years ago, the renewal that is happening right now, all those things can take into account that family reunification goal we have. representative: thank you very much. i have been told drug addiction is a complex brain disease characterized as an uncontrollable desire to continue taking drugs, with the pendency to -- with dependency to increase over time, resulting in physical and psychological

dependence. without-risk youth, there are many factors involved in drug addiction -- early stress, use of drugs by a family member, having friends who use drugs, financial crisis, academic crisis, all kinds of things. what seems to work best? what are best practices for preventing and successfully treating youth using drugs? ms. labelle: pediatricians, for many people, play a really important role for young people in identifying risky substance use. they may not be at the point where they have a substance use disorder, but that is why early intervention by a pediatrician or primary care doctor is really important. the second thing is the role of parents. many of us