    [House Hearing, 112 Congress]
    [From the U.S. Government Publishing Office]

                       PRESCRIPTION DRUG ABUSE EPIDEMIC
                                   IN AMERICA

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

                                    HEARING

                                   BEFORE THE

                       SUBCOMMITTEE ON CRIME, TERRORISM,

                             AND HOMELAND SECURITY

                                     OF THE

                           COMMITTEE ON THE JUDICIARY

                            HOUSE OF REPRESENTATIVES

                          ONE HUNDRED TWELFTH CONGRESS

                                 SECOND SESSION

                                   __________

                                 MARCH 7, 2012

                                   __________

                               Serial No. 112-95

                                   __________

             Printed for the use of the Committee on the Judiciary

          Available via the World Wide Web: http://judiciary.house.gov

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                           COMMITTEE ON THE JUDICIARY

                          LAMAR SMITH, Texas, Chairman
    F. JAMES SENSENBRENNER, Jr.,         JOHN CONYERS, Jr., Michigan
        Wisconsin                        HOWARD L. BERMAN, California
    HOWARD COBLE, North Carolina         JERROLD NADLER, New York
    ELTON GALLEGLY, California           ROBERT C. ``BOBBY'' SCOTT,
    BOB GOODLATTE, Virginia                  Virginia
    DANIEL E. LUNGREN, California        MELVIN L. WATT, North Carolina
    STEVE CHABOT, Ohio                   ZOE LOFGREN, California
    DARRELL E. ISSA, California          SHEILA JACKSON LEE, Texas
    MIKE PENCE, Indiana                  MAXINE WATERS, California
    J. RANDY FORBES, Virginia            STEVE COHEN, Tennessee
    STEVE KING, Iowa                     HENRY C. ``HANK'' JOHNSON, Jr.,
    TRENT FRANKS, Arizona                  Georgia
    LOUIE GOHMERT, Texas                 PEDRO R. PIERLUISI, Puerto Rico
    JIM JORDAN, Ohio                     MIKE QUIGLEY, Illinois
    TED POE, Texas                       JUDY CHU, California
    JASON CHAFFETZ, Utah                 TED DEUTCH, Florida
    TIM GRIFFIN, Arkansas                LINDA T. SANCHEZ, California
    TOM MARINO, Pennsylvania             JARED POLIS, Colorado
    TREY GOWDY, South Carolina
    DENNIS ROSS, Florida
    SANDY ADAMS, Florida
    BEN QUAYLE, Arizona
    MARK AMODEI, Nevada

               Richard Hertling, Staff Director and Chief Counsel
           Perry Apelbaum, Minority Staff Director and Chief Counsel
                                     ------

            Subcommittee on Crime, Terrorism, and Homeland Security

                F. JAMES SENSENBRENNER, Jr., Wisconsin, Chairman

                      LOUIE GOHMERT, Texas, Vice-Chairman

    BOB GOODLATTE, Virginia              ROBERT C. ``BOBBY'' SCOTT,
    DANIEL E. LUNGREN, California        Virginia
    J. RANDY FORBES, Virginia            STEVE COHEN, Tennessee
    TED POE, Texas                       HENRY C. ``HANK'' JOHNSON, Jr.,
    JASON CHAFFETZ, Utah                   Georgia
    TIM GRIFFIN, Arkansas                PEDRO R. PIERLUISI, Puerto Rico
    TOM MARINO, Pennsylvania             JUDY CHU, California
    TREY GOWDY, South Carolina           TED DEUTCH, Florida
    SANDY ADAMS, Florida                 SHEILA JACKSON LEE, Texas
    MARK AMODEI, Nevada                  MIKE QUIGLEY, Illinois
                                         JARED POLIS, Colorado

                         Caroline Lynch, Chief Counsel

                         Bobby Vassar, Minority Counsel

                                C O N T E N T S

                                  ----------

                                 MARCH 7, 2012

                                                                       Page

                               OPENING STATEMENTS

    The Honorable F. James Sensenbrenner, Jr., a Representative in
      Congress from the State of Wisconsin, and Chairman,
      Subcommittee on Crime, Terrorism, and Homeland Security........     1
    The Honorable Robert C. ``Bobby'' Scott, a Representative in
      Congress from the State of Virginia, and Ranking Member,
      Subcommittee on Crime, Terrorism, and Homeland Security........     2

                                   WITNESSES

    The Honorable Harold Rogers, a Representative in Congress from
      the State of Kentucky
      Oral Testimony.................................................    11
      Prepared Statement.............................................    13
    The Honorable Nick J. Rahall, II, a Representative in Congress
      from the State of West Virginia
      Oral Testimony.................................................    18
      Prepared Statement.............................................    20
    The Honorable Mary Bono Mack, a Representative in Congress from
      the State of California
      Oral Testimony.................................................    22
      Prepared Statement.............................................    24
    The Honorable Stephen F. Lynch, a Representative in Congress from
      the State of Massachusetts
      Oral Testimony.................................................    27
      Prepared Statement.............................................    29

                                    APPENDIX
                   Material Submitted for the Hearing Record

    NIH Public Access Study on Opiod Deaths in Rual Virginia.........    45
    Prepared Statement of Ameritox, Inc..............................    65
    Prepared Statement of Anne McGee, Director, Cabell County
      Substance Abuse Prevention Partnership.........................    68
    Prepared Statement of Greg Puckett, Executive Director, Community
      Connections, Inc...............................................    70
    Prepared Statement of Timothy Bradley, Captain, West Virginia
      State Police...................................................    85
    Prepared Statement of Kimberly Becher, MD; and Kane Maiers, MD,
      Paul Ambrose Health Policy Fellows, Marshall University
      Department of Family and Community Health......................    88

                       PRESCRIPTION DRUG ABUSE EPIDEMIC
                                   IN AMERICA

                                  ----------

                            WEDNESDAY, MARCH 7, 2012

                  House of Representatives,
                  Subcommittee on Crime, Terrorism,
                                 and Homeland Security,
                                    Committee on the Judiciary,
                                                        Washington, DC.

        The Subcommittee met, pursuant to call, at 10:02 a.m., in
    room 2141, Rayburn Office Building, the Honorable F. James
    Sensenbrenner, Jr., (Chairman of the Subcommittee) presiding.
        Present: Representatives Sensenbrenner, Goodlatte, Marino,
    Gowdy, Adams, Conyers, Scott, and Jackson Lee.
        Staff present: Caroline Lynch, Majority Chief Counsel;
    Arthur Radford Baker and Tony Angeli, Majority Counsel; Ron
    LeGrand and Ashley McDonald, Minority Counsel; Lindsay
    Hamilton, Clerk; and Veronica Eligan.
        Mr. Sensenbrenner. The Subcommittee on Crime will come to
    order. Without objection, the Chair will be authorized to
    declare recesses during votes in the House.
        The Chair yields himself 5 minutes, in order to make an
    opening statement.
        Today's hearing examines the subject of prescription drug
    abuse in America. According to the most recent data from the
    U.S. Centers for Disease Control and Prevention, legal and
    illicit drugs killed almost 40,000 people nationwide in 2009.
    Over 100 people die from drug overdoses in the United States
    every day.
        Nearly 3 out of 4 prescription drug overdoses are caused by
    prescription painkillers, also called opioid pain relievers.
    Common examples of these painkillers are Vicodin, Percocet,
    OxyContin, and Demerol.
        In 2008, there were nearly 15,000 deaths from prescription
    painkiller overdoses. For every one of these deaths, there are
    10 admissions for drug abuse treatment, and 32 emergency room
    visits for misuse or abuse of prescription drugs. That amounts
    to over 475,000 emergency room visits per year, a number which
    has doubled in just the last 5 years.
        Prescription painkillers work by decreasing the perception
    of pain. These powerful drugs can create feelings of euphoria,
    cause physical dependence, and frequently lead to addiction.
    Prescription painkillers also slow down a person's breathing. A
    person abusing prescription painkillers might take increasingly
    larger doses to achieve a euphoric effect. These larger doses
    can cause breathing to slow down so much that breathing stops,
    resulting in a fatal overdose.
        Very few prescription drugs involved in overdoses come from
    pharmacy theft. The vast majority come from physicians'
    prescriptions obtained by one person and sold or given to
    another. More than 3 out of 4 people who misuse prescription
    painkillers get their drugs from someone else. For the past few
    years, individuals who doctor shop, or seek care from multiple
    physicians, but fraudulently pretend to be in pain, have been a
    primary source of diverted prescription drugs.
        The law enforcement officials in Florida, once the
    epicenter of prescription drug diversion, have left other
    States to initiate expensive enforcement programs, as the so-
    called pill mills migrate across the country.
        Prescription drug abuse has been an epidemic for much too
    long. Some of the more notable people who have died from
    prescription drugs include Marilyn Monroe, Bruce Lee, and Elvis
    Presley. Even former Indiana Senator Edward A. Hannegan
    overdosed on morphine in 1859. In December of 2010, a 13-year-
    old Utah boy died after stealing a bottle of OxyContin from a
    kitchen counter of a friend's house. He took all the pills in
    the bottle, except one, and died in his sleep. Famous or not,
    no one is immune from the grip of prescription drug overdose.
        This hearing will explore the growing issue of prescription
    drug abuse in our Nation. We have here today four distinguished
    Members of Congress, who have dedicated their efforts to stop
    prescription abuse in America. I look forward to hearing about
    their legislative proposals and other efforts to address a
    serious national challenge. And I would like to thank our
    witnesses for participating in today's hearing.
        It is now my pleasure to recognize for his opening
    statement, the Ranking Member of the Subcommittee, the
    gentleman from Virginia, Mr. Scott.
        Mr. Scott. Thank you, Mr. Chairman. Mr. Chairman,
    prescription drug abuse is a serious problem. The number of
    overdose fatalities has increased dramatically over the recent
    years. I must admit, though, Mr. Chairman, I am puzzled as to
    the purpose and usefulness of today's hearing. I am used to
    hearings being an opportunity for witnesses to put forth
    varying views regarding an issue or issues before us, with the
    opportunity to question such witnesses to gain a keener insight
    and understanding of the issues.
        We would then have a legislative hearing for further input
    and analysis, including legal analysis, and ensuring that we
    have constitutional and effective legislation. While I have no
    doubt that our colleagues who are witnesses today will provide
    helpful information, I anticipate that they will discuss the
    bills that they have sponsored or cosponsored, which makes them
    advocates for the bills, and limits us to one side of the
    debate on the issues raised by those bills.
        Therefore, I trust and also ask that this hearing not serve
    as the only basis for any Judiciary Committee or other
    consideration of legislation that we will hear about, but
    merely serve as a traditional opportunity we give Members, on
    occasion, to appear before us to present their legislation.
        The bills I anticipate my colleagues will discuss as
    witnesses include H.R. 1316, 1065, 1925, and 2119. To the
    extent that they provide additional education, training, and
    research on safer administration and use of prescription drugs,
    I am inclined to believe that they may contribute to
    effectively addressing the problem. However, to the extent that
    they impose congressionally mandated restrictions on access to
    legitimate medications and business-as-usual draconian
    increases in Federal penalties, I am inclined to believe that
    they will be counterproductive.
        Such approach is not likely to be successful, as our
    efforts to effectively address elicit drugs. They will lead to
    over criminalization, over federalization, and cause many
    people the laws purport to protect to end up with unjust and
    inflexible prison terms, such as the mandatory minimums, which
    one of the bills calls for.
        Mandatory minimums have been proven to be a waste of the
    taxpayers' money, and violate common sense, when compared to
    traditional sentencing. And I would ask unanimous consent, Mr.
    Chairman, to introduce the Rand study that points this out.
        Mr. Sensenbrenner. Without objection.
        [The information referred to follows:]

                                   __________

        Mr. Scott. When we think of a pill mill operator dispensing
    death and destruction on a mass scale, we may conclude that no
    punishment is too great, but without definition of what limits
    the application of such person to such circumstances, the,
    quote, Pill mill operator may be a college student in a dorm
    room, with a bunch of pills given to his dorm mates.
        What has proven to work best to address drug abuse, in
    general, including prescription drug abuse are evidence-based
    solutions aimed at preventing drug abuse addiction, injury, and
    death, rather than inflexibly rushing to increased penalties,
    and restrict legitimate excess to prescriptive drugs.
        We should not continue to take the same approaches, hoping
    for different results. I am not saying that we should not
    punish lawmakers, but we are already using the criminal justice
    system as much as reductively can be used. We now need to focus
    on prevention and early intervention.
        There are innovative evidence-based approaches that are not
    likely to be discussed today. One is the use of Naloxone. That
    is a lifesaving medicine used to reverse opiate-based drug
    overdoses. It has been FDA approved since 1971, and is the
    first line of treatment for paramedics and emergency room
    physicians who encounter an opiate overdose victim.
        It presents no potential for abuse, because it has no
    pharmacological effect. It has no effect if it is taken by a
    person who does not have opiates in their system. It takes as
    little as 2 minutes to start working, and provides a 30- to 90-
    minute window to call for medical assistance during a drug
    overdose.
        Drugs that can be reversed are heroin, OxyContin,
    methadone, Vicontin, and several other drugs. If we are
    concerned about drug overdose deaths, we should be considering
    this as one of the suggestions.
        The second thing we need to consider, Mr. Chairman, are a
    911 Good Samaritan law. The chance of surviving an overdose
    like that, of surviving a heart attack, depends greatly on how
    fast one receives medical treatment. Witnesses to heart attacks
    rarely think twice about calling 911, but witnesses to an
    overdose often hesitate to call, or simply don't make a call,
    because they fear police involvement.
        People using illegal drugs often fear arrest, even in cases
    where they need professional and medical advice, or assistance
    for a friend or family member. The best way to encourage
    overdose witnesses to speak up and call 911 is to provide some
    kind of immunity to those that make such calls.
        Mr. Chairman, such legislation does not protect people from
    arrest for other offenses, such as outstanding warrants or
    other crimes, but this policy protects only the caller and the
    overdose victim from arrest and prosecution, simply for calling
    911. Several State legislatures, including New York, New
    Mexico, Washington, Illinois, and Connecticut have passed 911
    Good Samaritan laws, and Congress should consider doing the
    same.
        For the reasons stated above, Mr. Chairman, I agree with my
    colleagues that prescription drug abuse is an issue about which
    we should be concerned. Anyone who has a friend that is a
    physician or a dentist will recite patients that present with
    symptoms that call for these drugs, and they go doctor to
    doctor, shopping, and we need to do something about those who
    will actually prescribe to those patients. But we should not
    rush to enact such legislation without thorough assessment of
    the effective options we have before us, and I certainly do not
    agree that imposing more severe mandatory minimums on
    physicians and pharmacists, who provide legitimate medications,
    would be a good use of our time or efforts.
        Mr. Chairman, I would ask, also, unanimous consent to enter
    into the record a letter to us from the Drug Policy Alliance.
        Mr. Sensenbrenner. Without objection.
        [The information referred to follows:]

                                   __________

        Mr. Sensenbrenner. It is now my pleasure to introduce
    today's witnesses.
        Hal Rogers has represented the Fifth District of Kentucky
    since 1981. He currently serves as Chairman of the House
    Appropriations Committee, of which he has been a Member for 29
    years. He received both his bachelor of arts and LLB from the
    University of Kentucky.
        Congressman Nick Rahall has represented the Third District
    of West Virginia since 1976. He currently serves as the Ranking
    Member of the House Transportation and Infrastructure
    Committee, and received his bachelor of arts from Duke
    University in 1971.
        Mary Bono Mack has represented the 45th District of
    California since 1998. Ms. Bono Mack sits on the House Energy
    and Commerce Committee, and serves as Chairwoman of the
    Subcommittee on Commerce, Manufacturing, and Trade. She
    received her BFA from the University of Southern California in
    1984.
        Congressman Stephen Lynch has represented the Ninth
    District of Massachusetts since 2001. He currently sits on the
    Financial Services Committee, and the Committee on Oversight
    and Government Reform, where he serves as Ranking Member of the
    Subcommittee on Federal Workforce, U.S. Postal Service, and
    Labor Policy. He received his bachelor of arts degree from
    Wentworth Institute of Technology and his master in public
    administration in 1998, from Harvard.
        Without objection, all of the witnesses' written statements
    will be entered into the record in their entirety. And I ask
    that you please summarize your testimony in 5 minutes or less.
    And we will start out with Congressman Rogers, since I kind of
    respect seniority.

     TESTIMONY OF THE HONORABLE HAROLD ROGERS, A REPRESENTATIVE IN
                  CONGRESS FROM THE STATE OF KENTUCKY

        Mr. Rogers. I thank you, Mr. Chairman. Chairman
    Sensenbrenner, Ranking Member Scott, Mr. Gowdy, and other
    Members of this great Committee, thank you for granting me a
    few minutes to speak on an epidemic that quietly began in rural
    parts of Kentucky, West Virginia, and Virginia, one doctor at a
    time, and now grips every corner of our great Nation in
    prolific fashion. As you will no doubt hear from the panelists
    and fellow Members of the Congressional Caucus on Prescription
    Drug Abuse, the statistics about this problem speak volumes.
        In 2010, Mr. Chairman, 254 million prescriptions for
    opioids were filled in the U.S. That is enough painkillers to
    medicate every single American adult around the clock for a
    month. ONDCP has identified prescription drugs as the fastest
    growing drug problem, easily eclipsing cocaine and heroin
    abuse.
        Our military soldiers are coming back from war hooked on
    these pain pills. In the last 2 years, over 150 soldiers have
    died from overdoses. In my home state, we are losing about 82
    people a month to prescription drug abuse. More than car
    crashes. Our medicine cabinets are more dangerous than our
    cars.
        But statistics are just numbers. The four of us on this
    panel each have been touched in a personal way by this tragedy.
    In some counties in my district, Mr. Chairman, 50 percent of
    all children are living in a home without their parents, over
    half, in large part, because of prescription drug abuse.
        I have met with single moms struggling to get through drug
    court, kids living with foster parents, unsure of where their
    real parents are. We have lost mothers, grandfathers, police
    officers to this scourge. My home county sheriff, Sam Catron,
    community leader, personal friend, dedicated public servant,
    was assassinated, because of his pursuit of prescription drug
    traffickers. A tragic loss. My field representative's nephew, a
    physician in my district, was shot down, senselessly, by a
    disgruntled drug abuser unable to get his fix.
        The most dangerous job in my district? The driver of a
    delivery truck, UPS, FedEx, carrying drugs by mail. I suspect
    my colleagues have similar stories that they would share. This
    epidemic touches big city movie stars and rugged mountain men,
    and it has to stop.
        We all recognize that this problem will require a
    coordinated multi-pronged approach that incorporates law
    enforcement, treatment, education, and research. I have worked
    closely with Congressman Frank Wolf, to stand up a leading
    grant program in the Department of Justice, which supports
    State-run prescription drug monitoring programs. PDMPs monitor
    the sale and purchases of controlled substances, bridging the
    gap between legitimate medical need and potential misuse.
        Since 2002, we have seen the number of States with
    authorized PDMPs triple from 15 to 48. That is a huge
    accomplishment, but our work is nowhere near done. The next
    challenge will be facilitating the secure interstate exchange
    of data among these PDMPs, so we can eliminate once and for all
    the doctor shopping which has fueled the pill pipeline around
    our country.
        In the next few weeks, I plan to introduce legislation to
    support the DOJ in opening up lines of communications between
    States. At the appropriate time, I would request that you give
    this bill, Mr. Chairman, your immediate consideration.
        I also helped to establish an organization in my
    congressional district called Operation UNITE, standing for
    Unlawful Narcotics, Investigations, Treatment, Education. It is
    a bright star in our charge to empower our youth and create an
    anti-drug culture, and knock out abuse for good. So far, on the
    law enforcement side of that organization, it covers some 42
    counties. Those undercover agents, some 30 of them, have sent
    to the prison around 4,000 pushers, in just my district.
        UNITE, with its focus on investigations, treatment, and
    education, is a fantastic model, ripe for replication around
    the country. Operation UNITE is the lead sponsor for the
    national RX drug summit later this spring in Florida.
        Collectively, Ms. Bono Mack, Mr. Rahall, Mr. Lynch, and
    others have introduced a number of bills focused on law
    enforcement, prescriber education, and research that would help
    to curb the rising tide of abuse. Many of them have been
    referred to this Subcommittee.
        While I appreciate the opportunity to elevate this issue,
    which continues to plague my people and communities around the
    country, I would much rather see your Subcommittee mark up
    these bills, move the ball forward, and take decisive action to
    end this debilitating drug problem. And I stand ready, Mr.
    Chairman, Members of the Committee, willing and able to assist
    you in any way that you might request.
        [The prepared statement of Mr. Rogers follows:]

                                   __________

        Mr. Sensenbrenner. Thank you very much, Mr. Rogers. And I
    understand that you have an appropriations meeting to go to.
    So, I think it is best we excuse you. But don't forget the
    appropriation for our Subcommittee for our Subcommittee,
    please. [Laughter.]
        Mr. Rogers. Rest assured, Mr. Chairman.

    TESTIMONY OF THE HONORABLE NICK J. RAHALL, II, A REPRESENTATIVE
              IN CONGRESS FROM THE STATE OF WEST VIRGINIA

        Mr. Rahall. Thank you, Mr. Chairman. I appreciate the
    opportunity to be before your distinguished Committee today.
    And while I do outrank Mr. Rogers in seniority, I certainly
    agree with you yielding to him first, as the Chairman of the
    Appropriations Committee, and my dear friend and neighbor from
    across the river, in my district.
        Mr. Sensenbrenner. Praise will get you a long way, my
    friend.
        Mr. Rahall. I appreciate that, Mr. Chairman. And I
    certainly associate myself with his testimony, and commend him
    for his efforts in organizing UNITE, to which he referred in
    his testimony. I appreciate the efforts of my colleague from
    California, Ms. Bono Mack, and from Massachusetts, Mr. Lynch.
        This is an issue that crosses all partisan lines,
    philosophical lines, class lines, every line in our society.
    This issue crosses and affects all of us.
        I will be presenting testimony to the Subcommittee on
    behalf of law enforcement officials from my district,
    healthcare professionals, and community leaders. And I am sure
    this Subcommittee will make this testimony public in our
    continued efforts to educate the public and the American people
    as to this tremendous epidemic that faces all of us.
        It was once described as America's silent epidemic, but it
    can now be openly witnessed any hour, any day, or any night on
    countless street corners across the country. It is the
    crippling epidemic of prescription drug abuse that we are
    facing. And every day we face new stories and reports of
    overdoses, deaths, accidents, families torn apart by the
    vicious cycle of prescription drug abuse.
        Headlines such as this, dealing with addiction in McDonough
    County, in my district. These appear every day in every
    newspaper. And believe you, me, they are touching stories about
    how these communities are trying to deal with this vicious
    cycle.
        Unlike cocaine or heroin, as Mr. Rogers has said,
    prescription drugs are legal, frequently prescribed by caring
    physicians, lead by the principle oath of ``First, do no
    harm.'' Yet, alarming statistics show that children and adults
    are blind to the harmful consequences of these drugs. Even as
    they become addicted, paying upwards of $150 per pill to buy
    them on the black market.
        Distressingly, my home State of West Virginia has our
    Nation's highest rate of drug-related deaths. In fact, between
    2001 and 2008, more than 9 out of 10 of those deaths involved
    prescription drugs. And incredibly, as Mr. Rogers has, again,
    pointed out, drug overdoses now kill more West Virginians than
    car accidents.
        But the alarming use and deaths by prescription drugs is
    not just in West Virginia. As our other distinguished Members
    will testify, it is across this country. And I could go into
    the figures, Mr. Chairman, but you have those figures as well,
    about what drug overdose death rates are in this great country,
    how they have tripled since 1990, and have never been higher in
    our Nation's history.
        I have met numerous times with law enforcement, community
    organizations, educators, physicians, and many more of my
    constituents. We have had drug summits, and we will continue to
    have networking processes in which we try to involve all
    aspects of our community, and to involve those that are
    personally affected, to get them to get to communicate. If they
    don't want to openly, at least at these networking seminars,
    with those law enforcement officials with whom, perhaps, they
    have been afraid to have contact in the past, but now find a
    forum, and find other people in like circumstances as them, and
    which their fear is no longer preventing them from coming
    forward and telling what is happening on the streets, and how
    they feel the problem can be addressed.
        So, these networks are important. This hearing is vitally
    important. We must strengthen drug diversion, educate our
    children and adults on prevention, work with the medical
    community on addiction and pain treatment, and treat and
    rehabilitate those that are affected by this vicious addiction
    before they succumb to the death spiral.
        There are a number of pieces of legislation I and my
    colleagues have joined in cosponsoring. This Subcommittee is
    certainly aware of those. And I leave it in your wisdom to join
    these bills, perhaps, or to pick, as you see as most
    appropriate, which bills should make it to the floor of the
    House of Representatives. But many bills will establish
    mandatory physician and consumer education, as well as
    authorizing Federal funding to help States create and maintain
    prescription drug monitoring programs that all States can
    access.
        This is one of the bills that I have introduced. It would
    set up a uniform system for tracking painkiller-related deaths,
    helping States and law enforcement personnel to be able to
    manage and report data. The West Virginia State Police, our
    attorneys general, and even physicians all consistently stress
    the need to access a prescription drug monitoring system that
    is shared between State lines and updated in real time.
        So, Mr. Chairman, I urge you and this Subcommittee to
    consider and move forward on legislation that encompasses the
    provisions I have mentioned, and many others. Let us act with
    dispatch and compassion, with an acute understanding of the
    enormity of the challenge before us.
        I conclude by thanking you once again for conducting this
    hearing, and allowing me and my colleagues to be with you.
        [The prepared statement of Mr. Rahall follows:]

                                   __________

        Mr. Sensenbrenner. Thank you very much, Mr. Rahall.
        Ms. Bono Mack.

    TESTIMONY OF THE HONORABLE MARY BONO MACK, A REPRESENTATIVE IN
                 CONGRESS FROM THE STATE OF CALIFORNIA

        Ms. Bono Mack. Thank you, Mr. Chairman. I am honored to be
    here with my colleagues, as you hold this critically important
    hearing on the growing and deadly dangers prescription drug
    abuse poses to our Nation.
        One incident last year, in particular, graphically captures
    the seriousness of this issue. On June 19th, in Medford, New
    York, a man walked into a pharmacy and murdered four people for
    11,000 tablets of Hydrocodone. One of those gunned down was a
    33-year-old customer, who was just engaged to be married.
    Instead, she was buried in her wedding dress. A 17-year-old
    pharmacy employee was also killed, and later buried in her prom
    dress, along with her high school diploma.
        This senseless tragedy is just one example of a growing
    wave of drugstore robberies by prescription drug addicts. But
    it is also part of a larger rapidly escalating struggle
    nationwide against prescription drug abuse and addiction, which
    is expected to claim the lives of nearly 30,000 Americans this
    year. Just last weekend, I met in California with dozens of
    parents who have lost children to this horrible epidemic.
        Two classes of medicines, painkillers, and insomnia and
    anxiety drugs, are responsible for about 70 deaths and nearly
    3,000 emergency room visits every day. That is right, a day.
    And these are truly stunning numbers.
        But what is very insidious is the way these powerfully
    addictive narcotic prescription drugs quickly turn people,
    without any real emotional or physical problems into desperate
    people suddenly facing life-or-death struggles. Few things are
    more destructive.
        According to the CDC, drug overdose is now the leading
    cause of injury death in the United States, not just in West
    Virginia, but in the United States, in large part due to
    prescription drug abuse. It is not hard to understand why.
    Today, some 12.5 million Americans regularly abuse prescription
    drugs, and the problem, as I have said, is growing rapidly.
    There are approximately 7,000 new abusers every day, many of
    them teenagers and young adults.
        This alarming trend, now a health epidemic, according to
    CDC, is taking a huge toll on society. Today, the abuse of
    prescription drugs, especially painkillers, stimulants, and
    depressants, is the fastest growing drug problem in America.
        As Chairman of the House Subcommittee on Commerce,
    Manufacturing, and Trade, which has jurisdiction over consumer
    protection, I have made combating prescription drug abuse a top
    priority. I believe there needs to be a national awakening
    about the threat this alarming epidemic poses to our families
    and to our communities. Simply put, we are in the midst of an
    American tragedy.
        What can we do? For starters, we must do a better job of
    monitoring and limiting access to prescription drugs containing
    controlled-release oxycodone hydrochloride, including the
    popular painkiller and killer, OxyContin.
        Originally, OxyContin was intended to be prescribed only
    for severe pain, as a way to help patients dealing with last-
    stage cancer and other severe illnesses. Today, however, more
    and more people across America are prescribed OxyContin, as
    well as other generic oxycodone drugs for less severe reasons,
    clinically known as moderate pain, greatly expanding the
    availability and potential for abuse of these powerful
    addictive narcotics. Someone with a toothache or a sore knee
    should not be prescribed a potentially addictive painkiller.
        Clearly, expanded public education plays a role in
    addressing the problem, but we are not going to make any real
    progress until we limit access to these powerful narcotic
    drugs, and ensure that only patients in severe pain can obtain
    them.
        We must also improve prescriber education by getting
    doctors, dentists, nurse practitioners, and other prescribers
    up to speed on the dangers of addiction. Today, I have
    legislation pending in Congress, the Ryan Creedon Act, H.R.
    2119, to accomplish this goal.
        The pervasiveness of prescription drug abuse made national
    headlines when Federal, State, and local law enforcement
    agencies, led by the DEA, cracked down on so-called pill mills
    in Florida, where painkillers were routinely dispensed just
    like M&Ms from a gumball machine.
        Congress needs to make it much more difficult for these
    rogue pain clinics to operate, and we should treat offenders
    like any other street drug dealer. By better coordinating the
    efforts of local, State, and national agencies, and by reducing
    the supply of highly addictive opioid painkillers, I am
    convinced that we can eventually save thousands of lives, and
    spare millions of American families from the heartache of
    addiction. Mr. Chairman, no child should ever be buried in a
    prom dress again, because we ignored this problem.
        And I just want to say, in closing, that this past weekend,
    when I met with these parents, a number of them spoke about a
    Dr. Lisa Tseng, in Rowland Heights, California, who is being
    charged for three counts of murder for supplying prescription
    drugs to young men, who all overdosed. These parents went and
    confronted the doctor, and she showed absolutely no remorse,
    whatsoever. And I think we should do all we can to ensure she
    is put away for a very, very long time, if she is found guilty.
        So, thank you very much for allowing me to testify today.
        [The prepared statement of Ms. Bono Mack follows:]

                                   __________

        Mr. Sensenbrenner. Thank you very much.
        Mr. Lynch.

     TESTIMONY OF THE HONORABLE STEPHEN F. LYNCH, A REPRESENTATIVE
              IN CONGRESS FROM THE STATE OF MASSACHUSETTS

        Mr. Lynch. Thank you, Mr. Chairman, and Ranking Member
    Scott, for your kindness in allowing us to testify on this
    important issue.
        My colleagues have told the story of drug abuse in America
    today, but I do want to amplify the issue that Ms. Bono was
    speaking about, and that is OxyContin. I will associate myself
    with the remarks of the 3 previous speakers, and rather than
    take my whole 5 minutes, I just want to offer a couple
    thoughts.
        Number one, this OxyContin is so powerful, it is so
    powerful that in a very limited period of time a person who is
    prescribed this becomes addicted. And we have seen stats now
    that 99 percent of addicts who are involved with heroin, that
    are in facilities today in the United States, started on
    OxyContin. And the pattern is that they stay on OxyContin until
    they are financially unable to do so, and then they switch over
    to heroin, which is much, much cheaper.
        But when you allow a company to create a product that is so
    powerfully addictive that in a very short time they create
    customers for life, that is a very troubling situation. It got
    so bad in my district that I had to create, well, a residential
    rehab facility, first, for boys, and then later for girls,
    because these kids are getting addicted so young, there is
    nowhere else to send them. We didn't have any adolescent rehab
    facilities in my State. So, we had to create two.
        We have a situation now where Perdue Pharma lost their
    exclusivity, and now OxyContin is going to go generic. This is
    tremendously powerful. And think about this, the profits here
    are enormous. We are creating a national healthcare system that
    will allow all of these people to continue to financially get
    the support from these pill mills, the drug from these pill
    mills, having the American taxpayer contribute to that. So,
    this is a very, very dangerous situation.
        And I noticed that on March 1, OxyContin was actually
    pulled from the shelves in Canada. That is according to the
    Toronto Star and the CBC news. I sponsored legislation here in
    Congress several years ago to remove OxyContin from the market.
    But, let's face it, there are so many drug company lobbyists up
    here that that bill didn't have a prayer, because the
    pharmaceutical company lobbyists outnumber Members of Congress
    probably 7 to 1.
        We have a serious problem here. And I commend you for
    giving us the time here to try to address it. And I commend my
    colleagues for the fights that they are making in their own
    districts, and now, hopefully, we will be able to collectively
    use our experience to push this issue nationally.
        So, I thank you for your time. I appreciate it. And I yield
    back the balance of my time.
        [The prepared statement of Mr. Lynch follows:]

                                   __________

        Mr. Sensenbrenner. Thank you, Mr. Lynch.
        I would like to thank all of the Members of Congress who
    took time out of their schedules to come and testify here, as
    well as the Members on the Subcommittee who have come and
    listened to all of these graphic stories. And I am sure that
    this is just the tip of the iceberg. This is a very serious
    issue. It is one that needs to be addressed, and it needs to be
    addressed in the proper manner.
        Does the gentleman from Virginia have anything else he
    wants to say or to insert into the record?
        Mr. Scott. Yes, Mr. Chairman. Another Rand study showing
    that demand investments work better than supply control.
        Mr. Sensenbrenner. Without objection, the material is
    inserted.
        [The information referred to follows:]

                                   __________

        Mr. Conyers. Mr. Chairman, can I congratulate you on
    starting our inquiry in this matter with Members of Congress
    who have some great and different experiences about this
    problem? And I thank you for starting it.
        Mr. Sensenbrenner. Well, I thank the Chairman emeritus. I
    am always happy to accept congratulations. They mean more from
    that side of the aisle than my own. [Laughter.]
        So, again, thank you very much. And without objection, the
    Committee stands adjourned.
        [Whereupon, at 10:36 a.m., the Subcommittee was adjourned.]
                                A P P E N D I X

                                  ----------

                   Material Submitted for the Hearing Record

                  Prepared Statement of Anne McGee, Director,
              Cabell County Substance Abuse Prevention Partnership
        My name is Anne McGee and I have been the director of the
    Cabell County Substance Abuse Prevention Partnership, a
    coalition of concerned individuals, agencies and organizations
    for the past six years. We are located in my hometown of
    Huntington, WV which is located on the Ohio River and borders
    Kentucky and Ohio. The single biggest change in my hometown, in
    my lifetime, has been the devastation wrought by the ``drug
    problem.'' When the Cabell County Substance Abuse Prevention
    Partnership was founded in 2006, we thought that crack cocaine
    being brought in from Detroit was the main problem. As we
    gathered data and studied the problem, we learned that crack
    may be the drug that garnered the headlines and the attention
    of law enforcement, but far more disturbing and pervasive was
    the non-medical use of prescription drugs. Our teenagers were
    reporting increasing use of prescription drugs; the lines at
    the for profit methadone clinic every morning were out the
    door; drug overdose fatalities were reaching record highs;
    obstetricians were reporting more addicted patients; and
    reports of drug seekers in the emergency rooms were a daily
    occurrence.
        In 2007, we held a roundtable discussion for healthcare
    providers to discuss the data we had gathered regarding
    prescription drug abuse. The consensus from those in that
    earliest discussion was that the overprescribing of
    prescription pain relievers and benzodiazepines by the local
    medical community was a major part of the problem. We followed
    up with a community wide drug summit where we included all
    sectors of the community. We learned that not only was
    overprescribing a problem, but it was far more complicated:
    prescription drugs and the selling of those drugs by the
    patient on the black-market was supplementing the incomes of
    many living on fixed incomes; that patients have unrealistic
    pain expectations and demand and expect pain free recuperation
    from injury or surgery; that the Appalachian culture promotes
    and supports the sharing of prescription drugs among friends
    and family. And that our children were diverting medications
    prescribed to the adults in their lives for both medical and
    non-medical purposes. Our schools reported that many of the
    expulsion hearings were for students caught bringing
    prescription drugs to school. Local property crime rates were
    increasing throughout the county and copper and other metal
    thefts were rampant. Then the Journal of American Medical
    Association published the findings of a CDC study showing WV
    had the highest death rates in the nation for prescription drug
    overdose. Fatality rates began to skyrocket across the nation
    with WV leading the charge with greatest number of fatalities
    and Cabell County having some of the highest mortality rates in
    the state.
        As we focused on our youth, we realized there were no
    evidenced based strategies or programs that focused on
    preventing prescription drug abuse, we also knew from community
    readiness assessments that the community as a whole had little
    or no awareness of the growing prescription drug abuse problem,
    unless and until it struck too close to home. We took the
    lessons learned in preventing youth use of other legal drugs
    like alcohol and tobacco and we started with general awareness
    strategies combined with attempts to limit youth access to
    prescription drugs.
        We recruited a few physicians to our cause and they drafted
    a letter on the coalition's behalf to every healthcare provider
    with prescribing privileges in Cabell County, sharing our data
    and urging and encouraging the use of the WV Board of Pharmacy
    Controlled Substances Monitoring Database. We conducted
    awareness presentations throughout the community. We offered
    trainings to nurses, teachers, coaches, parents and
    grandparents. We conducted social marketing campaigns and held
    dozens of public forums and summits; and we recruited
    volunteers and coalition members along the way. We have
    involved the media in every one of our efforts and we have seen
    community readiness increase and a slight decrease in the
    percentage of students reporting the non-medical use of
    prescription drugs.
        Knowing that limiting access is a key strategy in reducing
    youth substance use, we have sponsored and promoted
    prescription take back events collecting over 500 pounds of
    unwanted medications in the past year. We have partnered with
    the local hospital to provide information to local senior
    citizens regarding medication safeguarding and disposal. We
    have sponsored programs for the local medical society and we
    have talked to every elected official who will listen.
        Prescription drug abuse is destroying southern West
    Virginia. The statistics and data support the severity of the
    problem. Unlike illegal drugs, prescription drugs are subject
    to regulation and control. Community efforts like the Cabell
    County Substance Abuse Prevention Partnership can only do so
    much in reducing the abuse and misuse of these substances. We
    need stronger and better controls over controlled substances.
    We are losing our children, our work force, and our quality of
    life to an epidemic that is 100% preventable.

     Prepared Statement of Kimberly Becher, MD; and Kane Maiers, MD, Paul
    Ambrose Health Policy Fellows, Marshall University Department of Family
                              and Community Health
        Drug abuse in Southern West Virginia has an effect on our
    daily practice of medicine. As family medicine residents we are
    not only exposed to drug-seeking behavior, but see the long
    term effects of drug abuse in our patient population. Because
    we are new providers in the community, our continuity clinics
    are targeted by patients requesting controlled substances for
    recreational use. These visits not only take away slots in
    which we could be treating legitimate medical problems, they
    frustrate us as providers. We chose to be family physicians
    because we have a genuine desire to improve the health outcomes
    of our communities and we sincerely value the physician-patient
    relationship. We work hard to develop rapport and do not like
    to disappoint our patients. Despite the level of compassion and
    professionalism displayed as we deny unreasonable requests for
    pain medication, many visits with drug-seeking patients end
    with aggression, anger, and occasional threats of violence
    toward the provider. On more than one occasion a patient has
    revealed a weapon in our office.
        Unfortunately, the most difficult of cases involve patients
    with progressive chronic disease that is unable to be properly
    addressed due to the patient's fixation on obtaining opiates or
    benzodiazepines. These patients emotionally drain us as
    providers. We spend the most time on these visits and make the
    least progress in decreasing the patient's morbidity and
    mortality despite our attempts at intervention. This patient
    population contributes a disproportionate amount to the cost of
    health care in West Virginia. This is not only limited to
    emergency room visits but also to the complications of
    untreated comorbid conditions that require hospitalization for
    a population that is largely uninsured or receiving Medicaid.
    The addiction circle is not limited to the patients we see in
    the office. To the unemployed, obtaining a thirty-day
    prescription for oxycodone will more than adequately pay their
    bills. One resident reports admitting at least one patient to
    the ICU per night who overdosed on prescription drugs they were
    not prescribed.
        We need help combating this epidemic in Southern West
    Virginia. We need a national controlled substance monitoring
    program that is real time. Patients routinely fill
    prescriptions in Kentucky and Ohio, but we have also had
    trouble with more organized patients travelling to pharmacies
    in Florida. We need educational opportunities that prepare us
    to properly address prescription drug-seeking behaviors from
    the first day of practice. There is no grace period here. For
    many of us, our first patient encounter was a test of our
    ability to deny an unwarranted prescription.
        Thank you for championing the development of legislation to
    curb prescription drug abuse.