[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
OFFICE OF NATIONAL DRUG CONTROL POLICY: REAUTHORIZATION
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HEARING
BEFORE THE
SUBCOMMITTEE ON
GOVERNMENT OPERATIONS
OF THE
COMMITTEE ON OVERSIGHT
AND GOVERNMENT REFORM
HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
FIRST SESSION
__________
DECEMBER 2, 2015
__________
Serial No. 114-87
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Printed for the use of the Committee on Oversight and Government Reform
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COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM
JASON CHAFFETZ, Utah, Chairman
JOHN L. MICA, Florida ELIJAH E. CUMMINGS, Maryland,
MICHAEL R. TURNER, Ohio Ranking Minority Member
JOHN J. DUNCAN, Jr., Tennessee CAROLYN B. MALONEY, New York
JIM JORDAN, Ohio ELEANOR HOLMES NORTON, District of
TIM WALBERG, Michigan Columbia
JUSTIN AMASH, Michigan WM. LACY CLAY, Missouri
PAUL A. GOSAR, Arizona STEPHEN F. LYNCH, Massachusetts
SCOTT DesJARLAIS, Tennessee JIM COOPER, Tennessee
TREY GOWDY, South Carolina GERALD E. CONNOLLY, Virginia
BLAKE FARENTHOLD, Texas MATT CARTWRIGHT, Pennsylvania
CYNTHIA M. LUMMIS, Wyoming TAMMY DUCKWORTH, Illinois
THOMAS MASSIE, Kentucky ROBIN L. KELLY, Illinois
MARK MEADOWS, North Carolina BRENDA L. LAWRENCE, Michigan
RON DeSANTIS, Florida TED LIEU, California
MICK MULVANEY, South Carolina BONNIE WATSON COLEMAN, New Jersey
KEN BUCK, Colorado STACEY E. PLASKETT, Virgin Islands
MARK WALKER, North Carolina MARK DeSAULNIER, California
ROD BLUM, Iowa BRENDAN F. BOYLE, Pennsylvania
JODY B. HICE, Georgia PETER WELCH, Vermont
STEVE RUSSELL, Oklahoma MICHELLE LUJAN GRISHAM, New Mexico
EARL L. ``BUDDY'' CARTER, Georgia
GLENN GROTHMAN, Wisconsin
WILL HURD, Texas
GARY J. PALMER, Alabama
Jennifer Hemingway, Staff Director
David Rapallo, Minority Staff Director
Jeff Post, Government Operations Subcommittee Deputy Staff Director
Alexa Armstrong, Professional Staff Member
Sharon Casey, Deputy Chief Clerk
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Subcommittee on Government Operations
MARK MEADOWS, North Carolina, Chairman
JIM JORDAN, Ohio GERALD E. CONNOLLY, Virginia,
TIM WALBERG, Michigan, Vice Chair Ranking Minority Member
TREY GOWDY, South Carolina CAROLYN B. MALONEY, New York
THOMAS MASSIE, Kentucky ELEANOR HOLMES NORTON, District of
MICK MULVANEY, South Carolina Columbia
KEN BUCK, Colorado WM. LACY CLAY, Missouri
EARL L. ``BUDDY'' CARTER, Georgia STACEY E. PLASKETT, Virgin Islands
GLENN GROTHMAN, Wisconsin STEPHEN F. LYNCH, Massachusetts
C O N T E N T S
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Page
Hearing held on December 2, 2015................................. 1
WITNESSES
The Hon. Michael Botticelli, Director of National Drug Control
Policy, Office of National Drug Control Policy
Oral Statement............................................... 6
Written Statement............................................ 9
Mr. David Kelley, Congressional Liaison, National HIDTA Directors
Association
Oral Statement............................................... 20
Written Statement............................................ 22
Mr. David Maurer, Director, Justice and Law Enforcement Issues,
U.S. Government Accountability Office
Oral Statement............................................... 28
Written Statement............................................ 30
APPENDIX
RESPONSE from Director Botticelli-ONDCP to Questions for the
Record......................................................... 84
OFFICE OF NATIONAL DRUG CONTROL POLICY: REAUTHORIZATION
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Wednesday, December 2, 2015
House of Representatives,
Subcommittee on Government Operations,
Committee on Oversight and Government Reform,
Washington, D.C.
The subcommittee met, pursuant to call, at 10:01 a.m., in
Room 2154, Rayburn House Office Building, Hon. Mark Meadows
[chairman of the subcommittee] presiding.
Present: Representatives Meadows, Jordan, Walberg, Gowdy,
Mulvaney, Buck, Carter, Grothman, Connolly, Maloney, Norton,
Clay, Plaskett, and Lynch.
Also Present: Representatives Chaffetz, Turner, and
Cummings.
Mr. Meadows. The Subcommittee on Government Operations will
come to order. And without objection, the chair is authorized
to declare a recess at any time.
The Office of National Drug Control Policy, or the ONDCP,
is charged with guiding the big picture strategy for addressing
illicit drug problems here in this country and the consequences
thereof. I think we can all agree that this is a problem that
merits meaningful solutions. And over the years, we as a Nation
have tried a variety of approaches to address the illicit drug
problem. From its launch in 1988 to the last reauthorization in
2006, and still today, the ONDCP has been intimately involved
in the spectrum of drug control efforts.
Today's hearing will take a look at the ONDCP, particularly
since its last reauthorization, which expired at the end of
fiscal year 2010. There are important questions for
consideration. One, has the ONDCP evolved to match the
evolution in our Nation's drug control strategies? Two, what is
the value of this office and is it correctly placed and
appropriately resourced to fulfill those functions?
And earlier this year, the agency actually sent a letter to
Chairman Chaffetz and Ranking Member Cummings and their
counterparts in the Senate, and the letter included proposed
language for reauthorization of the ONDCP, and today's hearing
will focus also and discuss that proposal.
We will also hear testimony from the Director of National
Drug Control Policy, Mr. Botticelli, who will speak
knowledgeably to the work that is being done there as well as
the proposed authorization language. And as we look at this,
these proposed changes to the authorization of the High
Intensity Drug Trafficking Areas program, referred to as the
HIDTA program, now, the HIDTA program has been a leader in
bringing together local, State, national, and tribal law
enforcement entities to reduce the supply of illegal drugs by
targeting and disrupting drug-trafficking organizations. I
might note that in that particular area, we are very familiar
with that with local law enforcement in western North Carolina,
as we have one of those areas that has that cooperation.
The ONDCP changes would allow for the use of the HIDTA
funds for engaging in prevention and treatment efforts.
Previously, only limited HIDTA funds would be used for
prevention efforts and no funds were permitted for treatment.
So in response to this proposal, the National HIDTA Directors
Association wrote to members of the Oversight Committee
suggesting a compromise that would allow for the use of funds
for prevention and treatment, but with a cap. I imagine that
the congressional liaison for the National HIDTA Directors
Association, Mr. Kelley, will be able to provide further
explanation on that letter and the proposed language.
And so we look forward to hearing from you and all the
witnesses today. And I would now recognize Mr. Connolly, the
ranking member of the Subcommittee on Government Operations,
for his opening statement.
Mr. Connolly. Thank you, Mr. Meadows. Thank you, Mr.
Chairman, and thank you for holding this hearing, a very
important topic.
The Office of National Drug Control Policy plays a critical
role in coordinating the Federal response to our troubling drug
epidemic, in which the annual deaths from drug overdoses now
outnumber those caused by gunshots or car accidents. The Office
itself manages a budget of $375 million, with two national
grant programs, and coordinates the related activities of 39
Federal departments, agencies, and programs, totaling more than
$26 billion.
So it's more than a little concerning that Congress allowed
the Office's formal authorization to expire 5 years ago,
allowing it simply to subside on annual appropriations rather
than a long-term authorization. It's been nearly a decade since
Congress seriously considered our national drug control
policies and activities, and as we'll hear from today's panel,
a great deal has changed in that interim period--sadly, not for
the better.
Mr. Kelley of the National HIDTA--High Intensity Drug
Trafficking Areas program--Directors Association, aptly notes
in his remarks that the scourge of drug abuse has no
boundaries, it does not recognize geography, social, economic
status, race, gender, or age. The efforts of the ONDCP are
vital to and visible in each of our respective communities. So,
Mr. Chairman, I appreciate the bipartisan spirit with which
we've approached this hearing on the ONDCP's performance and
its proposal for reauthorization.
I know many of us are troubled, very troubled, by the spike
in heroin use in our communities. Heroin used to be actually a
very static demand drug. No longer. In my home State of
Virginia, for example, the number of people who died using
heroin or other opiates is on track to climb for the third
straight year. Heroin-related deaths doubled in my own home
county of Fairfax, just across the river, between 2013 and
2014, and that follows a troubling trend all across the
national capital region. And I know Eleanor Holmes Norton
shares that concern as well.
Communities in my district have been fortunate to receive
assistance from both the High Intensity Drug Trafficking Area
program, which provides grants to local, State, and tribal law
enforcement agencies to counter drug trafficking activities,
and the Drug-Free Communities Program, which provides grants to
create community partnerships aimed at reducing substance
abuse, especially among young people. Virginia now has 20
counties out of 95 that have been designated as High Intensity
Drug Trafficking Areas. Four are part of the larger Appalachian
region HIDTA and 16 are part of the Washington-Baltimore area
HIDTA.
While the HIDTA program has historically been more
enforcement focused, we're beginning to see an increased
emphasis on prevention and treatment, and I think that's
appropriate. That's reflected in the administration's
reauthorization proposal.
Current law caps at 5 percent the amount of funds that can
be used for prevention activities--5 percent. Twenty-seven of
the 28 designated regional High Intensity Drug Trafficking
Areas support prevention activities. The statute actually
prohibits funds from being used for treatment programs, with
the exception of two grandfathered programs in the Washington-
Baltimore and Northwest regions, as their efforts predate the
prohibition in the previous authorization.
In fact, my district benefits from that particular
exception, with Fairfax County receiving a subgrant to fund one
full-time position--one--providing residential day treatment
and medical detoxification services.
I think that 5 percent limit does not make sense,
especially in light of a lot of changes in the demand for
opiates and other drugs.
I look forward to hearing more from Director Botticelli
about the shift to public health-based services within the
National Drug Control Strategy. The administration's proposed
reauthorization language would allow the regional drug
trafficking areas, upon request of their boards, to spend
funding on treatment efforts and to spend above the current cap
on prevention efforts. That would amount to a considerable
investment in strategies such as diversion or alternative
sentencing and community reentry programs that have proven
successful here in the national capital region and other
communities across the country.
I appreciate, Mr. Kelley, with your law enforcement
background, acknowledging that we cannot arrest our way out of
this problem and that we're moving more and more to a
partnership between public safety and public health to create a
more holistic approach to the substance abuse challenges facing
so many communities across America. Director Botticelli's
compelling personal story speaks to the power of treatment and
recovery.
Mr. Chairman, I hope our subcommittee can play a
constructive role in helping to advance this important
reauthorization effort, and I very much appreciate the
bipartisan spirit with which you and our colleagues have
approached it. I look forward to hearing the testimony this
morning. Thank you.
Mr. Meadows. I thank the gentleman.
The chair now recognizes the gentleman from Maryland, the
ranking member of the full committee, Mr. Cummings, for his
opening statement.
Mr. Cummings. Thank you very much, Mr. Chairman. And as I
listened to Mr. Connolly, I could not help but be reminded, in
this day and age we are fully realizing that drug addiction has
no boundaries--has no boundaries. It affects blacks, whites,
rich, poor, from one coast to the other of this United States.
And his statements, that is Mr. Connolly's statements with
regard to treatment, ladies and gentlemen, some of the most
profound words that will be spoken here is we better wake up
and begin to address this more and more as a health problem,
because, again, what we're seeing now with heroin, I've known
about heroin for many, many years in Baltimore. But now it's
spreading everywhere and now people are beginning to understand
that prevention is so very, very crucial.
And so the Office of National Drug Control Policy, or
ONDCP, has a difficult but crucial mission. It is tasked with
leading efforts across the Federal agencies to reduce drug use
and mitigate its consequences. ONDCP is also responsible for
developing and implementing strategies and budgets annually
while also furthering long-term goals. Although none of these
responsibilities are simple, I have been impressed with how
diligently this administration has tackled these tasks while
being efficient with the resources that are provided.
We're here today to discuss the reauthorization of this
Office's vital work, which includes the Drug-Free Communities
Program, which I'm very familiar with, a valuable grant program
that mobilizes our communities to prevent youth drug use. It
also includes the High Intensity Drug Trafficking Areas, or
HIDTA, program, which operates through regional efforts with
State, local, and tribal law enforcement agencies to dismantle
and disrupt drug-trafficking areas.
ONDCP's overall goals are substantial and the stakes are
high. They include reducing drug use among our youth, reducing
the chronic abuse of a wide range of substances, and lowering
drug-related deaths and illnesses.
Despite what often seem to be insurmountable obstacles,
ONDCP is making progress on many of these fronts by engaging
all of our community stakeholders, from police officers to
health professionals.
In 2010, ONDCP took a crucial step in recognizing that
addressing drug addiction is not merely a public safety issue,
it is a public health issue. We must tackle the demand for
drugs as well as their supply. We must recognize that
prevention and treatment are crucial tools that complement the
law enforcement's efforts.
I have seen up close and personal the ways that drug abuse
can be destructive. I've often said that if you want to destroy
a people, if you want to destroy a community, and you want to
do it slowly but surely, you can do it through drugs.
In my own city of Baltimore I've seen entire communities
fractured and broken by drug use. I've seen landmarks like our
world famous Lexington Market become synonymous with drug
trafficking. I've seen people in so much pain, they don't even
know they're in pain. I've seen people who used to be hard-
working citizens in our communities staggering through our
streets, slumped over from the effects of heroin addiction.
Right now, if you went to Baltimore in certain areas, you will
see hundreds of them, people who have lost their way. And this
is not the Baltimore where I grew up and it is not the
Baltimore I know is possible.
The leaders of the Washington-Baltimore HIDTA hold this
conviction too. Over the years, they have demonstrated exactly
how prevention and treatment efforts can complement law
enforcement efforts. I'm also encouraged that our HIDTA is one
of five organizations, as Mr. Connolly said, that will receive
$2.5 million to address our Nation's heroin epidemic situation
through the Heroin Response Strategy. Using wrap-around, a
wrap-around approach that encompasses law enforcement,
community involvement, and treatment and prevention strategies,
the Washington-Baltimore HIDTA has dismantled 92 drug-
trafficking organizations, seized almost 12,000 kilograms of
marijuana and nearly 3,000 kilograms of cocaine and 410
kilograms of heroin all since 2013.
It is because of these demonstrated successes that I was
pleased to learn that the ONDCP is asking that Congress equip
all of its HIDTAs with crucial prevention and treatment tools
as well. Today I look forward to learning more about the
changes ONDCP is proposing and what it has been doing to
address recommendations for improvement provided by the
Government Accountability Office.
Finally, this is an issue that affects all of us, it
affects all of us, and if it has not affected you yet, I
promise you it probably will. Whether you live in west
Baltimore or in the mountains of New Hampshire, drug abuse
affects every community in America, every one of them.
I look forward to working with all of my colleagues to
ensure full and swift reauthorization of ONDCP, a program that
is absolutely crucial to the future success, safety, and health
of our great Nation.
With that, Mr. Chairman, I thank you, and yield back.
Mr. Meadows. I thank the gentleman for his insightful and,
I guess, personal words, as it brings it home up close and
personal for all of us. I thank the ranking member for that.
I would hold the record open for 5 legislative days for any
member who would like to submit a written statement.
Mr. Meadows. And the chair has noted the presence of the
gentleman from Ohio, earlier has checked in, Mr. Turner, a
member of the full committee, and his interest in this
particular topic is important. He has stepped out for an Armed
Services hearing, but will be back joining us. So without
objection, we welcome Mr. Turner to participate fully in
today's hearing. Seeing no objection, so ordered.
We will now recognize our panel of witnesses. And I'm
pleased to welcome the Honorable Michael Botticelli. Is that
correct?
Mr. Botticelli. Botticelli.
Mr. Meadows. Botticelli. All right. I'll try to get that
better. The Director of the National----
Mr. Connolly. He's more famous for painting paintings.
Mr. Meadows. I got you. I got you.
The Director of the National Drug Control Policy at the
Office of National Drug Control Policy.
Welcome.
Mr. David Kelley, the congressional liaison at HIDTA, which
is the National High Intensity Drug Trafficking Areas Directors
Association. And Mr. David Maurer, Director of Justice and Law
Enforcement Issues at the GAO.
Welcome to you all.
And pursuant to committee rules, we would ask all witnesses
be sworn in before they testify, so if you would please rise
and raise your right hand.
Do you solemnly swear or affirm that the testimony you are
about to give will be the truth, the whole truth, and nothing
but the truth?
Thank you. You may be seated.
Let the record reflect that all witnesses answered in the
affirmative.
And in order to allow time for discussion, please limit
your oral testimony to 5 minutes, if you would, but your entire
written statement will be made part of the record.
And, Mr. Botticelli----
Mr. Botticelli. Very well.
Mr. Meadows. --we will recognize you for 5 minutes.
WITNESS STATEMENTS
STATEMENT OF MICHAEL BOTTICELLI
Mr. Botticelli. Chairman Meadows, Ranking Member Connolly,
Ranking Member Cummings, and members of the committee and
subcommittee, thank you for the opportunity to appear before
you today to discuss the administration's proposed legislation
to reauthorize the Office of National Drug Control Policy. It's
truly an honor to be in this position and to be at this hearing
today.
ONDCP was established by Congress under the Anti-Drug Abuse
Act of 1988 and was most recently reauthorized by the Office of
National Drug Control Policy Reauthorization Act of 2006. As a
component of the Executive Office of the President, ONDCP
establishes policies, priorities, and objectives of the
national drug control program and ensures that adequate
resources are provided to implement them. We develop, evaluate,
coordinate, and oversee the international and domestic anti-
drug efforts of the executive branch and, to the extent
practicable, ensure efforts complement State and local drug
policy activities.
ONDCP is responsible for issuing the administration's
National Drug Control Strategy, which is our primary blueprint
for drug policy. The strategy treats our Nation's substance
abuse problems as public health challenges as well as public
safety ones, an approach used to address drug control policy
since this administration released its inaugural strategy in
2010.
In that strategy, ONDCP set ambitious and aspirational
goals for reduction of illegal drug use and its consequences.
We knew advancing these goals would be challenging. A careful
examination of the most recent data shows that significant
progress has been made in many areas, but we know we have far
to go in many other areas as well.
For instance, we have moved toward achieving our goals
related to reducing chronic cocaine and methamphetamine use and
we have met our goals related to reducing lifetime prevalence
of tobacco and alcohol use among eighth graders. Looking at our
goals related to the prevalence of illicit drug use by youth
and young adults, we find that marijuana use so overwhelms the
data that the progress we have achieved in reducing the use of
other illicit drugs is not apparent.
In addition to our activities across the interagency to
address substance use disorders, ONDCP administers two
significant grant programs, the High Intensity Drug Trafficking
Area program and the Drug-Free Community Support Program.
The HIDTA program was created as part of ONDCP's original
authorization to reduce drug trafficking and production in the
United States by facilitating cooperation among Federal, State,
local, and tribal law enforcement agencies. The HIDTA program
is a locally based program that responds to the drug-
trafficking issues facing specific areas of the country in
which law enforcement agencies at all levels of government
share information, enhance intelligence sharing, and coordinate
strategies to reduce the supply of illegal drugs in designated
areas. There are currently 28 HIDTA programs in 48 States.
The DFC Program provides grants to local drug-free
community coalitions, enabling them to increase collaboration
among community partners to prevent and reduce substance use
issues. During fiscal year 2015, ONDCP was able to award DFC
grants to almost 700 community coalitions.
The reauthorization legislation that the administration has
provided to the committee would reauthorization ONDCP for 5
years. The proposed statutory changes would strengthen ONDCP's
ability to effectively respond to the range of complex drug
problems confronting our Nation today.
The legislation expands the list of authorized demand
reduction activities to include screening and brief
intervention for substance use disorders, promoting
availability and access to healthcare services for the
treatment of substance use disorders, and supporting long-term
recovery. Language has also been added expressly making the
reduction of underage use of alcohol part of ONDCP's demand-
reduction responsibilities.
The proposed legislation would also extend authorization
for the HIDTA program for 5 years. In addition, the bill will
allow HIDTA boards, with the approval of the ONDCP Director, to
provide support for programs in the criminal justice system
that offer treatment for substance use disorders to drug
offenders. Upon the request of a HIDTA executive board, the
Director may authorize the expenditure of HIDTA program funds
to support initiatives to provide access to treatment as part
of a diversion alternative sentencing or community reentry
program for drug offenders.
We all know that such programs have proven successful in a
number of jurisdictions across the country in breaking the
cycle of drug dependence and crime by assisting offenders to
overcome their substance use disorder.
New language would also authorize the expenditure of HIDTA
program funds for community drug-prevention efforts in excess
of the current 5 percent level. Note that these expenditures
for prevention and treatment efforts will be driven by the
HIDTA executive boards should they see a need and at their
discretion. In some instances, the use of a limited amount of
funds to support a treatment program for drug offenders or to
support a community prevention initiative may be means of
reducing drug-related crime.
As we have discussed with the committee, ONDCP intends to
rearrange its organizational structure to facilitate greater
collaboration among ONDCP's public health, public safety, and
international policy staff across the spectrum of drug policy.
Our new structure will facilitate the formation of broad-based
issue-focused working groups, bringing together staff with
policy expertise. This internal reorganization is separate and
independent from the reauthorization bill and can largely be
accomplished through our existing authorities.
However, as most of the major drug control issues facing
our country cannot be placed neatly into demand or supply
reduction categories, the proposed authorization would
eliminate ONDCP's deputy director positions. Leadership,
however, will be overseen by the Director and coordinated
through staff.
I am glad to be here to discuss these issues with you in
further detail. We are continually grateful for Congress and
this committee's support for ONDCP's work to address substance
use in this Nation. Thank you.
[Prepared statement of Mr. Botticelli follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Meadows. Thank you very much for your testimony.
Mr. Kelley, you're recognized for 5 minutes.
STATEMENT OF DAVID KELLEY
Mr. Kelley. Thank you. Chairman Meadows, Ranking Member
Connolly, Ranking Member Cummings, and distinguished members of
the subcommittee, I'm honored to appear before you today to
offer testimony highlighting the High Intensity Drug
Trafficking Area program and to speak to the reauthorization of
the Office of National Drug Control Policy, specifically to the
recommendations of the HIDTA directors with regard to proposed
reauthorization language.
ONDCP establishes priorities and objectives for the
Nation's drug policy. The Director is charged with producing
the National Drug Control Strategy that directs the Nation's
efforts. The current strategy promotes a focused and balanced
approach.
The HIDTA program is an essential component of the National
Drug Control Strategy. The 28 regional HIDTAs are in 48 States,
Puerto Rico, the U.S. Virgin Islands, and the District of
Columbia. HIDTAs enhance and coordinate anti-drug abuse efforts
from a local, regional, and national perspective, leveraging
resources at all levels in a true partnership.
At the national level, ONDCP provides policy direction and
guidance to the HIDTA program. At the local level, each HIDTA
is governed by an executive board comprised of an equal number
of Federal, State, local, and tribal agencies. This provides a
balanced and equal voice in identifying regional threats,
developing strategies, and assessing performance.
The flexibility of this leadership model creates the
ability for the executive board to quickly, effectively,
efficiently adapt to emerging threats that may be unique to
their own HIDTAs. Investigative support centers in each HIDTA
create a communication infrastructure that facilitates
information sharing among law enforcement agencies to
effectively reduce the production, transportation,
distribution, and use of drugs.
The strengths of the HIDTA program are truly
multidimensional. One of the cornerstones of the program is its
demonstrated ability to bring people and agencies together to
work toward a common goal.
The neutrality of the HIDTA program is viewed as another
key to its success. HIDTA is a program, not an agency. HIDTAs
do not espouse the views of any one agency, nor are we beholden
to the mandates of any one agency. HIDTA serves only to
facilitate and coordinate.
While the enforcement mission remains paramount, HIDTAs are
also involved in drug-prevention activities. The fact that we
cannot arrest our way out of this drug problem is well
recognized in the law enforcement community. The emerging
partnership between public health and public safety has never
been more important, and HIDTA provides the perfect platform to
promote that partnership.
The Washington-Baltimore HIDTA seeks to break the cycle of
drug abuse and crime through well-organized criminal justice-
based treatment programs. The focus is to reduce crime in
targeted communities and change the drug habits of repeat
offenders.
The New England HIDTA has partnered with the Boston
University School of Medicine SCOPE of Pain program. Here, the
opioid heroin epidemic is addressed at the front end through
extensive prescriber education. Through an innovative use of
discretionary funding, five HIDTAs have jointly developed a
heroin response strategy to address the severe heroin threat in
their communities. The strategy provides a unique,
unprecedented platform designed to enhance public health,
public safety collaboration across 15 States.
ONDCP and the HIDTA program currently enjoy a collaborative
and cooperative working relationship that has never been
stronger. The National HIDTA Directors Association strongly
encourages Congress to reauthorize ONDCP during this session.
The National HIDTA Directors Association supports the
existing language of the ONDCP Reauthorization Act of 2015,
with three exceptions. First, the existing authorization
specifies that the Director shall ensure that no Federal funds
appropriated for the program are expended for the establishment
or expansion of treatment programs. The proposed revision of
this prohibition would allow the Director, upon request of a
HIDTA executive board, to authorize the expenditure of program
funds to support drug treatment programs. We support this
change, but believe that funding should not exceed a cap of 10
percent of the affected HIDTA's baseline budget.
Second, in the past, no more than 5 percent of HIDTA funds
could be expended for the establishment of drug prevention
programs. The new wording allows the Director, upon request of
the HIDTA executive board, to authorize the expenditure of an
amount greater than 5 percent of program funds. We support this
change, but again believe that funding should not exceed a cap,
a maximum cap of 10 percent of the affected HIDTA's baseline
budget.
Third, and finally, the language authorizes an
appropriation to ONDCP of $193.4 million for the HIDTA program.
This amounts to a 22 percent reduction in program funding. This
reduction would severely handicap the HIDTA program. The
National HIDTA Directors Association respectfully recommends
funding in the amount of $245 million, which was the amount
awarded in fiscal year 2015.
I thank you for allowing me this opportunity to testify
before you this morning and I look forward to answering your
questions.
[Prepared statement of Mr. Kelley follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Meadows. Thank you, Mr. Kelley, for your testimony.
Mr. Maurer.
STATEMENT OF DAVID MAURER
Mr. Maurer. Good morning, Chairman Meadows, Ranking Member
Cummings, Ranking Member Connolly, and other members and staff.
I'm pleased to be here today to discuss GAO's findings on
Federal efforts to curtail illicit drug use and enhance
coordination among Federal, State, and local agencies.
Combating drug use and dealing with its effects is an
expensive proposition. The administration requested more than
$27 billion to undertake these activities in 2016. Ensuring
this money is well spent, that we're making progress, and that
the various agencies are well coordinated is vitally important.
Over the years, GAO has helped Congress and the American
public assess how well Federal programs are working. In many
instances, it's, frankly, hard to tell, because agencies often
don't have good enough performance measures. ONDCP, to its
credit, has focused a great deal of time, attention, and
resources on developing and using performance measures.
Five years ago, the National Drug Control Strategy
established a series of goals with specific outcomes ONDCP
hoped to achieve by 2015. In 2013, we reported that a related
set of measures were generally consistent with effective
performance management and useful for decisionmaking. That's
important to remember, especially when the conversation turns
to what those measures tell us.
Overall, there has been a lack of progress. According to a
report ONDCP issued 2 weeks ago, none of the seven goals have
been achieved, and in some key areas the trend lines are moving
in the opposite direction. For example, the percentage of
eighth graders who have ever used illicit drugs has increased
rather than decreased. The number of drug-related deaths and
emergency room visits has increased 19 percent rather than
decreasing 15 percent as planned. Substantially more Americans
now die every year of drug overdoses than in traffic crashes.
Now, it's also important to recognize progress in some key
areas. For example, there have been substantial reductions in
the use of alcohol and tobacco by eighth graders, and the 30-
day prevalence of drug use by teenagers has also dropped.
There has also been recent progress in Federal drug
prevention and treatment programs. Two years ago, we found the
coordination across 76 Federal programs at 15 Federal agencies
was all too often lacking. For example, 40 percent of the
programs reported no coordination with other Federal agencies.
We recommended that ONDCP take action to reduce the risk of
duplication and improve coordination.
Since our report, ONDCP has done just that. It has
conducted an inventory of the various programs and updated its
budget process and monitoring efforts to enhance coordination.
Another GAO report highlighted the risks of duplication and
overlap among various field-based multi-agency entities. To
enhance coordination, ONDCP funds and supports multi-agency
investigative support centers in HIDTAs. These centers were one
of five information-sharing entities we reviewed, including
joint terrorism task forces and urban area fusion centers.
We found that while these entities have distinct missions,
roles, and responsibilities, their activities can overlap. For
example, 34 of the 37 field-based entities we reviewed
conducted overlapping analytical or investigative support
activities. We also found that ONDCP and other agencies did not
hold field-based entities accountable for coordination or
assess opportunities to improve coordination.
Since our report, ONDCP and the Department of Homeland
Security have taken actions to address our recommendations.
However, they have not yet sufficiently enhanced coordination
mechanisms or assessed where practices that enhance
coordination, such as serving on one another's governance
boards or collocating with other entities, can be applied to
reduce overlap.
In conclusion, as Congress considers options for
reauthorizing ONDCP, it's worth reflecting on the deeply
ingrained nature of illicit drug use in this country. It's an
extremely complex problem that involves millions of people,
billions of dollars, and thousands of communities. There are
very real costs in lives and livelihoods across the U.S. GAO
stands ready to help Congress oversee ONDCP and the other
Federal agencies as they work to reduce those costs.
Mr. Chairman, thank you for the opportunity to testify
today. I look forward to your questions.
[Prepared statement of Mr. Maurer follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Mr. Meadows. Thank you so much. I appreciate the fact that
you acknowledge maybe deficiencies, but also areas where
performance was good. So thank you for that balanced testimony.
The chair is going to recognize the vice chair of the
subcommittee, Mr. Walberg, for his 5 minutes of questioning.
Mr. Walberg. Thank you, Mr. Chairman. I appreciate that and
enjoyed my time in your district over Thanksgiving. I'm
notifying you of that now since you don't have a chance to call
the sheriff.
Back to serious. Like many areas across the country, the
communities in my district, Mahnomen County right on the Toledo
line and others, have experienced some significant struggles in
fighting against the growing tide of heroin use and abuse and
also the misuse of medication, prescription pain medicines as
well.
I'm aware that ONDCP has increased some of their efforts in
this area, specifically through the Heroin Response Strategy.
Unfortunately, this program is limited to certain regional
areas.
Mr. Botticelli, what efforts has ONDCP undertaken to
address prescription drug abuse and heroin use?
Mr. Botticelli. Sure. Thank you, Congressman, for that
question. And I think there's no more pressing issue that faces
ONDCP and the country right now than the morbidity and
mortality associated with prescription drugs and heroin.
You know, part of the work that ONDCP does is continuing to
monitor these drug trends and make sure that we are putting
resources and efforts against those. In 2011, ONDCP released a
prescription drug abuse plan acknowledging the role that
particularly prescription drugs were playing at the time as it
relates to some of these issues. These included broad-based
efforts to reduce the prescribing of these prescription
medications, to call for State-based prescription drug
monitoring programs so that physicians would have access to
patients' prescribing histories, to look, working with our
partners at the DEA, to reduce the supply of drugs coming from
many of these communities, and to also coordinate law
enforcement actions.
We also simultaneously called for an increase in resources,
particularly treatment resources, to deal with the demand that
we've seen for those resources.
And we've made some progress in those areas. We've seen
reductions in prescription drug misuse among youth and young
adults. We've seen a leveling off of prescription drug
overdoses over the past several years. Unfortunately, however,
that's been replaced by significant increases in heroin-related
overdose deaths.
Mr. Walberg. Is that simply where they're going because of
reduced cost to them, accessibility, and other reasons?
Mr. Botticelli. So when we look at data, it appears that
only a very small portion of people who have misused
prescription drugs actually progress to heroin, about 5
percent. But if you look at newer users to heroin, 80 percent
of them started misusing pain medication. So we know to deal
with the heroin crisis compels us to deal with the prescription
drug use issue.
But we're also focusing on how we address the heroin issue,
again from a comprehensive perspective. We know that some of
this is related to the vast supply of very cheap, very pure
heroin, in parts of the country where we haven't seen it
before. As Congressman Cummings talked about, we know that
heroin has been in many of our communities for a long time, but
we really have to diminish the supply that we have.
But we also have to treat it, make sure that people have
access to good evidence-based care. And we've also been
working, quite honestly, in our partners with law enforcement
to diminish and reduce overdoses through the overdose reversal
drug Naloxone.
And, you know, I have to say I've been really heartened by
how law enforcement across this country has taken on not only
reversing drug overdoses, but also to the point of not
arresting people, are shepherding people into treatment. So not
only have we seen our law enforcement entities respond in terms
of reducing overdoses, but are really accelerating and coming
up with what I think are really innovative programs to get
people into treatment.
Mr. Walberg. Okay. Thank you.
So, Mr. Kelley, what efforts has the HIDTA program
undertaken to address prescription drug abuse and heroin use,
following up with what Director Botticelli said?
Mr. Kelley. Sure. And thank you for that question.
The HIDTA program has historically always identified the
most prevalent threat. There is no greater threat, certainly in
the Northeast, but throughout other areas of the country, than
the abuse of heroin and controlled prescription drugs. It is
probably the overriding issue taking the lives of so many. So
for that reason, the HIDTA program has put that firmly on the
radar.
The HIDTA program, through its enforcement efforts of
Federal, State, and local at the ground level, comprised of
Federal agencies, State, and local working together to
identify, number one, the source of the heroin that's coming
into this country, dealing with the drug-trafficking
organizations that have literally invaded our communities
through a variety of investigative methods.
But the HIDTA program also embraces, as I said earlier, a
very holistic and multidisciplinary approach. We recognize in
law enforcement across this country each and every day that we
can't arrest our way out of this problem. And so for that, we
have reached out to the public health community, we have made
partnerships where partnerships never were before.
Mr. Walberg. International as well?
Mr. Kelley. International as well. International through
ONDCP and the DEA, which are probably the backbone of many
HIDTAs, have worked to identify where it's coming
internationally. And when we do that, we try to interrupt that
supply line. The supply line goes to distribution areas
throughout the United States. We have HIDTA groups that day in
and day out focus primarily, again, on the major trafficking
organizations, not the user on the street per se, not the
person that's afflicted medically that's the victim of a
disease, but by those organizations that are making money at
the anguish of so many.
So we look at it in a multidisciplinary approach from
enforcement, from prevention, and from partnerships that we've
established throughout the public safety and public health
community.
Mr. Walberg. Thank you.
And my time has expired, and thanks for the latitude.
Mr. Meadows. I thank the gentleman.
The chair recognizes the ranking member of the
subcommittee, Mr. Connolly, for 5 minutes.
Mr. Connolly. Mr. Chairman, I would be pleased to defer to
the distinguished ranking member of the full committee, Mr.
Cummings, if he wishes to go.
Mr. Cummings. Thank you very much.
In trying to tackle drug use from all angles, I understand
that ONDCP uses demand-reduction efforts as well as supply
reduction efforts. I also understand that ONDCP would like to
clarify in the definition section of this new reauthorization
that it is demand reduction work can include prevention,
treatment, and recovery efforts.
Now, Mr. Botticelli, can you give some examples of what you
mean by prevention, treatment, and recovery efforts, briefly?
Mr. Botticelli. Thank you, Congressman.
As you noted, one of the overriding efforts of our office
is to restore balance to drug policy, that for too long we have
used public safety as our prime response to issues of drug use
in many of our communities. And under this administration we've
really tried to focus on a balanced portfolio of increasing our
demand-reduction efforts and treating this as a public health
issue.
Our understanding of addiction has changed dramatically
from understanding this just as a criminal justice issue, but
as an acute condition and really understanding this as a
chronic disease, that one that we can prevent. We've seen some
dramatic reductions in underage youth use through our DFC
coalitions.
But we also know that many times we have let this disease
progress to its most acute condition. And so that's why we're
calling for language to allow us to do a better job of
screening people and intervening early in their disease before
they reach that acute condition and before, quite honestly,
they intersect with the criminal justice system.
But we also know that to treat this issue requires more
than just acute treatment, that this is a chronic disease that
requires long-term recovery. And we know that people need
additional supports beyond just treatment, things like housing,
employment, peer recovery networks. So part of our language
change allows us to focus on that continuum of demand-reduction
strategies that we know to be effective in dealing with this as
a public health issue.
Mr. Cummings. Now, I understand that ONDCP would like
Congress to allow all HIDTAs at the request of their boards to
use treatment efforts and to expand their abilities to use
prevention efforts. I support this, because 27 of the 28 HIDTAs
already understand the importance of using prevention-focused
activities. I also support this because I have seen HIDTA
treatment efforts work so well in the Baltimore-Washington
HIDTA, which is one of the two HIDTAs that currently allows for
treatment.
Our Washington-Baltimore HIDTA has provided drug treatment
to about 2,000 individuals with criminal records to date, and
over half of these have successfully completed their treatment
programs. Furthermore, the recidivism arrest rate for these
HIDTA clients after 1 year has been just 28 percent, while
comparable recidivism rates across many States is over 40
percent.
In addition to the successes I mentioned in my opening
statement, the Washington-Baltimore HIDTA has captured over
4,000 fugitives from drug charges and removed over 2,000
firearms from the streets in the last 3 years alone.
So, Mr. Kelley, in your written testimony you noted that
the law enforcement community recognizes, ``We cannot arrest
our way out of this problem.'' Would you agree that treatment
and prevention efforts have augmented the Washington-Baltimore
HIDTA's ability to carry out its mission, and how so?
Mr. Kelley. I would agree with that, Congressman. And how
so is that the HIDTA program traditionally has been an
enforcement-based program, and that's where our greatest
success has lied over the years and continues to show great
success from that. But we also recognize as law enforcement
professionals that the multidisciplinary, multifaceted approach
is so very important as the landscape of drug abuse has
changed, that treatment and prevention play crucial roles in
the overall strategy. The Washington-Baltimore for many years,
and has had treatment programs well before the prohibition was
in place, has shown great success.
However, we also recognize that it is a very, very
expensive proposition, the treatment end of things. Prevention
has been throughout the HIDTA program for a number of years.
The flexibility of the HIDTA program, the beauty of the
HIDTA program is our ability to bring people together to make
the best possible use of resources, to tap into other treatment
sources, to tap into other prevention resources, together with
some limited HIDTA funds to make a great impact. I really
believe that that can continue should the Congress reauthorize
under the current reauthorization language, and I believe that
treatment does have a place at the table. I think most HIDTAs
across the land, if not all, would agree with that. And the
executive board would have that ability to bring that aspect of
the strategy into play should they desire to do that.
Mr. Cummings. Now, Mr. Botticelli, other HIDTAs are also
using prevention tools like encouraging law enforcement
departments to use Naloxone. And I'm very familiar with
Naloxone. And one of the things that has concerned me is that
they jacked up the prices. The manufacturer, knowing that this
is a drug that could save people's lives and has saved people's
lives, they jacked up the prices. And I've been all over them,
I mean.
And I'm just wondering what efforts have you all--I mean, I
know you know this, and I'm wondering, what, if anything, that
you all have done to try to encourage the manufacturer of this
lifesaving drug to be reasonable.
Mr. Botticelli. Thank you for those comments. And I too was
very disturbed that the manufacturer decided at this time of
great demand to more than triple the price of Naloxone. We know
that it diminishes the ability of many of our community-based
organizations and law enforcement to really expand this
distribution.
You know, we have been pursuing a number of goals. I am
pleased to say that just a few weeks ago the FDA approved a new
nasal administration developed by another manufacturer. So we
hope that that will continue to bring some competition to the
marketplace and drive down demand.
We have also looked at establishing part of our work over
the past several years of establishing dedicated grant programs
either through existing Federal grants or additional dollars to
help support the additional purchase of Naloxone because of
this lifesaving drug. But it is particularly disconcerting to
me, Congressman, that people took advantage of some of the
incredible dire need that we have out there to significantly
raise the price.
Mr. Cummings. Thank you very much, Mr. Chairman.
And thank you, Mr. Connolly, for yielding.
Mr. Meadows. I thank the gentleman.
The chair recognizes the gentleman from South Carolina, Mr.
Mulvaney, for 5 minutes.
Mr. Mulvaney. Thank you very much.
Gentlemen, thank you very much for being here today.
I just want to go over a couple of things that Mr.
Botticelli said in his opening testimony, Mr. Maurer touched on
briefly, and it's in the reports that we have in front of us.
I heard Mr. Botticelli said that they've made substantial
or significant progress in the area since 2010, but I heard Mr.
Maurer say something a little bit different. So let's drill
down into these seven goals.
Mr. Maurer, I couldn't find the seven goals. Could you
briefly tell us what they were that the GAO took a look at? You
mentioned one of them, which was eighth grade marijuana use, I
think, or something like that. But tell us what the seven goals
were.
Mr. Maurer. Sure. The seven national goals that were set
out in the 2010 strategy were to look at 30-day use by
teenagers; eighth grade lifetime drug use, and that was broken
down by illicit drugs, alcohol, and tobacco; 30-day use by
young adults; the amount of chronic users of different illicit
drugs; drug-related deaths; drug-related morbidity; and then
rates of drugged driving.
Mr. Mulvaney. All right. And if I read the GAO's summary
correctly, here's what I see. Mr. Botticelli, stop me if I'm
wrong, and I'll come back and ask you to answer some questions
on this. That in March of 2013, the GAO said that, on those
seven goals that had been laid out in 2010, that you folks, Mr.
Botticelli, had made progress on one, no progress on four, and
there appeared to be a lack of data on the other two.
Fast forward to a couple weeks ago when your own analysis
came out, and you folks said that you had made progress on one,
no progress on three, and what someone described as, ``mixed,''
progress on three others.
So I guess here's my question, guys. It's now 5 years. None
of them have been achieved. You've made progress on one, Mr.
Botticelli. Tell me, why are we still spending money on this?
Why are you all still--why are we still doing this if you've
had 5 years and we're, according to Mr. Maurer, we're actually
getting worse, not better? So tell me how substantial progress
has been made.
Mr. Botticelli. Sure. So let me go over in detail in terms
of where our progress is.
Mr. Mulvaney. Sure.
Mr. Botticelli. And I will be happy to have a subsequent
conversation with you.
One of the main measures we look at, particularly as it
relates to youth, because we know that youth are particularly
vulnerable, when we look at the decrease in prevalence, 30-day
prevalence rates of drug use among 12 to 17-year-olds, that we
have made considerable progress toward those goals that are----
Mr. Mulvaney. Twelve to 17 is the young adult group that
he----
Mr. Botticelli. Correct.
Mr. Mulvaney. Okay.
Mr. Botticelli. Correct. And clearly we know that substance
use by young adults really can set a lifelong trajectory of
pattern.
When we look at eighth graders, because, again, we know
that early use predicts lifetime--often predicts lifetime use,
when we look at illicit drug use, that's where we have not made
progress. And, again, if you take marijuana out from other
illicit drugs, that we have made progress, not on marijuana,
but on other illicit drug use. But we have met the goals as
it's related to alcohol and tobacco use.
Mr. Mulvaney. Let me stop you there and go to Mr. Maurer on
this.
Do you agree with that, by the way? If we take marijuana
out, have they made substantial progress on the other?
Mr. Maurer. We didn't have access to the root data to allow
us to perform that kind of analysis, but it seems to fit with
some of the broader trends we've seen in other sources.
Mr. Mulvaney. Okay. Thanks.
Go ahead, Mr. Botticelli.
Mr. Botticelli. So one of the other issues that we look at
is chronic users, because we know that these are folks who
often have addictive issues, they often are involved in
criminal behavior. And when you look at a number of those
markers in terms of cocaine use and in terms of methamphetamine
use, we've seen significant reductions and we are moving toward
our goal.
Marijuana use we're not. We're moving away from that goal.
And we've seen a dramatic increase in the chronic use of
marijuana, particularly among young adults in this country.
If you look at our marker that looks at reducing drug use
among young adults in the country, we've seen no change. But,
again, if you take marijuana out of the young adult use, we've
seen significant, and actually would have met our target for
reducing drug use if it were not for marijuana--increases in
marijuana use.
Mr. Mulvaney. Mr. Maurer, if you had the access to that
root data and had the ability to separate out marijuana use--
and maybe marijuana use is different now than it was in 2010,
we've got States legalizing it, decriminalizing it--would it
give Congress better data, a better look into what Mr.
Botticelli's organization is accomplishing if we could separate
out that particular illicit drug?
Mr. Maurer. Absolutely. Access to better data would give
better information to inform congressional decisionmaking. We'd
be happy to do that.
Mr. Mulvaney. Mr. Botticelli, are you able to do that?
Mr. Botticelli. Yes.
Mr. Mulvaney. Okay.
Thank you, Mr. Chairman. I yield back the balance of my
time.
Mr. Meadows. I thank the gentleman.
The chair recognizes the ranking member of the
subcommittee, Mr. Connolly, for 5 minutes.
Mr. Connolly. I thank the chair.
Mr. Botticelli, Mr. Mulvaney was just asking about metrics.
And Mr. Maurer's testimony, I think, left the impression that
actually, rather than progress, we're experiencing
retrogression. Are we making progress in heroin use in the
United States?
Mr. Botticelli. Clearly we are not, sir.
Mr. Connolly. Are we making progress in cocaine use in the
United States?
Mr. Botticelli. Yes, we are.
Mr. Connolly. And marijuana, of course, is now in a legal
limbo, not at the Federal level, but clearly States are moving
away. And I think Mr. Mulvaney's quite right, you need to
desegregate that if we're going to have accurate data.
I mean, one of the things about metrics is, and it seems to
me that even the seven metrics cited, they're a little bit
broad. And we kind of want to dig down, because I think all of
us on a bipartisan basis, what we want to do is try to end the
drug scourge. Whatever is the most efficacious way to do that,
you know, it's what we want too.
One of the concerns I've got, Mr. Kelley--and by the way,
where--are you from Boston?
Mr. Kelley. I'm----
Mr. Connolly. Where are you from?
Mr. Kelley. I am.
Mr. Meadows. We were commenting that the----
Mr. Connolly. If I could have----
Mr. Meadows. --the accent is a little bit----
Mr. Connolly. I'll rephrase it. Where are you from?
Mr. Kelley. Melrose, Massachusetts.
Mr. Connolly. Melrose. All right. Brighton and Allston. I
can talk that way if I have to, but I try not to now that I
represent Virginia, of course.
Currently, Mr. Kelley, we have in law in the last
reauthorization a 5 percent cap on prevention and treatment for
your program. Is that correct?
Mr. Kelley. That's correct.
Mr. Connolly. And the new legislation proposed by the
administration would double that to 10 percent. Is that
correct?
Mr. Kelley. It would allow for a--the current language
would allow for an amount greater than 5 percent, and the HIDTA
Directors is recommending that it be capped at 10 percent.
Mr. Connolly. Effectively capped, but not statutorily
capped?
Mr. Kelley. Not statutorily.
Mr. Connolly. Right.
Mr. Kelley. It would be a recommendation.
Mr. Connolly. Okay. That's what I was getting at. Because I
have a problem with a cap, because any cap is arbitrary, and in
any given program you might determine or your colleagues around
the country might determine, you know, in this particular case,
the prevention and treatment rate is the way to go. And so the
mix might be different in South Carolina or North Carolina or
Virginia, and I want to make sure you've got flexibility
without diluting the value of the program. Is that the goal
you're seeking as well?
Mr. Kelley. That's exactly right, Congressman. The goal is,
is to maintain, to strike that balance, to maintain the
integrity of the HIDTA program as we all know it, and the
success of the program, as we all know it, which has primarily
been enforcement based, disrupting, dismantling drug
trafficking organizations aimed at the supply. We also
recognize the prevention and treatment aspect of the holistic
approach.
So the HIDTA directives, in trying to avoid diluting the
program or mission creep, being law enforcement professionals,
knowing that there's already a 5 percent, which, I might add,
that no HIDTA in the country has approached--in recent memory,
has approached 5 percent of this spending on a prevention
program, yet they have that ability. We feel that allowing an
open-ended spending, or funding for those, has a possibility of
changing the structure and integrity of the HIDTA program or a
particular HIDTA as we know it.
The strength of the HIDTA program across the Nation, all 28
or 32, depending on the southwest border, how you choose to
view it, is its unity in strategy. If we had one or more that
really bent a particular way because of open-ended funding, I
think it would change the landscape of HIDTA as we know it.
Mr. Connolly. Okay. But your testimony also says we can't
arrest our way out of this problem. Let me ask the devil's
advocate question: Why not? Why not just arrest anybody who's
misusing drugs and just put them where they belong and call it
a day? Isn't that a more effective strategy?
Mr. Kelley. No. Unfortunately, that is not the case. I
think----
Mr. Connolly. For everyone watching on C-SPAN, that was a
devil's advocate question.
Mr. Kelley. Right. But it is--no, we can't arrest--there is
not enough jails, there are not enough police officers, there
are not enough law enforcement officers to do that, number one.
Mr. Connolly. And isn't it also true, Mr. Kelley, that when
people do end up in the jail, they get treatment, or they have
to get treatment because we can't ignore the problem in jail
either?
Mr. Kelley. We would hope that that would be the case but
not always, not always. And sometimes they come out worse than
when they went in. And so, I think law enforcement across the
land has had a paradigm shift, and they understand, for that
very reason, it's kind of a cliche now, we can't arrest our way
out of a problem, nor do we want to. They also recognize an
addiction is a disease, and needs to be treated.
However, those that capitalize and benefit from that
tragedy are the ones we're after.
Mr. Connolly. Final question. You talked about budget
reductions from fiscal year 2015. Can you just expand on that
and what the impact of those budget reductions have been?
Mr. Kelley. Well, the HIDTA program is historically--has
been very valuable in using the funding that's been
appropriated. We have, in the past, provided a very substantial
return on investment. To reduce this program would put us back
many, many years in the progress we've made. Certainly, the
language in the authorization----
Mr. Connolly. Have we reduced the program?
Mr. Kelley. Have we reduced it? No, we have not. In fact--
--
Mr. Connolly. But I thought you talked about a budget
reduction from fiscal year 2015. Did I miss that?
Mr. Kelley. Let me just check.
Mr. Connolly. Mr. Botticelli.
Mr. Kelley. No, I----
Mr. Connolly. Well, while he's checking, Mr. Botticelli,
did you want to--I'm sorry. I'm taking a little more time.
Mr. Botticelli. Sir, thank you for that question. The
dollar amount reflected in the reauthorization language was
actually taken from the President's fiscal year 2016 budget
proposal.
Mr. Connolly. Okay.
Mr. Botticelli. And not representative of level funding of
the program.
Mr. Connolly. Mr. Kelley.
Mr. Kelley. My testimony was, Congressman, is that what the
HIDTA directors were recommending, instead of going back, in
fiscal year 2015, the HIDTA program, Congress awarded us $245
million, and we've done tremendous things with that money. To
go back to 193.4 as--and I know it comes out of appropriations,
but in the language of reauthorization in print, should someone
decide to latch onto that, would be a 22 percent reduction, it
would severely handicap the program.
Mr. Connolly. Thank you. And thank you, Mr. Chairman.
Mr. Meadows. I thank the gentleman. The chair recognizes
the gentleman from Ohio, Mr. Turner for 5 minutes.
Mr. Turner. Thank you, Mr. Chairman. I want to follow on to
the issues of my good friend, Gerry Connolly, about the issue
of incarceration and treatment.
Director Botticelli, I want to thank you for your
leadership on this issue of the heroin epidemic, and your
visiting with members of the Ohio delegation about its impact
in our communities.
As you know, we've discussed that judges and prosecutors in
my district have said that upwards of 75 percent of the
individuals they arrest or prosecute are suffering with
substance abuse or addiction. And you and I have discussed the
fact that actually the Federal Government has barriers in place
that inhibit an ability for someone who is incarcerated to
receive treatment, and I want to talk about two of those with
you today and get your thoughts.
The SAMHSA policy, for example, since 1995, the Substance
Abuse and Mental Health Services Administration has had a
policy in place that prohibits the use of grants from its
Center for Substance Abuse Treatment for treating individuals
who are incarcerated. Obviously, in this instance, we're not
talking about additional resources, just resources being
applied to those who are incarcerated.
Our second one is that Medicaid IMD exclusion. Medicaid's
institution for mental disease exclusion expressly prohibits
reimbursement for services provided to individuals who are
incarcerated. Now, these are individuals who are entitled to
receive Medicaid, they qualify for Medicaid, and the treatment
services that they would receive are not permitted during the
period of incarceration, and one of the things that we know
from heroin addiction is it often leads to theft to feed the
addiction or other types of criminal activity that results in
their incarceration.
Now, I've introduced H.R. 4076, the TREAT Act, which would
repeal both of those prohibitions. It would allow SAMHSA money
to be used during incarceration for treatment, and also for
those individuals who are Medicaid-eligible during their
incarceration for Medicaid to be able to reimburse for those
expenses for treatment, because as you indicated, Mr. Kelley,
people are not receiving treatment once they're incarcerated.
Director Botticelli, I was wondering if you would speak for
a moment about those two exclusions of the use of Federal
dollars, and whether or not you believe lifting those barriers
might help others get treatment?
Mr. Botticelli. Great. Thank you, Congressman. It was a
pleasure meeting with the Ohio delegation. I really appreciate
your interest in this.
So to your point, first and foremost, we want to divert
people away from incarceration in the first place. I expressed
to you privately, I saw a really innovative program in Dayton,
Ohio, where the police chief is actually holding community
forums to get people into care instead of arresting and
incarcerating them.
But to your point, for those people who are incarcerated,
we do want to ensure that they have good access to high quality
treatment. As Mr. Kelley talked about, unfortunately, that
takes a tremendous amount of resources, and because of the
prohibition on Medicaid, that often goes to the State, either
the corrections or the State public health agency, to help
support treatment, but unfortunately, too few people have
access to them.
So any opportunity that we have to work with Congress to
look at how we get additional--how we ensure that people who
are incarcerated get good care behind the walls becomes really
important, because we know those people come back to our
community, and that untreated addiction, when they come back,
will just perpetuate the cycle of crime and addiction.
Mr. Turner. In the SAMHSA policy, same thing, grants that
are being made available to communities, and--but they're
excluded to be used for those who are incarcerated.
Mr. Botticelli. We'd be happy to work with you because,
again, I think, you know, any opportunity that we have to
increase the capacity of our jails and prisons, to expand
treatment capacity for people behind the walls is a top
priority for ONDCP.
Mr. Turner. Director Botticelli, I appreciate your interest
in this.
Mr. Kelley, I appreciate your bringing to focus the issue
that there aren't the resources to bring treatment there. Do
you have any comments that you want--wish to add?
Mr. Kelley. No, I--Congressman, I bring those comments
because I'm well aware in our area, in New England, we deal
with correctional institutes on a fairly frequent basis on a
number of issues. I can tell you from my past law enforcement
experience, most, if not all, issues that I dealt with had some
relation to drugs, a drug abuse, and there were a number of
people that I knew personally that went into the correctional
institute, came back out, and within a short period of time,
without treatment, they were back committing crimes and back on
the addiction. So it is very, very important from a personal
standpoint.
Mr. Turner. Mr. Maurer, do you have comments?
Mr. Maurer. Yeah, we've done some work looking at the
Federal prison system at GAO, and the Bureau of Prisons has
expanded the amount of resources it spent over the last few
years, specifically on drug treatment programs for inmates in
the Federal system who are eligible for those programs.
One of the big incentives for inmates to take advantage of
those programs is they can have a reduction in the amount of
their sentence if they successfully complete those programs.
Mr. Turner. Thank you.
Mr. Meadows. I thank the gentleman for his insightful and
well-informed questions, and so the chair now recognizes the
gentlewoman from the District of Columbia, my friend, Ms.
Norton.
Ms. Norton. I appreciate this hearing, Mr. Chairman. We've
heard--we've heard from Mr. Maurer about the increase in use,
and I certainly am not going to blame that on HIDTA or the drug
administration, nor does he. In fact, staying ahead of the drug
du jour has become such a challenge that I think we ought to
concede that it will always be a challenge. If we concede that,
then looking into what we can really do would make sense.
I really have a question on the drug du jour in the
District of Columbia, synthetic drugs, and another question on
marijuana. But we certainly remember when the drug that the
entire Nation was focused on was crack cocaine. Now, of course,
everybody is focused on opiate and heroin, and it is going to
change tomorrow.
I was very interested in Mr. Turner's question about
treating people when they are behind bars, because I had a
roundtable last night. You know, there are 6,000 Federal
returning citizens now all around the country, because of the
reduction in the sentence for mandatory minimums.
This was one of the great law and law enforcement American
tragedies. We treated crack cocaine differently from cocaine,
100 to 1, and you essentially--or we essentially--by the way,
Democrats and Republicans. This was certainly not partisan--
essentially destroyed what was left of the African American
family. Most of these were black and Latino men in their mid-
30's, by the way, right at the prime of life.
All right. So today, you hear about opiates, of course, and
heroin, and, well, you might, and about the law enforcement
approach that you have been authorized to pursue. But I must
ask you, Mr. Botticelli, in light of prevention, I don't see
how you can prevent the next drug du jour. I mean, we haven't
even brought up the word synthetic drugs yet, but I am
cosponsor with several members on the other side of a bill to
deal with that new phenomenon. But if--you can't expect law
enforcement to prevent new drugs or drugs from changing, I'm
not sure why they change.
At the very least, it seems to me, at least my roundtable
told me, that once you have somebody, you will often find, as
we did when we had these witnesses who had just been released
from mandatory minimums, had their mandatory minimum reduced by
an average of 2 years; in questioning them, the length--these,
of course, were drug traffickers. They got into drug
traffickers by using drugs, and I couldn't help but believe
that if somehow treatment had been earlier available, we might
have prevented what was one of the worst tragedies in law
enforcement in American history, and now we're trying to make
up for it.
So you say, okay, shouldn't be 5 percent, should be 10
percent. That has the ring of a number pulled out of the air,
because you now have 5 percent because you're flat-funded, and
because you don't think you can get anymore. I mean, is that
essentially the long and short of it in terms of what is
effective, as you now pursue newer and newer drugs every
decade, it would appear? Where did you get 10 percent from,
especially as a cap?
Mr. Kelley. Where we got the 10 percent from,
Congresswoman, is that was a figure that was derived in two
different ways. Number one, using the prevention history of the
HIDTA program. Even though that 5 percent of funding has been
available for some period of time across the Nation, many
HIDTAs have never approached that, and it's not from the lack
of----
Ms. Norton. How about treatment?
Mr. Kelley. Treatment has never been----
Ms. Norton. Except in this region we have--because we were
grandfathered in.
Mr. Kelley. You were grandfathered in, correct.
Ms. Norton. Has the experience that the ranking member
spoken about educated you at all about treatment?
Mr. Kelley. Is that directed to me?
Ms. Norton. Yeah, to you, or Mr. Botticelli.
Mr. Kelley. Oh, certainly it has, and, in fact, I speak for
all HIDTA directors, when they recognize the value of
treatment, most definitely, but----
Ms. Norton. But how did--I mean, what was the basis for 10
percent?
Mr. Kelley. 10 percent was based on----
Ms. Norton. I'm not suggesting another percentage. I'm just
suggesting it may not be evidence-based, particularly in light
of treatment.
Mr. Kelley. It was more based on the budget, and the fact
of the matter is, is that, historically, we've never exceeded,
in the prevention realm, more than 5 percent. I also spoke
about the partnership that we have with ONDCP and the fact that
we, as law enforcement professionals, value that, and the fact
that by elevating it to increasing, almost doubling, that would
give the executive boards fairly wide discretion in using an
effective baseline.
Now, the baseline of a HIDTA differs across the Nation.
Some of those, for example, in New England, HIDTA's baseline is
$3.1 million per year. That would allow the executive board,
upon approval of the director, to use upwards of $300,000 as a
maximum. That is also very important to realize is that that is
not the only source of funding for treatment that would be
available.
The beauty of the HIDTA program is our partnerships across
the spectrum of health care, and in coordinating with other
people, we can really maximize that impact. But I think it goes
back to allowing for treatment, allowing for prevention,
allowing for enforcement, that multi-disciplinary approach is
very, very important, and we recognize that, but we also
recognize the fact that we are flat-funded across the Nation.
Discretionary funding sometimes is--varies, and discretionary
funding would allow--the more discretionary funding certainly
would allow HIDTAs across the land to use more money for these
kinds of programs.
Mr. Meadows. All right. I thank the gentlewoman. Thank you,
Mr. Kelley, for your response. The chair recognizes the
gentleman from Wisconsin, Mr. Grothman, for 5 minutes.
Mr. Grothman. Thank you. I guess I would ask Director
Botticelli, how many of people died of heroin overdoses last
year in this country?
Mr. Botticelli. Sir, we had over 8,000 people die of heroin
overdoses in the United States, and that was data from 2013.
Mr. Grothman. I think that's a lot higher. You're sure it's
only 8,000?
Mr. Botticelli. That's the best available data that we
have. I think there has been some estimation that because of--
because of the information variability that comes from medical
examiners and coroners, that that might be underreported, but
that's the best available data that we have.
Mr. Grothman. And when I just look at--because when I get
around my district, I talk to my sheriffs, how many people died
in your county last year of heroin overdoses, and I don't--I
don't really think of Wisconsin as being the heroin center of
the world, and I'm telling you, when I multiply it out, you
know, by counties or by population, it would be higher than
that by a factor of, you know, three times or something. Are
you sure it's only 8,000, even close to 8,000?
Mr. Botticelli. Let me just say that this is 2013 data,
that we expect in the next few weeks to have 2014 data
available. Based on my conversations and my travels around the
country and what I've heard as well, I would highly anticipate
that the number of heroin-associated deaths is far higher than
that 8,000.
Mr. Grothman. How do you--I mean, that just bothers me off
the top of a bunch of other questions, but I mean, how are you
getting that data? Is every county reporting? I mean, is that
comprehensive, or do different counties have different ways of
reporting? You think 8,000?
Mr. Botticelli. So the way that the reporting works is that
county medical examiners, or coroners, report that data to the
State and to the Federal level. You know, as I've indicated,
there is probably wide variability and the reliability of that
reporting----
Mr. Grothman. Yeah.
Mr. Botticelli. --about what goes on those death
certificates. We've been actually trying to work at enhancing
the quality of our data, but again, this is 2013 data.
Mr. Grothman. Okay. Maybe I can help you with that.
Mr. Botticelli. Okay.
Mr. Grothman. Why don't you get me the data for Wisconsin--
--
Mr. Botticelli. Sure.
Mr. Grothman. --and then I can tell you the Wisconsin data
is accurate, and we get a clue as to whether you're right or
wrong.
Second question. Where is this heroin coming from?
Mr. Botticelli. So we know that the vast majority of heroin
that's coming into the United States is coming from Mexico, and
this really compels us to not only work domestically with
demand reduction strategies and with domestic supply reduction
strategies, but with our colleagues in Mexico.
I was just in Mexico 2 months ago meeting with our
colleagues there, and one of the main agenda items of our
security dialogue was what additional actions that the Mexican
government can take in terms of eradication of poppy fields, of
going after heroin labs. We are seeing a dramatic increase in
fentanyl-associated deaths, which we know that the fentanyl,
which is this very powerful morphine-like drug that seems to be
driving up deaths across the United States, but much of the
fentanyl appears to be coming from Mexico as well.
So part of our overall strategy has to be looking at
working with our Mexican colleagues, reducing the supply that's
coming from Mexico, and working at our border to intercept more
heroin that's coming in.
Mr. Grothman. You're telling me something new here, too. I
was under the impression a lot of these poppies were growing in
Afghanistan or worked over there. You're saying the whole thing
is a Mexican thing, growing, produced, da-da-da-da-da, right up
here, so it's a Mexican problem and probably another reason why
we should be doing a lot better job than we currently are of
locking down that southern border.
Mr. Botticelli. Correct.
Mr. Grothman. Okay. On the--how much prison time do you
expect to get if you are--first of all, is it a Federal crime,
possession of heroin? Is that a Federal crime or just a State
crime?
Mr. Botticelli. I believe it's a Federal crime.
Mr. Grothman. You sure?
Mr. Botticelli. I'm pretty sure. I could--yes.
Mr. Grothman. Okay. It's a Federal----
Mr. Botticelli. I am looking at my legal counsel who's
telling me this.
Mr. Grothman. If I am caught with enough heroin, which you
know I am selling, which is kind of a small amount, but if I am
caught with an amount of that, what type of prison sentence can
I expect in a Federal court?
Mr. Botticelli. I don't know the exact answer to that in
terms of what you can expect, but what we do promote,
Congressman, is that we know that many people who sell small
amounts of a drug, largely to feed their own addiction, right,
so these are not the folks who are preying on our community.
But--so we want to make sure that those folks who are doing
that activity, largely because of their own addiction, are
getting good care and treatment. But, however, we want to make
sure----
Mr. Grothman. It's a little shocking that you don't know. I
mean, to me, in Wisconsin, you know, we have money for
treatment and da-da-da, but a frustrating thing is the cost of
heroin is so low, and the reason the cost of heroin is so low
is the people who are selling the heroin are not paying enough
of a price, okay. I mean, heroin was around, like, in the
1970s, but it wasn't so abused like it is today. Things are
getting a lot worse.
And I think one of reasons why the cost is going down is I
am learning today, that I don't think you guys consider
enforcement enough of a priority, and enforcement should be a
priority. I mean, people are killing people. I believe right
now, in the State of Wisconsin, more people are dying of heroin
overdose than murder and automobile accidents combined. I think
that's certainly true in individual counties. And something the
Federal Government can do is to begin to make the cost of
heroin go up a little bit.
And I'm a little bit concerned, you know, that you guys are
not, Oh, we can't, you know, prosecute our way out of this.
Well, you got to try to prosecute your way out of it or the
cost of heroin is not going to go up.
Mr. Botticelli. So I will tell you, Congressman, that
honestly, when we look at public health strategies to reduce
other issues, decreasing the availability and increasing price
has been a prime strategy, and that's part of our goal with
heroin. Because of the cheap availability of heroin, that we
know that that has prompted the dramatic increase, part of the
dramatic increase in heroin.
That's part of why we are focusing on domestically working
on law enforcement to dismantle these organizations. That's why
we continue to work with Mexico on reducing the supply, how we
work with Customs and Border Protection to interdict more drugs
that are coming in, because we know that there is this nexus
between the supply of heroin in many communities and demand.
You know, I will be the first to admit that while we need
to continue to ramp up our demand reduction strategies, that
needs to complement our demand reduction--or our supply
reduction work. I would absolutely agree that we have to really
look at how do we diminish the--both the supply of heroin and
the trafficking organizations who are moving it.
Mr. Grothman. Right. Good. I hope you do that sincerely,
because I'm a little bit afraid to this point, you know, you're
just throwing up your hands and saying all we're going to do is
education or something or other.
Mr. Meadows. Okay. The gentleman's time is expired.
Mr. Grothman. Well, a little shorter than the last one, but
that's okay.
Mr. Meadows. The chair will recognize the gentleman from
Missouri, Mr. Clay, for 5 minutes.
Mr. Clay. Thank you, Mr. Chairman, and thank you--thank the
witnesses for being here. Let me ask of Director Botticelli.
You know, and let's stay on the subject of heroin addiction. We
are in an epidemic that's afflicting Americans from every part
of this country of every background, so reauthorization of your
office is timely and urgent.
I've heard you speak eloquently and powerfully about how
treatment is one of the ways that we can reduce the 17,000
deaths annually from prescription painkillers, and 8,000 deaths
annually from heroin. And I have seen firsthand the value of
life-saving and life-renewing services offered by community-
based nonprofits that provide residential treatment for
substance use disorder.
They provide the full continuum of care for addiction, from
residential treatment to outpatient to aftercare support upon
completion of their program that is essential to them staying
clean and being a productive member of society. So it shouldn't
be all about throw them in jail and lock them all up. I think
this is a disease that needs to be treated.
And I agree with Mr. Turner. Unfortunately, if you are
poor, and you rely on Medicaid for your health care, which we
know a lot of States have not expanded, under the ACA, there is
an outmoded policy, over 50 years old, known as the Institution
of Mental Diseases Exclusion, better known as the IMD
exclusion, which bars Medicaid from paying for residential
treatment at a facility of more than 16 beds. And The New York
Times covered this extensively last year about how the IMD
exclusion prevents people from accessing the intensive care
they need as heroin addiction is surging.
This yields a two-tiered healthcare system, where only
people on Medicaid lose access to a kind of treatment that may
be clinically indicated and medically necessary. I believe this
is wrong, and it must be changed, and I want to join with my
friend from Ohio, Mr. Turner, in trying to change that.
Mr. Director, do you agree that people on Medicaid should
have access to the same kind of treatment for substance use
disorder of people who don't rely on Medicaid?
Mr. Botticelli. Congressman, thank you for that. You know,
one of the things that we know to be effective with dealing
with substance use disorders is that people need to be
connected to a continuum of care, and that residential
rehabilitation, removing people from their environment, giving
them new skills, getting them jobs, are particularly important
for people's long-term success. So we want to make sure that
people have access to the--that everybody has access to that
continuum of care, not just people who can afford it out of
their own pocket.
I would agree with you that the administration has taken a
look at the institute--IMD exclusion, and actually, Secretary
Burwell just sent out a letter a number of months ago to State
Medicaid directors basically saying that there are a number of
levers that Medicaid can use to help support a continuum of
care, but to also waiver from the current IMD exclusions.
I know, as I've traveled around the country, I use to
administer State-funded treatment programs that many of our
programs are under significant demand right now, and that IMD
exclusion can seriously limit the ability of our treatment
programs to serve more people. So we should want to look at how
do we expand treatment capacity, how can we ensure,
particularly folks who are on Medicaid, have access to that
care.
The last thing that I'll mention is even in spite of the
Affordable Care Act and Medicaid expansion in many States, that
there are many people who remain uninsured, and I want to make
sure that they have access to all of that care as well. So part
of our goal at ONDCP in working with Congress is to ensure that
our safety net funding, primarily through our Substance Abuse
and Prevention and Treatment Block Grant, which every State
gets, remains intact so that everybody has access to that full
continuum of care.
Mr. Clay. Yeah. And I'm glad to hear about the plan to
approve waivers, but what happens in those States that don't
seek waivers? Shouldn't this be a national policy?
Mr. Botticelli. So we actually--through not only the
Affordable Care Act, but through the implementation of the
Mental Health Equity and Addiction Parity Act, I think really
have to look at making sure that we treat addictions like we do
any other chronic disease, and that we reimburse for those
services like we do with any other chronic disease.
So I think we need to use every tool in our toolbox,
whether that's parity enforcement, the block grant, IMD, to
make sure that people have access to care when they need it,
not just because they can afford it. I'm sure you know,
Congressman, that people who realize they need care often have
to wait weeks before they get into care and often get very
limited duration when they need long-term care and
rehabilitation.
Mr. Clay. Thank you for your response. My time is up. I'm
sorry, Mr. Chairman.
Mr. Meadows. I thank the gentleman. The chair recognizes
the gentleman from Georgia for 5 minutes.
Mr. Carter. Thank you, Mr. Chairman, and thank all of you
for being here. Gentlemen, as you can imagine, prescription
drug abuse is very important to me. As a pharmacist and the
only pharmacist in Congress, I have dealt with this, I've
experienced it, I've lived it, I've seen it to--I've seen it
ruining lives, I've seen it ruin families, and it's obviously
very, very important to me.
As a matter of fact, as a member of the Georgia State
Senate, I sponsored Senate Bill 36, which created the
prescription drug--monitoring program in the State of Georgia,
something I'm very proud of.
And Mr. Botticelli, I wanted to ask you, can you tell me
what the National Drug Control Policy, what's your direct role
in combating prescription drug abuse?
Mr. Botticelli. So we play a prime role. We know to your--
first of all, sir, let me express my appreciation for you and
your leadership on this issue, and particularly your focus on
prescription drug monitoring programs, because that's been one
of our prime goals is to ensure that every State has a robust
prescription drug monitoring program.
I'm happy to report that that was one of our main goals
when we released our plan. When we started, we only had 20
States that had prescription drug monitoring programs, and to
date, we have 49. Part of our role is to make sure that those
programs are, to the largest extent possible, adequately
resourced. We know that having good real-time data
availability, that sharing information becomes important.
Mr. Carter. Let me--I don't mean to interrupt you, but let
me ask you about that. How do you fund those? Through grants
or----
Mr. Botticelli. Sir, those are through grants through the
Bureau of Justice system.
Mr. Carter. And in those grants--because I remember when we
set up our program, we weren't eligible for certain grants
because we did not have certain programs within the
prescription drug monitoring program that we needed, for
instance, sharing information across State lines. I just
couldn't get the bill passed at that time with that included in
it, which it made us noneligible for those type of grants.
Mr. Botticelli. To my knowledge, I don't know, but I'd be
happy to work with you, Congressman, if there are additional
eligibility requirements, that you feel like our--become a
burden in terms of States not being able to have access to
the--to those bills----
Mr. Carter. Right.
Mr. Botticelli. --I'd be happy to work with you.
Mr. Carter. Right. Well, certainly, you know, that's an
important element, and my hope is that we can get that changed
in the State to where we can share information, because that's
important.
For instance, I practiced right on the Georgia/South
Carolina line and the Georgia/Florida line, so I'd get
prescriptions quite often--or I used to practice. I get
prescriptions quite often from those States and need that
information as well.
I want to switch real quickly. Mr. Maurer, you mentioned a
while ago, and I took some interest in this, because I know
that in the legalization of marijuana, and the
decriminalization of marijuana, I suspect that that's had an
impact, and I was wondering if you've done any studies. I've
always viewed marijuana, and full disclosure, I am adamantly
opposed to the decriminalization, or to the legalization of
marijuana.
I am a practicing pharmacist for over 33 years. I have
spent my career using medication to improve people's health,
and so it is just a pet peeve of mine. But nevertheless, what I
want to know is, in those States that have legalized, that have
or decriminalized it, had--I've always viewed it as being a
gateway drug. Has--have we seen a decrease or an increase or
any impact at all in other drug use in those particular States?
Mr. Maurer. We currently have a report that's going through
final processing right now looking at part of that issue. It
will be issued at the end of this month. It's looking at the
experiences in Washington and the State of Colorado, and more
specifically, what the Department of Justice is doing or not
doing in those States involving their use of marijuana. That
report may address some of your questions.
In terms of preparing for today's hearing, we don't--I
don't have any specific information in response to your
question, but it's right on point, and I think it's an
important issue that needs to be addressed. We need to get that
information and help inform the policy debate.
Mr. Carter. Right. Another point that was brought up during
this conversation I have found very interesting. We've done
quite a bit of criminal justice reform in the State of Georgia,
and we've talked about it here in Congress, and certainly
having programs in our prison system, because our prisons are
full of people who are in there for drug abuse problems and
drug--illegal drug use, and we need to have programs in our
prison system that are going to treat them because it is a
disease. I can tell you, as a professional, it is a disease,
and it's something that needs treatment.
What are we doing to help in the prison system, to help
with those type of programs?
Mr. Maurer. In the Federal system, which is what I'm
familiar with, inmates are eligible for residential drug
treatment programs, if they are--if they have come into prison
with an addiction, and they can get that treatment and they can
get reductions in their sentences if they successfully complete
the program.
Mr. Carter. But--so it's voluntary?
Mr. Maurer. Yes.
Mr. Carter. It's not required. Why aren't they required?
Mr. Maurer. Why aren't they required?
Mr. Carter. Yeah. Why aren't they required--if you go into
prison for drug abuse or drug dependency, why aren't you
required to go through therapy?
Mr. Maurer. I think that's a great question to ask the
Bureau of Prisons. In the legislation, the ability to have
inmates to have their sentences reduced creates a pretty strong
incentive for them, and I know that for a number of years, BOP,
Bureau of Prisons didn't have adequate resources to meet the
demand for that program. They've since made a lot of progress
in addressing that particular issue.
So I can't speak to whether every single inmate who goes
into the Federal system actually gets treatment. I do know that
many inmates want to get that treatment program, both to
address their addiction as well as to get out sooner.
Mr. Carter. Well, many inmates may want to get that
treatment program, but I suspect that all citizens want them to
get it. I can assure of you that.
Thank you, Mr. Chairman. I yield back.
Mr. Meadows. I thank the gentleman. The chair recognizes
the gentleman from Massachusetts, Mr. Lynch, for 5 minutes.
Mr. Lynch. Thank you, Mr. Chairman, and I want to thank the
witnesses for your excellent testimony.
Full disclosure. Mike Botticelli is a pal of mine and used
to run the Substance Abuse Bureau in Massachusetts, and Mr.
Kelley, my district is a high-intensity drug trafficking area,
and Mr. Kelley has been a frequent flier to my district in
trying to address the problem there.
Most pointedly, we've had a critical situation in
Massachusetts in my district, as well as other parts of the
State, and maybe--maybe just explaining that will offer some
value to what the office of National Drug Control Policy
actually does.
We have had a pernicious problem with heroin coming into my
district from Mexico, and it was through Director Botticelli's
help that we sort of figured--figured all this out, but it's
coming out of Mexico and Colombia. The earlier drug trafficking
network was through the Dominican Republican. We had a lot of
Dominican gangs that were providing that, as Mr. Kelley had
informed us. But between the office of the National Drug
Control Policy and HIDTA, we were able to bring in resources
from--now, remember, we are dealing with a system that is--
we've got local towns, cities, counties, the State, now the--
one of the hot areas was Providence, Rhode Island, so we're
dealing with Rhode Island as well, and then, of course, we're
dealing with the Mexican border and the Mexican Government.
So ONDCP actually pulls all that together so we can get all
these resources. They brought--I had a number of homicides in
my district that were, that have the population in full alarm,
brutal, brutal murders, and directly tied to the drug trade.
And so ONDCP did a remarkable job. And I just--you know, from
member to member and how you deal with this in your district,
ONDCP is a very, very important part of that. And that's--
that's how we bring all these resources together, which are
scarce.
I do want to express support for Mr. Turner's idea about
maybe accessing SAMHSA, but they're short-funded on that end as
well, as Director Botticelli pointed out, but maybe we could do
something on a pilot program where county prisons or State
prisons might identify a certain program in a certain area like
Dayton, Ohio or like Gloucester, Massachusetts where we're
trying some innovative stuff here to deal with the inmate--or
potential inmate population.
So I just appreciate the work that you all have been doing,
and thank you, Mr. Maurer, for your testimony as well.
I want to just back up a little bit because one of the--one
of the problems that I see on a day-to-day basis, and I'm
dealing with it. I'm up to my neck in this stuff in my
district, is the power of oxycodone, and I've got--I could tell
you some horror stories about, you know, young people that
we've been dealing with that, you know, one young woman and had
a tooth extraction and got a prescription of OxyContin, and
then she falsely--she tells me now she falsely claimed a
persistent tooth pain, got another prescription of OxyContin.
Two scrips later, she's fully, fully addicted, and then she
started complaining about other teeth, having other
extractions. So this young woman was having teeth pulled out of
her head just to get the OxyContin.
Now, when people are doing that, it tells you that this is
a very powerful, powerful drug, and because of the tolerance
that--what it does to the brain and because of the tolerance
that develops and resistance that develops, greater dosages are
needed. So using that as just one example, and I can give you a
bunch more, why is it that we're allowing drug companies to
produce these powerful, powerful drugs that--by which they are
building a customer base for life. By getting people on this
OxyContin, it is--it's overloading their brains, and it's
just--it's grabbing them, and there's a commercial advantage to
producing customers for life.
If you can get these people hooked, you've got them
forever, they can't get off this. So, you know--and now the
FDA, God bless them, but they just expanded the use to
children, and so it seems like we're not--we're not all rowing
in the same direction here. I actually--when I was first
dealing with it, I actually filed a bill to ban OxyContin, and
there were more lawyers and lobbyists all over me on that. I
didn't have a prayer.
So how--what is it that we could do to sort of look again
at the substance that we're allowing people to sell out there.
And I'm not against pain management, but this is ridiculous.
We're overmedicated. You know, we've got--you know, it's just
off the charts in terms of the opioids that we're putting out
in the street. How do we address that issue?
Mr. Meadows. If you could briefly respond, sure.
Mr. Botticelli. Thank you, Congressman. So to your point,
we are prescribing enough prescription pain medication in the
United States to give every adult American their own bottle of
pain pills. We all want a balanced approach here, making sure
people have access to these lifesaving medications for those
who need it.
You know, we continue to work with the FDA to promote abuse
deterrent formulations, but one of the areas where we haven't
made enough progress, and we'd love to work with Congress on
this, is ensuring that every prescriber has a minimal amount of
education around safe and opiate--safe and effective opiate
prescribing. That's why we're really thrilled with the New
England HIDTA in promoting--because that is often the place
where it starts, right.
So I'm sure this dentist was--thought he was very well
intended in treating someone's pain. I would assume that they
got little to no training on pain prescribing, on identifying
addictive behavior. So we've got to work on all fronts, not
only on making sure that we make these medications more abuse
deterrent, but also that we're stopping this overprescribing
that we see throughout the country. It's really critical for us
to rein in the prescriptions of this, and that critical point,
Congressman, is often with a doctor/patient relationship.
Mr. Lynch. I thank the chairman's indulgence. Thank you.
Appreciate it.
Mr. Meadows. I thank the gentleman. The chair recognizes
himself for a series of questions.
Let me be real brief in terms of the introduction. I think
we have a bipartisan agreement that this is something that we
need to address. The question for me becomes is with the
reauthorization, and some of the suggestions that have been
made in that is that the appropriate place and money funding.
I can tell you that I started a nonprofit with a very good
friend of mine who lost his grandson, and there is a cycle
within that family of drug abuse. And so we went in and
developed a nonprofit to work on the prevention side of things.
And so this is something that's near and dear to my heart, but
I want to--I want to go a little bit closer because I think
this is all about coordination.
Mr. Maurer talked about it early on, that there is
virtually little, if no coordination, among some of the
agencies, and yet we spend billions of dollars. Mr. Kelley, you
were talking increasing the authorization amount. I'm willing
to really look at that to make sure that you have the resources
necessary, but as we look at these caps, I want to make sure
that we're not taking away from HIDTA, which I consider more of
a law enforcement component, and spending the money on
prevention and treatment when it would be better allocated in a
different agency that already does prevention and treatment,
okay.
And I think you're following where I'm going with this is
because it gets back to the mission creep. So let me ask my
tougher question to you, first, Director, and that is, is in
the reauthorization language, there is talk about getting rid
of the new performance reporting system. Why?
Mr. Botticelli. So one of the things that we've looked at,
as we've undertaken our reorganization, is how do we achieve
greater efficiency within our organization to really focus on
our main goals and our main mission here. And one of the things
that we've looked at--and we are fully cognizant of our role,
both to ourselves as an agency, to Congress, and to the
American people, that we monitor performance, that we are--
that----
Mr. Meadows. But you came up with this new development
performance system. Why get rid of it? Just cut to the chase.
How do we--why are you getting rid of it?
Mr. Botticelli. So part of what we're trying to do is
achieve greater efficiency within our organization.
Mr. Meadows. So how do you do that by getting rid of an
evaluation program?
Mr. Botticelli. Because what we've looked at is through the
existing--we do have existing mechanisms within our current
administration that monitors performance.
Mr. Meadows. So who made the mistake of doing the new
performance----
Mr. Botticelli. I think----
Mr. Meadows. Because you created a new one, and then you're
doing away with it, and I don't understand why we would do
that.
Mr. Botticelli. So I want to be clear and up front that
there were elements of the performance review summary that
helped in our ability to continue to monitor performance.
Mr. Meadows. All right. Let me be clear and up front. I
want you to work with GAO to keep the system of performance
review in place. Make it meaningful, make it measured, because
the appearance--and I just got finished saying that I'm willing
to look at increasing the authorization and renewing it, but
the appearance is, is that you didn't meet your performance
standard, and you got rid of the program, and that's not
satisfactory.
And so, do I have your commitment today to work with Mr.
Maurer and the folks at GAO to make that meaningful and put
that back in?
Mr. Botticelli. I will be happy to work with you because I
do want to assure you----
Mr. Meadows. With GAO.
Mr. Botticelli. And with GAO.
Mr. Meadows. Okay.
Mr. Botticelli. That we satisfy your request to make sure
that we are monitoring and that we are----
Mr. Meadows. Performance is all about it, and if we are
spending billions of dollars, and we are not getting what we
need, then we need to reallocate those funds, okay?
So if you could put up the chart, and this gets back to how
I opened up a little bit. This actually--I believe this chart
is one that comes from the performance fiscal year 2014 or
2016, excuse me, budget and performance summary that was
produced by your group, ONDCP.
So we can see there that prevention and treatment across
agencies is substantially higher already. You know, I guess
that's $11 billion is where that would be. And so some of the
wonderful programs that have been talked about today that
actually I've taken advantage of and used with grants and some
of those are actually working in treatment and prevention, and
you drop down to the next group, that's domestic law
enforcement.
So let me--let me be specific, knowing that you have a
willing participant here to help you with the reauthorization.
I am very concerned that we're taking HIDTA, and we're making
them a treatment and prevention group when we're already
spending $11 billion in other agencies to do that, when just
better coordination, as Mr. Maurer with GAO has already
mentioned, would actually address that.
So what I'd like us to do is relook at that, if we can, and
look at--and if we're not meeting the 5 percent cap, you know,
and the gentlewoman from the District of Columbia and the
gentleman from Maryland had both talked about how that
treatment component with HIDTA is effective, but yet we're
still not meeting the 5 percent cap that's in pro, what I want
to do is make sure that we're allocating the money with the
proper agency to perform those functions, and not making a law
enforcement officer do treatment and prevention, because I want
to give him the tools to refer, but they are not in the
treatment and prevention business, they are in the law
enforcement business. And when you do that, it is very
concerning. Will you agree with that?
Mr. Botticelli. I would agree. You know, one of the things
that I do want to point to is that despite the fact that we
have significant funding and increased funding for prevention
and treatment, we know we have gaps in many parts of the
country.
Mr. Meadows. I will agree with that, but is HIDTA the best
place to do that? Because I can tell you, my bias is that it's
not. You can sell me. I'm waiting to hear.
Mr. Botticelli. No. So one of the things we do work with
the HIDTA program on is making sure that if they are investing
dollars in prevention and treatment, that they go toward
evidence-based programs, right.
Mr. Meadows. I understand that, but let me tell you, I've
got a HIDTA program in three counties, and that is McDowell,
Buncombe, and Henderson County in my district, and the only
common thread there is transportation. You know, we're looking
at main corridors coming from the south. I mean, and--and to do
away with money from the HIDTA program there is not addressing
the treatment or prevention aspect, because it is all about
transportation, and that goes from a--both a Democrat and
Republican sheriff that are working in those counties. They
work better together, and to reduce their funds concerns me. So
you follow my logic?
Mr. Botticelli. So I appreciate your comments on this, and
let me just reiterate that, you know, our purpose here with the
language was, in no way, shape, or form, to dilute the main
mission of our HIDTA program.
Mr. Meadows. I believe that.
Mr. Botticelli. Okay.
Mr. Meadows. But what I'm saying is, is it could do that if
we go that way. So will you readdress the reauthorizing
language with that in mind and my bias, and I'll give you,
after this time, because I need to go on to my other
colleagues.
Mr. Botticelli. Sure.
Mr. Meadows. You can try to sell me.
Mr. Botticelli. I think we can, and I think one of the
things that we can work on is maybe establishing better
criteria for--as we look at the----
Mr. Meadows. So let me put it bluntly. Will my sheriffs
agree that we need to increase the amount of money going to
treatment and prevention in HIDTA and go away from them? Would
they agree with that?
Mr. Botticelli. I honestly don't know what the locals are
saying.
Mr. Meadows. Okay.
Mr. Botticelli. As long--but I will say that they probably
would object, and we would object if that dilutes from their
main mission.
Mr. Meadows. If they object, we're going to have an issue,
and I'll go to this----
Mr. Botticelli. And probably on the HIDTA board.
Mr. Meadows. Yeah. I'll go to the gentlewoman from the
Virgin Islands, Ms. Plaskett, for 5 minutes.
Ms. Plaskett. Thank you very much, and good morning,
gentlemen. Thank you for the work that you do. You know, I am
so incredibly appreciative of everything that you all are
putting forward in your testimony, your thoughtfulness. My
first job out of law school was a narcotics prosecutor in the
Bronx, so I understand this completely and the importance of
the work that you do.
As a Member of Congress representing the United States
Virgin Islands, I very much strongly support the bipartisan
effort of reauthorizing the Office of National Drug Control
Policy. I see how important it is, not only for our Nation in
terms of treatment, but preventative as well in terms of
stopping the flow of drugs in and out of this country and its
transportation throughout.
For years, the otherwise peaceful communities in the U.S.
Virgin Islands have been experiencing elevated levels of crime
and violence. Much of it is related to our economy, and that
economy has, in turn, moved tremendously to a growth in illegal
drug trade. And we are very grateful for HIDTA's presence in
the Virgin Islands, and would be in favor of increased presence
in the Virgin Islands in Puerto Rico, because we are aware that
much of the traffic of drugs that's coming into the mainland is
coming through the Caribbean corridor, which many people are
not aware of how much drugs are coming into this country
through such a small area of the United States.
And so you can imagine, if it's coming through such a small
and porous border in this small community, the effect, the
tremendous effect it's having on the people that live there,
neighborhoods, individuals completely afraid to go out not only
at night, but now even during the day where we're having drug
wars and shootings occurring, not even blocks away from schools
in the middle of the day in this community.
And although a significant effort has been made in recent
years to secure additional Federal attention and resources to
address drug trafficking through the U.S. territories in the
Caribbean, in our opinion, much remains to be done to help stem
the flow of drugs and related crime, as well as to diminish the
negative impact of drug abuse in the communities across the
United States, Virgin Islands, and Puerto Rico.
Now, in response to a congressional directive earlier this
year, ONDCP took a major step forward in helping to promote a
well-coordinated Federal response to those issues by publishing
the first ever Caribbean border counternarcotic strategy. And I
would ask you, Director Botticelli, as well as Mr. Kelley, as
to whether or not you believe that explicitly including the
U.S. Virgin Islands and Puerto Rico and statutory mission of
ONDCP would help ensure that drug-related issues facing the
American's Caribbean border are fully included in aspects of
your work.
Because we're so small in numbers, in population, people
are unaware that almost 40 percent of the drugs that come into
this country come through those two areas.
Mr. Botticelli. Thank you, Congresswoman, for your question
and for your concern. We share your concern in terms of look at
trafficking and increasing crime in Puerto Rico and the U.S.
Virgin Islands. To do that, we have seen an increased flow in
the Caribbean as it relates to some of the drug flows, so we
share your concern, and we're happy to comply--to produce the
2015 Caribbean counternarcotic strategy, which addresses a wide
range of issues.
We are actually going to be convening all of the relevant
stakeholders in early 2016 to review our progress against our
goals and ambitions for this, and have every intent, going
forward, to include specific action items in our strategy,
going forward, that address the Caribbean and U.S. Virgin
Islands. It will continue to be a priority.
Ms. Plaskett. I will work as closely and be as supportive
of you as possible in that. You know, our families and our
elders, our children really need your support at this time.
Mr. Botticelli. Thank you.
Ms. Plaskett. Mr. Kelley, do you have any thoughts? I
visited HIDTA's--the group in Puerto Rico about a month ago,
was impressed by the work that they're doing, have been
speaking with even our Coast Guard, who is doing quite a bit of
that work as well, and would like to get your thoughts on this.
Mr. Kelley. Thank you, Congresswoman. In fact, you've
struck a number of points that I've written down that are very
germane. The HIDTA program has been intimately involved with
the Caribbean, not only through our HIDTA program that's there
presently, but we, on a monthly basis, we have a conference
call, sometimes attended as many as 90 people on the conference
call, and it's the Caribbean intelligence conference call where
members of not only ONDCP, but all the Federal agencies here in
the United States to talk about the transportation of drugs and
the sharing of intelligence, and we've made some great, great
progress. So much so that it has been a repetitive--a
repetitive conference call and will continue to do that.
To your point on including in the reauthorization and the
type of border strategy, I think it's very, very important, as
we look at the drug issues here in this country, that we not
only have to look inward, but we have to insulate ourselves
from the outside, and whether it's a northern border strategy
or southwest border strategy, or Caribbean border strategy,
that is the transportation corridors where these drugs are
invading our community.
So it makes perfect sense to me, and I think to ONDCP, or
with the strategy that just came out, that the Caribbean is a
very, very important partner in this issue of reducing the
supply that comes from elsewhere in the world, and we know that
we have to take greater strides in protecting not only the
people of the Caribbean and those nations and those
territories, but to prevent the transportation of drugs through
there to make that a no-go zone for these drug trafficking
organizations.
Ms. Plaskett. Thank you very much, gentlemen. Thank you,
Mr. Chair. I'm going to be so impressed with working with you
all in that, but know that, you know, I'll be on you. I'll be
watching.
Mr. Kelley. Thank you.
Mr. Meadows. I thank the gentlewoman, and before I
recognize the gentlewoman from New York, Mr. Director, could
you--why are you requesting 22 percent less for the HIDTA
program?
Mr. Botticelli. So the--part of the challenge----
Mr. Meadows. You were just talking about what a good job
they do, so you punish them by reducing their budget by 22
percent?
Mr. Botticelli. Again, you know, it's not reflective of
what our value of the HIDTA program is. I think you know in the
current----
Mr. Meadows. My wife was a waitress. She said appreciation
is green.
Mr. Botticelli. I know.
Mr. Meadows. So what's it reflective of?
Mr. Botticelli. I think it's just a reflection of some
challenging priorities that the President's budget has.
Mr. Meadows. So where did the other money go? Can you get
that to the committee?
Mr. Botticelli. I could get that to the committee.
Mr. Meadows. Because I'm concerned.
Mr. Botticelli. Sure.
Mr. Meadows. And I'll recognize the gentlewoman from New
York, Mrs. Maloney, for 5 minutes, and a gracious 5 minutes.
Mrs. Maloney. Okay. Thank you very much and thank you for
this hearing, all of your testimony, and I join this chairman
in really underscoring that you should not be eliminating
review processes, but strengthening them, and certainly,
knowing the problem that we haven't, we shouldn't be reducing
what we're spending, but we should be maintaining it, hopefully
growing on it.
But I want to go back to the conversations we've been
having on opiates, that they've been prescribed very deeply and
strongly and the increase of prescriptions for it. Are you
tracking whether the prescriptions are coming from doctors or
are there illegal prescriptions?
Mr. Botticelli. As we look at data, the vast majority of
prescription pain medications that are coming into the supply
are coming from legitimate prescriptions. So we only see a
small percentage that are coming from pharmacy--Internet sales
or street level purchases. Seventy percent of people who start
misusing prescription pain medication get them free from
friends and family, who often got those from just one doctor.
But we know as people progress, they often do move from
doctor to doctor, but that really comprises a very little
proportion of overall prescription pain medication in the
supply. So we know if we're going to deal with this issue that
we've got to diminish the prescription pain medication.
Mrs. Maloney. And also there are reports that people on
opiates then become addicted to heroin. Have you been tracking
that? Apparently heroin is cheaper than the opiates. Is that in
your database, one of the questions you ask, were you on an
opiate before you went to heroin? And then often heroin goes to
crime. So----
Mr. Botticelli. So we know that about 80 percent of people,
newer users to heroin, started misusing prescription pain
medication, because they're both opiates and they act the same
way in the brain. We do know, however, that when you look at
heroin use, it's much, much lower as a percentage of use than
prescription drug misuse.
So we know that it appears that only a small percentage of
people are progressing from prescription drug misuse to heroin.
However, because of the magnitude of the prescription drug
issue, that has led to a really significant increase in the
number of people who are using heroin.
Mrs. Maloney. Well, is there any punishment to doctors that
abuse these opiates? I thought the example from Congressman
Lynch was astonishing, that the woman had teeth pulled out of
her head to get pain medicine. Obviously the doctor was
incompetent if he was pulling out of her head teeth that did
not deserve to be extracted. And so what is the punishment for
a doctor for prescribing pain killers or any medicine
inappropriately?
Mr. Botticelli. So I think we have to distinguish between
those physicians and dentists who are prescribing who are well
intended, who are not doing it with a malice of intent, versus
dealing with those physicians who are just doing this as a huge
cash business. And we've seen that in many parts of the
country.
Mrs. Maloney. How is it a huge cash business? They just get
money for prescribing the drug?
Mr. Botticelli. So let me give you a very telling example.
In one county in Florida, because of lax laws and because they
didn't have a prescription drug monitoring program, 50 of the
top 100 prescribers were in one county in Florida. And working
with the DEA, working with the police, working with the
prescription drug monitoring program, we were able to enact
laws and reduce these huge pill mills that we saw that were
often a for-cash business. So law enforcement and reducing
those pill mills become a prime strategy for us.
But we've also been working with the Federation of State
Medical Boards, who have oversight and disciplinary action as
it relates to physicians who are clearly outside of the range
of appropriate prescribing, because, you know, taking
disciplinary action against those physicians and other
prescribers who are clearly outside the bounds of what normal
prescribing behavior would be needs to be part of our overall
strategy.
Mrs. Maloney. And my time is almost up, but I did want to
ask you, I guess Mr. Maurer, about the GAO released report on
ONDCP's coordination efforts of drug abuse prevention. The
report identified an overlap in 59 of the 76 programs included
in the GAO's review. And what is the possible impact of this
overlap and why did you raise that in your report?
Mr. Maurer. Sure. This was a report we issued back in 2013.
At that time, we found overlap. And what we meant by that was
that there were disparate programs that could potentially be
providing grant funding to the same grant recipient and they
wouldn't necessarily know, so the right hand wouldn't
necessarily know what the left hand was doing.
The good news on that is we issued our findings, we made
recommendations to ONDCP to take a look across this universe of
programs. They have done that, they've identified the need for
greater coordination, they put mechanisms in place to improve
that coordination, they've addressed that recommendation, and
we have since closed it as implemented.
Mrs. Maloney. That's a very fine success.
My time has expired. Thank you.
Mr. Maurer. Thank you.
Mr. Meadows. I thank the gentlewoman.
Just so you will know, we are going to do a very, very
limited second round, and by very limited, we're going to--I'm
going to recognize the gentleman from Wisconsin for 4 minutes,
a strict 4 minutes, and then we're going to recognize Ms.
Norton for a strict 4 minutes, and then do closing remarks.
The gentleman from Wisconsin is recognized for 4 minutes.
Mr. Grothman. Okay. So I had to come back, because I kind
of thought it was a rhetorical question as to whether
possession of heroin was a Federal crime. But what is the
expected prison term you get if you have enough heroin with you
that you're probably some sort of dealer? Do you know what you
guys ask for?
Maybe I'll ask Mr. Maurer. What is the standard as you
prosecute it locally? What do the Federal prosecutors ask for?
Mr. Maurer. I don't know what the standard sentence is. I
do know that there are a lot of factors that go into
sentencing. Mandatory minimums would weigh large in this
particular case, depending on the amount of heroin.
Mr. Grothman. Is there a mandatory minimum if I have enough
heroin that I apparently am not using it for personal use?
Mr. Maurer. It's a function of prosecutorial discretion and
what actions they chose to take, but there are mandatory
minimums associated with heroin. I don't know what those are,
though.
Mr. Grothman. Okay. Do you know how many people are in
Federal prison for selling heroin?
Mr. Maurer. I don't know how many are in Federal prison. I
do know that well over half of the current Federal inmate
population is serving a sentence that's predominantly based on
drug possession or drug trafficking.
Mr. Grothman. Okay, the reason I say is to me there's a big
difference between heroin and other drugs, okay. I mean,
nobody--I'm for marijuana being illegal, but there's nobody,
you know, dying of a marijuana overdose. This heroin thing is a
whole new thing, you know, much worse than the cocaine thing,
much worse than anything, and that's why I don't like it kind
of blended with the other things.
But do you know how many prosecutions for heroin, heroin
either possession or selling it every year?
Mr. Maurer. I do not know.
Mr. Grothman. Okay. I want you to get me those things.
Mr. Grothman. And I think it's important for you three, who
are after all supposed to be the Federal people out in front
fighting the heroin, to familiarize yourself a little bit about
what's going on in the criminal Federal courts dealing with
heroin. I mean, I'm asking you these questions. I thought you'd
give me answers, and you don't know the answers.
Mr. Maurer. We'd be happy to work with our colleagues in
the executive branch----
Mr. Grothman. You should know the answers. You've got
important jobs. And I'm glad you're going to get the answers,
but I think if you had your job, I'd know the answers.
But, okay, I guess we'll ask you some more questions later
when you have to time get the answer. I'll give you one more
question, though, which is an entirely unrelated thing, but
kind of a follow-up.
One of the problems we have is that there are physicians
out there who are clearly selling prescriptions for opiates
that they shouldn't be selling. Another problem, to me, is we
have physicians prescribing more opiates than you would
traditionally need. You know, somebody goes in for a root canal
and instead of giving you a prescription for 3 days, they give
you a prescription for a month.
Do you want to comment on that and why that practice has
taken hold?
Mr. Botticelli. Sure. We would completely agree with you
that not only are we overprescribing, but in many instances
people who need only a limited duration of pain medication are
getting up to 30- and 60-day doses of that.
Part of what we've been focusing on, not only in terms of
our prescriber training, but the Health and Human Services is
in the process now of developing clear and consistent clinical
guidelines as it relates to the prescribing of pain medication
for these exact purposes of not only appropriate prescribing,
but also not overprescribing the amount of medications that are
given out in many instances.
Mr. Grothman. I'd only just say it's a Federal business,
but since so many of the prescriptions today I suppose are paid
for Medicare or Medicaid, do you think it would be Federal
guidelines on the appropriate amount of opiate prescriptions
paid for in these two programs?
Mr. Botticelli. You know, one of the issues that we're
particularly looking at with our Medicaid programs is not only
the implementation of these clinical standards to looking at,
but also continuing to focus on what we call lock-in programs,
to ensure that people who might be going to multiple physicians
or multiple pharmacies are locked into one physician and one
pharmacy.
So we're looking at a wide variety of mechanisms, both
within our Medicare and Medicaid programs, to look at how we
might diminish the scope and the associated costs with
prescription drug use in both of those programs.
Mr. Meadows. Thank you. The gentleman's time has expired.
The gentlewoman from the District of Columbia is recognized
for 4 minutes.
Ms. Norton. I certainly appreciate the chairman's
indulgence.
I really felt I had to ask you a question on synthetic
drugs. And I want to say the chairman mentioned that his
sheriffs wouldn't want you to take away from law enforcement
function. I would agree with you. My police chief wouldn't want
it either, especially in light of the fact that I think you
took down 19,000-plus packets of synthetic drugs only recently
here in the District of Columbia, and I think it was your very
HIDTA law enforcement that did it. It made big news here.
These synthetic drugs present a new challenge. I want to
know how you're handling it. We've had in October alone
emergency services were called 580 times, more than 18 times a
day, to respond to synthetic drug emergencies. Here we have
bipartisan legislation that has been introduced. I'm not sure
any of it can be found to be constitutional, because unlike
heroin, which is what it is, for example, they change the
composition.
Are you pursuing synthetic drugs? In light of the fact that
a criminal statute cannot be overly broad or it violates due
process, do you have the tools to do your law enforcement work
with what is now a growing menace across the United States? My
Republican members who have this problem, for example, on the
bills, come from Texas and Pennsylvania.
Mr. Botticelli.
Mr. Botticelli. Thank you, Congresswoman. I'm glad I have
the opportunity to talk about synthetics. And while we've been
talking about the opiate addiction, you know, one of our prime
concerns has been the dramatic increase in these new
psychoactive substances. Both in terms of my job and as a
resident of the District, I've seen the incredible impact that
it's had.
You know, we have working with our counterparts in China,
because we know that the vast majority of these precursor
chemicals are coming in from China. We're happy to say that
China just moved to schedule over 100 of these substances.
One of the areas, to your point, about how do we stay ahead
of these new chemical compositions has been a challenge for us
at both the Federal and State level. We're happy to work with
Congress in terms of the legislation that's been introduced
that would give Federal Government additional and quicker
scheduling authority----
Ms. Norton. You do need, as China is doing new legislation,
you do need new legislation to be able to do effective law
enforcement?
Mr. Botticelli. I believe that we have not been able to
stay ahead of these new chemical compositions and we need to
look at----
Ms. Norton. I have one more question before my time is up.
I know that four States and the District of Columbia have
legalized possession of small amounts of marijuana. The other
four, of course, have legalized sale as well. In D.C., they are
sending our people to the illegal market, because you can't
get--do the sale.
How much of your work goes for marijuana in light of the
fact that this drug is increasingly--you have 20 States that
have decriminalized it. Are you really spending resources on
marijuana, particularly in light of the fact that in terms of
the white, black, again, getting into what happened with
mandatory minimums, the arrest records are almost entirely
black or Latino, because the white kids are not in, I suppose,
the law enforcement areas and don't get picked up. In light of
that racial disparity, how much of your funds for law
enforcement goes for marijuana, which is being legalized before
your very eyes?
Mr. Botticelli. So I could get you an exact breakdown in
terms of where our law enforcement efforts, but I----
Ms. Norton. Can you send the chairman of this committee a
breakdown in terms of----
Mr. Botticelli. Sure.
Ms. Norton. Mr. Kelley has a breakdown.
Mr. Kelley. No. I was going to address one other issue that
you raised, if I may, if the chairman allows.
Ms. Norton. Well, excuse me. Could this question be
answered, Mr. Botticelli?
Mr. Botticelli. I'd be happy to do that. But I think to
your point, you know, the vast majority of the resources that
ONDCP and the Federal Government looks at are really for
enhanced prevention and treatment programs. You know, we
don't--and I think the Federal Government and the Department of
Justice has issued guidance saying that we are not going to be
using our limited Federal resources to focus on low-level folks
who are using this for largely personal use. I think you've
heard today that folks want to use every opportunity to divert
people away from the criminal justice system.
But I do have concerns based on the data that we shared
here in terms of marijuana use what the implications of both
decriminalization and legalization mean for the people of the
United States. I've been doing public health work for a long
time. We know there are disproportionate health impacts,
particularly with poor folks----
Ms. Norton. Well, I support those studies, especially when
it comes to children. Of course, we know that most people don't
smoke marijuana once they leave college.
Mr. Meadows. Mr. Kelley, we'll give you some latitude to
make that last comment, then we'll close up.
Mr. Kelley. Thank you, Mr. Chairman.
Congresswoman, I just wanted to bring your attention--for
the record, I would certainly in the Washington-Baltimore
HIDTA, which is in your district, I would certainly invite
you--in fact, I spoke to the Director prior to coming down
here, knowing that this is a prevalent issue here--I would
invite you, that he would be able to speak to you at any time
that you wish.
I also have with me a threat assessment that was done on
synthetics in this very area and a number of recommendations,
which I'll be glad to share with you.
Mr. Kelley. That was developed by the Washington-Baltimore
HIDTA in their initiatives that they're working very closely
with the chief of police, who sits on their board, to address
these very issues.
Mr. Meadows. Thank you, Mr. Kelley.
And I'd just like to thank all of you for your testimony,
for your indulgence. It's been a very insightful hearing.
I want to--Director, we have a number of to-do items for
you to get back.
It is critical, because as we look for reauthorization, as
we get back into a normal budgeting process, a normal
appropriations process, some of these have been appropriated
without reauthorizing, as you know. Those days are growing
fewer in number, and so it is more critical that we look at
reauthorization, but look at meaningful budget numbers too.
I am extremely troubled, based on the testimony today, that
your request is to cut a program. Now, if it's not working, cut
it all out, but that's not what I heard from you. And then yet
we're taking a program that what my local law enforcement
officers say works with them, it's a critical tool, and we're
somehow wanting to give greater flexibility--it appears that
we're wanting to shift the money into prevention and treatment
and ultimately do away with HIDTA. And you're going to meet
great resistance in a bipartisan way here, I think, if that's
truly the direction. And I don't want to put words in your
mouth. You're very eloquent with your words.
So I just want to say thank you all for your time. I think
we can make real good progress here working through. Director,
you have to do, to work with GAO to make sure that we keep
those performance reviews in a meaningful and statistically
accurate manner.
And if there is no further business, without objection, the
subcommittee stands adjourned.
[Whereupon, at 12:16 p.m., the subcommittee was adjourned.]
APPENDIX
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Material Submitted for the Hearing Record
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