i think the really -- you know, samsa is a very important agency. i think to some extent the nimh has disassociated itself from the public health orientation partly because samsa is there but samsa doesn't have the expertise to do the public health research that the nimh has. so i made a comment -- in the written comments. when i worked at samsa two days a week last year, there was not a psychiatrist there. there was not one psychiatrist. as i left, one psychiatrist joined samsa. there was only one epidemiologi epidemiologist. that's a failure in public mental health. >> dr. hepburn, you mentioned 30 years in mental health. i was a governor at that time and i noticed the change. i just have a minute here. but what advice would you have for states based on your experience and perspective about what the focus should be as they move aweighed with the dollars that they have, both state, federal, and private? >> yeah, i think that that's a basic question that commissioners have to deal with on a regular basis. trying to take care of as many people as pos

she's worked at samsa since 1998. earned a bachelor's degree and master's degree in psychology from ucla and is also a graduate of harvard kennedy school of government. r final witness is louis melahone, deputy assistant administrator, office of division and control within the drug enforcement administration. in that position he's responsible for overseeing and coordinating major pharmaceutical and chemical division investigations, drafting, and promull gating regulations. he's been with the d.e.a. in multiple capacities since 1997. and holds a b.a. from villanova university and j.d., rutgers. we'll go with the way that we inter-- introduced you. would you please start out. you appeared before our committee many times. thank you. >> thank you, chairman grassly. members of the committee, thank you for the opportunity to be here today to discuss the issues surrounding opioid drugs, including heroin and fen continue no -- fen continue no in the united states. this is an important issue for president obama. the president

today i'll focus specifically often samsa's role in each of these areas. with respect to prescribing behavior, it's an obvious tactic to prevent prescription opioid misuse by reducing the numbers of people's medicine cabinets. to do that, physicians and other providers need to be better educated on proper describing and dispensing opioids. to manage chronic pain and treat addiction. we understand that the vast majority of physicians and other prescribers are not bad actors. most are dedicated, well trained professionals who are committed to their patient's good health, but they are very busy. and it's hard to find time for elective training. training that's not required. since 2007, samsa's provided clinical support system for opioid therapies has provided continuing education to over 72,000 primary care physicians, dentists, and other health care professionals. that is tremendous progress, but we have a long way to go. samsa's also addressing the issue of prescribing practices through grants to increase interoperability and in f.y. 2016 with congress' sup

samsa is updating the toolkit. it will be publicly available later this month as a piece of work that we're proud of. another take-home point for you. detoxification is not treatment. detoxification is necessary to break the cycle of dependence, tolerance, and withdrawal. it is not always necessary to begin treatment. you don't have to be detoxified to start bupo epinephrine but it is for meloxone. it should be a follow-on step, it should be standard for those not seeking an opioid agonist. detoxification is better thought of as the medical management of opiate withdrawal. it and not change the risk factors for relapse or the course of the disease. it does increase the risk of fatal overdose should the person relapse. medication is not a treatment by itself. it will control the disease much the same way the high blooped pressure sin will krl your blood pressure but not change the course of the disease itself. your doctor is probably telling you you have to lose some weight, start exercising, stop smoking, control y

samsa does not have the has.tise that nimh when i worked at samsa for 2 days a week, there was not one psychiatrist there. as i left, one psychiatrist had joined. there was only one epidemiologist at the national institute of health. that is the failure in public mental health. : you mentioneder 30 years ago, i was a governor at that time. what advice would you have for states, based on your experience and perspective, about the focus should be as they move ahead with dollars, both federal and private? >> trying to take care of as many people as possible, as cost-effective as possible -- moving further upstream towards prevention and earlier you cantion so that take care of more people as they start to show symptoms, or where they are at risk for symptoms. one problem 30 years ago is that we were waiting until people had severe mental illness until we started treating them. now with the public health model, we are trying to move further upstream to early intervention. trying to spread the dollars out. we still have to take care of who are severely mentally ill. but trying to get to tho

the state mental health authorities work with samsa which has been an excellent partner. the acting administrator is a respected leader in the field. we respect her as a partner. samsa has provided strong leadership in providing the best practices for individuals with severe mental illness. the best example of that is the first episode psychosis program. this program started with research. the research showed that it was a best practice -- to promote the program. its implementation is now across the country. it is an excellent way to show how the federal government can work with the state and providers in order to promote best practices. it is important to note that the role of the state mental health authorities has changed over the last 30 years. 30 years ago states were primarily involved in state hospitals. 75% of the budget went to state hospitals. now most of it goes to the community. 30 years ago the private sector was not really addressing issues in the public sector. now it is hard to separate them. when it comes to admissions to state hospitals, now almost all a

samsa is providing a new round of grants to help in assisted treatment and has funds to dedicate to overdose prevention thanks to the budget you worked so hard to pass. i want to thank you for setting aside the block of time to gather more information about treatment options for opioid abuse disorder. i cannot begin to fathom the number of equally critical issues you are faced with and that demand your attention. i came away from the first forum a few weeks ago really deeply impressed with the urgent need i felt from the members in attendance for ready come out-of-the-box direction for what could be applied to help your constituents. so, i'm going to try to really be concrete today in this presentation and not be too high level or repeat too much of what dr. compton has already presented. the other thing i want to tell you about myself is that i spent 10 years as a prescriber before i came to government. five years in my solo private practice doing primary care medicine. then five years as medical director of an opiate treatment program in pittsburgh. i maintained my private practice over th

that was a samsa grant that we have taken over the funding. i don't have specific numbers over the impact. perhaps dr. schmidt might. >> thank you. >> treatment alone from what i said, i think i already emphasized this. treatment alone, we've done a lot of treatment. it has to be more than treatment as to affect alcohol. it has to be information to the public and for those at risk at drinking. for those that do not serve alcohol, we are concerned there is exposure of alcohol to young people in places where they work, meet and study and also as another feature of this, coffee shops are typically a safe place for people in recovery to meet. so harms to health from alcohol should be taken into account and considered in policy and regulations related to categories of alcohol outlets. in public health we use health impact assessments to evaluate proposed policy and regulations and this evidence based approach could better inform our alcohol policy options. the department of public health has been in collaboration with researchers and professors at

i think you'll hear, some of the work samsa has done nationally, 4 out of 5 people started with overusing or misusing prescription drugs. to your point, chairman, that you raised in your opening, we also right now with a patient survey are actually encouraging reimbursement based on how satisfied people are with pain. and that has to be addressed as well. i know that cms is looking at this but it has to be a priority. because we don't -- this was brought to our attention from doctors who are concerned that if they're worried about an addiction issue, they're being judged on a survey that's saying how -- how is your pain satisfaction? so that has to be addressed as well. >> senator portman, then senator klobuchar. >> quickly, mr. chairman, i don't disagree with the comments made here. as a result, in this legislation we not only have the drug monitoring programs which are incentivized, and to the question of how the states will respond to this legislation, it doesn't mandate states to do this. it does provide incentives. some states have done some cutting-edge work and they should be the l