    [Senate Hearing 110-472]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 110-472

         ROGUE ONLINE PHARMACIES: THE GROWING PROBLEM OF INTERNET DRUG
                                  TRAFFICKING

    =======================================================================

                                    HEARING

                                   before the

                           COMMITTEE ON THE JUDICIARY
                              UNITED STATES SENATE

                           ONE HUNDRED TENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                  MAY 16, 2007

                                   __________

                              Serial No. J-110-35

                                   __________

             Printed for the use of the Committee on the Judiciary

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                           COMMITTEE ON THE JUDICIARY

                      PATRICK J. LEAHY, Vermont, Chairman
    EDWARD M. KENNEDY, Massachusetts     ARLEN SPECTER, Pennsylvania
    JOSEPH R. BIDEN, Jr., Delaware       ORRIN G. HATCH, Utah
    HERB KOHL, Wisconsin                 CHARLES E. GRASSLEY, Iowa
    DIANNE FEINSTEIN, California         JON KYL, Arizona
    RUSSELL D. FEINGOLD, Wisconsin       JEFF SESSIONS, Alabama
    CHARLES E. SCHUMER, New York         LINDSEY O. GRAHAM, South Carolina
    RICHARD J. DURBIN, Illinois          JOHN CORNYN, Texas
    BENJAMIN L. CARDIN, Maryland         SAM BROWNBACK, Kansas
    SHELDON WHITEHOUSE, Rhode Island     TOM COBURN, Oklahoma
                Bruce A. Cohen, Chief Counsel and Staff Director
          Michael O'Neill, Republican Chief Counsel and Staff Director

                                C O N T E N T S

                                  ----------

                        STATEMENTS OF COMMITTEE MEMBERS

                                                                       Page

    Feinstein, Hon. Dianne, a U.S. Senator from the State of
      California.....................................................    15
    Leahy, Hon. Patrick J., a U.S. Senator from the State of Vermont.     1
        prepared statement...........................................   161
    Sessions, Hon. Jeff, a U.S. Senator from the State of Alabama....     3
    Specter, Hon. Arlen, a U.S. Senator from the State of
      Pennsylvania...................................................     2

                                   WITNESSES

    Califano, Joseph A., Jr., Chairman and President, The National
      Center on Addiction and Substance Abuse at Columbia University,
      and former Secretary, Department of Health, Education, and
      Welfare, New York, New York....................................     7
    Haight, Francine H., Founder of RYAN's Cause, Laguna Niguel,
      California.....................................................     5
    Heymann, Philip B., James Barr Ames Professor of Law, Harvard Law
      School, and Former Deputy U.S. Attorney General, Cambridge,
      Massachusetts..................................................    10
    McLellan, A. Thomas, Chief Executive Officer, Treatment Research
      Institute, Philadelphia, Pennsylvania, statement...............    14
    Rannazzisi, Joseph T., Deputy Assistant Administrator, Office of
      Diversion Control, Drug Enforcement Administration, Department
      of Justice, Washington, D.C., statement........................    13

                             QUESTIONS AND ANSWERS

    Responses of Joseph A. Califano to questions submitted by
      Senators Leahy and Specter.....................................    27
    Responses of Philip B. Heymann to questions submitted by Senators
      Leahy and Specter..............................................    38
    Responses of A. Thomas McLellan to questions submitted by
      Senators Leahy and Specter.....................................    45
    Responses of Joseph Rannazzisi to questions submitted by Senators
      Leahy, Durbin and Specter......................................    51

                           SUBMISSIONS FOR THE RECORD

    American Pharmacists Association, Washington, D.C., statement....    85
    Califano, Joseph A., Jr., Chairman and President, The National
      Center on Addiction and Substance Abuse at Columbia University,
      and former Secretary, Department of Health, Education, and
      Welfare, New York, New York, statement and attachment..........    89
    Federation of State Medical Boards, James N. Thompson, M.D.,
      President and Chief Executive Office, Dallas, Texas, statement.   111
    Haight, Francine H., Founder of RYAN's Cause, Laguna Niguel,
      California, statement..........................................   116
    Heymann, Philip B., James Barr Ames Professor of Law, Harvard Law
      School, and former Deputy Attorney General, Cambridge,
      Massachusetts, statement and attachments.......................   122
    Marshall, Jon, Kentucky State Police, National Narcotic Officer's
      Associations Coalition, Frankfort, Kentucky, statement.........   163
    McLellan, A. Thomas, Chief Executive Officer, Treatment Research
      Institute, Philadelphia, Pennsylvania, statement...............   169
    National Association of Chain Drug Stores, Alexandria, Virginia,
      statement......................................................   173
    Rannazzisi, Joseph T., Deputy Assistant Administrator, Office of
      Diversion Control, Drug Enforcement Administration, Department
      of Justice, Washington, D.C., statement........................   178

         ROGUE ONLINE PHARMACIES: THE GROWING PROBLEM OF INTERNET DRUG
                                  TRAFFICKING

                                  ----------

                            WEDNESDAY, MAY 16, 2007

                                           U.S. Senate,
                                    Committee on the Judiciary,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 10:07 a.m., in
    room SD-226, Dirksen Senate Office Building, Hon. Patrick J.
    Leahy, Chairman of the Committee, presiding.
        Present: Senators Leahy, Feinstein, Specter, and Sessions.

    OPENING STATEMENT OF HON. PATRICK J. LEAHY, A U.S. SENATOR FROM
                          THE STATE OF VERMONT

        Chairman Leahy. Good morning. Today the Committee will be
    holding an important hearing on the growing problem of rogue
    online pharmacies that illegally traffic in highly addictive
    painkillers and other controlled substances.
        You know, in many ways, the Internet has made our lives
    better. I have been one of its biggest proponents for those
    reasons. It removes the historic constraints from geography; it
    provides access to information and knowledge that might
    otherwise remain unavailable, especially to people like myself
    who live in rural areas. Distance learning, access to medical
    knowledge at the finest hospitals, and increased commercial
    competition--these are all aspects of the Internet that are
    important. Vermont businesses sell Vermont products throughout
    the Nation and around the world through the Internet. At the
    same time, the Internet has enabled Vermonters, and others,
    better access to convenient and more affordable medicine, which
    should be stressed.
        But the online sale of pharmaceuticals presents a more
    complicated and problematic aspect. Rogue online pharmacies
    increasingly have become a source for the illegal supply of
    controlled substances. Dangerous and addictive prescription
    drugs are too often only a click away without the proper
    constraints of local doctors and pharmacists.
        Controlled drugs, such as pain relievers, tranquilizers,
    stimulants, and sedatives, can be too easily bought illegally
    over the Internet. Anyone--including children--can readily
    obtain dangerous controlled substances from online pharmacies.
    All they need is access to a computer and a credit card. The
    check and security provided by our local pharmacists in local
    pharmacies--those who have served Americans for generations and
    helped us get well and keep us well--is not always replicated
    online.
        The 2006 National Survey on Drug Use and Health indicates
    that almost 6 million people currently misuse prescription
    drugs and, of them, more than two-thirds 4.4 million people--
    abuse pain relievers such as OxyContin. Some celebrities have
    been involved in high-profile cases, but I am more concerned
    about the fact that people in every state and increasingly from
    every age group and demographics are affected. When abused,
    these drugs have enormous potential to cause harm and illness
    and addiction, and as we are going to hear this morning from
    one of our witnesses, tragically even death.
        American teenagers are always particularly vulnerable to
    Internet drug trafficking. Among young people, prescription
    drugs have become the second most abused illegal drug. In fact,
    if you exclude marijuana, more adults and teens report abusing
    prescription drugs than all the other illicit drugs combined.
        Too many American teenagers mistakenly believe that abusing
    addictive narcotics is a safe way to get ``high.''
        As we learned just last week, some drug companies have
    themselves contributed to that dangerous impression by giving
    consumers misleading information about the addictive qualities
    of these drugs. Purdue Pharmacies, the maker of the powerful
    painkiller OxyContin, and three of its corporate executives
    pled guilty to intentionally misleading the public when it
    promoted OxyContin as less addictive than narcotics. It is a
    sad day when pharmaceutical companies act like tobacco
    companies and mislead the public rather than alerting the
    public to the risks associated with the use of its products.
        We have legislation referred to this Committee that would
    create potent new tools for law enforcement to prosecute those
    who illegally sell drugs online and allow State authorities to
    shut down online pharmacies even before they get started. And I
    will work with the Senators from California and Alabama and
    others on these matters.
        As the longtime Co-Chair of the Congressional Internet
    Caucus, I will ask the Caucus to consider the issue of the
    growing danger that online pharmacies pose to youth.
        Internet drug trafficking has presented another challenge
    for law enforcement. If drug dealers came into our
    neighborhoods selling these kinds of drugs, Americans would be
    up in arms.
        So I thank our distinguished panel of witnesses for
    appearing today, and I also especially want to thank Senator
    Specter for his work in connection with this hearing.
        [The prepared statement of Senator Leahy appears as a
    submission for the record.]
        Senator Specter?

    STATEMENT OF HON. ARLEN SPECTER, A U.S. SENATOR FROM THE STATE
                            OF PENNSYLVANIA

        Senator Specter. Thank you, Mr. Chairman, for scheduling
    this important hearing. The problem of drug addiction has been
    with our society for decades. I first saw it in an intense
    fashion when I was district attorney of Philadelphia four
    decades ago, and the problem has been increasing in seriousness
    and is a major problem in our society.
        With the Internet and technological advances, we now find
    that drugs are accessible by the rogue pharmacies, and the
    problem is one of enormous importance. It came into sharp view
    in Philadelphia in 2006 when there was a DEA bust of a major
    Internet drug ring run from Philadelphia by two foreign
    graduate students at Temple University and 25 co-conspirators
    who were arrested in four different countries.
        It is possible to have legitimate purchase of drugs over
    the Internet, but there were only 12 such DEA registered
    pharmacies. Most of the other Internet pharmaceutical sales in
    the United States are legally suspect. Federal law mandates
    that there is a prescription before dispensing the drugs, which
    we all know, but that is avoided. The Center on Addiction and
    Substance Abuse discovered over 3 years the total number of
    websites been selling prescription drugs has increased
    enormously. The regulation of online pharmacies and doctors
    consists of a very patchwork arrangement so that it is the
    subject which requires, I do believe, Federal legislation, so I
    am glad to see such a distinguished panel here today.
        We very much appreciate your presence, Mrs. Haight, with
    the situation that your son, Ryan Thomas Haight, died of an
    overdose of narcotics he had purchased on the Internet without
    a prescription.
        We have a very distinguished array of experts, and,
    regrettably, we are not going to have a very extensive array of
    Senators--not necessarily distinguished even when present,
    except for Senator Leahy and Senator Sessions. But it is a
    very, very busy day on Capitol Hill.
        I am going to have to excuse myself to return to
    deliberations which are underway on the immigration issue. We
    have had more than two dozen meetings of lengthy duration,
    mostly in excess of 2 hours, where 12 Senators sit still--that
    is, we sit still; our jaws are not still--as we try to work
    through an extraordinarily difficult legislative issue.
        Then that is compounded by the problem that we are having a
    series of votes at 10:30, and votes come ahead of everything
    else. That is our basic paycheck in the United States Senate,
    what our voting record is. But I have staff here who will be
    following the proceedings very closely, and I am sorry to miss
    the testimony, because this is an extraordinarily distinguished
    panel.
        Chairman Leahy. During this, as the votes start, we will
    stop and start. Some of you are familiar with that.
        Senator Sessions has worked hard on this. Jeff, did you
    want to say anything?
        Senator Sessions. If you do not mind, Mr. Chairman.
        Chairman Leahy. Go ahead.

    STATEMENT OF HON. JEFF SESSIONS, A U.S. SENATOR FROM THE STATE
                               OF ALABAMA

        Senator Sessions. I will not be long, because we do have a
    distinguished panel and we want to hear from them. But I am
    glad that with your leadership and, really, with Senator
    Specter last year, we have had a good chance to move this
    important legislation forward. I am convinced that it is good
    legislation. As a former Federal prosecutor who prosecuted a
    great many drug cases, it is amazing to me that with the
    regulations we have in so many different areas that even a
    teenager with very little effort can order drugs, controlled
    substances, off the Internet. It just undermines this entire
    system that we have.
        I remember after I ceased being United States Attorney
    representing an individual who was a young person that had a
    knee injury, started taking pain pills. He was going all over
    town. There was nothing he would not do. He was president of
    his class. But he just had to have these drugs. The addiction
    is very powerful. Some people think it is because it is a
    prescription drug, the addiction is not as powerful or cocaine
    or some of the other drugs. It is a powerful addiction, and
    people do things that destroy them, and they cannot seem to
    stop. And being able to obtain large amounts of drugs off the
    Internet allows that addiction to continue and delays the
    intervention that can be life saving.
        The bill that Senator Feinstein and I have introduced--and
    I certainly appreciate her leadership. She understands this
    issue very well. She has had a personal experience with people
    who have tragic losses as a result of prescription drug abuse
    through the Internet, and it is a pleasure to work with her.
        I was interested to note and am pleased to note that in the
    Washington Times today, there is an op-ed by John Horton, a
    former Assistant Deputy Director of the White House Drug Policy
    Office, and Kristi Remington, a former Deputy Assistant
    Attorney General in the Justice Department, which endorses the
    legislation Senator Feinstein and I have offered. And they note
    in their article that, ``The Online Pharmacy Protection Act,
    which will be considered today by the Judiciary Committee,
    brings the law regulating the sale of controlled substances
    into the Internet age and is a vitally important tool in our
    Nation's anti-drug efforts. It should be sent to the full
    Senate for passage.'' They note that, ``Ms. Feinstein and
    Senator Sessions have ensured the bill takes into account
    legitimate issues concerning telemedicine and the practice of
    covering practitioners, but in each case, a physician who is
    familiar with the patient, can determine whether medication is
    truly necessary or if the person is possibly acquiring the
    prescription drug because of an addiction.''
        So thank you, Mr. Chairman, and I would offer this article
    for the record.
        Chairman Leahy. Thank you. It will be included in the
    record.
        Would you please stand, all of you, and raise your right
    hand? Do you solemnly swear that the testimony you will give in
    this matter will be the truth, the whole truth, and nothing but
    the truth, so help you God?
        Ms. Haight. I do.
        Mr. Rannazzisi. I do.
        Mr. Califano. I do.
        Mr. Heymann. I do.
        Mr. McLellan. I do.
        Chairman Leahy. We will begin with Ms. Francine Haight. I
    have already chatted with her briefly and, again, I commend you
    for your courage in being here.
        She is the founder of RYAN's Cause, Reaching Youths Abusing
    Narcotics. It is a nonprofit organization dedicated to
    educating parents, families, and communities on issues
    concerning the Internet and drug abuse. Ms. Haight founded
    RYAN's Cause after her 18-year-old son, Ryan Thomas Haight,
    tragically died from an overdose of prescription drugs which he
    had purchased through the Internet.
        Ms. Haight has told her story around the country to help
    educate and bring public awareness to the danger of sales of
    drugs on the Internet. Her son's story was mentioned in the
    recently aired HBO series ``Addiction.'' In June of last year,
    Ms. Haight was a sponsor to the first national candlelight
    vigil out at DEA headquarters in Arlington, Virginia, for those
    that died from the drugs.
        Ms. Haight, I know this is not an easy time for you, but I
    just want you to know how much we appreciate the fact you have
    come here from California to speak, and please go ahead.

       STATEMENT OF FRANCINE H. HAIGHT, FOUNDER OF RYAN'S CAUSE,
                       LAGUNA NIGUEL, CALIFORNIA

        Ms. Haight. Good morning. My name is Francine Haight, and
    thank you for inviting me to testify at this hearing about a
    very important topic that tugs at my heartstrings every day.
    Many of the speakers here today will give you statistics and
    numbers, but I am here to put a face to those numbers. And I am
    very sad that today that face is my son, Ryan Thomas Haight.
    Unfortunately, he was a victim of illegal sales of
    pharmaceuticals through the Internet.
        Ryan was born on December 28, 1982, and died on February
    12, 2001, from an overdose of prescription drugs he had
    purchased on the Internet. He was only 17 when he purchased
    these drugs, and he was only 18 when he died.
        He was an incredible boy. From the time he was little, I
    always believed that he would make a difference in this world.
    He was intelligent and excelled in school, was an A student and
    maintained a 4.0 or above during his years in high school. He
    looked forward to going to college.
        He was athletic, loved the thrill of competition, played
    Open Junior Tennis tournaments, and went on to play varsity
    tennis for Grossmont High School in La Mesa, California. He
    loved to ski, snow ski, water ski, kneeboard, and he attempted
    all sports with great enthusiasm.
        But Ryan also loved using the computer. He was thrilled to
    find out that he could chat online, that he could receive and
    send e-mails, and that he learn and talk about educational and
    current events. He learned to surf the Internet. It was a
    perfect place for him to use for his papers in school or to
    seek information he was curious about. He used the computer to
    play games, and he enjoyed trading baseball cards on eBay. But
    on February 12, 2001, that all stopped.
        On February 12, 2001, I found Ryan in his bed, lifeless. I
    tried to resuscitate him, but could not bring him back. Ryan
    had died. And I was in shock. Just the night before, we had
    dinner together after he came home from working at a nearby
    retail store. That night I had kissed him and said good night,
    and he said, ``I love you, Mom.'' Those were the last words I
    would hear from him. Ryan died from an overdose of the
    prescription drug Vicodin. He also had a small amount of Valium
    and morphine. And I thought, How? How did he get these drugs?
    After one of his friends told me that he got them on the
    Internet, we gave our computer to the DEA to investigate. And
    through their investigation, they found how Ryan had ordered
    the drugs.
        Ryan had made up a story. He had said he was 21. He said he
    had been in a car accident and had back pain, and he made up a
    doctor's name, Dr. Thomas, which happened to be his middle
    name. Dr. Robert Ogle, whom Ryan never saw and was never
    examined by, prescribed them, and an Internet pharmacy, Clayton
    Fuchs of Mainstreet Pharmacy, delivered them to our home. I was
    in shock. I thought, How could this be possible? I am a
    registered nurse; Ryan's father is a physician. We know that
    all controlled substances have to be accounted for. We count
    each and every drug that we give when we administer it to a
    patient. They are under lock and key. How could he get these
    off the Internet so easily? At a time when we were worried
    about our children being exposed to pornography and predators,
    marijuana and alcohol, we did not know that drug dealers were
    in our own family room.
        After a long investigation and trial, Dr. Robert Ogle and
    Clayton Fuchs, who together made millions by their drug
    dealings, were prosecuted by the United States Attorney in
    Dallas and are now in Federal prison. I attended the sentencing
    of Clayton Fuchs, and although it does give me some peace that
    justice was served, it does not bring Ryan back. I am still
    shocked at the ease and availability of buying controlled
    substances on the Internet. I receive e-mails every day from
    13-year-old children to adults that they are just overwhelmed
    by the problems that they see happening from drugs being sold.
        Over the last few months, Ryan's story has been told in a
    documentary called ``Online Nightmares,'' and it was produced
    by E Entertainment. It has aired about 15 times, and since then
    the mail that I get is just overwhelming in my mailbox. This is
    an ongoing problem.
        After Ryan died, it took me almost 3 years to get enough
    strength to do what I am doing, and I started RYAN's Cause--
    Reaching Youths Abusing Narcotics. And I have done a lot of
    news and gone out, and I just hope that it will raise awareness
    of this growing problem among our teens in hopes to prevent
    other families from suffering such a devastating loss.
        I am here today because I want to help fight this war
    against drugs and too many people are dying.
        Congress needs to attempt to counter the growing trend of
    prescription drug abuse by passing a bill, the Ryan Haight
    Internet Pharmacy Consumer Protection Act or perhaps by adding
    Ryan's bill as a noncontroversial amendment to the prescription
    drug user fee which governs FDA issues and prescription drug
    review and addresses the safety issue incumbent in drug sales.
        I am a parent that belongs to a club that I never wanted to
    join. I am an ordinary person who could be your neighbor, your
    coworker, or member of your house of worship. But drugs took my
    son from me, and some days the grief is still unbearable. Drug
    abuse is an equal opportunity killer. It is not confined to one
    kind of neighborhood, one socioeconomic group, or one kind of
    child. Ryan was the boy next door. We need to do everything we
    can to protect our children. Tighter regulations on the sale of
    controlled substances on the Internet will not totally solve
    the drug problem, but I guarantee you it will help and it is a
    good place to start.
        Thank you for allowing me to speak and for listening to
    this very important issue. Ryan continues to make a difference.
    I just did not know he would be so far away.
        [The prepared statement of Ms. Haight appears as a
    submission for the record.]
        Chairman Leahy. Thank you very much, Ms. Haight. We were
    talking about your testimony last night at home. My wife is a
    registered nurse, and she is struck by what you said about
    having to account for all narcotics, and she remembers how
    careful those are checked and double-checked. You are
    absolutely right.
        Joseph Califano is the Founding Chairman and President of
    the National Center on Addiction and Substance Abuse, CASA. It
    is an independent, nonprofit think tank affiliated with
    Columbia University. He is an adjunct professor of public
    health at Columbia University's Medical School and School of
    Public Health and a member of the Institute of Medicine of the
    National Academy of Sciences. He has extensive experience in
    Government. He joined the Kennedy administration in 1961,
    served as general counsel of the Army and Special Assistant to
    the Secretary and Deputy Secretary of Defense. From 1965 to
    1969, he served as Special Assistant for Domestic Affairs to
    President Lyndon Johnson. From 1977 to 1979, he was Secretary
    of Health, Education, and Welfare in the Carter administration.
    He is a graduate of Holy Cross and Harvard University Law
    School.
        Mr. Califano, thank you for being here. Please go ahead.

     STATEMENT OF JOSEPH A. CALIFANO, JR., CHAIRMAN AND PRESIDENT,
        THE NATIONAL CENTER ON ADDICTION AND SUBSTANCE ABUSE AT
       COLUMBIA UNIVERSITY, AND FORMER SECRETARY, DEPARTMENT OF
           HEALTH, EDUCATION, AND WELFARE, NEW YORK, NEW YORK

        Mr. Califano. Thank you, Mr. Chairman, for the invitation
    to testify today. The National Center on Addiction and
    Substance Abuse at Columbia University has studied the Nation's
    problem of controlled prescription drug abuse and has
    documented for 4 consecutive years the Internet availability of
    these drugs.
        In 2005, CASA released its landmark report, ``Under the
    Counter: The Diversion and Abuse of Controlled Prescription
    Drugs in the U.S.'' This report revealed that our Nation is in
    the throes of a growing epidemic of controlled prescription
    drug abuse involving opioids like OxyContin and Vicodin,
    depressants like Valium and Xanax, and stimulants like Ritalin
    and Adderall.
        From 1992 to 2002, prescriptions written for such
    controlled drugs increased more than 150 percent, 12 times the
    rate of increase in our population and almost 3 times the rate
    of increase in prescriptions written for all other drugs.
        Mirroring this increase in prescriptions has been an
    increase in the abuse of these drugs. From 1992 to 2003, the
    overall number of Americans abusing controlled prescription
    drugs rose 94 percent, 7 times faster than the increase in the
    U.S. population. The number of 12- to 17-year-olds who abused
    controlled prescription drugs jumped 212 percent, more than
    triple.
        In 2003, the number of Americans who abused controlled
    prescription drugs exceeded as you said, Mr. Chairman, the
    combined number abusing cocaine and all other illegal drugs
    except marijuana, and they are on course to exceed abuse of
    marijuana on the track they are on. Abuse of controlled
    prescription drugs has grown at a rate twice that of marijuana
    abuse, 5 times that of cocaine abuse, 60 times that of heroin
    abuse.
        Particularly troubling are the implications for our
    children. From 1992 to 2002, new abuse of prescription opioids
    among 12- to 17-year-olds was up an astounding 542 percent,
    more than 4 times the rate of increase among adults. In 2003,
    nearly 1 in 10 12- to 17-year-olds abused at least one
    controlled prescription drug; for 83 percent of them, that drug
    was an opioid. Teens who abuse controlled prescription drugs
    are twice as likely to use alcohol, 5 times likelier to use
    marijuana, 12 times likelier to use heroin, 15 times likelier
    to use Ecstasy, and 21 times likelier to use cocaine, compared
    to teens who do not abuse such drugs.
        In 2005, 15.2 million Americans abused these drugs
    including more than 2 million teens. The explosion in the
    prescription of addictive opioids, depressants and stimulants
    has, for many children, made their parents' medicine cabinet a
    greater threat than the illegal street drug dealer. But,
    perhaps the most wide open substance supermarket in the world
    is the Internet. The Internet has become a pharmaceutical candy
    store, its shelves stacked with an array of addictive
    prescription drugs offering a high to any kid with a credit
    card at the click of a mouse.
        For 4 years now, at CASA, in collaboration with Beau Deitl
    & Associates, we have been tracking online access to controlled
    prescription drugs. In the first quarter of each year, we have
    devoted 210 hours to documenting the number of Internet sites
    advertising and dispensing controlled drugs. These findings are
    a snapshot of availability at a given point in time and show
    trends from year to year. They do not capture the total number
    of sites advertising or selling controlled prescription drugs
    online, which may be many times the numbers I am using now.
        Today CASA is releasing the fourth in its annual series of
    reports entitled `` `You've Got Drugs!' IV: Prescription Drug
    Pushers on the Internet.'' Here are the report's disturbing
    findings. From 2006 to 2007, there has been a 70-percent
    increase in the number of sites advertising or selling
    controlled prescription drugs over the Internet, from 342 to
    581; a 135-percent increase in the number of sites advertising
    controlled prescription drugs; a 7-percent increase in the
    number of sites selling controlled prescription drugs. Eighty-
    four percent of the sites selling controlled prescription drugs
    do not require a prescription from the patient's physician, and
    most of the remaining 16 percent of sites that ask for a
    prescription simply ask that it be faxed, allowing a customer
    to forge it or use the same prescription many times to load up
    on these drugs.
        There are no controls--no controls--to stop the sale of
    these drugs to children. Over the 4-year course of our
    analysis, the number of selling sites has climbed from 154 to
    187. Since there are no controls preventing sale of these drugs
    to children, all a child needs is a credit card number and
    access to a computer and ``You've Got Drugs!'' Efforts to crack
    down on this illegal trafficking are complicated by outdated
    Federal law written before the Internet and inadequate State
    laws.
        There is a mechanism in place for certifying Internet
    pharmacy practice sites. It is the National Association of
    Boards of Pharmacy, which verifies Internet pharmacy practice
    sites. However, the process is voluntary. Of the 187 sites
    found selling in 2007, only two were certified.
        The widespread threat to the public health demands that
    Congress now take action to: clarify Federal law to prohibit
    the sale or purchase of controlled prescription drugs online
    without an original prescription issued by a DEA-certified
    physician based on a physical examination and evaluation; and
    require certification of online pharmacies to assure that they
    meet rigorous standards of professional practice.
        The Feinstein-Sessions bill is a step in the right
    direction and an important step. We have a few suggestions to
    strengthen it that we can discuss with your staff, but we
    really applaud, Senator Feinstein and Senator Sessions, what
    you have done in introducing this bill.
        The report we are releasing today makes other
    recommendations that I hope you will consider.
        Mr. Chairman, just in closing, substance abuse and
    addiction--involving prescription drugs, alcohol, nicotine, all
    of it--is the Nation's most serious domestic problem. It is
    implicated in most crimes, most killing and crippling
    illnesses, most domestic violence, most child abuse, most
    homelessness, poverty, most teen pregnancy, and the wildfire
    spread of AIDS and other sexually transmitted diseases. I have
    titled my book on this subject ``High Society,'' and I will
    give you one simple fact. We Americans are 4 percent of the
    world's population; we consume two-thirds of the world's
    illegal drugs.
        This problem is all about kids. A kid who gets through age
    21 without smoking, using illegal drugs, or abusing
    prescription drugs or alcohol is virtually certain never to do
    so. Over the past 12 years, the fastest growing drug abuse
    among our Nation's children involves prescription drugs. I
    applaud the work of this Committee to curb the availability of
    these drugs. We will do anything to help.
        We are submitting our report along with my statement for
    the record, and we really appreciate, Senator Leahy, you and
    this Committee attending to this incredibly important problem.
        [The prepared statement of Mr. Califano appears as a
    submission for the record.]
        Chairman Leahy. Thank you very much, and the report will be
    part of the record.
        Professor Philip Heymann is currently the James Barr Ames
    Professor of Law at the Harvard University Law School.
    Professor Heymann has served at high levels in both the State
    and Justice Departments during the Kennedy, Johnson, Carter,
    and Clinton administrations, including serving as the Deputy
    Attorney General for the Justice Department from 1993 to 1994.
    He served as the Assistant Attorney General in charge of the
    Criminal Division from 1978 to 1981. He spent a lot of time in
    this room, I might add. He was Acting Administrator of the
    State Department's Bureau of Security and Consular Affairs,
    Deputy Assistant Secretary of State for the Bureau of
    International Organizations, and numerous other high-level
    positions in Government. He was also a former associate
    prosecutor and consultant on the Watergate Task Force. He also
    helped establish the Keep Internet and Neighborhoods Safe
    project and developed proposals to reduce illegal Internet
    prescription drug sales to youth. He is a graduate of Yale
    University and Harvard Law School and clerked for former
    Supreme Court Justice John Harlan.
        Professor, the floor is yours.

     STATEMENT OF PHILIP B. HEYMANN, JAMES BARR AMES PROFESSOR OF
     LAW, HARVARD LAW SCHOOL, AND FORMER DEPUTY ATTORNEY GENERAL,
                        CAMBRIDGE, MASSACHUSETTS

        Mr. Heymann. Thank you very much, Mr. Chairman and members
    of the Committee.
        With Mathea Falco, the Director of Drug Strategies, who is
    sitting behind me, we assembled a group of people from the
    major facilitators of this traffic and from the major
    enforcement agencies. On page 6, we list them in short:
    Verizon, AOL, AT&T, Earthlink, Microsoft, Comcast, Google,
    Yahoo!, UBS, Morgan Chase, MasterCard, Visa, Paypal; UPS, DHL,
    FedEx, the DEA with Joe as their representative, the Department
    of Justice, and so on.
        Because we wanted to address one aspect of this problem--
    which has been so well described that I am not going to repeat
    it. We find it of the same size and importance and danger that
    the others have described. But we saw in it the prospect of a
    new form of sale of contraband which is, we think, the world of
    globalization merged with the world of Internet. And we think
    that is going to change everything, limiting the reach of drug
    law enforcement no matter how important that may be, too.
        The fact of the matter is the Internet service provider may
    be in the Ukraine, the drugs may be in Somalia, the credit card
    user--the seller of the drugs, the receiver of the money may be
    in Turkmenistan. We are dealing with a brand-new world out
    there, and the aspect of this problem that engaged us was the
    international aspect--not yet the largest, probably. Most
    people probably get their prescription narcotics out of their
    parents medicine cabinet. But it will be the largest, and it
    will be the future. And we wanted to tackle the future, and we
    did in six full-day meetings.
        Now, the secret, we discovered, was that we could--that
    this traffic in Internet globalized contraband can only take
    place with the cooperation of credit card companies, Paypal,
    Internet service providers, search engines. If you think of it
    from the beginning, a search engine is out there advertising
    the sale of the drug. You cannot get to the advertisement--I am
    sorry. You click on the Google advice, and it will send you to
    thousands and thousands of responses to the search by OxyContin
    without prescription. And they will all be selling it without
    prescription at all. Of course, it is just as bad if they use a
    phony prescription, but they will not even bother to use a
    phony prescription. It will be sent in in a brown bag that
    looks like 2 trillion others coming into the customs offices in
    New York, and it will get through. And if it does not get
    through, the drugs will be replaced.
        So what can you do about this? The Judiciary Committee is
    looking at a brand-new problem, a brand-new dimension of a very
    old problem--a massive dimension--and it will be the same with
    everything that can be sold over the Internet, and it will be
    worldwide.
        OK. Here is what you can do. There is no reason why
    Internet service providers should be putting--they can easily
    remove from your household Internet connection anybody who is
    promising to sell OxyContin, Vicodin, any of a list of drugs,
    without prescription. It is no burden to them. They know how to
    do that. They are doing it now as to other things, such as
    pornography. They can do it in a minute. No cost.
        Google and Yahoo! and Microsoft can, when somebody puts in,
    as I did on Mother's Day, ``Buy OxyContin without
    prescription,'' and got 800,000 responses, including a chat
    room run by Google where you can talk to friends about where to
    buy OxyContin without prescription. When anybody searches for
    OxyContin without prescription, there can be a banner at the
    top of the Google, Yahoo!, or Microsoft search saying it is
    illegal to buy this without prescription. That message ought to
    come right away.
        MasterCard, Visa, Paypal, American Express should trace
    anybody who is offering to use their credit card as a device to
    pay for the purchase of one of these prescription narcotics
    without a prescription. They can do that, too. They do it if
    somebody is misusing their credit card. They do it if someone
    is cheating on their credit card. They can do it in a minute,
    no problem.
        So why aren't they doing it? In other words, we have
    powerful local companies, thankfully local, facilitating the
    sale of powerful narcotics to children over the Internet. They
    say they have two big problems. One problem is they do not know
    who they are dealing with. The other problem is that they are
    worried about legal liability.
        With this large group--and without them necessarily all
    agreeing with all of our recommendations, by a long shot, but
    generally in the same ballpark--we put together a model bill
    that would solve those two problems by: No. 1, creating a
    small, inexpensive but technically sophisticated organization,
    an Internet monitoring group that would go onto the Internet
    and see who is advertising the sale of powerful narcotics
    without a prescription, and notify the Internet service
    providers, the search engines, the carriers, like Federal
    Express, and the credit card companies. That would send them
    all into action, and we would not have to worry about their not
    being able to know. We can tell them who, if the Congress will
    create this small unit.
        Second of all, they need a safe harbor from liability if
    they act on the basis of the recommendations of the Internet
    monitoring group.
        With those two things, the only thing that we think is--
    right now we believe that the finance companies are bound by
    Treasury regulations to act vigorously to stop the use of
    credit cards in these sales. We believe that the Internet
    service providers are serious about their willingness to do
    this on their own, but we do not like the idea of not
    monitoring them and the finance companies.
        We, therefore, propose that there be an annual accounting
    to the Congress of the number of children--we take those
    figures every year--who are continuing to use narcotics over
    the Internet and an annual accounting of the cooperation of
    these large companies in their delivery.
        Thank you, and sorry for being over.
        [The prepared statement of Mr. Heymann appears as a
    submission for the record.]
        Chairman Leahy. That is all right. It is an important
    subject, and I have allowed time for everybody to go over.
        Senator Feinstein is leaving for a vote that has started,
    and I don't know whether, Senator Sessions, if you want to go.
    I am going to stay here and ask some questions. I will go to
    vote. When she comes back, she will reconvene it, or whichever
    one of us gets back first, we will reconvene it.
        Joseph Rannazzisi is the Deputy Assistant Administrator for
    the Office of Diversion Control at the Drug Enforcement Agency.
    He is responsible for overseeing and coordinating major
    diversion investigations, establishing drug production quotas
    and conducting liaisons with the pharmaceutical industry,
    international governments, State governments, other Federal
    agencies, and local law enforcement agencies. He has a degree
    in pharmacy from Butler University, received his J.D. degree
    from the Detroit College of Law at Michigan State University.
    He is a registered pharmacist in the State of Indiana.
        Thomas McLellan, Ph.D., is a professor of psychiatry at the
    University of Pennsylvania and Founder and Executive Director
    of the Treatment Research Institute in Philadelphia. He has
    published more than 300 articles and chapters in addition
    research, recently became the editor-in-chief of the journal
    Substance Abuse Treatment. Dr. McLellan is well known for his
    leading role in creating the Addiction Severity Index and the
    Treatment Services Review, two of the most widely used
    instruments in the field of substance abuse. His work at TRI is
    dedicated to reducing the devastating effect of alcohol and
    other drug abuse on individuals and families. He is a graduate
    of Colgate, Bryn Mawr College, and Oxford University.
        They will be available to answer questions. Their
    statements will be placed in the record. Under our rules, it
    did not arrive in time for statements to be given at this
    hearing.
        [The prepared statements of Mr. Rannazzisi and Mr. McLellan
    appear as submissions for the record.]
        Chairman Leahy. Ms. Haight, if I might--and, again, I
    emphasize, as both Senator Feinstein and Senator Sessions have
    said to me, I know this is painful. First, let me compliment
    you for speaking out. Those of us who can speak out from
    theoretical knowledge or reading the statistics is one thing.
    You speak out from personal knowledge. I think that is a far
    more compelling story. Unfortunately, I believe there are other
    people that could give the same kind of testimony, as you have
    discovered.
        What is the most important thing young people should know?
    Assuming somebody is actually watching this, what is the most
    important thing they should know about the dangers of
    purchasing prescription drugs over the Internet?
        Ms. Haight. Well, first of all, I think quite a few of the
    kids today, they are not aware of how prescription drugs are
    very dangerous and that they can cause death or addiction. And
    the kids really need to be aware and be educated upon
    prescription drugs because they are mostly afraid of cocaine or
    meth and those type of drugs and thinking that they are
    dangerous. And there has been a lot of education out there
    about that. But prescription drugs really is kind of the new
    trend for our youth to be using, and so I think it is really
    important that they are educated how dangerous these drugs
    really are.
        Also, they need to be educated that some of these drugs on
    the Internet are not what they are. A lot of them can be
    counterfeit. They have actually found that some drugs have been
    laced with heroin. Some drugs are twice the potency of what
    they say they are because they want them to become addicted.
    These drug dealers want them to come back and buy.
        Chairman Leahy. Do we change the law then? Do we have to
    change the law to protect the public from these kinds of
    online--
        Ms. Haight. Yes, and, therefore, we need a law. And these
    doctors that are writing prescriptions are saying, hey, it is
    not illegal.
        Chairman Leahy. You would like to see us make it illegal?
        Ms. Haight. Absolutely. Absolutely. We need to do
    everything we can to protect our youth, and adults as well,
    that are finding themselves in this situation.
        Chairman Leahy. Mr. Rannazzisi, would you agree with that?
        Mr. Rannazzisi. Yes, absolutely. The perception of
    children, the perception of adults that controlled substances
    that are pharmaceutical are safe and effective because they are
    manufactured--or safe because they are manufactured by a drug
    company is really -it is a misperception that could be deadly.
    We have seen this over and over again. There was a study done
    where a large percentage of adolescents showed--basically
    reported that they thought--their perception was that these
    drugs were safe to take, where they would rather take those
    drugs than cocaine or heroin. So that perception is out there.
    So that is absolutely correct.
        Chairman Leahy. Secretary Califano?
        Mr. Califano. I think that what Joe just said is absolutely
    right. We survey teens every year. We have been surveying 12-
    to 17-year-olds for 11 years, Mr. Chairman, and it is quite
    clear that they think these drugs are safer than street drugs.
    They do not understand that they aren't.
        I think it is very important, in addition to law, the kind
    of legal suggestions that Professor Heymann made, which are
    very similar to the ones in the CASA report released today to
    also think parents are very important here. I think parents
    have really got to understand they are the front line, until we
    get a law passed, in terms of how their kids use the Internet,
    what they are using the Internet for. And it is very difficult.
    It is very difficult, but they--
        Chairman Leahy. Well, and I think there, I think if parents
    are watching this, this may be an eye opener to them, what is
    available there. If we have prescriptions to be filled, we go
    to the same pharmacy. They make it easy. You can call up on a
    touch-tone phone or a computer, but it is a pharmacy and it is
    the same pharmacist, it is with the records. We will get
    questions asked when we go there, and I am delighted to see it.
    I mean, they know who I am. They will ask for an ID just the
    same. And I think this should be done. And a lot of parents are
    used to that same thing.
        I think this may be an eye opener to a lot of parents. You
    know, we have--going on computers, these kids are pretty smart,
    and it is pretty easy to hide what they are doing, the chat
    rooms, the number of chat rooms. The professor raised about on
    OxyContin, I mean, the back-door way you can go. Professor, I
    assume you feel we should be changing the law to make this
    tighter.
        Mr. Heymann. Mr. Chairman, we believe that the law should
    be changed and tightened, and certainly the doctors who issue
    prescriptions without ever seeing the patient should be subject
    to sanctions of some sort. But we keep seeing the end game as a
    question of companies spread across the globe dealing highly
    anonymously with kids in--
        Chairman Leahy. Azerbaijan.
        Mr. Heymann. And the only way to deal with that is to
    enlist the cooperation--and I think it will be forthcoming--of
    the search engines, the Internet service providers, and the
    financing companies.
        Chairman Leahy. But don't you need something beyond just a
    banner that says ``Caution, this is an illegal"--I mean, you
    have got to have the site blocked, don't you?
        Mr. Heymann. That is correct. The banner comes from the
    search engine. The Internet service provider should block the
    site at the request of any parents.
        Chairman Leahy. I think it should be blocked, period, I
    mean, if you are doing it this way.
        Mr. Heymann. It should be blocked, period. There is some
    remote First Amendment problems. It is easy, otherwise.
        Chairman Leahy. I think we can handle that part. I yield to
    nobody in the defense of the First Amendment, but I think there
    is a way of doing that. I think you are getting very close to
    yelling ``Fire'' in a crowded theater here.
        Dr. McLellan?
        Mr. McLellan. One thing I would like to add is that in a
    sort of darkly paradoxical way, it is safer to buy drugs over
    the Internet; at least the drugs are much more dangerous than
    commonly perceived. But if your choices are to go--I live in
    Philadelphia--to 52nd and Baltimore and purchase something from
    a thug versus have it delivered into the comfort and privacy of
    your home with virtual certainty, it is safer.
        So in many ways, it is an enticement to start drug use, and
    that is something that I think has not been brought out. A lot
    of policy in this country is considered around starting drugs,
    like cigarettes and marijuana. There are kids today starting
    drug abuse with Vicodin, starting drug abuse with OxyContin,
    because it is easier.
        Chairman Leahy. Thank you. Doctor, I am not trying to cut
    you off, but I just got handed a note I have 4\1/2\ minutes to
    get to the floor to vote. We will stand in recess until either
    Senator Feinstein or I come back, and we will pick up where we
    left off.
        [Recess at 10:56 a.m. to 11:04 a.m.]

      STATEMENT OF HON. DIANNE FEINSTEIN, A U.S. SENATOR FROM THE
                          STATE OF CALIFORNIA

        Senator Feinstein. [Presiding.] We will reconvene the
    hearing and continue on.
        Mrs. Haight, I just want to say welcome. It is wonderful to
    have you here again. As you know, it was the death of your son
    that really brought my attention to this issue. And as Mr.
    Califano has continued on with it, we see how extensive it is
    and how many people are able to really receive drugs that
    otherwise would require the prescription of a physician. So I
    thank you, and although Ryan is not with us, he has made a
    major contribution to this effort. I want you to know that.
        Mr. Califano, I think your report is excellent. I would
    certainly recommend it to everyone to take a look at this and
    read it. And Senator Sessions and I have put forward a bill
    which, as you say, does certain basic things. I believe I would
    be supportive of adding that banner that you spoke of, Mr.
    Heymann, to the legislation, and I will talk with Senator
    Sessions about doing that, see if we can do it. As you know, we
    have changed some sentences in this. I think you have raised
    what for me is a very disturbing part of this, and that is, the
    world community is now such that the Internet facilitates all
    kinds of criminal enterprises as well as legitimate
    enterprises, and Government becomes not able to regulate.
        I had to leave to vote, and it was a big vote. This is a
    vote on Iraq. If any of you have any other suggestions of how
    Senator Sessions and I might tighten up our legislation, the
    floor would be open to you.
        I will start with you, Dr. Heymann.
        Mr. Heymann. Thank you very much, Senator Feinstein. Of our
    recommendations, the banner is in some sense the least
    important. Again, our total focus is on the international
    aspect. That is where we think it is going, where it
    substantially is, and we think that is the growth area, and we
    are very anxious, careful to urge you not to close one of two
    doors and just let the traffic go through the second door. That
    will not reduce anything.
        Our most important recommendation is that a monitoring
    group inform MasterCard, Visa, American Express, Paypal
    whenever it finds their logos at the bottom of an offer to sell
    a prescription drug over the Internet without prescription.
        Senator Feinstein. In other words, that our bill create
    this group and empower this group to at least inform--is this
    what you are saying?
        Mr. Heymann. We think that one the financing companies are
    informed, present Treasury regulations require them to take
    action to stop the transaction and to report the transaction to
    law enforcement, the purported transaction.
        Mr. McLellan. And they do it every day.
        Mr. Heymann. And they do it. But they say--we do not
    believe that they know who it is--they are not monitoring the
    website with the rigor--the websites, the Internet, with the
    rigor that they have to if we are going to make it dangerous
    for someone to sell in exchange for a credit card payment.
        So we would like perhaps Treasury to make it perfectly
    clear that that is required whenever they get information, a
    lead that someone is selling narcotics without a prescription
    over the Internet using their credit card, and we would like to
    have an organization, a very small one--we called it an
    Internet monitoring group--whose full-time business it would be
    to monitor the Internet and, with the push of a button, send to
    the credit card companies, to Paypal--to the Internet service
    providers, too, because we want something from them--
    information about who is offering to sell without a
    prescription.
        Senator Feinstein. I would invite Senator Sessions to
    become involved in this, too, and sort of open it up. My
    concern is the term ``monitoring group,'' which is not an
    official organ of Government, that it seems to me it would be
    the responsibility of a Government agency to do this and be
    empowered with authority to even shut down the site?
        Mr. Heymann. Shutting down the site is, let's say, our
    second most important option. But that will be less useful
    because it will quickly be replaced. And to monitor sites even
    now will require a medium sophisticated program because
    apparently most of the sites are hijacked websites. I was
    working on it with Mathea Falco a month or two ago, and we
    played it out, and the site turns out to be the University of
    Oregon. Somebody has just hacked into the University of Oregon,
    put up there an offer to sell drugs, and so you have to get
    behind that offer, which will only, I am told, last for hours.
    It is a hijacked front. You have to get behind that to who is
    the real seller, and for that it takes a medium sophisticated
    program.
        Senator Feinstein. Yes, sir, would you like to add
    something? Then Mr. Califano.
        Mr. McLellan. If I could just add to that, the Treatment
    Research Institute has worked with Drug Strategies and Harvard
    in doing this, and we think the simplest of all strategies is
    to simply follow the money. The reflex impulse is to close
    something down and have a Government action. Please keep in
    mind now 88 percent of these sites and the figures behind the
    sites are offshore in countries where it is not necessarily
    illegal for them to sell drugs to Americans. It is illegal for
    us to buy.
        Please keep in mind also that there are issues of
    entrapment and less than perfect boundaries about authority for
    the Government agencies. That is why we specifically suggested
    a nongovernmental group provide actionable evidence. If you had
    somebody going on a site and actually attempting to purchase
    and the credit card number were exercised by that company, that
    is actionable evidence. And in hearings that were conducted by
    Professor Heymann, we have heard nothing but support from the
    credit card companies, the delivery agencies, the whole chain
    of supply, the money supply. So we think that may be the
    strongest, if imperfect, way of bringing this to a restricted
    end.
        Senator Feinstein. Mr. Califano, did you want to say
    something?
        Mr. Califano. I share your concern. I would not have it as
    an independent agency. I think if something like this is going
    to be done, it should be done by Government that is going to be
    responsive, not a private agency.
        I do want to second something that Phil said, though. If
    you notice in our CASA report, just on the sampling of sites we
    took, of the 152 sites we identified in 2004, by 2005 all but
    29 of them were gone. As we have done this in that 210-hour
    period, in the course of just those 210 hours, sites disappear
    and pop up again. So that is a very difficult problem.
        I do think that it should be against the law to have on the
    Internet any pharmacy that has not been certified, and I think
    that alone can have a substantial impact here. And there is a
    system in place for certifying pharmacies, and that can be
    helpful.
        I think the other parts of your law are--I think it is a
    good statute, and my instincts would be to give a good portion
    of this authority to the DEA, which is the right agency to go
    after this stuff. I think it is terribly important. And I also
    think there is an education campaign here that is important,
    that we need, whether through the Internet or other places, to
    educate parents and children about the dangers of abusing these
    prescription drugs. That is one thing.
        I think we need to have the Food and Drug Administration be
    required to press these pharmaceutical companies to formulate
    these drugs in ways that make them much harder to abuse.
    OxyContin, all you have to do is crush it, and you could snort
    it, and you have got your heroin high. That is an inexcusable
    kind of approval, and I think also when there are addictive
    drugs that are being allowed to come on the market, before they
    come on the market, the Food and Drug Administration should
    have a plan--require the pharmaceutical company to have a
    detailed plan about what to do on the first indication of
    abuse. That was not true with respect to OxyContin. The plan
    came afterwards.
        Aside from all the criminal conduct of those individuals, I
    think things like that are necessary as well.
        Senator Feinstein. Thank you.
        Mr. Rannazzisi, do you have a comment to make on this,
    specifically whether it be a Government responsibility or some
    private entity?
        Mr. Rannazzisi. Well, ma'am, we reviewed that proposal, and
    at this moment in time we are not prepared to provide a
    recommendation or comment. But I would like to get back to
    something that we have discussed before with certification in
    the pharmacies.
        We look at this as two separate problems. There is a our
    domestic problem and our international problem. Obviously, we
    have no regulatory control over international pharmacies, and
    most of these are not even pharmacies. They are just storefront
    operations. But we do have regulatory control over the domestic
    pharmacies, and as we talked about certifying, DEA does not
    certify pharmacies to operate on the Internet. DEA registers
    pharmacies to procure and dispense controlled substances
    pursuant to a legitimate or valid prescription.
        If you look at the first placard up there, that is a
    comparison of a brick-and-mortar pharmacy, your normal brick-
    and-mortar pharmacy that operates in your community every day.
    That is an average number. They dispense about 88,000 tablets
    of hydrocodone a year, hydrocodone combination products. Now,
    if you look at the 2.9 million, that is a rogue Internet
    pharmacy. Now, remember, a rogue Internet pharmacy is a DEA
    registrant. Somewhere down the line on that Internet site, they
    are going to have to get their drugs, if they are domestic,
    from a brick-and-mortar pharmacy that is servicing that
    Internet site. The 2.9 million is the average. We took 34 known
    and suspected Internet pharmacies and looked at their purchase
    records for 2006. Nearly 99 million hydrocodone combination
    products were sold out of those pharmacies 99 million. So you
    could see the great difference.
        If you look at the second placard, the cyber pharmacies, as
    compared to the brick-and-mortar pharmacies, your average
    brick-and-mortar pharmacy does about 89 percent of
    noncontrolled substances as compared to 11 percent of
    controlled substances. Now, if you look at those cyber
    pharmacies, about 95 percent--they are not full-range
    pharmacies 95 percent of their sales are controlled substance
    sales as compared to about 5 percent, about 425 prescriptions a
    day. So you could see there is a major difference between the
    brick-and-mortar cyber pharmacies and--
        Senator Feinstein. What are you saying? I mean, do not
    mince words. What are you saying?
        Mr. Rannazzisi. What I am saying is that those are rogue
    pharmacies that are dispensing outside the scope of good
    practice. They are doing something illegally.
        Senator Feinstein. So are you saying do not worry about
    them, just let them continue?
        Mr. Rannazzisi. No. I am saying that we have to do
    something about, yes, absolutely, and we are.
        Senator Feinstein. I am sorry. I am not aware of what you
    are doing.
        Mr. Rannazzisi. OK. For starters, we are starting to look
    at their purchase records. Every Internet pharmacy that we have
    seen has a purchase footprint. We know based on their sales
    that they are Internet pharmacies. So what are we doing? In
    addition to going after them criminally, we are also going
    after them--we are taking their registrations--
        Senator Feinstein. How many have you gone after criminally?
        Mr. Rannazzisi. Organization-wise, I could not tell you the
    exact number. I could get back to you on the exact number.
        Senator Feinstein. Yes, we would like to have the number.
        Mr. Rannazzisi. Absolutely. But I can tell you that we have
    been shutting these pharmacies down using our regulatory
    authority and immediate suspension authority. We have gone
    after them and immediately taken their registration so they
    cannot dispense and procure controlled substances.
        Senator Feinstein. Let me just say something. I introduced
    this bill with Senator Sessions in 2004. We have heard nothing
    from you. There is no comment on the bill, there are no
    suggestions, there is nothing--which indicates to me that it is
    an agency that is not taking this very seriously, to be very
    candid with you.
        Mr. Rannazzisi. Well, I take exception to that, ma'am. We
    do take it seriously. In fact, you know, as you can see, using
    our regulatory authority, we are shutting these down. We are
    going after the distributor instead of the--
        Senator Feinstein. I would like to know how many you have
    shut down, and today you cannot answer that question.
        Mr. Rannazzisi. I will give you an exact number.
        Senator Feinstein. I appreciate that.
        Senator Sessions, would you like to take over? I know a
    second vote has been called. Or perhaps we should recess again?
        Senator Sessions. I may not be able to come back after this
    vote, so I would appreciate the opportunity to share a few
    thoughts with the panel.
        Senator Feinstein. You go ahead.
        Senator Sessions. And thank you for your work on this
    legislation, your commitment to it. These charts up here are
    stunning to me. I thought it was bad, but it is worse than I
    thought.
        Senator Feinstein. It is.
        Senator Sessions. That is a stunning, stunning chart, and I
    really should not be surprised based on the experience that I
    have had in which you see people want these drugs, they learn
    how to make money off of them, they may be personally addicted
    to them, they just want to try them, whatever.
        Senator Feinstein. Senator, will you continue then?
        Senator Sessions. Yes.
        Senator Feinstein. I will go and vote and try and come
    back. Senator Leahy may be back in the interim.
        Senator Sessions. Thank you.
        Senator Feinstein. Thank you.
        Senator Sessions. [Presiding.] All right. Let me ask this.
    Mr. Rannazzisi, you talked about--I believe, Mr. Heymann, you
    served as Deputy Attorney General. I remember him here a number
    of times, know his experience. He has indicated that there are
    sites up all over saying ``OxyContin without a prescription.''
    Now, how can you get OxyContin without a prescription? I mean,
    how can this be? Publicly or all over the Internet, hundreds of
    sites, apparently.
        Mr. Rannazzisi. From our experience, those sites are
    probably operating overseas because OxyContin or oxycodone
    products are Schedule II. The level--
        Senator Sessions. Which means they have to have a--
        Mr. Rannazzisi. A written prescription.
        Senator Sessions. And if you go to a physician and the
    pharmacy, they account for every single pill.
        Mr. Rannazzisi. That is absolutely correct.
        Senator Sessions. Everything is done to the nth degree. The
    prescriptions have to be maintained and kept so your people
    can--now, Mr. Secretary, Mr. Heymann, you have been through
    this Government rigmarole over the years. Both of you have. I
    am aware of how hard it is for the DEA to get a foreign country
    to cooperate or move quickly against these sites. It is just a
    nightmare for agencies. Could the State Department, if they
    made it a high priority, a condition of good relations or
    trade, is it a feasible thing to think that we could pressure
    these companies in the foreign countries?
        Mr. Califano. I think the odds of the State Department
    giving this a high priority are very, very low, and I will just
    give you--I go all the way back to the Johnson years. When we
    first saw heroin coming out of the ghettos and into broader
    society, I talked to Dean Rusk, and I said, you know, ``We have
    got to do something with Turkey.'' That is where all the heroin
    was coming from in 1967. And he said, ``Well, we have to be
    very careful about Turkey. We need Turkey as an ally in the
    cold war, and we have to be very measured in our response.''
        The same attitude existed when I was Secretary of HEW. In
    that 2\1/2\ years, trying to get the State Department--with
    someone as distinguished and as special as Cyrus Vance being
    the Secretary--we could not get the State Department to give
    this subject any priority.
        Senator Sessions. Secretary Shultz was not very interested
    in it, either.
        Mr. Califano. Secretary Shultz was not interested in it.
    And I dare say that if you went to Condoleezza Rice and said,
    you know, ``We are getting killed by all this stuff coming
    in''--it is prescription drugs. It is all illegal drugs, the
    marijuana, the heroin, the cocaine pouring in here, heroin from
    Afghanistan. We are going to have the cheapest heroin in the
    history of the country because of what is happening, the way it
    is coming out of there. If you said, ``Make that a priority,''
    I do not think it is real. That is why I think we need
    something like this statute--
        Senator Sessions. Now, you think it is impractical--Dr.
    McLellan, you nodded, and I think Professor Heymann--to expect
    that we could solve this problem in that fashion. We probably
    should not go into the details of it because our time is short.
    But is it being shipped from these foreign countries?
        Mr. McLellan. One of the things that is being missed is it
    is not just registered pharmacies in Afghanistan. Remember,
    they are called ``rogue pharmacies.'' These are little
    factories that are making Vicodin and OxyContin knock-offs. By
    all means, they have opiate in them, but they are very
    difficult to regulate, too. And as Phil said, they pop up and
    they shut down.
        I repeat, taking nothing away from all the typical Federal
    ways to go at this, I suggest right now follow the money. Get
    the source of the dollars and squeeze that neck with the
    cooperation of existing--and they are very cooperative. The
    credit card companies, the banks behind those companies, and
    the delivery agencies want to stop this.
        Senator Sessions. Well, we have a group of people--a small
    group, maybe--who think the Internet is a crime-free zone; that
    is, nothing is a crime on the Internet. And it is religion with
    them and that to mess with it at all is a heresy of some kind,
    a sinful act. But do not want to mess up the Internet and turn
    it into a lawsuit-creating mishmash of regulations and all.
        Professor Heymann, your idea was that the credit card
    companies could work with this in a way that they would be
    happy with?
        Mr. Heymann. The answer, Senator, is yes. But we simply do
    not think that law enforcement--we think DEA has the least
    chance of being effective as a law enforcement agency operating
    in the Ukraine or in Somalia because it would require an
    extradition for DEA to make a case. So, first of all, we will
    not get any cooperation. Second of all, DEA's concern is making
    a case before an American court.
        The State Department will also have difficulty, but now and
    then it may very well be able to press the Ukraine or Somalia
    to bring a case against a rogue seller in those places. But we
    think the problem is one of scale. My calculation is that every
    year, just OxyContin and Vicodin are going to more than half a
    million high school students. Every year.
        Senator Sessions. A half a million?
        Mr. Heymann. Half a million. And so we have to find a way
    to deal with that problem with scale. One case is not going to
    help much. That is why we want the credit card companies to
    systematically go after everybody who is--and they are trained
    to do this. They are doing it under money-laundering
    legislation that you have passed, and they are very good at it,
    and they are very accustomed to it. We want them to track down
    which is the bank that is making payment to a dealer. And if
    they find the bank, they can have a contract, which it is very
    hard for us to regulate a bank, the United States to regulate a
    bank in the Ukraine.
        Senator Sessions. My vote time has expired. I hope I have
    not missed it. If you do not mind, we will return, I am sure.
        Mr. Heymann. I would appreciate that, Mr. Sessions.
        [Recess at 11:28 a.m. to 11:46 a.m.]
        Chairman Leahy. [Presiding.] You know, it is interesting.
    This is an example of C-SPAN. While I was on the floor voting--
    and this last vote is still going on--I had two or three
    Senators in both parties come up to me and talk about this
    hearing and what they have been seeing, some of the information
    they are getting and saying, ``We have got to talk with you and
    with Senator Feinstein and Senator Sessions about this.'' They
    did not realize what the problem is. So in case you are
    wondering, even with this back and forth whether it carries, it
    does.
        Now, we have learned today--and this is a question for
    everybody on the panel. We have learned today about online
    rogue pharmacies. They are using electronic forms rather than
    in-person consultations to give out bogus prescriptions for
    prescription drugs, including highly addictive painkillers. And
    it appears that one of the loopholes used by what are, I think
    we would all agree, unscrupulous online pharmacies that allow
    access to drugs illegally on the Internet.
        I want to emphasize that the drug store my family and I go
    to, and others, if you have tight controls in there, it can be
    very helpful, both to be able to go online or to call and use a
    touch-tone phone. But what Senator Feinstein has done is
    introduce legislation to require in-person consultation with
    doctors for any purchase of controlled drugs over the Internet.
    I cannot imagine how that would in any way inconvenience--it
    certainly would not inconvenience anybody in our family. I
    think Senator Feinstein's legislation could be a first step in
    attacking the serious problem.
        So let me ask the person from DEA, do you support
    legislation to require in-person consultations for
    prescriptions used to buy controlled drugs over the Internet?
        Mr. Rannazzisi. DEA, the Department of Justice, and the
    administration are looking at all different measures that could
    be implemented. At this point in time, we are not prepared to
    make a recommendation of a specific measure.
        Chairman Leahy. When will you be?
        Mr. Rannazzisi. I cannot give you an answer right now, sir.
    I could tell you right now that all levels of the Department,
    the Domestic Policy Council, HHS, we are all looking at this
    together. We are having regular meetings to discuss these
    issues.
        Chairman Leahy. Do you have any recommendations that have
    been made?
        Mr. Rannazzisi. Not at this point in time, sir, no.
        Chairman Leahy. Thank you.
        Secretary Califano?
        Mr. Califano. Let me just note--and it is in our CASA
    report we are releasing today. This is the American Medical
    Association. ``Physicians who prescribe medications via the
    Internet shall establish or have established a valid patient-
    physician relationship. The physician shall obtain a reliable
    medical history and perform a physical examination on the
    patient.''
        Chairman Leahy. So by this you would agree with Senator
    Feinstein?
        Mr. Califano. There is no question about that. The four
    elements of a doctor-patient relationship are that the patient
    has a medical complaint, that a medical history is taken, that
    a physical examination has been performed, and that some
    logical connection exists between the medical complaint, the
    medical history, the physical examination, the drug prescribed.
    So it is right on. And the Federation of State Medical Boards
    agrees with you, too, Senator Feinstein.
        Chairman Leahy. Professor Heymann?
        Mr. Heymann. As I remember Senator Feinstein's proposal, it
    requires at least one meeting, one live meeting with a doctor.
    That seems to me to be exactly right.
        Chairman Leahy. Ms. Haight?
        Ms. Haight. Yes, I agree with that totally. That is how it
    has always been in hospitals.
        Chairman Leahy. Dr. McLellan?
        Mr. McLellan. Well, I think it is completely appropriate
    for all legitimate pharmacies, all legitimate physicians, and
    especially those in the United States. I remind you that more
    than 80 percent of everything we are talking about has
    essentially nothing to do with the United States--
        Chairman Leahy. I understand. I am trying to figure out,
    though, what kind of laws are in place that make it easier to
    block those others, which goes to what Professor Heymann has
    said about the First Amendment things. You are going to have to
    have certain legal requirements if you are going to block
    activity which then becomes illegal and do it constitutionally.
        Mr. Heymann. Senator Leahy, our answer to that was to have
    Internet access blocked for sellers of prescription narcotics
    only at the request of the households. In other words, any
    Internet service provider would have to ask every household to
    which it provides Internet service, ``Do you want this to be
    blocked?'' If they said yes, they would then block any further
    offers to sell drugs.
        Chairman Leahy. How many did you find on Mother's Day when
    you went on?
        Mr. Heymann. Well, they have not done that yet, but I
    literally--you know, the Google number at the top--
        Chairman Leahy. Someone has a BlackBerry nearby.
        Senator Feinstein. Me. Sorry.
        Chairman Leahy. You are getting a lot of supportive
    testimony, Senator Feinstein. Do not block that.
        [Laughter.]
        Chairman Leahy. Go ahead.
        Mr. Heymann. The google number at the top was 800,000. I
    looked and my search was for ``Buy OxyContin without
    prescription.'' It was not Vicodin. It was not steroids. It was
    a single drug, though many of them would overlap. And I only
    looked at the first 20 or 30, but each of them looked to me
    like a purchase--like an offer to sell a highly addictive
    narcotic to anybody without bothering with a prescription.
        Chairman Leahy. Well, the thing that gets me--I mean, I
    want to find some way to stop it. I think everybody agrees,
    parents would agree, we do not want pornography to go to our
    kids. But kids can move around pretty quickly, usually a lot
    better than parents can, on the Internet because they live on
    it. I told the story of a 4-year-old grandson wanting to do an
    interactive--I think it was Disney or something like that, a
    perfectly appropriate thing where you could draw pictures, do
    interactive things. He wanted to use the computer to do it. And
    I said, ``Fine, but I have to get the site for you,'' because I
    wanted to make sure that is exactly the site. The site came up,
    and he said, ``Yes, that is the one,'' took the mouse out of my
    hand and said, ``I better take over now because it gets very
    complicated.''
        [Laughter.]
        Chairman Leahy. You mentioned OxyContin. We know how they
    misrepresent how addictive their drugs were in marketing and
    advertising. The press has been full of this, especially the
    last couple of weeks. According to court records, the makers of
    the drug, Purdue Pharmaceuticals, agreed to pay more than $600
    million in fines and penalties. And three of its top executives
    admitted they were responsible for misleading those who bought
    and prescribed the drugs.
        Do we need to change how we regulate these kinds of
    painkillers? We will go one, two, three, four, five. Go ahead,
    Mr. Califano.
        Mr. Califano. I would make a note of a couple of things.
        One, a quarter of these sites we know claim to be in the
    United States. That has been consistent over the 4 years we
    have done this sample. About half of them say they are
    overseas, and about a quarter of them are unknown origin. So
    there are sites in the United States.
        Two, with respect to what happened with Purdue Pharma, my
    own view is if those guys had been street drug dealers, they
    would be in jail, and they did just as much damage as street
    drug dealers. So they walked.
        And, last, vis-a-vis Senator Feinstein's point, I would
    like to quote--we have a quote from Joe Rannazzisi in our
    report that we are releasing today, and let me read it. ``A
    legitimate doctor-patient relationship includes a face-to-face
    consultation where a licensed physician can examine the
    physical symptoms reported by a patient before making a
    diagnosis and authorizing the purchase of a prescription
    medicine. Filling out a questionnaire, no matter how detailed,
    is no substitute for this relationship.'' And I realize he does
    not have authority to support in a formal way what you propose
    in your bill, but that certainly supports it.
        Mr. Heymann. We think that there has to be somewhere--and I
    am about ready to concede to Senator Feinstein and to Joe that
    perhaps it should be a governmental responsibility. There has
    to be someone who is monitoring the Internet to see if
    somebody--to see the long list of people who are offering to
    sell prescription narcotics without a prescription.
        Once that is done--and I suggest you put it in the Office
    of Justice Programs, Senator Feinstein. I do not think it is
    DEA because it is not law enforcement, and the law enforcement
    is the focus for DEA. And Mr. Califano has already commented on
    the likelihood that the State Department would be very
    vigorous. It will not be very vigorous. I would give it to OJP,
    the Office of Justice Programs, and tell them to set up a small
    unit. We are talking about five, ten people. A few thousand
    dollars will create the programs, and then whenever they get
    information, send it to the credit card companies and expect
    the credit card companies to cutoff the credit and track down
    who is getting it, and send it to the Internet service
    providers and expect the Internet service providers to add it
    to their list that is cutoff from any family that does not want
    these ads coming into their house.
        Chairman Leahy. I have actually gone beyond my time. I am
    on Senator Feinstein's time. I am going to hand it over to her.
    Does anybody wish to add very, very briefly to what was said?
        [No response.]
        Chairman Leahy. OK. Thank you.
        Senator Feinstein, I cannot thank you enough for bringing
    up this subject, and I can assure you we will work on it, and
    the Committee will followup on it.
        Senator Feinstein. [Presiding.] Well, thank you very much,
    Mr. Chairman, and thank you for having the hearing because I
    think it was very constructive. I myself think that we have to
    develop this second part of it, and we will proceed to do so.
        I do not know what is wrong with DEA, but something is. All
    during the methamphetamine discussion, which has gone on for 10
    years from when I introduced the first bill in 1996 to the last
    bill that we did with Senator Talent, I have asked for DEA
    help, and DEA is nowhere. And now once again, on this issue,
    which clearly by your own chart is a big issue and clearly by
    the statement that Secretary Califano read, you have got to
    agree with it. And yet I do not know whether it is partisan or
    what it is, but I cannot get help on these matters from DEA. So
    I would like to just publicly ask for help. I would welcome
    DEA's suggestions. I know Senator Sessions will as well. We
    would like to make this as strong a bill as possible; that
    people who sell drugs illegally over the Internet without a
    physician's prescription, without a physician visit, should be
    prevented from doing so; and if they continue, shut down. That
    is my view, and we are trying to get as close to that as we
    possibly can.
        I do not know that the Internet should be able to
    facilitate acts which are not legal in this country. But when
    you have young people who, as Senator Leahy testified and Mrs.
    Haight testified with her son, are so facile on the Internet,
    are young, want to try anything, can have exposure to a whole
    illegal field of very powerful drugs, it is extraordinarily
    dangerous.
        Dr. Heymann, I am amazed. This was on Mother's Day that you
    pulled up 800,000 sites? Or was it hits?
        Mr. Heymann. Let me send you what I pulled up, Senator
    Feinstein.
        Senator Feinstein. Well, could you define for me again what
    it was?
        Mr. Heymann. I put into Google, ``Buy OxyContin without
    prescription.'' I believe the number was 800,000 hits. In an
    instant, 800,000 hits. I looked through the first 20 to make
    sure we were not picking up a lot of other things, and the
    first 20 were overwhelmingly offers to sell OxyContin using a
    credit card to whoever pushed a button on that website.
        Senator Feinstein. Do you remember how many of these were
    in country as opposed to out of country?
        Mr. Heymann. You cannot tell from the website, though Dr.
    McLellan has some judgment on that.
        Mr. McLellan. Yes, in fact, our group was the group that
    discovered this. Dr. Robert Forman had the first article about
    this, and we have been tracking it scientifically since then.
    And, by the way, 800,000 is about the same number for that
    substance since 2002. And I say that because, to the credit of
    DEA and the credit of a lot of law enforcement, there have been
    a lot of busts in this country, and they have knocked out huge
    rings, and it does not stop because they pop up just as fast.
    The market is overwhelming. There is a very brisk business in
    this, and it is not going to go away simply by local law
    enforcement.
        You can tell the registry of a site by digging into, you
    know, where it is--that takes a lot more work. It is almost not
    worth it because literally tomorrow, if you stopped my website
    today, literally tomorrow, and in another country, in the snap
    of a finger, I would have another one up.
        Senator Feinstein. And the drug, Dr. Heymann, that you were
    looking for was OxyContin?
        Mr. Heymann. It was OxyContin, and Vicodin would have been
    many more, I suspect. Many more than 800,000. It was OxyContin.
        Senator Feinstein. All right. Does--
        Mr. McLellan. Two million nine hundred thousand.
        Senator Feinstein. Two million nine hundred thousand?
        Mr. McLellan. For Vicodin.
        Senator Feinstein. Hits for Vicodin?
        Mr. McLellan. If you put ``No prescription Vicodin''--
        Senator Feinstein. Would you turn on your microphone,
    please?
        Mr. McLellan. Sorry. If you put the words ``No prescription
    Vicodin'' in Google, right here, right now, you will have no
    less than 2,500,000 hits.
        Senator Feinstein. So, clearly, I mean--
        Mr. McLellan. And 88 percent of them are direct offers to
    sell. I should just say one quick thing. Remember, a telephone
    is a computer. Now it is clear that if you have a purchase and
    you give them your website, they will text message you. Some of
    these pharmacies will text message you, ``Need a refill?'' And
    if the kid says ``Yes,'' you get billed in ring tones, almost
    as though they are trying to make it impossible for Mom and Dad
    to check as to what is actually being bought.
        Senator Feinstein. Clearly, there is a big problem, and
    clearly, DEA ought to be producing some solutions. I would like
    to ask for those solutions. I would like to ask, respectfully,
    for DEA's views, any suggestions you might have as to how we
    can take actions which can effectively stop this. I just hate
    to think that we have to throw up our hands and say it cannot
    be stopped.
        Mr. Rannazzisi. Ma'am, if I may, we have never said that it
    cannot be stopped, and we will provide any technical advice
    that you need, and I think we have to your staff in the past.
    But the fact remains that when you do a search like that, most
    of those are portals or informationsites. When you get right
    down to it, when you get right down to the anchor sites that
    are selling the drugs, there are far fewer than 800,000, or
    whatever the number is. And domestically those sites are being
    serviced by one pharmacy or two pharmacies or a hundred
    pharmacies. Each pharmacy is servicing--I do not know how many.
    They could be servicing 30, 40, 50 websites. So the key is not
    the sites. The key is those pharmacies. The key is to hit the
    pharmacies and to shut them down. The sites are going to
    regenerate.
        Senator Feinstein. Well, then, why doesn't DEA shut them
    down in this country?
        Mr. Rannazzisi. We are. We are using our regulatory
    authority--
        Senator Feinstein. Again, I have asked you how many have
    you shut down, and you cannot give me a number.
        Mr. Rannazzisi. And I told you, ma'am, I will give you an
    exact number that we have shut down.
        Senator Feinstein. I was just handed your written remarks,
    which during 2006, SOD has coordinated over 90 investigations
    resulting in the arrest of 64 individuals and the seizure of
    approximately 14 million dosage units of controlled substances
    and approximately $30.9 million in United States currency.
        Mr. Rannazzisi. Yes, ma'am. You wanted the number of
    pharmacies.
        Senator Feinstein. So at least you were doing something.
        Mr. Rannazzisi. Well, in all of our investigations, we
    follow the money, and we put people in jail. That is what our
    job is. But you wanted an exact number of pharmacies that we
    shut down, and I told you I would get back to you on that.
        Senator Feinstein. OK. Fair enough. Fair enough.
        Mr. Rannazzisi. OK.
        Senator Feinstein. I think the other thing is any
    suggestions DEA might have for legislation which is aimed at
    shutting them down. I recognize the Constitution, I recognize
    the difficulties, but we have to find a way to do this.
        Mr. Rannazzisi. Yes, ma'am.
        Senator Feinstein. I think that is probably it, unless
    somebody else has something that they would like to say. I
    would like to thank you all very much. I know some of you came
    from long distances, and it is very much appreciated.
        So thank you, and this hearing is adjourned.
        [Whereupon, at 12:05 p.m., the Committee was adjourned.]
        [Questions and answers and submissions for the record
    follow.]
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